Health Committee on Dec. 7th, 2017

[The Chair, Liberal, Bill Casey]

I call our meeting to order. Welcome, everybody, to meeting number 84 of the Standing Committee on Health.

Today, we are going to have a study of the supplementary estimates. We welcome our Minister of Health, the Honourable Ginette Petitpas Taylor, to join us here today.

I see in your notes, Madam Minister, that you are going to introduce your colleagues beside you, so I am going to leave that to you. Normally I introduce them.

You can open up with a statement of 10 minutes, if you would. We would appreciate your comments. Then we'll go to questions.

[Ginette Petitpas Taylor, Liberal, Minister of Health]

Thank you very much, Mr. Chair.

Thank you for inviting me today to present the health portfolio financial overview of supplementary estimates (B) for the period 2017-18.

I am thrilled to be accompanied today by my deputy minister, Simon Kennedy; Dr. Theresa Tam, our chief public health officer; Carolina Giliberti, executive vice-president of the Canadian Food Inspection Agency; Yves Bacon, CFO and vice-president of the corporate management branch of the Canadian Food Inspection Agency; and Michel Perron, executive vice-president of the Canadian Institutes of Health Research.

We are pleased to have the opportunity to discuss the resources that we are requesting to maintain and improve the health needs of all Canadians.

The health portfolio continues to deliver on several priority initiatives for our government. In these supplementary estimates (B), the health portfolio's budget will increase by just over $297 million, raising its proposed authorities to date to $7.16 billion. This constitutes an increase of approximately 6% over our authorities to date.

This funding will allow the health portfolio to achieve several key objectives in several priority areas, which I will now briefly address.

Our government recognizes that Canadians expect the health care system to adapt to their changing needs. They also expect federal, provincial and territorial governments to work together to strengthen our health care system.

In August, the Government of Canada and the provinces and territories agreed to a common statement of principles on shared health priorities. This common statement of principles outlines the priorities for federal investments in mental health and addictions as well as home, palliative and community care. It commits governments to work with the Canadian Institute for Health Information on a set of common indicators to measure progress in these areas. And it reaffirms a shared federal, provincial and territorial commitment to improve the affordability, accessibility and appropriate use of prescription drugs.

Every province and territory has also agreed to its share of $11 billion over 10 years in federal funding for home care and mental health. They have also agreed to the broader funding arrangements under the Canada Health Transfer, which will provide more than $200 million in federal health funding over the next five years.

Health Canada is now in negotiations with each province and territory to develop multi-year bilateral agreements that will outline the terms and conditions for the remaining funding over 10 years.

The Government of Canada is committed to a renewed nation-to-nation relationship with indigenous people. Part of that commitment involves ensuring that first nations and Inuit have access to culturally appropriate health programs and services.

In December, the Government of Canada announced the formal creation of the new Department of Indigenous Services Canada. This is truly an important step in the government's transformation of services to indigenous peoples. By consolidating services into one department, we will be improving the sharing of information and strengthening our capacity to meet the needs of the people we serve.

Therefore, significant funding associated with indigenous programming included in these supplementary estimates will now fall under the purview of Minister Philpott.

I truly remain committed to supporting our government's important goal of improving indigenous health. Throughout this transition period, I will support my colleagues, Minister Bennett and Minister Philpott, to help ensure that first nations and Inuit continue to have access to high-quality health services and programs. I will also work to ensure that we maintain effective relations with our indigenous partners.

Another key file under the health portfolio is the legalization and regulation of cannabis. We know that the current approach to cannabis does not work. It has allowed organized crime to profit while failing to keep cannabis out of the hands of our young people. This is why our government introduced Bill C-45 to legalize and strictly regulate access to cannabis.

In these supplementary estimates, we are requesting $39.1 million to develop, implement and administer a federal framework to legalize and regulate cannabis. This will include the licensing and oversight of producers of cannabis for medical and non-medical purposes.

Another health priority that we are addressing is the opioid crisis. We continue to use all the tools at our disposal to address the growing number of overdoses and deaths caused by opioids. As you know, there were more than 2,800 apparent opioid-related deaths in Canada in 2016, and the preliminary data for 2017 suggests that the number of opioid-related deaths will exceed 3,000. These estimates include an increase of $6.2 million to address the crisis. This includes funds to support increased access to harm reduction measures and to prevent infectious diseases that may result from sharing drug-use equipment.

This is a complex health and social issue, and it will not be fixed overnight. This is why our government will continue to work with partners from across the country to take action on this public health crisis.

With respect to the impact of climate change on the health of Canadians, I am pleased that Budget 2017 allocated $471 million over five years to Health Canada, the Public Health Agency of Canada and the Canadian Institutes of Health Research to address the health risks associated with a changing climate.

