Health Committee on Oct. 4th, 2012

[The Chair, Conservative, Joy Smith]

Good morning, ladies and gentlemen.

I want to welcome the firefighters this morning.

It's terrific to have you here. As you know, we're having a meeting today on vaccine priority lists during pandemics. I'm going to give you the opportunity to make a seven-minute presentation. At the end of the presentations from each of you, we're going to go into questions and answers. We certainly want to invite you to give us your insights into this issue.

We're very pleased to have you here at committee. I know that members of the committee have been very active in recommending that you come here today.

Welcome.

We will begin with the International Association of Fire Fighters and Scott Marks.

[Scott Marks, Assistant to the General President, Canadian Operations, International Association of Fire Fighters]

Thank you.

Good morning. On behalf of the International Association of Fire Fighters and the 22,000 professional firefighters and emergency medical responders we represent across Canada, we appreciate this opportunity to share our views about vaccine priority lists with the health committee.

The full-time firefighters we represent risk their lives and safety on a daily basis to protect the lives and property of our fellow citizens. Professional firefighters protect 85% of the nation's population and infrastructure and are first on the scene in virtually any kind of emergency, whether it's a structural fire requiring rescue and suppression, a medical emergency such as a heart attack or respiratory distress, or a vehicular or industrial accident requiring an extrication.

Firefighters are also first on the scene at haz-mat and CBRNE calls, whether it's the result of an industrial accident, a highway accident, a natural disaster, or an act of terrorism.

Professional firefighters are Canada's first line of defence and part of the nation's critical infrastructure.

The IAFF, which represents 300,000 professional firefighters and paramedics in North America, has been researching pandemic issues for years. As part of our mandate to be an international leader in firefighter and public safety, the IAFF first published a guide during an influenza pandemic close to 10 years ago to educate our members on how to respond safely and effectively.

In early 2009, a couple of months before the H1N1 virus emerged, the IAFF was sitting on a pandemic advisory committee that was examining various contingencies in the event of a flu pandemic. Little did we know when we began that work that it would include a real-time example of pandemic planning and response.

When the World Health Organization declared H1N1 to be a pandemic illness in June 2009 and it became clear that a second wave was coming, the timeframe for an H1N1 vaccine suddenly became a hot topic. When would the vaccine be ready, and who would be the first group to get it?

This is where a gap in Canada's pandemic plan exists, as shown by the events leading up to the release of Canada's H1N1 vaccine.

The most vulnerable citizens and those who maintain our health care infrastructure, such as doctors, nurses, and paramedics, were rightly prioritized for the vaccine in “Guidance on H1N1 Vaccine Sequencing”, released by the Public Health Agency of Canada in September 2009. But essential services workers, who maintain the nation's emergency infrastructure, were not.

Is it okay to protect the nation's health care system and not its emergency services infrastructure? Risk analysis experts from the United States and Canada have calculated that without intervention such as priority access to vaccines and antivirals, up to 30% or 40% of firefighters could be unavailable for duty in the case of a moderate or severe influenza pandemic.

Even in this technological age, firefighting is still a labour-intensive operation. With that kind of absenteeism, there are simply not enough firefighters available to adequately perform the critical life-saving functions that citizens expect and deserve, such as fire suppression, search and rescue, protection of our national infrastructure, and, in most cities, first response to medical emergencies such as heart attacks.

As fire department capabilities decrease, so does public safety in general. I wish to emphasize this point. Priority vaccination for firefighters during an influenza pandemic is not a matter of firefighter safety—it's a matter of public safety. It becomes even more important to vaccinate firefighters to ensure public safety when you realize that the role firefighters play as emergency medical responders puts them at an increased risk of exposure to the influenza virus.

[The Chair, Conservative, Joy Smith]

I think Kevin White is going to be sharing your presentation.

Go ahead, Mr. White.

[Kevin White, Fire Fighter, Barrie Professional Fire Fighters Association]

Thank you.

The federal government's guidance on vaccine sequencing, released through the Public Health Agency of Canada in September 2009, was drafted as a guideline for provincial and health officials to help them determine who to prioritize for the H1N1 vaccine once it became available. By drafting this document for provincial and local health officials, the federal government, through the Public Health Agency of Canada, clearly took a role in the vaccine sequencing decision process, especially when they stated upon releasing the guidance that:

Provinces and territories are expected to use the guidance for planning purposes and will interpret it based on local circumstances and realities.

