I call this meeting to order.
I'd like to welcome everyone to meeting 31 of the House of Commons Standing Committee on Health. Pursuant to the order of reference of May 26, 2020, the committee is resuming its briefing on the Canadian response to the outbreak of the coronavirus.
To ensure an orderly meeting, I would like to outline a few rules to follow. Interpretation in this video conference will work very much the way it does in a regular committee meeting. You have the choice, at the bottom of your screen, of the floor, English or French. As you are speaking, if you plan to alternate from one language to the other, you will need also to switch the interpretation channel so that it aligns with the language you are speaking. You may want to allow for a short pause when switching languages.
Before speaking, please wait until I recognize you by name, except during questioning. The questioner will generally indicate to whom the question is directed. When you are ready to speak, you can click on the microphone icon to activate your mike. I remind you that all comments by members and witnesses should be addressed through the chair. When you're not speaking, your mike should be on mute.
I would now like to welcome our first panel of witnesses. From the Canadian Center for Vaccinology, we have Dr. Scott Halperin, director of microbiology and immunology and professor of pediatrics at Dalhousie University. From the Canadian Generic Pharmaceutical Association, we have Mr. Jim Keon, president, and Mr. Peter Hardwick, chief commercial officer and executive vice-president of Apotex. From Innovative Medicines Canada, we have Ms. Pamela Fralick, president, and Mr. Dion Neame, country medical lead for Sanofi Canada.
With that, we will go to witness statements. Each group will have up to 10 minutes to make a statement.
We will start with the Canadian Center for Vaccinology.
Please go ahead, Dr. Halperin, for 10 minutes.
Good morning. Thank you for the invitation to meet with your committee and provide my thoughts about Canada’s response to the COVID-19 pandemic. I am speaking to you as an individual and I am not formally representing any particular group. I will spend most of my time describing the research group and the research networks I lead, since my message to you is reasonably short and the details of my research activities will provide you with greater context for the questions you may have for me.
I am a professor of pediatrics and microbiology and immunology at Dalhousie University. I am also a pediatric infectious diseases subspecialist at the Izaak Walton Killam Health Centre in Halifax, Nova Scotia. I have been in Halifax for 35 years, after growing up and undertaking all of my training in the United States. I spend approximately 25% of my professional time doing clinical work, 25% in teaching and administrative work, and the remaining 50% dedicated to vaccine-related research. My declarations are that I am a researcher and I receive research funds from multiple sources, including federal and provincial funding agencies, foundations and vaccine manufacturers. I also serve on federal and provincial government advisory bodies, and ad hoc industry advisory panels. One such federal committee currently is the Canadian immunity task force.
As part of my 50% research time commitment, I am the director of the Canadian Center for Vaccinology, or CCfV for short. CCfV is a research collaboration of investigators at Dalhousie University, the IWK and the Nova Scotia Health Authority. While primarily based in Halifax, CCfV also has investigators from St. Francis Xavier University and other Atlantic academic centres. CCfV is organized into three groups.
The discovery group comprises basic scientists, including virologists, bacteriologists and immunologists, with the goal of creating new and improved vaccines, new adjuvants and new vaccine delivery systems, and understanding the immune response to infectious disease pathogens. The discovery group is actively involved in COVID-19 vaccine development. It is establishing the animal model for COVID-19 infection and evaluating biomarkers of COVID-19 disease.
The evaluation group is made up of clinician scientists, epidemiologists and statisticians who do epidemiological studies [Technical difficulty—Editor]. As one of the primary vaccine trial sites in Canada, our group is busy preparing for multiple phase one COVID-19 studies.
The policy, programs and implementation group is our most diverse group, comprising nursing researchers, pharmacists, health economists, bioethicists and experts in health law, anthropology, psychology, pediatrics, internal medicine and public health. This group endeavours to understand how and when vaccines are used, understand attitudes amongst the public and providers, and evaluate the effectiveness of public health policy and programs. The PPI group has CIHR and SSHRC funding to explore the effects of public health COVID-19 policy on various communities in Canada and overseas.
As part of my research program, I am the nominated principal or co-principal investigator for two national networks relevant to vaccine research. The designation “nominated PI” is a term that designates a person as responsible for administering the network in a fiscally responsible manner and meeting the funder’s objectives. It does not imply that the person is the one doing most of the research, which in fact gets done by the co-PIs and co-investigators.
IMPACT, the immunization monitoring program, is a Public Health Agency of Canada-funded surveillance network administered by the Canadian Paediatric Society at 12 of the country's pediatric hospitals, accounting for 90% of the tertiary care pediatric hospital beds in Canada. IMPACT has been in existence for 30 years and it undertakes surveillance for selected vaccine-preventable, or soon to be vaccine-preventable, infectious diseases and adverse events following immunization that are severe enough to require hospitalization.
