Evidence of meeting #46 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was practice.
A recording is available from Parliament.
4:35 p.m.
Chief Public Health Officer, Public Health Agency of Canada
It must be. The rates were four to seven times....
Thank you, Sue. Monday marked the fifth week...I'm not sure how.... Anyway, don't mind me. I'm not sure what planet I'm on at the moment.
4:35 p.m.
Conservative
4:35 p.m.
Voices
Oh, oh!
4:35 p.m.
Chief Public Health Officer, Public Health Agency of Canada
It's all a blur.
Monday marked the fifth week since Canada's largest immunization campaign began. This week, almost 4.8 million doses will be distributed. That brings the total to over 15 million doses, enough to vaccinate close to half the population. We anticipate more than 5 million more doses next week.
In many provinces and territories, vaccine clinics have been opened to the general public. Our message to Canadians is that it is as important as ever to be immunized as soon as possible. By encouraging all Canadians to take the vaccine, we're aiming to lessen the impact of the current wave and then any further waves of activity. Even after a large second wave, many people at risk will not yet have been infected. They will remain susceptible to the virus, making subsequent waves possible, and our best protection then is to immunize. There will be enough vaccine for every Canadian who wants to receive it.
As I noted last week, since clinics have opened, the Public Health Agency, Health Canada, the collaboration of provinces and territories, the Canadian Paediatric Society, and a network of researchers have been actively monitoring serious events. All reports associated with the vaccine are received weekly from the provinces and territories and are investigated. The most frequent reported events are minor, including nausea, dizziness, headache, fever, vomiting, and injection site reactions. For anybody who has had this, many of us, certainly, end up with a sore arm for a few days.
We're seeing an increased interest in reporting and that is a very good sign that our surveillance system is working. The one recognized potentially serious adverse event is anaphylaxis, a serious severe allergic reaction. The reported rate of anaphylaxis is 0.32 per every 100,000 doses.
Immunization remains, then, our strongest line of defence. We have a safe and effective vaccine. Programs are rolling out across the country and they have the potential to make a strong impact on the way the virus behaves.
In communities where flu activity is still high, mass immunization can result in a more rapid levelling off of flu activity and an earlier and smaller peak. In communities where flu activity is levelling off or possibly decreasing, immunization is still effective in reducing the risk of severe disease and death.
Merci.
4:35 p.m.
Dr. Paul Gully Senior Medical Advisor, Department of Health
Thank you, Madam Chair. Of course, I'm always on the same planet as Dr. Butler-Jones.
Over the last two weeks we've seen that the rate of increase of influenza-like illness in first nations communities is levelling off, as per Canada as a whole. According to FluWatch, since the beginning of the second wave of the pandemic after August 30, aboriginal people represent 4.5% of hospitalizations, 6% of ICU admissions, and 7.8% of all deaths. This is a marked reduction in the level of severity from wave one, when aboriginal people represented 18% of hospitalized cases, compared with 4.5% now; 15% of ICU cases, compared with 6% now; and 12% of all deaths, compared with 7.8% now.
As aboriginal peoples in Canada account for approximately 3.6% of the Canadian population, the data to date certainly suggest an overrepresentation of the population in severe cases in wave two, but this is expected given the high proportion of aboriginal people with risk factors such as underlying chronic conditions, youth, pregnancy, and adverse socio-economic conditions.
First nations make up the bulk of hospitalizations of aboriginal people, 129 out of 152, with Métis and Inuit accounting for smaller numbers. A similar trend was observed for aboriginal cases admitted to ICU. The majority of cases, 29 out of 33, were first nations. Most of the deaths, 7 out of 10, were also first nations. It is important to note that this number includes not only first nations on-reserve, but first nations off-reserve.
Health Canada will continue to track H1N1 activity on-reserve, keeping in close contact with community nursing stations to watch for patterns of patient visits, the number of antiviral prescriptions, vaccine adverse events, and any required medical evacuations. This will allow us to work with first nations community leadership and provincial governments to respond as required to any community-level outbreaks.