If we look at the Public Health Agency's H1N1 vaccine guidance, we see that the medical role of firefighters is described perfectly where the document defines health care workers. It cites direct patient care. It even lists emergency medical services. By this token, it should have been easy to determine that firefighters should be in the top tier of the vaccination. The problem is that firefighters weren't specifically named in the first tier, but they were in the second tier, under “others who would benefit from immunization”. This doesn't sound alarming until you realize that there are only two tiers, and it's the same tier as the general public.

A provincial or local health official looking at the agency's guidance to see where the firefighters should be in the vaccine sequence would have seen this, and not the definition of their job that's listed in the tier above. This is an error that needs to be corrected and made clear in the name of public safety.

It is also a mistake in the guidance on vaccine sequencing to imply that it's for their own benefit that firefighters should receive influenza vaccine. It misses the point that vaccinating firefighters benefits the public by guarding critical public safety services.

The United States got it right. They viewed the threat of a pandemic from a wider perspective, and the decision about vaccine sequencing was made by the Office of Health Affairs, which is part of the Department of Homeland Security.

In the U.S., fire protection is correctly recognized as a part of the nation's critical infrastructure, and professional firefighters were included in the first tier of vaccinations, which, in addition to public groups at risk, identified emergency services sector personnel.

Even a subsequent priority list issued by the U.S. Centers for Disease Control in July 2009 in the event of a vaccine shortage still prioritized health care and emergency service personnel with direct patient contact.

[Scott Marks]

Meanwhile, in Canada, firefighters in one province were actually ridiculed in writing by a senior provincial health official for daring to ask during the H1N1 pandemic that they be properly recognized as front-line health care workers and be prioritized. In another province, firefighters were turned away from a vacant H1N1 vaccination clinic that had been set up for health care workers at a city hospital.

The firefighters weren't recognized as front-line health care workers despite the fact that they were coming into direct contact with citizens infected with H1N1 in the course of their duties as medical first responders and accompanying them to the hospital.

This is typical of what we saw during the H1N1 pandemic and the vaccine rollout. Some firefighters were successful in getting priority, but many weren't. A patchwork of protections was in place.

In testimony here Tuesday, we heard about the need to maintain flexibility in vaccination prioritization so that a vaccine can be targeted to those in the greatest need. Provincial and local health officials will still have a say in the final vaccine sequencing, so the federal government should not be afraid to formalize language that recognizes firefighters as front-line health care providers and as essential service providers who need to be protected.

I would add that in Canada, 50.4 million doses of the H1N1 vaccine were ordered, and there are approximately 25,000 professional firefighters. In the city of Ottawa, for example, you're talking about prioritizing an extra 900 individuals who could be vaccinated by paramedics in fire halls, thus not taking space in vaccination clinics for at-risk public groups. In many places, such as Saskatoon, firefighters did receive priority vaccination without any recorded consequences to other groups.

The Canadian pandemic influenza plan includes a good discussion about vaccine prioritization, including some good language about the recognition of firefighters as health care workers and the need to protect firefighters in order to minimize the societal impact of the pandemic. Unfortunately, these facts seemed lost when the Public Health Agency's guidance in H1N1 vaccine sequencing was drafted and released to the provinces.

The IAFF believes that all Canadians are deserving of an equal level of protection in the event of an influenza pandemic, and we believe that the Government of Canada has the responsibility to create a clear, nationwide protocol for vaccine sequencing that considers the protection of all facets of the nation's critical infrastructure.

We also understand that consultation is now under way on a revision of the plan, including vaccine prioritization. The International Association of Fire Fighters, Canadian Office, would welcome the opportunity to be a stakeholder in those discussions and also when future vaccine guidance is being drafted in response to a future pandemic.

To clarify testimony delivered here on Tuesday, the IAFF was not consulted by the Public Health Agency of Canada on this issue until yesterday.

In closing, we request the committee to recommend that the Government of Canada, through the Public Health Agency of Canada, clearly state in the Canadian pandemic influenza plan and in any subsequent vaccine sequencing guidance that professional firefighters should be included among the first to be eligible for available vaccines and antivirals in the event of an influenza pandemic, in recognition of their role as front-line medical first responders as well as the need to protect the nation's emergency services infrastructure.

The IAFF appreciates the committee's consideration of our views and our recommendation, and I am glad to answer any questions you may have. Thank you.

[The Chair, Conservative, Joy Smith]

Thank you.

We will go to questions after all the presentations.

I'll now go to the Canadian Association of Fire Chiefs, with Mr. Daniel Albert, please.

