EVIDENCE

Standing Committee on Health NUMBER 030 1st SESSION 43rd PARLIAMENT Tuesday, June 23, 2020 Le mardi 23 juin 2020 Standing Committee on Health CANADA [Recorded by Electronic Apparatus] EVIDENCE June 23, 2020 Committee NUMBER 030 NUMBER 030 NUMÉRO 030 30 23 06 2020 2020/06/23 11:00:00 House Of Commons Comité permanent de la santé Standing Committee on Health HESA Chair Mr. Ron McKinnon 1 43

(1100) [ English ]

The Chair (Mr. Ron McKinnon (Coquitlam—Port Coquitlam, Lib.)) :

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.

Mr. Lawrence Gostin (O'Neill Professor of Global Health Law, Georgetown University, and Director, WHO Collaborating Center on National and Global Health Law, As an Individual) :

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.

(1105) 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.

(1110) The Chair :

Thank you, Dr. Gostin. We go now to Dr. Konyndyk. Please go ahead for 10 minutes.

Mr. Jeremy Konyndyk (Senior Policy Fellow, Centre for Global Development) :

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. 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.

(1115) 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.

(1120) 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.

(1125) The Chair :

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.

Mrs. Tamara Jansen (Cloverdale—Langley City, CPC) :

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?

Mr. Lawrence Gostin :

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.

Mrs. Tamara Jansen :

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?

Mr. Lawrence Gostin :

No, because we don't really have a lot of enforcement or compliance with WHO recommendations.

Mrs. Tamara Jansen :

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?

Mr. Lawrence Gostin :

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—

(1130) Mrs. Tamara Jansen :

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.

Mr. Lawrence Gostin :

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—

Mrs. Tamara Jansen :

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?

Mr. Lawrence Gostin :

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—

Mrs. Tamara Jansen :

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—

The Chair :

Mrs. Jansen, could you let the witness answer, please?

Mr. Lawrence Gostin :

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—

Mrs. Tamara Jansen :

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.

Mr. Lawrence Gostin :

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—

Mrs. Tamara Jansen :

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—

The Chair :

Mrs. Jansen, please let the witness answer.

Mr. Lawrence Gostin :

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—

Mrs. Tamara Jansen :

I think I have to challenge that suggestion—

The Chair :

Thank you, Mrs. Jansen. Your time is up. Dr. Powlowski, please go ahead for six minutes.

Mr. Marcus Powlowski (Thunder Bay—Rainy River, Lib.) :

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?

(1135) Mr. Lawrence Gostin :

Jeremy, did you want to answer that or shall I?

Mr. Jeremy Konyndyk :

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.

Mr. Lawrence Gostin :

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.

(1140) The Chair :

Thank you, Dr. Gostin. [ Translation ] Mr. Thériault, you have six minutes.

Mr. Luc Thériault (Montcalm, BQ) :

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?

[ English ]

Mr. Lawrence Gostin :

Jeremy, do you want to go first, or shall I? I'm happy either way.

Mr. Jeremy Konyndyk :

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.

(1145) Mr. Lawrence Gostin :

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.

[ Translation ]

Mr. Luc Thériault :

Thank you.

The Chair :

Thank you, Mr. Thériault. [ English ] We will go now to Mr. Davies. Mr. Davies, please go ahead for six minutes.

Mr. Don Davies (Vancouver Kingsway, NDP) :

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?

Mr. Lawrence Gostin :

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.

(1150) Mr. Don Davies :

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?

Mr. Lawrence Gostin :

I think we may hear more imminently from the President of the United States on this issue, and I'm not at liberty to disclose exactly.... I now have over 1,000 signatures from leading public health people in the United States, urging Congress to block the withdrawal. I do believe it would be the most ruinous decision of a president in modern history to simply turn our back on the World Health Organization. I never thought I would see that in my country. I think it would weaken the global order. It would weaken public health, and I think it would put the United States itself at a higher security risk.

To your second question—they're both fantastic questions—the WHO is an intergovernmental organization. It's often been called the world's health democracy, because it's one country, one vote at the World Health Assembly. To think that a private donor.... As much as I do admire Bill and Melinda Gates—and they do have their hearts in the right place and they're a wonderful foundation and wonderful human beings—we nonetheless can't let a private foundation that's unaccountable and non-transparent and has its own preferences to make decisions that could affect global health priorities.

We do need countries to step up—

Mr. Don Davies :

Mr. Chair, do I have time for one more quick question?

The Chair :

You have 20 seconds.

Mr. Don Davies :

Last, Mr. Gostin, you mentioned the accessibility of vaccines. How can the international community ensure equitable worldwide distribution of any COVID-19 vaccine or therapeutic that might result in the months and year ahead?

Mr. Lawrence Gostin :

Thank you very much for that question. I'll send you a JAMA

article that I co-authored on that very subject. The idea is that we need to plan for it now. I would like to see that planning under the auspices of the World Health Organization, whereby all countries pledge to not have a price on intellectual property competition and to equitably share the vaccine, but it could be under the auspices of the G7, the G20 or the United Nations. I think what we need is a coalition, and I can think of Canada as being one of the leaders of this coalition and trying to push countries. We need to plan for equity now, before anybody knows that they're going to win the race.

Now everybody has an incentive to co-operate, so we need to plan for that equitable distribution very early on. Thank you so much for those questions. I do appreciate them.

(1155) The Chair :

Thank you, Mr. Davies. That ends our first round. We will now start our second round with Mr. Webber. You have five minutes.

Mr. Len Webber (Calgary Confederation, CPC) :

Thank you, Mr. Chair. I have a point of order. MP Davies took all these fantastic questions of mine and asked them, so now I'm scrambling. My questions may not be as fantastic as Mr. Davies' were, so bear with me. My first question is for Mr. Konyndyk. You mentioned that you served in the government and led the Obama administration's response to the 2014 Ebola outbreak. In a recent Frontline documentary, you speak about the political pressures public health officials are subject to and the pressure to downplay the bad news.

Canada is a country that is highly integrated and dependent on a close relationship with the United States. What words of advice do you have for us? Can we trust the U.S. government to provide accurate and thorough information to us when we need to make key decisions, such as reopening the border to non-essential travel?

Mr. Jeremy Konyndyk :

Maybe we could go back to the other questions you had. That's a hard question. It's a very important question for Canada and, frankly, it's an important question for the United States. It is abundantly clear that political pressure is curtailing public health advice from the U.S. government. There's no question. The President himself has effectively admitted it. The President was asked earlier today if he was kidding when he said the government should slow down COVID testing; and his response was that he doesn't kid. There is clearly intense political pressure on U.S. public health officials.

I still have great confidence in the people of the CDC and the people of the NIH. I think we're not hearing nearly enough from them. I trust what I hear from the CDC, from people like Tony Fauci, but I think you have to triangulate. The CDC is clearly not being allowed to speak in an unfettered way. The last time we heard from the CDC in an unfettered way was late February, when Dr. Nancy Messonnier said there was going to be a lot of disruption to American lives. That so upset the White House that they spent days walking back that comment, but she was of course completely correct.

I would very much like to get back to a point when we can hear that kind of unfettered truth from the CDC again. We haven't heard it in a long time, and they clearly feel very curtailed politically, so I think it's best to triangulate on it. Just to complete the point, you have to triangulate between that and what you're hearing from public health commentators in the U.S. more broadly, and I think that's what the U.S. public is doing right now.

