I call this meeting to order.
Welcome, everyone, to meeting number 42 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.
I would like to welcome the witnesses. From the Canadian Association of Optometrists, we have Monsieur François Couillard, Dr. Michael Nelson and Laurèl Craib-Laurin. From the City of Windsor, we have Mayor Drew Dilkens. From the Region of Peel, we have Dr. Lawrence Loh, medical officer of health, public health, and Dr. Jennifer Loo, acting medical officer of health and chief executive officer, Algoma Public Health. Furthermore, we have Dr. Christopher Mackie, medical officer of health, Middlesex-London Health Unit. We also have, with UNITE HERE Canada, Michelle Travis, research director; Elisa Cardona, hospitality worker, Local 40; and Kiran Dhillon, hospitality worker, Local 40.
With that said, we will invite the witnesses to make a five-minute statement.
I will display a yellow card when your time is nearly up and a red card when your time is over. If you see the red card, you don't have to stop right away, but do try to wrap up quickly.
With that, I will invite the Canadian Association of Optometrists to begin. Go ahead, please, for five minutes.
Thank you very much, Mr. Chair.
Good morning. Thank you to all the members of the House of Commons Standing Committee on Health, in particular Luc Thériault, the member for Montcalm, for the opportunity to present on behalf of the Canadian Association of Optometrists.
My name is Dr. Michael Nelson and I'm the president of the association. I'm also a practising optometrist in Winnipeg, Manitoba, and I'm joined by François Couillard, our CEO, and Laurèl Craib-Laurin, our senior manager of government and stakeholder relations.
The Canadian Association of Optometrists represents over 5,400 optometrists who serve as Canada's primary eye care doctors. Our experience during the COVID-19 pandemic has been to have an increase in patients complaining of a variety of vision problems. Canadians are realizing the importance of their vision and that they should not be taking it for granted. Optometrists are seeing higher rates of eye fatigue, increased incidence of dry eye disease and a growing rate of myopia. Conditions like diabetic retinopathy, which can lead to vision loss, have worsened as some Canadians have chosen to delay their routine eye exams.
The growing myopia rate is especially alarming for optometrists and should raise a flag for government. Last year, the World Health Organization's inaugural world report on vision included some startling findings. Listen to this: The rate of myopia is expected to rise from 28% in 2010 to 50% by 2050. This is very alarming as myopia increases the risk of glaucoma, retinal detachment and vision loss in adults. While heredity plays a large part in myopia, it is further exacerbated by what we have seen through the COVID-19 pandemic with more and more near and close time and not enough outdoor time. This is especially worrisome for children because of the increased screen time for school and recreational activities.
For those living with diabetic retinopathy, a condition that is particularly predominant in indigenous populations, the problems of accessing care during the pandemic have resulted in worsening eye health.
There are some high-level policy issues regarding eye health that deserve the attention of the federal government, as they have major implications not only for the health of Canadians, but also for the economy and productivity of our nation.
A Deloitte Access Economics research paper released last month estimates the total cost of vision loss in Canada was $15.6 billion in 2019. That was before the COVID‑19 pandemic.
The lack of a coordinated primary health care system for eye health was particularly evident during the COVID‑19 pandemic, which significantly reduced the ability of optometrists to provide care to Canadians. Vision problems affect the majority of Canadians, with six out of 10 Canadians reporting having had a vision problem. Every year, nearly one million Canadians miss work or school, or have their performance affected by vision problems.
We would like to encourage the Standing Committee on Health to conduct a study on vision, once this pandemic is over.
For whatever reason, Canada's many health care systems do not recognize that our eyes deserve the same level of care as other parts of the body. There is an urgent need to prioritize eye health and access to appropriate vision care for all populations.
We have the opportunity to make eye health and vision care an integral part of health care delivery from birth. Seventy-five per cent of vision loss can be treated or prevented, which means that early detection and treatment can improve population health and help avoid more costly future interventions and treatments.
Thank you very much for your attention.
Thank you very much, Mr. Chair, and it is windy here from time to time today.