[Daniel Albert, Assistant Director, Gatineau Fire Services, Canadian Association of Fire Chiefs]

Hello, Madam Chair. I would like to thank you for giving me this opportunity to talk to you about the Canadian Association of Fire Chiefs' position.

My name is Daniel Albert. I am the Assistant Director of the Gatineau Fire Services and a member of the Canadian Association of Fire Chiefs.

In 2009, I was among those who had to manage the pandemic at the local level. I also tried to organize and structure the whole process. Let me tell you that it was not an easy task. It was chaos on a number of levels. Contradictory information was provided at various points from different people and organizations.

The reason that I mention this is that clear communication regarding the fact that our firefighters are front-line health care workers is very important for fire services, the directors and the firefighters, who work on a full-time, part-time and volunteer basis. Let us not forget that there are approximately 3,500 fire services in Canada, a large number of which include part-time and volunteer firefighters.

When your ambulance attendants are overwhelmed with work, who are you going to call? Clearly, you will call the firefighters, both professional full-time firefighters who work in the large municipalities and firefighters who work part-time.

In Gatineau's neighbouring communities, volunteer firefighters are the first responders. They help ambulance attendants and paramedics on a daily basis. It is clear for we members of the Canadian Association of Fire Chiefs that the Public Health Agency of Canada must ensure that all its provincial and territorial counterparts know that fire services staff must be given priority access to vaccinations. It is also important that they understand why. My colleagues, Scott Marks and Kevin White, spoke at length on this subject. I will therefore not reiterate the reasons it is important that firefighters be given priority access to vaccinations.

All municipal public health authorities must be aware that fire services staff need to be treated as a priority and they must understand why. It is for the same reasons mentioned by Mr. Marks and Mr. White, in both pandemic and other interventions. Other interventions will continue to be needed. There will still be fires and car accidents. Clearly, those things are not going to stop happening. When municipal, provincial and federal infrastructure crumbles, firefighters will be there to help. That is for certain. It is guaranteed.

In the larger communities that have their own fire, police and emergency services, specialized clinics should be set up that are separate from the clinics for the general public. Why specialized clinics? Sending firefighters, police officers and first responders to the same clinic as the general public creates disorder and imbalance. It does not send a good message because seniors will be there with able-bodied young men. People may get the impression that we are getting preferential treatment. Rest assured, we are not asking for preferential treatment. Firefighters do not want preferential treatment. They want to be there to help people, to help Canadians in communities big and small.

Since volunteer firefighters are very important in small communities, additional efforts must be made to ensure that volunteers are able to receive the vaccination quickly. Let us not forget that 78% of the 108,000 firefighters in Canada are volunteers.

Finally, I would like to add that every effort must be made to avoid preferential treatment, to avoid fraudulent vaccinations, which undermine the credibility of a large organization such as the Public Health Agency of Canada.

There is no doubt about it: we were lucky that the 2009 pandemic was not more serious. Canadians may not be so lucky the next time.

The message that our association wants to send to the Public Health Agency of Canada is that fire services know their role in a pandemic. We know that our role is potentially dangerous, but we are there to help. In co-operation with the Public Health Agency of Canada, the association can do a lot to protect Canadians.

If you have any questions, I can respond to them at the end.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you so much, Mr. Albert, for your presentation.

Now we'll go to M.D. Ambulance Care Limited, with Paul Hills, paramedic.

[Paul Hills, Advanced Care Paramedic, M.D. Ambulance Care Ltd.]

Thank you. Good morning. I appreciate the opportunity to be in front of you today and to share some of my experiences.

My name is Paul Hills. I'm an advanced care paramedic for M.D. Ambulance in Saskatoon as well as a professional development officer there. I also serve another role, as vice-president of the association that represents the members of M.D. Ambulance.

As my experience shows, as front-line health care workers, Saskatoon paramedics received priority access to the H1N1 vaccine once it became available in October 2009, in accordance with the federal guidance on vaccine sequencing. We were then able to administer this in-house to our own staff. This allowed us to safely and effectively continue our jobs without fear of serious symptoms or side effects from being exposed to or infected by the virus.

The other factor that we needed to consider was the incubating of the virus and exposing other staff and family, or infecting our patients who may have come into contact through our service.

The medical protection afforded by prompt access to the H1N1 vaccine gave us peace of mind to continue doing our jobs on the front lines without any fear or hesitation. This was critical at the time of considerable anxiety for everyone, as the second wave of the H1N1 virus hit.

