Health Committee on Oct. 26th, 2020

[The Chair, Liberal, Ron McKinnon]

I call the meeting to order.

Welcome, everyone, on this early morning, or early morning for me, to meeting number three of the House of Commons Standing Committee on Health. The committee is meeting today to discuss committee business. Today's meeting is taking place in a hybrid format.

I would like to start the meeting by providing you with some information following the motion adopted in the House on Wednesday, September 23, 2020. The committee is now sitting in a hybrid format, meaning that the members can participate either in person or by video conference. All members, regardless of their method of participation, will be counted for the purposes of quorum. The committee's power to sit is, however, limited by the priority use of House resources, which is determined by the whips.

All questions must be decided by a recorded vote unless the committee disposes of them with unanimous consent or on division. Finally, the committee may deliberate in camera, provided it takes into account the potential risk to confidentiality inherent in such deliberations with remote participants. The proceedings will be made available via the House of Commons website. Just so you're aware, the webcast will always show the person speaking rather than the entirety of the committee.

To ensure an orderly meeting, I would like to outline a few rules to follow for those participating virtually. Members and witnesses may speak in the official language of their choice. Interpretation services are available for this meeting. You have the choice, at the bottom of your screen, of floor, English or French. Before speaking, click on the microphone icon to activate your own mike. When you're done speaking, please put your mike on mute to minimize any interference. I remind you also that all comments by members and witnesses should be addressed through the chair.

Should members need to request the floor outside of their designated time for questions, they should activate their mike and state that they have a point of order. If a member wishes to intervene on a point of order that has been raised by another member, they should use the “raise hand” function. This will signal to the chair your interest to speak and create a speakers list. In order to do so, you should click on “participants” at the bottom of the screen. When the list pops up, you will see next to your name that you can click “raise hand”.

When speaking, please speak slowly and clearly. Unless there are exceptional circumstances, the use of headsets with a boom microphone is mandatory for everyone participating remotely. Should any technical challenges arise, please advise the chair or the clerk. Please note that we may need to suspend for a few minutes, as we need to ensure all members are able to participate fully.

For those participating in person, please proceed as you usually would when the full committee is meeting in person in a committee room. Keep in mind the directives from the Board of Internal Economy regarding masking and health protocols. Should you wish to get my attention, signal me with a hand gesture, or at an appropriate time call out my name. Should you wish to raise a point of order, wait for the appropriate time and indicate to me clearly that you wish to raise a point of order.

With regard to a speakers list, the committee clerk and I will do the best we can to maintain a consolidated order of speaking for all members, whether they're participating virtually or in person. In order to be fair to all committee members, the list of speakers will only be activated once the meeting has officially started, and not upon admission to the room.

Having said that, let me just go to—

[Chris d'Entremont, Conservative, West Nova, NS]

On a point of order, Mr. Chair, if the clerk is looking for someone dialing in, Mr. Dalton will be replacing Ms. Rempel Garner for a few moments.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. d'Entremont.

On the participants list, I see that we have Mr. Van Bynen first.

Mr. Van Bynen, please go ahead. You have the floor.

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

Thank you, Mr. Chair.

Mr. Chair, earlier this year we had over 34 meetings of the health committee. We heard 171 witnesses and received 51 informative briefs covering an array of issues, but only one of the 34 meetings that we held over the spring and summer focused on mental health. While it was enough to open our eyes, it was certainly not enough for us to get a better understanding of the urgency of the situation and what we are facing relative to the mental health of Canadians.

In that meeting, we had alarming testimony from Margaret Eaton, the CEO of the Canadian Mental Health Association. She said:

We are already seeing signs of a potential “echo pandemic” of mental health issues as a result of COVID-19. Just last week the CBC reported on the surge in demand at CMHA Nova Scotia. It typically receives 25 calls per day, but is now fielding 700 daily requests for mental health support. These requests come mostly from people without a history of mental illness.

She also said that the phones at the CMHA centres across the country “are ringing off the hook”, and this was a couple of months into the pandemic. I can only imagine what that's like now.

There's no doubt that mental health needs to be a priority for all of us right now and we need to have an informed strategy on mental health going forward. Most importantly, we need to act while we still have time, before this crisis becomes worse.

I am by no means suggesting that studying mental health is the only good idea, much less the only key issue surfacing from this pandemic. One of the strengths of the studies in smaller scope is being able to make well-informed, targeted recommendations that will help to make a real impact on the lives of Canadians.

That's why I proposed a motion for the committee to study the impacts of COVID-19 on the mental health and well-being of Canadians, including recommendations that look specifically at understanding the impacts, including the gendered impacts of COVID-19 on the mental health and well-being of Canadians and the impacts on indigenous people, racialized Canadians and vulnerable populations, as well as the availability of mental health promotion programs and supports for those experiencing related mental health stress and anxiety and how to support the offices that are going to be overburdened with this. We also need to understand the effectiveness and availability of virtual mental health services and how our government can assist provinces and territories.