Mr. Lawrence Gostin :

Obviously you can see that both Jeremy and I have deep concerns about our own government and how it has handled the situation and how it has muzzled science. There's no question about that, but on the other hand, we also need to express the strengths of the United States. It's not in the White House; it's in civil society, in whistle-blowers, in the CDC, in the NIH, in our community action. I believe we have robust institutions, a robust civil society. We need to remember that President Trump doesn't speak for all America, and there are many sane voices in the United States that we can listen to.

Mr. Len Webber :

Thank you for that. Mr. Konyndyk, in your closing remarks you talked a bit about international monies not getting to the front lines. Of $2.5 billion, $2 million is going to the front-line organizations. Where is 99% of that money going? Can you give us some clarification, please?

(1200) Mr. Jeremy Konyndyk :

Yes, certainly. It's not to say that the $2.5 billion is not being well spent. It is going to really important work being done by large UN agencies, and some of that gets to front-line local organizations second- or third-hand. The problem is that this shouldn't be the main thing or the only thing. This is a broader critique that I have of the way that humanitarian work is financed, and that's the background I come out of. The UN agencies do vitally important work, and they're doing vitally important work on this, but they're not the only ones.

Making them the principal, almost sole, recipient of humanitarian financing for COVID, which is the habit that the humanitarian system has had for many years and is now being applied to this crisis, is not going to serve us well here. Usually there's a comfort blanket in giving a lot of money to the UN, knowing it will look after it well.

I think it is very important for donors like Canada and the United States to find creative ways and to take some risks they're not used to taking to get money not just to the UN but also to those front-line community organizations that don't normally get direct donor money, that usually have a lot of intermediary layers among them. Those front-line community organizations are going to do really vital work. In the lesson we saw in Ebola in west Africa, those organizations were some of the most credible, the most persuasive and the most engaged in their local communities.

We need to make sure they're getting the support they need from the big, familiar international groups.

The Chair :

Thank you, Mr. Webber.

Mr. Len Webber :

Great. Thank you.

The Chair :

We go now to Mr. Fisher. Mr. Fisher, please go ahead. You have five minutes.

Mr. Darren Fisher (Dartmouth—Cole Harbour, Lib.) :

Thank you very much, Mr. Chair. Mr. Konyndyk and Professor Gostin, you both said it was a great honour to be here in front of our committee today. I will tell you that the honour is all ours. I thank you for being here today. When I think of this pandemic, when I think of COVID-19, I think of the faces of public health. I think specifically of the importance of Dr. Tam, of the importance of Canada's relationship with the World Health Organization and of the absolute importance of trusting our experts.

With regard to a novel virus, of course we are learning along the way as citizens, as the public and as health experts. I think of the importance of following science and data rather than politics. Personally, I feel that Canadians are very lucky to have Dr. Tam as Canada's chief public health officer. Professor Gostin, I believe it was you who spoke of public trust and solidarity. How important is it that we continue to trust in science and experts through this pandemic and into the future, assuming there will be more?

Mr. Lawrence Gostin :

I think that's really important. For me, trust in science and public health experts begins with really good health communication. I've been in close touch with the WHO about health communication, because we all know about their advice on masks, asymptomatic transmission and things like that. We're in an evolving science. This is a virus we've rarely confronted. It's really pernicious. It's hard to fully understand. This is how good public health communication should be: We should, honestly, trust the public.

We should be honest with them, tell them what we know and be clear and consistent on that without a political undermining of the science that we know. Tell them what we don't know, because there's a lot that we still don't quite understand. Then tell them what we're doing to find out what we don't know. If every politician and every scientist did that, we would be in such great shape. You know, the White House at one point in this pandemic asked the CDC, the NIH and others to clear public health messaging with the White House.

I would say it should be the exact opposite: Politicians should clear what they say with the scientists. Science is so important, and it's so easy to do. The media have conspiracy theories. On social media, on one day something is said and the next day something different is said, but we have to rely on science and the objectives of science. Otherwise, we're lost.

(1205) Mr. Jeremy Konyndyk :

Can I add something quickly on that?

Mr. Darren Fisher :

Absolutely.

Mr. Jeremy Konyndyk :

I think communicating uncertainty has been a weakness of virtually all public health authorities in this response. It's a really core part of good public health communication. I think the WHO has not done well enough in proactively communicating uncertainty. With a novel virus, we don't know everything. At the beginning, we're working from the closest parallels we see. What do we know about influenza? What do we know about SARS? What do we know about MERS? Those are the closest things to this virus, so we'll recommend what we know about those viruses, and then, as we learn more about this one, we can refine it.

I don't think that process was well explained or well communicated. It's really important—this is written into the CDC communications guidelines—to communicate up front the uncertainty, to say that the guidance will change, so bear with us. You will know what we know as we know it.

Mr. Darren Fisher :

Yes. Thank you very much. I couldn't agree more. So much has been said by both witnesses and members of Parliament about the World Health Organization. I expect that when this is all over, we can have a post-mortem. We can evaluate how we did as a country. You both mentioned how well Canada has done compared with some countries. Professor Gostin, you said, and I quote, “The WHO director-general must have freedom to act in the best interest of public health and science without political interference.” Do you want to add anything else on that, or to elaborate on that quote?

Mr. Lawrence Gostin :

Yes. I said at the beginning I worked with the World Health Organization for a long time. I think a good friend of the World Health Organization is a good friend. A good friend will tell you when you're wrong, but they won't try to blame you, tear you down, defund you, withdraw their membership or get you in the middle of geopolitical struggles between superpowers. That's not what the world needs right now. We need constructive engagement with the World Health Organization. It's not perfect. We can make it better, but we don't want to tear it down.

Anybody who thinks that the solution is to say, “My country would have done great if the WHO had only done this”.... That can't be the real world. Anybody who says we don't need a world health organization.... When you think of not just COVID-19, but polio eradication, safe childbirth, mental health, injury prevention and non-communicable diseases, you see these diseases are still there. We need a WHO to be more robust when we come out of it, not weakened.

The Chair :

Thank you. Ms. Jansen, please go ahead for five minutes.

Mrs. Tamara Jansen :

Thank you. It's been very fascinating so far this morning. I'm going to be sharing my time with MP Webber. First, what I've heard so far is that we should trust the experts. Regular citizens are kind of like anti-science bumpkins, and they're going to weaken the global order. I really question that premise. I would like to read to you an email that I received on January 29 from a regular constituent in my riding. He said, “MP Jansen, I'm hoping you can urge the government to have a more serious approach to raising the threat level assessment of coronavirus. I'm a screening officer at YVR.

Most of the employees at YVR feel strongly we are not prepared to fight or prevent the spread of the virus. Since Health Canada determines the threat level is low, there are no face masks provided to the employees, and the official language is “not recommended but respected” towards staff's personal choice to wear the mask. We are only told to wash our hands more than 20 seconds but a lot of passengers and some employees don't wash their hands or the soap runs out during peak hours in some of the popular washrooms.

Health Canada ensures the public that a healthy person will be safe from the virus by washing their hands and staying two metres away from others. “Currently that's impossible. Our searches do not allow officers to keep two metres distance when conducting searches nor do we have space needed at checkpoints. I know for a fact that a lot of movement flow from YVR staff and inbound and outbound travellers are mixed together in certain areas.

While China has gone so far to lock down cities and other countries like Britain - they've stopped flights to and from Beijing, it worries me and other YVR staff to see that the Canadian government is taking such an optimistic approach for something so contagious and dangerous. We're concerned and even if we want to help ourselves by wearing our own masks, they're sold out and I've even gotten teased on my choice of using my own mask by upper management.” Again, you need to understand that this was a regular Canadian sending me an email on January 29 asking me to beg that we take this more seriously. Who do I...?

You tell us we have to trust the experts, but I'm concerned that the experts were giving us the wrong information.

