Natural Resources Committee on March 30th, 2010

[Peter Goodhand]

I would echo those comments. There are definitely two levels of diversity.

We also talked about--and I think you mentioned it--the issues of interchangeability. On part of the problem today, you heard that the target that gets irradiated looks like a ruler, but in a different place it looks like a pencil. You can't make the ruler go through the slot, so it's a matter of the interchangeability of those targets. If they all looked the same or there was flexibility, targets irradiated in different reactors could be processed in different processing facilities. If they're unique to that piece of technology within the reactor model, they're not interchangeable.

Then there's a second level of diversity, which means looking at things like cyclotrons.

There is the opportunity to have redundancy within a facility. If they feel there's a critical point, rather than having just one processing line you could have two processing lines so that one could be maintained and the other operated.

So there is redundancy in that straight chain and interchangeability between the chains. That will be particularly important in North America. Because of the shipping times, it's better to have a regional solution where there is a great deal of interchangeability, and perhaps secondarily, the ability to switch from Europe to Africa, North America, and Asia, but certainly within a regional geography.

As we think about long-term solutions it will be incredibly important that U.S. and Canada collaborate, not just in supply agreements, but in technology design and complementarity.

[Paule Brunelle, Bloc, Trois-Rivières, QC]

The issue of collaboration is another thing that worries me, since you are working together. Mr. Littlejohn, you say there is international coordination to secure the supply, which is logical. I imagine you do that as a business person, since you need to be sure of your supply. Furthermore, the expert panel says we must collaborate with other countries. Is there a formal structure for such collaboration or is it based on personal negotiations with your business contacts? Would it be necessary to have another structure on top, in order to ensure that this collaboration takes place?

We know that it will be quite some time before Canada can produce isotopes. Will Canada still have a market share? I don't know. Will we finally be able to ensure that patients get their supplies? We know, as you know even better than I do, that production is regularly interrupted.

That is how I see the question. Are things working well on the international level, where the expert panel recommends that there be more collaboration? Could there be a better way of doing it?

[Stephen Littlejohn]

The answer to your question is that both exist. On an international level, the OECD high-level working group--I think Canada is represented by Serge Dupont on that panel--met in December and meets again in June. It brings together representatives from nation states around the world to discuss and focus on these issues.

In last December's meeting it established a number of task forces. In fact, we're working on one on iodine-131, and there are other task forces. At the same time, there are very robust efforts going on. I would highly recommend some connecting with the European Union. They recently did a massive report on everything you ever wanted to know about medical isotopes. They put out this preliminary report in October. It's a great resource. They're having another meeting of nation-states in May in Luxembourg.

On the piece with the companies, we see that diversity of supply and interchangeability--that's an excellent point--are important to us as a business. We're driving that, so there's an alignment of interest there. But I do think that more frequent international communication will be a good thing here.

[The Vice-Chair, Liberal, Alan Tonks]

Thank you, Madame Brunelle.

Thank you, Mr. Littlejohn. We'll note that research paper, Mr. Littlejohn. If you can make that available, I think the committee would like to have access to it.

Mr. Cullen.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Thank you, Chair.

Thank you to our witnesses this morning.

Mr. Goodhand, just to locate this again for committee members, remind us who is implicated by the shortages that are going on right now. I'm not sure which hat you'll be wearing when you answer this question.

[Peter Goodhand]

First of all, if Mr. Littlejohn was saying that I'm the doctor here, I'm not. You would have received a better answer to that question from Dr. Turcotte last week.

When you say “locate” in terms of who's impacted, do you mean at the patient level?

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Yes.

[Peter Goodhand]

Going back to the lessons learned through December 2007 and the ad hoc group brought together to advise the Minister of Health, I think the work that's been done over the last year has been a remarkable testament of the commitment and dedication of the medical community and the broader health care community, the supply community, and the various levels of government.

From the point of view of the Canadian Cancer Society and cancer patients, we're probably the last to be impacted, because of the urgency and importance of the cancer patient tests. I'm hearing that last week was a really tough week, and you've heard that May is going to be tough. There are very clear triage mechanisms in place, and there will be other patients in other disease states more immediately impacted by a switch to a different isotope.

