Health Committee on Dec. 2nd, 2025

[Rita Dhami]

What we do here from our pharmaceutical industry colleagues is.... Unlike other drugs, antimicrobials are often prescribed for shorter or time-limited courses of treatment. We also know that while stewardship programs improve and optimize the use of antimicrobials, they can also have that detrimental effect of limiting the growth potential of antimicrobials.

From our—

[The Chair, Liberal, Hedy Fry]

Can you wrap up, please, Dr. Dhami? We're well over time in this round. You can elaborate in another round when someone else asks you a question.

[Rita Dhami]

Sure. No problem.

[The Chair, Liberal, Hedy Fry]

Thank you very much. I'm sorry about that.

I'll now go to Ms. Larouche from the Bloc for six minutes, please.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Madam Chair.

Since this is the Standing Committee on Health and I'm wearing a red ribbon, I think it's appropriate to quickly remind you that yesterday, December 1, was World AIDS Day, an important day. We still have a long way to go in 2025.

Dr. Magnish, you spoke in your opening remarks about procurement in China, and my Conservative colleague also asked questions about that. You reminded us of the importance of avoiding sourcing from places where forced labour is used. You cited, among other things, the case of the Uyghurs in China. You also mentioned the impact, as we understand it, on product quality.

On October 21, our party introduced a bill to put an end to what we call the funding of modern slavery, particularly so that Canada can take note of the fact that not all countries produce goods under the same conditions, as in the example of China and the Uyghurs.

So a bill like this is important to reduce the arrival of products, particularly in the area of supplying garments or personal protective equipment. What impact would a bill like this have?

[Scot Magnish]

I should point out that you gave me a raise. I'm not actually a doctor, but thank you.

In terms of protecting the importance of this issue, I believe that we actually have legislation right now in Canada, Bill S-211. I'm not sure if there's something new in the works or if the government or your party is introducing something, but it's absolutely important.

If you look at the issue here, man-made textiles coming out of the Uyghur Autonomous Region are one of their leading products. It is one of the top things they make. We're talking about a population who most governments around the world have agreed are living in forced labour camps to make dangerous products.

This is all in violation of Bill S-211 already. The problem with Bill S-211 is that nobody's enforcing it. Companies have to attest to the steps they've taken to purge forced labour from their supply chains every year. They file that with the Minister of Public Safety, I believe. Companies are doing this, but it's essentially a checklist where they just check a box and say they have no forced labour.

There are small steps they claim to take around the training of their employees, but I can tell you that if you open up a catalogue from one of Canada's leading health care suppliers, pick a product—which is literally what I did—and then run it through an open source database run by human rights groups, you will find forced labour. You'll find products being made with forced labour.

The government has renewed contracts with some of these companies. Certainly, our health care institutions have too. In every single hospital in Canada, I guarantee you will find products that have been made with forced labour.

Anything we can do to address this as Canadians is important. It takes a step away from antimicrobial stewardship, but quality products can only help us in that regard as well. It starts, though, with actual enforcement. Somebody needs to investigate these companies and lay fines just as the act gives somebody the power to do.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you very much, Mr. Magnish. I'm sorry about the promotion, it's just that we're surrounded by doctors today.

By the way, the criticism of the legislation that came out of Bill S‑211 is precisely that it doesn't go far enough. That is why the Bloc Québécois introduced a bill to go a little further and give the act more teeth.

Dr. Elsayed, you concluded your remarks quickly, because your time was up. I'll give you the opportunity now to share elements of your conclusion that you didn't have time to give.

[Sameer Elsayed]

Madam Chair, I'd be happy to answer that question.

The other thing I want to mention is that the lack of access to some of these newer antimicrobials is not just about mortality. Mortality is a big thing and something we think about. We have seen an increased number of deaths in our hospitals, especially during the COVID-19 pandemic. We had multi-drug resistant organisms that we needed to go through the special access program. During that time, it was very challenging, as we didn't have the drugs on hand.

