Health Committee on May 30th, 2007

[Susan Kadis, Liberal, Thornhill, ON]

Thank you, Mr. Chair.

Welcome to our witnesses today.

This is a somewhat general question, which I think Ms. Priddy asked in her way as well. Do you believe, both of you, that the health of Canadians is just as safeguarded with or without the requirement for reporting by land conveyances?

Again, this is somewhat broad, but I think it's a very important idea to pose to you. When we're dealing with the serious nature of communicable diseases and the changing global environment, and the increasingly closer global environment that we do currently live in with the dynamics that exist now, should we not be erring on the side of caution, even if, yes, it may be somewhat costly or definitely not foolproof? We know that even air and sea are not foolproof. No one would say they were. But we still believe, and the proposal is to continue this element, that it is still important enough and essential enough to keep that in the act.

So I would just ask both of you, regarding this particular amendment, do you not believe we should be erring on the side of caution when it comes to the health of Canadians?

[The Chair, Conservative, Rob Merrifield]

Go ahead, Monique. We'll give Dr. Kendall a few seconds to think about it.

[Dr. Monique Douville-Fradet]

Okay.

Well, maybe this is why we were saying that if it is at all possible for land transportation to be able to reach the normal way of doing so with the 24-hour duty of public health, then, if it's possible, why not? But it doesn't justify--to us, at least--putting people or quarantine services everywhere.

There is this 24-hour duty list. It's all around Canada. It's in the United States also. And anyway, people will go through where exactly this thing comes into, which is a hospital, and from a hospital to public health.

[The Chair, Conservative, Rob Merrifield]

Dr. Kendall.

[Dr. Perry Kendall]

We would be just as safe without this. I agree with Dr. Douville.

As far as erring on the side of caution goes, my concern would be that if we set up a process that had many advance calls to quarantine officers or others, which then required public health professionals to be diverted from what they were currently doing or to get up at 2 o'clock in the morning, the downside risk is that we would take away scarce resources and basically be diverting them for no additional benefit. I think we'd end up with a net loss to the system rather than a net gain.

[Susan Kadis, Liberal, Thornhill, ON]

Thank you.

The other issue I want to have addressed is the issue of provincial reporting and communication. Unless I'm mistaken, I'm not seeing it addressed appropriately here, in my opinion, in terms of mumps and other things that have been raised.

Do you feel that is an element that should be put in here or strengthened in here in terms of land conveyance within Canada and communication?

[Dr. Perry Kendall]

I think all medical officers in provinces and territories have the abilities within their acts and exceptions within their protection of privacy acts to enable them to make the appropriate communications to other public health officials in other provinces and territories or indeed at the federal level. I believe they routinely do that at the present time, with our current information-sharing agreements and with our public and territorial health acts.

[Susan Kadis, Liberal, Thornhill, ON]

You believe the federal government does have a role to play in that coordination of information.

[Dr. Perry Kendall]

Yes. We're attempting to develop specific and official memoranda of understanding through the public health network, with sign-off by ministers of health at the federal, provincial, and territorial levels so that everybody is very explicitly clear that we have that ability, that we have practised it, that we have particular protocols for respiratory outbreaks or gastrointestinal outbreaks or any other kind of outbreak. We're developing the protocols to enable us to do routine, regular cross-jurisdictional reporting and communication.

[Susan Kadis, Liberal, Thornhill, ON]

Maybe I could just finalize with Madame Douville-Fradet. I thought I heard, perhaps, you suggesting that you think it would be appropriate if there were not quarantine officers at every single border crossing but perhaps a practical mechanism to ensure prior knowledge in terms of possible communicable diseases, that that's something you would possibly support.

[Dr. Monique Douville-Fradet]

Well, that was the idea, but I do agree that it would have to be a type of mechanism that would not put in too much burden on public health resources. By that I mean that if someone is having trouble, or whatever, we need a diagnosis. This cannot be done without going to a hospital and having the proper tests.

Before we can say that this is very transmissible, that this is a big thing, that we have to go and look for contacts and everything, we need a diagnosis. It's not possible to have that without proper consultation of specialized resources.

