Health Committee on March 21st, 2023

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 57 of the House of Commons Standing Committee on Health. Today we meet with witnesses for the final panel in relation to the study of children's health. I have also saved some time at the end of the meeting for committee business, so that we can consider study budgets and the amendment deadlines for upcoming meetings.

Today's meeting is taking place in a hybrid format, pursuant to the House order of June 23, 2022. I have just a couple of comments, primarily for the benefit of witnesses, all of whom are online today. Interpretation for you is at the bottom of your screen. You have the choice of floor, English or French. Screenshots or photos of your screens are not permitted. The proceedings today will be made available via the House of Commons website.

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

I would now like to welcome our witnesses, who are with us this afternoon by video conference.

With have with us Professor Nathalie Grandvaux, Université de Montréal; Professor Alain Lamarre, Institut national de la recherche scientifique; Dr. Erik Skarsgard, member of the Pediatric Surgical Chiefs of Canada; and Patsy McKinney, executive director of the Under One Sky Friendship Centre.

Thanks to all of you for taking the time to be with us today.

Each of you has up to five minutes for your opening statement.

We will begin with Professor Grandvaux.

Welcome, Professor.

[Dr. Nathalie Grandvaux, Professor, As an Individual]

Thank you, Mr. Chair.

Mr. Chair, committee members and witnesses, thank you for this opportunity to appear as a full professor from the Université de Montréal and director of the host-virus interaction laboratory at the CRCHUM, Montreal.

I am the co‑founder of Quebec's COVID pandemic network, the RQCP, which I co‑managed until 2022. I am also a member of the Coronavirus Variants Rapid Response Network, or CoVaRR‑Net, which is funded by the Canadian Institutes of Health Research.

I have no conflicts of interest to declare today.

During the initial outbreak of COVID-19, it was evident that children were much less affected by severe acute respiratory symptoms than adults, and particularly the elderly. These observations guided initial public health policies. Children were included in population health measures to limit the general impact of COVID-19 on vulnerable people and to protect the capacity of our health system, rather than to specifically protect their health.

Across Canada, different measures have been taken to limit the transmission of the virus, including at different times the closure of schools, the use of remote education, mask mandates, vaccination or the use of air purifiers. It is reasonable to note that these measures have certainly had negative impacts as described by social science experts.

The optimistic assessment at the start of the pandemic regarding the impact of COVID-19 on children has led to many questions about the relevance of the sanitary measures imposed on children. However, considering that knowledge of COVID-19 has only been made as the pandemic has progressed, several scientists, including me, have supported the application of the precautionary principle in the management of COVID-19 for children.

What is the state of knowledge after three years of the pandemic?

First, the airborne transmission of SARS-CoV-2 is now recognized by the World Health Organization and other public health bodies, and has achieved consensus among the scientific community. It is now clearly established that COVID-19 is transmitted in schools and spreads from schools to homes. Not all children are equal when it comes to complications from COVID-19, and some of the children are also living with relatives who have vulnerabilities to complications related to COVID-19.

The first serious complication observed in children was the multisystem inflammatory syndrome, which has had an incidence of up to six to 10% depending on the age group according to certain studies before 2022. The omicron variant, however, led to a significant increase in transmission among children, accompanied by a major increase in hospitalizations.

It is now clearly established also that COVID-19 is not a disease of the respiratory system only. The acute phase presentation was only the tip of the iceberg. There is now ample evidence of the short- and long-term effects of infection and reinfections. Several studies have now described neurological, cardiovascular and other multisystem impacts of COVID-19 in adults and children independent of the initial presentation of their disease. We can easily imagine that long-term illness will have a major impact on the social well-being and learning ability of children.

The immunity established by vaccines and past infections does not confer complete and infinite protection against reinfections. Immunity to SARS-CoV-2 infection remains relatively short, leaving the children vulnerable to reinfections leading to lost learning days.

We have made a lot of progress in the face of COVID-19, it must be recognized, however, we must draw lessons from our current knowledge. The risk of SARS-CoV-2 infections on children cannot be ignored. Therefore, what is the avenue that we should take in this context to ensure, in the least restrictive way possible, the health but also the learning of children?

Were we right to use methods of limiting transmission in schools given what we know today? My answer is most definitely yes. The precautionary principle and the measures put in place have made it possible to limit infections that have potential for long-term effects. Relying on hybrid immunity established by vaccination and repetitive infections involves the risk of developing long-term complications, the post-vaccination rate of which remains to be determined with accuracy. This risk is not acceptable.

