Health Committee on Oct. 18th, 2018

[The Chair, Liberal, Bill Casey]

I call the meeting to order. I'm sorry we're a little late getting started.

Welcome to meeting 116 of the Standing Committee on Health. We're studying the motion M-132 on federally funded health research.

We welcome our guests.

Mr. Davis is not here yet, but we understand that he is in transit.

Today I welcome Doctors Without Borders, Dr. Jason Nickerson, Humanitarian Affairs Adviser; Universities Allied for Essential Medicines, Louise Kyle, North American Coordinating Committee Member, and Rachel Kiddell-Monroe, Board Member; and from the Multiple Sclerosis Society of Canada, Benjamin Davis—who is not here yet—National Vice-President, and Dr. Karen Lee.

We're going to start off with each group having 10 minutes for an opening statement.

We'll start with Doctors Without Borders and Dr. Nickerson.

[Dr. Jason Nickerson, Humanitarian Affairs Advisor, Doctors Without Borders]

Good morning. Thank you for the opportunity to address the committee on this important topic.

I am the humanitarian affairs advisor for Doctors Without Borders, or Médecins Sans Frontières, MSF, based here in Ottawa. I am also a respiratory therapist with clinical and public health experience across Canada and internationally, and I have a Ph.D. in population health. I am also appointed as a clinical scientist at a hospital here in Ottawa.

MSF is an international medical humanitarian organization that provides impartial medical assistance to people affected by armed conflicts, natural disasters, disease epidemics, malnutrition crises and other emergencies. Last year, our teams carried out over 10.6 million outpatient consultations, treated more than 2.5 million cases of malaria, and cared for more than 200,000 people on first-line antiretroviral therapy for HIV. We're also the largest non-governmental provider of tuberculosis treatment in the world, and last year started more than 18,000 people on first-line treatments for TB and 3600 people on treatment for drug-resistant TB. We have operations in over 70 countries.

To deliver high-quality medical care, MSF needs both affordable access to and innovation for drugs and other health products, like diagnostics, vaccines and medical devices We have worked for decades to push for more affordable access to them and for health research systems that prioritize public health needs.

I want to first note that the M-132 study has the potential to get to the heart of some of the other issues that the committee is studying or has studied, including access to treatments for rare diseases, antimicrobial resistance and even pharmacare.

While each of these issues is complex, the fundamental question is often similar: How can we best develop and deliver new, needed drugs and other health products, and ensure that patients in Canada and around the world have timely, affordable access to them?

The fundamental issue here is not just high prices. High prices are a symptom of a broken health research and innovation system. The fundamental issue is how the system is working and the outputs it's producing.

The problem is clear. The business model that underpins the health research and innovation system that we have is not delivering drugs and other health products that are affordable and that address global public health priorities. If we want different outputs, we need a different model.

I'm going to give the committee four Ps to consider to better align Canada's health research system with patient needs and access: one, prioritize health needs; two, use partnerships to develop and deliver products to meet them; three, have policies in place to ensure access to new health products developed with public funds; and, four, pay for it.

Canada has the ability to prioritize health research that responds to public health needs and does so through a number of different ways. However, while these priorities may open up avenues of funding for the discovery of new health products, the main mechanism by which drug discoveries move out of labs and into the development pipeline is through commercialization.

Generally, that's using exclusive licensing or sale to the private sector in exchange for royalties, but with few to no safeguards that ensure Canadian and other patients around the world will be able to access the final product, even when the public has paid for the discovery. During the rare diseases study, the committee heard from a witness who noted that because Canada lacks the infrastructure to support research and development, we have become “net buyers” instead of net contributors to drug development.

Drug development is a costly endeavour. However, while the pharmaceutical industry says it costs billions to develop a new drug, that is not MSF's experience. In 2003, MSF, along with five public research institutions, founded the Drugs for Neglected Diseases initiative, or DNDi, an international not-for-profit research and development organization that was created to respond to the frustration of being faced with having to use medicines that were ineffective, highly toxic, unavailable, or had simply never been developed despite a public health need. DNDi has been an experiment in innovation, both in what it did—develop new treatments for neglected populations—and how it did it—by testing a model of drug development that was driven by patient needs and not profit maximization.

