Evidence of meeting #42 for Health in the 44th Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was shortages.
A recording is available from Parliament.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
What I'm hearing is that we are basically ready to peak or are at the earliest stages of peaking, because with fall and with winter coming, this thing is going to get worse.
President and Chief Executive Officer, Children's Healthcare Canada
Typically, RSV would peak in the January and February time frame. Typically, our flu virus season would be a little bit later and towards the holiday season as well, so we're definitely seeing an early onset of both of these two respiratory illnesses.
I'm not confident to say that we're nearing the peak. I don't think we have the data to support that, but I do believe that the peak is still to come. We're already well above capacity in the vast majority of the children's hospitals and are taking urgent or unprecedented measures, including doubling the capacity of pediatric inpatient care units or looking at decanting children to adult care hospitals.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you.
Thank you for correcting me on being near the peak.
In your closing remarks, at the end you talked about how, if given a chance, you would be able to elaborate on some of the recommendations. Whatever time I have, Mr. Chair, it can be allocated to Ms. Gruenwoldt to explain or share with us the recommendations that she has.
President and Chief Executive Officer, Children's Healthcare Canada
Sure. Some of them are consistent with what we heard Dr. Ahmed, I believe it was, speak to earlier in thinking about how we create a pan-Canadian critical medications list specifically for children.
It's also thinking about how we coordinate education and communications campaigns for parents and caregivers to help them understand at what point they need to seek out urgent or emergent care and what sorts of symptoms they can manage at home safely and how.
As well, it's thinking about how we create a communications response not only for our children's hospitals but also for our community hospitals, and especially those in rural and remote communities, as well as our family health care teams and pediatricians, so that they have a line of sight into where are we today in terms of the shortages and when we can expect additional supply.
Then, lastly, I would say that we really still need a coordinated push on immunizations, generally speaking, whether it's a flu shot campaign or whether it's a COVID-19 booster or original vaccine for children. These are essential measures that we know work, just like we know our masks work.
There are lots of actions that we can take collectively at both the federal and the provincial level—and the local level—and we would like to see those measures put in place as soon as possible.
In the longer term, I think we do need to evaluate the merit of strategic reserves for these essential medications to make sure that we're not caught on our hind feet for shortages like these. I think we would also support a call from the Canadian Paediatric Society to have an expert pediatric pharmacological advisory committee tasked with reviewing these drugs that are in short supply and with considering a list of alternative agents.
Liberal
Majid Jowhari Liberal Richmond Hill, ON
Thank you, Mr. Chair.
I'm not sure how much time I have, but I would like to ask the witnesses to formally submit their recommendations to the committee.
Liberal
Bloc
Jean-Denis Garon Bloc Mirabel, QC
Thank you very much, Mr. Chair.
I would like to start by asking Mr. Mousseau a question.
I have in front of me an article from The Toronto Star, published on November 9, which mentions that the shortage of children's Tylenol is getting worse and that bilingual signage is part of the problem. Personally, this strikes me as a case of ordinary racism against Quebeckers and French-speaking minorities in Canada.
Mr. Mousseau, you probably know the subject better than the person who wrote this article. Can you confirm that this analysis is accurate?
Director General, Association québécoise des distributeurs en pharmacie
The language question is certainly not an issue. I would even say that it is part of the situations we are used to dealing with.
At the beginning of the pandemic, there was no signage in both official languages for some of the early vaccines and rapid tests. It was the same recently, when Quebec and Canada experienced a shortage of infant formula.
There are solutions that are fairly easily put in place, so there's no problem there.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
Now that I am reassured, I will move on to the crux of the matter.
You talked about the price of drugs, the price of supply and the mechanism by which distributors are paid and drugs are delivered.
As I told the deputy minister earlier, drug prices have decreased in recent years. As a result, some distributors have less revenue, while the demand for drugs is increasing. Essentially, this is reducing margins and hurting the ability of companies to keep a reserve supply of drugs.
Can you explain how regulation, and particularly federal regulation of list prices, can contribute to further shortages?
Director General, Association québécoise des distributeurs en pharmacie
Yes, of course.
There's a misconception that population aging has led to an increase in medication use, and by extension, higher revenues for distributors and wholesalers. That's not true. As you mentioned, the deflation of prices for patented and generic drugs is at play.
The distributor compensation model is based on a percentage of the drug price. Here's a real-life example. In Quebec, the distribution margin is 6.5%, but we have to apply a prompt payment discount, which lowers the actual margin to 4.37%. On a $50 drug, the distributor would get $2.19 no matter where the drug is distributed in Quebec.
