I call this meeting to order. Welcome to meeting number 36 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic, specifically today examining Canada's national emergency response landscape.
I would like to welcome the witnesses. We have from the Privy Council Office, Ms. Christyne Tremblay, deputy clerk; Ms. Thao Pham, deputy secretary to the cabinet operations; and Ms. Jodi Van Dieen, counsel to clerk of the Privy Council and assistant deputy minister, Privy Council Office legal services sector. From the Department of Public Safety and Emergency Preparedness, we have Mr. Rob Stewart, deputy minister. From the Ministry of Health of Israel, hopefully we will have later on Dr. Asher Shalmon, director, international relations division. From the Regional Municipality of York, we have Mr. Bruce Macgregor, chief administrative officer.
I will invite the witnesses to make their opening statements. We will start with the Privy Council Office and Ms. Christyne Tremblay for six minutes.
Thank you for the opportunity to appear before this committee to discuss the federal response to COVID-19 in the context of emergency management.
My name is Christyne Tremblay, and I am the deputy clerk of the Privy Council and associate secretary to the cabinet, and the deputy minister for Intergovernmental Affairs. I am joined today by my colleagues Thao Pham, deputy secretary to the cabinet for operations; Jodie van Dieen, assistant deputy minister of Privy Council Office legal services; and Rob Stewart, deputy minister of Public Safety and Emergency Preparedness.
The Government of Canada's efforts responding to the pandemic run the gamut from federal investments in public health such as testing and contact tracing or the purchase of personal protective equipment; to providing direct financial support to individual Canadians and businesses; ensuring adequate and reliable supply of therapeutics and medical supplies across the country; maintaining effective border measures to minimize the importation and spread of COVID-19 and its variants; and purchasing and distributing vaccines to the provinces and territories.
The federal government has also worked collaboratively with the provinces, territories and indigenous communities to manage the pandemic. Public Health measures are largely within provincial and territorial jurisdiction, and the federal government sought to ensure that they had the tools and resources to exercise their jurisdiction.
Federal funding to support Canadian workers and businesses provided the space for provinces and territories to enact public health measures in their jurisdictions, tailored to their specific circumstances.
Through the Safe Restart Agreement, the federal government provided nearly $20 billion to support the provinces and territories in their efforts to deal with the pandemic. A further $7.2 billion in pandemic support was provided for provinces, territories and indigenous communities, in recognition of the ongoing pressures COVID is putting on the health care systems.
The federal government also provides PPE, medical equipment and surge capacity support to the provinces and territories. This includes the provision of testing and contact tracing supports and mobile health units. The federal government has responded to more than 70 requests for assistance, including by deploying the Canadian Armed Forces to long-term care facilities, supporting vaccinations in remote First Nations communities, and most recently deploying nurses and medical assistance teams to Ontario hospitals. My colleague Rob Stewart is responsible for coordinating these responses to requests for assistance.
Additionally, the federal government has provided health care staff and equipment to the front lines and more rapid testing and support for contact tracing thanks to teams at Statistics Canada. We have also provided additional drugs and developed laboratory testing capacity within our federal labs. Through our partnership with the Canadian Red Cross, support has been provided to long-term care facilities in several provinces, and additional nurses and physicians were recently deployed to assist in Toronto.
The Privy Council Office has played a central role supporting the and Cabinet throughout the COVID-19 pandemic. This includes supporting the Cabinet Committee on the Federal Response to the Coronavirus Disease, or COVID-19, which has a mandate to ensure leadership, coordination and preparedness for the response to, and recovery from, COVID-19 across Canada. The committee has also played a coordination function, working with all federal departments participating in managing the pandemic.
We have also played a central convening and coordination function, working with departments and agencies horizontally across government on a wide array of COVID-related priorities as well as communications through our COVID communications hub. My colleague, Thao Pham, is very much involved in this work.
Our responsibilities for Intergovernmental Affairs has also meant that the Privy Council Office has been leading engagement with the provinces and territories, including supporting 30 first ministers meetings in the past 15 months, which have focused primarily on the response to the pandemic. The last meeting was held 10 days ago and every provincial and territorial premier was in attendance.
I understand the committee is interested in discussing the legislative tools that exist at the federal level to respond to emergencies like the current public health crisis the country finds itself in. Parliament has granted the government authority to deal with emergency situations and some of these authorities have already been employed in dealing with the pandemic. An example of this is the Quarantine Act, which has been used to implement restrictions at the international border, including mandatory testing and quarantine requirements for travellers.
The Emergencies Act also exists as one possible tool for dealing with emergencies on a national scale. There are four types of emergencies that can be declared under the act: public welfare emergency, public order emergency, international emergency, and war emergency. Pandemics such as the COVID-19 pandemic are considered a public welfare emergency. The act includes a specific definition of a national emergency as urgent, critical and temporary in endangering the lives, health and safety of Canadians that exceeds the capacity of the provinces and territories to deal with. Importantly—
Thank you for inviting me. It's a pleasure to be here.