(1210) Mr. Lawrence Gostin :

Jeremy, do you want me to answer that or would you prefer to?

Mr. Jeremy Konyndyk :

I have some thoughts, but if you want, you can go first.

Mr. Lawrence Gostin :

Okay, thanks. I don't think any of us said quite what you suggested we said. I don't think that experts come down from on high and almighty and know all the answers. This is a process that we need to learn together and understand. You and all the members of this committee, and all Canadians, really have the same objectives. We really want to find the best way of doing this. I don't know all the details of what Health Canada is saying. If they're saying, “You can be absolutely safe”, I'd be very surprised. If they said you'd be safe by doing x , y and z , then that would not be right.

What they can say is, “This is what we know: If there's universal mask use, if there's social distancing, if there's really good hand hygiene, we will have a reduced risk.” Right now I'm—

Mrs. Tamara Jansen :

Sorry, but my time is a bit limited. I just want to point out that universal mask usage was not recommended by the WHO or by Health Canada until far past January 29, and that is the concern. If a regular fellow in my constituency wants to wear a mask, he should be able to wear a mask, and it would have made a whole lot more sense. I want to make sure that Mr. Webber has time, and so if I could, I'll pass it on to him.

Mr. Len Webber :

That's fine, MP Jansen. Mr. Konyndyk, you had some comments to make on that.

Mr. Jeremy Konyndyk :

Yes. The mask thing, probably more than anything else, is an area where the guidance has shifted, and I think it's important to understand why. In the early phases of this virus, we knew almost nothing about it, and the public health guidance coming out at that point was based on the closest parallels that were available. It was also guided by the fact that there was not, in public perception, a distinction between medical and non-medical masks. There was a—

Mrs. Tamara Jansen :

But under the circumstances, would it not have been wise out of an abundance of caution to use a mask? Why were we not able to?

The Chair :

Mrs. Jansen, you no longer have the floor. Mr. Webber has the floor. Mr. Webber, please carry on.

Mr. Len Webber :

Okay, well I'm going to pass my questions back to MP Jansen then.

The Chair :

Thank you. Mrs. Jansen, your time is up. We go now to Dr. Jaczek. Please go ahead.

Ms. Helena Jaczek (Markham—Stouffville, Lib.) :

Thank you very much. The analysis that both of the witnesses have given has been very insightful for all of us who have been following this pandemic for a number of months. I assure you that I'll give you plenty of time to answer my questions. I was in public health practice as a local medical officer of health for nearly two decades. Certainly the communication of risk and people's perception of risk do vary tremendously, and it's very difficult to communicate that.

Professor Gostin, you started by talking about trusting the experts, making sure that people understand that a lot is unknown, that you are trying to communicate honestly and so on. Going forward, what do you see as the role of the WHO in communicating risk and making sure that people voluntarily adopt physical distancing and the public health measures that are recommended? Can you give us what you would see as an ideal way forward?

(1215) Mr. Lawrence Gostin :

The WHO is in a more difficult position in terms of risk communication and health advice than the national government would be, because its advice goes to every country. I think Jeremy was right that the mask issue occurred because of evolving science, and some of it.... We just didn't realize that it was such a risk mitigation measure, particularly because there was asymptomatic transmission going on. On the other hand, there are some countries where mask use is not as easy and effective as it would be in other countries. The WHO is in a difficult position.

My advice to the WHO—and I'll state it publicly, and they know it—is exactly what I said before: to actually state honestly what we know and what we don't know, and to express that uncertainty. If anybody tells you that we are sure of something in this COVID-19 pandemic, you need to take it with a grain of salt. I've said to myself, “Larry, we have to approach this virus with some humility.” That doesn't mean we ignore science. We have to double down on science to try to find the answers, but we do have to have humility, and we don't want to be preachy.

We want to explain what the levels of uncertainty are, understanding that people have different risk tolerances and different risk perceptions. They absolutely do. All the science tells us that.

Ms. Helena Jaczek :

Mr. Konyndyk, would you have anything to add?

Mr. Jeremy Konyndyk :

Yes, I agree with Larry. I think partly what we're seeing here is the process of science playing out. We start with a lot of uncertainty and we make a best guess based on the closest parallels we have. There is a real challenge in public health communication in providing that information in a way that is authoritative without being overconfident or without being misleading. I don't think, frankly, that much of the world has done a good enough job of communicating that uncertainty. As we understand more about the science of the disease, the recommendations evolve and change. I think that's what you're seeing.

We are finding that to control COVID, we need to do things that are different from what we needed to do to control SARS, because SARS did not have the kind of asymptomatic transmission we're seeing here, and it is different from what we needed to control flu, but at the beginning, we had no way of knowing that. Recommendations were based on the closest known parallels we had. As we gather more data and more information, those recommendations have evolved. I think that is a difficult thing.

If you're a member of the public and paying only partial attention to this, and you see those changing recommendations without really understanding the rationale behind them, it is confusing and it does undermine trust.

Ms. Helena Jaczek :

In Canada we have another complication, in that we have a very vast country with different geography and different demographics. One of the issues on which I think public trust was somewhat eroded was that there was a lack of consistency in public health guidelines in terms of allowable behaviours, and even now as we're opening up the economy. There has been some suggestion that we would be best served with some national standard. In a way, Mr.

Konyndyk, I think you alluded a little bit to gradations within public health emergency standards so that it's fairly clear that different jurisdictions might have different responses depending on where they are within the emergency gradation, so to speak. Do you have some comment, Mr. Konyndyk, on how a vast country like Canada might ensure some more consistency?

Mr. Jeremy Konyndyk :

Absolutely, and we are struggling with the exact same problem here. One of the challenges is that for reasons we don't yet fully understand, it hits different places at different times. It's easy for the areas in the United States that locked down earlier, that locked down before they had a raging crisis, to then look at that and, rather than think they dodged a bullet, think they were bulletproof. Some of the states that have now reopened, in my view too early and too recklessly, are paying a real penalty for that.

Arizona is about to have its hospitals overwhelmed, as are parts of Texas, and I think Florida is not far behind. The reason was that they assumed there was some difference inherent in their states that meant they were not going to face the same sort of situation that New York faced eventually, or that this problem was unique to New York. I think there are absolutely differences and there are gradations, but the fundamental thing we know is that if you give this virus oxygen, it will burn you down. If you do not have some way of controlling it.... You can't sustain a lockdown forever, and you shouldn't need to.

I think what we see from South Korea, Hong Kong, Taiwan and some of the better performers in East Asia is that if you have good testing, tracing and strong public health measures and you're following science, you don't need these long-term, very crushing lockdowns, but you have to pass the baton to something if you're not going to keep the social distancing measures in place. If you lift social distancing without having the other measures in place, as much of the U.S. is doing, that's disaster.

(1220) Mr. Lawrence Gostin :

I might just add two dimensions to this discussion as well. Canada, the United States, and other countries, such as Russia, are federalist countries. How do you deal with a pandemic in a country that divides its powers and its influence among various jurisdictions? Often federalism has strengths, because you can have local innovation and local experimentation, but you also need, as you said, consistent national guidance and a consistent national response, because if there is a fire in one place, it will spread to other places, so you do need that federal leadership.

The other thing we're seeing in Canada, the United States, Brazil and many other places is a political and cultural divide. A virus should make us all think that it doesn't matter what political party we are or what ideology we have, whether we're rural or urban, or what our culture is. We all need to respect that virus in the same way, but somehow this has become a political cultural symbol. It's very unhelpful when we start to do that.

The Chair :

Thank you, Dr. Jaczek.

Ms. Helena Jaczek :

Thank you.

