Health Committee on Nov. 18th, 2009

[The Chair, Conservative, Joy Smith]

This is the schedule we have to—

[Karin Phillips]

But I have to confirm this with my colleague, in terms of translation dates and making sure that everybody has the report on time to consider.

[The Chair, Conservative, Joy Smith]

Having said that, this is how the schedule can unfold. Because Dr. Bennett has withdrawn her motion, I'll set some time for business. You'll have some time to think about this and run it over in your minds. And I'll set maybe 15 or 20 minutes for business on Monday so we can continue to discuss anything without taking away from the reports right now.

Is that agreed, everybody?

[Some hon. members]

Agreed.

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

Wait a second. I would suggest that is the very important, ever-anticipated meeting on isotopes. I am not sure we want time taken away from that, but if the clerk and the researchers can come forward with a plan that we could quickly adopt, that's different from actually having a full debate. We've been waiting to hear about isotopes for a very long time.

[The Chair, Conservative, Joy Smith]

That would be better, because we have planned the isotopes.

We'll continue on, then, as we have pre-planned, unless Ms. Davidson has something.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

I just had a question.

Are we putting forth witnesses, then, to come to the one-hour briefing? Is that what is happening? I heard Dr. Bennett talking about having all these people who she thought wanted to come. I'm sure the rest of us d too.

[The Chair, Conservative, Joy Smith]

We have a very full schedule. Dr. Bennett has withdrawn her motion, but we could still have that discussion.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

We haven't decided that yet?

[The Chair, Conservative, Joy Smith]

No, we haven't decided that.

Is there anything else, Dr. Bennett?

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

I'm sure in all of our ridings there are people who have suggestions or ideas. If any member of the committee had been approached by somebody who would like to appear before the committee, I think it would be appropriate to let the clerk know. Maybe there would be one meeting where we could do H1N1 or have a long meeting or a round table on H1N1. Between now and Christmas, we could do a full Monday morning or we could do a proper round table before we break for the holidays.

[The Chair, Conservative, Joy Smith]

I'm just going to let the analyst speak to that, because she's been working with this issue. We're just running out of time. We don't have time for this.

[Karin Phillips]

Essentially, if we devote an entire meeting to H1N1, then we won't be able to consider the reports. That's the long and short of it. We don't have enough time. We'd have to cancel--

[The Chair, Conservative, Joy Smith]

We're as tightly scheduled as we possibly can be right now. As Ms. Phillips said, there's just no time.

Ms. McLeod.

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

Madam Chair, we do need 10 or 15 minutes in a future meeting, but I think we also discussed the importance of leaving the full hour. We have our witnesses here, so if we don't have the motion to deal with, could we maybe—

[The Chair, Conservative, Joy Smith]

That's just what I was about to say before I answered your hand.

I'd like to welcome our guests today.

Dr. Butler-Jones, you're well known to this committee, as is Dr. Gully and Elaine Chatigny.

Can we start with Dr. Butler-Jones?

[Dr. David Butler-Jones, Chief Public Health Officer, Public Health Agency of Canada]

Thank you.

I am very pleased to be providing you with a brief update on the situation regarding the influenza A (H1N1) virus.

We're now well into the second wave of this pandemic, seeing increases on all fronts. As of yesterday, a total of 198 deaths were reported. In the week ending November 7, the number of reported hospitalizations in one week is close to what we saw in the whole of the first wave. There was a large number of admissions to intensive care units, 136 in one week, compared with a total of 289 over the 18 weeks of the first wave.

These are sharp increases, but fortunately--or unfortunately--they're what we might expect at this point during the pandemic. It's important to recognize that if not for the efforts at all levels to ensure effective prevention and appropriate treatment, the number would be much higher.

Provinces and territories are also well into their vaccination campaigns and are reporting steady progress. For example, Nunavut announced today that they have now immunized about 60% of their population.

There have been several new and important elements from the viewpoint of the federal government since my last update to the Committee.

These include approval of unadjuvanted vaccine, freeing up 1.8 million doses; distribution of additional unadjuvanted vaccine ordered from CSL, our Australian supplier; and continuing distribution of adjuvanted vaccine to provinces and territories.