It's not just about mortality. There's also increased pressure in the hospital system in terms of the census of hospitals. For instance, if we don't have access to one of these first-line antibiotics through the special access program, we have to use a second-line agent, which not only doesn't work as well usually, but also has more toxicity. The patients end up staying in hospital for a longer period of time.

There's also some misalignment with the clinical practice guidelines and the drugs that we have access to. That needs to be looked at from the federal side, but especially on the provincial side, where we want to send patients home on an antibiotic and there's no coverage there.

I'm happy to address other questions but, because of the time, I'll conclude there.

[The Chair, Liberal, Hedy Fry]

Thank you very much.

I'll now go to the second round.

I will begin with Mr. Epp from the Conservatives.

You have five minutes, please, Mr. Epp.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Thank you, Madam Chair.

Thank you to all the witnesses for appearing today.

I'm going to focus on Mr. Magnish for my questions.

In your testimony, you referenced fact number two, saying, “We all know how that story ended.” You were referencing the fact that we were dependent upon China for our PPE.

Can you elaborate a bit more on exactly what you mean by how that story ended?

[Scot Magnish]

That story started in 2020. The federal government issued an RFSO, a request for standing offer, to companies to supply the national emergency strategic stockpile. There was nothing wrong with that RFSO. They awarded it to several different companies. They were the same companies that supply the hospitals and the same companies that you're probably all familiar with.

The problem is that all these companies source their material or their products from overseas, mostly China but Southeast Asia as well. When the pandemic hit, they could not continue the supply. I'm sure that everybody in this room can remember the Prime Minister at the time asking companies in Canada like ours to pivot their focus and manufacture personal protective equipment. Nurses were wearing scarves wrapped around their faces.

This is how that story ended. The pandemic finally subsided, and Canadian companies like ours had stepped up and were supplying the national emergency stockpile. Life got back to normal, and everybody started buying products from China again. Hundreds of millions of dollars were spent standing up Canadian industry on this front. It's an industry that's probably worth about $1 billion a year, and we gave it all back to China.

Let me just add one last thing. We're still doing it. As late as August of this year, we renewed one of the contracts with one of those same companies, and we extended it for another nine months. This is strategically disastrous, because we know exactly what happens when we put all our eggs in one basket.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Mr. Magnish, I have toured your plant. I have seen the 20 robots, and they're sitting idle right now. Is this an issue of cost? Is that why the industry has gone back? This is unfathomable.

We have an entire country trying to reshore right now, yet we are sourcing from China and, as Madam Larouche alluded to, potentially with forced labour as well.

What's going on here?

[Scot Magnish]

It's about the cost, definitely. Our hospitals all struggle with budgets, and they look for the best price they can get. Asia is able not only to provide lower costs because of the lower human labour costs, but they're also able to manipulate the market, because they are state run. If they want it to be cheaper, they can just make it cheaper.

As a result, it makes it very difficult for Canadian companies to compete. Our competitive advantage, as I said, is that we make our gowns with robots equipped with lasers and ultrasonics.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

I hate to put you off, but I do want to get more in.

That's fine if we're comparing apples to apples. My understanding is that we're not comparing apples to apples when it comes to quality.

You mentioned that some of these gowns are flammable. Can you prove that?

[Scot Magnish]

Yes. In anticipation, I brought a video that I can share with the committee at your leisure. It's on a memory stick that I can leave with somebody.

We did a side-by-side test of hospital gowns pulled from a local hospital in southwestern Ontario, and we set them on fire to see what would happen. There is no shortage of evidence. You could buy one today—they're all publicly available—just to see how they perform. We've tested our Chinese competitors' gowns, and they're definitely inferior. We can beat them or at least meet them on price because of the competitive advantages that we have.

The second part of this is that it comes down to preferences, where doctors might just like a particular brand. They've already gone through the process of vetting it. They're comfortable with it, so they just keep buying it.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Right now, our government is going for a cheaper route as opposed to a safe route. They're going to a foreign supplier as opposed to a domestic supplier when we have the capacity right here.

