Health Committee on March 23rd, 2023

[The Chair, Liberal, Sean Casey]

I call this meeting to order.

Welcome to meeting number 58 of the House of Commons Standing Committee on Health. Today we are meeting for two hours to consider the supplementary estimates (C), the main estimates and the departmental plans.

Today’s meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022. We have one member of the committee participating virtually. In accordance with our routine motion, I'm informing the committee that Mr. Jeneroux has completed the required connection tests in advance of the meeting.

First, allow me to welcome the Honourable Jean-Yves Duclos, Minister of Health, who is joining us for the first hour.

He is joined by the following officials: from the Canadian Food Inspection Agency, Sylvie Lapointe, vice-president, policy and programs; from the Canadian Institutes of Health Research, Dr. Michael Strong, president; from the Department of Health, Stephen Lucas, deputy minister, with Jocelyne Voisin, assistant deputy minister, strategic policy branch, and Dr. Supriya Sharma, chief medical adviser, health products and food branch; and from the Public Health Agency of Canada, Heather Jeffrey, president, and Dr. Howard Njoo, deputy chief public health officer.

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

We will begin with opening remarks.

Minister Duclos, welcome to the committee. You have the floor for the next five minutes.

[Jean-Yves Duclos, Liberal, Minister of Health]

Good morning, Mr. Chair.

Thank you for the opportunity to speak to you today about the main estimates for the 2023‑24 health portfolio.

As you noted, I am joined by Mr. Stephen Lucas, deputy minister; Ms. Jocelyne Voisin, assistant deputy minister of Health Canada's strategic policy branch; Dr. Supriya Sharma, chief medical advisor and senior medical advisor for Health Canada's health products and food branch; and Heather Jeffrey, the new president of the Public Health Agency of Canada. I would like to take this opportunity to congratulate her on her new role and responsibilities. Dr. Howard Njoo, deputy chief executive officer of the Public Health Agency of Canada; Dr. Michael Strong, president of the Canadian Institutes of Health Research; and Ms. Sylvie Lapointe, vice president of policy and programs at the Canadian Food Inspection Agency.

On February 7, Prime Minister Trudeau announced the plan, “Working together to improve health care for Canadians”, which provides $198.6 billion in additional investments over 10 years. It includes $46.2 billion in new funding to the provinces and territories and $2.5 billion in additional federal support.

This is a collaborative plan with the provinces and territories to deliver real and meaningful results for our health care workers and for patients and their families.

In addition to guaranteed increases to the Canada health transfer, $25 billion in bilateral funding to provinces and territories will be dedicated to shared health priorities. For example, this funding will improve access to quality family medicine when people need it, especially in rural and remote areas. The funds will also support our health care workers to retain, train and recruit more of them, as well as recognize the skills of workers trained elsewhere in the country or abroad, which will contribute to reducing surgical and diagnostic backlogs. Another priority is to improve access to timely, equitable and quality mental health and addiction services. Finally, because data saves lives, we want to work together to modernize our health system so that Canadians have access to their own health information electronically, which they can share with their professionals to improve the quality and safety of the care they receive.

Protecting the health and safety of Canadians is a top priority of the health portfolio, now and in the months and years to come. The main estimates that I am presenting today reflect just this and identify the actions we are taking towards that goal.

In total, I am seeking $10.5 billion on behalf of the health portfolio, which includes Health Canada, the Public Health Agency of Canada, the Canadian Food Inspection Agency, the Canadian Institutes of Health Research and the Patented Medicine Prices Review Board.

I'll start with an overview of Health Canada's plans.

The 2023-24 main estimates reaffirm Health Canada's focus on providing services that are important to people in Canada, including the implementation of an interim Canada dental benefit plan. To achieve this and other objectives, I'm seeking of a total of $4.1 billion. As you know, the COVID-19 pandemic exacerbated existing mental health and substance use challenges for people in Canada. My colleague, Dr. Carolyn Bennett, will provide details later today on the investment that addresses these challenges.

