Health Committee on Aug. 12th, 2009

[The Chair, Conservative, Joy Smith]

Welcome, everybody.

I want to especially welcome Minister Aglukkaq, the Minister of Health. It is indeed an honour, Minister, to have you here today. Thank you so much for making yourself so available right in the middle of summer. We appreciate it very much.

We also welcome Ms. Woods and Dr. Butler-Jones to the table.

In the first hour we are going to be having the minister present and then have questions and answers. I'm not going to give you a time limit. If you would just make your presentation, Minister, then we'll go into the questions when you've completed your remarks.

Minister.

[Leona Aglukkaq, Conservative, Minister of Health]

Thank you so much.

Good afternoon, Madam Chair and members of the committee. As always, it's a pleasure to be here with officials to provide an update on the activities taken to date by the Public Health Agency of Canada and Health Canada to address the challenges presented by the H1N1 flu virus outbreak.

Appearing before me today are the chief public health officer, Dr. Butler-Jones, and Shelagh Jane Woods, who is from Health Canada's first nations and Inuit health branch. I may turn to them to respond to technical matters during today's session.

Since the outset, I have stressed the importance of collaboration in every action taken to manage the outbreak on behalf of Canadians. Our response has been supported by systemic ongoing contacts with the World Health Organization and other international partners.

Within our borders, we have made a concerted and coordinated effort to share information and lessons learned with our provincial and territorial counterparts. In my view, this collaboration reflects an unprecedented spirit of cooperation. Experts and decision-makers from all jurisdictions and the entire spectrum of public health management have come together to ensure an appropriate and timely response to the outbreak. I know there are critics out there who don't think we've done enough fast enough for enough people, but I am confident that the actions taken so far and the efforts we continue to make have and will serve Canadians well. I take very seriously the commitment of my government to support all members of Parliament in their duties to their constituents.

At my first appearance before the committee in February, I indicated that it was my intention to be open and to listen in order to build effective relationships with stakeholders and colleagues, as well as with critics. Having provided more than 20 briefings for opposition members of Parliament since the outbreak, I think I've lived up to that commitment.

While the course of this pandemic may have been unexpected, we have demonstrated our ability to adapt quickly and effectively to rapidly changing environments. The federal government's influenza pandemic planning efforts have paid off. This is a plan built on years of collaboration with provinces, territories, and the medical community. As quickly as the H1N1 virus hit Canada, we implemented our plan.

One of the cornerstones of our pandemic planning is to make sure we're talking to Canadians. In early May, we launched the first of a multi-phased marketing campaign that saw print advertisements placed in daily and weekly newspapers across the country. These ads reminded Canadians about appropriate infection prevention behaviours. They were supplemented by information on the website of the Public Health Agency of Canada and by posters at Canadian airports and transit ads in major Canadian cities. It's why more and more Canadians are getting the message: cough into your sleeve, wash your hands regularly, clean common surfaces, and stay at home if you feel sick.

You will continue to hear these messages and more as we move into the fall and the next flu season. The marketing efforts will continue to ensure that Canadians have the information they need to make informed decisions to protect themselves and their families.

When the outbreak began, I held daily news conferences with the chief public health officer. As the days passed and we came to learn that the severity of the outbreak was milder than first anticipated, we continued with weekly briefings, including the one we just had today. We are committed to ensuring that Canadians have the information they need.

I seem to have used the words “collaboration”, “cooperation” and “coordination” to the extreme in my comments today, but I am convinced that these characteristics are critical to our continued success in managing a possible more severe wave of H1N1 flu virus in the fall.

As Prime Minister Harper and Presidents Obama and Calderón made clear this week in Mexico, we will remain vigilant and commit ourselves to continued and deepened cooperation. We will work together to learn from recent experiences and prepare North America for the upcoming influenza season. Certainly, this applies to our efforts at home with the provinces and territories, front-line medical professionals, and first nations and Inuit leaders.

No matter what comes our way this fall, we are well prepared. Already we have seen pockets of greater severity. This has included outbreaks in a small number of first nations and remote communities. From day one, we have been working with first nations leaders and provinces to ensure that communities have everything they need in a timely manner, based on the best public health advice.

