Health Committee on June 8th, 2016

[The Chair, Liberal, Bill Casey]

I call this meeting to order. Thank you for waiting for us. I am sorry we are late.

I am pleased that we made it. Lately, we have sometimes not made it all, but we made it a little bit late.

I have just checked with some of the members. If it is possible, we would like you to reduce your introductory statements to five minutes. If you could do that, it would allow us more time to ask questions and learn more.

We will start with the opening remarks by the Department of Health.

[Jamie Tibbetts, Assistant Deputy Minister and Chief Financial Officer, Chief Financial Officer Branch, Department of Health]

Thank you, Mr. Chair and committee members.

On behalf of Health Canada, I am pleased to appear before you to discuss the proposed changes to spending from what was previously outlined in the main estimates. Today, I am sitting here with Mary-Luisa Kapelus, the director general of strategic policy—I am going to get the full name wrong—for the first nations and Inuit health branch of Health Canada.

I am Jamie Tibbetts, the chief financial officer and assistant deputy minister for finance at Health Canada.

Allow me now to provide you with a quick overview of the supplementary estimates that were tabled on May 10, 2016. The department has put forward several important initiatives, which will result in an increase in funding of $165.2 million. This means that Health Canada's total budget will now be about $3.9 billion for the current fiscal year. These are outlined in the supplementary estimates, if you have them before you, on pages 2-26 and 2-27.

Most of the items included in these supplementary estimates are related to measures announced in budget 2016, particularly around infrastructure spending initiatives. In terms of specifics, the department is seeking, in voted appropriations, increases of $94.9 million for affordable housing and social infrastructure projects. This includes $82 million to support community health facility infrastructure, consisting of nursing stations; health centres; acute care facilities, known as “hospitals”; and drug and alcohol treatment centres on first nation reserves. That $94 million also includes $12.8 million to repair and retrofit existing infrastructure associated with the aboriginal head start on reserve program.

Another key item we have put forward in the supplementary estimates, related to budget 2016 infrastructure spending, is $25 million to renew and enhance the public health components of the first nations water and waste water action program. We continue to provide public health services related to water and waste water in 395 first nation communities across Canada. This falls under the category of public transit, green infrastructure, and existing programs mentioned in the budget.

Another increase the Department of Health is seeking is $25.4 million, again from budget 2016, for the initiative called “Addressing Climate Change and Air Pollution”. It is a renewal of funding. It allows Health Canada to continue to provide scientific research, under the clean air regulatory agenda, on how air pollution impacts health.

Health Canada is also seeking $12.7 million for infrastructure spending initiatives to support a variety of infrastructure improvements, such as upgrades to the security of federal laboratories to address failing structural, electrical, mechanical, plumbing, ventilation, and fire systems, etc. These are in various regions in the country.

Another request is for $2.4 million for this fiscal year for the federal contaminated sites action plan. It is related to budget 2015, and it is phase III implementation of the federal contaminated sites work.

Finally, there is $600,000 to maintain critical food safety activities, which is, again, a renewal of funding that had sunsetted in the prior fiscal year.

I will cut off my comments here.

Thank you, once again, for inviting us here today. We look forward to answering your questions.

[The Chair, Liberal, Bill Casey]

Perfect. Thank you very much.

Next is the Canadian Institutes of Health Research.

[Dr. Alain Beaudet, President, Canadian Institutes of Health Research]

Thank you, Mr. Chair.

As president of the Canadian Institutes of Health Research, or CIHR for short, it is my pleasure to address this committee and apprise the committee of some of our recent activities that are helping drive innovations in health care.

As I am sure you are aware, CIHR is the Government of Canada's agency responsible for supporting all sectors of health research, from biomedicine to social determinants of health.

Our mandate is not only to support the creation of new knowledge, but also to ensure that this knowledge is translated into practice in order to improve health services and products, and, in turn, the health of Canadians. In other words, we are ensuring the social and clinical impacts of health research, and stimulating health innovation.

This is achieved through investments in two types of research projects. The first type of projects are investigator-initiated, as they are spurred by the curiosity of researchers. They account for approximately 70% of CIHR's annual budget. The remaining 30% are priority-driven projects, which respond to emerging threats such as Ebola or H1N1; major societal issues such as obesity or dementia; or emerging opportunities in health innovation, such as big data and personalized medicine.

In your review of the supplementary estimates (A), you will see that CIHR has requested the funding allocated through budget 2015, which will advance health research into two priority areas for Canada. The first is in the area of clinical trials, a cornerstone of evidence-based practice, and a critical step for determining which intervention, drug, or diagnostic procedure works, and for whom.

