Industry Committee on Oct. 21st, 2010

[Serge Cardin, Bloc, Sherbrooke, QC]

What would you say Canada's contribution is to the $13 billion?

[Richard Elliott]

A few weeks ago, the Prime Minister announced to the UN what Canada's contribution was. I can't remember the exact figure, but I think it was five dollars per Canadian more or less. So you can do the math.

[Serge Cardin, Bloc, Sherbrooke, QC]

You forgot to say “only”.

We are talking about CAMR. Mr. Lake told us that the new bill would be pointless. And, to be honest, CAMR has not been very useful in the last six years. Overall, how does Apotex's involvement fit in the big picture? It is quite insignificant. We could say that it amounts to practically nothing. So, as Dr. Kilby was saying earlier, if we do nothing, if we don't take any risks, precisely nothing will happen and, therefore, there will be no major developments.

In addition, you confirmed that the patented drugs were second rate compared to the generic drugs and therefore, less effective most of the time.

[Dr. Don Kilby]

No, that is not what I said at all. Second-line drugs are just as effective, but more expensive.

[Serge Cardin, Bloc, Sherbrooke, QC]

Oh, I see. Earlier, you were talking about first-line and second-line. You were saying that we had to think about using second-line drugs in order to improve treatment. But I was talking about generic drugs versus patented drugs. There is a difference, isn't there?

[Dr. Don Kilby]

There is a difference in cost, but not in how effective they are, since they have to be bioequivalent.

[Serge Cardin, Bloc, Sherbrooke, QC]

All right.

I have met with pharmaceutical representatives who told me they were involved in a number of international projects. I am sure that you work with pharmaceutical companies. In terms of patented drugs, how could the pharmaceutical industry get involved more directly? You wish there would be a jump from 5.2 to 10.4 million people, but I don't suppose a lot of patented drugs are sold to these patients.

[Richard Elliott]

That's right. I will continue in English, if I may.

The majority of the 5.2 million people who are receiving HIV treatment now in the developing world are on generic medications because that's what has made it affordable. That's how we've made the progress Mr. Lake was referring to.

There is nothing now that prevents the patent-holding brand-name companies from selling in those markets, and there is nothing in CAMR and nothing in Bill C-393 that prevents them from doing that. The point of having a patent is you actually have the right to sell the product. In fact, you have the exclusive right to sell the product unless someone else gets a licence, which is what CAMR is supposed to do.

This is simply about opening up the field, allowing greater competition in those markets. When the brand-name companies have had to face competition in the developing world selling their products, we've seen that that is what has brought the prices of medicines down. We need to keep that dynamic going. That's the purpose of something like le Régime canadien d'accès aux médicaments.

[Serge Cardin, Bloc, Sherbrooke, QC]

Do you think that the companies selling the patented drugs could one day open up to international co-operation and to this market?

[Richard Elliott]

We haven't seen that so far. You would have to ask them.

[Dr. Don Kilby]

Absolutely nothing is stopping them, and each company has a specific program to ensure that their medicines get on the market at a reduced price, meaning a price that is different from the price in the north. Also, these companies have the exact same systems in place to make sure that the drugs will not go back north: here they have a different name, a different colour and the labels on the packaging are different.

The companies are already part of a dual system where the north pays more than the south. But the difference between the price of patented drugs and the price of generic drugs is so big that this is not an option for most markets where the drugs are needed.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Kilby and Mr. Cardin.

We're a little bit over our time and we just have a little portion of time left.

Mr. Kilby and Mr. Elliott, I'd like to have your closing remarks, and they are compliments of Mr. McTeague, who decided to give up his time in order for you to have some closing remarks.

If we could keep it to two minutes, Mr. Elliott, and then two minutes for Mr. Kilby for any closing remarks you'd like to make, please.

[Richard Elliott]

Thank you.

Let me just address two points quickly, to get back to the question that a few people posed.

The first point is the issue of diversion of medicines, which of course we don't want to see happen. Dr. Kilby put it very well. We have to take some risks here. The legislation preserves the measures that were already negotiated and in place to mitigate the risk, to minimize the risk of diversion happening, and, let's not forget, that we cannot let the perfect be the enemy of the good here.

We have not had a significant problem with diversion, for example, of the donated discounted brand-name drugs that have been provided in these countries because they are using the same sorts of mechanisms that are provided for here for generic drugs. That has not been a significant problem.

That is not to say never say never. Should there be at some point a shipment of medicines that gets diverted, let's say if 99% of the shipment got through and we saved hundreds of thousands of lives because of it, if one shipment went missing, that is a price worth paying. But we have mechanisms in place that are there to prevent that from happening. Let's not overstate the risk there and use it as an excuse for not fixing this and making it workable.

The second point I wanted to speak to was your question about the amendment to the Food and Drugs Act. It is fair to say that the core of the problem with the current access to medicines regime has been the licensing process. The process about how you review the drugs for quality and safety and so on is secondary.

We should, if there are difficulties with something like the proposed subsection 38(1) that's in Bill C-393, look at that. If you feel it doesn't provide adequate protection for making sure that things are properly reviewed before they get to the countries, let's tweak it and let's make it work there, but let's not lose sight of the core objective here and use that as an excuse to not pass this.

The reality is if you talk to the generics—I think they'll tell you this next week—they're going to go through the Health Canada review process anyway, because that is the thing they are familiar with. So as you see in this proposed provision in paragraph 38(3)(a), all of the existing regulations that are made under part II of the Food and Drugs Act, section 30, which is the one that has all of the regulations about quality, safety, and efficacy, will be entirely applicable. Bill C-393 will not change that.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Elliott.

Now we'll go on to Mr. Kilby, please.

[Dr. Don Kilby]

I'll be very brief.

First of all, I want to thank you all for listening to us today.

I really do think, as Richard has said, that we have to take some risks to make this happen. The world has really taken risks already to get 5.2 million people onto therapy and has done things that nobody thought people from resource-limited settings were able to do. Every day people take risks. I think we have the capacity and the ability within our country to be really significant players and significant contributors to what is a global problem and to offer up a viable solution for procuring cheaper, affordable treatments for people affected by HIV and AIDS and other conditions.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Kilby and Mr. Elliott, for your testimony today. We greatly appreciate it.

For the members, before you go, please remember that Tuesday, because of the need for scheduling priority witnesses, our meeting will be from 8:30 until 1:00, with three separate groupings of witnesses. Also, please keep in mind that next Thursday will be clause-by-clause on this particular bill, and we'll need to have any amendments you're considering as soon as possible.

That said, the meeting is adjourned.