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37th PARLIAMENT, 2nd SESSION

Standing Committee on Health

EVIDENCE

CONTENTS

Tuesday, October 21, 2003

0910

The Chair (Ms. Bonnie Brown (Oakville, Lib.))

Mr. Ian Green (Deputy Minister, Department of Health)

0915

The Chair

Dr. Alan Bernstein (President, Canadian Institutes of Health Research)

0920

0925

The Chair

Mr. Rob Merrifield (Yellowhead, Canadian Alliance)

Mr. Ian Green

Mr. Rob Merrifield

Mr. Ian Green

Mr. Rob Merrifield

0930

Mr. Ian Green

Mr. Ian Potter (Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health)

Mr. Rob Merrifield

Mr. Ian Potter

Mr. Rob Merrifield

Mr. Ian Potter

Mr. Rob Merrifield

Mr. Ian Green

0935

The Chair

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ)

Mr. Ian Green

Mr. Réal Ménard

Dr. Alan Bernstein

0940

Mr. Réal Ménard

Dr. Alan Bernstein

The Chair

Mr. Réal Ménard

The Chair

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.)

Mr. Ian Green

0945

Mr. Jeannot Castonguay

Mr. Ian Green

Mr. Jeannot Castonguay

Mr. Ian Green

The Chair

Mr. Grant Hill (Macleod, Canadian Alliance)

Mr. Ian Green

0950

Mr. Grant Hill

Mr. Ian Green

Mr. Grant Hill

Mr. Ian Green

Mr. Grant Hill

Mr. Ian Green

Mr. Patrick Borbey (Assistant Deputy Minister, Corporate Services Branch, Department of Health)

Mr. Grant Hill

Mr. Patrick Borbey

Mr. Grant Hill

Mr. Ian Green

Mr. Grant Hill

Mr. Ian Green

Mr. Scott Broughton (Assistant Deputy Minister, Population and Public Health Branch, Department of Health)

Mr. Grant Hill

Mr. Scott Broughton

The Chair

Ms. Hélène Scherrer (Louis-Hébert, Lib.)

0955

Mr. Ian Green

The Chair

Dr. Alan Bernstein

1000

Ms. Hélène Scherrer

The Chair

Ms. Hélène Scherrer

The Chair

Mr. Gilbert Barrette (Témiscamingue, Lib.)

M. Ian Green

Mr. Ian Potter

1005

The Chair

Mrs. Brenda Chamberlain (Guelph—Wellington, Lib.)

Mr. Ian Green

Mrs. Brenda Chamberlain

Mr. Ian Green

1010

Mrs. Brenda Chamberlain

The Chair

Mrs. Brenda Chamberlain

The Chair

Mrs. Brenda Chamberlain

Dr. Alan Bernstein

Mrs. Brenda Chamberlain

Dr. Alan Bernstein

Mrs. Brenda Chamberlain

Dr. Alan Bernstein

Mrs. Brenda Chamberlain

The Chair

Ms. Carolyn Bennett (St. Paul's, Lib.)

Dr. Alan Bernstein

1015

The Chair

Mr. Ian Green

The Chair

Ms. Carolyn Bennett

The Chair

Ms. Carolyn Bennett

The Chair

Ms. Carolyn Bennett

The Chair

Ms. Hedy Fry (Vancouver Centre, Lib.)

1020

Mr. Ian Green

Mr. Scott Broughton

The Chair

Mr. Grant Hill

The Chair

Mr. Grant Hill

The Chair

CANADA

Standing Committee on Health

NUMBER 059

2nd SESSION

37th PARLIAMENT

EVIDENCE

Tuesday, October 21, 2003

[Recorded by Electronic Apparatus]

¿ (0910)

[English]

The Chair (Ms. Bonnie Brown (Oakville, Lib.)): Order.

Good morning, ladies and gentlemen. I apologize for being late. It had something to do with the weather and the lack of green buses and a variety of other things.

This morning we are going to fulfill our duty and look at the supplementary estimates, pursuant to Standing Order 81(5).

We have with us this morning representatives from the Department of Health, including Ian C. Green, the deputy minister. I will turn it over to Mr. Green and he will introduce others who are with him.

Mr. Green.

Mr. Ian Green (Deputy Minister, Department of Health): Thank you, Madam Chair.

I'm pleased to appear before you today to discuss our supplementary estimates for the 2003-04 fiscal year.

As you say, before I go further, I should take a few moments to introduce my senior colleagues from the department. Since the estimates, as you know, cover a range of detailed activities for which we are responsible, with your permission, Madam Chair, I may ask them during the discussion to provide additional explanations as appropriate.

I'd like to introduce to you Patrick Borbey, our ADM, corporate services; Ian Potter, our assistant deputy minister for First Nations and Inuit Health Branch; Diane Gorman, our assistant deputy minister for Health Products and Food Branch; and Scott Broughton, our assistant deputy minister forPopulation and Public Health Branch. As well, Hélène Goulet is our acting assistant deputy minister for Healthy Environments and Consumer Safety Branch, and Wendy Sexsmith is the acting executive director of the Pest Management Regulatory Agency.

If you will allow me, I'd like to take a very brief moment just to describe our supplementary estimates and then perhaps hand it over to Dr. Bernstein. Then we can go to questions or comments from members.

Just in terms of understanding the supplementary estimates process, I should provide a bit of background on the estimates and their major components. I know your committee, like others, has an ongoing interest in the operations and resources of government departments.

Overall, our supplementary estimates represent investments that are designed to improve and maintain the health of Canadians, that we need to manage effectively on behalf of Canadians. As you know, we start developing our financial plans for the forthcoming fiscal year several months before the year starts. Those plans are finalized as main estimates, and tabled in the House of Commons in February. While we are doing that work, the budget decision-making process is simultaneously under way across the government.

Since the budget usually comes down in February, we are not normally in a position to adjust our fiscal plans in time for the main estimates, which are tabled at about the same time. In any event, the announcement of budget commitments by the Minister of Finance does not translate automatically into allocations for specific departments under specific votes. The budget is normally followed by a process of clarifying all the terms and conditions for those funds and timeframes for expenditures. That can take months, even when the funds are essentially allocated to just one department. But when a budget commitment has implications for a number of departments, the process can be even more complex.

Those terms and conditions and resource allocations are resolved through Treasury Board decisions through the spring, summer, and often the fall or later, which leads to the need for the supplementary estimates, which you have in front of you. Supplementary estimates are therefore the vehicle for the department to access additional resources to deliver on these new commitments.

[Translation]

Madam Chair, as you know the 2003 Budget recognized the importance that Canadians attach to our health system. It followed through on the many commitments that the First Ministers agreed on through the First Ministers' Accord on Health Care Renewal in February 2003.

As a result, the 2003 Budget had many implications for Health Canada and government investments in the health of Canadians, more generally. For the most part, those are the formalization of Budget commitments.

There will be other changes to our Estimates resulting from the normal course of events over the year. These would appear in the final Supplementary Estimates in March 2004.

