Evidence of meeting #37 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was shortages.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Richard Chisholm  President, Canadian Anesthesiologists' Society
  • John Haggie  President, Canadian Medical Association
  • Gail Attara  Chair of Operations Committee, President and Chief Executive Officer, Gastrointestinal Society, Best Medicines Coalition
  • Suzanne Nurse  Representative, Best Medicines Coalition
  • Diane Lamarre  President, Ordre des pharmaciens du Québec
  • Myrella Roy  Executive Director, Canadian Society of Hospital Pharmacists

March 29th, 2012 / 10:05 a.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Thank you, Madam Chair.

I want to thank all the witnesses. Your comments are somewhat reassuring, but they also call for government involvement.

I was rather confused and concerned when Dr. Leitch said that the federal government had no responsibility regarding this issue, even though you all agree that it is a matter of public health. This morning on Radio-Canada, the Association médicale du Québec, Quebec's medical association, and the Fédération des médecins spécialistes du Québec, Quebec's federation of medical specialists, said that the federal government should get involved. All of you agree with that.

As has been said here, the regulations on drug safety, effectiveness and quality fall under federal jurisdiction. Suppliers must be approved, and that also comes under federal jurisdiction. It is being said that drugs are produced abroad and that shortages are an issue. I believe it was you, Ms. Lamarre, who said that, since 2006, shortages have quadrupled. The situation is serious. Something must be done. Patients are the ones caught in the middle of this.

I would like to know whether you feel that a security clause should be included in supply contracts to ensure that alternatives are always available. That echoes what the Canadian cancer association suggested before this committee last Tuesday. Ms. Attara talked about a Canada-wide guide for patients and doctors. That would make it possible to obtain the information in a consistent manner and to react to those issues.

I would first like to hear from Ms. Lamarre, and then from Ms. Attara.

10:05 a.m.

President, Ordre des pharmaciens du Québec

Diane Lamarre

Sandoz already has supply contracts with Canada's three biggest wholesalers. Unfortunately, it's become clear that was not enough to meet the needs. Our three conditions overlap to an extent. For instance, we will certainly want to protect essential painkillers like morphine and ensure access to a number of producers who will guarantee its availability. At the provincial level, in terms of group purchasing, penalties are already set out for cases where companies fail to supply the products. However, that does not seem to provide sufficient protection.

When it comes to drugs, we must also keep in mind the ripple effect, which very often forces us to obtain supplies abroad. For instance, when a specific painkiller is no longer available, we use another one. However, if the production of that other painkiller was planned to meet the needs of perhaps 50% of the market and not of the whole market, the result is a domino effect. That really makes us very vulnerable. It is a very important issue.

I agree that a security clause should be included, but I think it would have a limited effect as long as access to medications through two or three suppliers is not guaranteed and as long as a balanced rotation and allotment mechanism involving a certain number of distributors and producers is not implemented.

10:05 a.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

Thank you.

Ms. Attara, you talked about a guide for patients. That is what you are asking for.

10:05 a.m.

Chair of Operations Committee, President and Chief Executive Officer, Gastrointestinal Society, Best Medicines Coalition

Gail Attara

I think it's really important—again going back to the leadership—in that we really need to have some central kind of place where those reporting can be. We also absolutely need a safe supply of medications and whatever it takes to get there.

Even when I say leadership, I don't necessarily mean that it's regulatory, other than taking these meetings and going forward. I'm not saying what it has to be, but I'm saying that we need to come together, and who better to take the lead on it than the federal government, because it is a global situation, as we have clearly understood. I think it would be more challenging for provinces to negotiate on a global scale than it would be for the federal government to do it.

That's why, from our perspective as patients, we say it's really important that someone has to be the one to take the lead. And it is time; it's really time.

10:05 a.m.

NDP

Anne Minh-Thu Quach Beauharnois—Salaberry, QC

In Canada, there aren't necessarily any resource persons who deal specifically with shortages. However, the FDA has 11 employees who deal only with that. For instance, had Sandoz wanted to alert Health Canada....

10:10 a.m.

Conservative

The Chair Joy Smith

I'm sorry, Ms. Quach, if you have a timer in front of you I'm sure you know it's past five minutes.

Mr. Lizon.

10:10 a.m.

Conservative

Wladyslaw Lizon Mississauga East—Cooksville, ON

Thank you very much, Madam Chair.

Thank you, witnesses, for being here this morning. My question goes to the Canadian Anesthesiologists' Society. It was stated in the news that Minister Aglukkaq did not respond to your letter. We have a copy of the minister's response to your organization from September 7, 2011, explaining all the action she has taken to encourage the industry association to come up with their plan to share drug shortage information. I understand you sent out a follow-up letter just a couple of weeks ago, on March 6. I understand that the response to your letter is being drafted at the present time.

Do you not think that the minister and her department were busy 24/7 dealing with this drug shortage, trying to address the shortage on the ground, identifying suppliers and fast-tracking approvals so that patients get the medication they require? Can you comment on it?

10:10 a.m.

President, Canadian Anesthesiologists' Society

Dr. Richard Chisholm

When I wrote to Minister Aglukkaq in January I did receive a response to our letter in March. We didn't say in our brief that she did not reply. In fact we give credit to the initiative she has started, but unfortunately, despite that, where we are today with drug shortages is far greater than when we first started last year.

10:10 a.m.

