Health Committee on June 1st, 2022

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 23 of the House of Commons Standing Committee on Health.

Today we're going to meet for one hour to hear from witnesses for our study on the emergency situation facing Canadians in light of the COVID-19 pandemic.

Before I introduce today's witnesses, I have a few of the standard reminders for meetings.

This meeting is taking place in a hybrid format, pursuant to the House order of November 25, 2021.

For members, please wait until I recognize you by name before speaking, and please mute yourself when you're not speaking.

For the witnesses, if you aren't already aware, 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, of course. Please refrain from taking screenshots or photos of your screen. All of the proceedings today will be made available on the House of Commons website.

To our members, in accordance with our routine motion, I am informing the committee that all witnesses have completed the required connection tests, probably multiple times, in advance of the meeting.

Let me now welcome the witnesses and tell you how much we appreciate the efforts you have made to be with us. We very much look forward to hearing from you, and obviously you look forward to speaking to us. Otherwise, you wouldn't keep coming back and having to deal with the exigencies of democracy in Canada in June.

With that, we have with us here today, Dr. Wai Haung Yu, assistant professor, department of pharmacology and toxicology at the University of Toronto, and independent scientist, brain health and imaging, Centre for Addiction and Mental Health; Dr. Noni MacDonald, professor of pediatrics, infectious diseases, Dalhousie University and the IWK Health Centre; and from the Canadian Pharmacists Association, we have Danielle Paes, chief pharmacist officer.

Again, thank you so much for being with us.

We're now going to hear opening statements of five minutes or less.

Dr. Yu, we're going to start with you.

You have the floor. Welcome.

[Dr. Wai Haung Yu, Assistant Professor, Department of Pharmacology and Toxicology, University of Toronto, and Independent Scientist, Brain Health and Imaging, Centre for Addiction and Mental Health, As an Individual]

Thank you, Mr. Chair and the honourable members of the committee, for the opportunity to speak with you today.

As the Chair has mentioned my name is Ho Yu, and I'm an independent scientist at the brain health and imaging centre and geriatric mental health research services at the Centre for Addiction and Mental Health, or CAMH. I am also an assistant professor in the department of pharmacology and toxicology at the University of Toronto, and a member of the Canadian Association for Neuroscience, a professional organization with over 1,000 brain scientists across the country.

I am here to discuss the impact of brain health on society and the importance of research.

It's estimated that one in five Canadians experiences depression annually, and two in five young adults experience moderate-to-serious psychosocial stress. Through research, we also know that depression and anxiety are risk factors that impact older adults and contribute to dementias like Alzheimer's. This comes from not only clinical research, but basic or fundamental and translational research that untangles the complexity of the brain. In fact, disabilities from brain disorders represent the largest impediment to productivity. This alone is a major reason to tackle a problem that has only been magnified during the pandemic.

While COVID research is focused on its impact, spread and treatments, we need to consider the long-term biological and psychosocial effects from the pandemic to address the brain health needs of Canadians. Researchers have noted that individuals who are experiencing the greatest anxiety are also those who are most vulnerable to COVID, including young children and older adults.

During the pandemic, Canada invested extensively in research to ensure the safety and well-being of the people. This is an example that when resources are committed to scientific research, it can dramatically improve outcomes.

In March 2020, right before the start of the pandemic, I returned to Canada and came to CAMH, after almost two decades at Columbia University and New York University. I hope that I can represent a reverse brain drain, but this requires the support of stakeholders like you and your colleagues.

At CAMH, I have been able to maintain an innovative program in the lab, training early-career scientists, and working with my colleagues at CAMH to inform the public on brain health and aging.

From the 2021 census results, and globally, we know that one of the fastest-growing populations are the elderly. With colleagues across Canada and the world, our mission is to understand the intricacies of the brain, share our knowledge with society and hopefully abate an oncoming global health crisis of dementia.

Funding support is critical for the success of these health programs, and research is part of that integrated and comprehensive process. When we discuss translational and clinical research, we must also consider the fundamental basic science behind that. Canada has had a successful history of researchers, from fundamental science to application. Drs. Donna Strickland, Wilder Penfield, Maud Menten and Pieter Cullis are only some of the many transformational Canadian scientists. This requires funding support, so that we can maintain and continue to excel in the technology industry and maintain the tradition of science excellence in Canada.

