Allan Rock

[Questions On The Order Paper, April 13th, 1999]

Hepatitis B is a potentially serious disease, spread by blood and body fluid contact. From 1990 to 1994 the incidence of hepatitis B in Canada was on average about 10.3 per 100,000 per year, with corresponding mortality, morbidity and the potential for long term complications and chronic carriage. The best time to introduce the vaccine into the routine schedule is before children become sexually active. Targeting high risk groups only is an ineffective strategy, which is why the vaccine is being offered for infants or children.

(a) The decision in France was taken in response to pressure exerted by opponents to the vaccine who allege that immunization with the vaccine is associated with the development of some types of neurologic disease. It was not based on scientific evidence.

The French Minister of Health announced on October 1, 1998 that school based vaccination programs would be temporarily suspended, in part due to pressure from opponents to the vaccine. Allegations have been circulating in France, despite a lack of scientific evidence, linking hepatitis B vaccination and the development of demyelinating diseases such as multiple sclerosis, MS. In contrast, the vaccine is still recommended for routine infant immunization, and for adults in high risk groups. More importantly, vaccination is still recommended and available to adolescents through their family doctor's office. The French minister highlighted that this move was temporary, and it will permit a reassessment of the method of delivery of adolescent immunization in school settings. France embarked on a very large scale hepatitis B immunization effort several years ago, to the point where some 25 million doses have been distributed and over one-third of the population have been vaccinated.

(b) The Laboratory Centre for Disease Control, LCDC, Health Canada and the National Advisory Committee on Immunization, NACI, have continued to review available evidence, including results of postmarked surveillance in Canada, in light of the allegations against hepatitis B vaccine. There is no evidence to suggest any change in the current recommendations for the routine use of hepatitis B vaccine in Canada. There is no credible scientific evidence linking hepatitis B vaccination and MS and chronic fatigue syndrome.

The World Health Organization, WHO, has reaffirmed the safety of hepatitis B vaccine and strongly recommended that all countries already using hepatits B vaccine continue to do so, and that countries not yet using the vaccine begin as soon as possible. Health Canada's role with regard to the hepatitis B vaccine is multifaceted.

The Therapeutic Products Program, TPP, reviews the vaccine through a process of careful assessment of pre-market clinical trials to ensure it meets required standards of safety and efficacy. In addition, each lot of vaccine is individually cleared by TPP before being allowed on the market.

The National Advisory Committee on Immunization, reporting to the Assistant Deputy Minister, Health Protection Branch, issues guidelines and recommendations on the use of the product. NACI indeed has recommended routine use of the vaccine and continues to do so.

The Division of Immunization, Bureau of Infectious Diseases of the Laboratory Centre for Disease Control is responsible for the postmarked surveillance of vaccines in Canada, including the hepatitis B vaccine. It undertakes both passive and active surveillance of vaccine associated adverse events and supports an external expert advisory committee on vaccine safety. There have been no concerns regarding MS identified in Canada, and an investigation into whether the vaccine causes chronic fatigue syndrome found no evidence of an association.

The monitoring of vaccine safety relies on many interrelated activities in addition to case reporting. Not only do the Laboratory Centre for Disease Control, LCDC, Health Canada and the National Advisory Committee on Immunization aggregate and assess all reports received to be able to detect any signals of increased, unusual or previously unrecognised adverse events, but in addition Health Canada funds a national program, through the Canadian Pediatric Society, which actively monitors for serious reactions to vaccinations in children and adolescents at 11 pediatric hospitals. The Division of Immunization has also established a committee of medical and vaccine experts to review all the reported serious cases and to further investigated any concerns and take appropriate action as required.

(c) The World Health Organization, WHO, has issued a press release reaffirming the safety and benefit of hepatitis B vaccination. It concluded, after careful review with the assistance of external experts, that available scientific evidence does not demonstrate a causal association between hepatitis B immunization and central nervous system disease, including MS. The Viral Hepatitis Prevention Board, a World Health Organization collaborating centre for the prevention of viral hepatitis, called a technical consultation at the end of September 1998 to review accumulated data. Participants at that meeting were presented with data, including preliminary and still unpublished recent analytic epidemioligic studies conducted in France, the United Kingdom and the United States. Although they acknowledged that the data available to date was limited, none demonstrated a causal association between hepatitis B vaccination and demyelinating disease. They concluded that no evidence was presented at the meeting to indicate a need to change public health policy with respect to hepatitis B vaccination. Routine immunization programs against hepatitis B are in place in 100 countries around the world.