[English]

Altogether, these supplementary estimates project an increase of $289.2 million over main estimates. There are five major changes, which I will touch on briefly. The changes include additional funding for first nations and Inuit health programs sustainability, the therapeutics access strategy, the health-related elements of the government's public security and anti-terrorism initiatives, major elements of the first ministers accord on health care renewal, and additional grants and contributions. I'll very briefly describe each of them.

In terms of additional funding, this is a net increase of $190.4 million for first nations and Inuit health programs sustainability. As you know, roughly half of the Health Canada budget goes to meet our jurisdictional responsibility for health services to first nations, people living on reserves, and Inuit people in their communities. In fact, that responsibility gives us a larger health budget than six of the provinces.

All jurisdictions face a range of factors that are increasing costs, and on top of those we face other drivers--rapidly growing first nations and Inuit populations, serious disparities in health status between aboriginal people and other Canadians, and the remoteness of many of the communities that we provide service in.

This additional funding will help us do a great deal. For example, we will improve the quality of water and waste water treatment on reserves through a new first nations water management system. We will improve our health facilities on reserves and in Inuit communities. We will take actions to attract and keep the professionals who provide those front line services.

There is much more, and I hope as we go through it we will be able to delve into this area in more detail, as you wish.

We are being allocated, as well, $35.4 million for our therapeutics access strategy. That strategy is meant to improve timeliness and transparency of the regulatory review of drugs and other health products, provide greater vigilance around safety issues once those products have been marketed, and contribute to the cost-effectiveness and sustainability of the health care system. The new funding will help us act on those and other priorities.

¿ (0915)

[Translation]

These Supplementary Estimates include $26.5 million for the health-related elements of the government's Public Security and Anti-Terrorism Initiatives. Essentially, this money will ensure that Canada has the capacity to respond to an outbreak of smallpox — with vaccines, medical supplies, storage, transportation and the contingency plans to deal with a situation effectively and promptly.

[English]

Major elements of the first ministers accord on health care renewal are included in the supplementary estimates, Madam Chair. While much of the attention was paid to increased transfers to which first ministers agreed, and which are flowing, they also agreed to other actions for which Health Canada has specific responsibilities. These other actions will address important health system needs. I will simply list a few of them for now: a start on the patient safety initiative; implementation of health human resource initiatives; implementation of the health technology assessment strategy; funding that will implement the health council; and support for the national immunization strategy.

I know there's a great deal here, Madam Chair, so we welcome the chance to provide details in answering any questions that follow.

Finally, I should note that the supplementary estimates include funding for additional grants and contributions. Almost all of this money will flow to territories under the agreement between the Prime Minister and the three territorial leaders that followed the first ministers health accord in February. The funds are meant to address the higher costs that the territories face in delivering services to their residents.

Madam Chair, as I say, there's a lot here. We've been asked to take on important and additional work that the supplementary funding will support.

Now, with your indulgence, I'd like to turn to my colleague from the Canadian Institutes of Health Research to address the committee on their supplementary estimates.

The Chair: Thank you, Mr. Green.

Dr. Bernstein, welcome.

Dr. Alan Bernstein (President, Canadian Institutes of Health Research): Thank you very much, Madam Chair.

I'm very pleased to be here this morning to present CIHR's supplementary estimates and to answer any questions the members of the committee might have.

[Translation]

These Supplementary Estimates contain two items both of which were announced in the federal Budget of February 2003.

[English]

You will recall that the budget provided for a $55 million increase to CIHR's base budget as well as significant funding for the Canadian graduate scholarships program, through which CIHR will administer $2.5 million in the current year.

Our mandate, as laid down in legislation, is to excel in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products, and a strengthened Canadian health care system.

The funding provided through the supplementary estimates will make a significant contribution in helping us address these objectives. We will increase our investments in high-quality health research through both open competitions and strategic health research initiatives launched by our 13 institutes. The “open competitions” refers to the funding of research projects and personnel support that cover the full spectrum of health, from basic biomedical sciences to health policy, health services, and population health research.

The strategic initiatives, which are launched, as I said, primarily by our 13 institutes, focus on strategic areas of research and capacity building in areas of importance to Canada. These initiatives also include grants to develop commercialization opportunities, knowledge translation, and ethics in health research.

The additional funding provided to CIHR's base budget through the supplementary estimates will be directed about equally between these two broad categories of research--that is, to open competitions and to strategic initiatives.

The Canada graduate scholarships program will provide incentives, important incentives, I believe, for increased enrolment in graduate studies across Canada. That program aims to improve the attractiveness of pursuing graduate studies in Canada by awarding scholarships to qualifying students and by making these awards financially attractive.

While I'm here today, Madam Chair, I'd like to take the opportunity to update committee members on the progress CIHR has made since its creation in 2000, three and a half years ago.

¿ (0920)

[Translation]

I firmly believe that health research is transforming our lives and our health care system.

[English]

From understanding the most intimate molecular secrets of the cancer cell, to the sequencing of the genome of the SARS virus, to an objective evaluation of clinical procedures, to addressing the problems and poor health outcomes faced by Canada's aboriginal populations, to documenting and addressing medical errors and adverse events in our health care system--CIHR is funding all of this and much more right across this country.

We currently fund over 7,500 researchers in universities, teaching hospitals, research institutes, and community groups right across Canada. The number of grants has increased by 61% in the last three-and-a-half years. The average value of our grants has also increased, from about $80,000 per year to over $100,000 per year, and our 13 institutes are developing new national platforms and initiatives, which I'd be happy to talk about later.

CIHR has also developed an overarching national strategic plan, a blueprint for health research, that's built on excellence in research that's strategic, inclusive, and responsive to the health challenges facing Canadians.

Our 13 institutes have recognized that the complexity and scale of today's health research challenges require that researchers reach out beyond their own areas of expertise and that we experiment with new methods and modes of bringing people together to work on important problems. Thus, our institutes have developed and implemented eight new programs to encourage problem-based, multidisciplinary approaches to the health challenges facing Canadians and to the exciting scientific opportunities that are opening up daily.

Minister McLellan recently announced the results of our second round of new emerging teams, just one of those eight new programs, to fund researchers right across Canada. I'd like to give three examples of the 23 new teams that we and our partners are funding to a level of over $30 million over the next five years.

First, Pat McGrath, a CIHR distinguished investigator at Dalhousie University, and a team from right across Canada are working on gender differences between boys and girls in terms of how children experience pain.

Debra Morgan and her team at the University of Saskatchewan, with partners in the Alzheimer Society and the Saskatchewan Health Research Foundation, a provincial health research body, are working on strategies to improve the care of persons with dementia in rural and remote areas of Saskatchewan. Actually, that team was featured in the Star-Phoenix, in today's paper.

Michel Tremblay at the Centre hospitalier de l'Université Laval is working on transcriptome and proteome analysis as a new approach to study susceptibility to HIV infection.

We have launched innovative new programs to encourage and catalyze the commercialization of research, including our new proof of principle program to allow researchers to add value to their discoveries prior to having to go to the marketplace for more funds. I've never seen a more successful launch of a new program.

Indeed, if you see today's Ottawa Citizen, there's a story on John Bell, a researcher here in Ottawa, working on an entirely new approach to cancer treatment using the cold virus as a way of exploiting and killing cancer cells. Dr. Bell has a proof of principle grant as well as an operating grant from us to pursue that sort of research.

