Health Committee on May 6th, 2020

[Paul-Émile Cloutier]

—warning that Canada's research councils will likely see 10,000 to 15,000 jobs lost in the next few weeks if they are not granted access to some form of federal support. The federal government can avoid those layoffs by granting the research institutes based in health care organizations access to the Canada emergency wage subsidy on the same terms and conditions as other industries.

This is why we are urging the government to do this today and to treat us equally. This could be done by a simple change of regulations, a minor change that would give Canada's health researchers the security they need to weather the storm of the present crisis.

Now I'll pass it on to my colleague, Dr. Brad Wouters, to say a few words from his perspective.

[Dr. Bradly Wouters, Representative and Executive Vice-President for Science and Research at the University Health Network, HealthCareCAN]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Before you start, I'd like to remind everyone that it really helps with the translation if when you speak French, you go on the French channel, and when you speak English you go on the English channel. I know it's kind of awkward when you have both languages integrated into your speech, but otherwise the sound levels on the translation come through at the same level as the floor and it's very hard to hear.

Thank you very much.

Please go ahead, Dr. Wouters.

[Dr. Bradly Wouters]

Mr. Chair, thank you for the opportunity to speak today.

As Paul-Émile mentioned, on March 15, nearly all hospital-based, non-COVID-related research across Canada was suspended. At that time, our organization had budgeted $460 million for our hospital's research operations for the fiscal year, a sum which employs 1,000 scientists and 4,000 other highly skilled research staff, including clinical research associates, research nurses, laboratory technicians, biostatisticians, data managers, graduate students and post-doctoral fellows.

Our organization is the largest research hospital in Canada. It is one of the top centres in the world. It includes the Princess Margaret Cancer Centre, ranked in the top five cancer centres in the world. It also includes the Toronto General Hospital, ranked this year by Newsweek as the fourth best hospital in the entire world.

We perform more organ transplants than any hospital in North America. We have over a century of research accomplishments that include the development and application of insulin to treat diabetes and the discovery of stem cells. But never in our history has our research future been more at risk than it is today.

The majority of our industry revenue has been lost because the clinical trials and research projects they support have been suspended. Charities, as you've heard today, have also begun to cut their giving, resulting in forecasted losses of revenue for our institution alone of more than $10 million per month. We have managed to stretch our resources for the past seven weeks without job action and layoffs in hopes that the federal government would provide us access to support programs like the Canada emergency wage subsidy.

We operate in an extremely competitive environment with other health academic medical centres around the world. It has been important for us to keep our staff engaged, part of our institute and ready to relaunch and compete for funds when we come back.

Many of our researchers and scientists have also jumped in and contributed to a rapid response to COVID-19, bringing their unique skills and talents to the treatment and prevention of this disease. We have launched new clinical trials in patients. We are exploring the fundamental biology of the virus and we are developing new vaccines and therapies. However, 80% of our staff remain unable to continue essential research into cancer, lung disease, cardiovascular disease, Alzheimer's disease, rare diseases, diabetes and many other key diseases that kill the majority of Canadians.

Since our suspension, we have had numerous contacts with officials in several government departments. All of them have been extremely responsive and understanding of the situation we are in. We have asked to have the same opportunities as other businesses and not-for-profits, but have been excluded from these key programs because we are located inside a public hospital.

On May 1, we were forced to begin the process to identify roughly 1,500 staff for a first round of job layoffs because of the suspension-induced loss of revenue. If we continue to be unable to access these federal supports, we will face large end-of-year operating deficits, additional layoffs and insufficient revenues to support our cause.

Honourable members, institutions like mine all across the country are currently ineligible for the wage subsidy based largely on a technicality. Because these health research institutes are physically based in public hospitals they are designated as public institutions and are excluded from eligibility.

Our hospital and the care of patients is funded by the provincial ministry of health. However, we are legislatively prohibited from using any of that provincial support for our research. Instead our research is funded by a wide mix of over 900 different organizations. For the most part we are not funded out of public sources. To the extent that those funds do come from public sources through competitive research or innovation grants these have also stalled since March.

I would also mention that eligibility for these programs would come at a marginal cost to the government. The staff, if we are forced to lay off, will have access to the Canada emergency response benefit, but it is clear that it would be much more effective to keep those employees part of our organization. If we are forced to lay off that staff, they will be unproductive. They will be unable to contribute to COVID-19 research, and we will be at risk of losing them. This jeopardizes our ability to restart research and to compete for international industry and other funding when we come back.

