I call this meeting to order.
Welcome, everyone, to meeting number 38 of the House of Commons Standing Committee on Health. The committee is meeting today to study a number of matters relating to the emergency situation facing Canadians in light of the COVID-19 pandemic.
I would like to welcome the witnesses. From Canada Border Services Agency, we have John Ossowski, president, and Denis Vinette, vice-president, travellers branch; from the Department of Health, Dr. Stephen Lucas, deputy minister; from the Department of Public Works and Government Services, Mr. Bill Matthews, deputy minister; from the National Advisory Committee on Immunization, Dr. Matthew Tunis, executive secretary; and from the Public Health Agency of Canada, Mr. Iain Stewart, president, and Dr. Theresa Tam, chief public health officer.
We'll start with statements from our witnesses.
Let's begin with Mr. Ossowski, please, for five minutes.
Good morning, Mr. Chair and members of the Standing Committee on Health.
Thank you for inviting me to participate in this discussion today.
I am pleased to be here to respond to your questions about how the Canada Border Services Agency is implementing and enforcing border measures during the pandemic. I am here with Denis Vinette, vice-president of the travellers branch at the CBSA.
Since the start of the pandemic, the CBSA made its pandemic response a priority. To help keep Canadians safe and protected, the Government of Canada has put in place emergency border measures to limit the introduction and spread of COVID-19 and its variants in Canada.
CBSA border service officers apply over 90 acts and regulations to safeguard Canadians. Over the last year, we have also implemented the provisions of 50 orders in council that apply to foreign nationals and residents of Canada. The OICs are designed to restrict travel and establish public health requirements so that we can reduce the spread of the virus into Canada. The measures have resulted in 96% less air traffic and a 90% drop in non-commercial traffic entering Canada by land, compared with pre-pandemic volumes.
It's important to point out that Canadian citizens, permanent residents and people registered as an Indian under the Indian Act have a right to enter Canada. However, all travellers seeking to enter Canada go through enhanced screening measures by CBSA border service officers, and must meet testing and quarantine requirements to keep Canadians safe, unless they qualify as exempt.
Of course, some cross-border travel is necessary to maintain the flow of goods and services critical to our economy and our people. The majority of individuals crossing in vehicles at the land ports of entry are essential service providers, such as truck drivers and nurses. We must continue to strike a balance between keeping Canadians safe and keeping the economy running.
Data shows that Canada’s pre-arrival, on-arrival and post-arrival testing requirements, and quarantine requirements, are working. For example, over 99% of travellers entering Canada have either complied with the pre-arrival testing requirement or were exempt from it.
The CBSA continues to work with other Government of Canada organizations on the pandemic response. Our agency works in close co-operation with the Public Health Agency of Canada to implement and uphold the public health measures that are recommended at the border. The last year has shown that the CBSA is able to rapidly adapt its operations to put new processes, rules and orders in place. We are certain that we will be able to continue to respond to new and evolving measures, including the potential use of proof of vaccination credentials, to facilitate travel and manage the border.
Since the beginning of the pandemic, we have supported the government’s efforts to establish strong measures to secure Canada’s borders and to help prevent further introduction and transmission of COVID-19 and its variants into Canada. We have demonstrated our resolve and willingness to adjust restrictions based on scientific evidence. I am very proud of the work CBSA officers have done, and will continue to do, to protect Canadians and the Canadian economy in the face of this pandemic.
I would be happy to respond to questions from committee members.
It's a pleasure to be here along with colleagues from the CBSA, PSPC, Public Health Agency of Canada and NACI.
My remarks today will focus on the actions that Health Canada has taken to keep Canadians safe during this pandemic.
Health Canada is the regulator for health products, including therapeutic products, vaccines and medical devices. Our scientists review health products for their safety before they can be sold in Canada.
Early on, we recognized the need to facilitate the authorization of COVID-19 treatments and vaccines, given that in the early stages of the pandemic none were available. Health Canada expedited the review of COVID-19 clinical trial applications, treatments and medical devices through the use of interim orders so that Canadians could have access to the products they needed to keep safe. We have authorized 265 disinfectants, more than 4,500 hand sanitizers, 645 medical devices and two treatments.
In the context of treatments and vaccines, rolling reviews permitted manufacturers to submit their requests for authorization before they completed all of the clinical trials, allowing Health Canada to evaluate the data of promising candidates as it became available.
As you know, Health Canada has authorized five different COVID-19 vaccines. Ongoing monitoring of the safety and effectiveness of these vaccines is a priority for Health Canada. We also require evidence of product quality before each lot of vaccine is distributed in Canada. This is true for the Janssen vaccines received on April 28 that contained drug substances that were manufactured at the Emergent site in the United States. Health Canada continues to work closely with Janssen and our international partners, including the United States Food and Drug Administration, to confirm the quality of the supply, given the issues reported by the USFDA after its inspection of the Emergent facility in April.
Let me take a moment now to say a few words about testing and screening, which, along with public health measures and vaccines, help to slow the spread of COVID-19.
As of May 15, the department had approved 68 test kits, including 17 rapid tests. More than 27 million rapid tests have been shipped to the provinces and territories. In addition, as of May 18, the Government of Canada has provided almost 1.5 million rapid tests directly to private and not-for-profit organizations in critical sectors across the country. These rapid tests used in screening programs can help to identify pre-symptomatic and asymptomatic cases so they can be isolated early to help stop the spread of COVID-19 in workplaces and other settings.