The Public Health Agency of Canada recently accepted proposals for the Infectious Diseases and Climate Change Fund. These proposals will address gaps in knowledge related to climate-driven food-borne, water-borne and zoonotic infectious diseases in Canada. This includes preparing for and protecting Canadians from climate-driven infectious diseases, including Lyme disease and the West Nile virus.

Our government is also committed to promoting and improving public health and increasing vaccination rates across the country. Vaccination remains one of the most effective public health tools to protect Canadians, which is why we are allocating $1 million in funding towards an advertising and public education campaign to help Canadians make informed decisions on vaccinations.

Vaccines are effective and safe, and they play an important role in the protection of our health and of our communities. I am pleased that the government, in partnership with the provinces and territories, has endorsed new vaccination coverage goals and targets for reducing vaccine-preventable diseases by 2025.

These supplementary estimates reflect an increase of $7 million in the budget of the Canadian Food Inspection Agency, which will support the CFIA's important ongoing work in plant protection, animal health and food safety.

Safer food remains a top priority for the CFIA. While Canada already has one of the safest food safety systems in the world, our government is dedicated to improving that system so that Canadian families continue to have confidence in the food they eat.

The CFIA has increased its focus on prevention, preparedness and response to minimize risks to human, animal and ecosystem health. This includes plant protection and animal health, the first links in the food chain.

In conclusion, I am confident that the amounts noted in these estimates and the funds identified in Budget 2017 will allow the health portfolio to continue to support better health outcomes for all Canadians and to build a healthier country.

Thank you again to the committee for inviting us to join you today. I look forward to answering your questions.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we'll go to seven-minute rounds of questions, starting with Dr. Eyolfson.

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

Thank you, Chair.

Thank you so much, Minister, for coming. We appreciate your doing this today.

As you know, I'm a recovering emergency physician. I spent 20 years working in emergency departments. Any problem with public health often came down on our departments first, and we would see trends. Among the trends we would see was the detrimental health effects when people couldn't afford their medications and became ill simply because of that.

As you know, we're studying the structure and implementation of a national pharmacare program. One of the things we've found is that Canadians pay the second-highest drug costs in the world. Although the report is not out, we have a parliamentary budget office report that says that if we had a national pharmacare program, the nation would save roughly $4 billion a year.

Could you share with us what steps you, and Dr. Philpott before you, have taken to reduce the costs of medications to Canadians?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

It's certain that our government is committed to strengthening Canada's health care system, and that includes enhancing accessibility and affordability, and appropriate prescription drug use. At the end of the day, that's absolutely a priority of our government.

In budget 2017 we were able to invest $140 million to lower drug prices, improve access to prescription drugs, and support the appropriate use of medication. We were also able to join our provincial and territorial partners, and we became members of the pan-Canadian pharmaceutical alliance. This enabled us to actually do bulk buying when it came to prescription medication. As a result, we've been able to save a significant amount of money with respect to the costs related to that.

As I'm sure you're aware—because you've been doing some studies—we are in the process of modernizing the patented medicines regulations in the Patent Act, and that is certainly going to be very helpful in the work that needs to be done. When we look at the Patented Medicine Prices Review Board, modernizing it is something that hasn't been done for many years, so it is certainly a step in the right direction. I look forward to the continued work that's going to be done there.

I'm also aware that your committee has done in-depth research on this issue, and once again I'm really looking forward to reviewing the recommendations brought forward by the committee, as I think we can certainly continue our conversation.

Finally, I'd like to say that in October I had the privilege, for the first time, of having a meeting with the provincial and territorial health ministers. The issue of drug prices came up, and both the provinces and territories and the federal health department have indicated that it's a priority of ours to improve access to medication. We recognize that Canadians pay way too much for drugs, and that is certainly something we want to address.

Taking these steps to start off is certainly a step in the right direction.

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

Thank you very much.

I've also noted the good work that's been done by the ministry regarding addressing the opioid crisis. Again, I keep coming back to what I was doing in my previous life. It was something I saw a lot of in that job, and sometimes with very tragic results, which I had to witness.

I was very pleased that the government was able to pass Bill C-37, which increased the ability of community health groups to make safe consumption sites available. We know this is something that would save lives. The initiatives making naloxone more available have been a very important life-saving tool as well.

We undertook a study of the opioid crisis, and we produced a report that had 38 recommendations. Would you be able to tell the committee what progress you've had in implementing that series of recommendations?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

With respect to the work that we've done in the opioid crisis, first of all, as indicated in my opening statement, we recognized as the government and as all Canadians have that we're faced with a public health crisis when it comes to the opioid situation. Again today, we've seen some numbers that have been released from Ontario, and the numbers are devastating. We recognize that they're not just numbers. These are people's children, their mothers, their fathers. They're personal stories, and the damage that is created by these losses, the collateral damage, is huge to families and to communities. It's certainly an area of priority of mine as Minister of Health.

