Health Committee on April 11th, 2016

[John Oliver, Liberal, Oakville, ON]

Is it the same with anthrax? Is anthrax currently viewed to be a public threat? How prepared are we for anthrax?

[Dr. Gregory Taylor]

Anthrax is a little different. It's a bacteria. Yes, it still could be a bioterrorism threat, so we keep a couple of antibiotics for anthrax in the stockpile, and we're looking to purchase some vaccination for anthrax as well.

If you have an exposure to anthrax, we would selectively treat those people closest to the exposure with antibiotics, potentially, and vaccinate around them. It's a very slow-growing bacteria so you have some time to do that. We're looking at storing both of those as well.

[John Oliver, Liberal, Oakville, ON]

I think the minister mentioned Ebola as well. Is that something new? Obviously there was a world crisis two years ago, but it seems to have resolved. I think we had a few active cases in Canada. What's the status of Ebola?

[Dr. Gregory Taylor]

Luckily, we've never had a case in Canada. In West Africa, in Guinea, there's an outbreak currently. It's very small. I think there are about nine or 10 cases. There are three cases in Liberia. This is a little worrisome in that it's not totally eliminated, but I think a lot of experts predicted that we'd have this sort of new reality in terms of Ebola.

As for what we did with regard to Ebola, these are reprofiled dollars. We got some money for this a couple of years ago, and we're looking at two things. One is supporting vaccination with our vaccine, which is doing very well. That's what's being used in both Liberia and Guinea right now to control this. I think Canadians should be very proud of the Canadian Ebola vaccine.

We're also looking at a new technology called “monoclonal antibodies”. These are synthetic antibodies. The antibodies that your body would produce are synthesized and given to people who are sick with Ebola, once they're infected. This is the so-called cocktail of the ZMapp. We had two lines of investment in that, including looking at plant-based monoclonal antibodies—ZMapp—which we do have some of at the agency in the lab in an experimental status. We're also looking at trying to build capacity in Canada to produce it on an animal model. You need an animal model to produce larger quantities of this.

That's being rolled over from previous years until the current fiscal year. The rationale for this is that it took a lot longer to negotiate and to try to find the capacity in Canada, because it just didn't exist. We're using that resource to try to build that capacity, and again, to try to keep some of those in our stores in Winnipeg at the lab.

[John Oliver, Liberal, Oakville, ON]

Thanks.

For the Canadian Institutes of Health Research, in the main estimates there's the “inaugural competition for the Canada First Research Excellence Fund”. How does that new program differ from other federal research programs?

[Dr. Alain Beaudet]

As you know, this is a major initiative aimed at allowing the institutions—the universities, actually, or the academic health research centres—to propose the creation of a centre of excellence in one priority area that would make the centre a really unique centre of excellence in the world in that specific area.

It's a highly competitive process. As you can see, they're very large grants. Two of the successful grants in the previous competition were in the health sector. One was in regenerative medicine in Toronto and beyond, and the other one focused on the north and on optics, at Laval University in Quebec City. There's a health component and the money flows through CIHR.

[John Oliver, Liberal, Oakville, ON]

With regard to the additional CIHR funding, I've heard from many of the different universities and others that they've had difficulty in maintaining their Ph.D. programs and that the cuts to research, or for your health research, have been felt across Canada. Are you looking at how we're going to restore, rebuild, or keep the health research programs active across Canada and rebuild the programs for Ph.D. students and make sure we have the right leadership in this area?

[Dr. Alain Beaudet]

Yes, absolutely, and I must say that the injection of $30 million in additional recurrent funding to the Canadian Institutes of Health Research has been extremely welcome. As recommended, as per the budget language, this money will be entirely invested in projects that are initiated by investigators. We're extremely happy that we'll be able to inject the money we're receiving this year into an ongoing competition. That will allow us to fund a larger number of researchers than we originally expected. It's really needed and it's good news.

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to go back to the question that my colleague asked you on tamper-proof opioids. One of the clear concerns about this has to do with the so-called balloon effect; that is, if you make tamper-free resistance in one molecule of Oxycontin, that will drive users to other forms like fentanyl.

Isn't the answer to that exactly what the U.S. drug administration has done, which is to make tamper-proof regulations across the entire class of opioids? In terms of not being able to do it, the U.S. has done it and it has resulted in a reduction in opioid deaths, which, as you know, are reaching epidemic proportions across Canada. Why not just make it across the entire class of opioids?

[Simon Kennedy]

One of the things we are definitely doing is coming out with guidance for pharmaceutical firms that wish to bring forward tamper-proof formulations and be able to make a claim for tamper resistance. We actually are consulting. I don't have the date immediately top of mind, but certainly we're already out in the field with proposals around what criteria would have to be satisfied in order to be able to sustain a claim that something is tamper resistant. There are criteria you need to go through in order to be able to demonstrate from an evidence basis that something actually will be tamper proof and that people won't be able to defeat those features. Health Canada has been doing a lot of work to enable the pharma sector to come forward with those kinds of proposals.

We are doing a lot in the area of prescription drug abuse and particularly with regard to opioids. I would say a lot of the actions we've taken are very similar to those in the United States. We've certainly been talking to the Americans about the work we've been doing.

