Industry Committee on Oct. 26th, 2010

[The Chair, Conservative, David Sweet]

Thank you, Mr. Garneau and Mr. Livingstone.

We now go to the Bloc Québécois.

Mr. Malo, you have five minutes.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Thank you very much, Mr. Chair.

I want to thank all our witnesses for assisting us in our study of this bill.

Like Mr. Garneau, I am somewhat disappointed that the Apotex representatives are not here. We are very concerned about how long it took to deliver the medicines. We were told that it took far too long, but Mr. Dearden was not of the same opinion. Public officials who appeared before the committee at the beginning of the study agreed with him. Mr. Perry told us that his company handled everything promptly. We're really wondering what all that time was wasted on. That's why it would have been interesting to hear what Apotex representatives have to say about this.

Ms. MacLean, I'd like you to clarify some of your comments. You said that first-line generic medicines could be supplied at low cost because companies were competitive. So, first-line medicines are available at a lower cost. We need the same level of competition for second- and third-line medicines.

I'm just wondering how amendments to the current regime will help create more competition if Canada is the only country making such changes.

[Emilou MacLean]

As has been said, Canada and CAMR are not the only solution to all of these problems. Canada needs to be a player, and Canada has taken a leadership role. There's a lot of mobilization. We've seen all the grandmothers who are here today; we've seen a number of other political actors who have come forward to say that this is a priority; we've seen two hearings in the last week on this, as well as a number of hearings that have taken place before. There is a lot of momentum here that does not exist in other countries.

Canada is in a position to really take on a leadership role, demonstrate what can be done, demonstrate what the most effective language would look like in a paragraph 6 decision or an August 30 decision that could work. There is a critical need, and an increasingly critical need, as India's generic market is under threat because of TRIPS, as all least-developed countries are going to need to implement a TRIPS-compliant intellectual property regime within the next five years.

So Canada is in a position to take a very strong leadership role. It's not the only solution, and other countries hopefully would come forward as well. But there is a real need, and Canada can be a real player in this.

I hope that answers your question.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

It doesn't, but your answer is very interesting. We must build on the momentum to ensure that more medicines become available. I understand that very well.

However, my question was about your comments. You said that for a drug to be available at a lower cost, we need competition among companies, since competition would drive down costs. If only Canada amends its regime, how will that create more competition in the second-line medicine market?

[Emilou MacLean]

I understand the question perfectly now. Thank you for the clarification.

One of the key components of the competition is the generic competition as compared with the originator drug. That is already competition. If Canada is producing a second-line drug that is not available in generic form elsewhere, which may be true when India's generic market is under threat, and if other countries are not actually producing generic drugs, because all countries with generic manufacturing capacity are now obligated to adhere to the TRIPS regime, there are very limited, and increasingly limited, options. So the inclusion of any additional generic competitors into the market, especially the market for newer drugs—second-line drugs, third-line drugs, or new and improved first-line drugs.... There's already competition to the originator drug, which does not exist. That's why we see the very expensive drugs now, as compared with the first-line regimen.

Does that answer your question?

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

You're getting a little closer.

[Emilou MacLean]

Please, feel free.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

I'll ask you another question, since I know that Doctors Without Borders is present in many countries that, like Canada, would likely allow medicines to be supplied. I'll talk about second-line medicines, such as second-line antiretrovirals.

Would it be possible, through various agreements, to help open the market to competition, not only here, but throughout the world? Does Doctors Without Borders notice such problems in the rest of the world?

[Emilou MacLean]

I'm not sure whether it's a problem in translation, and I apologize that my French is not better, but I don't quite understand what you're saying. What agreements do you mean? Where the market is opened up? Are you speaking about and thinking about the free trade agreements, or are you thinking about something else?

I apologize if it's the language and the translation; I apologize to the translators.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

My question was perhaps a little too vague. I will be more specific.

Mr. Attaran, among others, said that a number of countries have regimes that are similar to Canada's Access to Medicines Regime. However, abroad, there were no medicines available. There were not even first-line medicines. There were simply no medicines available.

Is that because there are too many international barriers, or perhaps because there is no genuine goodwill when it comes to access to medications? I would like to know what Doctors Without Borders thinks about this.

[The Chair, Conservative, David Sweet]

Be as brief as possible. We went way over for that clarification.

[Emilou MacLean]

Yes.

Canada's is one of the more developed mechanisms, and the work that's happening right now demonstrates how this ends up being developed. There have been many conversations about what this would actually look like; there's been a lot of engagement in this process. Some other countries, while they may have something that looks like implementing legislation, don't necessarily have implementing legislation that is workable or that is defined enough to be able to move forward.