It's important for me to make it clear for you all today that pandemic planning for first nations communities is a shared responsibility. For example, Health Canada provides basic nursing services on reserves. However, first nations needing treatment for severe H1N1 symptoms receive hospital services through the provincial health care system. This arrangement calls upon all governments to cooperate to protect the health of communities. That is why we are committed to maintaining and improving our strong working relationship with provinces and first nations to ensure that all Canadians receive the care they need when they need it. Of course, we're committed to making sure that first nations have the support they need to protect their communities. As a result, we're providing all nursing stations in first nations communities with additional protective medical supplies, such as gloves, gowns, and masks. We're pre-positioning antivirals so that if they're needed in a remote community, they can be accessed as quickly as possible.

As we did in response to the situation in northern Manitoba, we're prepared to reallocate nurses to where needs are greatest. In addition, we're training home-care nurses to be ready to administer the vaccine once it's available. We're continuing to assist communities to complete and test their pandemic plans. Thanks to the support from Indian and Northern Affairs Canada, we're working to deliver supplies of water to communities to help prevent and control infections in homes on reserves.

Moving into the fall, we are increasing efforts to get the H1N1 and seasonal flu vaccines to those Canadians who want and need them most. Last week I announced the federal government's intention to purchase 50.4 million doses of the H1N1 vaccine from GlaxoSmithKline. This will be enough to cover the needs of Canadians. GSK is on track to deliver the vaccine doses, as planned, by mid-November.

In closing, I want to emphasize yet again my ongoing commitment to collaboration, transparency, and communication. They are our tools that will enable us to work best with our partners internationally and domestically.

I understand Dr. Butler-Jones will now make some brief remarks, after which I'll be happy to take any questions.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Minister. Again, thank you for being so available today in this very important meeting.

I'll now ask Dr. Butler-Jones to begin.

You have seven minutes, Dr. Butler-Jones. We look forward to hearing your comments.

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

Thank you, Minister. And thank you, Madam Chair, for the invitation to speak before the committee today.

As the minister mentioned, the H1N1 flu virus has presented some challenges that we had not faced before.

One of our key messages during the response has been acknowledged as truly our best defence.

To build on the minister's remarks, I'll divide my comments this afternoon in terms of how we're getting information in, through cooperation with our partners, and how we're getting information out to the public.

First, in terms of information in, sharing information and cooperation between jurisdictions enables us to learn a bit more every day about how the virus behaves and spreads. This morning, as you know, the minister announced that the Public Health Agency of Canada has mobilized public health officials, intensive care specialists, and medical experts from Canada and abroad to share and discuss best practices for clinical care of severe H1N1 cases. That meeting will take place in Winnipeg on September 2 and 3. The meeting offers an opportunity for public health officials and critical care specialists to gain insights into the epidemiology of severe H1 disease, to discuss strategies for prevention and early recognition of severe disease, and to share best practices for clinical care, disease management, and resource utilization. This will assist us all in managing the anticipated fall pandemic wave.

I cannot emphasize enough how critical the strong collaborative working relationships we have established with our public health partners—domestic and international—has been to our overall response.

For example, early on in the outbreak, the Government of Canada established with its provincial and territorial partners the special advisory committee on the H1N1 flu virus, SAC. It is made up of chief medical officers of health, such as me and others, as well as other senior public health officials, and it has a network of committees under it. Its mandate is to provide policy and technical advice to the federal, provincial, and territorial deputy ministers of health, where I sit, on public health matters related to the H1N1 flu virus outbreak. This committee has been crucial to the management of the H1N1 outbreak response. I believe this collaborative effort, along with the many activities that are under way, has ensured Canada's place as a leader in public health management of the international H1N1 response.

I'd also like to discuss the many efforts under way in the agency to get information out--that is, about how we are getting information to the public. As the minister indicated, our communication efforts have been intense since the outset of the flu outbreak. On a weekly basis, the Public Health Agency receives an average of 50 to 70 H1N1-related media calls, resulting in hundreds of stories and media interviews. As of today, more than 20 national news conferences have been held and webcast.