Conservative

Wladyslaw Lizon Mississauga East—Cooksville, ON

As members of the committee stated several times today, and at the previous meeting, when we met with the drug manufacturers and associations, this is a provincial responsibility. The federal government does not negotiate contracts for medication, to purchase drugs. Even manufacturers stated that they have their own problems.

This will go to the comments made by Dr. Haggie. They stated they have problems even getting their components, some active components, for drugs. Of course, this is their own manufacturing issue. However, we have to realize that we are in a market situation on the supply and demand basis, and the fact that the provinces and territories decided on a single supplier...it's a very risky decision in any business. Any serious business that would rely on a single supplier has to be responsible for the risk associated with it. There are shortages of other supplies in the world that we don't know about and they don't involve patients. It is very important.

I don't think that even an executive order of the President of the United States of America will actually address drug shortages. This is a market issue, and unless the policies of the provinces and territories are changed, I don't think we're getting anywhere close to the solution.

Dr. Haggie, could you comment on this, please?

10:10 a.m.

President, Canadian Medical Association

Dr. John Haggie

I have a couple of things in no particular order. I think it's heartening that you seem to be getting to the bottom of some of big pharma's issues, or the pharmaceutical industries' issues with their processes. As I say, it's a black box to me, and I've tried to open that unsuccessfully.

I would take a slightly different view. Everyone at the moment is talking about team-based care and collaborative approaches for physicians and health care providers. I really think that what I'm seeing here is an example of the pot calling the kettle black. Really and honestly, you guys need to have a collaborative approach to health care. You can't just hive off a bit based on one interpretation of a piece of legislation that's 170 years old or more. You can try, but it really is not an edifying spectacle for the patients who don't have their medications. The bottom line, from the patient's point of view, is that drugs are not like gas, for example. Just imagine what would happen if we had rotating random shortages of gasoline in communities and how the response may differ from random rotating shortages of drugs. Drugs are different. Drugs have become an essential part of chronic disease management and acute disease management in a way that nobody ever envisaged when medicare was set up.

10:15 a.m.

Conservative

The Chair Joy Smith

Thank you, Dr. Haggie.

Now we'll go to Dr. Sellah.

10:15 a.m.

NDP

Djaouida Sellah Saint-Bruno—Saint-Hubert, QC

Thank you, Madam Chair.

I want to thank all the witnesses for joining us today to tell us more about this crisis. As I have said, unlike some of the colleagues from across the table, I am aware of a huge elephant in the room. For now, I am not looking to figure out who brought it in. What I am trying to do is address this pressing issue.

At this point, we can refer to it as a crisis, since this phenomenon has been around for a decade. However, it has been getting worse for the last few years. I think it's too bad that the government is not taking on a leadership role, that it is not adopting a proactive attitude to try to ease the current crisis.

I had already put the question to some of the witnesses who attended our hearings.

Do you think Canada should opt for a monitoring system and a mandatory—as opposed to voluntary—system of reporting, similar to what is in place in the neighbouring United States and in New Zealand?

10:15 a.m.

President, Ordre des pharmaciens du Québec

Diane Lamarre

We are convinced that a mandatory system is necessary, because there is the issue of the ability to respond to these shortages as well as the required response time. We are seeing that right now. Findings have been made. At the end of the day, the Sandoz case brings to light all the problems, all the causes and all the consequences. It is an unfortunate situation, but it still gives us an opportunity to learn and respond.

These considerations must be recognized. A mandatory system is needed, because every minute counts. Sandoz was notified in November, and the warning was issued in February. I am not trying to single out Sandoz, but I want it to serve as an example for us, just as health professionals would learn from a patient's case.

There was a three-month window when they could have responded. The lack of a mandatory requirement made us more vulnerable and put us at the mercy of others. Companies, even after they are given the go-ahead for production, take months to respond and adjust their production. That is key.

I have also seen that, on the American side, the FDA has managed not quite to eliminate all the shortages, but to reduce them dramatically. We are seeing that in 2010, a total of 38 shortages out of 178 were avoided. In 2011, some 195 shortages out of 250 were avoided. That is a meaningful improvement. In 2012, from January 1 to February 9, there were 18. That is significant.

We have to use these methods. We have a social responsibility toward Canadians to take all measures necessary. Various levels come into play. Certainly, there is the monitoring component and the obligation to report problems as soon as they are identified.

Sometimes, certain companies make choices. We can respect those choices, but they must be announced immediately. When you are dealing with situations that affect production increases—as in the case of Sandoz—warning must be given, and the manufacturer must have an obligation to alert authorities immediately.

10:15 a.m.

NDP

Djaouida Sellah Saint-Bruno—Saint-Hubert, QC

What concerns me is the fact that the FDA sounded the alarm on Sandoz, saying there were sanitation issues in its manufacturing facilities, but that Health Canada did not sound that alarm.

What can you say about that? Does the U.S. have more stringent standards than Canada?

10:15 a.m.

Chair of Operations Committee, President and Chief Executive Officer, Gastrointestinal Society, Best Medicines Coalition

Gail Attara

I have a bit of information about that.

What I understand from that situation is that this drug was for export only when they discovered a problem with it. It wasn't a drug that was used within Canada. So that company is making products that go outside Canada, when maybe a priority should be on getting drugs for Canadians, if they're manufactured in Canada.

I don't have a whole lot more information on that.

To your earlier point that while mandatory reporting could be a viable option—and I'm not totally sold that it has to be mandatory, but I might be able to be convinced—the other part of that is really the sole-sourcing issue. If you have competition and you have multiple sites, if one site comes under attack, it doesn't make sense from a practical point of view to have one source for anything.