Health Committee on Oct. 2nd, 2012

[The Chair, Conservative, Joy Smith]

If I might, I just want to say that Dr. Plummer also wants to make a comment. I just want to make you aware that we've only got about a minute and a half.

[Dr. John Spika]

It wasn't a quick decision based on limited data. We had quite a bit at the time. I'll turn it over to Frank.

[Dr. Frank Plummer]

I would add to what John said. The picture emerges over time. The H1N1 virus is a good example. When it first emerged in Mexico, it appeared to be a pretty severe problem because the most severely ill people are the ones who come for medical attention first. But as things evolved we learned that it could be severe, but most cases were pretty mild and got better fairly quickly. It's a constantly changing picture, and you don't know when you're starting. You can make some guesses based on past experience, but you don't know until you've actually seen what's happening.

[The Chair, Conservative, Joy Smith]

Thank you very much.

Dr. Spika, you've got 30 seconds or so left if you have anything else that you'd like to add to that.

[Dr. John Spika]

Clearly, we are also learning from our neighbour to the south. The U.S. was experiencing it as well. There was a fair amount of epidemiological data that was floating around and being exchanged under existing international agreements we have between our countries, as well as the global health security initiative countries in Europe.

The decisions we came to were very reasoned and based on the best data that were available, and there were enough data available to make good decisions.

[The Chair, Conservative, Joy Smith]

Thank you.

Now we'll go to Dr. Carrie. Mr. Brown, I think you're splitting your time. We'll begin with Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

My question is for Dr. Plummer and Dr. Spika.

Dr. Spika, you mentioned that one of the suggestions for improvement was that we should be more flexible and more scalable, when we're looking at these lists, who's on the list, who's off the list. All kinds of very important work gets done during a pandemic, but I do understand there are challenges. I know for example that in Nunavut first responders are typically nurse practitioners because firefighters are not traditionally the first to arrive on the scene up north.

If the federal government actually starts dictating who should be on the list and who should be off the list, would that make our pandemic plan more flexible, more scalable, or would we be doing the exact opposite of what has been asked of us?

Would you be able to comment? Maybe Dr. Plummer has a comment, too.

[Dr. John Spika]

Personally, I think it would make it less flexible, less scalable. Clearly, given that pandemics are unpredictable, it makes it very difficult to try to force ourselves into a corner. A classic example is what happened in 2009. We developed a plan based on a 1968 scenario, and that wasn't the case at all.

[The Chair, Conservative, Joy Smith]

Dr. Plummer, do you want to comment on that?

[Dr. Frank Plummer]

I would add that I completely agree with Dr. Spika. I think it would box us in.

[The Chair, Conservative, Joy Smith]

Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

I come from Barrie, Ontario, and I've talked about this issue with local firefighters. I have a lot of sympathy for their concern on this issue.

I have an interesting story about how they're all working in the same area in terms of being first responders. I talked to a nurse, Kim Sweeney, and a police officer, Mark Hyatt. They told me about the percentage of nurses, police officers, and firefighters who are married. It is incredible. They mentioned about 10 different cases of firefighters, police officers, and nurses in Barrie who actually are married, because they work so closely together. There are EMS nights. The reason they have this close relationship is that in many cases, in a lot of their work in their day jobs or night jobs, they are there first. They get called to the same calls. That's why I think there was a concern from police and firefighters about their not being on that list.

I realize there's an effort to have provincial discretion on this. How far have some of the provinces gone on pandemic preparation? In the case of my home province, Ontario, was there a rationale as to why firefighters weren't included on the Ontario list? I understand that in some parts of the country, there might have been inclusion.

I apologize if this was raised in the first hour. I was at a different meeting during the first hour.

Could you maybe enlighten us on that?

[The Chair, Conservative, Joy Smith]

Doctor, go ahead.

[Dr. John Spika]

I don't know if I'm the best one to respond to that, as opposed to Dr. Hanley, given that it's sort of a provincial issue.

How and why certain jurisdictions make their decisions is really up to them. We can provide the higher-level plan.

[The Chair, Conservative, Joy Smith]

Do you have an answer to that, Dr. Hanley?

