Health Committee on March 30th, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order. Welcome to meeting number 14 of the House of Commons Standing Committee on Health.

Today we will be meeting for two hours to hear from witnesses for our study of the emergency situation facing Canadians in light of the COVID‐19 pandemic. I would like to begin by thanking our witnesses for being with us today and for your patience as you waited for the delayed start of this meeting because our our votes in the House. I understand there's a fair possibility that we will be interrupted by votes again, but we very much look forward to hearing from you. Again, thank you for your patience.

Today's meeting is taking place in a hybrid format pursuant to the House order of November 25, 2021. Per the directive of the Board of Internal Economy on March 10, 2022, all those attending the meeting in person must wear a mask, except for members who are at their place during the proceedings. For the benefit of the witnesses and members please wait until I recognize you by name before speaking. For those participating by video conference please click on the microphone icon to activate your mike and mute yourself when not speaking. For those on you on Zoom you have the choice, at the bottom of your screen, of either the floor, English or French. For those in the room, you can use the earpiece and select the desired channel.

I remind you that all comments should be addressed through the chair and that you are discouraged from taking screenshots of your screen. Everything that we do here will be made available on the House of Commons website. In accordance with our routine motion, I am informing the committee that all witnesses have completed the required connection tests in advance of the meeting.

I would like now to welcome our witnesses who are with us this afternoon for two hours. Here as an individual, we're pleased to have Dr. Isaac Bogoch, associate professor of medicine, University of Toronto, and staff physician in infectious diseases, Toronto General Hospital. As an individual, we also have Dr. Emilia Liana Falcone, director, post‐COVID‐19 research clinic, Montreal Clinical Research Institute, and attending physician, infectious diseases, Centre Hospitalier de l'Université de Montréal.

From the Canadian Association of PPE Manufacturers, we have the president, Barry Hunt. From the Canadian Cancer Society, we have Stuart Edmonds, executive vice‐president, mission, research and advocacy, and Kelly Masotti, vice‐president, advocacy. From the Canadian Mental Health Association, we have Rebecca Shields, chief executive officer, York and South Simcoe Branch; and from the Neighbourhood Pharmacy Association of Canada, we have Sandra Hanna, chief executive officer.

Again, thanks to all of you for appearing today. We're going to begin opening remarks from each of you in order you are listed on the notice of meeting. As you've probably already been advised, if you could limit your opening to five minutes that will allow us more time to ask questions.

Dr. Bogoch, we're going to start with you. Welcome to the committee. You have the floor for the next five minutes.

[Dr. Isaac Bogoch, Associate Professor of Medicine, University of Toronto, Staff Physician in Infectious Diseases, Toronto General Hospital, As an Individual]

Thank you so much.

Thank you for the invitation and the opportunity to speak at this meeting of the House of Commons Standing Committee on Health.

My name is Isaac Bogoch. I’m an infectious diseases physician and scientist based out of the University of Toronto and the Toronto General Hospital. I have worked closely with various levels of government in both a formal and informal capacity during this pandemic.

As we trudge forward somewhat exhausted from the last two years, it's still appropriate to acknowledge that COVID is not going anywhere any time soon, and we will see an ongoing waxing and waning of disease activity in Canada and also in communities around the world, and this is, of course, going to be associated with morbidity and mortality, unfortunately. COVID is obviously a global issue, but I'm going to focus my talk locally.

With that in mind, how do we plan ahead so that Canadian society is not disrupted significantly by future waves or variants? Or, said another way, how do we live with COVID? By “live with COVID”, I mean how do we protect all Canadians, including and especially vulnerable individuals and at-risk communities?

I’m approaching this with the understanding that we should never close businesses or schools again. We have the tools to avoid this. This involves being proactive and not getting caught flat-footed.

I see two main pillars that we should be addressing. Pillar one is building resilient health care systems, and pillar two is really fostering resilient communities and environments.

