Health Committee on Aug. 28th, 2009

[The Chair, Conservative, Joy Smith]

I'm sorry, we just have one minute. Could you answer Dr. Duncan's question, please, Shelagh Jane? Thank you.

[Shelagh Jane Woods]

I think I kind of missed the question.

[Dr. Paul Gully, Senior Advisor to the Assistant Director-General, Health, Security and Environment, World Health Organization]

I've been on the job for two days, and therefore it'll be a short answer.

What I've learned is that there has been a huge amount of work done on the side of the First Nations and Inuit Health Branch and the Public Health Agency of Canada, and the provinces and territories, in collaboration with first nations and other aboriginal peoples. However, there clearly is a difference in information. I won't say perception, because that would imply that it's incorrect, but there is a difference in information that exists on one side to the other.

I take your question, and we will go back, we will look at the information we have, and we will present what we have, and we will have to check that.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Gully.

Monsieur Malo, I know you're next, but Ms. Wasylycia-Leis has to catch a plane. May she go first?

Stop hugging him, Ms. Wasylycia-Leis.

[Some hon. members]

Oh, oh!

[The Chair, Conservative, Joy Smith]

Would you please ask your question quickly?

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you very much.

I have three quick questions.

Number one, given what we heard about the need for better coordination on first nations communities—and I don't think anybody here will dispute that—have you thought about a way to do that in terms of either hiring and putting on staff an adviser to you and the minister, as we have in Manitoba with Cathy Cook? Or do you have another suggestion to respond to the clear need today to get this information out and to start dealing one on one with reserves to make sure they're actually up and running?

Number two, would you be able to say, here and now, that aboriginal people will be put at or near the top of the list in terms of vaccinations and access to quick delivery of the vaccine and other necessary services, something I think Manitoba has recognized? I think Dr. Joel Kettner has stated that in one way or another, and I think we're waiting for an answer about where you stand in terms of prioritizing first nations and Inuit people.

Third, will you support flu kits financially?

[Dr. David Butler-Jones]

I can't speak to the financial; that's in another area. I do support families having things in their households, as we've talked about before, and the items that I've talked about before and that Dr. Kettner has spoken to as well.

On the issue of prioritization--or it's really, again, sequencing of the vaccine--clearly, while the final decisions, which are a collective decision across the country, are not finalized yet, isolated and remote communities are going to be at the top of the list in terms of prioritization because of the nature of health care access. And if you are wrong and they do get sick, they're going to have to be flown out, etc.

In addition, antivirals are already pre-positioned in those communities to provide early treatment. So even in advance of a vaccine, that's in place at the nursing stations and others.

Third, those with underlying risk conditions—we recognize diabetes, pregnancy, etc.— are going to be at the top of the list whether they're aboriginal or non-aboriginal. What we have not been able to sort out scientifically is whether a perfectly healthy person of aboriginal descent is at greater risk or substantially greater risk of developing serious disease with H1N1 for no other reason than that they are aboriginal. That we have not been able to sort out. Even if it is a slightly increased risk, the logistical challenge is in reaching that group other than on reserves, etc., which will be obviously high on the list because it will be one in a thousand, and so you're chasing 999 to try to find that one.

But that having been said, regarding the provincial and territorial plans, the local plans to actually roll it out, you will be going into a community and doing a community. You will not be going into a community and asking, “Do you have diabetes or not?” You're going to do the whole community. So again, from a practical standpoint, once the vaccine is available, people will be getting it. In the meantime, there will be antivirals in order to address that.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

Monsieur Malo.

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

Thank you, Madam Chair.

First of all, I hope there is general acknowledgement that the testimony we heard this afternoon was extremely worthwhile and brought to light a number of issues facing the different communities.

Dr. Butler-Jones, I understand that, at this stage, we cannot focus primarily on the long term, because there is concern about the fall, which is the short term. However, as we heard, it is clear that general living conditions in these communities have to be looked at. The fact is that the circumstances in which they live weaken the communities, making them more susceptible when pandemics occur, such as the H1N1 flu pandemic.

One of the witnesses told us that it may be because Health Canada is lacking information. I hope that is not the reason why no action has been taken to deal with these issues and make improvements to general living conditions in these communities.

Earlier, Ms. Wasylycias-Leis made reference to the availability of vaccine. That could also be a problem: when they receive the vaccine, will they actually be in a position to administer it? Have you also looked at that and have you taken steps to ensure that they will be able to immunize their population once the vaccine is available to them in the communities?

I also heard the representatives of the Inuit communities say that they do not have clear understanding of the federal government's role with respect to developing a strategy or plan to deal with the H1N1 virus. I am not necessarily asking you to provide clarification now, but at the very least, you should be cognizant of the need to work with these people in order to clarify everyone's role, so that the communities will have an effective plan to deal with the H1N1 virus.

Also, will those plans be tested? I know that Dr Duncan referred to this earlier. That is another interesting point.

As well, how is it that the tool developed by the Garden River First Nation was completed forgotten for four or five years? Is that because it fell between the cracks or because you lost sight of the need to pay close attention to the development of tools for prevention?

[The Chair, Conservative, Joy Smith]

Who would like to take a shot at that?

[Shelagh Jane Woods]

Once again, there are a lot of questions in there--

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

That's true, but it's because the testimony was so instructive.

[Shelagh Jane Woods]

It was for me as well.