As vaccine rollout continues, testing and screening remain important in protecting public health and supporting reopening.
Now more than ever, Canadians need access to virtual health care services.
The government is supporting the expansion of virtual care in Canada, which will help reduce the pressure on health systems and provide Canadians with needed health services and authoritative information in a safe and secure manner through telephone, text or video conferencing, in addition to face-to-face visits.
In May 2020, the government announced an investment of $240.5 million to increase access to virtual services and digital tools to support Canadians' health and well-being, and $150 million of that funding is being provided to provinces and territories through targeted bilateral agreements. In addition, Canada Health Infoway will receive an additional $50 million to support provinces and territories in their efforts to implement these new virtual health initiatives and work with the Canadian Institute for Health Information on content standards for virtual care.
In conclusion, we continue to work closely with provinces, territories and other partners to adapt to the challenges of delivering health care during the pandemic.
I look forward to answering your questions.
Thank you, Chair and members of the Standing Committee on Health, for inviting me to speak to you today.
The Government of Canada has taken a whole-of-government approach in its response to the COVID-19 pandemic.
Every day we are achieving important milestones in Canada's vaccine rollout. In just five weeks, we have doubled the number of COVID-19 vaccine doses given across Canada, from 10 million doses administered by mid-April to almost 20 million doses administered to date. As of May 15, 55% of eligible adults have received at least one dose of COVID-19 vaccine.
As outlined in Canada's COVID-19 immunization plan, the goal throughout our campaign has been to enable as many Canadians as possible to be immunized as quickly as possible against COVID-19 while ensuring that high-risk populations are prioritized. In doing so, we will reduce serious illness and death while minimizing societal disruption.
To meet these goals, we have conscientiously relied on the accumulating scientific data, the emerging evidence and the guidance of public health experts to inform our decisions, strategies and recommendations. The Public Health Agency of Canada's vaccine rollout task force has been guided by committees of immunization experts such as the National Advisory Committee on Immunization and through close collaboration with provincial and territorial partners.
Grounding our approach in public health science and equity resulted in the identification of priority populations and the extended dose strategy currently in place. These strategies have been instrumental in meeting our public health goals and maximizing protection both for at-risk groups and the population overall.
Although the national daily number of COVID-19 cases remains high as we continue to feel the effects of a variant-driven third wave, there is reason to be optimistic, as public health measures are demonstrating an impact and vaccination coverage broadens. Over the past seven days, there has been a more than 25% decrease in daily cases, and compared to last week, the number of patients in hospitals has dropped by 10%. Nationally, deaths have decreased by 15% compared to last week.
The success of vaccinating priority populations first, specifically people 70 years of age and older and those living in congregate settings, is borne out by the observation that this age group has the lowest case rate nationally, and its hospitalization rate is also decreasing.
While nationally all age groups are seeing a decline in case rates, people aged 20 to 39 years old now represent the highest rate of infection. As additional age groups become eligible to book vaccines in different jurisdictions across the country, this highlights the importance of everyone stepping up to get their shot as soon as it becomes available to them.
We are committed to removing barriers to vaccination and building vaccine confidence. The success of the vaccination campaign relies on as many people as possible taking part. We are broadcasting this message loud and clear through the nationwide “Ripple Effect” communications campaign launched this week, which uses multiple multiple mass media formats to encourage vaccine uptake. I, myself, am reaching out to key priority groups such as personal support workers and key influencers such as faith leaders and YouTube personalities popular amongst younger adults.
The good news is that a strong majority of adults in Canada have indicated an intention to become vaccinated. However, despite this encouraging finding, we know that we must sustain our pace of vaccination even as coverage rates climb. As case rates come down and there is pressure to relax health measures, there remains a risk that those who face barriers to accessing vaccines will be left behind.
In this regard, community-based efforts to encourage vaccination will be crucial in the coming months. We know from experience that those approaches are effective. For instance, we have seen positive results in vaccine uptake using approaches that engage indigenous leaders and supporting, for instance, urban vaccine clinics operated by indigenous organizations, and we have seen success in reaching racialized and marginalized communities with information about vaccines by engaging individuals in their own languages and on platforms they already use.
Through dedicated funding, we are doing more to support the efforts of those with the expertise and capacity to promote vaccine confidence in their communities, especially in those communities experiencing health and social inequities or that have been disproportionately impacted by the COVID-19 pandemic.
The immunization partnership fund has provided $3 million per year since 2016, supporting 22 projects to increase vaccine uptake. In 2020 an additional $30.25 million was confirmed to fund more than 100 projects focused on capacity for health care providers and community-based programs, specifically social media campaigns, targeted resources and frontline interventions.
The vaccine community innovation challenge, funded with $1.5 million, supports projects in diverse communities to help spread the word about vaccines, increasing vaccine confidence through creative, community-driven and culturally appropriate means.
There is reason to be hopeful as we begin to feel the impacts of widening vaccine coverage across Canada, but we're not yet in the clear. Long-range modelling suggests that new cases will continue to decrease if current measures are sustained. We have an important window of opportunity to bring COVID-19 under control in Canada very soon, but it requires two key actions. The first is getting vaccinated as soon as it is possible to do so. The second is continuing to follow public health measures until it is truly safe for them to be relaxed. These two elements will provide the vaccination campaign the environment it needs to yield the highest possible results to protect Canadians and support the reopening that we all so eagerly await.
