Health Committee on June 11th, 2021

[Luc Thériault, Bloc, Montcalm, QC]

I'd like to hear you talk about another point you raised, a very important one. It's about the value, over the next 10 years, of innovative drugs in oncology and immunology. Therapies are becoming more narrowly focused, and even individualized. Innovative molecules and drugs are going to become important.

Can you tell us more about this value?

It's as if we were looking at medicines strictly from the cost standpoint, when what we should be looking at is the therapeutic value and positive impacts not only on the patient, but also on the economy, system costs, and society as a whole.

[Yanick Labrie]

Yes, that's right. It's a part of the debate that remains completely hidden. We focus a lot on prices, but the other side of the story is the benefits in all spheres of the economy. We shouldn't look at prices alone, but rather at what we get in exchange. In the case of drugs, as you mentioned, the progress made over the years has been extremely positive.

Dr. Lexchin alluded to the fact that sometimes there are only minor improvements. However, it's important to understand how innovative processes work in the pharmaceutical world. Generally speaking, technological process comes as a result of many gradual improvements in methodology and existing products. It's the same in all sectors, and even more so in pharmaceuticals. In other words, sometimes we only become aware of the progress that has been made after several years.

The development of the COVID‑19 vaccines was based on other drugs that had been developed and on other research efforts conducted in the past, including efforts to find an HIV vaccine. We are now benefiting from this work.

If we fail to cover drugs on grounds that they are too expensive, we risk depriving ourselves over the longer term of drugs that are extremely valuable to Canadians.

In this debate it's important to have a vision that is much more dynamic than static .

[Luc Thériault, Bloc, Montcalm, QC]

It also represents savings for the system. It's important to consider not only the patient's quality of life, but also the costs of drugs. You gave the example of colorectal cancer, which generates significant costs to the system, but we don't appear to take this into account when determining a drug's beneficial effects.

[Yanick Labrie]

We often neglect these aspects. And yet, the drugs were able to replace much more expensive surgical procedures. Not only do patients benefit directly in terms of health and quality of life, but hospitalizations and operations that are often much more expensive are avoided. It also means workers can return sooner to the labour market. There are gains in productivity and income for these patients. Society as a whole benefits. It has to be taken into consideration.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Thériault.

We go now to Mr. Davies for six minutes, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Lexchin, can you explain why 90% of new drugs approved in Canada fail to offer significant new therapeutic advantage and, if that's the case, why they would be approved?

[Dr. Joel Lexchin]

There are a number of things that you have to consider.

First of all, it's that drug companies, by and large, look at established markets. They see that there's a drug on the market and it has good sales, and they want to get a piece of that pie. They develop their own version of that product. They manipulate a few molecules and produce that new drug. Then they market that new drug very heavily to doctors. The last figures I saw showed that drug companies were spending about $450 million per year on their sales representatives and ads in medical journals. That's about $60,000 per doctor, per year, just on those two forms of promotion.

When you look at the regulatory requirements for approving drugs, you see that they don't have to be better than what's on the market. They can, in fact, be inferior to what's on the market. The only thing that's required to get a new drug on the market in Canada and in other countries is that they be better than placebos, and the amount “better” is marginal.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thanks.

I'd like to move to the amount of time it takes to get new drugs approved in Canada. A recent article said that the most important factor explaining delays in getting drugs to market and in approval of new medicines in Canada is “the difference in the dates on which manufacturers submitted new drugs to agencies for regulatory approval”.

It turns out that the average gap between regulators for approving new drugs is actually very, very small once they've received applications; in Canada it is about four days different from the U.S. and nine days different from the EU. Can you outline why pharmaceutical companies are delaying access to new drugs in Canada by waiting over a year, on average, to submit their applications to Health Canada?

[Dr. Joel Lexchin]

Primarily it comes down to economics. Even the large drug companies have limits on resources, and they are going to submit to get a drug on the market in places where they can get the largest return on those drugs, and that's the United States. The United States prices for brand name drugs are two to three times higher than virtually any other country around. Second and third in terms of new drug prices are Switzerland and Germany. After the United States, you go to those two countries, because you can get more money back. Then they go to places like Canada, Australia and New Zealand, where the market size is smaller and prices are more controlled.

[Don Davies, NDP, Vancouver Kingsway, BC]

I'm going to turn to a different subject, and that is vaccines. In a March 2020 op-ed in Open Canada, you co-authored a piece that said the following:

We cannot increase vaccine supply without worldwide expansion of production capacities. One way to facilitate this is through the COVID‑19 Technology Access Pool...formally launched in May by the World Health Organization. The overall aim of C‑TAP is to promote open innovation, pooling not only research outcomes and intellectual property rights but also manufacturing processes and other kinds of “know-how”. C‑TAP has the backing of 40 countries, but Canada is not one of them.

