I call the meeting to order.
Welcome, everybody, to the 128th meeting of the Standing Committee on Health. Welcome to our guests.
We have a full house today and lots of questions, and I'm sure we'll have lots of answers.
First of all, I want to welcome the Honourable Ginette Petitpas Taylor, Minister of Health and my neighbour in New Brunswick.
Welcome to our committee.
I want to welcome the officials here.
From the Department of Health, we have Simon Kennedy, deputy minister. From the Canadian Food Inspection Agency, we have Paul Glover, president. From the Canadian Institutes of Health Research, we have Michel Perron, executive vice-president. From Patented Medicine Prices Review Board, we have Douglas Clark, executive director. From the Public Health Agency of Canada, we have Siddika Mithani, president, and Theresa Tam, chief public health officer.
My understanding is the minister has to leave at 9:45 or thereabouts. Is that correct?
Thank you very much, Mr. Chair.
Good morning, everyone, and thank you so much for inviting me to the Standing Committee on Health.
It's truly important for me to be here today to discuss with you the supplementary estimates (A) for the year 2018-19. I always welcome this opportunity to highlight some of the priorities and to discuss our efforts to keep Canadians healthy and safe. As always, I'm grateful to the committee members for your contributions to discussions, and I look forward to answering your questions.
Before I begin, I would also like to thank my officials who are accompanying me today.
They are Mr. Simon Kennedy, deputy minister of health; Dr. Siddika Mithani, president of the Public Health Agency of Canada; Dr. Theresa Tam, chief public health officer and from the Public Health Agency of Canada; Monsieur Michel Perron, vice-president of external affairs and business development at the Canadian Institutes of Health Research; and last but not least, Mr. Paul Glover, the president of the Canadian Food Inspection Agency.
They are masters in their fields and I am always happy when they accompany me at committee here. Also, I may turn to them for details with respect to some of the questions.
First, I would like to speak to Health Canada's authorities. Through the supplementary estimates (A), we are asking for an increase of $33.5 million. This would raise Health Canada's total authorities to just under $2.4 billion. This increase in funding would allow us to deliver on key priorities of the Government of Canada. I will describe these for you now, starting with opioids.
As Minister of Health, the first file that I was briefed on as Canada's health minister was the opioid crisis.
Since 2016 this crisis has claimed the lives of over 8,000 Canadians. This is a national tragedy that must be stopped, and it's why our government has taken action to save lives and to turn the tide on this national public health crisis.
So far we have restored harm reduction to the core of our approach and opened more than 25 supervised consumption sites. We have implemented the emergency treatment fund through budget 2018, and we are working to reduce stigma, which is a barrier to health and social services for people who use drugs, through public education.
Nevertheless, the opioid crisis continues to take lives and devastate communities. We must do more, and we will do more. These enhanced efforts include Health Canada's substance use and addictions program, which provides more than $28 million annually to support initiatives that work to prevent, treat and reduce all forms of harm from problematic substance use.
As a part of these estimates, this program has realigned $7.3 million to help address the opioid crisis.
Let's turn now to cannabis.
To support the legalization and regulation of cannabis, Health Canada received an additional $500,000 for operating expenditures from the central advertising fund as a part of these estimates for the cannabis pre-legalization advertising campaign.
This funding is a part of our government's significant investment of $108.5 million over six years to support cannabis public education, awareness and surveillance activities. We know that it's essential to invest in public education efforts surrounding the health and safety facts of cannabis, specifically targeting youth, in advance of the coming into force.
These campaigns began long before legalization. They're intended to give Canadians, especially youth, the honest facts about cannabis, and to put them in a position to make informed, responsible and healthy choices. While healthy choices are the most important part of maintaining good health, environmental factors also have an impact.
Now let's turn to the new impact assessment and regulatory processes.
As you know, our government is renewing the federal impact assessment and regulatory system. The enhanced system will better protect Canadians' health, as well as our environment, fish and waterways. It will also rebuild public trust in how decisions about resource development are made.
This system will apply to all projects that are subject to federal assessment, such as mines, dams, pipelines and marine terminals.
Health Canada is the key federal department positioned to provide expertise on human health impacts of projects like these.
