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37th PARLIAMENT, 3rd SESSION
Subcommittee on Human Rights and International Development of the Standing Committee on Foreign Affairs and International Trade
EVIDENCE
CONTENTS
Wednesday, April 28, 2004
| ¹ | 1535 |
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The Vice-Chair (Mr. Stockwell Day (Okanagan—Coquihalla, CPC)) |
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Dr. Jack Chow (Assistant Director General, HIV/AIDS, TB and Malaria, World Health Organization) |
| ¹ | 1540 |
| ¹ | 1545 |
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The Vice-Chair (Mr. Stockwell Day) |
| ¹ | 1550 |
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Mrs. Karen Redman (Kitchener Centre, Lib.) |
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The Vice-Chair (Mr. Stockwell Day) |
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The Vice-Chair (Mr. Stockwell Day) |
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Mr. Yves Rocheleau (Trois-Rivières, BQ) |
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Dr. Jack Chow |
| ¹ | 1555 |
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Mr. Yves Rocheleau |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
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Hon. Eleni Bakopanos (Ahuntsic, Lib.) |
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Dr. Jack Chow |
| º | 1600 |
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Hon. Eleni Bakopanos |
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Dr. Jack Chow |
| º | 1605 |
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The Vice-Chair (Mr. Stockwell Day) |
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Mrs. Karen Redman |
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Dr. Jack Chow |
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Mrs. Karen Redman |
| º | 1610 |
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Dr. Jack Chow |
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Mrs. Karen Redman |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
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Mr. Yves Rocheleau |
| º | 1615 |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
| º | 1620 |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
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Dr. Jack Chow |
| º | 1625 |
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The Vice-Chair (Mr. Stockwell Day) |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
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Mrs. Karen Redman |
| º | 1630 |
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Dr. Jack Chow |
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Mrs. Karen Redman |
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Dr. Jack Chow |
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Mrs. Karen Redman |
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Dr. Jack Chow |
| º | 1635 |
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Mrs. Karen Redman |
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The Vice-Chair (Mr. Stockwell Day) |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
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Dr. Jack Chow |
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The Vice-Chair (Mr. Stockwell Day) |
CANADA
Subcommittee on Human Rights and International Development of the Standing Committee on Foreign Affairs and International Trade |
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EVIDENCE
Wednesday, April 28, 2004
[Recorded by Electronic Apparatus]
¹ 
(1535)
[English]
The Vice-Chair (Mr. Stockwell Day (Okanagan—Coquihalla, CPC)): Colleagues, we are going to start our meeting. Obviously, for the moment, we will hold the motions. At this point, we want to hear from Mr. Jack Chow. His resumé is before you.
Mr. Chow, we are honoured that you would have the time to come and speak with us from the point of view of your vast experience. It is considerable, especially on a topic on which we are fixed.
About this time last year, as a matter of fact, our own Stephen Lewis, special envoy of the secretary general for HIV/AIDS in Africa, was making similar presentations, and it's somewhat unique that you are here about a year later. I know you are aware of the committee report on HIV/AIDS. So we are delighted and honoured.
As I also indicated, some of us, at least, are kind of in a pre-election mode, and there's a lot going on in and around not just Ottawa but the country right now.
I'm pleased that we have before you some colleagues who are very instrumental on issues like these.
Your comments of course are recorded and available for reporting. We hope your comments are widely reported, as a matter of fact.
Thank you again, Dr. Chow, for coming. Please go ahead with your remarks.
Dr. Jack Chow (Assistant Director General, HIV/AIDS, TB and Malaria, World Health Organization): Thank you, Mr. Chairman and members of the committee.
On behalf of WHO's director general, Dr. J. W. Lee, I thank the subcommittee for the privilege of coming before you today to discuss the commitment by the World Health Organization to confront three devastating global diseases: HIV/AIDS, tuberculosis, and malaria.
First, I'd like to say that WHO deeply appreciates the long-time support of Canada in advancing our agenda of promoting better health for all. We count Canada as a stalwart ally in our efforts. Canada has partnered with WHO on path-breaking initiatives such as the global drug facility, which has revolutionized delivery of tuberculosis medicines to people in need. Furthermore, CIDA has provided, and continues to provide, core support to expand the TB strategy known as DOTS, directly observed treatment system, in high-burden countries. We also welcome the effort by the Government of Canada to pass legislation that would enable safe, effective, low-cost generic medicines to be exported to areas of need. We also value the contributions by the research-based pharmaceutical companies to add to the antiretroviral armamentarium.
