Health Committee on Sept. 30th, 2009

[The Clerk of the Committee, Ms. Christine Holke David]

Honourable members of the committee, I see a quorum. We can now proceed to the election of the chair of this committee.

I must inform the members that the clerk of the committee can receive only motions for the election of the chair, and no other types of motions. He cannot entertain points of order nor participate in debate.

I am ready to receive motions to that effect.

Pursuant to Standing Order 106(2), the chair must be a member of the government party.

Mr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

I would like to nominate Joy Smith.

[The Clerk]

It has been moved by Mr. Carrie that Mrs. Joy Smith be elected chair of this committee.

Are there any further motions?

Is it the pleasure of the committee to adopt the motion?

I declare the motion carried and Mrs. Joy Smith duly elected chair of the committee.

Before I invite Ms. Smith to take the chair, if it pleases the committee, we will move on to the election of the vice-chairs.

I am now prepared to receive motions for first vice-chair.

Pursuant to Standing Order 106(2), the first vice-chair must be a member of the official opposition.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I'd like to nominate Ms. Murray.

[The Clerk]

It has been moved by Ms. Duncan that Ms. Murray be elected first vice-chair of the committee.

Are there any further motions?

Is it the pleasure of the committee to adopt the motion?

I declare the motion carried and Ms. Murray duly elected first vice-chair of the committee.

I am now prepared to hear nominations for the position of second vice-chair. Pursuant to Standing Order 106(2), the second vice-chair must be a member of an opposition party other than the official opposition.

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

I nominate Judy Wasylycia-Leis.

[The Clerk]

It has been moved by Mr. Malo that Judy Wasylycia-Leis be elected second vice-chair of the committee.

Are there any other nominations?

Is it the pleasure of the committee to adopt the motion?

(Motion agreed to.)

I declare the motion carried and Ms. Wasylycia-Leis duly elected second vice-chair of the committee.

I will now invite Mrs. Joy Smith to take the chair.

[The Chair, Conservative, Joy Smith]

Good afternoon, committee members. I want to thank you so much for getting the selection out of the way.

I want to welcome Ms. Hall Findlay. It's very nice to have you here today.

I want to congratulate Ms. Murray and Ms. Wasylycia-Leis for being vice-chairs of this auspicious committee. This is very nice.

The order of the day previously planned for today has changed, and I have to explain that. The deputy minister, Morris Rosenberg, and Dr. Paul Gully are not available today to brief the committee on the body bag inquiry. In light of this, we've tried to reschedule the weekly briefing at 3:30 p.m. today, but the Public Health Agency officials are not available before 4:30; therefore our meeting will only start at that time.

I'm sorry about this. I've just been given this notice.

I want to make one comment. The minister met with the chiefs last week, and I was in that meeting with Chief Ron Evans and Chief Harper, and committed to discussing the findings of the report prior to making it public. So the minister agreed with that. Consequently, the deputy minister requested his appearance be delayed for one week, until October 7, in order to honour the minister's commitment and to respect the concerns of the chiefs. That's a result of her visit to Winnepeg with the chiefs last week.

Do we have agreement to suspend until we are called again at 4:30, or do we have some discussion on this?

Ms. Davidson.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you, Madam Chair.

Perhaps I could ask one question for clarification. Did you say that the chiefs asked that the report be delivered to them before it was made public?

[The Chair, Conservative, Joy Smith]

I wasn't in that actual discussion, but when they came from the meeting it was agreed on both sides. The minister said she would like to have her investigation finished before we went any further with any discussion on it. The chiefs agreed this was the best way to do it. Chief Ron Evans, Chief Harper, and all the people around the table did agree to that.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Joy Smith]

Can we suspend the meeting until 4:30, at which time our guests will come?

[Some hon. members]

Agreed.

[The Chair, Conservative, Joy Smith]

Thank you. The meeting is suspended until 4:30 p.m.

Welcome back, colleagues. We will continue now. Thank you very much for your patience.

We have before us the witnesses from the Department of Health, Dr. Paul Gully, senior medical advisor, and from the Public Health Agency of Canada, Dr. David Butler-Jones, who is the chief public health officer, and Elaine Chatigny, director general of communications. Welcome.

Dr. Butler-Jones, I'd like to again relay my congratulations to you on your reappointment. I can't guarantee you will get your life back for a good long time, but we're glad you're with us today. It's an honour to have you.

Could we start with the Department of Health? We will have a ten-minute presentation as usual, Dr. Gully, then seven-minute rounds of questions and answers. Thank you.

[Dr. Paul Gully, Senior Medical Advisor, Department of Health]

Thank you, Madam Chair.

Good afternoon. Thank you for the opportunity to provide you with an update on pandemic influenza planning and response on first nations reserves.

Nationally, the number of cases of influenza-like illness in first nations communities, as for the rest of Canada, remains low since the peak of the first wave in mid-June to early July.

