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I call this meeting to order.
Welcome to meeting number eight of the House of Commons Standing Committee on Health. The committee is meeting today to study the Patented Medicine Prices Review Board’s guidelines.
I thank the witnesses for appearing today for the first hour, and we will do some planning for our COVID-19 and PMPRB studies in the second hour. The witnesses will come back for a second hour on Friday.
The witnesses we have here today are from the Patented Medicine Prices Review Board: Dr. Mitchell Levine, chairperson, and Mr. Douglas Clark, executive director.
Today’s meeting is taking place in a hybrid format. I will start the meeting by providing you with some information following the motion that was adopted in the House on Wednesday, September 23, 2020.
As the committee is now sitting in a hybrid format, meaning that members can participate either in person or by video conference, all members, regardless of their method of participation, will be counted for the purpose of quorum. The committee’s power to sit is, however, limited by the priority use of House resources, which is determined by the whips. All questions must be decided by a recorded vote, unless the committee disposes of them with unanimous consent or on division. Finally, the committee may deliberate in camera, providing that it takes into account the potential risk to confidentiality inherent to such deliberations with remote participants.
The proceedings will be made available via the House of Commons website, and so you are aware, the website will always show the person speaking rather than the entirety of the committee.
To ensure an orderly meeting, I will outline a few rules to follow. For those participating virtually, members and witnesses may speak in the official language of their choice. Interpretation services are available for this meeting. You have the choice, at the bottom of your screen, of either “Floor”, “English” or “French”.
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As a reminder, all comments by members and witnesses should be addressed through the chair.
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When speaking, please speak slowly and clearly. Unless there are exceptional circumstances, the use of headsets with a boom microphone is mandatory for everyone participating remotely.
Should any technical challenges arise, please advise the chair. Please note that in that case we might need to suspend for a few minutes as we need to ensure that all members are able to participate fully.
For those participating in person, proceed as you usually would when the whole committee is meeting in person in a committee room. Keep in mind the directives from the Board of Internal Economy regarding masking and health protocols. Should you wish to get my attention, signal me with a hand gesture, or at an appropriate time, call out my name. Should you wish to raise a point of order, wait for the appropriate time and indicate to me clearly that you wish to raise a point of order.
With regard to a speaking list, the committee clerk and I will do the best we can maintain a consolidated order of speaking for all members, whether they are participating virtually or in person.
Thank you.
We will now go to our witnesses. I will invite the Patented Medicine Prices Review Board to make a statement for 10 minutes.
Please go ahead.
Good morning.
My name is Mitchell Levine. I'm the chairperson of the Patented Medicine Prices Review Board, or PMPRB. I am also a practising physician and assistant dean and professor in the Faculty of Health Sciences and a faculty member of the Centre for Health Economics & Policy Analysis at McMaster University.
With me today is Doug Clark, the PMPRB's executive director. Mr. Clark will be familiar to some of you from his testimony in 2019 during his Standing Committee on Health appearance regarding the study of access to treatments for rare diseases and disorders in Canada.
Before I turn things over to Mr. Clark to walk us through the changes that have been made to our pricing regime and their impact, I thought it would be helpful to do a quick refresher on the PMPRB to provide a little background on the circumstances that have led to our issuing new guidelines last month.
As you know, the PMPRB was created in 1987 as the consumer protection pillar of a major set of reforms to the Patent Act which were designed to encourage greater investment in pharmaceutical R and D in Canada through stronger patent protection for pharmaceuticals.
The PMPRB is a quasi-judicial tribunal with a regulatory mandate to ensure the patentees do not abuse their patent rights by charging consumers excessive prices during the statutory monopoly period. Its creation arose out of the concern that stronger patent protection for medicines might cause prices to rise unacceptably and become unaffordable to consumers. The PMPRB is a creature of the Patent Act, which is the responsibility of the Minister of Innovation, Science and Economic Development, but given the nature of the products that we regulate, the provisions in the act that relate to us are the responsibility of the Minister of Health. While the PMPRB is part of the health portfolio, our role as an administrative tribunal with a quasi-judicial function means that we operate at arm's length from the minister and from other members of the federal health portfolio.
The PMPRB's regulatory framework is administered day to day by staff, public servants who monitor and investigate patented medicines that appear to be excessively priced. Staff apply the tests and thresholds specified in the PMPRB guidelines to identify potential cases of excessive pricing. When a price seems excessive, an investigation is then opened by the staff, and the patent team may be asked to submit a voluntary compliance undertaking, or VCU, which may include a written commitment to lower the price of the patented medicine and to pay back any excess revenue. In the absence of an acceptable VCU, an investigation may proceed to a public hearing before a panel composed of board members, like myself, who are part-time Governor in Council appointees. During such a hearing, the board panel acts as a neutral arbiter between the patentee and the staff. If the panel determines that the patented medicine was sold at an excessive price, it may issue a legally binding order requiring the patentee to reduce its price to a reasonable level and to repay any excess revenue that resulted from selling the patented medicine at an excessive price.
Since the establishment of the PMPRB over three decades ago, our operating environment has undergone significant change. Most notably, the nature of the products we regulate has changed dramatically. In the late 1980s and through the 1990s and into the early 2000s, the top-selling products in Canada were conventional small-molecule drugs for common ailments like high blood pressure or elevated cholesterol that would cost between a few hundred dollars to $1,000 a year per patient. In the early 2000s, the pharmaceutical industry began to shift its R and D focus to complex biological drugs that are often used to treat less common conditions and can cost several hundreds of thousands of dollars per year.
We have witnessed the upshot of that shift over the past decade, with the average annual cost of the top-selling patented drugs increasing by approximately 1,000% and the proportion of high-cost drugs—that is, drugs costing more than $10,000 per year—rising from 5% to 40% of overall pharmaceutical spending, while less than 1% of the population are using these medicines. By any measure, Canadians are paying a great amount of money for this new wave of high-cost patented medicines.
Of particular concern is that Canada pays the fourth-highest prices among the 31 OECD countries, 17% above the median price of those countries. Canada is the second highest in the OECD in terms of how much it spends on patented medicines as a proportion of total health care costs and in per capita spending. Only the U.S. is higher in both cases. From 2014 to 2018, growth in spending on patented medicines in Canada has doubled that of GDP, and it is over three times the growth of inflation.
As expensive drugs for rare diseases account for a rapidly increasing share of total spending, payers are becoming very concerned about sustainability. Not only are these drugs incredibly costly relative to the top-selling products of a few decades ago, but their market characteristics also shift the balance of power decidedly in the favour of patent-holding monopolists when negotiating a reimbursement price with public or private insurers.
This point was made rather emphatically by the pan-Canadian Pharmaceutical Alliance, pCPA, in its submission to this committee last year on access to treatments for rare disease.
It stated:
The pCPA often negotiates under very challenging circumstances starting with an extremely high list price, severe untreated disease, no competing products, and high patient and care provider expectations to conclude negotiations quickly. As such, the pCPA remains very concerned that the prices achieved through negotiation remain largely unfair, excessive and not cost-effective and that pCPA needs collaborative federal support to manage.
As members of this committee well know, Canada is the only developed country with a public health care system that doesn't include price coverage for prescription drugs. The pCPA accounts for approximately 43% of total pharmaceutical expenses in Canada, with the remainder being taken up by private insurance and out-of-pocket payments. If the pCPA believes its power buying is woefully insufficient to secure a fair price from monopolist pharmaceutical companies for the types of drugs that are increasingly dominating the market, one can only imagine how the mixed bag of buyers who account for the remaining 57% of pharmaceutical expenditures in Canada can fare in their efforts to negotiate a price they can afford.