To date, with total expenditures of $375 million Canadian, DNDi has delivered seven new treatments for four diseases—malaria, sleeping sickness, viral leishmaniasis, Chagas disease and pediatric HIV—that are affordable, adapted to the places where patients live, and not patented. In addition, DNDi has created a robust pipeline with 30 R and D products covering six disease areas, including 15 potential new chemical entities or new drugs.

Factoring in the usual attrition rates in the field of infectious diseases, DNDi estimates that it can develop an improved treatment, for example, by repurposing a drug—which the committee discussed on Tuesday—for between $14 million to $58 million Canadian, and can develop a new chemical entity for between $144 million and $216 million Canadian. That's much cheaper than the billions of dollars the pharmaceutical industry says it costs them.

How is this possible? Through partnerships and collaboration and guiding principles, the DNDi model is what's known as a product development partnership, or PDP. DNDi does not have its own laboratories or manufacturing facilities. It relies on partnerships to integrate capabilities from academia, public research institutions, non-governmental organizations, health charities, governments, and the more than 20 pharmaceutical companies that DNDi has partnered with on early-stage research, clinical development and implementation. This model creates a framework for collaboration among the actors involved to better leverage research investments to more efficiently address public health priorities. The work is guided by access and affordability principles to ensure the final products are available to patients who need them.

The product development partnership approach, guided by principles of access and affordability, could be adapted to the Canadian context and used to develop and deliver new products that are needed by Canadian patients and which serve a global public good. This could be applied to solving pressing public health problems, for example developing new short-course oral cures for tuberculosis which, as the committee heard during its study on antimicrobial resistance, are desperately needed in Canada and in low- and middle-income countries.

Our policy recommendation number one is to identify priorities for health research and development that address global public health needs. Once priorities are identified, public funders should think through the steps needed to develop and deliver tools to address them from start to finish; act as the coordinator of needed innovation; and experiment with Canadian models of product development partnerships that leverage the expertise and investments of government, universities, industry and civil society to develop new drugs and health products that address these priorities.

This of course needs to have policies in place that ensure access to the innovations developed with public funds. Canada needs policies that articulate not only the desire but also the ways in which funders of health research are maximizing the use of public funds to deliver public goods. The Canadian Institutes of Health Research, or CIHR, the main funder of biomedical research in Canada, has a mandate to support the creation and translation of new knowledge into improved health for Canadians and more effective health services and products.

While this mandate includes reference to developing new and needed health products, what it lacks is a clear commitment to ensuring that Canadians and other patients will have access to the products that are developed with the federal funds provided to researchers and research institutions. Ensuring a public return on public investment should be a guiding principle of publicly funded health research. In the context of the development of drugs, devices, vaccines and other health products, this should translate into timely, affordable access to products developed in whole or in part with Canadian public funds. Profitability for research institutes, for investigators, or for the Government of Canada should not be a guiding principle behind decisions on how or whether to develop or commercialize health products.

Our policy recommendation number two is that federal funding agencies like CIHR and others should require recipients of public funds to have access and affordability policies in place for discoveries that are made with public funds. This could be one of the institutional eligibility requirements for receiving federal funding and could include the broadly applicable institutional plans and principles to guide the way universities manage their discoveries. This would better ensure publicly funded discoveries are affordable, globally accessible, and registered in countries that need them, and that the science used to develop them is made available for others to build on.

Finally, pay for it. Financing and incentive mechanisms must be sustainable and include appropriately designed incentives that delink, or as it was referred to on Tuesday, decouple, the cost of R and D from the price of medicines. Setting priorities and creating a framework to coordinate product development through a principle-driven partnership model is one step towards this, but it is important to also create the appropriate incentives to participate in it. One example is the use of prize funds to reward researchers who reach certain milestones in product development—for example, registering a clinical trial or a new chemical entity—and who agree to license the products to developers who will ensure affordable and accessible pricing and registration. Instead of relying on royalties as a means of revenue generation, Canada could simply replace the royalty incentive and reward researchers and institutes who reach certain milestones with, for example, cash prizes, bursaries or additional grant funding.

