Evidence of meeting #8 for Government Operations and Estimates in the 43rd Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was testing.
A recording is available from Parliament.
Liberal
Francis Drouin Liberal Glengarry—Prescott—Russell, ON
I want to thank Dr. Smith for appearing before the committee today.
I have a couple of questions with regard to the state of clinical trials in Canada, and perhaps you could speak to UHN's own experience and how it relates to COVID-19. Are you seeing that collaboration that you spoke about in the way that clinical trials could eventually work in Canada without compromising, obviously, patient safety? Do you see innovation within that system that could get to a vaccine faster?
President and Chief Executive Officer, University Health Network
Monsieur Drouin, with apologies, I'm not hearing any translation. I'm still awaiting that, but as soon as I get it, I will try to answer your learned question. It didn't come through on my mike, I'm afraid. I'm sorry about that.
Liberal
Francis Drouin Liberal Glengarry—Prescott—Russell, ON
Okay, I just selected English, so it should be working now.
I was just asking about the clinical trials, the impact of COVID-19 and whether or not you're seeing innovation within the system of going through phase one, phase two, and phase three, and whether you're seeing a more rapid system within the clinical trials without compromising, obviously, patient safety.
President and Chief Executive Officer, University Health Network
I am seeing a more rapid enrolment of clients. I would say we're not yet at the point where there are many clinical trials—phase one, phase two, phase three—but we're more into the trials of testing. There are few Canadian studies I'm aware of that are currently under way in randomized controlled trials with interventions that would look at vaccine-like status or serum conversion. There is much more testing going on, and I'd like us to go even further than that.
Yes, it has been easy, for example, in my own institution, with our own research ethics board. There's something called the Respect study, looking at the uptake of the disease and the disease in health care workers, and very rapid movement through an REB, very rapid deployment, very rapid enrolment, very rapid engagement of the laboratory system for testing.
One of the challenges I do believe we have at the moment, particularly for randomized control trials, is access to supplies, so again swabs and reagents. There are usually, with RCTs, significant amounts of laboratory testing and data collection, and there is a yin and yang or a bit of worry at the moment whether we have enough for our clinical needs so that we don't allow our research need to take it away from Canadians who need the test for clinical purposes.
Increasingly, we're trying to look at the overlap, where those who need the test for clinical purposes can also be enrolled in research studies, with their consent.
Liberal
Francis Drouin Liberal Glengarry—Prescott—Russell, ON
Before I pass it on to my colleague Majid, I just have a question with regard to something you mentioned. Canada is a small player relative to other bigger nations when it does purchasing, but at the same time, if the private sector does find a vaccine and chooses a market, it will be more attracted, by default, to countries such as, for instance, the U.S., because it has 330 million people versus Canada's with 36 million people. Is there any regulatory change that you would advise Canada to undergo to ensure we become an attractive market for those potential clinical trials or for the miracle vaccine that everybody is working on?
President and Chief Executive Officer, University Health Network
Unquestionably, for the multinational drug companies, much of this does come down to the quality of science, where Canada punches well above its weight. Canada truly outstrips others, despite our size, when it comes to both leadership in and conducting of clinical trials. Where we unfortunately haven't seen that conversion is into the manufacturing of products and services, and those who are much more expert than I am in the econometrics of drug companies and what makes pharma choose a nation to be in. It usually comes down to labour costs, taxation and the attractiveness that jurisdictions can offer.
We know that in the United States, for example, state governments make it very, very attractive in certain parts of the country to come and locate, particularly for early start-ups, and often this is the case with those reagents and actions that are found that we wish to have taken to phase-one clinical trials.
It's often a group of remarkable investigators who discover something. They are then wooed by jurisdictions where perhaps more ambitiously there is the waiving of, for example, municipal, provincial and federal levels of taxation for a period of time. In terms of labour supports, they have made it very economically attractive. If we think backwards, many years ago the Province of Quebec made a concerted effort around—
Conservative
The Chair Conservative Tom Lukiwski
Unfortunately, Doctor, we are out of time.
My apologies for interrupting, but we have to get to our next intervenor.
Mr. Aboultaif, go ahead for five minutes, please.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
Thank you, Dr. Smith, for a very informative session today.
I go back to Mr. Barsalou's question about the social contract. If I gather correctly from your response, you're talking about a financial issue, funding specifically. If that is a problem and new social contracts are needed between the federal government and the rest of the provinces, why are we talking about this now, if, as you say, this has been going on for a long time? Can you please explain that?
President and Chief Executive Officer, University Health Network
I would say a number of us have raised that. I can't remember the date, but I'd be happy to share with you an op-ed piece I published before the pandemic, in The Globe and Mail, that talked about this very topic. A number of us have been talking about this for a long time as we've seen, for example, pre-pandemic occupancy rates in hospitals of over 110%, and individual front-line providers have given us feedback about the conditions. Frankly, we've been very fortunate in this pandemic to be able to take that occupancy down so dramatically. That kind of occupancy rate, in and of itself, presents an infectious disease risk that greatly diminishes our effectiveness outside of COVID and with any other infectious disease as well.
This is not a new topic. It's a topic that has been undertaken for some period of time by a number of us. However, this has made it all the more obvious. I believe I heard the Prime Minister, in one of his daily updates, also recognize that we will need to revisit how these services are delivered. I would suggest that if that's the case, one has to look at the resources to do so.