Just focusing on the first one, building a COVID-resilient health care system, this really involves proactive vaccine and therapeutics procurement and perhaps production. We saw early on that our inability to produce these products locally was a true health security threat, and now we're taking steps to remedy this, but we still need momentum on that front.

Related to vaccine and therapeutic procurement is vaccine and therapeutic rollout to the population. We have to continue to be nimble and fast with policy to be able to keep abreast of emerging evidence in real time and convert this evidence into sound policy. It also means rolling out vaccines and therapeutics in an evidence-based and equitable manner with as few barriers as possible. That might seem abstract, but a good example of this is how, in parts of the United States, they're going to roll out COVID treatments at some pharmacies. Pharmacies are present in most neighbourhoods and are staffed with knowledgeable health care professionals; they often don’t require an appointment, and they're often more accessible than traditional routes for health care. COVID therapeutics at pharmacies without a prescription is just one of an infinite number of examples of how we can lower barriers to health care and provide fast, meaningful high-quality health care to populations.

The other big issue in the health care system is preparing for surge capacity. This involves outpatient care, hospital care and, of course, ICU care. We will see more variants. We will see more waves, and eventually we are going to have a real flu season coupled with COVID, and it’s going to be a challenge. We can’t continue to cancel scheduled surgeries every time we have a wave and our system is stretched. It's vital to have medium and long-term strategies to build more beds and to staff them, not just with doctors but also with allied health care providers. This involves meaningful investments making the health care sector a more attractive place to work, and, of course, less red tape preventing skilled health care providers who have trained in other countries and are now living in Canada from working.

Let's focus our attention now on building more resilient populations and environments. It's easy to say, hard to do. The lowest hanging fruit is normalizing mask use during COVID surges. This is a light-touch intervention, and while, of course, masking is not perfect, it still helps the individual, it helps vulnerable people, it helps the community and I think it's about as easy as it gets.

An additional strategy is further study on how we can build safer indoor spaces. This is where COVID and other respiratory viruses transmit. That, for example, includes improving indoor air quality. This involves an interdisciplinary approach with social scientists, engineers, infection specialists, building owners, building managers and others. It’s not just as simple as installing HEPA filters.

Last, I think an area for improvement includes enrolling social scientists, behavioural change experts and communications experts into the larger pandemic plans. We are going to continue to see rapid scientific advancements. We're going to see variants, we're going to see waves, we're going to see a fair bit of the unknown. Policy has to be data driven and relevant, and it has to keep up with our lightning pace of discovery. Some of what's true now may not be true in the near future. We need public trust and public buy in. Behavioural scientists and communications experts can help communicate change and adaptation and communicate the unknown in an age, language, and culturally appropriate manner. I think they'd be invaluable in our future pandemic response.

I have several other thoughts and I'm happy to keep the conversation going during the question period. Thank you for your time.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bogoch.

Next, Dr. Falcone, you have the floor. Welcome to the committee.

[Dr. Emilia Liana Falcone, Director, Post-COVID-19 Research Clinic, Montreal Clinical Research Institute, Attending Physician, Infectious Diseases, Centre Hospitalier de l'Université de Montréal, As an Individual]

Thank you, Mr. Chair and members of the committee, for offering me the opportunity to speak with you today. The thoughts that I will be sharing with you reflect my experiences during the COVID-19 pandemic as an infectious diseases specialist, researcher and director of the post-COVID-19 research clinic of the Montreal Clinical Research Institute. The views shared today are my own.

The COVID-19 pandemic began one year after I was recruited to the Montreal Clinical Research Institute. Prior to this recruitment, I spent eight years at the United States National Institutes of Health, completing my infectious diseases training within the National Institute of Allergy and Infectious Diseases, which is led by Dr. Anthony Fauci. During this time, I also obtained my Ph.D. at the University of Cambridge. This combined training in medicine and basic science laboratory research was essential in allowing me to anticipate, at the start of this pandemic, that there would be long-term sequelae of COVID-19. As such, I submitted a proposal for funding to CIHR in May 2020, which was unfortunately not retained. However, eight months later, I obtained sufficient funding from the Quebec government to allow for the opening of Quebec’s first long COVID research clinic.