Thank you and members of the committee for the opportunity to appear today and make the case for border communities, not just Windsor but across the country, to gain access to surplus vaccines that have been offered by our neighbours in the United States.
In my community prior to the onset of the pandemic, the border between Windsor and Detroit was much like that between Ottawa and Gatineau, in the shadow of Parliament Hill.
Thousands of health care workers live in my community but cross to work every day in Detroit.
At the onset of the pandemic when Detroit was a hot spot for cases—in fact, among the worst in the United States—Canadian nurses crossed the border each day to support the health care system in southeast Michigan. It's no exaggeration to suggest that without Canadian health care workers, entire hospitals would have closed in Michigan, creating widespread problems. In fact, the United States State Department recognized this invaluable contribution, and the U.S. consul general came to Windsor. He and I handed out thank-you gift cards to doctors, nurses and pharmacists who were crossing at the Windsor-Detroit tunnel and the Ambassador Bridge.
That was April 2020.
When the vaccines began to be delivered, the City of Windsor stepped up to support all aspects of the process. Hundreds of city staff have been redeployed to support different mass vaccination clinics across Windsor. We set up a special call centre to help ensure the process was smooth and efficient.
It hasn't been without challenges, the largest of which relates to the mismatch between supply and demand.
In the beginning we had 12,000 seniors over 80 years old on our wait-list. Some had waited for six weeks for the phone call to book their first appointment.
I actually booked 180 of these appointments myself. When I called one 86-year-old, she broke down crying on the phone with joy. She hadn't left home for six weeks. She wouldn't even take out her recycling without bringing her phone for fear of missing the call that would set her on a path to, once again, hug her grandkids.
The problem is that the fear and uncertainty she felt in the beginning was only exacerbated after she received her first shot, because we told her to go home and wait for up to four months now for someone else to call and book the second appointment.
Members of the committee, we can and we must do better until everyone has been fully vaccinated. Today, multiple medical officials in Detroit and the State of Michigan have offered to provide us with surplus vaccines, many of which would otherwise expire and be thrown away because vaccine uptake is slowing just two kilometres away in Detroit.
Last week it was reported that the State of Michigan saw 35,000 doses hit the landfill, and I submit to this committee that those were doses that could have gone into the arms of Canadians.
I appreciate there are a host of issues that would need to be resolved in order to make this sort of international inoculation effort possible. I'm not here to minimize or trivialize the effort that's required to make this happen, but I am here to advocate for that effort to be sped up, because it would help get Canadians access to their second doses faster than would otherwise be the case.
The federal government's COVID-19 testing and screening expert advisory panel report released on May 28 specifically highlights that Canadians with only one dose are at a significant public health disadvantage. I appreciate that a pathway exists for Canadians to get fully vaccinated based on the supply procured at the national level, which is allocated to the province, but this process will take months to hit all eligible Canadians. Multiple offers for surplus vaccines have been made to Canadians from U.S. counterparts today.
An urgent dialogue is required with all respective parties on both sides of the border to find a way to make this happen.
Throughout this pandemic, governments at every level have found ways to move mountains to safeguard the health and safety of the public. Policy initiatives which would otherwise have taken years get resolved in a matter of days, and I commit to doing everything and anything in my power to create the conditions for success.
Last week the board of the Windsor-Detroit Tunnel Corporation voted to authorize the closure of the international tunnel for the purpose of hosting a vaccination clinic at the border line below the Detroit River. I established an online wait-list for Windsor-Essex residents who are ready to stand in line for U.S. surplus vaccines. As of today we have over 11,500 Canadians on that list.
Creative solutions have been found at the Carway crossing between Alberta and Montana, and I congratulate everyone involved on both sides of the border for the creativity employed to make the right thing happen there. Surplus vaccines from Montana are getting into the arms of waiting Canadians. I'm asking for that same type of creativity and effort to be [Technical difficulty—Editor] so that we can accomplish our shared binational goal to fully vaccinate our residents so that we can reunite families, reignite our economies, get people back to work, get businesses open, and reopen the world's longest undefended border.
