Evidence of meeting #37 for Health in the 40th Parliament, 2nd session. (The original version is on Parliament’s site, as are the minutes.) The winning word was h1n1.
A recording is available from Parliament.
Conservative
Conservative
The Chair Conservative Joy Smith
I'm going to ask you to watch the light, because when I turn that on, it means we're over time. I'd like all members of the committee to have an opportunity to ask you questions.
Thank you.
We'll now go to Monsieur Malo.
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you, Madam Chair and thank you to our witnesses for joining us this afternoon.
Can everyone understand what I am saying?
Doctor, As an Individual
I'm sorry, I've never used this before. Nobody gives you instructions when you get here.
All right.
Conservative
The Chair Conservative Joy Smith
All right, Monsieur Malo. Are you on channel 2? That's where you should be.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Thank you for joining us this afternoon.
For the past several meetings, I have always started off by putting the same question to all of the witnesses, because there seems to be some confusion about the importance of getting vaccinated. I know that all of you mentioned this point during your presentations. However, I would like you to list clearly all of the reasons why you feel it is important for members of the public to get vaccinated.
Chief Executive Officer, Canadian Public Health Association
I apologize; my French is very poor, so I won't burden you with that. I'll speak in English.
I think it's a matter not only of individual responsibility to take care of yourself but also a duty to take care of others as well. So it's not just a matter of vaccinating to protect yourself and your family; it's a matter of protecting the entire population. Immunization has been one of the greatest achievements in public health, and when you look at the number of diseases that have been completely eradicated, it's been because of immunization. What we know is that there have been pockets where immunization hasn't been successful, for instance in some countries in Africa where polio is resurrecting—we thought this disease was long gone. So it's both an individual duty and a public duty, from my perspective. And it's one of the safest and most effective public health initiatives we've ever had.
President and Chief Executive Officer, Canadian Healthcare Association
I can only repeat what Ms. Lynkowski has said. But if one moves away from the duty issue, which is paramount, and looks at the practicalities, we think they're very much intertwined: your own health, the health of your family, the health of your co-workers, the cost to the health system of dealing with actual cases as opposed to prevention, and the cost to the productivity of this country—one could go on and on with the practical side on top of the duty.
As far as we know, this is a very safe process. I think there will always be a question. People still say they won't have the seasonal flu shot because it gives them the flu. We have a lot of difficulty in dealing with myths out there. That's why at this time we need leadership, and we need leadership from those in the country who are best positioned to show it. I'd go on TV, but no one knows me from a hole in the wall. You folks do represent.... I'm not pushing the idea that you do this, by the way, but frankly I propose it, for all those reasons.
Doctor, As an Individual
I have a very visceral and straightforward approach to vaccination. I mean, I had 50 people struggling for their lives in the intensive care unit. And this wasn't a case of, you know, you go on the ventilator for two days and you get better. This was, by and large, three weeks of daily battle to keep people alive. These were the sickest people I've ever seen in my life as a group, and it's a small miracle that we only lost 20% of them. Had they been older, had they been in their fifties or sixties, we probably would have had a 60% mortality rate.
The fact that you can have a vaccination and just avoid the problem—I don't know if I'm allowed to say it's a no-brainer, but it's not a difficult decision, as far as I'm concerned, if you accept that the vaccine is very safe and very effective. Most of these people would have told you that their risk is very low and that they're young and healthy—“How could I get that sick?” But they were that sick. So I think it's a very clear-cut kind of case.
President and Chief Executive Officer, Canadian Healthcare Association
Just to add one comment, I would ask everyone on the committee how they feel about seat belts. There was a time when no one wore seat belts. Frankly, even today you can wear seat belts and may not survive a car crash, but we all wear seat belts. We're looking at limiting the use of hand-held cell phones and have done so across the country.
So to quote my colleague, it's a no-brainer; it's about prevention and promotion. And for some reason, we don't attend to that concept in the health discussions in this country and elsewhere. It's about doing upstream activities that prevent so much heartache, death, and cost, all in one fell swoop.
Bloc
Luc Malo Bloc Verchères—Les Patriotes, QC
Ms. Fralick, in your presentation, you alluded to the possible future psychological effects of the pandemic. Would you care to elaborate on your statement?
President and Chief Executive Officer, Canadian Healthcare Association
I'm sorry, but while I would like to answer your question in French, my French is a little rusty. If you don't mind, I will continue in English.
I don't know that they are all documented. We're just starting to hear those words, that language, from our members.
But there are a number of levels that one could approach. First of all, in terms of ethics and decisions around resource allocation, Doctor Kumar has just mentioned to us.... Your statistic, I think, was an anticipation of 1,500 to 2,000 serious cases requiring intensive care. And we only have 3,000 ICU beds in this country. What happens if the number is 3,500? How do we decide who receives the care if we run out of vaccine, if we run out of N-95 masks, whatever the supplies are? There's that level of decision-making. There are no guidelines out there. There are ethical review boards. They don't have the capacity to respond so quickly. So that's a huge difficulty.