For those who can only be effectively diagnosed with TC99, there has been tremendous flexibility shown by the triage system, the nuclear medicine specialists, and scheduling clerks. We even hear stories of parking lot attendants staying late to make sure the patients have access after hours. So there is tremendous commitment, dedication, and flexibility being shown by the medical profession and the health care community at all levels.

My concern, and what we have heard through testimony to our committee, is that it's not sustainable.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

That was more my question. You used the word “triage”, and that's often been associated with what's been happening in Canada and other places over the last while, that we're making do. Triage is something one associates with a war zone or a disaster area, that you simply do what you can with what you have, but it's not ideal and you can't keep doing it forever.

[Peter Goodhand]

Right.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

That is the concern I have. We hope to hear from the minister on that, especially as there was a report put together by the best experts and submitted four months ago on an issue that is obviously urgent—certainly for the people you represent through the Cancer Society and the other patients with other diseases who are affected by this.

I'll get to a question, and it might be for both of you. Is there any advantage to having a domestic supply at all? We seem to be at a bit of a crossroads here. The Prime Minister has suggested that we should get out of the isotope business altogether, that Canada shouldn't be in it. Meanwhile, money is being poured into shoring up the Chalk River reactor, and, potentially, your group suggested building a new research facility. That was your first recommendation, which will cost many hundreds of millions of dollars.

Is there an advantage to Canada having its own supply, or should the free market reign and we just pick up isotopes from wherever they may be around the world, through Mr. Littlejohn's services and others'?

[Peter Goodhand]

When we focused on the multi-purpose research reactor, as I said at the beginning, it really talks to the broader policy issues of where Canada's emphasis is from a research point of view, from a commercial development point of view, and from that of job creation. If a major focus remains on nuclear, then it makes absolute sense to have integrated isotope production. It's an area of expertise for us. It would give regional balance in North America—and the reactor base production is the only proven technology we have today.

It's also about the global business model. One of the reasons for the high-level working group and for others is that the source of the molybdenum is government-owned reactors operating on essentially the same business model. Then the private supply chain takes over at different points, but the central piece is typically a government-owned research reactor with a multi-purpose approach.

If that policy question is answered in the affirmative, such that we want to be in this area, it makes absolute sense to use that as a platform for isotope production and the commercial arrangements that follow. If that decision isn't taken, there is still great interest from a Canadian point of view in the research platforms in accelerator technology, both linear accelerators and cyclotrons that could create surge capacity and redundancy to help protect Canadians and North Americans from any shortfall in that global supply chain, particularly given that it's been described as fragile. It is likely to remain fragile until major fixes to several reactors come into place.

[Nathan Cullen, NDP, Skeena—Bulkley Valley, BC]

Just to get you right, for competitive advantages, for the research capacity it would give Canada, and for the fragility of the supply chain, which would put Canadian patients at risk, if I follow the logic, if we don't have our own supply, your panel came back with the recommendation that we should build another research facility similar to Chalk River but obviously a bit more modern. I'm assuming your panel also took into account that the Prime Minister essentially did make a bit of a policy statement in saying Canada should be out of the isotope business. Did that not factor into your panel's recommendation? You said it was a policy choice. There's a crossroads here. The Prime Minister seems to have suggested we're going down one of those roads, and it does not involve being in the isotope business.

[Peter Goodhand]

We heard the statement, as everyone else did. We looked at this from a patient perspective, from the question of achieving a sustainable supply of technetium 99. You are correct, a global solution is absolutely necessary. It is a global marketplace. Anything that happens has to take place in that global context. It is quite possible that Canadian patients will be supplied without the presence of a domestic producer. But if we want to ask what Canada can do to ensure the best possible sustainable secure supply, one of the things we could do as a country is to follow the recommendations in our report. I think five countries in the world out of 195 are global suppliers, six now with Poland, and there are probably another four or five countries who do domestic supply. So you've got 195 countries being sourced by ten or so. We could choose to be one of those ten or we could choose to be one of the other 185.

[The Vice-Chair, Liberal, Alan Tonks]

I'm going to have to jump in, Mr. Cullen. We're out of time.

We'll go to Mr. Anderson for seven minutes.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Thank you, Mr. Chair.

I find this fascinating. We had witnesses in last week who were talking about some of these same issues. I want to talk about the future in a minute. But first of all, I'd like to go back to the past. You say there is no standardized design. How did that come about? Was there not vision to see that this is, as you said, a global situation with a global solution?

