Health Committee on Feb. 2nd, 2017

[Don Davies, NDP, Vancouver Kingsway, BC]

Second, a drug survey conducted by Mercer Canada found that 65% of employers that continue to provide retiree benefits are likely to eliminate drug coverage for future retirees if drug costs and liabilities continue to escalate. Of course, there's the aging of the population and the reduction of coverage by public drug plans. We also, in that study, see that 33% of employers may attempt to eliminate or reduce coverage for current retirees as well.

Alberta Blue Cross, have you noticed a reduction in the number of employers offering supplemental health insurance to their employees in recent years because of rising drug costs, or have you seen employers in Alberta opting for more restrictive or limited drug plans for their employees as a result of rising costs?

[Margaret Wurzer]

I'll answer that question in the context of your initial comment about the senior population and employers potentially backing out of coverage there. We have seen that, not so much for the people who are are over 65, because in Alberta you get pretty good coverage under the coverage for seniors program, but we have seen that as it relates to early retirees. With our legislative mandate, we're there to help promote the health and wellness of Albertans through all stages of their lives. Right now we are designing plans for the employer groups as well as the individual market for those individuals who are retiring off their group plan to provide them with options for coverage when they're early retirees without coverage under the coverage for seniors.

To your second question about whether we are seeing scale backs in coverage in general, I would say, given the economic situation in Alberta, that we are having some challenging discussions with employers. They see their benefit line as a cost on their budget, and they're making some tough decisions about whether they have to scale back on the benefit coverage or potentially lay off employees. I have been in those discussions. We do everything we can to try to get the cost of those benefits down so that they can stay on it, but tough decisions are being made by those plan sponsors.

[The Chair, Liberal, Bill Casey]

Your time is up, Mr. Davies.

That completes our round of questions. I want to thank the witnesses. You could stay for a few more hours and we would learn a great deal more, but we have another presentation that we are about to hear. I just want to thank you on behalf of the committee for coming and providing this information. We may come back to you with more questions, but in the meantime, thank you very much.

We'll adjourn for a few minutes, and then we'll have our presentation on blood donations.

[The Chair, Liberal, Bill Casey]

We'll resume our meeting. Now we have the very distinguished member from Edmonton-Centre to make his first presentation at committee, Mr. Randy Boissonnault. He's going to tell us about the events that happened in January at the meeting on the blood donation restrictions on men who have sex with men.

Randy, you have 10 minutes.

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

Thank you, Mr. Chair.

Ladies and gentlemen, colleagues, it gives me great pleasure to be here today. This is the first time that, as senior advisor on these issues, I have had the honour of addressing a House of Commons standing committee.

Thank you for this great opportunity. I think I will remember this moment for quite some time. Thank you all very much.

I want to give an overview of what happened at the Canadian Blood Services and Héma-Québec conference held in Toronto regarding the blood ban for men who have sex with men. I was honoured to bring opening greetings to that conference on behalf of the Minister of Health, the Honourable Jane Philpott. The reason is that Health Canada provided the funding for researchers to actually look at closing the gaps in this population of men who have sex with men. This conference was an opportunity to bring together leading researchers from Canada and around the world in terms of the leading best science.

What I thought I might do, Mr. Chair and colleagues, is to give you a couple of highlights from the remarks, and then also share some of the feedback that I received from stakeholders and people who attended that conference.

The whole theme of the speech was on pursuing research to make sure we have the safest blood system possible, and also making sure that our donor supply can be as inclusive as possible. We care about this as Canadians because blood safety is paramount. Our interest as a government—we ran on this—is that we want to know the best research to close the knowledge gaps on donor screening of men who have sex with men. We're going to talk about that term later, because I've had some pushback from the community on the actual term itself.

The call to action is that everyone has a role to play in the blood screening process and in making sure we have enough blood for people who need it. However, there are some perverse effects that have stemmed from the fact that we have the blood ban in place. We need to reconcile the need to protect the safety of Canada's blood supply with the need to make sure that the donor system is as inclusive as possible.

