Health Committee on Oct. 2nd, 2012

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

I thank the witnesses very much for being here.

In the Senate committee report entitled "Canada's Response to the 2009 H1N1 Influenza Pandemic", the committee made recommendation 15, which reads as follows:

The committee therefore recommends that Health Canada's First Nations and Inuit Health Branch work collaboratively with Indian and Northern Affairs Canada as well as the Public Health Agency of Canada to identify and address the conditions particular to on-reserve First Nations and Inuit communities such as overcrowding and poor access to clean water that make them vulnerable to communicable diseases, including pandemic influenza, and that this collaboration include measures to improve the public health infrastructure.

I have a question relating to this recommendation that I would like to ask one of the representatives of the Public Health Agency of Canada.

The report was tabled in December 2010. So the recommendation was made close to two years ago. What progress have you made in this regard with the Department of Indian and Northern Affairs? Have you been able to implement this? Has much progress been made on this recommendation?

[Dr. John Spika]

We have certainly some ongoing work with the first nations and Inuit health branch of Health Canada, but in terms of a response, I would probably want to defer that to Health Canada to respond because we're not directly involved in that interaction.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Okay. I asked the question because your agency's name was in there. But, I will put my question to a Health Canada representative.

I am very much interested in the aboriginal populations, particularly when it comes to health. Therefore, I have other questions that the most qualified person could answer.

It was mentioned earlier that…

[The Chair, Conservative, Joy Smith]

Dr. Morin, if I could intercede; that's a very good question. We had invited the Department of Health and they said that it's not within their jurisdiction. Perhaps when we have them in again, you could ask that question.

It's a very legitimate response, Dr. Spika. I know that you're not avoiding the question. It's just not your jurisdiction. That might help you a little bit.

[Dany Morin, NDP, Chicoutimi—Le Fjord, QC]

Thank you for the suggestion.

I will continue with my next questions. Are there aboriginal professionals in on discussions about determining priority sub-groups? Since the aboriginal populations are different and have particular needs, because their health is more vulnerable than the rest of the population, I suppose that you have a different approach when it comes to them. Could you speak some more about that? How do you modify the sub-groups when aboriginal groups are involved, especially when it comes to intervention methods? Obviously, individuals living on native reserves do not necessarily have the financial or qualified human resources to implement the recommendations and the implementation plan related to a pandemic.

[Dr. John Spika]

Those are good questions.

At this point in time, in terms of developing a new pandemic plan that responds to the concerns of the Senate report, we've worked primarily with the provinces and territories, as well as some stakeholder groups, to address the main body. We're hoping that main body of the pandemic plan will go out at least to our provincial and territorial stakeholders this fall. The idea is that we would more generally engage all stakeholder groups in the spring on the main body of the umbrella document, in terms of the approach we're using.

Having said that, we're also prioritizing certain annexes for development, one related to vaccines, the use of antivirals—currently issues related to first nations and aboriginal groups—as well as the communications component, the laboratory network component. Those I anticipate will be coming along over the course of the next year.

Certainly from our standpoint, the first nations and Inuit health branch of Health Canada has been involved in that planning process. We have not actually gone out, at this point in time, to engage the first nations groups as part of that consultation, but it is coming.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Morin.

Now we'll go to Mr. Lobb.

[Ben Lobb, Conservative, Huron—Bruce, ON]

When a municipality is planning for development around a lake or a river, it is looking at 100-year events for floods and whatever. When you're doing your planning, I'm sure you do the same for 100-year events for pandemics.

Could you tell us a bit about that?

[Dr. John Spika]

Pandemics in general occur three to four times a century. You can look back 400 years, and what appear to have been pandemics have been occurring with that frequency. Of the ones that we're aware of, every one is different, from the most severe one in 1918 to perhaps one of the milder ones in 2009.

In the previous pandemic plan, I guess we tried to pick a most likely scenario.

[Ben Lobb, Conservative, Huron—Bruce, ON]

The way I look at it is, if you looked at a 100-year event with a pandemic, the worst case—even if you used 1968 as the example—and thought, in all practicality, who would be on the priority list: firefighters, yes; police officers, yes; EMS, yes; and all those who are currently on the priority list, and I know EMS is on the priority list, is it possible in a 100-year plan that isn't going to cut it, either?

On this list I don't see any of the military. It's possible in a 100-year event the military could be called upon to provide some help as well. I'm curious as to why members of the military aren't on any of the lists.

[Dr. John Spika]

The military are not the responsibility of public health. The military have their own supply of vaccine that they purchase. They made their own decisions about the vaccine they were getting. They're not on there because it's public health, but they're definitely getting the vaccine. They have their own priority groups.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Within their structure they will prioritize that as well.

[Dr. John Spika]

That's right. Certain groups that are—

[Ben Lobb, Conservative, Huron—Bruce, ON]

Hypothetically then, just so I'm clear, would they receive it before any of the people who are on the primary list, or would they receive it at the same time?

[Dr. John Spika]

As part of the purchase of vaccine, they had their own supply going to them. They had their portion of vaccine, out of the overall pot, that was going to the military.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Mr. Hanley, let's say we included firefighters. Let's say we included police officers. Let's say we included absolutely every single person we could think of—the coast guard, you name it. We include everybody on the primary list. For your government, under what obligation are you to receive all these people on the priority list? You're independent to decide for yourself which ones you're going to put on the priority list and which ones you're not, right?