To give you an example of the thirst for information, 1.8 million visits have been made to the H1N1 web pages on the FAQ website between April and August. We are also giving out information directly to thousands of Canadians through our 1-800 toll-free telephone line.

The Public Health Agency is committed to providing Canadians with the information they need to make appropriate decisions related to the H1N1 flu virus to protect themselves and their families. This includes communicating with at-risk populations, such as pregnant women.

In early May, the agency launched a comprehensive marketing strategy, which the minister referred to earlier. I can assure you that extensive planning is under way to continue this marketing effort into the fall and through the flu season. Our continuing goal is to raise awareness and knowledge so that individuals and families, regardless of whether they are living in a remote community or a major city, feel they have the best information readily available to them so they will know what to do in any given situation.

In closing, I would like to remind the Committee that, as Chief Public Health Officer, I have maintained a consistent public presence through all of these developments.

My top priority has been, and will continue to be, to ensure that the Public Health Agency is in a constant state of readiness for the fall.

I've been working diligently, as have many, many others, on everything from issues of vaccine supply to guidance documents, to maintaining close consultation with our domestic, international, and myriad other partners to make this happen. Canadians need to have all appropriate knowledge about self-care, family care, immunization, and pandemic preparedness should a severe second wave of the H1N1 pandemic occur during the 2009-10 flu season.

Information in and information out: these are critical to our readiness for the fall. I believe that together we are succeeding.

Thank you, Madam Chair. That concludes my remarks. Merci.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler, for your very insightful comments.

Now the committee will go into questions and answers, and the first round will be seven minutes for both questions and answers. I'm going to keep to the time very tightly so everyone gets a chance to ask all the questions they want, so they can get all the answers they want.

We will begin with Dr. Bennett.

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

Thanks very much, Madam Chair.

Thank you very much, Minister, Dr. Butler-Jones, and Shelagh Jane Woods.

First, I want to say it is very important to us that you have come today. As a committee, we take the responsibility given to us by Parliament very seriously. I hope you will understand the difference between parliamentary oversight and an informational session or a briefing; that all members of this committee have been given the responsibility to make sure that we're as prepared as we possibly can be by the fall; and that we hope this meeting and others like it will help Canadians understand that, as their representatives, we are doing everything we possibly can to make sure they feel confident that they will know exactly what to do when this pandemic hits again in the fall.

I believe Canadians want to know where the gaps still are. In your remarks, you have said this afternoon that we can rest assured that this government is well prepared for this pandemic and will continue to implement the plan. We have been criss-crossing this country and know there's a lot of people who still don't know quite what they will do or what the mom will do about sending their children to school in two weeks, or their university student going off to university. There are also day care supervisors, and particularly chiefs and councils. Last week we heard from the Federation of Canadian Municipalities, but also particularly from the premiers, who were calling for immediate and meaningful cooperation in tackling H1N1.

After SARS, the Naylor report said we needed to focus on four Cs: collaboration, communication, cooperation, and a clarity of who does what and when. We are very concerned that clarity does not exist, and we need you to help us understand who is expected to do what and where in the plan. How can Canadians understand what is in the plan and what is their responsibility?

Minister, I want to know when you will be meeting with your provincial and territorial colleagues. Have the roles and responsibilities been signed off? As to the money that is expected, is there enough money? And will you identify the gaps for us of the things you're still working on and the things that we, as parliamentarians, could help with?

[The Chair, Conservative, Joy Smith]

Madam Minister.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you. I'll start off with the response, and then Dr. Butler-Jones may want to add more to the response.

In terms of having conversations and working with them, it's been a daily contact with the provinces and territories. Last week I was teleconferencing with the ministers of health across the country pretty well daily in regard to planning for the fall. The FPT will be meeting on September 18 in Winnipeg, where we'll be finalizing some other plans on a going forward basis related to the pandemic.

In terms of what we are doing for the fall, Dr. Butler-Jones made reference earlier to the fact that we are working with guidelines based on best information that will be going out there, and this continues to be worked on to date. During the summer months it's a very busy time for many chief medical officers across the country who have formed committees to deal with guidelines for schools, guidelines for the private sector, guidelines for medical practitioners, and so on, and that work continues to date.

