Health Committee on Nov. 18th, 2009

[The Chair, Conservative, Joy Smith]

We will now go to Ms. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Madam Chair.

Dr. Butler-Jones, you said that once the vaccines are distributed, in seven to ten days the provinces use them, but do we actually know the numbers? Is there a tracking system? Can we say that in Ontario versus Alberta there have been this many vaccines?

[Dr. David Butler-Jones]

They are collecting that information as they go. Again, the focus is on getting people immunized more than the counting. But every single immunization is documented, including the lot numbers, etc., in case there are any issues we're concerned about. We will eventually have those numbers for the country.

As I said, Nunavut announced today that they had covered 60% of their population. We will look to the provinces to identify that as they go, but they have been telling us that they are actually gearing up and, whatever vaccine is available, they will be able to deliver it.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

I know you said that you're still hoping for 75% of the population to be able to be vaccinated by Christmas. Is that correct?

[Dr. David Butler-Jones]

The planning assumption has been for 75% of the population to be immunized. I am hoping for more, obviously. We are certainly quite confident that we will have sufficient vaccine to accomplish that before the end of the year.

[The Chair, Conservative, Joy Smith]

Would you like to add some comments, Dr. Gully?

[Dr. Paul Gully]

Might I add to that? As I've alluded to, we do have good information in terms of coverage on the first nations communities. What we've learned is that the effort that has to be put into getting the consent form, recording that, collecting that information, which may be by fax to a regional health authority and to the province, and then collecting all that, is actually a huge effort.

Certainly for the larger provinces, it means it will take time to get information on the coverage. I'm sure it will come, but it will take time. We realize that putting needles into people's arms is part of it, but there's a lot more around it as well.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you, Dr. Gully.

One of the things I struggle with, and maybe you can help me, is that delivery has always been the big issue. When we started planning for H1N1, it was actually how do you get the vaccines to as many people in as short a time as possible. There was talk of triage centres, there was talk of doctors, and talk of a combination. I'm wondering what oversight existed to ensure that there would be effective delivery. That is one issue.

The other piece of this is that we are dealing with 1950s technology. I think we know that there could potentially be slowdowns. What was the contingency plan for those slowdowns and how do we change the system going forward?

[Dr. David Butler-Jones]

It doesn't matter whether it's a big outbreak or a small outbreak; we always review the lessons learned in terms of how things might be done differently another time. Each jurisdiction has its experience, its responsibilities, and its interest in doing this as quickly and as efficiently as possible. They've adapted very quickly to address that.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Was there federal oversight there—

[Dr. David Butler-Jones]

Basically, this is provincial jurisdiction. The federal oversight is to try to coordinate and ensure that people have access to the tools they need and the information they need, that we do have a safe, effective vaccine as quickly as possible, that we have joint stockpiles, that we have plans in place, and that we have all of these things. At the end of the day, we have senior public health professionals in every jurisdiction in this country. We have ministers, we have governments, we have others, and they are quite competent to actually deliver this.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Dr. Butler-Jones, I understand that. I was speaking to a group this week, and there was some frustration from the front lines. As everyone here tries to recognize, they're the people doing great work, but they felt that they've done their planning for several years and they planned on the federal government being responsible for the distribution. When there were slowdowns, it was difficult for them.

What is the oversight and what is the contingency plan to help?

[Dr. David Butler-Jones]

In terms of the slowdown, no manufacturer in the world has produced as much vaccine as quickly as they'd hoped to. Our American cousins, with five manufacturers, have less vaccine per capita than we do, so moving forward--

[Kirsty Duncan, Liberal, Etobicoke North, ON]

But that comes back to the technology.

[Dr. David Butler-Jones]

Well, one of the things is that we are using an adjuvant that gives us four doses for one and gives us excellent immunity, including for those who normally do not mount good immunity. This is the next generation of vaccines in terms of influenza.

So in terms of what we can do moving forward to see if there's anything that would be different, we'll obviously be revisiting all of this to see what we can do, as every jurisdiction will be, and as every local health authority will also be examining, and as they already have, because we've seen how they've changed their programs in response to what they saw in the first two weeks of the campaign.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Now we'll go to Ms. McLeod.

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

Thank you, Madam Chair.