I was asked to speak about Israel's vaccination campaign, which is quite a successful one. We started early. On December 19, the Prime Minister and the Minister of Health were publicly vaccinated, and from the morning of the 20th we started to vaccinate widely all over the country.
We decided to go on a simple scheme, meaning that from the first day we vaccinated everybody who was age 60 and above, and medical personnel and first responders all over the country, with no subgrouping. Then, on a weekly basis, we dropped the age by five years, until at the point of week eight, the campaign was fully opened for the whole population over the age of 16.
We are now discussing when to start vaccinating teenagers. We have not yet authorized vaccine for ages 12 to 16, but we are working on it. I believe that at the end of next week, or the week after, that will be authorized in Israel and we'll be ready to start.
As you may know, Israel decided to take a single approach. We are using only Pfizer-BioNTech vaccines. We do have a clear deal with Pfizer regarding shipment dates and the exact terms of how the whole project is working. We were appealing to them, as we are running it as a national IT-driven operation where every case is fully registered not only with the national registry, but at the same time, registered by the recipient's HMO into their personal electronic medical record.
As I mentioned, the whole project was paperless. You had to pre-register for your appointment, although if you did not register, you had a good chance to be vaccinated anyhow.
At the peak of this vaccination program, we vaccinated more than 200,000 people a day. To remind you, we have 9.25 million residents here in the State of Israel. We vaccinate everybody here: citizens, temporary residents, diplomats and foreign workers. Even asylum seekers and illegal immigrants were fully vaccinated from the first day. As well, we vaccinated our diplomatic corps around the world. We hoped to have some bilateral agreement with countries and we understood that it could not work at the pace that we were looking for, so we basically vaccinated everybody by ourselves.
Compliance was good. I think the psychology of supply and demand in the beginning was a major issue for the public. People were queuing and were trying to get it sooner rather than later. Of course, it changed as this campaign moved on, and now we are putting a lot of emphasis on the last part of the population who are hesitant or against it. We do understand that a devoted anti-vaxxer will never be convinced, so we are putting our efforts into hesitant people and into some communities that were slow in terms of the numbers, such as the Bedouin in the Negev and some of the Orthodox communities, who we are pushing ahead to be vaccinated.
It's not obligatory. You have the right not to be vaccinated, although there are some crucial working places, such as the health sector, that expect everybody who gives crucial services to the public to be vaccinated. We do not have a legal framework to force it, but it's kind of an understanding that it is what we expect from our employees.
We issue what is known as a “vaccination certificate”, which is fully electronic; it's a bar code. You get it a week after the second dose.
At this point, I might add that we decided to stick to the manufacturer's protocol and to vaccinate everybody for the second dose on day 21.
The green pass is another document, which you are entitled to receive if you are COVID-recovered or fully vaccinated. That allows you into what are known as “green pass zones” in the country, mostly restaurants and bars. Gyms used to ask for it, but now, by law, gyms are open to everybody, including public swimming pools. Large cultural events and concerts, all of them, could operate under a green pass registry, meaning that they are allowed to have much larger gatherings of people than what is known as the “purple tag”, which is a standard COVID-19 restriction for general places like supermarkets, pharmacies, hospitals, and so on.
Just to sum up the numbers, more than 90% of our medical personnel are vaccinated. More than 90% of those 60 and above are vaccinated. If we look at the adult population of Israel, 80% of the population were all vaccinated with, at least a single dose or had recovered. Around 9% of our population was found by PCR test to be positive in terms of carrying COVID-19 at some point during the past year.
That's where we are. I would be very happy to answer questions. I guess there will be a few.
Thank you, Mr. Chair. As a former soccer coach, I'm a little sensitive to yellow and red cards, so I hope you won't be using them.
I'm the CAO of York Region. There are nine cities and towns that extend north of the City of Toronto to Lake Simcoe that serve as home to over 1.2 million Canadians. We are an upper tier municipality and provide 14 core services to all of our communities, ranging from courts to policing, transit, water and wastewater, to name a few.
We also deliver public health services, as one of 34 public health units in Ontario, under the direction of Ontario's chief medical officer of health, as described under the Health Protection and Promotion Act. This is a model that differs from practices in other provinces.
Our public health responsibilities are also delivered through a community and health services department in an integrated model that also includes paramedics, social services, long term care and housing, all of which have a focus on the social determinants of health.
The perspective I'll provide you today is as the CAO of a large greater Toronto area municipality where our regional council also serves as the board of health.
York Region has a comprehensive emergency management and preparedness program that is tested annually as required by legislation. Through our emergency management program, threats are assessed annually using hazard identification and risk assessment. Since SARS in 2003 and H1N1 in 2013, pandemic risks have increased in priority and focus. Formalized business continuity planning is also part of our emergency preparedness, and is centred on maintaining critical services.
On January 23, 2020, our medical officer of health, Dr. Karim Kurji, activated the public health emergency operations centre to respond to the COVID-19 pandemic threat, one month before York Region recorded its first case. On March 17, 2020, York Region activated the regional emergency operations centre, and by March 23, York regional chair, Wayne Emmerson, had declared York Region's first ever state of emergency under the Emergency Management and Civil Protection Act.
