Health Committee on Oct. 28th, 2009

[Dr. Marcia Anderson]

That's true. I haven't personally asked all of them or done a poll.

We have more than 150 members: first nations, Inuit, and Métis. We have members on both coasts, east to west, as well as in the far north, so first nations, Inuit, and Métis are all represented at the training level--so medical students, right up to retirees. That was the easy part of the question.

With regard to the second part, I don't know if they are all going to get vaccinated or not. I do know that several have called me for advice on the vaccinations, with the intent to get themselves and their families vaccinated.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

What is the prudent advice you gave your colleagues?

[Dr. Marcia Anderson]

It's the same advice as I gave my own grandmother and grandfather, both of whom are first nations and have chronic diseases, which is to get in line as soon as you can.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you.

Grand Chief Evans, could you tell us whether you have seen much improvement in communications between the Canadian government and first nations since the communications protocol was signed by the Government of Canada and first nations in late September? Mr. Sanderson may also be able to answer that question. Earlier, I said to my colleague that there were a certain number of answers we needed to hear.

[Grand Chief Ron Evans]

With regard to the protocol, that's something that was done between the Assembly of First Nations and the federal government. As far as I know, that remains to be seen. In regard to that particular protocol, I believe there is a meeting coming up. I guess it will determine exactly how well it's working.

But right now, in terms of what we're doing and in terms of the things that need to be done, it's working well for us. I don't speak for the rest of the first nations, of course, but in Manitoba the communication lines are open. I don't know what's happening at the national level with the other first nations. And I guess this is where the protocol will be tested.

[Glen Sanderson]

In terms of the protocol nationally, we're not involved. Well, at least I'm not involved in that. I'm involved in the provincial tripartite group. We have really good protocol on communication, on everything. I get a daily tracking sheet of medevacs, of people coming into the rural hospitals, the city hospitals, the nursing stations, all displaying ILI. I get a tracking sheet every day. We have medevacs; they're on there as well. People who are admitted into ICUs are all there as well. I get updated every day and I pass the information on to the people who need to know.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Grand Chief Evans, when you appeared before us in August, you said that your H1N1 flu kits had been paid for mostly by private partners and by your provincial government. You said you hoped that Health Canada would get involved. During your remarks earlier, you said that there had been results on that front.

Could you share them with us? I got the sense that you were not entirely satisfied. Could you tell us what the Government of Canada did to help you in terms of kit distribution?

[Grand Chief Ron Evans]

Thank you for that question.

With regard to the flu kits, at that time in August when I was here, we didn't have any flu kits, but we wanted to get flu kits to the communities. We wanted the support of the federal government to help us assist the first nations and be able to do what we've done in the last couple of weeks. The provincial government didn't have a problem with it. They helped us when the private sector stepped up. It wasn't political; they just did what they felt they needed to do for the first nation citizens in Manitoba.

Last time I was here, I spoke about the need for annex B to be funded, because it's the federal government's pandemic plan for first nations. I spoke strongly because our communities are not ready. Even though the communities had plans, you can have the plans, but if you don't have the resources, that's all they are: plans. They're difficult to implement without the resources. Since then what we've done is really work hard to make sure we had people who could actually focus.... As opposed to volunteers or taking people out of other programs to make them pandemic coordinators, we now will have pandemic coordinators who will specifically work with those communities to make sure about what needs to be done with their plans. Wherever the shortfalls are or whatever needs to happen, we will now have that information, so we can be very specific as to what exactly needs to happen in each of those first nation communities. That's where we are.

We believe that's a good first step, and then we'll see what happens once the coordinators are actually at work.

[The Chair, Conservative, Joy Smith]

Thank you, Grand Chief Ron Evans.

I want to thank all our guests for coming today and for your very insightful comments.

I'm now going to suspend the committee for two minutes so everyone can clear, and then we'll go into the H1N1 briefing. Everyone's welcome to stay and listen to that, if they'd like to do that.

Thank you.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Madam Chair, with due respect, the vote is not until 5:45. It does not take us more—

[The Chair, Conservative, Joy Smith]

We're dismissed.

[The Chair, Conservative, Joy Smith]

Could you take your seats, please? We now have to go into the H1N1 pandemic part of the meeting.