Further to the reforms introduced by the Patented Medicine Prices Review Board, or PMPRB, the price of that drug could drop by 10%. Just like that, instead of getting $2.19, distributors would receive $1.97 for the same distribution activities, storage and reshipping.
Deflation translates into lower revenues for wholesalers. As a result, they need to think about the possibility of reducing inventories, because storage is expensive and inflation is high. That's where the problem lies.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
It's absolutely appropriate to regulate drug prices. As mentioned earlier, what the federal government is trying to do with these regulations is prevent excessive drug prices, but it almost seems as though the government forgot that the drugs have to be distributed. That's what you're saying.
Director General, Association québécoise des distributeurs en pharmacie
I don't think people understand how the drug supply chain works.
As I said, a mechanism is available to reduce the actual price for the payer, whether it's a provincial government, the federal government or an insurance company. It's called a listing agreement. Under that mechanism, it is possible to lower the actual price, which is already well below the list price.
The fact of the matter is that the PMPRB's reforms will not result in any actual savings for the provinces or the federal government because the price in the listing agreement is already below the new list price. That means the reforms won't have the desired effect but will, as a direct result, put wholesalers in a weaker position.
Jean-Denis Garon Bloc Mirabel, QC
Have you discussed it with federal government or Health Canada officials? Are they aware of that? Do they have a plan to deal with it, or is their only answer to import Tylenol from Australia?
Director General, Association québécoise des distributeurs en pharmacie
We've met with them a number of times. We've had many discussions. We've also had discussions with PMPRB representatives. We pay close attention to what the pan-Canadian Pharmaceutical Alliance is doing, because it's dealing with the same phenomenon, but its negotiations are confidential. At the end of all this, the reduction in prices will, once again, impede our ability to stock drugs and maintain regional service levels.
It's a real problem, but neither the federal government nor the provincial government has put a solution in place as of yet. We are in contact with the provincial government, as well. This is concerning because inventory levels may need to be revised given the new financial context. That's true for pediatric medications, but it's also true for all other medications.
Bloc
Jean-Denis Garon Bloc Mirabel, QC
I'm going to switch topics now.
A shortage is always a possibility. I understand that. Even if we had a more effective, more responsive regulatory regime, a shortage could still occur in a country like ours. We belong to the G7, and an idea being floated around the G7 is a list of critical molecules, which refers to a reserve of critical molecules and inventory management capacity.
How long has that idea been around? Is it something the federal government is aware of? How long has the federal government known it could be a good idea? Why hasn't the government followed through?
When people talk to me about it, I don't see it as something futile. I see it as something doable in a G7 country.
How is it there's no more Tempra for children?
Director General, Association québécoise des distributeurs en pharmacie
Some provinces have reserve inventory mechanisms in place for hospitals and institutional pharmacies. Those mechanisms aren't in place, however, for community settings. That's something we've recommended, and we are definitely putting the idea on the table. A discussion is certainly warranted to determine which critical medicines should be stockpiled. Inventories could be managed on a dynamic basis to take into account expiry dates and prevent wastage. Surely, that's a viable option.
That said, it's not the only option. A shortage can occur when supply drops or demand rises. The shortage in this situation is largely due to increased demand. While not every shortage can be avoided, this option would give the provinces and the country additional tools to deal with these types of situations.
Liberal
NDP
Don Davies NDP Vancouver Kingsway, BC
Thank you to all the witnesses for being here.
Dr. Ahmed, I have a couple of short snappers just to establish a context, and then I want to dig into some solutions. I want to check my perceptions.
Am I correct that Canada has had a long-standing problem with drug shortages?
NDP
Don Davies NDP Vancouver Kingsway, BC
Am I correct that this is a fairly broad and pervasive problem? It's not just a drug here and there; it extends to literally hundreds of drugs in a given year. Is that correct?
NDP
Don Davies NDP Vancouver Kingsway, BC
Am I also on the right track if I suggest that Canada's pharmaceutical supply has become overly dependent on foreign imports and global supply chains?
Physician, Critical Drugs Coalition
Particularly for IV drugs, which form the bulk of our critical drugs, that is correct.
NDP
Don Davies NDP Vancouver Kingsway, BC
Do you know if Canada's domestic production of pharmaceutical drugs has gone up or down in, say, the last 10 or 20 years?
Physician, Critical Drugs Coalition
Generally speaking, it has gone down. If we dive into the weeds of it, we are quite vulnerable for IV medications, which, again, form the bulk of our critical medications in a hospital.