Our final policy recommendation, number three, is to experiment with the use of different funding mechanisms and incentives that delink the cost of R and D from the final price of new health products. Consider how funding agencies could reward health researchers who meet milestones for developing new health tools and who agree to access and affordability safeguards. Any rewards that are provided should require recipients to have an access strategy in place for the product to ensure it will be available and affordable for patients.

Thank you very much for having me here today. I want to emphasize that if members of the committee have any additional questions or want clarification, you're welcome to contact me.

I'd also encourage the committee to consider additional hearings on this issue in order to hear from other organizations with experience and expertise in this area that I know would be interested in speaking with you.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we'll go to Universities Allied for Essential Medicines for a 10-minute opening.

[Dr. Rachel Kiddell-Monroe, Board Member, Universities Allied for Essential Medicines]

Good morning. Thank you for inviting us to be here to present to your committee.

I'd first like to thank MP Raj Saini for all the incredible work that he and his office have done to bring this study to light. I really appreciate it.

It's many years that I've been working on issues of access to medicines. I was involved with Canada's access to medicines regime back in 2002-2003 and was slightly disappointed to see that it actually never really took ground. I think we need to find new ways to try to get at these issues and make sure we address the issues of access to medicines here in Canada.

My background is that I've been working with Médecins Sans Frontières for 25 years. I am an international board member of Médecins sans frontières. I am also a professor at McGill University in international development, and I was actually the founding president of Universities Allied for Essential Medicines, which is a global student group trying to make sure that their universities fulfill their social missions, specifically in regard to biomedical research and development.

I've lived and worked in many countries throughout the world where people are not able to access the drugs they need.

My first experience with MSF was in Rwanda during the genocide, where I had to watch people die because they could not afford HIV/AIDS medicines in that country. At that time, the drugs cost $10,000 per patient per year. I've also seen children who die of malaria in Congo because the medicines they have are no longer effective and no one was interested in creating better drugs. I've also watched children in Bolivia suffer from Chagas disease because there was no market interest in the drugs that those children needed.

What we know today is that one in three people in the world cannot access basic essential medicines. Many of these people are suffering and dying absolutely needlessly just because they cannot access the drugs they need.

These are all signs that the system, the model, that we have currently just simply does not work. Even here in Canada, we're watching as our Inuit populations are suffering from 300 times the rate of tuberculosis over and above that of the non-indigenous Canadian-born population.

This national crisis that we have here in Canada today around tuberculosis is also reflecting a global crisis that we have around tuberculosis: a global crisis that is killing two million people per year. People with multidrug-resistant tuberculosis today are dying because they do not have access to the treatment they need.

The treatment that exists is over 63 years old, requiring 14,000 pills and multiple injections, which leave one in two people deaf. This is the treatment that most people with multidrug-resistant TB are using today. There is a new drug, an amazing new drug that could really change things, but it's just too expensive; it's out of reach for most of those people.

Why is this happening? As Jason just very clearly laid out, this is happening because the current model that we have, the biomedical research and development model—or the R and D model, as we like to call it—is simply not fit for the purpose. It's failing patients globally. It's failing patients here in Canada. Even the United Nations, on many, many occasions, has made it extremely clear that we need to do this differently. We've been talking about this at the United Nations level since the early 2000s, if not before.

We can do it differently. What's really interesting is that at Universities Allied for Essential Medicines we did a study of all the alternative research and development models that are out there. We found 81. What Jason mentioned—DNDi—is just one of those models, but there are many of them. We know that we can do it. It's just a matter of giving these models the space, the financing and the ability to be able to do what they know they can do. There are ways to do it that are different from what we do today.

What we want to do today—and I'm going to this pass over to my colleague Louise—is propose a practical model that could be part of a new approach to biomedical R and D and that UAEM has been working on for over 10 years now.

[Louise Kyle, North American Coordinating Committee Member, Universities Allied for Essential Medicines]

Hello. Good morning, everyone. My name is Louise Kyle. I'm a law student here at the University of Ottawa and a member of Universities Allied for Essential Medicines, or UAEM.

In my spare time, I like to enjoy the great outdoors of our country with my partner and my family. In order to do that, I rely on an essential medicine that was developed here in Canada.

I'm here today to share my story with you. I have lived with type 1 diabetes for 25 years. By a simple accident of birth, I have been fortunate enough to have consistent access to insulin my entire life. In contrast, 99% of children with type 1 diabetes who are living in sub-Saharan Africa will die within six years of being diagnosed—six years.

