Evidence of meeting #48 for Health in the 39th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was conveyance.
A recording is available from Parliament.
Conservative
The Chair Conservative Rob Merrifield
I'd like to call the meeting to order and thank everyone for coming. We have enough of our committee present, as well as our witnesses here.
First of all, I want to say thank you very much to Christiane Gagnon for taking the chair at the last meeting. I appreciate that very much.
I understand it was your birthday and that you were not fully disclosing your age. I have news. It was 39. That's my story and I'm sticking to it. Is that fair?
Conservative
The Chair Conservative Rob Merrifield
I appreciate that very much.
We have a different subject today. We're talking about the Quarantine Act. We're going to go through a presentation from the department as well as take a look at the piece of legislation. We'll determine after presentations and questions how far we'll go and whether we want to call more witnesses.
With that, I want to thank the witnesses for being here.
I see Mr. Clarke is here. You have a delegation. You're the speaker, I assume, so I'll let you introduce your delegation. The floor is yours.
Dr. Robert Clarke Deputy Chief Public Health Officer, Infectious Disease and Emergency Preparedness, Public Health Agency of Canada
Good afternoon. I'm very pleased to be here today in support of Bill C-42, an act to amend the Quarantine Act.
I would like to introduce my colleagues: Dr. Howard Njoo, director general of the Centre for Emergency Preparedness and Response; Dennis Brodie, manager of the legislative and regulatory policy group; and Mr. John Cuningham, senior counsel.
As you know, Bill C-42 was introduced in the House of Commons and given first reading on the same day that the new Quarantine Act was brought into force, on December 12, 2006. I wish to express my gratitude to this committee for your past efforts and for your direct contribution in strengthening Canada's public health system. It was your hard work, commitment, and spirit of collaboration that led to the development of this renewed public health legislation.
The Constitution Act of 1867 gives legislative authority for quarantine to the Parliament of Canada. To date, federal jurisdiction for quarantine has been applied to travellers, conveyances, and cargo that is arriving in and departing from Canada. The federal government fulfills this constitutional responsibility through a national quarantine program under the legislative authority of the Quarantine Act.
You may recall that the modernization of the new Quarantine Act was the key deliverable in response to the SARS crisis. This significant communicable disease outbreak vividly demonstrated that emerging and re-emerging infectious diseases will continue to pose a threat to the health and safety of Canadians.
With the introduction of antibiotics in the 1940s, many communicable diseases were brought under control and the need to apply the Quarantine Act gradually diminished. However, beginning in the 1980s, dangerous infectious diseases such as Ebola virus and drug resistant strains of tuberculosis began to emerge.
At the same time, international air travel greatly increased, contributing to the rapid spread of disease from one part of the globe to another in a matter of hours. The most recent example of this new migration of health reality was of course SARS. The outcome resulted in two epidemic waves and 43 deaths, not to mention considerable distress to the health care system and significant economic loss.
Acknowledging the work that unfolded in this committee and in the Senate, this government made a decision to bring the new Quarantine Act into force, with the exception of section 34. The decision to bring the new Quarantine Act into force without section 34 was not taken lightly. However, the government deemed it important to do so, given the heightened concerns surrounding the Avian influenza and the looming threat of a possible human influenza pandemic.
Honourable members, section 34 mandates an advanced reporting requirement to be met by conveyance operators. Unfortunately, a problem was discovered with the language used in section 34 when attempting to draft a supporting regulation and section 34 was found to be unworkable. As a temporary fix, and to keep present protections in place for Canadians, two existing quarantine regulations have been maintained until the wording of section 34 is amended.
Having a new Quarantine Act in force, with the exception of one section, gives federal officials access to new and modern authorities. This allows Canada to mitigate contemporary risks associated with global disease transmission. It also provides an opportunity for the government to amend the problematic wording of section 34 so that the Quarantine Act can gain full entry into force.
To this end, Bill C-42 proposes new wording for section 34 and it offers a solution to a minor and technical problem. In general terms, section 34 will require operators of conveyances used in the business of carrying persons or cargo to report in advance of arrival into Canada any illness or public health concern or death on board.
