Health Committee on Aug. 12th, 2009

[Leona Aglukkaq, Conservative, Nunavut, NU]

We have two months' time to develop the guidelines for that, and the vaccine will be ready in the fall.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I have one last question on prioritization—

[The Chair, Conservative, Joy Smith]

Thank you.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to start by personally thanking the minister for being here today and really explaining. I think Canadians are pleased to know that our government took a proactive approach to this back in 2006, to put that $1 billion aside, and that we're far advanced compared to other countries in the world.

I know you came from a system of consensus and collaboration, so I think you're well positioned to deal with this situation, and I want to thank you for your approach. I too have been watching the media and I'm a little disappointed with the trend to play politics here on such an important issue, because I think Canadians expect all public officials to work together.

I want to thank you for taking a leadership role in that regard, because when I was on the health committee before in opposition, I was never offered departmental briefings. I never had access to a minister in the way you've made yourself accessible. I really appreciate the fact that you've had those 20 briefings with opposition members. I think that's totally unprecedented. As well, with over 20 press conferences, again I think that's totally unprecedented.

So thank you very much for your approach in this very serious matter and for working together with all levels of government so that we can implement this plan and adapt the plan as it moves forward. That's what I want to ask you about.

We've learned a lot since the spring. I wonder if you could let Canadians know what lessons we have learned from the spring and how this is going to shape our planning for the fall.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that.

Overall, I think Canada's experience of the first wave of H1N1 highlighted that while we may have had strong pandemic plans in place, we can always continue to improve our ability to apply those plans in real time and look at gaps that may exist. The challenge has been in implementing the plan as we learn about H1N1. We didn't know anything about H1N1 until April, so as we learned about the virus, we needed to respond accordingly with the provinces and territories, and to communicate that in real time with provinces and territories to respond, and we will continue to do that. I think we've learned over the first few months that, come fall, that will be essential to how we respond. We don't know the kind of severity of cases we will be seeing, and so on, so that will require us to be vigilant and continue along that path.

With the other jurisdictions, other countries, involved, we recognize that it's an issue that sees no boundaries and we need to respond accordingly as provinces and territories. Cooperation is key, communication is essential. We've also learned that we need to work very closely with Mexico, with the United States, and the WHO, in how we plan. It's not only a plan within Canada. Public health officials have been working very hard, and I've had meetings with the United States as well as the Mexican health ministries, simply in terms of how we will plan for the fall and how we can better position ourselves.

This is ongoing work that we need to do, the assessments and evaluations in terms of how we're responding. We're learning from other countries in terms of their vaccine development, and that will help us make the best decision in real time about who requires the H1N1 vaccine, when, and so on. The information and the time we have over this summer are essential in getting the necessary and the best information, based on real cases and situations that we face in our country, to prepare for the fall.

We have to enhance our surveillance systems come fall. That communication strategy will become essential, and again, that involves provinces and territories. There are many stakeholders involved, such as the municipalities, and it takes a lot of coordination; there are many agencies involved to prepare. It's not one agency's responsibility. We as individuals have a role as well, to communicate with our families and friends and so on, but in order to allow Canadians to make the best decisions with the best information we have at the time, it is going to be essential for them to make informed decisions on how they can prevent the spread of H1N1 and so on.

I don't know if that answers the question. You may want to elaborate a bit more.

[Dr. David Butler-Jones]

I'll simply give you a couple of quick, simple examples. When we ran the operations centre, traditionally we would use directors general, senior officials, experts in their field, and what we found is that we really needed them managing their part of the department as opposed to managing the outbreak. So we're in the process of training other people to do that.

At the provincial level, people recognize that.... We assume that hospitals, because there have been guidelines for years on how to manage respiratory cases...and suddenly because it's H1N1, they look to Public Health and say, “Tell us how to do this.” Well, you're the respiratory specialist, so apply what you already know. It's no different from that. Again, we've been able to take some of those lessons and apply them as we move forward. Some of them are very basic and simple like those; some are bigger in terms of making sure we've got the right connections, because even when we assume people know where to look or what they have, it requires constant reminding.

[Colin Carrie, Conservative, Oshawa, ON]

Dr. Butler-Jones, as we're learning here, it sounds as if you're getting, as you said, the information in and information out. It looks like you're able to get that information in, make a decision, and get that information out.

Because we did mention different comments in the media and I heard that somebody in the media mentioned that you may be muzzled by the government, I was wondering if you could comment. Speak freely. We're in committee here, and could you let us know, number one, if you feel that you're being muzzled in any way in your decision-making process? And would you let Canadians know how you have found the process so far?