Without urgent support from the federal government, we run the risk of setting back health research in Canada by decades and undermining patient outcomes in Canada in the future.

[The Chair, Liberal, Ron McKinnon]

Thank you.

We go now to the Heart and Stroke Foundation.

Ms. Simard, please go ahead for 10 minutes.

[Anne Simard, Chief Mission and Research Officer, Heart and Stroke Foundation of Canada]

Thank you very much, Mr. Chair, committee members and co-witnesses.

[The Chair, Liberal, Ron McKinnon]

Your sound is very weak.

[Anne Simard]

I'll make my comments in English, but I can answer your questions in French or English.

At our organization, the Heart and Stroke Foundation, there is a lot that echoes what other witnesses have said. In my testimony, I am going to highlight for you the impacts of COVID-19 on those with heart disease and stroke, and their caregivers, and how we have been responding and supporting them through this time. I will also address the financial toll the pandemic has brought on us within this sector and, to echo some other comments, specifically the issues regarding health research, at a time when science and research are incredibly important.

I will first focus on COVID and the intersection in our understanding. We know that it has worse impacts on people with underlying conditions, such as heart disease and stroke. We know that people with heart conditions are four times more likely to die if they have the virus than those with no underlying conditions, and those with previous strokes are three times more likely to die. As some of the other witnesses spoke about, we know that it has devastating respiratory impacts, but underlying and emerging evidence is showing that it actually has a significant involvement with the cardiovascular system and serious consequences like clotting, stroke, cardiac arrest and heart attack.

Right now, as others have talked about, people with heart conditions and risk factors are very much adhering to the physical distancing and self-isolation precautions, but what is really happening—and it is a very worrisome, unintended consequence of the pandemic—is that people experiencing signs and symptoms are not seeking medical attention for fear of coming into contact with the virus, or are justifiably worried about overwhelming our health system.

We at Heart and Stroke have just done a piece of data analysis with the Canadian Cardiovascular Society. We found that in Ontario there's been a 30% reduction in ER visits over the period of March and early April for STEMIs, which are the most serious type of heart attack, and a similar reduction for stroke-related visits. At Vancouver Coastal Health, they're seeing a 40% reduction in STEMIs.

We're very quickly mobilizing to continue to draw attention not only to COVID but also to the importance of really treating medical emergencies as such and seeking care. I also very much echo what some of my colleague witnesses have spoken about. People with heart disease and stroke are managing complex, chronic conditions with a lot of medications and rehabilitation, and a lot of them now are not getting the kind of support and care that they need, in addition to things like delayed surgeries and delayed treatments.

In fact, for us at Heart and Stroke, the number of people seeking guidance and support has been a bit overwhelming. In the last two months, we've had one million people coming to our website and nearly 100,000 accessing our COVID-specific resources, webinars, supports, online—

[The Chair, Liberal, Ron McKinnon]

Excuse me, Ms. Simard. Could you hold your microphone a little closer to your mouth, please?

[Anne Simard]

Certainly. Is that better, Mr. Chair?

[The Chair, Liberal, Ron McKinnon]

That's much better, thank you.

[Anne Simard]

Heart and Stroke produced the best-practice guidelines for stroke, and we have adapted them to work with how clinicians and institutions can treat stroke in this very challenging time. One of the realities is that despite all the quick action during COVID, we know there are going to be very significant lasting impacts, and for organizations such as ours, quite a reduced capacity to provide the kind of support we have always provided.

Like other health charities, we have had significant impacts from the pandemic. All our fundraising activities, except online, are largely on hold. We have already had an immediate revenue loss of $25 million, and have accordingly made many difficult decisions, including laying off nearly half our staff. At the same time, however, we recognize that heart disease and stroke affect nearly 1.6 million people every year, so we still need to be focused on going forward.

Within all the things we talk about in information and support and working with the health care community, the other function we also perform is funding. After the federal government, we are the second-largest funder of research into cardiovascular disease. We support some 700 researchers across the country, and our funding for them is quite precarious.

I think the challenge we're all quite concerned about is that health charities like ours have delayed or cancelled our competitions, and we're wondering about delaying payments. However, as COVID does create some research opportunities, many researchers and tremendous innovation, there are also hundreds of other research projects with years of money invested, millions of dollars, that are nearing completion and are now in danger of being wasted if we can't continue.

