Health Committee on Feb. 12th, 2008

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

Thanks very much.

I guess I'm having a little trouble believing that you couldn't predict that there would be a problem on November 27, and that you would then wait for the calls and letters to be coming in--in a panic--at the first clinical problem, instead of actually predicting it.

Therefore I am having trouble with what Mr. Malkoske said, which is that planning is not the issue, only communication is. That means there isn't a plan B. If the only possible solution is starting up a shaky forty-year-old reactor in an earthquake zone--if that's plan B--we aren't doing very well in terms of planning. I guess I want to know where we are going on plan B in terms of what you would do again. I haven't heard that we've learned anything so far.

Secondly, you said the problem was mainly communication. I guess I would like MDS Nordion to have a chance to answer the CMAJ allegations that a lot of the problem seems to be a lack of communication between you and AECL, in that you don't seem to be at the meetings and being able to say what each other is doing. Then there's the allegation from the Netherlands in that article that said we never get any information from the Canadians, and that you wouldn't cooperate with Europe's two large-scale isotope suppliers. Nordion is represented at our meetings, but either AECL doesn't tell Nordion or they don't allow Nordion to tell us.... The breakdown in communication, let alone the nonsense between the natural resources minister and the health minister, who don't seem to have a telephone....

Could you help me with what plan B is? Then I would like MDS Nordion to tell me what R and D you are doing so that in the future you could use fluoride, you could use partical accelerator kinds of isotopes that do not require the high-grade enriched uranium at all, in terms of how we move forward out of this pickle of your monopoly for 50% of the world supply with no plan B.

[Grant Malkoske]

There were a number of questions, and I will try to address them in order.

First of all, I wouldn't call a 50% supply a monopoly. We are a supplier. We do have--

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

In Canada. You have a Canadian monopoly.

[Grant Malkoske]

As I mentioned, we supply to a radiopharmaceutical manufacturer. They are one of the two suppliers who supply back to Canada. Bristol-Myers Squibb and Covidien are the suppliers of radiopharmaceutical products to Canada. We supply Bristol-Myers Squibb with the medical isotopes that go into their finished products. Covidien obtains their material from the Netherlands. So there is a dual supply stream.

On the first part, about a plan B, I agree with you that this is a tenuous situation. I think what we need is a national isotope supply strategy for Canada. At 50 years old, the NRU reactor is the most reliable reactor in the world. It has a 97% supply reliability. It stands as the pre-eminent reactor in all of the world to do that. So an investment into the NRU infrastructure to keep it operating, to keep it licensed beyond 2011, we believe is absolutely essential.

The MAPLE reactors are solely dedicated isotope production reactors. One alone could provide the capacity that we require. The second one is a complete backup system. Bring the MAPLE reactors on line as quickly as possible.

So we think there is a plan B. But the difficulty we all face today in the world is the eventuality of a precipitous event like NRU. It would be something like if Saudi Arabia were shut down from supplying gas or oil to the world, what would you do immediately? There would be a shortage. That's the kind of situation we were facing with NRU.

So it's not a matter of planning for such a precipitous event. How do you do that? The global capacity was only able to fill 15% of the NRU gap. If NRU had continued on, it would still be a 15% gap. So planning three months or six months in advance would not have alleviated that situation. It is interesting to note that during this period of outage we contacted the Belgians, we contacted the people in the Netherlands, and we contacted the South Africans on November 23 to try to get any incremental amount of backup supply that we possibly could. We were very diligent; we consistently went through that.

Interestingly, during this outage there was one European reactor that was down completely during that outage period because of a pre-planned maintenance cycle. It did not come on line until somewhere around December 18. Interestingly enough, a reactor in France shut down during that period, before Bill C-38 was passed. What kind of planning would prevent that from happening?

There is a global capacity issue that needs to be dealt with. That is the fundamental issue in all of this.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Malkoske.

I will now go to Mr. Tilson.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Thank you, Madam Chair.

I have a question for Dr. Abrams.

CNSC used to have a medical advisory committee, and for some reason the former Liberal government disbanded that committee. I have two questions of you. Do you know why it was decided that this committee should be disbanded? Secondly, should we have a committee of medical experts when we have situations such as we had in December, to advise everyone, including the government?

[Douglas Abrams]

To answer the first question, I do not know why they disbanded the committee.

The answer to the second one is yes, I think it would be very good for us to have an advisory committee with some nuclear medicine specialists on the CNSC to help them evaluate the medical needs. That would be useful not only in situations like this, but just to review the regulations and how they impact upon patient care.

[David Tilson, Conservative, Dufferin—Caledon, ON]

The next question would be to both of you, Dr. Malkoske and Mr. Abrams.

Mr. Malkoske, I appreciate your giving us copies of your written comments. You say that government and industry and nuclear medicine should find a long-term solution.

Mr. Abrams mentioned that communications should be better.

