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View John McKay Profile
Lib. (ON)
I call the meeting to order.
It's 3:30, colleagues, and it's nice to see you. It's not so nice to see you in these circumstances, but nevertheless we will soldier on.
This is the sixth meeting of the public safety committee, and little did any of us think, coming from the fifth to the sixth meeting, that we would be at the intersection of two of the most significant crises of our time, namely systemic racism and the realities of COVID.
It's regrettable that we have to meet this way, in that we are physically present. Ideally, we would have been other than physically present, but it is what it is.
First of all, I will read this protocol so that we all understand what it is. I'll summarize the four points.
We've been asked to limit our movement in the room and to wear a mask unless seated. Obviously, people can follow the markings on the floor. Microphones and seats, as I can see, have been distanced from each other. I see my friend Greg Fergus way down there; at least, I think that's Greg Fergus.
We have a limited number of personnel in the room, one for each party, and I'll think you're familiar with all of the other protocols that we're exercising.
We are looking at three motions this morning. I think the first is up on the screen.
This, as you well know, has been called as an emergency meeting. It is moved:
That pursuant to Standing Order 108(2) the committee undertake a study of systemic racism in policing in Canada; and that the Minister of Public Safety and Emergency Preparedness as well as the Commissioner of the Royal Canadian Mounted Police be invited to testify on Tuesday June 23, 2020.
The motion is in English and in French.
Do I have a motion to accept the meeting?
(Motion agreed to)
The Chair: The second item is the budget, is it not?
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View Pam Damoff Profile
Lib. (ON)
This is a new system, John. There is way less paper. This is a good thing.
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View John McKay Profile
Lib. (ON)
Yes.
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View Pam Damoff Profile
Lib. (ON)
This is a good thing, Jean-Marie. We're not killing a forest to have a meeting.
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View John McKay Profile
Lib. (ON)
Jean-Marie has done an amazing job in the past week. We are very fortunate as a committee to have Jean-Marie here, and if you had any inkling of all the toing and froing to get to where we are today.... I just want to publicly thank Jean-Marie for his work. I'll thank him more enthusiastically if he can find this thing, this budget.
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Jean-Marie David
View Jean-Marie David Profile
Jean-Marie David
2020-06-23 15:35
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I can find it; I just can't move it.
I'm sorry, Mr. Chair, but I can't display it. If you want, I can give the details to the members.
The budget is in the amount of $3,300. It's a very small budget, but it's enough to get us going for this first meeting at least.
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View John McKay Profile
Lib. (ON)
That's fine.
Go ahead, Madam Damoff.
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View Pam Damoff Profile
Lib. (ON)
I'm going to bring a motion forward to add some meetings to what we're doing. Will that impact your budget, or will we just look at another budget if that motion passes?
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Jean-Marie David
View Jean-Marie David Profile
Jean-Marie David
2020-06-23 15:35
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Well, usually when we adopt budgets, we don't spend most of it anyway. I would say that we'll just keep this budget for now, and if there is not enough money, then I can always bring a new budget for additional funds to the committee for adoption.
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View John McKay Profile
Lib. (ON)
Is there any other discussion?
(Motion agreed to [See Minutes of Proceedings])
The Chair: The third motion—and it's entirely at the discretion of committee members—is that the meeting be on television and be in public, but the subject matter I'm proposing to discuss at this point is further meetings and witnesses. I'd be interested in knowing whether members wish to go in camera at this point.
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View Pam Damoff Profile
Lib. (ON)
I would suggest that we go in camera, Chair. Normally when we're discussing meetings and witnesses, it is done in camera. Then we can come back to a public meeting once we've had that discussion.
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View John McKay Profile
Lib. (ON)
Okay.
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View Pam Damoff Profile
Lib. (ON)
I can move it if you would like.
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View John McKay Profile
Lib. (ON)
Sure.
Do you have a point of discussion, Charlie?
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View Charlie Angus Profile
NDP (ON)
View Charlie Angus Profile
2020-06-23 15:36
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Yes. I don't see this as being controversial. My feeling about staying in public is to reassure the public we are taking these issues very seriously and that we are recognizing the concerns that are being raised, particularly in indigenous and racialized communities, and that we're here to talk, as parliamentarians, to find the best in who should be there.
I'd prefer to stay in public, but this is my first time at your committee, Chair.
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View John McKay Profile
Lib. (ON)
The only point of going in camera was that there would be a witness list, and some will be in favour of this and some will be in favour of that. It's probably better as a private discussion than a public discussion, but I am in the hands of the committee.
Is there any other discussion? We'll be going in camera right now, and then we'll go back in public when the witnesses are called.
