Health Committee on Aug. 12th, 2009

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Dr. Butler-Jones, there will be a gap.

[Dr. David Butler-Jones]

I'll get there. I'm working through your questions. Thank you.

So we will have vaccines, so that we should be able immunize everybody with at least one dose before Christmas. After Christmas is when we would normally see it. Interestingly enough, the trials in the U.S., trials in Australia, etc., aren't really going to generate much of anything earlier than what we will have in order to move forward. The reason for that being in November in the northern hemisphere is because WHO asked all of the companies to make sure they've finished off their seasonal flu production first. So they weren't actually able to start with the H1N1 until that time.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I appreciate that. But there's a gap period in between.

[Dr. David Butler-Jones]

But that was part of the answer.

So now in terms of in between, that's partly because the planning is comprehensive. It's not just about planning for a vaccine, it's also for what else you do. So there are the distancing measures, the stay-at-home measures, which will slow its spread, the guidelines for schools. And we have antivirals sufficient to treat anybody who needs treatment.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Can I address the antivirals, then? We know about the plan and what needs to be done. On antivirals, I have real questions here. Why are we not providing the same level of protection for emergency service providers, like firefighters, police, paramedics, and organizations like the Red Cross? They're going to be critical.

[Dr. David Butler-Jones]

They're all the same. In the spring, because we were coming to the end of flu season, because of the uncertainties about the development of resistance, universally it was felt that we wanted to use Tamiflu or Relenza for those with underlying risk conditions that put them at greater risk of severe disease. That was the recommendation: everybody had access to that. We did not release the joint stockpile for general use, because again we didn't want it to be used in ways that would promote resistance. Come the fall, it doesn't matter who you are, the necessity for treatment is the same. It doesn't matter whether you are a firefighter or a Wal-Mart greeter; access to the antivirals is the same and will be the same. So there should be no issues there, and if there are issues, then they'll be dealt with directly.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Butler-Jones.

We'll now go to Mr. Clarke.

[Rob Clarke, Conservative, Desnethé—Missinippi—Churchill River, SK]

Thank you, Madam Chair.

I'd like to thank the witnesses for attending the meeting today.

First of all, I'm first nations and 62% of my riding is first nations. Earlier this summer I took a tour through my riding and went to the most northern part, to the community of Fond Du Lac. That community is a fly-in and is remote. They are part of the Athabasca health region. One of the questions that came forward was preparedness. Are they prepared? The answer, I was told, is yes. This is a first nations reserve, and they showed me their stockhouse of supplies for a second-wave pandemic, if it should occur.

One of the things I hear about here today is first nations and aboriginals, but I think we also have to look at the big picture. We are all Canadians. There are no ethnic lines here. We are here as the health committee for Canadians and to address these issues. It gets me a little bit upset, because my wife is non-aboriginal and we have a blended family. We look at ourselves as Canadians.

The question I have is this. For the 62% of my riding who are aboriginal, is there an adequate supply of antiviral drugs available for first nations? Can you give this committee your assurance that there is or will soon be an adequate supply?

Second, will first nations be part of a national pandemic plan that includes a strategy for reaching remote communities and will include an extensive public education program?

Thank you.

[Dr. David Butler-Jones]

Thank you. I'll start, and Shelagh Jane can continue.

On the issue of antivirals, collectively the provinces and territories have built a stockpile of 55 million doses. In addition, the federal government, in our national emergency stockpile, has another 20 million doses. That should be more than sufficient to treat anybody who needs treatment in this country come the fall. It doesn't matter what your ethnic background is or whether you are a firefighter or a policeman or a Wal-Mart greeter; there are sufficient antivirals to treat all those who need it and want it.

On the issue of vaccine supply, again, it is the same. We are indiscriminate and are purchasing enough vaccine for everybody who would possibly need it and want it.

