Health Committee on June 18th, 2021

[The Chair, Liberal, Ron McKinnon]

I call this meeting to order.

Welcome, everyone, to meeting number 45 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic.

Before I welcome the witnesses, however, I would like to draw the committee's attention to the supplementary budget request for this study. I believe all committee members should have a copy from the clerk. This request supplements our previously adopted budget for this study. It requests an additional amount of $4,125. This covers additional costs for witness headsets, video conferencing, shipping and such. If there's any discussion, we can bring it up later. I'm hoping, however, that it is the will of the committee to approve this budget at this time.

Do we have unanimous consent to do so?

[Some hon. members]

Agreed.

[The Chair, Liberal, Ron McKinnon]

Seeing no dissent, thank you, all. The supplementary budget is therefore approved. Thank you.

I would now like to welcome the witnesses.

We welcome, as an individual, Professor Alain Lamarre from the Institut national de la recherche scientifique (INRS).

Also as an individual, we have Professor Ambarish Chandra from the University of Toronto. We have Dr. Michael Silverman, chair and chief of infectious diseases at Western University. From the Lu'ma Medical Centre, we have Dr. Michael Dumont, medical director and family physician.

We'll start with statements. I will advise the witnesses that I shall hold up a yellow card when their time is in the vicinity of being over, and I'll hold up a red card when it's actually over.

If you see the red card, please try to wrap up. You don't have to quit instantly, but do try to wrap up. Thank you.

We'll begin with Mr. Lamarre.

Professor Lamarre, you have the floor for five minutes.

[Alain Lamarre, Full professor, Institut national de la recherche scientifique, As an Individual]

Thank you very much, Mr. Chair.

First, I would like to thank the committee for inviting me to participate in this meeting.

I would like to take a few minutes to talk about the importance of significantly increasing research funding in Canada, particularly for basic research. I believe that this is a key issue in maintaining and enhancing Canada's place on the world stage of health innovation.

I am a full professor at the Centre Armand‑Frappier Santé Biotechnologie of the Institut national de la recherche scientifique in Laval. I have been studying the immune response to viral infections and vaccines for over 20 years. As a result, I have been able to see a relative decrease in research funding in Canada during that period.

Basic research is an indispensable component of the development of new technologies for the prevention and treatment of disease. For example, the messenger RNA technology, which is the basis for the new COVID‑19 vaccines, grew out of developments in the design of new approaches to cancer treatment. This means that the development of innovative approaches cannot always be accelerated by targeted, problem‑specific investments, but often comes from broad investments in basic research, the potential benefits of which were often unsuspected at the outset.

The business model of the pharmaceutical industry has changed dramatically in recent decades. Large pharmaceutical companies are increasingly turning to the public and academic sectors to develop new technologies, rather than relying solely on their own research and development resources. For this reason, a rich and diverse public research ecosystem is increasingly important in the development and commercialization of innovative new treatments for patients.

The majority of biomedical research funding in Canada comes from the Canadian Institutes of Health Research (CIHR). According to a recent analysis by the Canadian Association for Neuroscience using CIHR data, the success rate of funding applications to CIHR open competitions has steadily declined since 2005, from a 31% success rate to less than 15% in 2018. Such a low success rate means that excellent applications are not funded and will need to be resubmitted, placing a significant additional workload on researchers and potentially even leading to the closure of successful labs, especially for researchers just starting their careers. In addition to the low success rate of CIHR projects in open competitions, applications that are funded typically see the budget reduced by more than 25%, further demonstrating the glaring lack of funding.

According to data from the Organisation for Economic Co‑operation and Development (OECD), Canada is the only G7 country where gross domestic expenditures on research and development have been declining since 2001. It is now the second lowest in the G7 on this measure, ahead of only Italy. As an example, the per capita amount of research investment is more than three times higher in the United States than in Canada. This clearly demonstrates the considerable effort that Canada should make to become a world leader in this area.

As a contribution to the reflection on these strategic issues, I would like to propose two measures that the Government of Canada could consider in order to maximize the benefits of its investments in biomedical research. These actions are consistent with recent recommendations from the Canadian Association for Neuroscience and with the final report of the Advisory Panel on Healthcare Innovation, entitled “Unleashing Innovation: Excellent Healthcare for Canada.”

First, federal investments in basic research in Canada should be increased by 25% now, and by 10% per year for the next 10 years, in order to catch up with other G7 countries. Second, federal investments in leading‑edge research infrastructure through the Canada Foundation for Innovation (CFI) must be continued and increased. We know that new advances in basic research require state‑of‑the‑art infrastructure. Such infrastructure entails significant operating and maintenance costs for researchers and universities. It will therefore be essential in the coming years to continue and increase CFI investments, not only in infrastructure, but also in its long‑term operating and maintenance costs.

