Health Committee on March 21st, 2022

[The Chair, Liberal, Sean Casey]

Good afternoon, everyone. Welcome to meeting number 10 of the House of Commons Standing Committee on Health. Today, we will be meeting for two hours to hear from witnesses on our study of Canada's health workforce.

Before I introduce today's witnesses, I have a few regular reminders for hybrid meetings. Actually, I think we can dispense with the reminders, because we have all of our members present, and the witnesses who are appearing virtually have all appeared before. In the interest of brevity, we're going to go right to our witnesses.

We have with us today the Honourable Jean-Yves Duclos, Minister of Health; and the Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health.

Online, from the Canadian Food Inspection Agency, we have Sylvie Lapointe, vice-president, policy and programs branch. From the Canadian Institutes of Health Research, we have Michael J. Strong, president. From the Department of Health, we have Stephen Lucas, deputy minister. From the Public Health Agency of Canada, we have Harpreet S. Kochhar, president; and Dr. Theresa Tam, chief public health officer.

Thank you for taking the time to appear today.

We will begin with opening remarks from each of the ministers, beginning with Minister Duclos.

Minister, welcome to the committee. You have the floor for five minutes.

[Jean-Yves Duclos, Liberal, Minister of Health]

Thank you, Mr. Chair.

Thank you for giving us the opportunity to appear before you today to speak about main estimates for the health portfolio. As you mentioned already, joining me today is my honourable colleague, Ms. Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health. Joining us virtually are Stephen Lucas, deputy minister of Health Canada; Dr. Theresa Tam, chief public health officer of Canada; Dr. Harpreet Kochhar, president of the Public Health Agency of Canada; Sylvie Lapointe, vice-president of the policy and programs branch of the Canadian Food Inspection Agency; and Dr. Michael Strong, president of the Canadian Institutes of Health Research.

Let me begin with a few words about the current COVID‑19 situation.

Across Canada, the pandemic outlook is improving. Infection rates have peaked in many areas of the country, followed by a slow decline in hospitalization rates.

After two years of following individual public health measures, people in Canada know what to do to keep themselves and each other safe.

Now, as jurisdictions across the country are adapting their public health measures and restrictions in alignment with their respective situations, we are collectively moving towards more sustainable management of the virus.

Today, I'm here to talk about resourcing plans for the health portfolio.

As you know, we tabled our supplementary estimates (C) on February 19. These estimates seek parliamentary approval for $7.1 billion in new spending. Keeping Canadians healthy and safe has been the top priority for the health portfolio, and these supplementary estimates identify key actions toward this goal. This includes the procurement of rapid tests and therapeutics, funding to address anti-indigenous racism in health care, funding to support long-term care, and advancing pharmacare in Prince Edward Island, among many other important investments.

I'm happy to answer any questions you may have about these estimates later this afternoon.

I would like to turn my focus and your attention to the main estimates for 2022-23. In total, we are seeking $14.47 billion on behalf of the health portfolio, which includes Health Canada, the Public Health Agency of Canada, the Canadian Food Inspection Agency, the Canadian Institutes of Health Research, and the Patented Medicine Prices Review Board.

I’ll start with an overview of Health Canada’s plans.

The 2022‑2023 main estimates reaffirm Health Canada’s focus on providing services that are important to people in Canada, including support for long-term care, improved access to palliative care and safe access to medical assistance in dying.

To achieve these and other objectives, I am seeking a total of $3.88 billion.

As you know, the COVID‑19 pandemic has exacerbated existing mental health and substance use challenges for people in Canada. My colleague Dr. Carolyn Bennett will provide details on the investments that address these challenges.

The main estimates for the Public Health Agency of Canada for 2022-23 propose a total budget of $8.49 billion. This proposed spending will help ensure that PHAC has the resources in place to continue to deliver on its mandate to protect the health of Canadians during the pandemic, including for the procurement of boosters and therapeutics, and the continuity of PHAC's pandemic response and recovery.

The Canadian Food Inspection Agency protects people in Canada against food safety risks, supports the food supply chain and safeguards the health and safety of people working in food manufacturing and distribution.

The CFIA has a proposed net increase of $52.1 million in its 2022‑2023 main estimates.