Vaccination not only protects the individual but limits any future transmission of the virus. This is paramount, especially when firefighters and paramedics are caring for the public. Compounding the wait for vaccines in Saskatoon was a shortage of N95 respirator masks and protective gowns that we prefer to wear on every call in the spirit of universal precaution. It can be hard to estimate a required number of masks and gowns for a particular service to stockpile or quickly access in the event of something like an influenza pandemic. But if recommendations for guidelines could be made in this area, it would be most welcome.

I want to describe how our emergency medical response system works in Saskatoon. It is served extremely well by around 125 paramedics and dispatchers who provide critical life-saving service to a population of 250,000 in Saskatoon and the surrounding area. We have a coordinated response with Saskatoon fire and protective services, whose members have medical training as emergency medical technicians. Through 911, a call is classified into different response tiers, and for most moderate to severe calls, firefighters are notified for simultaneous response to assist in the patients' care.

Due to pressures on the ambulance service system, a fire crew sometimes arrives at a 911 call prior to the ambulance and provides care to the patient until a transport crew arrives. Also, there may be other cases where firefighters are requested to provide assistance to paramedics at the scene of an emergency for extra resources due to patient care requirements.

Firefighters also provide integral assistance to the community and paramedics for what's called the lift assist. This is very common in our community, when we're treating patients who literally need to be lifted off the floor and require further assessment for potential injuries. These lift assists often don't trigger an EMS response through 911 unless they're activated by firefighters on scene after an appropriate assessment is done. So an elderly person who falls and can't get up may do so because they're weak from symptoms of influenza, and that information doesn't get caught and prioritized before the responding crews are exposed to the virus.

Firefighters may be on scene and in contact with any kind of patient for 10 to 60 minutes at any given emergency medical call, depending on the availability of an emergency transport unit.

There are pre-set determinants, based on the nature of the complaint that comes in through the 911 system, which dictate whether firefighters are also dispatched to a medical or trauma call. You get a brief description of the complaint, but it often doesn't end up being the main complaint or giving you the whole picture. There are so many variables in this determination.

A simple complaint of a sore back may gain status for a coordinated response based on being short of breath due to pain. So when both paramedics and firefighters arrive on scene, the patient may have back pain but also be a carrier of the influenza virus without it being known. For example, a 911 call may report someone with chest pain and dizziness or fainting, and firefighters and EMS would be dispatched. These symptoms could be caused by coughing or generalized aches, influenza symptoms, and from low blood pressure due to dehydration from the influenza infection.

Depending on how the patient represents their complaint over 911, it could be taken any number of ways that might not give us a high index of suspicion for influenza, therefore leaving all responders at an increased risk for exposure. There's a chance we could all be exposed to influenza at any given call. We don't know it when we're rolling out of the station to respond.

The environment in which paramedics and firefighters work is much more unpredictable than a hospital setting due to the significantly lower amount of pre-information that we receive and the need to administer emergency medical care in a less controlled setting.

We were one of the jurisdictions in which firefighters did receive prompt access to the H1N1 vaccine during the pandemic in 2009. Saskatoon paramedics went to the fire halls to vaccinate the Saskatoon firefighters, and it was done very easily. It did not tie up other public vaccination clinics because the paramedics were able to visit the halls and administer it to the firefighters who were on duty. This was a good thing because of the coordinated response model that I described above, in which firefighters and paramedics work side by side on the front lines.

I would have found it strange to be working alongside a firefighter I knew personally and professionally to find out on a medical call, where a risk of H1N1 was present, that the firefighter had not been vaccinated because he or she was not eligible yet. Yet I understand this was the case in many regions of Canada due to the lack of clear guidelines from the federal government for provincial and local health officials. From my perspective, the firefighters are at a similar risk of exposure to influenza in the field as the paramedics are, and they should be protected accordingly.

I wish to comment on risk analysis studies that projected that absenteeism rates are 25% to 30% higher among firefighters in the absence of intervention such as priority vaccination. From my perspective, again, as a paramedic, I can see where this would not only decrease fire protection but also emergency medical response capability, given the coordinated response we have in Saskatoon. A decrease in the number of firefighters available for duty would also be a decrease in the number of firefighters available to assist emergency medical calls. And it would come at a time when the entire medical system is already under strain due to a moderate or severe pandemic.

It's when our system is under this strain that we rely on firefighters the most as an additional resource. In my opinion as a front-line health care worker, a high absentee rate of firefighters during an influenza pandemic, or at any other time, would constitute a significant decrease in overall emergency medical response capabilities and consequently affect public safety.