[Peter Goodhand]

Do you want me to go first?

I'll do the layperson first. One of the reasons we recommend that multi-purpose is if you think of this over a 40- or 50-year time span, when those reactors were built nobody had even thought of isotopes. Isotopes came along in the 1970s. So they grew up on an experiential basis in each one of the reactors. I think there is more interchangeability in Europe, and I'll speak to that. There was a U.S. presence in this until the middle or late eighties, which is the last time I think there was reactor-based production in the U.S. But even within Canada, within our research reactors, because the reactor wasn't designed the same way because it didn't have the same primary purpose, when it adopted and started to make isotope production, it did it in different ways at different times.

The other thing is although we're focused on the reactor, the other aspects of this are critically important, and to understand the processing.... That reactor will be used for many purposes. The processing is dedicated to isotope production. So it's often interchangeable at the processing level, not just at the reactor level.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Why would we assume that in the future it will be standardized if things are being done in completely different ways with different technologies?

[Peter Goodhand]

On the reactor-based products and the processing that follows, I hope we'd look to design we'd learned from the lessons of the past. As I said, I think the European experience and the reasons companies like Covidien and Lantheus can interchange is that their European facilities have more flexibility. But I'll let Mr. Littlejohn speak to that.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

How far away are we from standardized technology?

[Stephen Littlejohn]

I can't give you a direct answer on standardization of technology, but as I think you pointed out, Doctor, it's the interchangeability into the reactors. You might have the tubular version as well as the flat panel. To some extent that is a function of how you can fit it into the reactor, because the medical isotope production, the setting up of the racks and the thimbles, if you put next to the core, is a function of how you can get in there and next to the core, and that depends on how the reactor is structured.

As mentioned, the other piece is the processing. We're able to do in Europe both the tubular design that BR2 uses and the flat plate that HFR and Maria use. Understand there's another wrinkle in all of this, and that's the conversion to LEU, low-enriched uranium. That's going to be a whole new generation of targets, and you have to think about that both in terms of processing as well as.... Now, the shape doesn't really change all that much, but it's the processing piece. There's an opportunity now. There's an inflection point to think this through.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

Good. I was going to stop you there, because I don't have much time.

That leads into the future. Last week, on Thursday, it seemed as though our witnesses were saying that the level of production from the large reactors would pretty well be consistent with what it is now, but that there would be new technologies developed to test things. The cyclotron, accelerators, and those kinds of things would be bringing on additional capacity. They really seemed to see that the future direction was a shifting to those new technologies.

I'm not hearing that from you today. Are you agreeing with them? They weren't saying that reactors were going away, but that we are on “the cusp of new technology”—I think those were the words they used. I'm wondering about your reaction to that.

[Stephen Littlejohn]

I would agree that we're on the cusp of new technology. We still have to cross over into seeing whether it is commercially viable and can give us the quantities, and also whether, if you have changed the investment paradigm, hospitals will invest in it. There are a number of factors there. I'm not going to say it won't happen, and we're not here to say that. For the sake of patients, it's important for all sorts of alternatives to be explored.

I listened to Thursday's discussion on replay. Even with that said, the prediction is that you are still going to need enough technetium for about 30 million procedures, at a roughly flat level going into the future. So while you may not see a lot of growth in tech, you are still going to need it.

[Peter Goodhand]

Could I also speak to that?

Every expert we spoke to, every group we reviewed with, established for the foreseeable future—10, 15, 20 years—a firm base of technetium demand. They also saw that there were significant ways that you could use new technology, with advanced spec cameras, to achieve greater utilization, lower patient dosage, and faster processing time. Introducing state-of-the-art cameras into technetium usage as it is today is a use of technology at the front line that is different from introducing PET, which is different again from producing TC-99 in a cyclotron. You have to separate the new imaging modalities, which are coming and will influence and change medical practice in Canada.

It may be that in 20 years' time there will be no demand for technetium as we know it today, but everybody has said that there is a stable market for the next decade or so.

[David Anderson, Conservative, Cypress Hills—Grasslands, SK]

But the challenge is that in order to make those policy decisions for the future, as you said, it depends on what, for example, a research reactor is aimed towards. If it is aimed towards research, it can be up and running quite a bit earlier than it is if it's going to be this multi-use facility. The cost is a factor there as well.