As a federal ceiling price regulator, the PMPRB exists to protect payers in precisely these circumstances, and thereby serves as a proxy for the monopsony power that Canada lacks because of the patchwork nature of pharmaceutical coverage in this country.
If one accepts the proposition that an unbridled free market is not in the public interest when it comes to patented medicines, then really the only question is, what rules should a regulator apply in seeking to protect consumers from excessive prices in today's pharmaceutical marketplace?
The PMPRB has been actively consulting stakeholders and the Canadian public on this all-consuming question for the better part of five years. This brings me to the last point I would like to make before Mr. Clark explains to you the rules that the government has ultimately landed upon, and their projected impact over the coming decade.
I understand that some stakeholders have taken issue with the transparency and authenticity of these consultations, describing them as a sham that largely took place behind closed doors. The truth is quite the opposite. Between Health Canada and the PMPRB, the government has produced more than a dozen policy documents over the past five years, and has twice travelled from coast to coast to consult with anyone who expressed even a passing interest in them.
In the past year alone, we have held multiple policy forums where attendees were encouraged to voice their views of concern and dialogue directly with government representatives. After the initial consultation process, the PMPRB published its first proposed draft of new guidelines in November 2019.
Since then, the PMPRB has attended over 60 meetings across Canada with more than 260 members of its stakeholder community. Every document that we have ever published or presented at any forum at any time throughout this process is available on our website. We have received more than 300 stakeholder submissions in response to the documents we've put out over that period.
During this period we published a revised set of draft guidelines in June 2020, which was followed by an additional consultation period. Then in October we published the final version of the revised guidelines. We have made substantive changes to our initial guidelines proposal as a result of that feedback. While these changes are too numerous to mention now, we would be happy to provide a comprehensive list to the committee if its members are interested in the details of those changes. More than 90% of the changes are favourable to industry.
It is a complex and contentious area for policy development by any government at any time, because it seeks to reconcile seemingly conflicting public policy objectives—namely, facilitating access to patented medicines at non-excessive prices while recognizing the legitimate interest of pharmaceutical patentees in maximizing the value of their intellectual property. Not surprisingly, the PMPRB’s stakeholder community holds divergent and even diametrically opposing views on these reforms, with the industry on one side, the payers on the other side and patient groups scattered across the divide. Although consensus is not a realistic goal for us, we have made every effort through the consultation process to foster a productive, fair and transparent dialogue with our stakeholders, to listen carefully to their concerns and to have them reflected in the final guidelines document to the greatest degree possible
We believe the final product of our efforts represents an important step towards greater fairness in pricing, not only by bringing Canadian prices more in line with international comparators but also by introducing new pricing tests based on value for money and the health system's affordability.
While I recognize that our guidelines have given rise to a great deal of angst on the part of industry, I would ask the committee to consider how that could ever be avoided when the desired outcome of the policy is to lower prices and to reduce total expenditures on pharmaceuticals. To put the matter another way, what inferences might one draw about these reforms if they did not elicit such a reaction from industry? Nevertheless, a non-excessive price should be a fair price, and a fair price means a price that will permit the sustainability of both the health care system and the pharmaceutical industry.
Thank you very much for your time and attention.
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I'll just refer you to the PowerPoint presentation that was sent to committee over the weekend. I'm going to zip right through this. I know that the committee has passed a motion to review and study our guidelines, but it's important to understand and to situate these guidelines in context.
They're actually non-binding and they sit atop—I'm on slide 2 of the presentation—a pyramid, if you will, of legal instruments that begins at the base with the Patent Act, which is obviously the responsibility of the Ministers of and to the extent that our provisions are concerned and, ultimately, Parliament. It's in the act that the PMPRB is created and the excessive pricing factors are provided for, so I'll talk a bit more about those excessive pricing factors in a minute.
Then, above the Patent Act, we have the regulations, and they are the responsibility of the . They were recently amended. I'll be talking about that as well. It's in the regulations where patentees are directed to provide certain types of information and data to the PMPRB so that staff can administer the act and regulations on a day-to-day basis.
One of the factors in the act that the board is required to look to when trying to determine whether a price is excessive or not is the price of that same drug in other countries. The regulations also prescribe the list of countries that the PMPRB is to look to in making that comparison. Those are seven countries. I'll come back to that composition in a moment, because it has been amended. We call those the PMPRB7.
Then, at the very top, as I mentioned at the outset, are the guidelines. They don't have force of law, unlike the regulations and the legislation, but that's where the rubber hits the road. The act doesn't have a definition for what an excessive price is. It really doesn't offer a lot of specificity, nor do the regulations, so for a lot of the core administrative concepts, life is breathed into them in the guidelines, and that's where patentees turn to when they're trying to figure out how to comply on a day-to-day basis with the act and regulations.
As Dr. Levine mentioned—I'm on slide 3—we've been at this for quite some time. We published a strategic plan back in 2015 and identified some of the things in our environment, which Dr. Levine alluded to and that we feel have changed the nature of the game considerably. That was really when we put ourselves on a reform track and said that we needed to modernize and strengthen the regime if we were going to have the right tools to regulate the types of ceiling prices or types of products that were increasingly dominating the marketplace.
Shortly after we released our plan, we issued a discussion paper on guidelines modernization. It's important to understand that the guidelines are within the exclusive purview or authority of the board, so we wanted to get the ball rolling by engaging our stakeholders in a discussion on a document that we ourselves could amend independently and autonomously.
However, the ideas that were set out in that document were quickly picked up by the Minister of Health. Budget 2017, as some of you may know, earmarked additional funds for the PMPRB, CADTH and Health Canada to accelerate the market entry of patented drugs and to make them more affordable in Canada.
The types of changes we were talking about, and the guidelines, eventually got anchored into a more load-bearing document—the regulations—and the minister issued a white paper on regulatory reform. Ultimately, those proposed changes were published in the Canada Gazette in December 2017 and finally adopted in the Canada Gazette, part II, in August 2019.
Pretty much since that time we've been consulting on changes to our guidelines, for the better part of the past year. As Dr. Levine mentioned, we issued an initial draft for public consultation in November 2019, and then, based on the feedback we received, we revised that draft and issued a second one in June, and then made some additional changes to the version that is now final and was issued just last month.
I'm on slide 4 now. The changes to the guidelines are necessary to give effect to the changes, the amendments and the regulations.
What are those amendments? Basically, there are three types of amendments that we're talking about. First off, as I mentioned on the countries that we compare ourselves to currently, that list of countries, what we call the PMPRB-7, is being changed. The two most expensive countries are being removed from the list and countries with health systems and GDP per capita that are more in line with Canada are being added in. These countries also have prices that are more in line with the OECD median, if you will. The U.S. and Switzerland are out, and Australia, Belgium, Japan, Netherlands, Norway and Spain are in. That's the first change. The new list of countries we're calling the PMPRB11; there are 11 countries in it.
The second change is to add additional factors. I mentioned that section 85 of the Patent Act sets out the factors that the PMPRB is to consider when trying to make a determination as to whether a patented product is excessively priced in Canada. Those include the price of that same product in other countries, the price of other products in the same therapeutic class in Canada and in other countries and then the consumer price index.
However, section 85 also contemplates further factors being prescribed by regulation. For the first time in the PMPRB's history, the minister saw fit to introduce new factors by regulation through these amendments, these being primarily pharmacoeconomic value and market size. I suspect you'll have a number of questions on these new factors. I think I'll leave it to your questions to unpack them. They are complex and esoteric concepts, but I've become well versed in explaining them to people in layperson terms. I would be happy to do so in a moment.
As a result of these new factors, ceiling prices will be considerably lower in Canada. You've probably heard that concern expressed by industry and patient groups. In order for pharmaceutical patentees to be able to comply with those new lower ceilings that would result from the application of these new factors, it's important that the PMPRB have access to the true price of the product in the market.