Why has the Government of Canada refused to support of the COVID‑19 Technology Access Pool, and is that justifiable?

[Dr. Joel Lexchin]

As to why it's refused, you'd have to ask the people in government who are in charge of that kind of decision-making.

If you look at the history of Canada, the Canadian government has had to make a choice between supporting improved access to medications in low- and middle-income countries versus supporting intellectual property rights, and we go back to 1999. There have been about six or seven times when they've had to make that choice, and every time they've made the choice of supporting intellectual property rights as opposed to better access to medications in the poorer countries.

[Don Davies, NDP, Vancouver Kingsway, BC]

You've also written about Canada's failure to be able to produce domestic vaccine manufacturing. You say that we have ignored warnings that go back to SARS in 2003 and H1N1 in 2009. The Naylor report following SARS noted the lack of security of vaccine supply and recommended the development of a national vaccine strategy, but that was basically ignored by successive governments.

Right now, have we taken adequate steps, in your view, to address this lack of domestic vaccine production capacity?

[Dr. Joel Lexchin]

The government is putting money into a number of facilities. There's the NRC plant that's being built in Montreal, and there's Medicago in Quebec City. They're investing money in Sanofi in northern Toronto, but none of these are Canadian-controlled companies.

What we've seen is that, when companies are controlled internationally, those decisions are not necessarily made with the best interests of Canada in mind, so we've got a COVID vaccine being developed by Sanofi and GlaxoSmithKline. Sanofi has the plant in northern Toronto. GlaxoSmithKline has a plant in Quebec, but if that vaccine is successful and is approved in Canada, it's not going to be made in either of those places; it's going to be made in the United States.

[The Chair, Liberal, Ron McKinnon]

Thank you, Mr. Davies.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

Thank you, Dr. Lexchin.

[The Chair, Liberal, Ron McKinnon]

Thank you, all. That wraps up our first round of questions. I think we will have time for a short, snap round, maybe two minutes per party.

On that basis, I will invite Mr. Maguire to go ahead, please.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, my clock says we have over 15 minutes. Could we not do three minutes per party?

[The Chair, Liberal, Ron McKinnon]

Okay, we can take a shot at that. Three minutes is always four or five, but let's do the best we can.

Mr. Maguire, you have three minutes.

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

Thanks, Mr. Chair.

Thanks to my NDP colleague for that.

Mr. Labrie, in your initial comments in this section you mentioned that drugs increased 19% in 2016. I wonder if you can just elaborate on that. You also indicated that we should not support the PMPRB drug pricing recommendations. I got your details as to why. Is there anything else you'd like to elaborate on in that area, since we're not manufacturing them here in Canada?

[Yanick Labrie]

Thank you for your question Mr. Maguire.

The data I reported on price differences came from PMPRB annual reports. The 19% rate represents the difference between average prices in Canada and in the rest of the OECD countries in 2017.

However, as I mentioned, these differences are difficult to establish. Comparisons can be distorted by all kinds of factors, some of which I listed. For example, populations and economies vary in size. Some OECD member countries are poorer and others richer.

If we break down the data by drug group, it can be seen that drugs for rare diseases are…

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

Pardon me for interrupting, Mr. Labrie.

How does that impact the price we've had to pay for our COVID drugs? I know you're talking in general, but what are your thoughts on that?

[Yanick Labrie]

Some information is available for drug prices, but I've been unable to determine whether it is accurate. Once again, it was impossible to make international comparisons that struck me as credible.

One thing is clear, and that is that decisions are made in favour of certain markets when the conditions are right. In Quebec, as in other Canadian provinces, conditions are not favourable, partly because of the uncertainty caused by this debate over regulatory changes.

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

Mr. Ahmed, I will quickly move to you.

In regard to not losing ground on mental health because of COVID, you mentioned the support of the private sector in developing and funding mental health. What do you think the private sector's role should be in that? I know you want to keep all governments working together. Where does that fit in?

[Ansar Ahmed]

There's a small organization here in my hometown of Newmarket called Inn From the Cold. I've seen the tremendous work that they're doing first-hand, primarily through the support of volunteers, to try to support those suffering from mental health, homelessness and other issues. I think there is definitely a role for government to play in providing those non-profit organization some line to stable, long-term funding, so that they can continue to provide these invaluable services.

The other thing is that if we don't do that early intervention in terms of those mental health programs, then by and large we're going to end up paying a price through other social services, the justice system or other areas. It behooves us as a society to make sure we do that early intervention.