As such, we are requesting $5 million to help transition to the new impact assessment and regulatory processes.
Let's turn now to pay administration. I would now like to turn to an important administrative issue.
As you know, the Phoenix pay system continues to pose challenges for the public service, including employees of Health Canada and its portfolio organizations. For this reason, we are requesting $1.3 million in additional funds to address the issues in pay administration and to help ensure that our employees are paid properly and on time.
I will now speak in more detail about our portfolio organizations, their priorities and their specific requests for funding.
The Public Health Agency of Canada, PHAC, is asking for a net increase of $6.7 million to its authorities. This would bring the total authorities for 2018-2019 to $687.2 million.
This increase includes nearly $5.5 million to support the Aboriginal Head Start in Urban and Northern Communities Program.
This program funds indigenous community-based organizations in urban and northern areas to develop programs that promote healthy development of indigenous preschool children.
The increase we are requesting also includes $1 million to support PHAC's childhood vaccination campaign. This advertising campaign will raise awareness of the importance, safety and effectiveness of vaccination.
As a part of the health portfolio, the Canadian Food Inspection Agency, also known as CFIA, works to uphold a strong and reliable food-safety system.
The supplementary estimates we are presenting today reflect an increase of $9.4 million for CFIA for specific time-limited activities, bringing its total authorities for 2018-2019 to $762 million.
The specific time-limited activities include funding for the Canadian Food Safety Information Network. This network will strengthen Canada's ability to detect and respond to food hazards by connecting and coordinating food safety and public health authorities.
The Canadian Institutes of Health Research, or CIHR, is Canada's health research investment agency. It provides $1 million per year to support Canada's health scientists.
Through these supplementary estimates, CIHR is seeking an increase of $0.4 million, for a total of approximately $1.1 billion in available authorities. This increase will support the creation of new scientific knowledge—knowledge that will lead to improved health, more effective health services and products, and a stronger Canadian health care system.
In conclusion, Health Canada, and indeed all five organizations in the health portfolio, is committed to spending funds responsibly, efficiently and effectively. The work I have outlined today will be instrumental in helping us achieve our mandate to protect the health and safety of all Canadians.
Thank you for this opportunity to speak about our work and to explain our budgetary priorities.
I am now pleased to take your questions.
Thank you very much, Ms. Sidhu, for the question. I want to take this opportunity to thank you for the leadership that you've shown with respect to the area of diabetes and also for the work that you've done on the all-party caucus on diabetes, and thank you for bringing forward the motion to ensure that the HESA committee could study this very important issue.
We certainly recognize that many Canadians live with diabetes, either type 1 or type 2 diabetes, and we certainly recognize that there are many contributing risk factors as to why people live with diabetes. Our government is deeply concerned with this area, and that's why we've made significant investments there.
I was very pleased that in budget 2016-17, an investment of $47 million was made in the area of diabetes research. We've also been able to partner with the JDRF, and we were able to collaboratively invest $30 million in the research component of type 1 diabetes. We still have some work to do with respect to that investment, but the money continues to roll out.
Also, I have to say that I was very pleased that over the past several months, I've been able to meet with officials from Diabetes Canada, and they've been able to provide me with a snapshot of the good work that is being done.
I was very pleased to hear about the Diabetes 360° program that they have brought forward. Just a few weeks ago—and I think I saw many of you there that day—they had their mobile unit here on the Hill, and many of us were able to stop in. I think that several members of the health committee were there, as I'm looking around the table. Many of you had your health checks and had your report cards that looked at the risk factors associated with diabetes. Again, we certainly are pleased with the work that Diabetes Canada is doing.
Finally, I think that as a government, we've certainly done a lot of work in addressing the risk factors for diabetes. We recognize that diabetes is a serious, chronic disease, and, as I indicated at the very beginning, we recognize that it affects millions of people and that investments made at the front end can certainly prevent people from living with and suffering from diabetes.
More work needs to be done in the area of research with respect to treatment and prevention. I know that as health minister, I'm extremely pleased with the investments that we've made and the strategies that we've brought forward, such as the healthy eating strategy and the tobacco strategy. We certainly recognize that education also needs to be done to ensure that Canadians are aware of the risk factors associated with diabetes.
