Evidence of meeting #34 for Health in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pandemic.
A recording is available from Parliament.
4:50 p.m.
Senior Medical Advisor, Department of Health
I'll come back to your other specific questions, to which in fact I don't have an answer because the data do not exist for aboriginal people or I think in general for other Canadians, and further research would have to be done.
In terms of your other question, the theoretical possibility that one could actually contain and stop the pandemic is done on the basis of modelling, as we well know. The impression I have is that by the time that, especially in a small community, H1N1 became evident by disease, it was probably too late to do intensive social distancing and other methods of containment. Then one would want to use antivirals and other methods to respond. I think we've learned things, from experience in the spring, such that we may do things slightly differently in terms of antivirals next time.
4:50 p.m.
Conservative
4:50 p.m.
Chief Public Health Officer, Public Health Agency of Canada
I'll briefly finish off.
Clearly, in this pandemic, if you're seeing the first cases in the world, it's a different issue. Once it's established, which it was—well-established by then—early treatment is key for those who are most vulnerable, and remote communities are vulnerable. That's why antivirals are pre-positioned, so that early treatment can take place. And we've noticed a major difference in the impact, once this has been implemented.
On the issue of updates, there really hasn't been much change since July; things are updated as changes occur and develop. The guidelines around vaccine are being developed currently—that's for everybody. They need to be in place before we actually do immunize, but they don't need to be as of today.
4:50 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you, Madam Chair.
And thank you to our witnesses for being here this afternoon.
I am also glad to see Ms. Chatigny, Director General of Communications, because, as I am sure you would agree, we are hearing a lot about the H1N1 virus. There are even emails going around about a possible conspiracy. Certain people in the health sector are taking a critical look at vaccination.
What is your comprehensive communications strategy to get across your point of view, which, as we have seen, is based on science and research, research that you have done and continue to do?
Do you feel that you have the financial resources necessary to get the right message across?
4:50 p.m.
Elaine Chatigny Director General, Communications, Public Health Agency of Canada
Thank you, Madam Chair.
As for resources, that is not a concern at this time. We have to do what we have to do.
In terms of the amount of information going around, you are absolutely right: there is a lot. A lot is being said, and we cannot systematically respond to every bit of information, blog or comment out there. You were right when you said that we need a more comprehensive communications strategy to try to communicate with all Canadians across the board. But we also need to develop more targeted strategies for certain at-risk groups. That is what we are doing, and we are not doing it alone, as the federal government. As you know, we are working with the provinces and territories, which, for a long time now, have been committed to working with us on a national communications strategy through a number of committees.
As for vaccines specifically, we have clinical trial research, information on the risks and benefits, and contraindications. Health Canada will clearly identify and communicate that information. We are also developing several communication products, not only for the Web site, but also for a multimedia campaign that we will be launching very soon. In the coming weeks, we will launch the next phase of the marketing campaign, among other things; it is a document approximately 20 pages long describing the symptoms of the H1N1 virus and the steps to take in looking after yourself and loved ones. We will also talk a little bit about the vaccine and prepare the public for the third phase, which is relevant and detailed information on the vaccines. We are talking about a risk communications strategy here. In other words, not a public relations campaign. We are not trying to sell the public on anything; we must provide fair and appropriate information and address the risks and benefits. Ultimately, we are leaving it up to Canadians to make an informed decision about their own health, and the health of their children and loved ones.
Those who object to the vaccine are not necessarily basing their opinions on science. Obviously, we are going to try to present information that is science-based, but we will still give people the chance to make their own choice. We will be using a number of communication measures to achieve this goal. We will use all the tools available to us. As I said before, this campaign will have several phases.
4:55 p.m.
Senior Medical Advisor, Department of Health
Can I add something with respect to aboriginals? Health Canada has an agreement with the AFN
the Assembly of First Nations,
on hosting a virtual summit specific to the H1N1 virus in aboriginal communities. The purpose of the summit is to give people an opportunity to ask questions about immunization and to answer those questions. I hope that the summit will take place at the same time as immunization and that it will specifically answer the questions that aboriginals have.
4:55 p.m.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Dr. Butler-Jones, “pandemic” is a loaded word. For ordinary citizens, it may bring to mind the Spanish influenza pandemic of 1918, causing them to automatically associate it with a virulent and fatal phenomenon, whereas the actual definition of a pandemic, according to the WHO, is a widespread phenomenon worldwide. It does not mention virulence.