This research clinic represents a novel clinical infrastructure where every patient is enrolled in a research protocol, allowing for a comprehensive clinical evaluation, parallel data collection, human specimen biobanking, and by extension, the completion of laboratory research almost simultaneously within the same building. We are therefore able to perform translational research, which is research where we have the privilege of learning first-hand from the lived experience of patients with long COVID, and can then use this information to inform our research questions in the laboratory.

According to the World Health Organization, WHO, post-COVID‑19 illness, or long COVID, is a condition that occurs in people who have had COVID‑19, usually three months after the initial infection, with symptoms that last at least two months and cannot be explained by any other diagnosis. Symptoms may occur even after an acute asymptomatic infection or after initial recovery, and may fluctuate over time.

The diagnosis of long COVID is therefore complex and often requires longitudinal follow‑up. In addition, the symptoms associated with long COVID are numerous, and many of them, such as fatigue and shortness of breath, overlap with other diseases. Some sequelae of long COVID can last more than two years, be extremely debilitating, and negatively impact patients' personal and professional lives, resulting in a number of patients being unable to return to work.

With a conservative estimated prevalence of 10%, the number of patients with the disease far exceeds the capacity of the specialist clinics already established in Canada, which can be costly to the Canadian health care system, as some patients may develop additional complications, while others will have to undergo several additional tests, in addition to being referred to several specialists.

Long COVID is a complex diagnosis to make, made even more complex by the fact that we do not yet have a full understanding of the cause of this condition. The management of long COVID is also challenging as it requires a multidisciplinary approach and we are currently lacking specific pharmacological treatment options. Without fully understanding the mechanisms that underlie the novel disease entity that is long COVID, it is challenging to identify reliable biomarkers that may either predict who will develop long COVID or help make a long COVID diagnosis. These biomarkers are especially important in the context where COVID testing by PCR is not available to all. Most importantly, the understanding of the disease mechanism is ultimately essential to identify therapeutic targets that may quicken the recovery from long COVID, especially if these treatments are administered early on in the course of the disease.

It is within this context that we need to be forward thinking and maximize our learning when faced with a new clinical entity such as long COVID or even a new infectious disease. One way to maximize this learning with a structured and efficient approach is through a translational research infrastructure that is integrated into clinical care pathways. The integration of a research clinic model, such as the one established at the Montreal Clinical Research Institute, into specialized centres across Canada would be essential for the rapid identification of diagnostic biomarkers and new therapeutic targets. This model would be even more effective if it were integrated into a network that would use standardized protocols and have an established infrastructure for real-time data sharing and integration. With this coordinated and rapid approach, we would further distinguish ourselves as a country, not only in the context of long COVID but also in the management of other complex and chronic diseases.

In addition, such an infrastructure would foster collaborations between government, industry and academia at both the national and international levels. Undoubtedly, these efforts will also allow us to be better prepared to rapidly manage the next pandemic.

I thank you again for the opportunity to speak to these issues, and I welcome any questions that you may have.

[The Chair, Liberal, Sean Casey]

Thank you very much, Dr. Falcone.

Next, we're going to hear from the Canadian Association of PPE Manufacturers.

Mr. Hunt, you have the floor for the next five minutes.

[Barry Hunt, President, Canadian Association of PPE Manufacturers]

Thank you, Chair and the committee, for the invitation to speak here today.

The Canadian Association of PPE Manufacturers, CAPPEM, is made up of 30 Canadian controlled private corporations, SMEs, who answered the government's call to produce PPE here in Canada.

At the start of the pandemic, Canada had no N95 manufacturers, testing labs, or national standards. Canadian hospitals only bought N95s from multinationals that sourced from foreign countries. The N95s in the national emergency strategic stockpile had expired long ago, and most had been destroyed.

