Health Committee on Aug. 28th, 2009

[Shelagh Jane Woods]

Yes, I can start.

Again, there were a number of questions.

I will begin in French, although I find it difficult.

I am pleased to hear that we agree the First Nations communities are ready. I also believe that to be the case.

I would say that in the province of Quebec about 96% of the communities completed their plans some weeks ago. So I'm not surprised you heard that.

Of course we are concerned about Manitoba, where the rate of completion was considerably lower—and we are putting a lot of effort there. We are concerned wherever we see pandemic plans not being completed. And of course there was the added factor of the outbreaks in Manitoba, so we are taking that very, very seriously.

I forgot the rest of your question.

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

When the pandemic began, the different communities, both Aboriginal and non-Aboriginal, were not at the same level in terms of their preparation. These communities had plans, but there were differences with respect to the evaluation and implementation of those plans.

Manitoba is facing an additional challenge, because that is where the pandemic first appeared. It's a little like when SARS first appeared in Toronto. Other communities benefited from the fact that there was a realization the pandemic had begun.

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

Minister, in your presentation a little earlier, you basically identified three risk factors: being between the age of 16 and 25, pregnancy or underlying chronic disease. You seemed to be saying that the reason why Aboriginal communities are more affected than others is that there are greater numbers of individuals in those communities with those sociological or physiological characteristics. Therefore, there are more cases in Aboriginal communities for those very reasons.

Is that actually true? Has the Public Health Agency of Canada done any studies showing that there is a higher incidence in Aboriginal communities as a result of these factors, or are there other realities that could also be considered risk factors?

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll respond first to the question and then I'll pass it on to Dr. Butler-Jones.

I have said all along that the chief medical officers across the country have been looking at all of the cases we have seen in Canada, particularly the severe cases, which in some cases have resulted in death, to study and examine the underlying conditions those individuals may have had that resulted in death, and they are looking at the population, and so on. Next week, on Wednesday, the chief medical officers are gathering to further examine what other factors there may be and who is more affected.

But what I have outlined today is what we have seen, particularly in the higher-risk and serious cases--with pregnant women, as an example--and the younger population being hit by H1N1 across the country, aboriginal or not. This is the kind of information being collected that will help shape the guidelines we will be prepared to implement in the fall, as well as the sequencing of how the vaccine will be implemented.

Perhaps, Dr. Butler-Jones, you may want to elaborate a bit more on that.

[Dr. David Butler-Jones]

Well, it is not totally clear. I should say, however, that there are many challenges facing Aboriginal Canadians.

The fact is that 30 people died in hospital, in intensive care. The health status of 60% of them predisposed them to severe illness. In the general population, that percentage is only 4% or 5%, but that is not a complete explanation. We will continue to study this in order to get at the reasons. There will be a meeting next week with experts from different fields to help us gain a better understanding.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

We'll now go to Ms. Wasylycia-Leis.

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

Thank you, Madam Chairperson.

Thanks, Madam Minister, Dr. Butler-Jones, Shelagh Jane Woods, and Dr. Gully. I appreciate your being here.

This is a week after our first meeting, and the reason we all felt it would be important to hear from you at this meeting, as well as from representatives of first nations and Inuit communities, is that we had the sense that of all the areas of a possible pandemic, we were least prepared in terms of aboriginal issues.

Today you presented a fairly rosy picture, Madam Minister, suggesting that we're in great shape as we head into the fall, when we might be faced with a pandemic. But that flies in the face of everything we're hearing from first nations communities. We will hear from them again later today. They seem to feel that in fact we aren't as prepared as you're suggesting. They have big questions. There are very grave concerns about the adequacy of supplies, resources, staff, and communications.

So we're here to try to figure out what's missing and how we can fix the problems, because I don't think anybody here today would dare suggest we're as prepared as we should be at this point, near the end of August, facing a possible outbreak in September.

