I'd like to welcome everybody to the third meeting of the Standing Committee on Health of the 39th Parliament. We want to encourage everybody to take their seats, and we'll proceed as quickly as we possibly can.
I want to thank the minister, the Honourable Tony Clement, for joining us this morning. I understand that time is tight and we only have 45 minutes with the minister, so we don't want to delay getting to him.
Dr. David Butler-Jones, and Jane Allain, general counsel, legal services, thank you for coming.
I welcome you all to the Standing Committee on Health. We want to get right to it. We are introducing Bill C-5, the Public Health Agency bill.
I want to remind the committee that the minister has a very tight timeline, so we'll restrict our comments specifically to the bill. The minister will soon be coming back to the committee to talk about other issues.
I'll remind the committee, before we get into the questioning, that it's a different process when the minister is here. There are 15 minutes for the official opposition, 10 minutes for the Bloc, 10 minutes for the NDP, and then 10 minutes for the government side. Then we'll proceed with five-minute rounds.
We'll start with the minister's comments.
Thank you for coming.
Thank you very much, Mr. Chairman.
I am pleased to appear before the Standing Committee on Health to discuss Bill C-5, An Act respecting the establishment of the Public Health Agency of Canada and amending certain Acts.
As we've heard in the House of Commons, there's strong support for public health in Canada and for providing a federal focal point to work with provinces, territories, and other public health stakeholders to address public health issues. I was pleased to see the strong support of my colleagues for this particular piece of legislation. I hope I can continue to count on their support, depending upon how well I do at committee today, I suppose.
Mr. Chair, we have an opportunity at this committee to discuss key elements of this bill and why we need legislation for the Public Health Agency of Canada.
With me, by the way, is Dr. David Butler-Jones, who serves as the Chief Public Health Officer, and he will be here beyond my testimony to answer any questions as well.
In the wake of the 2003 SARS outbreak, we had discussions and debates on the state of public health throughout the country. Two subsequent expert reports—one completed by Dr. David Naylor and the other by Senator Michael Kirby—pointed to the need to establish a federal focal point to address public health issues. Specific recommendations included the establishment of a Canadian public health agency and the appointment of a chief public health officer for Canada.
In response to these recommendations, the Public Health Agency of Canada was created in September 2004 through orders in counsel; however, this agency currently lacks parliamentary recognition in the form of its own enabling legislation. This legislation would give stability to the agency and to the Chief Public Health Officer of Canada that only an act of Parliament can provide.
This legislation is needed not just to provide the stability for the agency to continue its leadership, partnership, innovation and action; it is also needed to be able to respond to public health threats.
In the event that we are faced with a public health emergency, such as an influenza pandemic, the agency and the CPHO must have the authorities and tools to be able to effectively respond. For example, the Chief Public Health Officer must be formally recognized as Canada's lead public health professional, with the expertise and authority to communicate to the Canadian public. In providing a statutory footing for the Public Health Agency of Canada, this legislation gives the agency and the Chief Public Health Officer the parliamentary recognition and tools they need to promote and protect the health of Canadians.
Let me, Mr. Chair, briefly highlight the three key elements of this piece of legislation, which collectively will help to protect and promote the health of Canadians.
First, the legislation establishes the agency as a departmental entity separate from Health Canada, but part of the health portfolio.
So this will bring greater visibility and prominence to public health issues. As a key player in the federal system, the agency will be able to have a greater influence in informing and shaping public policy than it would have as an isolated arm's-length body. Further, the departmental model will give standing to the agency and to the CPHO to work with other federal departments to support a more coordinated and integrated approach to addressing public health issues and to prepare for public health emergencies.
For example, the agency developed, in collaboration with provinces and territories, Canada's Pandemic Influenza Plan, which is recognized by the World Health Organization as one of the most comprehensive in the world.
As the federal focal point, the agency will be better able to engage provinces and territories and link into worldwide efforts in order to provide the best public health advice to Canadians.
Bill C-5 does not expand existing federal activities relating to public health. I want to make that point absolutely clear. It simply creates a statutory foundation for the agency and establishes the position of the Chief Public Health Officer as Canada's lead public health professional.
The federal government has a well-established leadership role in public health. It's been around since 1919, working in collaboration with the provinces, territories, and other levels of government.