In terms of the planning and all the other work we are doing, we have a specific committee that is looking at rural and remote isolated communities and the special needs of those communities and how we're going to address them. Shelagh Jane actually co-chairs that committee with André Corriveau, who was previously of the NWT and is now of Alberta.

I'll stop there and turn it over to Shelagh Jane.

[Shelagh Jane Woods, Director General, Primary Health and Public Health Directorate, First Nations and Inuit Health Branch, Department of Health]

Thank you.

I guess I'd say I'm not actually surprised at the experience you had, because we know that over 90% of the first nations reserve communities do have completed pandemic plans.

As you are probably aware, we've spent a lot of time, a number of years, working with the communities to make sure they do complete plans and also, importantly, that they make the necessary links to the rest of the provincial health system, because that's critically important.

The other thing we did as H1N1 began to emerge, before we knew exactly what it was, but as it looked potentially serious, we started to pre-position things like antivirals in our nursing stations because we knew that the response time--the time in which you start to use them--has to be quite short. We are particularly aware of those communities that are remote and isolated and have access issues. So we pre-positioned some antivirals. We also provided some additional personal protective equipment for all of the front-line health care workers in the reserve nursing stations and health centres.

[The Chair, Conservative, Joy Smith]

You have only half a minute left. You will have to talk very quickly.

[Rob Clarke, Conservative, Desnethé—Missinippi—Churchill River, SK]

Right.

I do recall in my experience as a police officer having to sit down in the early 2000s and work out a pandemic plan for first nations and non-first nations and Métis communities throughout northern Saskatchewan with the health care agencies, the hospitals, the ambulance attendants, and I do recall being supplied protective outfits for such a pandemic outbreak. I'm very pleased that this is still taking place today.

[Dr. David Butler-Jones]

That's nice to hear. At the time, I was chief medical officer for the province. That's what we're trying to do.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go on to Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chair.

I would like to thank our witnesses and the Minister—who was with us earlier—for attending this afternoon's Committee meeting.

Dr. Butler-Jones, I listened to the press conference you gave with the Minister where you made a number of announcements. You have awarded a $926,000 contract to the International Centre for Infectious Diseases, which will be working in partnership with the Canadian Chamber of Commerce to develop a communications strategy aimed at the 300,000 small businesses in Canada, in order to ensure they do not encounter too many problems. That is extremely important, because the H1N1 virus is a health issue that will have economic consequences.

If you do the arithmetic, that means about $3 per business. Have we been generous enough? Would it be possible to provide more money and develop a more specific plan aimed at the business sector? Also, have you discussed the potential impacts of this with the Department of Industry?

[Dr. David Butler-Jones]

We work cooperatively with all the other government departments. We have also prepared tools in French, English and another language. This resource is being made available to all businesses in order to facilitate their own planning. We are trying to help them improve their emergency response plans. It is easier for us to help them now, because significant resources are available for the activities that businesses and public organizations will need to develop. We are focusing on improving their readiness.

[Nicolas Dufour, Bloc, Repentigny, QC]

Basically, the $926,000 will be used to develop a communications strategy; but will that communication be aimed solely at the business sector? Will there be more than just guidelines or something of the sort? Will there be visits to business facilities to see what practical assistance they can be given?

[Dr. David Butler-Jones]

This is in addition to local activities, to what is being done by local public health authorities, and so on. There is also a telephone and web-based advisory service. That is not necessarily a perfect solution for everyone, but it is an important contribution.

[Nicolas Dufour, Bloc, Repentigny, QC]

Earlier, we were talking about the choice of antivirals. According to Danielle Grondin, of Health Canada, we still do not know how many injections will be needed to protect people against H1N1. In 80% of cases, Tamiflu will be used. Yet some studies done abroad suggest that Tamiflu could lead to complications—in children, for instance.

Some are expressing concerns about the choice of antivirals. Could you tell us overall why that is the case?