Prior to, and throughout, the pandemic response, York Region and our nine local cities and towns have worked together very closely. Our local municipalities have been an added source of assistance during York Region's mass immunization efforts.
With public health embedded in our organization, we were able to redeploy approximately 1,000 staff from within our organization to support the public health response. Additional critical internal supports were immediately redirected to enable staff working remotely. We redirected procurement to rapidly acquire personal protective equipment, human resources to quickly hire required specialized staff for long-term care and public health, and communications to ensure updates were available through multiple communications channels.
Business continuity plans documenting essential services and functions with assigned priorities helped to quickly identify services that could be suspended or reduced to shift staff resources to support the COVID-19 response while ensuring that critical core services continued uninterrupted during the pandemic.
York Region has in place robust and well-tested incident management systems that will serve emergency response efforts well into the future. We've strengthened relationships with our local municipalities, community partners and elected officials, and forged new relations with experts from various fields, such as the Red Cross, St. John Ambulance, local physicians, hospitals and pharmacies, all of which will support our future decision-making.
What we have learned through forced digital transformation will not be lost, with efficiencies and opportunities incorporated into our new normal moving forward.
Provincial and federal funding programs have enabled many Canadians to refrain from going into workplaces while enabling business to receive support during shutdowns. Without this financial support, the pandemic outcomes would have been much worse with respect to community and workplace transmission. While most of York Region's population has access to consistent and reliable broadband technologies to support remote working, there are many rural parts of our communities that experience the ongoing challenges that persist in rural areas throughout Ontario and Canada. As we optimistically shift from the response phase of the pandemic and into recovery, individuals and businesses will continue to require provincial and federal assistance and supports, hopefully with a stronger commitment and component of funding critical public infrastructure.
Through the COVID-19 experience, York Region's state of preparedness is higher than ever before, and as we look ahead to the potential of recurring infectious diseases, it will become critical to remember this experience and guard against complacency. We're hopeful for progress in three specific areas, working together with our provincial and federal partners.
First is encouraging domestic production and he supply of personal protective equipment and vaccines; second is investing in broadband to support all Canadians in working and schooling from home; and third is ensuring consistent and clear communication among all levels of government to educate and inform the population we serve, as a vital component of any emergency response.
Thank you, Mr. Chair, for your time this morning and for the opportunity to share York Region perspectives shaped by our organizational emergency management and public health model and experience.
Thanks to our witnesses with us here today. I want to especially thank Bruce Macgregor from the Regional Municipality of York for taking time out of his busy schedule to bring a regional perspective into our discussions. I also want to thank him and his team for their work during these difficult times.
It has always been great to work with you, Bruce, and I appreciate the updates on the current situation that your team has been sending out regularly.
Bruce, in your opening statement you mentioned that throughout the pandemic the region has worked closely with the municipalities. I'm wondering if you could expand on this collaboration and share with us a bit more about the roles played by the province, the region and local municipalities, including the differences between roles.
It's certainly a privilege to bring the local experience to this federal table. As municipalities, we are creatures of the provinces and consequently are guided by legislation. In Ontario that legislation includes a bit of a deeper dive into what are normally services provided by the provinces elsewhere in Canada, so we deliver public health, housing and social services in partnership with the Province of Ontario, with funding, of course, as well from provincial sources. All of that can't possibly fit into a property tax bill. We do also provide services municipally and we share those municipal services with our local municipalities that are a collection of towns and cities, like Markham and Vaughan with 400,000 population each and growing, and small rural towns, relatively smaller rural areas with populations of 30,000 to 40,000.
At the regional level, we deliver the large consistent services across that area, including the provincial services. We've deliver policing. We deliver paramedic services. We deliver water and wastewater services, transit and transportation. Local municipalities deliver library services, fire and recreational services as well, so with respect to the pandemic, of course, our emergency services are connected quite tightly. Those are paramedics and police at the regional level, and fire services at the local level, with our provincial oversight bodies, of course, engaged as well.
Our medical officer of health takes direction from the provincial chief medical officer of health. Of course, there is information flowing from federal sources in the health sector as well.
Mr. Chair, that's a quick answer to that question. I hope I haven't left anything out.
The Emergencies Act embodies the federal-provincial-territorial collaboration and working together, and, in fact, requires consultation with the provinces and territories, and specifically requires that invoking the Emergencies Act for a national emergency only occurs when other federal, provincial or territorial legislative measures are not sufficient.
In addition, in subsection 8(3) of the Emergencies Act, it says that where a declaration of emergency were to have been made, following such a declaration, it is, of course, anticipated that the provinces and territories would continue to act within their legislative spheres and that the federal government's actions should not unduly impair or intrude upon those actions.
I would say that the Supreme Court, since 1987, has very much spoken of co-operative federalism as a key constitutional concept, and I would say that the Emergencies Act, as passed by Parliament, reflects co-operative federalism and federal-provincial-territorial collaboration.
