Health Committee on Oct. 18th, 2023

[Dr. Kathleen Ross]

Chair, if I can add on to that—

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Dr. Barrett.

Thank you very much, Ms. Sidhu.

I'm sorry, Dr. Ross. You'll have to try another time. That's the end of Ms. Sidhu's round.

Thank you very much.

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

[Luc Thériault, Bloc, Montcalm, QC]

Thank you, Mr. Chair.

I thank the witnesses for their patience and apologize for the digression. It's not that the subject isn't serious and important, but I'd like to reassure you and tell you that, when the Standing Committee on Health receives witnesses, it usually conducts at least one round of questions before moving on to another subject, when the subject is important. We're going to do that now, but I wanted to apologize anyway. This is not the way the committee usually operates. I thought the motion would have been tabled after at least a first round of questions.

So, I return to Mr. Taillon.

I'd like to go back a bit, because over time, we may have lost a bit of the essence of your testimony.

First, you said that Bill C‑293 was unnecessary insofar as you wondered whether legislation was really needed to put forward an action plan. On the other hand, are we to believe that the authorities currently involved are not already developing a plan and addressing the shortcomings of the pandemic?

Did I understand you correctly in this respect?

[Patrick Taillon]

Yes.

If Bill C‑293 is all about planning and thinking, I'd say those are already powers amply available to the federal bureaucracy. So there's no need to legislate. All this is already possible and permitted. Otherwise, we're talking about giving the government coercive powers to force things through, particularly with regard to harmonization with the provinces and attempts to standardize. If that's the case, I think we're putting our energies in the wrong places.

When I heard Dr. Ross, with respect, talk about a registry for the training of health care personnel, I thought to myself that we were then touching on the field of education, which is a provincial jurisdiction. It's normal that at the federal level, we don't have this information, because it doesn't fall under federal jurisdiction. Professional corporations, which determine who can become a doctor or nurse, fall under provincial jurisdiction, as does hospital management.

The challenge in the next crisis—it may be opioids, it may be an environmental crisis, it may be something else—would be for everyone to get their responsibilities right. The federal government has had its shortcomings, such as border management during the pandemic, which wasn't always perfect. There was also the management of vaccine supplies, which wasn't always perfect either.

So we mustn't let Bill C‑293 become an excuse to avoid doing the imperative assessment of how Ottawa has discharged its responsibilities. It's as if we were in primary school, with good students and mediocre students, and the worst student in the class wanted to teach the other students how to study.

That's not how things works. Everyone needs to do their homework on their own; the federal government has lessons to learn from the last crisis in its own areas of jurisdiction if it wants to better exercise its powers without trying to take control, coordinate everything, and harmonize what doesn't fall under its responsibilities.

[Luc Thériault, Bloc, Montcalm, QC]

In your testimony, something really struck me. You said that there's a danger in this desire to centralize everything, because when you make a mistake, you make it at every level, from coast to coast, and in a uniform way.

I think we were able to cope relatively well during the pandemic. People were able to experience different health measures from coast to coast, precisely because there was a capacity and a duty to coordinate, but the effectiveness lies in decentralized coordination, even in Quebec, as regards health measures.

[Patrick Taillon]

Absolutely.

[Luc Thériault, Bloc, Montcalm, QC]

During the pandemic, I sat on the health committee. Quebec was in charge of health measures. In fact, Quebec was the first to declare a state of health emergency, and the federal government was in charge of supporting people. That's how it was in Quebec. In Quebec, we applied a policy of different health measures. At a certain point, we realized we had to put an end to confinement, and all of a sudden, the vaccines arrived faster than expected.

What do you have to say about this? You've got one minute.

[Patrick Taillon]

Management that is as close as possible to citizens is more humane and closer to the real issues. It can also be a form of competition. If British Columbia makes a good move, it can inspire Quebec. If Quebec does well, it can inspire Alberta, and vice versa. This form of competition can become a source of inspiration, and in the end, everyone wins.