Do you think that the WHO should change its definition of a pandemic so as not to confuse the public?
4:55 p.m.
Chief Public Health Officer, Public Health Agency of Canada
There is currently a big debate on the importance of clarifying the differences between large-scale pandemics and smaller scale pandemics, but all pandemics affect a large population. Even if the death rate is less than 1% among several billion people, that still represents a lot of deaths. It is very different from the annual flu.
To distinguish between this situation and a tsunami, a hurricane or similar disaster, in the future, everyone can have a system to identify the different levels. This virus may be very similar to the virus of the first pandemic in the 20th century because the world is now very different. We have antiviral drugs, vaccines and good treatment. A lot of progress has been made since the First World War. Things are very different, but the virus has characteristics similar to the influenza virus, the flu. In addition, healthy people are more affected. They have a higher death rate.
5 p.m.
Conservative
September 30th, 2009 / 5 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you, Madam Chairperson.
I want to start by asking about a concern raised with us by the Canadian Federation of Nurses Unions. I don't know if you've seen their documentation, but their concern is that the general guidelines being circulated for input and discussion by the federal government on health and safety are weaker than those of other provinces, and in particular they reference Ontario.
They would like to know if the government is prepared to look at those guidelines and change them to ensure that health care workers in Canada get the best personal protective equipment available, to ensure that a nurse in one province is protected as much as a nurse in another.
In particular, they reference two things out of the SARS report. One is the use of N95 respirators for health care workers. The other is the inclusion of references to occupational health and safety, as opposed to health and hygiene, as important in reflecting the provincial and legal realities.
5 p.m.
Chief Public Health Officer, Public Health Agency of Canada
The guidelines are based on the science, not on opinion. It is also important to recognize that they are guidelines based on the science on a national basis. That does not take away from health and safety occupational health-based considerations, for which there is legislation in every jurisdiction; nor does it take away from the importance of an assessment of the situation the worker is in. It does not override or change that. It is based on the science that in most situations a surgical mask is perfectly adequate and appropriate, and in fact is better for dealing with droplet infections.
There are certain conditions where you're generating a large aerosol, where you're in close contact, etc., and where an N95 mask may be more useful. But the reality is that wearing an N95 mask on a constant basis is very difficult. In fact, we now have research suggesting that nurses who are using N95 masks have the same rate of infection as those who are using surgical masks. So it does not actually provide any additional protection in the general situation. You can think of many reasons for that around the appropriate use of surgical masks: they're uncomfortable, they take time, it's difficult to move quickly. As soon as you touch your eye or face you've negated any effect from that.
As far as the washing of hands, appropriate hygiene, and being careful when you're working around patients--not just about H1N1--that requires a local assessment and decision-making by the professionals involved. None of these guidelines take away from that, but they do provide the best science and advice for most situations we will encounter. We're confident about the appropriateness of them. Again, that does not take away from whatever occupational health standards or individual situation decisions that people need to make.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
I appreciate that response. In one of the letters they wrote to us, they cited the Council of Canadian Academies, which states that N95 respirators protect against inhalation while surgical masks offer no significant protection against inhalation of alveolar, tracheal, or bronchial-sized particles.
5:05 p.m.
Chief Public Health Officer, Public Health Agency of Canada
That's absolutely true, but we're not talking about a virus like measles. We're not talking about tuberculosis. We're not talking about viruses like smallpox that are airborne as opposed to droplet-borne. So that's absolutely true if I were dealing with a case of smallpox. I would want a heck of a lot of protection. But when you're dealing with a virus that is basically transferred when you cough, you handle it--you rub your nose, you touch your eyes, or you put your hands in your mouth. That and close contact are the ways it spreads, and a surgical mask will reduce that. The studies we are now seeing would suggest that a mask works as well as an N95 respirator for influenza.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you.
I'd like to ask a question about the sequencing that was announced—the H1N1 vaccine sequencing—which we appreciated receiving. What I found noticeably absent under the health care workers section was the question of first responders and where firefighters, paramedics, police, RCMP, and anyone else who is involved on a first-response basis fits into this sequencing.
5:05 p.m.