[ Translation ]

The Chair :

We'll now continue with Mr. Thériault or Mr. Desilets.

Mr. Luc Thériault :

I'll be speaking, Mr. Chair.

The Chair :

You have the floor for two and a half minutes.

Mr. Luc Thériault :

Over nine million people were reported infected and over 472,000 people were reported dead. In the United States, over 2,300,000 people were reported infected, which amounts to a quarter of the population of Quebec. We have no vaccines or antivirals. Our strategy has only just been implemented. We have no serological test. In short, we know very little about the virus. Right now, there's a lull, an in-between period. What worries me is the lifting of the lockdown. From a public health perspective, there's little reason to lift the lockdown quickly.

The basis for lifting the lockdown isn't public health, but economic pressure. Mr. Konyndyk, if we don't want to see a second and even more deadly wave on the planet, at what rate should the lockdown be lifted right now, given what you said about rich countries and poor countries?

[ English ]

Mr. Jeremy Konyndyk :

That is the biggest question that I think every country is facing right now. I would say a few things. First, the lifting of confinement or stay-at-home orders needs to be very cautious, very gradual and driven by data. If some measures are lifted and this does not provoke a spike in the virus, then go to the next phase, wait, make sure it does not cause another spike in the virus. I've worked with other colleagues here in the U.S. in laying out a series of recommended steps for local areas to determine whether they are ready to safely reopen. That is based on a range of things.

You need to understand what the virus is doing locally. What is the status of the local outbreak? Have incidents come down to a low absolute level? Is testing positively down to a low absolute level? Second, is there enough testing and contact-tracing capacity in place to then manage the spread of the virus so that if you see a rise in cases, you can use testing and contact tracing to begin containing that? Is there readiness in the hospital system for a future wave? These are all the measures that need to be in place in order to safely reopen.

Then, by all means, have a conditions-based reopening with safety measures in place to contain the virus through other means. What's dangerous is a reopening that is not based on clear conditions and that does not have the tools to contain the virus through other means once the social distancing measures are relaxed. The last thing I would say is that what we're coming to learn about the virus is that super-spreading events—these events where large numbers of people in an enclosed space become exposed at a single event—are probably the most dangerous and aggressive way the virus spreads.

Those are the sorts of things that should be among the last things to reopen only once the virus is almost totally suppressed.

(1225) [ Translation ]

The Chair :

Thank you, Mr. Thériault. [ English ] Mr. Davies, please go ahead for two and a half minutes.

Mr. Don Davies :

Thank you. I really appreciate the refreshing and frank advice. I can tell you that it really resonates with me that one of the lessons I think we ought to learn out of this is our need for public health officials to express uncertainty. I think almost every country is guilty of that to some degree. I know President Trump talked about opening by Easter. China, of course, famously didn't report it [ Technical difficulty—Editor ].

The Chair :

Mr. Davies, are you there? It looks like your line or your session is frozen. We will suspend the meeting for a brief time while we get Mr. Davies sorted out. The meeting is now suspended.

(1225) (1225) The Chair :

The meeting is now resumed. Please carry on, Mr. Davies.

Mr. Don Davies :

Bringing a whole bunch of threads together, I think it's very accurate to say this was a novel virus we were feeling our way through. Of course the essence of [ Technical difficulty—Editor ] predict and replicate results in a predictable fashion, which is difficult to do. I take the example of masks. We were strongly advised not only not to use them, but that they would be harmful. This is a lesson from the WHO. Where does the precautionary principle intersect with science?

If the WHO were to say they were not quite sure about the efficacy of masks, but they have been helpful in reducing the transmission of droplets [ Technical difficulty—Editor ] so they would recommend that we use them if we want to as opposed to a hard no, is that one of the lessons that comes out of this? Perhaps we need to adjust the public health advice we give when we're not sure.

(1230) Mr. Jeremy Konyndyk :

I think that's a fantastic question. One of the challenges with the masking was early on we knew that medical-grade masks were needed for health facilities to keep health care workers safe. We knew there were not enough of them, and we knew that masking guidance was being interpreted by the general public to buy an N95 mask from the hardware store. These are very common masks, and many people would normally have them. There was an overreaction early on to try to deter people from buying masks because they were competing with critical health care supplies. I think this is a takeaway lesson.

A better job should have been done of distinguishing between medical and non-medical grade masks, saying not to buy medical grade. Some of this was done but it was not forthright enough. The science on the value of masking in the general population was uncertain. The science on the value of masking in the medical situation was certain, and that was what we were going on initially as the understanding of the virus evolved.

I agree I don't think that was well-enough explained, and I think there are lessons there for the future about how that uncertainty and the state of the evidence, the state of understanding, is communicated with the public going forward.

The Chair :

Thank you, Mr. Davies. That wraps up round two, our first panel. I thank the witnesses; you've been enormously helpful. We certainly appreciate your time and expertise. With that we will suspend as we bring in our next panel. We are changing

interpretation so it will probably be a 20-minute suspension. We will start as soon as we can. We are running a little short of time.

(1230) (1250) The Chair :

The meeting is now resumed. I'd like to welcome the members back. I welcome the witnesses 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. I would like to make a few comments for the benefit of the new witnesses. Before speaking, please wait until you are recognized by name. 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. I remind everyone that all comments should be addressed through the chair.

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 floor, English or French. As you are speaking, if you plan to alternate from one language to the other, you will need to also 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. When you are not speaking, your mike should be on mute. I'd like now to welcome our second panel of witnesses. From Statistics Korea, we have Asaph Young Chun. Mr. Chun is the director general of the Statistics Research Institute. [ Chair spoke in Korean ] [ English ] We have, from the Taipei Economic and Cultural Office in Canada, Mr. Winston Wen-Yi Chen. [ Chair spoke in Mandarin ] [ English ] Thank you to both of you for being here.

You each will have time for a 10-minute statement. We will start with Statistics Korea. Mr. Chun, please go ahead for 10 minutes.

Mr. Asaph Young Chun (Director-General, Statistics Research Institute, Statistics Korea) :

I'm so honoured to be speaking with the Canadian House of Commons at the invitation of the House standing committee. I prepared a PowerPoint slide, and I was just informed that it was not possible to share my screen at the moment. I will just rely on perhaps some of the talking points rather than a number of visualizations that I thought may be more informative to this committee. I will just use the slides as my talking points. As a background, I titled my remarks “nudging data and science-based exit policy”.

I'm going to talk about partnership lessons from the crucible of the pandemic crisis, and that is the theme of my remarks today. What do I mean by this title to begin with? Since the crisis that Canadians, Koreans and people across the globe are facing at the same time, I consider that this is a crucible because this is the trial that we can bear with and we can learn lessons from. Korea and Canada have crafted a very good partnership since last March. I'm going to talk about some of those partnership lessons that we have learned from it.

The partnership is based on data and science, and those are the main points that I'm going to talk about. Why science-based policy-making? This is very important. I think the best practice that I consider critical policy-making.... In today's 21st century, we need to have evidence and data for the science to inform our policy-making that includes this COVID-19 health policy-making that we all consider very important. I'm going to make three points in this short presentation. The first point is about the data and science-based best practices to flatten the epidemic curve.

Second, I'm going to talk about other sorts of innovation and the future that we need to plan in the post-corona period. Last I'm going to talk about the partnership ideas that I can suggest between Canada and Korea to deal with this coronavirus, but also I think there's some additional collaboration that we can partake in together. In March, as I just briefly mentioned, the Statistics Research Institute and the University of Toronto, especially David Fisman's research team, worked together to model and then predict the life-course of this COVID-19, especially in Korea.