There is an urgent need to consider airborne transmission of SARS-CoV-2 in infection prevention and control. Ignoring it is no longer an option for the long-term management of COVID-19. One of the key measures that must become a priority in our schools, but also in busy public and private environments, is the improvement of indoor air quality through sustainable measures that do not depend on individual human behaviour. Some countries have already committed to implementing such measures, and we must follow in their footsteps to enable a passive reduction of airborne transmission, and thus reduce the need for the use of restrictive personal protective measures. Good indoor air quality has the advantage of protecting against COVID-19 infection, independent of circulating variants, but it also protects against a wide range of other respiratory infections.

Improving indoor air quality is a new frontier in public health, requiring commitment from our leaders at both local and political levels. Just as access to clean water has eliminated the transmission of certain infections in the past, improving air quality will reduce the impact of airborne viral infections.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Grandvaux.

Next we're going hear from Dr. Alain Lamarre from the Institut national de la recherche scientifique.

Welcome to the committee. Please go ahead.

[Dr. Alain Lamarre, Full Professor, Institut national de la recherche scientifique, As an Individual]

Thank you, Mr. Chair.

I wish to thank the committee for inviting me to this meeting. I am a research professor at the Centre Armand-Frappier Santé Biotechnolgie of the INRS, or National Institute of Scientific Research, Laval. I also hold the Jeanne and J.‑Louis Lévesque chair in immunology. For more than 30 years, I have researched immune antiviral responses and the development of vaccines and immunotherapy to fight cancer and infections. I would like to speak to you today about the importance of adequate funding for health research, particularly for the development of new vaccines, and for maintaining children's immunization status.

Various stakeholders who have appeared at previous committee meetings have highlighted the negative impact that the COVID‑19 pandemic has had and continues to have on a number of health determinants and on the education of children in Canada, particularly among indigenous peoples, racialized populations and those living in poverty. Among the negative effects of the pandemic, we expect children's immunization status to suffer in the future. That decline could have serious effects on public health and expose certain children to serious infectious diseases that can be prevented by immunization.

There are various possible explanations for the decline in immunization, but one merits closer attention, in my opinion. I am referring to the increase in disinformation related to the COVID‑19 vaccination campaign which has caused some fear in parents when it comes to having their children vaccinated. It is therefore essential to better understand the key sources of vaccine hesitancy among the public in order to better equip parents through reliable information about immunization so they can make informed decisions about vaccinating their children.

I would now like to take a few minutes to discuss the importance of significantly increasing research funding in Canada, including research on pediatric diseases. There are still a number of gaps in our ability to prevent and treat various childhood infectious diseases. Those include respiratory syncytial virus, which caused serious respiratory distress among children last fall and for which there is still no vaccine.

I have been a professor at the INRS for more than 20 years and have observed a significant drop in research grants in Canada in that time. Funding for biomedical research in Canada comes primarily from the Canadian Institutes of Health Research, or CIHR.

According to a recent analysis by the Canadian Association for Neuroscience based on CIHR data, the success rate of funding applications in CIHR open competitions has dropped steadily since 2005, falling from 31% to below 15% in 2018. Moreover, the budget for approved funding applications has dropped by more than 25% overall, further highlighting the glaring lack of funding.

In addition to the lack of funding for research labs in Canada, there has been no significant increase in the amounts awarded to graduate students by the three federal councils, in most cases, for more than 20 years. As a result, some graduate students are now below the poverty line and are in precarious financial situations. This discourages a number of such students from pursuing a research career.

According to data from the OECD, the Organization for Co‑operation and Economic Development, Canada is the only G7 country where whole gross domestic expenditures on research and development have been in decline since 2001. It is now second from the bottom among G7 countries in this regard, with only Italy spending less. The United States, for instance, invests three times more per capita in research than Canada does. This clearly illustrates the considerable effort that Canada will have to make to become one of the world leaders in this regard.

To contribute to the examination of these strategic issues, I would like to suggest three measures that the Government of Canada could consider to maximize the benefits of its investments in biomedical research.

First, Canada's federal investments in research must be increased by 25% immediately, and by 10% per year for the next 10 years so Canada can catch up to other G7 countries in this regard.

Secondly, federal investments in cutting-edge research facilities and in their long-term operating and maintenance costs must be maintained and increased, through the Canadian Foundation for Innovation.

Third, the amounts of student research grants have to be reviewed and indexed to inflation so that young people do not lose buying power and therefore also lose interest in a career in research.