The main estimates for the Public Health Agency of Canada propose a total budget of $4.2 billion for 2023-24. This proposed spending will help ensure that PHAC has resources in place to continue to play a pivotal role in safeguarding and improving the health and well-being of Canadians. PHAC's main estimates include funding for the procurement and deployment of COVID-19, mpox and domestic influenza vaccines.

CFIA, the Canadian Food Inspection Agency, also has an important mandate in safeguarding food, animals and plants, which enhances the health and well-being of Canadians, our environment and our economy. CFIA has a proposed net increase of $4.3 million in its 2023-24 main estimates, which will enable the agency to continue to contribute to the health and prosperity of all Canadians.

As Canadians learn to live with COVID-19, the importance of investing in health and medical research becomes more important than ever. CIHR's proposed spending on health research for 2023-24 is $1.4 billion.

In conclusion, these investments demonstrate the government's resolve to continue supporting health and health care for all Canadians.

These commitments are outlined in more detail in our recently tabled departmental plans, which will also be reviewed today.

Thank you for the opportunity to provide these introductory remarks. I would be pleased to respond to any questions or comments.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

We will start with the first round of questions.

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

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

Thank you very much, Chair, and thank you to all the witnesses and to the minister for being here today.

Health care is always going to be a significant and important area for discussion for all Canadians, perhaps now more than ever, given that the system is in a significant state of flux and change of course.

Minister, if I might, I'll start with active pharmaceutical ingredients. These are the building blocks of medications, of course, and one of the concerns that I would appreciate your sharing with the committee today is that of remote inspections. Historically, there would be on-the-ground inspections for active pharmaceutical ingredients in producing nations. Of course, due to the pandemic, remote inspections have perhaps become more the norm.

That being said, we're looking at potential drug shortages given contamination, which we've seen historically in Canada, and certainly we know that at the current time there are significant shortages of every oral pediatric antibiotic.

Could you comment, sir, on the mitigation processes for those drug shortages that are likely to occur in the future?

[Jean-Yves Duclos, Liberal, Québec, QC]

That's a great question.

Thank you for your interest in this issue, which is obviously a great source of concern, stress and sometimes distress for families and their caregivers, and certainly for patients and clinicians across Canada. That's why, as you've suggested, we have made some important progress over the last year when it comes to the production and inspection of those facilities, some of them obviously involving collaboration with provinces and territories and, in some contexts, with international producers and importers.

On the specifics of inspections, and remote inspections in particular, I would like to turn—if that is fine—to Dr. Sharma.

[Dr. Supriya Sharma, Chief Medical Advisor and Senior Medical Advisor, Health Products and Food Branch, Department of Health]

In terms of the remote inspections, it's true that we relied more on those over the pandemic, but it wasn't the first time we had done those sorts of paper-based assessments of facilities.

First of all, the remote inspections were on the lowest-risk products, such as the APIs, which have other controls on them as they go through the drug manufacturing process. The second part of that is that we were building on a lot of work that we'd done internationally with confidence building through our international partner organizations on how best to use that type of information. We would still prioritize for in-person inspection anything that would be of higher risk, again not just because of the product but because of potential issues with any of the other finished products that would go into them.

Really it's a risk-based approach that we take to inspections, and the pandemic allowed us to pilot a few other IT solutions as well that helped enable those inspections.

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

Thank you very much.

Through you, Chair, if I might, is it not true, though, that nitrosamines have been a significant contaminant in medications that we brought here to this country and have caused rolling shortages in very common medications? Certainly, in my experience as a practitioner, that has been the case with antihypertensives, and it has caused significant consternation to Canadians, who have needed to change which medication they're on, sometimes on a monthly basis. Of course, this can cause confusion and potential health risks to those patients.

[Jean-Yves Duclos, Liberal, Québec, QC]

Again, that's a great question. We have Dr. Sharma, who is also an expert. Coming from you, Dr. Ellis, I think these questions are very appreciated, and we feel not only the concern but also the expertise behind them.

Please go ahead, Dr. Sharma.