Over the past two decades or so, prices in the pharmaceutical market have really gone underground, not just in Canada but also globally. Industry is increasingly negotiating confidential discounts and rebates with large institutional payers. Canada is no exception. No country knows what another country is truly paying for its patented pharmaceutical products. The irony in Canada is that the PMPRB is doubly handicapped in the sense that we don't know what other countries are paying and we also don't even know the real prices in Canada, because we don't have access to that true net price that takes into account the confidential rebate.
The third change in the regulations was to add a provision that requires patentees to provide us with those prices. However, as some of you may know, the regulations are being challenged before both the Quebec Superior Court and the Federal Court by the industry, two separate challenges. One of those challenges resulted in a decision from the Federal Court trial division earlier this year. It upheld the first two types of changes—the new countries, the new factors—but it did find that this third requirement that patentees provide us with this information was ultra vires of the enabling provisions of the act and therefore is of no force or effect. That decision is currently under appeal before the Federal Court of Appeal, but that has had consequences for how we are going to apply the new regime coming out of the gate in January of next year, 2021, when it comes into force.
It's important to understand that since inception, the PMPRB has taken the exact same approach to regulating all medicines that come under its jurisdiction. We look at them through the same lens. We apply the same tests. We only review the price substantively. We give a scientific and price review at introduction. We set the price, and that's it in terms of a substantive review of the appropriate price ceiling.
Going forward, however, in addition to changing our guidelines to implement these amended regulations, we're also taking a somewhat different approach, what we're calling a risk-based approach, to apply in our regulatory mandate. When new medicines come under our jurisdiction, we're going to apply screening criteria and divide them up into either category I medicines—medicines that we feel are at higher risk of excessive pricing—or category II medicines, which are medicines that we feel are at lower risk. You can see the screening criteria on slide 6.
With regard to the drug in question, its annual treatment cost is above 1.5 times GDP per capita, so it's about $90,000 annually. That will land it in category I. If its expected revenue in any of the first three years on the market is above $50 million annually, that will also land it in category I, in which case it will be subject to greater scrutiny under our new regulatory regime. I'll explain what I mean by that in a moment.
We expect that about 25% of new medicines will fall into category I and that the remainder will fall into category II. Although this represents a minority of the new medicines coming under our jurisdiction over the next decade, those medicines will account for the majority of sales of new medicines over the coming decade. The risk-based approach really scrutinizes a minority of drugs that will eventually account for the majority of sales.
I'm going to go straight to the impact; I think that's what people are really interested in. There's a lot of conflicting information out there about what the impact of these changes will be, ultimately, on prices, revenues and savings in the Canadian system.
There are three types of medicines, if you want to unpack the impact. First are all the existing drugs under our jurisdiction today—that is, everything that's patented and on the market today. As a result of these changes, their list prices, on average, will go down by about 5%, and that will result in about $4.6 billion in savings or less pharmaceutical spending over the next decade. That's for all existing medicines today. They will account for the lion's share of sales over the coming decade and result in about $4.6 billion less in pharmaceutical expenditures.
Then we have category I drugs. Their list prices will go down by about 8%. The corresponding savings to the system will be in the order of about $1.1 billion over the next decade.
Finally, we have category II medicines. Their list prices are expected to go down about 13%, and the corresponding savings to the system will be about $500 million.
Slide 11 puts this in context. It gives you a fictional example of a drug that currently has a price of $1,000 and how this would be impacted, either as an existing grandfathered drug or a category I or category II drug going forward. It gives you some context as to what to expect on a go-forward basis.
It's important to understand that for existing drugs, the ceiling price that we're going to apply is the highest international price of these new 11 countries. It's going to take quite some time before Canadian prices align with median and OECD prices or with median prices of new countries that we're comparing ourselves to. You can see on slide 12 that we're the second highest. It won't be until all these existing drugs have exhausted themselves and have been displaced by new medicines that have lower ceiling prices that we will see a reasonable alignment of Canadian prices with the OECD median.
I mentioned the global impact. If you add up all those numbers, it's about $6.2 billion over 10 years. That sounds like a lot, but when you consider, to put it in perspective, that we currently spend about $18 billion a year on patented drugs and that by 2030 we'll spend about $22 billion a year, you see it's not an insignificant sum, but neither is it an earth-shattering sum either. It's about 3.9% of total spending over the next 10 years.
With that, I'm happy to answer any questions that the committee members may have.
Thank you for your patience.
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One thing I should point out, and I did get into this a little bit in my presentation, is that when the regulatory amendments were published, they contained a cost-benefit analysis that projected about $8.9 billion in savings as a result of these changes, in net present value.
I did try to unpack the numbers a little bit for you on how we project the impact of the new regime with both the guidelines and regulations operating in tandem. It is quite a bit lower than that. It's more in the neighbourhood of $6.2 billion. That's probably an overestimate of the impact over the coming 10 years, because that looks at list prices and it doesn't take into account.... We look at list prices and we see how much they are going to come down as a result of these changes, and then we calculate how much less we are going to be spending on pharmaceuticals. However, the reality in the market is that list prices don't represent the true price in the market most of the time.
Let's say you have a drug with a list price of $100. As a result of these changes, the list price would come down 5%, to $95. If the true price in the market is $90—if the pCPA has negotiated a deal for $90—that won't have any real impact on pharmaceutical expenditures in Canada. That $6.2 billion is probably an overestimation of the impact by a considerable margin.
There is a significant gap between what we're projecting today versus what was projected in the cost-benefit analysis, the CBA, because of the impact of that Federal Court decision and our inability to apply new factors in a meaningful way.
To circle back to your original question, Dr. Levine mentioned this in his opening remarks. Canadian prices vacillate between third- and fourth-highest in the OECD, currently, for patented medicines.
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Oh boy, that's a complex question. I will let Dr. Levine chime in if he wants to supplement my answer.
We hear a lot from advocates for patients for rare diseases' pharmacoeconomic value. This is a very esoteric topic, but it shouldn't have application in this space because there are unique features of these products that make them not amenable to that type of analysis. When I meet with my counterparts in other countries around the world, and with health technology authorities in particular who do this type of analysis on behalf of payers and governments worldwide, they take issue with that argument.
I will give you an example of the point I'm trying to make. The U.K. sets pharmacoeconomic value thresholds. If a drug costs more than a certain amount for one quality-adjusted life year, the U.K. health authority won't reimburse it unless the price comes down. There are varying thresholds that apply to different drugs. Rare disease drugs have a higher threshold than regular drugs.
At some point, people became very concerned that a lot of the new oncology drugs, for rare diseases in particular, weren't meeting these thresholds—even the more elevated thresholds. The U.K. decided to create a special fund just for cancer drugs and forgo the pharmacoeconomic value assessment for these drugs.
I think the fund started off with $1 billion. It was quickly exhausted. Authorities soon realized that health outcomes for cancer patients hadn't improved an iota over that period. In fact, they probably suffered a lot more side effects as a result of allowing medications on the market that didn't have good clinical data and weren't able to establish significant value in terms of their cost effectiveness.
I'm wary of putting these medications in their own little bucket. I'm very sympathetic to people who are concerned about the impact of these changes on rare disease medications, but that's one of the reasons we introduced that $12-million annual revenue insulatory mechanism that I alluded to earlier.
Dr. Levine has more experience day to day as a clinician dealing with these types of medications. Do you have something you want to add?
I also want to thank the witnesses for joining us.
The industry and several patient advocacy groups recognize the importance of modernizing the existing basket of comparator countries to ensure a more standardized and accurate comparison of different categories of drugs. However, there are still concerns about patient access to treatment.