We intend to continue this approach. The preamble of Bill C-5 clearly states the federal government's desire to promote cooperation with provincial and territorial governments and to coordinate federal policies and programs.
For example, the agency is working with provincial and territorial authorities through the Pan-Canadian Public Health Network, which is a forum for multilateral, intergovernmental collaboration on public health issues that respect jurisdictional responsibilities in public health.
So in establishing a departmental model and in providing a statutory footing for the agency, this legislation continues the strong tradition of cooperation and collaboration that has been part of Canada's approach to public health for decades.
A second key element in the legislation is that it formally establishes the position of the Chief Public Health Officer and recognizes his unique dual role.
As deputy head of the agency, the Chief Public Health Officer will be accountable to the Minister of Health for the daily operations of the agency and will advise the minister on public health matters.
The Chief Public Health Officer will also have standing to engage other federal departments and be able to mobilize the resources of the agency to meet threats to the health of Canadians.
In addition to being deputy head, the legislation also recognizes that the Chief Public Health Officer will be Canada's lead public health professional with demonstrated expertise and leadership in the field. As such, the Chief Public Health Officer will have the legislated authority to communicate directly with Canadians and to prepare and publish reports on any public health issue. He will also be required to submit to the Minister of Health, for tabling in Parliament, an annual report on the state of public health in Canada.
Stakeholders have made it clear that they want the Chief Public Health Officer to be a credible and trusted voice. Providing the Chief Public Health Officer with authority to speak out on public health matters and ensuring that the Chief Public Health Officer has qualifications in the field of public health will confirm this credibility with stakeholders and with Canadians.
Finally, the legislation provides specific regulation-making authorities for the collection, management, and protection of health information. This authority will ensure that the agency can receive the health information it needs to fulfil its mandate. More precisely, the regulation-making authorities will allow parameters to be set around information-gathering and use in a way that ensures that information is collected and used in compliance with the Charter of Rights and Freedoms and the Privacy Act and is consistent with federal, provincial, and territorial privacy legislation.
The SARS outbreak clearly showed the importance for the federal government to have not only accurate information but also the ability and means to receive this information in a timely manner. With the potential threat of an influenza pandemic, the Public Health Agency of Canada must have clear legal authority to collect, use, disclose, and protect information received by third parties.
This will provide the needed assurance to provinces and territories that they can lawfully share information with the federal government.
Thus, the provisions in the agency's enabling legislation and the regulations enacted under them will clarify the agency's authority to gather information, while ensuring protection of confidential information.
In conclusion, by providing a statutory footing for the agency and supporting a dual role for the Chief Public Health Officer, we will be demonstrating to Canadians that we have listened to their calls to establish a permanent federal focal point to better address public health issues and that we are taking the necessary steps to strengthen the public health system as a whole.
As we all know, preventing and managing disease and promoting good health is key to having a healthier population and to reducing pressures and wait times on the acute health care system.
From my own experience as Minister of Health for the Province of Ontario, and dealing with the SARS outbreak, I can tell you how important it is to have such legislation, which will provide a statutory foundation to the Public Health Agency of Canada and support our collective efforts to strengthen public health in this country.
Clearly, we all have a shared interest to protect and promote the health of all Canadians. In providing a statutory footing for the agency, this legislation continues the strong tradition of cooperation and collaboration that has been a part of Canada's approach to public health for decades.
Ultimately, this legislation will give the Public Health Agency of Canada a sound legislative footing to assist me, as Minister of Health, to protect and promote the health of all Canadians.
Thank you, Mr. Chairman.
Thank you for the question.
Certainly I'm very well aware, having been a former provincial minister of health, of some of these challenges, although when always looking for silver linings where you can find them, one of the things we observed post-SARS was that there was an increased interest among medical students in public health, because it really underlined just how fragile public health is and how it can be, quite frankly, an exciting, very important, and very rewarding line of work to be involved in as a medical doctor, or a nurse, or any other kind of medical professional. So you find these silver linings where you can, sometimes. I'm not trying to diminish the suffering during SARS, but this is one thing we observed after SARS was over.