An accident of birth separates me from a young man about my age who died last year in the United States rationing his insulin after being kicked off of his parents' insurance.

As you may know, insulin was discovered here in Canada by researchers at the University of Toronto, a publicly funded university. After witnessing countless people die from type 1 diabetes, Sir Frederick Banting wanted to see insulin mass-produced and distributed to those who need it. He chose to sell the patent rights to insulin for a symbolic $1 to the University of Toronto. He famously said, “Insulin does not belong to me; it belongs to the world.” That was in 1921. It's incredible to me that today this life-saving medicine is unavailable for one in two people who need it. Let me say that again—one in two.

As highlighted by previous witnesses, we need to continue to support research in the public domain. This provides the foundation on which all medicines will be discovered.

You heard Dr. Nickerson talk about the CIHR. The CIHR invests $1 billion per year in health research, and I pay taxes that go to those dollars. The Canadian government has the capacity, and I would say the responsibility, to ensure that medicines discovered with Canadian taxpayer dollars are available to those who need them.

Many medicines are developed in whole or in part with public funds at universities. Universities have goals that are socially oriented, yet they license promising research to private corporations on an exclusive basis. The problem is that these private corporations do not have the same goals as universities. As a result, private corporations are not making these publicly funded medicines available and accessible to all those who need them. Global access licensing would remove the exclusivity to a single corporation, and universities would therefore retain the right to license to other institutions.

Take sofosbuvir, for example. It cured over 90% of hepatitis C cases, but at a cost. One pill carried a price tag of $1000. That was $84,000 for a full course of treatment. This model does not reflect the goal of universities. Whereas a private pharmaceutical corporation is responsible to its shareholders, universities answer to the public.

Global access licensing aims to change the current dynamic. Global access licensing is non-exclusive licensing that allows multiple companies or institutions to access promising research. Global access licensing is a two-part solution. First, a federal funding agency like the CIHR requires a global access licensing provision in any funding that they provide; then, the university is able to license the research to multiple companies or institutions. This licensing is non-exclusive, meaning it allows for competition. This means that versions of the new medicine or the technology can be made available at an affordable price. To ensure access for populations beyond Canada's borders, federal funding for biomedical research should include obligations to sell final products at cost, or other access provisions.

[Dr. Rachel Kiddell-Monroe]

What we see is that it's actually a very simple proposition. Basically, it's that medicines funded by the public should be accessible to the public.

UAEM's proposal is also very simple. It's a very elegant, ethically sound solution. It just requires a policy shift. It's an easy fix. It actually doesn't require major legislative change, but it does have the potential to impact people in Canada and all over the world.

What's more, the solution that Louise has just been talking about is a solution that's already in practice both nationally and internationally.

First of all, it was adopted as a recommendation by the United Nations High-Level Panel on Access to Medicines in 2016. Also, over 10 leading universities in Europe have adopted global access licensing. On our continent, there are at least 20 universities that have adopted it, including Harvard University, Yale, Johns Hopkins and the Federal University of Rio de Janeiro.

Here in Canada, one university has also adopted it, the University of British Columbia, which was a real pioneer university in adopting global access licensing in 2007. They've shown that it can be done.

What we're trying to do here by considering this motion is give the federal government the chance to adopt this approach at a national level, to make it a systemic issue. This would represent a massive step forward in ensuring the systematic affordability of publicly funded medical technologies.

As a champion of global access licensing, Canada can take a lead on the global stage in promising public benefits of federally funded health research.

From the development of insulin in 1922 all the way to the production of an Ebola vaccine in 2014, we've seen how Canadian laboratories and researchers have a long legacy of providing groundbreaking research. For them to contribute to this ever-growing body, we need to make sure the work of those scientists helps all of the people, not just the people who have the luxury to afford it.

These are our drugs, they're our labs, and ultimately they're our responsibility.

Thank you very much.

[The Chair, Liberal, Bill Casey]

Thank you.

Now we'll go to the Multiple Sclerosis Society. Welcome, Mr. Davis. You had a little travel connection problem.