The Collective Oncology Network for Exchange, Cancer Care Innovation, Treatment Access and Education has strong concerns about patient access to innovative cancer treatments. In my view, the most significant criticism is the following: “Moreover, considering only the price without taking into account the treatment's value in terms of the health of patients and their caregivers, and the resulting economic and social benefits, constitutes a false dichotomy.”
In its submission, the network noted that, at the Canadian Agency for Drugs and Technologies in Health, or CADTH, four factors were considered: clinical benefit, cost effectiveness, patient values, and feasibility of adoption. It acknowledged the need for more flexibility and pragmatism in the evaluation.
The national institute of excellence in health and social services, or INESSS, is another organization that takes these values into account in the establishment of prices.
The network noted a shortcoming in the analytical approach to the reform. It stated the following:
This limited analysis does not take into account the overall value of these drugs to the health care system or the positive social and economic impact of having patients recover more quickly and resume their normal daily activities, including getting back to work. It also does not take into account the money saved in terms of care, long-term disability claims, drug claims and the use of the health care system. It overlooks the economic contributions made by individuals recovering from an illness when they resume their active lifestyle, their normal purchasing habits and their contributions to social programs.
Mr. Clark, what do you think about this?
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Thank you, Mr. Chair, and thank you, Mr. Thériault.
I'm very pleased the committee is finally getting to work on business. I think all of us are feeling some sense of relief and satisfaction that we are getting witnesses before our committee to do the work that we are supposed to do. I think I speak for all of us, and certainly for myself, when I say that it feels good to be doing that. Really, we need to continue the good work we did last meeting, making progress in working together to determine an orderly calendar of business in front of us.
As you pointed out very helpfully, Mr. Chair, we basically have four meeting after this week. This meeting and I think Friday are essentially allocated. We really have four meetings before the seasonal break in December. I think we can even look beyond that. I would suggest that with those four meetings, we allocate at least the first three to the COVID study. In the fourth meeting we can come back to the PMPRB study and pick that up. I say that for the following reasons.
We haven't heard from a single witness on COVID this fall. I think Canadians would be very surprised to know, given that we're in the middle of a raging crisis across this country, that their health committee at the national level is not meeting and discussing what is clearly the number one health priority facing Canadians. People are dying every day.
Two, this isn't just any old motion. This motion came from the House of Commons. We were directed, by a majority vote in the House, to study this matter.
Three, we have submitted our topics. We had all submitted our priority topics by Wednesday of last week. We have topics ready to go. I think that gives the analysts a chance for us to submit witnesses and then schedule those witnesses starting next week and the week after.
I would point out that given our start on the PMPRB study today—we've had half a meeting today and we have another half-meeting on Friday—by the end of this week we will have had the equivalent of one meeting on PMPRB. I don't want to read Mr. Thériault's mind, but he started to say something important, I think, which is that we have received a number of submissions on PMPRB. I have just started to wade through them. That's why I would like a chance to actually read those submissions and digest them to help me focus my questioning on PMPRB. If we proceed with COVID next week and have the first two meetings on COVID and then maybe the following meeting on Monday on COVID, that leaves us with our final meeting on Friday. It gives us two weeks to do justice to those submissions and determine who the witnesses will be and how we want to home in on that topic.
We also just heard from Mr. Clark and Mr. Levine on the PMPRB study. I think we're all getting a sense of where the essence of the dispute is, but there is no question that there has been extensive consultation. Patient groups want their voices heard, and I think that's important. Patient groups and patients have to have their voices heard at this committee, but it's not correct to say that they have not been consulted or that they have not had an opportunity to make their views known to the government. This is a process that's been going on since 2015. It was either Mr. Levine or Mr. Clark who detailed the process that has happened so far, with the plan in 2015, and then a discussion paper, and then a white paper, and then consultations over the last year, and then more consultations since the guidelines have been published.
That's not to minimize the importance of having those voices heard. It's meant to help put it into perspective that this is not a situation of groups who want to comment on PMPRB not having an opportunity to do that. They have. That's just a fact.
What people have not had a chance to do is to comment on the second wave of COVID that is ravaging our country right now. I think we as the health committee need to follow the directions of the House and get to work on the first topic that has been provided by the Liberal Party. We'll have to determine how many meetings we want to allocate to that.
My final point is that there is no emergency on PMPRB. These changes are going to come into force in January, but nothing our committee is going to do is intended to stop them from coming into force. That is not the purpose of our committee. We are not rushing to do a quick study of PMPRB so that we can stop the implementation of the PMPRB changes slated for January. Instead we need to have a considered, thoughtful approach to understand these changes and to understand how they're going to operate, because I think we're going to have to follow them closely for the next several years to determine how they are acting and to ensure that they don't have the unintended consequences, which many people fear, of restricting access to life-saving drugs. None of us wants that to be the case. We want to make sure all patients get access to the drugs they want. That's what I'm going to suggest.
I'm also going to suggest that we have until Wednesday, and I will put that in the form of a motion if necessary. I think today we should allow the Liberals to name the topic they want to study. Then by Wednesday we can submit our witnesses. The House has already told us that there will be equal witnesses, so each party has to come up with one witness for next Monday, one witness for the following Friday and one witness for the Monday after that. That gives the analysts some time to start scheduling these witnesses.
I want to stop and say for a moment that we have not been fair to our analysts. We all know, sitting on committees, that it's difficult for the analysts to contact these witnesses and get them arranged and scheduled. We need to give them acceptable lead time to do this. By choosing the next four meetings after next week, we give the analysts the ability to move these witnesses around. Some might not be able to come on the Monday—maybe it's the Friday—and this gives the analysts some flexibility with the witnesses over those three meetings to make sure we can get the witnesses the parties want, if not necessarily on the day in question.
I think that's another really functional reason why we need to deal with that. Also, it will give us a change. Therefore. I would say by Wednesday or maybe by Friday, we should submit the names of the witnesses we want for the PMPRB study when we pick it up two Fridays from this Friday.
My final point will be this, and if need be, I will put it into a motion as well. I think it's very important that all witnesses who appear before this committee on the PMPRB study declare any potential conflicts of interest. I'm going to ask the analysts to provide a standard document that is very commonplace in the medical and scientific profession.
Often we have heard doctors and other people—researchers—who appear before our committee make a brief 10-second statement at the beginning of their testimony to declare whether they have any conflicts or potential conflicts, including whether they're receiving money from any particular group. That may be important for us in weighing their testimony.
We know that the pharmaceutical industry is very strongly against the PMPRB changes, and we know—we just heard testimony, and it stands to reason—that one of their main concerns is about the economic impact the changes are going to have on them. We also know that many groups in this country receive funding, sometimes not transparently, from the pharmaceutical industry. I think we need to consider that as we are weighing testimony.
It doesn't necessarily mean that the opinions of anybody receiving money aren't as valid, but knowing about that will help us to objectively weigh the evidence we're going to hear. In fact, I would probably argue that a basic conflict screen should be a standard affair for every witness who appears before our committee on any subject. It would probably be a good practice, and I'm happy to do that. I don't want to single out this study or this particular.... We do know that this is absolutely a real issue with respect to the PMPRB changes.
If you want, here is the motion.
I move that we have three meetings starting next Monday, the first three on our COVID study and the fourth on PMPRB. We will proceed with the first order of business as determined by the Liberal Party. We will then determine how many meetings we will allocate to that first topic proposed by the Liberal Party. We will submit our witnesses for the COVID study by the close of business this Wednesday and we will submit our witnesses for the PMPRB study. Again, it will be one per party for the PMPRB study meeting two weeks from this Friday. Finally, all witnesses who appear before this committee on the PMPRB study will declare any potential conflicts of interest and fill out a standard document as may be provided by the analyst to them.
