Foreign Affairs Committee on June 4th, 2015

[Andrea Lucard]

That is a really excellent question. Enough? I would say it's not enough. One of the ways that MMV in particular is dealing with this is that we've essentially developed what amounts to a mentoring system. We're finding that there are some really excellent laboratories all around the world, including in endemic countries.

However, what they frequently don't have is experience in drug development. While you can do early stage research, moving from early stage research into drug development needs the mentoring of those people who have been working in this field.

MMV is doing that. In fact, we have open source malaria box, where we're providing compounds and actual mentoring and expertise to help move these kinds of things forward.

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Are countries like Canada sending drug development skills there or bringing the research skills here from those countries to collaborate on that?

[Andrea Lucard]

The way that we've worked it.... Actually, MMV has shipped compounds to Canada for Canada to test.

At MMV, we have an expert scientific advisory committee. It's made up of drug experts from around the world. We have taken that expertise, and as we find compounds that are useful, we essentially direct that mentoring and drug development experience into the most promising compounds. Whether that's people coming in or going out, it's essentially a virtual drug development that we do hand in hand with them.

Does that answer your question?

[Laurie Hawn, Conservative, Edmonton Centre, AB]

Yes, thank you.

Senator, with regard to the experience of Cameroon, you talked about basically half of the population being protected by nets and so on. How does that compare with other countries in your region that you're aware of? You obviously cooperate and collaborate with them and share information with them.

[Pierre Flambeau Ngayap]

Experts in analysis on a global scale, like Hervé, will be able to corroborate my remarks. As I said earlier, Cameroon can be used as an example, given its location, its level of development and its ability to respond to any subsidies offered. Those figures are easily transposed to other countries in the region, in terms of the proportion of the population receiving prevention measures like treated mosquito nets or hospital treatment for malaria. Just now, I mentioned that, of every 100 patients in hospital, 40 are there for malaria. Half of the Cameroonians going to medical appointments are doing so for malaria.

That is not all. I am a pharmacist in a privately managed dispensary. Like many other countries, Cameroon has no universal health insurance. Everyone looks after themselves and pays for treatment out of their pockets when they see a doctor or buy medications. Since the people are poor, they do not go to a doctor very often, they go directly to a pharmacist. That is not accounted for as a medical consultation. So we can say that well over half the population is suffering from malaria. In our countries, this is a major, high-priority, overriding public health problem.

[The Chair, Conservative, Dean Allison]

Thank you.

Thank you very much, Mr. Hawn.

We're now going to finish off our first round with Mr. Garneau, sir.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

Thank you, Mr. Chair.

I've taken preventive medicines when going into countries with malaria. How much of the medicine that we're talking about today is preventive versus medicine that's used once you have malaria?

[Hervé Verhoosel]

I suppose you're referring to Malarone or products similar to Malarone. The preventive medicines are used more by people travelling to those countries, because when you are living in a non-endemic country, you cannot take it every day for medical reasons and for financial reasons. You cannot take a medicine for prevention. The prevention is very often the use of bed nets treated with insecticide. It's very important is to use the test, and that's dovetailing to resistance. Too often in the past when people had a fever, they would immediately think they had malaria and would take some pills for malaria. They were taking too many pills, even though they maybe were not sick with malaria.

Now we push very aggressively the use of very small diagnostic tests that give results in a few minutes to make sure that before you take a medicine, you have malaria. Most of the medicines are for treatment—at least for the population living there.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

I have a couple of more questions. I'm limited on time, so please forgive me.

My question is for you, Madame Lucard.

I want to get a sense of what MMV is about. It sounds like you raise capital but it's not clear to me what the venture is. Do you give that capital to drug companies to develop the medicines? Is that what happens? What do you do with it?

[Andrea Lucard]

What we do is we work with partners, which include drug companies, and also includes academic partners and others, to co-develop the drugs. What we're doing is we provide funding, but we also provide guidance, expertise, oversight, and an outlook for the public interest. About half of our staff are research scientists.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

Why aren't the companies doing it by themselves?