In conclusion, the COVID‑19 pandemic highlighted the need for a rich and diverse research ecosystem in order to be better prepared for future health crises.

If Canada wants to once again be a world leader in research and development, over the next decade it will have to make a significantly greater effort and make massive investments in research grants, particularly for children's health.

Thank you for your attention. I am available to answer your questions.

[The Chair, Liberal, Sean Casey]

Thank you, Professor Lamarre.

Next, we have a member of the Pediatric Surgical Chiefs of Canada, Dr. Erik Skarsgard.

Welcome to the committee, Dr. Skarsgard. You have the floor.

[Dr. Erik Skarsgard, Member, Pediatric Surgical Chiefs of Canada]

Good morning, Mr. Chair.

I'd like to begin by thanking this committee for the privilege of attending today. My name is Erik Skarsgard. I am a pediatric surgeon in Vancouver and surgeon-in-chief at the British Columbia Children's Hospital. I am also a member of the Pediatric Surgical Chiefs of Canada. I have no conflicts of interest to declare.

I've been practising pediatric surgery in Canada for 22 years. For much of that time I've been able to deliver timely, high-quality surgical care to children and their families. That has changed. Increasingly, my surgical colleagues and I are unable to look in the eyes of parents of children who need surgery and tell them with confidence that their child will be all right. This causes anxiety for families and moral distress for our surgical teams, who feel helpless in their ability to ensure optimized health outcomes for the children they treat.

The root cause is reduced access to scheduled surgery for children due to a severe contraction of capacity. This is not a new problem. It was first revealed by the 2007 federally funded Canadian pediatric surgical wait-times project, which resulted in nationally endorsed, diagnosis-specific wait-time targets across the spectrum of children's surgery.

Delivery of surgical care within a benchmarked wait time is critical to optimizing developmental and functional outcomes, with significant delays threatening a child's vision, hearing, speech development, mobility and learning potential, with risks of avoidable pain and long-term disability.

As late as 2018, national data confirmed that only 65% of scheduled surgery in Canadian children's hospitals was performed within the window. With the arrival of the COVID-19 pandemic and the more recent respiratory viral “tridemic”, things have only gotten worse. Surgical wait-lists have essentially doubled, and the percentage of children waiting longer than their wait-time target is as high as 70% in some provinces.

What factors have caused this?

As you are aware, we are in the midst of a human health resource crisis, with a reduced pipeline of specialty-trained nurses to care for hospitalized children with increasingly complex care needs. These include nurses who work in surgical areas like the operating and recovery rooms, but also nurses who work in the emergency departments, wards, and in mental health and critical care areas. It cannot be overstated that this crisis is affecting the care of all children, not just those in need of surgery. The workforce shortage extends beyond nursing to allied health, anaesthesia and subspecialty pediatricians and surgeons, including some hard-to-recruit specialty areas such as pediatric ophthalmology and cardiac surgery.

Many children's hospitals face space shortages, particularly in terms of operating rooms, minor procedure rooms and outpatient clinic space. When surgeons are not in the operating room, they are usually seeing patients in an ambulatory clinic setting. Some specialties have very long wait-lists for new referrals, and despite innovation in referral management, including centralization and the increasing use of telehealth, there are children who are languishing on referral wait-lists with time-sensitive diagnoses. These children represent an unmeasured demand for surgery.

Fewer than a half of all operations in children 18 and younger are performed by trained pediatric surgeons in children's hospitals. Across the provinces there is poor integration between specialty services uniquely available in children's hospitals and community-based services with the capacity to deliver surgical care to some children. In our geographically vast provinces this disconnect means that families often travel to a children's hospital to receive surgical care that could be safely and effectively delivered much closer to home. The lack of coordinated funding of hub-and-spoke models of children's surgical care causes disorganized utilization of existing surgical capacity, and uniquely disadvantages families who live outside the urban areas where children's hospitals are located. It also means there is no line of sight on children waiting for surgery in adult hospitals, where they represent a tiny piece of the pie and risk being overlooked in favour of adult surgical priorities like joint replacements and cataract surgery.

What can be done?

First, our children need targeted and sustained federal and provincial funding for children's surgical services.

Second, our children need pediatric-specific HHR recruitment that will address gaps in all service areas.

Third, our provinces need coordinated, integrated health services planning that “right sizes” child health services to population need so that children have the right operation at the right time by the right surgeon as close to home as possible.

