Foreign Affairs Committee on March 24th, 2014

[Dr. Peter Saranchuk]

This is the key at the moment, or one of the keys; it's investing more in research. Fortunately, two new anti-TB drugs have come along in the last couple of years. The thing is that we don't know yet how to use these in combination. We can't just use one anti-TB drug to effect a cure. We need to use them in combination. We don't know how to best combine the drugs at the moment. We need to research this and we need to develop other better, more tolerable drug options.

So yes, research and development is very important at this stage.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

Are the pharmaceutical companies investing in it, or is it one of these situations where they don't think there's a very good return on their investment?

[Dr. Peter Saranchuk]

I'm maybe not the best person to answer that question, except to say that these two new drugs were developed by pharmaceutical companies.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

Thank you.

[The Chair, Conservative, Dean Allison]

Thank you, Mr. Garneau.

We'll now start our second round.

Ms. Grewal, you have five minutes, please.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Thank you, Mr. Chair.

I would like to thank both of you for being here today with us.

Canada has one of the lowest TB rates in the world, so it may come as a shock to learn that every year, as Ms. Upperton said, nine million people are infected with tuberculosis. The disease takes the lives of about 1.4 million people annually, many of whom are never diagnosed. The Government of Canada, as Ms. Brown said, has committed to not only further reducing rates of TB in Canada but also tackling this tragic disease in other parts of the world.

In 2009, as Ms. Brown said, Canada pledged over $120 million to the Stop TB Partnership to found the TB REACH initiative, a mechanism focused on using community-driven programming to promote early and increased detection of TB cases and to ensure their timely treatment. TB REACH has also so far supported about 109 projects in 44 countries. Our Prime Minister announced in December that our government would contribute $650 million over three years to the Global Fund to Fight AIDS, Tuberculosis and Malaria, meaning that thousands of people across the world will receive the life-saving treatments they need, and we will move even closer to eradicating TB in our lifetime.

In your opinion how can western countries or governments best help in the fight against TB?

[Helen Upperton]

Are you asking me?

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Both of you can answer.

[Helen Upperton]

Thank you for the question.

I think that again it goes back to research. In the current drug regime, there's no specific drug plan for children. That means children are typically overdosed or underdosed with the medication, which is a really sad thing.

To me, the contribution that the western world and countries such as Canada make already is incredible, but there needs to be more research and development towards earlier diagnosis as well as greater accessibility to drugs in order to improve the rate of cure. Without those things, it will continue to be an issue.

[Dr. Peter Saranchuk]

I would repeat that as well. I think an important point is related to operational research. The money that Canada has contributed to the Global Fund is fantastic, but the problem remains that treatment is too difficult for most people to take. So we need to put some money into looking at drug-resistant TB treatment regimens that are more tolerable, that can be given in a number of months instead of a number of years. Also, as Helen mentioned, there need to be child-friendly formulations. Often it's children who suffer. When somebody has drug-resistant TB, their whole family or community is affected.

[Nina Grewal, Conservative, Fleetwood—Port Kells, BC]

Mr. Chair, I'll pass on my time to Mr. Anderson.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Thank you.

There's the Global Alliance for Vaccines and Immunisation. What role does that play in dealing with this disease?

[Dr. Peter Saranchuk]

I'm sorry, but I'm not the best person to answer that. As it stands now though—sorry it was....

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

It was about a vaccination.

[Dr. Peter Saranchuk]

As it stands now, the only vaccination we have for TB is called BCG. It's given to children. It's mildly effective for children. It helps to reduce a serious type of TB in children, but for the most part it's not effective for adults and is not given to adults.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

So if it is given to children, you're saying that when they grow up and are in the situations you're talking about, it is not likely to be effective in their lives.

[Dr. Peter Saranchuk]

The people at risk of developing TB are those with weakened immune systems, so those who are HIV-positive, diabetics, malnourished people, children under the age of five, and the elderly. If children under the age of five receive this BCG vaccination early in life, they tend not to develop the serious forms of TB such as tubercular meningitis. Instead they'll get the pulmonary TB, which causes less morbidity and mortality.

[The Chair, Conservative, Dean Allison]

David, we'll come back to you. That's all the time we have.

We're going to move over to Mr. Saganash and Madam Laverdière.

[Romeo Saganash, NDP, Abitibi—Baie-James—Nunavik—Eeyou, QC]

Thank you.

I want to thank the both of you for contributing to our work.

Congratulations, Helen. I think what you're doing is very admirable. You have reason to be a proud Canadian, in my view.

I was sent to live in an Indian residential school when I was young. There were many cases of TB in those schools.

I represent a region that is home to many aboriginal communities. And the living conditions in some of them are arguably no better than those in the third world. Overcrowded housing is a common problem.

Do we know the figures around TB and its impact on aboriginal peoples in Canada? Do we have that kind of information? Dr. Saranchuk, I am asking you.

[Dr. Peter Saranchuk]

Thank you for the question.

Again, I'm not the best person to answer this. My experience is mainly working overseas, but it is true that within Canada there are pockets where TB continues to be a problem. In my mind, I'm just speaking for myself here, it's sad to come back to Canada and hear about that. TB is curable. Early diagnosis, early treatment can quickly and easily reduce a burden in any setting around the world, including in Canada. I don't have the data related to that unfortunately, but just to say that, yes, we need early diagnosis, early treatment for TB and drug-resistant TB around the world.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

Thank you.

You talked about how hard it was to treat children with TB. My understanding is that there are also challenges around diagnosing TB in children.

It's more difficult. Can you explain a bit further why it's more difficult with children than with adults?

[Dr. Peter Saranchuk]

Thank you for the question.

In order to diagnose TB we need to try to get a specimen. Usually we try first to get a sputum specimen. So for an adult that's not usually a problem if they're coughing, but to have a young child cough and produce sputum that we can test in a lab, that becomes difficult. That's one issue.

Another is that children are more likely to develop extrapulmonary TB. That's TB outside of the lungs. Again whether it's meningitis, whether it's in their lymph nodes, whether it's in their kidneys or other parts of their body, it's difficult to get a specimen for testing. That's the first part of the battle.

The second part is that for drug-resistant TB, children are forced to use adult formulations. So we take these four to five to six different drugs used for adults, and if they come in a capsule form you have to open the capsule, you have to mix the powder with water, you have to give them half in the morning, half at night. Children are invariably either underdosed or overdosed. There are problems both with diagnosis and treatment of TB, especially drug-resistant TB in children.

[Hélène Laverdière, NDP, Laurier—Sainte-Marie, QC]

Thank you.

For both of you, do you think we'll meet the MDGs, the millennium development goals, regarding TB?

[Dr. Peter Saranchuk]

The short answer is for drug-sensitive TB, yes; for drug-resistant TB, no way. Drug-resistant TB is a problem that's only going to get worse unless we invest now. If we don't invest now, 20 years from now it's going to be twice the problem and much more expensive. So it requires an investment now from every country around the world.

[The Chair, Conservative, Dean Allison]

Thank you very much.

Now we'll finish up with Mr. Anderson for five minutes.