Thank you.
Contrary to what Mr. Davies was saying, we don't need to provide a witness list again for either the PMPRB study or the COVID-19 study. The deadline was Wednesday at 6 p.m. All these lists have already been submitted with our priorities, as requested in Mr. Davies' motion, last time, on the organization of the proceedings.
However, the issue here is that Mr. Davies' motion—which is, once again, a motion about the organization—changes the purpose of the motion that we adopted on the PMPRB study. I'll read it again, because I think that some people don't remember it.
The motion moves the following:
That, pursuant to Standing Order 108(2), the Committee undertake a study on the Patented Medicine Prices Review Board (PMPRB) Guidelines issued on October 23, 2020; that, as part of this study, the Committee invite experts and pharmaceutical industry representatives, as well as civil society organizations or associations (representing patients), to appear; that the Committee hold a minimum of four (4) meetings; that this study be conducted in parallel with the Committee's study on COVID-19; that additional meetings be added to the Committee's schedule if the Committee deems it necessary; that the Committee issue a request for written briefs and for requests to appear by the end of the week with a submission deadline of November 6, 2020; that the Committee report its findings and recommendations to the House; and that the government provide a response to these results within 30 days.
I'll go through the points one by one to remind you of the motion's purpose. The 30-day period was related to the date of January 1. Ms. Rempel Garner introduced the idea of a simultaneous study because we didn't want to go beyond January 1.
We can't say that we have time to discuss this because the motion had an urgent nature. That's why we adopted it in this manner.
Why did we set November 6 as the date for the submission of briefs? This deadline was very short. We needed time to debate the motion and make our recommendations before January 1. That was the goal.
However, at one point, issues related to the organization of rooms and logistics made it difficult for us to find times to meet. However, we spent at least three meetings on COVID-19 not discussing the substance of the issue, but trying to agree on the organization of the proceedings. These meetings could have already been used to address the matter.
I'm speaking out, not for the pharmaceutical companies that have a legal department to represent them, but for patients, sick people, individuals with rare diseases and cancer patients who want access to the best drugs available and who are worried right now. I'm fighting for them.
We can say that this matter isn't urgent and that we can move this once the guidelines have been implemented. However, I'll say that this wasn't the purpose of the motion. I moved the motion. We introduced things in the motion. I believe, Mr. Chair—
:
Mr. Chair, I am talking about the motion.
Mr. Davies' motion is based on a false premise. He actually believes that we have time and that we could go beyond January 1 to discuss the PMPRB. His motion is based on the idea that we will use only one meeting for that at the end of this session. But we are neck deep in briefs.
I have read all the briefs we have received since Thursday. If I had a half an hour to put questions to people, I could have done so. I did what I had to do. So I don't need time to read the briefs. I made it my duty to read them, since I asked those people to submit them by November 6.
I made a point of reading all of them before I met with people who claim to be acting for the good of Quebeckers and Canadians by establishing those guidelines. The fact that a process has taken five years—and this is the fallacy of time—does not mean everything has been done for things to be carried out properly. If that were the case, we would not still be here talking about it. There are issues related to this, and it would be in our interest to change our view of things.
Furthermore, it is currently considered urgent for the committee to submit a report on the study of this pandemic's second wave, as if it was up to us to make decisions on its management. The committee makes no decisions on that. The report it will produce will follow the government's decisions. How can we continue our work on COVID-19? That is one of the reasons I wanted to hold back my support for the Conservatives' motion until the issue of the report and the work we have done on the study of the first wave was included in this motion.
But how can we continue our work if we do not hold at least one meeting to deal with this report and with what has been implemented since the first wave? The analysts, about whom Mr. Davies expressed concerns, have been working tirelessly. Yet, we're behaving as if that work has in no way informed our questions on the assessment of the second wave or given them relevance.
What cannot wait today are patients who are concerned about the implementation of those guidelines preventing them from accessing medicines. It is certain that pharmaceutical companies will be the ones to decide whether to do business in Canada. That won't happen if they decide to pull out because of the ongoing competition across the planet. As I said earlier, the cost of drugs is not the only issue. It won't be once that has taken place that it will be time for us to return to the topic. Lives are at stake, and people on the front lines are managing the COVID-19 crisis. Those people are not waiting for the committee's advice to make their decisions. The committee is analyzing decisions that will be made to determine whether things will be done correctly when a third wave, a fourth wave or the next crisis hits.
What is urgent is for us to produce a report to identify the points of convergence among industry, patients and government, which wants to reduce the price of drugs. There is no issue on that side. However, some organizations—such as INESSS, in Quebec—are already setting drug prices and have considerably more comprehensive parameters than the PMPRB does. Those people have provided no analysis of the direct impact on patients, the network or the business.
So I will move a subamendment to Mr. Davies' amendment. I want us to set aside three meetings for the study on the PMPRB and one last study on COVID-19, or two meetings on the PMPRB study, another meeting on the COVID-19 study and another one on the PMPRB. I propose that we hold four meetings. We could use one for the study on COVID-19, but we have already wasted three of them even though dealing with this issue was urgent. We spent time on hardware issues and bickered over details. During that time, concerned people have been calling the clerk every day to find out when we will focus on the PMPRB. Patients are victims of COVID-19. Of course, the impact is collateral.
Those patients don't want to be collateral victims of COVID-19 or of a study that does not require waiting for January 1 to be carried out. We would do the same thing that is currently happening.
My mind on the PMPRB is not made up. If Mr. Davies' mind is made up, that's his problem, not mine. I want to be able to make a free and informed decision, and that is why we have to hear the voices of the most concerned people, and not only briefs read by experts.
I propose that we hold two meetings on the PMPRB, one meeting on COVID-19, and one last meeting on the PMPRB. That is my subamendment.
However Mr. Thériault wants to clarify it, the bottom line is that it sounds like we're in agreement. There is nothing that ever said that the PMPRB study has to be done by January 1. I want to also state that the motion does say that we have to hold at least four meetings, and I believe it even provides for our choosing to have supplementary meetings if we wish to as well.
What I'm talking about is having two meetings of the PMPRB study to be completed before we break for the seasonal break in December. That will be the one we have this week, and then one more, and then three on COVID.
I don't want Mr. Thériault—and if it's my error, that's fine—to consider that I'm suggesting that we do not have the remaining meetings on PMPRB when we come back in the new year, which we can do. What I am suggesting is that when we come back in January or February, we schedule the remaining two meetings on PMPRB and maybe even consider having more, if that's the will of the committee.
I would finally just point out that what was curious about the PMPRB motion was that it spoke to conducting that study in parallel with the COVID study. We did that was because, as we all know, it's the normal course of action for committees to usually deal with one study at a time, but we wanted to have two going at the same time. Of course we have very different, unique circumstances in terms of scheduling committee time in this COVID environment.
The COVID study is going to be going on for months. We have just submitted 16 different topics, and we're going to deal with the very first one next week. Obviously the COVID study will continue in January, February, March and April. We honour the PMPRB motion by having four meetings conducted in parallel with the COVID study. Nothing says we do that first.
I'm going to conclude by saying this: I agree that the PMPRB study is important. What I'm saying is that the COVID crisis must take priority right now for the reasons I indicated before, and we can move the PMPRB study in parallel in due course as we study COVID.
If we don't get to work on the COVID crisis very quickly.... Maybe Mr. Thériault and I disagree on this, but I say that Canadians want us to get to work on the COVID crisis right now and start dealing with the very serious, imminent and pressing health and life challenges that we are dealing with right now as we also move forward on the PMPRB study.
Thank you, Mr. Chair.
:
Mr. Chair, this has already been said, and I repeat it.