A new investment of $13 million a year, announced through budget 2015, will be allocated toward a major new initiative aimed at developing innovative approaches to the conduct of clinical trials in Canada. This innovative clinical trials initiative is part of Canada's strategy for patient-oriented research, or SPOR, a broader program developed in partnership with the provinces and the territories as well as with charitable and private sectors, to bring health innovations to the bedside and share best practices across the various jurisdictions in the country.

Through its innovative clinical trials initiative, CIHR will fund researchers to develop and adopt innovative methods for carrying out clinical trials as alternatives to traditional randomized control trials. Developing new and innovative methods for clinical trials will offer the possibility to test interventions, drugs, and practices in the real world as opposed to narrowly selected population samples, and to take advantage of the provinces exceptional data banks through emerging big data analytics. Through this initiative, we hope to stimulate the development of new approaches aimed at reducing the cost of conducting trials, at reducing the amount of time needed to answer research questions, and at increasing the relevance of research findings to patients, health care providers, and policy-makers.

The second area where CIHR is driving innovation in health is in antimicrobial resistance, or AMR. Increasingly over the last few years, AMR has been recognized internationally as an emerging health crisis that threatens to undermine our ability to control bacterial infections.

As you know, antimicrobial resistance results from the adaptation of microorganisms to antimicrobial medicine, which allows it to counter the effects. The evolution of resistant strains is a natural phenomenon that has always occurred; however, we are now seeing a disturbing acceleration of this phenomenon due to misuse in animal farming, veterinary medicine and clinical use among humans.

If the spread of antimicrobial resistance (AMR) is not checked, and if new methods for treating bacterial infections are not found through research, we face returning to a pre-antibiotic-like era. This would be absolutely devastating and, in some respects, reverse decades of scientific progress.

To put this into perspective, according to a major 2014 study, 300 million people are expected to die prematurely because of drug resistance over the next 35 years. This would lead to a decrease in the world's GDP of between $60 trillion U.S. and $100 trillion U.S.

CIHR has identified AMR as a research priority for over 10 years, and has launched a number of strategic initiatives in this area to better understand and address the health challenges posed by antimicrobial resistant infections, including the development of alternatives to antibiotics, such as phage or monoclonal antibody approaches. Many of these initiatives are being carried out in collaboration with international partners, notably, the European Commission, with which CIHR co-directs a research funding initiative.

The additional $2 million per year allocation provided through budget 2015, which will be further leveraged through a one-to-one matching from private sector partners, will be devoted to supporting research aimed at developing, evaluating, or implementing point-of-care diagnostic tools to improve appropriate identification and, therefore, treatment of microbial infections.

Through targeted initiatives, like the two initiatives I have described today, CIHR is building and mobilizing Canada's research capacity to address critical health issues and opportunities in health. These efforts aim to maximize the collective efforts of the many players in the Canadian health research enterprise to unlock resources and reap the benefits of our joint investments.

Thank you, Mr. Chair.

[The Chair, Liberal, Bill Casey]

Thank you. Now we have the Canadian Food Inspection Agency.

[Paul Mayers, Vice President, Policy and Programs Branch, Canadian Food Inspection Agency]

Thank you, Mr. Chairman. I am Paul Mayers, vice-president of policy and programs at the Canadian Food Inspection Agency, or CFIA.

The $38.8-million increase reflected in supplementary estimates will help the agency continue to deliver on its mandate for food safety, animal and plant health, and the Government of Canada priorities.

There is $14.1 million to maintain critical food safety activities that prevent, detect, and respond to food-borne illness outbreaks. This renewed funding will support activities focused on listeria in ready-to-eat meat, as well as the broader food safety inspection system.

There is $12.5 million to maintain daily shift presence in federally registered meat processing establishments. This renewed funding will primarily support front-line meat inspectors and program specialists in Canadian meat-processing plants. It will sustain domestic and international confidence, while supporting continued trade.

There is $5.5 million allocated to maintain critical food safety activities, which have been part of the action plan to modernize food safety inspection in Canada.

This renewed funding will support critical program activities that are now a core part of the food safety system. These include enhanced inspections, laboratory testing, program management, health risk assessments, and training, all of which are designed to prevent, detect, and respond to food-borne illness outbreaks through increased inspection, addressing listeria in non-meat products, and investing in modernizing the agency's food safety oversight for both meat and non-meat products.

There is $5.1 million to maintain the CFIA's inspection verification office, which strengthens the agency's overall system. This renewed funding is required to maintain delivery of unannounced reviews of CFIA's inspections of federally registered establishments based on risk. These reviews make sure that inspections are being carried out according to CFIA guidelines. By tracking results from these verifications, the CFIA is able to identify trends, systemic issues, and best practices, which help to inform and improve the overall performance of Canada's food safety inspection system.