Could both of you elaborate on that issue? That's one of the main reasons why we're here today, to find ways to improve the handling of such a situation, if it were to recur.

[Grant Malkoske]

If I may, I would address the point I mentioned in my opening remarks. I think it goes back to the national isotope supply strategy for Canada. When we take a look at the pre-eminent position Canada has in the world because of research and development in nuclear technology, Canada and we, Nordion are well-renowned internationally for everything we do.

This goes to the heart of NRU; it goes to the heart of the MAPLE project. We need some way to ensure that NRU continues to operate until the MAPLE reactors are brought on line. I think that will give us the reliable supply of medical isotopes in Canada that is so important.

[David Tilson, Conservative, Dufferin—Caledon, ON]

Mr. Abrams—specifically on your comment about our need to have better communications...?

[Douglas Abrams]

Yes. I think the need for better communication is apparent in the way we handle the patients and how we can triage the patients. If we know in advance, we can do two things. All physicians can look at their patient workload and triage appropriately. They can speak with other modalities about triaging the most needy patients into different modalities, and from the supply distribution point of view, one can triage appropriately to make sure that everyone gets a fair share of what is needed.

That's where communication is important, and the earlier the better, because it's much easier to make plans if you have time.

[David Tilson, Conservative, Dufferin—Caledon, ON]

I'd like to rephrase the question that was asked of you before, Mr. Abrams. On the issue as to whether people could have died, I understand you're saying you're not qualified to give that statement. However, the deputy leader of the Liberal Party said: “The Canadian Association of Nuclear Medicine estimates that 50,000 Canadians a month will experience delays in their medical tests.” He called it a medical crisis and also said the situation was endangering the lives of millions of Canadians. So clearly there was a situation.

Let me ask the question in perhaps a different way. Would the lives of millions of Canadians be endangered, with this situation? In other words, if Parliament hadn't taken the action it did—if the bill hadn't been passed—would the lives of millions of Canadians have been endangered? I use the word “endangered”.

[Douglas Abrams]

Taking into consideration what I've said in the past about my qualifications, essentially there are a small number of patients who require nuclear medicine scans who have a 20 percent to 30-some percent risk--and I'm taking this from Dr. O'Brien--of further consequences, patients with pulmonary emboli in particular. We also use them for transplant patients in renal situations. These are very important tests, where the implications of poor diagnosis and poor treatment could result in death.

Millions of Canadians being at imminent risk of death through this nuclear medicine shortage is probably an overstatement.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Abrams.

Monsieur Malo.

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

Thank you Madam Chair.

Mr. Malkoske, can you tell us if the sale of radioisotopes is MDS Nordion's only business?

[Grant Malkoske]

Nordion has a couple of business lines. One of them is what we would call our isotope business, where we sell molybdenum-99 and iodine-131. We also have a line of business that includes cobalt-60 sources and radiation systems for the sterilization of health care products.

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

What percentage of your revenues come from the sale of radioisotopes?

[Grant Malkoske]

I'm sorry, I'm not able to disclose that. Our annual revenues at Nordion are about $290 million, which is publicly stated.

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

Thus, it would be correct to say that most of your income comes from the sale of radioisotopes.

[Grant Malkoske]

A large percentage of it does, yes.

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

How can you say that the fact of acquiring supplies elsewhere would have no effect on your business and that price was not a factor in your decision?

[Grant Malkoske]

It's really quite simple. As I mentioned earlier, we have backup supply agreements in place with our suppliers. Those backup agreements have pricing defined. So it's already pre-defined, well in advance, what we would pay for those isotopes and that is part of our normal business evaluation.

The critical point here is we have an obligation to the health care system. So we went out to those other suppliers and we asked them to send us more product in accordance with the agreements that we have in place.

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

In your opening remarks you said that you immediately put your emergency protocol into effect on the evening of the 21st. Obviously, your emergency protocol does not work very well, because Parliament had to quickly pass a law to permit the temporary restarting of the reactor.

What conclusions do you draw regarding the emergency protocol you had in place?

[Grant Malkoske]

I think it's important to understand that we are not the reactor operator; we are not the reactor licensee in the world. What we do is we receive medical isotopes from reactors around the world, including the NRU reactor. The dialogue, in terms of restarting the NRU reactor, was a dialogue between Atomic Energy of Canada and the Canadian Nuclear Safety Commission, a licensee-licensor dialogue, to which we are not privy. So what we have done is we get information from AECL, the best information that they have available, on the restart.

As I said earlier in my opening remarks, during that first period in November--the last week of November--it was in a state of flux. It wasn't clear when the reactor would restart or what would be required to restart it. Even with that uncertainty, we took the step to contact all of our suppliers and asked them to start sending material to us. So in fact the protocol worked.

The issue I mentioned earlier in my discussions is there is a world-wide capacity limitation that cannot replace NRU. We do not have the authority to start up another reactor in another country. Of course it's not our authority to do so.

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

In the light of that, what should be done now?