In this [ Technical difficulty—Editor ] time, very critical to 51 million people in Korea back in February and in March. As director-general of the Statistics Research Institute, I've already been informing the good ground of a lot of good people to work together. We needed the scholars and then the models to work together. David Fisman was very generous and very willing about the request that I proposed. We worked to get better, to model and then predict the life-course of this COVID-19. In the past several months, we've been working together to plan a lot of these details about what the high point of—

(1255) [ Translation ]

Mr. Luc Thériault :

Sorry to interrupt you, Mr. Chun. Mr. Chair, there hasn't been any

interpretation for quite some time.

[ English ]

The Chair :

Mr. Chun,

interpretation has stopped. With sound issues, it's very difficult for

interpretation. I wonder if you're able to maybe speak louder; perhaps it might help. Just back up a bit and continue your statement from that point, if you could. Thank you.

Mr. Asaph Young Chun :

Okay, I'll try. I'll speak slowly and loudly so that the interpreter can catch it. I was discussing the science and the database, the partnership. The scholars in Korea and in Canada have worked together in the past several months to model [ Technical difficulty—Editor ] of COVID-19 and then predict the actual course of this COVID-19 so that we can plan our policy-making accordingly in advance. That is the point. When you have this certain data and you know the pattern of this COVID-19 for the rest of its [ Technical difficulty—Editor ] life-course, then you can plan things better.

That is the sort of partnership that we have together, and we've actually been very successful in predicting the life-course of this COVID-19 in Korea. We've had about eight modellings so far together to put this life-course at a very reasonable level of certainty. In this process, there are a few things I'd like to share. Once we know the life-course of this COVID-19, one of the things—

(1300) The Chair :

I'm sorry, Mr. Chun, the

interpretation has stopped again. It's very important that the francophone members are able to hear the translation. Simultaneous translation is a very challenging undertaking. When there are issues with the sound quality and sound levels, it makes it even that much more challenging, so please bear with us. The meeting is suspended.

(1300) (1305) The Chair :

We will now resume the meeting. Due to some technical issues with Mr. Chun, he will be joining us later. Mr. Chen, go ahead with your statement for 10 minutes, please.

Mr. Winston Wen-Yi Chen (Representative, Taipei Economic and Cultural Office in Canada) :

Good afternoon, Mr. Chair and honourable members of the Standing Committee on Health. It is my great honour to provide a statement before this committee on such an important topic during such a challenging time. It is my hope that during the course of this discussion I may be able to provide some insights as to how Taiwan has approached its fight against COVID-19 and that we will have the opportunity to discuss how countries such as Canada and Taiwan can share their experiences to better combat this virus. Allow me to take a moment to reflect upon Taiwan's experience.

Despite its proximity, close trade ties and tourist exchanges with China, Taiwan avoided the worst consequences of the pandemic. Indeed, with only 446 confirmed cases, seven deaths and 72 straight days without local transmission, Taiwan's success has allowed schools and businesses to remain largely open and operational as normal. As Taiwan is neither a member nor an observer of the World Health Organization, this was all accomplished without the timely access to critical information that many other countries have benefited from. How then was Taiwan able to successfully fight the disease?

First, our fight began before the enemy was even present. Following the hard lessons of the 2003 SARS outbreak, Taiwan comprehensively reformed how it prepared for and would respond to eventual outbreaks. Another key to our success was our government's quick and decisive action at the very beginning. When our Centers for Disease Control learned of atypical pneumonia cases in Wuhan, we began actively screening passengers as they arrived in Taiwan. This action started on December 31, 2019, more than three weeks before Wuhan entered its lockdown period.

At the same time, Taiwan warned the WHO about a potential novel virus in Wuhan with human-to-human transmission. Regrettably, this warning was ignored, and the global community lost valuable time in terms of preparing for and combatting the virus. It must be stressed that Taiwan's exclusion from the WHO remains an impediment to global health, so we are grateful for parliamentarians in Canada and throughout the world who have supported Taiwan's meaningful inclusion in this organization and other international fora.

As the situation in Wuhan worsened, the Government of Taiwan activated its central epidemic command centre, or CECC. The CECC established a clear chain of command and began holding press briefings that disseminated accurate, up-to-date and transparent information to the public a full three days before Wuhan entered its lockdown. Moreover, the CECC was led by medical experts who jointly held important political offices. Minister of Health and Welfare, Dr. Chen Shih-Chung served as the chief for our CECC, holding daily press briefings and coordinating all public efforts at the national level.

Our approach to combatting the disease and informing the public was proactive and aggressive. This had the dual effect of stemming the virus early and combatting disinformation by gaining the public's trust. Over the course of the pandemic, the CECC has initiated more than 120 COVID-19 countermeasures. These include various restrictions on movement and travel, health screening at points of entry, mandatory self-isolation and much more.

(1310) The CECC also coordinated communication in an orderly and clear fashion so as to provide the most accurate real-time information. Moreover, we applied innovative, data-driven information technology solutions to track the spread of the virus, combat community transmission and allow citizens to have up-to-date information on the availability of crucial supplies to avoid panic buying. This was only possible through the consolidation of real-time data from a variety of government ministries and through the active co-operation of Taiwanese citizens.

Importantly, Taiwan made every effort to secure its supply chains for crucial medical goods, such as masks. We implemented a system whereby each citizen was provided with a stable allotment of masks, while production was simultaneously ramped up so that we could maintain a steady supply of personal protective equipment, PPE, for our citizens and health care workers. Taiwan's strategy has allowed for a daily production of up to 20 million masks. This has meant that our government has been able to provide masks and other crucial medical supplies to countries around the world, including Canada.

To date, we have contributed 1.5 million surgical masks, 100,000 N95 masks and 100,000 protective and isolation gowns to Canada in total, through the Canadian Red Cross, for distribution to front-line health care workers and indigenous communities. We believe it is imperative that countries with the means to help one another do so openly, graciously and co-operatively. Taiwan is striving to do precisely that. As for what can be done to further this co-operation, it is useful to consider the joint partnerships that our government has engaged in with other countries.

For instance, Taiwan is conducting joint research and development of rapid tests, vaccines, treatments, information technology and more with our partners in the United States. We also maintain agreements with a variety of countries to ensure stable access to important medical supplies. In any case, Taiwan stands ready to co-operate openly and in good faith with the Government of Canada. In that spirit, it our hope that countries like Canada can work with Taiwan to develop and share solutions.

By working in concert with one another, I am sure that our two countries can promote better health outcomes for our societies and the world at large. Honourable Chair and members of the committee, on behalf of Taiwan, I would like to express my sincere gratitude for your time and thoughtful consideration. I look forward to taking your questions later.

(1315) The Chair :

The meeting is now suspended so that we can test Mr. Chun's sound.

(1315) (1315) The Chair :

The meeting is now resumed. I invite Mr. Chun to carry on with his statement. Please go ahead, Mr. Chun.

Mr. Asaph Young Chun :

Let me get back to the main points. I was going to talk about three points in my presentation. First, we have had partnerships between scholars and officials of the Korean and Canadian governments since last March. Second, based on this partnership we have crafted, especially as we are going through this difficult time across the globe, we need to come up with an exit strategy. I'm going to talk about some data science and AI-based innovation in the digital economy. Finally, I'll talk about the next steps we can take to further enlarge and accelerate this Korea—Canada partnership.

When it comes to the first point of this partnership between Canada and Korea in the past several months, I'll talk about the important modelling activities we have done so we can plan things accordingly. Professor David Fisman and his research team based at University of Toronto and the Statistics Research Institute and many other research institutions based here in Korea have worked together since last March. We can model the course of this pandemic and then forecast some marginal data, and so we can plan a lot of things in advance.