[Andrea Lucard]

Drug development is a very risky business. It costs a lot of money and the financial returns are uncertain. The financial returns are even more uncertain if you're dealing with malaria in endemic countries where you're talking about a very low price per treatment as would be sold in the senator's pharmacy. Therefore, they simply cannot undertake this risk by themselves. At the same time, this is where the industrial might and expertise exists. What we really have to do is to take the risk from the pharmaceutical companies, use their expertise, but also make sure that the public interest is maintained. That's what MMV does.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

Thank you.

How much does the Government of Canada finance either MMV or Roll Back Malaria Partnership at the moment, or does it?

[Andrea Lucard]

The Government of Canada does not currently fund MMV. Hervé was talking specifically about the Global Fund.

[Hervé Verhoosel]

Yes, it's the same for the Roll Back Malaria Partnership. Canada was a member of the partnership years ago, but they've left the partnership now. Our main donors are U.S., U.K., France, and such countries. Canada is not a member of the partnership, but Canada is supporting the Global Fund very well. That's very true.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

Through the Global Fund, okay.

You mentioned the advantage of a partnership and I see the advantage: you are talking about 500 members. A partnership is able to look for common objectives, set priorities and work together to implement them. At the same time, if everyone goes off in different directions, a partnership is not very effective.

Can you give me an example of an objective that the partnership, with its 500 members, decided to make into a priority? Since your funds are limited, how are you tackling the malaria problem?

[Hervé Verhoosel]

The budget of what we call the RBM Partnership Secretariat is a small one. In total, it is about $20 million. In other words, we are not a huge organization. One of our priorities at the moment is to make sure that we help the countries. Basically, the countries are the priority. Support for an endemic country itself is what counts. For example, a lot of countries wanted to get support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, but had difficulty preparing applications. One of the partnership's priorities is to help countries in preparing and monitoring their files. So, when it is necessary, we send technical experts from the ministry of health to help them in preparing those presentations.

Another priority is appealing for international funding. My goal today is not to make an appeal for ourselves, but for the global fund, and for malaria in general. That is one of the primary objectives at the moment. Sometimes, political authorities do not realize that investment in the fight against malaria works well.

With the NGOs and the UN system, which I also represent, we are really trying to make member states understand that. On a technical level, we make sure that only appropriate medications are used. Some countries are still using previous generations of drugs. While that is now less and less the case, those drugs no longer work. We make sure that the drugs and the mosquito nets are used correctly. Sometimes, you send mosquito nets and people do not use them correctly. We are working at a local level with NGOs and ministries of health to find out how we can make sure that the mosquito nets are properly distributed and properly used.

I will tell you a little story about that. We use soccer a lot. At the Africa Cup of Nations, the players recorded TV spots with us to tell 5-year-old kids, who will not listen to us but who will listen to a soccer player, that they have to sleep under their mosquito nets at night. That whole aspect of the appeal works very well

Finally, there is the famous global plan. Developing a global action plan that the whole world will embrace really is a priority for us.

[Marc Garneau, Liberal, Westmount—Ville-Marie, QC]

My question goes to the senator.

Are you making progress against malaria in Cameroon? Is the number of people who have it or who die from it decreasing?

[Pierre Flambeau Ngayap]

Yes, it is. Less than 10 years ago in Africa, almost one million deaths per year were attributed to malaria. In the last two or three years, that number has decreased by almost half. Black Africa now only has about 580,000 deaths per year and that can be attributed to concerted efforts both in prevention and in treatment. We have to keep up those efforts, and, in that respect, I conform what my colleagues are saying.

I wanted to be part of this appeal. I know that you can well understand what one of your colleagues said, especially about the medical and economic sector. The efforts have to be “mutualized“, not fragmented. We do not want to ask you to take a new approach, but to stay the course that you have charted up to now, to reinforce it if possible and to keep steering towards the same funding destinations. We have not come to ask you to raise funds, but to keep giving what you gave in the past and, if possible, to give more as the result of our appeal.