Madame Tremblay, on November 27, the Clerk of the Privy Council, Mr. Shugart, wrote to this committee with respect to the document production order adopted by the House of Commons on October 26, 2020. He wrote, “Preliminary estimates suggest that there are millions of pages of relevant documents.”
However, according to the law clerk, only 8,166 documents have been turned over by the government to date. Can you confirm whether the government is purposely withholding documents or explain why it is being so slow to produce documents ordered by the House of Commons to this committee?
I call this meeting back to order.
Welcome, everyone. We are resuming meeting number 36 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic. Specifically today, we're examining Canada's national emergency response landscape.
I'd like to welcome the witnesses. We have, as individuals, Dr. Isaac Bogoch, physician and scientist, Toronto General Hospital and University of Toronto; and Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine.
From the Ministry of Health of the Slovak Republic, we have Brigadier-General Dr. Vladimír Lengvarský, Minister of Health of the Slovak Republic, and we have....
Is it Dr. or Mr. Martin Pavelka, epidemiologist?
Thank you so much. Again, thank you for the invitation to chat today.
My name is Isaac Bogoch, and I'm an infectious diseases physician and scientist based out of the Toronto General Hospital and the University of Toronto. I sit on several provincial and federal COVID-19 committees and task forces.
Over the next few minutes, I'd like to focus on a few semi-related issues related to the pandemic response. I think it's important to frame our conversation within the current and the near-future Canadian context.
We're still embroiled in a pretty large third wave across most of the country. Provinces such as Nova Scotia and Alberta, unfortunately, have higher rates of infection than ever before, but other provinces are slowly turning the corner.
No matter what, we're far from where we need to be. With mass vaccination efforts expanding, I think it's fair to say that we're going to realize some significant benefits from this vaccination, much like other countries that are a few months ahead of us, like the United States, Israel and the U.K. We're just a couple of months behind them. With sound public health measures and ongoing vaccinations, we will likely be far better off in the near future than where we are right now.
With that in mind, I think it's important to focus on a couple of current and near-term issues, and to really start thinking about what our off-ramp looks like.
The first one is regarding border measures. Now, we know COVID-19 isn't going anywhere any time soon; it's going to be around for awhile. At least for the near future, I think it's reasonable to ensure that people travelling, and Canadians returning to Canada, demonstrate either evidence of COVID-19 vaccinations, or if people choose not to be vaccinated, they still must quarantine and show evidence of negative testing.
This virus poses a significant public health threat, and we know it disproportionately impacts our low-income and racialized neighbourhoods. Border measures like this won't be perfect, but they'll still reduce the importation of virus. Policies like this seem prudent for the near future. Longer-term strategies remain unclear.
Related to the border, I think it's also important to discuss vaccine passports. When I say “vaccine passports”, I'm referring to requiring evidence of vaccination to cross an international border. Regardless of what our personal views are of the virus or vaccinations, there's a growing list of countries globally that require proof of vaccination for COVID-19 to enter them. We should be proactive in ensuring that Canadians who choose to be vaccinated will have acceptable documentation of their vaccine status to enable international travel.
Another point is with regard to essential workers who cross the border. We know there are tens and tens of thousands of people crossing our borders daily, and many of them are essential workers, such as truck drivers bringing in vital goods to Canadians. They should have priority vaccinations. For example, we know there's a great program on the Manitoba-North Dakota border for vaccinating truck drivers. This program is exemplary, and we should see more of that.
I have a couple of other quick points.
With regard to airports, if we were going to shut down all non-essential travel to the country, the time to do it was over a year ago. The current measures are clearly not perfect, but they still buffer Canadians from importing a significant number of cases of COVID.
When we look at the current and projected pace of vaccination and the benefits afforded by vaccination, I think it's pretty clear that there are significant questions when we raise the utility and costs of further restricting already restricted travel versus the potential gains. We could also create safer travel by ensuring that those who enter the country are vaccinated and continue to quarantine, as mentioned above.
Lastly, to touch on the Emergencies Act, or other measures for federal intervention at the provincial level, a lot of this is easy to say, but I imagine it's much more challenging to operationalize. I don't think there's the capacity for the federal government to micromanage health care or public health at the provincial level, or even regional level. There would have to be very, very clear and prespecified divisions of labour to make this work effectively.
There are plenty of other COVID-19-related topics to discuss, but unfortunately I don't have a lot of time. I'd be happy to address any of these in the question period that follows.
Again, thank you for your time. I'm happy to chat.
Dear Mr. Chairman, vice-chairs, members of the standing committee on health, dear friends in Canada, I would like to extend my cordial greetings from Bratislava to all of you. I'm pleased and honoured to have this opportunity to address you. Likewise, allow me to convey my special thanks to the Honourable Michelle Rempel Garner, a great friend of Slovakia, for the invitation to share the Slovak experience with nationwide population testing.
