House of Commons Hansard #69 of the 40th Parliament, 2nd Session. (The original version is on Parliament's site.) The word of the day was going.

Topics

Sri Lanka
Petitions
Routine Proceedings

12:10 p.m.

Liberal

Derek Lee Scarborough—Rouge River, ON

Madam Speaker, I have a petition from over 100 residents of the area I represent in Scarborough.

The petitioners bring the attention of the House to the plight of many thousands of displaced Sri Lankan persons in camps in northern Sri Lanka following the civil war there. Many of those displaced persons are now contained in camps surrounded by military and barbed wire.

They urge the Government of Canada to bring every diplomatic means to bear to assure that aid is delivered to these people and that they are assured appropriate human rights.

Questions on the Order Paper
Routine Proceedings

12:10 p.m.

Regina—Lumsden—Lake Centre
Saskatchewan

Conservative

Tom Lukiwski Parliamentary Secretary to the Leader of the Government in the House of Commons

Madam Speaker, the following questions will be answered today: Nos. 138 and 142.

Question No. 138
Questions on the Order Paper
Routine Proceedings

12:10 p.m.

Liberal

John McKay Scarborough—Guildwood, ON

With respect to Canadians with diabetes who suffer severe and life-threatening adverse reactions to synthetic insulin and are unable to obtain domestically, an alternative animal-based insulin: (a) what actions has Health Canada taken or will take to ensure that Canadians who require such medication will continue to have access to it; (b) is the government (i) investigating methods of producing the medication via public funds or public-private partnership, (ii) initiating a process seeking approval of the drug for domestic production and distribution, (iii) initiating a consultation process with the manufacturers of animal insulin seeking domestic production and distribution, (iv) providing incentives to manufacturers to produce animal insulin domestically, (v) securing a guarantee from the manufacturer that the drug will be permanently available, (vi) stockpiling the medication to ensure near-term supply; (c) what has Health Canada done or what will it do to ensure that these Canadians receive financial assistance due to high costs as a result of provincial health insurance plans not covering certain medications or treatments;(d) what action has Health Canada taken or will take to ensure (i) that people who suffer negative effects from synthetic insulin are aware of and have access to proper treatment as well as expanded choice in treatment options, (ii) that medical professionals who are responsible for treating Canadians with diabetes are aware of the availability of alternative forms of medication such as beef and pork based insulin; (e) what action has Health Canada taken or will take to ascertain how many Canadians suffer adverse reactions from synthetic insulin; (f) has Health Canada investigated or will be investigating the implementation of a protocol to address this issue, if not, why have steps not been taken to address this issue; and (g) does the lack of the availability of this type of medically necessary treatment represent a barrier to equal access to healthcare services and, if so, what steps has Health Canada taken or will take towards addressing this situation?

Question No. 138
Questions on the Order Paper
Routine Proceedings

12:10 p.m.

Nunavut
Nunavut

Conservative

Leona Aglukkaq Minister of Health

Mr. Speaker, in regard to a) Health Canada has been working continuously for the past years to implement a multi-pronged approach to resolving the issues around the availability of animal insulin (beef and pork). Health Canada believes that it is important to have a variety of choices for treatment in order to provide the optimal care to all patients, as much as possible.

In regard to b) Since there are no longer any domestic manufacturers of animal insulin (beef or pork), Health Canada has approached several manufacturers of animal insulin abroad, in England, Argentina and Poland. Of these, only one filed information required to market insulin of animal origin. Also, this same manufacturer, Wockhardt, although producing both pork and beef insulin for domestic use, has refused to file for the marketing of beef insulin in Canada. Similarly, two other manufacturers of insulin from abroad, have declined to file for authorization to market their insulin, be it pork or beef. Despite having discussed Canadian requirements with two of the three manufacturers noted above, and despite the fact that these manufacturers were made aware of the potential for some financial incentives, including the reduction (even to zero) of fees charged for the review of therapeutic products, they indicated that unless there is a sufficiently large market, none of the incentives offered were of interest to them.

Health Canada does not have the authority to compel manufacturers to file a submission for a therapeutic product. Similarly, incentives other than the regulatory ones, would place Health Canada in a conflict of interest.

Furthermore, Health Canada does not have the legal authority to secure guarantees for continued insulin supply. Stockpiling of insulin is outside the scope of the mandate except for situations of emergency, such as Pandemic flu.

However, Health Canada does make beef insulin available via the special access programme for those who require it. There is a small number of patients who avail themselves of special access programme.