Yes, it is really important to use every method available. At this point in time, when vaccines are essentially now being provided to all eligible groups in many areas of Canada, I think having more targeted approaches means really listening to the community and what their needs are. That is very important.
Some of it will necessarily come from providing more information to individuals, but a lot of it is about trust. Having community leaders, having language support and having the clinics open during all hours are really important for access purposes. I do think that all of these efforts combined are really important.
As I mentioned in my opening remarks, some of the key target groups will be younger adults, as well as workplaces and engaging the private sector to see what more can be done to encourage vaccine uptake. With some of the examples we have, I think that best practices can be transferred across Canada.
Our vaccine community innovation challenge has been really very, very popular in these projects supporting diverse communities like the ones you just talked about. I'm really optimistic, and I think, with everybody's support, including community groups, we will get there.
Thank you very much, Mr. Chair.
My first question is for Dr. Lucas.
This week, we learned that, like Europe, Health Canada is allowing Pfizer-BioNTech vaccine to be stored in the refrigerator at normal temperature for 31 days, whereas so far the recommendations have been to keep it at minus 60 to minus 80 degrees Celsius. That's very good news in itself.
First, I'd like to know what's changed. How is it possible to do that now?
Then, can you tell us how that will accelerate vaccine rollout?
As the honourable member noted, indeed this week Health Canada authorized the submission by Pfizer to extend the period in which the vaccine could be stored, subsequent to thawing it in a refrigerator between about 2°C and 8°C, to 31 days. It had been previously authorized five days in refrigerators. Pfizer has gained experience through its initial work with ultra-cold storage and then for a period of time at -20°C and now is able to store it for up to 31 days in refrigerators.
This will enable a broader utilization of the Pfizer vaccine. I'll make a few comments and then turn to Iain Stewart for any further comments, given the Public Health Agency's responsibility for vaccine rollout, but it will enable broader use of the Pfizer vaccine in settings such as pharmacies or in the territories, as well as in settings such as family physicians' practice clinics.
Mr. Chair, I would turn to Iain Stewart for any further comments.
Thank you for that, Steve.
Mr. Chair and honourable member, the portfolio approach that we've taken has proven robust. A number of the vaccines that we were hoping would be part of our immunization campaign have had challenges—sometimes in production and sometimes in their approval—and so the net result is that we've ended up with a couple of vaccines that are playing a very foundational role.
As you would know, both Pfizer and Moderna have been a major part of what we've done, as well as AstraZeneca to a lower level. Having that diversity of options, in fact, has been very beneficial for the country and therefore I think the portfolio's been quite advantageous.
With respect to the difference among them or the quality—
Mr. Chair, I think we are at a turning point, for sure, given the supply. The vast majority of vaccines will be the Pfizer vaccine. Having a diverse portfolio as a backup option is always a good idea.
With the AstraZeneca vaccine, the provinces and territories have chosen to pause giving any more new first doses. We do, however, need additional supplies, which we have, for the second dose for people who wish to take the AstraZeneca because they started on that schedule.
As you probably appreciate, there are data that we are still looking at on the mixed schedule. The National Advisory Committee on Immunization, once they have that data, will be able to provide a recommendation to determine whether the mRNA vaccines, such as Pfizer, are suitable for that second dose.
After that, there still need to be some backup options for people who might be allergic to mRNA vaccines or who for some other reason can't take them. It's still important to have some diversification in our approach.
The data is still accumulating. Some studies have shown that even with one dose there is a reduction in transmission to others. It won't be 100%, nor would it be that even with two doses. I think the data is trending in a very positive direction.
I would just clarify. Of course, if you prevent infection, whether symptomatic or asymptomatic, you will reduce transmission. That's one thing. Those vaccines, even after one dose, have had a very high vaccine effectiveness, particularly against serious outcomes. That's very positive.
One study, for example, from the United Kingdom, demonstrated a 50% to 60% or so reduction in transmission. Overall, even with one dose we expect to see that effect.
Mr. Chair and honourable member, this question would be for me, I think.
Remember, honourable member, we just received a shipment of 655,000 doses of AstraZeneca. Those are only being distributed over the past week. A lot of them will be in handling and storage for further onward distribution.
The answer, then, I guess is, more than 655,000, to the extent that the provinces have had a few left over from the previous shipment.
Mr. Chair and honourable member, I'd like to just add a couple of things if I could.
The public policy rationale of the government-approved accommodations, the hotels, is that somebody comes off an international flight, we don't know if they're infected and infectious or not, so they do the test. They're tested immediately if they come off the plane, and then they go to the hotel to wait for the result.
A lot of people coming in internationally, of course, are boarding a domestic flight and what we didn't want was infected people, perhaps carrying the Indian variant or something like that, getting on a plane from Toronto to Winnipeg and infecting a bunch of people on the plane. That was the public policy rationale for that.
At the land border, you don't get the same type of profile. People are usually arriving in a conveyance and continuing on. That's one thing I wanted to mention.
The other thing to mention is that the infection rate of people arriving by air is about 1.7%, so about 6,185 people out of about 369,000.
Thanks to all of the witnesses for joining us today. This is quite a panel, and I appreciate your taking time off of your schedules to answer some questions today.
I'd like to start my questions with Dr. Tam.
We continuously said that, as we learn more about this virus, our approach will evolve, and, as we vaccinate more and more people from different priority groups and locations, I think it's fair to say that our knowledge about these vaccines evolves too.