I have to say that the first briefing that I received as Minister of Health was specifically on the opioid crisis and it's my number one priority, which I'm dealing with on a regular basis, on a daily basis. As you've indicated, in terms of some of the key steps that we've been able to take so far, when it comes to Bill C-37 that was certainly an important step in the right direction in order to streamline the application process for the consumption sites that are out there.

We certainly need to make sure that we have a harm reduction approach when it comes to dealing with these situations and we are pleased to see the progress that has been made.

When we formed government, we had one of these sites available in Canada and now we have a total of 28 supervised consumption sites available. Those are certainly, again, steps in the right direction.

Also, when you mentioned about making naloxone more readily available, ensuring that it's a non-prescribed medication certainly allows many individuals to have access to that tool. That's exactly what it is, something they need to effectively deal with the situation on the ground. Certain provinces make sure that is available free of charge, but again, that's a decision that's brought forward by provinces and territories. We certainly need to do all that we can to ensure that the naloxone product is more readily available.

We've also made significant investments as well when it comes to addressing this situation. When the Health accord was being negotiated last year, there are a few provinces that indicated that the opioid crisis was an absolute priority in the areas that needed to be addressed. Above and beyond the monies that they received for the health transfers, if we look at the Province of British Columbia, for example, they received $10 million in direct funding to deal with this crisis on the ground.

If we look at the Province of Alberta, they received, I believe it was $6 million to deal with this crisis on the ground. There's also Manitoba, there was a series of targeted issues that they needed funding for but opioids was certainly one of those as well that was listed. They received additional funding as well.

Aside from that, we also can't forget that Canadians as a whole have told us that mental health and addictions is absolutely a priority for them. Through our budget in 2017 and with the health care agreements, we recognize that we made significant investments, $6 billion in the area of mental health.

Again, they're steps in the right direction, but I can't say enough that we recognize that we cannot be complacent when it comes to this crisis. We have to continuously monitor the situation. We have to address the needs that are out there. We have to be progressive. Also, we can't deal with this alone. There's no one single solution to this, and we recognize that we have to work with the provinces and the territories and front-line workers. That's going to be key.

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

Thank you very much.

[The Chair, Liberal, Bill Casey]

Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair, and thank you, Minister, and your staff for being here today.

Minister, you alluded in your presentation to the topic of Lyme disease briefly. Of course, after almost six months, this committee did finally just yesterday get your letter, your response on the Lyme disease investigation that we did here in committee. The response from you, Minister, is certainly not going very well in the Lyme community and I'm not surprised.

There are hundreds if not thousands, as you know, Minister, of Canadians suffering daily from Lyme disease. We know that there are likely many more that have been misdiagnosed or are not getting the treatments that they need. There have been conferences. We studied it here in committee. There have been experts who provided their opinions and recommendations, and we've had public consultations as well. Enough talking has happened and now it seems that no action is really taking place. Without proper funding, nothing is going to happen.

The government of course, as you know, has set aside $4 million. Let me put that into perspective. We spent more on a hockey rink out on Parliament Hill than we are now spending on this major public health issue. Why do you, Minister, believe that proper Lyme disease research can be done for less than the cost of putting up a patch of ice on Parliament Hill?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

I'm pleased to hear that you did receive my letter that was provided I believe late this week.

First of all, I have to take a step back. Our government certainly recognizes that Lyme disease is an emerging infectious disease in many parts of Canada. I know, coming from New Brunswick, there are certain hot spots that have been identified in our province alone. I'm certainly quite aware of it. I'm also aware that the long-term impacts and the physical impacts on individuals who live with Lyme disease are tremendous.

In my riding of Moncton—Riverview—Dieppe, I had an opportunity to attend a support group last year because I received several emails from individuals who live with Lyme and suffer from Lyme disease. I wanted to have an opportunity to meet these individuals and to hear their stories because I really didn't know a lot about the topic. To hear those testimonies certainly hit home for me.

I also recognize Ms. Ludwig on your committee has done a lot of work in the area of Lyme disease as well. Again, we certainly recognize the devastating impact that Lyme disease can have on families

[Len Webber, Conservative, Calgary Confederation, AB]

Minister, do you think $4 million is adequate funding for this disease?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

To address your question on the investment, I'm sure you're very much aware that in May 2017 we were able to release the federal framework. The federal government's role, as I see it, has three pillars, three priority areas where we have to lead. When we look at the issue of surveillance, we recognize that we have to gather better data to get a clear picture of exactly what is going on and the magnitude of all this.

[Len Webber, Conservative, Calgary Confederation, AB]

We certainly understand that here on this committee.

