Health Committee on April 18th, 2007

[The Chair, Conservative, Rob Merrifield]

That's fine.

I'll just follow up and maybe add to the question. I think this is what he was going for.

At the same time, I understand, as we implemented the Quarantine Act, the international community, the IHR, was going through theirs. Was the assumption that they would include ground transportation at the time this act went through, and then they did not put it in?

[Dr. Howard Njoo]

No, there was never any assumption. If you look at the old International Health Regulations and the new, modern ones, which in a sense are completely different, all that the old International Health Regulations required--and my legal colleague, Dennis Brodie, can add to this--was mandatory quarantine for three diseases: plague, cholera, and yellow fever. That was it.

In terms of what's happened since the old ones were in place, such as SARS and other new, novel, emerging diseases that WHO and the member states recognize, we really didn't have any sort of framework for coordination and collaboration. There weren't any previous International Health Regulations that had reporting requirements for conveyances. It was really just for the reporting of diseases.

When all the member states of WHO came to Geneva and negotiated the terms of a new, improved way forward in terms of the control of infectious disease outbreaks at the international level, all aspects were looked at, really, from a fresh start. So when, finally, all the expert deliberations were finished, it came to the point, as we've indicated before, in terms of advanced reporting, that there needed to be a good risk management approach for aircraft and watercraft.

[The Chair, Conservative, Rob Merrifield]

Okay, one quick question here.

[Dave Batters, Conservative, Palliser, SK]

All this work went into this, and all these officials got together at Geneva, so why did the Canadian Parliament go further? Why did the Canadian Parliament go where the experts in the world didn't go? The experts in the world said “marine and air”, and the Canadian Parliament went “all conveyances”, for advanced reporting.

[Dennis Brodie]

The Canadian Parliament went first, and that was the difficulty.

[Dave Batters, Conservative, Palliser, SK]

That's a good answer.

[The Chair, Conservative, Rob Merrifield]

And that got to where my question was coming from.

Ms. Brown.

[Bonnie Brown, Liberal, Oakville, ON]

I would just like to put on the public record that some of the material that came from the agency in trying to get us to pass these amendments suggested that they were technical, but I think the questions from both sides of the table have illuminated us to understand that these are not technical, except for the technical difficulty the staff is having in developing regulations. This is a major policy change from the intent of Bill C-12. Now, maybe Bill C-12 was unimplementable, but none of these same officials told us that at the time. So I'm not going to take the blame as a parliamentarian for the fact that we enthusiastically supported it.

Mrs. Davidson asked whether we ever had land rules. We had the expectation that the land rules and quarantine officials were going to be available at land border crossing points, not just at the airports and ports, as they had been in the past.

And if Mr. Batters wants to know why Canada went further, first of all, in time we were first, but I believe that our SARS experience informed the high standards we were trying to set. Very few of the other countries making these international health regulations had had a SARS epidemic as we did. So we were trying to set the bar rather high. I'm not naive enough to think that this Quarantine Act is going to save us from anything that will ever enter our country again, but we were trying to suggest ways that we could protect ourselves better than we had on an act that was 70 years old, and perhaps better than some other countries.

The problem with international health regulations is that when countries get together, in the same way as when provinces get together to agree, sometimes the standards have to go down to what the various members can afford. So sometimes you do get the lowest common denominator, which is why, while I respect the fact that there are international health regulations, I don't think our fate should be completely determined by them.

Thank you, Mr. Chair.

[The Chair, Conservative, Rob Merrifield]

We'll go to Ms. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thanks very much.

I have a concern, Dr. Clarke. Just explain to me what would happen if a plane lands in Seattle and the tour bus fills up with people from Southeast Asia, and then comes over to Vancouver and to the Rockies, and somebody gets sick on the way? What are you giving up? How would you intervene in a situation like that if you thought everybody on the bus was at risk, and a whole bunch of them said they didn't want to stay, they wanted to go home? What do you do in that situation as the deputy chief medical officer of health for Canada? The plane arrives and they get on the tour bus, or the plane arrives in Seattle and they come across the border and somebody gets sick. Why don't we care about those tour buses that are all over the place with writing on them that clearly means these are South Asian tour companies bringing people either directly to Canada or to Canada via the Rockies or all of those things? What are we doing there?

And secondly, I guess my question.... You might as well answer—

[The Chair, Conservative, Rob Merrifield]

We'll get the first done first and then we'll get—

[Dr. Robert Clarke]

When the bus arrived at the border, if there was someone ill, they would still have to report that there was someone ill to the customs officials, who could then, if they thought this was something that looked suspicious, call our quarantine officer in Vancouver, who would then take appropriate action.

Now, if people got ill after they entered the country, then we would still rely on the medical officers who were treating people to inform us, and then an epidemiological investigation and perhaps quarantine could be instituted, depending on what the disease was.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I still don't understand. That happens with a plane, too, right? I don't understand what the difference is.

Secondly, if you're counting on the local medical officer of health, how do we make sure that this medical officer of health tells you, the Public Health Agency of Canada, about the suspicious person, when I understand that at the moment it's sort of voluntary in discussion, and that we don't seem to be able to track this stuff other than by volition?

[Dr. Robert Clarke]

There are a number of different scenarios here. If someone arrived in Vancouver--came across the border and didn't have any symptoms at the border--and became ill in Vancouver, the local attending physician would contact the local public health officials there, and they would deal with it. If they thought that this was something very unusual, they might seek assistance from us at the federal level, for instance, for testing at our national microbiology lab, which is the only lab in the country that is actually set up to deal with exotic diseases, which is why we have the level four containment lab there. So we would get those cases in any case, because we're the only ones who can do those kinds of testing procedures.

We have very good relations with the provinces in those kinds of situations, because they—

[Carolyn Bennett, Liberal, St. Paul's, ON]

Aren't we having trouble with TB? I was pretty embarrassed on World TB Day when it said for Canada “no report” because the provinces hadn't handed in their numbers. If the person was coughing and spluttering and had just boring TB on the bus, and didn't need the containment lab and all of that, why would the job of the Public Health Agency of Canada or the chief public health officer be different from what it would be for a bus that came from a plane that landed in Seattle or at Vancouver airport?

[Dr. Robert Clarke]

The difference is the advanced reporting function. As was mentioned, in a plane or a ship, there is no chance to disembark. For a bus coming across the border, if someone is obviously ill and is coughing, the screening officer, the customs official, would contact the medical officials. Even if the person did come into the country and sought medical attention, the provincial authorities are quite well versed in dealing with tuberculosis.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I guess my question is, why would you give this up if you might need it one day? Isn't it better to have something there that you would never use, than to not have something you might need?

[The Chair, Conservative, Rob Merrifield]

I was going to let them answer, but if you keep asking, I won't.

[Carolyn Bennett, Liberal, St. Paul's, ON]

It's all the same thought, just backwards and forwards.

[The Chair, Conservative, Rob Merrifield]

Okay, could we have a quick answer on that? And then we'll go over here.

[Dr. Robert Clarke]

There is provision, as you mentioned, for the minister, under the prescribed conveyances clause here, to actually implement this if he thought it was appropriate. If conditions change, the minister can make regulations and can issue orders under this clause to change and actually implement what you're talking about.

[The Chair, Conservative, Rob Merrifield]

Sorry, your time is up, Ms. Bennett.

Mr. Batters.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I don't think that's good enough. Does the minister have the ability to quarantine the bus?

[The Chair, Conservative, Rob Merrifield]

You can put your name on the list, and we'll go afterwards.

[Carolyn Bennett, Liberal, St. Paul's, ON]

This is serious, so just tell me, can the minister quarantine the bus or not?