The current pandemic is a humanitarian crisis that is threatening to leave deep social, economic and political scars for years to come. It is therefore highly desirable and responsible to adopt corresponding strategies that have the potential to relieve impacts of the pandemic.
Before the introduction of the vaccines, the testing itself was the only efficient tool for countering the pandemic. In this context, Slovakia opted for nationwide testing, which has proven to be helpful in revealing the areas hardest hit by the virus as well as in reducing the rate of incidence. This information was crucial for preparing and adjusting the corresponding region-based measures.
Overall, I perceive that it's extremely important to build synergies at the international level, including through sharing examples of best practices. Let me thank you once again for your interest in the Slovak experience related to testing. Mr. Pavelka is ready to provide you with further information on this matter.
Stay healthy and keep safe. Thank you.
Thank you to the committee for inviting me.
Very briefly, I'm an M.D. Ph.D. pediatrician-scientist and I co-lead efforts to develop vaccines for neglected diseases of poverty in addition to coronavirus infection vaccines and a new COVID-19 vaccine. For the last two decades, we've built an academic research centre known as a PDP, a product development partnership, and we use industry practices to make the pharmaceuticals that industry generally won't produce because they mostly target diseases of the poor.
Our PDP is know as the Texas Children's Center for Vaccine Development at the Texas Children's Hospital and Baylor College of Medicine. We've now developed a low-cost recombinant protein vaccine to prevent COVID-19. Some refer to it as a people's vaccine because it could be scaled for production at extremely low cost, we think as low as $1.50 U.S. per dose, and it requires simple refrigeration. Biological E., one of the big vaccine producers, has now started to scale up production to more than one billion doses, and the Indian regulatory authority has now given us the green light to advance it to phase 3 clinical trials with the hope that there will be an emergency-use authorization in India later this summer. In parallel, CEPI, the Coalition for Epidemic Preparedness Innovations, is working with Biological E. for a global road map for phase 3 trials internationally.
There's just one other biographical piece. I do have a meaningful Canada connection. My grandfather Morris Goldberg grew up in the Jewish quarter of Paris and emigrated to Montreal around the time of World War I. Years later, he lost many family members during the Nazi occupation of Paris, so I always like to say that I exist only because of the goodness of the Canadian people who accepted my grandfather, and I've never forgotten that.
Today, I hope to raise two issues, one on COVID-19 vaccinations and the other on COVID-19 vaccines. With regard to vaccinations, according to the New York Times tracker, as of yesterday, only 3.2% of Canada's population has been fully immunized, and just under 40% has received a single dose.
In contrast, in the U.S. the numbers are 34% fully immunized and 46% having had a single dose. In the U.S. we also do have our problems though. We have a troubling blue- and red-state divide so that the real situation is that states such as Vermont, Massachusetts and Connecticut will reach the point where almost one-half of their populations are fully immunized, whereas deep red states such as Idaho and Wyoming and the mountain area in our southern states are only about one-quarter in. This disparity reflects an awful level of anti-vaccine aggression in our country.
Okay. I'm sorry about that.
I'm also a bit of an expert on this anti-vax scenario because my youngest daughter, Rachel, has autism and intellectual disabilities, and I wrote a book previously called Vaccines Did Not Cause Rachel's Autism, which often makes me public enemy number one with the anti-vaccine group.
Regarding Canada, I've publicly expressed my concern that our U.S. government could, and should, do more to help Canada vaccinate its population, especially now, given that only 3% of Canadians are fully immunized. In my public appearances on the cable news networks and podcasts, including the CBC, I've explained why there are both practical reasons and emotional reasons for this.
On the practical side, we share an enormous border. We simply cannot slow transmission by vaccinating all of Detroit, Michigan, for instance, without doing the same in Windsor, Ontario, or Buffalo, New York, on either sides of the Peace Bridge.
On the emotional side I've stated that there are not many nations who showed the United States unconditional love—and here I recount my remembrance—in the days after the 9/11 attacks when 100,000 Canadians stood on Parliament Hill in solidarity with the American people. I would point out not many nations do such things. I've therefore stated that when it comes to providing immunizations against COVID-19, there should be no daylight between the U.S. states and the Canadian provinces.
Specifically In the area of vaccines, I also believe that Canada has the potential to do more in vaccine science and production. You're a nation of some of the world's greatest research universities and medical schools; people come from all over the world to train at UBC, Toronto, McGill, Queen's, Waterloo, Western, Alberta, just to name some. Ultimately it was the Public Agency of Canada's National Microbiology Laboratory that led to the development of the successful Ebola vaccine that stabilized the situation in the Democratic Republic of the Congo.
Our licence to Biological E. in India is not exclusive, and we'd be more than willing to transfer our technology to Canada so we could produce it for the world, if not for internal use. This might be part of a larger opportunity for the NML, the National Microbiology Laboratory, possibly in collaboration with one of Canada's research universities, to build a world-class centre for vaccines, science, development and production, doing so would propel Canada to the forefront of global vaccine diplomacy.
Thank you again for this opportunity, and I look forward to having a discussion and dialogue and answering any questions you might have.