Advanced notification allows for the timely development and coordination of an appropriate response at the receiving port of destination. This response often involves other key public health partners and emergency responders across all levels of government. Both chambers supported this provision in 2005 because it provides the Minister of Health with timely information that would be helpful in deciding whether to order the diversion of a conveyance to any place in Canada, if necessary, to protect the health and safety of Canadians.
Advanced notification of important public health information will trigger an intervention by a quarantine officer and the subsequent management of a suspect risk to public health. It facilitates the application of appropriate control measures at the point of entry to stem the spread of disease. Examples of possible interventions may include the isolation of a sick traveller and the conduct of a health assessment, the cleansing of a conveyance, and possibly the temporary quarantine of those who are exposed.
Section 34 serves an operational purpose in the context of emergency preparedness, response, and public health protection. As previously mentioned, the problem with section 34 is minor and technical in nature. The language used in section 34 is simply too restrictive.
In its current wording, section 34 requires direct reporting to a designated authority situated at the nearest entry point. This is problematic for three main reasons.
First, in practice, a conveyance operator may not be able to determine which entry point is the nearest at the time of reporting.
Second, a designated authority may not be situated at an entry point. As you may recall, an entry point is defined in the Quarantine Act as a place where a customs office is located or a point in Canada designated by the Minister of Health.
Third, the current wording implies direct reporting. It does not take into account the role of third parties and other established communication protocols.
Bill C-42 proposes a solution. It amends the current wording to promote flexibility in practice and in the utility of section 34. Simply put, a newly worded section 34 will obligate conveyance operators in the marine and air community to inform a quarantine officer as soon as possible, before the conveyance arrives at its destination in Canada. Operators of conveyances in the process of departing from Canada through a designated departure point are also obligated to inform a quarantine officer as soon as possible.
The proposed new wording will not require the development of a regulation regarding the designation of an authority situated at the nearest entry point, as required in the present section 34. Instead, the designated authority is replaced with a quarantine officer.
New wording ensures that the reporting obligation extends beyond the time when the conveyance reaches the territorial sea of Canada or the airspace above Canada, and the obligation continues until the time the conveyance arrives at its destination in Canada. This is consistent with international practices.
New wording will also allow for indirect reporting as long as the quarantine officer is informed. Giving this advance notice through an intermediary, like an air traffic control centre, is sufficient, provided that the information reaches the quarantine officer as soon as possible.
As well, this indirect reporting through an intermediary actually makes the proposed section 34 stronger than the present section, as it expands the number of contact points for reporting of urgent public health problems on board conveyances coming into Canada. This also honours existing communications protocols and mirrors present practices.
As pointed out during second reading, new wording does limit the reporting obligation to conveyance operators in the marine and air sectors. New wording does allow for the development of regulations in the future, to be prescribed to other conveyances.
From an operations point of view, this decision supports a risk management approach toward protecting the public's health. The risk of dangerous infectious diseases entering or leaving Canada via ground conveyance is significantly lower than the risk of spread by air or marine transport for a number of reasons.
First, it is important to note that air or marine travel is significantly different from ground travel. Passengers are often in close proximity to each other for significant periods of time, with no opportunity to disembark. This makes it easier for communicable diseases to spread from one sick traveller to another.
Air travel is a special concern from a risk management perspective. In today's world, passengers can travel from one continent to another in a matter of hours, rather than weeks, or less time than the average incubation period for most diseases. This new migration health reality accelerates the global spread of disease in a way that land travel does not.
Further, the United States is not a country of great concern when it comes to serious communicable disease outbreaks. These are more likely to occur in countries where there is not a strong public health system in place to provide citizens with access to potable water, immunizations, and proper health care and treatment. These travellers arrive predominantly by air.
In practice, operators of rail or land conveyances will likely address a serious health threat before the conveyance arrives at the Canadian border. For example, a sick traveller on board a bus or train heading for the U.S.–Canada border is able to disembark and seek medical attention in the United States. This is not a practical option for air or marine travellers.
In the event of a very sick traveller seeking entry into Canada, the reporting of any public health concern will be captured at the border point, when travellers are processed for admittance by a customs officer, who is also a screening officer under the Quarantine Act. Under section 15 of the Quarantine Act, all travellers, including conveyance operators, are required to disclose any issue of public health concern at the point of entry, and to answer all relevant questions posed by the screening officer. If a public health risk is discovered at this process point, screening officers have various powers under the Quarantine Act. For example, they can isolate sick travellers or detain a conveyance. Further, they are required by law to immediately notify a quarantine officer or an environmental health officer for further direction.