This budget includes funding for three items: maintaining a daily inspection presence in federally registered meat processing establishments, maintaining and further strengthening food safety measures, and addressing antimicrobial resistance.

As we learn to live with COVID‑19, the importance of investing in health and medical research becomes more important than ever.

The Canadian Institutes of Health Research proposes to spend $1,242 million on health research in 2022‑2023. These investments will help provide the evidence needed to make better health care decisions, during the pandemic and beyond.

In closing, Mr. Chair, the investments I have outlined today will help the health portfolio deliver on its mandate of maintaining and improving the health of people in our country. Our commitments, as set out in our estimates and departmental plans, are a reflection of our most pressing health priorities. They demonstrate how we are taking action, and are an assurance to Canadians that we'll continue to protect and improve the health system.

Thank you for the opportunity to provide my comments. I would be pleased to take questions from the committee after my colleague Dr. Bennett presents her remarks.

[The Chair, Liberal, Sean Casey]

Thank you, Minister Duclos.

Minister Bennett, the floor is yours for five minutes, please.

[Carolyn Bennett, Liberal, Minister of Mental Health and Addictions and Associate Minister of Health]

Thank you for the opportunity to appear before the Committee today for the first time as Minister of Mental Health and Addictions and Associate Minister of Health. I am here today with my colleague, Jean‑Yves Duclos.

I would like to begin by acknowledging this meeting is taking place on the traditional territory of the Algonquin people.

I'm pleased to share with you our resourcing plans for 2022-23.

We all know that COVID-19 and the protective public health measures associated with it continue to adversely affect the mental health of individuals and families across the country. It's no surprise that many people are reporting an increase in stress, anxiety, depression and loneliness. The pandemic has also led to an even more uncertain and dangerous illegal drug supply, resulting in significant increases in overdose-related deaths.

Our government is committed to being there for Canadians, particularly in these exceptionally difficult times.

As the Government of Canada's first Minister of Mental Health and Addictions, I have been mandated with ensuring that mental health is treated as a full and equal part of our universal health care system. I'm working collaboratively with provinces and territories, experts, community leaders and those with lived and living experience to develop and implement a comprehensive, evidence-based plan to support the mental health of Canadians.

Early in the pandemic, we launched the Wellness Together Canada online portal to provide free, 24-7 mental health and substance use services and resources to people in need across Canada, including one-on-one counselling. In January, the digital access to this platform was enhanced with the companion app called PocketWell, to ensure that Canadians have access to the mental health and substance use services they need, no matter where they live.

Last week, I announced that we will be moving forward in partnership with the Standards Council of Canada, as well as other stakeholders and partners, to develop national standards to address the needs of Canadians related to mental health and substance use. This work on national standards is supported by $45 million from budget 2021. We are committed to ensuring that all Canadians have access to high-quality, safe and equitable mental health and substance use services.

Our hearts go out to all of the loved ones and communities of those we have lost to the worsening toxic drug supply and opioid overdose crisis. We are working closely with our provincial, territorial and municipal partners—along with other key stakeholders like the impressive Moms Stop the Harm—with over $700 million to reduce harms, save lives and get people the evidence-based supports they need.

We know the provision of a safer supply of drugs is essential to help prevent overdoses, and a safer supply is a vital part of our comprehensive approach to combat this crisis. We have invested over $60 million to expand access to a regulated supply of prescription opioids and are committed to doing more. We firmly believe that this is a health issue, and we're working to divert people who use drugs away from the criminal justice system and toward supportive and trusted relationships in health and social services. Our government will use every tool at our disposal to end this national public health crisis.

Our commitment to these and other key priorities is reflected in the health portfolio’s main estimates and supplementary estimates (C), which we are here to discuss with you today. These include $82.4 million requested by the Public Health Agency of Canada to support the mental health of those most affected by COVID-19, and $14.3 million requested by Health Canada for the Mental Health Commission of Canada. Health Canada is also seeking an additional $65.1 million for its work to address the opioid overdose crisis, and the Canadian Institutes of Health Research is requesting $2.25 million for two catalyst grant funding opportunities to support the development of national mental health and substance use standards.

Thank you for this opportunity to discuss my new mandate and the health portfolio’s estimates. I look forward to expanding on my remarks through your thoughtful questions.