[Benjamin Davis, National Vice-President, Government Relations, Multiple Sclerosis Society of Canada]

A boat would have been faster from Halifax, Mr. Chair, this morning.

Thank you.

Good morning. My name is Benjamin Davis, and I am the national vice-president of government relations for the Multiple Sclerosis Society of Canada. I am here with my colleague, Dr. Karen Lee, National Vice-President of Research.

We are pleased to speak to Motion No. 132 and the importance of investment in health research, the unique role health charities and patients play in the health research ecosystem and increasing access to medicines. All are key priorities for Canadians affected by MS.

I will give you a bit of context about MS in Canada.

Canada has one of the highest rates of MS in the world, with an estimated one in every 385 Canadians living with the disease. MS is a chronic, often disabling disease of the central nervous system. Since that includes the brain, spinal cord and optic nerve, MS can affect vision, memory, balance and mobility.

Women are three times more likely to be diagnosed with MS than men.

MS is the most common neurological disease affecting young adults in Canada.

Sixty per cent of adults diagnosed with MS are between the ages of 20 and 49 years.

On average, 11 Canadians are diagnosed with MS every day.

For Canadians living with MS and their families, research is key to new treatments, better quality of life and ultimately a cure.

Now I'll turn it over to Dr. Lee.

[Dr. Karen Lee, National Vice-President, Research, Multiple Sclerosis Society of Canada]

Canada remains at the forefront of MS research around the world. Through generous contributions from donors, corporate sponsors, and fervent fundraisers, the MS Society of Canada has invested over $170 million in research since its inception in 1948.

This investment has led to significant results for people affected by MS. More specifically, MS Society-funded studies have gone the distance in areas such as imaging, diagnosis, genetics, tissue repair and rehabilitation.

Let me share with you a story of a young woman diagnosed 20 years ago at the age of 20, at a time when there were very few treatment options available to her. She quickly progressed in her disability, becoming wheelchair-bound and unable to continue to work. Today, I'm happy to report that we witnessed her getting married, which included her walking down the aisle in heels, and she is back at work as a contributing member to Canada's economy. This story has a happy ending because the MS Society funded a stem cell clinical trial in the early 2000s, which she was a part of.

Although we have witnessed first-hand the real-life benefits of funding research for the person living with MS and their families, the MS Society continues to fund fundamental research, as we still don't know what causes MS or how we can prevent it in the future.

Most importantly, we need more treatments for progressive MS. This past year, we announced the funding of an international clinical trial in which the lead researcher is based here in Canada. The trial is focused on bringing immediate intervention to people living with the most debilitating form of MS—progressive MS.

We recognize that we are unable to do this on our own. Hence, the MS Society believes strongly in investing in research through collaboration and partnerships here in Canada and globally. However, we believe that there are important improvements that can be made to federally funded research to deliver better outcomes for Canadians.

We recommend that federally funded research include fundamental research, and include health charities as key partners of government, universities, and private industry.

Additionally, we recommend creating a framework for enhanced coordination among these four groups to better leverage health charity research investments with additional public and private investment dollars for research.

Finally, as part of the collective voice of the Health Charities Coalition of Canada, we recommend that national health charities do not provide funding for the indirect costs of research, such as the cost to the institutions of hosting research programs and laboratories. We believe that is the role of the government.

Canadians rely on advances in fundamental research to explore questions about how a disease develops, determine whether a new treatment may be effective, and help to identify optimal care. Investments made in research serve the dual purpose of not only impacting health outcomes and promoting innovation, but also of stimulating the economy through employment opportunities that lead to the commercialization of products and the development of intellectual property.

For the MS Society, turning research findings into life-saving outcomes for people living with MS is a top priority. This is why we recently partnered with the Brain Canada Foundation and Biogen Canada in a multi-million-dollar study to understand the MS population in Canada over time. It is only through these important innovative partnerships across different sectors that we can achieve a better understanding of what MS is and how treatments can impact Canadians living with MS in the community.

The Canadian MS progression cohort will provide research solutions that will provide hope not only for those living with MS here in Canada but around the world. To ensure that momentum in MS research continues, we must invest in the next generation of MS researchers. The MS Society of Canada annually invests in young researchers through grant funding in their graduate and postgraduate research. Funding researchers and providing them with educational opportunities across the academic and clinical spectrum enables training for the next generation of MS leaders while reinforcing their passion in the field.