When the pandemic hit, China, Taiwan, and the U.S., banned exports of N95s, and the U.S. locked Canada out of NIOSH N95 certification. When the chips are down, we simply cannot rely on multinationals or foreign countries to protect our country. CAPPEM was created to ensure that Canada would never again be vulnerable to foreign countries and multinationals for the supply of PPEs.

When COVID hit, Canada was desperate for PPE, but the multinationals could not deliver. The government response was three-fold. One, compete in the world market to fly in billions of dollars of overpriced PPEs, 30% of which were found to be defective, counterfeit, or contaminated. Two, sole-sourced multi-year contracts and grants to the same two multinationals, 3M and Medicom, who could not deliver foreign N95s to Canada, when Canada needed them most. Three, a call to action to Canadian business to create a new domestic PPE industry.

SMEs make up 99% of the Canadian economy. They employ 90% of the private work force and 10 million Canadians. Canadian SMEs are the economic engine of Canada and we are here to help.

Today, we need your help. Medicom and 3M represent the 1%. Multinational manufacturers of foreign goods have been invited now by government to manufacture N95s here in Canada with plants bought and paid for by Canadian taxpayers. They were given sole-source contracts in the order of $600 million to sell N95s in competition against Canadian industry. This undermines the entire domestic Canadian PPE industry.

Despite promises made by the government to support the new PPE industry with flexible procurement, Canadian SMEs have been locked out of both federal and hospital contracts for almost two years now. Unless government reverses course, we will continue to be locked out for the next decade, and perhaps forever. The federal government says it no longer has an appetite for PPE procurement. In other words, there will be no contracts for Canadian industry. Over 100 Canadian SMEs answered the government call to action, and 70% of them are now out of the PPE business—many now bankrupt, and others on the way to bankruptcy.

The remaining CAPPEM SMEs, committed to a sustainable industry, can now produce 800 million high-quality N95s, two billion medical masks, and millions of reusable N95s every year. However, while Canadian industry is suffering from a lack of hospital contracts and promised government contracts, and now faces additional unfair competition from dumping and unfair labour practices, because the pandemic tariff exemption for PPEs has long outlived its usefulness.

SME innovation drives Canada’s economic growth. There’s been more innovation in Canadian PPEs in two years than in the previous 50 years worldwide. We’ve created new filter materials, new elastomeric N95s that look like cloth masks, and a new CSA national standard for N95s with the highest performance requirements in the world. We’ve also developed the world’s first industry standard for bioaerosol masks to protect the general public from virulent airborne disease.

There is no stockpile today of suitable bioaerosol masks intended for the public. We believe this is a major failing in emergency preparedness. Some 14 major variants of concern have already emerged, with no signs of stopping. We need to prepare for the very real possibility that some day we may face a highly virulent strain. Canada’s eight-week stockpile of N95s would be gone in eight days. We have nothing in our stockpile to provide to our eight million children.

A sustainable domestic PPE industry is absolutely the right thing for Canada. It has overwhelming public support, but it does not have the government support to make it a reality.

We were unprepared two years ago for a virulent airborne pandemic. We are still unprepared today. We heard testimony from PHAC that we are “now well situated...with N95 respirators, with domestic manufacturing in Canada.” I can assure you that we are not. We need to support our domestic PPE industry now, or it won’t be there when we need it.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Hunt.

Next, we have the Canadian Cancer Society with Mr. Edmonds and Ms. Masotti.

[Dr. Stuart Edmonds, Executive Vice-President, Mission, Research and Advocacy, Canadian Cancer Society]

I'm going to start, Mr. Chair.

Thank you to the members of the committee for the opportunity to present today.

My name is Dr. Stuart Edmonds. I am the executive vice-president of Mission, Research and Advocacy at the Canadian Cancer Society. With me today is Kelly Masotti, vice-president of advocacy.

With respect and gratitude I am joining you today from the traditional territory of many nations, including the Mississaugas of the Credit, the Anishinabe, the Chippewa, the Haudenosaunee and the Wendat people, which is now home to many diverse first nations, Inuit and Métis people. I also acknowledge that Toronto is covered by Treaty No. 13 and the Mississaugas of the Credit.