I was quite puzzled, actually, to hear my colleague talk about 1950s technology. To me, it's absolutely astounding that we have a new virus and that we've identified this virus and created an effective vaccine. We've tested that vaccine for safety and we've looked at mass production and distribution. All of this is in only seven short months. So although there perhaps have been challenges along the route, I think we have to be so thankful that our medical system has the capacity and that we have your agency overseeing it.

I think that if you look into the future.... In some of the conversations we had in our earlier sessions, we talked about how perhaps a comprehensive medical electronic health record would help and whether for the medical home there are future opportunities, but I want to congratulate you on the work to date.

I do have two questions. One is for Ms. Chatigny.

You're doing some significant communication activities. Do you have any process whereby you're doing a rolling evaluation in terms of the effectiveness of those activities?

[Elaine Chatigny]

Yes. In particular, under the communications policy of the Government of Canada, we have to do evaluations of all of our marketing activities, the major marketing activities, so we do have plans in place to go back into the field and to assess whether or not levels of knowledge and awareness were attained through some of the marketing activities we've undertaken. Of course there may be more to come, and therefore we will be doing this kind of evaluation in the months ahead as well.

Not all of the communication in the entire communications enterprise is formally evaluated. For example, how do you formally evaluate the 46 news conferences that the minister and Dr. Butler-Jones have held, and whether or not their messages were properly captured and disseminated, other than in media analyses or those kinds of evaluation that are not very formal from a methodological perspective?

So we have a mix of means of understanding how the message is being disseminated and how it's being captured. Ultimately, we also do some ongoing assessment of whether or not we're seeing behavioural change as a result of our communications. We do know that we're seeing a greater number of Canadians report a change in their behaviours around handwashing, coughing into their sleeve, and staying home when they're sick. We're seeing progress in that regard. That's in terms of the behaviours and whether or not they noticed our ads and our work.

For example, on the pamphlet you have received today, which was distributed to 10 million households, we know that almost 400,000 Canadians have called Service Canada, 61% as a result of having seen our pamphlet. So we can, through a whole host of means, assess whether or not our messages are being captured, read, understood, and acted upon.

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

Thank you.

On my next question, perhaps you talked about it a little bit earlier and I just didn't quite click into it. It's on the unadjuvanted vaccine, which of course we have more of than we have pregnant women. Is that being distributed and given out to the regular population? What is happening with that?

[Dr. David Butler-Jones]

Yes, it has been distributed already. What we've fortunately found with the unadjuvanted vaccine is that in those with healthy immune systems--adults with healthy immune systems--it gives a percentage elevation of antibodies in the low nineties, so we have two very effective vaccines in that population.

It's not suitable for seniors, and it's not suitable for kids in terms of not producing a good enough immunity, or for those who are immunocompromised, but for the rest.... So it's now part of the mix, and much of that has already been distributed, other than some reserve to ensure that they do have capacity, should they need it, for additional pregnant women.

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

We certainly are focused on the H1N1. We were also looking at what we call the typical flu. Is that happening right now? I don't know which particular strains you were looking at this year. Are we identifying a normal flu season that could happen?

[Dr. David Butler-Jones]

Not yet. In influenzas, essentially it is almost all the H1N1 pandemic strain.

This is actually early for regular flu season. Whether we'll see a return of influenza B or the H3N2, it's unlikely we'll see a return of the old seasonal H1. I think that's unlikely. We may not see much in H3N2. I am concerned about B, because usually we see that late in the season and that can be a problem. That is part of the seasonal flu vaccine as well.

We're watching very closely, but at the moment it's basically all H1 all the time, when it comes to influenza. There are other viruses out there, though, that cause colds and flu-like symptoms. They're not as miserable as influenza, but they're out there.

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

Australia went through this before us. Did they have to look at the two coinciding together? How did it play out in Australia this year?

[Dr. David Butler-Jones]

When we had to make all the decisions about seasonal flu vaccine, etc., most countries in the southern hemisphere were seeing both. But as the season went on, basically H1 crowded out most of the other influenza A, depending on the country. Some countries had both.

What we will see going forward is impossible to predict. Particularly as we protect people against H1, will another seasonal influenza return? Will we see B, as we normally see in the spring? Again, we'll hedge our bets. Fortunately, we have both vaccines.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Butler-Jones, Dr. Gully, and Ms. Chatigny. We really appreciate your time at committee. I know you're so busy. Your expertise is reassuring, and your leadership in this has been amazing.

Thank you so much for joining our committee.