Industry Committee on April 18th, 2007

[John Kelsall]

Just to quickly add to that, we actually have worked with one African country with a view to sourcing antiretroviral drugs from Canada. In fact, that particular country, after a process and an examination, really wanted investment in their own country to produce the antiretrovirals locally. They already were producing antiretrovirals for 60,000 people, and they were looking at opportunities to manufacture in their own country.

It's interesting to see that the African Union ministers of health just met in South Africa, and one of the discussion points was to try to increase the manufacture of antiretroviral drugs in Africa.

[The Chair, Conservative, James Rajotte]

You have 40 seconds.

[André Arthur, Independent, Portneuf—Jacques-Cartier, QC]

I think I'll follow your lead and pass on the time. I'll come back at my turn.

[The Chair, Conservative, James Rajotte]

Thank you.

Mr. Masse.

[Brian Masse, NDP, Windsor West, ON]

Thank you, Mr. Chair.

One of the benefits of Parliament and this committee is Hansard. You get a chance to go back and review the past and how things were developed.

We hear more and more what a dog's breakfast this legislation really it, and how simple the solution could be. But it took 550 days to craft that piece of legislation and have it passed to become what it is today. We have to keep that in mind.

To the panel--and Ms. Devine, I'm particularly interested in your response—in that time were there any Canadian champions, either politically, bureaucracy-wise, or department-wise, who, once you got stuck at a certain point, helped move the log jam of what you were facing or identified the problem and brought some solutions back? Whatever comes out of the pipeline here, I'm concerned about whether or not we need to appoint some type of champion who will make sure this legislation moves and shakes throughout the world--if it actually does work.

[Carol Devine]

Thank you for your question.

This legislation had every champion in the government when it was passed. It had all-party agreement. So it started out with every government person championing it.

At MSF we are able to work in war zones and in difficult countries because of our mandate of neutrality, so it's not my place to name specific champions. But it can certainly be said that we've seen people working very hard on this. We were in endless meetings from mid-fall 2003 until recently, and during the AIDS conference, so we've seen champions. This drug was approved quite quickly by Health Canada, even though we felt it didn't need that extra step that was TRIPS-plus.

So there certainly have been champions, but the championing has been undermined. If you look at the report we've submitted to you, and in a point to honourable member Byrne, we have set out several NGOs and what the particular problems have been. I think it's quite easy to figure out who was the source of those blocks.

But we believe it can be championed again, and the main part now is fixing the legislation. The European Parliament wrote a good 52-word description of how this WTO solution could work, and it has turned into 3,000 to 5,000 words. So I think we just need more champions, and today is the possibility.

[Brian Masse, NDP, Windsor West, ON]

Would anyone else care to add to that? I'll move to the next question.

Mr. Elliott, you've outlined a simpler process and specific recommendations on this legislation. What's happening with other governments? Are they identifying that their legislation doesn't work, and are they are trying to fix it right now? Are there comparable issues amongst our countries, so if we are able to come up with better legislation to fix this, we could go to them and bring them along in the process as well?

[Richard Elliott]

To the best of my knowledge, none of the other half-dozen or so jurisdictions that have adopted something similar to the Canadian regime have moved to the step of doing the kind of review Canada is now doing. That's probably partly because Canada was one of the first to move on this. So we have the most experience under our belt with this so far. Unfortunately, it hasn't brought us to the desired objective.

I am quite optimistic that if Canada, at the end of this review process, were to actually legislate some of the reforms we are proposing to streamline and simplify our compulsory licensing for the export process, that would be of significant interest to a number of other jurisdictions that have adopted similar sorts of processes based on the same flawed underlying WTO decision. I think Canada is in a very good position at this point to say it doesn't work, having tried in good faith to make this WTO system work.

We've had all this expenditure of time and energy by groups like MSF. We've had a generic drug company actually come to the table to develop a product. It's been through a number of the hurdles after much work, and we're still not able to actually get this product out the door.

Something needs to change, and if Canada were to set that precedent and actually say, “We're going to use other flexibilities in the WTO rules to legislate a simple, straightforward process with one licence at the beginning and that's it”, that would embolden a number of other countries to re-examine their own regimes and perhaps think about doing something similar. I think that would be a tremendous contribution for Canada to make.

[Brian Masse, NDP, Windsor West, ON]

Just quickly to Mr. Fox, it's important we understand that this isn't just about AIDS and HIV. You mentioned in your presentation that tuberculosis and malaria were particularly noted in the last go-round. Can you quickly give us a couple of particular examples of where other types of treatments could be of real benefit?