Where the blood ban came from, as you all know as members of this committee and as Canadians who lived through this, was in the response to the Krever inquiry. In the early days of the blood ban, it was a lifetime ban. If you were a gay man who was involved in any sexual activity with another man after 1977, it was a lifetime ban. More recently, that lifetime ban was reduced to a five-year ban. Then, as a party, we ran on getting that five-year ban down to zero. We now have the blood suppliers, Héma-Québec and CBS, who have declared a one-year deferral period.

Now, it's clear to members of the community, although the distinction is not always there, that it's not the government saying that the deferral period is in place. It is CBS and Héma-Québec who have put those restrictions in place.

What I wanted to convey, and what I did convey at the conference, is that we have to talk about the central role that evidence needs to play in protecting the blood supply, but also making the blood supply as inclusive as possible. If you look at the microbiology, at the science, what is the reason for having blood in the supply for two months after nucleic acid tests, knowing what's in the blood supply, and then not allowing people to use that blood or give that blood for a year, five years, or 20 years? The microbiology doesn't support it.

One of the analogies I used—it wasn't in my remarks but I used it because I hear this all the time as a member of the community—is how it is possible that a young college student, of any gender, with multiple partners can give blood as a heterosexual, and all of that student's partners can give blood unrestricted, but two monogamous gay men living in partnership cannot, unless they declare that they have not had sex together for a year. Show me the science that shows that makes sense, because I don't have many explanations for the community to explain how that makes sense.

We have two choices as a community, and this was hotly debated by researchers and members of the community. We get to a behaviour-based analysis where we look at the population of men who have sex with men and at populations within that large basket of people—takings labels aside—and the risk factors, or we take a look at increasing our screening so that regardless of who you are or the risk factors that come to bear, the screening technologies provide the safest blood system possible. Those are the two largest areas that the researchers were debating. Do we have a world-class screening system that doesn't exclude anybody, or do we look at a behaviour-based process?

I just did my first western tour as special adviser, and we were in Winnipeg, Toronto, Vancouver, Saskatoon, and Edmonton. I can tell you that in talking with members of the community, we had several men in the community who objected to the very term “men who have sex with men”.

They said, “I'm just a person, and like other people, I have sex. Why am I a part of the subgroup? Why can't we just talk about risk factors for all populations regardless of sexual orientation or gender?”

When we take a look at the restrictions that CBS and Héma-Québec have put on the trans community, it is even more onerous. We are actually forcing people to go back to their birth gender to determine if they can give blood or not. I had one trans activist in Vancouver who said she is now 14 months after surgery, and as of two days ago her blood is fine, but if she was another gender, her blood wouldn't be fine. We have gotten ourselves into this kind of perverse way of defining populations and sub-populations when it's clear to the community and it's clear to me as a parliamentarian that I want a safe blood supply, but I also want an inclusive blood supply. I can't give blood, as a gay man, unless I say that I haven't had sex for a year. I lived in the United Kingdom from 1994 to 1996, so I may never be able to give blood because that was the time of the tainted blood scandal.

We have to take the blood supply seriously, but we also need to make it the most inclusive blood supply possible. With that in mind, $3 million was put on the table for researchers to move forward and take a look at this issue. I have to give a shout-out to the Canadian Blood Services—congratulations—and to Héma-Québec for the work they did in bringing several organizations, stakeholder organizations, from across the country to the conference.

Héma-Québec and Canadian Blood Services have done a great job of reaching out to members of the community, leaders of the community, including Egale Canada, including various organizations across the country. That partnership, if you will, that advisory role that members of the community play, is a very important role for us to know as parliamentarians. What the community wants, and what we would like to see, and what I urge you as parliamentarians to push us to get, is the data that will help us get to a behavioural approach so that we can de-stigmatize gay men who are in committed relationships, because I think it's important that we de-stigmatize the population.

I mentioned this in my opening remarks. We know that there are allies who are long-time friends with members of the gay community who do not give blood because of the blood ban. That is perverse. When Canadians who are allies to our LGBTQ community aren't giving blood because they disagree with the science and the fundamentals around the blood ban, and those units are not in the system, we are losing out as a country.

I think there's a way forward. The Minister of Health and I have talked about this. As an evidence-based government, it's important for us to have the data, but it's also important for us to make sure that we are not acting in the absence of data. That's why this $3 million and this conference room was important.