In terms of immunization, uptake of H1N1 vaccine in first nations communities remains good, and clinics in first nations communities have been operating smoothly and effectively overall. We're nearly one month into the vaccination rollout; to date, approximately 99% of first nations communities have initiated immunization clinics, and we believe that those that have not have in fact ensured immunization in other communities. Over 193,000 doses of H1N1 vaccine have been administered on-reserve.
As a result of collaborative efforts, we've confirmed that at least 47% of on-reserve first nations populations have been vaccinated to date. The actual number will be higher once we receive complete up-to-date information.
As I mentioned last week, the virtual summit on H1N1 in first nations communities was held on November 10, and the webcast recording of it is still available for you if you wish to see it, on www.fnh1n1summit.ca, until the end of December. We continue to promote that website.
In addition, we've been taking other steps to implement the joint communications protocol on H1N1 signed with the Assembly of First Nations and Indian and Northern Affairs Canada. For example, the AFN is now participating in monthly ADM-level meetings with INAC and Health Canada to ensure timely updates on our joint plans and activities.
We also have been sharing our experiences and approaches more broadly. Yesterday evening, I participated in a call with government officials from Canada, Australia, and the U.S. to discuss international approaches to the management of H1N1 in indigenous populations. Further calls will be held that will be valuable in examining the influence of risk factors on indigenous populations as well as immunization programs. These communications activities build on our already strong collaborative working relationships to ensure that first nations communities receive the health services they need.
Since coming to Health Canada at the end of August, I've been very impressed by the level of collaboration shown between first nations, federal departments, and provincial governments. It has made a significant difference, I believe, in terms of outcomes, whether in terms of the completion and testing of pandemic plans or in the good progress to date in terms of uptake of H1N1 vaccine.
We're actively engaging with provincial colleagues and aboriginal partners at both the national and regional levels, including work under the pandemic coordination committee and the utilization of our formal tripartite planning tables in British Columbia and in Manitoba.
It should be noted that annex B of the Canadian pandemic influenza plan does go back to 2004 but was updated in 2008, a process involving the Public Health Agency, Health Canada, the provinces, and the Assembly of First Nations. I fully expect that this level of collaboration will continue as we move forward and begin to more closely examine the lessons learned from the current pandemic.
Thank you.
4:40 p.m.
Conservative
The Chair Conservative Joy Smith
Thank you, Dr. Gully.
We'll start now with our seven minutes of Qs and As.
Dr. Martin and Ms. Murray, you're sharing your time. Would you please watch very carefully that you don't go over? Because unfortunately sometimes the other partner doesn't get a chance to ask a question.
Thank you for doing that.
Dr. Martin.
4:40 p.m.
Liberal
Keith Martin Liberal Esquimalt—Juan de Fuca, BC
Thank you, Madam Chair. I'll share my time with Ms. Murray.
Thank you all for being here. This probably seems like old times for you once again.
I have three quick questions for Dr. Butler-Jones.
First, given what you've gone through in this entire process, what jurisdictional changes would you recommend to improve the rollout of a vaccine nationally when addressing a pandemic?
Second, are there any deleterious health effects from squalene in the adjuvanted vaccine?
Lastly, do we have enough stockpiled meds to keep patients intubated in the ICU in the case of a larger peak that may be forthcoming?
Thank you.
4:45 p.m.
Chief Public Health Officer, Public Health Agency of Canada
I'll address each question in turn.
In terms of jurisdiction, in a federated state I think each level of government has a role to play, and certainly for the federal government's role in terms of coordination, access to vaccine, antivirals, etc., I think that's very important. The delivery of public health is fundamentally a local activity. It needs to be coordinated at each level and the local jurisdictions are in the best position to actually do that.
We can facilitate and have certainly facilitated the sharing of information and of lessons learned, so that we've seen a major improvement in the clinics as we've moved forward. I'm not sure there's a jurisdictional issue there, since we're working well together.