I've heard of a few cases abroad where the antibodies were found in babies whose mothers received the vaccination while they were pregnant. I think this is certainly something to give us some hope.
I'm wondering if either nationally or internationally you have seen any of these cases. Are there are any studies about these situations, and if so, can you tell us about them?
Mr. Chair, that decision has been very impactful, because COVID-19, of course, has a disproportionate impact on certain populations, including our most senior age groups as well as those in congregate-living settings such as long-term care, and then, of course, those at high risk of exposure to the virus such as health care workers.
I'll just point out that, in this third resurgence, the number of deaths—and we should take note of every death—is much smaller, whereas we would have expected that to be much higher. As the protection of the very effective vaccines have taken hold, long-term care facility cases and outbreaks have dramatically decreased. That was the first thing that we noticed about the vaccine program. Then the rates in the 80 years and older age group plummeted, really, at a very fast rate. That was another really good sign.
Vaccine effectiveness studies being carried out in Quebec and British Columbia indicate the effectiveness of even the first dose of vaccine. Health care worker cases have also dropped as a result of their being vaccinated as a priority group, so I do think that those prioritizations have had an impact.
First nation communities and the territories were prioritized and have had a really high vaccine uptake. I do think the vaccine has played a very key role in protecting those populations.
Thank you, Mr. Chair, and hello to my colleagues. Thanks again to the witnesses for coming here today.
My first two questions will be directed to Dr. Stewart. If I can, I'm going to ask a third question of Dr. Tam.
My questions are going to change a little bit. I was going to ask some questions around vaccines, but from what I'm hearing today and what I'm learning on a daily basis, we're trending in the right direction with respect to doses. We're looking at 19.6 million doses of COVID-19 vaccines being administered so far in the country. If I'm not mistaken, that's a little over 55% of eligible adults who have received at least one dose. That's really encouraging.
I'm going to pivot to rapid tests, actually.
Dr. Stewart, as you and everyone knows, I'm from Nova Scotia and our province has done a really good job at managing the virus, but the third wave, I have to tell you, has been challenging here. This week, the Nova Scotia Health Authority said that its province's asymptomatic rapid testing sites have been key in identifying, I think, at least 10% of all confirmed cases.
My question to you is this: Are there any lessons to be learned from Nova Scotia's experience with rapid tests?
As I'd noted before, Nova Scotia has really been a leader in the use of rapid tests as part of their broader program. Prior to the resurgence that they've been experiencing, they have used them to effect in downtown Halifax, as I've noted. Now they have a broader utilization of rapid tests for screening purposes, which allows for quick determination of potential or presumptive positives and then follow-up confirmatory tests.
That can lead to broader screening in a workplace or in other settings if, for example, cases are detected, and effective utilization of the PCR tests. I think that has allowed them to really get a broad handle on the number of cases and effective tracing and isolation of cases and contacts. The steps they've taken, coupled with other public health measures, have allowed them to control the spread and bend down the curve of the resurgence they've experienced.
The government is working on a number of pathways, as I had previously responded. The government has distributed a significant number of rapid tests to provinces and territories—that started in the fall—and worked to provide guidance and support on their use.
We have been providing rapid tests directly to employers working in critical sectors where there's a risk of infection in the workplace. We've been working as well with pharmacies to distribute rapid tests to small and medium-sized enterprises. We've been supporting the Canadian Chamber of Commerce in a program where they partner with provinces to be able to distribute rapid tests to small businesses. We've been supporting the Canadian Red Cross, as well, who are working with not-for-profit organizations and community organizations and settings, such as homeless shelters, to be able to use rapid tests in those environments.
We see this multipronged effort as really helping to be able to identify those cases and follow up with action, as I'd noted in the case of Nova Scotia.
Thank you very much, Mr. Chair.
My question will be for Mr. Ossowski.
In the spring of the first wave, although no one would have thought that we would be asking so many questions about vaccines today, the government passed a special law that temporarily suspended patents and authorized vaccine production under licence. Now, as vaccines are emerging, that provision is not being renewed despite all the issues we have had because we depend on foreign countries for our vaccine supply.
The question is simple. Why has the provision not been extended?
Has there been any pressure not to extend it in your negotiations with pharmaceutical companies?
I just don't accept the assertion that we have enough vaccines in Canada right now. We're essentially on a nationwide lockdown, waiting, and some people are being told they will have to wait four months between vaccinations.
NACI has approved a four-month dosing, so I find it problematic that the head of PHAC thinks that we have adequate supply in Canada right now and that we shouldn't be pursuing every option for Canadians to get vaccinated. I mean, Vaccine Hunters is not going to enable every Canadian to get a second dose. It's just, frankly, preposterous and arrogant to make that comment.
I will continue.
Do you believe, Mr. Stewart, that a physician telling a Canadian, or writing a note, to go get a vaccine in the U.S. is not medically necessary, based on your comments that you made earlier?
I think conducting meetings and asking questions and actually allowing the answer isn't a sign of the patriarchy; it's actually doing our job as MPs to get the testimony from the witnesses we've asked to be here.
In that vein, it's interesting that the Conservatives talked about our never going to have vaccines until 2030, and then today they're saying that we have to get more vaccines or allow Canadians to take additional risks to go to the U.S. even though there are vaccines available in Canada right now. I believe it was yesterday that Canada surpassed the U.S. in first doses.