At CAN we hope that this committee recognizes the importance of this research funding. In recent years, and especially during the pandemic, funding growth has slowed, including from the major tri-agencies, which are CIHR, NSERC and SSHRC. Couple that with inflation, and we are starting to lose pace in terms of research potential. Canada has slipped to sixth among the G7 nations in terms of R and D spending to GDP.

Research investment is not only important for brain health, but it's an economic multiplier, providing not just short-term economic growth, but high-value employment and long-term financial and societal dividends from these discoveries. We also train highly qualified professionals, not just the next generation of scientists, but entrepreneurs, policy-makers and medical professionals, ensuring the medical and technological success for generations to come.

COVID hit all of Canada hard, and that includes science. Labs face hyperinflation due to supply chain issues, rising wages, especially for those early-career scientists, and higher costs for newer technology to compete and innovate.

We ask that when the government consider funding priorities, tri-council investment in research be highly valued, including a 25% short-term stimulus, and commitment to sustained annual growth of about 10% to research programs to benefit society economically and medically.

I believe that Canada research is viable. We have a difficult task ahead of us when it comes to brain health and disorders, and we must also learn from the past, both errors and successes, to ensure that scientific research is robust in this country. We look to this committee and all MPs to sustain research investments through tri-council to support generations to come.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Yu.

Dr. MacDonald, you have the floor for the next five minutes. Welcome.

[Dr. Noni MacDonald, Professor of Pediatrics (Infectious Diseases), Dalhousie University and IWK Health Centre, As an Individual]

Thank you.

I'm pleased to be able to speak to the committee looking at the COVID-19 pandemic and the issues that have been raised. A number of them are very important.

One of the big issues that was raised was equity. There was inequity in the impact of the disease based on age. There was inequity in terms of vaccine access and acceptance. There was inequity in adherence to public health non-pharmaceutical measures. Also, we certainly saw a huge stretching of the health care systems across the country, some more seriously than others because of differences in the rates of the disease and the rates of vaccine acceptance across the country.

The WHO has recognized that one of the major problems we saw during this pandemic was the infodemic, the misinformation and disinformation, and it has had a huge impact on equity in terms of acceptance of public health measures and acceptance of vaccines. This has literally cost Canada millions and millions and millions of dollars.

We've done fairly well overall. If you look at Canada and COVID, compared to the U.S. we have about one-third the death rate per million. We are also better than the United Kingdom. We are around the rates for Israel, but we're not as good as Norway and a number of other countries.

I chaired at committee at the Royal Society of Canada, which issued report that looked at COVID vaccine acceptance. The framework was put forward and the executive summary was presented to you.

Vaccine acceptance is very complex. There are four domains that are in the framework as well as four themes, but in the domains, the usual ones we've always talked about are where people are in their place, their culture, their social societies and their organizations, but we've added the health care system, because it really mattered where the health care system was in terms of their practices and their policies, and in terms of the politics of what was going on during that time.

We also recognized immunization. It's the green box in the framework. The ability to access accurate and reliable knowledge was not the same across Canada and very clearly showed that we have a deficit in the ability of many in our population to think critically to be able to understand when somebody's trying to con them with misinformation and incorrect recommendations.

In the Royal Society of Canada report, there are a number of recommendations for the federal, provincial and territorial governments. In particular, I want to emphasize numbers 8, 10, 11 and 13.

Number 8 speaks directly to federal, provincial, territorial and indigenous governments, in asking that they “ensure that all aspects of all parts of the vaccination process”—and, I would reiterate, not just for COVID vaccines but for routine immunization, because not doing this costs us money as well—from approval of the vaccination programs to adherence to the “fundamentals that engender the development of trust”, are really understood. There's a table that goes with this in the full report.

Number 10 states “That all jurisdictions put laws in place that support the development and implementation of a National Immunization Framework that includes equitable access to vaccines” across our country, and this equitable access is for all—vulnerable minority groups, Blacks, indigenous people, persons of colour, children, the elderly, everyone—and that we adhere to the fundamentals that are important for that to happen, and that we support routine immunization across “all ages” and also support “immunization research”.

Number 11 states “That government departments, including departments of Health and Education” at the provincial and territorial levels, supported by the federal government, “work together to optimize immunization acceptance strategies.” This includes ensuring that we get critical-thinking education in our schools and, I would say, from grade 1 all the way through to high school and on to post-secondary education. Not doing this means that we are going to continue to be so susceptible to the infodemic, whether it's about health, climate change or even what provincial government party or federal government party is going to come in. There is so much misinformation out there.