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View Pierre Paul-Hus Profile
CPC (QC)
View John McKay Profile
Lib. (ON)
You wish? Does that mean you're in favour of the motion?
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View Pierre Paul-Hus Profile
CPC (QC)
I want maximum transparency.
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View John McKay Profile
Lib. (ON)
Oh, yes. We're all in favour of maximum transparency, but there are times we want to talk among ourselves as colleagues.
I see five on this side...six. The motion is passed.
(Motion agreed to [See Minutes of Proceedings])
The Chair: Thank you, colleagues.
We are going to go in camera at this point.
[Proceedings continue in camera]
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View Ron McKinnon Profile
Lib. (BC)
I call this meeting to order.
Welcome, everyone, to meeting number 30 of the House of Commons Standing Committee on Health.
Pursuant to the order of reference of May 26, 2020, the committee is resuming its briefing on the Canadian response to the outbreak of the coronavirus.
To ensure an orderly meeting, I would like to outline a few rules as follow.
Interpretation in this video conference will work very much like in a regular committee meeting. You have the choice at the bottom of your screen of either floor, English, or French. As you are speaking, if you plan to alternate from one language to the other, you will also need to switch the interpretation channel, so that it aligns with the language you are speaking. You may want to allow for a short pause when switching languages.
Before speaking, please wait until you are recognized by name, and during questioning the questioner will signal to whom the question is addressed. When you are ready to speak, you can click on the microphone icon to activate your mike.
As a reminder, all comments by members and witnesses should be addressed through the chair. When you are not speaking, your mike should be on mute.
I would now like to welcome our first panel of witnesses. As an individual, we have Professor Lawrence Gostin, O'Neill professor of global health law, Georgetown University, and director of the WHO Collaborating Center on National and Global Health Law; and from the Centre for Global Development, we have Jeremy Konyndyk, senior policy fellow.
We will begin with Mr. Gostin for 10 minutes.
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:03
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Mr. Chair, thank you. I'm very much honoured to be with you.
My charge today is to discuss the international dimensions and governance dimensions, particularly the role of the World Health Organization and the performance of the international health regulations.
I've worked with the World Health Organization now for over 30 years. I'm also on the director general's roster of experts for the international health regulations committees.
I've been closely involved in many epidemics and pandemics, ranging from AIDS, to SARS, MERS, Ebola and, of course, now the COVID-19 pandemic, so I'm going to give you the benefit of my many years of experience.
I consider myself a very close friend of the World Health Organization, but I'm also willing to be a friend, and state honestly when I think it could have done better, or should do better. What you'll get from me is a non-political, factual account of how I think the World Health Organization has performed, and how it can do better. I ask members to not take that as a political statement, because there's been so much politicization of the World Health Organization, particularly by my country, the United States, but also China.
Essentially, there have been several criticisms of the World Health Organization during this pandemic. The first is that it didn't report quickly enough to the outbreak of a novel coronavirus infection in Wuhan, in the Hubei province of China. The second is that it did not inform others quickly enough that there was rapid community spread in that province. The third is that early on in the pandemic it recommended against travel and trade restrictions.
Early on in the pandemic, China was reporting to the World Health Organization that there was very limited or no human-to-human transmission of this novel coronavirus. At that time, the World Health Organization reported the same data and conclusions it had received from China. In retrospect, should the WHO have done anything differently? At most, it could have said, “Here is the data we're getting from China, but we're not able to independently verify it.”
Dr. Tedros, the director general, made the decision—and I respect and admire it—to push China quietly and diplomatically from the inside, but not to criticize China publicly. It should be very clear that under international law and the constitution of the World Health Organization and international health regulations, the WHO had no power to require China to report truthfully. It had no power to go onto Chinese soil without China's permission. Therefore, it's entirely unfair to criticize the World Health Organization for doing something that the world did not give it the power to do.
Going forward, I have a number of proposals, and many of my colleagues do, including those working in public and global health law in Canada, that could improve the situation remarkably and give the WHO the power and authority it needs the next time this kind of horrific event occurs.
The same is true with regard to community spread. There was no way for the WHO to independently verify China's report regarding that.
Then there was the question of travel. It certainly has turned out, for better or worse—and we can discuss that—that the world has now essentially closed its borders due to COVID-19. However, early on the WHO recommended against travel restrictions, even though many countries had already imposed them. After the SARS epidemic, when Canada was instrumental in the reform of the international health regulations, there was a balance between public health, trade and travel, and human rights. Canada was justly concerned that countries were too quick to have trade and travel restrictions during SARS. The same thing happened during the west African Ebola epidemic.