Moving forward, we aim to knit an even closer relationship with Canada and to jointly identify new pathways of innovation. This is needed now more than ever, as the three pandemics continue to spread. Collectively, these three diseases kill 6 million people annually, and it is a toll that is growing. It is a toll that rivals the annual combat casualty rates of World War II globally: 3 million from HIV/AIDS, 2 million from tuberculosis, and at least 1 million people from malaria. For each of them there are proven, effective interventions for prevention and treatment that can and must be scaled up. In addition to the expertise on medicine and public health provided by WHO, we also recognize the need for a strong, robust contribution by civil society and the need for political commitment at national and community levels.
A critical linkage was made between international development and public health less than three years ago by the declaration of a series of eight millennium development goals, articulated by heads of state at the United Nations. The MDGs provide important milestones towards the progressive attainment of basic access to care. They cover areas that directly concern the work of WHO, such as reducing child mortality, improving maternal and child health, combating HIV/AIDS, TB, malaria, and other infectious diseases, and improving access to water and sanitation, as well as access to essential drugs at affordable prices. With the MDGs, the international community set ambitious targets to spur action. To attain them, we believe what is needed is a strong chain of concerted action by all actors in the public health arena.
If you can visualize it in your mind's eye, this chain can be thought of as having three basic links. Link one is commitment from financial institutions and donors. After years of unwavering activism, more financial resources are being allocated to fight these three diseases. WHO applauds the advances made by our partners, such as the Global Fund, the American President's emergency plan for HIV/AIDS relief, the Gates Foundation efforts, and the World Bank. This growing roster of bilateral donors, including Canada, is contributing much needed resources. Canada has actively supported the creation of the Global Fund and has pledged a significant amount of money to it to date.
Link two is the need for high-quality technical support as more resources are made available to fight these diseases. The challenge of providing quality, sustained technical support is more important than ever. This includes working with governments, but also coordinating the different actors working on the ground. WHO delivers this much needed assistance to countries in an effort to maximize the use of valuable resources. We provide technical leadership and excellence through a combination of norms and standard-setting, consensus-building, and recruiting and fielding of international staff. Therefore, at WHO we are a neutral and trusted voice and are uniquely positioned to ensure that money to fight these diseases is spent on effective strategies. The WHO has the mandate and the responsibility from the international community of supporting countries in their efforts to face public health challenges. Such legitimacy and trust underpins our capacity to convene donors and recipients alike to plan and coordinate an effective response. Also within this link are key providers of technical support at the global and country levels, such as CIDA and Health Canada. We work closely with them and believe they too ought to be as fully resourced as possible.
¹ (1540)
Link three involves strong collaboration with implementing partners. The collective response must be comprehensive and sustainable, not just to the individual challenge posed by a single disease, but also to build a lasting public health infrastructure that is sufficiently robust to confront a number of challenges. Partnerships, coalitions, and alliances at both the international and community level are an ascendant form of organized response in public health. Equally important is assuring that health systems are built with sufficient resources to confront future health crisises effectively.
As I mentioned at the outset, Canada has shown the way in creating innovative means to attain these goals through its ground-breaking support of the global drug facility. The results have been so compelling that the GDF is now serving as a model for the development of similar initiatives in HIV/AIDS and malaria. The investment in building this strong, coherent chain of concerted action helps convert resources into results.
With broad strokes, Mr. Chairman, let me describe our primary initiatives across the three diseases.
On HIV/AIDS, with the co-sponsorship of UNAIDS, the “three by five” initiative seeks to secure treatment for 3 million people in developing countries by December 2005. It is a framework for collective action in which all capable institutions and individuals can make a contribution. For its part, WHO has bolstered the response at the country level by an unprecedented deployment of 40 Geneva-based staff and by now recruiting 25 “three by five” advisers to be posted in key countries. We have simplified and standardized medical regimens. We have prequalified a 3-in-1 combination antiretroviral pill that vastly simplifies therapy for patients and simplifies the logistical supply chain. We are now creating an AIDS medicines and diagnostic service to help countries secure these needed goods. We are working to build monitoring and evaluation systems to replicate our successes and improve on bottlenecks we discover on the way.
On tuberculosis, we are advancing on our global goal of a 70% detection rate and an 85% cure rate. We are concerned about the co-infection of TB and HIV internationally, as well as the rise of multi-drug-resistant strains that are many times more lethal and more expensive to treat. We believe Canada's support of the Stop TB partnership and the global drug facility is vital to progress.
On malaria, this past Sunday was Africa Malaria Day. Malaria kills at least 1 million people a year. Tragically, three-quarters of them are African children under the age of five. It is the number one cause of child mortality there. We are promoting the use of a new generation of artemesinin-based medications. We are working with the private sector and NGOs on promoting the use of long-lasting insecticide-treated bed nets that last six years, as opposed to those that last six months currently.
These diseases require strong health systems, resilient public health workforces, logistical and management capacity, and good economic incentives to start, maintain, and augment these systems. We have created a new department in my cluster, strategic planning and innovation, to create new initiatives in this realm.
