Health Committee on April 18th, 2007

[Susan Kadis, Liberal, Thornhill, ON]

I'm personally not supportive of those particular areas of change, those amendments, Mr. Chair. I know there's some interest in going clause by clause, but I don't think we're anywhere near that point of dealing with it today. I think we need more information.

[The Chair, Conservative, Rob Merrifield]

Okay, that's your time.

Mr. Brown, you have five minutes.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Mr. Chairman.

We've heard some reference from my colleague about the issue of ground. We wanted to know if we've looked at other international examples. I saw one of the reports; it talked about looking at Ebola, tuberculosis, and also SARS. Was there any evidence that any of these dangerous infectious diseases have spread on a ground level, or when they spread, has it been by marine and air?

[Dr. Robert Clarke]

Certainly there are a number of different issues here. When it comes to diseases such as Ebola, that disease is found in Africa, and it obviously would have to come by air or marine when people travel, so virtually all those exotic diseases would come by air or marine.

With other diseases, such as tuberculosis, screening is done for tuberculosis with immigrants, which CIC is involved with. People have to go through a medical and they're tested for that before they're allowed to immigrate. We also share a lot of information with the United States on diseases such as tuberculosis and some endemic diseases we have within the countries. So we have very good knowledge of what diseases are circulating between our two countries, and very similar patterns.

The primary threat for us is these exotic diseases, diseases Canadians would not have any experience with. They're the ones that tend to be the most problematic, so that's why we're more focused on the air and marine, because they're more likely to come from—

[Patrick Brown, Conservative, Barrie, ON]

I realize they might have been more likely, but is there any evidence you have that even a small percentage of the threat...? For example, with SARS, was there any that came to Canada via ground that we know of, or is there any...?

[Dr. Robert Clarke]

No; it was primarily air travel.

[Dr. Howard Njoo]

I think another important point to make is that it would be naive to think we're going to stop infectious disease at the border with any sort of number of measures. The practical fact is that many infectious diseases, based on the incubation periods and when people actually declare their symptoms, are discovered after the fact.

So a large part of how we're going to control infectious diseases coming from other countries is by training our health care system providers--physicians in emergency rooms and in doctors' offices--to be on the lookout, to be always vigilant, and if someone comes to their office who is sick, they pick up a careful travel history and ask where they've been recently. When someone walks through an emergency room in Saskatoon, you can't just assume they're from the local area. They might have started 24 hours ago in South Africa or some other part of the world, taken a bunch of flights, and ended up in that emergency room.

Our experience is that for many of the infectious diseases that are actually diagnosed in Canada and reported, yes, these people actually did travel from other parts of the world and came to Canada by a variety of means--air, marine, or land--but actually didn't fully become symptomatic and seek medical attention until after they were in the country. That's really another important point to note. It's not going to be because of certain measures that we're going to catch everything at the border. That seems to be accepted and—

[Patrick Brown, Conservative, Barrie, ON]

Recognizing that our border is with the U.S., what is their policy on this? Would these changes bring us more in line with them? Recognizing there's a difference then with someone who came by air to the States and then came by ground to Canada, is there a sense of uniformity between the two policies?

[Dennis Brodie]

As far as I know, the U.S. does not require advanced reporting by conveyances travelling between Canada and Mexico.

[Patrick Brown, Conservative, Barrie, ON]

How about by air? Are their policies by air the same as what we're advocating?

[Dennis Brodie]

Yes. In fact, all countries of the World Health Organization that administer their International Health Regulations only require air and marine advanced reporting.

[Patrick Brown, Conservative, Barrie, ON]

And what about Mexico?

[Dennis Brodie]

I'm not familiar with what Mexico requires, but I assume it's consistent with the International Health Regulations.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Now we'll go on to Monsieur Malo for five minutes.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you, Mr. Chairman.

Mr. Njoo, from your earlier answer to Ms. Kadis, I understand that it is essentially a matter of a cost-benefits comparison. Given the benefits that it might produce, it would be too costly to implement a risk assessment or to report people travelling by land. You said earlier that it would be too costly, compared to the benefits obtained, to inform bus companies and give them access to special phone numbers to make those notifications possible. I understand that the risks are rather minor. From what you answered to Mr. Brown, even the United States do not require that kind of control.

[Dr. Howard Njoo]

I am sorry, but I may have misspoken. It is not a cost issue but a matter of risk management. As I explained earlier, the mandatory reporting of a sick person on a plane or a ship is to make available the necessary resources at the point of entry. If someone gets ill on a bus, there should be hospitals and medical services providers on both sides of the border. It is a matter of practical management. If a person gets sick, it is possible to disembark him or her in another city before arriving to the border and to have a follow-up. There are many such possibilities. However, when it happens on a flight, it is only possible to act after landing and this is why there is mandatory reporting. This is to ensure that the required measures will have already been put in place. Is this clear enough?

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

As concerns the control of people travelling by land, has that kind of measure already been included in a bill or a quarantine legislation? Or is it something that has never been the object of any control?

[Dr. Howard Njoo]

There are controls at the present time. In fact, when you arrive at the border, it is mandatory—

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

I am talking about the advance reporting.

[Dr. Howard Njoo]

In terms of risk management, I do not believe that it is practical to notify before arriving at the border. There are many potential options to deal with the problem ahead of time. If there is a sick person on a bus, you can notify the border officials, but if the situation gets worse, you could take that person to a hospital before arriving at the border rather than keeping him or her on the bus.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Are there countries where that kind of control is done? It does not exist anywhere?

[Dr. Howard Njoo]

No. As was mentioned earlier, we are talking about an international standard. In doing so, Canada might become the only country in the world with that requirement.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Ms. Davidson, please.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, and I'd like to thank the presenters.

I need some clarification. What we're looking at today is the amendment to the Quarantine Act. Some statements were made—at least I think this is what I heard—that we are decreasing the coverage of advance notification. Is that correct? Are we decreasing anything?