As I recollect, the past several months this so-called idea-based model has been working really well, and we are able to forecast the maximum number of new cases we might have across Korea and in certain regions and the lowest point of the daily cases we are going to have, so we can plan a lot of non-pharmaceutical interventions accordingly. Because when you know the near future you are in good shape and can plan a lot of policy-making better.

For example, when you know how serious this epidemic is going to be and the extent to which it is going to impact families and kids, you can better plan all this online learning and school openings. When you have this kind of information you can encourage some of the teleworking sooner rather than later. When you know the course of the epidemic, you can find a good time to start mass gatherings, so the economy can still go on. Those are the main lessons and the benefits we have learned from each other when we did this modelling together.

My colleague David Fisman and his research team also have picked up what we have gone through in the past several months when it comes to non-pharmaceutical interventions. This was the give-and-take, a very healthy exchange and partnership, so we can learn from each other and can handle our crisis better with data, evidence and science-based approaches. I'll talk a bit about the non-pharmaceutical interventions we have institutionalized and have made best practices among the public.

When we knew the three factors that affect non-pharmaceutical interventions, we tried to reduce the probability of infection at the personal level by encouraging the use of masks from the start, back in February, and hand-washing hygiene.

(1320) Second, when it comes to the societal level of nonpharmaceutical intervention, we knew that social distancing should be a very effective measure. Rather than waiting, we actually had sort of a proactive measure, a proactive sort of implementation of social distancing—like virtual education, teleworking and preventing mass gatherings—way in advance, back in March, so that this epidemic would not be as large as what other countries have gone through. Third, this government-level intervention is using the 3T: testing kits, ICT-based tracing mechanisms, and treating patients with very good practices.

We call this a 3T framework, and it has been working pretty well based on ICT-based tools, ICT-based guidance and a lot of these innovations that we started way in advance. That's the short of the main point. When it comes to the second point I was going to tell you about, the exit strategy that we are considering at the moment, we've been actually discussing the so-called dynamic distancing. Once you know the cycle.... You know that this is kind of going down, but you're still uncertain whether it is going to come back, and you have this economy that you need to manage.

You cannot simply lock down the whole country; you cannot continue to have a lot of the social distancing. We have come out with this sort of dynamic distancing, on and off. We keep the balance between a component of the economy to keep going and a moderate level of social distancing, while we have some other personal-level and government-level interventions in place. That's what we call dynamic distancing, and it's been working pretty well so far.

The Chair :

Mr. Chun, I apologize, but I wonder if you could wrap it up very soon.

Mr. Asaph Young Chun :

Okay, sure. That's the idea that we are currently experimenting with in real time. There are a lot of uncertainties here and there, but I think Canada and Korea have been working together to learn that this is actually going to work. My last point is that this is not the end of our partnership. I think we can continue our partnership so that we can plan for this post-coronavirus period by working together with AI and data science-based innovation, and also some policies and collaboration when it comes to stemming the second wave or multiple waves of this coronavirus.

There are a lot of other things we can talk about, but I'll stop here and listen to your questions so that I can answer. Thank you.

(1325) The Chair :

Kamsahamnida . Thank you. We will now start our questioning. We will only have time, unfortunately, for one round of questions. We will do six-minute time slots, and we will start with Dr. Kitchen.

Mr. Garnett Genuis (Sherwood Park—Fort Saskatchewan, CPC) :

I just have a brief point of order, Mr. Chair. Given the technical problems—and this happens, I understand; it's nobody's fault—I wonder if these witnesses could be brought back at a later date in order to take further questions. The experiences of Taiwan and South Korea have been so critical to our understanding of what needs to be done that I think there would be a consensus to give them another opportunity for further questioning at a later date.

The Chair :

Thank you, Mr. Genuis, for your point. We will take it up as a committee in due course, but thank you for your intervention. I apologize that we're not going to have a second round here. We just don't have the time. Dr. Kitchen, please go ahead for six minutes.

Mr. Robert Kitchen (Souris—Moose Mountain, CPC) :

Thank you, Mr. Chair. I agree with my colleague's point of order, and hopefully that will be discussed. Thank you, gentlemen, for being here today. It's greatly appreciated. First of all, I would like to thank Ambassador Chen for his contribution, or Taiwan's contribution of PPE to Canada. It was greatly appreciated. Thank you for stepping up and doing that. My first question is for you, Your Excellency. Taiwan leads the world as the most-prepared and best-equipped nation to fight the pandemic. We've seen that Taiwan can help and that Taiwan is helping. Could you describe what roles Taiwan can play in this unprecedented and challenging environment?

Mr. Winston Wen-Yi Chen :

Thank you. I think the COVID-19 pandemic is really a challenge, not only to my country but also to Canada and others around the world. In Taiwan, we try everything we can with our resources and power, and then work together with our international partners to make sure we protect the lives of our citizens. Given that the real situation is that we are not members of the World Health Organization and everybody understands the virus knows no borders, we cannot do our part by ourselves. It takes a lot of co-operation with neighbouring countries and international society.

That's the reason why the government and the people of Taiwan want to engage with the international community from time to time. Particularly in this pandemic, we noticed that our experience can be shared with our friends. Nowadays, people are talking about the Taiwan model. With that in mind, I'd like to take a few minutes to share the real nature of the Taiwan model.

To make a long story short, I'll say that number one is pre-pandemic preparedness; the second thing is quick, coordinated and proactive decision-making; third is health-forward policy-making, including by instituting border control, health checks at all points of entry and more; four is the application of big data, artificial intelligence and technology broadly; five is management of the production, purchase and dissemination of critical medical supplies; six is open, accurate, timely and transparent dissemination of information; and seven is productive and good-faith international co-operation.

In fact, we can use three words to describe it: transparency, technology and teamwork.

(1330) Mr. Robert Kitchen :

Thank you very much. Infectious disease expert Dr. Ronald St. John has recently been quoted as saying that he thinks Canada's response to COVID-19 in January was a bit slow, and he also stated that the situation probably should have been taken a little more seriously. I would point out that Dr. St. John was the first director general of the Centre for Emergency Preparedness and Response at the Public Health Agency of Canada, and the national manager for Canada's response to SARS. How important was speed when it came to the responses from Taiwan and South Korea, Mr. Chen?

Mr. Winston Wen-Yi Chen :

As I mentioned earlier, given the proximity and the close exchange between Taiwan and China, for the government and people of Taiwan to prevent the spread of the virus in the early stage was essential. That was something the government had to take a quick decision on, and we did.

Mr. Robert Kitchen :

Thank you. Mr. Chun.

Mr. Asaph Young Chun :

I think all the preparation is very essential, especially when you have some information that there is an asymptomatic part of the epidemic. You have to have very good tools in your hands when it comes to testing and tracing mechanisms. This is critical to the entire process of prevention. This is where I think Korea was able to come up with some innovative ways of testing and tracing, way back in February, by creating some partnerships between government and industry. We gave more leadership to industry so they could come up with an innovative way of testing and tracing.

Mr. Robert Kitchen :

Thank you, Mr. Chun. Following the SARS pandemic in 2003, most countries developed pandemic response plans that could be put in place almost immediately, and we've seen that Canada struggled with this, even though that's part of why the Public Health Agency of Canada was created, to deal with the response to SARS. Part of what they talked about was preparing, doing drills and simulations. Did your governments ever conduct reviews, drills or practices for a pandemic response plan? Mr. Chun.

Mr. Asaph Young Chun :

I would not necessarily say that is was the drills. I think the more important thing here is that we came at it by asking what sort of legal framework we could use to help the population to go through a difficult time together. I think they worked with some of this individual liberty versus the collective group of lives at stake, and then it's question of whether they can handle that kind of balance. This was the very important legal framework that Korea was able to handle, when the Korean people went through SARS and then the MERS crisis in the past.