Chief Public Health Officer, Public Health Agency of Canada
To the extent that sequencing is related to the fact that we will have enough vaccine for the whole population within a matter of weeks, unlike other jurisdictions where it will be many months, or not at all for some...it's about timing as it relates to that.
The reason certain groups are there is because they are most vulnerable to get severe disease. You want to protect them first because they're the ones more likely to die. In general, firefighters and police are not more likely to die from this disease. You also want to ensure that those who are actually going to manage the pandemic and those who are going to care for those who are ill, if they do get ill, are immunized first so that they're available to actually work in the hospitals to care for people.
In general, first responders will be very quickly immunized, and certainly if they have underlying risk conditions, then they're obviously at the top as well. But that is the target for the first group versus the second group, which includes all first responders as well as others.
5:05 p.m.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
In the case of first nations communities, they're isolated and they may rely on a single RCMP officer. I assume that in isolated communities that person would be vaccinated as a priority. What happens if that person—I'm asking hypotheticals because that's what I think we're faced with—gets sick, leaving the community without a vital support person or an RCMP officer? Or what happens if that person feels that their health is at risk and they're in danger of contracting H1N1 and decide to leave their job? I think that is probably allowable under the Canada Labour Code.
5:05 p.m.
Chief Public Health Officer, Public Health Agency of Canada
We should have Labour Canada deal with the specifics of the labour code, but there were issues of people with fear. Your risk of working in a community is the same risk, by and large, as working in Ottawa, Toronto, Montreal, or wherever. This is a virus that is essentially anywhere. You cannot run away from it unless you climb to the highest mountain where there's no other person for the next hundred miles. That's the first thing.
The second thing is that all of these communities do have antivirals for early treatment, which is key. As you presumed correctly, when the community is immunized, it's not like some will be immunized and some won't. Everybody in that community will be offered the vaccine.
5:05 p.m.
Conservative
5:05 p.m.
Senior Medical Advisor, Department of Health
I would just like to emphasize that it's not only the first nations communities that are isolated, but other individuals who are living close to those communities would be covered, not only by immunization programs but also with access to primary care that exists in those communities.
5:05 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
Thank you very much, Madam Chair.
First of all, I would like to congratulate officials on your information campaign. I mentioned to Dr. Butler-Jones that I've heard your radio commercials. But you often wonder if these things are working. I actually had my seven-year-old come home with the first cold of the school season and she was coughing into her arm. So I guess you are very popular with the seven-year-old crowd with a high volume of boogers or whatever.
Dr. Gully, you've been on the job now for a month. We've heard from different witnesses. Some have said that 90% of communities have their plans in place and 80% have been tested, but I've been on some panels with colleagues and some of the chiefs are saying that's not even close. Could you explain a little bit more about the discrepancy? We've heard about the importance of communications with the first nations communities--and these are significant discrepancies.
I listened to your answer to my colleague Dr. Duncan. Is it that the communications are going to the health stations, and the health stations are the ones that are stating that they have a plan and it has been tested, but perhaps information is not getting disseminated to the local communities? Are you able to help us with that discrepancy that we keep coming back to?
5:10 p.m.
Senior Medical Advisor, Department of Health
I appreciate the opportunity to answer that question. When I was in Manitoba recently, I went through the list of communities with the regional office and asked them where they got the information about the existence and status of those plans. Sometimes it was one of the health care workers; sometimes it was the pandemic influenza coordinator. It was always somebody from the community who we got the information from about the status of those plans.
I'm not going to hypothesize about why the assessment from some individuals is different, because I think all we can do is rely on what we are actually getting. As you said, the letter we wrote went from the region to the chiefs of the communities, telling them where we got the information from so that they could come back if they were actually concerned about that.
As I said before, I think there's a sense that, because of the increased challenges in those communities, therefore it is actually more difficult for a community to be prepared, and I accept that, because then the challenges in the community in terms of spreading infection are greater. Those concerns are there, which is why we're concentrating on those communities, concentrating on getting responses to those communities, and in fact then working with the communities where there is most concern about the capacity to implement those plans that actually go out there.
5:10 p.m.
Conservative
Colin Carrie Conservative Oshawa, ON
What is Health Canada doing to ensure that the first nations receive timely information? Could you go over a little bit more of the detail? I know we recently signed a communications protocol agreement between Health Canada, the Assembly of First Nations, and INAC. Specifically, how will it help first nations communities address the H1N1 influenza?
