Health Committee on May 7th, 2015

[The Chair, Conservative, Ben Lobb]

We'll continue on with our meeting. We'll continue on through our rotation with Mr. Rankin for five minutes.

[Murray Rankin, NDP, Victoria, BC]

Thank you very much.

Thank you very much, officials, for being here. As I said earlier I appreciate it. I'd like to first talk about off-label use of drugs as an issue. That is the misleading advertising for unapproved uses of drugs. The International Journal of Risk and Safety examined how Health Canada regulates and enforces Canadian drug advertising. It reviewed complaints for a decade between 2000 and 2011, and it concluded that Health Canada was not doing enough.

The official opposition asked an order paper question that revealed Health Canada received 359 complaints about pharmaceutical advertising, but didn't levy a single fine in response. They wrote letters and Health Canada “worked with them to achieve compliance”. There are big fines under the amendments of Vanessa's Law to the Food and Drug Act, big fines of $500 million and so forth, but if you don't enforce them why would anybody take it seriously?

We appreciate your having to work with companies to achieve compliance, but if there are no teeth in the rules prohibiting it, why are they ever going to comply or ever going to do the right thing? If you just get a warning letter, what does it matter?

[Simon Kennedy]

Mr. Chair, thanks for the question.

As part of the department's plan for transparency and openness, we're going to be moving ahead shortly to make available publicly all of the various advertising complaints we receive and the manner in which the department takes action to address the issue. The health and safety of Canadians is obviously our top priority, and the way in which we respond to these issues is always proportionate to the risk. In many circumstances we discovered sending a warning letter and talking to the firm in question leads to a resolution. They cease their activity. We will be making those statistics, what our follow-up actions are and whether they were successful, publicly available in the next number of months. I hope that will shed some light on what we're doing in this area to try to make sure we have compliance.

[Murray Rankin, NDP, Victoria, BC]

That would be helpful. Thank you, Mr. Kennedy.

Now I'm going to talk about research and the Canadian Institutes of Health Research, or CIHR. In budget 2015 there was a zero increase to the granting councils, but for the $15 million a year that went to the CIHR, $13 million of that was for the strategy for patient-oriented research, of which the minister spoke, and $2 million for antimicrobial research.

The information I've been given is that there's essentially what has been termed a “time out” for researchers. They expected money to continue flowing. but there's a gap in the funding and researchers are simply waiting to hang in there while that gap during that time out is filled. They need $8.5 million for each of the two years to cover the gap during the transition of the phasing out of the old programs. There's great concern in the research community about that. There was lots of rhetoric about the innovation panel, but the concern is about the actual dollars. I wonder if you could comment on that.

[Michel Perron, Vice-President, External Affairs and Business Development, Canadian Institutes of Health Research]

Thank you for the question.

Just to clarify, the question of gap that the member refers to relates to the change in our funding approach with our open investigator grant program, which is a significant portion of our budget that allows investigators to apply for funding. There has been a change to the program. We consulted with the universities and the academic institutions for approximately three years to inform them of the change. It has been minimized as much as possible to a shorter time of a three months potential gap, which is not unusual in the research setting among academics in terms of funding the start and cessation of different funding programs. For that gap that is referred to, we don't know the exact number because we haven't concluded the first pilot program results, which will be available shortly.

In the course of the gap it has been identified very early on with the academic institutions to minimize any potential impact that could not be avoided otherwise. The gap time has been shortened as much as possible to three months.

[Murray Rankin, NDP, Victoria, BC]

The scathing report of the Auditor General on the failed diabetes prevention strategy would be something I would love to get into. It was absolutely scathing, and I'm just wondering if anything has been done to address the scandalous conclusions that they reached in their 2013 report. Weak management practices, no strategy, no priorities, no performance measures are the words that they report.

[The Chair, Conservative, Ben Lobb]

Mr. Rankin, maybe we could have a brief response and then we'll turn it over to the next questioner.

[Krista Outhwaite, President, Public Health Agency of Canada]

Thank you for the question.

We've actually done quite a bit of work on the chapter that the member is referring to in terms of the audit of the diabetes prevention strategy. In fact the world, Canada, the Public Health Agency, and all of its partners have moved upstream to address the causes of diabetes. A lot of work has gone into healthier lifestyles for children and adults that will help to prevent or mitigate the onset of diabetes.