In three short years, our institutes have developed important new partnerships with the provincial health research agencies, industry and health charities here in Canada and abroad. We have signed major new collaborative agreements with partners in the U.K, France, Germany, Mexico, Australia, and New Zealand to conduct research collaboratively on genomics, HIV/AIDS, diabetes, aboriginal health, tobacco addiction, and heart disease, to name just a few. These new partnerships have resulted in a substantial increase in our partners' contributions to funded research here in Canada to almost $80 million per year.

I believe, Madam Chair, we're making tremendous progress. It's clear that we have moved past the old days of the Medical Research Council and the old ways of our granting council past.

Just yesterday I was in Edmonton as part of our Institute of Gender and Health's second annual symposium. Canada is the only country in the world with an institute on gender and health issues. There were almost 100 health researchers there from across Canada to discuss a variety of research issues around four broad themes--access and equity for vulnerable populations, new perspectives on gender and health, building healthy community through rural and northern health research, and gender and health across the lifespan.

I believe, Madam Chair, our country no longer has a funder simply of medical research; it has a driver of health innovation.

Thank you for your attention.

¿ (0925)

The Chair: Thank you, Dr. Bernstein.

Now we'll move to questions from the members, beginning with Mr. Merrifield.

Mr. Rob Merrifield (Yellowhead, Canadian Alliance): Thank you for coming in and for having such a wide array of individuals to be able to answer our questions.

When we look at some of the dollars and cents on some of these estimates, we always have to ask the question, are we getting value for dollar, or are we just throwing money into dark holes that just gobble it up?

First of all, with the first nations, you're putting $190 million into water, health facilities, and access to health records. Is that where we're going? I know we had quite a discussion about that this spring, and it came up again when we were travelling, I believe in western Canada--or maybe it was here, I can't remember. With regard to the access program, I think you had moved it from September to March to have this access or the consent forms actually complied with.

I am wondering how that's going, from your perspective. Could you just comment briefly on those dollars and justify where they're being spent?

Mr. Ian Green: Thank you.

On the sustainability of first nations funding that we are proposing, $151 million of that is going into non-insured health benefits. This is designed to assist in sustaining the program. As you know, we have responsibilities under that program to provide dental, vision care, prescription drugs, medical supplies--

Mr. Rob Merrifield: Is that because the demand is that much higher?

Mr. Ian Green: The demand historically in that program has been increasing, as it has for many jurisdictions, at a significant rate. We were capped at a 3% growth rate historically, and a significant amount of the funding is to allow us an adjustment in terms of costs that have exceeded 3%, which, as I said, is not unusual and is being experienced by many jurisdictions.

I should add at the same time, though, that we are also looking at the implementation of cost management measures and medical transportation and pharmacy as part of that program. So we are very much looking at efficiencies in terms of how the program operates.

Just in terms of the other elements of the program, it also includes investments in health facilities and physical assets. We do have a physical plant responsibility in terms of the construction and renovation of facilities on reserves and the provision of new resources for the operation and maintenance of health facilities. A very important part is a nursing investment strategy. This is a critical issue for us, attracting health human resources in many rural and remote communities. We want to reduce high turnover by providing clinical supports and access to professional development and training, and improving health service delivery and distance education through electronic applications.

We also have a health integration initiative. We are strongly of the view that in fact to improve service to many of these communities, we need to work effectively and develop pilot projects between ourselves, provinces, aboriginal communities, health authorities, etc., as well.

Finally, there's a component for an on-reserve immunization strategy, which is aimed primarily at aboriginal children, to decrease the incidence of vaccine-preventable diseases.

So we believe, when you look at each of the areas, they in fact respond to issues that will enable us, at the end of the day, to ensure that these investments are helping our services and helping our clients.

On the consent issue, which you have raised, it is true that we have deferred the implementation of that to March of 2004. We have had consultations with the Assembly of First Nations. We have an undertaking from the national chief that he will help us in terms of moving ahead with the implementation of our consent requirement, which, as you know, flows from recommendations of the Auditor General and from recommendations that have been made by the public accounts committee, if my memory serves me correctly, where, given the application of our drug utilization review, we're also being told that from the point of view of privacy and the charter, we also need to ensure that we have an effective consent regime to enable the information to be gathered and then shared appropriately, which is designed to try to make sure that the programs are being applied in a safe way.

Mr. Rob Merrifield: I'm more concerned about whether it's going to actually happen this time or whether you're going to have to extend it. Nonetheless, don't use all your time answering that one, because it will unfold as it will, regardless of what you answer.

The $150 million, if I caught you right, is going to the non-insured pharmaceuticals program. One of the concerns that has raised its head and that I've been dealing with in the last couple of days is what you're doing with the methadone treatment. You've taken Saskatchewan's level and applied it across the country, reducing, let's say, the value of that in some provinces up to 80%, so much so that pharmaceuticals are refusing to comply or to even handle the product any more.

Is that an oversight, and something you're going to readjust and re-look at, or are you just going to close down this program in a lot of our communities?

¿ (0930)

Mr. Ian Green: I mentioned when I started that we were quite concerned about ensuring that we managed our non-insured health benefits program, which has been growing quite rapidly, as efficiently and effectively as we can. So we have started to look at, and compare, price issues as they exist across the country.

In respect to the distribution of methadone, there are at least three fees that can be applied in terms of its dispersal. One is the product cost, the second is the professional dispensing fee, and the third is an interaction fee. We have found that those fees in British Columbia are significantly higher in certain areas than they are in other parts of the country. Given that they are significantly higher, we have entered into negotiations with the Pharmacists Association to basically review the question of whether those costs are appropriate. In our view, there are a number of unanswered questions about why in one area of the country they are significantly lower than they are in another. We think it's part of our responsibility in terms of the efficient management of the program to look at those kinds of issues.

I just want to ask Ian Potter if in fact I've left anything out in terms of the situation.

Mr. Ian Potter (Assistant Deputy Minister, First Nations and Inuit Health Branch, Department of Health): I might just add that we are quite concerned that for those patients who need methadone there is continuing access to that therapy. We have had discussions with the Pharmacists Association, and to date no patient has been denied therapy. We are speaking with them, and are discussing with them the cost. We have also taken steps so that we can provide alternative access to patients should the pharmacists refuse to provide that service.

Mr. Rob Merrifield: That's to date. When did you change the fee?

Mr. Ian Potter: The new fee scale went into effect on October 1.

Mr. Rob Merrifield: That's right. So you're not in negotiations. This is a fait accompli.

Mr. Ian Potter: We have made changes to the fee schedule. We have indicated to the Pharmacists Association that we are prepared to discuss the fee schedule. We believe the fee schedule that we're providing provides a fair remuneration, but we have said to the pharmacists that if they have information that would indicate that this is wrong, we are prepared to open the question.

Mr. Rob Merrifield: Well, something's not right. You changed the fee schedule October 1. You say you're into negotiations, and you say that nobody has ever been denied methadone yet. But it isn't even the end of October yet, so I think it's pretty invalid to say that nobody has been denied it, because now is when they're starting to say...they're going to shut it down, it's not worth it for them to carry it any more, and a lot of these communities are not going to be able to have the product.