But I need help and leadership from our federal government, and I'm here again asking for that today.
Thank you, and I look forward to the questions and discussions this morning.
Good morning. Thank you, members of the committee, for the opportunity to present today.
I will be focusing largely on my experience as a medical officer of health for the Region of Peel. I'm also honoured to be joined today by my colleagues, Dr. Chris Mackie, Middlesex-London Health Unit, and Dr. Jennifer Loo, medical officer of health for Algoma Public Health. They will be able to complement my observations with their own experiences from other areas of Ontario.
Peel Region is one of 34 public health units in Ontario. It serves 1.5 million people in the cities of Brampton and Mississauga and in the Town of Caledon. As many of you on the committee likely know, Peel Region has been one of the regions most impacted by COVID-19 in Canada, due to population factors such as a large proportion of essential workplaces as well as socio-demographic and economic diversity. We are also home to the country's busiest international airport, which has been a source for introduction of variants of concern into our community.
Throughout the pandemic, local public health efforts are supported through ongoing collaboration with federal and provincial partners, our local municipalities and community partners. Some specific examples of the support we have received in Peel from the federal government include $6.5 million in funding from the Public Health Agency of Canada to support voluntary isolation housing for residents who cannot self-isolate at home; $13.1 million in funding received through the reaching home program to make a meaningful impact on supporting some of our most vulnerable residents; and federal support for long-term care outbreak management from the Canadian Armed Forces to protect some of the most vulnerable seniors in our community.
We've greatly appreciated these and other supports we've received. We recognize there are other areas where collaboration can be strengthened.
In the short term, financial support from both the provincial and federal governments have aided our immediate pandemic efforts. In Peel, those efforts have entailed the redeployment of most of our staff, new hiring and suspension of most of our public health programs. We're grateful for this support.
However, looking to the longer term, the federal government could further assist Peel Public Health and public health units in Ontario by allocating public-health-specific funding in provincial transfers, as most health funding is traditionally used for health care provision. In addition, it could enhance the resources and governance of the Public Health Agency of Canada to better support a national response to infectious diseases, which would include the chief public health officer having the autonomy and authority to direct public health measures, including maintenance of international surveillance programs. It could also provide additional resources to address pre-existing, non-COVID public health crises such as the opioid epidemic, as well as those that will arise due to the delayed provision of public health services. We would be happy to expand upon key COVID issues faced by the public health sector during the question and answer session, as needed.
Another area for review would be outbreak management for first nations communities. My colleagues from Middlesex-London and Algoma who are with me on this call today have reported taking on a primary role at the local level in responding to what is a defined federal mandate. This may require supplementary support and resourcing.
The federal government can also support our pandemic response by enhancing travel and border control measures to further decrease the influx of variants of concern or interest from interprovincial and international destinations.
We support federal and provincial measures to restrict non-essential travel. To emphasize our level of concern, Peel regional council recently called for the suspension of all non-essential travel from interprovincial and international destinations to Toronto Pearson International Airport. As the international situation changes, prompt adjustments to travel restrictions should be implemented.
Dr. Loo will also speak to an additional point, regarding Algoma's experience with the land border. Their experience has underlined a desire for local input into any proposed restrictions that have an impact on our communities.
Parallel to this, it is also important to protect those who are vulnerable and impacted by restrictions. In Peel, this includes international students who arrive in Canada. Many of these individuals are targeted with marketing by unscrupulous landlords and are charged very high amounts to share inadequate living spaces during and after isolation. Support from the federal government could assist in providing arriving students with better information about their isolation options.
We also need to ensure that our workforce is protected. In Peel, an analysis of our large essential work sector found that 25% of work place outbreak cases had reported employees going to work even after symptom onset. Without proper sick leave, essential workers are often unable to isolate or stay home when ill or access vaccination in a timely manner. The previous enhancements to the Canada recovery sickness benefit and Ontario's new worker income protection benefit are steps in the right direction. However, further improvements could include minimizing interruption of individuals' income flow with timely release of funding and removing the the requirement to demonstrate a 50% loss of income prior to application. These changes would remove barriers and help to ensure that our workers can follow public health guidance when they're sick.