We will have bells ringing at 5:15. Everyone's welcome to stay and listen, if they would like to do that, but we just have to get started.

We have the debriefing on the H1N1 and the vaccination issues. From the Department of Health, we have Dr. Paul Gully, senior medical adviser; and of course from the Public Health Agency of Canada, we have Dr. Danielle Grondin, acting assistant deputy minister, infectious disease and emergency preparedness branch, and Elaine Chatigny, director general from communications.

Who would like to begin? Dr. Grondin, thank you.

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

Thank you very much.

Good afternoon. The last time I appeared before the committee, I promised to get back to you regarding one of your questions. You should have received the pandemic information sheet on pandemic vaccine monitoring and surveillance.

This is a follow-up of the promise we made to you that you would be receiving the details about the various surveillance systems to assess the secondary effects. This is to let you know that you should have it now.

As a start, I would like to briefly give you the situation in Canada with the H1N1 flu virus. As you know, we are in the second wave nationally, and as you have seen in the media, there has recently been a death reported. We are very saddened by that, but this is, unfortunately, part of this disease. It was expected. It is expected that there will be a number of hospitalizations and ICU cases with ventilation requirements, and deaths will continue. For that reason, it is very important to continue to put into application the recommendations on public health that we have made, the package of recommendations, certainly the preventive ones, which include the vaccine. This is, to stress again, a new disease.

It is a new strain of the flu. It is very different from seasonal influenza, which has been relatively stable over the past 30 years. When a new flu strain emerges, the first wave can be fairly minor, moderate, but the second and subsequent waves can often be fairly serious. That is very important to keep in mind. As you now know, the vaccine is available in all provinces and territories. Flu shot clinics are underway. We are encouraging all Canadians to get vaccinated.

I would also like to mention that since the last presentation by Dr. Butler-Jones there has been new guidance. This is the one that was published today and is available on the web. It's about public transportation, for people travelling in trains, buses, boats, and ships. These guidelines are not only for the people using mass transportation, but also for the staff working on these modes of transportation. It is also for the agencies and the operators. This is to complement the wealth, if I may use that word, of the various guidelines, recommendations, and information that we have put out for the health professionals, schools, people at home taking care of people who are sick, and so on. This is a complement, and again we stress the importance that it is an individual responsibility to protect oneself and one's family.

I would like to stop there to give an opportunity to my colleague to present, and for questions. Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you.

Who would like to continue?

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

I will.

[The Chair, Conservative, Joy Smith]

Dr. Gully.

[Dr. Paul Gully]

Thank you, Madam Chair.

Based on Flu-Watch, across the country we're seeing increased levels of influenza-like illness in British Columbia, Alberta, southern Saskatchewan, southern Ontario, and the Northwest Territories. What we're seeing in first nations communities reflects what we're seeing in those provinces. Most cases on reserve continue to be mild, but we continue to monitor them closely in the nursing stations.

I'll concentrate on immunization. We continue to promote immunization through our nurses, the community nursing stations, local radio, community bulletins, and chiefs and councils. It has been shown, particularly by the example of Grand Chief Evans and other leaders, that the leadership of the community will be particularly important. We're hearing that the uptake of immunization in first nations communities is good. In fact, there are line-ups in those communities just like those we've seen elsewhere.

We expect that clinics will be in place in all remote and isolated communities by the beginning of next week. In Manitoba, we expect the remote and isolated communities to be completed by the end of next week. We will have to be back for those requiring second doses, which may require individual appointments or special clinics.

Over the next few days, we will give updates and more comprehensive data, as will the agency. We're hearing that the uptake has been good. In one community in Alberta, for example, half the community, 700 out of 1,400, were immunized in one day, yesterday. I can also confirm that first nations communities will receive, on a per capita basis, their share of non-adjuvanted vaccine, which you heard made public by the Minister of Health. We are continuing to encourage uptake of immunization and the use of other forms of medicine. We want to complement traditional medicines, if that is the wish of individuals.

That's my report. I will be willing to answer questions and update in the future.

[The Chair, Conservative, Joy Smith]

Thank you.

Ms. Chatigny, would you like to make some comments?

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

Sure.

[The Chair, Conservative, Joy Smith]

Thank you.