The sentence saying that the study should be carried out in parallel with the committee's study on COVID-19 was added to the motion because we had to consider two emergencies, which is fairly rare. That is why it was included. Otherwise, it would not have been.
Everyone knows this very well. Even the government representatives here, and Mr. Fisher, who attended a forum on the Trikafta drug, are well aware of this.
January 1 has been brought up several times. I even insisted on this twice, following comments made by Mr. Davies, who was trying to explain it. Absolutely nothing he is doing today surprises me.
However, if it's not down to the emergency issue related to January 1 and the implementation of guidelines, give me another reason why it is being added to a motion that this study must be carried out in parallel with the COVID-19 study.
Earlier, Mr. Davies was talking about one meeting plus three—so one at the end, just before we resume after the holidays again. If you want, we can always hold eight meetings after January 1. What will that lead to? People will realize that nothing will change by January 1. The government's current position is to accept the date of January 1, see what will happen and adjust next year.
Mr. Chair, put yourself in the shoes of someone who is waiting for access to a drug that will save their life. That is what we are talking about today. Saying that we can take the time we need to carry out this study seems inappropriate and insulting for patients that have a great deal of hope for that drug. The clerk could surely attest to this. I'm convinced that people are eager to testify and that they are only waiting for the opportunity. What Mr. Davies' motion is saying to them is that they will be entitled to one meeting. We will have only one meeting, which means a maximum of eight witnesses, before the holidays. Are you really serious?
I am speaking to the Liberal government's representatives around this table. Are you really serious? Many innovative medicines are coming on the market. Are you seriously ready to look rare disease and cancer patients lacking access to two of the six drugs in the eye and to tell them there is no emergency?
Mr. Chair, I will stand by my position and will not accept that, as I'm the one proposing the motion. We can always say that January 1 is not a set date. We don't need to do that because it corresponds to the implementation of the guidelines. However, a 30-day time frame, for instance, was provided in the motion.
I would like us to get back to common sense and intellectual integrity, and to recognize the true intent of this motion. That must be recognized.
If I have understood correctly, people don't even want to discuss my subamendment. That speaks volumes. People watching us with great hope in terms of the work we could do before Christmas on the PMPRB will be able to pass judgment on everyone here.
I will be able to look in the mirror because I am not distorting the motions that have been passed. If we were to look at the blues to consider the entire argument, we would see that what I am presenting has been voted on. I have presented the same thing I am talking to you about today.
:
Thank very much, Mr. Chair. I appreciate your patience with my hand raised there.
I have a comment on Mr. Davies motion, and maybe Mr. Davies can correct me when he has a chance to intervene as well.
On his motion for the three meetings that we're going to have on COVID, he doesn't discern how many are going to be for the Liberal topic, and so on. I know that in the motion we've approved, there will be up to four meetings per issue. My concern would be with this, and I look to Mr. Davies to maybe clarify in his motion.
The Liberals' first priority is mental health, which I think all of us here would agree is extremely important. It's something that we all want to address. Certainly, mental health issues and the opioid crisis and things like that are reaching numbers never seen before. However, my concern is that I would like to see us have at least one meeting before we rise in December on a vaccine distribution, which is the Conservatives' number one topic.
The reason I raise this point, Mr. Chair, is we could very well have a vaccine of some sort ready to be distributed in Canada by the end of January or early February when we return. We haven't had a chance to even discuss potential vaccines that are being assessed and any sort of distribution plan. To put that in context, the United States has Operation Warp Speed. They have already started an assessment in co-operation with the military, the CDC and the health department to ensure that when a vaccine is ready for distribution, there is a strong, solid distribution strategy in place to make sure that every American gets access to that vaccine.
In contrast, as far as we know, Canada has no such distribution plan in place in partnership with the provinces and territories. It may or may not with the Canadian military. I think if we are going to have a vaccine ready for distribution, we haven't had any insight as parliamentarians, and certainly on the health committee, on questions such as what that distribution strategy looks like, how it will be distributed, who will distribute it, infrastructure on storage and transportation, the role of the provinces and territories and which provinces get what. We don't know if remote and rural communities and first nations communities will have access to an amenable number and whether it will be based on per capita or what. We don't have any answers to any of those questions. I think as a committee and as the health committee, this is a critical issue right now that we need to address.
I know Mr. Van Bynen is a strong champion for the mental health issue. I think all of us on here would agree that it is important. My colleague Todd Doherty, with the 988 helpline, has been pushing on this very hard as well. I think it's something we should include as part of that discussion, but I don't think there's any question that when we talk about COVID, we have to prioritize this. We have to triage the issues that are coming through. I completely understand that for the Liberals, mental health is number one, but I would say that the number one top-of-mind issue for Canadians is to know when a vaccine is going to be ready, how many doses we are going to have and how it is going to be distributed.
That is the Conservatives' number one priority. I would like to see us at least address that topic with one meeting prior to rising at Christmas, as we likely won't have a chance to come back to talk about it until February, when that vaccine may be ready and some process may be in place.
To Mr. Davies, I don't think you specified in your motion how many meetings of those three would be for a specific topic, but I would like to see two meetings on mental health and at least one on vaccine distribution before Christmas.
Thanks very much, Mr. Chair.
:
I wanted to clarify that four meetings are important. Last week the list of the top four topics for study for each party was submitted, and it's no surprise to anyone here that the impacts of COVID-19 on the mental health of Canadians is at the top of our list.
I want to thank my colleagues for their support in prioritizing this important topic. Today I'm seeking the support of my colleagues to have no less than four meetings on mental health. In the motion I introduced earlier this fall asking for a mental health study, I outlined a number of key areas for the committee to focus on, and having four meetings on mental health will allow us to cover these topics without rushing through them or missing any of them.
I know it's been a while since we've had a chance to read the motion, so I'd like to briefly refresh our memories.
The first area was understand the impacts, including the gendered impacts of COVID-19 on mental health and the well-being of Canadians.
The second was to analyze the impacts on indigenous peoples, racialized Canadians and vulnerable populations in an effort to identify and address the support gaps.
The third was to study the availability of mental health promotion programs and supports for those experiencing new pandemic stress-related issues, the anxiety that those issues produce and how we're going to be able to respond.
Next was to study the effectiveness and availability of virtual mental health services, and also to analyze how the Government of Canada can assist the provinces and the territories in alleviating potential new demands on their health care systems that would result in an increase in depression, psychological distress and substance abuse, as well as PTSD and domestic violence.
Mr. Chair, I believe it was—and I can't speak for Mr. Davies—the intention to attribute the three meetings to the current year, and it was my understanding that the fourth meeting would be next year.
I do want to emphasize how important it is, given what we're trying to cover, to have four meetings allocated to the mental health study.
:
Mr. Chair, this is getting a bit complicated.
First, according to Mr. Davies' motion, we would have three meetings for one study and one meeting for the other study by the holidays.
Second, Ms. Sidhu proposed four meetings on our priorities. The Liberals' priority is mental health. The themes we were to submit had to be related to mental health. The motion passed by the House could include other topics that have actually been rejected by the Liberals. They could have proposed mental health, since they just did that.
My understanding of Ms. Sidhu's motion is that the Liberal Party wants to set aside four meetings for mental health. That won't be done by Christmas. That will be done as part of the study and motion passed by the House on COVID-19.
It is pointless to move a subamendment to Mr. Davies' amendment, as his amendment strictly concerns organizing our work until Christmas. Why does this subamendment need to be moved when what is proposed by Mr. Davies does not currently go beyond Christmas?
I am struggling to understand why we are receiving this subamendment when Mr. Davies' amendment concerns the organization of the work we will do until Christmas. Does that mean Ms. Sidhu absolutely wants four meetings on mental health by Christmas? That is what the subamendment means if you accept it, Mr. Chair.