In terms of our role and responsibility, I'm going to let Dr. Butler-Jones say his piece on this, but we're very cognizant that, in terms of pandemic planning, it really cannot be the federal government acting as an island in its preparations. To be very effective, there has to be a seamless approach, involving local public health authorities all the way down to the municipal level, the provincial public health authorities, the national public health authorities, as well as the continental and the international.
There's an immense degree of collaboration now. So we have to be respectful of each other's duties and responsibilities, but also aware that in the end we're all in this together.
Thank you very much, Minister, for coming here.
I also want to thank your government very much for continuing to support the initiative of our last government in setting up this particular public health agency.
The question Madam Brown had was one that I wanted to follow up on.
As you know, if we're going to be coordinating public health, there needs to be a rapid response. Dr. Butler-Jones might be able to answer this: what is the role of the federal government's Public Health Agency in coordinating that, especially in areas where certain provinces and certain municipalities may not have the resources for rapid response?
Secondly, is there going to be a linkage with researchers and with clinical places such as ERs and so on, and with community groups and hospitals? That's the kind of rapid response....
I know in British Columbia, when SARS came down, we had the ability to respond very rapidly because we had genomicists who tested to see if it was a man-made or mutated organism. It was mutated. We were able to move seamlessly throughout all the emergency rooms and we were able to contain it very rapidly in B.C.
So what is the role of the federal government if there isn't the ability for provinces and municipalities to do that? Do we have resources to help them?
The next part is, what will be the position of the agency with regard to setting measurable benchmarks for population health in Canada? Is this going to be a federal responsibility? We're going to work with provinces, obviously, but will there be one standard across the country for benchmarks on this issue?
Clearly, first of all, public health is a local function. That's where the action happens. But it needs to be connected regionally, provincially, nationally, and internationally.
The other thing is that no jurisdiction has the capacity alone to deal with these issues. So what the federal government brings, and through the agency and others--not just the agency--is, in that partnership, looking at what the capacities are and how we can contribute to that in a collaborative way.
We bring special expertise. We bring resources. For example, when there are outbreaks, in virtually every jurisdiction in the country we have sent field epidemiologists to help with the investigation. It's still managed locally and it's still in their authorities, but we can support technically and otherwise, as well as in an intelligence-related way elsewhere.
In terms of the research community and so on, there are intensive linkages not just to public health laboratories, but under the public health network that is now established there are expert committees and other federal-provincial-territorial and expert connections that could look at these issues across the country and internationally and identify who can do what best and who is in the best position to respond to those issues.
As the committee knows, the health goals for Canada were accepted by ministers of health previously. The intent is that each jurisdiction takes those to work up in terms of their strategies, targets, and so on, as appropriate to the jurisdiction, including federal jurisdiction. So we will be having conversations across departments as to how, as Canada, we deal with our accountabilities in this or what we hope to achieve in this, as well as, through the network, coordinating to the extent that people want to coordinate, sharing information, sharing ideas, and so on, and doing that collaboratively across the country.
Thank you, Mr. Chairman.
We are pleased to have you here today for the first time before this committee.
Mr. Butler-Jones, congratulations on your new duties. We have many questions to put to you this morning.
The Bloc Québécois is concerned on several fronts about the establishment of this new agency. The bill provides the agency with a statutory footing. We know that you are currently in office. The responsibilities granted to this agency are far broader than you stated this morning, Minister. The goal is far broader than the intent to create a legislative framework and provide public health support in the event of pandemics or of an avian flu outbreak.
The various documents provided to us by the Public Health Agency of Canada regarding the division of powers state that the new agency will now be promoting health and chronic disease prevention, for cancer for instance, diabetes, and cardiovascular diseases. There are going to be integrated strategies for this.
We have some concerns about the encroachment into provincial areas of jurisdiction. Moreover, in your preamble, you speak of a vision which may be cause for concern with respect to provincial areas of jurisdiction.
You speak of disease and injury prevention and public health emergency preparedness and response. You then go on to say you intend to encourage collaboration and cooperation in this field.
Encouraging cooperation is not the same thing as respecting provincial areas of jurisdiction. In my opinion, this is rather weak. There is some cause for concern as to how this bill will be received by the various governments, specifically the Government of Quebec, which will see this as an independent authority, under your control, but giving the agency far more latitude. So, we are concerned about encroachment.