In Canada, public health is a shared responsibility between all levels of government. Coordination and collaboration are essential. Ensuring flexibility to meet local challenges is equally important. Moving forward support from multiple levels of government with local action is essential as we move out of the response and into recovery.
My colleagues and I are happy to answer any questions you may have.
Hello. I would like to thank the committee for inviting us here today.
My name is Michelle Travis, and I'm the research director for UNITE HERE Local 40, the hospitality workers' union.
COVID-19 has had a devastating impact on the hotel workers who were put out of work by the pandemic. Nowhere is this more true than at the Pacific Gateway Hotel, which was taken over by the federal government under the Quarantine Act last year.
Shortly, you will hear from two workers who have been directly impacted by the takeover and are calling for government action.
The government is spending untold amounts of public money on a hotel that recently fired over 140 long-term workers, mostly women. There is no transparency on the terms of the federal takeover or how long it will last.. We have asked for a copy of the agreement between the government and the hotel, but the hotel says there is no contract.
Hard-hit workers deserve to know why the government repeatedly extends its time at, and subsidizes, a hotel that takes advantage of the pandemic to fire much of its staff. Workers should be allowed to return to their jobs as travel restrictions ease. Every day the government subsidizes this hotel more workers risk losing their jobs.
We are urging the government to state its end date at Pacific Gateway, share a copy of their agreement and to please move to another site.
Now I would like for you to hear from Elisa and Kiran.
Good morning. Thank you so much for your time.
My name is Elisa Cardona, and I worked full time for seven years as a hostess and server at the Pacific Gateway Hotel near Vancouver Airport.
When the government took over the hotel, they brought in the Red Cross. Some of us were displaced from restaurants, kitchen and housekeeping jobs.
The government has repeatedly extended its takeover of our hotel. We were told they would be out last May, then August, then November, then it got extended to March 30, 2020, and now it's been extended to the end of the summer of this year.
The hotel has used a federal takeover as an excuse to terminate me and 142 of my co-workers. That's over 70% of our staff.
Many of us were fired in the last two months and are women. I'm a single mom raising two children ages 12 and 14, and I have been worrying about my finances and money this past year. It has been incredibly stressful for me and my family. I expected to go back to my job when it was time.
We asked the hotel to allow us to return to our jobs after COVID-19 had passed and when the work becomes available again. They have refused the whole time.
The federal government is subsidizing a hotel using a temporary pandemic to fire and replace us for less. These have been good, family-supporting jobs. Why is the government allowing this to happen?
promised us a feminist recovery, yet women are bearing the brunt of firings at Pacific Gateway on the government's watch. A human rights complaint has been filed against the hotel for sex and racial discrimination against women because their jobs have been disproportionately impacted.
How much has the government spent on this hotel while women like me are treated like we're disposable? After the latest round of mass hirings, we went on strike and remain on the picket line. What's happening at our hotel is not acceptable. The government can and should act. That's why we're asking the government to stop subsidizing the Pacific Gateway Hotel.
Good morning, everyone.
My name is Kiran Dhillon. I worked as a room attendant cleaning hotel rooms at Pacific Gateway for 17 years until the pandemic hit.
I raised my children on this job. When the government took over our hotel as a quarantine site, they brought in the Red Cross. Other people were trained to do our jobs.
I was terminated last month along with many of my co-workers. The hotel fired 90% of housekeeping staff. Most of us are women who have been working there for decades. Women at Pacific Gateway are taking the brunt of job losses while the men's jobs are more likely to be protected.
We filed a human rights complaint on the basis of sex and racial discrimination because of how we have been treated. The hotel terminated 74% of its female staff. More of my co-workers could lose their jobs this summer if the government continues to use our hotel.
My co-workers and I want to know when will the government stop using Pacific Gateway and how will the government help women like me return to our jobs so that we aren't treated like we are second class.