How appropriate would it be, if we're actually administering more first doses to Canadians than the U.S., to take supply away from another country when we have adequate supply here? I find that a bit odd.
I want to speak to the first-dose strategy. I have a number of questions. The first-dose strategy was also criticized by the Conservatives, which again is very confusing because you can't get a second dose until you have a first dose. Therefore, it makes a lot of sense to administer first doses, and again, we have surpassed the U.S. on this.
To Dr. Tam—or if there are others who would like to jump in, please do so—the real world data has looked very promising in terms of protection from first doses, although people are not 100% protected after a first dose. In real world data on first doses, as well as something I know the minister likes to talk a lot about, a community with less COVID is safer for everyone. If you have a lower risk, even with a first dose, that in fact makes your community safer because that spread is down.
Could you maybe speak to that piece of it and why it's important for Canadians to continue to get that first dose, and why it's so important that our momentum with vaccines and these doses is increasing and continuing?
Mr. Chair, maybe I'll start with the answer to that question.
I think the first-dose, fast strategy was taken up as a result of the National Advisory Committee on Immunization reviewing existing information on the COVID-19 vaccines, but also a wealth of knowledge —decades of experience—about vaccinology, immunology and how vaccines work. Together with mathematical modelling and other considerations, it meant that there was a consensus amongst chief medical officers of health in the provinces and territories to do this strategy.
I think it has paid off and has contributed to increasing population protection. More and more data is coming out, including from the United Kingdom, which shows that the first dose offers significant protection, particularly for serious outcomes, and that the duration of that protection does last.
We also have Canadian data, from Quebec and British Columbia, that I think will provide the world's first glimpse into just how good that first dose is even beyond the 12-week mark. It has been very encouraging.
If you can imagine, if you're doing mathematical modelling, covering twice as much of the population with an effective first dose provides significant benefit, but that doesn't mean you can forget the second dose. You have to come back fast with that second dose.
On that, I will just clarify that the National Advisory Committee on Immunization said “up to 16 weeks”. As the supplies improve, I think we will see that interval potentially being compressed more. I believe British Columbia has just come up yesterday with a 13-week interval now, given their supply management. I think you will see that interval being more compressed as we go along as well.
Just rest assured to Canadians that first doses do matter and they have worked and have prevented a lot of serious outcomes in Canada already.
Yes, I can attempt that.
NACI has advised us that, based on what we know about the immune system, intervals that are longer can provide the immune system more time to generate a robust immune response. We have seen in some of the clinical trials, such as those for AstraZeneca, that a longer interval resulted in more protection and a better immune response. There have also now been some studies published showing similarly for the Pfizer vaccine that a longer interval can provide a stronger immune response.
These are all things that the committee continues to weigh out, as they look at the interval strategy. As Dr. Tam said, jurisdictions are now looking at whether they can revise their strategies as supply shifts. NACI has always said that an interval of up to 16 weeks could be used, based on their deep understanding of the immune system, immune responses and what we've seen historically from other vaccines—that more time can allow the immune system more time to generate a better response.
Thank you, Ms. O'Connell.
That questioning went way over what I expected, so I will give Mr. Maguire a little extra time here.
I want to update the committee in response to Mr. Davies' point of order. My understanding is that there was a brief interval at the beginning of the meeting, about three to five minutes, when WebVU and ParlVU were not operating, but they have been operating since.
That's my information.
Mr. Maguire, please go ahead. I'll give you five minutes plus.
We have been working with Switch Health to improve their delivery.
The key thing is for the people who are waiting for their eight-day test in particular—and I believe when you talk about rural delays, it's those eight-day tests when people are in quarantine.
One of the things that we did first of all was to provide more time. We made it an eight-day test, not a 10-day test, so it was less likely to impact the person waiting for the result. We've added, as I mentioned, more service providers gathering up samples in rural areas—as I mentioned, three new service providers, and then for other areas we have added Uber as well. We work with their company on their level of staffing—
My riding extends from Thunder Bay to the Manitoba border and includes all of the Canada-U.S. border in that region. It's a very large region and largely a very isolated region. Many families and businesses have close connections with families and businesses on the other side of the border.
A lot of people have been severely affected by the border closure. Grandparents haven't been able to see their grandkids. People haven't been able to see their children. People haven't been able to see their spouses. Also, particularly in northwestern Ontario, businesses that deal with tourism have been really devastated because they're almost totally dependent on the American market and American tourists. There is increasing evidence that being fully vaccinated significantly decreases the risk of transmission. The CDC in the United States is recommending a relaxation of social measures, and we've seen it. It seems to me that EU has announced that it will allow fully vaccinated Americans into the EU.
Given the severity of the effects of the border closure, I think it is reasonable for people to ask when we can expect some sort of decision as to the border being open. I would suggest that certainly the summer would seem to be a reasonable time, especially given the effects on the tourism industry where, if there are no American tourists this year, a lot of businesses are going to go bankrupt. A lot of people will lose their livelihood.
I know Ms. Rempel Garner asked about that and I think it's a reasonable question. When can we expect to hear when fully vaccinated people, especially Americans, will be allowed into Canada?
I do think that Canada is probably on a good trajectory in terms of its epidemiology and our own vaccination coverage. I do think that between now and moving toward the fall we would expect some shift in that policy.
I think one of the other aspects to remember is that we have to actually look at the proof of vaccinations. As I said, there are some operational considerations, standards and that type of thing that need to be worked out as well.
