Health Committee on June 4th, 2007

[Paul Haddow]

From a very general level across the piece, I would say no. It's to get rid of differences that don't make a difference. It explicitly recognizes that there will be differences. Simply in the area of plant health, for example, Canada has a different climate, and we will always have different regulations from what the Americans and Mexicans have.

The idea that there will be differences at the end of the day is a given. It's just that there may be occasions when the fact that there are differences is simply an unintended result of history. It's to try to synchronize things to the extent possible; to recognize that at the end of the day, you have three sovereign governments that will make three sovereign decisions; and to recognize that we live in three different environments for one thing.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Go ahead.

[Emmy Verdun, Executive Director, International Affairs, Canadian Food Inspection Agency]

I would like to add to what Daniel Chaput said about the fresh fruit and vegetable initiative. What we're looking at in that initiative is not regulation; it's standards. It's good agricultural practices, which are on-farm food safety practices. Those are voluntary standards that the industry uses; they're not regulatory. That group is not looking at regulation at this point.

As he explained, they picked the fresh fruit and vegetables based on consultation with stakeholders, because this has been identified as a higher priority, and it links to issues related to the kinds of problems we face with, for example, cantaloupes and lettuce and so on.

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

Very briefly, on many of the things we're facing in public health, having common approaches is actually to our advantage. Being engaged in the discussions about standards being lower in other places and being able to come up is to our advantage in terms of protecting Canadians.

[The Chair, Conservative, Rob Merrifield]

Thank you.

Madame Gagnon.

[Christiane Gagnon, Bloc, Québec, QC]

Thank you for being with us today.

You all read on the weekend about the case of Andrew Speaker, who has contracted a communicable form of tuberculosis. I know that measures were taken. When the diagnosis was made, he was told not to travel. However, because 14 days went by before the authorities were notified, Mr. Speaker had time to make several trips.

How would you explain this lapse in the chain of events, which could put people's lives in danger? They are trying to find everyone who travelled during the same period, particularly people who were in the most contact with him.

I would like to ask Mr. Butler-Jones what went wrong. We are in the process of enacting Bill C-42, An Act to amend the Quarantaine Act. We are told there is no problem, but we have to know what went wrong, so that the situation does not happen again. Was there a flaw in the system used by public health authorities in the United States for communicating information?

[Dr. David Butler-Jones]

I am in contact with Julie Gerberding at the CDC in the United States. We will be meeting to draw lessons and identify all measures that might help to avoid this kind of situation happening again in future.

I will speak English, because I want to be very precise and my English is much better.

The challenge here was that an individual, who fortunately may have been minimally infectious but was not very infectious, chose to travel to a number of countries, and then not to follow up on the advice they were given. We do see that from time to time. Every jurisdiction sees that.

We will be reviewing that with our American colleagues, as we have with French, Italian, and the Czech and the European CDC, in terms of what measures might have facilitated earlier engagement with this person, so they would not have travelled, etc.

Subsequent to that, as soon as we found out, we then engaged with the airline, with the Americans and others, to identify who the travellers were so they could be followed up.

The thing with tuberculosis, which is different from some other infections, is that there's a long period between the exposure of someone and when they may be infected, and an even longer time before they can infect others. We actually have some time to get the story right, to figure out what really went on, so that when we actually do contact these people we will have the best information possible in dealing with them.

That's why over the weekend we worked with the various authorities, the airline and others, to get the manifest, and then the information became more public after that, which did facilitate finding some of the people faster, but there was still abundant time to do so.

If it had been something like meningitis or some other disease that you actually have a short window to follow up and do whatever measures possible, then as soon as we had known it very quickly would have been a public issue.

[Christiane Gagnon, Bloc, Québec, QC]

Like everyone else, I read about this case in the newspapers. He was given advice, he was told not to travel, or it was suggested that he not travel. Do you think mere advice is reasonable in a case like this, given that the disease is transmitted from person to person? My doctor can tell me not to go swimming because the water is polluted and it is dangerous for my health, but I can say that he never told me that.

Should we have a mechanism that would notify the patient, in writing, of how dangerous he or she is? Ultimately, a person is responsible for transmitting this disease from one person to another, if the person is not vigilant. Could we implement a mechanism that would provide written proof of the discussion with a doctor?

A person who has been infected can say that he or she was never notified, and was simply given advice. The person does not even acknowledge that he or she may be a potential danger.

This case sounds an alarm.

[Dr. David Butler-Jones]

I don't know all of the details of the conversations yet. I think that will be debated for some time among the various protagonists as to what actually went on in advance. I do know that for many situations we do in fact provide.... When I worked in local public health, for example, if there was a situation in school, there would be a notice, a note that would actually go home to parents to explain what was going on, what they needed to do, etc. Those are all some very practical kinds of things.

Normally, most people comply quite straightforwardly with whatever direction is being given. Most people are sufficiently concerned to do so.

Again, we don't know all the details of this case, what actually went on at this point, but each of these events becomes another opportunity to question whether enough was done, and if not, what needed to be done or will need to be done next time.

[Christiane Gagnon, Bloc, Québec, QC]

Is the person likely to be charged, for three years or $500,000?