I think as the member may know, under the Pest Control Products Act, there's a requirement every 15 years to go back and kind of re-examine the chemical that's been approved to make sure that there haven't been updates on the science or on the use that might suggest an issue.
We're now 15 years past the passage of that legislation, so one of the things we're seeing as a department is that a lot of the chemicals that had been approved 15 years ago are now coming back in for re-evaluation. I know that some members question why these chemicals are being looked at again and why the PMRA is undertaking this. It's a statutory requirement, and we're doing our best to fulfill the requirements of the legislation.
When we do the review, we do try to engage as extensively as possible with various stakeholders, obviously, including the agriculture sector. It's very important for PMRA, the pest management agency, to understand the usage patterns. There is a real issue of talking to the industry and to the manufacturers to have an understanding of how this stuff is used and to make sure that if restrictions are put in, it's done in a way that's obviously as sensitive as possible to how the product is actually used in the marketplace.
Often an initial proposal, which might call for more extensive restriction, actually will be amended through the consultation process because we get better data from the agriculture sector on usage. I just wanted to make that clear.
The second thing I would say is that we are very well aware that often there may be a lack of alternatives. As a result, when there are restrictions that have to be put in place, there is work to determine an appropriate phase-out schedule so that a transition period is available. The statute really does put an emphasis on health protection and the environment. That's obviously what we follow as a regulator.
Welcome, Madam Minister, and thank you for being here with us.
Madam Minister, in your mandate letter, it says: “facilitate collaboration on an organ and tissue donations and transplantation system that gives Canadians timely and effective access to care”.
I congratulate you and thank you and your team for having accepted to work with me and having sponsored, if you will, motion M-189, which was tabled a few weeks ago in the House of Commons. It was accepted unanimously by my colleagues, whom I also thank.
I'd like to know what the situation is now. Still today, out of the list of 4,500 people, 250 die every year while they are waiting for an organ donation, either to save their life or to improve their quality of life.
In the near future, how will the provinces, territories and stakeholders work together to facilitate organ and tissue donation in Canada?
Thank you very much for your question.
As you know, even before cannabis was legalized, there were several prevention and education programs to inform young people especially, but also the rest of the population, with regard to the risks associated with the consumption of cannabis.
As Minister of Health, I've always said that I did not want to encourage young people, nor the rest of the population, to consume cannabis. However, we also recognize that young people had access to it before legalization. Therefore, we wanted to protect our young people and put an end to the black market. That was in fact the objective of the bill.
That said, we are still going to invest over $108 million in education and prevention, since we want to make sure that we inform young people about the risks involved in consuming cannabis. It has already been a year and a half since we began setting up partnerships with several community groups who are helping us to do this. I could mention, for instance, Drug Free Kids Canada, with whom we have good co-operation. That organization has developed a work tool that helps professionals and other people who work with young people raise the topic of drugs with them. That type of conversation can sometimes be a bit difficult or delicate, and people don't always know how to go about it. This tool, which has been distributed to thousands of Canadians, helps stakeholders get the conversation started about drugs with our youngsters.
Our department is going to continue to establish working relationships with various community organizations. We have also developed our awareness campaigns, as have our colleagues from the Department of Public Safety and Emergency Preparedness.
At this time, we want to make sure that our messages get through. There will thus be awareness-raising messages on television and radio. However, if we want to reach young people, we have to remember that they are different from adults. Personally, I still watch a lot of television, but young people are more inclined to use social media. And so our awareness campaigns aimed at young people have to be directed to social media.
The results we've obtained confirm that our messages are reaching millions of young people, and that our campaigns are working, because we go where the young people are. We want to ensure that young people are aware of the dangers of cannabis and impaired driving.
Of course, it is a big issue around this table too. Everyone is passionate about the bill and about passing Mr. Ayoub's motion as well. I'm putting that right back at you, Mr. Ayoub. Your motion was wonderful. We supported it wholeheartedly.
To continue on that bill, , there is a little hiccup here right now. I am finding it very difficult to get it through the House before Christmas. I wanted to get a vote before Christmas so it can get to the Senate and then get to the CRA before their deadline to ensure it gets on the form in 2019.
Right now it looks as though it may not get on there until 2020, which to me is an extra year of people dying when they shouldn't be.