The guidelines will be implemented through the provinces and territories. There are a number of stakeholders involved. Provinces deliver health care; we know that. We need to work with the provinces as ultimately, at the end of the day, they will be the ones responsible for the delivery--

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

Do you have a memorandum of understanding with the provinces in terms of roles and responsibilities?

[Leona Aglukkaq, Conservative, Nunavut, NU]

The memorandum of understanding has been shared with the provincial and territorial ministers and is being finalized as we speak.

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

So it has not been signed.

[Leona Aglukkaq, Conservative, Nunavut, NU]

The memorandum of understanding that talks about.... I'll give you one example. Each province has credential recognition of health care professionals. They have a process in place that will say that this nurse will practise here, and each one of them is different. In the memorandum, as one example, that piece needs to be ironed out in the case of a pandemic, when you have an outbreak in one province that may require additional health care in some other--that support system. That needs to be an agreed term within that MOU. That memorandum of understanding is being finalized. It's with the provinces and the territories and should be completed very shortly.

Dr. Butler-Jones may want to elaborate on that.

[Dr. David Butler-Jones]

All these memoranda have been supported in principle by all the jurisdictions in terms of the roles and responsibilities on information sharing and on mutual aid, as well as working through some of the financial annexes on the information sharing. We're anticipating ministers dealing with that in the fall. However, it has not impeded the work in any way. The thinking that goes behind these memoranda is the essential matter we're dealing with in terms of cooperation, collaboration, and sharing of information. All those things are in place and are working.

In terms of the question with regard to not everybody knowing, I'm sure that's true. That's always true. Seven years ago, long before I started this job, I was working with the local health authorities, with municipalities, with representatives from multiple municipalities, from police, from fire, as well as undertakers, working on the pandemic plan for that region. That's a region that probably has a lot of things in place now, seven years later, that some others may not have.

We know, at the outset of H1, not every jurisdiction was at the same level of planning or had the same level of connection between medical officers, municipal officials, hospital officials, etc. We've been encouraging, because we don't do it. Public health is a local activity. The hospital is local, everything is local, but it can connect through provinces, territories, and the national and international governments.

So we've been working to encourage that, to develop the resources, to build collaborative mechanisms to foster that, but at the end of the day it really is a shared responsibility that each level, each jurisdiction, needs to address. So if there are questions to be answered, part of it is asking the question; and if it's the local police or fire, it's talking to the local medical officer, because that's actually where the action takes place. The issue of the broad guidelines is important, but those are broad guidelines at a national level that then need to be adapted and used locally.

I think many of those guidelines were actually in place before H1, because we've been working on these issues, as I think the committee knows, for a long time. But then when we saw H1, they needed to be adapted, because it's not exactly what we expected. We had guidelines around for health care facilities, etc. Once we saw H1, in the first weeks, we adapted those guidelines for H1, and we've recently revised them based on, now, several months of experience.

That revision will continue to go on. They get posted; they get shared. Sometimes there are gaps in the information because not everybody knows at the same time, but again, it's key, and I want to stress that, from all areas, if people don't know, they need to ask. We'll communicate. Each level will communicate, but it's important also that they ask, and there is the planning that needs to take place locally.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

I want to interrupt for a minute to tell Dr. Bennett that the time is up for her questions, but please finish your answer and we'll go to Monsieur Malo after that.

[Dr. David Butler-Jones]

Early on we established the special advisory committee, which I referred to, of public health officials and others. We bring together the expert committees, etc. We have weekly meetings of deputy ministers, as well as bilateral meetings. For example, last week I was on the phone to every jurisdiction in the country.

To allow for more questions, I'll leave it at that.

[The Chair, Conservative, Joy Smith]

Thank you.

Monsieur Malo.

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

Thank you, Madam Chair.

Thank you very much, Minister and Dr. Butler-Jones, for being with us today.

Last week, you announced that you would be purchasing vaccine. A little earlier, you announced that you would be buying antivirals, and this morning, there was another announcement about money that will be used to develop a strategy to support small business. We are seeing a series of public announcements that look very much like a communication strategy. However, these are isolated announcements. At this stage, we are not in a position to have a more comprehensive picture of the situation.

