Foreign Affairs Committee on March 24th, 2014

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

Thank you, Mr. Chair.

I have a quote here and I would just like you to address the different picture that it's giving from what we're hearing from you and see if the two things fit together. This is by Dr. Bertozzi who has been a director of HIV at the Bill & Melinda Gates Foundation and is dean at Berkeley. He said:

Because of investments made by the Global Fund...the world is achieving tremendous progress against these diseases. More than half of people in need of HIV treatment now receive it; the vast majority of TB cases are detected and treated; and more than half of families at risk of malaria in Africa are protected by bed nets. Since the early 2000s, deaths related to AIDS, TB and malaria have declined significantly. This is a record of saving lives that we can and must build upon.

He also compliments Canadian leadership.

I'm wondering how that fits in with the picture that you're talking about. Are both those things happening at the same time? Are we having success at the same time that it's spreading in other areas?

[Dr. Peter Saranchuk]

Thank you for the question. Sorry; just to clarify, I agree with that statement, but again, we need to distinguish between drug-sensitive and drug-resistant TB. For drug-sensitive TB, that statement is true. For drug-resistant TB, that's not happening at the moment. We need to invest more in order for that to happen.

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

You talked about adult formulations of these drug mixes that are used. I'm just wondering why they're not in children's packages. Is it just not marketed that way, or have the pharmaceutical companies made a decision not to do that? What are the reasons why?

[Dr. Peter Saranchuk]

Again, maybe I'm not the best person to answer that. An overly simplistic answer might be that there's just not the incentive there. There aren't enough children being diagnosed with drug-resistant TB in order for a pharmaceutical company to say, “Let's invest in making a child-friendly formulation.”

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

Are they not reading the tea leaves correctly, then? Why would they be under the impression that there are not enough cases for them to address? Have they missed something, or are they just not reacting?

[Dr. Peter Saranchuk]

Well, there are estimates and there is the actual number of cases being diagnosed. Because it's so difficult to diagnose TB in children, very few children end up in these actual statistics and data.

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

But you're here saying that this will be a huge problem right across certain areas of the globe, yet it seems like drug companies are not reacting to that information.

[Dr. Peter Saranchuk]

Well, maybe I'm sounding a bit too negative. Just to put a positive frame on it, pharmaceutical companies have to work together with governments and with researchers to develop what we need. We don't have what we need yet, especially to control the drug-resistant TB epidemic, especially for children.

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

Okay.

To both of you, I'd like to ask a question about funding. I'm told that $12 billion was pledged in Washington in December. Sometimes all of that money doesn't come through in the end, but I'm wondering, how would you, or would you, break that up amongst R and D and delivery? Where do you think those lines should be drawn in terms of how that money is used? What would you suggest?

[Helen Upperton]

That's a tough question and a good question. Perhaps it's a little bit outside my realm of knowledge and expertise, but again, from everything I've learned, and from the experience I had...and it was just my initial experience. Every day I learn more about TB and about what we're doing as a country and as a global community to help with it, but I still hear over and over that continuous improvements for the diagnosing and the medication still have to be the priority. We can keep giving the drugs we have now, which will cure some of the people, and the diagnostic techniques will find some of the cases, but if you really want to end, to eradicate, tuberculosis, you have to have better tools.

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

Do you think that some R and D needs to be done ahead of application, that there are some things we're missing at the beginning of the process?

[Helen Upperton]

I think it probably has to be a two-pronged approach.

I learned even more today from Peter. I'm sure he can touch on this better, because I might not get it correct, but I think he said that once somebody with TB gets the correct medication, they don't transfer the germs after one to two weeks. It's that quick.

It's the same for drug-resistant TB. It takes a little bit longer, but it could be that within a couple of months they're no longer spreading it. They still have to complete the medical regime for a two-year period, but if people are given the right drugs, or the cure is happening quicker, you can imagine that the spread of tuberculosis and drug-resistant tuberculosis will drop drastically.

I thought that was really interesting to find out. The problem is the misdiagnosing and the lack of adherence to the very complicated treatment plan.