I'm just wondering what you're going to do, change the fee or provide it some other way. There are some serious problems with methadone, with just carrying it, in some of these small communities, just in terms of safety alone.

I don't know if you have any better answer than what you've just given me, but I'm not too impressed with it.

Mr. Ian Green: I think we agree that it's an important issue in terms of ensuring access to the product. On the other hand, we feel that we have a responsibility to ensure that the program is being administered efficiently and to assess the prices that are being charged in respect of that distribution. Our view is that we have set a fair price.

If I used the word “negotiations”, I'm sorry, because I meant “discussions”. We did make a decision on it. But we are continuing discussions with the pharmacists around the application of the policy, with a clear sense that we want to ensure that access is maintained in terms of the product.

¿ (0935)

The Chair: Thank you, Mr. Merrifield.

Mr. Ménard.

[Translation]

Mr. Réal Ménard (Hochelaga—Maisonneuve, BQ): I'm going to ask two questions, with your permission. The first concerns the 2003 announcement that $17 billion was to be reserved pursuant to an agreement between the First Ministers and the federal government. From what I understand, an additional vote of $16,268,000 is being requested today.

I would like you to tell us more specifically what this amount will be used for and briefly give us a breakdown of expenditures. You could table that information or send it to the Clerk. In fact, I would like to know the spending breakdown by province. For the moment, you could give us a little more information on the use that will be made of the $16 million. Then I'll have a second question on the Canadian Institutes of Health Research.

[English]

Mr. Ian Green: I believe the member is referring to the health reform fund, which was the $16 million that was allocated in the accord. The health reform fund is a five-year fund. It will flow over a five-year period, and will then be integrated into the Canada health transfer at that time, subject to a review of the fund's operation by first ministers.

I'm sorry, I don't have...I was dealing with the supplementaries today. It is not in our estimates, but I would be happy to get the member a breakout, year over year, of the health reform fund, and the allocation by province. The fund essentially has three objectives as laid out in the accord. It is designed to ensure that all jurisdictions move to having 50% of their population in primary health care arrangements within the period of time specified in the accord. Second, ministers undertook to develop a series of home care initiatives in three particular areas--acute home care, community mental health, and end-of-life or palliative care--and to also, by 2006, move to implement catastrophic drug coverage.

So it had the three objectives, with provision for flexibility for provinces to use the funding as appropriate in their jurisdiction for each, but the reform fund basically was premised on the agreement that those three objectives would be the end result of in fact those investments over that five-year period.

[Translation]

Mr. Réal Ménard: So if possible, you'll send us a detailed breakdown by province.

I'd like to talk with Dr. Bernstein about the Institutes of Health Research. I was a member of the committee when we studied the bill that ultimately resulted in the abolition of the Medical Research Council of Canada and the creation of the 13 research institutes. That measure was clearly very much awaited because, since 1995, various OECD reports have referred to a problem regarding funding of research in Canada.

When the institutes were created, some concern was felt in the Quebec scientific community. The Medical Research Council of Canada had served Quebec well, always setting aside 25 percent of funds for Quebec researchers. Now that the Institutes of Health Research have operated for more than a year, are you in a position to talk to us a little about the funds that have been allocated to Quebec and the manner in which the institutes have taken over?

Dr. Alan Bernstein: Thank you for asking me that question.

[English]

I can get you the exact numbers, but I would estimate that the amount of money going to Quebec researchers as a result of the transformation and the increases in our budget has roughly doubled over the past three years. Equally important, I think, we have many partnerships with Fonds de la recherche en santé du Québec around training, around particular research programs. Dr. Bureau, who just stepped down as the head of the Fonds de la recherche en santé du Québec, sits on the conseil d'administration at IRSC. So Quebec is very strongly represented at the very highest levels.

In addition, three of the scientific directors of CIHR's 13 institutes are Rémi Quirion, the scientific director for the Institute of Neurosciences, Mental Health and Addiction; Réjean Hébert, the scientific director for the Institut du vieillissement; and Phil Branton--

¿ (0940)

[Translation]

Mr. Réal Ménard: I know Rémi Quirion very well: he's just next door to my riding and I'm in touch with him.

I'd like to ask you a final question, which, while remaining within a budget perspective, establishes links with work that has been of interest to the committee. To date, have the institutes used public funds to finance research on stem cells?

[English]

Dr. Alan Bernstein: At the moment, we fund adult stem cell research right across Canada. In Calgary, for example, Sam Weiss is one of the world's leaders in adult stem cells in the nervous system. A group in Vancouver is working on hematopoietic stem cells, blood stem cells, adult stem cells.

As I said to this committee the last time I was here, we are not funding at the moment any research involving human embryonic stem cells. We are funding work involving mouse embryonic stem cells, on experimental animals, but not involving humans. We are awaiting anxiously Parliament's opportunity to pass the legislation that is in front of Parliament at the moment.

The Chair: Mr. Castonguay--

Mr. Réal Ménard: It will not be adopted.

The Chair: Go ahead, Monsieur Castonguay.

[Translation]

Mr. Jeannot Castonguay (Madawaska—Restigouche, Lib.): Thank you, Madam Chair.

We received Dr. Naylor's report on the SARS epidemic which everyone will no doubt remember. The minister told us that there would be a follow-up to that report. Can you tell us what the department is doing to act on the report's recommendations?

In your opinion, what have we learned from that epidemic? What are we doing to prepare ourselves for the next time? The question isn't whether there will be a next time, but when that next time will be. We know there will be other epidemics of this kind. What is the department doing in order to be ready?

[English]

Mr. Ian Green: Thank you very much, Dr. Castonguay, for the question. The Naylor report has essentially two sets of recommendations. One deals with short-term requirements to be ready quickly for the next flu season. The second also makes a series of recommendations in terms of improved surveillance, laboratory networks, coordination, etc., for the medium term. He also makes a number of machinery recommendations, including the idea of a Canadian public health agency.

We are working very quickly to assess the Naylor report, and to support the minister in early discussions with her cabinet colleagues about the report and the directions it proposes. Our minister has made a number of statements recently that she intends to move forward to consult with her cabinet colleagues quite quickly, and we're supporting her in that respect.

In terms of steps that need to be taken quickly--for instance, increased surveillance capability, improved laboratory capacity, enhanced support to front line workers, augmented research capabilities for the National Microbiology Lab, and travel measures consistent with the existing screening measures that we have in place--we are working on those now with chief medical officers across the country, and also in provincial and territorial jurisdictions, to ensure that we have those steps in place before the next flu season.

In terms of the experience last time, which was a new experience for all jurisdictions involved, and one we all had to learn from, I think we learned that collaboration with other jurisdictions is of the most importance, as is the need to ensure that we have a clear sense of roles and responsibilities and that we can coordinate seamlessly--as Dr. Naylor says, from the local to the global level.