In regard to c) The federal government provides significant funds to ensure the sustainability of the whole health care system; the administration and delivery of health care, including drug coverage, is a provincial and territorial responsibility.

Under the Canada Health Act, all medically necessary drugs when administered in hospital must be insured by provincial and territorial health insurance plans. Prescription drugs provided outside of hospital are outside of the scope of the Act and therefore, provincial and territorial governments determine, at their own discretion, whether, and under what terms and conditions, to publicly finance prescription drugs. As to catastrophic drug coverage, i.e., coverage for high out-of-pocket drug costs relative to income, most jurisdictions, including Ontario (the Trillium Drug Plan), already offer a form of catastrophic drug coverage to their residents. As well, most jurisdictions (Ontario included) have, for persons who are eligible for coverage, exceptional access programs for drugs not listed on their benefit formularies.

Pursuant to the 2004 Health Accord, the federal government committed to providing an additional $41.3 billion over 10 years to provinces and territories in support of strengthening health care, including pharmaceuticals management. These monies are provided through the legislated Canada Health Transfer, which grows by six per cent annually and will reach $24 billion this year. How jurisdictions use these funds is their decision, but these funds can help provinces with the costs of their drug plans, including catastrophic coverage. Several jurisdictions (Saskatchewan, Nova Scotia, and Newfoundland and Labrador) have recently expanded drug coverage for their populations, and Health Canada welcomes such initiatives.

As part of the same accord, the federal government agreed to a shared agenda with provinces and territories to improve the collective management of pharmaceuticals, recognizing the complementary roles (federal responsibilities include regulating market access and patented drug prices, and post-market drug surveillance). The government continues to welcome opportunities for meaningful collaboration on pharmaceutical issues to realize efficiencies in the health care system, so that public resources can be used most effectively.

In regard to d)i) Health Canada convened an expert panel to examine the clinical/medical facets of the issues surrounding the usage and availability of animal insulin. The panel has recognized that there is a medical aspect to the question of animal vs biosynthetic insulin. The report of the panel has been submitted to Health Canada and it will be studied in order to develop an action plan for implementation of the recommendations in the report.

In regard to d)ii) Health Canada is preparing a plan for educational materials to ensure that the medical community is fully aware of the issues surrounding the use of animal vs biosynthetic insulin. The plan will be finalized in conjunction with the action plan following the recommendations of the expert panel on animal insulin.

If a manufacturer or potential manufacturer approaches Health Canada, it will ensure that such a sponsor can file a submission to market animal insulin, be it pork or beef, in the shortest possible time.

In regard to e) Health Canada regularly reviews safety data concerning insulins submitted by market authorization holders and adverse reactions submitted to the marketed health product directorate’s Canada vigilance database. The safety data submitted by market authorization holders and adverse reactions reports in the Canada Vigilance database are regularly reviewed to ensure that all insulins on the market remain safe for human use.

In regard to f) As indicated above, Health Canada is reviewing recommendations from an expert panel formed to address the issue of animal versus biosynthetic insulins. Educational materials are also being prepared to raise awareness of the medical community on this issue.

In regard to g) Under the Canada Health Act, the provinces and territories are required to extend provincial and territorial health insurance plan coverage to their residents for medically necessary hospital and physician services. For services that are outside the scope of the act, including prescription drug benefits, coverage is at the discretion of the individual provinces and territories, on their own terms and conditions.

Question No. 142
Questions on the Order Paper
Routine Proceedings

12:10 p.m.

Liberal

Carolyn Bennett St. Paul's, ON

What is the government’s strategy to protect Canada’s drug supply in face of the United States’ increasing demand for discount drugs?

Question No. 142
Questions on the Order Paper
Routine Proceedings

12:10 p.m.

Nunavut
Nunavut

Conservative

Leona Aglukkaq Minister of Health

Mr. Speaker, recent data indicate that sales to the U.S. have decreased significantly from their 2004 peak. While there are initiatives underway in the U.S. that may potentially increase the volume of sales in the future, these are not yet in effect or finalized. Pre-emptive action is not required at this time, and it would be more prudent to assess the final version of any U.S. initiative before making a determination on a course of action.

Cross-border drug sales, CBDS, have been occurring for some time now, via both “foot traffic” and mail order. Health Canada has monitored CBDS levels and U.S. legislative activity in this regard since approximately 2002, assessing potential risks to Canada's drug supply. CBDS from Canada to the U.S. via mail order rose steadily from the beginning of 2000 until it peaked in 2004 at approximately $850M. Latest estimates of annual mail-order sales are about $173M, approximately 20% of the 2004 peak. Primary factors explaining the decline include: the implementation of U.S. Medicare Part D (seniors’ prescription drug benefit); supply restrictions to Canadian-based Internet pharmacies by the drug industry; and the surge (until recently) in the value of the Canadian dollar (relative to its 2003-2004 value).

