Health Committee on March 30th, 2022

[The Chair, Liberal, Sean Casey]

Mr. Davies, go ahead.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I'm mindful of the fact that we are now beginning the questioning at the time that the committee meeting was supposed to end, and I appreciate the 80 minutes. I cannot stay longer than 6:30 at the absolute latest, so that's a hard exit for me.

I'm not sure how much time the witnesses have who have been waiting since 3:30 eastern, but out of respect for their time, and those of us who have other obligations to go to, I would say that there should be a hard stop at 6:30. That would give us enough time for two rounds, I would think.

[The Chair, Liberal, Sean Casey]

That would give us two full rounds.

[Don Davies, NDP, Vancouver Kingsway, BC]

Maybe we can agree to do two rounds or 6:30, whichever comes first.

[The Chair, Liberal, Sean Casey]

I'll ask for a motion to adjourn at 6:30, and hopefully that will carry the day.

Very well, we are going to begin with rounds of questions, beginning with Mr. Barrett for six minutes.

Mr. Barrett, you have the floor.

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

Thanks very much, Chair.

Through you, Mr. Chair, to our witnesses, I want to extend my sincere thanks for your appearance today, and also for your patience as we engage in democracy, voting in the House of Commons today. Thank you very much for your patience and for your statements today.

I want to go back to Dr. Bogoch.

It seems that you spoke quite a while ago now. You said that we can't cancel surgeries anymore, we can't be closing businesses and we can't close schools, because we have the tools to make sure that it's not necessary. I agree.

I'm wondering if you can take a moment to expand on some of the ways that we can innovate to increase capacity in our health care system.

[Dr. Isaac Bogoch]

Obviously, we could spend hours on this, but I'll be as brief as possible.

In terms of expanding health care, we have to be a little bit creative as well. One thing is we need more people working in health care and we need more beds. That's a solid investment over time and it's a solid investment to train individuals.

We also have very skilled health care providers in the country who are not able to work. These are internationally trained graduates and foreign medical graduates. They're involved in multiple health care professions beyond medicine, nursing and other allied health care professions, and they are not able to work because Canada has not accepted their credentials. There's a lot of red tape in Canada preventing them from working. We have way more health care providers in the country than are mobilized at this point, and they're eager to work. That's an area we can explore further.

Related to preventing shutdowns, we have the tools. We have very simple tools, like masking. Masks alone don't stop a wave, but they certainly blunt a wave. They protect vulnerable individuals. We have vaccines and we have a growing array of therapeutics that are slowly launching in out-patient settings. That's really good. Vaccines keep people out of hospital. Therapeutics can keep people out of hospital. We have to have timely and equitable access to them.

My pharmacy colleague on this call will be much better prepared to answer this than me, but pharmacies and pharmacists are in every neighbourhood. They're accessible. They can do the testing. They can do the treatment. I appreciate that there are drug interactions. Who's better to look at drug interactions than a pharmacist? They're qualified health care providers who can provide timely access to health care on the neighbourhood corner, without some of the barriers that exist with more traditional aspects of care, like seeing your primary care provider.

We can expand on all of those fronts, but we have the tools and we'll have a growing array of tools to really help prevent people getting sick and landing in hospital, such that we don't have to, for example, cancel scheduled surgeries, like we've seen in the past.

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

Thank you very much for that answer—

[The Chair, Liberal, Sean Casey]

Mr. Barrett, I'm sorry to interrupt.

I just got a note from the clerk that we're going to lose Ms. Shields in about 10 minutes. I wanted to alert you to that. If the next couple of questioners have questions for her, they [Technical difficulty—Editor].

Go ahead, sir.

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

Thank you, Chair.

Following up on Dr. Bogoch's point, Ms. Hanna, what are the regulatory burdens that restrict the ability of pharmacies to expand their service offerings to complement and support our overwhelmed health care system in some of the ways that Dr. Bogoch mentioned and that you mentioned in your opening remarks?

[Sandra Hanna]

Dr. Bogoch mentioned it, and he stole the words right out of my mouth.

Pharmacies and pharmacists are not only in every community, but we're also supplied by a very robust supply chain that allows us to have timely access to these therapies in every single community. At the moment, depending on the province.... Obviously, the jurisdictions and the provinces vary in the scope of practice and ability of pharmacists to prescribe certain products. Dr. Bogoch mentioned that these products should be available without prescription, and pharmacists can still counsel, supply, educate and ensure that these products are made available to the right patients in an equitable, accessible and safe way.

In terms of regulatory barriers, if it is not a prescribed product, it's a question of supply, of access and of its being available through the pharmacy sector, which, in many provinces right now, it is not. It is restricted to primary [Technical difficulty—Editor] testing or public health centres.

I think it's more of a planning question and making it accessible to the pharmacy sector to make it accessible to Canadians.

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

Thank you very much for that.

I have just under a minute left. We heard talk about vaccines and the availability of some of these different products.

With my remaining time, Chair, I want to provide the committee with notice of a motion. I'm not moving a motion; I'm providing notice to the committee. It's been sent to the clerk in both official languages. It reads:

That, pursuant to Standing Order 108(2) the Committee undertake a study on the government’s role in the development and procurement of the Medicago vaccine and that the Minister of Innovation and Minister of Health be invited to appear before the committee to testify.

That's also being made available now to the clerk in print in both official languages.

With my last five seconds, I want to again thank all of the witnesses for their patience, their expertise and their ongoing advocacy for the health and well-being of Canadians.

Thank you very much.

[The Chair, Liberal, Sean Casey]

Thank you, Mr. Barrett, and thanks for watching the clock.

We're going to Mr. Jowhari next for six minutes, please.