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
How optimistic are you of achieving that, given that now, unfortunately, is the perfect time to talk about it? It's a shame we are not going to be able to implement something or solve a problem that is happening right now and has been going on for a long time.
How optimistic have been getting anyone to listen in the government or governments in general?
President and Chief Executive Officer, University Health Network
I would be very optimistic about people willing to engage in the discussion. I recognize there is an opportunity cost for all these initiatives and the question comes up: Is this not right, or what do we not do in order to do more of another initiative?
I think this has pointed out to us that we can any longer believe that Canada is immune to this.
I think the other piece of this we will and should hear loudly: the risks for those, not only patients and families who are most important to us, but also our front-line providers who have been very frightened during this pandemic. As always, evidence catches up; it doesn't always lead.
I feel bad that many people working in the health care system today are saying they know they're being told that the science doesn't say they need an N95 respirator, but they'd like a belt-and-suspenders model in case they do, so they're not putting themselves at risk in caring for another Canadian in desperate need of their support. In addition to that, they need to know that the infrastructure is there behind them, not only those who provide direct service, but equally important—and sometimes more so—are the unsung heroes: the housekeepers, porters, food service workers. These are all essential to high infection control standards in Canadian hospitals.
I think it has to be there, and I have every confidence that Canadians will demand this discussion, especially as it relates to the frailest of Canadians, our seniors in long-term care—70% of our current deaths are those individuals who built our nation. We can do better.
Conservative
Conservative
Ziad Aboultaif Conservative Edmonton Manning, AB
I want to thank Dr. Smith for a very informative session. I hope to see you again.
President and Chief Executive Officer, University Health Network
Thank you, sir.
Conservative
The Chair Conservative Tom Lukiwski
For my final intervention I have Mr. MacKinnon, but I'm not sure whether Mr. MacKinnon or Mr. Jowhari wants to take this five-minute round.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
In the interest of time, I'm ready to take it if Mr. MacKinnon wants to share his time with me.
Thank you, Dr. Smith.
Over the last month or so we've heard about the development of a vaccine, and then its going through the tests, as well as mass manufacturing, distribution and the administration of it. The timeline that's being discussed is anywhere from a year to 18 months.
I'd like you to shed some light on the overall timeline. Where are we in that process in your view, and how long do you think the clinical trial—phase one, phase two and phase three—is going to take?
President and Chief Executive Officer, University Health Network
I truly wish I had a crystal ball on this one. It's a very difficult question, although I am somewhat encouraged.
As you know, recently there has been a clinical trial out of Oxford University, and from all I can understand from the popular press, they have produced over one million trial drug samples. That encourages me to the degree that someone who is producing that large a sample population probably, I hope, has some indication of the effectiveness in preclinical trials of the intervention.
I recognize that 12 to 18 months is the estimate, but again, trying to be on the eternal optimist's side, the world scientific community has literally paused and is focused on COVID-19. I've never seen anything like this in my life, and rightly so. It should be focused on it when we look at the devastation it's wreaked, not only on individuals and families but on our economies, and we know that health is directly related to wealth.
I believe we will see protracted opportunities. I also think there may be some opportunities to consider whether or not some of those traditional phase one, two and three trials need to go sequentially, or that with some early data, we might think about concurrent runs after phase one, to ensure that we're not harming individuals, of course.
That being the case, I think the latter part of this discussion has to be around the ownership and intellectual property of a vaccine, as Mr. Green mentioned. I'll leave it to ethicists and business consultants who are more scholarly than I on the ethics of that being true, or opening up that production to international productivity to address a pandemic of the proportion we've never seen. I think that would be the desired outcome.
In preparation for that, I think all countries should be thinking about whether we are able to quickly stand up a production facility that would serve our nation, as I heard from the previous speakers. Each nation wishes to produce for itself first, and I hope Canada is thinking about how we would produce a successful vaccine, whether invented elsewhere or not, to ensure that Canadians can be among the first to receive it.
Liberal
Conservative
The Chair Conservative Tom Lukiwski
Yes, it does, Mr. Jowhari. Thank you very much for being so prompt with your time.
Colleagues, thank you all for a great discussion today.
Dr. Smith, I want to thank you particularly for being available to us on such short notice.
President and Chief Executive Officer, University Health Network
Thank you.
Conservative
The Chair Conservative Tom Lukiwski
Colleagues, we will resume our next discussion on Monday at 2 p.m. Eastern Standard Time.
I hope everyone has a great weekend. Stay safe.
Yes, Mr. McCauley.
Conservative
Kelly McCauley Conservative Edmonton West, AB
Before we break, Mr. MacKinnon and Mr. Drouin, I'm just sending you both something to your P9s. I just need a call back.
I'm sorry to interrupt, but it's somewhat important.
NDP
Matthew Green NDP Hamilton Centre, ON
Mr. Chair, could I also just raise a point here for the official record? On both occasions in both rounds, because of technical difficulties, both the Bloc and I were cut out from the rounds. I just want to put on the record that these technical difficulties are coming at our expense, to our ability to intervene a second time, because of the speaker rotation by the chair.
Conservative
The Chair Conservative Tom Lukiwski
Yes, I understand that, Mr. Green. Unfortunately, because of our tight timelines, we have to adjourn at one o'clock.
For individual interventions, when there have been technical difficulties, I have extended extra time to the individual intervenor, but the block of time we had was only two hours.
Hopefully over the course of the next few meetings in the next few weeks, we'll get all our technical difficulties straightened out. I take your point.