The other thing that came up, and I would encourage members of this committee to consider in the future, is to invite Héma-Québec to present to this committee. They indicated to me that they had not presented in some time and that CBS had, so that may be something you would like to explore.

With regard to this whole issue, I think that, with the help of science, it is possible to have a very inclusive Canadian blood system, while maintaining the security of this system. It is very important that Canadians be more involved in their blood system and that this system be very inclusive.

I think what I would say, having heard from stakeholders after the conference, is that this is emotional. We heard from members who lived with tainted blood before the Krever inquiry. We absolutely have to get this right. We have to balance the needs of patients who are receiving blood, Canadians who are receiving blood, with the overwhelming desire of members of the LGBTQ community to contribute to the blood supply.

Mr. Chair, members of the committee, this was a good first start. There is much research that needs to be done. I urge you to pay close and constant attention to this issue. I think that when we are able to work with researchers and scientists to demonstrate the true risk factors of gay men living in committed relationships and we can get this one-year restriction reduced, you will see an increase to the blood supply and one of the safest blood supply systems in the world.

Thank you for your attention.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we're going to have one round of questions, five-minute questions, and we're going to start with Mr. Kang.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you, Mr. Chair.

I want to thank the member from Edmonton Centre for coming and shedding some light on this very important issue.

You raised a few questions here. My first question is that the Canadian Blood Services and Héma-Québec put in place a policy allowing men who have sex with men to only donate blood after a year of abstinence. Where does the rationale to implement this policy come from? How did this come about? Before it was five years. Where did the rationale come from?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

It's my understanding that when Héma-Québec and Canadian Blood Services looked at their most recent research, they were able to make a case to reduce it from five years to one year.

The push-back that I would offer, and that I explained at the conference is, how does the microbiology change? If you have the blood, and after two months, you do a new nucleic acid test and you know exactly what is in the blood supply, why is it one year? Why is it two months?

The answer is that they don't have the science to say why it's one year versus no years. If we're going to have a behavioural approach that encourages people to defer the blood from the system because of behaviour, then it's important that we understand any risk factors associated with that population. I would like to see, as a government, that we have the data to analyze all populations that would pose a risk to the blood supply, and that we don't use a broad brush stroke on one community.

You would have to ask Héma-Québec and Canadian Blood Services why they advocated for one year, when we have seen other jurisdictions around the world have no deferral period or a deferral period of two months.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Thank you, sir.

My second question is, why do you think those men who have tested negative and have identified as being in a long-term relationship with another man are not considered to be safe to donate blood?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

The short answer is that we don't have the data to distinguish between high-risk homosexual men who have riskier sexual practices, either through not using condoms or through any sort of intravenous drug use or any other behavioural risk profiles, and a different part of the community who are in monogamous, long-term, committed, safe relationships.

With the tools at our disposal as a government and as a scientific community, we have used a very broad brush stroke—and we know the community has many more different elements to it—so all gay men got lumped together. That's why I stated earlier that the original deferral wasn't a deferral, it was a lifetime ban. As the science has been able to demonstrate risk factors, and connected that to behaviour, we have been able as a country to get this blood ban closer and closer to no ban at all.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

In your opinion, what else could we do to make this blood supply inclusive? You said the blood supply will definitely increase if we lifted the ban, like the one-year ban. What kind of number would you put forward? By how much would the blood supply go up if there were no ban? Is there any data?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

It's a great question, and it's one of the notes that I made at the meeting to see if we can quantify how many allies are out there withholding blood from the system. I don't have an answer for you yet, but it's a question that is an open question.

Again, as a community, as a country—and this came up in the scientific discourse—we have two choices. We can have an infallible screen that applies to everybody, regardless of behavioural factors, and that is about the science and about testing what's in the blood; or we can have a system that first imposes a behavioural screen.

Where we are now is that we have a process that imposes a behavioural screen, and the choice that CBS and Héma-Québec have made is that a one-year period, where a man does not have sex with another man, satisfies their criteria for safe behavioural practices to then allow that blood into the system.

Does the science bear a difference between a two-month deferral, a six-month deferral, a one-year deferral? Many scientists will tell you no, and they did so at the conference. That is why it's important for the research that comes out of this conference to show us what the behavioural risks really are.