[The Chair, Conservative, Dean Allison]

Thank you.

Do you want a quick comment, Dr. Saranchuk? Then we'll wrap up.

[Dr. Peter Saranchuk]

Just to reinforce what Helen said, as an incentive for diagnosis there has to be a good treatment available. For drug-resistant TB, there's not a good treatment available. If and when there is, diagnosis improves, we diagnose everybody, we treat everybody, they quickly become non-infectious, and TB is no longer transmitted.

[The Chair, Conservative, Dean Allison]

Thank you.

Dr. Saranchuk, thank you very much for being here. It was nice to have you here.

Helen, thank you very much as well for your passion for this subject.

We're going to suspend the meeting. Then we'll get started again with our new witnesses.

Thank you.

[The Chair, Conservative, Dean Allison]

If we could resume the meeting, I want to welcome our two witnesses this afternoon.

Joining us via video conference from Washington, we have Michael Druckman, who is the resident country director....

I'm sorry, Michael. I'm having a hard time with my notes. I guess I'm going to have to get glasses after all. I've been fighting it for a while—

[Voices]

Oh, oh!

[The Chair, Conservative, Dean Allison]

—but it looks as though I don't have that choice anymore.

Michael is joining us here from the IRI, where he is resident country director.

Thank you for being here.

Joining us from the National Endowment for Democracy is Carl Gershman, who is the president.

Welcome, Carl. We're glad to have you here.

Yes, Mr. Anderson?

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

Chair, may I interrupt you for one minute?

I just want to make a bit of a point, in that we had done some hearings on Ukraine and the Russian intervention there and had almost, I think, come to the point where we thought that maybe we were moving on. I think that what we've seen in the past few weeks has rekindled the committee's interest in this issue. Certainly, we've been—I think I can speak for all of us—appalled by the aggressive actions that have been taken by Russia with regard to Ukraine.

The Prime Minister and the Minister of Foreign Affairs have spoken with and stood with the people of Ukraine right from the beginning of this action and will continue to do that. The Minister of Foreign Affairs was the first minister on the ground in Ukraine in recognizing the new government. The Prime Minister is now the first leader to go to Ukraine to support the government there.

I'm very happy to see that we have come together in the House of Commons. I think all of us are on the same page with regard to this. We may vary in some small particulars, but overall, the Canadian people are very strongly behind the actions and the commitment of our Parliament and our government with respect to Ukraine. For example, today in question period, the first question of the day that was asked by the leader of the official opposition was in regard to this issue, and later we heard the Liberals, on a question of privilege, raise this issue again.

We look forward to working with the opposition and with the other members of Parliament. Certainly, we're very disappointed in this aggressive action that Russia has taken and in their position to take further aggressive action against Ukraine, and we believe that how we engage on the issue of Ukraine is inextricably intertwined with how we respond to Russia as well.

Thank you for allowing me that short intervention.

[The Chair, Conservative, Dean Allison]

Okay. What we're going to do is—

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

I'm sorry, Mr. Chair. Could I get 20 seconds to reply to that?

[The Chair, Conservative, Dean Allison]

Sure.

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

Thank you very much, Mr. Chair.

I would like to say that we are all extremely concerned about the situation in the Ukraine. It's an issue that transcends partisanship. We have worked with the government on the issue. The first question asked by the Leader of the Opposition today was about the situation, and we intend to keep working with the government on this critical issue.

Thank you very much, Mr. Chair.

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

I'd like to reiterate that certainly the Liberal Party is in unity with the government and with the NDP on this matter. We appreciate the briefings that have been given to us by the government. We are ready to contribute in any way that we can. We all stand in solidarity with respect to the question of Ukraine and the actions that are now being contemplated or taken against Russia.

[The Chair, Conservative, Dean Allison]

Thank you.

With that, why don't we get started?

Michael, why don't we turn the floor over to you for your opening statement? Then we'll follow with Carl after that.

Welcome, sir. The floor is yours.