[Dr. David Butler-Jones]

I guess the thing I want to say particularly about that is that I've always felt the only thing that's truly mine is my integrity. It's something I will guard forever. Those who have worked with me at all levels of government in other things know that on things that really matter, I'm not easily muzzled. I'm open to suggestion, open to conversation. We've always had those kinds of discussions about what's important and what isn't. It's important for me to have every perspective possible in doing that, but then at the end of the day, for what I'm responsible, I have to make that decision.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

I understand, Minister, that you had an hour to give to us and that you have other meetings lined up and you now have to depart the meeting. I want to thank you once again so much. I know Dr. Butler-Jones will be remaining for additional questions, but I want to thank you so much for joining us today. We all appreciate it, as a committee.

We'll give you some time to depart, and then we'll go on with the questions.

We'll be going into a second round of five-minute questions, starting with Dr. Duncan. Perhaps we'll get right into it so we don't lose any time.

Dr. Duncan.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I have a point of order, Madam Chair.

We were not made aware that the minister was only going to be here for one hour. Some of the most serious concerns we have are about our aboriginal people, which is not the responsibility of Dr. David Butler-Jones or, with due respect, Shelagh Jane Woods. The responsibility for aboriginal people is a direct responsibility of the Government of Canada, and I am very disappointed that the minister is leaving now.

First, I don't think an hour is enough to deal with this, period, and I don't know what the minister's going to that's more important than this. But secondly, if indeed there was some pressing thing she had to go to, we needed to be advised of that. We would have reorganized our questions. This is unacceptable, and I hope that we will right now commit to a full meeting on the state of our aboriginal peoples, with the minister present, as early as next week.

And it is unsatisfactory for us to be treated like this, as parliamentarians, for one of the most important reasons we called this meeting. With the experience that my colleagues have had on reserves across the country, meeting with aboriginal leaders, being at the Assembly of First Nations meeting--we were all there--we have huge concerns, and that was to be the second and third line of questioning for us.

I am extraordinarily disappointed that you, Madam Chair, did not make us aware of that at the beginning of this meeting. Parliamentary committees decide this themselves. This is unacceptable, and I hope that—

[The Chair, Conservative, Joy Smith]

Dr. Bennett, just one moment. This is not a point of order. I think clearly this—

[Carolyn Bennett, Liberal, St. Paul's, ON]

It is point of order. Why is the minister going to leave?

[The Chair, Conservative, Joy Smith]

Dr. Bennett, you're out of order, and I'll suspend the meeting if you don't allow it to go on.

I'm just saying, quite categorically, that everyone here was very interested, showed up today, made sure we were here, when the members called for this very important meeting. The minister herself cut short what she was doing to make sure she was present at this committee meeting today. This is a very important issue, and Dr. Butler-Jones, who works in very close collaboration with the minister, is remaining for another half hour.

I think we all agree that this is an extremely important issue that needs to be discussed at this committee, and I don't think it's appropriate to continue in this manner when we have this very important issue to discuss today.

Minister, thank you for coming today. I know you do have to go.

We're going to go into the second round—

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I have a point of order.

[The Chair, Conservative, Joy Smith]

This wasn't a point of order, and I'm not going to entertain something that isn't, Ms. Wasylycia-Leis.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

I have a point of order.

Yes, I would like, since the minister has to go—

[The Chair, Conservative, Joy Smith]

Yes, she does.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

—just to ask for her to come back to us with some information pertaining to the scientific and serious evidence that suggests first nations people are actually being affected more seriously than others, and in an acute way, by H1N1. We would like to know very clearly what the government's plan is for dealing with the fact that first nations people and Inuit people are more seriously affected by this flu than others.

[The Chair, Conservative, Joy Smith]

Thank you for that suggestion. I will ask for a written response and get back to the committee on it.

We're going to be going into our second round now of five-minute questions and answers.

Thank you once again, Minister, for being for so kind for being here.

Let's begin with Dr. Bennett.

Did you have a comment, Minister? Go ahead.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you for that.

Just quickly, I am prepared to have a discussion in regards to first nations and Inuit health at any time. I come from an Inuit community, if you want to call it that, one of the 25 isolated communities in Nunavut territory. We also have officials here who work very closely with the provinces and the territories in regards to the delivery of health care.

As I said in my earlier comments, first nations health in every jurisdiction is a shared responsibility, because once you leave the community and work in a hospital, it is a provincial responsibility, so it is a matter of cooperation. I'm prepared to have a discussion on that, and the staff here have worked very closely with first nations communities. I will also be meeting with the new chief in regards to planning for the fall, communication and so on.