[Elaine Chatigny]

I want to take this opportunity to update you on some of our activities moving forward from last week. Today I believe you all received a two-pager, a summary of some of our communications activities.

I wanted to show you this document. I would be happy to have it updated systematically. You will be able to see everything that the Public Health Agency of Canada is doing in terms of H1N1 social marketing and communications to reach Canadians and those concerned.

As you can see, we've undertaken a huge number of activities in the last six months. When we look at the traffic on our website and the amount of interest in our preparedness guide, we have to go to another reprint. We are running out of them. We launched the guide just two weeks ago.

There's a huge amount of interest. The level of awareness of H1N1 is extremely high when you consider that six months ago no one had ever heard of H1N1, or pandemic H1N1. We're seeing a high rate of awareness across the country.

People are asking questions about the vaccine and whether or not they'll get vaccinated. It's a reflection of a lack of information. I think people are currently in the process of making decisions about their health and assessing the choices they have. I think the information campaigns, all the outreach, all the interviews that Dr. Grondin and Dr. Butler-Jones have provided, the ongoing three-times-a-week media conferences we're holding, are just a few tactics that clearly demonstrate that a lot of information is being provided to Canadians.

I can say that Tuesday, after the clinics started across the country— some got started on Monday—we saw a threefold increase to the fightflu.ca website that we manage at the Public Health Agency. An all-time high was 60,000 visits. We got 196,000 visits on Tuesday. That's 22,000 visits an hour on our website. Canadians know about fightflu.ca. They're coming to our website in high numbers.

They're visiting up to three pages per visit, which is very good; they're spending more time on those pages. That means they're reading the information; they're going deeper to find good, reliable information. And interestingly, our metrics show us they're not going to the vaccine safety fact sheet, they're going to other fact sheets on risk benefit and other information, because they do want to make a well-informed decision about their health and the health of their family.

So from the perspective of whether or not our communications strategy is working, I think there's ample evidence that Canadians are going to the clinics and they want to get vaccinated.

The national strategy is also a cascading strategy. I mentioned that last week. It's not just the federal government that provides information to Canadians; it's in partnership with the provinces and territories and the local authorities. So for those of you who spend any time in Ottawa, who may live here during the week, you know that ottawa.ca provides a huge amount of information to residents of Ottawa on where they can find the clinics and other information on the vaccine and on H1N1. And because they are linked to Ontario Public Health and the Ontario Ministry of Health is linked to us through our network, all the information Canadians are getting from reliable public health sources is consistent and coherent.

You may question that there are a lot of other voices out there. That's right. And increasingly, when we hear and see vaccine myths or....

There is misinformation out there, which really does nothing to help Canadians make informed decisions. We are being aggressive in countering those sources of information, and we are trying to direct those who have questions to our Web site, FightFlu.ca. I just wanted to share those statistics with you. I know they may just be numbers that do not mean much to you, but as I tell you every week, I would be happy to update them in order to keep you informed of our activities.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We're having bells at 5:15, so at 5:14 I'm going to suspend just to make sure we get out.

With the indulgence of the committee, I'm going to ask that instead of going to seven-minute rounds we go to five-minute rounds, starting with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Thank you to the officials.

We know how hard you're working to get the message out about the vaccine. I think there are some challenges. Can I put a few on the table?

On what date will the non-adjuvanted vaccine be made available to pregnant women? Is the Australian vaccine the same as the Canadian vaccine? What data indicates that the adjuvanted vaccine is as safe as the non-adjuvanted vaccine for pregnant women? The reason I'm asking is that I have a friend who is 21 weeks pregnant. She has worked in pandemic preparedness. She knows the field. She's talked to 10 obstetricians and six nephrologists. She has questions and she's just over at.... I think people need some reassurance. What is the possible impact of the adjuvanted vaccine on mother and fetus?

I think there are questions for immunocompromised people--those who are taking chemotherapy, those who are HIV positive. Should they be getting the vaccine, and if so, which one?

What about people who have autoimmune conditions? I mean, if the adjuvant helps the body develop a stronger immune response by increasing the inflammatory response...how might the adjuvant boost? Is it local? Is it systemic?

[The Chair, Conservative, Joy Smith]

Dr. Duncan, could we stop there?

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Can I ask one more?