The last one I wanted to emphasize is number 13, which is that federal, provincial, territorial and indigenous governments “aggressively support upgrading [the] electronic health information systems across [the] country to ensure” that all have “patient centred and fully integrated” health information systems.

Without this, we made a mess of trying to roll out and know who should get immunizations, who was at highest risk, because we simply didn't have that information. That's unacceptable in 2022, because we know how to do that.

Lastly, I want to say one other thing about our health care workers and those in public health. They have suffered significantly from what's called “moral injury”. They had to bear witness...and failed to be able to act in the way they wanted to act, because there was a failure to support them, to do what needed to be done to give the patients the care they wanted, whether they were patients in hospital or people in the community. That is just wrong.

To fix moral injury, it is not about giving them a wellness break and saying they are just burned out. No, it's about our institutions stepping up to support them, to give them what they need to be able to do the jobs they have been trained to do.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. MacDonald.

Next, from the Canadian Pharmacists Association, we have Danielle Paes.

You have the floor.

[Dr. Danielle Paes, Chief Pharmacist Officer, Canadian Pharmacists Association]

Thank you, Mr. Chair.

Good evening and thank you for the opportunity to bring a pharmacist's perspective to this important work.

My name is Dr. Danielle Paes. I am the chief pharmacist officer at the Canadian Pharmacists Association. Today I am joining you from the traditional and unceded territory of the Three Fires confederacy of first nations, the Odawa, Ojibway and the Potawatomi.

I'd like to focus my remarks on the impact COVID-19 has had on patient access to primary care and how this has changed pharmacy practice in Canada.

When the pandemic began, access to regular community health services for patients became very limited. Lockdowns meant that many clinics closed and wait times grew tremendously. Because pharmacies are designated as essential services, we stayed open. It was a scary time for us as we didn't know how the virus was transmitted or how to keep our staff safe.

Adding to this, with everything shut down, patients were coming into pharmacies in droves trying to renew all their prescriptions at once. Our set-up isn't designed to withstand that kind of demand and so it caused huge pressures on drug supply. With most of our medications manufactured outside of Canada, we didn't know if there would be a long-term impact on the supply chain and so we essentially spent the first few months trying to manage and protect access to medication.

At the same time, because we were among the few health care services seeing patients in person, we became a primary source for reliable COVID-19 information. It's only recently that we've started to truly understand the toll that those early days have had on our pharmacy workforce.

Fast-forward a bit, and as the committee will know, pharmacy teams have played a huge role in COVID-19 testing and vaccinations. In fact, we've administered over 17 million COVID-19 vaccine doses, and some provinces are now relying completely on pharmacies to administer these vaccines moving forward.

While the pandemic has dominated much of our attention, the opioid crisis continues to rage on. Thanks to a federal exemption provided under the Controlled Drugs and Substances Act, pharmacists have been able to close some of the gaps in care for patients who use opioids and controlled substances.

Before the pandemic, if a patient came into the pharmacy on a Friday evening for a dose of methadone, the prescription had expired and their doctor's office was closed, a pharmacist could not dispense that drug. The patient would have been sent to an emergency department or, worse—as we've heard—they would have turned to street drugs and risked an overdose.

In the current environment, especially as we're facing shortages of primary providers, access to additional services and care from pharmacists is proving to be extremely valuable to people living in Canada. Unfortunately, our scope and ability to offer equitable care across the country is limited. This is particularly true in our remote and rural communities and our northern territories.

Point-of-care testing, prescribing and the ability to adapt drug therapy are some areas of pharmacy practice that are vastly inconsistent from one jurisdiction to another. For example, in Quebec, pharmacists were the first in the world to be given the authority to prescribe Paxlovid to treat COVID-19. A few other provinces are now moving in the same direction but regulatory obstacles have prevented many patients who would benefit from this life-saving therapy from getting it quickly.

Limited access to basic care during the pandemic has been the reality for most people living in Canada. Nearly 15% of people went into the pandemic without a regular health care provider and about half had a hard time getting the care they needed in that first year. The reduced access to care throughout the pandemic and the backlogs we're now seeing across the country have also led to delays in diagnosing and treating chronic diseases, which will have long-term impacts on our health care system.

Pharmacists are already equipped with the skills, knowledge and expertise to take on further roles in primary care and should continue to be part of the solution, but to do so, we need adequate public funding. Other obstacles include lack of access to patients' medical histories, onerous administrative tasks, and barriers to providing virtual pharmacy services.