Those are areas that I have talked to my P/T counterparts about, where we have in fact agreed that we are going to create a special task force very quickly to assess the areas that health ministers, at their meeting in September, asked us to look at--namely, issues of ensuring that our roles and definitions are well defined, that the lab capacity network we have across the country is sufficient, that we have the appropriate research framework in terms of moving ahead, and that we have the surveillance systems that we need to deal with this.

So in the short term, we're very focused in terms of making sure we have the data we need as we enter into the flu season, looking at a number of short-term initiatives, as I said. In the medium term, we're working with provinces and putting proposals together that the minister will be discussing shortly with her cabinet colleagues.

¿ (0945)

[Translation]

Mr. Jeannot Castonguay: You know that the flu season is imminent. We can't say that it will be in six months. It can hit us next week, in two weeks or in a month.

Can we be sure that we're ready, that measures have been taken to cope with flu season? One of the problems we must face is the fact that symptoms may be deceiving. Very often at the outset, SARS may look like a very minor flu. How can we be sure that we can detect this kind of virus, which won't necessarily be the SARS virus because it could be another?

What actual awareness and preparatory actions have been taken to make us ready to face that?

[English]

Mr. Ian Green: Yes, we believe we are working to increase our surveillance capacity to ensure that we have sufficient advance knowledge of infectious disease outbreaks around the globe. We are working to improve laboratory capacity to test and diagnose SARS. We've enhanced support to front line workers. We're looking at two deployable teams that would be available from Health Canada. We've augmented the research capacity already of the National Microbiology Laboratory to compare the performance of different diagnostic tests and develop new diagnostic tests and tools. The travel measures that we put in place, which consist of the existing screening measures established at the height of the SARS outbreak, continue to be in place in Toronto, Vancouver, Montreal, Calgary, and Ottawa international airports. We are having ongoing discussions with the World Health Organization to confirm travel advisory criteria for decision-making and advice to affected countries. And we are improving our ability to share information with domestic and international partners, including, for example, recent exercises with a number of countries internationally.

So we're moving across a number of areas to ensure that we're ready for the flu season and that we have the foundation for any long- or medium-term changes that we put in place in response to the Naylor report.

[Translation]

Mr. Jeannot Castonguay: Often on the battlefield, you have to talk about soldiers. Very often, in epidemics, those soldiers are health workers, who are represented by professional associations. Are we also working with those groups? It is very important not to work in isolation at a bureaucratic level. I believe we have to talk about soldiers. Are steps being taken in this direction?

[English]

Mr. Ian Green: Yes, we have several networks in place that include the public health network, that include conversations with chief medical officers. Scott may want to add something on that.

We have ongoing discussions with those networks and chief medical officers around the work we're doing. We also have a number of advisory committees that are well connected to hospitals and infectious disease experts across the country and that are helping us as well.

The Chair: Thank you, Mr. Castonguay.

Mr. Hill.

Mr. Grant Hill (Macleod, Canadian Alliance): Thanks, colleagues, and I apologize for being late this morning.

One of the things that has troubled taxpayers is the inordinate hospitality and travel expenses in some departments of government. Have you taken a look at all the departments under your purview to be sure that...or have you taken a look to see where those items are in relation to your department?

Mr. Ian Green: Yes, we are aware of the need to scrutinize travel and hospitality. We have undertaken a strategy at several levels. We have created a quality assurance unit that assesses travel and hospitality requests that we get as a department. We're also restructuring our travel management unit to accommodate the government shared travel services initiatives across the department. And through a range of training sessions, particularly in relation to the values and ethics exercise we run as a department, we emphasize the responsibility to be aware of guidelines, to be responsible in terms of the use of travel and hospitality.

One of the issues I think it's important to remember, though, in terms of our department is that our department, given its wide range of responsibilities in terms of provinces and territories, working with interest groups, and international responsibilities, does have travel and hospitality expenses as a legitimate part of our business. But in the context of participating and making sure that we have the information quickly, that we have the quality assurance unit, and that staff are trained in terms of their responsibilities, we're undertaking those efforts to ensure that we're responsible in expending moneys in those areas.

¿ (0950)

Mr. Grant Hill: Have you found any irresponsible spending to date?

Mr. Ian Green: We have some areas that are of concern to me and that I am reviewing.

Mr. Grant Hill: Would you like to divulge in what departments, what areas?

Mr. Ian Green: No, not at this time, sir. I would like to essentially review where we are. I think it would be premature for me to indicate that I think there are any problems in terms of those. But in the interest of ensuring quality assurance and making sure that we're operating within Treasury Board guidelines, we are assessing some areas.

So it's too early for me to indicate that I think there's a real problem, but for the system to work, we need to see if there are issues and we need to look at them carefully and analyze them.

Mr. Grant Hill: You have found some spending, then, that is outside Treasury Board guidelines?

Mr. Ian Green: Patrick, do you want to help me out?

Mr. Patrick Borbey (Assistant Deputy Minister, Corporate Services Branch, Department of Health): I guess in any large organization where you have hundreds of individuals who travel or use hospitality, it's complex, and it takes some time to review. We are undertaking a review through our quality assurance unit. We have found some anomalies where maybe there were some Treasury Board policies that were not completely followed. Whether it was an issue of the traveller not fully understanding, or my staff, in reviewing the file, who perhaps did not sufficiently review all the details...but these are relatively small anomalies. We have not found anything that's outrageous in terms of large expenditures. We feel that we have the right kinds of controls in place, that we've strengthened those controls over the last couple of years.

When it's required, we will bring our internal auditors to look at particular cases or particular issues and see whether there is action that's required. And we will take action if there are individuals who do not follow policy.

Mr. Grant Hill: You are satisfied, then, to summarize this discussion, that there is nothing outrageous in your department. There is no pattern of spending that the taxpayer would find troubling.

Mr. Patrick Borbey: I can't guarantee you that there not anomalies, that there are not issues where there have been excesses in spending or not following Treasury Board policy. I can't guarantee you that. We have hundreds of travellers. But I can guarantee you that we have put the measures in place to be able to find those and deal with them.

Mr. Grant Hill: All right.

Let's turn to the issue of biologic terrorism. Our neighbour to the south has taken steps to be able to vaccinate against smallpox for every man, woman, and child. What is Canada's smallpox vaccine status, and where are we going?

Mr. Ian Green: Our status is that included in these estimates are funds to purchase--

Mr. Grant Hill: I simply want to know, how much vaccine have we, and where are we going?

Mr. Ian Green: We're in the process of purchasing 10 million doses.

Perhaps Scott could tell me if I'm right.

Am I correct, Scott?

Mr. Scott Broughton (Assistant Deputy Minister, Population and Public Health Branch, Department of Health): Absolutely correct. We currently have 2 million doses, enough for 2 million people, in stock between ourselves and DND. The initial order we made was for an additional 10 million, based on the search-and-contain strategy that we would propose to use in the event of any bioterrorism act. We ensured that we had in the contract a capacity to get an additional amount, and we will be exercising that option.

Mr. Grant Hill: When will we have the 12 million?

Mr. Scott Broughton: By the end of this calendar year, between December and March, we will take possession of 35 million doses.

The Chair: Thank you, Mr. Hill.

Madame Scherrer.