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Another pillar that I believe is very important is the issue of education and awareness. Many Canadians perhaps are aware but we also know that we have to provide more information on detection and awareness, and the list goes on.

Finally, another area where I believe we have a role to play is in the area of guidelines and best practices. Those are the key areas we know the federal government certainly wants to focus on. With the investments we've made with respect to the federal framework, it's certainly a beginning and a step in the right direction.

I would like to ask Dr. Tam if she could provide a bit more information on the work that's being done.

[Len Webber, Conservative, Calgary Confederation, AB]

We've been through this already. We've had a study on this, Minister, but thank you anyway. Perhaps you can answer my question, Dr. Tam.

My concern and many people's concern with the blood system is its safety.

Minister, you said in your letter, “there is no evidence that Lyme disease can be transmitted through the blood supply.” This is very different from saying science has proven that Lyme disease cannot be transmitted through the blood supply. It's like saying, I haven't seen it happen, so it can't happen.

I would like to know from Dr. Tam, or you, Minister, what is being done to scientifically prove that Lyme disease cannot be transmitted through the blood supply. Can the minister unequivocally state it is impossible to get Lyme disease through the national blood supply?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

Dr. Tam, would you mind taking that question, please?

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

I believe the Canadian Blood Services has provided some of the response to this question as well.

There has been no evidence to date of any Lyme disease in the blood supply. While not every blood donor is tested, Canadian Blood Services screens out people who are sick. They also do studies intermittently to look at the donor group. They haven't found any evidence.

I also want to go back to the fact that we are investing $4 million in research, together with CIHR. Some of the investments are in diagnostics. Some of the investments in other areas of research will bring us more evolving information.

[Len Webber, Conservative, Calgary Confederation, AB]

Do you believe that $4 million is adequate, not only for research but now we have surveillance, the education, and the guidelines and best practices, the three pillars the minister has mentioned? I don't believe it is.

[Dr. Theresa Tam]

Certainly from the Public Health Agency, and I can probably say from the CIHR perspective, we welcome the dedicated funding. That's the first time we've received it. We announced the $4 million for the research network. On top of that there is $3.7 million for other activities.

Only part of the $4 million goes to research. Very importantly the rest funds the education of front-line medical professionals and also patients. We are also leveraging the responsible parties like the health professional societies who do have a role to play, and also surveillance.

[Len Webber, Conservative, Calgary Confederation, AB]

I can't say enough about how inadequate this funding is. It seems there's more priority for a 150th celebration on our front lawns here on Parliament Hill.

Minister, I am sure that your office, like mine, is being inundated right now with emails from folks who are unhappy about an excise tax on medical marijuana. These Canadians point out that no other prescription medication is subject to an excise tax.

Minister, why is this government taxing one prescription medication and not any others? Is it the government's intention to maintain this policy or bring medical marijuana's tax treatment in line with all other prescription medication?

[Ginette Petitpas Taylor, Liberal, Moncton—Riverview—Dieppe, NB]

As you're aware, the health committee worked very hard at studying Bill C-45, and you did tremendous work at the beginning of the summer. If my memory serves me well, you were here well before we were all here, and you heard from many witnesses over five long but very interesting days, I was told. We also have to recognize that the task force has met people from coast to coast to coast and provided some recommendations to government with respect to some areas that we should consider.

With respect to the area of taxation, as you're very well aware, Minister Morneau is meeting with his provincial and territorial colleagues next week, I believe, and the issue of excise tax is certainly going to come up with respect to where the profits are going to be going, or where the monies collected are going to be going. That is a conversation that is ongoing with them as well. I don't know if my deputy minister wants to add anything to that.

[Simon Kennedy, Deputy Minister, Department of Health]

In terms of the minister's comment, tax policy matters are generally the purview of the finance department, so in those areas we defer to them. That would be a good question to raise with colleagues from the finance ministry.

[The Chair, Liberal, Bill Casey]

Time's up.

Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you for being with us, and thanks to your staff.

Minister, in 2009 the H1N1 flu virus caused 428 deaths in Canada. In response, the federal government mobilized an emergency operations centre 24 hours a day, seven days a week. This provided more than 6,000 person-days of assistance to help coordinate emergency responses across the country. Now, in comparison, we had 2,800 deaths in 2016 and 3,000 deaths this year from the opioid overdose crisis, yet only 113 person-days of assistance have been reported by the Public Health Agency of Canada, and that's to help write two reports.

In addition, during the H1N1 outbreak, the Public Health Agency of Canada spent $322 million on communications and advertising alone. In contrast, your government's total commitment to fight the opioid crisis is $123.5 million, and that's spread over five years.

Minister, given the longer, more entrenched, and more serious death toll of the opioid overdose crisis, why has your government's response been so substantially less than what was done for the H1N1 health crisis?