Health Committee on March 9th, 2023

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Fantastic. I couldn't agree more. I'm very proud to have an amazing indigenous midwife who cared for me in my first pregnancy and who is now caring for me in my second pregnancy. I know that I have a better experience because of that.

Dr. Nuyt, I could see that you were nodding, so I'd like to hear your view of midwives and infant care.

[Dr. Anne Monique Nuyt]

I'm going to stick to my field of expertise. I'm a pediatrician and a specialist in neonatal intensive care. That means that my view of things is biased, because all I ever see are the cases when things did not go well. I think it's more of a question for obstetricians.

I know that, by definition, pregnancy is not an illness. If the number of perinatal deaths has declined considerably, it's because of care. Of course, care is not only provided in university hospitals, but the situation could nevertheless be improved. There are many countries where the experience of childbirth with midwives is well documented.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Fantastic.

I'm going to switch to English but still continue with you, Dr. Nuyt, because I have very little time.

How important is adequate prenatal care to overall infant health?

[Dr. Anne Monique Nuyt]

It's very important.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Fantastic.

Is the fact that many first nations families and children in communities can't get access to adequate prenatal care concerning to you?

[Dr. Anne Monique Nuyt]

I would say yes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Goodridge.

Dr. Powlowski, you have five minutes, please.

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

Thank you.

Dr. Nuyt, you talked about the delays in getting approval for pediatric medications that aren't approved here but are already approved by the FDA, and I think you said EMA is the comparable organization in Europe. You also talked about accessing pediatric formulas.

In COVID we saw jurisdictions around the world all independently having to decide on approving different vaccines and different treatments for COVID, which would seem to me to be a rather inefficient process. I don't know about you, but working as a doctor, one of the wonderful things I've found about medicine is that it's universal. People all around the world suffer from basically the same problems. When you open someone up, they're exactly the same.

Now I'm going to ask you a bit of a political question.

Given the delays in getting approval, and delays in smaller countries like Canada, which fall behind bigger countries.... The FDA, for instance, has more people and probably more ability to rapidly assess which drugs should be approved. Does it make sense that every country has its own regulatory process? Do you think we ought to be considering more of a global approach in terms of an international regulatory system to test and approve new vaccines and drugs so that when we have something like COVID again or when there are new outbreaks of antimicrobial resistance, we're better able to respond rapidly to these problems globally?

[Dr. Anne Monique Nuyt]

I think it's very logical. As you said, medicine is universal. We read the research from our colleagues from everywhere.

I think it's very important that within each country we have an entity that can be le garant, like Health Canada, so that whatever is sold and approved in Canada is good for Canadian children and all Canadians. What we're calling for is enhanced conversations and collaborations—exactly.

As to giving an answer on whether it's with one jurisdiction or many, I think facilitating jurisdictions goes beyond my competence. Certainly we need to help each other, and probably this is what happened also during the pandemic.

Dr. Quach-Thanh, who has expertise on what happened with the vaccine approbation between all the countries, could answer that better than I could.

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

Before turning to Dr. Quach-Thanh about the same question, the WHO is currently in the process of developing a new international treaty on the control of infectious disease. Do you think that should be something that is included in that treaty?

I'll ask you first, Dr. Nuyt, and then I'll turn to Dr. Quach-Thanh for the same question.

[Dr. Anne Monique Nuyt]

Certainly I think approval of medication and the sharing of expertise need to be accelerated. In fact, children from Canada are recruited for the initial studies for medications that end up being approved in the U.S. but not in Canada, but then they're not approved in Canada. It speaks for itself that we need to have some collaboration. To what extent, I'll leave to the political aspect.

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

Dr. Quach-Thanh, do you have a response to the same question?

[Dr. Caroline Quach-Thanh]

I agree that more collaboration is needed. I still have to say, though, that during the pandemic, Canada had approvals almost at the same time as the U.S. The reason that we sometimes make different recommendations is based on our population, on our epidemiology and other factors.

In terms of Health Canada, I have to say they were quite expedient during the pandemic. They worked rapidly. They changed their process. They allowed NACI to be able to look at the data at the same time they were.

Yes, collaboration is needed, absolutely. I know that the EMA in Europe has collaborations between all European countries. Still, once EMA makes a recommendation, each country still has to review it. As Dr. Nuyt said, I still think we need to make sure that what we approve for our country is what we want. The legal implication in the jurisdiction might be different.

I agree with collaboration, but again, I'm not a regulator, so you might as well ask Health Canada.

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

Mr. Chair, how much time do I have left?

[The Chair, Liberal, Sean Casey]

You have about 20 seconds, if you want to make a final comment.

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

No.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Powlowski.

Mr. Thériault, you have the floor for two and a half minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Will I have another two and a half minutes in another round, Mr. Chair? Are these the last minutes available to me?

[The Chair, Liberal, Sean Casey]

They are your last minutes.

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Dr. Nuyt, you've done research into the lifelong health consequences of premature birth.

To your knowledge, how many studies have monitored or studied cohorts of preterm or extremely preterm children in Canada, or even around the world?

Are there any, and if so, how many?

[Dr. Anne Monique Nuyt]

In Canada, I'm aware of two main ones.

One was carried out by Dr. Sarah McDonald in Ontario, and the other by me with Dr. Luo Zhong‑Cheng in Quebec.

There have also been studies in Scandinavian countries. In fact, there are more and more studies being done around the world.

[Luc Thériault, Bloc, Montcalm, QC]

Over how many years did these studies track patients?

[Dr. Anne Monique Nuyt]

The patients we were looking at, meaning the cohort of young people who came back to our offices in adulthood, were aged 25 to 30 years. According to epidemiological data from the MED‑ECHO databases of the Régie de l'assurance de maladie du Québec, some patients were in their mid‑40s

[Luc Thériault, Bloc, Montcalm, QC]

So you are following up on patients from birth to 40 years.

How many people are in that cohort?