(d) Reassessment of existing evidence has not been considered for the time being in view of the aforementioned notification from WHO. Its statement is based on the conclusion from the international expert meeting at Geneva, on September 28-30, 1998, at which all available information was reviewed in detail—national public health and regulatory authorities, academia, the hospital sector, the pharmaceutical industry and the World Health Organization; experts in public health, epidemiology, immunology, neurology and pharmacology—in response to the decision of the Minister of Health in France to temporarily suspend the school based immunization program.

(e) There two hepatitis B vaccines available in Canada, both of which are recombinant products. This means that they consist of a non infectious subunit derived from the hepatitis B surface antigen harvested and purified from cultures of a strain of yeast. Therefore, no blood products are used at any stage of the manufacturing process. Before the approval of these two vaccines in 1987 and 1990, human plasma was involved in the manufacturing of hepatitis B vaccine. Those “plasma-derived” vaccines have been discontinued with the availability of recombinant products and are no longer in use.

Question No. 194—

[Hepatitis C, March 25th, 1999]

Mr. Speaker, this government is very proud that there is an agreement in principle with respect to a proposal for thousands of Canadians who were infected between 1986 and 1990. We expect that will soon go before the courts for approval.

What is more is that this government has offered over $500 million to people outside that period to ensure they get the care they need. That is what this is about, providing care to people when they are ill.

[Health, March 24th, 1999]

Mr. Speaker, Canada still very much supports the code. As the hon. member may know, it was in 1981 that the World Health Assembly met and discussed this matter. Member states were instructed to adapt the principles of that code to their own domestic situations.

Here in Canada we had unanimous agreement between the Government of Canada and the provincial governments that that should be done through promotion, education and collaboration. That is what we have done. Over the years Health Canada for its part has done everything it can to promote breast feeding as the most natural and appropriate way of infant nutrition.

[Medical Use Of Marijuana, March 22nd, 1999]

Mr. Speaker, I am very pleased that other governments followed Canada's example. As has already been announced, we intend to carry out research on the results of marijuana use for medical purposes. We shall be doing so shortly.

[Aboriginal Affairs, March 18th, 1999]

Mr. Speaker, I have met on two occasions since January with the chiefs in Manitoba to speak to them about the challenges we face in delivering health services in those communities.

It is not just in aboriginal communities but it is in all rural and remote communities that we have difficulties recruiting and retaining health professionals, both doctors and nurses.

We formed a working group in Manitoba, as we have in northern Ontario, to deal with these issues. Those efforts in common with aboriginal communities themselves, taken together with the additional moneys provided in the recent budget, will help us toward solving these very difficult problems.

[Questions On The Order Paper, March 16th, 1999]

Canada's health system provides high quality health care services in every jurisdiction to adults and children alike. Children who were infected with hepatitis C through the blood system will continue to have access to these services no matter where they live in Canada.

On September 18, 1998, the federal Minister of Health proposed to provinces and territories, a comprehensive set of hepatitis C initiatives. Recognizing that the provision of health care, including travel arrangements, falls within the jusrisdiction of provinces and territories, this proposal included an offer of up to $300 million in transfers over 20 years to help provinces and territories pay for needed medical care so that people who were infected with hepatitis C through the blood system are ensured access to the treatments they need.

Question No. 172—

[Health, March 15th, 1999]

Mr. Speaker, I welcome the report from the Senate committee. Many parts of that report are excellent. The whole thrust of the report fits very nicely with what we are doing at Health Canada: reviewing the way the health protection branch does its job, reaching out to the science advisory board, getting independent scientists of international reputation to advise on hiring good science for the department. There are the steps we took in the budget. We added some $60 million for health protection to strengthen our food and safety branch. These are all going in the same direction which is toward protecting the safety of Canadians because that is our bottom line.

[Aboriginal Affairs, March 9th, 1999]

Mr. Speaker, I have been to those communities. I have seen for myself the importance of working to keep families together and meeting the health care needs of first nations. That is the very reason that this government in the budget included well over $200 million for aboriginal health, including over the next three years about $190 million that will be devoted among other things to community and home care for aboriginal and first nations on reserves and in their communities so families can stay together while people recover from illness and while they are treated for disease.

That is the approach of this government, to support families and first nations and their communities.

[Women's Health, March 9th, 1999]

Mr. Speaker, Health Canada is working on many fronts to meet women's health needs.

For example, we have set up five centres of excellence for women's health in order to identify the best means of meeting their needs.

We are continuing our fight against breast cancer. We are also continuing our efforts to eliminate family violence, our anti-smoking campaign—

[Health, March 9th, 1999]

Mr. Speaker, the member would do well to await the RCMP investigation of the events in the mid-80s.