There is $1.6 million to maintain and upgrade federal infrastructure assets. In 2016-17, the CFIA will begin a two-year initiative to undertake structural stabilization of the general services building and address aging infrastructure at our Lethbridge laboratory in Alberta.

The Lethbridge laboratory has a rich history of contributing to animal health and protecting our animal resources through diagnostic testing and research initiatives. The Lethbridge lab celebrated its 110th anniversary last year.

Mr. Chair, the increased funding I have discussed today allows the CFIA to continue to innovate, to continue to be vigilant and to continue to work on behalf of all Canadians. It provides a clear indication of the value the government places on food safety and consumer protection.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now to the Public Health Agency of Canada.

[Carlo Beaudoin, Chief Financial Officer, Office of the Chief Financial Officer, Public Health Agency of Canada]

Good afternoon, Mr. Chair and members of the committee. My name is Carlo Beaudoin. I am the chief financial officer for the Public Health Agency of Canada. I am here today with Elaine Chatigny, who is our assistant deputy minister of the health security infrastructure branch. It is our pleasure to be here today.

Budget 2016 proposes to provide $129.5 million over five years, starting in 2016-17, to seven departments and agencies to implement programming focused on building the science base to inform decision-making, protecting the health and well-being of Canadians, building resilience in the north and indigenous communities, and enhancing competitiveness in key economic sectors.

For the Public Health Agency of Canada, the 2016-17 supplementary estimates (A) would increase spending authorities by $1.7 million to a total of $591.4 million. This increase is in support of new funding for climate change announced in budget 2016. The Government of Canada has committed to working with international partners to reach global agreements anchored in science and leading toward a low-carbon, climate-resilient economy.

This funding of $1.7 million will be used for year 1 of the program. The agency will be returning to request additional funding for years 2 through 5 in the fall of 2016, for a total investment of $9 million over five years. This means $1.8 million per year, if we include employee benefits and accommodations.

With this new funding, the Public Health Agency of Canada will provide the public health focus on climate change adaptation with respect to the spread of infectious diseases at the national level. We will work closely with provinces and territories in this regard.

The new program will provide funding for enhanced surveillance and monitoring on Lyme disease and related vectors in collaboration with provinces and territories; development of public health tools, such as risk assessments and risk modelling; enhanced laboratory diagnostics; health professional education and awareness activities; and partner and stakeholder engagement.

This investment fulfills the Public Health Agency of Canada's role in supporting the government to deliver on its budget 2016 commitment to help Canadians adapt to the impacts of climate change and to protect the health and well-being of Canadians.

We're happy to address any questions from members of the committee. Thank you.

[The Chair, Liberal, Bill Casey]

Thank you very much.

We'll open up the first round with seven-minute questions and answers, starting with Mr. Ayoub.

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

Thank you, Mr. Chair.

I would also like to thank the witnesses for being here today.

Sometimes witnesses appear before the committee at just the right time.

My question is for the Canadian Food Inspection Agency.

We learned recently that the agency had recalled certain products due to listeria. In the amounts you request to detect this bacteria, I would have liked to see a distinction between the detection and protection processes for meat or other products. I will not list the products that have been recalled since there were a number of them. A few days ago, it was granola bars.

Can you tell the committee about the detection methods used?

[Paul Mayers]

Thank you for the question. Listeria monocytogenes is an environmental pathogen. As a result, it can be present in a wide variety of products as an environmental contaminant. The approach that the agency uses in terms of its oversight with respect to listeria includes sampling and testing of a diverse range of products. We have seen over the years listeria-related recalls range in products from fresh-cut fruit, frozen vegetables, to most recently, chocolate milk. That wide diversity of product types highlights the challenge for the agency in terms of its oversight.

The methodology for the detection of the organism, however, is primarily focused in food processing plants on environmental sampling of the plants through swabbing of the food production environment and laboratory testing of those samples to detect that listeria is present in the plant environment, as well as final food product sampling and testing. That methodology is similar between both meat and non-meat products.

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

Granola bars are prepared and wrapped and ready to be eaten. How difficult is it to detect contamination before these products reach the shelves? In the case of meat, is it unlikely that they will stay on the shelves since they are purchased quickly.

Will the budget you requested help you improve processes in those cases?

[Paul Mayers]

The improvement relates to a greater focus on preventive controls on the part of both industry and government. Indeed, the Safe Food for Canadians Act includes important enhancements in terms of authorities with respect to the requirement that businesses assess the potential routes of introduction of hazards.