[Robert Fox]

Well, before we leave AIDS, I think the point that was made around children's formulas, around the appropriate dosage and treatment for children, around the whole question of second- and third-round treatment, is that these are the sorts of things we're still beginning to understand, and they're really important.

The fact is that for many people in the south, we're talking about.... Just to state the obvious for a moment, these are people who earn less than a dollar a day in income. There isn't a medical system. For them, the biggest barrier to health care is the cost of the drugs themselves. A lot of them are purchasing these privately, on a market, through a market system. A range of issues, including, as I say, cancer, diabetes, or TB treatments--TB tends to get caught through the medical care system, but other things not necessarily—can have a phenomenal impact on people's lives, livelihoods, and communities.

You can cite all sorts of examples of where, because of pressure on governments in the south, the cost of drugs is actually increasing significantly--in Peru, in Bolivia, in Colombia, in countries in sub-Saharan Africa. The accessibility of drugs has been significantly retarded as a consequence of those pressures and the impact of regional trade agreements.

[The Chair, Conservative, James Rajotte]

Thank you.

We'll go now to Mr. Martin.

[Keith Martin, Liberal, Esquimalt—Juan de Fuca, BC]

Thank you very much, all of you, for the work you do to save the lives of the voiceless. I've been a big admirer and supporter of what you do, so thank you, and thank you for being here.

Just as a preceding comment, we all know, and I hope we put it in this context, that unless we have the medical personnel, unless we have the clean water, the adequate nutrition, the diagnostics, and the integrated health care system required in order to roll this out in an appropriate fashion, then we're not going to do what all of us are here to do, which is to ensure that this sick patient is going to get the care they need when they need it, and that it's affordable.

To whoever is here from CIDA, I hope we put this in the context of Canada taking a leadership role to fulfill those health care human resources, and the diagnostics and other components required to fulfill this.

I have a couple of questions. The first one I had posed to Mr. Lewis.

Let's say Canada were to change its legislation in such a way that both brand name companies and generic companies were able to compete in an RFP that was directed by CIDA. So CIDA would put out the RFP for medications for a particular country, and whoever wanted.... If it's the brand names, they fill it. If it's the generics, they receive a compulsory licence and they fill it. But that connects the group with the financial resources with the group that can actually manufacture. Would that not be a way of actually rolling out the medications to the countries that need it?

Second, to Ms. Devine, what would prevent you from being able to work with Mr. Kelsall to get the medications you need for the excellent work that MSF does? Because in the case of Mr. Kelsall's group, Health Partners, we were able to get $19 million worth of medications—it's a beautiful partnership—post-tsunami in Southeast Asia within two weeks. If Mr. Kelsall had the resources from the Government of Canada, MSF could work together with him, and he would be able to fulfill your group's needs on the ground. Is that possible?

[Carol Devine]

To your first question, I don't feel an appropriate place to comment about CIDA, and working with...I mean, we have a WTO commitment, a WTO decision that Canada was part of. We have legislation that's not working. We put a lot of effort into seeing if it would work, and then having the experience to share here today. So that for me is a possibility, but it distracts from the fact that Canada still has a commitment and that this needs to be solved.

On the second question, we might work together. As I said, MSF does drug procurement in many countries. We're always looking for opportunities. We're looking for the best price, looking for quality drugs. We may get involved in a smaller level in Canada, but then we have to remember that we're an international organization. Right now 82% of our drugs are coming from India. We are trying to think laterally and look for other resources. That's why we're involved with patent issues. We have a commitment to our patients who are being treated now, and with second-line, sometimes the drug prices are from 12% to 50% more.

So indeed, we might do a partnership.

[The Chair, Conservative, James Rajotte]

Can Mr. Elliott and Mr. O'Connor briefly comment?

[Richard Elliott]

Thank you, Mr. Chair.

Let me comment briefly on your first question. Certainly, I don't think any of the NGOs that are working in the struggle against HIV or for health generally would be unhappy to see CIDA put up more money to help support health in developing countries. Indeed, many of us have called for that and continue to call for it.

I would caution, however, that we not run afoul by falling into tied aid; that we don't somehow think that by putting up a bunch of Canadian taxpayers' dollars through CIDA we can somehow buy our way out of the fundamental problems with the Canadian regime and the compulsory licensing process. I think that would be, if one is to be cynical for a moment, almost a way of trying to paper over the more fundamental problem with the compulsory licensing process. You might, as a result of it, grease the wheels enough by subsidizing Canadian companies to maybe get one or two things out of the pipeline.