In closing, I'd also like to recognize the invaluable role that pharmacy technicians, pharmacy assistants and other pharmacy support staff have played as part of our efforts to address the urgent needs of people in Canada. They have put their lives at risk on the front lines and their critical contributions cannot be underestimated.

The pandemic has taken a devastating toll on all of us, but it has also been the catalyst that enabled pharmacists to care for our communities more effectively. We now need supports to maintain these positive changes to health care in Canada.

Thank you to the committee for the opportunity to share this with you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Paes.

Now, we're going to begin with the rounds of questions, starting with Dr. Ellis for six minutes.

Go ahead, please.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

I certainly want to echo the chair's comments to all three of you for being here, and your unbelievable patience. If I were on the other side of the call, I don't know what I might have done. I probably would have left, but that's just me. I'm not a very patient person. Thank you very much for your great understanding.

Dr. MacDonald, you talked a bit about the concept of vaccine hesitancy.

Could you characterize your thoughts on how Canada did, as a country, with respect to vaccine hesitancy?

[Dr. Noni MacDonald]

I can answer that wearing several different hats, my provincial hat, my Public Health Agency of Canada consultant hat, and also my WHO consultant hat.

Relatively speaking, Canada, depending on which province you were in, did brilliantly well or did not. We had quite a range across our country. Again, I think a big chunk of this was due to misinformation and disinformation. As well, we learned that what politicians say makes a huge difference. We had not appreciated before the COVID pandemic how much political impact there is on what people decide to do.

I helped draft the 2014 WHO report on vaccine hesitancy, and we didn't even talk about politics and the impact of that, nor did we talk about misinformation and disinformation, because it wasn't a big factor.

So, yes, there are big differences across the country, and there are, therefore, differences in vaccine acceptance, which led to differences in mortality rate per hundred thousand. It mattered where you lived.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Right.

Certainly we realize that even at the federal level, there's significant input via political interference. Again, stigmatizing, dividing and name-calling, etc., certainly were not in the playbook of vaccine hesitancy and moving that forward, which is exceedingly unfortunate. I realize that you would certainly agree with that.

I guess one of the things I always think are important are lessons learned and how we could do better in the future. Getting politicians not to talk is pretty hard, as you can tell.

[Some hon. members]

Oh, oh!

[Dr. Noni MacDonald]

There are two things I would raise in regard to that.

Number one is that the whole emphasis that I tried to put forward is that we really need to be teaching people how to do critical thinking, so they can understand when people are speaking to them whether or not they are using the techniques that we know sell misinformation and disinformation. You can be taught this. We know it. There's evidence to show that it works. When you do it, people are much less prone to misinformation and disinformation, even if it's coming from a politician.

This is the critical thing that needs to happen, and it needs to happen in our schools. We need to then move it on beyond that. Kids influence what their parents learn too, and it's a way of getting to parents. We need a national program that's going to address misinformation and disinformation.

I would say to all of you, each one of you as a politician, that you want to get that right, because you want your information to be out there being used properly, and “not disinformation”.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thanks, Dr. MacDonald.

That folds nicely into the next thing we will begin to look at. Certainly it's likely we would invite you back, if you would have us, so to speak, but we're going to start a children's study. Part of that is the negative effects on children with respect to COVID, and isolation and language acquisition.

Do you have any, perhaps brief comments, on what you have seen in some studies or what you have heard of what's going on?

[Dr. Noni MacDonald]

Sure.

Again, Canada was kind of a middle of the road. We did not shut our schools as completely as a number of other countries did, but we already have evidence that this still had a negative impact on the development of children, on their reading and writing skills. I think we will not know the full impact of the negative pieces that went with this for probably a decade or two.

The other part is that it was inequitable. There were families who don't speak English or French and don't have access. You can give them a Chromebook, but they don't know how to use it. They cannot read the instructions that are being sent by the teachers. So it was very inequitable how we tried to do virtual teaching.

I realize why it was done. There are some of us who think it was overdone and that kids could have gone back to school with masks much earlier. That's a whole other discussion to have. It was a lesson learned.

I would very much welcome coming back to talk more about what I think needs to be done for kids, and to try to prepare us for the next time something like this happens, but also prepare us to have kids for the next generation who are going to be much better prepared to not be swung by misinformation and disinformation. Too many decisions were made on mis and disinformation.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Dr. MacDonald, it's a bit of a hot-button topic, but we're talking about vaccines and adverse events, and certainly again those are going to be in our “lessons learned”, I think. Given the complex reporting requirements for adverse vaccine events, how do we then begin to unpackage what we know has happened? Again, I think that has to be part of our lessons learned.