[The Chair, Conservative, Dean Allison]

Thank you very much, Mr. Garneau.

We're going to start our second round, which will be for five minutes each. We're going to lead off with Ms. Brown.

[Lois Brown, Conservative, Newmarket—Aurora, ON]

Thank you very much, Mr. Chair. Thank you to all of you for being here.

I have two questions I'd like to focus on. Perhaps, Senator, you could address the first one and then the second one will be for all three of you.

Canada has concluded a free trade agreement with Cameroon. I think we are doing some good things there. I know that when I was in Cameroon three years ago, they were talking about 13 billion dollars' worth of private sector money coming into Cameroon, mostly in initiatives to build hydroelectric dams for electricity. Is there an opportunity for the private sector money that's going into countries all over Africa to be incented to participate in some malaria reduction program? Obviously there's a vested interest for them because they need a healthy workforce in order to be productive. Is there some mechanism that could be established there?

My second question is for all of you. You've noted the work we're doing in maternal, newborn, and child health. One of the initiatives is to get front-line health care workers out into the most rural and remote areas and provide care for the most vulnerable people. Being proactive, is there something we can do to help increase the ability of the health care system in a country, particularly in sub-Saharan Africa, to be more robust?

[Pierre Flambeau Ngayap]

Thank you, Mr. Chair.

Ms. Brown, thank you for your question, which is a very important one for Cameroon.

For ten years or so now, Cameroon has been putting a lot of effort into organizing a structured dialogue between the public and private sectors. We now have the Cameroon Business Forum, which meets twice a year. This forum brings together public and private partners to reflect on the common actions they can take to move the most important national initiatives forward. This is very new for Cameroon and it is working very well. There is a new vision on the part of the authorities that puts together transversely what the public and private sectors can do together to solve certain problems.

Globally, of course, we are all using a strategy of economic liberalization where the state is progressively less involved. In Africa, the state is taking a little more time to disengage, but the system is underway. Private-sector participation in major public policy decisions is now positive and anchored in Cameroon's governance strategy.

[Hervé Verhoosel]

If I may, on that specific question, madam, I just came back from a mission in Cameroon and Benin. We try to meet more and more of the private sector and explain it to them with numbers. We have some companies that are fighting malaria already today who come with us. We organize meetings between companies already active in the fight against malaria with companies that do nothing, to make them understand it is important to start by protecting the workforce. They see, after we go to see them, the direct return on investment that they will have if they spend $3 for that bed net that we were talking about. That is working very well, because they see the direct financial interest.

After that we try to go to the next step, which is more corporate social responsibility. After you protect your own workforce, because you will have more money in your pocket thanks to that, spend a bit of that money to protect the communities around the companies where you are situated, not only on your workforce but the people around you, and that will be good for development anyway. That has started to work very well.

In Benin, for example, we were there to meet with many representatives of different countries, and in Cameroon also. For example, in Cameroon, in Douala there is a very important port, which is big part of the economy in Douala. The head of the medical department of the Port of Douala, after a meeting with him, said “Look, I'll take the engagement now. We have never done anything for malaria, but from now on we will protect the workforce because I understand that it's in our interest.”

That is something that member states should try also to promote. That's one of the activities, one of our priorities at the moment, to explain and bring the private sector to the table.

[Lois Brown, Conservative, Newmarket—Aurora, ON]

Mr. Chair, I stand corrected by my colleague. Apparently it's a FIPA that we've signed with Cameroon, a foreign investment promotion and protection agreement, but we are moving forward with trade agreements with Cameroon, and I believe there is great opportunity. I'm very pleasantly surprised to see that Cameroon is now advertising on our television stations, looking for investment coming in. It's exciting.

[The Chair, Conservative, Dean Allison]

It's a good start.

We're going to continue with Madam Laverdière, for five minutes, please.