Many epidemics have triggered harmful and unnecessary travel and trade restrictions. In this case, it may very well be that travel restrictions were warranted, but at the time, the WHO was following the international health regulations in the way they were meant to be followed.
I might have done some things differently, but I cannot believe that in the middle of a pandemic it would be right to be casting blame and have finger pointing between countries that would harm the international rule of law and harm international institutions that are so vital to us, such as the World Health Organization.
The WHO is not perfect, but we as a collective community can make it better, and the reason I'm so pleased to be here in front of the Standing Committee on Health in the House of Commons is that I so admire Canadian leadership around the world. You have been a shining light, and I have a close connection in heart to you. My son was born at McMaster University and is a citizen of Canada, and I have very close connections with my colleagues in Canada.
In trying to forge unity in the world in the midst of this chaos, in the midst of conspiracy theories about the origins of the virus and all the blaming among the superpowers, we need to come together. We need to come together now even more than ever, because we're facing the most consequential set of actions in our lifetime, the race to find a COVID vaccine.
As a global community, we need to ensure that the vaccine is safe. Therefore, we don't cut corners and don't skip ethics. We also need to ensure that it's equitably and fairly distributed to all countries around the world, and that we do not see what we've seen in the case of personal protective equipment, testing kits and ventilators, which were a prize for intellectual property competition. I regard vaccines and therapeutics for COVID-19 as a global public good, and I look to Canada for your global leadership.
I find it a great honour to be in front of you and I will be very delighted to answer any of your questions.
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View Ron McKinnon Profile
Lib. (BC)
Thank you, Dr. Gostin.
We go now to Dr. Konyndyk. Please go ahead for 10 minutes.
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Jeremy Konyndyk
View Jeremy Konyndyk Profile
Jeremy Konyndyk
2020-06-23 11:13
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Thank you so much.
Just echoing what Larry said, it's a real pleasure and a privilege to be speaking with you all today. I also have ties to Canada. My mother grew up in Hamilton and I still have a lot of family there in Ontario, so it's really nice to be speaking to all of you.
I have a few quick words on my background and how I come at these issues.
I come from a disaster response and humanitarian background and have worked on many health crises over the years. Most significantly, I was the head of international disaster response for the U.S. government during the Ebola outbreak in 2014 and 2015 and played a key role in leading the U.S. government's response to that outbreak.
As part of that, I became involved with WHO emergency reform and advised the then director general, Margaret Chan, on the post-Ebola reforms that were implemented. Along with Dr. Theresa Tam of Canada, I have served for the last four years on the independent oversight body that is overseeing and advising member states on the WHO's implementation of those reforms. I had a front-row seat both for the WHO's Ebola failures and shortcomings in 2014 and for their handling of this outbreak, this pandemic, and many of their other crises in-between.
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Jeremy Konyndyk
View Jeremy Konyndyk Profile
Jeremy Konyndyk
2020-06-23 11:14
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To be clear, I'm speaking today in a personal capacity. I'm not speaking on behalf of the oversight committee or on behalf of WHO unless I otherwise say very explicitly.
I've been asked to speak about a few things: some of the emerging lessons from COVID-19 around the world, particularly in the developing world; WHO's effectiveness; and the support that is needed in the developing world going forward.
I would like to make first just a few observations of what, I think, we're seeing from around the world. We're seeing in many countries now that social distancing measures have worked, but they are hard to sustain. Particularly, the more drastic social distancing measures are very difficult to sustain economically, politically and socially. We're moving from a phase, I think, in which governments were largely imposing distancing measures to a phase in which we need communities and populations to voluntarily adopt distancing measures, whether governments are imposing those or not.
What we do see is that anywhere that people have let their guard down, the virus takes advantage of that. We're seeing that in real time right now in the United States. Some of the states that had not been badly affected early on dodged a bullet, concluded that they were bulletproof and began relaxing measures. Now we're seeing enormous spikes in Florida, Texas, Arizona and some of the other southern states. We're also seeing this in some of the areas of southern California where they relaxed measures too early.
I don't think we're at a point where we can go back to governments just imposing measures from the top down. They need to be adopted and owned by the population. That then becomes a matter not of governments imposing measures, but of governments communicating effectively with their people, and of public health authorities communicating effectively with their people. I think the countries that have done the best with clear communication and with building trust with their populations are the countries that have done the best and will do the best. The countries that have seen the most confusion, the most mistrust, are the countries that will do the worst.
The worst-performing countries in the world right now are the United States and Brazil, and in both of those countries, there has been horrible communication between the government and the public, a lot of confusion and a lot of mistrust.
The countries that have done the best job of communicating clearly—and I think Canada, from my observations, has done a better job of it—will do better and have done better. I will return to that point in a moment when I talk about the developing world in a bit more detail.