As the subcommittee has human rights in its mandate, let me spend a few minutes addressing this profoundly important area. Human rights have been a core value of WHO's work since its inception. In 1946 the creators of WHO's constitution stated that “the enjoyment of the highest attainable standard of health is a fundamental right of every human being”. Our commitment to health for all sets out the right to health as a guiding principle of WHO.
The health sector has an important obligation and contribution in ensuring that testing, counselling, prevention, and treatment are accessible to those who need them most urgently and that global efforts to increase access to these interventions also seek to dispel stigma and discrimination.
¹ (1545)
Greater accountability to and stronger relationships with civil society groups and people living with these diseases are important elements in reaching these objectives.
We have also found that effective interventions are failing to reach the most vulnerable groups. At the heart of the primary health care and the health-for-all movement, which has been so influential in shaping health policies globally, lies a concern for equity. But we all know that in every country, groups of people miss out on what these health systems have to offer. The human rights framework can help us address the needs of these groups.
To conclude, Mr. Chairman, the tasks ahead of us are enormous and will grow even larger. We at WHO are fully committed to advancing the campaigns against AIDS, tuberculosis, and malaria to the fullest extent possible. Having the support of the people and the Government of Canada gives propulsion and lift to our efforts. As I've said in many of my conversations with government officials, the “three by five” campaign, at its core, is a campaign of liberation. It is a campaign of liberation because by making treatment accessible, by suppressing one virus, we liberate many generations now and into the future to live their lives freely, openly, joyfully, and to have parents alive for their children. For us, Mr. Chairman, there is no more compelling mission that the WHO and Canada can embark upon.
Thank you.
I'll be pleased to answer your questions.
The Vice-Chair (Mr. Stockwell Day): Thank you, Dr. Chow.
Your presentation is compelling. The task is daunting, but you give us some rays of optimism if the action is indeed there to follow.
While members prepare their questions, I want to deal with a couple of administrative items, with quorum currently available. Then we'll immediately go back to questions for Dr. Chow.
We have a first motion, which David Kilgour has asked to have come forward. You can see it there. It has been duly circulated. The motion reads:
| That, pursuant to the Orders the Standing Committee on Foreign Affairs and International Trade of February 24, 2004 referring requests for the Committee to consider issues relating to the human rights situation in China to the Subcommittee on Human Rights and International Development, the Subcommittee, pursuant toStanding Order 108(2), undertake a study of human rights in China |
Would someone like to move this forward?
Mrs. Redman.
¹ (1550)
Mrs. Karen Redman (Kitchener Centre, Lib.): I so move.
(Motion agreed to)
The Vice-Chair (Mr. Stockwell Day): In Ms. McDonough's absence... and I would like to make note that this has to do with the Rwanda situation. In fact, today she is meeting with retired Lieutenant-General Roméo Dallaire. That's why she is not able to be here.
We have the following motion:
| That, Pursuant to the Order of February 24, 2004 of the Standing Committee on Foreign Affairs and International Trade, the Subcommittee, pursuant to Standing Order 108(2), consider the 1994 genocide in Rwanda, and invite the following with a view to preparing a report to the House on lessons learned and actions that could be taken, to help prevent another genocide from happening. |
And you see they've listed... I don't imagine this is an exhaustive list, but it is the list we are anticipating in terms of witnesses.
(Motion agreed to)
The Vice-Chair (Mr. Stockwell Day): I appreciate you allowing us to attend to that.
We will now go to questions, and we'll first go to the Bloc.
Dr. Chow, all of your comments are simultaneously and duly recorded in French also, so if you want to distribute them to your French-speaking friends around the world, it'll be readily available for you.
Monsieur.
[Translation]
Mr. Yves Rocheleau (Trois-Rivières, BQ): Thank you, Mr. Chairman.
Good day, Dr. Chow.
As our Vice-Chair noted at the outset, we had the pleasure and privileged of welcoming last year Mr. Stephen Lewis, who made a fascinating, compelling address to the committee on this very subject. Your testimony today has a familiar ring.
Accordingly, I'm curious as to your opinion of the value, purpose or usefulness of the bill that was tabled several weeks ago by the Canadian government with the express view of making it easier to market generic drugs to treat diseases such as AIDS and malaria in African nations.
Firstly, are you familiar with this draft legislation? Does it satisfy the requirements and live up to the expectations of the WHO, for example? Does it go far enough?
[English]
Dr. Jack Chow: Thank you.
First of all, Steven Lewis has been a strong advocate for WHO's effort, and as a Canadian, he is, I'm sure, a favourite son. We value his efforts, and he is very much a partner in knitting together the coalition of the caring and committed. So I praise Ambassador Lewis for being a stalwart ally with us.
Yes, I am aware of Bill C-9, and as I said in my opening statement, we look forward to the completion of this important bill. What is important globally is to have an ever-growing, unimpeded supply chain of both generics and research-based pharmaceuticals available for deployment in AIDS-stricken countries.