[Translation]

Ms. Hélène Scherrer (Louis-Hébert, Lib.): Thank you, Madam Chair. Thank you everyone as well for coming.

I don't know who my question is for exactly, but I always have the same reaction when we talk about Health Canada's budget and health budgets as a whole.

We know to what extent all levels of government are experiencing problems with regard to health. Consequently, I'm always surprised to see that there are no major investments in prevention. I see we're currently reacting to SARS, to budget issues, to certain viruses, to terrorism, but, over the past year, we've learned of statistics that are perhaps less spectacular on things that may have killed people in a less striking manner, but which should be taken into consideration. Among other things, I'm referring to statistics on obesity, sedentary lifestyles and tobacco abuse. These scourges kill perhaps in a less obvious way, but they kill in a very significant way as well.

I know that, in the last Throne Speech, we could sense that the minister and the Prime Minister shared the same concern and that the speech contained a “healthy life” component. It talked about nutrition and physical activity in particular. I saw no major budget in the initial budget. I'm still disappointed to see that here too, at a time when people are reacting to SARS in Toronto or elsewhere, we're not making major investments in prevention, because prevention is the basis. It would help lower health costs. Our youth is seriously concerned, but that doesn't seem to affect anyone.

I would like amounts to be invested in this area and in research or elsewhere and I would like Health Canada to take that seriously and to work toward establishing partnerships with the various levels of government to implement measures that will counter these elements which will affect us and are very disturbing.

¿ (0955)

[English]

Mr. Ian Green: Thank you for the question.

Just because it's not in the supplementaries it doesn't mean we're not focused on it, or don't see it as a priority. The supplementaries, in fact, deal with a number of areas that receive funding in the budget, but by no means do they mean that health promotion and prevention are not important priorities. Investing upstream in order to ensure that the downstream consequences are prevented and are minimized in fact reinforces the sustainability of our health care system.

I should note that on some of these investments we're talking about, though, in terms of safe drinking water, in terms of the supplementary estimates that you have in front of you, the possibility that the health council will broadly assess, over time, the implementation of a health accord that in fact contains a number of provisions that can have an impact in terms of health promotion and prevention. There are elements in here. This does not totally ignore it.

That said, we continue to run large, and I think very successful, programs in terms of health promotion and prevention. This does not include reference to the fact that we're spending more than $450 million on a tobacco control strategy, a strategy that in fact is working, in many instances, in terms of reducing the prevalence of smoking, having an impact in terms of young people, actually saving lives in terms of how it operates.

In terms of your question about partnerships, we have recently undertaken a healthy living initiative with provinces and territories and a wide range of stakeholders who have agreed on an approach, increasingly coordinating activities and focus in terms of dealing with issues like healthy eating, healthy weights, obesity, physical activity, etc. That's going to continue to be an area of priority attention from the point of view of partnerships and from the point of view of, I think, positively affecting outcomes. And that's not to mention the fact that we have a very significant range of grants and contributions programs in first nations and also in the Population and Public Health Branch, which deals with health promotion and prevention issues, diabetes, early childhood development, and a range of initiatives designed to deal with the kinds of issues you're talking about.

So the fact that it's not here does not mean it's a neglected area or one that's not a priority for the department.

The Chair: I think Dr. Bernstein would like to comment on that as well.

Dr. Alan Bernstein: Yes, perhaps I could add a few words

You make a very good point, and I'll list a few initiatives that CIHR has now launched around prevention. You mentioned obesity and nutrition. Our Institute of Nutrition, Metabolism and Diabetes has declared that its major and sole priority area will be obesity. There's a high risk factor, obviously, for diabetes and heart disease, amongst other things. So we are funding a number of different programs in that area, including a partnership program with community groups in Saskatoon, a program called “Saskatoon in Motion”, to convince young people in Saskatoon to get more physically active.

We will be building on that and announcing later on this fall a major program, called “Canada in Motion”, where we will be providing, with a private sector partner, pedometers for over a million Canadians. We will be studying, in an evidence-based way, whether giving people pedometers actually encourages them to get more physically active. So that's one example of initiative.

Another one--I mentioned Rémi Quirion earlier--is launching a tobacco initiative to look at the biology of addiction and the psychological aspects of addiction, focusing on providing the evidence of what is it that actually can convince young people not to start smoking.

A third example is workplace safety. Prevention and health promotion is a big area in the workplace, and again, we're funding a very large program out of Memorial University in Newfoundland on workplace safety in the fishing industry. And this is a partnership between researchers. Barbara Neis is the principal investigator at Memorial with trade unions and the canning industry in Newfoundland to increase workplace safety.

À (1000)

Ms. Hélène Scherrer: Can I say something else?

The Chair: Well, you're over time.

[Translation]

Ms. Hélène Scherrer: In spite of it all, we're not winning the battle. Of course there are a lot of programs, a lot of things, a great deal of attention, but the statistics on obesity, sedentary lifestyles and other youth problems are the same. With regard to the First Nations, we realize that we haven't achieved the desired results. The same is true with regard to our youth right now. Every time new statistics appear, they're even scarier: our young people are even more obese and even more sedentary.

I would have liked to see strong initiatives investing in this area. We need more than lip service. This has to be included and it has to be part of the budget. Something has to be done. We're losing the battle. Since it doesn't seem too serious, because no one's dying from it here before us, there's not much action and we say we're going to introduce initiatives.

This is a cry from the heart. I'm pleased to have made it.

[English]

The Chair: Thank you, Madam Scherrer.

Mr. Barrette and then Mrs. Chamberlain.

[Translation]

Mr. Gilbert Barrette (Témiscamingue, Lib.): Thank you, Madam Chair.

One of the greatest concerns in my life as a politician is the fate of natives, of Aboriginal people. There are reserves in my riding, as there are elsewhere in Quebec and in the country. I visit them regularly and I'm concerned by the general level of health there.

You're investing, but what steps have you taken or are you going to take to gather information? What steps have you taken or are you going to take to inform them?

Are you targeting action areas or fields where you want to invest, whether it be in health, nursing care or in the social work component, for example?

I have a quite striking example for you. On a reserve of 350 inhabitants, three out of 17 teenage girls have had children between the ages of 15 and 17, and four more are pregnant. I figure that's going to create some social problems.

I would like to know what steps you are considering or have considered implementing in an attempt to solve these kinds of problems.

M. Ian Green: I'm going to ask my colleague to give you some details on that subject.

[English]

Mr. Ian Potter: Thank you very much.

You've raised a very important question, and we are working on this at a number of levels.

With respect to information, we have taken steps to get much better information on the health services and health status of first nations and Inuit. Health Canada has been funding a study that parallels the Statistics Canada study on aboriginal health that is in the field and is expected to be available in the next six months. It's being conducted by the National Aboriginal Health Organization, and it will gather information primarily from reserves and Inuit communities, which were under-sampled, or Statistics Canada had difficulty in getting information in those communities. So we'll have much better information on health services in terms of the access to health services and the health conditions.