Since our last update, we have also seen that the vaccine is providing remarkably high immune response in those receiving it. The response is in the range of mid- to high 90%. Normally seasonal flu vaccines provide effective antibody levels in the range of 60% to 80%.

Further, since clinics opened, the Public Health Agency of Canada and Health Canada, with the collaboration of provinces and territories, the Canadian Paediatric Society, and a network of researchers, have been actively monitoring serious adverse events following immunization with the vaccine. This surveillance began once the campaign began.

The most frequent reported events are minor and include nausea, dizziness, headache, fever, and soreness at the injection site.

There were several reports of allergic reactions. These have onset mostly within minutes of the immunization and have been treated promptly by medical personnel.

Serious adverse events are reactions that could cause life-threatening illness, hospitalization, disability, or death, such as a severe allergic reaction. Amongst the first 6.6 million doses that were distributed, there have been only 36 serious adverse events reported. These included reports of febrile seizures, a seizure brought on by high fever, and anaphylaxis. Anaphylaxis is a severe allergic reaction.

We take seriously all of the serious adverse event reports, which all trigger an investigation.

It should be noted that these are rare. The rate of serious adverse events following immunization in any campaign is about one for every 100,000 doses distributed. It's important to remember that even though a medical event follows vaccination, it may not have been caused by the vaccine itself. It may have been caused by other factors, such as a pre-existing medical condition.

By the end of this week, 10.4 million doses will have been distributed across the country. As we stated at yesterday's news conference, this is enough to immunize close to one-third of Canada's population. To put it in perspective, this is close to the volume we deliver in a whole regular flu year, and we're only a few weeks in. Our supplier is continuing to ensure that there is much more vaccine coming every week.

Our goals have not changed--namely, to reduce the overall impact of a pandemic--and we remain on track to have enough vaccine available for every Canadian who wants it by the end of December. This puts us in one of the best positions in the world. However, we cannot be complacent. Pandemics are unpredictable. Like any flu season, changes to our approach are necessary as we receive new evidence about the virus and its behaviour. Thanks to our experiences in dealing with outbreaks and our years of comprehensive pandemic planning, we are better able to adapt to these new challenges as they arise.

And if Canadians continue to get vaccinated as they are doing now, as a country, we will avoid a lot of infections.

We have a great deal of work ahead of us still on all fronts. Paramount in our efforts is the push for vaccination.

I look forward to providing further updates as we move forward.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you.

Dr. Gully, you're up next.

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

Thank you, Madam Chair.

As Dr. Butler-Jones has said, we're still seeing widespread influenza activity across Canada. And the experience among first nations, as we know it, is a reflection of that. This means that we will see some severe illness, hospitalizations, and deaths in first nations and among other aboriginal people. We will continue to monitor activity in the community nursing stations to watch for issues on which we have to provide extra advice.

On immunization, we're finding that the rollout of H1N1 vaccine on reserves has been well planned, well managed, and well received by the communities. During the first three weeks of immunization, approximately 93% of first nations communities held immunization clinics. In fact, probably all those communities that have a significant number of individuals have been covered. There are some very small communities and also some communities that are seasonal. It's important to note, though, that 100% of remote and isolated first nations communities have in fact launched immunization.

Over 162,000 doses of H1N1 vaccine have been administered on-reserve. To this point, approximately 40% of on-reserve first nations populations have been immunized. However, that does not take into account the fact that we do not have the most up-to-date information from two large provinces. Therefore, that is an underestimate. For those regions for which we have up-to-date information and are confident about it, the coverage rate ranges from 55% to 85%.

There have been some challenges, as one might expect. As per other communities across the country, there has been some slowing down of the vaccine rollout. But as Dr. Butler-Jones said, that will continue to be dealt with. Health Canada is helping the affected communities readjust their plans accordingly by rescheduling clinics, adjusting volunteer schedules, and in fact, in some cases, reallocating supplies of vaccine among communities.

Health Canada continues to monitor the vaccine rollout, and the regional offices are monitoring any communities where there are significant challenges with clinics. We expect that the immunization of first nations on reserve will be completed at the same time as, if not before, the rest of Canada.