But in terms of my territory of Nunavut and the plans there, where 85% of the Inuit live, Dr. Butler-Jones was also just up in the territory and he can speak to that as well. If there are questions at a later date, I'm prepared to have a conversation in regards to that. I'm open to that.

At the same time, in regards to the science and information we're studying this summer, it will help us understand the question Ms. Wasylycia-Leis raised. These are things that can be responded to by Dr. Butler-Jones.

I want to thank the committee members for your time today, and I'll leave it at that.

[Dr. David Butler-Jones]

Madam Chair, if I may, just to add to that in terms of the request and the science, it's still very early to tell whether or not that is true, and if so, for what reasons, because we're not seeing that in other aboriginal communities.

To what extent what was experienced in northern Manitoba was a function of this being early in the outbreak and therefore being a little slower to come to the fore as opposed to other communities; whether it is a matter of underlying risk factors that we know put people at greater risk of severe disease, such as diabetes, chronic lung disease, smoking, obesity, pregnancy, etc.; or whether in fact it was in any way a genetic basis, we don't know, and it will take some time to figure that out. There won't be a quick answer to that.

Certainly in the Inuit communities we have seen less severe disease. In fact, there've been very few medivacs, very few hospitalizations, relative to the number of people affected. We don't know all of the answers to that, but what I can say is that we are focusing on it very carefully--the Public Health Agency, FNIHB, and the provinces and territories--and have a committee looking specifically at the issues of remote communities and how we need to adapt and address issues there.

So it doesn't matter what your ethnic background is; if you are at risk, we need to be able to address these issues. People need to be assured that for vaccinations and treatment with antivirals, we have plans in place to actually address those and then to respond when people are severely ill—if that happens to them.

[The Chair, Conservative, Joy Smith]

Thank you so much.

I wish all of us could work together very collaboratively on this particular issue, because I know your concern, Minister, and everybody's concern that it's of paramount importance. So the committee just wants to make sure they have all bases covered.

Thank you for your gracious reply.

Dr. Butler-Jones, I know you'll remain for some more questions. I know Dr. Duncan is up next. Perhaps she would like to ask some of those questions.

Thank you very much, Minister. I'm sorry you were a little delayed.

We will now go into the five-minute round; that's five minutes for questions and answers. We'll start with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you to the officials for coming.

I really want to stress at the beginning that it was not partisan politics to bring this committee back. We have a window of unprecedented opportunity to prepare for a pandemic, to reduce the economic and social impacts, the cases, hospitalizations, and deaths. We don't know what the fall will bring. We have to be prepared, and preparedness is our insurance policy.

I have many concerns. Back in June, I put close to 35 questions on the order paper, one question with 35 parts. Dr. Bennett and I submitted a letter with 17 questions to the first nations and Inuit health branch on June 16. We are still waiting for the answers to those questions. Dr. Bennett did an open letter to the minister, and she is still waiting for that information. There needs to be a real dialogue with Canadians, providing real information, without being alarmist.

For example, when do you seek urgent care and when do you not need to worry? People need to remain vigilant, but that's just a word. What does “vigilant” mean? Have we looked at the communication among stakeholders? What was the public awareness, degree of concern, complacency? We need to encourage our communities and vulnerable populations to be prepared.

We have been in first nations communities. We were in a community five minutes away from a community that was beautifully prepared, and they really hadn't started their planning. They didn't even know that they could order supplies. We know now that there is going to be help with business planning.

My real concern, though, is a possible gap, a gap between when vaccines might be ready, mid-November, and if this was to start earlier in the fall. So my question will be around vaccines. First of all, why do we have to wait until mid-November? And the second part of that is, what are we going to do in the meantime should this hit earlier?

Thank you.

[The Chair, Conservative, Joy Smith]

Dr. Butler-Jones.

[Dr. David Butler-Jones]

I assume that question was meant to come to me, and certainly on the questions, we had thought—and apologies there—that through the regular briefings and the opportunity to answer questions they were being answered. A formal response obviously is something you want, so that will come. I'm not sure about the 35 questions on the order paper, but we'll make sure that you get the answers to all of your questions shortly.

On the issue of the vaccine, mid-November is when we anticipate everything having been done—the regulator being happy, the trials having been done, etc.—so that we can actually commence immunization. By that time, if all goes as we expect it will, we will actually have in hand between 15 million and 20 million doses already in vials, ready to immunize people, unlike anybody else in the world.