Meeting 42 of the CSA COVID-19 Expert Panel

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As part of the response to the COVID-19 pandemic, the Chief Science Advisor of Canada created the Expert Panel on COVID-19 to advise her on the latest and most relevant scientific developments. This information assists the CSA in providing current, cross-disciplinary and independent advice to the Prime Minister and government.

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Overview of discussions

Held by MS Teams on April 23, 2021

The following discussion reflects evidence and scientific knowledge up April 22, 2021.

Participating experts

• Mona Nemer PhD, Chief Science Advisor of Canada (chair)

Disease modelling

• Caroline Colijn PhD, Simon Fraser University
• Daniel Coombs PhD, University of British Columbia

Risk and behavioural sciences

• Daniel Krewski PhD, University of Ottawa
• Kim Lavoie PhD, Université du Québec à Montréal
• Louise Lemyre PhD, University of Ottawa

Biomedical and clinical sciences

• Deborah Cook MD, McMaster University
• Maziar Divangahi PhD, McGill University
• Eleanor Fish PhD, University of Toronto
• Joanne Langley MD, Dalhousie University
• Salah Mahmud MD, PhD, University of Manitoba
• Allison McGeer MD, Mount Sinai Hospital, University of Toronto
• Samira Mubareka MD, Sunnybrook Research Institute
• Caroline Quach-Thahn MD, Université de Montréal
• Supriya Sharma MD, Health Canada
• Cara Tannenbaum MD, Université de Montréal, Health Canada Departmental Science Advisor

Participating guests

• Vivek Goel MD, University of Toronto
• Rosa Stalteri MSc, CanCOVID Network

Other

• Lori Engler-Todd MSc, Office of the Chief Science Advisor (support)
• Vanessa Sung PhD, Office of the Chief Science Advisor (support)
• Priya Gurnani PhD, Office of the Chief Science Advisor (support)

Key COVID-19 issues in Canada

The Expert Panel was asked to consider the current COVID-19 situation in Canada and identify key areas and gaps that could benefit from science-based advice and warrant prioritization. The experts’ suggestions fell into the five themes described below.

1. Intention to vaccinate

• The ongoing iCare study has captured some data on vaccine hesitancy in Canadians, including:
  • Some individuals with children under 18 years old are hesitant to get vaccinated. They would be less likely to vaccinate their children as well.
  • Vaccine hesitancy, defined by responses lower than “very likely to vaccinate” in the survey, was 35-38% for adult Canadians between January to March 2021.
• Given the extended interval between vaccine doses in Canada, it will be important to find ways to ensure that people return for their second vaccination appointments. This may be even more challenging in provinces where second appointments are not being pre-scheduled.
• There are concerns if news on potential rare vaccine-related side effects is discouraging vaccination among Canadians. Anecdotally, there had been reports of increased aversion to the AstraZeneca vaccine, with some failing to arrive at their appointments and others refusing it on site. However, younger adults seem to have less hesitancy toward this vaccine.
  • A recent Danish study (preprint) found that in eight western democracies (not including Canada), the news on AstraZeneca and Johnson & Johnson vaccines and their potential link to thrombosis did not negatively impact vaccination intention^{Footnote 1}.
• It would be helpful to have clear and consistent messaging on vaccines across the country, and have it delivered by trusted sources.
• Vaccines need to preferentially go to populations at highest risk of exposure and infection, with appropriate analyses of how much supply can be redirected and how it might impact the populations from which the vaccines are being temporarily shifted away.
• More focus could be placed on the positive social outcomes of vaccination, i.e., what we will be able to do once enough people are vaccinated.

2. Variants of concern

• The B.1.1.7 variant of concern (VoC), first identified in the UK, is now predominant in Canada^{Footnote 2}. Incidence of the P.1 VoC, which as first identified in Brazil, is starting to increase, whereas growth of the B.1.351 VoC which was first identified in South Africa, appears to be more stagnant. Cases of other variants not yet designated as VoC, such as B.1.617 which was first identified in India, have also been detected in multiple provinces.
• The UK shared good data on the disease severity and transmissibility of B.1.1.7 at the end of February. Canada was nevertheless unable to prevent B.1.1.7 spread. With the current approach to monitoring for VoCs, by the time sequencing data becomes available on an emerging variant, it may likely be too late to control its spread.
• It is likely that more SARS-CoV-2 variants of concern will arise. Future vaccine strategies should be planned with this in mind, among other, we must:
  • Monitor for waning vaccine effectiveness against present or future or variants in vaccinated individuals
  • Establish criteria for a shift to new vaccines developed against VoCs and which vaccines would be used.
• Increased coordination is needed among the groups that currently involved in VoC monitoring and research, including the PHAC’s National Microbiology Laboratory (NML), the Coronavirus Variant Rapid Response Network (CoVaRR-Net), and the Canadian COVID-19 Genomics Network (CanCOGen).
  • VirusSeq, a new national portal for SARS-CoV-2 sequencing data to be launched soon by CanCOGen, may help facilitate data sharing. Early feedback on this platform from researchers suggests that maximizing its utility requires collecting information such as the reason for sequencing and the vaccination status of the host (i.e. infected).

3. COVID-19 long-term impacts and considerations

• There are numerous long-term COVID-19 impacts that require prioritized attention. These include:
  • The long-term effects of the pandemic on the healthcare workforce - a recent survey found that 33% of nurses polled^{Footnote 3} may resign following the pandemic. Efforts are needed to care for and re-energize this workforce.
  • The long-term effects of long COVID.
  • The long-term effects of COVID-19 vaccines, if any.
  • The indirect impacts on non-COVID healthcare activities, such as cancer treatments and patient-oriented research.
• Using the experiences of other countries that are in more advanced stages of vaccination, such as Israel, it may be possible to anticipate how Canadians may behave and plan the safe lifting of certain restrictions.
• Public communications will need to be framed for the long-term to prepare Canadians for the possibility that things may not completely return to normal for a long time.

4. Implementation of available science-based advice and policies

• A more consistent approach to implementing policies informed by consensus-based guidelines and recommendations is needed. For example, PHAC developed guidelines for SARS-CoV-2 sample sequencing and for identifying and confirming SARS-CoV-2 variants^{Footnote 4}; these have not been consistently implemented across the country.
• The development of a consistent and coherent strategy for managing the border needs to be prioritized as international travel will begin to increase in the months ahead.

5. Children

• Data suggests that there has been a drop in uptake of routine childhood vaccinations during the COVID-19 pandemic^{Footnote 5}. There may be broader impacts on children’s health beyond COVID-19 itself.
• Mandatory COVID-19 vaccination students (schools and university) may warrant consideration.
  • An increasing number of universities in the US are announcing COVID-19 vaccination as a return to campus requirement.
• There is a need for pediatric health to be better represented at decision-making levels, for example, via the Canadian Pediatric Society.