Dear Mr. Chairman, vice-chairs and honourable members of the Standing Committee on Health, and dear friends in Canada, it's a great opportunity to present to you the Slovak experience of rapid antigen mass testing and how it can be effectively used to suppress COVID prevalence in the population.
In the next few minutes, what I want to do is convey three key messages and present the Slovak experience, bust some myths about antigen tests and mediate the message on how to conduct effective, efficient and practical rapid antigen mass testing.
From the Slovak experience, for us, PCR testing actually was not the best test for the COVID-19 epidemic, for several reasons.
The first one was the time lost in processing. By the time you got a time slot to be able to go to a mass testing centre, the laboratory processing time or the time lost was just an opportunity for the virus to produce new generation lines.
Second, the limited laboratory capacity meant that only symptomatic people were basically favoured for the PCR tests. On the other hand, for the antigen tests, you can scale them up, and because of the low cost you can do them at high frequencies and you can actually cut more strains of transmission.
I'm going to give you some basic data about our antigen tests. Between January and April, through antigen testing, we detected almost twice as many infections as through the PCR channel. There were 250,000 infections detected in this short time period. That is 5% of Slovakia's population. Half of these infections were completely asymptomatic at the time of testing. These people would never have been detected through standard syndromic PCR surveillance.
One in 20 people were detected through antigen tests, so more or less everyone in Slovakia now knows someone from their close circle who was detected through antigen tests and who, through timed isolation, was able to basically prevent infecting their parents, their friends and their loved ones.
Slovakia did three main mass testing campaigns, one in November and then again from late January onwards. Now, every week, Slovak residents are tested, and the tests allow them to use exemptions from the stay-at-home order. You can go to work and you could go to the post office, the bank and so on.
The methodology was basically laid out by Michael Mina and Daniel Larremore. I call them the fathers of rapid antigen testing. Slovakia was one of the very first countries to actually conduct tests in cycles, so I call them the poster children of the antigen mass testing.
In our dataset, the specificity of the test is actually really massive. From a low test prevalence in our symptomatic counties, we could calculate that the specificity of the antigen tests used in our country is no less than 99.96%. From the 30 million antigen tests conducted during this period, no more than 12,000 were false positives, so really, when it comes to specificity, the false positive tests are not of concern.
When it comes to sensitivity, the tests in Slovakia have proven to very well detect infectious individuals. As I said, with the PCR test, by the time you are actually confirmed to be infectious, you may not be infectious anymore. With these antigen tests, we are in fact [Technical difficulty—Editor] infectious people.
As a very final point, there are three key messages or ingredients from our own experience that make a rapid antigen mass testing campaign so successful.
First of all, it's the volume. Other countries have tried it. In Austria, for example, Vienna tried it and it didn't work; only 5% of the population of Vienna turned out. That's not enough to cut transmission chains so you can flip the reproduction number below one. Regularly, one-third of the population gets tested every week. This seems to be working.
Second is communication. One of the misconceptions is that people don't trust antigen tests because of their lower sensitivity. Now, the point of rapid antigen mass testing is not to accurately detect the infectious status of every resident. That's not the point. It's not a clinical test. The point is to detect enough strains of transmissions, and by cutting them, you are flipping the reproduction number to below one. That's all you need. By switching that, the epidemic will be decelerating.
Communication is very important. The rapid antigen mass testing only works when you communicate the messages very clearly to the population.
Finally, the most important ingredient from our dataset is that we learned it's not enough to isolate the positive case, but to isolate the whole household. That's because of the secondary attack rate of the virus. Once it gets into a household, the member of the family will effectively infect the rest of the household members, so you need to isolate the whole household
Thank you very much. I'm ready to take questions.
I'll briefly start with Dr. Hotez.
I want to thank you for your work in vaccine advocacy and dispelling myths around the vaccine link with autism. I think it's really important, and I want to thank you for doing that.
I am going to direct most of my questions to representatives from Slovakia.
You have the benefit of three members of this committee having been to Slovakia.
The national story of rapid testing is one that really should be celebrated internationally. I think it probably saved a lot of lives, and it's one that, in Canada, we're very interested in, particularly as we wait for vaccine shipments to arrive in Canada.
Mr. Pavelka, I'll start with you.
I read your study called “The impact of population-wide rapid antigen testing on SARS-CoV-2 prevalence in Slovakia”, which found that multiple rounds of population-wide rapid antigen testing decreased COVID-19 prevalence by 58% within one week.
Can you explain, and elaborate perhaps, on how that rapid testing was able to achieve this?
There is a slight difference between the November campaign and the current mass testing we're having now. The one key difference is back then, we didn't have the B.1.1.7 strain. Now, almost 100% of our positive samples are B.1.1.7, which is more transmissible. We are not actually achieving 58% suppression of prevalence between each round, as we did in November, when we were still dealing with the old variant.
It's still measurable. We have the same vaccine coverage as all the other members of the European Union, yet we have one of the lowest infection rates and were one of the first countries to actually get to almost the bottom very rapidly.
