Health Committee on March 7th, 2016

[Dr. Dana Devine]

It's one of the critical questions in our screening process. We ask every donor if they've travelled outside of Canada. If they say yes to that question, then we ask them further questions about where they went.

[The Chair, Liberal, Bill Casey]

Thank you.

Dr. Eyolfson.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you. That was a very useful presentation. I think it should allay the fears of a lot of people. As we've said, there's been so much excitement in the media. It's nice to hear a scientific voice of reason saying, “Don't panic.”

I had a few questions. The vast majority have already been asked and answered here.

In regard to neurological symptoms, to things like Guillain–Barré and that sort of thing, have there been any identified cases in Canada to date with this association?

[Dr. Gregory Taylor]

Guillain–Barré is something that happens. It is rare, as you've mentioned, and it is associated with all kinds of different viral infections. There's a small number of cases of Guillain–Barré in Canada every year. We're watching that and looking to see if there has been any increase. You're probably aware from the media there has been Guillain–Barré associated with Zika, but you would expect that because viral infections can cause Guillain–Barré syndrome.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

Further to the question on organ donation, as you said, it's a clinical decision anyway. Given that the only at-risk people are pregnant women and it's a risk to the fetus, and since we don't do organ transplants on pregnant women, is there any thought to simply leaving that restriction on organ donation aside and just saying that only in a very rare case you might be considering this on a pregnant woman?

[Dr. Dana Devine]

I think we've left this right now to the decision of the transplanter, so that thinking can go through that truly clinical decision-making path. As we learn more about Zika virus and its biology, it may in fact turn out that some of these restrictions get modified.

[Doug Eyolfson, Liberal, Charleswood—St. James—Assiniboia—Headingley, MB]

Thank you.

I don't have any more questions now.

[The Chair, Liberal, Bill Casey]

Ms. Sidhu, we have a minute. Would you like it?

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

Thank you, panel, for giving us information about the Zika virus. I appreciate that.

On the spread of the Zika virus, in regard to whether they're transmitting the virus, do we have any mandatory tests? For example, for a person who goes to affected countries and comes back, even though they don't show any symptoms, are there any mandatory tests that doctors or family doctors can prescribe?

[Dr. Gregory Taylor]

There's no mandatory testing at this point in time. There are just the two tests that Matt has described, both looking for the virus in the blood or looking for antibodies toward the virus.

[Sonia Sidhu, Liberal, Brampton South, ON]

On the PHAC website, they recommend a two-month waiting period before trying to conceive when there's a possible case of Zika virus.

Are there any diagnostic tests available at this point to establish the virus is no longer going to affect—I know it's 21 days—but is there any test now to determine if they can conceive?

[Dr. Gregory Taylor]

A test during the two-month period? The test could be done on the male. That's the concern, the male having that, and I assume semen could be tested. They'd have to submit that specimen and be tested, or serology in the male could be done.

[Matthew Gilmour]

There would be a risk too because we have the test. We could test semen and if we found Zika then we rule it in. You confirm that Zika is present, but are we in a position to confidently rule it out? That would be the challenge that we're in. That would be part of the discussion that a physician would have with a patient to understand and accept those risks if they wanted to pursue testing. Maybe it's not a confident rule-out test at this moment, but we can certainly rule in that Zika is present.

[Sonia Sidhu, Liberal, Brampton South, ON]

I know this is on the website, and is it in any other language besides English?

[Dr. Graham Sher]

In French.

[Sonia Sidhu, Liberal, Brampton South, ON]

It's in French. Thanks.

[The Chair, Liberal, Bill Casey]

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chairman.

I have a couple of things. I appreciate that we need to be science-based and certainly any kind of sensationalizing of this is not helpful. I want to drill down a little bit into the three million Canadians who are travelling to Zika-infected areas. Am I correct in understanding that the phenomenon really has occurred in the last year, in 2015, after being dormant for decades, or not having this kind of impact?

Would it not be the case then that we're just in the early days? I understand the mosquito that transmits Zika is not currently present in Canada and may not be, but with three million Canadians travelling to Zika affected areas, say, in 2016, would it not be logical to think that we're going to have an increased number of Zika infections in Canada in 2016?