I think the fundamental challenge is to actually make the process work in a more sustainable way, so that compulsory licensing is actually easily done, not just when CIDA might put up enough money tied to purchasing from Canadian suppliers, if in fact there might be a better deal from some other supplier.

[The Chair, Conservative, James Rajotte]

Mr. O'Connor.

[Michael O'Connor]

I think the Canadian contribution through CIDA would be a drop in the bucket. We're talking about a lot of drugs over a long period of time, and the RFPs you're suggesting are not the way business is being done.

And I think it's for good reasons. Countries are responsible for their own health care. Botswana is responsible for addressing the needs of people in Botswana. If Botswana and a lot of countries are putting plans in place to address their HIV health issues, we should be supporting them as countries to do that. The main impact of this legislative change is creating opportunities, for the $8 billion that's out there to buy the drugs, to start their coming from Canada—making the competition happen.

[The Chair, Conservative, James Rajotte]

I have Mr. Kelsall.

Unfortunately, our time is up, Keith.

Mr. Kelsall.

[John Kelsall]

Just to add to that, I would say that for Health Partners International of Canada, all of the product we source in Canada is actually donated. When we send overseas, it's donated. CIDA assists us in terms of costs, or private donors do.

In terms of working with MSF, I was just whispering that in fact we have worked with MSF in Bosnia and have worked in partnership before.

All I would say is this. I have seen this overall scheme as kind of transitional. Frankly, I think the African countries, as has been mentioned before, have to come to the table themselves. They have a responsibility. They are interested in investment; they are interested in producing within their own borders. I think that is really to be encouraged.

[The Chair, Conservative, James Rajotte]

Okay, thank you.

Thank you, Mr. Martin.

We'll go now to Monsieur Arthur.

[André Arthur, Independent, Portneuf—Jacques-Cartier, QC]

Thank you, Mr. Chair.

Good afternoon, everybody.

My question would be specifically for those of you who I understand have workers on the ground over there, namely Monsieur Fox, Madam Devine, Monsieur Kelsall.

More than three years after WTO laid this egg, we are still unable to count one single dose of medicine that has been shipped over there, either by Canada or by more than 30 countries that have tried to do the same. I'm quite sure that a failure of such magnitude cannot be attributed to one single cause. It's most probably a galaxy of causes.

Of all the things that have been mentioned here two days ago and today, and by you, we seem to realize that the countries that could be receiving those medicines simply don't ask for them. There are many other factors, I'm sure, legal and otherwise, political and otherwise, but they simply don't ask for the medicine that would be available if they asked for it in the proper, complicated way.

That brings me to the fact—and only Madame Brunelle has alluded to it, when she talked about the diversion of medicine—that most of those countries are dirt poor, that most of those countries would accept all Canadian funds that could be sent their way, that they would never say no to money, but yet they say no to medicines.

That brings us to the inevitable questions of corruption. Most of those countries have people who live on $1 a day, but have elites who are very rich and have bank accounts in Switzerland. Is it possible that they will accept all the money we'd send their way but are not interested in asking for our medicines because medicines are much more difficult to send to Switzerland? Is this a problem of corruption also?

[Robert Fox]

I think it's really important that we be really clear that the countries of the south are asking for this every single day. They're not asking Canada persistently, because it's not apparent, until we get one pill out of this country, that it's worth asking for a pill from this country. They've got people dying, so what they need to be doing is going to India and going to Brazil and going to other sources today, because they don't have the luxury of waiting for us to make this legislation work.

As soon as it works, and as soon as there are Canadian manufacturers producing those drugs, they will be here buying from Canadians. But this isn't about corruption, and it isn't about their using money for something else. This is about as soon as we can deliver, they will be here to buy.

[André Arthur, Independent, Portneuf—Jacques-Cartier, QC]

Madame Devine.

[Carol Devine]

I would agree with you about the galaxy of problems and the real politics of why these countries are not asking for drugs.

I won't go down the corruption route, because MSF is concerned too. We're spending Canadian and international and Swiss money, and we have donations from all around the world. We're concerned that our money go to the patients, so we're watching that, but we see the diversion question or the corruption question in this case as not the fundamental question.

I think if we look at the Thailand case, where they did issue a compulsory licence, they got their knuckles rapped publicly and badly. One thing Canada can do besides fix the legislation would be to publicly and vocally support Thailand's pursuit of the compulsory licence. I think we can support those countries.

On corruption, I would agree with Robert that these countries want the drugs, and it's just that the rich countries have made it too difficult.

[André Arthur, Independent, Portneuf—Jacques-Cartier, QC]

Mr. Kelsall.