Health Committee on Sept. 30th, 2009

[Elaine Chatigny]

We have been doing research going back to 2004, trying to establish a baseline around, first of all, people's attitudes and behaviours and levels of knowledge around infection-prevention issues and, at the time, avian influenza, pandemic influenza, and seasonal flu, for example. In the early days our strategy was to try to clarify the differences between bird flu and human flu. Subsequently, our research has continued to delve into other areas of pandemic response, particularly vaccines and attitudes and knowledge about vaccines. So yes, in our communication strategy the outcome is very much the ending for us, which is a behavioural outcome ultimately.

So, for example, in the spring we were testing very much people's levels of awareness and behaviour around handwashing and cough etiquette and the infection-prevention behaviours we wanted them to adopt. Throughout the spring we could actually track changes in people's behaviours. In the early days we saw a tracked change in behaviour around handwashing, and coughing in the sleeve was slow. It's really amazing, you could see a change in behaviour as you changed your messaging, and when you changed your tactics as well. Then mid-course, when we started pushing the message around sneezing in your sleeve more aggressively, we started seeing a shift as well in the numbers.

But what's also true is that the moment you stop aggressively pushing a message, people can revert to old behaviours. We saw that during SARS, a big change in behaviour around handwashing, then two or three years later we saw that the numbers were going down again, which speaks to the importance of collectively working with our partners, provinces and territories, all of our partners in public health, to continue to communicate certain messages.

In terms of messages and behaviours, what we know about people's attitudes towards vaccine is that they shift week to week in terms of uptake, intention to uptake, which is why--to Mr. Malo's questions earlier--a strategy will shift very soon to more sustained messaging on the risks and benefits of vaccination in the hopes, of course from a public health standpoint, of seeing a certain uptake in vaccine.

How we define success is something we could all debate, whether success is ensuring that Canadians have the information they need to make a well-informed decision or whether success is a certain rate of uptake. That's something we're in the process of finalizing as part of the strategy.

[Cathy McLeod, Conservative, Kamloops—Thompson—Cariboo, BC]

I'm going to try to squeeze in two quick other ones. There's been criticism of the Government of Canada that we don't have a specific approach to pandemic planning for first nations communities, and it sounds like it's creating confusion.

To Dr. Gully, you've been there for a couple of months. Simply put, do we have a plan for first nations, and are we following it?

[Dr. Paul Gully]

Yes, we do. There's annex B in the Canadian pandemic influenza plan, which specifically relates to first nations and roles and responsibilities. And what we are doing for first nations, particularly remote and isolated communities where we're responsible for care and treatment, is ensuring that what we would expect the province to do elsewhere in terms of access to care and treatment and tertiary care and so forth is available in those communities--recognizing, though, that there are certain specifics relating to difficulties of transportation, but also recognizing the increased risk of transmission in some communities as well, which is being recognized in the sequencing of vaccines relating to remote and isolated communities. Also, there's recognition of the need to continue to communicate, as I mentioned before, with first nations at all levels to ensure there's an understanding and recognition and that we get feedback about those plans.

[The Chair, Conservative, Joy Smith]

Thank you so much, Dr. Gully.

We'll now go to Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Madam Chair, thank you for giving me a few minutes to ask my questions.

I am going to ask you three quick questions in a row, and then you can answer.

Why does the H1N1 vaccine contain an adjuvant, when the flu vaccine does not?

In Europe, they have already authorized the commercialization of vaccines manufactured by GSK, GlaxoSmithKline. Why are we still at the clinical testing phase in Canada?

Ordinarily, Health Canada does not recommend the use of adjuvants, but GSK is being allowed to use AS03, one of the least used adjuvants on the market.

[Dr. David Butler-Jones]

There are many reasons for using this adjuvant. First, for each content... perhaps four vaccines, with an adjuvant. Second, the adjuvant protects against virus mutations, which is an advantage. Third, there is evidence that certain groups, particularly seniors, have a better immune response with this type of adjuvant.

The Americans and Europeans have worked with us on developing regulations. We have reviewed the tests and research studies. All of the studies are good. Health Canada has reviewed the information and will make its decision very soon.

[Nicolas Dufour, Bloc, Repentigny, QC]

We could get approval very soon.

[Dr. David Butler-Jones]

Yes. No one has the vaccine yet, not the Americans, the Europeans or us. But we will have it. I think that the next two weeks will be critical in the decision-making process.

[The Chair, Conservative, Joy Smith]

Dr. Butler, I'm so appreciative of all your insightful comments, and Dr. Gully and Ms. Chatigny. I thank the committee.

Bells are ringing now, so I guess we have to go and vote.

The committee is adjourned.