The environment that firefighters work in when operating as EMS response puts them at huge risk for contracting influenza during a moderate to severe pandemic. We never really know what is waiting for us at the other end of a 911 call, regardless of how well we try to pre-screen the calls for the potential risks. A shortage of firefighters to assist in these calls would negatively affect initial response times, as well as patient access and transportation to hospital, for example, in those lift-assist cases.

It is certainly appropriate to vaccinate paramedics and other health care professionals on a priority basis during a pandemic. But as was experienced during an H1N1 pandemic, an entire sector of front-line medical responders was missed because the guidelines that were sent to provincial and local health officials by the federal government put the firefighters in with the general public.

I would ask the committee to consider the issue closely, and to consider recommendations to the federal government that would ensure all front-line medical responders across Canada have priority access to any subsequent influenza vaccine.

Thank you. I look forward to any questions you may have.

[The Chair, Conservative, Joy Smith]

Thank you for your presentation, Mr. Hills.

We are now going to go into the seven-minute Q and A section.

We'll begin with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you very much, Chairperson.

First of all, thank you to the witnesses for being here today. I feel that you've provided us with detailed and thorough information of the actual experience, and, of course, that's very, very valuable. I don't think you have to convince us of how important it is that firefighters be included in the top tier.

I know in my community in east Vancouver, which includes the downtown eastside, with the role the firefighters play, particularly in terms of the people who are on the street and are very marginalized, high-risk—their health is compromised—it would be unthinkable that firefighters would be compromised because a plan wasn't properly executed. I think the subject we're discussing today is very real and obviously has direct consequences for your member firefighters. I'm glad to hear that it was a better experience for the paramedics.

It seems quite extraordinary that we are at a committee, listening to this issue to try to fix it and work it out, and this wasn't addressed a long time ago. I was one member of Parliament, and I know there were other members, who wrote to the minister last year as a result of the lobby by the IAFF to ask the minister to be proactive on this issue. The response we got was “Here is the plan. It's basically implemented by provinces and territories.” It was sort of passing it on.

It's very clear from what you said today that this is unsatisfactory and that we need to take more assertive direction and action.

I wonder if you could answer a couple of questions. First of all, is there any sense of what kind of lack of coverage there was? You've given us the number of firefighters, but could you say that more than 50% had difficulty getting the vaccination because they had to hassle at the local level? It would be nice to have a sense of that, even if it's anecdotal.

Secondly, you made it very clear that you're asking us to say something about the revision of the plan that's under way. I'm hoping that, as a committee, we could maybe write a letter or something to the minister.

I wonder if you have any specific wording you would want to include in this, so we can be very, very clear that what we're saying needs to be addressed in the revision of the plan.

[The Chair, Conservative, Joy Smith]

Mr. Albert, you are going to take that.

[Daniel Albert]

If you don't mind, I'll try it in English.

What I can say is that during the pandemic, we started off by getting access to the vaccine. We had the authorization locally to give vaccinations. We set up a private clinic to do the vaccinations, and when we got to the day of vaccinations, the plug was pulled on us, so we didn't get the vaccine.

[Libby Davies, NDP, Vancouver East, BC]

How did that happen?

[Daniel Albert]

That's local management—they got orders from provincial management in l'Agence de la santé. So that's our reality. In that same week, our firefighters heard that in Montreal or another part of the province they got their vaccines.

In dealing with a real pandemic situation, not just an epidemic, communication is really important. It's the front line of action, and we need leadership from l'Agence de la santé publique du Canada to give a clear message to everyone about the order in which they're going to do the vaccinations. I'm just talking about vaccinations, and that's where the firefighters were uncomfortable. They needed reassurance as front-line workers in the medical field.

We had to go as far as screening out and telling the local Agence de la santé that we would not answer if there was fever and H1N1 symptoms. We had to go that far to protect our personnel. Don't forget that every leader in the fire department has obligations, and one of those is to put everything in place so the workers are safe, and that's where the Canadian government, or the provincial government, did not go far enough. That's where we should have been more specific.

[Libby Davies, NDP, Vancouver East, BC]

Is there time for Mr. Marks to add anything?

[The Chair, Conservative, Joy Smith]

Mr. Marks.

[Scott Marks]

Considering the firefighters, and we represent 22,000 across Canada, I would say it would be in the vicinity of 90% who did not receive the vaccine. It was an anomaly that we're the ones who did receive the vaccine in that first tier. It was due to the confusion and the miscommunication that occurred among everyone else.