Regarding the issue of transporting cargo by ground conveyances, the detection of a public health problem by a conveyance operator is not likely, given that most cargo is packaged and contained appropriately for shipment. For example, under the Transportation of Dangerous Goods Act, there are stringent packaging requirements for the shipment and transport of dangerous human pathogens, meaning live agents capable of causing disease in humans.
It is also important to note that other government departments have a role to play in protecting the health and safety of Canadians. For example, the detection of a disease-carrying cargo, such as contaminated spinach or alfalfa sprouts being transported from the United States, will likely come from federal officials in the Canadian Food Inspection Agency or directly from U.S. counterparts. The problem may also be detected by local public health authorities in the post-arrival stage.
From a public health point of view, expanding Bill C-42 to include ground conveyances will not add value to the current system of controls. The benefit of this measure does not outweigh the burden to the stakeholder community and the quarantine program, given what happens in practice and the fact that adequate screening measures do exist at the border. As such, a decision was made to maintain the current reporting requirements under the Quarantine Act for the marine and air transport sectors only. This decision supports current reporting requirements to be met by conveyance operators.
I would also like to note that this decision is compatible with requirements for advance notification under the International Health Regulations, which were being revised at the same time that the Quarantine Act was being modernized. Expanding the scope of Bill C-42 to include ground conveyances would likely be perceived as overly prescriptive and unnecessary. As of now, no other country in the world imposes this requirement.
In closing, I would like to reiterate that proposed section 34 does allow the reporting requirement to be extended to land travel in the future. This can be achieved through a regulation or an interim order, should there be a change in the threat and risk environment to support this measure.
I wish to thank the Standing Committee on Health in advance for taking the time to review and study this proposal. It is my hope that Bill C-42, in its current form, will address your concerns as a collective and will proceed to the next stage of the parliamentary process in a timely manner.
Thank you.
Conservative
The Chair Conservative Rob Merrifield
Thank you very much for that snapshot of why the changes are presented in this piece of legislation.
We'll now open it up to questioning, and we'll start with Ms. Brown, for ten minutes.
Liberal
Bonnie Brown Liberal Oakville, ON
Thank you very much, Mr. Chair.
Thank you for coming.
When I read these changes in these amendments to Bill C-42, which we worked on pretty seriously here, I didn't hear any concerns from the officials at the time that it was too onerous for land transportation drivers to report. This is new.
From whence did this initiative come? Did it come out of the Public Health Agency? Did it come out of the officials who were trying to figure out how to apply the new Quarantine Act? Did it come out of a worry about how much money it was going to cost and how many quarantine officers would have to be hired? Where did this come from?
Deputy Chief Public Health Officer, Infectious Disease and Emergency Preparedness, Public Health Agency of Canada
Dennis, would you like to respond?
Dennis Brodie Manager, Legislative and Regulatory Policy Group, Public Health Agency of Canada
Yes, I can try to answer that.
It came out of the work that we undertook to figure out how we were going to implement the act. It was during that process that we discovered that this is not going to work in practice. We tried various ways to get around it, but none were feasible. That then led to the proposal to amend the section.
Liberal
Bonnie Brown Liberal Oakville, ON
In essence, from the intention of the first Quarantine Act, in that number of years, we'll be reducing the reporting requirements through these amendments, unless a minister in the future decides to name other conveyances in addition to those that come in by sea and air.
Manager, Legislative and Regulatory Policy Group, Public Health Agency of Canada
It's reduced from what Bill C-12 originally said. However, it is not reduced from the point of view of the existing regulations. The existing regulations, which have been in effect for probably fifty years, only required air and marine conveyances to report. Furthermore, as Dr. Clarke pointed out, the International Health Regulations only require marine and air conveyances to advance-report.
Liberal
Bonnie Brown Liberal Oakville, ON
But somehow, after SARS, the first bill drafted on this subject did include land transportation, because the purpose of it was to protect public health.
I would disagree with some of the phrases used in the presentation. People on buses do spend hours in close contact. People on trains do spend hours in close contact. While I know there are weird diseases coming from other continents, our own continent has also experienced certain diseases that could easily come across the border. It seems to me that what this mainly does is exclude land travellers from our neighbour to the south from any requirement of reporting.