People want to travel again. There's no reason why we should lose our jobs during a temporary pandemic.
Thank you so much.
I'll be directing my questions to Mayor Dilkens.
Before I do, I just want to say to Ms. Cardona and Ms. Dhillon that your testimony was shocking and should wake every member of this committee up. I can't believe you had to go through that. I reiterate calls for the government to scrap the non-scientific and discriminatory hotel quarantine program.
I am so sorry you have had to go through that. I'm in shock. It's ridiculous.
Mayor Dilkens, it's my understanding that prior to this meeting—about three minutes before the meeting—you got some correspondence from PHAC that said that if a U.S. pharmacist reached her hand across the border line to give a Canadian a dose that would otherwise go in the garbage, it would be considered importing the drug for sale and would need Health Canada approval. Is this correct?
Thank you to all of the witnesses who are joining us today.
I'll be directing my questions to Dr. Loh, but I would first like to thank him and his team for all of the hard work they have done in our community during this pandemic.
Dr. Loh, the new delta variant has been found in our community. On June 2 you said that we need to move quickly with second doses in Peel and other hot-spot zones for maximum protection. I agree with you on this need for prioritization.
Have you heard any feedback from the provincial government on prioritizing hot spots for the second dose?
Thank you for your question, Mr. Trudel.
I would like to start by saying that there is very little research done in optometry, in Canada. Between 0.5% and 1% of the overall research budgets in Canada are devoted to vision care.
When you look at the work that is being done in the Canadian Institutes of Health Research, or CIHR, there is no entity within these institutes dedicated to vision care. By comparison, the National Institutes of Health in the United States includes an institute specifically dedicated to vision care, but there is nothing like that in Canada.
Much of the research is done by and funded by the provinces. The Quebec government, among others, devotes a lot of funds to it. Private Quebec foundations also do research.
There is some basic research and research into advanced therapies for certain health problems that can lead to vision loss. Clinical trials are also being conducted on new drugs that may help slow the progression of vision loss.
The pandemic has shown that all of us—kids, adults and everyone—are using our screens much, much more and has highlighted the importance of vision to us. We're having more people coming in with symptoms related to screen use. That's highlighted to us that our vision is important, and Canadians are feeling that this is a valuable area for the federal government to have some leadership on.
If we talk specifically about kids—I talked about myopia—we know there are some studies that are linking increased screen use and screen time with increased myopia or nearsightedness, which can result in vision problems down the road and an increased risk of eye disease and pathology later on.
What this pandemic has been reminding Canadians is not to take their vision for granted. Our vision is important, and we need the federal government to take leadership on this.
As far as I know, there has never been any such campaign. Anything to do with vision care has really been neglected in the past, if you compare it to dental care, or mental health care, now. For a very long time, mental health was a taboo subject, but now there are a lot of campaigns about it.
We envisage a campaign a bit like the one done in the past to stop smoking. We really need to educate the public and make them aware that some things are good for the eyes and others are not. You need to make frequent appointments with eye specialists to make sure that you are following up on your visual health and to be able to detect problems early on so that they don't become much more serious problems that can cause blindness.
There hasn't been a campaign like this in the past, and that's why we and many of our partners nationwide are trying to develop one.
I have one more question before I turn it over to Mr. Masse.
The federal government is using a hotel behind picket lines, operated by an employer who has fired and locked out hundreds of workers—mostly women. They are sending tax dollars—your tax dollars—to that very hotel right now, behind picket lines, a hotel that is operated by an employer who is facing a human rights complaint for sex and race discrimination.
Can you tell us, UNITE HERE members, what advice you would give this federal government in those circumstances?
Thank you for the question.
Being on the international border, we are very unique here in that we own our half of the Windsor-Detroit tunnel. The City of Detroit owns their half. It's really the only case like this between the United States and Canada. With the approval of the board, which we got—unanimous approval—we have the ability, as the board said, to close the tunnel down as often as we need for as long as we need to be able to facilitate vaccination at the centre line.