[Dr. Supriya Sharma]

It's true that we've had recalls of products based on nitrosamines. Nitrosamines, as you know, are impurities that can happen from manufacturing. We have seen more products test positive for nitrosamines over the past few years. It may be that we've also had better technology for detecting them. We're working internationally with our partners, specifically the European Medicines Agency, to share information on how to improve the manufacturing process. We're also being very clear about what limits are acceptable, because certain nitrosamine levels in the products are acceptable, while others may potentially cause longer-term problems.

Certainly, any time there is a recall, we always weigh the risks and the benefits of that, and we are very cognizant of the fact that people are depending on these medications and it may not be that easy to switch. This is definitely not just a Canadian issue but a global issue, and international collaboration is ongoing on getting to the bottom of the manufacturing processes that may give rise to these higher levels of impurities.

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

Thank you very much.

Through you, Chair, to the minister, I think this issue is of such significant importance to Canadians that we'd appreciate regular updates on it, because I think there is somewhat of a difference related to, perhaps, remote inspections and the concerns and drug shortages we already have, so we would really appreciate that.

I have perhaps a minute or so left, and I'm going to change gears significantly. The spotted lanternfly is a significant pest, and we are concerned about it coming to Canada. However, the approach to mitigating this is to perhaps look at all the lumber coming into Canada, which is about 3% of the traffic coming in, and which would cause significant bottlenecks at border crossings. There are pesticides in the States, three of them as a matter of fact, that could be used in Canada. We know that those used in the United States are not affecting the wine and other consumables in Canada, so why would we not license these products in Canada?

[Jean-Yves Duclos, Liberal, Québec, QC]

That's another very good question.

These are matters related to both regulatory issues and enforcement issues connected to, as you signalled, the border rule that will be applied to protect the health and safety of Canadians as well as the health and safety of whatever we produce here on Canadian soil.

I would suggest that for the right level of answer, we should perhaps turn to DM Lucas.

[Dr. Stephen Lucas, Deputy Minister, Department of Health]

Thank you, Mr. Chair.

Within Health Canada, the Pest Management Regulatory Agency works closely with registrants or those seeking registration of their pesticides and has a rigorous review process in terms of ensuring the safety of those products with respect to human health and the environment. It is an open process. Should a registrant choose to bring their product to the Canadian market, we welcome their submissions and have an engagement to help support them in providing those submissions, and then there is a rigorous review of those.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Lucas.

Ms. Sidhu, please go ahead for six minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair. I'm sharing my time with Adam.

Thank you to the officials and the minister for coming to our committee to give us important updates.

Minister, recently you were in Brampton and meeting many in the leadership of the local health care community. You heard from the CEO of the William Osler health care system, one of the busiest in Canada. We know that wait times and backlogs are very concerning. Can you expand on the purpose of the immediate one-time Canada health transfer top-up and how it will address these urgent needs?

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you.

I was indeed very fortunate to be able to visit you, Sonia, just a few weeks ago, and to meet with lots of experts, caregivers and patients, including representatives from the William Osler organization.

We know that COVID-19 has impacted lots of Canadians, but also, in particular, younger Canadians, and that's true in all sorts of ways, with lots of mental health issues, obviously, for adolescents and others, but also backlogs in surgeries and diagnostics, which have an impact not only on the short-term well-being and health of these younger Canadians, but also on their long-term prospects in life.

That's why the $2 billion you were signalling is so important. It's an immediate $2 billion that will be sent to provinces and territories very soon to look after the crisis we have and that we continue to see in pediatric settings, including in pediatric hospitals. That's in addition, obviously, to the overall increase in the CHT next year. In fact, a few weeks from now, the CHT will be increased by 10% and another 6% next year, in addition to a minimum increase of 5% over the next five years.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Minister.

The next question is on the many doctors and nurses across Canada who, because they were trained abroad, cannot work in their fields even though they have strong experience and want to work in their communities. Can you expand on the steps that our government has already taken towards implementing national credential recognition and other measures with the provinces and territories?