I'd like to update you now on the virtual summit, which was held November 10. It was shown live over the Internet and was co-hosted by the Minister of Health and the national chief of the Assembly of First Nations. This was a live webcast provided to first nations and other partners across the country. It provided a comprehensive overview of first nations pandemic preparedness and response.

There was a panel that led the discussion that included Dr. Kim Barker, from the Assembly of First Nations; Dr. David Butler-Jones; Gina Wilson, who is the senior assistant deputy minister for INAC; and me. Initial feedback indicates that it was a success and certainly achieved the goal of delivering important information on H1N1 to first nations communities.

There were over 1,000 unique log-ins during the roughly two-hour webcast, but it is difficult to estimate the total number of individuals it reached, as quite likely there were a number of individuals at each site. The recording of the webcast will be up on the AFN website until the end of December for anyone who wishes to consult it.

The virtual summit fulfills a key commitment under the joint communications protocol of the AFN, INAC, and Health Canada and was an excellent example of collaboration among the parties. In particular, the use of modern communication tools ensured that the summit was relevant to first nations youth. Members of the AFN National Youth Council were involved in the summit through pre-recorded video segments. They expressed their thoughts and concerns and posed youth-focused questions that were put to and responded to by the expert panel.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you.

We'll go into our first round.

Dr. Bennett.

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

Thanks very much.

The first question would be for Dr. Butler-Jones.

Obviously we all have concerns about the healthy people with no pre-existing conditions who have succumbed to this illness. Have you seen any pattern? Did they wait too late to seek attention? Did they not get their Tamiflu in time? What have we learned from that and what could we do?

There was a CBC piece this afternoon about an older gentleman who died in Gander who did have pre-existing conditions and had been sent away from the hospital. He'd been given a Tamiflu prescription but he didn't get it filled until 24 hours later.

What have you learned? What could we do differently in terms of changing this?

[Dr. David Butler-Jones]

A couple of things are relevant, and we have seen a change since the spring. The pattern of illness is one that is seen in pandemics, that middle group of previously healthy. For whatever reasons, their immune system is not able to cope, or they develop a complication like myocarditis or something like that, which leads to arrhythmia and death. It is unpredictable, but what we have seen, certainly in the ICU review, is that for those who present late, those who are initially getting well and get sicker, we recognize that this is an important sign that you may either have a secondary infection or something is happening that's different. If you have severe illness or shortness of breath--as you have seen through the summer, our messaging has been pretty clear about the importance--if you have these signs or a more severe disease, get medical treatment as soon as possible.

We have seen a change. For example, in the spring we saw a number of pregnant women in ICUs. We're just not seeing that anymore. Unfortunately, we've now had around 200 deaths. But when we look back, if we'd seen the patterns...if we hadn't got the antivirals out there in communities, if we hadn't got the work with the ICUs around sharing of best practices, we would be seeing a considerably greater number. So continuing that message even after people are immunized is going to be important.

Finally, the more people who get immunized, the risk of spreading it to someone, who we can't predict will have a severe outcome, is less. Clearly, if people are getting sicker at home, they need to be seen, and the antivirals have proven an effective treatment, and not just if you get them early. Even for those who are going sour, starting antivirals at any point rather than waiting improves your outcome.

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

A lot of us are pleased to see the new brochure that lists the symptoms people should be looking for and the severity indicators, although I still think the language is a little.... I'm not sure if everybody even knows what “indicators” means.

When we were visiting some of the local public health units last week, we saw the need to get these into other languages and then the retranslation back from that language, because particularly if it's just sent to ethnic media that don't have a public health background.... The retranslation is very important to make sure the message has been delivered correctly. I'm still asking whether it is possible to have these kinds of messages on the Public Health Agency of Canada website for local public health to download. It's not a lot, but would it not be possible to have this kind of message in 60 languages on your website so small public health units that only have a small pocket of a certain community could avail themselves of the federal resources?

[Dr. David Butler-Jones]

I will get Elaine to speak to that.

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

The issue of different languages is being looked into. I cannot say right now how many or which ones.