We do also expect to continue, I think, to do some testing, even in vaccinated individuals, given the potential for variants that may have escaped vaccines, for example. We would be taking all those factors into account.
Mr. Chair, I hope I understood the question correctly.
If someone has already had COVID-19, currently the National Advisory Committee on Immunization's recommendation is still that they be provided with the full schedule of vaccines. However, I believe that NACI will be reviewing that information on an ongoing basis, because as the public is probably interested in, it is likely that the original infection provides some level of immunity.
We know that in a lot of the studies vaccines provide better immunity in terms of antibody responses than the actual natural infection, so giving a vaccine after someone has been infected is still the recommendation, but I look towards the committee to provide further information on the exact number of doses.
Mr. Stewart, I guess this question is for you.
In April, the U.S. FDA stopped AstraZeneca from using the Emergent BioSolutions plant in Baltimore, and halted production of the Janssen vaccine as it began an investigation into multiple areas of concern, including contamination and quality-control issues.
On April 25, Health Canada claimed to have verified that the 1.5 million doses of AstraZeneca vaccine imported into Canada from that facility met the quality specifications, but the FDA's inspection report noted that, “There is no assurance that other batches have not been subject to cross-contamination”.
How was Health Canada able to verify the quality of those doses when the FDA is unable to provide assurances that vaccine batches produced at the plant were not subject to cross-contamination?
On that same day, Health Canada issued a statement regarding those contamination issues and they claimed that, “Janssen vaccines anticipated to come into the country next week do not come from this facility."
However, five days later, on April 30, Health Canada was forced to retract that statement after learning that a drug substance produced at the Emergent site was used in the manufacturing of the initial Janssen vaccines received on April 28 and intended for use in Canada.
Why did Health Canada make an unverified statement of fact on the source of Canada's Janssen vaccines on April 25?
If you could, please do.
Dr. Lucas, I don't mean to be the contrarian here, but in your first answer you said that you don't know what they're referring to, and now you're telling me that no data could be collected. Clearly, though, this report is saying that discussions are happening on the collection of data.
Could you table with the committee exactly what data may be referenced in this report and also, say, how many Canadians could be affected and what the government is planning to do with any data that's being referenced in that alert app's advisory council report?
Mr. Chair, I will make a first attempt at answering that question.
The vaccine impacts of variants of concern are being tracked globally from real, live data that has to be collected. So far, we know that the vast majority of the variants of concern are concerning because they have an increased ability to spread quickly.
In terms of impacts of vaccines, the current data suggests that for the B.1.1.7 variant, and indeed for the latest variant of concern, the B.1.617 variant—originally reported from India, some of these subtypes—we expect the vaccines to provide coverage. For others there may be some reduced impacts of the vaccine, but we still expect that the vaccine will work to a certain extent.
The most important thing is to get vaccinated. Of the variants spreading the most in Canada, we expect the vaccines to have an impact on them.
Mr. Chair, I'll start and maybe others who are more engaged on that front from a communications standpoint can add.
That campaign is just one out of many approaches. This is a much broader media campaign. It demonstrates, I think, to all Canadians that of course the vaccines protect individuals, but they also have a ripple effect, in that they protect others in the community. If we could all get vaccinated as fast as possible and do so, then we could get back to the things we cherish the most, with much less chance of impacting our health care system and other systems.
I think the concept is that every time someone rolls up their sleeve, the impact permeates through their community and as well protects them as individuals.
I'll make a couple of points, I guess, to start.
The vaccine portfolio includes vaccines across three platforms. I think members know that there are four authorized in Canada: the Moderna, Pfizer, Janssen and AstraZeneca vaccines. Pfizer and Moderna make up the vast majority of deliveries to date.
The other point to make is that there are still vaccine contracts that have yet to deliver. They are still in the works, in terms of stepping through their clinical trials and then going on to production. It's the variety of the portfolio across numerous types of vaccines, but also numerous different suppliers, that is the best mitigation against risk in terms of lack of delivery. There will be bumps, and we've seen them. It's this variety that's important to protect or ensure deliveries for Canadians.
If the member's question is more around the benefit of having various different types of vaccines, from an mRNA to a viral vector to a protein type, I'd have to turn to the Public Health Agency or maybe Dr. Tam.
There is a scenario in which the United Kingdom data supports NACI's giving guidance that the messenger RNA vaccines are a suitable second dose, and in that instance, you might see, yes, less demand for AstraZeneca.
I think there will continue to be a demand for AstraZeneca by people who are looking for a second dose and want the same vaccine, and so on, and as I think Theresa mentioned earlier, the messenger RNA vaccines don't always....
You can have an allergic reaction, and so on, so you want to have a diversity of portfolio. Therefore, there will be some demand, but much less if it happened that way.
Thank you, Chair and member, for the question.
I must say that right from the onset of our preparation of our response at the border, our officers' personal health in the performance of their duties on a day-to-day basis was front and centre in all of our preparation, in everything from making sure they had sufficient personal protective equipment on. Since that time, we've moved into providing shelter from some travellers by using plexiglass, and we've instituted sanitization chambers so that their tools can all be sanitized at the end of their work day. It's been an ongoing effort to ensure their safety.
As for how the work has changed, I must say that commercially, the truck traffic and the commercial cargo entering the country have actually surpassed pre-pandemic levels, and so we've been successful in ensuring that economic activity and trade have continued throughout the pandemic, notwithstanding that there was an immediate lull through the March to June period of last year.