We are also concerned about the cost. I don't know to what extent you drew inspiration from the Naylor report, which is over 300 pages long. In fact, there were recommendations on the order of $200 million per year, plus a budgetary increase to deal with the findings of the Naylor report on SARS. You started out with SARS, a pandemic, but you have spread your tentacles out with respect to the Public Health Agency of Canada's responsibilities.
I think this could lead to a monster, a white elephant in terms of bureaucracy, in terms of paperwork. We've been given a great deal of documentation, and we believe that is cause for concern. This nation's bureaucracy is a concern for us on several fronts.
Could you respond to that, Minister and Mr. Butler-Jones?
Thank you very much, Mr. Chair.
I'd like to welcome Dr. Butler-Jones and Ms. Allain for appearing before our committee. I also appreciated the chance to hear from the minister this morning.
First of all, I'd like to congratulate Dr. Butler-Jones on his appointment as the Chief Public Health Officer for our country. As a Saskatchewan member of Parliament, I know that when he was named, it was a great day for Saskatchewanians. Dr. Butler-Jones previously worked in Weyburn, in the Sun Country Health Region, and we were all very proud of him. The health care of Canadians is in good hands.
Dr. Butler-Jones, as the legislation is set up, my understanding is that you are a deputy. I have a couple of questions.
Have you been working in close contact with other deputies—I'm especially thinking of the public security and emergency preparedness deputy—to monitor and prepare for potential threats to the public health of Canadians? Obviously, I'm talking along the lines of pandemics.
Regarding avian flu, which everyone in the world is certainly concerned about, it seems to be spreading from east to west, from country to country. I'd like you to comment a little on whether we are ready to tackle that in this country. Can you reassure Canadians that they are safe?
Maybe you can speak a little about Tamiflu, giving us an update regarding that. I think Ms. Demers' question perhaps touched on how many doses we have stockpiled and what percentage of Canadians that would cover. I've seen statistics that a low percentage of Canadians would be covered by the available Tamiflu.
Could you also give us an update as to whether private citizens can purchase Tamiflu, or has that been stocked by the manufacturer to protect the general public should Tamiflu be needed to tackle avian flu?
Those are a few different questions, and I'd appreciate your thoughts, my fellow Saskatchewanian.
I'm an adopted prairie boy, for sure.
Thank you very much for the questions. It's a good list.
First, in terms of relationships with other departments and deputies, there are the deputy-level relations I have on the committee that's specific to pandemics. But I also sit on other deputy committees that relate to public health, safety, and other public health aspects. We have regular discussions.
Also, when it comes to planning and thinking about pandemics, there are at least three departments that are really key: Agriculture and Agri-Food Canada, as well as the Canadian Food Inspection Agency, us in Health Canada, and Public Safety and Emergency Preparedness. And then there are other departments, too, depending on the issues. For example, there is Environment Canada, as it relates to wild birds, and others. So I think that's something that seems to be, from my perspective, working well and is very collaborative.
This isn't a plug, but I must say that I'm really impressed with the commitment of the people I deal with and their interest in engaging and addressing these issues. It's not just within government, but as I go across the country and internationally, there's a very different spirit about collaboration, the need to work together, and the recognition that none of us can do this alone. That's the positive.
In terms of preparation, it's important to make the distinction between the bird flu, the H5N1 Asian that we're seeing, and a pandemic of human flu. The bird flu is continuing to spread around the world. We don't know when we'll see it in wild birds in Canada; it may be as soon as this fall. That clearly is an agricultural issue. It's a biosecurity issue in terms of poultry flocks, contact with wild birds, and the risk to poultry flocks. It is a smaller issue, but a present issue, for humans, because we see a very small percentage of humans who get sick as a result of contact. It's from fairly extensive contact--and in a very small percentage of people--with this bird virus. It's not as if there's wild bird flu, and suddenly we're going to have all kinds of people sick.
So preparations continue from an agricultural perspective, but also with us working very closely with Agriculture and Agri-Food Canada and CFIA, including giving advice, in terms of the human implications. So if they do have to cull flocks, what's the best way to protect the workers who are having to deal with that?