In terms of vaccine and squalene, squalene itself is basically a fish oil with water and vitamin E. Other than increasing the risk of local side effects, we're not really seeing anything major related to the adjuvant other than the improvement of immunity, greater cross-protection, and a lower dose of the actual antigen being required.
In terms of antivirals as well as the medications in ICUs and in hospitals, hospitals in health regions across the country have been adding to their stockpiles, given the recognition in the spring of the kinds of medications that we need for these patients given the complexity of their disease, which they don't typically see with influenza. Some of the medications they would not normally use as much of, they went through very quickly, particularly in Manitoba, which was very hard hit. Each jurisdiction has added to its stockpiles of those.
As well, we have added them to the national emergency stockpile, with backup to the provinces and territories. We should be in a good position going forward. As we're now seeing 25% to 30% of the general population having been immunized, as well as much higher rates in the north and remote communities, rates of 50% to 60% or more, we should be getting well ahead of this over the next month.
4:45 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
Thank you, Madam Chair.
Welcome back.
In the past I've raised the issue of Vancouver Coastal Health's plan to address the 2010 Vancouver Olympics in terms of preparedness for H1N1. We have, plus or minus, half a million people coming to Vancouver. They'll be descending on our city through airports, largely, and crowds and gatherings will be the norm.
When I last spoke with the health authorities, there were no additional resources from the federal government to help them carry out their plan. I'm advised that it's a good plan, a comprehensive one, but there has been no help with resourcing. That's unprecedented in a mass vaccination program coordinated from the federal government.
Given that we have 79 days left until the 2010 winter games begin, has that changed? Are resources now being provided to help implement the plan? As well, what specifically has the federal government done to address the public health challenges posed by the 2010 winter games?
Really what I want to know is this: what assurance can the chief public health officer give to Canadians that Vancouver is on track to host the world in a safe, secure environment that's not at risk of being a ground zero for a resurgent H1N1 pandemic?
Thank you.
4:45 p.m.
Chief Public Health Officer, Public Health Agency of Canada
From a public health standpoint, I think we're in good shape. We've just gone through “Exercise Gold”, and have a series of other exercises that involve both federal-level as well as provincial- and regional-level people. We will be placing a number of resources there in terms of support locally around enhanced diagnostics, etc.
We've been involved very closely, obviously, with BCCDC and B.C. around how things will be managed. Whether it's a half-million people in Vancouver for that or for other major events across the country, it is something that the local authorities address, the province supports, and generally we federally support the provinces in addressing those issues. We bring specific expertise in addition to the support we provide.
As you know, BCCDC is an extremely competent organization, with good capacity, and the local health authority can address that. On the issue of specific staff, etc., depending on the issue, every jurisdiction really plans for that and addresses the needs accordingly. First their approach would be to the province, and then, if the province needs support, we can provide support to the province. That's normally how it works, whether it's an event like this, the Pan-American Games in Winnipeg, or some other major event--even the increasing tourism in the summertime.
That's all part of the planning, and the way in which we deal with outbreaks is being reviewed with VANOC and other levels of government, including other departments of government that have an interest in everything from the outbreak of infectious diseases to the potential for other events that need to be addressed. It's quite a comprehensive plan.
4:50 p.m.
Liberal
Joyce Murray Liberal Vancouver Quadra, BC
I guess what I'm struggling to identify is whether there are actually funds in place to help ensure that this plan is able to be rolled out appropriately. These are Canada's games. Vancouver will have an influx of people from around the world and the rest of Canada, and I do see a strong logic for the federal government to assist in financing the H1N1 plan.
The reassurances that--
4:50 p.m.
Conservative
The Chair Conservative Joy Smith
I'm so sorry, Ms. Murray, but your time is over.
Dr. Butler-Jones, can you just make a comment on that?
4:50 p.m.
Chief Public Health Officer, Public Health Agency of Canada
Yes, I'll speak to that.