As it pertains to dealing with travellers, clearly we've trained them on understanding the new legislation as it passed through the OICs for its application. We've continued to support them in many ways. They have 24-7 access now to our border task force, which provides them with policy advice on the application of the legislation. Also, we've ensured that they have all of the latest information on what is transpiring as their work has shifted. They've been briefed by local health authorities, certainly at the onset, about what COVID was and what protective measures they could take, so that they could continue to come through and report to work.
We're extremely proud of the professionalism of the men and women of the CBSA and of all frontline workers, who continued to come to work on a daily basis, making sure that the borders are secure.
I think it's very encouraging. Of course, with the groups at the highest risk and seniors, the uptake has been really remarkable, and also in long-term care. I think the key is to keep it up.
The latest surveys indicate that the vast majority of Canadians—more than 80% for sure—want to be vaccinated or have already been vaccinated with at least one dose. Once you get one dose on board, the key is to keep up with making sure people remember to get the second dose.
I think we could do more work in making sure that the younger adults, at this point, and the younger youth, also pick up on that momentum. Things are, however, extremely encouraging at this point.
A Government of Canada document entitled “Vaccines for COVID-19: Shipments and Deliveries” states that, as of May 11, 2.3 million doses of the AstraZeneca vaccine have been distributed in Canada. The Janssen vaccine has not been distributed.
However, Quebec and some provinces have already indicated that they will limit their use of the AstraZeneca vaccine to the first dose due to unpredictable supply and safety concerns. I am concerned about the agreements between the vaccine manufacturers and the federal government. The agreements are for 20 million doses of AstraZeneca vaccine and up to 38 million doses of Janssen vaccine.
Is the federal government responsible for the full cost of the doses obtained despite issues with vaccine supply and safety?
Do the agreements include provisions that allow future shipments to be cancelled without financial penalty?
Mr. Chair, we have used dynamic modelling to look at some of these scenarios.
In the model I have presented publicly, the scenario is that if you have at least 75% of Canadians getting the first dose—and we were at that time looking at adults 18 years of age and over—as well as 20% getting their second dose, if at that time we lifted, and this would be up to the provinces, of course, the more restrictive measures, we wouldn't have as much of a risk of overwhelming our health system or of hospitalizations. That was one benchmark.
The second benchmark would be to have 75% of Canadians getting both doses. At that point, we're looking towards a hopeful fall season, when people can get back inside and have a reduced risk of transmission and can get back to the things we miss quite a lot. We're looking forward to universities, schools and other of those social settings getting back towards normal without overwhelming the health system. That was a benchmark.
Since then, many of the provinces and territories have come out with their reopening approaches. I think that some of the provinces have indicators and targets that are in that kind of ballpark, but they also take into account the infection rates in their own province and so may go higher or lower, depending upon how much of the population may already, for example, have encountered the virus itself. You'll see a bit of shift in those, depending on the jurisdiction, but they are roughly in that kind of ballpark.
For my next question, I'll stay with Dr. Tam.
Last week, Nova Scotia, along with several other provinces, paused the administration of the AstraZeneca vaccine, as we all know. In Nova Scotia, my understanding is that it was primarily due to the shortage of the vaccine, but we know that it's still a safe and effective vaccine in preventing the spread of the virus.
However, I have had a lot of constituents concerned about their second dose, quite frankly. They feel as though they are in limbo. I know this through calls and emails. I believe there have been some recent international studies on mixed vaccination doses, such as the reports that were released in the U.K., I believe, and in Spain.
Can you tell the committee what Canada learned from these studies?
I know we touched upon it here, but maybe this is an opportunity to do a little bit of a deeper dive in terms of the answer.
Mr. Chair, I'll answer the question in a couple of parts.
One is that there shouldn't be any concern about supply itself. We do know that there are supplies of AstraZeneca vaccine should the second dose be AstraZeneca.
The more important point is the answer to the last part of the question, which is that I think the international data is looking quite promising towards the effectiveness and safety of a mixed schedule—an mRNA vaccine, for example, following the AstraZeneca vaccine. I am optimistic that there's in fact an option there. Again, we await the NACI examination of that data as per the timeline Dr. Tunis mentioned.
I just want to acknowledge that it is, of course, anxiety provoking, and that's understandable. For those who received that first dose, that answer will be available within a reasonable timeframe for that second dose.
I think the might be surprised by some of this line of questioning, because on social media he seems to indicate that border measures need to be stronger, but then here at committee Conservative members argue to loosen those border measures that are in place to keep Canadians safe and stop the spread. So, there might be a disconnect within the Conservative Party right now. That's unfortunate.
Mr. Stewart, I want to talk about those questions a little bit—about crossing the border to get vaccinated.
Correct me if I'm wrong, but I'm going to lay out a little bit of a scenario. If a Canadian wants to cross the border to get a vaccine, doing so requires more contacts presumably than, let's say, if they were to book an appointment locally, go to that pharmacy or facility to get vaccinated and then go home, versus crossing the border whether by land or air, where many more contacts would be involved. Then there is the notion that there wouldn't be a quarantine requirement if they were even able to gain entry into the U.S. for vaccination, which the U.S. has indicated is not an essential medical service. Notwithstanding that, if they did cross that border, I don't understand how the argument to remove any quarantine measures makes any sense given the fact that even when I went for my vaccine or when my parents got their initial vaccine, they were told that vaccines are not immediately effective. They don't offer immediate protection. Dr. Tunis even mentioned studies that discuss the length of time for your body to build up antibodies against the virus.