Two in five Canadians are expected to be diagnosed with cancer at some point during their lifetime. Cancer is the leading cause of death in Canada, accounting for 28% of all deaths.

Today, we will share with you how the COVID-19 pandemic has impacted the cancer experience of many people living in Canada, and their loved ones.

Multiple waves of COVID-19 have put a tremendous strain on Canada's health care system. To ensure that there was sufficient health system capacity during surges of COVID-19, hospitals across provinces and territories were directed to pause all their procedures deemed non-urgent, including cancer screening, diagnostics and surgeries. This has subsequently led to a growing backlog of delayed cancer screening, diagnostics and surgeries, which means people living with cancer are waiting longer to receive care.

We know that when cancer is found early, it's often easier to treat. Delays in screening and diagnosis may result in poorer patient outcomes, including an increased risk of death.

The impact of COVID-19 on cancer prevention, diagnosis and treatment will be felt for months and years to come. Studies are starting to be published on how COVID-19-related delays impact people living with cancer. A recent Ontario modelling study published in the Canadian Medical Association Journal estimated that longer wait times for cancer surgery may lead to shorter long-term survival. This study highlights the importance of maintaining timely access to cancer surgery to prevent the harmful impacts of delayed care on people living with cancer, even during times when health resources are constrained.

In CCS-led surveys between July 2020 and March 2022, people with cancer reported having their cancer care appointments postponed or disrupted. Almost half the patients reported disruptions in the first wave of the pandemic, and while disruptions dropped over time, they have increased slightly since August 2021. In our last survey, one-fifth of respondents reported disruptions to their cancer care appointments.

For many patients there is a window of opportunity for treatment. Delays in appointments and treatment may lead to missed opportunities, and the cancer may have spread.

CCS-led surveys found that people living with cancer had higher rates of anxiety during the early stages of the pandemic. The sense of anxiety was higher among caregivers, with more than three-quarters of respondents stating they were more anxious than normal.

CCS continues to hear from people affected by cancer who say they are frustrated by a lack of access to their health care teams, and although this concern has lessened over the course of the pandemic, we're still supporting them through our support programs, and we're still hearing from people who feel forgotten.

We need federal leadership. CCS was pleased to see the introduction of BillC-17 on Friday, which would provide an additional $2 billion to address immediate pandemic-related health care system pressures, particularly the backlog of surgeries, medical procedures and diagnostics. We encourage all parties to work together and pass Bill C-17 promptly. Every moment matters as has been evident by the recent CMAJ paper. Cancer is not waiting, and neither should the government.

CCS also urges the federal government to continue to make necessary investments to expand the domestic capacity of vaccines, therapeutics and other life-saving medicines. We were pleased when the government launched the biomanufacturing and life sciences strategy last July, with a commitment of $2.2 billion expected to be allocated over seven years.

One of the strategy's key investments created a $250-million new funding stream, the clinical trials fund. CCS welcomes this funding and looks forward to the details on this development and implementation of this fund. These investments are critical to keep Canada at the forefront of new innovations in health care and provide really early opportunities for Canadians to access potential game-changing new therapies and diagnostics.

I now want to turn it over to my colleague, Kelly Masotti.

[Kelly Masotti, Vice-President, Advocacy, Canadian Cancer Society]

Thank you, Stuart.

I want to acknowledge I am joining virtually from Ottawa, which is the unceded territory of the Algonquin Anishinabe Nation.

The COVID-19 pandemic has also shown us that substantial gaps persist in accessing palliative care, particularly at home or in the community. Caregivers for a loved one at home experienced a sharp increase in their duties, exacerbating the need for greater psychosocial, physical, and practical support for caregivers. As a member of the Quality End-of-life Care Coalition of Canada, we urge the government to continue to implement the framework and action plan on palliative care, including an office for palliative care to help coordinate aspects like data collection on palliative care, and to continue to invest in palliative care research.