I'm happy to elaborate if there's an interest in it, but I know you don't have a lot of time.

[Don Davies, NDP, Vancouver Kingsway, BC]

Maybe after.

Is it fair to say there's a possibility of adopting regulations to go to opioid-class tamper resistance in the future? You're not closing the door to that.

[Simon Kennedy]

At the end of the day, I think that would be a policy decision that governments would have to make, and we would also have to consult with the provincial and territorial governments.

When we looked at the particular regulation that was out for discussion last year, one of the concerns was exactly this issue of the balloon effect. The other thing was that most provincial formularies had taken generic oxycodone off of their formularies. It's the tamper-proof version that they make available, but there are a number of Canadians who, for financial or other reasons, may not be able to afford that kind of medicine. You have to realize that the tamper-proof formulation is two to four times more expensive. If you move an entire class of pain medication into that kind of technology, you would effectively be dramatically raising the cost of—

[Don Davies, NDP, Vancouver Kingsway, BC]

I want to move to another issue. I'm sorry to interrupt, but I have limited time.

Regarding indigenous health, we know there's a crisis facing our indigenous communities across the country. A number of bands have declared public health emergencies. There's been an alarming number of suicides and attempts made by first nations people, most compellingly by many youth, yet the main estimates that I've looked at confirm that this government will cut first nations and Inuit primary health care spending in 2016-17 by some $30 million over what was spent in 2014 and almost $90 million over 2013 numbers. I don't see any specific money targeted for mental health.

Is it appropriate that funding for primary health services for first nations and Inuit Canadians should be cut in these circumstances? I have the reference to that part of the budget here, if you need it.

[Simon Kennedy]

I think one of the things that I'm sure is frustrating for parliamentarians—it's certainly frustrating for officials—is perhaps the way information is presented in the estimates. It's been a long-standing issue and I know many people are familiar with it.

Actually, our funding for indigenous health is going up—

[Don Davies, NDP, Vancouver Kingsway, BC]

May I interrupt you?

I know, but I'm reading the line, “First Nations and Inuit Primary Health Care”. This is from the main estimates, page II-130. It says the government is spending $843 million this year, and I'll leave the change off. It was $809 million last year, but $870 million in 2014-15. I realize, globally, you may be increasing health care, but on first nations and Inuit primary health, there's easily a $30-million reduction over two years ago.

[Simon Kennedy]

The three major funding decreases in the estimates, when you kind of break it out, are primarily the sunsetting programs. Therefore, funding to support the Indian Residential Schools Settlement Agreement, that was mental wellness funding. There is money for first nations water and waste water. We do work with first nations to test their water systems and provide them advice on how to make sure there's good water quality. There's also some funding for clean air, which is not directly related, but all of those are actually being renewed or have been renewed in the budget.

It's hard to see in the estimates, but the bulk of the reductions are for sunsetting programs that have subsequently been renewed. I can assure you that, generally speaking, in terms of funding for first nations health—recognizing that the minister said there's more to be done—there's not actually an absolute reduction. There are actually increases.

[The Chair, Liberal, Bill Casey]

Thank you.

Now, according to our original rules we're supposed to go back to a seven-minute session, but I'm going to propose that we go to five minutes for questioning so that we get in more questions. Is that okay with everybody? All agreed? Okay.

[Don Davies, NDP, Vancouver Kingsway, BC]

In the same order, though, as the first round, but just cutting the time down...?

[The Chair, Liberal, Bill Casey]

Yes, it's the same order.

[Nick Whalen, Liberal, St. John's East, NL]

Then I guess I don't need to bring a point of order about having been skipped over.

[Voices]

Oh, oh!

[The Chair, Liberal, Bill Casey]

No, no. You're up.

[Nick Whalen, Liberal, St. John's East, NL]

On that same line, in addition to the programs you talked about that are going to be renewed, presumably we're going to see the information in supplementary estimates (A), when they come out, that those programs have been renewed. As a result of the budget being tabled a month after the main estimates, are we likely to see any other big-ticket items in supplementary estimates (A) on which the policy and the costing have already been developed and that we should be aware of now so that we can have this discussion?

[Simon Kennedy]

In regard to the single biggest area, members will be familiar with the significant investments in the budget on indigenous priorities more generally, but with regard to the health portfolio, the biggest investment would be in infrastructure for on-reserve health facilities. For example, we operate many nursing stations in remote communities in Ontario and Manitoba. A lot of those facilities are not in the best condition, so the budget set aside $270 million over the next five years to renovate and expand these sorts of health facilities.

There was also some funding to renovate and fix up facilities for the aboriginal head start on-reserve program. This is a program to give an advantage to young indigenous children and to provide a kind of cultural element, but basically it's to support early learning for indigenous children. We received some money to actually renovate those facilities as well. Within the ministry right now, we're putting it as a pretty big priority and trying to get it out the door quickly.

We have quite a few projects that we need to get moving on—three or four dozen—and that was provided for in the budget.

[Nick Whalen, Liberal, St. John's East, NL]

Thank you.

Along a similar line, then, in terms of some of the other items in the budget for mental health and home care, and what sorts of timelines there may be, what has been done on each of those topics to develop policy and program delivery specifically with respect to mental health initiatives and home and palliative care? When can we see budgetary proposals or estimates in that respect?