I think of all the partnerships among health charities that are more public and vocal and talking about the change that needs to happen, working closely with research institutions, researchers, scientists, clinicians and translating that science into action. Those partnerships are very successful, but they are at risk, and if we can't continue, not only is that knowledge translation at risk, but there will also be an erosion of expertise and a loss of progress on experiments and clinical trials. It's a very beautiful thing when it works, and a complementary piece that is so fundamental to caring for the many people with chronic disease in Canada.

Our focus and our appreciation of being able to speak with you today is to speak to the partnership among health charities. We've heard reference to the Imagine Canada partnership and the Health Charities Coalition of Canada that are asking for broad support for not-for-profits' and charities' operating costs. If we just focus on the research component of the help we need, we fund about 155 million dollars' worth of health research every year and are at a period where we're wondering if we're going to be able to continue to do so.

A way we could come forward and sustain that decades-long partnership—century-long partnership if you're the Lung Association; we're a mere 70 years old—is sustaining our ability to be part of that research and then to translate that research into impacts on patients.

I would mention two other small points. The federal government has made huge investments, $1.1 billion, in COVID. I think one of the questions is how much of that will look at the intersection between underlying medical conditions and compromised and vulnerable people and what those outcomes are. I think there's a real sense that it will be much worse for them, and we know that already.

The last point is that we as health charities have for a long time had many partnerships, including with the federal government. We're very open to solutions, and one idea is to do a partnered model by which we could match donor dollars with federal dollars, public dollars, to sustain some of those research investments.

At the Heart and Stroke Foundation, we've been very grateful to the federal government for the five-year, $5-million investment into research on women's heart and brain health, in which we matched donor dollars to federal dollars to really push women's health equity.

In closing, I would just echo not only my comments, but the comments of other witnesses. This is a precarious time for health charities, as it is for other organizations, but the intersection between the patient experience, the caregiver experience and health research and the translation of that into awareness, information and action is really a unique place in which the health charities operate.

We thank you for your consideration and attention to our requests.

[The Chair, Liberal, Ron McKinnon]

Thank you, everyone, for your presentations.

We'll start our rounds of questions at this point. We want to have three rounds, and we will start round one with Dr. Kitchen.

Dr. Kitchen, you have six minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Everybody, thank you for your presentations. Hearing from you is greatly appreciated.

Definitely we have heard across this country how COVID-19 has consumed everything, and other diseases or illnesses have been totally forgotten. As we've seen and have heard, patients are not seeking care from hospitals or are not seeking care from their doctors when they're presenting with signs and symptoms, because of their fear that they might contract COVID-19 in some manner.

Dr. Wouters, thank you for your statement, when you talked about the exclusion of your researchers on the issue of the wage subsidies program. That's something we had tried to point out. When this program was brought out, a number of issues were missed, in particular small businesses that were sole practitioners, and so on. This is another one that we definitely need to be focusing on, because our health research is paramount for this country to progress and for the safety of all Canadians.

I thank you for your comment on that. We will bring that forward, or at least I will anyway.

[Dr. Bradly Wouters]

Thank you.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

This committee has heard, time and again, that PHAC was not adequately prepared to deal with the spread of COVID-19 in an efficient way, in part due to the underfunding and mismanagement of health care preparedness. In fact, just yesterday we heard from the Canadian Manufacturers & Exporters, who had a plan put forward in 2009 after the SARS epidemic, dealing with an influenza pandemic program. Basically what they said to us was “We forgot about it; governments forgot about it.” That seems to have happened when PHAC actually started in 2003 to develop these things. It seems to have been forgotten about.

Mr. Cloutier, in a recent article in The Hill Times, you said a couple of things that struck me. One was that given Canada's experience with SARS, Canada “should not have experienced the critical shortage of medical supply in its health care system”. Further in that interview you said that PHAC's visibility and access to cabinet should be increased, even outside a disease outbreak, through the establishment of a “pandemic preparedness council”.

Given that PHAC was established as a result of the SARS epidemic and given that we have seen significant gaps in preparedness by PHAC, what would a pandemic preparedness council do differently to address the shortcomings in Canada's COVID-19 responses? If you could comment on that, please, I'd appreciate it.