Fourth, our children need governments to encourage and fund innovation that specifically benefits child health. This should span the spectrum of discovery research, implementation science, AI, health technology assessment and regulatory approval so that we are continually improving care and health outcomes for children while introducing efficiency that will drive value in health care.

More than ever before our children need advocacy within a public health system for their unique care needs, including prioritization for surgery. Children are not small adults and are not less deserving.

Thank you for your attention.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Skarsgard.

Finally, we have Patsy McKinney, executive director of the Under One Sky Friendship Centre.

Welcome to the committee, Ms. McKinney. You have the floor.

[Patsy McKinney, Executive Director, Under One Sky Friendship Centre]

Good afternoon, committee.

My name is Patsy McKinney. I am the executive director of Under One Sky Friendship Centre in Fredericton.

I want to recognize that I am joining you today from the unsurrendered, unceded traditional lands of the Wolastoqiyik in Fredericton.

I want to thank you for the invitation to appear before the House of Commons Standing Committee on Health today.

The indigenous population in Canada is young, rapidly growing and largely urban-based. Nationally, approximately 65% to 80% of Canada's two million indigenous people live in urban settings. The urban indigenous population continues to expand at a rate four times faster than that of the non-indigenous urban population.

Despite being one of the largest and fastest-growing segments of the Canadian population, urban indigenous children face a range of complex health challenges across a variety of social determinants. Our children continue to be denied their inherent rights and equitable access to culturally grounded, quality services due to unstable and insufficient funding, lack of continuity in a patchwork of programs and services, jurisdictional ambiguity and a lack of indigenous control over the planning, design and delivery of programs.

I want to talk briefly about the friendship centre movement and its work.

With a vast majority of Canada's indigenous population living in urban environments, friendship centres fill an essential gap in service provisions as one of the few organizations directly catering to urban indigenous needs in a status-inclusive model. For more than 50 years, friendship centres have aided first nations, Inuit and Métis living in urban environments. Collectively, we refer to our network of over 100 local friendship centres as the friendship centre movement. We deliver over 1,300 programs and serve over one million people per year. The friendship centre movement is Canada's most significant and comprehensive urban indigenous service delivery network.

Historically, the Government of Canada has failed to uphold the rights of children and care for their well-being. Public policy decisions and budgetary allocations often do not prioritize Canada's youngest citizens, which is evident at all levels of government.

Indigenous children continue to be disproportionately represented in the Canadian child welfare system. This ongoing and growing crisis is the result of the lasting impacts of colonization and the residential school system. Compared with non-indigenous children in Canada, our children are more likely to grow up in families affected by intergenerational trauma and the multiple and interrelated downstream effects of poverty. They are more likely to be removed from their homes, cultures and communities by the contemporary child welfare system.

Urban indigenous children, youth and families face additional barriers to accessing culturally safe programs and services that reflect their needs and best interests, both as indigenous people and as children. The need for culturally safe and accessible urban indigenous-specific and urban indigenous-driven community support is high and continually growing.

There is an urgent and pressing need to ensure that all indigenous children, regardless of residency, can fully appreciate their rights both as indigenous peoples and as children. All indigenous children ought to receive culturally relevant programs and services offered by indigenous-owned and indigenous-operated entities, whether they reside within their respective communities or in an urban setting. Solutions to the health crisis facing indigenous children can be found within our own communities and our organizations.

Friendship centres have a long and demonstrated history of effectively supporting the health and well-being of indigenous children through wraparound services. Friendship centres across Canada will continue to support the holistic well-being and safety of urban indigenous children, youth and families.

The ongoing threats to the health and well-being of children and the violations of children's rights in this country warrant immediate attention, investment and action by all levels of government. With a solid majority of indigenous people living in urban areas and as a young and fast-growing population, effective policy, programs and legislation must adopt an urban lens. Urban indigenous communities and indigenous-led organizations must be part of any solution to meaningfully improve the lives and future of Canada's children.

The friendship centre movement is unique in its ability to uplift and support urban indigenous communities, mobilizing advocacy and collaboration through a national network. All levels of government should be prepared to work with friendship centres, community leaders and indigenous peoples in urban setting to develop collaborative and meaningful solutions that consider the perspectives of all affected individuals and communities.

I want to thank you for your time and consideration. I look forward to answering any questions you may have.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. McKinney.

We're going to move to questions right away, beginning with the Conservatives.

Ms. Goodridge, please go ahead for six minutes.

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

Thank you, Mr. Chair.

Thank you to all our witnesses for participating with us today.