In terms of the WHO's effectiveness, I agree entirely with everything Larry said. Having closely observed the calamitous performance of the WHO in the early phases of the 2014 Ebola response in West Africa, I will say there's just a night and day difference between that and what they're doing now. At that time, it did not have a robust emergency capacity. Its leadership did not take the threat seriously from the beginning, and its country offices were disengaged and inattentive. There were problems at every level of the organization.
I think what we're seeing here is a very different thing. From the beginning, the organization was fully engaged. Within days of getting the formal confirmation from China of the outbreak, WHO was putting out technical guidance to all member states, at that time based largely on diseases like SARS and influenza—parallel diseases that we had seen before—because there was not much data to go on about the virus itself in those early days. That is not uncommon with a novel virus. There is always an inherent amount of uncertainty in the early phase of the emergence of a novel virus.
As Larry laid out already, there were some real challenges with China's initial reporting. I think WHO's handling of that was problematic not in terms of WHO's performance, but problematic in terms of what WHO was actually authorized to do.
The international health regulations tie the WHO's hands very tightly as to what it can say above and beyond what member states report to it. I think WHO's reporting in those early phases was.... If you read between the lines a bit, it was definitely hedging because it knew that what it was getting from China might not be the full picture.
As that picture fleshed out, within about three weeks from the confirmation from China, the WHO's country office in China was authorized to do a mission to Wuhan and and an on-the-ground investigation. Immediately after that, which was on January 20 and 21, the WHO came out and confirmed human-to-human transmission. Within another day or two, it convened the emergency committee to review whether to declare it a public health emergency of international concern.
At that time, the WHO confirmed a basic picture of the virus that still holds up pretty well today: It is a novel respiratory coronavirus that is transmitting efficiently from human to human; it has a reproduction number, or a transmissibility factor, that is higher than the seasonal flu; and it has a severity and death rate that are absolutely multiples higher than the seasonal flu. This initial picture of the virus is an extraordinarily scary picture.
Within another week of that meeting, the WHO took the step of declaring a public health emergency of international concern, which is the highest level of alert that member states have created for the WHO under the international health regulations. At that point, the WHO rung the loudest alarm bell it had available to it and provided a picture of the virus that holds up pretty well today.
This should have been very alarming, but what we saw was a huge amount of variance in how states reacted to that. Some countries, particularly the East Asian countries that had prior experience with SARS, took it extraordinarily seriously and began immediately implementing very drastic measures. South Korea, Taiwan, Hong Kong, Japan, Thailand and Vietnam all clamped down very quickly and began scaling up their testing, implementing distancing measures and so on. Western Europe and most of the Americas did not. You had different countries looking at the same information from the WHO and doing very different things.
I think that is more reflective of those countries than it's reflective of the WHO, but I think it also reflects something else. In a report that the committee I serve on published last month, we highlighted a few emerging takeaways from that period. One is that it's important to distinguish between where the failures were and where the weaknesses were. What were the things that the WHO, as a secretariat and institution, did poorly? There are some, but I think broadly they handled it well. What failings were due to countries' reactions to the information the WHO was providing? I think many countries were far too cavalier in assuming that this would be a problem in China and would not affect them. What problems rest within the international health regulations? For which problems was the WHO's ability to do more or ability to be louder and more forthright limited or inhibited by the restrictions member states have created within the international health regulations? I can go into more detail on that, but I agree with some of Larry's points on this from earlier.
In the committee report, we also noted that the public health emergency of international concern, this alarm bell that the WHO can bring, is far too blunt a tool. It is a binary, on or off. It does not have any gradations within it. It is declared for something like this, a world-threatening pandemic that could potentially kill millions of people. It's also declared for something like the Ebola outbreak that has been going on in eastern Congo for the past two years, which has killed 2,000 people and has not really gone beyond that subregion of Africa.
There's a huge range of health crises that are included in that kind of a tool. We need more gradations so that countries can read those signals a bit more clearly to know what the level of threat is to them when a declaration of emergency is made.
We also found that the post-Ebola reforms have been effective, even though they were premised on a different sort of crisis. They were premised on the Ebola crisis in 2014 and the range of humanitarian emergencies that the WHO normally contends with, and something on this scale has hugely strained the bandwidth and capacity of the WHO. The WHO has not always done as good a job with managing some of the capacity trade-offs there as we would like to see, particularly when it comes to keeping an updated set of technical guidance and recommendations for countries. That's the last point I want to make there.