[The Chair, Conservative, Rob Merrifield]

I'm sorry, Madame Gagnon, your time has gone. Thank you very much.

Mr. Patrick Brown, you have five minutes.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Mr. Chairman.

I have two sets of questions, and the first set is mostly toward the Department of Health and Mr. Butler-Jones.

I want to get back into the Quarantine Act. I understand we're seeking to include advanced notification by land conveyance operators to section 34 of the Quarantine Act, after it was removed in Bill C-42. What I wanted you to touch upon was the fact that previously we had the Public Health Agency of Canada officials at the committee and it was said that we didn't need advanced notification by land conveyances. Now we're saying that we do. What has changed that would lead to that impression?

I also wanted you to touch upon why these amendments are necessary. Wouldn't a bus or a train operator in the U.S. with a sick passenger on board simply seek medical attention rather than continue to the border?

I would also like it if you could comment on the costs associated with the amendments and if you have any rough numbers of how many people enter Canada by land, air, and water.

[Dr. David Butler-Jones]

Basically what was presented before was the best public health advice. Our view was--and as I think you heard from provincial officials, from a public health perspective--the risks that we're trying to address largely are not from the United States. If, however, the circumstance changed, then what we would have done is brought in regulation, which we have the power to do, to include land conveyances.

That said, we've heard the committee's view, which I think reflects people's views generally, and certainly the view of the minister, that in the circumstances we should try as efficiently as possible to include land conveyances. So we've said, well, there is no additional risk. Sometimes when you do something, you actually increase the risk. There's a principle in medicine: first do no harm. So sometimes you introduce something and you actually increase different risks. My assessment is this does not add to the risk. It may have some benefit, but one of the other things that will be useful is if we did have another event, we would not have to bring in a regulation. It's already in place in terms of land conveyances. Secondly, it may actually facilitate movement at the border in terms of having advance notification and people can figure out what needs to be done or not--take that person aside, etc.

In terms of the costs, we're going to absorb those costs. We're not sure exactly how much it will be, but part of it, the biggest costs, will be in making sure those who do the land conveyance are aware of it, have the 1-800 number, etc. We do see 88 million or 89 million people come to Canada every year, 79 million of those from the U.S., with 66 million of them by land. The vast majority of those are individual conveyances. They're not buses and trains, etc. There is still a requirement under the Quarantine Act that if someone is sick, even if they're in a personal car or van, they are supposed to declare that.

[Patrick Brown, Conservative, Barrie, ON]

In terms of other countries, are there other countries with similar arrangements for advance notification?

[Dr. David Butler-Jones]

As far as we can tell, at least in terms of air and sea, that is what's expected in international health regulations. As far as we know, it does not include land, for the practical reasons that I think officials have outlined before. As far as we can tell, Canada is the only one. It may not stay the only one into the future.

[Patrick Brown, Conservative, Barrie, ON]

Why is it necessary if other countries don't deem it to be necessary? Is there another motivation that makes it specific to North America, given the larger land mass? Were there specific concerns as to why it was more appropriate to take this measure within our geography?

[Dr. David Butler-Jones]

I think the public health assessment is still the same. It's only of very small marginal benefit, but it is the view of this committee and the view of my minister that even though the benefit may be marginal, it's something we should incorporate and respond to, and we're pleased to do so.

[Patrick Brown, Conservative, Barrie, ON]

Okay, thank you.

If section 34 of the Quarantine Act is not currently in force, what protections exist at the border in the event that a conveyance approaches Canada with a public health emergency on board?

[Dr. David Butler-Jones]

Sorry, I'm not clear on your question.

[Patrick Brown, Conservative, Barrie, ON]

If section 34 of the Quarantine Act was not currently in force, what protections exist at the border in the event that a conveyance approaches Canada?

[Dr. David Butler-Jones]

The existing legislation that remains in force from the previous legislation addresses air and sea, so there is a requirement to report currently. It has been in force for some time and we've been having airlines and others comply with that. That section of the old act will be revoked once this one has passed, assuming it goes forward in Parliament and the Senate.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

We'll now move on to Ms. Penny Priddy.

[Penny Priddy, NDP, Surrey North, BC]

Thank you, Mr. Chair.

I was pleased and interested to see in the notes that were distributed that the goal of SPP is to both strengthen competitiveness and also enhance security and quality of life in the United States. Actually, you're here today, I suppose, because we've had two things come together: one is the Quarantine Act and one is the increased pesticide on vegetation coming across the border. So I guess it's some coming together of the stars.

I'd like to ask a question. I don't know whether it's for Mr. Chaput or Dr. Butler-Jones.

Do you think raising pesticide residue limits will make Canadians healthier and safer? Just yes or no would be actually an excellent answer.

[Dr. David Butler-Jones]

I'll speak generally in terms of the issue of public health. The regulations and the addressment of what are appropriate standards I think go through a fairly important assessment in terms of risk. One of the challenges we have scientifically is we're now able to measure things to such a small level that we really have no comprehension of the benefits. There's always a trade-off. Virtually everything at the right dose is useful and at the wrong dose is harmful. The regulators are in Health Canada on that, yes.

[Penny Priddy, NDP, Surrey North, BC]

So does it make Canadians healthier and safer to raise the pesticide limits?