Dr. Howard Njoo Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada
I don't think it actually is a concern, because as Dr. Clarke pointed out, it's a matter of risk management. From a practical point of view, if we have sick Americans or anyone coming to the Canadian–American border, those people are much more likely to be identified as having a certain illness. In terms of medical follow-up, it's much more practical to have them disembark before they get to the border and have them get the appropriate medical attention in a medical facility. That's not—
Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada
Then when they actually land at the border, through the customs officials or the quarantine officers, those people will also be required to identify, or they can be identified at that point.
Liberal
Bonnie Brown Liberal Oakville, ON
What about a bus driver who picks up somebody he thinks is showing symptoms of being ill on a trip, even a short trip, say, from New York City to Windsor or something like that?
Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada
I think it would just be common sense for either the bus driver or the person, if he's ill, if he's sick enough, to try to seek medical attention before getting to the border, because in most cases, the best medical attention would be in medical facilities on either side of the border and not at the border. However, if there is a situation where someone actually lands at the border, certainly our customs officials can identify that person and have him sent for further follow-up at a medical hospital.
The requirement for advance reporting is really a practical application in that if someone is on an airplane, there's no way to disembark and go to a medical facility in advance of landing at the port of destination. Therefore, it is practical to have advance reporting so the officials, including quarantine at the airport in Toronto, can make the necessary arrangements to welcome the plane when it finally lands and have the person, obviously, forwarded for medical attention.
Liberal
Bonnie Brown Liberal Oakville, ON
One of the former chairs of this committee found herself quite ill on a plane, and the plane landed in Texas to get her to a hospital quickly. It isn't unknown, when people are sick with something unknown to them, for planes to do that, as well.
What I'm failing to see is the difference between land transport and sea or air. To me, this reduces the requirement and saves money but might put Canadians' health at risk. In other words, you're saying that there are very strict rules to be applied to people who travel by sea or air, but if they travel by land, you're hoping that common sense will prevail.
Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada
I don't think we're saying that. What we're saying is that when someone is on any conveyance and becomes ill, in terms of the bus driver or the tour operator, the expectation would be that he or she would take appropriate steps to seek the best medical attention for the sick passenger on board.
Liberal
Bonnie Brown Liberal Oakville, ON
It's based on an expectation that hopefully somebody has common sense, whereas the other people are subject to these very strict rules.
Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada
The rules notwithstanding, the point is that if someone is sick on board an airplane, it is difficult to get medical attention before landing, and therefore it makes sense to have advance reporting so the necessary arrangements can be made at the port of entry. If someone is on a bus, certainly there are lots of options in terms of getting the appropriate medical attention prior to the person arriving at the land border.
Liberal
Bonnie Brown Liberal Oakville, ON
That wouldn't be my experience. If I were sick on a bus and I was coming towards Toronto, I'd want to get home. I wouldn't tell anybody how sick I felt, even if I had perspiration flowing down my face. I'd want to get home. I'd want to meet my family and get to my own doctor. But I could be bringing in a disease, and I think if there were a bus driver on that bus, he should be required to report, as well.
What is the real technical issue that makes this so difficult? Is it the whole problem of having quarantine officers available, say, at two o'clock in the morning at the Ontario-Michigan border? I'm sure there's something else underpinning this change, because it is reducing the requirements that were set out in Bill C-12.
Deputy Chief Public Health Officer, Infectious Disease and Emergency Preparedness, Public Health Agency of Canada
In terms of having people available at the border when a land traveller is coming across the border, the screening officer, if he sees that someone is ill, will require the person to have a consult with a quarantine officer. Each person is screened by a screening officer. If the person appears to be ill, then at his discretion, he can refuse entry or he can call the quarantine officer to make a further assessment.
Liberal
Bonnie Brown Liberal Oakville, ON
In the case of a commercial conveyance like a bus, should the driver not have the same responsibility as a pilot of an aircraft or the captain of a ship to report ahead of time? You just said that it's better if the correct people are there waiting at the border or at the point of entry.
Deputy Chief Public Health Officer, Infectious Disease and Emergency Preparedness, Public Health Agency of Canada
I suppose the other issue here is the international health regulations.