[Majid Jowhari, Liberal, Richmond Hill, ON]

Thank you, Mr. Chair, and thanks to all of our witnesses. We really appreciate your patience and your insight into the topic that we're talking about.

I'd like to also thank my colleague for allowing me to take his place.

Ms. Shields, you will be leaving soon, but welcome to our committee. You and I have been working very closely on the mental health front in the York Region for the past couple of years. In your opening remarks you talked about youth services and also about integrated care. First of all, I want to thank you for the work that you're doing in the York Region community as the CEO of the CMHA.

I also want you to provide us with some insight into the innovative initiatives that are currently under way by your branch, which is the mental health crisis hub. Perhaps you could kindly talk a little bit about it with the view of integrated care and the community base, as well as why this is leading in Canada and how our federal government can support you.

[The Chair, Liberal, Sean Casey]

The floor is yours.

[Majid Jowhari, Liberal, Richmond Hill, ON]

I think she's on mute.

I think Ms. Shields might have gone....

[The Chair, Liberal, Sean Casey]

She is still on the screen, but her camera and her mike are off.

All right. Do you have another question, Mr. Jowhari?

[Majid Jowhari, Liberal, Richmond Hill, ON]

No, I'll yield my time to my colleague, Dr. Powlowski.

[The Chair, Liberal, Sean Casey]

We have Dr. Powlowski, please.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

Dr. Bogoch, I wanted to ask you about medical therapeutics.

In the last two years we have been on a number of committee meetings together, and you probably heard my questions about this. In Ontario, we now have two forms of therapeutics that I think are fairly readily available: Paxlovid, an antiviral, and also sotrovimab, a monoclonal antibody. Both have been shown to be quite effective in preventing hospitalization and serious illness when given early to high-risk people.

Off the top of my head, my numbers are that sotrovimab results in an 80% reduction in hospitalization, and with Paxlovid, I think the original studies were that it was 90%. Now those are probably out of date. It would seem to me that this ought to be a big part of trying to ensure that future waves don't end up shutting us down. When people who are at high risk get sick, they should be able to access these treatments, and thereby we can prevent a lot of hospitalizations, ICU admissions and deaths.

Let me start off by asking this: Are you using those forms of therapeutics very much, and are doctors in Canada using them as much as they ought to be?

[Dr. Isaac Bogoch]

Thank you for your question.

Yes, this is obviously a rapidly expanding area in Canada. Just to rewind for a second, earlier in the pandemic we had some very good therapeutics for hospitalized patients [Technical difficulty—Editor] an armamentarium of therapies for non-hospitalized patients with the whole goal to prevent people from getting sick and landing in hospital.

There have been hiccups, unfortunately. Sotrovimab, for example, and the other monoclonals don't seem to work very well against the current omicron variant. They are not being used, or not being recommended. Paxlovid is in very short supply and has a very narrow range of use. It has to be used very early on in the course of illness and has to be initiated within about four or five days of the onset of illness.

This really dovetails beautifully with our earlier conversation about getting therapeutics out quickly and in a low-barrier manner. For example, of course, we have family physicians, maybe emergency departments, maybe dedicated COVID centres, but also pharmacies and pharmacists, because they're available and they're everywhere. Pharmacists are highly qualified health care providers who can provide this quickly. They can also do the testing on site and respond to that test in real time by providing a drug that's needed in a very timely manner.

We are using these drugs. We're using them to a limited degree because we have (a) a limited supply, and (b) unfortunately omicron took the monoclonals out of our tool box, because they just don't work as well on it. There are a few others that work okay in an outpatient setting, for example, remdesivir, but again, that's an intravenous drug, so it's a bit more challenging to use. With time, we will have more access and more drugs available, and we can put those to good use.

[Marcus Powlowski, Liberal, Thunder Bay—Rainy River, ON]

My impression is—and this impression results from my not having enough to do as a member of Parliament, so I work Saturdays at a walk-in clinic. I see quite a few people with coughs, and nobody is doing PCR tests anymore; everybody is doing rapid testing, and everybody knows the drill. Okay, it's negative the first time, so we'll test tomorrow and the next day, and it becomes positive. They're quite familiar with it.

I don't think—and correct me if I'm wrong—that a lot of the public knows that therapeutics work or are available, so I'm a little worried that a lot of people who could be getting treated aren't getting treated because there's a lack of awareness that if you are at high risk—if you're 65, obese and have had one shot—maybe you ought to be getting Paxlovid or something.

[Dr. Isaac Bogoch]

For sure, 100%. I'll go back to my five minutes of time I had earlier. I think it's extremely important to enrol social scientists, communications experts, and really engaging in a culturally appropriate manner so that they're aware that vaccines are widely available and necessary and that therapeutics are increasingly available, and here's how you get them. We can go a long way. We certainly are underutilizing our social scientists and our communication experts. There are populations at risk who remain at risk, and they will have growing access to these drugs that are underutilized.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Bogoch and Dr. Powlowski.

Mr. Thériault, you have the floor for six minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Falcone, I am very pleased that you accepted our invitation. I hope that CIHR, or the Canadian Institutes of Health Research, will show as much innovation and research spirit as the Government of Quebec has done.

That said, I have nearly 15 questions to ask—we'll see what we can do in six minutes—which are divided into different categories. First, there are the risk factors, the effects of vaccination on long COVID, and the symptoms. Why do there seem to be more cases in women, for example? What about recovery and the effects of long COVID? There were fewer NAATs, or nucleic acid amplification tests. Is this related to the effects of long COVID? Anyway, I'll start.

Are there any particular risk factors that might accentuate the possibility of developing long COVID?

I am aware that in eight months you may not have been able to get all the answers to the questions I have today. Please feel free to tell me so.