Mr. Robert Kitchen :

Mr. Chen, can we get a quick answer?

The Chair :

Go ahead, Mr. Chen.

Mr. Winston Wen-Yi Chen :

I think that in Taiwan's case, the general public and the government, we have a consensus that.... Of course, we had a hard lesson. We learned a hard lesson from the SARS in 2003. We are isolated from the international health community, so we believed that we had to respond quickly, based on the scientific evidence and the expert advice. We did not necessarily have a drill, but we had the legal framework already in place after SARS in 2003.

That's the reason we could quickly establish the CECC and mobilize the private sector and government agencies to work together as a team, and then respond properly and quickly. Also, the democracy.... I think people are certainly worried about a loss of...even a very timid one. They worry about the loss of security and safety in this pandemic. I think that's the reason the government can get the trust of the people. You have to be open and transparent, with lots of communication. That would certainly give the government more power to proceed with the mechanism that is required.

(1335) The Chair :

Thank you, Mr. Chen. We'll go now to Mr. Van Bynen. Mr. Van Bynen, please go ahead. You have six minutes.

Mr. Tony Van Bynen (Newmarket—Aurora, Lib.) :

Thank you, Mr. Chair. Thank you to the witnesses for participating today. The idea of a greater pan-Canadian network has been a recurring topic of conversation during these committee meetings. Witnesses have repeatedly stated that such an approach would increase collaboration in the health systems across Canada, to the benefit of the whole country. I heard that Mr. Chen indicated that what was important was a clear chain of command. Is there such a network in South Korea or in Taiwan? If so, could you elaborate on how it was implemented and whether it has benefited your country's health system?

If not, why would you say such a network has not been used? I would invite a response from both of our witnesses, please.

Mr. Asaph Young Chun :

I can go first. Speaking of past experiences and crises that we've had to deal with—I'm thinking of SARS and MERS—Korea was able to institutionalize a very good system of governance when it comes to crisis management. Even before this pandemic, learning from those past lessons, we had a very centralized system around who is controlling this whole crisis, who is going to actually specialize in dealing with a lot of those issues on the ground, and how the central government and the local governments need to work together.

All those systems were already in place, so the Korean government did not take any time to plan or implement all those things; I think it was less than 24 hours. That's the sort of system that I think we were able to reinstitutionalize when we had this crisis really coming up on us, and then use that to deal with the crisis in a very proactive way, because we didn't have time to have any disaccord between the central and local governments. A lot of co-ordination was already in place and institutionalized.

Mr. Tony Van Bynen :

Thank you. Mr. Chen.

Mr. Winston Wen-Yi Chen :

I think by the latter part of January our CECC was well established. The health minister was in charge of giving briefings on a daily basis, explaining to citizens the real situation about what was going on and the new regulations and mechanisms that were in place. I think that helped people a lot. They knew how to get PPE at the convenience store. By using big data, I think the government can control and limit the number of confirmed cases and make sure people are well placed for quarantine. In suspicious cases as well, people know how to behave in terms of self-quarantining or self-isolating.

I think it's a kind of teamwork. People have a sense that it's a crisis. They know how to do things for the public good. There is a debate in society about using modern technology. Particularly in a democracy like Taiwan, people worry about losing their privacy. How to balance this is extremely important for the democratic institutions. In this area, I think our Parliament plays a very important role, checking the regulations on a daily basis, checking government mechanisms or new regulations, to make sure that people's privacy is secure.

In a civil society, we want the guarantee that we can handle the pandemic properly but that we won't lose, in the meantime, the most precious principles in a democratic society—our privacy and our civil rights.

(1340) Mr. Tony Van Bynen :

Thank you. It's great to see that both of you are now working with Canada on some research project. Based on your countries' experiences, do you have any lessons learned or any suggestions for Canada as we move forward to reopening the economy? We'll start with Mr. Chun again.

Mr. Asaph Young Chun :

Again, Canadians, Koreans and other people are really eager to reopen and revitalize their economies. This is very critical to many people, especially disadvantaged people in terms of the economy and in other ways. I think you need to have the system ready before you reopen a lot of economic sectors. If you do not have a system in place for testing, tracing and then treating patients with a very good health system, then I think you'll certainly experience a resurgence of this pandemic. That is what other countries have been experiencing. Even in Korea, I think in the past few weeks we've been very concerned.

Once we relaxed some of that social distancing and went after dynamic distancing, so that people could have more economic activities, we noticed that some cases were coming back and then quarantined some people in certain communities. We are, to some extent, pretty content that we have a good system in place. Again, I would go back to the 3T system. We also have trust between government and the public, so that we can rely on each other.

If you have those in control, and if you know that your public health infrastructure is very resilient so that the crisis is kept within the threshold, then you can certainly be prepared to reopen certain areas of your economic sector. However, I would recommend that you do it step by step, gradually, and not open up everything completely at the same time.

Mr. Tony Van Bynen :

Thank you. Mr. Chen?

The Chair :

Mr. Van Bynen, your time is up, but Mr. Chen may respond if he wishes. Please go ahead.

Mr. Winston Wen-Yi Chen :

Yes. To make a long story short, how to revive our economy in the post-pandemic period is extremely important. Our country also pays much attention to how we shape our economy model and how to revive the spirit of the economic power. Make sure society can sustainably develop. That's extremely important. In the last three or four months, for the business community in Taiwan, although domestically it's business as always, for sure international tourists from abroad have been stopped from the border line. They are not allowed to visit. At this point, the government has made it very clear.

It has selected 15 countries. In the first stage, it will allow business people from those 15 countries to visit Taiwan. It will make the isolation time as short as possible, five to seven days, to encourage the business community to continue to come to Taiwan and engage with Taiwan. I totally agree with what Mr. Chun mentioned, that we have to do that gradually, state by state, and make sure the pandemic doesn't come back a second time. That's extremely important. How to balance all this is certainly.... Each country has its model.

As I said earlier, I tried to portray the real model of Taiwan to you, but Taiwan's model is not perfect for all countries and regions. It's certainly not a one-size-fits-all solution. Each country has its culture, background and customs, but I believe international co-operation is so important and so essential, because we can learn from each other and combat this terrible pandemic. Thank you.

(1345) The Chair :

Thank you, Mr. Chen. [ Translation ] Mr. Thériault, you have the floor for six minutes.

Mr. Luc Thériault :

Thank you, Mr. Chair. Welcome, Mr. Wen-Yi Chen and Mr. Chun. Your countries are often referred to as models of effectiveness in controlling this pandemic, which poses specific challenges. We're close to the largest source of contagion on the planet. This was also the case in Taiwan, with mainland China. I'll speak to you first, Mr. Chun. You touched on this topic earlier with Mr. Van Bynen. You were among the first to act systematically and to not wait for analyses from other authorities before putting measures in place. You're currently anticipating a second wave. We expect the second wave here in the fall.

There are economic pressures. However, how do you explain the possibility of a second wave? In a way, it's necessary to lift the lockdown if we want to rebuild and restart the economy. Does the rate at which the lockdown is lifted necessarily lead to people becoming careless, which creates or revives sources of infection? What are you doing to address this? We want to learn from your best practices in order to fight the next wave coming our way.

[ English ]

Mr. Asaph Young Chun :

Yes. I would not say that Korea is perfect. I think we try. I think we use the collective wisdom of—

[ Translation ]

Mr. Luc Thériault :

Mr. Chair, there's no

interpretation.