Ms. Sidhu did not specify why she moved her subamendment. I would like our true intent to be clarified.
Mr. Davies' amendment concerns the organization of work from now until Christmas. He talked about three meetings for one study and another meeting for the other study. Earlier, he said two meetings to look good because we are in fact having a meeting on the PMPRB today. If we count them, we have had a number of meetings on COVID-19 and half a meeting on the PMPRB. We have not had a two-hour meeting today. I would not take today's meeting into account.
Mr. Chair, can you clarify what we are talking about?
Why have you accepted Ms. Sidhu's motion, which concerns the work after the period mentioned in Mr. Davies' motion?
I would like to thank Mr. Barlow and Mr. Kelloway for their thoughtful questions. I think Mr. Thériault is correct that there's a little bit of complexity here, but I think it can all come together.
The reason Ms. Sidhu's motion makes sense is that my motion is simply trying to deal with the remaining meetings we have before Christmas—and, by the way, what else is there to deal with? I think I can say without offending anybody that we've wasted a lot of time in the last couple of months. What I'm trying to do is get an orderly system of business so that we can get down to hearing witnesses both on the PMPRB study and on COVID. That requires us to determine what our remaining four meetings in the next two weeks are going to be.
The reason that Ms. Sidhu's motion is entirely in order is that if you go back to the motion we passed setting up the COVID study, we said that once we determine the order of issues, then it would be Liberal, Conservative, Bloc and NDP, in that order. We left it open to the committee to vote by majority as to how many meetings would be allocated to each topic.
Now we know that the Liberals want to proceed with mental health. That's established. We know we have three meetings on COVID before Christmas, according to my motion, if it passes. The question before this committee is how we are going to use those three meetings. The Liberals have said mental health, so now we have to determine whether we will have one, two or three meetings on mental health.
It's entirely in order and it is entirely sensible, because if the Liberals said they want to study mental health but we only want one meeting on it, then we would schedule that for the second meeting next week, and then we would have two more meetings on COVID, at which time we would proceed to the Conservatives' topic. Then we would take their first priority and have a discussion about how many meetings the Conservatives would like on that topic, ranging from one to four. Of course, we can have more by, I think I said, unanimous consent. The range of one to four meetings was to ensure that every party would get at least one meeting devoted to their topic, but no more than four.
I hope that we can proceed to the vote on this motion now, because otherwise, if we don't pass this today, despite everybody's pronouncements about how important these issues are to them, we're not going to be able to move ahead with any of them with the remaining four meetings we have—not PMPRB, not COVID. I would like to move forward on both of them.
I'm agnostic on the number of meetings. I do think all of us agree on mental health being an important issue. The issue of vaccines was the NDP's number one topic. I don't know if we've distributed the topic choices, but my number one pick on the COVID study was vaccines, so I empathize with Mr. d'Entremont's comments on that.
The reality is that we're not going to be able to get to everything or do justice to the subjects. Let's honour the motion we passed. We said we would go in order. The Liberals have identified their issue. We just have to determine how many meetings we want allocated to mental health. They want four. That's fine with me. When we come back after the holiday season, we will finish off that fourth meeting and then we will proceed to the Conservatives' next choice. Hopefully, before we break for the holidays, we'll determine how many meetings are appropriate for the Conservatives' next choice as well. That gives the analysts January to schedule those witnesses and for us to get our witness lists in.
Please, let's get down to business and start getting witnesses before this committee and do the work we're supposed to be doing here.
:
Things are becoming a little clearer now. Committee members cannot do through the back door what they cannot do through the front door.
We have spent a number of meetings on the motion relating to the COVID-19 study, which had to be proposed in the House of Commons. The Liberal Party tried to make us conduct a study on mental health. Mental health is one of my priorities, but there was a debate, and the House made a decision. We got our marching orders to work on the COVID-19 study, and the priority leading up to Christmas was not supposed to be mental health.
In that sense, I agree with Mr. d'Entremont. When the Bloc Québécois sent its list of witnesses and topics Wednesday of last week, we tried to address what would not be covered by the other parties, to avoid overlap and ensure relevant issues would be studied.
What this subamendment would do is have the committee meet three times on mental health and once on the PMPRB before Christmas. I can't support that, because I agree with Mr. Barlow, Mr. Powlowski, Mr. d'Entremont and Mr. Davies.
If we are going to spend only one meeting on COVID-19 before Christmas, it should focus on vaccines. Unfortunately, the Liberal Party is going through the back door to delay the COVID-19 study.
Mr. Van Bynen does not deserve that. What he is trying to do is commendable. I am as interested as he is in examining the issue. I am going to have to vote against the subamendment, not because I am anti a mental health study, but because it has taken us a long time to get to where we are today. We can't turn back the clock and do things through the back door. If we do, we will never see this through. We will never get anywhere if members keep trying to put a spoke in the committee's wheel.
:
First of all, I think all of the issues that are being talked about and raised are important. I think one thing we have to resist as a committee is to get involved in politics about which one is more important and that if we vote in favour of studying this or that, it means we don't care about the other one. That's just not the case.
I can think of 10 different extremely important issues on COVID. Vaccines are one, treatment is another, mental health is another, and long-term care, where we've had 80% of the deaths.... My colleague Ms. Sidhu has been a champion on that. That's extremely important.
There is PMPRB reform to all those patients who are waiting for life-saving drugs. That's critically important. I'm already seeing on Twitter and other places the idea that if we push with one or the other, it means we don't care. We all care about all of those issues.
The fact remains we have four meetings in front of us. That's what we have. Surely as a committee we're going to have to start making those little compromises to get going, because if we don't get these meetings done, nobody's talking about anything before Christmas.
The truth is that we passed a motion last week that established a fair order of how we were going to proceed. It's not perfect, but it's a compromise. It allows each party to take their position in turn. The Liberals have gone first, and I think that's as it should be, because they are the government and they have the most members. If you have to determine who goes first, that's the fairest way to determine it.
We then left it to this committee, once each party identifies its topic, to determine how many meetings we as a committee feel ought to be addressed to that topic. I'm happy with what Mr. Barlow said. As I've already pointed out, for my part, I would proceed with vaccines, but in fairness to the Liberals, they are entitled to select their first topic, and that's mental health. They have decided that they would like four meetings for that, and we've passed that. That's not what I would have done, but that's what they've done, and I suppose they'll have to defend that decision politically as well if they want to.
Mr. Barlow's point, I think, is a fair one, which is that they don't have to be consecutive. I think it's understood in the motion we passed last week that we go in turn, so each party picks their issue and we deal with that issue. All we have to do is set the appropriate number of meetings.
I think it would really be up to the Liberals whether they were willing to split up their four meetings. I think if we're most faithful to the intent of the motion we passed last week, we would deal with each topic in turn as we determine the number of meetings for each topic.
Let's face it: Vaccines are going to be a critically important issue in January, February and March as well. While I would love to have some focus on them in one meeting, one meeting in December is not going to do sufficient justice to any of these important issues, including vaccines. I do note that we directed a lot of questions to on Friday about that, and I know we have a session in the House of Commons this Thursday. I believe we have a committee of the whole with the health minister there, so there will be a chance to focus on those issues there as well.
Look, it's not perfect, but it gets the ball rolling. I just think we should get the ball rolling for these four meetings. We're not going to be able to deal with all the important issues that we need to before the holiday season, for sure, but let's get started on it. It doesn't mean that the issues coming afterward are any less important, because they're not.
[Translation]
Mr. Chair, a moment ago, Mr. Davies was calling for consensus and co-operation. He talked about the importance of getting the ball rolling.