Generics are valuable as they are low-cost, effective medicines that can be deployed in very rapid order. We also need research-based pharmaceuticals, because the HIV virus is a very powerful mutater. That's why today we need three different medicines to keep the suppression effect going. Also, many of these medicines generate side effects for different people, so we need an ever-growing supply chain of new medicines, with a lower side-effect profile.
I understand that the bill is still in the legislative process. I must refrain from debating the pros and cons of the individual amendments, but we look forward to the completion of the bill as it will be able to trigger a very good and growing stream of much needed generic medicines.
Thank you.
¹ (1555)
[Translation]
Mr. Yves Rocheleau: Do you feel the cooperation of the international pharmaceutical industry is appropriate in this case or, do you think a public awareness or education campaign, or more pressure, is needed to get people to set aside the notion of profit, shift gears a little and feel greater compassion for the more disadvantaged of this world?
[English]
Dr. Jack Chow: The WHO has helped create a partnership called the Accelerating Access Initiative, which is a consortium of the research-based pharmaceuticals. We work collaboratively with them to find ways to make these drugs more widely available. They recently reported at the Global Fund board meeting in Geneva that through their company's monitoring of the distribution of the medicines they provide, they have seen an uptake, a significant rise, in the number of people under antiviral treatments—from 75,000 to 150,000.
We continue to urge all pharmaceutical companies to work with the WHO on overcoming the barriers to access through cost, delivery, and simplicity, and we work with UNAIDS to harness the innovative power of this industry and drive it forward.
The Vice-Chair (Mr. Stockwell Day): Thank you, Monsieur Rocheleau.
Madam Bakopanos.
Hon. Eleni Bakopanos (Ahuntsic, Lib.): Thank you very much.
As our chair said, Mr. Chow, we congratulate you and we wish you good luck, because you certainly have a tremendous task ahead of you.
I believe more in prevention. I always think that's what we should be focusing on, besides the initiatives we've already taken and the drugs--and as you said, there is room for both the generic and the brand names.
I'd like to know--and maybe you can educate me on this--what other efforts are being made in terms of prevention, for example, for women or young girls who are not educated on safe sex or on prevention of pregnancies or other things.
I think if I were to say where we should be putting our main focus, it would be on education. And education has to begin, in my opinion, at a very early age. I have some experience because I am a foster mother, if you will, of two children in sub-Africa. I get regular reports on their progress, and things are not improving, unfortunately; they're actually deteriorating. One of the main things the father recently wrote to me about was the fact that the school that his daughter, who I was sponsoring, is going to had unfortunately been closed down by the authorities. I won't mention the country.
So should we--and I'm asking you this question--be putting our efforts into working, first of all, to assure that the governments that exist are democracies, and that those democracies in fact provide a very basic education so that in future generations we won't have to continue to tackle this problem? We'll never tackle it if it continues. That's my impression.
That's my first question.
Dr. Jack Chow: Thank you very much.
It's a vital issue. WHO believes in prevention. Prevention is the core mission of WHO. With the three-by-five initiative and treatment for tuberculosis, we have seen that treatment is often undervalued, because there is a sense it's complicated and there are many obstacles. Nonetheless, we believe the “three by five” campaign is knitted with prevention and care efforts.
By tying treatment to voluntary counselling and testing, now there's a clear incentive for people to come to know their HIV status. Nearly 95% of those living with the virus do not even know they have the virus. If there's no treatment available at BCT, there is no incentive to come in for testing, or there is less incentive to come in for testing, and discover you're HIV positive. It's a push-pull mechanism.
We also believe in the importance of the ABCs of awareness that lead to behaviour change. As you rightly pointed out, many people don't even have knowledge of what HIV/AIDS is all about. There was a survey in a major developing country, in the rural regions, where the great majority of women had never even heard of HIV/AIDS. To then expect they could embark upon protective behaviour without this knowledge is ludicrous.
We are working with our member states, working with the Global Fund on projects supported by the Global Fund, to advance prevention. We believe prevention is essential in low-prevalence countries to keep the prevalence low, as well as the importance of prevention in high-prevalence countries. It's both protecting the population and humanely treating those who are infected. By doing so, and having a dovetailed strategy of prevention, treatment, and care, it de-stigmatizes it and there's a real incentive to get the care they need.
º (1600)
Hon. Eleni Bakopanos: My other question is one that comes often from my constituents. It's not particularly a criticism in terms of this particular issue, but in general terms. Why are we giving so much aid to Africa when we have sick people or poor people here in Canada?
My answer has always been that because the world is a global community; we are not isolated from those problems. Where am I going with this? If we have to place our priorities in terms of prevention, and if we have to educate the Canadian public on the necessity of increasing our aid package to your organization, for instance, or to other organizations that are doing this work on the ground, you have to be able to tell people that we actually have results. I'm tying two things together. Does the money really go to the people who really need it?