I'm going to start by thanking you, Dr. Skarsgard, for providing your notes in advance. It's always very helpful when we have the notes in advance.

One of the questions I have from your notes is about the importance of having a health human resources program and plan that is pediatric-specific. I'm just wondering if you can expand on what that would look like if you were to design something along those lines. What would you want to see in that?

[Dr. Erik Skarsgard]

Thank you very much for this question and for an opportunity to respond to the greatest challenge, which is that of human health resources. This is a problem writ large in health care. I don't think that's a secret to anyone.

Our challenge is that the needs of our patients in hospital and out of hospital are unique and developmentally specific. We are seeking human health resources that would largely be represented by specialty-trained nurses who have gone that extra mile to get training that is child-specific. This involves post-graduate training programs. They're usually hospital-based. They often require a commitment of time and often are not financially supported. We really need this pipeline of nurses to have a significant number of them directed into or incentivized into being child-specific in their focus of care.

Nurses often travel great distances to come to work in a children's hospital. There are community hospitals that are much closer. The unions would pay equivalently for them to work in a nearby community hospital. It's only their dedication to children that makes them drive farther, commute at greater expense and, really, live out their passion, which is to care for children. That's something that's shared by all of us who work in child health care.

The answer to your question is, really, that we need to enhance the pipeline and then we need to direct part of that pipeline and entice them and retain them in a pediatric career.

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

That's fantastic. That leads really well into my next question.

You talked about how there's a disorganized system that disadvantages families who live outside of urban centres. As an MP who represents a large northern isolated region in northeastern Alberta, I know that there are no children's hospitals throughout my entire riding. That means families in my riding who need those kinds of services often have to go into larger centres like Edmonton or Calgary, which are five or nine hours away, in order to get services.

There has been movement in the last little while to have more services delivered at community hospitals. I'm just wondering if you think situations like that would help not only with the health human resources, to allow some of these nurses who have specialized to stay in their communities, but also to provide solutions to families that are outside of those urban centres.

[Dr. Erik Skarsgard]

Thank you for this question.

What you described really highlights what I think is the next challenge in children's services planning by the provinces. That is to really make sure we are using existing capacity in the most effective and efficient way, so that we limit children travelling to an urban tertiary or quaternary children's hospital. It goes without saying that some children will have to, if they have a condition that really mandates the type of specialization that's uniquely available in children's hospitals, and then we have to have systems to get them there. However, a lot of the care that's provided in children's hospitals is care that could be safely and effectively delivered in community settings.

What's required for that to happen?

First, we need strengthened partnerships with the regional health authorities. Second, we need to have codesign of pediatric health services planning so there is consideration for having a certain number of pediatric beds and a certain skill set among nurses and pediatricians and allied health within those community centres to provide the type of care, such as surgery, that a child in those centres might need to access.

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

Thank you. I appreciate that. I do have a very limited amount of time, and I want to switch gears here a little bit.

Ms. McKinney, I have quite a few friendship centres across my entire riding. They do amazing work connecting with the community. I'm wondering if you could touch on how important healthy living is for having healthy kids. I've seen some of the innovative work your friendship centre is doing, and I'm wondering if you could expand a little bit on that. I think there's quite a bit there.

[Patsy McKinney]

Sure. Absolutely.

We know that children's health isn't based just on the medical system. I'm sitting here with a group of medical professionals, which is amazing. What we also try to do as a friendship centre is to come in upstream so that we're providing programs and services before these children end up unwell. That means supporting families with some of the programs that we're offering, including food security. I know that many of the friendship centres across the country during COVID offered immunization clinics around all of that.

We're better prepared than most mainstream institutions to do this because we understand our community. We understand the people we're serving. The reality for most friendship centres is that they are struggling to be able to do this with a growing population. Just here in Fredericton, I think the indigenous population off reserve has quadrupled.

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

Thank you so much. I think we all appreciate hearing this, but I will cede my time, because I know that we're now over.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Goodridge.

Thank you, Ms. McKinney. Don't worry, because I'm sure you'll get a chance to expand on that.

Next is Ms. Sidhu, please, for six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I'd like to thank the witnesses for being with us today to share their important perspectives.

My first question is for you, Dr. Skarsgard. Can you discuss the impact of the COVID-19 pandemic on pediatric surgery services? How do you believe that the new federal funding commitment will help clear up any backlogs? You talked about the target funding. Can you expand on that?

[Dr. Erik Skarsgard]

Certainly. Thank you for the question.