As far as actual language goes, we would certainly welcome the opportunity to be a stakeholder in any discussion on the revision, but I think the most important part of the revision has to be the recognition of firefighters as front-line emergency medical providers—

[Libby Davies, NDP, Vancouver East, BC]

In the top tier, just spell it out: in the top tier.

[Scott Marks]

—or not to differentiate them. I understand the concerns about tying the hands in the actual plan, but I think that any time there's an inclusion and discussion of emergency medical providers, firefighters should be part of that definition.

[The Chair, Conservative, Joy Smith]

Thank you, Mr. Marks.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

I want to thank all of you for being here today for this very important discussion we're having and for your testimony. I think everybody around the table recognizes the important role that firefighters play in our different communities.

Earlier this week we did have some testimony, as you mentioned. It did get into some of the challenges we have in Canada, with the delivery of health care being more of a provincial-territorial jurisdiction because of the vastness of our country. I know the minister is from Nunavut, and in Nunavut, the nurse practitioners tend to be the first responders.

You mentioned even in Quebec there were different priorities in different regions.

When the federal government and the provinces and territories get together, they do sit down and try to come up with plans that will work for everybody and to be as flexible as possible. One of the concerns I had—and I did ask the witnesses here on Tuesday. Sometimes politicians can be well-meaning, but sometimes you make changes. It was interesting, I think Mr. Marks said, tying the hands of the plan. When you have different regions within provinces, things are so different.

We heard from Nova Scotia, where their biggest concern at the beginning was the school kids, because the outbreaks were in the schools. I believe Nova Scotia was one of those jurisdictions that decided to give vaccination priority to firefighters.

It is a huge challenge. I am interested in what you have to say, because we were told earlier this week by the Public Health Agency of Canada that the implementation of any recommendations in the Canadian pandemic influenza plan on priority access to vaccines would fall on the provinces and territories. Our role is to provide guidance.

Mr. Marks, do you think the federal government should determine how provinces and territories distribute these vaccines?

[Scott Marks]

I think it's clear that it is a guideline. I don't think we dispute or are suggesting the government should go beyond issuing a guideline. We're suggesting that the plan and subsequent guidelines that are released have to be very clear and clearly understood.

Again, I think in any situation you're going to face—H1N1, in many ways, in a positive way, was a perfect storm. We had a situation where a virus emerged just before the school break. It allowed things to slow down before the second wave hit. By the time the second wave hit, we had a vaccine, and we had ample supplies. In any of the pandemic planning that has looked at the H1N1 scenario...we realized we were extremely lucky in the way the plan rolled out.

What I think is of concern to us still is that the plan itself has to make that basic distinction of who firefighters are. They are first-line emergency workers. Any subsequent guideline shouldn't draw distinctions just based on an occupational category. For instance, I use the H1N1. If firefighters weren't separated in that second tier and named as firefighters, I'm not sure we would have had the problem we had, because we clearly met the criteria as an emergency medical responder.

I don't think the question here is that we're saying the federal government should be necessarily making those determinations without allowing provinces or municipalities to look at their unique situations. All we're saying is that the current plan and the subsequent sequencing that came out of it were unclear. It's clear that it was unclear by the amount of confusion and the patchwork that went on because of that. That's what we're really looking to clear up—that confusion and the lack of clarity.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you for that answer.

I was wondering, because there is the partnership component of all these things; as you said, everybody recognizes the plan does have to be flexible. We're always thinking ahead: what's going to happen next time? I agree with you that H1N1 happened to turn out a lot better than people predicted.

Have you been in touch with the provincial health ministers regarding your concerns about firefighters getting priority access to the vaccine? If you have been in touch with them, what responses have you had from the provincial levels? It's interesting. When you talk about provincial-federal jurisdiction, sometimes if you have different agreements, it makes things a little bit easier. What's been your advocacy there?

[Scott Marks]

There has been no concerted effort by us to deal with it at a provincial level because quite frankly we see the confusion originating at this level. If the guidelines and the plan were clear on that, I think the individual issues that may arise at the provincial and municipal levels could be handled within that jurisdiction.

At the end of the day, most provinces adopted the federal guideline. Most provinces looked at firefighters specified in the second tier and said, “That's what we're doing.”

I guess I'm not understanding how we would fix anything by approaching the provincial governments. Quite frankly, to try to do it during a pandemic is the wrong time.