In the media, because, again, media now is so prevalent everywhere, there are certain countries where it's said the drugs don't go to the actual people who need them, but they go through an intermediary, who in fact takes them and sells them on the market for profit. What is your organization doing in terms of ensuring the money we invest in your organization, or in terms of the drugs that will eventually be allowed to get into these countries, will prevent a middle person profiting from that, so I can tell my constituents it is going to those who have the greatest need?
I know you're not the only one who can answer that question. I don't want to put you on the spot, but it is an issue that keeps coming up in terms of my constituents.
Thank you.
Dr. Jack Chow: Thank you.
It is becoming increasingly evident—and I believe Canadians palpably understand this—that many diseases are literally a plane ride away. We're looking at not only SARS and avian flu. As I mentioned in my testimony, the rise of multi-drug-resistant forms of tuberculosis is a very strong concern of ours. It can be imported into any country. I point to my own country, the United States, where a multi-drug-resistant strain of tuberculosis hit New York City a decade ago. It cost $1 billion to treat that, which could have been spent on other vitally needed public services.
The best public health defence is a collective public health offence. By suppressing tuberculosis, treating HIV/AIDS, and defeating malaria, we ultimately add to the collective public defence of our people.
On having a supply chain that is direct with little transaction costs, we are working with the Global Fund. As I said in my testimony, having a chain of concerted action—having donors, working with the technical experts, working with implementers—to have the moneys and material supply be as direct as getting them into the hands of health care workers and the patients is one of our top priorities.
We are very pleased with... If I might show the subcommittee this box, it is Canada's contribution to global health. It is a Stop TB kit. Through the global drug facility we take generic tuberculosis medicines and assemble a six-month supply in one box, half the size of a shoebox. It has instructions on the outside. We distribute it widely in developing countries. This one box has the cure for one patient and costs $15 Canadian.
Our vision is to leverage the expertise Canada has contributed to looking at malaria. We'd like to have a box for malaria bed nets with malaria medicines, as well as a box for antiretroviral medicines. By simplifying and standardizing the supply chain, it gets it down to the doctor-patient level and in entrusted hands, where they can directly observe people taking the medicines. Canada has really contributed to and revolutionized the treatment of tuberculosis, and now we seek to revolutionize the fight on AIDS and malaria.
º (1605)
The Vice-Chair (Mr. Stockwell Day): Mrs. Redman.
Mrs. Karen Redman: Thank you, Mr. Chair.
Dr. Chow, thank you. You gave a very impassioned intervention. Clearly this is your life's work, and it shows the conviction you have for it.
Our Standing Committee on Health did a report recommending that Canada double the money being invested through Health Canada in HIV/AIDS research. I guess we can say it's still a work in progress.
Can you give us your perspective on the pharmaceutical industry? We have heard it is also cutting its HIV/AIDS funding for such research areas as drugs, vaccines, and other interventions. Are you seeing a falling off of that kind of investment by the big multinational drug companies?
Dr. Jack Chow: We have a unit at WHO called the tropical disease research unit. It is the focal point with research institutions--Health Canada, the National Institutes of Health--producing the public good of the intellectual property, the scientific expertise, that then feeds into a technology transfer process with the private sector and those that can translate the research knowledge into tangible products. I have to refer to those who have the statistics about the trends, but we certainly would like to see an increase in research and development for an ever-growing supply chain.
We are also concerned about a number of diseases that, because they are propagated in poverty-stricken regions or maybe smaller populations, are collectively known as neglected diseases. The challenge is how we can create incentives for the companies to produce medicines for these particular diseases.
There are millions of people with HIV/AIDS, TB, and malaria. There's a bigger population and the market analysis can be done more readily. But dengue fever and a lot of variants are also killers, so we must find ways at the macroeconomic level to provide the incentives, from either the public sector or the private sector, to create new medicines.
Mrs. Karen Redman: I've started an initiative in my riding, and I actually had the opportunity to discuss it with Stephen Lewis. It's a bit of a pilot project, and we have asked all of the groups in our region that are doing interventions, specifically with HIV/AIDS in Africa, to respond to my invitation so we can put it up on a website.
Can you talk just a little bit, from your perspective, about the roles of the non-governmental organizations in the faith community?
We came to know--or certainly I did as a member of Parliament--that in an area where there was an awful lot of interest in providing some kind of relief to the people of Africa, a lot of these groups didn't know about each other. One was trying to supply cheap medicine while another was funding a public health nurse or somebody in Africa.
We thought if we started a conversation.... I think one of the many strengths of WHO is the fact that you provide a venue for those kinds of conversations. We're hoping that some synergies will be developed through this initiative.