[Jean-Yves Duclos, Liberal, Québec, QC]

Very good. There is an obvious connection here between the people and the talent. We know we need more people, more talent, in Canada, and that's why the leadership of our colleagues and your own leadership when it comes to sustaining and encouraging stronger immigration flows into Canada is so important. When people come, they want to come and work quickly and use their talents and expertise to serve Canadians as quickly as possible. That's why we want to enhance the ability for credentials that were internationally obtained to be recognized quickly by provinces and territories. We also want national credentials to be recognized across Canada.

That's why the great news is that with the efforts we've collectively made over the last months, we've seen significant positive movement, just a few weeks ago in Atlantic Canada. In all four Atlantic provinces, we're going to end up with regional licensure for physicians, which we can then hope to extend nationally. Other provinces, such as Ontario and British Columbia, are moving very quickly in terms of recognizing the credentials of nurses and other health care professionals. This is great news. It's great news not only for the ability of those workers to be up to their full potential, but also for the ability of patients to receive the timely and critically important care they need, and in many different settings.

[The Chair, Liberal, Sean Casey]

Mr. van Koeverden, you have two minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you very much, Mr. Chair.

Thank you, MP Sonia Sidhu, for allowing me to share your time today.

Thank you to the witnesses for being here.

Minister, thank you for being here. It's an honour and a privilege to work with you as your parliamentary secretary.

We all know that physical activity improves lives and improves health. It improves physical and mental health and makes our communities stronger, but if we have a healthier society, it also reduces the strain on our health care system. Recently, we've seen some data from UNICEF indicating that for children's health—a study we've just almost completed—the rates are lower than we'd expect for a country with our considerable wealth and resources.

The promotion of physical activity is crucial, but also, I think, our government has a role to play in bridging the gap and reducing some barriers to access to physical activity, because it is medicine. It is preventative health care. We talk a lot about health care and perhaps not enough about health. What can we do to promote physical activity and exercise—not just for youth, particularly, but for all Canadians—and to also reduce some of the barriers to access for that preventative health care measure?

Thank you, Minister.

[Jean-Yves Duclos, Liberal, Québec, QC]

Thank you very much, Adam.

As you know, I certainly want to say openly that it's good fortune that I and many others have you to work with as parliamentary secretary, connecting your roles as parliamentary secretary of sport and health to sports—not health care, because you're making a big difference between health and health care. The two are obviously connected, but there is no minister in Canada who is a minister of health care. There are 14 different ministers of health, not of health care.

That's because, as you mentioned, prevention, among many other things, is key to well-being in health in Canada and elsewhere. I may open a brief parenthesis: Experts estimate that about 80% of health outcomes have nothing to do with health care. They have everything to do with physical activity, healthy eating, having friends, being connected to the community, sleeping well, avoiding abuses, smoking as little as possible, and just being engaged physically and emotionally. From a community perspective, that's what drives most health outcomes.

As you said, that is particularly true for children, as you well know as parliamentary secretary to sports and having been such a leader and a driver of good health, physical and other habits.

The $20 million in annual support to community-based initiatives is to improve health behaviour, including physical activity for populations at greater risk, including children in marginalized communities and children in indigenous communities. We know that it is even more important to focus on prevention, including physical activities.

Thank you for your leadership, and thank you for pointing that out.

[The Chair, Liberal, Sean Casey]

Thank you, Minister.

It is now the Bloc Québécois's turn.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

Welcome, Minister.

Do you know the percentage of Quebec's part of health transfers granted by the federal government in its 2023‑24 budget?

[Jean-Yves Duclos, Liberal, Québec, QC]

From a historical point of view, the part of—

[Luc Thériault, Bloc, Montcalm, QC]

I am not talking from a historical point of view. I'm talking about the recently tabled budget.

I would appreciate it if you answered my questions directly, because I do not have much time.

[Jean-Yves Duclos, Liberal, Québec, QC]

I was getting there.

From a historical point of view, if we take into account tax points transfers, the portion granted to Quebec is 35%. Thanks to the investments announced during the meeting on February 7, we're coming back to that same percentage as of next year.