[Benjamin Davis]

Not only is investing in health research critical and key to increasing benefits to the public, but we also recommend that federally funded research meaningfully engage patients in setting health research policy. We believe that federal research funding programs should be informed by the perspectives of patients, their caregivers and health care providers.

Health research is essential to addressing unmet patient needs by furthering our understanding of diseases and how to cure and care for those living with them. With their lived experiences, patients provide a unique perspective on the current state of clinical care that must shape the health research agenda moving forward. As such, the perspective of patients should be embedded within the health research agenda.

We recommend that the federal government implement research agenda priority-setting approaches that include patients and health charities across granting programs. Health charities are leaders in this area and have extensive experience in using a variety of mechanisms to help shape the agenda, including direct engagement with patients and international collaborations.

The MS Society has taken big steps to engage with diverse stakeholders in the MS community to develop a research priority agenda. This happened through a series of discussions that took place across the country with the intent of understanding their experiences and perspectives. This was instrumental in mapping out our research priorities, and we continue this ongoing engagement today.

At the same time, we are continually engaging the MS community directly in our research programs, including having them involved in the research decision-making process. It is through this forum that we have seen thoughtful discussion on the importance of research from someone with lived experience. For the scientist, it is a reminder that the work they are doing has a direct impact on those living with MS and their families. The discussions we have witnessed have brought a richness to our review process and have been invaluable for both the scientist and the person affected by MS.

As we mentioned earlier, Canadians affected by MS believe research is key to new treatments and ultimately a cure. Therefore, it is imperative that individuals have access to new and emerging therapies that can improve health outcomes or even cure diseases. Today there are 14 disease-modifying therapies approved in Canada for people with relapsing forms of MS. Ocrevus, a treatment for early primary progressive MS, was conditionally approved in Canada in February 2018. This is the first time that a treatment targeted at progressive MS has been made available to Canadians.

The MS Society believes strongly that a population health perspective may not reflect the needs of individual patients, especially as it relates to a unique disease like MS. In MS, no two people have the same course of the disease or respond in the same way to the same medication. We also know that early intervention is vital to avoid many of the long-term economic and personal costs that result from unnecessary irreversible disability. Literally, for brain health, time matters in MS.

We need to translate these advances in research into better outcomes for Canadians living with MS and their friends and family. We recommend that the federal government ensure timely and affordable access to all Health Canada-approved treatments for MS. Additionally, we believe that people living with MS and their unique perspective need to be proactively engaged throughout the drug review process, from Health Canada to the pan-Canadian Pharmaceutical Alliance.

In closing, we want to reiterate the importance of investing in federally funded research while recognizing the unique role health charities and patients have in the health research ecosystem. By all of us working together, we can achieve better outcomes for Canadians in accessing medicines.

Thank you for this opportunity to speak.

[The Chair, Liberal, Bill Casey]

Thanks to all of you for your presentations.

We're going to go to our seven-minute rounds. Our first questions will be from Mr. Ayoub.

You have seven minutes.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you, Mr. Chair.

I'd like to begin by thanking the witnesses for their presentations, especially Ms. Kyle, who shared her personal experience. That always gives the theoretical a whole other dimension. It's always important to hear what people have experienced personally.

My question is for Dr. Nickerson and Ms. Kiddell-Monroe.

Given your experience in countries other than Canada, would the models you described be applicable elsewhere? Would it be possible to replicate them? We'd rather not reinvent the wheel; we'd prefer to build on something that already exists.

Does the model you described exist elsewhere? How long would it take to set up? Ms. Kiddell-Monroe said it wouldn't take very long. The fate of this initiative ultimately depends on politicians. Where are we going with this?

The common thread in all of your proposals is money. All of you mentioned that, at the end of the day, nothing happens without money. The research funding is there, but it's the administration of that money that's being called into question, and we all know that money isn't limitless.

Is this type of model used in other countries? If so, how does it work?

[Dr. Rachel Kiddell-Monroe]

Yes.

Thank you for the question.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

You can answer in English. That's okay with me.

[Rachel Kiddell-Monroe]

I'm fine to answer in French.