There is a whole range of levels. If you're talking about public health nursing services, or surge capacity in services, we are part of that. In terms of money, I mean, I've not seen a request, and it's not appropriate to come to me from the local health authority. The local health authority is there to deal with it in conjunction with the province. We are providing support to the province. How that gets addressed and allocated, based on....
It's the same thing for any other event, any other games, whether it's in Quebec or Nova Scotia or anywhere else. If it is a local activity, they identify what they need. Ideally what we expect is that the vast majority of Canadians will be immunized. That's our best protection no matter where we are in the country, whether we're visiting the games or staying at home and watching them on TV.
4:50 p.m.
Bloc
Nicolas Dufour Bloc Repentigny, QC
Thank you very much, Mr. Chair.
I would like to thank our intrepid witnesses who have been coming to meet with us week after week.
Mr. Butler-Jones, in a press conference recently, you mentioned that the provinces are presently tallying up the costs of the H1N1 pandemic. The government has a pandemic plan and has set aside about $400 million for situations like this.
Does the federal government intend to provide provincial governments with the money set aside for pandemics, since it is the provinces that pay the hospitalization costs for this disease?
4:50 p.m.
Chief Public Health Officer, Public Health Agency of Canada
Health is a provincial responsibility. The federal government has paid for anti-viral vaccines and for the preparation of plans at both federal and provincial levels. We have cost-shared. It was very important for the federal government to participate in that way because the whole country is facing this challenge.
I do not know how much this epidemic will end up costing the provinces, or whether the costs will be different from any other epidemic of seasonal flu. It may be that, after the vaccinations, we will find that the cost of this pandemic was less than the cost of a seasonal flu. We are committed to discussing various aspects of the pandemic afterwards, including the costs.
4:55 p.m.
Bloc
Nicolas Dufour Bloc Repentigny, QC
If the cost is lower, the provinces will be paying the bills without any federal help. If this epidemic costs less than normal flu, there will be no assistance. That is how I understand it.
4:55 p.m.
Chief Public Health Officer, Public Health Agency of Canada
To date, we have invested a considerable amount of money, more than $1 billion for the vaccine, the preparations, and so on. All provinces and territories decided to deal with the pandemic first and to gather all the facts, costs and other details afterwards. The decision will be made when the pandemic is over.
4:55 p.m.
Bloc
Nicolas Dufour Bloc Repentigny, QC
Last week, there was an announcement that, after examining people who had died from H1N1 flu in Norway, it was found that the virus has mutated. I am going to ask you three quick questions.
Have we seen that mutation in Canada? Can you confirm whether the virus has mutated or whether the virus that is presently going around is a new strain? Is Canada ready for a mutated form of the virus that is resistant to anti-virals and the GSK vaccines?
4:55 p.m.
Chief Public Health Officer, Public Health Agency of Canada
Those are good questions. The change seen in the virus in Norway is similar to what has happened in six other countries. This is not a form of the virus that is normally found in the population. The virus is always changing; there is always a risk of it mutating. We are seeing it, but it is not causing us great concern at the moment, unlike in previous weeks.
In Canada, there is some protection because most vaccines contain an adjuvant and an adjuvanted vaccine helps to prevent the spread of the virus. This is a good thing for us. We are on the lookout, and we have seen a similar virus in Canada, but it has not infected other people. There is perhaps a risk of it spreading in a group of people, in a family, for example, but there are no more serious risks of infecting others.
4:55 p.m.
Bloc
Nicolas Dufour Bloc Repentigny, QC
No tests have been done on people who have had the virus in Canada in order to determine if a mutation has taken place?
4:55 p.m.
Chief Public Health Officer, Public Health Agency of Canada
A mutation has taken place, but not into a form of the virus that can spread to the population. Sometimes, we have seen the virus passed on. It is important for us to watch for occurrences of that kind, but they only become significant if the virus changes and starts to spread into the population.
4:55 p.m.
Bloc