Health Committee on Oct. 21st, 2009

[Samuel Godefroy]

I can start maybe by speaking to baby foods.

In fact the addition of salt and sodium to baby food, and particularly to infant food, is regulated. We do have stringent requirements for the addition of salt to infant food. They are mandated by regulation. These levels are so low that industry does not resort to the addition of salt in infant food, so it doesn't seem to be a category right now that would be posing a challenge specifically for infants. Again, industry has resorted to no addition.

And the other part of the question...? I'm sorry, maybe....

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

We've embarked on a labelling process. Has that changed any of our consumer habits? Even though you haven't finished your group, is there any sort of...? You talked about hypertension. That is hitting people who are sort of well past the post. What about our young citizens? Where are they getting the information that they need?

[Dr. Hasan Hutchinson]

Let me speak briefly about the labelling side of things. We certainly know that Canadians have taken to this new tool, are at least using it, but as I think has been pointed out, perhaps we're not always very clear about exactly how to use it and how to understand it. Certainly our group carried out quite a large education campaign a year and a half ago. We have collected information about that. Right now, we are embarking on the planning of a new campaign for next year as well, which will get to one element at least of what is needed, and that's really education, about how to use the panel itself. Certainly we are moving well ahead already on the planning of that part of the campaign.

With respect specifically to sodium, what we are trying to put together is a very comprehensive social marketing awareness education campaign that involves all of the different stakeholders and different sectors. It's a very coordinated approach as we move forward.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We have a very special event today, so could I have the attention of all committee members? I am so glad that you are here to join us, because we are very cognizant of good healthy practices on this committee. If you'll notice, when we have to bring some food in, there is always fruit and things like that. But we have a little secret thing going on behind the scenes. We have to give an award to one of our committee members today, because he discovered the secret.

Will Monsieur Dufour please approach the bench?

I am serious. You are getting an award.

I have to tell you, what we did is to decide that we would not have caffeinated coffee, we would have decaffeinated coffee. We appropriately labelled it and did everything. We thought that somebody somewhere at sometime would cotton on to the fact that this wasn't the real thing, that it was decaffeinated coffee, but no one did. So I went merrily along my way until today, when Monsieur Dufour tippy-toed up and spoke to the clerk and said, “Do we only have decaffeinated coffee?”

So today I will present to Monsieur Dufour a Starbucks card and congratulate him.

[Voices]

Hear, hear.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you.

[The Chair, Conservative, Joy Smith]

Having said that, we will suspend the meeting for two minutes, so we can prepare for our next guests.

I thank you for your presentations.

[The Chair, Conservative, Joy Smith]

We will resume our meeting. I thank the witnesses today.

I would ask the people in the room who are having conversations to be so kind as to take the conversations outside.

Today we're very pleased to have Dr. Danielle Grondin, acting assistant deputy minister for infectious disease and emergency preparedness. You're not new to this committee, and we thank you for coming today.

We also have another person who is not new to this committee, Elaine Chatigny, general communications. We also have, from the Department of Health, of course, Dr. Paul Gully, senior medical advisor.

You know the routine. We have a five-minute presentation and then seven minutes of questions and answers.

Dr. Grondin.

[Dr. Danielle Grondin, Acting Assistant Deputy Minister, Infectious Disease and Emergency Preparedness Branch, Public Health Agency of Canada]

Yes, thank you very much.

I'm very pleased to be back to talk to you today and to give you an update on H1N1. I want also to express regrets for Dr. Butler-Jones, as you know. But you have heard today the very important announcement that the adjuvant vaccine has been authorized for release to be used by the public.

Basically, what that means is that we are now confident that the safety and the effectiveness of the vaccine has been demonstrated, and in the next few days all the health professionals in the provinces and territories will be in a position to implement their plan for the rollout of the vaccine.

What also was important in today's announcement is that we have made recommendations for its use.

We have made dosing recommendations for the vaccine. We recommend two half-doses of adjuvanted vaccine for children aged six months to nine years, and the interval between doses should be a minimum of 21 days. We also recommend that anyone 10 years of age or older should receive one dose of adjuvanted vaccine. As for pregnant women, we recommend that they receive the unadjuvanted vaccine.

However, should a pregnant woman live in an area where the non-adjuvant vaccine is not available, she should be offered the adjuvant vaccine.

Again, as of today, there have been in Canada over 1,500 hospitalizations, 300 of them in intensive care units, and 83 deaths. As you have said, it's not that we want to be alarmist about that, but just to stress that it is really a serious illness and the best way to stop the transmission of this virus is to immunize as rapidly as possible as many people as possible.