Mr. Barlow is proposing a subamendment on an issue that the population as a whole seems to care a lot about. The first thing we see happening is that the government is realizing its desire to make mental health the main priority of the Standing Committee on Health before Christmas. However, we, the opposition members, spent opposition day trying to make sure that the COVID-19 study would cover a series of issues. Mental health is one we could have added to the list, but today, the government is successfully imposing mental health as a topic of study before Christmas through a work planning motion.
I have nothing against mental health, but people are wondering why the committee is not getting anywhere. Because we keep being tripped up at every turn, because the government keeps putting a spoke in our wheel at every junction. There is no genuine willingness to co-operate. The government is going to study what it wants to study. The meetings that were derailed were used by both sides to stonewall.
All of this is being duly noted. Today, I hope the folks who thought we were going to make progress on the PMPRB issue are not questioning our intention as lawmakers. These kinds of political games are unacceptable. I don't understand Mr. Davies' position or the way he is voting. Although he can vote how he likes, he should walk the talk, as the saying goes, and he isn't doing that right now.
I was sure there was support for the study on vaccines, which is one of the NDP's priorities. Nevertheless, we find ourselves conducting a study on mental health before Christmas—and that comes as quite a surprise. I am having a lot of trouble understanding how we work on this committee and what each member's real intentions are.
Perhaps Mr. Davies still means to condemn the fact that the government is focusing on mental health instead of vaccines. He did make that point earlier, but he voted with the government, so I'm totally confused. Consequently, I'm going to abstain from the next vote.
Definitely, I have the same sentiments that my colleague Mr. Thériault has. We always sit in these meetings and we all say that we should find ways to get along, and yet when we make reasonable suggestions, it seems that the government tries to avoid them.
Mr. Chair, we don't have any answers on vaccines, and even though we got to ask a few questions about vaccines on Friday, we still don't have the answers we need to understand how people are going to be getting the vaccines, when the vaccines might become available, or how they are going to be transported from place to place to place.
I thought that in this new era, when Mr. Davies got going, we were actually going to find a way to manage the next few meetings so that everyone could be on the same page. Unfortunately, we're finding that is not the case. We're finding that since they were not able to get their way the last time around when Mr. Van Bynen tried to run the motion on mental health to try to take up the time of this committee and was turned down because of the motion in the House of Commons, here we are again today, with their taking up the four meetings consecutively, except for the PMPRB meeting that is going to be stuck in the middle.
I find it unfortunate that we cannot get along when it comes to the number one issue that comes before us, which is for us to have a vaccine and to be comfortable with how it's going to transported across the country and how people are going to be able to get it. That will alleviate the anxiety that most Canadians have—not all Canadians, but a good chunk of them—because they are worried about the vaccine.
The example is really good here in the bubble, and I know that a number of my colleagues on this call—
I have to agree. I thought we were operating in the spirit of co-operation and moving rather well there for a while. We have three meetings on COVID and one on the PMPRB. We know the work schedule here for the next while. I don't think it was too much at all to ask for one meeting on vaccines, and I don't want to put all the pressure on Mr. Davies either. There are Liberals on this committee who know that the vaccine is a big issue. They said so today, and I appreciate that.
Back home in Manitoba, I can tell you, where we have the highest per capita COVID cases in the country on a per 100,000 basis, vaccines are the big issue.
Now, not everybody is going to want the vaccine when it does come; don't get me wrong. For those who do, though, this is a big issue. How to spread those around, how to deal with the people who are in long-term care homes and how to deal with the workers in those homes I think is a huge issue.
People would be able to be a lot more relaxed over the Christmas holidays if we actually had a discussion about vaccines, how they are going to be distributed and where the priorities would be in these areas. A lot of these people are seniors. A lot of the people who are dying are in their eighties and nineties. Many are in their seventies, and some are much younger. We could really still help ourselves here by being accountable to people in Canada by dealing with vaccines as the number one issue, and it will help everyone's mental health—
:
I only have one point to make, and that is, to the extent that there have been some minor aspersions about people's motivations, I think all of us are on the same page here. Look, I drafted the motion last week. Where did I put the NDP? Last. I'm going to be getting my issue maybe in March or April.
What I would say is this: Vaccines are important. As I said, it's my number one pick. If I were picking first, that's the one that I would go with, but we passed a motion giving the Liberals first choice and the Conservatives second. I assume the Conservatives will choose vaccines as their second pick.
Having one meeting on vaccines in December can't begin to plumb the depths of the issue of vaccines. Yes, it would be helpful, but vaccines are going to be incredibly important in January and February as well.
I agree with the Conservatives. It would be nice, if the Liberals saw fit, to have two of the four meetings and then one on vaccines. That would be helpful and it would be collaborative, but they're not required to do that. They're entitled to go first. They're entitled to pick their issue. They chose mental health. The question is, how many meetings do we want to allocate to that? I could go either way. There were sensible arguments made all around, but I'm warning us all again that if we don't make a vote on this right now, nobody's talking about anything next week. We will render meaningless all the profound commitments to all of these important issues if we don't pass this motion now.
There are many other vehicles to discuss issues. I think it is a very wise move on the Conservatives' part to have a debate in the House in committee of the whole with the health minister. That's an excellent venue in which to bring up vaccines, as well as in question period and other things.
Let's not make perfection the enemy of the good here. Let's proceed on this, and we can come back. I'll go on the record right now to tell you that I'll be supporting the Conservatives in having four meetings on vaccines when we return in January. Let nobody here think that vaccines aren't going to be a ferociously hot issue in terms of health care in January and February, because they will be. I don't think we're losing very much by getting this thing moving now.
I urge my colleagues: Let's just pass this motion, please.
:
Mr. Chair, the motion Mr. Davies successfully put forward last week established a rotation among the parties and topics. That rotation was agreed upon.
If we look at the remainder of the committee's meetings leading up to the holidays, it's clear that the rotation is not being respected. That is not at all in keeping with the motion that was adopted. If we hold a meeting on vaccines before Christmas, it doesn't mean that we won't hold more meetings on the issue after Christmas.
I repeat, what I find odd is that we started going adrift and wasting time right when the government members did not want us to move forward with the COVID-19 study. They tried to introduce topics that prevented the committee from dealing with the subject. Today, after spending a number of meetings on work planning and discussing proposals, we are in the same boat we were in five, six or seven meetings ago.
It's absurd that we let the government use a work planning motion to impose a decision on an issue that was the focus of an opposition day in the House. When must we bring forward a motion in the House that does not pass muster, that cannot be settled in committee? When the committee is at an impasse.
We sought direction from the House, and that direction was amended by a motion on the scheduling of committee business. Now, here we are confronted with the Liberal government's initial intention not to discuss hot topics related to COVID-19.
I just wanted to say this. No one is pulling the wool over our eyes. We are more than capable of seeing the alliance between the government and the NDP.
:
Mr. Thériault, I recognized you to respond to Mr. Davies. Did you wish to make a further intervention? Your hand has gone down.
Is there anyone who wishes to speak to Mr. Davies' motion as amended by Ms. Sidhu?
Seeing none, I will ask the clerk to conduct the vote.
(Motion as amended agreed to: yeas 10; nays 0 [ See Minutes of Proceedings])
The Chair: Thank you all.
I will ask the clerk to distribute to all members the text we just agreed to, as well as the other motions upon which we're operating at this point regarding this study.
As per this motion, you are asked to get your lists of witnesses for the study on the mental health aspects of COVID-19 in by Wednesday and for the PMPRB in by Friday. On that basis, we will put together an appropriate panel.
Note that the House motion allows us one witness per one-hour panel and two witnesses per two-hour panel, so depending on the number of witnesses, we will decide what the panels are going to look like.
The meeting is adjourned.