To pivot to the question of lower- and middle-income counties, I think the WHO and institutions like the CDC in the U.S. have been too slow to adapt the strategy and guidance that has been developed largely for rich countries to lower-income settings. One of the interesting characteristics of how this outbreak has played out is that it predominantly affected wealthy countries at first. China is a wealthy country with a very developed health system. Then it hit Italy and hit Spain and then the United States. All of these countries have a high capacity for clinical treatment, have a lot of resources to scale up testing and have a lot of resources to sustain large-scale social distancing and lockdown measures.
Few of those things are true in the developing world. The WHO, along with the rest of the UN system, did put out very good guidance on this in mid-May. It should have come out earlier, and that's partly a capacity issue within WHO. That left a lot of lower-income countries struggling to figure out the strategy they should apply, because scaling up ventilators, mass testing and PPE production was not something that was really available for them to do financially. The ability to sustain a lockdown when you have a large informal economy or a large grey economy is also very difficult.
One other point I would make about lower and middle-income countries is that there is very little money getting to front-line and local organizations in those countries. I published a piece this week that looked at the humanitarian aid flows that have gone for COVID, which amount to about $2.5 billion now in response to the global humanitarian COVID appeals. Of that, less than $2 million out of $2.5 billion is reported as having gone directly to local front-line organizations.
That's a recipe for failure, because, as I said, we're at a point now where we need to transition this response from something that is government owned to something that is community owned and led. If more than 99% of the money is going to international organizations and international partners, and the local community and local groups are getting only the scraps of the scraps of the scraps, it's going to be hard.
I'll stop there.
Thank you.
I look forward to your questions.
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View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Konyndyk.
We'll go now to our first of two rounds of questions, starting with Ms. Jansen.
Ms. Jansen, please go ahead for six minutes.
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View Tamara Jansen Profile
CPC (BC)
Thank you so much.
I would like to begin my questions with Professor Gostin.
Based on WHO recommendations, Canada did not implement a travel ban early in the pandemic. In an article you published in the The Lancet on February 13, you claimed that Canada was legally bound to follow that recommendation when, in actual fact, that's not the case.
How much pressure did the WHO put on Canada to follow this non-binding agreement to the detriment of Canadian's public health?
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:27
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The international health regulations are a binding treaty, and Canada is one of that's treaty's signatories, but you're absolutely right that when WHO makes recommendations and once it declares a public health emergency of international concern, those recommendations are recommendations. But they do have a strong, normative force, so we would expect countries to take them very seriously.
You're probably right. Being bound by it in a formal legal way is probably not true since it is stated specifically in the international health regulations that they are recommendations.
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View Tamara Jansen Profile
CPC (BC)
I'm just curious, have you heard of a single member state filing an article 56 dispute against another member state for instating travel restrictions due to COVID-19?
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:28
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No, because we don't really have a lot of enforcement or compliance with WHO recommendations.
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View Tamara Jansen Profile
CPC (BC)
That is my concern. If WHO and people working with it give the impression that we are legally bound, and therefore we did follow those recommendations, it actually did hurt Canadians' health.
If you look at South Korea and Taiwan, both faired far better than Canada. They imposed travel restrictions on February 4 and 7, which was contrary to what WHO was recommending, whereas Canada waited until March 16.
If you look at South Korea, they had 5.4 deaths per million. Taiwan had a total of only 7 deaths, whereas Canada has had 228 deaths per million by comparison. That's an abysmal statistic, wouldn't you say, for a first-world country?
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:29
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It's not ideal, but I would not blame the World Health Organization for the death rate in Canada; absolutely not. I know WHO well. The WHO is very, very unlikely to have put enormous pressure on Canada.
Remember, Canada was one of the major movers under the international health regulations to actually balance trade and travel with public health. Canada was rightly quite concerned, after SARS and during SARS, that there were so many travel restrictions placed....
Normally, travel—
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View Tamara Jansen Profile
CPC (BC)
But the thing is that travel restrictions would have actually saved Canadian lives. I think you can see that from the impact of South Korea, Taiwan and a lot of those other nations closing their borders.
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:30
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No, I don't agree with that. I worked very closely with Taiwan, South Korea and others on their response, and the reason they did well—
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View Tamara Jansen Profile
CPC (BC)
If I consider Sam Ellis, the Taipei bureau chief for Bloomberg News, he believes Taiwan's isolation from WHO helped their country by forcing it to rely on its own judgment on health issues. They were turning away cruise ships and doing health checks at airports even though WHO was assuring them the risks were low.
Mr. Lawrence Gostin: No, the—
Mrs. Tamara Jansen: Would you agree that South Korea and Taiwan were far more successful at containing the virus than those countries who followed WHO advice?