We actually drew the line in the tunnel. The idea here is that on the U.S. side, we have multiple offers from folks who live in Canada, from Canadians, to facilitate and to secure the vaccines. We're trying to find a way to do this that is maybe not the easiest. There are better solutions that are more optimal, but we're trying to find a practical way to deal with all of the logistics on both sides of the border. We can close the tunnel, bring people down and vaccinate them right at the border line. Then they'd be fully vaccinated Canadians.
You know what? Guess what? It would be better for everyone else in Canada who is waiting for a vaccine. We've acquired other vaccines from other sources, and everyone else would move up on the list faster.
Mayor Dilkens, thank you for coming.
As an Ontario MP, I understand the frustration of the Ontario government with some of the vaccine rollout plans. I'm sure you've expressed that, including some of the four-month timelines, because other provinces had moved sooner to change that, but we're happy to see Ontario starting to put that pathway out for second doses.
I'm sure you've been having some fiery conversations with Premier Ford on that.
With regard to some of the conversations around these doses, while I certainly appreciate and agree that no doses should ever be wasted, the crux of this is that these doses don't belong to Canada. They belong to the U.S. and the U.S. people, and the taxpayers who paid for them.
Although we want to make sure that Canadians can access doses, we would need the State of Michigan, the U.S. government and, frankly, even Premier Ford to support this, which is what we were able to do in Manitoba and North Dakota. All of those levels of government came to the table, so it wasn't about creativity; it was really precise planning.
Do you have the support of the State of Michigan, the U.S. government and Premier Ford for the import of these vaccines like we had in other provinces?
That's a great question.
Premier Ford has been very supportive of this creative effort to get additional vaccines, which were destined for the landfill, into the arms of patiently waiting Canadians.
I would suggest that if it weren't for active efforts by this federal government to make this almost impossible, this would have already happened, as you see happening in other jurisdictions between the United States and Canada.
That is the most difficult part for me to accept. We are telling everyone that it's a race between the vaccine and the variant—
That is a very good question.
I must stress that this report contains a lot of expert information. It was prepared by experts who work for a subsidiary of Deloitte in Australia. It's very accurate, timely data.
At the Canadian Association of Optometrists, we prefer to quote the $15.6‑billion figure, because these are very tangible costs. These are health and productivity costs.
The $30‑million figure is for quality of life losses. It is not really about a tangible loss of productivity, nor costs. Those who prepared the report have a methodology for quantifying the loss of quality of life.
The Canadian Association of Optometrists prefers to refer to the $15.6‑billion figure. This is what we mentioned in our comments.
I call this meeting back to order.
We are resuming meeting number 42 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation for Canadians in light of the COVID-19 pandemic.
I'd like to welcome the witnesses. From the Department of Health, we have 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; from the Public Health Agency of Canada, Mr. Iain Stewart, president, Dr. Theresa Tam, chief public health officer, and Brigadier-General Krista Brodie, vice-president, logistics and operations. From the Department of Public Safety and Emergency Preparedness, we have Mr. Rob Stewart, deputy minister.
With that, thank you to all for being here. We appreciate your time.
We will go straight to questions, starting with Mr. Barlow for six minutes.
Thank you to our witnesses for joining us again today. I know that, over the past few months, some of you have made yourselves available a number of times to answer questions, and I know it's a very busy time for you. I want you to know that the extra effort to meet with us is greatly appreciated.
I want to ask Deputy Minister Matthews a few questions on accountability to taxpayers, specifically on the subject of mobile health units.
There are some that have gone looking for conspiracy and cronyism where there is none, and I will ask you to clarify this for us with a few details.
What were the pandemic circumstances at the time that MHUs were identified as a possible necessity? Why was this anticipatory investment made?
This was done at a time when you were seeing things like emergency rooms overrun, with lack of space being an issue. You saw the cruise ship in New York Harbor, and we did notice that other countries were taking steps to put in place plans for mobile hospital units or health units.