In conclusion, the COVID‑19 pandemic has highlighted the importance of having a rich and diverse basic research ecosystem to better protect against future health crises.

Canada should make significant additional efforts to re‑establish itself, as a world leader in research and development and should invest heavily in research funding over the next decade.

Thank you. I am available to answer your questions.

[The Chair, Liberal, Ron McKinnon]

Thank you, Professor Lamarre.

We go now to Professor Chandra.

Please go ahead, sir, for five minutes.

[Professor Ambarish Chandra, Associate Professor, Rotman School of Management, University of Toronto, As an Individual]

Good afternoon, and thank you for inviting me today.

I'm an associate professor of economics at the University of Toronto. My past and current research focus is on airlines and the U.S.-Canada border. I have published articles in this area, and I have written a number of related opinion pieces in the media. I have previously provided testimony to Senate committees on the subject of airlines and cross-border travel. My statement today is on Canada's policies towards the border and international travel since the start of the pandemic.

In my opinion, Canada has made some correct decisions but also some mistakes in its approach to the border. I am sympathetic toward those who had to make quick decisions in stressful times, often with little available data or evidence, so these remarks are not meant to be overly critical. However, it is important to recognize the correct decisions, as well as identify the mistakes, to prevent them from happening again.

Economists do not generally favour severe restrictions on international travel. My own research shows the huge social and economic benefits of travel, yet last year I wrote to support the decision to stop non-essential travel between the U.S. and Canada. I still believe that decision was correct.

I also believe that Canada's government correctly identified major essential sectors that were exempted from any travel restrictions. These were defined by Public Safety Canada and include categories such as food, water, health, manufacturing and others.

I believe mistakes were made and continue to be made in the mandatory testing and quarantine procedures for travellers entering Canada. Many travellers were exempted from quarantine or testing, including those who provide essential services, those who maintain the flow of essential goods or people, and those who commute for work or school. We correctly exempted these travellers from testing and quarantine, yet we continue to impose these requirements on a small minority of travellers for little purpose.

To be clear, it was necessary to exempt truck drivers, other transportation staff, commuting workers and students, and anyone working in an essential industry. We have incredibly highly integrated supply chains with the United States. Our food networks, manufacturing supply chains and deliveries of everything from medicines to construction supplies require regular cross-border travel. Trucks won't cross if drivers need to quarantine for two weeks. Everyday commuters cannot realistically quarantine, and health staff should not be deterred from crossing the border.

By my calculations, around 14,000 trucks enter Canada every day from the United States, which is about five million per year. I also estimate around two million car trips by commuters per year. When I add together the truckers, commuters, essential workers and other exempt travellers, I estimate that over 80% of current cross-border travellers are not required to test or quarantine.

Canadians have been led to believe that testing and quarantine at the border protects us from infectious disease and emerging variants, but in fact these policies are weak. Consider, for example, returning snowbirds who cross the border by taxi, as they're permitted to do. Even if fully vaccinated, the snowbirds still need to test three times and quarantine for 14 days, meanwhile the taxi driver, who may well be unvaccinated, is not required to test or quarantine.

Given this, there can be little doubt that viruses and their variants that are present in, say, the United States, have made and will continue to make their way here no matter what. Why, then, do we require the remaining 20% of travellers to test and quarantine and to do so even when they have evidence of vaccination? Continuing to test and quarantine fully vaccinated travellers is extremely expensive for the government, time-consuming for CBSA and onerous for travellers, for no clear benefit.

Canada's government is currently ignoring clear recommendations from its own expert panel to let vaccinated travellers enter freely, and also to resume normal cross-border flows. This is baffling. Past governments have always supported the free flow of people and goods, and opposed moves to “thicken” the border. Canada acted quickly in the wake of 9/11 to prevent the border from being closed, and successfully carved out Canadian exemptions to American regulations such as passport requirements and the buy America provisions. Canada's policy has always been that a relatively open border is in the clear interests of Canadian citizens and businesses.

It would be a massive miscalculation for Canada to continue restricting most forms of travel, given the low case numbers in both countries, especially as U.S. lawmakers express their own bafflement and frustration at the continuing situation. At stake are not just the charter rights of citizens but also the survival of the tourism industry, which employs, directly or indirectly, 10% of Canadians.