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:31
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Oh, no, they were following WHO advice, very much so. You're focusing on travel. Why Taiwan and South Korea, which is a WHO member—
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View Tamara Jansen Profile
CPC (BC)
There were also masks, right? There were many things that we were told by WHO wouldn't work.
Mr. Lawrence Gostin: I have to—
Mrs. Tamara Jansen: I know that Dr. Tam was telling us not to wear masks, they don't help—
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View Ron McKinnon Profile
Lib. (BC)
Mrs. Jansen, could you let the witness answer, please?
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:31
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The major way in which South Korea, Taiwan and other countries dealt with this was by, very early on, using widespread testing and very aggressive contact tracing that included using electronic applications on smart phones, and isolation and quarantine. I worked extraordinarily closely with South Korea and also Taiwan on this, and that was the operative thing. It was not travel—
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View Tamara Jansen Profile
CPC (BC)
You're suggesting that it's only contact tracing. Closing borders would have made no difference. That's what you're suggesting. I guess that's the question here: Is that actually correct? I would put it to you that it might be incorrect.
I know that Vietnam imposed travel restrictions on February 1 and they suffered zero deaths due to the coronavirus.
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:32
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No, I'm not saying that travel restrictions couldn't or wouldn't have been helpful early on. At that time, we were facing a novel virus. Most of the time, travel restrictions weren't used. I think we just don't have the evidence to make strong assertions. We do know that testing, tracing, isolation, quarantine and universal mask wearing are very effective. We need to—
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View Tamara Jansen Profile
CPC (BC)
You suggest that we don't have enough science, and yet Vietnam had enough science to be able to keep their deaths at zero. Why is that, when we're at 228 deaths per million?
Mr. Lawrence Gostin: Well, frankly—
Mrs. Tamara Jansen: We have our own—
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View Ron McKinnon Profile
Lib. (BC)
Mrs. Jansen, please let the witness answer.
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Lawrence Gostin
View Lawrence Gostin Profile
Lawrence Gostin
2020-06-23 11:33
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You know, frankly, there are countries—mostly the United States, but less so Canada—that didn't take it seriously enough in the sense of really using their public health capacities. Many of the countries that had experienced SARs did do very, very well, as you said. Singapore would be another example of that.
I think the tenor of your conversation is what I don't accept. Deflecting the blame to an institution like the World Health Organization is not the answer. I—
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View Tamara Jansen Profile
CPC (BC)
I think I have to challenge that suggestion—
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View Ron McKinnon Profile
Lib. (BC)
Thank you, Mrs. Jansen. Your time is up.
Dr. Powlowski, please go ahead for six minutes.
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View Marcus Powlowski Profile
Lib. (ON)
Thank you, fantastic witnesses. I am glad to see that you both have a connection with Hamilton. You're affirming MP Bob Bratina's assertion that the world actually revolves around Hamilton.
One would hope that the world would come together after the COVID crisis. After all, it doesn't matter where we are in the world—other than maybe some places in the South Pacific—because we're all experiencing the same things. We're all forced to socially distance and wear masks in public. People are staying at home worried about the health of their elderly relatives, worried about when their income is going to start to come in. This should bring humanity together, but in fact, there are suggestions that this is undermining globalism, undermining our common sense of humanity.
Borders are closing. We're trying to make sure that supply chains are domestic rather than dependent on foreign countries. We're seeing diseases as coming from other places and affecting us.
Certainly, globalism has done a lot to make the world a better place. There are so many people who lived in abject poverty before globalization. There are countries like Mexico, China and India where there was a lot of abject poverty and now it's quite rare as a result of globalization.
Similarly, the world has been a fairly harmonious place with not a lot of international conflict since the formation of the United Nations in 1945. I'm a little worried post-COVID-19 that we're becoming a little more fractionated, a little less together in terms of humanity. This is pulling us apart, rather than together.
My first question to the panellists is this: Do you think this is the case? Are we going to come out of this more united globally or less united?
Second, what can we, as Canada, do to ensure the former, that we come out of this more united and strong, that our international institutions are stronger, not weaker, and that we're not going back to the kind of world we were prior to 1945?
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Lawrence Gostin
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Lawrence Gostin
2020-06-23 11:36
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Jeremy, did you want to answer that or shall I?
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Jeremy Konyndyk
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Jeremy Konyndyk
2020-06-23 11:36
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I'm happy to take an initial attempt at it.
I think that is a real risk. One of the things that has been really striking so far about this crisis, in contrast to, say, the 2014-15 Ebola outbreak, is just the lack of a sense of a common global effort. I put some of that, frankly, to my own country. I think there's been a lot of insularity in the way the U.S. government has handled this. Usually, you'd look to the U.S. government to be trying to lead and convene those kinds of global efforts and we haven't seen that. That's reflective of some broader trends in the world, but it's really unfortunate and, as you said, very rare.