[Dr. David Butler-Jones]

There is always a need to assess the benefits and risks of any drug. In the case of Tamiflu, the benefits are very considerable.

I would like to continue in English, in order to give you a more detailed answer.

I think the challenge is that we know that Tamiflu and Relenza are effective. They're not always as effective as we'd love them to be, but there isn't anything else in terms of treatment. We know they are also safe and effective in children. And the risk profile is good; in other words, the risks are low and tend to be minor. Given the choice between influenza and the potential risk of severe illness and death versus a theoretical small risk from taking an antiviral, that again would tip the balance. But again, it's still a choice; it's a clinical choice in the setting.

These studies were done on seasonal flu, not the new H1. Talking to pediatricians and others who are actually assessing and seeing these children, the reflection to me was, well, we don't have the studies yet, but they have consistently said to me that the kids who come in and get on Tamiflu earlier have done better than the kids who did not.

So in the face of that kind of experience and evidence, given the choice, particularly with moderate or severe illness, I think I would have no hesitancy about using Tamiflu in that situation.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

Now, Mr. Uppal.

[Colin Carrie, Conservative, Oshawa, ON]

Can I take his place?

[The Chair, Conservative, Joy Smith]

Absolutely, Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I was really impressed, Dr. Butler-Jones, when you were talking about information in and information out, and how we seem to be connected all over the world as far as the learning curve is concerned. We take examples such as Australia, which has gone through its flu season already.

I was wondering if you could give us some examples on how you are working on this “information in” with our world partners and how you're able to disseminate this information out to, let's say, the local communities through the provinces. What can the feds do to work with their provincial partners to make communication better with the smaller communities and first nations?

[Dr. David Butler-Jones]

Thanks very much.

There are many parts to that. I think it's really interesting when you look around the world. Influenza is such a variable disease. You'll have two communities side by side, and if you look at 1918 and others, the impact in neighbouring communities can be very different, or even within communities. And while the general risk factors, etc., may hold true, they may not hold true in all instances, because of this virus' variability.

For example, different parts of Australia were hit much harder than others. Now, that's not particularly useful, other than for the questions for the general public, but it's very useful as we start to plan and think towards the future. Or, for example, Argentina, unlike Chile, instituted all kinds of measures, such as closing schools, cancelling concerts, etc. Comparing Chile and Argentina would suggest that, in our view, cancelling schools and everything else is probably not helpful. It turned out actually to be true in their experience. So all of this is very helpful as we start to develop our guidance.

When it comes to communications, in a way you can never communicate too much. I'm struck by the differences in different communities, and part of that is the activities of local public health—and sometimes it's a local business that's interested.

I came back early to Ottawa from Nunavut to be here, and I was struck that in Nunavut, which again has a sparse population, there's a collaboration between the Nunavut government, the Canadian government, and local people. So you can't go into a bar or restaurant or hotel, or wherever, without signs graphically displaying how to cough, what to do if you're sick, how to wash your hands, etc. Even the small shops have signs and information, etc., and people are aware and are engaging in the conversation about how you can prevent this. We have done stuff in Inuktitut and a range of languages, and this can be adapted in other languages, as need be.

We can't communicate enough. We're continuing to do that. Will we ever do enough? I'm not sure, but again, these meetings, these forums, and the kinds of questions you're asking are all important in helping the public to understand the kinds of very practical things they can do, and what we as governments or organizations are doing to try to address this. People understand it better now than they did three months ago, or six months ago, and I'm sure as we move into the fall it will do well.

It's amazing. I was asked earlier today about culture change, and it's really interesting when I go out now. I remember that when H5 was ongoing, we were talking about hand washing and everything, and it was rare that I'd see someone leave a washroom without washing their hands. And then suddenly we started drifting back. Well, now it's coming back again. When people are out there coughing in public, people are looking at them funny or asking them to leave. So I think this will bode well not just for our ability to reduce the impact of a pandemic, but also for a range of other infections.

Thank you.