The second network is the Canadian Immunization Research Network, which is also called CIRN. CIRN was originally established in 2009 as the PHAC-CIHR Influenza Research Network, or PCIRN, to build Canadian research capacity in anticipation of a predicted influenza pandemic, which happened to be declared within one week of receiving funding. PCIRN was granted $3.5 million a year for three years, which was increased to $4.5 million a year when the pandemic was declared.
PCIRN was highly successful at undertaking rapid clinical trials of candidate pandemic flu vaccines, undertaking large-scale safety surveillance during the initial vaccine rollouts and establishing the safety of vaccination in individuals allergic to eggs, amongst many other studies. PCIRN was so successful that it was decided at the time of its renewal to expand its mandate from just influenza to all vaccines of public health interest, changing its name from “Influenza Research Network” to “Canadian Immunization Research Network” and cutting its budget in half from $4.5 million a year to $2.2 million a year.
Here's my first message.
While I'm very appreciative of the substantial research support for PCIRN and the continuing research support for CIRN, pandemics and emerging infectious diseases are not solved. They are mitigated and will continue to occur. Over the last 11 years, globally, the WHO has declared public health emergencies of international concern for H1N1, influenza, polio, Zika, Ebola—twice—and now, SARS-CoV-2. Cutting back on public health readiness between crises slows the response to the next emerging disease. While paying for readiness may seem wasteful and an easy target when cost-cutting is occurring, eventually a price has to be paid. Once the COVID-19 pandemic passes—and it will pass—we should not drop our guard in regard to pandemic research capability.
What is CIRN doing now, in the current COVID-19 pandemic?
CIRN is organized as a network that comprises eight subnetworks. These networks span the country. Over 100 investigators at over 30 institutions are members of CIRN. The CIRN networks are either actively engaged in the COVID-19 research response or are poised to participate once vaccine candidates are identified.
The serious outcomes surveillance network of adult acute care hospitals has already received supplemental funding to undertake COVID-19 surveillance at adult hospitals and collect specimens to understand how people develop immunity and biomarkers that might predict patients who develop severe disease.
CIRN's clinical trials network, which performed phase one and two studies on Canada's Ebola vaccine five years ago, is currently designing phase one and phase two studies for candidate COVID-19 vaccines. Over 10 groups have approached CIRN to undertake phase one studies for them, and five are in the active planning stage.
CANVAS, the vaccine safety network, is prepared to undertake broad surveillance to detect any vaccine-associated adverse events during the early phases of a vaccine's rollout. CIRN's social sciences and humanities network will examine the public's response to novel vaccines developed to prevent COVID-19.
CIRN's other networks, including the reference laboratory network, the modelling network, the special immunization clinic network and the provincial collaborative network will also be heavily engaged as vaccines become available.
What's going well with Canada's COVID-19 public health and research response?
I am very pleased with Canada's aggressive research response to this pandemic, with rapid calls for proposals and awarding of research funds. The tri-council competitions have been well publicized and well managed, and the amount of funding has been substantial. Could it be more? Sure. Given that virtually all research, except for COVID-19-related research, was brought to a halt in Canada because of the health restrictions in the workplace, including in universities. This means that all of Canada's research talent turned to focus on COVID-19.
Despite increased levels of funding, the success rate of grants at the granting councils did not rise, the scores required to be successful did not fall and research that received very high peer reviews still did not get funded. Message two is that Canada has a lot of talent, and if everyone focuses on a single topic, it takes a lot of money—even more than the impressive amount already committed—to fund all the projects that are worthwhile.
My next point is a bit beyond my scientific expertise and more of a personal observation. A key aspect of Canada’s successful public health and research response to the pandemic is that it has not become politicized. Canada, to date, has maintained the commitment to let the best scientific evidence guide its public health policy and research priorities. I think this is a critical factor in the control over the pandemic that we have achieved to date and our best effort to maintain control while awaiting a vaccine solution.
To close, while I don’t think there is anything that has gone poorly in Canada’s response, I do think there might be room for improvement. In the vaccine research and development arena, the process under way may have been more effective if there were a single person tasked to coordinate all of the activities required to bring a new vaccine into general use.
While all necessary activities are under way, some have been delayed, and information has not always been readily available when needed. There has been no single source for all information, or a directory to point someone in the right direction for answers about what are the required next steps. This leads to processes at times being established after actors in the field have already had to make critical decisions, leading to false starts and wasted time and effort.
A central clearing house established early in the pandemic in anticipation of vaccine development might have smoothed the process and made it more transparent to all involved parties. However, this is a criticism or suggestion regarding logistics in an otherwise very effective response to the COVID-19 crisis.
Good morning to you all. Hopefully you can hear me. I would like to thank the chair and honourable members for inviting the Canadian Generic Pharmaceutical Association to appear before the committee today.
In addition to my elected role as chair of the CGPA, I am the chief commercial officer and executive vice-president of Apotex, a Canadian-owned multinational pharmaceutical company and Canada's largest manufacturer of medicines.