I think the important point here is just how long these things take to design and implement. The design is one piece, but acquiring all the equipment that goes with it is another. You can't just purchase these off the shelf.
What was done at that time was that contracts were put in place for two different designs, one with Weatherhaven that goes inside an existing structure—and that's the one that has been deployed in Ontario—and another model with SNC-Lavalin and partners that is designed.... Sorry, the Weatherhaven one is a stand-alone one; it's not inside a building. The SNC-Lavalin and partners' one goes inside an existing building like an arena or something like that.
We worked to line those contracts up. Then we worked with health officials to design them and get going with procuring the equipment that would be necessary should these need to be deployed. As you know, we have requests from Ontario, and some units have actually been deployed.
My question will be directed to Mr. Lucas from Health Canada, and possibly Mr. Matthews at some point.
On May 3, 2021, the department approved interim order number 2 regarding the importation and sale of medical devices for use with COVID‑19. This order replaces the first interim order signed on May 23, 2020; it maintains the optional authorization pathway established to facilitate clinical trials of potential COVID‑19 drugs and medical devices. It does so by providing regulatory flexibility so that other types of clinical trials can be conducted effectively. The Health Canada page even takes pains to point out that interim order 2 continues to make Canada an attractive place to conduct clinical trials, which will improve Canadians' access to potential treatment options for COVID‑19.
Could you explain this regulatory flexibility to me?
Dr. Tunis, many Canadians have received their first dose of AstraZeneca. Many of them are now coming up for their second dose. Most provinces, if not all of them—I'm not sure—are not using the drug due to VITT concerns and supply issues. Of course, the mixing data, using AstraZeneca with messenger RNA vaccines, is apparently not conclusive to this day.
What is NACI's recommendation to Canadians who received their first dose of AstraZeneca on what they should be taking for their second dose? Should it be AstraZeneca or should it be a messenger RNA vaccine? What data is that answer based on, please?
NACI published new advice, as of last week, on the topic of mixing vaccine schedules. NACI has now recommended that either AstraZeneca COVID-19 vaccine or an mRNA COVID-19 vaccine product may be offered for the subsequent dose in a vaccine series started with AstraZeneca. Either may be offered.
The evidence that was used by the committee to issue that recommendation included both safety evidence and evidence on the immune response. There were several studies at the time, one from the United Kingdom, one from Germany and one from Spain. All of them reported a good safety profile when vaccines were mixed between AstraZeneca and mRNA vaccines. There was also one study on the immune response from Spain. I'll note that a number of studies came out preprinted last week as well, two from Germany, on the topic of immune responses when vaccines are mixed.
The committee has made that recommendation based on the risk of VITT, or thrombosis with thrombocytopenia, after first and second doses of AstraZeneca. They also considered the possibility of increased short-term reactogenicity with a mixed schedule and emerging data on the immune response from that mixed schedule that I mentioned. That was all—
That is an excellent point. I would say that with many data elements in this pandemic and the vaccine responses, that does continue to shift. Yes, on the risk of VITT following AstraZeneca vaccine, we have seen that change over time. It does continue to change. That informed consent process would ideally include a discussion about what is known and also the fact that it has been changing over time. NACI has acknowledged that in their advice to the government, namely, that informed consent should include discussion of that, which does change.
On the topic of the mixed schedules, those are being implemented in a number of countries around the world. The evidence is emerging and will continue to emerge over months as more studies come out exploring that topic, but a number of studies were reviewed by NACI when making this advice, and they continue to emerge.
Again, on the topic of mixed schedules, NACI felt very comfortable recommending, as many other countries have now done, that mRNA vaccines can be used to complete that series. Yes, they acknowledge that the evidence does continue to change and to evolve. We may learn more about whether a mixed schedule does in fact generate a stronger immune response. Those things continue to emerge.
First of all, I want to thank you for bringing the matter to my attention, honourable member. As you know, obviously we're very distressed at the situation that we've created for him. Second, we have in fact, in response, set up a change in procedure. Somebody in a similar circumstance now will be offered the opportunity to test locally, instead of continuing to wait in a situation of the nature you described.