We have substantive action plans in terms of addressing the specific concerns of the Auditor General in that particular chapter. We have completed almost all of the work that we had set out for ourselves in response to the concerns. In fact we may have even completed all of it. I would be happy to provide a report to this committee that demonstrates that.

[Murray Rankin, NDP, Victoria, BC]

Thank would be wonderful.

[The Chair, Conservative, Ben Lobb]

Thank you.

Mr. Toet.

[Lawrence Toet, Conservative, Elmwood—Transcona, MB]

Thank you, Mr. Chair. It is a real pleasure to be here.

I wanted to start, Mr. Kennedy, with you. The minister invited some of the members opposite to go through the process with you on the technical aspects of how the estimate process works. I've sat through many of these meetings on the estimates, and every time I walk away just kind of floored and flabbergasted by the simplistic approach that is quite often taken in trying to compare a main estimate to a main estimate and not understanding the whole supplemental process and how it all works.

Maybe you could give us some edification on that. We know we can't allocate funds to a program that has not been designated, so that's where the supplementaries come in. Maybe you could give us some focus on that and make sure we have a clear understanding of how this process actually works.

[Simon Kennedy]

Mr. Chair, sometimes I think the officials are as flummoxed as the honourable members are. On the issue that had been raised around the table with the minister on funding for first nations in particular, there are a number of programs in the department's budget where they do not have ongoing funding. They're programs that have periodic renewals, and that's often very useful because it's an opportunity to take stock to look at the underlying policy or spending and make adjustments.

In the case of the main estimates, what you see in the main estimates doesn't account for a number of those programs for which the money is actually there in the fiscal framework and they're going through a renewal process. Just in terms of the technical detail, under voted appropriations we have funding increases of $164.8 million, and those are for the following: $63.5 million for growth in first nations and Inuit health programs and services, $29.3 million in funding for implementation of the B.C. tripartite framework agreement on first nations health and for funds for the First Nations Health Authority, $22.3 million for the renewal of the first nations water and waste water action plan, and $23 million for the territorial health investment fund.

Now the main estimates also include decreases of $170.6 million, but those are for the programs that are actually being renewed, so those funds will actually show up in supplementary estimates. Between the $170 million sort of phantom decrease, which will be renewed in estimates, and the funding increases, there's a negative so it looks in the mains as if the funding is dropping. In fact the funding is increasing because we are going to have those renewals. You have to add both sets of programs together.

Generally speaking, we have a predictable steady increase in funding every year for the spending that takes in the first nations and Inuit health branch, and those funds are required because our expenses are rising. The funds provided in the fiscal framework actually go up every year. I can assure members—and I'd be happy to send a letter—that there is no decrease in funding in this area.

[Lawrence Toet, Conservative, Elmwood—Transcona, MB]

Thank you. I appreciate the explanation.

Dr. Taylor, I had the real pleasure just a short while ago to meet with you at the microbiology lab in Winnipeg and had the opportunity to see the work being done there, the great work that was done on the Ebola vaccine by the people in the lab there. I also had the opportunity to see the behind-the-scenes work that is done that I think a lot of us aren't aware of.

Concerning the implementation of these vaccines around the world, the central control that comes out of the microbiology lab, and the reports back, I'm wondering if you could give the committee a bit of a sense of the work that happens there. We hear about the vaccine, but what really happens with the rollout? What happens with the support in the background? How does that all come together? I was really fascinated at that visit to see all the different components coming together to really make something very special that Canada should be proud of.

[Dr. Gregory Taylor, Chief Public Health Officer, Public Health Agency of Canada]

Thanks for the question; it's a great opportunity. We're very proud of the work that's going on in our laboratory. It's world class and the laboratory has been recognized as world class for quite some time. On the vaccine itself that we developed, as you know we've licensed that out for commercialization. It's in the midst of clinical trials in West Africa right now.

On my recent trip to West Africa I came to see one of the Ebola treatment centres just as the staff were beginning an information session for the clinical trials that would actually try it on the staff. My understanding from the clinical trials is that our vaccine is doing very well. In fact, one of the companies we're working with, Merck, thinks it's going to be the vaccine to go forward, so we're very proud.

I think it's worth noting that the development of vaccines, from creation to actually using them in people, typically takes 10 to 12 years, the vaccine manufacturers tell us. Because of the Ebola outbreak, because we've worked collaboratively with many organizations around the world, including WHO, CDC, etc., that's been significantly shortened. As a result, we should be able to see some commercialization of this vaccine within the next few months, potentially in the fall, although we actually can use it now.