[Paul-Émile Cloutier]

Thank you very much for that very important question. I certainly would hope that, as I wrote in my article, SARS was really a wake-up call, and I think that COVID-19 is now seen as a clarion call.

I think what you have to look at is the power that's given to the Public Health Agency. When I used the word “council”, I pointed out that it would be important for the person who's head of the Public Health Agency to have access to cabinet and to present his or her views as to the state of our nation in terms of a pandemic.

At this moment I feel that it's a bit too bureaucratic. It is reporting to a number of people, when in fact we know that in Ottawa the decisions are really made at cabinet. I used the word “council" hoping that in this situation—and it's only in this situation because of the model that we would have—this person could actually be reporting to the Deputy Prime Minister through a committee that would be established at cabinet to discuss a pandemic or any major challenge that would be coming up rather than just staying in their offices and looking at what is being done.

The other thing is that the sharing of information and delegating of powers that there should be between the provinces and Ottawa, in my view, needs to be worked at and needs to be reviewed as we go forward.

I don't know if I've answered your question.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I appreciate that. It was something that caught my eye. Having you here gave me an opportunity to ask that question.

Further on in that article there was talk about the funding for PHAC. It has decreased over the past few years, with its budget declining by 7% in the fourth quarter of 2019. That equates to about $47 million being cut. What reforms need to be made at the federal level with respect to ensuring the sustained and adequate funding of PHAC, especially in terms of preparedness? Where do some of the gaps lie? Can you identify those?

[Paul-Émile Cloutier]

You may recall that a few years back we did have a minister of state for public health. We no longer have a minister of state for public health. At one point, the level of delegation and reporting authority that person would have had were much higher than it is at this moment.

I believe that if you really are serious about public health in Canada, you need to give them the tools. There can't just be a tool box that's not open and not used. I believe it's important that the person or the agency have the authority not only in Ottawa but also across the country to conduct research and analysis.

When you look at the PPE, the stockpile and the ventilators, these are things that should have been managed in a much better way. I think this is where the Public Health Agency, if it had been granted the authority, probably could have done a better job.

[The Chair, Liberal, Ron McKinnon]

Thank you, Dr. Kitchen.

We go now to Ms. Sidhu.

Ms. Sidhu, you have six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you to all the witnesses for taking part in this meeting.

On Sunday I hosted a teleconference with seniors in my riding. The major concern I heard from them was the pharmacy dispensing fee. We need to ensure that all Canadians have access to their medications. When restrictions came into play there were changes in the frequency of prescription refills, and those who used to have three months' worth dispensed were restricted to only one month at a time. That is also tripling the dispensing fee.

I would like to hear from Heart and Stroke or the Organization for Rare Disorders. What are your thoughts on how this is impacting Canadians?

Maybe the Organization for Rare Disorders can answer first.

[Dr. Durhane Wong-Rieger]

Thank you very much.

We have also heard many concerns around dispensing and dispensing fees. As well, as you said, they could get only a small supply of the medicines. Some of them could not get them from their normal pharmacies, and when they went to another pharmacy there were huge issues, especially for some of the rare disease patients, in that the medicines they were getting were not routinely listed in all dispensaries.

We also had a lot of problems with people who, because of COVID and because of the impact on them, were actually having to use more of their medications during that time of infection. They could not get an understanding from the pharmacy that what they were given was actually not a 30-day supply, that it was now a 10-day supply. This was a huge issue.

We also—

[The Chair, Liberal, Ron McKinnon]

Pardon me, Dr. Wong-Rieger. Would you please hold your mike a little further away.

[Dr. Durhane Wong-Rieger]

Yes. I'm sorry about that. I forgot.

We've heard a lot of those same concerns. Again, as I said, we had 50% of the people say that they could not get their regular medication. In almost every case, it had nothing to do with not having the drugs there, though in some cases it was, and it was actually the more routine medicines that were not there, such as amoxicillin. In some cases, we had a number of patients who reported they couldn't get access to, interestingly enough, chloroquine. This was something they used normally, and in several cases they were told, “We're holding on to the supply because we want to save it for COVID patients.”

[Sonia Sidhu, Liberal, Brampton South, ON]

Do you think the recent investment of $240 million the government has made in the provinces and territories for virtual care will ease this issue? Do you have advice for these Canadians? Does any other group want to comment?