Health Committee on Oct. 21st, 2009

[Dr. Paul Gully]

That varies from place to place. In first nations communities and some provinces nurses can say they would like it to be prescribed and they will call the physician. In situations where there are provinces that enable nurse practitioners to practise, they can make that decision.

Other provinces, such as British Columbia, are working toward a system so that registered nurses in isolated communities can make that decision. The nurses are licensed by the province and therefore under provincial jurisdiction.

We're comfortable that if an individual needs Tamiflu in a remote and isolated community they will get it if required.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Thank you.

With respect to non-adjuvanted vaccine for pregnant women, I know there's a limited supply at present. How will that get distributed? Carol was telling me about her own community in northwestern Ontario, small towns all over the place. What will pregnant women do, and how will they access the non-adjuvanted vaccine?

[Dr. Danielle Grondin]

Well, the non-adjuvanted vaccine, when it is authorized, will be distributed by similar mechanisms through GSK to the already established plans of distribution with provinces and territories, who will then distribute them to their various localities based on their geographical set-up.

[Judy Wasylycia-Leis, NDP, Winnipeg North, MB]

Is there a national standard across the country, in terms of distribution of the actual vaccine?

[Dr. Danielle Grondin]

Yes. In fact, the distribution was mentioned in our Canadian pandemic plan, when it was returned in 2006. Right now, in the logistics of it, the details of how to do this nationally, each province and territory was invited to identify distribution spots and where the trucks of GSK will go and so on. Once that has been established, each province will undertake the rollout in their respective province, absolutely.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Grondin.

Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

Reading the booklet that was given to us today, Your H1N1 Preparedness Guide, one thing that I found curious and wanted to get some feedback on was when I was looking at the symptoms there could be greater complications for, one of the things listed in the three categories was neurological disorders. Our health committee has recently struck a subcommittee on neurological disorders. I was curious if you could expand upon that a little bit and why that would involve greater complications.

[Dr. Danielle Grondin]

In looking for the H1N1 more specifically, neurologically it is when somebody may have perhaps some lethargy, tiredness, that type of thing.

Sorry, I want to see what I'm reading here.

[Patrick Brown, Conservative, Barrie, ON]

It's on page eight of the book.

[Dr. Danielle Grondin]

What type of neurological trouble they are suffering from to get the vaccine, do you mean?

[Patrick Brown, Conservative, Barrie, ON]

Yes. It mentions there would be additional complications.

[Dr. Danielle Grondin]

I have the French, sorry. I apologize.

Okay. The people who have chronic conditions, basically neurological disorders, people with seizure disorders, for example. That would be an example of this that could be considered.

[Patrick Brown, Conservative, Barrie, ON]

It could potentially provoke seizures, is that what you're saying?

[Dr. Danielle Grondin]

I'm not saying that it will provoke seizures. That has been a question, in all honesty, that has been asked. That's the reason we are talking with the Canadian Paediatric Society. For example, when you have young children who have what we call febrile seizures, if the vaccine can provoke a bit of fever, should that be a consideration? This is a question of concern to parents, for example, because the question was asked of us. So this is certainly one question we are looking at for the Canadian Paediatric Society.

I see Dr. Gully has one, and Madam Chatigny.

[Elaine Chatigny]

I simply want to clarify. What Dr. Grondin is talking about are potential side effects. These are not side effects. What this is about are people who are at risk of complications.

We're specifically saying that people with chronic conditions, such as those who may have diabetes or asthma or neurological disorders, may be at risk of greater complication of H1N1. That's what we're saying here. This is not a side effect.

[Dr. Danielle Grondin]

That's what I'm saying.

[Elaine Chatigny]

Yes, I needed to clarify that.

[Dr. Paul Gully]

Perhaps I could enlarge as well.

You are absolutely correct. Because certain individuals with neurologic disease may be more prone to pneumonia, for example, by virtue of their basic neurological problem, it may affect their ability to breathe properly. In addition, sometimes for people who have advanced neurologic disease it would be actually difficult to tell, perhaps, if they did have symptoms of H1N1. So it's logical that those individuals would be at increased risk, for a whole variety of reasons, to complication of H1N1, which may partly be related to a difficulty of diagnosis.

[Patrick Brown, Conservative, Barrie, ON]

I think my colleague Mr. Uppal had a question.

[The Chair, Conservative, Joy Smith]

Mr. Uppal.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Thank you, Madam Chair.

One of the things we've found is that information is probably the most powerful weapon we have against this. Good information is important for prevention and preparedness. Even now, with the rollout of the vaccine today, people need to have confidence in the vaccine. Good information is what's going to get them there.

Further to some of the information you've discussed already—the rollout of the radio ads, other purchased media, and the earned media we've been getting—is there a plan for new Canadians, different cultural communities, and different language groups? Is there information for them through different cultural media outlets?

[Elaine Chatigny]

It is definitely a component that's been considered. We have primarily focused on making our information bilingual in English and French. In some cases we're working with the First Nations and Inuit Health Branch to make it available in certain dialects for first nations communities and in Inuktitut for communities in the north.

Our colleagues in Ontario, with whom we work very closely on developing much of our approach, and in British Columbia in particular, translate virtually all their social marketing products into multiple languages. For the city of Toronto, for example, the Ontario Ministry of Health regularly translates into more than 20 languages.

What we do is ensure the coherency of messages by working collaboratively with provinces and territories. They then drill that down by working with specific communities and with local medical officers of health. They know where their communities are at and how they would like to receive information. It's much more tailored and much more pertinent.

The challenge with us doing that is that we are not on the ground in these communities. This is the cascading approach we take.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

Is this the provinces' responsibility, or is it the individual municipalities' responsibility?

[Elaine Chatigny]

It's not a matter of responsibility. This is not about responsibility or jurisdiction. It's about what makes the most sense. How do we work collaboratively? Where do we put our efforts? Where do they put their efforts? Where is their value added? Where is our value added?

It has nothing to do with jurisdiction.

[Tim Uppal, Conservative, Edmonton—Sherwood Park, AB]

But you're seeing it at the municipal level.