º (1610)
Dr. Jack Chow: Thank you for the question. The need for coordination at the country level is more important than ever. As the landscape of donor actions in AIDS-stricken countries multiplies, there is often confusion about who is doing what.
The UNAIDS, WHO, and civil society in Washington this Sunday from the World Bank announced the principle of having one national AIDS committee with the authority to coordinate and act. This will help clarify the playing field and enable NGOs and civil society to aggregate at the national AIDS committee and participate in a substantive and effective manner.
There's no question that NGOs and faith-based, church-based, organizations are very important institutions and platforms for prevention messages, as well as for making available access to treatment. Many communities rely on faith-based organizations because they are members of a faith and they trust and believe in the leaders of that organization. To be able to knit together a response with trusted community leaders is also part of our public health agenda. To enable, to educate, to train, to give NGOs and FPOs the tool kit to better minister to their constituents is something we support.
Your constituents may also be interested, because I've heard in my trip here, that NGOs or individuals or hospitals from Canada would like to make a contribution in terms of sharing information or providing direct assistance.
I refer to a very unique initiative instigated by the former Minister of Health of France, Bernard Kouchner. He created the Esther initiative. It basically twins or pairs a western hospital or clinic with a chosen counterpart in a developing country. It's almost like a sister city concept, or a sister hospital concept. That establishes a real-time link so that, say—I'm just making something up here—if the Toronto General Hospital wanted to help the Botswana General Hospital in providing training, of course, either by telemedicine or by trips, that's available. I'd be happy to put your constituents in contact with this Esther initiative—it's France, Luxembourg, and a number of European countries—and have Canadian participation in that effort.
Mrs. Karen Redman: That would be great.
Just for clarification, Dr. Chow, you mentioned when I asked about the statistics that you would refer to those who could better answer that. Is it possible for you perhaps at a later date to track down the statistics and send them to the committee?
Dr. Jack Chow: Sure, we'd be happy to do that.
[Translation]
The Vice-Chair (Mr. Stockwell Day): Do you wish to ask another question, Mr. Rocheleau?
Mr. Yves Rocheleau: If I understand correctly, you said that 6 million people die each year from diseases such as HIV, tuberculosis and malaria, and that these numbers are rising.
How do you explain the fact that despite the enormous efforts made, both in terms of funding—hundreds of millions, perhaps even billions of dollars—and the daily efforts of thousands of individuals and agencies, the death toll continues to rise? That's my first question.
Secondly, is the spread of these diseases not a result of macroeconomic and macropolitical factors, namely idleness, unemployment and economic inactivity? Are we not dealing with attitudes or areas... I'm thinking about agriculture, the key economic activity in under-developed countries. Given the sizeable grants to US industry and EU subsidies that can hurt the Canadian and Quebec agriculture industries, but can have a truly devastating effect on Africa, can we talk about problems such as these and forget that we are perhaps dealing with “macro” factors?
º (1615)
[English]
Dr. Jack Chow: These diseases are progressing from a number of very powerful forces. Number one is that these diseases are intersecting with the conditions of poverty, illiteracy, social inequity, which includes power differentials between men and women and stigmatized and discriminated groups.
One key issue is this. Even if we increased our public health investment, are there sufficient trained people in these countries to deliver the care? The human capacity issue is quite substantial. In a country such as Botswana, where we're making a very concerted effort, they do not have enough nurses or health care workers because (a) they have unfortunately died or (b) they get the education and training and they find a job at a higher paying rate in another country. That now requires the potential importation of large numbers of workers into these countries. The challenge is how do we develop indigenous, robust public health workforces, as I say, and that gets into the areas of macroeconomics. What are the conditions, the economic climate, that could potentially be reshaped to promote the indigenous talent?
Number two, the other driving force is the perpetual underinvestment in public health over the years that these diseases.... Because people do not have access to a primary care doctor, tuberculosis rises. There is a stunning fact that one-third of the world's population has the tuberculosis bacteria in their lungs. Fortunately, because of the body's own defences, only nine million people go on to have active diseases. If you don't have a good public health system in these countries because of perpetual underinvestment, these people who have the bacilli will then have a much higher chance to progress, to join the nine million, ten million who will go on to active disease.
It is a complex political and economic ecology, but we, as WHO, are a union of health ministers and we are advisers to health ministers. We don't have the capability to implement, but we want to knit together this chain of concerted action and speak out to say this is what is needed and these are the symptoms of perpetual underinvestment.
The Vice-Chair (Mr. Stockwell Day): I have a couple of questions, Doctor, if my colleagues permit the indulgence of the chair. Going back to what one of my colleagues has raised on the prevention side, you mentioned, for instance, one aspect of voluntary counselling, when people come in for treatment. It is of course excellent that this is made available. But I have to think that “when they come in for treatment” means they already have the disease. Thankfully, as you've laid out, there's a process to deal with the disease.
