Evidence of meeting #41 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was drugs.
A recording is available from Parliament.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
I understand the order of priority is that the United States pays the highest; I think Switzerland is second highest; and Germany or Canada, third highest.
Of the countries that pay lower costs—I guess there are 210 countries in the world—do the Belgiums, Frances, New Zealands and so on have less access to medicine than Canada does?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
That's a great question. People throw out these statistics and these stories, frankly, about drugs that don't come to market in Canada. The fact is that drugs go to market in a few places in the world in very large numbers, and then in other markets around the world, they go to market basically on the basis of whether the drug is truly a breakthrough that will earn market share. In places such as Germany and the United States, the legislation of those countries is set up to give manufacturers every incentive to bring anything to market, regardless of how clinically promising it is, but ones that are clinically promising end up in markets around the world.
The literature on this, which I recently did a systematic review on, is quite poor internationally because most of it is funded by pharmaceutical manufacturers. As a consequence, most of that literature has what we call a commercial bias, a bias that says that any drug in any market at any price is a good thing. The reality is that it's effective drugs that countries want, and effective drugs get to every market of the world.
NDP
Don Davies NDP Vancouver Kingsway, BC
Dr. Morgan, I really want a direct answer, if I could, because there seems to be a thesis developing that if we go through with these PMPRB reforms and they reduce the price of drugs, Canadians won't get access to those drugs.
I'm asking in a real world environment, where there are many countries that already pay less for drugs than Canada does, are they getting worse access to drugs than Canada is?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
No. One only needs to look at, for instance, the United Kingdom, a country that pays less than us, gets more medicines on its market and actually has higher research and development in the pharmaceutical sector, so there you go.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you.
Ms. Batt, in your view, will these PMPRB reforms discourage clinical trials in Canada?
Co-Founder, Adjunct Professor, Dalhousie University, Department of Bioethics, Breast Cancer Action Quebec
In my opinion, I haven't seen evidence that it will, but obviously it's up to the companies where they do their clinical trials. I'm not sure how important the PMPRB guidelines are to those decisions, but I don't have....
NDP
Don Davies NDP Vancouver Kingsway, BC
Okay. I'll move to the next question.
In your view, will PMPRB reforms discourage new drugs from coming to Canada?
Co-Founder, Adjunct Professor, Dalhousie University, Department of Bioethics, Breast Cancer Action Quebec
No. As Dr. Morgan said, I don't see evidence that the really good, important drugs won't come here. There's going to be the demand. I don't see how the provinces are not going to want to welcome drugs that are actually going to make a difference.
Canada is certainly a smaller market than the United States, but it's not a trivial market. We're spending a lot of money on drugs. I don't know why the companies would walk away from our market just because their prices are reduced a bit.
NDP
Don Davies NDP Vancouver Kingsway, BC
I think we've seen the media reports that the pharmaceutical industry offered the Canadian government $1 billion to delay bringing the PMPRB reforms in. According to an industry estimate, they say the regulations would reduce drug companies' revenues by about $19.8 billion over 10 years.
Do you think the opposition of the pharmaceutical industry to these reforms is based more on their interest in their own profits or on their concern that Canadian patients won't get access to drugs?
Co-Founder, Adjunct Professor, Dalhousie University, Department of Bioethics, Breast Cancer Action Quebec
I think they are concerned about their own profits. Certainly the United States is very concerned about high drug prices too, and is looking to Canada. If Canada gets an effective reform in place, I think there's certainly some concern on the part of the companies that the United States could follow suit. The dynamic between the two countries is very interesting and is very likely a factor in the drug companies' opposition to these new guidelines.
NDP
Don Davies NDP Vancouver Kingsway, BC
Thanks.
I have a quick question for Dr. Morgan.
Dr. Morgan, what percentage of research is created from publicly funded research, like in universities, that goes into new molecules? Can you give us a rough estimate?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
I don't have the number off the top of my head. I know that Chris McCabe will be speaking later with this committee. He might have that number. It's a significant percentage, particularly if you include tax expenditure subsidies, which we provide for the private investment, in addition to government grants and non-profit organizations sponsoring research itself.
Professor, School of Population and Public Health, University of British Columbia, As an Individual
I don't want to give you a number without having the statistics in front of me.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies.
