Industry Committee on Oct. 26th, 2010

[Serge Cardin, Bloc, Sherbrooke, QC]

I have some comments to make.

Thank you for being here.

Following up on Ms. Kiddell-Monroe's comment, I must admit that problems do exist. First of all, people are dying. Second of all, money is an issue. In addition, as you said at the beginning, we are currently part of an almost undemocratic process because sponsorship is not ensured.

The first step would be to at least refer the bill to the House, so that the matter can be decided. However, serious doubts could arise, as some people might have different goals in mind.

The bottom line is that people are dying. Money is also a problem. You mentioned the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is set at $13 billion a year. You say that Canada is contributing. We were told last week that Canada contributes $150 million or $160 million to the fund, which is about 1% of the total amount.

Companies also worry about money, but they often forget that dying people will never buy highly priced drugs. That much is obvious. How much could pharmaceutical companies contribute to the cause? Either way, they will never sell those people anything. Consequently, they might as well sell their products at no profit, or even at a small loss.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Cardin.

Now we're on to Mr. Wallace. Mr. Wallace, we have two more groups of people, so would you keep it as tight as you can, please?

[Mike Wallace, Conservative, Burlington, ON]

I actually only have one question, Mr. Chair, and we'll deal with that. I want to thank, first of all, our panel and our guests by video link who are joining us today.

I want to stick to the actual bill that's in front of us, and I'm going to ask Mr. Dearden a question and the same question to Mr. Abbott. Under the bill there is a change. At present, any drug leaving the country is approved by Health Canada. In the bill there is an option to have it approved by Health Canada or not, based on what the receiving country wants. I don't know the answer to this question: does that leave Canada with any legal liability because they're not exercising the opportunity to evaluate the drug before it leaves the country?

I'm assuming we have a liability now, since we've approved it. If we don't approve it, do we carry a new liability as a country? There are more than two legal minds here, but there are two people I've indicated to answer that question.

[Richard Dearden]

There's a third one to my left.

[Mike Wallace, Conservative, Burlington, ON]

And a fourth.

[Richard Dearden]

The requirement in CAMR now for Health Canada approval actually isn't mandated by the general council decision, but I don't think anybody, the generics or the innovative drug industry, object to the requirement being in there that safe drugs actually do get exported under the compulsory licence system.

My problem, Mr. Wallace, with any drug is that the “pharmaceutical product” definition in the general council decision was looking at epidemics and serious problems, not lifestyle drugs. Bill C-393 is offside, in my opinion, because it applies to all drugs, not the ones that we see in schedule 1, which is a limited list. That puts it offside there.

My colleague also wanted to add something, so I'll give him my time.

[Mike Wallace, Conservative, Burlington, ON]

We'll go to Dr. Abbott first--is that all right?

[Dr. Frederick Abbott]

Well, Mr. Dearden is correct that there is nothing in the WTO rules or dealing with the WTO that regulates the quality, safety, and efficacy of drugs. From that standpoint, there's no liability.

Secondly, as a general proposition, virtually all countries maintain domestic regulatory authorities that are responsible for determining the quality and approving the drugs that are put on their domestic markets. But in this case there is an even more practical issue and solution to what you're mentioning.

Virtually all of the antiretroviral drugs being supplied in large quantities into Africa are being supplied under the terms of large-scale procurement funding that is coming from multilateral organizations and donor funds like the global fund. All of those funds require that the drugs that are being purchased meet strict compliance guidelines. Those strict compliance guidelines may often be and are typically the WHO pre-qualification program.

As a practical matter, the notion that Canada would be exporting unqualified or unsafe drugs under this system is very unlikely, and I would just end with that.

[Mike Wallace, Conservative, Burlington, ON]

If the other two have any comments, I'd be happy to hear them.

[Dr. Amir Attaran]

Thank you for giving me the time.

I'm going to draw attention to something that Mr. Abbott said. He said that medicines sent abroad have to comply with “strict compliance guidelines”. Those were his words. He's right.

Strict compliance guidelines are not the same as law. Law is different from guidelines. Having it in the law, Mr. Wallace--because you did ask about the bill--that Health Canada must exercise the same regulatory oversight for medicines that are exported under CAMR as for medicines taken by Canadians...that's actually the only correct way to do it, not guidelines that aren't legally binding.

There is a problem that has been experienced in Europe. I have to be coy in these comments because a colleague of mine who spoke about this publicly was sued.

There is a European country in which there is a European company that supplies malaria medicines to Africa, some of which are substandard. Why? It's because the unnamed country's law allows medicines to be exported from Europe to Africa that do not meet the regulatory standards of the European country itself. This has certainly resulted in patients getting the wrong sort of treatment.

The tactics are so brutal in this industry that another professor was litigated against for even bringing this up.

[The Chair, Conservative, David Sweet]

Thank you, Mr. Attaran.

Madam Kiddell-Monroe.

[Rachel Kiddell-Monroe]

Thank you very much.

These two points, the list of medicines and the Health Canada approval, are both above and beyond what's required by the WTO. These were things the Canadian government decided to add in those negotiations; they are not necessarily according to WTO standards. If the argument goes that we should just refer to what the WTO says, we don't need them to be in there.

[The Chair, Conservative, David Sweet]

Thank you very much, Mr. Wallace.

Thank you very much to our witnesses, both here as well as abroad. We appreciate your testimony.

If members want to speak to the witnesses as they leave, I would ask them to please take it outside. We need to shift from these witnesses to another group for the next hour and a half, and we would like to do that as efficiently as possible.

We'll suspend for five minutes.

[The Chair, Conservative, David Sweet]

Ladies and gentlemen, we're now back in session. I'm going to introduce the witnesses at the table.