The key success behind that is, as I said, isolating households. When isolating the household, you're effectively cutting the chains of transmission. Especially with the B.1.1.7 strain, what we've found is that when a member of the family gets sick, the whole family eventually develops symptoms; whereas with the old Wuhan type, or the pre-existing variants, the secondary attack rate was around 20% or 30%. Now, literally the whole household gets sick.
By isolating just the positive case, you will not cut the transmission effectively. By isolating the household—
Thank you. I'm sorry to cut you off. My time is brief.
The other thing that was really interesting about the work that came out of Slovakia was showing the amount and the prevalence of asymptomatic cases, which likely had a significant cause of spread in many parts of the world.
In countries like Canada, we have had stay-at-home measures, and certainly in the early start of the pandemic, there may have been asymptomatic spread, but it wasn't necessarily detected. Then, I think there was this thought that, well, in the population, everything is fine, right?
Do you think there was a bit of a positive sociological impact, as well, on rapid testing? For example, when you tested the whole population, you were able to show that there was spread and this was something that the country needed to take seriously.
Do you think that perhaps helped compliance with the stay-at-home measures, and then subsequently with a desire for vaccination?
Dr. Hotez, I spoke to you almost a year ago on convalescent serums. Sir, I don't know if you remember. I didn't know then that you were one of the authors of the bible. I've worked a lot of years in tropical countries and before I go, I always buy the most up-to-date Manson's Tropical Diseases
, so I'm really impressed.
I think convalescent serum has been largely replaced by monoclonal antibodies. My understanding is that the United States National Institutes of Health now strongly recommends that these be used by high-risk people early in the disease. In the United States, if you get sick and you're high risk, you go to a website and the government directs you to where to go for your treatment.
In Canada, basically we don't use monoclonals. First, I want to get your opinion on that. Second, your government nicely surprised me, anyhow, with the Biden announcement that it would back the WTO waiver on intellectual property rights related to COVID. What is your response to that? Do you think it will work, and if you can answer quickly enough, I would like to also get Dr. Bogoch's response to both those questions.
I think the patent waiver could be useful. I have an article that just came out in Foreign Affairs this morning that basically says that the patent waivers are a good development but are insufficient to solve the problem because the problem with vaccines is that they are more complicated than small-molecule drugs. For instance, if you have the structure of an antiretroviral drug for HIV/AIDS, the likelihood is that you can bring together organic chemists and formulation experts and produce that drug; the only thing standing in the way is the patent. Vaccines are far more complicated. It takes years to know how to create and build vaccines and do it under a quality umbrella for quality control and quality assurance, having the regulatory authority in place. Just waiving patents will not be sufficient to solve this problem.
What we need is the help from the U.S. government to actually make a lot of vaccine for the world. Look at the scale that we're talking about. There are 1.1 billion people in sub-Saharan Africa, 650 million people in Latin America and about 500 million people in the smaller, low-income countries of Asia. When you add up those numbers times two doses, we're talking about five to six billion doses of vaccine. Where's that going to come from?
The mRNA technology is still new. It's a great technology—I got the Pfizer-BioNTech vaccine, and I'm grateful for it—but can we scale that up, and what will a patent waiver do for that? It's the same with the adenovirus vector vaccines, and we have our vaccine. For instance, with regard to our vaccine, we have Biological E. making a billion doses. Who's going to make the other four to five billion doses? I think there seems to be.... There's not an adequate foreign policy for producing vaccine at the scale that we need and in the time frame that we need. We really need it now.
We have the added problem, of course, that the whole game plan for the global vaccinations relied heavily on India to be the big producer between the Serum Institute and Biological E. Now those vaccines are not being exported because they're being kept within India, so it's like a domino effect and the whole thing is kind of falling apart.
I worry that there's not an adequate structure. The COVAX sharing facility was well-thought-out, but the vaccines simply aren't there right now. The key message, I think, for the Biden administration is this: “Thanks for the patent waiver. It's a good first step, but now what are you doing to do?”
They both work by the same principle. The idea is that the convalescent serum provides virus-neutralizing antibodies, and the monoclonal antibody works that same way. The advantage of the monoclonal antibody, of course, is that there's better quality control, so you know exactly how much antibody you're providing. With the convalescent plasma, there could be enormous variability. That's why you're getting very inconsistent results, as well.
If you have very high titre levels of convalescent antibody, it could work quite well, but a lot of places don't adequately measure it, so there is all that variability. Of course, the problem with both of those products is that you have to give them very early on in the course of the illness, when you're still interfering with virus replication. Remember, there are two components to COVID-19. There's the virus replicating phase, and then there's the host inflammatory response. Once you delay and allow that host inflammatory response to continue, it's clear that the monoclonal antibodies and the convalescent serum are not working very well, so you have to give it early on in the course. It's certainly no substitute for vaccination.
