Public Accounts Committee on March 24th, 2022

[The Chair, Conservative, John Williamson]

Thank you, Mr. Patzer.

MP Dong, you have the floor for five minutes.

[Han Dong, Liberal, Don Valley North, ON]

Thank you very much, Chair.

I want to thank all the witnesses for coming today.

The way I look at this study is the same way I look at most government regulations: On one end, you have the consumer benefits, so the safety of consumers. On the other hand, you have a thriving market that includes the producers, importers and retailers. I think somewhere in the middle would represent consumer choice, alternative medicine, affordability and the thriving market.

I do want to say that I was in Japan and Hong Kong. I know this industry has been thriving in Korea and Taiwan for many, many years. Mainland China is picking it up as well. I see signals in Canadian markets. Especially in big urban centres like Toronto, these shops are opening up. Obviously that's a sign that there's a market for it. If you go into Loblaws or Metro or these franchise chains, you will see this product on the shelf, so it is actually very important for us to get ahead of this and to take a look at the licensing and inspection.

I have questions on licensing. Just help me to understand the process here. First of all there is a lot being talked about manufacturing domestic products. What's the requirement for import products when it comes to licensing?

Maybe the deputy minister can start.

[Dr. Stephen Lucas]

Certainly. I'll provide an initial response and then turn to my colleague Pam Aung-Thin for further information.

Product licensing requirements are requirements for all products that are intended for sale in Canada whether they're manufactured in Canada imported. Those include requirements in terms of the safety, efficacy and quality of those products. In regard to the findings of the audited areas in which Health Canada has been taking and will continue to take action and strengthen our work, we are strengthening the information required that is associated with the quality of products as part of that pre-market or pre-licensing review. That includes moving from an attestation system in which that product site licence meets specifications to one in which we are seeking test results in terms of product quality and further notification. We will be building that into our regulations, but it's a practice that we're implementing now, as my colleagues have outlined.

[Han Dong, Liberal, Don Valley North, ON]

Thank you.

It sounds to me as though it's a bit easier to understand when it comes to domestic products because you have a manufacturer you can go to and a supply chain you can trace. However, when it comes to import products, do you just depend on the ingredients, the information the importer provides, or is there actually a requirement for a Canadian institution to test them to see the actual ingredients or proper labelling? Can you shed a light on that and tell us how long that period usually takes?

[Dr. Stephen Lucas]

I'll turn to Pam with regard to the free market review, and Linsey on the site inspection, where we do some on-site visits and work with other regulators internationally where we have trusted relationships to use their reviews.

Pam, please start.

[Pamela Aung-Thin]

Thank you, Deputy Minister; and thank you for the question.

For imported products, companies require a site licence to import those products. This is to ensure that the products meet the standards set out in regulations. The importer also needs to provide evidence that any foreign manufacturer meets good manufacturing practices.

In terms of the regulations we've put in place, they respect the range of cultural and philosophical diversity that underlie the broad range of products. You named a number of products in this space. Our regulations were informed by recommendations of the Standing Committee on Health.

For the second part of that question, I'll pass it on to my colleague Linsey.

[Han Dong, Liberal, Don Valley North, ON]

Okay. Go ahead.

[The Chair, Conservative, John Williamson]

Could you just keep it very short, please?

[Linsey Hollett]

Thank you. It will be very short.

I will add that, for many of the reasons you mentioned, importers are actually a huge focus of ours in the inspection pilot and will continue to be. As we move towards a more permanent program, half if not more of those we are inspecting for compliance with regulations are importers.

[Han Dong, Liberal, Don Valley North, ON]

How long does the licensing period take?

[The Chair, Conservative, John Williamson]

I'm going to have to ask you to come back on that question.

[Han Dong, Liberal, Don Valley North, ON]

Okay. I'll ask it later. Thank you.

[The Chair, Conservative, John Williamson]

Ms. Sinclair‑Desgagné, you have the floor for two and a half minutes.

[Nathalie Sinclair-Desgagné, Bloc, Terrebonne, QC]

Thank you, Mr. Chair.

Mr. Lucas, further to my last question, what would be the impact of any potential negligence in auditing and inspecting sites prior to their operation?

[Dr. Stephen Lucas]

I'll start by saying that Health Canada takes its responsibility to respond to all complaints and consider all available information very seriously. Our approach is to be reactive to information.

Ms. Hollett can provide further details, but I can say that we're working on a more proactive inspection system to target very high-risk products, like those claiming to treat cancer.

Ms. Hollett, I'll turn it over to you.

[Linsey Hollett]

Thank you.

We've had quite a robust for-cause inspection activity or program for some time now. That has always been very risk-based, and as the deputy minister shared, moving forward on all our proactive activity will also be risk based. We look at a fair number and a consistent set of criteria, including at the top, of course, imminent risk to public health and safety. We have a robust triage system that ensures that where we put our focus, but also where we put our highest service standards such as time to first action, is risk-based, ensuring again that we deal with the highest risk situations in a timely and immediate fashion in most cases.

[The Chair, Conservative, John Williamson]

I'm sorry, but you're already out of time.

MP Desjarlais, you have two and a half minutes.

Go ahead, please.