[Dr. Brendan Hanley]

Yes, that's right. I'm not quite understanding your question.

[Ben Lobb, Conservative, Huron—Bruce, ON]

We've talked a little about the political aspects of this motion. I guess what I was going to say is if I amended the member's motion to include everybody who was on the secondary list on the primary list, you, as the Government of Yukon, would not be beholden to accept that list, that everybody is on the primary list. You decide yourself as an independent jurisdiction, correct?

[Dr. Brendan Hanley]

That would be my understanding.

Of course, my particular position is also at arm's length to the Yukon government. My understanding of how the Yukon government would make its decisions in conjunction with my advice to the Yukon government and my direction to the Yukon government under a medical emergency would be that we would likely make our own decision.

However, there would be a great need to be doing something that is in harmony with what the rest of the country is doing, and that's the reason for the importance of the national discussions that Dr. Spika referred to, which we believe happened successfully in 2009. If one jurisdiction is doing something completely different from another jurisdiction, it becomes really distressing for everyone and difficult to carry out. Therefore, although we may not be obligated to, there may be more of a peer-based onus to do something that is harmonious with what the rest of the country is doing.

[The Chair, Conservative, Joy Smith]

Thank you very much.

You have no time for more questions, Mr. Lobb.

We now go to Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you, Madam Chair, and thank you to all the panellists for joining us today.

One of the essential issues for the need for a priority list seems to be the supply of vaccine. I'm wondering about two things. Could one of you explain to me how that supply process works?

I think, Dr. Spika, you called these novel viruses, so I presume vaccines need to be made up in response to a particular virus. I'm wondering what that process looks like, in very brief terms, and whether the pandemic plan has something in place to hurry that supply chain.

Also, there's the issue of jurisdiction and whether the federal government or provinces and territories are in control of that supply chain and getting hold of the vaccine.

Lastly, is there anything such as a geographic prioritization of where the vaccine goes? Do we prioritize places where the virus or flu may be arriving in the country?

[Dr. John Spika]

I'll give a short version of vaccine 101 here.

When the flu virus emerges, a new vaccine has to be made. It is a little more complicated, in that it is a different virus from the standard annual virus. There's an approval process that has to be gone through by the regulator.

In general, using egg-based technology, it takes about 20 to 22 weeks from the time they get the virus to the time they can start releasing the vaccine. That's just egg-based technology. You can shorten that by maybe four weeks using a cell culture-based technology. If we were to use some of the newer DNA technologies, we might be able to cut it in half. Canada was actually the first country in the world to develop a domestic capacity to produce a vaccine for its pandemic needs.

That isn't all the vaccine we need in one week; we have to wait until the vaccine is available. The capacity we had in the initial contract at the time was about eight million doses a month. That was put in place around 2000-01. The production capacity was upped so we might have the capacity to take on about 12 million doses a month, but it wasn't 30 million doses a month. We didn't have enough vaccine for all Canadians within a month after the pandemic. We also had that lag period.

Recognizing that even in a situation where we had earlier production of vaccines, the first wave had already passed before vaccine was available. We didn't start vaccinating until the second wave was approaching its peak. There were delays. There was demand. There was also the need for the infrastructure to be able to give the vaccine.

With regard to the provinces and territories, the agreement is that it's divided up based on population. The only exceptions to that were the three territories. Because the volume was so small, Yukon, the Northwest Territories, and Nunavut got all their vaccine at once. They didn't have the same prioritization concerns that the rest of the jurisdictions had based on the number of doses they were getting. They had it all. They just had to prioritize based on their ability to give vaccine using whatever mechanisms they used.

In terms of a geographic prioritization, by the time the vaccine was available, the virus was everywhere. If we'd had vaccine available earlier, perhaps one could have shifted...particularly if one could have intervened in the first wave, which was very spotty across the country. By the time the second wave happened in the fall, it literally was everywhere.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Mr. Lizon.

[Wladyslaw Lizon, Conservative, Mississauga East—Cooksville, ON]

I thank the witnesses for coming today.

My colleague, Mr. Strahl, spoke about the priority list and maybe it shouldn't be politicized. I understand that the priority list that was made during the H1N1 outbreak was based on scientific evidence and epidemiology, but I don't think we should forget about the psychological portion.

For people who work as first responders, the quality of their work would also depend on their state of mind. If the person is afraid to be in contact with people and the person's primary task is to be in contact with people who may be sick, how do we balance this? Let's say we're not going to put firefighters or police or anybody else on the list. We have scientific evidence for pregnant women, etc., but others can wait. It should be balanced, in my view. I think they should be on the list.

When you identify a strain, how do you know who is going to be affected the most? I would assume that you base it on the evidence that is perhaps after the fact.

Can you identify the risk groups based on the virus strain that you've identified?

[Dr. John Spika]

First of all, I think Canada was in a very privileged situation because the agency and the National Microbiology Laboratory were all engaged in the outbreak going on in Mexico well before we even recognized there was a pandemic going on. There was an increase in respiratory illness. Very early in the emergence of this virus, we actually had people on the ground who were learning about what was going on in Mexico, which was the first country to be heavily affected.

Also, in terms of the vaccine itself, it was not available until after the first wave had already gone through Canada. We also had a couple of months to gain information about the epidemiology of the disease here in Canada to be able to base our decisions on—