You have also heard, perhaps, Dr. Perry Kendall today speaking on behalf of the provinces and territories. The Province of British Columbia has announced that it is in the second wave. We have also experienced increased activity, as expected with the season, of this virus across Canada. The prairies and other provinces have seen an increase.

Really, it's very important to stress that now that the vaccine is out, the onus--if I may use the word “onus”--is on the provinces and territories to distribute and establish their clinics, but very importantly, on every Canadian, every single one of us, to now go and take the vaccine, which, again, has been determined safe and efficient.

Another piece of information I would inform you about as well is in regard to the second wave and this increase. We are working with provinces and territories to get timely surveillance data, as you are aware. We have established some made-in-Canada types of key indicators. They are for our country, with our specialists, to establish a sort of threshold that will signal the arrival of the second wave. These criteria are the ones that British Columbia has been using.

Basically those criteria are the percentage of persons who are testing positive for the H1N1 influenza, the absolute number of persons testing positive, the number of influenza-like consultations, the sales of anti-viral medications across the country, and information about hospital admissions and deaths. So the surveillance is really critical, and with the provinces and territories we continue to do so, strengthening even our flu watch that you are aware of.

Also, we at the Public Health Agency of Canada are currently exploring, with the front-line physicians and all the national partners, other surveillance programs to help us to keep on track with it, basically to try to receive as much information as possible, on time.

My time is almost up, so I will stop here, because this has been to encapsulate the important events, particularly in the last week and with the announcement today.

Thank you for your attention, and I will certainly be willing to take your questions.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Now we will go to Ms. Elaine Chatigny.

[Elaine Chatigny, Director General, Communications, Public Health Agency of Canada]

Thank you very much.

As Dr. Grondin said earlier, we held a press conference today to announce that the vaccine had been approved. We also updated our website, FightFlu.ca. The last time we appeared before the committee, we talked about fact sheets that we were preparing to put on the website. We put them on this morning. I invite you to go and look at the website. We have added fact sheets that provide information for pregnant women, young mothers or caregivers looking after babies under six months of age. There is also another one dealing with the benefits and risks of the vaccine and with what people should know before getting vaccinated. We have really increased the quantity and, we hope, the quality of information available so that Canadians can be well informed when they have access to the vaccine in their province or territory.

The last time we were here we mentioned we would be launching a personal preparedness guide, and you have a copy of this guide. It is available by calling 1-800-O-Canada, by downloading it on our website, and as of the end of this week it will also be available at Canada Post outlets across the country.

We launched this a week ago, and I can say that so far Service Canada has received more than 84,000 requests for this guide, which in seven days is huge. From a social marketing perspective it's highly unusual to get that much awareness and interest.

We have 7,800 downloads from our website for the product. Again, that's extremely high for a seven-day period, and that's only based on earned media--in other words, just the talk from media, not purchased media. That's coming. It also means that based on our analytics, we also know that through 1-800-O-Canada and the website some national organizations are also requesting quantities, so we know it meets the need of national organizations that require this kind of information for their own constituents and members of their organizations. We're really pleased with that.

Because we know that dosage is important to parents in particular and to individuals who want to know the facts on dosage, we created this downloadable document. It's an easy reference.

As well, later this week we are going to be mailing a pamphlet to all households that talks about symptoms: how to recognize symptoms, how to treat, what to do; it's very straightforward. It also contains the 1-800-O-Canada number and FightFlu.ca web URL, encouraging Canadians to obtain the preparedness guide.

Although there are clearly pockets of activity in some parts of the country as we move into flu season, we do know there's a level of complacency and a relatively low level of concern. We still think the opportunity is ripe to raise awareness about the H1N1 pandemic, to encourage Canadians to become informed about ways to recognize symptoms, and what to do if they become ill or need to care for family members.

I don't think we're there yet in terms of the level of awareness, in terms of some concrete actions that people need to take, so I think we've taken an important step in implementing our national social marketing strategy.

In a few days you're going to start hearing more radio ads encouraging people to become aware and informed of the symptoms of H1N1 and to take action, and in November we're also going to be providing more specific information nationally around the vaccine itself.

Although we announced the authorization today, we know the vaccine is just starting to roll out across the country. The intense activity around mass vaccination clinics will really start ramping up, so we're going to coincide our vaccination marketing activities and messages for that period of time, understanding that it will take between now and the end of December, probably around Christmas, before we have completed these vaccination campaigns. We need a certain window of time to ensure there are messages in the public domain so Canadians can make the informed choice they need to make.

That's the update I wanted to provide today.

[The Chair, Conservative, Joy Smith]

Thank you.

Now can we go to Dr. Gully?

