Health Committee on Aug. 12th, 2009

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Kendall.

Now, Dr. Bennett, please.

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

Hi, Dr. Kendall. It's Carolyn Bennett.

I wanted to congratulate you on the great work you're doing with the Public Health Network. I think your leadership has been hugely important. I guess I want to say I sleep better in my bed at night, knowing that you guys are there worrying about all of these things, In particular, I think that federal-provincial collaboration at your level has been way better than what we've seen before.

What we're hearing is concern that some of the other partners haven't necessarily felt included, in terms of the cities, but also some of the stakeholder groups, whether it's the chiefs or the family doctors, the people who are going to have to actually implement this plan. They aren't feeling confident that they know where all of this fits, given all of the various committees that have been working hard.

So I'd like to know what keeps you awake at night. What are you worried about, as we go forward into the fall, in terms of the potential gaps? What do you see needs to be done in terms of the people to man this plan and in terms of the human resources? But also, do you think the people at your level, in terms of the provinces, feel they have enough money to do this out of their regular budgets? Do you think it would be appropriate for us to be calling on the federal government to ask for more money for some of the resources that people are clearly saying they need, whether for masks or training sessions or rollouts of these things, because just handing down guidelines without a training module, without a tool kit or any of these things.... Certainly the people we've been talking to across the country don't yet feel confident they know what they will have to do this fall.

[Dr. Perry Kendall]

Thank you, Dr. Bennett.

I think the public health infrastructure across this country is thin. It doesn't have a lot of depth. If a few key people leave or are ill, then there are big gaps that are hard to fill. We have made this point on numerous occasions, I think, to federal, provincial, and territorial minsters of health.

I think there's bad news and good news. The bad news is that H1N1 has come along at a time of extraordinary economic constraint. The ability of provinces and territories to put any additional resources into their health care systems is strained. I can speak for British Columbia, where I know we are seeing constraints there. Nonetheless, some extraordinary purchases have been made and some funds have been made available both provincially and territorially and, I would think, federally.

What would have kept me awake at night was if this H1N1 had a much greater degree of severity that was closer to either the avian H5 that we were looking at, or the 1918 H1N1. Looking at what has happened in the southern hemisphere, where they haven't had the advantage of preplanning—Australia, New Zealand, and Chile have had very similar experiences—it has certainly stressed and strained their health care systems. It has not overwhelmed their health care systems; it has not created mass absenteeism in the health care or other workforces. So I feel that if we see the same patterns as they have seen in New Zealand and Australia, we'll actually come through this. We'll be able to cope with this. It won't be any worse, for example, than the 1996 A/Sydney, though it will certainly be worse than the last two or three years, which have been very, very mild.

I think that in a way it's a training virus. I think we could use more resources, certainly. I think if I were to put resources into one particular area, for sure it would be communications, because we do have vulnerable populations. We know there will be vulnerable populations in the fall: pregnant women in their third trimester or in the first four weeks post-partum, younger people under the age of 55 with chronic conditions of morbid obesity, smokers, first nations people, etc. I think we should be now very aggressively promoting these vulnerable groups to be visiting with their physicians to talk about what to do in the fall and how to get quick and easy access to antivirals for people who will really benefit from them, people who are most at risk of respiratory complications or pneumonitis, who are also the people most likely to end up in hospitals. So I'd like to see a really strong campaign directed to them.

I'd also like to see a strong campaign talking to physicians about how to proactively talk to and manage and maybe pre-emptively write prescriptions for antivirals for those people who will fall into those risk groups. Our great limiting factor, until we get the vaccine, is rapid access to antivirals, within 24 hours ideally, for people who most need them, who are most at risk. So I'd like to see a really strong, vigorous campaign talking about that, focusing on people, and focusing on their physicians, outlining the mutual responsibility they could have toward each other.

Then I'd like to also see a campaign that talks about what we could expect in the fall for schools and universities, etc., and be assured that we have plans in place to communicate those expectations. Then I think we'll be looking at delivering a vaccine at the end of November. My guess is that we will have had the second wave of vaccine after that, so we need to get through the fall in a way that manages to minimize morbidity, mortality, and pressures around the infrastructure pieces that we talked about.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Kendall. Your input into today's committee has been of paramount importance. We thank you for joining us today and we look forward to speaking with you further on this. Thank you.

I want to especially thank the witnesses who have come forward.

We will go in camera now. I would ask all people who are not committee members or designated staff members to be so kind as to excuse us. I'll suspend the meeting for one minute so you have time to leave the room. Thank you.

[Proceedings continue in camera]