That ends our first round of questions. We'll start our second round at this point with Mr. d'Entremont for five minutes, please.
Conservative
Chris d'Entremont Conservative West Nova, NS
Thank you, Mr. Chair.
I want to thank the witnesses for being here today.
I would say at this point that we've taken hundreds of mémoires from organizations that have presented to us. I think they're as diverse as the views we see here today. Quite honestly, this is meeting two of a three-meeting process. We're getting close, I believe, to the end of our process, where we need to have an idea of what we're going to recommend, and yet we have PMPRB changes going in place in just a few weeks. It's hard to synthesize a lot of the things we're seeing before us.
It was six months ago that we had our last meeting. We invited the PMPRB to be at this meeting to bounce some of these thoughts of them and for consultations. Unfortunately, they didn't want to be here today, which I find a bit awkward, as we're trying to find ways, to my mind, to help them come up with the best piece of rules and regulations in order to do that.
We talked a lot about pricing today, but we had the issue on the other side of the equation. We talked about the patient side.
Kelly Grover, thank you so much for being here on behalf of CF patients. I get a lot of folks from the patient groups talking to us. I know Tom will probably ask a few more questions on this if he gets the opportunity, but have you had an apology from PMPRB for what was truly their attack on patient groups? I find it difficult that we're attacking patient groups right now.
Chief Executive Officer, Cystic Fibrosis Canada
Thanks for your question. We've met with many of you, and you've met with your constituents, and we thank you for that.
We, CF Canada, didn't ask them for an apology, but there was another letter this week that was written to another patient group that was called out. There was a letter written—and I was copied on it—by the board chair of the PMPRB, and I think that's when what I said before.... I'm sorry to keep talking about my feelings, but I felt just really disappointed and sad about the letter and its tenor. On my part, if I had a communications plan after doing something wrong, or whatever, I might have started with this: “I'm sorry you felt that way and here's where we're coming from.” But that was not it. The tenor of the letter was almost like they doubled down. They're very offended by the patient groups. Dr. Batt spoke to some of the language online. They're very offended by that. There's no consideration of where patients are coming from. There's no understanding of that or trying to empathize with them.
On top of that, I found it curious in their note that they stated that they are the experts on this and that's what they advise government on. I found it curious their use those words, because I thought this was a consultation process, whereby we all bring in Dr. Morgan's suggested things and we are all bringing our voices to the PMPRB to make these the best guidelines. I might be a bit naive about that, and I'm not trying to play that card with you right now, but if that was the point, that you were just information gathering from all of us and it wasn't a consultation process, then call it that. But that wasn't what it was called. If you look at their consultation principles, it's about meaningful discussion and debate, and that didn't happen.
I don't expect there to be an apology to us, to be honest. I'm not going to waste my time on that. We were invited here, we've written our letter and that's that.
Conservative
Chris d'Entremont Conservative West Nova, NS
All right. Thanks, Kelly.
The other side of this.... We have patients on one side and, from a health system standpoint, the patients should be number one on that. In the time I spent there, it was about patient service and trying to find better ways so that people could get their treatments, drugs and whatever they possibly needed from our health care system.
We also have the other side. I see that Minister Champagne actually is out there trying to bridge a few gaps right now. Because of the way the PMPRB is coming down, he's reaching out to research and development and drug companies.
I would like to ask Ms. Perrault a question.
Ms. Perrault, where do investments for research in the pharmaceutical industry come from?
Chief Executive Officer, BIOQuébec
Thank you for the question, Mr. d'Entremont.
Investments come from a number of sectors. At BIOQuébec, our members are not large pharmaceutical companies. They are biotechnology companies that do clinical and preclinical studies. They are part of the ecosystem.
However, the ecosystem is very different from what it was 10 years, 15 years, 20 years ago. It has changed quite a bit and is now much more horizontal. The large pharmaceutical companies are now involved in academic research, biotech and clinical trials. Venture capital comes from a number of countries. It's international. It's not true that we work in a vacuum. We work in a much more horizontal way. Research is indeed publicly funded. Governments are still very much involved in basic research, but a whole ecosystem exists around that.