As you know, the numbers are going down. It may seem a little bit late, but I think we're going to continue to see this disease in the future and next time, thanks to our vaccine, we'll see a very different response and a very different outbreak.

[The Chair, Conservative, Ben Lobb]

Thanks very much.

Ms. McLeod, go ahead.

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

Thank you, Mr. Chair.

I do want to take advantage of having Dr. Taylor here to maybe talk a little bit.... Certainly, Ebola was a significant concern a few months ago. Maybe he could really give us an update in terms of where we are in tackling this particular outbreak.

[Dr. Gregory Taylor]

I'd be delighted, Mr. Chair. That's an excellent question.

Having just been there, I want to start by saying that the interventions are working. As you've seen, the numbers have gone down consistently. Clearly, if there's not another case by Saturday, Liberia will be declared Ebola-free. Sierra Leone's numbers are going down significantly; Guinea still has some. The interventions and the support, which from Canada I am proud to say with $110 million, our vaccine, our labs on the ground, our Canadian Forces, are making a difference.

I must say, from being on the ground in West Africa, I came back very proud to be a Canadian. It was truly a collaborative mission. I went with some staff from DFATD, as well as the CEO of the Canadian Red Cross, and the CEO of the Canadian Médecins Sans Frontières, or Doctors Without Borders. I was supported by our ambassador on the ground, and our high commissioner on the ground and staff. It was really an excellent mission. It left an indelible impression on me, I must say. You can read about it, you can see the pictures, but it's not the same as being there in person.

I was struck with the question of poverty. I was taken by one of my staff to a slum in Freetown where they had just lifted a quarantine. It was a household-based quarantine for one case. That included 50 to 60 people because they define that as the number of people using one toilet. It was right out of the movies in terms of standing beside a clinic and seeing somebody cooking two feet in front of me, then urine being dumped in the alleyway two feet beyond that.

Clearly, what was striking was the basic public health needs of these people. The needs of clean water and latrines are simply not being met. In Guinea, in that country, what was striking there was the sense of chaos. It was a lot of moving pieces, a lot going on at the same time. I'm left with a vision of goats being transported in a little car and the goats were on the roof racks of the car, just hanging on and barely falling off.

I did see our forces at Freetown. Our forces were working directly with our U.K. colleagues. It was a spectacular experience. They felt like one team and were very proud of what they're doing. I had a chance to speak to some of the young men and women and doctors and nurses who were working there and very proud.

I must say—and I use this word—I “tripped” over Canadians. When we arrived at one of the Ebola treatment centres a nurse who was working there and who I was unaware was from Nova Scotia, took us on the tour. That was one of the MSF treatment centres. Another treatment centre was run by the Red Cross, the French Red Cross. A doctor from B.C. took us on the tour.

Canada has a very high reputation in that country. I think the key message leaving is that it's not over yet. The numbers are going down, but as you probably saw in Liberia, it popped up because it now seems that it's transmitted by sex through intercourse. Seemingly, you can apparently have the virus for up to...it's looking like four to five months potentially, and that's what we think was the case in the one individual in Liberia. So it's not over yet, and long after Ebola is done the public health needs will remain quite high in those countries. There's been some interesting modelling suggesting that because the infrastructure has disappeared and kids weren't getting immunizations, perhaps measles will actually kill more children than Ebola did during the outbreak. That's not to mention, of course, that these countries have some of the highest rates of malaria in the world.

Clearly, it's not over. Clearly, they're going to need the international community's help. Clearly, Canada still has a lot to offer, I think, and I must come back to the fundamental issue of clean water. Sanitation is sorely needed in those countries.

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

Thank you.

My next focus will be with CIHR. I want to hear a little bit more specifically in terms of the patient-oriented research and how you see that. Obviously, that was flagged in the budget as being an important path forward. Could you share some of the details?

[Michel Perron]

Thank you, Mr. Chair and committee member, for the question.

Indeed, the Canada strategy for patient-oriented research, SPOR, as we call it, the acronym, is indeed a key platform for collaboration among federal-provincial partners on the ground—patients, as well—in terms of health innovation, with the potential for transformative results. The intention is really about bringing together from the bench side to the bedside, allowing for the research to flow through the system in a manner that allows for, as close as possible, a direct application to patient needs, to policy-maker needs, and the like.