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

Thank you, Madam Chair. Thank you for inviting me back again.

We continue to monitor cases of influenza-like illness in first nations communities in collaboration with the provinces and territories. As Dr. Grondin mentioned, there has been an increase in influenza activity nationally, in particular in British Columbia and now in Alberta and the Northwest Territories, and cases in first nations communities have reflected the activity in the provinces and territories. That's certainly been the case now in Alberta.

As we've said before, first nations communities continue to be able to access the appropriate medical equipment, supplies, antivirals, and so on in response to the pandemic. We continue to work with the first nations communities in terms of pandemic preparedness, and now our assessment in terms of our relationship and discussions with the communities is that in most regions almost all communities have a plan and almost 90% have in fact tested those plans.

In terms of the vaccine, we work with the provincial governments because the vaccine is distributed from the provincial governments. Health Canada's first nations and Inuit health branch then enables that vaccine to be distributed to communities. It will be distributed according to the provincial guidelines and will then be available, in most cases, as per seasonal vaccine. However, for H1N1 there will probably be more mass immunization clinics than there are normally. Remote and isolated communities have been included, as you are aware, in national vaccine-sequencing guidelines. In two provinces, I think Manitoba and Saskatchewan, first nations have been named in particular for prioritization.

As with seasonal influenza vaccine, regional differences in timing are to be expected. This will also apply to first nations communities. The precise timing will vary depending on the province and time of distribution, although the methods of distribution are there, as is the plan for occasional challenges in terms of weather. Sometimes the first nations communities will express a preference in terms of timing. I am aware, for example, that some communities across Manitoba have said that they would like it one week as opposed to another week.

Because the distribution is similar to other vaccine distribution in the province, there are therefore well-established processes for handling vaccine and implementing the programs. Community members will be notified of clinics through a variety of means, such as local radio, community bulletins, and posters, but we will be relying on chiefs and community leaders to promote the vaccine. I was in northern Manitoba yesterday and I would describe it as what I think is a partnership between the provincial government, the Government of Canada, and first nations in order to be able to promote the vaccine. It is a community-level activity.

As I've described before, we're now mobilizing health care professionals to support immunization campaigns in the provinces. I know that as of Sunday, certain individuals from Health Canada will be going to provinces to assist in mass immunization.

We continue to work with the Assembly of First Nations and Indian and Northern Affairs Canada to implement the various activities in the joint communications protocol. As you'll be aware, last week the Minister of Health visited the Cowessess First Nation in Saskatchewan and highlighted that community's success, which I certainly don't think was unique. We had a very positive discussion with members of the community, the chief, council elders, and the pandemic planning committee there.

In terms of citizen readiness, as Ms. Chatigny has outlined, that is ongoing and there are certain products that are tailored for first nations communities. And we're taking steps to ensure that the guide is available in communities, because not all communities have post offices and we want to ensure that first nations communities have this available as well.

Finally, we're making very good progress in planning for the virtual summit together with the AFN, the Assembly of First Nations, and we're having daily meetings with the AFN to plan for that. It should happen in early November and will have various webcast components and web-based content, which will then enable us, at the time that immunization is being rolled out, to answer questions and to continue to promote immunization in first nations communities.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

We'll now go into our round of seven minutes of questions and answers, starting with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you to all the officials for coming in, and your time, your effort.

If I could address two issues, one is surge capacity. We've been hearing that there is little or no surge capacity in the system, and I'm wondering what your modelling shows. We've heard 1% severe illness, we've heard one to 50, we've heard one in 1,000.

Even if it's one in 1,000, that's going to translate to 1,500 to 2,500 cases of severe illness needing ICU across the country potentially simultaneously, and perhaps 3,000 beds. I'm wondering what happens if the number is greater. Is there a national surge capacity plan? Is there a mechanism to move resources from places?

It's so encouraging to hear of the work that has been done in first nations and aboriginal communities. Last day we learned that Manitobans bore the brunt of the lessons learned in the spring, and that was both in the aboriginal community and the non-aboriginal community.

We know patient outcomes depend on how quickly you're treated. We heard that there was a real lag of perhaps seven to eight days. I am concerned going forward. How do we assure that there is not that lag?

One way is the prevention side of this, to make sure people get vaccinated. What is the rate of vaccination and what tends to be the pickup in aboriginal communities? I'm really concerned about social distancing measures when you have several families living in a dwelling. Do we need more money or resources?

Can I ask one more? I can just put it on the table.

[The Chair, Conservative, Joy Smith]

It depends on whether or not you want an answer.

Go ahead.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

In terms of the vaccine for pregnant women, if the unadjuvanted is not available, how have we come to the figure of 20 weeks? What is the evidence for that, and how does that compare with elsewhere?