Finally, we encourage the federal government to play a role in ensuring that Canadians are set up for success in making healthy and informed choices that make it easier to live smoke-free, keep a healthy weight, adopt a healthy diet, be physically active, be sun safe and reduce alcohol consumption. The federal government can play a strong leadership role in implementing policies and programs that will have an important population health impact.

We would also like to take the opportunity to thank the government for supporting the extension of the employment insurance sickness benefit. This extension of at least 26 weeks will change the lives of Canadians.

We look forward to continuing to work together to implement these very important recommendations for people living with cancer and living beyond cancer, including encouraging all parties to work together to pass Bill C-17 promptly, improvements to the delivery of palliative care, the implementation and the extension of the employment insurance sickness benefit and to see the clinical trials fund be implemented.

We thank you very much for your time today, and we look forward to your questions.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Masotti and Mr. Edmonds.

Next, from the Canadian Mental Health Association, we have Rebecca Shields. You have the floor for the next five minutes.

[Rebecca Shields, Chief Executive Officer, York and South Simcoe Branch, Canadian Mental Health Association]

Thank you, Mr. Chair and the committee, for the opportunity to present today—

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

I have a point of order, Chair.

[The Chair, Liberal, Sean Casey]

Hold on a second, Ms. Shields.

Go ahead, Mr. Barrett.

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

I apologize for the interruption, Ms. Shields.

Through you, Mr. Chair, the bells are ringing in the chamber for a vote. The last time we discussed this matter at committee, some members indicated that in the future they would not grant unanimous consent, because it's their absolute privilege to vote in person in the chamber, which is 100% correct. I would ask through you, Mr. Chair, if we could seek the unanimous consent of committee members to hear the opening statements of all witnesses, if time allows, and then proceed to the House to vote. I say this just in case any of our witnesses aren't able to join us following the conclusion of that vote in the chamber.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Barrett.

Colleagues, Mr. Barrett is quite right that without the consent of the committee, we're obligated to suspend the meeting. Do we have the consent of the committee to proceed to hear the remainder of the opening statements before suspending?

[Some hon. members]

Agreed.

[The Chair, Liberal, Sean Casey]

I understand there is consent in the room.

Thank you very much for that, Mr. Barrett.

Ms. Shields, please continue.

[Rebecca Shields]

Thank you very much.

I think we all know and all heard about the impact of the pandemic on the mental health of Canadians. I want to focus my remarks today on two specific areas where I think the federal government can help. I was very pleased to see that the federal government assigned a new Minister of Mental Health and Addictions. My remarks will be specific to some of the deliverables of that position.

Our research shows that one in five Canadians felt that they needed help with their mental health through the pandemic, but they didn't receive it, because they didn't know where to get it. They didn't think help was available, or they couldn't afford to pay for it. Beyond just building more services, I want to talk today a little bit about “how”.

The first topic I want to talk about is youth services. One of the deliverables was to introduce a new fund for student mental health that will support the hiring of new mental health care counsellors, improve wait times for service, increase access overall and enable targeted supports for Black and racialized students at post-secondary institutions. This is critical. Twice the number of children and adolescents have experienced depression and anxiety since the pandemic began; 11% of all people who experience homelessness are youth; one in four youth has clinically elevated symptoms of depression; one in five has clinically elevated symptoms of anxiety; and 70% of all mental illness starts in youth at the ages of 12 to 17. However, what I'm worried about is that the government will give the money to colleges and universities to hire mental health counsellors, creating yet another silo of care that is not integrated. We all hear that the major challenge is that people don't know how to get services.

Rather than funding an already established system of care.... I want to show an example of how this works. In its wisdom, the federal government, through IRCC, funded our agency to provide holistic mental health care through settlement agencies and through welcome centres since the pandemic. Since the start of that program, we have served 292 clients. Of those, 85% experienced an improvement in their depression-related symptoms, and 89% experienced improvement in their anxiety-related symptoms and remain connected to their settlement services. Integrating care is vital, as opposed to establishing a whole new section where we have to then build relationships rather than connect them into a whole system of care.