I would even add that, if public funds are going to allow research to be done—and the research we do in Canada is of high quality—I'd like Canadians to be able to benefit from it. At the end of the day, the drug is probably going to have been developed in several places around the world. Research will have been done all over the place, but certainly Canadians will have contributed. In the context of the current pandemic, Canadians contributed significantly to the preclinical trials for the RNA vaccines, which, by the way, were done largely in the Montreal area.
It would be unfortunate if Canadians could not benefit. That may happen later. Some countries receive drugs very quickly. Other countries, including Canada, will also receive them, but when? Will they get them in the middle third, in the final third of the timeline? I'd like Canadians and Quebecers to be able to benefit as quickly as possible.
This reform, which is only about drug prices, should be about the whole ecosystem and how it can benefit Canadians. Patients should be reaping the benefits of the research, the innovation, the clinical research and the drugs. So you need to take a holistic view.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Ms. Perrault.
Thank you, Mr. d'Entremont.
We go now to Mr. Van Bynen.
Liberal
Tony Van Bynen Liberal Newmarket—Aurora, ON
Thank you, Mr. Chair. Thank you to this panel for joining us today.
I think that all of us can agree that this is a very important discussion. I appreciate everyone's taking the time to join us.
My questions will be directed to Dr. Morgan.
Canadians have access to some of the best doctors and nurses, hospitals and treatments in the world, all of that through our publicly funded health care systems. This includes the incredible team at Southlake Regional Health Centre, where I had the pleasure to volunteer as a board member for many years and to gain some insight into the health care sector.
We've learned that some Canadians, particularly those with rare diseases, have difficulty affording the medications they need. Budget 2021 reaffirmed that the government will proceed with its announced plan to provide ongoing funding of $550 million for the program for high-cost drugs for rare diseases. How do you think this investment will help Canadians currently living with rare diseases now and in the future?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
Thanks. That's a great question.
There are a few things under way. The federal government is consulting to try to develop something of an actual strategy around rare diseases. Canada has lacked that to date. I think that's very promising. There's funding for the medicines when patients need them, but there are also the various mechanisms that need to be put in place for the assessment of medicines as they come to market, and to support both manufacturers and patients in navigating often complex and uncertain information about whether the medicines are going to work or not.
The $500 million that's dedicated towards helping provinces pay for expensive drugs for rare diseases is an important step in the process of developing a truly comprehensive national pharmacare program. For patients with rare diseases, I think it's a clear signal that they will not be left behind by a pharmacare program that is designed to cover all of the medicines Canadians need. I know there was a lot of fear at the outset of discussions about national pharmacare that patients with rare diseases would become the second or third in line after the patients with more common conditions like diabetes, asthma and other such things.
Liberal
Tony Van Bynen Liberal Newmarket—Aurora, ON
I'm looking at an article entitled “Pricing of pharmaceuticals is becoming a major challenge for health systems”. In that article it is said that “The pharmaceutical sector can potentially abuse market power because of the inelasticity of demand for necessary medicines.” Can you expand on that, please?
Professor, School of Population and Public Health, University of British Columbia, As an Individual
Yes, absolutely. The idea of having a patent as a mechanism for incentivizing research and development typically comes from markets where the price that a consumer is willing to pay is based on the idea that the consumer can always walk away from a transaction on a voluntary basis and not be harmed unduly by doing so. Unfortunately, in the context of necessary medicines, particularly for serious diseases, patients can't walk away. As a consequence, patients and their families would pay virtually anything for effective life-saving treatments. As a consequence, patients and their families and their organizations would try to convince governments to pay anything for effective life-saving treatments. This gives patent holders in the pharmaceutical market very unique market power, which the patent system really wasn't designed to provide. That's why safeguards like PMPRB regulations are a useful tool to make sure that there's incentive for innovation, but not an opportunity to abuse the market power of the patent.
Liberal
Tony Van Bynen Liberal Newmarket—Aurora, ON
Thank you.
One conversation we're hearing lately is about patents in relation to the COVID-19 vaccine. I'm curious to hear your thoughts about the patent process in relation to pharmaceutical drugs. Can you identify any areas where Canada could improve or further encourage pharmaceutical companies to develop their drugs in Canada?