I don't quite understand why monoclonal antibodies are not more widely available. In the U.S., too, there's been a problem. For instance, when my daughter-in-law got COVID-19, she was living in Arizona and wanted to get her monoclonal antibody, and the infectious disease attending at the medical centre there gave me a list of about a hundred criteria why she couldn't get it. They've made it so fussy and complicated and have limited the criteria so that, at least for the last few months—maybe it's gotten better now—it was almost impossible to actually get it used for anybody.
I'd like to thank our friends and colleagues from Slovakia for discussing their tremendous innovation and work.
I completely agree with the sentiment that you suggest and with the sentiment brought up by Ms. Michelle Rempel Garner earlier. These are excellent tests that have been underutilized in Canadian settings. We have access to them; we just haven't deployed them as broadly as we should have.
I think there is some general confusion among many Canadians as to the difference between a diagnostic test and a screening test. The PCR tests are very good for diagnostics. If you get sick and you want to know if a person coming into the hospital or clinic has COVID-19, you'd use a PCR test. We're talking about rapid testing to help keep workplaces safe. An example was given earlier: I'd much rather use a rapid test to detect most of the people coming in who are positive for COVID-19 by using these rapid tests than detect zero people coming in by not using any rapid tests. It's kind of a no-brainer, and they have been underutilized.
What's very interesting in Canada is that the business community figured this out first. While many of us in the medical and scientific community were debating back and forth, the business community just quietly went ahead and started integrating rapid testing, and created much safer work environments. This was most impressive. Here in Ontario, John Ruffolo is a well-known local business leader. He started pushing this forward, and we were applauding him from the sidelines.
I completely agree that we could utilize these tests much more significantly. There's room to do so. Quite frankly, this virus ain't going anywhere; it's going to be around for a while. Even with mass vaccine efforts in place, we still need to create safer workplaces. Given the way that point-of-care rapid testing was described by our Slovakian colleagues, it is a very smart way to do this.
Well, unfortunately, in the last administration, the vaccination plan was mostly about providing and ensuring that there would be adequate supply of vaccine. That was clearly important, but it became clear when the new administration took over that the plan and the logistics were largely focused on making certain that the boxes of vaccine would be kept without temperature incursions and delivered via FedEx and UPS and all of those usual mechanisms.
It was good that it happened, but there was really not an adequate plan to vaccinate the American people. The initial plan relied heavily on pharmacy chains and some of the hospital systems, and I think they did the best they could, but especially in some of the low-income neighbourhoods across the U.S., they're pharmacy deserts, and there was no mechanism for vaccinating, especially in low-income neighbourhoods or even in a lot of rural areas.
I think that there the contribution of the federal government was to put a new plan in place in order to scale up vaccinations very rapidly. That evolved as well, because when the Biden administration took office, they said that they were going to deliver 100 million immunizations in 100 days.
That made sense, I think, in January, until we realized that the B.1.1.7 variant from the United Kingdom was accelerating as fast as it was. A number of us in the scientific community said, “Well, it's great that you made that commitment, but it's not adequate, and you're going to have to triple that.” That was I think one of the more impressive things about the administration in 2021: how they regrouped to triple the rate of vaccination. That's why we're doing so well. There was that all hands on deck....
We still have problems now, because we do have—
Yes. There were two problems early on that we noticed back in December. Two groups were highly vaccine hesitant. One was black and brown communities, and then conservative groups. There were four news polls, one from PBS NewsHour and others from Monmouth University, Quinnipiac University and Kaiser showing that about 40% to 50% of Republicans said they would refuse vaccinations.
So I started doing two things. One, I began going on a radio podcast and a radio program that reached black and brown communities, and hesitancy really started going down. I was on one very interesting one with one of the historic black churches in Richmond, Virginia. A pediatrician from the church invited me together with the pastor. I said to the pastor that the numbers looked like they were going down. What did he attribute that to? He said that part of it was that doctors like me were reaching out but also that the clergy in black churches really work together to help make that happen. I think he's right. I think that made a big difference. But now the problem is more access in low-income communities than hesitancy. However, with the conservative groups, it still a rip-roaring problem. You're seeing it reflected now in this disparity between blue and deep red states.
My fear is that we're going to reach some of those benchmarks in the blue or blueish states and the Democratic strongholds—and that's already starting to happen. We're already reaching numbers that will look like Israel's numbers, but in the deep red states, we're still greatly underperforming and underachieving. I worry about ongoing virus transmission there. We have to do a better job reaching out to conservative groups. I'm trying to go back on Newsmax and Fox News and stations like that to do what I can. But it's been really tough.
Members, that pretty much brings our questions to a close.
I'd like to thank all ofthe witnesses, particularly our visitors from the Slovak Republic, for their presence here, and thank you once again to Ambassador Koziak for his attendance.
I would also like to extend my appreciation on behalf of the committee to all of the House of Commons staff, particularly today when we've had guests from all over the world. It's quite difficult sometimes to wade through the technical issues. Thank you for that—and as well to the interpreters. It's a challenging job at the best of times, but in times like this, it's even more so. Thank you to everyone.
With that, the meeting is adjourned.