When faced with huge problems, such as those experienced during a pandemic, it's better to leave room for some local innovation than to have the ambition to have everything coordinated from afar by the government. In any case, we don't even have the information, since health care doesn't fall under federal jurisdiction, except in the case of indigenous persons and the military. These are areas where there's a lot to be done.

Perhaps the federal government should focus its efforts on the health of indigenous persons and the military.

[The Vice-Chair, Conservative, Stephen Ellis]

Thank you very much, Mr. Taillon and Mr. Thériault.

Mr. Davies, you have the floor now for six minutes.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

Dr. Ross, a recent series from the British Medical Journal found that Canada's emergency response during COVID-19 was impaired by “long-standing weaknesses in [the] public health and healthcare systems, including fragmented health leadership...across the federal and provincial and territorial governments.”

Do you agree with that finding?

[Dr. Kathleen Ross]

The fact that we know the pandemic exacerbated our pre-existing fragmented and broken health care system is highlighted in that article. The pandemic raised awareness of the chronic gaps that we have in our health care system, which we continue to experience. The pandemic itself did not cause it.

This particular legislation certainly could help us identify what we could do to be better prepared for another pandemic because it takes into account not just what occurred during COVID-19, but also previous health crises. It could help us identify where we could improve as a country, as a unified health system and as a profession.

We spoke briefly about health data. I believe that's critically important. Canada lacks on interoperability in many different ways. We have the challenges in planning our workforce supply without adequate demographic service activity and geographical information.

That's the reality of the system that we're in right now. We need to work better together.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

I noticed that the U.K. and some other countries have already started public independent inquiries. The British Medical Journal also outlines several reasons why an independent national COVID-19 inquiry is needed in Canada with accountability for implementation of recommendations. They listed some of these as “failing to look to the past will ensure an unchanged future“ and “lacking an independent federal inquiry allows others to step into the frame”. It would provide “an actionable framework for reforming Canada's health care and public health systems” which were struggling prepandemic, as you have pointed out. It would ensure “accountability for losses”, which included 53,000 direct deaths in Canada.

Do you agree with the arguments outlined in the British Medical Journal?

Would you endorse the call for an independent national COVID-19 inquiry for these reasons?

[Dr. Kathleen Ross]

I think I would approach that by saying that an advisory committee and a subsequent report would serve as a tool to consider what needs to be done immediately to help our health care system to recover.

The Canadian Medical Association believes that health leaders will need to find efficiencies and employ strategies to optimize our capacity, such as virtual care and patient prioritization to clear the backlog in procedures, but we also know that decisive action needs to be taken to address workforce shortages, particularly of nurses, and ensure that our health system is operating efficiently. These are immediate and urgent needs that we have to address in our health care system.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

To World Animal Protection, in your submission to the committee, you wrote that World Animal Protection supports Bill C-293 because it takes a “one-health” approach to pandemic prevention, requiring government to address the underlying causes of pandemics.

What is the “one-health” approach, and how does it relate to both animal protection and pandemic prevention?

[Melissa Matlow]

Through you, Mr. Chair, “one health” is the intersection of animal health and welfare, the health of the planet and the health and well-being of people.

I think the way that animals are stressed in the wildlife trade, wildlife markets and intensive farming practices that necessitate the use of prophylactic antibiotics are all examples of how animal welfare can be the solution to reducing disease risk.

[Don Davies, NDP, Vancouver Kingsway, BC]

Thank you.

You also wrote in an open letter to the WHO that was published in The Lancet that over 200 medical and scientific experts identified industrial animal agriculture as a significant pandemic threat and major contributor to antibiotic resistance.

You touched on that. Can you expand on the role of animal health and welfare in preventing the emergence of zoonotic diseases?

[Melissa Matlow]

Through you, Mr. Chair, absolutely I can.

We just completed a literature review of animal welfare solutions to reducing prophylactic antibiotics. This includes everything from reducing animal density to reducing the mixing of unfamiliar animals, improving ventilation, sanitation, environmental enrichment and increasing the amount of time before animals are weaned and separated from their mother.

All of these are solutions to reduce the use of antibiotics given prophylactically, which is routinely done in Canada and around the world and the reason that 75% of antibiotics are given to farm animals today.