[The Chair, Liberal, Sean Casey]

Thank you very much, Minister Bennett.

We're going to begin with those thoughtful questions now.

We'll start with the very thoughtful vice-chair of the committee, Mr. Barrett, for six minutes.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Thank you very much, Mr. Chair. Through you to the ministers and to all the witnesses appearing, I thank them for their time today.

My question is for the Minister of Health. With 10 provinces having established plans that include benchmarks and dates by which all of their COVID restrictions will be lifted—based on advice from their top doctors, from the chief medical officer of health in each of the 10 provinces—what different information does the federal government have that is causing it to not provide dates or a plan that will see federal COVID mandates lifted?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you, Mr. Chair.

Obviously, we would all like to know by what time COVID-19 will end. In fact, we would all like COVID-19 to have disappeared a long time ago. The truth is that COVID-19 is still here in Canada, and certainly outside of Canada. That's what I think we should be mindful of in the way forward. We want to apply the least disruptive measures in order to protect the health and safety of Canadians, and the conversation will evolve as the situation evolves.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Through you, Mr. Chair, again to the Minister of Health, it would be important for Canadians to know what benchmarks the government has set that will see those restrictions lifted. I can appreciate that in the absence of those benchmarks, it's difficult to set a date. Is there a hospital capacity target that has been established by the federal government and that, once reached, will trigger the lifting of federal mandates?

[Jean-Yves Duclos, Liberal, Québec, QC]

As you know, and as we all know, when we speak about restrictions and public health measures, most of the measures in place are in the domain of provinces and territories. The measures that belong to the federal government relate to borders, transportation and the public service. These measures are focused on vaccination, because vaccination is the key to the least disruptive measures possible to protect the health and safety of Canadians and their loved ones.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Again, through you, Mr. Chair, to the Minister of Health, the number of fully vaccinated Canadians is over 85%. We've heard the Prime Minister say that the number is in excess of 90%. What is the vaccination target that has been established and that, once reached, would see the lifting of federal mandates?

[Jean-Yves Duclos, Liberal, Québec, QC]

Those are excellent questions.

Let me first speak to the fact that vaccinations still work. We sometimes hear views—and some of them are perhaps not as well informed as they should be—that vaccination doesn't work anymore. Vaccination still works, and it works particularly well if you have a booster dose, which I think we all collectively want to encourage everyone to do. We currently have less than 60% of adult Canadians who have received the booster dose. That's not enough. We need more than that to protect against omicron and future variants.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Through you, Chair, to the Minister of Health, is there a target number, a benchmark that has been established, which, once that number of eligible Canadians have received their booster dose, once that has been achieved, will trigger the end of federal mandates? If it's at 60% now, is it 70%, 80% or 90%?

[Jean-Yves Duclos, Liberal, Québec, QC]

That's an excellent question. The answer is complicated and depends on both the prudential precautionary attitudes and the epidemiological situation in Canada and outside of Canada. It also depends on waning immunity, including waning post-infection immunity.

If you are interested—and I think you might be—we might turn to Dr. Tam, who happens to be with us today.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Mr. Chair, I will ask the same question of Dr. Tam, please.

[Dr. Theresa Tam, Chief Public Health Officer, Public Health Agency of Canada]

Right now, the epidemiologic situation is improving, but it is a little bit unstable. We have seen in European countries, for example, that a resurgence is being undertaken at this point in time.

As the Minister of Health indicated, the federal responsibility, for example, is for the borders. We have to look at the international as well as the domestic situation, and not just the domestic thresholds. At the same time, there is a phased approach being undertaken to begin to lift some of these measures, as you have seen being announced.

Right now, the omicron resurgence, particularly the subtype BA.2, can still occur. I think this is just waiting to see what happens with that situation, ensuring the provinces are still able to cope as they release their measures—they're just doing that at the moment—and having that observation as the federal government makes a decision.

[Michael Barrett, Conservative, Leeds—Grenville—Thousand Islands and Rideau Lakes, ON]

Okay. Thank you for that reply, Dr. Tam. I have very limited time left.