We have developed a series of SUPPORT units, which are being co-funded by the provinces in this sphere, where CIHR, provincial governments, and other partners are investing over $270 million in the first six SUPPORT units, which demonstrates I think a very significant not only attention to but investment by the provinces in terms of this platform for bringing research to the bedside. We were very pleased to note that in budget 2014 we received an additional investment for the SPOR initiative, as we did for 2016-17 for $13 million in SPOR.

Clearly, this is an area that I think will merit continued attention perhaps by this committee, given the potential for its outcomes.

[The Chair, Conservative, Ben Lobb]

Thank you very much.

Next up is Ms. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you very much.

I am so pleased to be able to ask questions to the bureaucrats because I think I will get answers.

You actually, Mr. Perron, gave an explanation to the question that you were asked earlier by my colleague from the NDP, about the CIHR cuts. Some of us actually know how to read estimates, and we do know that what you put in the main estimates and what you put in the supplementary are what we are looking at, but you did mention the specific area of that transition. The problem, though, is why one recognizes that it is a problem. Something has to be done about it because none of these agencies have the ability to get money back to deal with the transition. I don't know if you have a plan for being able to do that.

[Michel Perron]

First and foremost, as you know, CIHR is invested with a significant amount of funds, a billion dollars, which we try to invest as efficiently and accurately as possible with respect to health research. In that regard, the changes we are implementing at CIHR were the result of a very significant consultation that we undertook with the provinces and the academic institutions and health centres on how we can reduce applicant burden, how we can ensure a more efficient application process to streamline the process by which the applications can come in and be peer reviewed.

I should mention that CIHR does have a world-leading peer-review process.

Essentially, the flowthrough of these changes has resulted in a functional program change, which does reflect a small gap, as I mentioned earlier, which possibly will affect 75 to 100 researchers. That's a very small number, notwithstanding an important number—not to dismiss it—of the 13,000 researchers we fund annually. We made every effort to minimize the gap, but the gap is very much a temporary one and one that is reflecting a change in our program approach to respond to the needs of the academic communities.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Thank you. I just wanted to go back to something that to me is an extraordinarily important thing to protect: the health and safety of Canadians.

To the CFIA, if you look at what your actual expenditures were in 2013-14, they were $805.7 million. Then we go to the main estimates for 2014-15 and there is a significant drop from $805 million to $619 million. Albeit in your supplementary you spent $691 million and you've moved that up to $698 million in your main estimates today, there is still a significant shortfall since 2013 of $107 million. For me, the answer that we have the best food safety system in the world doesn't wash, when every time we've heard of a problem it's because the United States refuses to take our food. Recently, this whole XL Foods thing came about because the FDA decided that it didn't want to have the beef that had come in recently.

I just need to know exactly how many meat inspectors were employed in 2013, 2014, and 2015; whether we have positions unfilled; and what the training is that's required for these inspectors. Finally, the last one is that of course it is said that 271 full-time equivalent employees will be eliminated from the meat and poultry program. What does that mean? How is that going to impact food safety?

[Dr. Bruce Archibald, President, Canadian Food Inspection Agency]

Thank you, Mr. Chair, for the question.

Actually, there are a number of questions there to respond to, so we'll try to work our way through.

I think the first one dealt with the actual issue of the budgets and changes in the budgets year over year. I'm actually going to ask Daniel Paquette, who is our vice-president of corporate affairs and chief financial officer in the agency, to talk about that piece of it.

[Daniel G. Paquette, Chief Financial Officer and Vice-President, Corporate Management Branch, Canadian Food Inspection Agency]

Thank you.

When you look at information in the main estimates, the information from year to year is inherently different, so it does make this analysis a little more difficult.

When we look at 2013-14, it truly reflects our actual expenditures and some of the incremental expenditures that were approved during some of the supplementary estimates. One big difference in our case here is also the statutory compensation payments.

If I look at the key difference here between $805 million and $698 million, in 2013-14 we had over 58 million dollars' worth of extra compensation payments, mostly related to infectious salmon anemia. Also, the difference between those two years is that this was the year we had, in budget 2012, the last savings reduction in our appropriations, and that was $45 million.

When you look sometimes a bit more in the future outlaying years, there are a few other reductions that are mainly sunsetters, for which we do expect to go forward and ask for renewal.