We're all facing a common enemy here, so we do need a more common approach. We're not going to be able to defeat this or be truly safe from this anywhere until it is controlled everywhere.
I think it ties back to the previous question on a travel ban. One of the concerns about travel bans is that, as all of the literature on travel bans suggests, at best they buy you two to four weeks of time to prep. They do not buy you enduring protection. They will delay, potentially, the arrival of an outbreak in a country, but they do not prevent it. Unless you're New Zealand or Fiji, they're not going to prevent it.
The utility of a travel ban, if there is such, is to slightly delay the arrival of the outbreak so that you can prepare, but it still will arrive. I think we're at a point now where this is in every country in the world. For a country like Canada or the U.S., or any country, we're not going to be able to rely on travel controls to keep us safe. We need to suppress it at home and we need to simultaneously work on suppressing it overseas because as long as those...
Every country is going to have a lot of dry kindling until we get a vaccine. As long as there are sparks flying from anywhere in the world, there's a chance that that dry kindling will get hit again. That's what South Korea and China have experienced as well. The greatest threat—maybe not the greatest threat but a significant threat—for them since they got it back under control has been the reintroduction of travel.
I think we're right. If we want to be able to get the economy back on track, we have to be able to get global travel back on track. About 10% of global GDP depends on travel or tourism. That's a big hit. That's a really big hit if we have to sustain two to three years before there's a vaccine widely available, with huge damage to global travel. The best way to do that is to suppress it everywhere and that has to be a global effort. That's not something that countries can just do individually.
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Lawrence Gostin
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Lawrence Gostin
2020-06-23 11:39
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I agree with Jeremy on everything he said in terms of the current COVID response and the need for unity. I think it's absolutely essential.
Marcus asked about the post-COVID world. That really interests me a lot, because one day this is going to be over. What will the world look like, and what will Canada's role be in that world? This is really important. Will it be a world that's more splintered? Will it weaken or undermine international institutions or international treaties? Will it weaken human rights? Will we see the first flare-up lead to large-scale lockdowns, mass quarantines, and travel and trade restrictions?
We've been down that road before. We really have, and it doesn't work. I appeal to Canada, because I've seen from your southern border the country that, frankly, I sometimes wish we were in the United States: one that engages globally, one that leads, that talks about human rights, that talks about trade, travel, globalism and the rule of law. That's what I want to see, and we have a choice as a world. We can go down one path and close everything and become nationalistic and thump our chests the way many of the strong leaders do, or we can co-operate.
Truly, if COVID teaches us anything, it's that we're all in this together and that we need to work together. That's going to be even more important as we try to get vaccines and therapeutics.
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View Ron McKinnon Profile
Lib. (BC)
Thank you, Dr. Gostin.
Mr. Thériault, you have six minutes.
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View Luc Thériault Profile
BQ (QC)
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2020-06-23 11:41
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Thank you, Mr. Chair.
Mr. Gostin and Mr. Konyndyk, I'm very pleased to have the opportunity to speak with you today. Given everything that you told us earlier, I'd like to speak with you for six hours. Unfortunately, I have only six minutes. I would encourage you to provide documents that relate to your thoughts regarding the questions that we'll be asking you. Your testimony is very valuable to us as we look for solutions.
I'd like both of you to answer the first question. When mainland China was facing a massive contagion, very few people thought that the United States of America would become the largest source of infection on the planet.
Given your extensive experience with global pandemics and your knowledge of health care systems and plans, did you anticipate the magnitude of the pandemic affecting our neighbours in the United States, with whom we share a very large border?
What do you think are the main reasons for this?
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Lawrence Gostin
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Lawrence Gostin
2020-06-23 11:43
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Jeremy, do you want to go first, or shall I? I'm happy either way.
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Jeremy Konyndyk
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Jeremy Konyndyk
2020-06-23 11:43
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I'm happy to say an initial few words on that, Larry.
It's a really great question. One of the things that we have seen from many countries is an underestimation of the risk this disease poses.
I wrote an opinion piece in The Washington Post that was published on February 4 in which I called for a “no regrets” approach. I urged the United States government, and really the world, to look at what was happening in Wuhan, China, at that point, and ask themselves whether it could happen here. This is because, in my view, as soon as we saw hospitals being overwhelmed in a wealthy metropolis like Wuhan, a city of 11 million people with a very modern health care system in a fairly wealthy upper-middle-income country, there was very little reason to think that any developed country—whether that was in North America, western Europe, east Asia or anywhere—would be immune.