All of us have an opportunity to get ahead of the second pandemic. If we don't take the appropriate steps now to act while we can, the outcome will be on all of us, especially on those who choose to move forward without giving the matter the attention it deserves. I urge my colleagues in committee to support this study for Canadians in my riding, in their ridings and across the country.

Mr. Chair, I move that we resume debate on my motion with respect to studying mental health.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Van Bynen. I believe that's a motion—

[Tony Van Bynen, Liberal, Newmarket—Aurora, ON]

It's to resume debate on my motion.

[The Chair, Liberal, Ron McKinnon]

I believe that's a non-debatable motion, so I guess we will go to a vote on that at this point.

Do I have the consent of the committee to adopt this motion? I'm seeing some dissent, so we'll have to go to a vote.

Mr. Clerk, would you please conduct the vote?

Monsieur Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I lost the audio for a while. Could you go back to what you said at the beginning?

There seem to be some technical issues this morning. Some colleagues may have had trouble connecting. Although Mr. Davies said last time that we can't criticize the way you see hands raised, I want to point out that I was the first person to raise my hand this morning before Mr. Van Bynen.

Anyway, could you repeat what you said, so that I can understand exactly what this is all about?

I also want to remind you to always take into account the lag resulting from the interpretation.

[The Chair, Liberal, Ron McKinnon]

Mr. Thériault, do you want me to start right at the beginning, when I began the meeting, or just after Mr. Van Bynen's speech?

[Luc Thériault, Bloc, Montcalm, QC]

No, I won't be a poor sport, Mr. Chair. I just want you to repeat what you said after Mr. Van Bynen's comments. I missed a large part of your line of reasoning.

[The Chair, Liberal, Ron McKinnon]

Okay. Thank you, Monsieur Thériault.

Mr. Van Bynen has moved to resume debate on his motion, so I asked if the will of the committee was to accept the motion. I was looking for unanimous consent. I saw some heads shaking, so we will go to a recorded vote on the matter.

The vote on the floor at this time is whether to resume debate on Mr. Van Bynen's motion to study the mental health aspects of COVID-19.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, I have a point of order, just for clarification.

I think you said it, but I think it will really help committee members. We're not voting on whether or not we want to adopt the motion. We are voting on whether we want to debate the motion. Is that correct?

[The Chair, Liberal, Ron McKinnon]

That is correct.

Mr. Clerk, once again, would you start the vote? A yes vote means we would resume the debate. A no vote would mean that we would not.

(Motion negatived: nays 6; yeas 5)

[The Chair, Liberal, Ron McKinnon]

The motion is defeated.

[Luc Thériault, Bloc, Montcalm, QC]

Mr. Chair, I have something to say.

[The Chair, Liberal, Ron McKinnon]

Yes, Mr. Thériault.

[Luc Thériault, Bloc, Montcalm, QC]

I want to move the following motion:

That, pursuant to Standing Order 108(2), the Committee undertake a study on the Patented Medicine Prices Review Board (PMPRB) Guidelines issued on October 23, 2020; that, as part of this study, the Committee invite experts and pharmaceutical industry representatives, as well as civil society organizations or associations (representing patients), to appear; that the Committee hold a minimum of four meetings; that this study be conducted in parallel with the Committee's study on COVID-19; additional meetings should be added to the Committee's schedule if the Committee deems it necessary; and that the Committee report its findings and recommendations to the House; and that the government provide a response to these results within 30 days.

Let me begin by explaining the end of the motion. Since the guidelines are scheduled to come into effect on January 1, the government must respond within a short time frame.

The purpose of this motion is to ensure that we can hear from experts who are in favour of the guidelines and from experts who are opposed to them. These experts aren't opposed to the spirit of the guidelines, which aim to control the price of drugs. Instead, they're opposed to the potential adverse effects of the guidelines. This view is particularly prevalent among associations of patients with rare diseases.

This motion is anticipated by a number of people. Of course, there were consultations, but they took place behind closed doors. We should now allow all the stakeholders and players involved, primarily the patients, to come and speak. That way, we, as legislators, can adopt informed recommendations on this issue.

It's not that the goal isn't commendable. Rather, the measures taken must be considered as a whole.

If we look at the drug strictly as a cost, in the next 10, 15 or 20 years, we'll be severely limiting our view of what's therapeutic. If we look at the drug as part of the quality of care, it becomes something else.

We must look at the ways in which this reform could disrupt all economic sectors tied to the pharmaceutical industry, for example, as well as life sciences.

