By Joel Lexchin,
and Barbara Mintzes
COVID-19 vaccines are starting to come into Canada again and hopefully there won’t be any further interruptions. Public acceptance of vaccines will depend on how confident people are that the best decisions have been made about which vaccines to purchase.
If it looks like decisions are based on advice from people with conflicts of interest with vaccine makers, then confidence and uptake of the vaccine could collapse.
In June, the National Research Council set up a 12-member COVID-19 Vaccine Task Force, but for months the names of people on the task force were kept secret. And even when they were revealed there was no information about any relationships with vaccine manufacturers.
In fact, the government decided it was acceptable for task force members to have conflicts of interest. A government statement said that in order to be sure that the leading experts were on the task force, there was a “deliberate decision … to include individuals who may have a real or perceived … conflict of interest with respect to one or more proposals to be evaluated by the … task force.” Task force members disclosed conflicts to federal officials but those disclosures were kept from the public.
At its meetings, the task force was asked to consider whether to recommend purchasing vaccines from Johnson & Johnson, Moderna, Novavax and Sanofi. One or more of the task force members declared a conflict with all of these companies but none of the conflicts were considered direct and therefore the members weren’t required to step away.
Subsequent to the task force recommendations, the Canadian government signed contracts with all of these companies.
Dr. Joanne Langley of Dalhousie University, co-chair of the task force, was asked in early September about whether there should be more transparency. Her reply was that government ministers receiving advice could see what was disclosed: “and whether or not the ministers decide to make that public, really, it’s not for me to say … I would have to review all the kinds of information that everyone has given to say, is it fair to make that public when people are doing this? … It’s volunteer service.”
The task force’s lack of transparency has led one member to resign. Gary Kobinger, who headed the Winnipeg team that developed a successful Ebola vaccine, pleaded for more transparency.
Probably because of all of the negative publicity, the federal government finally released the task force’s conflicts of interest declarations at five meetings between June 26 and Sept. 3.
When the task force discussed the vaccine being developed jointly by Sanofi Pasteur and GlaxoSmithKline (GSK), Langley declared that Dalhousie, where she works, has collaborated with Sanofi Pasteur and GSK in the past on clinical trials; she has collaborated on other research projects with Sanofi scientists (unpaid); and served as a consultant to Sanofi on influenza vaccines in 2018, with payment for this work going to Dalhousie’s Department of Pediatrics. According to the minutes of the meeting “as there are not direct, material linkages, it was not considered a conflict and recusal was not deemed necessary.”
The task force also decided that Mark Lievonen – the other co-chair, who was the CEO of Sanofi Canada for 17 years until 2016, still owns shares in Sanofi, is associated with a consulting company working with drug companies and the director of two other drug companies – was not considered to have a direct, material conflict. However, “in an abundance of caution M. Lievonen recused himself from deliberations and recommendations.”
Testifying before the House of Commons Standing Committee on Industry, Science and Technology in mid-February, Amir Attaran, an immunology PhD and University of Ottawa health law professor, said that the entire committee should be replaced to remove any trace of conflict of interest.
Other countries have handled this type of situation much better.
In April, the Australian government funded the National COVID-19 Clinical Evidence Taskforce to provide rapid, evidence-based, and continually updated advice on Australia’s health response to the COVID-19 pandemic. It ran its proposed conflict of interest standards by an independent panel (four of the authors of this piece formed the expert panel), made modifications based on the input and published the final policy. Since then, we have been consulted regularly about individuals’ decision-making roles and whether the requirements of the policy are being met.
Ultimately, while necessary, transparency is also insufficient. Independence is needed: task force chairs and most members should be unconflicted.
With Canadian lives on the line, trust in decisions about vaccines is going to be crucial. Instead, that trust has already been jeopardized.
Joel Lexchin is Professor Emeritus of Health Policy and Management at York University, Emergency Physician at University Health Network, and Associate Professor of Family and Community Medicine at the University of Toronto. Lisa Bero is Research Professor Public Health and Medicine at the University of Colorado Anschutz Medical Campus. Marc-Andre Gagnon is Associate professor with the School of Public Policy and Administration at Carleton University. Quinn Grundy is an Assistant Professor with the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto. Barbara Mintzes is an Associate professor with the School of Pharmacy and Charles Perkins Centre at the University of Sydney.
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