[Dr. Noni MacDonald]

Let me stick to a couple of points, and I need to give full disclosure here. I was a founding member of the Global Advisory Committee on Vaccine Safety with the World Health Organization, so this is something that I've been very involved with for more than 25 years.

There is something we did not do well, and we know that communication is key. We know that negative information sticks three times as much as positive information, so how you present risks and benefits of a vaccine really, really matters. The language matters, how you frame it, how you tell the story. We had too many people who did not understand all the safety components we had in place in Canada and how all the vaccines that were approved here in Canada followed all of those steps. There we none that didn't follow those steps. Their approval required that.

We did not do good communication. People, again, jumped ahead of what the data was. There were inferences drawn that were just wrong. I think we should actually be proud. We picked up adverse events that were exceedingly rare. When you're talking about one in 700,000, that's not a common thing to happen, but when you're giving millions and millions and millions of doses, you're going to see some of those events. I think that was a surprise for the general public and maybe for some of the people who were not involved as much in public health and in immunization, where we fully knew this was going to happen, but our communications were not as they should have been.

When these events happened, I don't think we necessarily addressed them in such a way that people could understand the context and understand what they meant and didn't mean. I think there are many people out there who think that the adenoviral vector vaccines are terrible because you can get thrombosis and thrombocytopenia. They don't know that you get by far a higher rate of those with COVID disease than with the vaccine, for example.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Ellis.

Next we're going to go to Dr. Hanley.

Go ahead, please, for six minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Thank you, Mr. Chair.

Thank you to all three witnesses.

I also want to give a shout-out to Ms. Paes for the work of pharmacists during the pandemic and the incredible frontline work. You were really part of the last people still operating and serving Canadians, so thank you for that.

I'm also going to concentrate my questions on you, Dr. MacDonald. It's really good to see you. You gave a real tour de force in five minutes. I can't believe how much you covered that is left to unpack.

One area in which we know we have lost ground is getting adults their third dose or, in some cases, their fourth dose. That is leaving us more vulnerable. We don't know what's coming by way of recommendations, but knowing what you do about hesitancy, what do you think we need to do to promote or convince a behaviour change to encourage Canadians to get their third dose and the doses that will be recommended in future?

[Dr. Noni MacDonald]

I wish we could give you some magic silver dust that we could sprinkle across the country. There isn't any magic silver dust.

What we do know is that there need to be multiple strategies. We need to look very specifically at what the issues are in the communities where we're not having the uptake we need. We need to look at what their barriers are, their enablers and what we can do to make that happen.

I'm sorry that I can't be more precise. I give lectures that are an hour long that only touch the tip of the iceberg of the question you just asked.

There are a couple of things that we know make a difference. I wish we could get more people singing from the same song sheet, because we know it matters. That's why I pulled up the politicians in our health care system.

The other thing was—and Dr. Paes really said it—we didn't necessarily make this easy for people to get immunized. We didn't give them the opportunities to come in at 9 o'clock on a Saturday night or a Sunday night. We made it hard, and that undermined it.

The other thing—and everybody here better nod their heads—is that we all want COVID done. We are tired of it, and the general public is tired of it, but that has not made it go away. We're likely going to see problems to come.

I know we've done well, if we look overall, compared to the U.S., for example. However, we shouldn't be holding them up as a comparator, because they haven't done well. We've done quite well at doing two doses. We seriously need to do well with those 60 and up, with three doses; and at 70 and up, we need to do well with four doses, and for those who have underlying problems. Again, if we had a fully integrated patient-centred health information system, we would know who all of those people are, and so would the pharmacist when they walked in. Then, we would be able to really target all of those groups to get exactly what they need.

At the current time, we can't tell you who's missing. We can tell you who got immunized for COVID, but we can't tell you who's missing because we don't have that kind of information system.

Over.

[Some hon. members]

Oh, oh!

[Dr. Noni MacDonald]

I'm sorry; I could talk for hours on this.

[Brendan Hanley, Liberal, Yukon, YT]

I'm not over yet.

[The Chair, Liberal, Sean Casey]

You still have two minutes.

[Brendan Hanley, Liberal, Yukon, YT]

Okay, that's great.

I'm going to try to squeeze two more questions in.

[Dr. Noni MacDonald]

Great.