One of the other witnesses very eloquently described the impact of COVID-19 on children. In the children's hospital perspective, it was something where we really didn't know what to expect and what impact it would have on children. We did learn some things about transmission to children, but really, in terms of comparative impact to adult health services, we did not see children dying in children's hospitals, as we did adults in the adult hospitals. In fact, what ended up happening was that we sent many of our critical care nurses to work in the adult health system or, in some instances, to look after adults in children's ICUs. It was a very different impact from what was seen in adult health services with COVID.

I think your question about prioritized funding for children was next. We're all so grateful for these transfer payments, but there's always a risk that children are forgotten because children's services represent such a small proportion. Less than 3% of surgeries done in my province are in children under 18. There's been some talk about earmarking a certain proportion of those transfer payments to the provinces so that they must be used specifically for children's services, and I applaud that. I encourage more of that thinking that targets resources specifically to children and does not rely on others to prioritize children with funding.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Dr. Skarsgard.

My next question is to Ms. Grandvaux.

I'm wondering how obesity can impact the immune system. Can you expand on the importance of ensuring healthy eating and active living? I've had a chance to visit many research sites, particularly around diabetes, and I know that we've talked about the rare diseases too. How can we ensure that children are involved in the research process and that their voices are heard when it comes to decisions about their health?

To follow up on that, how can we better support parents and caregivers in promoting children's health and preventing the spread of viruses?

[Dr. Nathalie Grandvaux]

Thank you for the question.

You have said it right. Obesity and diabetes were recognized as factors for vulnerability to COVID-19 very early on, in the beginning of the pandemic. These are definitely comorbidities that are impacting the immune system. That's not in terms of the research but, obviously, it has been described more in adults. Often, it is a negligible factor for illness in children.

As my colleague Dr. Lamarre explained, there is a need for improving research in pediatric diseases, especially infection and the impact of these comorbidities. There is definitely more research that needs to be done. I think this should be prioritized in the funding in the next years in Canada and worldwide. We need to have a better understanding of how life and comorbidities impact the capacity of children to combat infections.

This can be done through research, of course, but I also liked the intervention from Professor McKinney, who said we also need to work upstream. I think we need more education on all lifestyles and how what children eat impacts their capacity to fight infections and other diseases.

It's definitely a priority. It needs to be integrated. I think it needs to be part of the research program mission from the institute that funds health, but also the social sciences. All of these need to come together in integrated funding to address this question and educate more. It should also be part of education at school to help children very early in their lives to understand how this can impact their lives.

[Sonia Sidhu, Liberal, Brampton South, ON]

To follow up on that, is there any particular area of research or treatment that you feel is being overlooked in the field of children's health?

[Dr. Nathalie Grandvaux]

I think there are many aspects. I think the health of children has been overlooked overall, as my colleagues described.

It's a limited impact. I can only take the example of respiratory syncytial virus, on which we heard a lot. I have been working on that for 20 years now. It was widely overcome before, because we said it's a limited number of children who will be impacted. Also, indigenous people are highly impacted by this, compared to the general population.

In my opinion, what is widely overcome is what you just described before, which is the impact of comorbidities on the health of children in general, like the food they get all their life, together.... All of this impacts the capacity to fight the disease that will not impact a child, whilst all the good food and everything will make a good immune system to fight all of that.

It's more the correlation between.... We have a lot of research on specific diseases, but we always ignore that not all children are equal in the face of disease. We need to get a diversity of information about how children will respond in their capacity to fight different diseases, depending on their backgrounds and their lifestyles. That's something we have to put more emphasis on in research.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Grandvaux and Ms. Sidhu.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

What a great group of witnesses we have today to complete this study. We have people who conduct basic research and people working in the field. The entire health sciences ecosystem is represented.

I will try to ask smart questions.

Let me begin with Mr. Lamarre, because I think what he said is important. I think the pandemic showed us that basic research is the foundation for the biotechnology and technology expertise that enabled us to achieve results. This has been so overlooked in Canada, for decades, that we have lost researchers. We lost them because the research grants are pitiful. You mentioned that earlier. We cannot retain talent without adequate financial support, and those are the most important people during a period as critical as a pandemic.

I would like to hear your thoughts on that, Mr. Lamarre. Do we have a strong health sciences ecosystem right now?

In the last three years, have you seen greater awareness and concrete steps on the part of authorities?

You are making recommendations that I have seen before, Mr. Lamarre, and I think they have gone unanswered.