This particular organism is an environmental contaminant, so great care needs to be taken in the food-processing establishment with respect to sanitation. That is the best method of preventing the emergence of this organism in foods of wide types. The organism is destroyed by processes like cooking, but many of the products in which we've seen problems with listeria are not subject to further cooking by the consumer, such as energy bars or fresh fruit. Therefore, prevention, as you've noted, is a critical component.

This investment enables the agency to enhance its work with the food processing industry, particularly as it relates to non-meat foods, to improve the oversight of their sanitation activities and, as I noted earlier, to carry out strategies such as sampling the food processing environment to identify the presence of the organism and intervene appropriately to prevent its presence in the final food.

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

Thank you for your answers.

I now have a question for officials from the Public Health Agency of Canada.

The agency has request an additional $1.6 million for a horizontal climate change and air pollution initiative.

How do the agency's actions pertain to climate change and air pollution?

[Carlo Beaudoin]

Climate change has a huge impact on public health. Consider Lyme's disease or the West Nile virus. We carefully monitor the progression and development of these diseases. We also work to improve diagnostic tools in our laboratories to make it easier to make appropriate diagnoses. We are developing tools to help health professionals recognize and treat these illnesses which are spreading in the North.

There are also other illnesses related to climate change.

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

You are referring much more to the illnesses than to climate change as such.

[Carlo Beaudoin]

Yes, I am referring to the impact of climate change on public health.

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

Thank you, that answers my question.

I have no further questions, Mr. Chair.

[The Chair, Liberal, Bill Casey]

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Mr. Chair. I'd like to start off by asking a couple of questions of Mr. Mayers.

You mentioned in your speech, $5.1 million for the inspection verification office, so I wanted to ask you a bit about inspection modernization. The agency said that this is the biggest transformation of the food safety inspection process it's ever undertaken.

I was wondering a couple of things. First, does the agency have all the inspection resources it needs to safely implement this massive change? Also, have you done a scientific audit to determine if you have the resources to effectively implement the inspection modernization?

[Paul Mayers]

In terms of the resources to implement the change, yes, the agency has the necessary resources to implement this change. It has seen significant investment in terms of front-line inspection.

In terms of a specific resource audit, the Safe Food for Canadian Act does include a specific obligation with respect to an audit of resources five years after the coming into force and the agency is committed to following that course.

[Colin Carrie, Conservative, Oshawa, ON]

I'd like to ask a couple of questions about the Public Health Agency of Canada. When you're looking at estimates, it's interesting what's in there and what's not.

I was in Oshawa on the weekend and I had an ex-teacher come up to me talking about these marijuana dispensaries that are popping up across the country. The Prime Minister and the minister said that they're legalizing marijuana to keep the proceeds from organized crime and to keep marijuana products out of the hands of kids.

One of these dispensaries that has popped up in Oshawa is at 8 Simcoe Street. They're advertising that they're selling medical cannabis. I think everybody knows that Health Canada is responsible for administrating Canada's medical marijuana program, but some of these dispensaries are also selling kid-friendly products, like brownies and cookies, candies like gummy bears, and things along those lines.

As a public health issue, do you guys see this as a public health concern, these dispensaries popping up across the country, and do you have any resources to perhaps inspect them to see if there are any safety issues?

[Carlo Beaudoin]

We are not involved in the inspection of those dispensaries. To my knowledge that is a provincial and local jurisdiction, so we're not involved in the inspection of those dispensaries.

I'm sure our chief public health officer would have opinions on the public health impact of those dispensaries. As the head accountant, I really couldn't comment on that side of it.

[Colin Carrie, Conservative, Oshawa, ON]

Health Canada did a lot of work with natural health products and they had the ability to go and inspect health food stores to see if vitamin C was correctly labelled and things along those lines. These products are labelled. They're being sold.

I think even HST is being collected from it and the Prime Minister said they want to keep these proceeds out of organized crime. A lot of people are concerned. Is the money from the sale of these products going to organized crime? What about the safety of our kids?

Mr. Tibbetts, you had your hand up. Can you comment on that?

[Jamie Tibbetts]

Perhaps I could respond to that.

Dispensaries are illegal as are other sellers of marijuana that are not licensed under the current laws to do so. The operations are selling, basically, as you have pointed out, untested products that could be unsafe and a particular risk to children.

If people possess a medical marijuana prescription or a licence, there is a distribution chain through the licensed providers that are inspected and are providing product that meets the inspections that Health Canada performs, not the Public Health Agency. In fact, they are inspected with significant rigour, as you probably know.

The government is in the process of setting up a task force to consult on the future direction of legalization of marijuana and has promised to bring in legislation next spring to help deal with it. In the meantime, the position is that they are illegal and Health Canada supports the local law enforcement that is going on around these.