At some point, Canadians can expect to see a commission of inquiry to examine Canada's response to the pandemic. While there are many aspects that will be evaluated, the government's handling of the air and land borders must receive special attention. I have no doubt that an inquiry would reveal both correct and incorrect decisions. We must record and acknowledge these in order to improve our future decisions.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Professor.

We will now go to Dr. Michael Silverman.

Dr. Silverman, please go ahead for five minutes.

[Dr. Michael Silverman, Chair and Chief of Infectious Diseases, Western University, As an Individual]

Thank you for the invitation to speak to you today.

I would like to address the issue of health care worker COVID vaccination.

Vaccination of health care workers has been an incredibly effective intervention in the control of COVID-19. A study by the Cleveland veterans affairs department found that health care workers who had been vaccinated had a 19-fold lower risk of acquiring COVID than those who were unvaccinated. Furthermore, the institution suffered from four COVID outbreaks, all of which were associated with transmission from unvaccinated health care workers. There were no outbreaks from vaccinated workers.

A recent outbreak involved a single unvaccinated health care worker who transmitted COVID to 20 other health care workers and 26 residents, and led to three patient deaths. This occurred despite the facility having extensive patient vaccination.

In Canada, there is a wide variation in health care worker vaccination rates between institutions, with many having staff vaccination rates well below the general population. As having your personal health care worker vaccinated can help protect you from exposure, these variable rates in vaccination raise an important issue of equity in health care delivery and patient safety.

Many patients do not respond to the vaccine because of serious underlying conditions, such as cancer, dialysis, organ transplantation or other immunocompromising conditions. They are vulnerable, and thus dependent on the health care workers and those around them to shield them from exposure to COVID.

Unlike going into a private business, patients who need to go to hospital cannot simply choose to stay home. Therefore, we have a moral obligation to assure these people that we will do everything we can to prevent them from becoming catastrophically ill and dying while in our care.

This then raises the issue of whether vaccination should be mandatory for health care workers who provide direct patient care.

Several concerns about a mandatory vaccination policy have been raised. Firstly, due to personal privacy concerns, health care workers do not have to even report their health care information to their institution.

Although it is true that the principle of privacy of health care information needs to be maintained, there are well-established exceptions where the public has a right to know in order to be protected. An individual’s struggles with alcoholism should remain a private matter. However, if that individual is a commercial pilot, the airline safety regulator has a well-established right to demand this information.

In our own experience, many of us would not be comfortable having someone who was unvaccinated come into our home. However, when a patient is ill in hospital, they at present have no right to even ask whether the health care worker entering their room is vaccinated.

The vast majority of patients would not consent to being directly cared for by a non-vaccinated person. However, this practice is still commonplace and is only maintained because of a lack of transparency, which enables the system to deny this information to the patient.

Patients have a right to expect that when they are being cared for in a medical facility, scientific principles will be used to determine the approach to care. We would not accept a health care worker making a unilateral decision, based on the belief that hand washing is not necessary, to continue to provide care between patients without washing their hands. Certain scientific principles that have overwhelming consensus and important patient safety issues must be maintained in order to provide a science-informed basis in care.

I am not recommending that any individuals who feel strongly opposed to vaccination must undergo it against their will. However, I do say that providing frontline health care services is a privilege and not a right.

If health care workers choose not to be vaccinated, despite the well-documented risks to both themselves and their patients, then hospitals should be able to decide not to allow their patients to be put at risk. These workers may be redeployed to non-frontline activities, if possible, or if not, then terminated. Special arrangements for health care workers with a vaccine allergy will have to be made, but a true vaccine allergy is an extremely rare phenomenon.

Our hospitals already mandate that health care workers provide proof of vaccination against other common transmissible agents, including measles and hepatitis B. Several countries have instituted mandatory health worker COVID vaccination policies.

The United States Equal Employment Opportunity Commission has ruled that all companies can mandate employees to be vaccinated in order to protect their customers. Many large U.S. hospitals have, therefore, undertaken a mandatory staff vaccination policy.

In Canada, however, despite the fact that most health care leaders would like to institute such a policy, they have been hamstrung by concerns regarding the legal framework, including the Charter of Rights and Freedoms, and a lack of federal or provincial direction.

Federal guidance and a national strategy on this issue are urgently needed. I therefore request that a committee be set up that would include representatives of health care institutions, health care providers, ethicists, patient advocacy groups and legal experts. This would enable rapid development of guidelines regarding implementing mandatory COVID vaccination policies for frontline health care workers.

Thank you.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We go now to Dr. Michael Dumont.

Go ahead, please, for five minutes.

[Dr. Michael Dumont, Medical Director and Family Physician, Lu'ma Medical Centre]

Thank you.

