Health Committee on Nov. 15th, 2022

[Jean-Denis Garon, Bloc, Mirabel, QC]

I'm going to interrupt you, because I don't have much time, and you answered my question well. It's rare that civil servants answer well. I congratulate you on that, I'm very pleased.

When I look at the data, the Canadian situation looks worse than most of these places. I'd like you to tell me what other G20 country is at the same point today as we are, having to call health department officials before a parliamentary committee to get answers and try to understand these shortages. In Ireland, England and Germany, do parliamentarians have to question their health department officials to find out what is behind the shortages?

[Dr. Stephen Lucas]

I want to say something first and then my colleague Ms. Trombetti can answer your question in more detail.

First, there are factors that are unique to Canada. For example, demand has grown much more significantly in Canada, compared to other countries. The increase in demand started in August and has been going on since then.

There are also shortages of drugs elsewhere, such as Adderall in the U.S., that don't exist in Canada right now. So there are challenges in every jurisdiction.

As I said, there are factors today that are unique to Canada, particularly the fact that, for some products, demand has doubled, or even quadrupled.

[Jean-Denis Garon, Bloc, Mirabel, QC]

I understand.

What is Health Canada's obligation to communicate? There has been a shortage since the spring, and it took the Conservatives tabling a motion in our committee to try to find out what is going on. Despite that, we haven't had any data.

Since you are talking about supply and demand, I will use the example of the announcements that have been made this week on amoxicillin. What I'm hearing from the manufacturers and the people who trade in it is that it has created a panic among parents. In the last few days, the quantities of this drug that have had to be ordered are unprecedented.

What I understand from this, at least as an economist who has contacted the industry, is that the communications from Health Canada are so bad that people learn the bad news at the last minute and panic. You are part of the problem right now. You're contributing to the panic among parents and the abnormal increase in demand, which makes the shortage worse.

I have been paying attention to what the Minister of Health has said since the spring. He has said, among other things, that health funding is futile. Whatever else he has said, he has never alerted Canadians and families. He never reassured them and never explained the processes.

Do you have a job to do communicating with Canadians, or do we really need to drag you in front of a committee, like today, to make you talk?

[Dr. Stephen Lucas]

By the spring we were communicating on a weekly basis with industry and various stakeholders, such as pediatricians and children's hospitals. Since the latter part of the summer and early autumn, we have been doing it on a daily basis. So the level of involvement is very high. We communicate, but, importantly, they play their own role every day, too.

I will ask Dr. Sharma to—

[Jean-Denis Garon, Bloc, Mirabel, QC]

Excuse me, but I only have 15 seconds left.

At this time, parents are in a panic, so you understand that you must not have done a good job of communicating, right?

[Dr. Stephen Lucas]

I'll let Dr. Sharma respond to that.

[Dr. Supriya Sharma]

Mr. Chair, absolutely the point is well taken that communications need to be very carefully done when it comes to drug shortages. You don't want to precipitate any panic buying. What we've seen specifically with Tylenol and ibuprofen is that there was some tightness in supply back in the spring. There was an increase in supply as manufacturers stepped up to ramp up production. There were intermittent stock outages in different places, but really it was in August when there was more attention to the issue. That's when we saw this huge, drastic increase in purchasing. That's when it tripled and quadrupled, in August.

Again, it was variable across the country, but that's when we really had from the manufacturers the notification that they were unlikely to meet supply, and we then went to working with looking at alternatives to supply. That's when a lot of the communication started as well. We worked with the Canadian Paediatric Society to put out advice to patients. We worked with other stakeholders as well. Again, we had seen in August that some attention to this and some of the communications around it encouraged people to go out and potentially stock up and buy more than they needed. That's really when we started to see some of that shift in not being able to meet the demand nationally.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Sharma.

Go ahead, Mr. Davies, please, for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you, Mr. Chair.

On November 11 Health Canada announced that special imports of pediatric ibuprofen from the U.S. are awaiting distribution in Canada, and pediatric acetaminophen imports from Australia are imminent. The department didn't disclose how much was expected or how the stock will be divided, but it promised fair distribution of supply across Canada.

Can you please confirm how many doses of ibuprofen have been imported from the U.S. to date, and how many acetaminophen doses will be imported from Australia?

[Dr. Stephen Lucas]

I will turn to Stefania and Linsey Hollett to respond.

[Linsey Hollett, Director General, Health Product Compliance , Department of Health]

That is accurate in that we were prioritizing supply to hospitals and we were able to secure supply from two jurisdictions. Unfortunately, I'm not able to share the exact quantities, but what I can say around fair and equitable distribution is that you've heard a lot this morning on the importance that we placed on collaboration and a multistakeholder approach to the shortage. That is coming to benefit us greatly when we are determining fair and equitable distribution. We will look at things like historical patterns, certainly, and also, by having these open communication chains with pediatric hospitals, with provinces and territories, with health care professionals, we will have a very good line of sight on where need is greatest.

[Don Davies, NDP, Vancouver Kingsway, BC]

If I can interrupt, why can't you tell me how many doses have been imported? Is it that you know and you won't tell us, or you don't know?

[Linsey Hollett]

Thank you again for the question.

We work quite closely with market authorization holders. I'm sure you can appreciate that when we have confidential business information in our possession, we needed to treat it as such. Quantities have been established, but because of confidential business information, I'm not able to share them.

[Don Davies, NDP, Vancouver Kingsway, BC]

It's confidential how many doses Canadians can expect to receive of a medicine for their children that there's a shortage of? You won't tell them how many doses you have available?

[Linsey Hollett]

It's the information of those companies that are importing.

[Don Davies, NDP, Vancouver Kingsway, BC]

Do you have those doses? Have they been received in Canada?

[Linsey Hollett]

As I was saying, we are talking here about two different importations. One importation has arrived in Canada.

[Don Davies, NDP, Vancouver Kingsway, BC]

Is that from the U.S.?

[Linsey Hollett]

That's right.

[Don Davies, NDP, Vancouver Kingsway, BC]

Australia's you haven't received. When do you expect to receive Australia's?

[Linsey Hollett]

We expect to receive the Australian product this month. I don't have an exact date, but it's in the next couple of weeks. I can also say that to expedite the transport here to Canada, we are using air freight to get it here as quickly as possible.

[Don Davies, NDP, Vancouver Kingsway, BC]

I would hope so—not a boat.

Given that India and China account for approximately 65% of the world's production of active pharmaceutical ingredients, sometimes called “precursors”, do disruptions to these supply chains, such as geopolitical tensions or changes in export policies, have an impact on pharmaceutical security in Canada?

[Dr. Stephen Lucas]

Mr. Chair, as we've noted, the challenges with global supply chains and their exacerbation in the pandemic have been well noted and documented. We have worked with countries that produce those to sustain their importing, including for further fabrication in Canada, and we've worked as well to—

[Don Davies, NDP, Vancouver Kingsway, BC]

It was a yes-or-no question: Do they have an impact?

[Dr. Stephen Lucas]

Yes, they can have an impact. That's why we're working to diversify supply and strengthen manufacturing in Canada.