We have, from Doctors Without Borders, Emilou MacLean, who is director of the United States of America Campaign for Access to Essential Medicines. We have Grant Perry from GlaxoSmithKline Canada, vice-president of public affairs and reimbursement. We have, from the National Advocacy Committee of the Grandmothers to Grandmothers Campaign, Elizabeth Rennie and Linda Watson. From Apotex Inc., we have Bruce Clark, vice-president of regulatory and medical affairs. From Canada's Research-Based Pharmaceutical Companies, we have Russell Williams, president, and we have Laurence Dotto, director, government and external affairs.

Then we have, by teleconference, Angus Livingstone, managing director, University-Industry Liaison Office, University of British Columbia.

Who is going to make the opening remarks for the Grandmothers to Grandmothers Campaign?

Okay, if you would, please begin now, Ms. Rennie, for five minutes.

[Linda Watson, Member, National Advocacy Committee of the Grandmothers to Grandmothers Campaign]

May I make one comment to explain this box?

[The Chair, Conservative, David Sweet]

Certainly, but it will be part of your time. Go ahead.

[Linda Watson]

I'll just say that we have brought in this morning 3,000 additional pieces of correspondence, and more has been added just now, to the already 9,000 pieces of correspondence that have come from Canadians across this country to this committee in support of Bill C-393.

[Elizabeth Rennie, Member, National Advocacy Committee of the Grandmothers to Grandmothers Campaign]

We express our appreciation to Mr. Sweet, the chair of this committee, and to the committee members for hearing our brief on this bill.

We present as concerned grandmothers and granddaughters from across Canada. With me are members from British Columbia, Quebec, and Nova Scotia.

The Grandmothers to Grandmothers Campaign is made up of 240 groups--that's 10,000 people--across Canada. In addition to that are the thousands of others we call “grandothers”. In fact, a Pollara poll in 2009 indicated that 80% of Canadians want this bill passed.

We're concerned about the plight of African grandmothers. Why Africa? Because that is the region where, as you know, they are most heavily inflicted with the HIV pandemic.

This, ladies and gentlemen, is a pandemic that has hit the children: 13 million children are without either one parent or both.

This, ladies and gentlemen, is more than the total of all the children in Canada and Norway.

This is about women and children. The toll is particularly hard on those in developing countries. AIDS is the number one killer of babies. In fact, in the region of sub-Saharan Africa, most children who are HIV-positive die before the age of two.

Can you imagine, even for one minute, what it would be like to bury your children and then to take on the responsibility of raising two or four or ten orphans, very vulnerable children and adolescents? I met some of those people when I was in Africa.

What would it be like for Canada to be defined as a country that has lost a generation of workers, of adults? These parents, teachers, nurses, workers would be alive if they'd had the life-saving treatment that they couldn't afford.

Having highlighted the effect of HIV/AIDS on women, it's imperative to recognize that it is the women in sub-Saharan Africa who are literally holding that continent together because of their positive actions and their determination to stem the tide of this pandemic spreading. This can only happen if we increase the supply of affordable medication to them.

We have read the reports and the studies. We have visited MPs. And we have listened to the concerns. Your colleagues will tell you, as Linda has already indicated, that we have had responses from thousands of Canadians.

This is evidence that Canadians care. Canadians care. And it is our belief that there should be universal access to health care.

Canadian grandmothers are not naive. We know that passing this amendment without changes is but one solution. It's not a panacea. We know that. But we certainly question the wisdom of rejecting a viable solution and proposing the creation of another mechanism.

The argument has been raised that Canada must first address the issue of poverty. It's not a case of either/or. Each consideration regarding poverty infrastructure is hugely important. They all form the multi-faceted response that is needed to save lives and communities. But the fact is that there are places right now, even with drugs from China and India, where people who have infrastructures and who have water are being forced to remain on waiting lists until someone in the community dies before they are able to receive the medication. Treatment matters, and it matters now.

This debate should not be about patents or intellectual properties; it should be about people. It should not be about patent protection over human lives. This is a humanitarian bill. This bill is about people like you and me.

In May some of us went to Africa, and what was theory before is now reality. The statistics of millions took on a face. She has a human face and she lives a courageous life. Being in Africa for just over two weeks did not make us experts--we don't pretend that it did--but we didn't go as tourists. We went to listen and to learn.

We heard heart-wrenching stories. We walked, talked, ate, and danced with women from Kenya, Malawi, and Swaziland--from 13 African countries. Their requests had a common theme: “We know what to do. We know what we need. Support us. Be our voice in Canada.”

[The Chair, Conservative, David Sweet]

Thank you, Madam Rennie. I'm sorry, but we're well over time now.

[Elizabeth Rennie]

I know there are a lot of statistics. May I just tell one story please, Mr. Chair?

[The Chair, Conservative, David Sweet]

Do you mind if we give her one more minute, just to finish?

[Mike Lake, Conservative, Edmonton—Mill Woods—Beaumont, AB]

Yes, if there's agreement in the committee.

[The Chair, Conservative, David Sweet]

Go ahead, Madam Rennie.

[Elizabeth Rennie]

Thank you very much.

I listened to a woman in South Africa tell her story. This is a woman who has a face. She had taken her four-year-old child into her home because the child was HIV positive, and her husband left her because he wouldn't be in that home. As she told her story, tears just streamed down my face. She looked in my face and said, “Elizabeth, I don't want to cry anymore.” Then she broke into a deep, resonant song of hope that filled the room, and we all joined in, “Dumela, dumela”, a song of hope. African grandmothers told us face to face as they hugged us how empowering it was to realize that women in Canada cared about them. Imagine their absolute delight if they knew that the Canadian government was going to step up and show evidence of its global care and compassion.

[The Chair, Conservative, David Sweet]

Thank you.