Foot traffic, which existed prior to Internet commerce, remained steady at approximately $500M annually from 2004 to 2008. While the same factors as listed above would be expected to have reduced foot traffic, more recent data are not available.

Recent events in the U.S., such as the newly re-introduced bill seeking to legalize the bulk import of drugs, may have the potential to increase American demand for Canadian drugs if implemented successfully. The primary concern from some stakeholders has been with the potential impact on the Canadian drug supply and prices. This has led to renewed calls for possible Government of Canada interventions that could be used to address future drug supply issues in Canada. However, export prohibitions at this time are not consistent with Canada’s international trade obligations unless they fit within recognized exceptions, namely to protect human health or to prevent/relieve critical shortages.

This Government is committed to the health and safety of Canadians and would explore all available options in the event that Canadian supplies were jeopardized. Even if the U.S. legalizes bulk imports, actual implementation would take longer than a year, allowing time to prepare for any concern with the potential impact of bulk imports.

Health Canada officials, in co-operation with their colleagues at the Canadian Embassy in Washington, continue to monitor the export of drugs to the U.S., as well as the progress of U.S. legislation. Current CBDS levels, which are actually declining, do not warrant government intervention. As the American initiatives pass through the U.S. legislative process and evolve, Government of Canada officials will continue to assess them and formulate appropriate policy responses based on those assessments.

Questions Passed as Orders for Returns
Routine Proceedings

12:10 p.m.

Regina—Lumsden—Lake Centre
Saskatchewan

Conservative

Tom Lukiwski Parliamentary Secretary to the Leader of the Government in the House of Commons

Madam Speaker, if Questions Nos. 132, 141, 143 and 148 could be made orders for return, these returns would be tabled immediately.

Questions Passed as Orders for Returns
Routine Proceedings

12:10 p.m.

NDP

The Acting Speaker Denise Savoie

Is that agreed?

Questions Passed as Orders for Returns
Routine Proceedings

12:10 p.m.

Some hon. members

Agreed.

Question No. 132
Questions Passed as Orders for Returns
Routine Proceedings

12:10 p.m.

Liberal

Rob Oliphant Don Valley West, ON

With respect to the new United States Department of Agriculture’s Animal and Plant Health Inspection Service’s (APHIS) user fee requirements for Canada: (a) what did the government do, if anything, to negotiate this fee change with the United States; (b) what communications occurred between Canada and the United States in preparation for this fee change; (c) what notice, if any, was provided to Canadian railway companies by the United States government of the August 25, 2007 interim rule authorizing APHIS to collect fees to cover costs for agricultural quarantine, inspection as well as planned increases to the program’s inspection capacity related to ports of entry in Canada; (d) does the Government of Canada know why the exemption removal was issued by the United States government, as an interim rule, as opposed to publishing a proposed rule for comments; (e) why was the targeted risk management model for customs reforms in North America not followed; (f) what overall purpose did the additional inspection under the APHIS proposal demonstrate; and (g) why is this fee being imposed on railway companies seeing as railways do not engage in the shipping of any substantial quantities of agricultural products across the border?

(Return tabled)

Question No. 141
Questions Passed as Orders for Returns
Routine Proceedings

12:10 p.m.

Liberal

Carolyn Bennett St. Paul's, ON

With respect to tobacco: (a) what is the government’s strategy to combat the illegal cigarette trade and ensure tobacco control; and (b) what has the government done to follow through on the September 17, 2008 commitment to ban flavoured tobacco products that appeal to children and ban tobacco advertising in print and electronic media that can be seen and read by our youth?

(Return tabled)

Question No. 143
Questions Passed as Orders for Returns
Routine Proceedings

12:10 p.m.

Liberal

Francis Scarpaleggia Lac-Saint-Louis, QC

With regard to aquifers in Canada: (a) what percentage of Canada’s groundwater has been mapped by the government; (b) what percentage of Canada’s groundwater has been mapped by the provincial and territorial governments; (c) how much has the Canadian government spent, directly or indirectly, on groundwater mapping in each of the last ten years; (d) how much have each of the provinces and territories spent on groundwater in each of the last ten years; (e) is all federal groundwater mapping done by the Canadian Geological Survey, if not, to whom is third-party groundwater mapping contracted out; and (f) do provinces and territories share the data they collect on groundwater mapping with the federal government?

(Return tabled)