First nations continue to receive health care and anti-viral drugs based on provincial guidelines. Our forward strategy for first nations preparedness and response includes assisting communities to finalize and test their pandemic plans, to roll out H1N1 vaccines in collaboration with the provinces, and provision and restocking of medical equipment and supplies, including anti-viral medications. And I can confirm that these medications have in fact been pre-positioned in the first nations communities under our responsibility.

Next, contingency planning for key health services. We're focusing on ensuring that first nations individuals who are severely ill get the treatment they need rapidly, with ongoing communications with first nations communities and leadership to ensure that first nations have the best public health advice to implement their plans.

In terms of pandemic preparedness in particular, we continue to focus on that. According to the interaction between the regional offices and the first nations communities, they report to us that 94% of those communities do in fact have plans.

We know we need to focus on the communities that feel they need more support and information, and we are doing that in communication with the communities. Testing of the plans plays an important role. At the present time, approximately 80% of communities have tested their plans, and that figure actually is increasing.

So we continue to support community testing and provide informational support when it's needed.

I think the example of the community of Ahousat, in British Columbia, shows how well a community in fact can respond. They activated their plan in September, and the community has been dealing with the situation there in collaboration with Health Canada staff and with the Vancouver Island Health Authority. There have been no severe cases of H1N1 in the community, and anti-virals were pre-positioned in that region and were utilized.

In relationship to immunization, we continue to ensure that the immunization will cover first nations communities and the vaccine will be administered by qualified health professionals in nursing stations or via special immunization clinics.

All regional offices have mass immunization plans in place, including transportation, storage, and the necessary supplies. To support surge capacity for immunization, Health Canada has identified additional staff in national headquarters that can be deployed as necessary.

We will work with first nations communities in remote and isolated situations to receive the vaccine as soon as possible. We continue to communicate all this to first nations communities, and as you all know, Health Canada, with INAC, Indian and Northern Affairs Canada, signed a communications protocol with the Assembly of First Nations. That protocol outlines the roles and responsibilities that each one takes in terms of pandemic planning in clear communications.

I look forward to answering your questions and further briefing this committee as you so wish.

Thank you, Madam Chair.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Gully.

Dr. Butler-Jones.

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

Thank you again for the opportunity to discuss this matter with you.

I'm going to be very brief. I'm just going to touch on a few things, because I know you really want to get to questions.

The first is on the situation where we're at. We normally would see, with influenza season, a bit of an uptick in September after the kids come back to school. Then it would settle down. Then we would start seeing more cases again as you move later into the fall and through Christmas. It would really pick up after Christmas and would peak in January and February.

We are seeing clusters and outbreaks scattered across the country in different areas. At this point, obviously, we are continuing to track the numbers week by week to see what's happening. Whether next week there will be more or fewer--to speak to the point of whether we are in the next wave--only time will tell in which direction the cases will go, although as I was remarking at the media event today, for those of us, and many of you, who spend a lot of time on planes, I must say that I've started hearing a lot of coughing on planes, which I hadn't heard a week or two ago. Whether that is H1N1 or whether that is para-influenza or whether it is some other rhinovirus or other thing is hard to say. But obviously, we're paying close attention.

What has provoked a lot of media interest are the as yet unpublished case control studies that looked at people who had received vaccine against seasonal flu in doctors' offices and had then presented and been tested for H1N1, which suggested that somewhere in the range of perhaps twice as many of those who presented and were positive for the new pandemic H1N1 had had a seasonal flu vaccine. That could be for any number of reasons, one of which is that it does increase the risk. Or it could be that those who are more likely to get the vaccine are also more likely to go to a doctor's office and want to be tested for H1N1.

Given that no other country has seen this, and they've looked, and that they have the same, or similar, vaccines as us and have not seen that association.... It is, though, something we've seen now in several provinces when we look at it in the general population. There isn't really a good biological rationale for why that would be. We've never seen it before with influenza vaccines, and we're not seeing it anywhere else.

Again, it's speculative to say at this point, because a lot more work needs to be done to actually understand it, but there are a number of things that make Canadians different. We are a country that immunizes and has a greater awareness of influenza than just about any other country. We immunize more people than anybody else does. We have more campaigns, I think, focused on the importance of influenza vaccine, and so on, and we're fairly conscious of that. Now, would that actually drive people to do that in more ways to create that association? We don't know. It's an association. It's not a cause until we have a better picture of it. But you have to pay attention. You can't ignore that kind of information.

At the same time, we've undertaken some of our own studies, which are a little more easily controlled in terms of those confounding errors, such as looking at hospital and ICU cases. Unlike just choosing to go to a doctor for a viral illness, being admitted to an ICU or a hospital is not a self-selection. Someone else decides for you. There is a clear end point. You're severely ill and you need to be in hospital or in an ICU. In that group, there is no difference between those who are immunized and those who are not immunized. In other words, the rate of immunization is the same in the cases as it is in the controls, which would suggest that there's no increased risk of severe disease. So whether there is an increased risk of developing pandemic H1N1, having received, in the past, an annual flu vaccine, clearly, the evidence we're seeing would suggest that even if that were true, your risk of having severe disease really is no greater, which is pretty reassuring. It's pretty fundamental. But there's still a lot more work to do.