[Dr. Gregory Taylor]

Absolutely. You would expect that most of them, as I mentioned, either have no symptoms or very mild symptoms. We've detected 20, but we're not testing the vast majority of Canadians who go. I would suspect that a lot more than 20 Canadians have been infected with Zika, but either they have no symptoms, or it's self-limited and they're fine.

[Don Davies, NDP, Vancouver Kingsway, BC]

What resources or tools would be helpful to your organizations in getting in front of this, in preparing? We do have a little bit of a luxury of seeing this develop and hopefully not much comes of it. That tends to happen with these pandemic fears, but what kinds of resources from government would be helpful to your organizations?

[Dr. Graham Sher]

I'll certainly answer on behalf of Canadian Blood Services.

Our decision to act and act quickly was based purely on the precautionary principle and actually, you asked that question earlier, Mr. Davies. I want to reinforce that we decided to act even in the absence of evidence because the whole precautionary principle says the absence of evidence is not evidence of absence.

Even though we didn't know that it could be transmitted through blood transfusion, we felt that a broad-brush safety measure deferring anyone who may have travelled to those areas for a 21-day period was an appropriate thing to do.

In terms of what additional resources my organization would need to further enhance the safety of the blood supply, one thing I have to credit governments in Canada, particularly the provincial and territorial governments.... When Canadian Blood Services was established in 1998 on the heels of the tainted blood scandal and the failures of our predecessor organization, one of the most important risk-mitigating strategies governments gave us was the capacity to act in the name of safety without asking governments for additional money.

Canadian Blood Services has a contingency fund, meaning we could implement any test or any measure at any cost to protect the blood supply without asking government for permission to fund it. We have a prefunded contingency fund in the amount of $40 million that allows us to act in the name of safety.

That is perhaps the most powerful resource that this organization has. Unfortunately, we acquired it because of the lessons learned from the tainted blood scandal, but to the credit of governments, both federal and provincial governments, when Canadian Blood Services was established, we were given the resource and capacity to act in the name of safety without fiscal restraints or constraints. That's perhaps the single greatest assurance we can give Canadians, that we do that when necessary.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Mr. Gilmour or Dr. Taylor.

[Dr. Gregory Taylor]

Speaking from the agency's perspective, let me say that we don't have a contingency fund. I'm quite jealous. It would be nice to have that sort of fund.

We are looking. It's a hard question to answer, because we don't know what the future holds in the next little while. Right now our focus is on research and diagnostics at the laboratory and how we can assist with the potential vaccine. We're reallocating resources to take care of that need right now. But I think the question is best answered by a number of different departments: CIHR, who are doing some work involving research funding; and some of the aid agencies, in terms of how much we contribute to the WHO and how much we help other countries in the world. We're working on that exactly.

Currently, from a diagnostic perspective I think the agency is well resourced, but determining how best to deal with this organism really depends upon what the Government of Canada wants to do on the global scene.

[The Chair, Liberal, Bill Casey]

Congratulations. We did it right on time. We're right on schedule, we did a good job, and everybody got their questions in.

I'd like to give you, either one of your organizations, the opportunity to give any message to us that hasn't come up. Is there any message? Is there any challenge for us? Is there anything we should be doing?

Canadian Blood Services.

[Dr. Graham Sher]

Thank you very much, Mr. Chair. Again, thank you for the opportunity.

I would certainly reinforce what Dr. Eyolfson said; perhaps we all do need to stay calm in the face of uncertainty. My organization, as stewards of the national blood system, would certainly like to assure Canadians that we believe we have managed this risk appropriately. We will continue to work with experts around the world to ensure that the blood system in Canada is there to protect Canadians and to serve Canadians well.

This is not the last emerging virus we will face. There will always be the next one, after Zika. That's why I wanted to stress the emergence of other technologies, such as pathogen reduction technology.

But we have in place a very sophisticated surveillance and risk-based decision-making mechanism. We believe it has responded quickly and we will obviously continue to monitor this one as it emerges and changes its biology and its epidemiology. For now, I think we can confidently say that we are doing what we can to protect the blood supply and individuals who may receive transfusions in Canada from the likelihood of Zika transmission.

Thank you again for the opportunity to present.