With respect to a program's initiatives to change health, within the supplementary estimates one of the elements that is being funded is increasing nursing staff. We are going to increase nursing staff. We're building new accommodations so that we can increase nursing staff in the small communities, communities like the one you referred to of only 350 people. We're adding one nurse to every nursing station, so that's a total of 74 nurses. We're providing those nurses with much better tools in terms of trying to engage the community to change and to prevent illnesses.

As you remarked, the incidence of diabetes and other conditions among aboriginal people is worse than among other Canadians. We have a number of programs. I was looking at one the other day in Manitoba, funded from our diabetes initiative. It went into the schools and worked with the band councils, and got them to buy into a program of changing things like the availability of food, changing the food that was in the schools, changing the exercise pattern in the schools, and getting the band council to agree that at their events only healthy food would be available. They're working with northern stores and the other suppliers in those communities so that they would increase the availability of good food. And that program in Manitoba can demonstrate that there have been significant increases already.

So we're working on a number of efforts like that. I don't think it will change immediately. This is a long-term strategy. But we have quite a strong engagement from aboriginal organizations, including the AFN and the Inuit Tapiriit Kanatami, to support that direction.

À (1005)

The Chair: Thank you, Mr. Barrette.

Mrs. Chamberlain.

Mrs. Brenda Chamberlain (Guelph—Wellington, Lib.): Good morning.

I have a question around the fact that in the province of Ontario we have a real problem with the doctor shortage. I'm wondering, do any of you do anything with that? Do any of you look into that problem or work with the province to see how we can address that? Are dollars being put into that?

I mean, we have a very serious problem. People can't get GPs. They can't go further on to a specialist because they need a referral from a GP. People are really feeling the stress of this, and I think in this area we really need to pull up our socks.

So I'm wondering, is anybody in the department doing anything to try to move toward a solution?

Mr. Ian Green: A number of things are under way at several levels. We have been actively supporting and participating in the sector studies under way at Human Resources Development Canada that have been looking at the question of physician supply into the future.

The second is that contained in these estimates are proposals to work on a national approach to health human resources, which includes funding for three areas. One is planning, looking particularly at the issues of physician and nursing supply into the future. The second is in fact recruitment and retention, and the third is interdisciplinary training. So there are contained in the estimates initiatives that are actually designed to try to deal with this issue.

The accord is also structured on an approach that tries to recognize that increasingly, in terms of primary health care, the issue is one where the facilitation of access to services of interdisciplinary teams in which the doctor is not the only contact point is an important way of changing the system and in fact dealing with questions of supply, and, if you can do it, linking questions of promotion and prevention to the operation of those primary health care facilities.

So we have come at the issue in several ways--participation in the sector studies, the health human resources initiative, and the fact that we think the accord, in terms of some of the changes around an integrated continuum of care, is in fact designed over time to make sure that the services and the kinds of disciplines that Canadians need to access health are going to be there for them.

Mrs. Brenda Chamberlain: I'm glad to hear that you're working on it. Now, I have to say that in at least the last five years this has been a major problem in my area. I'm from Guelph. This is not some kind of backwoods place that no one has ever heard of and can't get to except by train or plane. This is a city that is in sort of the heartland of the southwest.

How long will it be until we have some solutions? I think it's great that you're looking at it, and moving towards a solution, but how long until somebody really can get to a doctor? To me, this is really serious.

Mr. Ian Green: I guess it's hard for me to predict exactly when individuals will be able to access doctors...or deal with the shortage. As I said, we are in fact working in terms of the sector studies. I will check on the timing of it. I can't, off the top of my head, remember when in fact it's reporting out. We will be working in terms of the health human resources initiatives that we've undertaken certainly in the near future to basically look at the three areas that I articulated. And the accord reforms obviously are going to play themselves out over a period of time.

So I can't pretend to have an easy answer in terms of the issue of access to physicians. I believe a number of the things we have in play from the point of view of developing a national approach and helping provinces and territories--in many ways a fundamental responsibility in terms of the supply--are to make decisions that will ensure that there are sufficient physicians available in the context of operating their health care systems. We're designing this to achieve a national approach, one that will help provinces and territories in their efforts.

À (1010)

Mrs. Brenda Chamberlain: I'd really appreciate it, if you have an idea, your forwarding to the committee a time when you think things will get better by. Because they're not better, they're worse. I think people really need to understand that. Things are not better in our communities, they're worse. So we need to start to go the other way and to move the right way, if that's possible. And it must be possible. I mean, we have a lot of smart people, and we must be able to figure out a way to start to inject more people who can look after the people who live here.

The Chair: Thank you, Mrs. Chamberlain--

Mrs. Brenda Chamberlain: This man wants to answer. Can he answer?

The Chair: By “this man”, do you mean Dr. Bernstein?

You can't keep Dr. Bernstein under control. That's the big problem here.

Voices: Oh, oh!

Mrs. Brenda Chamberlain: Oh, but I like him. Let him answer.

Dr. Alan Bernstein: I have two categories of comments.

First, I have a niece who is a family physician in Guelph, so if you need a name, I can give you her name.

Voices: Oh, oh!

Mrs. Brenda Chamberlain: I'll take it! How about other people?

Dr. Alan Bernstein: I'm sure she's a very good GP.

A voice: But is she taking new patients?

Mrs. Brenda Chamberlain: Yes, that's the question.

Dr. Alan Bernstein: And that I don't know.

Second, we've launched a number of initiatives, including a rural and northern health initiative, which really speaks directly to the point you've made, that while it can be difficult to get access to a GP in Guelph, imagine how hard it is in rural and remote parts of Canada. So we are funding a number of teams across Canada, experimenting with alternative methods of health care delivery, something that Mr. Green referred to, and studying and documenting the issue.

For example, we have a program in Nova Scotia on strokes among the elderly. An elderly woman will have a stroke and be sent home, because people don't stay in the hospital very long these days. But the children have moved to major cities and the husband has already died, so who looks after that woman at home? So this program, in partnership with the Heart and Stroke Foundation of Nova Scotia, looks at alternative methods of caregiving for people sent home from hospital after a serious event like a stroke.

Telemedicine is another use of technology, and again, we're funding some experimental programs looking at telemedicine in the far north.

Mrs. Brenda Chamberlain: But in the end, just to make the point, if you have to go to a specialist, you need that referral. And if you can't get a GP, you can't get there.

The Chair: Thank you, Mrs. Chamberlain.

Ms. Bennett.

Ms. Carolyn Bennett (St. Paul's, Lib.): Thank you.

I just want to know what we learned from the SARS experiment in terms of how research gets funded. Obviously, this is a discussion on supplementary estimates, but if....

We know, Dr. Bernstein, that we want to get you a billion dollars as soon as possible, right? But in emerging things, in things you could never have known about in terms of funding research and then things that Canadians desperately want you to find the results for yesterday, what would be the best way of funding that? Should you have a big reserve you don't touch in case something might come up? That would seem funny, because we would then be criticized that the money is sitting in the bank getting interest. Or should you have an ability with supplementary estimates to come and ask us for more money on an emerging thing?

If you were going to design the best way to sort out the next SARS or the next really urgent priority for Canadians, how would you do it?