The second area I want to talk about is the increase in substance abuse. I want to position this, though, in terms of a population perspective. COVID did not affect the genders or the populations the same. In fact, it was men who had higher rates of problematic alcohol abuse, up 28%, whereas for women it was only 18%. Men had problematic cannabis use, up 39%, and women just a little bit less. Overall, we also saw that females, especially females with children at home, had higher rates of anxiety and depression than men. They reported that men had more issues with social isolation and finance, where women had more issues with finance and caring for children. The situations are very different. “One size fits all” is not the solution. I urge the federal government, when it is designing a system of care to deal with substance abuse, to look at local solutions rather than broad public health strategies. It needs to invest in local communities where it can target populations directly.

I want to give another example of how this can work. Whether you look at OHTs or at health authorities, most of them have population-specific groups that bring together agencies who come together to deal with these issues. We have to leverage these and provide small community grants to be able to access these populations rather reach the norm through a broad scale, because COVID, as we know, impacted the mental health and the health of newcomers and minority populations far more often, or in far greater rates, than it did for white Canadians.

Really in summary, what I want to say is to integrate care with local existing, and do hyper-local responses.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Shields.

Finally, we have the Neighbourhood Pharmacy Association of Canada, represented by their CEO, Sandra Hanna.

You have the floor, Ms. Hanna.

[Sandra Hanna, Chief Executive Officer, Neighbourhood Pharmacy Association of Canada]

Thank you, Mr. Chair.

Honourable members, thank you for the opportunity to present to you today.

I am actually, first and foremost, a practising pharmacist who has had the privilege to work alongside my health system partners and governments in our collective efforts to meet the needs of Canadians as we weathered the storm of the COVID-19 pandemic over the past two years.

Today I join you as the CEO of the Neighbourhood Pharmacy Association of Canada, a not-for-profit trade association that represents leading pharmacy organizations, including chain, banner, long-term care, specialty pharmacies and grocery and mass merchandisers with pharmacies. We advance health care for Canadians by leveraging close to 11,000 pharmacies across the country in almost every Canadian community as integral community health hubs.

Pharmacies are often the first and most frequent touch point that Canadians have with the health care system, and 95% of Canadians live within five kilometres of a pharmacy. Canada's community pharmacies dispense over 750 million prescriptions annually, deliver the majority of influenza vaccinations each year, and in the past 12 months alone have administered over 18 million COVID vaccinations to Canadians, reducing the rate of illness and strain on an already overwhelmed health care system.... [Technical difficulty—Editor]

As we continue to navigate the steady stream of challenges caused by the pandemic, and as our federal political leaders reflect on the future needs of our health care system to support our citizens, treat those in need and protect our most vulnerable, there are even more opportunities to unlock the potential of pharmacy as a partner in communities across the country as we look to building resilient health systems.

Pharmacies and the robust supply chain that serves them have demonstrated unwavering commitment to Canadians and health systems throughout the pandemic as critical partners in the timely delivery of products and services, in mitigating supply chain challenges early on in the pandemic, and in helping Canadians to access vaccines and tests conveniently in virtually every community across the country. Without our services, medicine simply cannot get to Canadians.

Our priority is and always will be maintaining and continually improving access to prescription medicines for Canadians. While there are differences in opinion on a number of key files, including national pharmacare programs or pricing reform on patented medicines, we can all agree on one thing and it is that all Canadians should have access to the medicines they need.

Recent research demonstrates that while 82% of those surveyed support a national pharmacare plan, 70% of those supporters are opposed to a program that would replace their existing drug plans. In fact, 80% of those surveyed of those surveyed continued to be satisfied with their existing benefits. Canada's priority must be helping those who do not have coverage and those with insufficient coverage, including those with rare diseases, without disrupting the majority of Canadians who already do have drug coverage. By taking this approach we can minimize unnecessary expenses and costs to taxpayers, and allocate money to the many other critical health care priorities that we're discussing today.