I think that at a minimum, every country should have been preparing from that moment for the possibility that the conditions in Wuhan could happen in their own country. There was no good reason to think that would not happen. Every country should have been asking itself two simple questions on January 23, when Wuhan began shutting down: One, could that happen here? The answer in every country was clearly yes—if it could happen in Wuhan, it could happen anywhere. Two, are we ready for that to happen? Are we prepared if that does happen? That's the idea of a “no regrets” approach.
That was not the approach that the United States took. It was not the approach that most countries took. I think there was a certain magical thinking that somehow what happened in China would stay in China, but I don't think there was ever a scientific basis for believing that would be the case.
Therefore, yes, I did expect that this could happen in the United States. I was calling for preparedness and was disappointed to see that it didn't happen.
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Lawrence Gostin
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Lawrence Gostin
2020-06-23 11:45
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I thought that was a terrific question as well. Thank you very much for asking it in such a gracious way, I might say.
The global health security index—Jeremy and I are both involved in that—had the United States top of the list in terms of health capacities, and the International Health Regulations require all countries to develop core health system capacities to be able to rapidly detect and respond to novel outbreaks.
A very valid question is, why were high-income countries in North America, Europe and Asia hit so hard? I think the answer is that health systems are not enough. We need to prepare and plan, and we need leadership to act. As the Prime Minister of New Zealand says, “Act hard and act early.” We didn't do that. Certainly the United States and Europe and many other countries didn't do that.
I would come back to what Jeremy said in his opening statement. I was quite impressed—but I'm always impressed with what Jeremy says—about the idea, and I have said this, that trust is Public Health 101. You need to get the public's trust.
I note that there is something else we haven't discussed, which is the populist undermining of science and experts. One sees this in the attacks on WHO, one sees it in the undermining and sidelining of the U.S. CDC, and now even the White House coronavirus task force, and you see it in Brazil and other places.
Leadership matters, so we need two things. We need a strong health system, but we also need to take these things seriously and get the public on board with a consistent message of solidarity.
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View Luc Thériault Profile
BQ (QC)
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2020-06-23 11:48
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Thank you.
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View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Thériault.
We will go now to Mr. Davies.
Mr. Davies, please go ahead for six minutes.
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View Don Davies Profile
NDP (BC)
View Don Davies Profile
2020-06-23 11:48
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Thank you, Mr. Chair, and thank you to both witnesses for being here.
Professor Gostin, could I start with you?
You've written recently that “The WHO has achieved so much, even with paltry funding. Out of the COVID-19 pandemic, the WHO could be reimagined as a stronger, more responsive international agency.” Given the lessons learned from COVID-19, what reforms do you believe are necessary to strengthen the WHO?
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Lawrence Gostin
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Lawrence Gostin
2020-06-23 11:48
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I thought you'd never ask. Thank you.
There are a number of them. I'll start with sustainable funding. The World Health Organization now has a funding level that's less than one large U.S. hospital, one-quarter of the amount of the U.S. CDC, and it has a global mandate.
Even worse, of the paltry funds that it has, it only has control of about 25% to 30% of its budget. All the rest is directed to pet projects. No organization can succeed when it's funded at such a low level and when it isn't given discretion over focusing its resources on global priorities.
The second change I would make is just a basic one. The world has the WHO it deserves because it doesn't politically back the WHO. It puts the WHO in the middle of politics and in political fights. I'm working now closely with the WHO, and they're distracted just at the wrong time, so political backing would be the second change.
The third would be to strengthen compliance under the International Health Regulations to give the WHO tools for independent verification to the extent that we can, with state and official reports, partner with countries on the ground to get more clarity and compliance in terms of public health recommendations. I realize that those recommendations themselves have been in dispute.
Then there's the process for declaring a public health emergency of international concern.
I've said earlier that the WHO is not a perfect organization. Sometimes that can be so frustrating, but they are working really hard, and we need to make them the best global health organization we can, rather than tear them down.
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View Don Davies Profile
NDP (BC)
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2020-06-23 11:51
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Thanks.
If I could drill down a little bit on the funding, in a Vanity Fair article you were quoted as noting that the Trump administration's plan to withdraw from the WHO would “probably be the most ruinous presidential decision in modern history”.
You also said in a recent article that if the U.S. were to withdraw, that would leave the prospect of the Bill & Melinda Gates Foundation becoming the WHO's top donor. You pointed out that if that were the case—leaving a private foundation to be the highest donor—it would be transformational.
I'm going to ask you two questions in one. Can you explain why, in your opinion, the U.S. decision to withdraw would be so ruinous, and what the implications of the top donor being a private foundation would be?
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