Thank you, again, for bringing that to our attention.
Thank you, Mr. Chair. Hello to my colleagues; and again, thank you to the witnesses for being here.
My first question will be directed towards Dr. Tam.
Last week, Nova Scotia premier Iain Rankin and the chief medical health officer, Dr. Strang, announced that, beginning tomorrow, rotational workers with no symptoms, who have been fully vaccinated at least two weeks before arriving in Nova Scotia, will no longer need to self-isolate. The catch is that they must get tested on day 1 or day 2, again on day 5 or 6, and again on day 12, 13 or 14.
My understanding is that those who have one dose and are not coming from an exposure hot spot are required to self-isolate for 7 days after they have proof of two negative test results.
As we start looking at ways to safely reopen our national borders, what would you expect it could look like and what are your concerns around reopening, if any?
Last week, NACI advised that Canadians are able to move forward in terms of mixing and matching doses and that all vaccines approved by Health Canada are safe and effective.
I believe in one of our earlier committee meetings with the folks from PHAC we learned that there were several international studies that were informing NACI's decision. We have Dr. Tunis here, as well as some folks from PHAC, so I'll open this question to you folks.
Can you tell the committee what the new recommendations say, and what are the main takeways from those international studies?
I'll start with this. Last week, NACI recommended that either the AstraZeneca/Covishield COVID-19 vaccine or an mRNA vaccine may be offered for the subsequent dose in a series started with the AstraZeneca/Covishield COVID-19 vaccine and that the previous dose should be counted and the series need not be restarted.
NACI made this recommendation at the time, informed by several studies from the international landscape, one from Spain, one from the United Kingdom and one from Germany, all of which showed that when you provide an mRNA vaccine after an AstraZeneca vaccine, it is safe. There were actually multiple intervals studied—four weeks and also eight to twelve weeks. At any of those intervals studied, overall the mixed schedule was found to be safe.
They looked at immune response data from that study from Spain as well, which showed that you do, in fact, boost the immune response when the mRNA vaccine is provided after the AstraZeneca vaccine.
Since that time, there have been several studies that have also come out from Germany, looking at the immune response, that replicate that finding as well, that you get a good, strong boost to the immune response when you follow AstraZeneca vaccine with Pfizer.
That was underpinning NACI's recommendations. They had seen studies from multiple countries looking at multiple schedules, looking at safety and now also the immune response, that have demonstrated that this is a strategy that can be used. Provinces and territories are now looking at this and how they integrate that into their second dose approaches across the country.
Just quickly, because I don't have much time, the mayor of Windsor talking about getting doses from the U.S. I'm not sure who's been engaged in these conversations, so feel free to jump in if you have. I do recall the conversations about truck drivers, for example, in Manitoba and North Dakota, and that a significant amount of work was done with the premier, the governor and local authorities to make this process happen.
It's my understanding that the U.S. federal government has determined that travel for vaccination is not essential. The Governor of Michigan has not actually offered these doses to Canada. Perhaps it's some pharmacies that may have extra doses and surely don't want them wasted, and I understand that. Ultimately, these doses are owned and paid for by American taxpayers, so unless they are willing to give them to us, whether we say we want them or not, the owners of these doses must actually indicate they are providing them to us. Is that a fair and accurate summary of where the issue is?
It's not the fact that the Canadian government doesn't want to access doses. In fact, we're working with the U.S. federal government every single day to get surplus doses, but that the local government authorities have not authorized Canada to have these particular doses.
Thank you to all of the members for all of the good questions. We are short of time.
Thank you to the witnesses once again for appearing before us. I know you're all frequent flyers and it's good to see you all. Thank you for the work you do on an ongoing basis to keep us all safe and secure.
I would like also to thank the interpreters. I know there's a lot of sickness in the ranks. I really do appreciate it. I apologize that we've gone over the time, but thank you for all for your ongoing work—as well as that of all of the House staff.
With that, we are now adjourned.