Dr. Alan Bernstein: Thank you for that question. You've raised an important challenge for us, certainly, and therefore I think for the country in terms of exactly this sort of situation. I think SARS is an object lesson on how we might do things better in the future.

For example, we currently fund about $80 million to $90 million worth of research on infectious diseases, from mad cow disease to HIV/AIDS, etc. That money is all committed, of course, to projects. As members of the committee will know, if we don't spend money during the year and allocate it, it has to be returned to Treasury Board by the end of the year. I think that's what you were referring to, Dr. Bennett. So we're under constant pressure to make sure that 100% of our dollars, or as closely as we can get to 100%, is allocated.

Although we were spending almost $100 million on infectious disease research, when SARS broke out, we had virtually no money to spend on this. We cobbled together a few million dollars, and then an additional million was provided on an emergency basis through Health Canada, and through the minister, for our SARS research.

We made a submission to the Naylor commission and suggested that there be a reserve of money--a “floating” reserve, or whatever anyone wants to call it--of the order of $10 million that we have access to when the next SARS breaks out so we can tap into that fund.

I would say that the research community is ready. We announced three major initiatives when SARS broke out. One RFA was to develop diagnostics, vaccines, and antivirals. We were swamped with proposals, and are funding, I think, eight proposals in that area. A second one is dealing with the public health stigma and ethical issues around an epidemic like SARS. The third one is a national SARS consortium we've struck in partnership with the provinces and industry.

Members of the committee may have seen, I think two weeks ago now, a story in the national papers out of McMaster University on the amazing progress that's been made to develop a vaccine against SARS. That's all coming out of, really, the small amount of money we were able to put together and the $1 million we were given to mount the SARS initiative.

So I would strongly recommend that there will be, as Dr. Castonguay said, another SARS. I think we have to anticipate it, expect it, be ready for it.

À (1015)

The Chair: I think Mr. Green would also like to answer.

Mr. Ian Green: Just very briefly, yes.

In addition to what Alan has talked about, we clearly realized that research was one of our major challenges in terms of responding to SARS, and we also made additional investments in terms of trying to support the National Microbiology Lab in Winnipeg and in fact the public health network.

It underlines two things. One is the need to pay close attention to Dr. Naylor's recommendations, among others', on research, which I think is an important part of building for the medium and longer term. The second, I think, is to work very closely with provinces and territories to try to build on the expertise we have across the country; not duplicate it, not replace it, not have it compete. I think an important part of the longer-term SARS response has to in fact be the development of that network that brings together a number of the laboratories or scientific institutes that are engaged in this. I'm thinking particularly of the BC Centre for Disease Control, etc. They can all play an important role, I think, as we move ahead on this.

The Chair: Thank you.

Ms. Carolyn Bennett: Madam Chair, is it possible that this committee would consider a motion to support the Naylor report, as we think the minister is going to cabinet asking for the money?

The Chair: Maybe, but I don't know about at this meeting.

Ms. Carolyn Bennett: I just was wondering if we could amuse ourselves with some little motion.

The Chair: It is always appropriate for any member of this committee to circulate a motion, and for us to discuss it and vote on it, with 48 hours' notice. So if you would like to do that, you're more than welcome.

Ms. Carolyn Bennett: Thank you.

The Chair: Thank you, Ms. Bennett.

Ms. Fry.

Ms. Hedy Fry (Vancouver Centre, Lib.): I'm going to belabour this thing about SARS, etc. I notice you're asking for money for anti-terrorism initiatives. Now, you've been given money originally in the whole anti-terrorism package for dealing with anti-terrorism initiatives. Can you tell me what new initiatives are going to be put into this and what new initiatives you want to fund?

Second, given that SARS, or perhaps smallpox or other public health and infectious diseases, could be part of an anti-terrorism initiative, as far as we know, how are you going to blend those two? Are these going to be sort of separate, parallel, and, as I think we have found, not talking to each other kind of silos, or is this going to be part of a holistic way of dealing with what is going to be a problem down the road, not only with new diseases, given that we're all travelling all over the world and there is this sort of global ability to seed an infectious disease, but that it could be part of a terrorism package? This is tied in with the Naylor report, and this is tied in with infrastructure.

I think your biggest challenge in SARS had to do not just with research but with actual on-the-ground infrastructure for a rapid response. I want to know how those are related to each other. Are you going to deal with this within this spending? Is that the kind of initiative? Are you going to link them in any way, or are we going to continue to do things without seeing any linkages whatsoever, which I think is a major failing?

À (1020)

Mr. Ian Green: I'm going to ask my colleague to help me out, but it's an excellent question.

Just to be clear, the funding that's in the supplementary estimates deals with essentially the procurement of smallpox vaccine, the storage of it, the plans on how to distribute it, and issues like globulin, which we would need to balance the application of smallpox. It's a fairly focused initiative.

On the broader question, of whether emergency preparedness and response and initiatives that were taken from a bioterrorism perspective after September 11 should be a platform and be linked to what you want to do in terms of responding to Naylor, my view is that they absolutely should be--and they are, in our mind--linked. The number of initiatives we took post-9/11 in fact can support and supplement and be a platform for what we want to do. Dr. Naylor points that out, and I'm sure my own colleagues basically would make that connection as well.

So we very much do see the linkage, but the funding here is essentially for smallpox. The larger point, though, I quite take and accept, that we need to link the two.

Scott may want to talk to you a little bit about some of the details.

Mr. Scott Broughton: I think what's significant within Health Canada, specifically within the Population and Public Health Branch, is that we do have the National Microbiology Laboratory, we have the Centre for Emergency Preparedness and Response, and we do have the Centre for Infectious Disease Prevention and Control as three main bodies who look at the notion of infectious diseases.

It doesn't really matter whether it results from a bioterrorist act or something like SARS; the people who are looking at the research, the diagnostic testing, and the capacity to respond throughout the country from an emergency point of view are all contained within the same entities.

So I don't want to repeat what Mr. Green said, but that's essentially it, that the integration happens at that level.

The Chair: Thank you very much, Mr. Broughton.

I want to thank everybody who has come to answer these questions.

I'm going to ask the committee members now to consider votes 1a, 5a, 10a, and 15a. Is it your pleasure to deal with them as a group or separately?

Mr. Grant Hill: Do we have quorum now, Ms. Chair?

The Chair: Yes, we do now.

Mr. Grant Hill: You said we had to have two more back, and I saw one more arrive.

The Chair: We have nine, so it's all right.

Are you agreeable to having me deal with these votes as a group?

Seeing no objection, I will do so.

Shall votes 1a, 5a, 10a and 15a, under health, carry?

(Votes 1a, 5a, 10a and 15a inclusive agreed to)

The Chair: Shall I report the supplementary estimates A to the House?

Some hon. members: Agreed.

The Chair: Thank you very much.

This portion of the meeting is over. I thank you for your attendance.

I thank the staff not only for their good answers to our questions but also for the work they do on behalf of the government all year. I know it's not easy, and we want to use every opportunity to say we appreciate you, the work, and the people who work under you, and their work. Thank you very much.

We are moving in camera, so I'll have to ask visitors to depart with the witnesses, please.

[Proceedings continue in camera]