My first question is this. In Manitoba the first nations communities, under Grand Chief Evans, came together and requested funding for flu kits. The Province of Manitoba has agreed to provide some money for those flu kits. First nations communities have had to resort to doing fundraisers to raise money for flu kits. I was at the fundraiser last Friday night, which was well attended and raised a great deal of money, where Chief Evans indicated that this was a very important contribution to communities in Manitoba.

So my question to you is, Madam Minister, are you prepared to put some money on the table to support the provision of flu kits for every first nation and Inuit community in this country?

[Leona Aglukkaq, Conservative, Nunavut, NU]

I'll start off with the response to that issue of flu kits.

My officials have been in discussion with Manitoba's chief medical officer, I believe, to find out what is actually in the kit. I wasn't aware of what this kit actually entailed. That's the first issue.

I understand Manitoba has made a commitment to purchase a kit, but I'm not sure what is in it, nor have I been notified. I think Dr. Butler-Jones has had meetings since then to discuss what may be in the kit.

[Dr. David Butler-Jones]

Yes, and I think Dr. Kettner is also appearing before the committee later and he can speak to it directly.

But in essence, as you've heard me say before, it doesn't matter which family it is; there are some basic things that each family in this country should have, not just for a pandemic flu but for other flu-like illnesses at any time, and those are Tylenol for symptoms and a thermometer to know if someone actually has a fever or not. Obviously every household should have soap and water--and potentially a hand sanitizer to supplement that if you don't have easy access to water and soap--and information--

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

Could I interrupt you there, Dr. Butler-Jones?

If those items are part of the flu kit--because in fact many communities don't have those basics—is this government prepared to financially support the purchase of those flu kits, period? Yes or no?

[Dr. David Butler-Jones]

I think in terms of the flu kits, however the family finds the funds to cover this, this is not an expensive item. The other challenges are not, from a public health standpoint--

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

But you are talking about conditions on first nations communities that are under federal jurisdiction, where we know we're dealing with very serious economic and social problems. There isn't the same access to these products you've just outlined. There isn't a phone to pick up and call 911, and there isn't necessarily a way to move in and out of communities easily. So do you not see some responsibility to help provide for those flu kits?

It's not just the flu kits, but there's the question of resources in terms of extra nurses for nursing stations. You didn't yet answer the question that my colleague Carolyn Bennett raised. Are you prepared to support the rather enthusiastic outpouring in Manitoba and other places by nurses who are willing to go north? Are you moving them into first nations communities, and what is the plan to address the unique circumstances of first nations communities while you get more research?

I think the conference next week is great, but first nations communities know what they're dealing with, and they're asking for help right now. We're hoping to hear today what you're prepared to do to address that gap in services and support them in their cry for help.

[Leona Aglukkaq, Conservative, Nunavut, NU]

To start off the response, as an aboriginal person I have a very good understanding of what's in a community. I come from an aboriginal community of 1,000 people. It's an isolated community. I know very well what the limitations are of services. Not every community has a hospital. It requires partnership, and you know that.

I said in my opening comments that in severe cases, individuals are transferred to hospitals in provincial jurisdictions, as they would be in Nunavut to Yellowknife, Edmonton, Manitoba, or Ontario. I understand that environment because I was born and raised in that environment, and I continue to live in an aboriginal community. So that's one piece.

The second part is that our priority remains focused on ensuring that the nursing stations are adequately equipped with the supplies they need to respond to the pandemic in the fall. At the same time, we'll be implementing the immunization program in the fall, which is key to prevention. That's the goal we have, to get that out by October-November, and clinical trials are happening now.

As it relates to the question on these kits, I think it's also important to note that it is our responsibility, my responsibility as well as yours, to purchase hand soaps. Is that a federal responsibility?

These are questions I need to ask--

[The Chair, Conservative, Joy Smith]

Thank you, Minister.

[Leona Aglukkaq, Conservative, Nunavut, NU]

One of the things I should also clarify--

[The Chair, Conservative, Joy Smith]

We'll now go to Dr. Carrie.