In the not too distant future, rather than proceeding on a case-by-case basis to make announcements which, of course, are important, would it be possible to be given an overview so that, as Ms. Bennett was asking earlier, we could see where more preparation is needed, so that everyone is on the same wavelength?

[The Chair, Conservative, Joy Smith]

Who would like to comment on that? Perhaps the minister.

[Leona Aglukkaq, Conservative, Nunavut, NU]

Thank you, Madam Chair.

In terms of the overall plan that was adopted, the pandemic plan was established back in 2006, defining the different roles and responsibilities of federal, provincial, and municipal governments, and so on. Within the pandemic plan, there are a number of areas identified: roles and responsibilities, vaccine development, and pandemic vaccine or antiviral stockpiling. Those are all within that plan. They are being implemented at different stages in how we're responding to H1N1, depending on the situation we're coming across. It's a plan that's being modified or updated as we deal with the situation. It is the overall plan that defines the roles of the federal government, provinces and territories, municipalities, and health care providers. There are a number of agencies involved in the implementation of the plan.

The announcement made last week relating to the H1N1 vaccine and how much we need to purchase is part of the plan; part of the plan is to purchase the vaccine. To do that, we needed to have conversations with the provinces and territories to make decisions on the number of vaccines we would purchase, and then to place our order. So that was announced when we made those decisions.

Today we're working with private industry to assist small businesses to respond to H1N1, how they can better prepare themselves and get the information they need to manage their businesses as we go into the fall season.

So the plan outlines all of those pieces, and we are implementing them at different stages as we deal with the H1N1—and we are at different stages. So as we learn more, we share more. As we learn more about it, there are certain things that are triggered. And come the fall, the guidelines will be developed for schools, health care providers, private industry, and so on, and who will get vaccine first and how. That, and the timing of it, will all unfold as we go along. Again, that requires research and working with the provinces and territories.

One other example is that the Public Health Agency's national microbiology laboratory has been in partnership with intensive care units across the country to learn more about the severe cases in order to ensure that when we do the guidelines for the fall, the people who require the vaccine most will receive it first. This will allow us to make an informed decision in terms of prioritizing implementation, and so on, come fall with the vaccine. That's an example of how the provinces and territories are collaborating in developing the guidelines for the fall.

Dr. Butler-Jones may want to add to that. But the pandemic plan is at different stages, depending on what we're dealing with related to H1N1.

[Dr. David Butler-Jones]

Thank you.

We have a national plan, which you have read. Every territory, province and municipality has a pandemic response plan, but the level of preparation and needs vary from one city to the next. Planning is extremely important at every level. We believe our plan to be transparent and would be prepared to discuss the measures laid out in the plan, which covers the period from early summer to fall.

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

Minister, as I don't know when I will have another opportunity to speak with you, I would like to briefly address another matter, if you don't mind.

The medical isotope crisis is going to cost the provinces more money. Yesterday, the Quebec minister asked for financial compensation, like his counterpart from Ontario.

Will you bring the necessary pressure to bear on the President of the Treasury Board so that Quebec and the provinces receive fair compensation for the additional costs occasioned by the crisis?

[The Chair, Conservative, Joy Smith]

Monsieur Malo, I want to intercede here for a moment. I thought this committee meeting was called for H1N1, so can we stick with that and perhaps go on to the other issues another time? Do you have a question on H1N1?

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

Dr. Butler-Jones, when we met this winter, there was already a risk that H1N1 would evolve and mutate. I don't know to what extent you have been following the evolution of the virus per say, but what would happen to the vaccine if we were to realize that H1N1 were mutating in the fall, for example?

[Dr. David Butler-Jones]

That's a good question.

At the present time, the virus is the same; it has not changed. It is beneficial to buy a vaccine that contains an adjuvant. Experiments on the H5 virus showed that vaccines with an adjuvant can protect against mutations or changes in the virus. If that were to continue to be the case, it would be a good thing for us.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Malo.

Ms. Wasylycia-Leis.