There are psychological issues around, I would call it.... What did we call it today? PTSD, during post-traumatic stress disorder. But even as it's unfolding, seeing this level of illness and having to deal with that is going to have huge repercussions on health providers and family members. But it's a starting point. I see the light on.
Conservative
The Chair Conservative Joy Smith
Thank you, Ms. Fralick. It's very insightful information.
Ms. Wasylycia-Leis.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thank you, Madam Chairperson, and thanks to all of you.
First of all, I agree with all of you when you say we have a responsibility to carry out when it comes to acknowledging the importance of vaccinations. I think some of us were a bit miffed when the Prime Minister hesitated a bit when asked. And hopefully, that's been clarified.
But there is confusion out there, and some of it has come from the medical profession. There have been studies suggesting that we haven't really researched the vaccination enough, and therefore people aren't sure if it's safe. There have been people suggesting that there's a problem in terms of interaction between the flu vaccine and the H1N1 vaccine, and that has caused confusion.
What's the best thing we can do right now to undo that problem of confusion so that people get one message and get it fast, aside from each one of us standing up publicly and saying, “I'm going to get vaccinated”? What else can we do to increase the numbers of Canadians who say they're prepared to get vaccinated?
Chief Executive Officer, Canadian Public Health Association
I'll start with this. It's a very good question. It's very important.
Again, I want to reiterate a point that I'm sure you all know, but it is the challenge that we're dealing with something in real time, and the scientific debate is happening as we're trying to develop a vaccine and actually respond to the pandemic in the midst of the pandemic. So that is the challenge.
However, I would agree that there's an opportunity now to ensure that all messaging that comes forward through the media, through various public forums such as this, relies on the best science and evidence we have to date, recognizing that it will evolve with time and that we don't necessarily use the issue as an opportunity to put forward a number of platforms, as Ms. Fralick mentioned. There has been lots of debate in the media, and debate doesn't really help at this point.
The chief public health officer is out there with some good recommendations. Our local and provincial authorities are out there with good recommendations. And we should be urging the general public to listen to those recommendations because they are based on science.
Doctor, As an Individual
One of the difficulties is that in the initial phase of the epidemic the general public message was that this was a mild pandemic, and what people took from the term “mild pandemic” was that it's a mild disease, so why should I worry about it?
We need to be a little bit careful and on message that, yes, this is a mild pandemic from the point of view that most people who get it will have mild disease. But we need to be very clear in the message that there is a small subset of patients who will become seriously ill, and a good number of those may become life-threatening ill. And the reason to get vaccinated is to avoid being in that small minority. I think we need to be consistent about that.
NDP
Judy Wasylycia-Leis NDP Winnipeg North, MB
Thanks.
The issue that concerns me the most is not vaccinations, it's not prevention; it is the state of our acute care health care system in terms of responding if in fact there is a significant development with respect to the spread of H1N1. One of the articles I was reading was by Mark Humphries, who is with Mount Royal College in Calgary. He said that the lesson of the 1918 pandemic is to focus on treatment, not prevention. He suggests that our health care infrastructure is not prepared to meet the challenges if there are any serious developments in this area. Dr. Kumar, you have spoken a bit on this.
One of the studies that were released at the symposium at the beginning of September suggested that we are at full capacity now in terms of our acute care system. So what do we do if there is any kind of need? Second, they said there are currently only 8.7 medical ventilator beds per 100,000, and if we were talking about a full-bore H1N1, we'd need something like 3,000 ventilator beds per 100,000. And if we are talking about 30% to 35% of the population off sick, many of them needing intensive care for six to eight weeks, our acute care facilities are just not able to deal with this.
It's one of the areas where the federal government has been fairly silent and said it is all up to the provinces. I am concerned that we're leaving it out there as an unknown, and we are all hoping this isn't going to become serious, and if it does become serious we're going to be up a creek without a paddle, so to speak.
I need to hear your thoughts on the state of our acute care system. We have to talk about public health in the long term, and I agree with that, but I am asking whether right now, if something serious happens, we are ready to go.
President and Chief Executive Officer, Canadian Healthcare Association
I can start.
I'm not sure I have the answer for you, but given that I speak on behalf of the system that does include the acute care centres as well, the messaging I get from my members is prevention. That's why we focus on it. We don't want to get to the point where we can't in fact respond to the need, because you're absolutely right, the issues of staffing and surge capacity are frightening. We talked about those, as you know, in the health committee. Several of you have been around this committee for some time and you were, prior to H1N1, doing a series of consultations on HHR, health human resources. We're already in a crisis situation, and increasingly so with the U.S. potentially moving to a different system that will require more health providers for more of their people. Where are those health providers going to come from? For many of them, they will come to Canada. So already in crisis, we are going to be very challenged to deal with that. That is why, from my perspective, we focus so much on the preventive side and why it is so important.
The consistent messages are getting out there. We were slow with it, but they have improved dramatically, I would say, in the last few weeks to a month or so.
One of the points I raised in my presentation was looking at the labour mobility and licensing issues, which we have looked at since SARS. AIT is in place. We understand that all the provinces have signed on, but is it truly implementable? I don't know the science of this--perhaps Dr. Kumar does--but if the disease presents in different places at different times, can we move health providers around? Is that one of the solutions?