[Scot Magnish]

That would be a correct assessment, yes.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Would it also be an accurate statement that right now, our NESS, our national emergency strategic stockpile, is in worse shape than it was going into the pandemic?

You talked about expired goods, where polypropylene degrades over time. The quality of those very same gowns is suspect, based on your testimony.

[Scot Magnish]

Yes, it is. We are in worse shape today than we were at the beginning of the pandemic, in terms of preparedness.

[Dave Epp, Conservative, Chatham-Kent—Leamington, ON]

Thank you, Mr. Magnish.

[The Chair, Liberal, Hedy Fry]

Thank you very much, Mr. Epp.

I'll now go to the Liberals with Ms. Sidhu for five minutes please.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Madam Chair.

Thank you, witnesses, for coming here and for your very informative testimony.

My question is for Dr. Sameer Elsayed.

Dr. Sameer, you talked about the guidelines on antimicrobial medications. How can strengthened federal stewardship initiatives, such as national prescribing guidelines, support physicians in reducing inappropriate antimicrobial usage? One aspect is around how to reduce this, and the second aspect is around the guidelines in hospitals.

I want to share a story. Just last month in Brampton, a kid lost his mother because of sepsis. My question for you is, how could federal-provincial collaboration improve equitable access to rapid testing and to the new antimicrobials you said we need to access?

[Sameer Elsayed]

Madam Chair, we do have national guidelines for treating various infectious diseases, but we also rely on guidelines published in other countries, especially in the United States and also in the U.K. They have different health care systems and different kinds of funding programs. Some of the medications that are newly available in these countries are very expensive, and that's obviously one of the biggest barriers.

We also publish and develop our own local clinical practice guidelines for how to treat different infectious diseases. We actually have a web page in our hospital that talks about how to treat bloodstream infections, urinary tract infections, etc.

For antimicrobial stewardship programs, which I'm actively involved in at my hospital as the physician lead, we are an advisory program. That means we can educate and develop clinical practice guidelines, but we cannot force physicians—or twist their arms, if you want to put it that way—in terms of how they can treat an infectious disease.

We do have influence on the hospital formulary regarding what antibiotics we have available in our hospital and who's allowed to prescribe them. For these newer antibiotics for the AMR pathogens, there would need to be a gatekeeping function in the hospital so that they're prescribed appropriately.

I'm sorry to hear the story about the child's mother dying. I may have read the story already because I do look at and read these cases in the news so that it doesn't happen again, and I reflect on it. I don't know how that occurred, whether there was a delay in initiation of therapy or whether it had to do with a drug-resistant organism.

There is a disconnect between the federal and provincial and territorial health programs in terms of antibiotics. For instance, we do have Health Canada approved antibiotics that we use in hospitals, but they're not covered by the provincial formulary.

For instance, in Ontario, we have to go through the exceptional access program. I've had requests denied very frequently, even for something that's clearly recommended by clinical practice guidelines. I do believe there are some outdated guidelines as well that the Ministry of Health in Ontario uses. I know this is not a provincial forum here, but I can tell you there is a bit of a disconnect.

Health Canada generally will not approve a medication for outpatient use if it's not approved by Health Canada, so there's that issue.

However, clinical practice guidelines exist for many different infections. There are differences of opinion. For instance, in treating eye infections, there's a difference of opinion between the Infectious Diseases Society of America and the American Academy of Ophthalmology in terms of how to treat them, so that may get in the way for certain things.

In general, though, we do have good clinical practice guidelines. We know how to treat these infections with first-line therapies. Really, the problem is having Health Canada approval. That process is delayed much more than the processes are in the European Union and the U.S., for instance. I think that's one thing.

I hope I answered your question well, and I'm happy to answer any other questions later on.

Thank you very much for the opportunity.

[The Chair, Liberal, Hedy Fry]

Thank you.

Thank you, Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.