My name is Michael Dumont. I am Anishinabe Marten Clan. My family is from the Shawanaga First Nation, and I also carry mixed European ancestry. I am calling from the unceded territory of the Musqueam, Squamish and Tsleil-Waututh peoples, where I am honoured to make my home. I am a family physician and represent the Lu'ma Medical Centre, where I serve as medical director.

I would like to thank the committee for the opportunity to speak today about urban indigenous primary care in the COVID-19 pandemic.

Indigenous peoples in Canada experience unacceptable disparities in health outcomes, and there continues to be a large unmet need for culturally safe medical care to address this gap. With this goal in mind and guided by TRC call to action 22, in 2016 we established Lu'ma Medical Centre, an indigenous-operated not-for-profit society. Our centre delivers safe, culturally integrated primary care to 1,900 indigenous people in urban Vancouver through a team-based, two-eyes-seeing model, blending western and traditional indigenous approaches to health and healing.

We have been fortunate to build excellent partnerships with the First Nations Health Authority, Vancouver Coastal Health and our provincial health ministry in developing our community-guided service plan, which funds our multidisciplinary team. The support from our local MP, Don Davies, and our provincial MLA and health minister, Adrian Dix, has been invaluable.

However—

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

A point of order, Mr. Chair.

I was listening to the conversation in English and I did not realize that the interpretation was not being done. I am gradually becoming used to understanding English, but I would like to have access to the interpretation in French.

[The Chair, Liberal, Ron McKinnon]

I'll ask the clerk to check on that.

[Sébastien Lemire, Bloc, Abitibi—Témiscamingue, QC]

Okay.

I can hear it now.

[The Chair, Liberal, Ron McKinnon]

Doctor, could you maybe back up a couple of paragraphs and start over? I'll give you a little more time to accommodate that.

Thank you.

[Don Davies, NDP, Vancouver Kingsway, BC]

Yes, Mr. Chair, especially the part where he mentioned me.

I'm teasing.

[The Chair, Liberal, Ron McKinnon]

We're going to edit that out anyway, so that's fine.

Go ahead.

[Dr. Michael Dumont]

Thank you.

Indigenous peoples in Canada experience unacceptable disparities in health outcomes, and there continues to be a large, unmet need for culturally safe medical care to address this gap. With this goal in mind and guided by TRC call to action number 22, we established Lu'ma Medical Centre in 2016, an indigenous-operated not-for-profit society. Our centre delivers safe, culturally integrated primary care to 1,900 indigenous people in urban Vancouver through a team-based, two-eyed-seeing model, blending western and traditional indigenous approaches to health and healing.

We have been fortunate to build excellent partnerships with the First Nations Health Authority, Vancouver Coastal Health and our provincial Ministry of Health, in developing our community-guided service plan that funds our interdisciplinary team. The support from our local MP, Don Davies, and our provincial MLA and provincial health minister, Adrian Dix, has been invaluable.

However, we stand in a difficult position. We are facing unprecedented demand for our primary care services, fuelled by the overlapping health emergencies of the COVID-19 pandemic, opiate overdose epidemic and indigenous-specific racism in health care. We have run out of physical space in our building to meet the needs of our growing patient panel and seek financial support to make the necessary capital improvements to an adjacent unit in our building to expand our services.

With this planned expansion, we plan to build two additional medical exam rooms, a physiotherapy gym, a sacred space for group healing and ceremony, a traditional medicines room, a culturally integrated pharmacy and three counselling rooms. These improvements will allow us to fully expand to the full realization of our service plan, attaching 2,800 first nations away from home and urban indigenous people to culturally safe primary care.

We have fundraised $60,000 through local and provincial partners but need an additional $160,000 to complete this capital project. It is exceedingly difficult for indigenous health organizations such as ours to access capital funding to develop needed projects like this off reserve, where the majority of indigenous people—status, non-status and Métis—live.

We call for a partnership between Indigenous Services Canada and the Department of Health to develop a funding stream for capital grants to support the development of indigenous-specific health centres off reserve. This mechanism could provide enormous benefits for status first nations and other indigenous people living in urban centres away from their home communities and help the federal government meet its commitment to closing the health gap between indigenous and non-indigenous people in this country.

I'd like to highlight how we have responded to local care needs during the COVID-19 pandemic. We are currently the sole indigenous-specific COVID-19 vaccination site in the city of Vancouver, providing cultural support services through the full vaccination experience. Of the 10 mass vaccination clinics completed or scheduled, seven have had bookings handled under the provincial booking system. At these clinics, only 1% to 29% of attendees were indigenous, as non-indigenous people were still able to book appointments and displaced our community members, who sought the familiar safe environment of our centre for their vaccinations. In the subsequent three pilot clinics where the bookings have been coordinated directly by our organization, 99% of vaccines have gone directly to indigenous community members.