The federal government can demonstrate leadership by establishing national principles to ensure an equitable approach while maintaining the integrity of existing plans. The government has previously also cited COVID-19 as a primary reason for delaying the implementation of the PMPRB's regulatory reforms. As we continue to see economies reopen, we can all agree that the pandemic is not yet behind us. Canadians deserve to pay a fair and reasonable price for their prescription drugs; however, reductions in prices have unintended downstream impacts on the professional pharmacy services that Canadians rely upon day-to-day to ensure timely access, safety, appropriateness and effectiveness of their therapies. We are concerned that the impacts of the proposed PMPRB regulations and guidelines on patient programs will be severe, and that the implementation of these regulations during an ongoing pandemic will add undo burden on pharmacists and pharmacy teams as they navigate the impact of these changes on pharmacy operations.

We have seen pharmacies offer critical supports in areas of testing and vaccination, and we know that we're just scratching the surface of pharmacy's potential to increase capacity in many public health and primary care areas. We know that there is a huge backlog of health care services, such as surgeries, chronic disease diagnoses and immunizations, that we must work together to catch up on,. This requires that every health care provider work to their full scope and capacity to improve access to care for Canadians.

With pharmacies across the country now participating in the distribution of COVID tests, and many conducting tests on site, pharmacies are uniquely situated to support the health system with disease screening and prescribing and dispensing of antivirals such as Paxlovid.

Pharmacies can also create capacity in public health as we catch up on the one in four Canadian adults, and up to 35% of children, who have missed or delayed a routine immunization due to the pandemic. Evidence demonstrates that convenience is a key driver to vaccine uptake, and the accessibility of community pharmacies provides convenience like no other.

There's a lot of work ahead of us, not only to alleviate the strains the COVID-19 pandemic placed on our health care system, but also to ensure that equity and equal access to services are delivered to under-represented communities from coast to coast to coast.

Neighbourhood pharmacies and our members remain committed to working with the federal government and all stakeholders to leverage the expertise of our teams to create capacity and fill gaps in care.

Thank you once again for this opportunity to speak with you today. I'd be pleased to answer any of your questions.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Hanna.

As was indicated, as a result of Mr. Barrett's point of order, we're now going to suspend.

Just for the benefit of witnesses, I want you to know that in 17 minutes, members of Parliament will be casting a vote. If they decide to go over to the chamber to cast that vote, we'll be looking at a delay beyond that 17 minutes of at least another 10 to 20 minutes.

This is a chance for you to stretch your legs, get something to drink and [Technical difficulty—Editor] would be to resume to take questions subject to a motion for adjournment. As of right now, we're suspended, and you have probably 25 minutes or more to yourselves.

The meeting is suspended. Thank you.

[The Chair, Liberal, Sean Casey]

I call the meeting back to order. I understand that we have quorum.

I see that our witnesses have their cameras off, but they're filing back in.

Before we begin with rounds of questions, I would like to advise the committee that we have support from the House of Commons to go 80 minutes, but that is 80 minutes beyond what the witnesses and the members committed to.

I'd be interested in hearing whether there have been any discussions in the room and whether there's any agreement as to how long folks are willing to go, subject to the availability of our witnesses. Or, do we just want to start and call for a motion for adjournment to be presented virtually at any time?

Mr. Barrett, do you want to lead off?

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

Just on that point, Mr. Chair, I think there were some discussions. I'm not sure that we have a concrete time. I can say that Conservative members are prepared to fulfill the 80 minutes remaining of House resources, provided that witnesses are available.

[The Chair, Liberal, Sean Casey]

I would suggest that we begin, and at the end of two full rounds we canvass the room.

I'm looking at the witnesses. Are you able to stick with us for an hour and maybe a little more?

I see thumbs-up all around. Thank you.

We're going to begin now with rounds of questions.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Chair, may I speak to the motion, please?