The notion that the second you get this vaccine, you're protected and are not going to put anybody at risk and therefore don't require testing or quarantining.... Do I understand that correctly? Actually, you're at risk because you've now come into contact presumably with more people than if you went to be vaccinated locally, and secondly you're not immediately immune. Therefore, by not quarantining and not testing, you could actually unknowingly be putting even more community spread out there.
Just on the AstraZeneca piece, while we've been in this meeting I think Ontario announced its second-dose strategy, and in fact I've already been getting messages from friends who are excited that they've booked their parents for their second dose of AstraZeneca.
I guess this might be a question for Mr. Stewart or Mr. Matthews in terms of procurement. We don't quite know how many people yet will want to receive their second dose. Frankly, some are not eligible yet, just based on timing and the fact it's ultimately up to the provinces and territories to determine that schedule.
Are we actively monitoring the uptake of a second dose of AstraZeneca and are we working with provinces and territories to make sure that, if there are additional needs, whether it's AstraZeneca or, let's say, a Pfizer vaccine, those Canadians will still have access to a safe second dose? I guess the question is, are we confident and comfortable that this momentum with vaccines coming to Canada is going to continue and that we are still going to meet those targets?
First of all, I just want to note that I'm a one-dose AstraZeneca person thus far, and I'm looking forward to a second dose like many other people are.
In that regard, as I mentioned, we have 655,000 additional doses being distributed in real time that will cover all of the demand for people's timelines for second doses all the way through June. As Bill Matthews can speak to, we have other sources of supply lined up in the event there is a desire by the majority of people to continue with the second dose.
As Dr. Tunis was setting out, however, we're also going to have the option—it's quite likely, but not yet substantiated by way of the data—that people could get a second dose of messenger RNA. Therefore, I think everybody who is waiting for their second dose from a first dose AstraZeneca perspective is well looked after. There is supply, we have it now and we will have in fact further options in addition to what's required over the course of the coming weeks.
I don't know, Bill, if you want to add anything on the supply.
I thank the hon. member for his question.
Actually, as soon as the U.S. border measures were put in place, we had already begun to lay the groundwork for the reopening. We didn't think we would still be in this situation today, but we're projecting the volume of people who are going to come to the border. With Transport Canada and the Public Health Agency of Canada, we're looking at what measures will be needed to streamline the processes in place right now, to reopen the border in a thoughtful and orderly fashion, while also talking to our U.S. counterparts to coordinate the measures in place at both our northern and southern borders. So, operations are continuing.
With respect to your question about the vaccination rate, that will certainly be considered, but that information and guidance will come to us from the Public Health Agency of Canada and the people who are studying the medical science on this.
The COVAX facility recently announced that it has a supply shortage of at least 140 million doses, in part because of the ongoing COVID crisis in India. The WHO, UNICEF and other international agencies have called on G7 countries to donate excess supplies.
We know that the U.S., France and Sweden have announced plans to donate tens of millions of doses in the coming weeks and that Canada has yet to make the announcement. Instead, we continue to draw doses from COVAX.
Does Canada need to draw on supplies from COVAX to offer a second dose of the AstraZeneca vaccine to Canadians who received it as their first shot? Do we intend to donate any AstraZeneca vaccines not needed for second doses to the COVAX facility, and when?
I won't go back to look at the modelling of those criteria for safe lifting, but really, the concept is that as communities, as populations, we need to get the vaccine coverage up. With one dose, that's why we pointed to making sure still that people are vigilant. It's that one dose gives you good protection, but you should get that second dose for maximizing that protection and durability, and in the meantime, you should take all the precautions and follow local public health advice. Don't let your guard down and don't go halfway with your vaccine schedule, which is why this.... It's a prudent, precautionary approach. I think we should have our eye on the puck, as it were, as we skate towards that two-dose for everyone in Canada.
I was just checking the U.S. numbers. As of May 19, the U.S. had vaccinated 60% of Americans with one dose, and 37% have received two doses.
With these self-congratulations and the government patting itself on the back for finally getting first doses up, I'm just wondering if they're winning a race that nobody else is running in. Obviously, with the United States at 37% of full vaccinations, the U.K. at 31% of full vaccinations and even the EU at 16% of full vaccinations versus Canada's 3%, it means that the U.S. has 13 times the number of people fully vaccinated, the U.K. has 10 times the number of people who are fully vaccinated and the EU has five times.
It appears to me that you'd almost think we did this deliberately, that we decided we'd go for one vaccine because it was the best epidemiological approach, instead of the truth, which is that we did it because we had a shortage of vaccines.
I'm just wondering. Considering that the EU, the U.K. and the U.S. have all proceeded with a full vaccination strategy, Dr. Tam, can you tell me if it's not better to have more of our population fully vaccinated than not?
Thank you for the question.
As I said, we should have everybody getting two doses.
I think the stretched interval has been an extremely good strategy. The U.K. has done the same, by the way, and has seen very good results. According to their study—I was just bringing it up from the recesses of my memory—in fact, if you stretch the Pfizer vaccine dose, even for seniors 80 years of age and older, people will have a greater antibody response at 12 weeks, compared with three weeks.
As you said—and I totally agree—it's not a race with other countries. We need to take care of Canada. All Canadians should get that two-dose vaccine, and we will look towards a much more hopeful and optimistic summer and fall.