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

So you're not prepared to support the purchase of flu kits?

[The Chair, Conservative, Joy Smith]

Excuse me, your time is up, Ms. Wasylycia-Leis.

We'll now go to Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank the minister. It's good to have you back to make yourself available to the committee. I would like to thank the officials as well.

Minister, I know you have a toddler. I wanted to ask a question. I'm a parent with three small kids. I have a seven-year-old, a 14-year-old, and a 15-year-old.

I know, Dr. Butler-Jones, you've been working hard on the preparedness part of the plan.

It's September. The kids are going back to school, and a lot of kids are going back to day care. I was wondering, when their kids are going back to school, what does the average parent need to know about what's going to be happening in the schools?

[Dr. David Butler-Jones]

There are the general guidelines out there, but the basic information that parents need to deal with—and it's good common sense, but we don't always apply it—is that if you have a sick child, it's not the time to send them to infect other children. Having our kids understand about handwashing, how to cough, making sure that we keep contact surfaces clean as much as we can, knowing that the day care or the school are also reinforcing those, those are all important, and also knowing, whether it's a child or an adult, that if you're becoming severely ill, particularly with something like influenza, if you have shortness of breath, if you have chest pain, that is not something to wait and see about. On the other hand, if you have milder symptoms, there are things such as Tylenol, comfort, lots of fluids, etc.

These are all things that are not mysterious but need to be constantly reinforced. Certainly we do know that the virus spreads in schools, it spreads in communities, etc., but we also know that where kids are educated, supported, and observed, they're more likely to get the appropriate care they need.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Dr. Butler-Jones.

The minister said in her speech that knowledge is our best defence, and we've heard from the last meeting the importance of communication for Canadians, public awareness education. You just mentioned some really good things that parents should know. What actions have been taken by the federal government, in collaboration with their partners, to provide information to the public?

[Dr. David Butler-Jones]

As many of the members would have seen, there has been advertising, there has been information at airports, there has been advertising in the newspapers, etc. There are regular media briefings that have been well picked up by the media in terms of educating the public. There will be an escalating campaign as we move into the fall, appropriate to what we're seeing. We will add to that, when we come closer to immunization time, in terms of what the immunization procedures are, etc.

This is not just a federal activity. The provinces and territories have been doing this. I was recently in Nunavut, and I was very impressed, actually, with the collaboration between the federal government, the territorial government, and the local municipal councils there. Everywhere you went, there was information, both visual and in the official languages of Nunavut, about good hygiene but also what to do if you're ill, a whole range of things, and people were very aware. They had obviously taken that effort very seriously.

[Colin Carrie, Conservative, Oshawa, ON]

What about front-line workers? Before I was in politics, I was in the health care field for over 15 years. When SARS broke out in Ontario, I was actually quarantined.

Have you been providing guidance to the front-line workers? There is a concern out there, so I'm wondering what the Government of Canada has done to provide guidance to the front-line workers who are going to be right there treating this outbreak if it indeed does occur.

[Dr. David Butler-Jones]

The guidelines were part of the original plan and have been recently revised. We will continue to engage with the professional associations, experts, and others, and the guidelines will continue to be revised as we understand what's happening or if things change. So that's an important part of it. But it's also important to recognize that these are guidelines, and it's impossible, whether for a municipality, a band council, or a hospital, to get all the detail. That's where plans at every level really are important, because how you deal with it in a small rural hospital in Saskatchewan won't necessarily be the same way you'll deal with these things in downtown Toronto. So it really is important about applying these guidelines.

But the guidelines are there, they outline the important principles, etc., and then the local experts—public health, medical experts, and others—can apply them.

[Colin Carrie, Conservative, Oshawa, ON]

I think everyone on the committee is aware that this is an international issue. I know we've had some experience from Australia, which apparently has gone through its flu season. Could you elaborate on the role that Canada has played internationally and the communications we are having internationally? What are we learning at this stage?