[Darshan Singh Kang, Liberal, Calgary Skyview, AB]

Is there some screening process in place now? If there's none there, if you were to put some screening processes in place, has any cost study been done?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

All of the screening processes that regulate the safety of the blood supply are in place, and have been put in place by CBS and Héma-Québec. They are among the world's leading screeners for safe blood supply. We can always do better.

[The Chair, Liberal, Bill Casey]

Time's up.

Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

Thank you, Mr. Boissonnault, for coming here today. Good luck with your new appointment with your government. I wish you well on that.

Back in 2013, the Canadian Blood Services received approval from Health Canada to reduce the deferral period for men who have sex with men from indefinite down to five years. Of course, since then we've had an election, and I know through running against my opponent in my riding that the Liberal Party ran on this goal of reducing that five-year ban right down to zero.

In 2016, your government reduced that ban from five years to one year, and I applaud you for that, but you ran on an election platform that you were going to reduce this down to zero. Here we are in 2017, and we are working on this scientific study right now. We've spent $3 million to date on this two-day meeting we had and the research that has been done. You were at the meeting. We wanted to be there to sit through these meetings that we were not as a Conservative caucus invited to. We found this quite insulting, as we had been working on this for quite some time as well.

In light of of your promise of going down to zero, I want to know the time frame. When do you see this happening? This is a decision that you will have to make as a government. Is this something you are now backing off on? Please let us all know. Let Canadians know where you are going with this blood ban. Is it going down to zero?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

What is important to know about this conference is that the $3 million was used to bring the officials around the table and also to literally set the scientific agenda for the research that has yet to be conducted. We have yet to see the research. We have yet to see the results of the research.

What's important for Canadians to know is that there is a separation between the blood regulator and the government. What happened during the campaign—this came from our youth wing, and you would have seen it at the doors—is that the youth wing and many coalitions from around the country pushed very hard and we ran as a party to get the blood ban down to zero. When you look at the science in other jurisdictions in the rest of the world, this position is supported.

We are moving as fast and as well as we can as a government. We cannot tell CBS and Héma-Québec to reduce this to zero. That's not how this works. The blood regulators, with the best science they have at their disposal, make a recommendation to Health Canada. Then Health Canada approves that reduction in the deferral period.

The conference is an important first step in getting the data. At best, LGBTQ2 Canadians are invisible in the data. When you talk sub-populations of the LGBTQ2 population, the data isn't any more forthcoming. We need to understand the behavioural risks of populations. We also need to empower scientists who believe they can have a blood-screening system that can unequivocally tell us what is in the blood supply.

As to participation, I wasn't informed about the inability of Conservative MPs or other MPs to be involved. My role as special adviser is non-partisan. I'm here to advance the causes of LGBTQ2 Canadians regardless of political stripe. I want Canadians regardless of political stripe to give blood and be able to get blood.

If we can get more blood in the supply and it's more inclusive, that's what I'm here for. I can tell you the Minister of Health is moving fast on this. As an evidence-based government, we need to see the data and that's why this was an important first step. I appreciate your work on the file.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Randy.

I want to stress the fact that this was an election promise to bring it down to zero. Is this another one of these promises your government has made that you will not be able to move forward with?

[Rachael Thomas, Conservative, Lethbridge, AB]

You make it easy.

[Len Webber, Conservative, Calgary Confederation, AB]

It was something that certainly affected the Conservatives in the ridings we lost, these promises, and the fact that now you can't keep these promises is disturbing.

I would suggest that come 2019 the Liberal government should hold off on promises unless they can keep them.

[The Chair, Liberal, Bill Casey]

Thank you very much, Mr. Webber.

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm a little unclear, Mr. Boissonnault. I'm trying to understand your position. Is it your testimony that the current one-year blood ban on men who have sex with men is discriminatory and not based on science, or not, or are you unsure? What is your position?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

I think if we stigmatize any population based on sexual orientation, it can lead to discrimination and prejudice that can be harmful to that population.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is the current one-year ban based on science, yes or no?

[Randy Boissonnault, Liberal, Edmonton Centre, AB]

The current one-year ban, according to CBS and Héma-Québec is based on the best science they have available. What we saw at the conference is that there is science in other parts of the world that supports a deferral period of two months or none. We don't have Canadian data to support getting to zero, and that's why this conference was important.