But on the broader prevention side, we just heard, for instance, of a school being closed down. I know that's anecdotal, but it's probably somewhat prevalent depending on what shape the particular state is in. So with a school closing down, you then have all kinds of young people who are not exposed to anything in terms of prevention, which would leave it only to whatever the family structure is. In those situations, and you mentioned power relationships, even if you're instructing women, in a community where the men may not be acting responsibly the problem is going to continue.
I have a sense—but correct me if I'm wrong—that there is a tendency for political correctness to take over and somewhat limit what should be I think fairly aggressive instruction on the prevention side because it might clash with local and community mores. How can the organizations or NGOs, as we've heard, reach out to the various community and family groups that aren't being exposed right now because maybe they don't go to a school or they're not coming into a clinic?
The problem is huge, I would think. We know there are a number of ways of transmission, but obviously sexual contact is a key and significant means of transmission. What are you finding and seeing in terms of the so-called cultural barrier? Is there a political shyness about being aggressive to address those issues?
º (1620)
Dr. Jack Chow: Thank you, Mr. Chair, for your question.
Shaping or influencing behaviour, as you recognize, is a multi-dimensional dynamic. It is clear that when you keep removing platforms for education or messaging, whether it be a school closure or public health closure, or if there is no access to mass communications in many parts of sub-Saharan Africa or developing countries, you then put pressure on remaining platforms to convey that message vividly.
What is clearly needed is increasing the quantity of the platforms and having the resilience to recognize that if one platform for messaging goes away—though there may be a legitimate reason for that—the reality is that society can move very rapidly. We need to have a concerted communications strategy. That's why it's really going to be valuable to have one national AIDS committee in these countries, which can look at the landscape of communications channels and can look at a country and say, “We need to shape our message to tailor-make it to women in rural regions or to stigmatized groups in an urban setting”. Also valuable is looking at whether they need to use television, or pamphlets, or personal outreach, or empowering NGOs and faith-based groups with tailored messages, whether that is what is needed in the long term, so that you have the opportunity of quantity, quality, and intensity of that message.
The Vice-Chair (Mr. Stockwell Day): I appreciate your analysis and your sensitivity, but if I can push the question further, are you aware of this happening?
In Canada, we're very aggressive in terms of prevention education in schools, community groups, you name it.
I just have a sense—though I stand to be corrected—that it's not that aggressive because of the whole sense of political correctness. Is this reflecting back to a colonial mindset, where we're imposing our culture on other people, or whatever? Is the prevention message getting out there aggressively?
Dr. Jack Chow: I cite a program sponsored by the Henry J. Kaiser Family Foundation, based in the United States. They have a program in South Africa called Love Life. They project some very vivid, powerful messages on billboards and television that are quite punchy.
I invite your staff to maybe contact them or to look at their website. They can show you what they are doing in the country that is arguably most impacted by HIV/AIDS.
º (1625)
The Vice-Chair (Mr. Stockwell Day): I'll leave that question with you. Similar to what Ms. Redman said, in Canada taxpayers at this point are very willing and wanting to reach out to help those in need, to address areas, whether they be humanitarian disasters, or ecological disasters, starvation, or HIV/AIDS. However, there is a sense in my own constituency—and I think it's prevalent across the country—that if we're pouring money into something, our taxpayers want to know at the front end that all of the messaging is being delivered, so that it's not an exercise in futility of sustaining a life that's already infected. That is good, and we will do that, as people want to do that, but there is that sense of responsibility and obligation that taxpayers wonder about.
Before I go to a colleague, can I just ask, along the same line as malaria, if you are seeing—aside from medical treatment, whether it's from Canada or other countries—the infrastructure dollars going to the countries to deal with where malaria starts. Oftentimes, if we're talking about their capability in terms of sewage disposal, and where the infestation actually begins...are you seeing other countries stepping up with assistance on the infrastructure side to deal with some of that problem?
Dr. Jack Chow: Mr. Chairman, 90% of cases of malaria happen in sub-Saharan Africa. Out of 300 million acute illnesses, you have 270 million acute episodes of malaria in sub-Saharan Africa.
We are working very strongly and very aggressively with countries to switch over to using more of the artemesinin-based compound drug that has a high cure rate and, while still comparatively expensive, delivers good value for money.
The countries are also consulting with WHO on the judicious use of insecticides such as DDT for indoor residual spraying, spraying DDT on walls so mosquitoes don't propagate and have the ability to bite people.
The World Bank, as a development agency, is working with these countries on finding ways to mitigate the environment to eliminate stagnant pools of water and infrastructure alterations that will reduce areas where the mosquito can propagate.
The Vice-Chair (Mr. Stockwell Day): Even the mosquitoes need a safe sex program.
Do my other colleagues have a comment?