[ English ]

Mr. Asaph Young Chun :

—different key practices, so I think we can come up with the most practical solutions to the problems that you are concerned about. What are the impacts of this confinement, of staying at home, staying where you usually do not wish to spend the whole day? It has a lot of impacts on the mental and physical health of individuals and families, and it impacts a lot of people, so we are concerned about it. This is why we are also trying to have this sort of dynamic distancing, rather than complete social distancing, be granted.

With dynamic distancing, you allow a certain level of relaxation when it comes to a small gathering, working at the office, spending some time in public places, and things like that. Again, when you do relax, you certainly should be anticipating that this epidemic might be coming back. I think that's the trade-off that you need to be concerned about. This goes back to my earlier point. We have a system in place to deal with it. When you know, the surge in cases isn't actually going to haunt you.

If you are ready, you can handle it, and you can keep a sort of balance with economic revitalization and also the dynamic distancing. You mentioned a second wave. What is meant by a second wave? I think people have different opinions. In my personal opinion—and this is also based on the collective wisdom that we are putting together in Canada and in Korea with the scholars and then best practitioners—I think a second wave, if it is coming, is also up to what we are going to do with it. It is not just coming as a second wave. It depends on our behaviour, our community actions, our government actions.

If you have all these tools in place, you do not necessarily need to have a second wave in your country. That is my opinion. I think that in the case of Korea—we have less than 50 cases per day these days—Korean people are very concerned about even a small number of cases every day. We try to keep this under 20, across Korea. That's the sort of the intelligence here in Korea, and I'm with them. I'm an American, actually, by legal status—

(1350) [ Translation ]

Mr. Luc Thériault :

Mr. Chun—

[ English ]

Mr. Asaph Young Chun :

—so I know what they are thinking about. This is not the sort of.... Go ahead.

[ Translation ]

Mr. Luc Thériault :

Thank you, Mr. Chun. Mr. Chen, you spoke at length, and rightly so, about international co-operation. Where do things stand with regard to the research being carried out by researchers and scientists in your country in relation to this international co-operation? Are you in contact with them? I imagine that the issues with the WHO prevented you from taking

part in the solidarity clinical trial. I want you to tell us about this. Are you part of this? Are you concerned that this might affect your ability to participate in the trials and to access future treatments or vaccines? Where do things stand with regard to research and your scientists in relation to the international community?

[ English ]

Mr. Asaph Young Chun :

Yes. I think these are very important points that you have just brought up. Actually, between Korea and Canada, we are creating this AI—

[ Translation ]

Mr. Luc Thériault :

Sorry. My question was for Mr. Chen. If you'll excuse me, I don't have much time left.

[ English ]

Mr. Asaph Young Chun :

Okay. Go ahead.

Mr. Winston Wen-Yi Chen :

Yes, thank you. I'd like to share Taiwan's experience. Taiwan's experience is unique. Even though we are not included in the WHO, we had lots of co-operation and tried to reach out to work with like-minded countries, particularly those with democratic institutions, and made sure that we could get the necessary information in time. Also, sir, you mentioned research in the development of vaccines, or medicines or testing kits. That also involves teamwork with the international health community.

In our co-operation, particularly with Canada, we not only shared our PPE, but we also tried to facilitate the private sector, both in Canada and in Taiwan, to work together to try to establish the PPE supply chain in this country. I think our co-operation is everywhere. We try to find every avenue to work with our friends. In this country, Canada, we have a challenge in facing this pandemic, so we have tried to find a workable solution and to tackle the issues. I always say that no one should be excluded from the WHO because the virus could be transmitted from one area to other countries.

We had to work together as a team. It is so important. That's the reason we think we are on the right side of history. We did the right thing. We have good friends who are continuing to support us.

(1355) [ Translation ]

The Chair :

Thank you, Mr. Thériault. [ English ] We go now to Mr. Davies. Mr. Davies, please go ahead for six minutes.

Mr. Don Davies :

Thank you, Mr. Chair. Thank you to both witnesses for being here. Mr. Chen, when did the Taiwanese government recommend that its citizens wear masks? On what evidence did it make that recommendation?

Mr. Winston Wen-Yi Chen :

I think there is a lot of debate on the issue of whether or not, and at what stage, people should wear masks to protect themselves. I think everything really depends on the science-based evidence, and also the experts' advice. For instance, I, my family and my colleagues, we follow the guidance—

Mr. Don Davies :

Mr. Chen, if I can just interrupt, my question was, when did the Taiwanese government recommend that its citizens wear masks? When was it? When did that happen?

Mr. Winston Wen-Yi Chen :

I think that at the very beginning, in the early part of January, people had the sense to wear masks to protect themselves. As I have always said, we did it at the very early stage. There's a lot of debate on that, as I said, even in this country. Our customs and our culture helped us to convince people to wear masks. Certainly that helped us to be well prepared. The one challenge that people didn't really touch upon is, how could you possibly provide that many masks? In particular, we're talking about the health care workers, the front-line workers, and even police and firefighters. They are in the public space.

They urgently need face masks. For people who stay eight hours at home, they probably don't need face masks that urgently. I think the government in Taiwan, in the early stages, on a daily basis only produced two million masks. Certainly, we have a population of 24 million, and we were far short in our supply—

Mr. Don Davies :

Mr. Chen, I'm sorry to interrupt. I have limited time. I will be asking about your mask production, but I want to turn to Mr. Chun. Mr. Chun, when did the Government of South Korea recommend that its citizens wear masks?

Mr. Asaph Young Chun :

I recollect that it was early February. At that time, I think we had only a few cases across the country, fewer than 30 I would say, but I think it was based on some evidence.

Mr. Don Davies :

On what basis did the Government of South Korea make that recommendation?

Mr. Asaph Young Chun :

It was based on the potential risk of the asymptomatic cases of this epidemic. When you do not know who is infected since they're not showing symptoms, then I think you have to wear a mask so you can actually protect yourself from this asymptomatic infection.

Mr. Don Davies :

Do you think early adoption of mask wearing played a role in keeping the transmission rates low in South Korea?

(1400) Mr. Asaph Young Chun :

Yes, I think that was one of the best mechanisms. As I mentioned earlier, it was these personal measures, non-pharmaceutical interventions, using face masks and also washing hands, that hygiene. Those two were very critical to the entire process of non-pharmaceutical intervention, and we made it very mandatory. Even today, when you come to Korea you will find that almost everyone is actually wearing face masks.

Mr. Don Davies :

Thank you. Now we go back to Mr. Chen in Taiwan. I know that Taiwan was an importer of surgical masks before COVID-19. You created an onshore mask production industry just a month after registering your first infections. I know that's grown into a daily capacity of 20 million pieces as of May, and that initiative was led by the Government of Taiwan. Could you outline for this committee how the Government of Taiwan was able to ramp up mask production so rapidly in response to the COVID-19 pandemic?

Mr. Winston Wen-Yi Chen :

I just mentioned that the legislation is extremely important. After 2003, we had already passed the law, and that's why we could have the CECC in the very beginning, the early stage. That followed the rule of law, and the legislation and the follow-up mechanisms were in place, so certainly we could rally and try to support the private sector. I think society in Taiwan is also honoured to try to help the society and its citizens.

That's the reason, I think, we, in very short weeks, could rapidly mass-produce face masks with a daily production of two million—and, today, up to 20 million—and not only supply our people's needs but also try to ship to international societies to help our friends. You asked whether or not wearing a face mask is effective in preventing the spread of the virus. I'm not a medical expert, but I think in the society of Taiwan, it's the people's consensus that we not only protect ourselves but we also try to protect our friends and our family members.

Up to today, there have been a very limited number of confirmed cases, but in public gathering