[Blake Desjarlais, NDP, Edmonton Griesbach, AB]

Thank you very much, Chair.

I want to thank my colleague from Cypress Hills—Grasslands for helping to answer my last question related to traditional medicines. I appreciate the answer that was given related to the specific differentiation between indigenous people harvesting the medicine and sharing that medicine among the nation, and having the ability and support from the government to do that effectively and efficiently. I want to thank you for that very clear answer.

The sale of indigenous medicines—to put it more clearly, the sale of indigenous medicines by non-indigenous persons—would amount to appropriation in many ways and, in some sense, an abuse of the use of these sacred medicines. How do we find ways to warn people or create an environment where those who are seeking indigenous medicine go to indigenous people, rather than to Walmart or some big box store, where they're going to buy a whole package of sweetgrass and then never learn the importance and value of this medicine? It allows for the disenfranchisement of indigenous peoples and the understanding of how we use and apply those medicines in a good way.

It's akin, in some sense, to the abuse of over-the-counter prescription drugs. When you have those prescription drugs for the purposes of very specific things and ailments in western culture—let's say sleep medication—it's abused, oftentimes, for other purposes.

How do we make sure that the indigenous medicines that are for sale and that may be for sale by non-indigenous people are being regulated?

[Dr. Stephen Lucas]

I'll provide some brief comments and turn to Pam for any further comment.

The member raises an important point [Technical difficulty—Editor] indicating the importance of a broader, more holistic approach that not only includes those specific requirements in the regulations to ensure the safety, quality and efficacy of products—both before they get on the market and while they're on the market, as we've been discussing—and clarity in labelling, such as our labelling regulations, which were published in June 2021 and will be finalized this coming spring. It's also important in terms of advertising and awareness.

There is a public education dimension to this, which we think is an important part of the program. We want to continue to work with partners, including indigenous partners, in that regard.

Pam, I will turn to you on these important considerations.

[The Chair, Conservative, John Williamson]

Pardon me. I'm going to have to come back to you, Ms. Aung-Thin. I'm afraid we're out of time. If the question pops up again, hopefully, we'll hear from you.

We're turning again to MP Patzer. You have the floor for five minutes.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Thank you very much, Mr. Chair.

Commissioner, I'll get your response on this first, and then if Health Canada wants to respond, as well, you guys are free to do that.

One thing I find really interesting is a bit of a theme throughout the report as follows. The end of paragraph 2.6 reads:

However, the primary responsibility for the safety and efficacy of products and manufacturing sites rests with the industry.

We start seeing other stats and information, like in paragraph 2.32, which reads:

...88% of these products were advertised with misleading product information. Also, 56% of the products we examined were marketed with misleading label information...

A lot of these products must have a Health Canada stamp of approval on them. Am I correct in saying that?

To see that there's such a discrepancy between their advertised uses and what they actually accomplish despite having a Health Canada stamp of approval on them.... Are there any concerns from the department and from the commissioner on that?

If the commissioner wants, he can go first.

[Jerry V. DeMarco]

We definitely have concerns about the accuracy of the label and whether the contents of the package match what's been licensed. It's all the more challenging with consumer choice now being carried out in the Internet marketplace, as well as on store shelves. There are some challenges.

It's impossible, with 91,000 product licences out there, and who knows how many of those are actually marketed.... There's no comprehensive list of how many of those licences have come to market. With that amount of products, Canadians can't rely on the caveat emptor approach to this. We need Health Canada to guarantee the safety of these products. That is its mandate with respect to natural health products.

The report revealed our concerns with regard to that. The response, as well as the work plan of Health Canada, I think will go at least partway to addressing some of those concerns. They're not wholly within its control, though, because some of the responses signal the need for a legislative change.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Then, Health Canada, what are your thoughts on seeing that 88% of products advertised have misleading product information, yet had the Health Canada stamp on them? What do you think of that?

[Dr. Stephen Lucas]

Mr. Chair, in response, this is an area where we were taking action prior to the report, and have done so subsequently. We think it is critically important that the products are not only reviewed by Health Canada's commissioner...tested in a report, and that the pre-market review of safety and efficacy is done well and appropriately, but also that while they're on the market, it be ensured that Canadians accessing them can feel comfortable that they are safe, effective and of high quality.

We have gazetted, in the spring of 2021, labelling regulations to improve the quality and readability of information required, including dosage and warning information. Those will be finalized this spring. We have moved to proactive monitoring of advertising, including online, both for COVID products and, as I'd mentioned, for NHPs with cancer-related claims. We are going to be broadening this. We're taking steps to strengthen our ability to do this as well through increased resources by bringing in cost recovery from manufacturers and licence-holders for natural health products to strengthen our ability to provide this post-market oversight.

[Jeremy Patzer, Conservative, Cypress Hills—Grasslands, SK]

Okay. Thanks for that.

To Health Canada as well, paragraph 2.23 of the report refers to trusting or working with inspections “performed by domestic and regulatory authorities from other countries when licensing these sites.” What assurances do Canadians have that the standards of these other countries are the same as Canada's? What work has been done to ensure that that level is there.

The question for the commissioner is this: What needs to be done to ensure that those standards are met? Perhaps Health Canada wants to start with that one.