[Don Davies, NDP, Vancouver Kingsway, BC]

Turning to wild animals, you point out in your submission that more than 1.8 million wild animals were imported into Canada between 2014 and 2019, and 93% were seemingly not subject to any permits or pathogen screening.

Has the importation of wild animals led to the introduction of disease to domestic animal populations in Canada or provided any threat to human health?

[Michèle Hamers, Wildlife Campaign Manager, World Animal Protection]

I don't know if there are any direct links that I'm aware of, but it is certainly possible.

The most well-known link is chytrid fungus, which is affecting our native populations.

For farm animals, we do import mink, for example, which played a huge role during COVID in the spread and amplification of the disease.

The importation of wild animals, which is currently pretty unregulated and unmonitored, definitely poses a disease risk.

[Don Davies, NDP, Vancouver Kingsway, BC]

Can you tell us what the current state of knowledge or theory is about the source of the emergence of COVID-19? Is it still thought that it emerged from a zoonotic source? What can you share with us?

[The Vice-Chair, Conservative, Stephen Ellis]

Ms. Hamers, I'll have to interrupt you. The time is up. I'll gently suggest that you submit that answer in writing. Thank you very much.

Thank you, all.

We're moving into our second round of questioning now.

Dr. Kitchen, you have the floor for five minutes.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you, Mr. Chair.

Thank you to our witnesses.

Dr. Taillon, your comments were very enlightening. Clause 2 of the bill talks about the purpose of the proposed act, which is to “prevent the risk of and prepare for future pandemics”.

The function of the committee that it's trying to structure is as follows: The function of the advisory committee is to make recommendations for the improvement, throughout Canada, of preparedness efforts and response capabilities in relation to disease outbreaks in order to reduce the risks associated with future pandemics.

I'm sure, Dr. Taillon, you're well aware that the Public Health Agency of Canada was structured in 2004 after the SARS epidemic to do exactly what I've just quoted. In fact, when we look at the Public Health Agency's function, its function is to provide health promotion, health surveillance, health protection, population assessment, emergency preparedness responses and to “focus on preventing disease and injuries, responding to public health threats, promoting good physical and mental health and providing information to support informed decision-making.”

Not only are they doing that, they have also doing it with a budget in 2022-23 of $7,439,195,456 just for infectious disease prevention and control, not to mention the $404,242,000 for health promotion and chronic disease prevention.

If all of this is in place with the Public Health Agency of Canada to do what this bill is proposing, do you feel that this bill is supportive of that, or do we need to get rid of the Public Health Agency of Canada?

[Patrick Taillon]

Mr. Chair, one thing is certain: it's important to recall, as the member did, the scale of the funds already invested and the mission that already exists.

If the bill simply repeats the mission that already exists in other words, then it's useless. Otherwise, it must be interpreted as a bill that seeks to create a diversion, i.e., we're preparing for the future to avoid really taking stock of what happened, the mistakes and blunders that may have occurred during the last crisis. This is normal, because no government is perfect. No administration is perfect.

Otherwise, we legislate because we want to tighten the screws, we want new powers or more coercive authority. My fear is that this coercive authority will be aimed at the provinces, which would be forced to harmonize their practices when they should instead be allowed to innovate and apply their know-how closer to the ground. This would also plunge them into a dynamic of accountability, which would be a way of subordinating them, when there should be no subordination.

By trying to intervene too much in things that stray from its mission, the federal level is moving away from the basics. Its mission should be refocused on what lies at the heart of federal jurisdiction, for example, procurement and strategic reserves. This is the role of the federal government.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thank you. I appreciate that. I'm sorry for cutting you off. It's just that I'm short of time.

Sir, former minister Patty Hajdu said in April 2021, “We are open to an inquiry that is as deep as necessary”.

Former minister Duclos said, in response to a question, that he's “confirmed that the federal government still means to pursue some kind of review, eventually.”

Would you consider this similar to a national pandemic review?

[The Vice-Chair, Conservative, Stephen Ellis]

You have 10 seconds or less.