Yes, Ms. Redman.
Mrs. Karen Redman: Thank you.
Dr. Chow, you have a very impressive CV. I see you have diplomatic experience, not political, so this may be a somewhat non-political question.
I'd like to pursue your comments about investing in public health a little bit, because I absolutely agree with you. I think Canada is at a very exciting threshold right now in developing what our public health institute will look like.
I had the opportunity to accompany Minister Bennett down to the Centers for Disease Control in Atlanta, as well as going to Washington to visit the American Institutes for Research. One of the things I found, among very interesting things, was the fact that the institutes of health research actually get direct funding from the government and lobby groups know that.
If I pick one of my personal favourites, juvenile diabetes is on the cusp of a great breakthrough. When they come to lobby me, I have a lot of sympathy and empathy. I wrote to our Minister of Health suggesting that would be a really good place to funnel funds.
I look at HIV/AIDS and I realize it is a pandemic. Could you talk briefly about that in your comments? My understanding is that we're on the cusp of seeing another one develop in Asia or China.
º (1630)
Dr. Jack Chow: HIV/AIDS?
Mrs. Karen Redman: Yes.
Dr. Jack Chow: Yes.
Mrs. Karen Redman: I'm coming at this from a broader public health investment perspective. The fact is, whether it's HIV/AIDS that continues to roll out across the globe, SARS, avian influenza, or whatever it is, public health is a huge issue.
I have a background; I have spent a lot of time on the environment committee. You talk about stagnant water and the fact that clean air and drinkable water are huge public health issues.
As compelling as investment in specific diseases is, and as necessary as it is, very often, politically, you have tension between prevention and education versus investing in sickness. I find it an interesting tension, and I think one that Canada will continue to grapple with as we decide what our public health initiatives are going to look like. Could you comment on those issues?
Dr. Jack Chow: Thank you.
As I mentioned in my opening remarks, what's also important in spurring political leadership is having an assertive and appreciative citizenry who have benefited from public health investment and who make a claim on their government to say, “I have benefited from prevention”, or “My child has been saved because of a vaccine”. We need to advance that investment.
In my own experience, as a former U.S. Congress appropriation staff member, we've worked with constituents who were a part of the community heath centres. They benefited through primary care, and through their lobbying they were able to persuade Congress to maintain community health centres... where it's the leading backbone of American public health and primary care.
There's an opportunity in other countries to work with constituents to make vivid the benefit of public health.
More broadly, I think there's an unintended effect that public health expenditures from the government side are seen as an expenditure that's done, and there's currently no means to capture the savings of that public health investment in a way that would incentivize additional investment.
What I'm saying is, for too long, in my humble opinion, public health expenditures have been seen too much on the debit side of the ledger. We need to find ways to put public health expenditures on the credit side of the ledger. Perhaps the accountants can figure out a way to say that if you invest in a vaccine, then there's a credit generated if, say, a child's vaccine costs $1 and it yields a savings to the national health system of thousands of dollars when the child, coming down with Rubella, doesn't have to go to the hospital. I think this would be a very powerful incentive to maintain that investment.
So these are some of my thoughts having had experience in the legislative branches of my government, in my home country.
HIV/AIDS in China and Asia is a major concern, again. You have globalization of people in commerce, you have the rise of a middle class, of men who have money, who can then, for instance, be involved with sex workers. The vastness of the geography and the density of the population makes HIV/AIDS prevention very challenging.
We are working with India. India is another country with not only a large population but also different geographical, cultural, and linguistic segments.You have to almost tailor-make a prevention strategy, neighbourhood by neighbourhood.
So the rise of HIV/AIDS in Asia is very worrisome, and we are pressing our efforts and devoting what little resources we have—we wish we would get more—to be able to advise Asian countries on how to set up their prevention networks now, before it's too late.
º (1635)
Mrs. Karen Redman: Thank you.
The Vice-Chair (Mr. Stockwell Day): Before we conclude, does the Gates Foundation direct their funding in their own particular avenues, or do they go through the UN?
Dr. Jack Chow: The Gates Foundation is an independent body. They have a board of directors. They do not go through the UN, but they give grants. We are currently in conversation with them about some workstreams that they may join us and support us on.
The Vice-Chair (Mr. Stockwell Day): Dr. Chow, thank you, not just for travelling here from Geneva, but I understand you're also spending time consulting with our people in CIDA, and that is invaluable for us, to be able to draw from your experience, your medical knowledge, your government knowledge, and just your life experience. We appreciate so much that you've taken this time. It is an investment--we like that term. It's on the positive side of the ledger, and it will bear positive dividends for us and for others. Thank you so much for being here.
Dr. Jack Chow: Thank you, and thank you to the subcommittee and to the staff for inviting me.
The Vice-Chair (Mr. Stockwell Day): The meeting is adjourned.