We see this as a major success in overcoming vaccine hesitancy and improving immunity in our urban indigenous population, which faces higher rates of COVID-19 infection, hospitalization and death compared to non-indigenous Canadians.

We advocate for Health Canada and Indigenous Services Canada to build more direct partnerships with urban indigenous organizations such as ours, which have earned the trust of our local communities, for the safe and effective delivery of COVID-19 vaccines to indigenous people off reserve. We believe this approach will lead to higher vaccination rates and improved health outcomes compared with the current reliance on provincial or territorial partners for all off-reserve vaccinations for indigenous peoples.

Thank you very much for your time and opportunity to share the story of the Lu'ma Medical Centre in this forum.

Hay'qa o'siem. Chi miigwetch. All my relations.

[The Chair, Liberal, Ron McKinnon]

Thank you, Doctor.

We will start our questions at this point with Ms. Rempel Garner, please.

Go ahead for six minutes.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thank you, Chair.

I'll direct my questions to Dr. Chandra. Thank you for your testimony today.

I'll start by just asking if you're aware that the federal government extended the U.S.-Canada land border closure for another month today.

Maybe I'll give you a minute to talk about the impact of that in the context of the piece that you wrote in the The Globe and Mail recently.

[Prof. Ambarish Chandra]

I have to say that it's disappointing. It's also a little bit bewildering. It's not clear at this stage what threat we face from fully vaccinated people, especially fully vaccinated Americans. In general, the rates of community transmission in the United States are either comparable to ours or at times lower. Both New York state and Michigan, our immediate neighbours across from Ontario, which has the busiest land borders, have lower rates of infection than we do.

If we're going to continue to keep the borders closed now, then maybe we should never open them, because there will always be diseases, not just COVID but others.

I find it baffling, especially today's decision in the light of the high vaccination rates and low case numbers.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

I do as well.

The committee is trying to ascertain whether or not the policies we have in place are beneficial to Canadians at this point. You just alluded to the fact that, at this point, you couldn't point to a specific body of evidence that shows the benefit of this policy. You don't have to comment on this. I'm speculating that it is political at this point in time.

I think the other side of the equation on the land border closing right now really hasn't been discussed. That's the opportunity cost to industry. I noted that a lot of people are, for example, flying into Buffalo and then driving across the land border. Those rules are being skirted in some ways anyway.

Can you perhaps try to quantify for us the potential opportunity cost to closing the U.S.-Canada land border for another month without evidence of necessity?

[Prof. Ambarish Chandra]

One thing I'll just say is that the fact that some people are skirting the rules isn't necessarily evidence of failure. We design public policy all the time, but occasionally people do slip through the cracks and evade restrictions. As long as they work most of the time for most of the people, it's still good to design public policy with good aims.

Now you ask me to quantify the effects on industry. To some extent we won't know until much later. We won't know until months or years later exactly what effect this will have on industry.

I can tell you that the tourism sector in Canada, broadly defined, employs 10% of Canadians directly or indirectly. That's a staggering number. Of course, a lot of that is domestic as much as international travel, but a lot of these crown jewels of tourism will not survive without international travel. Niagara Falls, Ontario; Whistler, B.C.; Banff and Lake Louise are destinations that will not be able to keep operating in the future if we essentially make clear that we aren't interested in foreign travel, especially by people who are completely safe and fully vaccinated.

I can't give you a number on—

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

Thanks.

I just have a couple of minutes. I'm sorry to interrupt you. I would invite you to table any research that you have in this regard with the committee. It would be very helpful for our deliberations.

Again, I'm trying to get to a quantification of this. Could you ballpark a dollar amount or a number of jobs that the Canadian economy is now losing, let's say per month, for every month that the border closure is delayed without a plan in sight?

[Prof. Ambarish Chandra]

I'd be very reluctant to ballpark a number. I can try to come up with an estimate and send that to your office or to the committee later on.

I do think even the best estimate right now might prove to be wildly off once we fully realize the effects of this in the future.

[Michelle Rempel, Conservative, Calgary Nose Hill, AB]

At this point, as a legislator, without seeing data that shows a considerable public health benefit to keeping the border closed—and I'm very open to looking at that data, which has not been provided by the government to this committee—I am surmising that this is a political decision at this point.

Would you want to speculate on that or perhaps on the reason that you would think this is still in place?