If I can begin with your final point, I think it's very important that we ensure the communities have plans. However, we do not require that they provide copies of the plans per se.

We generally do not insist that the communities deliver the plan. Communities all have different ways of developing their plans. You heard Ms. Nolan refer to the fact that she'd heard that Health Canada had a template, but they chose to go ahead and do things in a different way.

I think I mentioned—I guess it was probably on a teleconference—that one of the things we did a couple of years ago was give some money to the Assembly of First Nations to develop templates for holistic plans in three communities, a pilot project to test to see how things would work. So there are different ways.

I assure you that people are going out, one to one, to talk to communities. If the community doesn't choose to share its plan, we have to take their word that they have one. We don't demand as a condition that they must show us their plan.

I think one of the things I have learned most this afternoon is that testing is very important, and we should be making sure that we're putting a lot of effort into ensuring that the maximum number of plans are tested. Again, I want to make it very clear that it's terribly important that we do this in collaboration with provinces wherever possible.

[The Chair, Conservative, Joy Smith]

Thank you very much, Dr. Woods.

Mr. Wallace.

[Mike Wallace, Conservative, Burlington, ON]

Thank you, Madam Chair.

I'll be relatively quick. I have just a couple of points from the discussion we've had today.

The Inuit community talked about a separate plan, an appendix plan, and I think they indicated that you, Dr. Butler-Jones, had made a commitment to them to look at that. Probably that won't happen overnight, because we have these other issues facing us, but was their statement accurate in that you think we should be looking at a separate plan for northern Canada?

[Dr. David Butler-Jones]

We actually have a working group on remote and isolated communities in terms of how to adapt the recommendations to that. It's a federal, provincial, and territorial expert working group. They are correct in terms of the question, though, because of the differences, particularly in the remote north. They have some similarities with, say, northern Saskatchewan, but not completely. So an adaptation for that is appropriate.

Going through the full FPT process, etc., in the midst of this is not appropriate. That is why we've committed to working bilaterally with them, along with the isolated group, to make sure we actually have modifications in place.

That having been said, it's really interesting that Nunavut has done some tremendous work in this area already.

[Mike Wallace, Conservative, Burlington, ON]

I appreciate that.

To Ms. Woods, I am new to the committee and I'm just coming in today to hear all this, but I've been reading and so on. I have a family member who was in the hospital with lung cancer during SARS, and it seems to me that there wasn't a lot of planning ahead for what happened with that issue.

Are we not much further ahead in this, facing the H1N1 issue, than we were at that time from a federal perspective?

[Shelagh Jane Woods]

Yes, that's absolutely true.

In my own case, I arrived in the job just as the last SARS cases were being dealt with. It was evident that our branch, the First Nations and Inuit Health Branch, learned a lesson from that. We said it was absolutely important that we started on pandemic planning.

We didn't have any resources to do that, so we organized ourselves to start in on pandemic planning. When resources were made available in due course, we started with information sessions to try to build awareness. One of the witnesses did refer to some of those.

We think the communities have actually done pretty well to get to the point they are now. It all comes down to the test, as several of them have said, but a lot of effort has been put in by communities. You heard it today. They haven't necessarily always waited for us, which is a good thing. We've been able to enhance some of their efforts in some cases.

I would say that generally speaking they have done a good job. There is almost no comparison between now and SARS.

[Mike Wallace, Conservative, Burlington, ON]

I have one final question, and it's for Dr. Gully. He's not getting completely off the hook today.

As you said, you're new to the job. Obviously when someone of your stature takes over a new role, you have a vision of what you want to accomplish or what the job is. Would you tell us what you think your value-added is to this issue?

[Dr. Paul Gully]

Thank you for that question. I do come into it with a more global perspective, but what I've heard in the last two days has been very instructive. I've actually learned a lot.

My vision would be very short-term. It deals with leading up to the fall, and we don't know what's going to happen.

One would be to ensure that there is the capacity to enable very sick individuals to be treated appropriately, and that will be not in their communities but probably in tertiary care hospitals. How do we do that? We'll have to make sure and find out if that's possible.

Second, we have to then ensure that there are sufficient nurses and medical care in the communities to ensure that those individuals who are sick are adequately assessed and then medevaced or transported out appropriately.

Third, on the issue of availability of vaccine to those communities that, broadly writ, have this constellation of risk factors, we have to ensure that this is dealt with and discussed so that they receive the vaccine as one of the priorities.

That's what I would like to see, and that's what I intend to work on.

[Mike Wallace, Conservative, Burlington, ON]

Do I have more time, Madam Chair, or am I all out?

[The Chair, Conservative, Joy Smith]

You have just 30 seconds.

[Mike Wallace, Conservative, Burlington, ON]

With my last 30 seconds, then, I'll say that we've heard a lot today, and I think we all, regardless of which side of the table we sit on....

Take the issue of water, for example. We've recognized that in the budget. We put about half a billion dollars toward new infrastructure on reserves for water and so on. There's no short-term solution.

I'm assuming that Chief Knott grew up in the place where 90% of the people don't have water. He didn't just move to that community. From a long-term vision point, it has been a problem for many years in Canada. How big a factor is that in the flu issue that we're having here now? Is it a major issue?

[The Chair, Conservative, Joy Smith]

Who would like to answer that question?

Dr. Butler-Jones, to end off, please.