I tried to get the bill to collapse yesterday. It didn't happen because your party, I'm sorry to say, wanted to continue the debate, so it went into a second hour of third reading. I tried unanimous consent. I talked to the government House leaders; your government is not willing to have unanimous consent.
If you could please talk to your House leader, to your party, to try to get unanimous consent on this bill so there can be a vote next week, I would appreciate it very much.
Minister, unfortunately, we know that opioid deaths have gone up in Canada in every year of your government so far. Hopefully that's not the case this year, but it's been the case.
You mentioned that stigma is a significant reason for people not getting the treatment they need, and no doubt stigma is an issue that needs to be dealt with. However, the evidence that we've heard at this committee, whether it was through our opioid study or pharmacare or any other one, is that there is a profound lack of access in this country to timely, affordable, appropriate treatment.
We heard testimony just this week from an Ontario treatment centre that deals with children, 13-year-olds to 18-year-olds, that their wait-list is over 12 months. We heard this stark testimony that when someone is ready to get treatment, you must get them into treatment immediately. You can't even wait a day or you're risking a death sentence.
Now, you've mentioned $150 million, which I applaud the government for, but if you divide that by 13 provinces and territories, it works out to about $12 million per province or territory if you distribute it equally.
There seems to be a consensus among people in the addictions field that we need to rapidly expand and significantly increase new dollars for treatment if we're really going to start tackling this crisis.
Do you agree with that?
Thank you, Chair. My first question will be for the deputy minister.
It is regarding cannabis regulations. I don't know if you heard the question I asked the yesterday in the House about a Montreal couple who had been convicted of having 997 cannabis plants and more than $15,000, and they're under investigation for trafficking of illegal drugs. They have been granted a licence to grow medical marijuana, 600 plants, by Health Canada. It's one of the enforcement things that doesn't appear to be happening.
I've also had complaints about marijuana production facilities in Lindsay, Ontario, and Leamington, Ontario, and my own riding of Enniskillen Township in Langley, B.C., where there are off-site odour impacts that are not in compliance with the regulation and in some cases, with the Lindsay example, no security fencing or anything that is required by the regulation.
When people have called Health Canada, they've been told “Don't call us; call the police.” The police have said, “We're able to enforce impaired drug driving and trafficking, but we don't enforce Health Canada's regulations. You have to call Health Canada.”
Can you tell me who in Health Canada is responsible for enforcement, and are you aware of these situations of the regulations not being followed?
Just to assure the committee, Health Canada takes drug shortages very seriously. This is a phenomenon that does not just affect Canada; I can certainly assure the committee of that.
Part of it has to do with the structure of the global pharmaceutical industry. There are cases in which there might only be a small handful of active pharmaceutical ingredient suppliers for a particular class of drug, and so you may have a phenomenon whereby a given API that's needed to manufacture a drug is in global shortage. Shortages are an issue. Actually, when we talk to our colleagues in other countries around the world, we find they're grappling with some of the same issues. I want to assure members of that.
The second thing I would say, with regard to EpiPen specifically, is that there have been approvals given to a number of manufacturers to market their products in Canada.
As to the decision of when they enter the market and so on—they obviously they have to set up supply chains to get the products onto shelves—we anticipate having some of the products we approved coming into the market over the next year, which will give Canadians other options.
In the case of EpiPen specifically, particularly given the concern around it, we authorized the import from the United States of an equivalent product. We've had bulk shipments of that product coming into the Canadian market to make sure that while the Canadian product is in shortage, people have an option.
We have a committee that works very closely together as a kind of federal-provincial-territorial committee, and when there's a serious drug shortage, we are, frankly, on the phone with our colleagues at the provincial-territorial level constantly to get a sense of where the supply is in Canada and how we can work together to make sure that patients are attended to.
The other thing I would say is that we are also on the phone with our colleagues internationally. In the case of EpiPen, I can assure members that we're talking to colleagues in other major industrial countries with similar regulatory systems to see whether they have supply and whether we can get the supply into Canada. When there's a major drug shortage, we hear about it instantaneously from provinces and we're all over it.
Obviously, though, sometimes there are limits to the ability to get our hands on product, and I appreciate that it's a real concern for Canadians.