Dr. Nickerson talked about the DNDi model in place at the international level. Under the model, partnerships with pharmaceutical companies like Sanofi have been established to carry out projects together.

The key to DNDi's success is that it's a virtual pharmaceutical company. That means it can leverage the expertise of scientists and people from all over the world. The initiative was the result of a six-way partnership, including the Malaysian and Indian governments, as well as other organizations. It's really a wonderful model, and it shows that, when all of these stakeholders come together, it's possible to create something at a much lower cost.

To answer your second question, I would say that it does exist elsewhere. For example, there is pricing competition. We come up with prices and people apply to get them. That's another way of going about it. Of course, it always takes money to do this kind of thing, so how does that money become available?

From a government standpoint, it's important to weigh the advantages against the drug costs. In Canada, a large chunk of the health care budget goes to medications. If we paid less for medications, we could do more in other health care areas. At the end of the day, it's about cost versus benefit.

What I've observed over the years is that investing in other models benefits the population because people gain access to drugs. Canada would also benefit. We have an excellent health care system, one that provides people with better support than is available in other parts of the world where people don't have that safety net. If we pay less for drugs in Canada, that would leave more money for other things, and that investment could be used to fund this other model, which also has the potential for a global impact.

Jason, would you like to add?

[Dr. Jason Nickerson]

Sure. We have all talked about a few things here. We've talked about the need to identify and set priorities. I think we can all agree that we need a process for identifying them. What are the tools that we are missing? What are the medicines, the diagnostics, the medical devices and so on that we need? Priority-setting is certainly one thing we need to do.

We've also heard, and we heard this on Tuesday as well, that we need a model that allows us to create this framework for collaboration among all of the different actors that are involved: universities, health charities, NGOs, patient groups, industry, and so on. That is really the missing piece that we just don't quite seem to have in Canada, this ability to set priorities, discover new things, and then develop them in a way that's affordable and accessible.

Canada is not alone in asking these questions. Other countries are thinking about this. We're seeing these discussions at the European Union. As Rachel mentioned, there is a UN High-Level Panel on Access to Medicines. Everyone is asking these questions and looking at this in very similar ways, trying to address similar problems.

What we see, and what UAEM has done a very good job of identifying, is that we have small pilots. We have universities that are taking action. We have DNDi that's delivering products. We have others that are actually experimenting with this and producing drugs and devices at a lower cost. What we need is to mainstream this. We need to integrate it into more funding streams.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

If I may interrupt, I have one minute left.

As my last question, how is it that UBC took the challenge to have the global access licensing and the others haven't followed yet? Do you have an answer for that?

[Dr. Rachel Kiddell-Monroe]

I think that UBC was a real pioneer and it had a vision. It recognized that its social mission as a university was to serve society, and it saw that the model that was in place was not doing that. It actually decided to change that.

We also had a band of amazing students at the university who really pushed—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

What about the others?

[Dr. Rachel Kiddell-Monroe]

The others? We've been working with them, and they're very slow.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Why?

[Dr. Rachel Kiddell-Monroe]

It's because people don't like to change the status quo. There's—

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Is there any benefit to that? Why did they stop?

[Dr. Rachel Kiddell-Monroe]

I would love to have a president of McGill University here to answer that exact question.

We are making a lot of progress, but it's a slow progress, and universities have their interests as well. To be very honest, we sometimes feel that some universities lose sight of their social mission. What we found with some of the universities that we started this with in 2007 was that some of their concerns were whether they were going to lose revenue and whether there was a big cash cow that was going to come with massive royalty payments.

Actually what they found—and Yale publicly said this—was that introducing that kind of licensing had no impact on their bottom line, not one single bit of impact.

When I spoke to the technology transfer officer at Harvard University, they even said, “You know what has actually increased? Our abilities to license, because now there are different companies coming to us wanting to license. We have more openness to other companies.” It actually was a reverse.

We're very much hoping that in the coming weeks, there will be some major announcements here in Canada about universities as well, so please watch that space. I would like to make the report of UAEM available to you so that you can see these 81 alternative models that exist worldwide. It's a website, and I would be very happy to share that with the committee if that would be of interest.

[Ramez Ayoub, Liberal, Thérèse-De Blainville, QC]

Thank you very much.