Some people have opinions on this. I haven't made up my mind on this issue yet. That's why I want us to hold meetings to discuss this issue. These meetings could be added to our schedule or could alternate with the other topics under consideration. Of course, in the coming days, the House will probably adopt an order concerning the pandemic and the study that we must conduct on the topic. That said, I think that we can walk and chew gum at the same time. In other words, we can spend time on this study as well, which we must carry out quickly, given the January 1 deadline.

In terms of the approach, the words “in parallel” imply additional meetings or alternating studies. The committee will decide how to proceed.

I encourage all my colleagues to support this motion if they want to give all associations of patients with rare diseases the opportunity to have their voices heard by the committee members.

I'll stop here for now, since I believe that I've clarified the motion. The debate is open.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

Next on my list is Mr. Kelloway.

Mr. Kelloway, please go ahead.

[Mike Kelloway, Liberal, Cape Breton—Canso, NS]

Thanks, Mr. Chair, and hello to everybody for our third meeting. It seems as though we've had a few more meetings than three.

I certainly would like to speak to Mr. Thériault's motion.

One of the many reasons I got involved in politics and decided to run had to do with health care, including the need for more doctors, nurses and specialists. Another was around pharmacare and the costs of drugs and other things. It hits home with me personally, having a mother who is ailing—persevering but ailing—when I look at what is covered and what is not covered.

I really appreciate Mr. Thériault putting this forward. He mentioned something that I think is really key. It's important to hear from big pharmaceutical companies, but it's also really important to hear from the end-user, from the family of three or four, or the individual who needs a voice and who needs to be able to provide some sound intel and learned experience.

At the last couple of meetings and the meetings we had prior to the summer, and even at the meetings we have had to date, we have disagreed vehemently on key things. In the last session we did as well. We got some work done. I think this is certainly something important, Mr. Thériault. It impacts all Canadians, and that's what we're here for. I really respect the fact that this has been put forward. It's something I look forward to hearing about from my colleagues. It is certainly something that has a very transformational impact on every single Canadian, and that's why we're here.

I want to send my appreciation to Mr. Thériault for that motion from a personal perspective, from a community perspective, and from a Canadian perspective as well.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Kelloway.

We go now to Mr. Maguire.

[Larry Maguire, Conservative, Brandon—Souris, MB]

Thank you, Mr. Chair.

I believe Mr. Thériault's motion here is about health care, and we need to move forward with it. I certainly think it's a very valid motion. We're looking at the situation of being able to deal with all of these issues in COVID, and certainly this is just one of many. I think that's the motion we need to be looking at and moving forward with. Mental health is extremely important. That's why it's included as part of these motions.

I do think we have an excellent opportunity here to be able to deal with the issue that's most important to Canadians. I think it's on everybody's mind out there. I mean, I flew home this weekend—if you want to look at a situation of everyone protecting themselves and helping others by wearing masks, by doing all of these things. We're distancing as much as possible, even in our airports and airplanes.

I think the issue that Mr. Thériault has put forward is one that urgently needs to be discussed. We just need to make sure we can move forward with motions like this. I think it's an excellent one to be a part of the motions on COVID discussions that we will need. There may be others that come forward as well, and debates that we're going to have and discussions on these motions that we're seeing. When we're seeing the increase in the numbers of COVID victims across the country, with people getting COVID-19 every day, the more urgent...the more breadth we can add to these motions, the better.

I commend my colleague from the Bloc for putting his motion forward and being able to make sure it's included in the whole discussion that we're having today.

Mr. Chair, I looked at the motions we had before, where we were looking at including mental health as part of those whole discussions, and I think that's a very sound way to go. We have an awful lot of circumstances where, to be blunt, we need to have more discussions on a broader base. There are a number of areas where we need information to be able to move forward and to be able to have discussions with the minister when the minister arrives at our committee meetings. I believe we need to move forward as much as we can with these types of motions.

That may be all I'll say on it for now. I think we need to be able to move forward as quickly as we can with a broader discussion of the whole area of what's required for the discussions we're going to have as we go forward. If other members of the committee want to chime in on that, I guess we would be quite happy to hear what they have to say, but I think it's the inclusion of a motion like this, along with all the other areas that have been talked about, that would be most important to Canadians.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Maguire.

We'll go now to Mr. d'Entremont.

Go ahead, please.

[Chris d'Entremont, Conservative, West Nova, NS]

Thank you very much, Mr. Chair.

I just want to make sure that we register our support for Mr. Thériault's motion.

This has been an important issue before Canadians and Health Canada for some time now. It's been our position for quite some time, since the task force recommended changes back in 2018, that any of these implementations so far will negatively impact the lives of Canadians who depend on medications. We're finding that they set aggressive price ceilings for some of those therapies, including those we hear of on a regular basis when it comes to rare disorders. I don't know how many questions asked in the House of Commons at this point have revolved around the issue of access to Trikafta. From what we saw, we don't feel that what we would qualify as a dump of information on a Friday will truly make a change or address the concerns of the different patient advocacy groups when it comes to access to those medications.