The theme I'm looking to establish, through the chair to Dr. Tam and the Minister of Health, is that we appreciate that the situation is evolving, but we have 10 provinces whose top doctors have all agreed that the epidemiological situation in Canada—based on hospital occupancy, based on waste-water surveillance reports, based on test positivity, based on reported cases every day—has created a situation where their requirements for vaccine mandates and for mask mandates have been lifted almost entirely, with all of them being lifted basically in the next 40 days. We know what that target is.

To the Minister of Health, what is the target we're going to see? If it's hospital occupancy and the situation evolves, once it drops back to 95%, to pre-COVID levels, the restrictions will be lifted, and then if it exceeds 105%, the restrictions will be re-engaged. Is that what we're talking about?

We're looking for what that benchmark is, Mr. Chair.

[The Chair, Liberal, Sean Casey]

Minister, we're well past time. If you could answer briefly, that would be appreciated. Please be as succinct as possible.

[Jean-Yves Duclos, Liberal, Québec, QC]

The question is excellent. You pointed out the fact that these decisions are made locally by provinces and territories, based on their epidemiological situation and their ability to manage the burden on their health care system, including hospitalizations. We still have 5,000 people hospitalized in Canada now because of COVID-19. These are 5,000 beds that cannot be used for other people.

So these decisions are based locally on their level of ability, their circumstances, and their ability to sustain the pressure that COVID-19 puts on them.

[The Chair, Liberal, Sean Casey]

Thank you, Minister, and thank you, Mr. Barrett.

Ms. Sidhu, you have six minutes, please.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you to the ministers and the officials who are appearing today.

Dr. Bennett, you mentioned that you're the first person to hold this portfolio. Congratulations on that.

First, much work has been done to reduce the stigma around mental health and addiction issues, but it still exists, particularly among newcomers and racialized Canadians. Can you tell us how you will ensure that any care and outreach funded by the federal government will be culturally sensitive and intersectional?

[Carolyn Bennett, Liberal, Toronto—St. Paul's, ON]

Thank you so much for the question. Even as we released the Wellness Together platform in all of the languages, we know that we have more to do to make people feel more comfortable accessing support. We were pleased to see that men came, and that the 2SLGBT community and young people were using the site, but I think we know that we have to do better at promoting the site in the more marginalized or ethnic communities. A number of members of Parliament have come to me saying that we need a specialized approach for the South Asian community, where the stigma is still very high.

I think overall, though, COVID has helped people admit that they're struggling. It seems to be more out there that people admit they're having trouble. I hope that, as the overall stigma comes down, we can focus on the populations where it's still too high. We want to make sure that people are able to access the care they need. It means having trusted people in those various communities leading this work. That's why we will need your help and the help of all members of Parliament.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Minister.

Minister Duclos, there are 11 million Canadians living with diabetes or prediabetes. I have met with many experts, and with Canadians living with this disease who may be at greater risk of severe COVID-19 outcomes. Can you tell us what action our government has taken on this matter?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you, MP Sidhu, for your leadership. You have been a leader, and because of that you've been able to make things happen quickly. One thing your work brought to Canadians was the National Framework for Diabetes Act. It's extremely important, because it's driven, as you said, toward caring for those who may be at risk or may be living with diabetes, as well as their families and their communities. There is also, associated with that, a $35-million investment over five years to do the research that is needed to care for those affected by diabetes.

It's teamwork, team success, and part of it is not only due to you, obviously, as a person, Sonia, but all those you have been able to work with over the last few months and years.

[Sonia Sidhu, Liberal, Brampton South, ON]

Through you, Chair, I have a follow-up question for Minister Duclos.

Minister, COVID-19 has had a significant impact, particularly on senior populations and elderly individuals. Can you please tell us what investment has been made in terms of seniors in long-term care homes and what actions we are taking to improve palliative care?

[Jean-Yves Duclos, Liberal, Québec, QC]

We've done two things regarding safe long-term care, and we'll do more, as I'll mention in a moment.

When we first invested in the safe restart agreement, there was a significant amount of resources intended for and used to help workers, personal service workers in particular, take care of our seniors. We then added last year, in budget 2021, another $3 billion for exactly the same purpose—to support health care workers in order for them to help care for our seniors.

We also said that we would put into place standards, which we are currently developing with external stakeholders and internal capacity, so that as we work with provinces and territories respectfully, we also treat our seniors in a respectful manner.