Then I would go back to the question of political will. There is an enormous amount of political will, as demonstrated by all of us who are here today and the thousands of postcards that are here and the many others who have spoken out on this issue, all of which has pushed this forward in Canada in a way that it has not been pushed forward in other countries.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Malo and Ms. MacLean.

Now on to Mr. Brown for five minutes.

[Gord Brown, Conservative, Leeds—Grenville, ON]

Thank you very much, Mr. Chairman.

And thank you to our witnesses today. I think this is something that all Canadians care about.

Mrs. Rennie, you said that Canadians care. I would go as far as saying you'd be hard pressed to find a Canadian who didn't care, and you'd probably be hard pressed to find a Canadian who wouldn't sign one of those postcards and send it in. I want to congratulate you on all your efforts in pushing this important issue.

Mrs. Rennie, you did say there were other things that could be done to help. Just quickly, could you tell us a few things that are on the top of your mind in that area?

[Elizabeth Rennie]

When I was in Africa, I saw evidence that the Africans are building their own infrastructure. I visited a number of projects where the women were in fact rebuilding their communities. I find it a bit patronizing for us to assume we should tell Africans how to build their infrastructure. But I think we need to give them the support, and the support means being alive. We can talk about all the infrastructure we want, but if people are not alive to work, then all the infrastructure in the world doesn't make any difference.

I'm not sure, Mr. Brown, whether I'm answering your question.

[Gord Brown, Conservative, Leeds—Grenville, ON]

No, but that's okay. Thank you very much.

Mr. Chairman, I, along with other members of the committee, am very disappointed we're not going to hear from Apotex. I have a lot of questions for them. We've heard a lot from witnesses over the last number of weeks about how CAMR has worked or hasn't worked, and they have been the only company that actually has used it.

Maybe some of our other folks--Mr. Perry, Mr. Williams, and Mr. Dotto--could help. They have had the opportunity to work a little bit with them.

How has Rx and D worked with generic companies to implement some of the goals of CAMR? Because Apotex isn't here, maybe you can help us with this.

[Russell Williams]

Absolutely. I think some of the criticisms about CAMR would be a little more credible if there had been a second application, or a third application, and it hadn't worked. At least Apotex moved forward on the first one, and that should be duly noted. Where has everybody else been?

I think what you're seeing on the international level is a movement towards more and more.... I think this is why this debate about compulsory versus voluntary is confusing. The action and the partnerships are actually being developed around the world--generics included, with us--on a voluntary basis. It gets very creative. It gets into some of those programs that the grandmothers have been talking about. It gets into infrastructure. It gets much more creative.

I think we're getting pulled into an IP debate when we're actually talking about humanitarian issues. We can be much more creative with that voluntary effort, and I think the two companies can talk about specific examples.

We get into investing in research and development. We get into community involvements around the world. Sometimes we do it in partnerships. There is the Canadian example of Health Partners International. We actually donate products with them, along with the generics. There are exercises we can do together, versus just focusing on rewriting CAMR.

I don't know if the two others would like to add examples.

[Grant Perry]

As we've already discussed, the one attempt by Apotex to discuss a voluntary licence, which we're willing to undertake with them, did not come to fruition.

Our main activity is global. We do a number of different things in terms of trying to meet the needs, and I think I've touched on some of them. We have voluntary licences with eight manufacturers in sub-Saharan Africa alone. Those eight manufacturers delivered 270 million tablets of antiretrovirals into sub-Saharan Africa.

You compare that to the 15 million tablets out of Rwanda, and that's just GSK. I know Pfizer, Abbott...every other company has their own way of moving forward and specifically working with generics.

That's just one piece we do, whether it's not-for-profit pricing, partnerships with the Gates Foundation and the like, partnerships with other parts of the UN.

That's one specific around generics globally.

[Gord Brown, Conservative, Leeds—Grenville, ON]

Other than Apotex, have there been any other generic companies that have indicated any interest in using CAMR?

[Grant Perry]

None. Not that we're aware of.

[Gord Brown, Conservative, Leeds—Grenville, ON]

All right.

[The Chair, Conservative, David Sweet]

Mr. Brown, it's your time we're using, but Madam Watson has had her hand up, if you wouldn't mind.

[Gord Brown, Conservative, Leeds—Grenville, ON]

I was just about to go to her.

Go ahead.

[Linda Watson]

Thank you, Mr. Brown.

[Gord Brown, Conservative, Leeds—Grenville, ON]

I'm not sure which question you wanted to answer, though.