As I said, we were sitting in on a conference on Friday with CF Canada, which we were very happy to participate in. Mr. Thériault was there, and Mr. Fisher was there as well. I thought we had a really good understanding and conversation about what would be good changes, what would be bad changes and what the concern of that group would be. From our cursory look at the changes, there is very little change there. I see it's going to be quite a barrier for Canadians to access these different kinds of therapies. I really think it is a great idea to study it.

I also like and respect the request from the honourable member that revolves around the issue of doing this concurrently or at least together. We can walk and chew gum at the same time. We can look at different things at the same time, which is why I think we can have a COVID motion going on at the same time we can look at PMPRB, and we can look at mental health. There are things that are, of course, included in many of our motions to this point.

I will just quickly thank the member from the Bloc, our friend Mr. Thériault, for making sure we look at something that's very important to Canadians. Hopefully we can influence at least some more changes, or at least a delay of some sort on the implementation of those changes, as we don't see them actually helping Canadians any further.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. d'Entremont.

We go now to Mr. Davies.

Mr. Davies, go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'd also like to add my thanks to Mr. Thériault for moving this important motion.

The PMPRB changes have been in the works for several years now. In fact, I argue they're overdue. They were supposed to be implemented on January 1, 2020, and then that was delayed to July 2020, and now they're delayed again to the end of this year.

I think it's important to note that there are positive changes in these regulations, and some concerns. The positive aspects are that there is no question that the PMPRB reform is necessary, and these guidelines will reduce the prices that Canadians pay for their drugs. They will also increase transparency in the pricing process.

As has been pointed out by some of my colleagues, there are concerns raised in the public and the pharmaceutical industry that these changes may negatively impact the availability of drugs in Canada. There is quite a bit of controversy around that point. Some believe that's the case; some don't. I think it's very important that we take a look at this.

I would suggest one thing, and that is in terms of how we proceed with this study. The elephant in the room right now is the motion that's going to be voted on by the House tonight. If that motion passes, then this committee will be directed to study COVID. I believe there's agreement across all party lines around this table that this is the number one public health issue facing our country. I'm concerned about House resources and how we would be able to proceed with two studies at the same time.

In my five years on committee, I don't think we've ever done that; I may be wrong. That doesn't mean we can't. I would suggest that we're in a unique situation now, because in normal circumstances we could just schedule more meetings. Now, with the technology issues and the limited resources of the House, I'm not sure we can meet more frequently. I would point out that this committee is still only meeting once a week, when it is our normal practice to meet twice a week. My understanding is that this is because there is a lack of resources and support for things like interpretation and technology.

I'm going to suggest that we vote for the study and proceed with it simultaneously, but we do it in this fashion: start with a briefing from the PMPRB itself, so all committee members know what the changes are. I know there were guidelines issued on Friday. I've read through them. It's a very complicated area; there is no question. This is not an easy thing to digest. Before we hear from anybody, I think we need to understand, as committee members, what exactly is being proposed in the PMPRB changes: What are they going to do? What are they not going to do?

Then, I suggest we invite the witnesses that Mr. Thériault has identified to send written submissions to the committee. Once we get those written submissions, we can then, armed with an understanding of what the PMPRB changes are and what the position of the stakeholders is, narrow it down and decide to hold hearings and hear evidence from those witnesses the committee feels are important to hear from first-hand.

That way we get the PMPRB study going right away. We start with a solid understanding of what the changes are; we create a portal for all the stakeholder groups that Mr. Thériault has identified to get their input into the committee, which is something they desperately want; and then we can be in a better position to use our very limited time wisely. Maybe it's late November; maybe it's early December. Maybe it's one meeting or two meetings or three meetings. I'm not sure how many we will need to hear from witnesses in person about their changes.

I'm going to conclude by saying that I want to add my voice to those of the cystic fibrosis community in Canada, who have done a great job in raising this concern, and also my thanks. Of course, they used the example of the fact that patients are not getting access to the life-saving and life-improving medication now, which is Trikafta. Speaking for my party, I will say that we believe that every Canadian should get the drug they need when they need it, without regard to their ability to pay.

There's clearly an issue, and a very live issue as to why they're not getting that medication. The pharmaceutical industry is blaming the PMPRB changes. Others say that is not the case, that big pharma...that there are other reasons those drugs aren't available. I think we do need to look into this issue and get to the bottom of it, but if it's okay with Mr. Thériault, if that process is okay with him, I think that accomplishes everything we want to do.

Finally, again, if the House motion passes tonight, we'll be directed to study the COVID issue. We will have no choice about that and will proceed with that, which will allows us to, as he says, walk and chew gum at the same time, but in a manner that I think is an intelligent and efficient use of our time and resources.