Regarding the pandemic of influenza, no one knows, quite honestly. Nature is very inventive. The H5N1 may mutate, but that would require several steps. Or it could recombine with a human virus, which is a typical development of a pandemic of influenza, so that you have a new virus that none of our immune systems recognize that spreads quickly around the world. That's unpredictable, and that's why the work internationally, the work of the Global Public Health Intelligence Network and the work of the WHO with partner agencies around the world for surveillance, early identification, and control is critical.
Generally, as the minister said, Canada is looked at as probably one of the most comprehensively prepared in terms of planning, but we still have a lot of work to do. Even with all the preparation, emergencies and epidemics are full of surprises. To say that nobody will ever have a problem.... No one could ever say that. But what we can assure people is that each month we are better prepared than the month before. Our capacity in the last budget, in the budget processes, will help to ensure that Canadians are in a position to look at a very difficult, challenging situation and hopefully reduce it from a major problem to one we can manage and move forward from.
In terms of Tamiflu, we currently have in the country in government hands—not private hands, because there's a lot more in private hands and in hospitals, and so on—about 37 million doses, which is enough to treat 3.7 million people. As the minister was saying, there is a meeting of FPT ministers this weekend, and one of the things they will be considering is the next level we should consider for Canada.
The thing that's unique about Canada...well, there are two things. Often people say that WHO says 25%. The WHO never said that. What the WHO has said is that countries that can afford it as part of their comprehensive planning should include antivirals as part of that. We've done that.
The advantage we have is a vaccine program. We have a domestic manufacturer that can produce enough vaccine to protect all Canadians, so we need the antivirals—if they work, which we don't know if they will—to reduce the impact in the first wave, and then we have the vaccine. Maybe one other country in the world has that capacity, and that's what will really stop it. That's why it's a combined strategy that's important.
I would like to be very clear on one point. We are not averse to there being projects under your strategy to fight pandemics and viruses, etc. What concerns the Bloc Québécois is the increase in responsibilities being given to Public Health Canada, because that will cause an increase in human resources.
It started out with the Naylor report on SARS and now, with this large structure being built, there is going to be some duplication. Money will be earmarked for the bureaucracy rather than being spent appropriately. Money needs to go to the provinces, because the idea of having Canada-wide standards and objectives is all well and good, but at the end of the day, the provinces need the means to implement their own structures.
I'd like you to explain some numbers in the field of human resources. We have noted that 1,200 Health Canada officials were sent to the Public Health Agency of Canada, but there are 1,825 of them. Mr. Naylor in his report said that there needed to be an increase in funding for the Public Health Agency of Canada in order to meet all the goals outlined in his report, and to respond to public health requirements. When you add in health promotion and chronic disease prevention, such as cancer, diabetes, cardiovascular illnesses... These are control measures. Given the resources in place, I wonder how you're going to deliver the goods. I think that costs will skyrocket over time. We know that the federal government is responsible for aboriginal people. Yet, with some 1,200 or 1,300 public servants, it is unable to deliver the goods in terms of public health or health in general for aboriginal people. This is one of the reasons why I was very critical of the new Public Health Agency of Canada and of all of the responsibilities you have given yourself under this bill. Moreover, in the preamble to the bill, you did not mention that you were going to respect provincial areas of jurisdiction, but rather that you intend to collaborate. Respecting provincial areas of jurisdiction and collaborating with the provinces are two different things.
Could we take our seats.
We'll get started on the last part of our meeting, if we can come to order.
Just to give the committee a little bit more information, before we start into the motions that are before the committee, if we were to move into clause-by-clause on Bill C-5 on Tuesday, we could do that if we had all of our amendments in--if there are any amendments; I don't know. And we don't want to necessarily limit witnesses. If there is an insistence upon having witnesses come on this bill, could we have that in very quickly? We asked for it on Tuesday, actually.
If there are no witnesses and no amendments, we can move to clause-by-clause on Tuesday very quickly.
So I'll just leave it at that. If you have either of those, get it to the clerk by the end of the day, and we can make the plans.
Let's move on to the motions before the committee. We have four motions. Madam Demers has introduced them. She gave us notice of motion on Tuesday. We'll start with the first one.
Madam Demers, would you introduce that motion, and we will debate, discuss, and vote on it.