[The Chair, Conservative, Joy Smith]

Who would like to tackle these questions? Dr. Gully, would you like to start?

[Dr. Danielle Grondin]

Of course.

There are several. I hope I've captured most of them I can answer, Madam Duncan.

On this capacity issue at the health care delivery itself, last time you heard Dr. Kumar and so on explaining. They are working.

In terms of a national plan, we have had our conference where we brought together all the intensivists and the persons, and there is also the network of the emergencies and the health care, and they are working on that.

There is one point I would like to make, though. It's important because this modelling and all those numbers that you brought forward--and we agree on them---are numbers that could happen if we don't have immunization, if people do not get immunized. That's the reason it's so important.

We have to work upstream.

How do I say that in English? We have to start at the beginning. Death is the ultimate result. Intensive care is the second.

The thing is that we have to work now to prevent it. Prevention is where we come in as the national Public Health Agency. The message is that if, for example, in the best scenario we succeed in immunizing 100% of the population, then the H1N1 will disappear.

It is important to know, and perhaps you heard this at the conference, that the efficiency of this vaccine is greater than all the vaccines that we have. It is well over 90%. So it has the capacity to stop H1N1, and that's the reason it is important.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I agree, but right now we are seeing that the percentage of people who are wanting to take the vaccine is down at 33%.

[Dr. Danielle Grondin]

I agree, but that's the reason it has become a collective effort here, as Madam Chatigny has explained.

The effort, if I may, in a respectful way, is your effort as well. You are powerful people in your constituencies, so you can pass on the message and try to change what we are hearing a little bit. I'm talking with a lot of respect here, but the thing is we go to the media, we explain the vaccine, and then we hear that people don't know what it is. Something is wrong somewhere. The message has to get out.

We have high regulatory standards in Canada. The vaccine, as we now know, is safe. It corresponds with what we are hearing. It is highly efficient. If people take it, it has the power to stop the H1N1.

That is the first thing, that the message has to get out loud and clear. I hope all of you will be taking it.

The other issue is

working upstream.

There is the vaccine, but there is also the message of the antiviral. Nationally, out in the provinces, there are enough antivirals in stock to treat every Canadian who needs them. That is the reason we have passed a strong message to Canadians and to health professionals to get early treatment with the antiviral. This is another step to try to avoid being hospitalized or admitted to the ICU.

We also have identified high-risk persons who are to get the vaccine and who should go quickly to see their physician.

So it's a package of everything.

The numbers you are quoting--yes, but the thing is that if people are not taking the means to protect themselves.... And it's not only to protect oneself. If I take the vaccine, I will prevent transmission. I will not transmit or be a vector of the transmission of the virus to any of you, if you don't take it.

These are important messages that have to come across. Certainly we are looking at you and the power, the influence of your position to pass this message very strongly to your constituencies.

That is about the numbers.

Regarding a pregnant woman and the 20 weeks, we don't have the evidence for the H1N1; it's a new virus. This will come. We have worked that out with the Society of Obstetricians and Gynaecologists of Canada to try to balance the risk of the mother, the fetus, and so on. Right now, 1% of the population in a given year is pregnant in Canada. Right now, 5% of pregnant women are among those who are hospitalized, and 5% die. It's very important.

We really need to bring the highest level of safety to these women, so they feel that within the first trimester, for example, [Inaudible--Editor] is not a risk, but then they can be protected.

There are also studies that the influenza might be a risk in those trimesters. We are working on that with the college.

[The Chair, Conservative, Joy Smith]

Thank you.

Monsieur Dufour.

[Nicolas Dufour, Bloc, Repentigny, QC]

Thank you very much, Madam Chair.

Thank you for being here today and for providing additional information on the H1N1 flu.

The vaccine has been approved and it was authorized today. If I understand correctly, clinical trials in Canada were not finished, but the vaccine was nevertheless authorized.

What led the agency to use European studies, rather than finish the ones it was conducting?

[Dr. Danielle Grondin]

I know that next Monday, you will be hearing from experts on regulations. I am not an expert in that area, but I can, however, provide some clarification.

For this vaccine, as for all other vaccines or medications, the Canadian government, Health Canada, our colleagues, examine all of the clinical studies conducted in Canada and elsewhere throughout the world. All of the data is compiled. Canadian studies were conducted, but they are perhaps not as comprehensive, because there are still more to come. The clinical data we received is sufficient to reassure us: the vaccine is safe and more than 90% effective for protecting Canadians who receive it.

[Nicolas Dufour, Bloc, Repentigny, QC]

Could it not have been approved much earlier?