[The Chair, Conservative, Rob Merrifield]

Mr. Fletcher.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

Thank you, Mr. Chair.

Dr. Kendall, you mentioned that British Columbia has a special arrangement with the states along the 49th parallel. Is there any such arrangement with Alaska?

[Dr. Perry Kendall]

Yes. Alaska is included in our meetings.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

We have you, Dr. Kendall, saying yes, it is reasonable to not have land conveyances included, and we have our other witness saying no, it's not reasonable. Is there a compromise here that would address your concerns, Dr. Kendall, or those of our friend from Quebec? Is there a compromise here that will meet the needs of Canadians while dealing with the public health issues?

[Dr. Perry Kendall]

I think, on Dr. Douville-Fradet's proposal, with very specified mechanisms of transportation such as a train, one wouldn't necessarily need to stop it at the border, but then if you had concerns that someone on board that conveyance was ill and needed medical attention, if you hadn't put them off to give them medical attention before they got to the border, then rather than putting them off at the border where there aren't diagnostic or care facilities, it would actually make more sense to arrange for them to be met by an ambulance and transported to a hospital at their closest point of destination.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

So if the act were able to include something that says “best efforts”, to recognize that there is a possibility over land but that the probability is low, if we could incorporate that in such a way, would that alleviate your concern, Dr. Douville-Fradet?

[Dr. Monique Douville-Fradet]

I agree pretty much with what Dr. Kendall has said. I don't think our position is that we need quarantine people everywhere. What I've said is that I'm thinking of a way, just a way, to have a heads-up, if it's possible, to be able to reach what is actually already there, which is

physicians in hospitals and a public health prevention and control system.

[Steven Fletcher, Conservative, Charleswood—St. James—Assiniboia, MB]

I've finished. That's it.

[The Chair, Conservative, Rob Merrifield]

Ms. Bennett.

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

Hi, Dr. Kendall.

Thank you very much, both of you, for coming. As you can tell, the committee is still somewhat unpersuaded that what was put in the bill—

[Penny Priddy, NDP, Surrey North, BC]

Well, you are.

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

Well, we're talking about consensus, not unanimity, madame.

I think there is a concern that what we had once thought we needed as a tool.... Why wouldn't you just leave it in the tool box, even if you never used it, as opposed to getting rid of a tool you might need?

I see the argument that when you're coming by land, you can hop off before you get to the border. But could there not be a situation where the person has hopped off before they get to the border, but the rest of the land conveyance is all now exposed?

I guess I'm still not understanding how international health regulations are not, as I had thought, a minimum standard rather than a maximum standard. Even though the international regulations don't make us do it, what has changed between the original bill and now, that we all of a sudden have decided we don't need any more?

I understand Dr. Kendall's concerns about resources: that if this is there, it shouldn't just be a piece of paper but should actually be the capacity to do it. But is there some way, as the parliamentary secretary asked, whether through a communications strategy or infrastructure, whereby you can...? Is there a compromise or something that would allay the fears of this committee that at some point there'll be a situation where we'll wish that we, in terms of our due diligence, had left the tool in the tool box?

[The Chair, Conservative, Rob Merrifield]

Go ahead, Monique.

[Dr. Monique Douville-Fradet]

I think what we've proposed is a communication strategy, but

we must keep in mind that a proper intervention takes a diagnosis. Therefore, we need some way to communicate so that we can pick the individual up and take him away for diagnosis. Only then can we intervene. As I said, very serious problems would be extremely rare. However, we can deal with them if they come up.

Moreover, if there is a case of tuberculosis, every person who was in contact with the case in an aircraft long enough to risk contracting the disease must be traced and given the necessary care. We are organized for doing this. We have powers that allow us to obtain the names and addresses of all the travellers in the aircraft. We know that every individual onboard the plane does not run the same risk of contagion, but we have the names of all the passengers who were onboard. We will specifically track down those who were close to the infected person and give them chemoprophylaxis if need be.