Seasonal flu continues to be a major challenge. We don't know when it will come. Usually it's not, again, until later in the season. We know that we will be seeing H1N1. We are seeing H1N1. The focus of all jurisdictions is to get a vaccine out as rapidly as possible and available for people who wish it, and to deal with the other issues related to a pandemic. There will be variations between the provinces and territories as to how they will roll out and deliver and think about their seasonal flu campaigns. As many don't actually start until mid-October to late October, which is around the time and close to the time when we're anticipating immunization against H1N1, again, as part of their planning, I think this is all fairly prudent.

From the international panel that we commissioned to look at that data, again not suprisingly I expect that what we will see is that yes, they're reasonable studies, but all case-controlled studies like this have confounding errors, self-selection being a major one of them.

I think I'll probably leave it at that for now and await questions.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones.

We'll now go to Dr. Duncan for seven minutes of questions and answers.

Doctor.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you all for coming and thank you for your presentations.

Dr. Gully, it's encouraging to hear these percentages. You've said that 94% of communities have plans and 80% have tested. I really hope that's the case, because we were struggling with having heard from northern Manitoba of 30 communities that had a plan too, and none had been tested. Is that an anomaly? What is the oversight to ensure that there is indeed a plan and that it's a sufficient plan, that the supplies are in place, and that those communities are going to have the HR resources?

[Dr. Paul Gully]

Thank you for that question. In Manitoba, for example, the regional director wrote to the chiefs of all the communities and in that letter informed the chief of the information and of where the information was obtained for each community. The information was obtained most often not from the chief but in fact from another individual, a person working in the health field or specifically in pandemic preparedness. That's where the information was from.

We requested them to express concern about the plans and readiness, given that information. In fact, I think we got just one response, which was negative, in relation to this. We have made efforts to confirm the information we had from certain individuals in the communities about that level of preparedness, and then we continue to offer assistance.

The challenge is the assessment of what is meant by preparedness, realizing that having a plan is not an assurance of preparedness necessarily and therefore doing exercises, but also visiting those communities that are of concern in terms of their ability to respond, which is what has been taking place in Manitoba.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

So have you been visiting the communities that...? Do we have a list of communities we're concerned about?

[Dr. Paul Gully]

Manitoba has that list; the regional office has a list of those communities where they think further assistance will be required. This is another reason for sending that letter, and visits have taken place to certain communities to further assist them.

Is it possible for every community to say they're absolutely prepared? I think the answer to that is no. Therefore, I can assure you that what we'll continue to do is work with those communities in every way—not only in terms of their plans, but in terms of supplies, antivirals, and so on—to assist them to get prepared as quickly as possible to respond.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I'm going to ask a number of questions, and perhaps then they could be answered.

What percentage of the hospitalizations, ICU cases, and deaths were among aboriginal peoples, and how do these compare with those for the Canadian population at large? I'm concerned about the time from symptoms to treatment for aboriginal communities and for people who require to stay in ICU.

I'll ask one more and then make a comment, if I may.

What was the average length of time on a ventilator and the average stay for an ICU patient, again for the aboriginal versus the Canadian population at large?

The other thing I wanted to briefly mention is that I was looking at our communications for this. If I compare what I see on the American sites, we tend to lag in terms of when things are updated. One of my concerns is for pregnant moms and breastfeeding moms. That information has not been updated since July 10, and I know the U.S. right now is struggling with new guidelines for.... There's no mention of even vaccine on that site.

I've probably asked way more questions than you can answer.

[Dr. Paul Gully]

We also will be responding in writing to those questions, Dr. Duncan.

In terms of hospitalization, the data available from the Public Health Agency of Canada—and there are various ways of getting information from the Public Health Agency of Canada, but also then directly from our regional offices—show that out of almost 1,500 hospitalized cases, about 17.5% were aboriginal, not only first nations. Of the 288 admitted to intensive care units, 15.3% were aboriginal. And out of the 76 deaths, nine or 11.8% were aboriginal.

The aboriginal population of Canada is about 4% and that of first nations around 2%. So it's undoubtedly the case that there is an overrepresentation of aboriginal peoples in those data, which one can try to analyse in a variety of ways. If the disease is present in a first nations community, for example, and if, for reasons that I think we well know in terms of challenges in those communities, it may spread more rapidly—this is what we saw in Manitoba—then, given that this is where the disease occurred and spread in the way it did, this overrepresentation may not be surprising.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Dr. Gully, may I ask a question there, if you don't mind?

If this had started in Southeast Asia, one of the ways we were going to attempt to slow the virus was through government quarantine and antivirals. When it started in Mexico and by the time it was in Canada, that opportunity had passed, although in first nations communities, where there are great distances, I'm wondering why we didn't do more in terms of containment.