Good afternoon, Madam Chair, ladies and gentlemen of the committee.
I'm here this afternoon with my deputy minister and my assistant deputy minister on this file.
It is my pleasure to address the health impact the Chalk River nuclear shutdown with you.
As members of the Standing Committee on Health, you are keenly aware of the importance of correct diagnosis, especially in cases of critical illnesses such as cancer and cardiovascular disease. Radioisotopes are used in the diagnosis and treatment of cancer and cardiovascular disease.
As members know, the Chalk River reactor is an essential source of medical isotopes in Canada and indeed world-wide. The extended shutdown of the NRU reactor significantly reduced the supply in Canada and throughout the world.
As soon as I became aware of the situation, on December 5, my officials and I started acting immediately to stem what was quickly evolving into an urgent health crisis. We communicated with 773 health care facilities across Canada, including 245 nuclear medicine facilities, to determine initially the severity of the shortage. We found that shortages were felt in smaller rural and remote areas, particularly in Atlantic Canada, and that shortages were imminent elsewhere.
We inquired into gaining supply from the four other medical isotope suppliers in France, Belgium, the Netherlands, and South Africa. In doing so, we found that French and South African reactors were going through routine maintenance at exactly the same moment. All in all, we found that overseas suppliers could increase their output by only 10%, or at maximum, 15%. Furthermore, overseas suppliers indicated that the earliest they could provide us with the additional supply would be December 29. Based on the information we were receiving, this would have been too little, too late, as the shortage situation would have, I'm absolutely convinced, escalated to unmanageable levels long before that.
During this time we also established a group of experts from the fields of oncology, cardiology, and nuclear medicine, as well as representatives of the Canadian Medical Association and the Canadian Society of Nuclear Medicine. Based on the information from this group, it was clear we were in the midst of a growing health crisis, and one that needed action. One of the members of our expert group, Dr. Karen Gulenchyn, told the natural resources committee of Parliament last week that “...we believe that unmanageable shortages would have occurred within a week”. This group estimated that approximately 10% of affected patients were indeed facing life-and-death decisions.
The group of experts also gave information that another 30% to 40% were facing the risk of under-equipped physicians making inappropriate diagnostic and treatment decisions. This message was reiterated in a letter dated December 10, 2007, to Linda Keen, and copied to me, in which Dr. Brian Day, who of course is president of the Canadian Medical Association, stated that the CMA “...joins the Canadian Society of Nuclear Medicine....to express our deep concern and profound disappointment with the disruption of supply of medical isotopes due to the extended shutdown of the reactor at Chalk River”.
He goes on:
The devastating impact that this has had on patient care across Canada, and indeed around the world, has been compounded by what we perceive as a true lack of understanding of what the extended shutdown means to patients who need access to vital diagnostic procedures. For physicians it means we are increasingly being forced to make difficult clinical decisions without appropriate critical diagnostic tools.
I'm hoping we can all agree that a faulty diagnostic or treatment decision today is the first step to a more complicated or critical situation tomorrow.
In short, in order to serve the needs of patients in a way Canadians rightfully expect, gaining a minimal supply of medical isotopes from overseas was no substitute for a running reactor at Chalk River, which produces more than half of the world's supply. As a result, we had a responsibility to seek information from the Canadian Nuclear Safety Commission about ways to resolve the growing health crisis.
First we wanted to see if there could be an expeditious hearing to consider the merits of AECL's safety case, without in any way directing the commission to reach a particular conclusion. Alas, such a decision was not reached.
Second, our government issued a policy directive stipulating that the commission's decisions take into account the health of Canadians who depend on nuclear substances to meet medical needs, but that had no effect.
So our government had to take decisive action on December 11 by proposing to Parliament Bill C-38. Of course this bill passed with all-party support, and by December 19 isotope production was returned to pre-shutdown levels, and deliveries resumed over the holidays.
Dr. Andrew Ross, a nuclear medicine specialist at Queen Elizabeth II Health Sciences Centre in Halifax, called our action “a great Christmas present”. Indeed, he was not alone. The Canadian Medical Association and the Canadian Society of Nuclear Medicine thanked all parliamentarians of “all political stripes” for the fast legislative action.
Now that the situation has passed, my officials are continuing to work with the expert advisory group to establish contingency plans in the event of any future supply disruption.
This includes assessing the possibility for alternative sources, along with substitute diagnostic techniques that could be used if needed, and examining opportunities for enhancing international collaboration to coordinate supply.
This work is also aiming to ensure timely notification of issues that may affect supply.
As a result, we have developed a notification protocol between AECL, Natural Resources Canada and Health Canada. It provides clarity about who needs to be contacted and when. As well, it states that information will be shared immediately when it concerns Chalk River's operations and therefore the supply of medical isotopes.
In the future, if my department receives information about a potential shortage, we will be able to draw on the best practices employed in December and the lessons learned from that experience to immediately establish contact with provinces, territories, the health care communities, and relevant experts to assess the potential impact and launch strategies to respond.
In closing, Madam Chair, I want to underline the fact that our government acted out of necessity for the health of Canadians. Going without isotopes provided by Chalk River meant health care providers were under-equipped to meet the urgent needs of patients. As the shutdown went on longer, the potential for a health crisis grew stronger. Accordingly, our government acted decisively to stop it before it was too late. We did so with all-party support in Parliament.
Together, all parliamentarians put aside partisanship to act as needed when lives were threatened.
Our government did what was needed for the health of Canadians—and I thank everyone here today for your votes in December which helped achieve this result.