[Dr. Brendan Hanley]

I can only say that it is not written into our plan. As I mentioned, our pandemic plan is high level and does not have that amount of detail. It is also subject to continually being revised. I think that really depends on what's going on with the actual epidemiology of the pandemic and the timing of the vaccine.

It's a valid question. If different parties of people are at the same scene, why should one be included and not the other? It's really a matter of the range of functions individuals have in their work.

It also speaks to the need, and this reflects some of the questions from the previous speaker, to have a very robust communications plan so that what we're doing has input from all parties.

It sounds as though there's a tremendous amount of anxiety associated with some of these questions. I think a lot of it—

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Hanley. In the interest of time, we need to carry on to the next question.

Mr. Goodale, I understand that Dr. Fry has given you her slot to ask a question.

[Ralph Goodale, Liberal, Wascana, SK]

Yes, she has, Madam Chair, if that is acceptable to you, and thank you for the opportunity. I'll try to be very brief. I have just two or three specific questions.

Dr. Spika, at the beginning of the meeting, right at the very end of your remarks, and I'm not quite sure this is on the record, the last paragraph was, “we will continue to engage with provinces and territories and key stakeholders, including organizations representing first responders, to prepare for pandemics and our broader emergency preparedness activities”. That's the way your statement ended.

In that effort, have you yet had an opportunity to meet with the representatives of the International Association of Firefighters? If not, I presume that they will be on your guest list, and you will consult with them.

[The Chair, Conservative, Joy Smith]

Dr. Spika.

[Dr. John Spika]

There are two firefighter groups: the international association and the Canadian association. We have had most of our contact with the Canadian association. We had face-to-face contact with them maybe a year ago or so, and before that, we had a number of interactions with them.

We have not had contact with them recently, but they are clearly one of the key groups on our stakeholder consultation list. As I mentioned, I anticipate that stakeholder consultation with the broader stakeholder group is going to start in late winter or early spring.

[Ralph Goodale, Liberal, Wascana, SK]

Good. I think that's an important consultation to undertake.

Madam Chair, I want to ask Dr. Spika, and perhaps the other witnesses, about two documents. One is “Guidance on H1N1 Vaccine Sequencing”, dated September 16, 2009, a document that was referred to earlier, and appendix to annex D, “Preparing for the Pandemic Vaccine Response”. I am looking at page 10, which includes a table that I think outlines in graphic form the framework you referred to earlier today listing the various potential prioritization categories.

I have two questions.

One is on the legal status of both these documents, the one back in 2009, which I presume is being replaced by the new one that's in the appendix to annex D for the period going forward. The legal status of these documents, I take it, is that they are not mandatory, in the sense that they're not legally binding, that they're advisory. They're intended to try to bring the most helpful coordination in the context of a national public health emergency. What is their legal status? Are they mandatory or advisory, always leaving flexibility for local variations?

In comparing the two documents, it appears to me that first responders have moved up in the appendix to the annex compared to where they were in 2009. My practical question is, given the nature of the job that first responders do, in that when they're at the scene of an accident they deal with what's in front of them, no matter what, why would first responders not be included in the same broad category as health care workers or health care responders, as opposed to the lower categorization of a social workers or responders? Why would these first responders not be among the health care responders, as opposed to the societal responders? On the scene of an accident they're going to be dealing with a person in some physical health distress, and if they don't do their job right, that person won't get to the hospital to be treated by a doctor.

[The Chair, Conservative, Joy Smith]

He's not going to be able to answer the question, Mr. Goodale. You have less than a minute, Dr. Spika.

[Dr. John Spika]

I'll have to talk fast.

The annex you're referring to is linked to the 2008 pandemic revision to that annex, annex D. In terms of status, those annexes would have been approved by the Public Health Network Council, and sometimes by the Conference of Deputy Ministers of Health.

The other document you referred to, I'm not familiar with. You said it was dated the 16th of September. This would have come off the web. I'll have to—

[The Chair, Conservative, Joy Smith]

I'm sorry, Dr. Spika, our time is up now, but perhaps you could answer that question. We could distribute it to the committee. You will have time to look at it and put it together.

Thank you, Mr. Goodale.

I will now suspend the committee. We're going in camera for business, so I'd ask all people who are not members to please remove themselves from the room. In 30 seconds we're going in camera to get all our business done.

[Proceedings continue in camera]