CGPA president Jim Keon and I are pleased to have the opportunity to share our industry's response to the COVID-19 pandemic and highlight some of the ways that Canada can do more to ensure a sustainable and more resilient supply of prescription medicines for Canadians, moving forward.
Generic pharmaceutical companies are Canada's primary medicine manufacturers and exporters. CGPA member companies operate the largest life sciences companies and pharmaceutical manufacturing facilities in Ontario and Quebec. The industry directly employs more than 11,000 Canadians in highly skilled research, development and manufacturing positions. In addition to producing medicines for the Canadian market, made-in-Canada generic medicines are exported to more than 100 countries around the globe.
Our industry also plays a significant role in supporting Canada's health care system. Generic medicines are dispensed to fill 73% of all prescriptions in Canada but account for 19% of the $31 billion spent annually on prescription drugs. Up to 10 generic prescriptions can be filled for the cost of one brand-name prescription today.
From the outset of the pandemic, CGPA member companies have worked to provide support to our front-line workers. This has included donations of personal protective equipment and hand sanitizers, as well as financial supports for hospitals.
The industry has also provided support for potential COVID-19 treatments that are generic medicines. This has included two primary areas of focus. First, our industry has worked to secure a supply of generic medicines for these products to meet existing patient needs to ensure the continuity of their care. Second, our industry has donated tens of millions of tablets for use in Canadian and international clinical trials, and has expressed a willingness to retool our facilities and ramp up production for such products if they are found to be effective COVID treatments.
Our industry has also worked with governments, public health authorities, hospitals and international partners to help develop lists of essential drugs that are needed now and those that are needed for stockpiling in the event of subsequent pandemic waves. However, perhaps the most significant contribution by the generic pharmaceutical industry to Canada's COVID-19 response has been to provide Canadians with the medicines they need every day and to work to meet the new demands for hospital products and other products required to treat patients with COVID-19.
The pandemic has created unprecedented challenges and uncertainty for global supply chains in all industries, with border closures and export restrictions imposed by some countries and significant reductions in global shipping capacity. The pharmaceutical industry was not immune to these challenges.
Consider for a moment the sheer number of medicines we are dealing with. Generic pharmaceutical companies supply the Canadian market with hundreds of different medicines in thousands of different dosage forms. These products are used to fill three out of every four prescriptions. While many of these medicines are made in Canada, the industry is fully globalized. Finished products, manufacturing inputs and active pharmaceutical ingredients are also sourced internationally.
The CGPA is extremely proud of the dedication and hard work of generic industry employees to keep medicines in production in our manufacturing facilities and to keep medicines moving through the supply chain. They continue to provide an essential service for Canadians every single day, and we thank them. We would also like to recognize the important work of Health Canada and the trade commissioner service in helping our members address supply chain connectivity challenges, as well as the work of several provinces, distributors and pharmacists to help us ensure equitable access to the supply of medicines in a time of global supply chain upheaval.
The movement of all products internationally, including medicines, is much slower and more difficult that it used to be, and it is much more costly. While the situation has stabilized considerably, our industry is monitoring developments around the world on an ongoing basis to identify potential supply chain risks.
I will now turn the floor over to Jim Keon to provide our industry's recommendations from the lessons learned from COVID-19.
I know the clerk has circulated to members a summary of the CGPA blueprint for a sustainable supply of prescription medicines for Canadians. The CGPA developed this blueprint based on some of the lessons learned during the first three months of the pandemic. It outlines our recommendations to make the prescription drug supply chain even stronger and more secure for Canadians.
The COVID-19 pandemic has served as a wake-up call for governments, health care professionals and the broader public on the importance of having a robust and resilient domestic pharmaceutical industry. In a recent interview with CBC Radio's The House, noted that “one of the consequences of coronavirus is going to mean, for the economy, a shift from a sort of just-in-time, get-the-very-cheapest-input-possible model, to a model that puts a greater emphasis on resilience, puts a greater emphasis on supply chains that are closer to home”.
Putting a greater emphasis on resilience in the pharmaceutical supply chain will mean challenging the status quo and adopting new policy approaches. That is precisely what the CGPA is recommending.
The CGPA identifies specific measures to enhance Canada's existing pharmaceutical manufacturing capacity and domestic capabilities, create a more resilient pharmaceutical supply chain with increased supply redundancy, ensure Canada's role within a well-functioning global supply chain and encourage the establishment of a more coordinated approach to equipping Canada for future health emergencies.
I'm going to turn to our first area: strengthening the domestic pharmaceutical industry. Investments are needed to support Canada's pharmaceutical infrastructure. Companies will need assistance in preserving, refocusing and expanding domestic manufacturing infrastructure, and in increasing other infrastructure capacity such as warehousing. Companies may also require additional support to address the significant financial burden associated with maintaining higher stock levels of key manufacturing inputs and medicines.
The second aspect of strengthening the industry is increased regulatory convergence, both nationally and internationally. The reality is that Canada is a costly and complex jurisdiction for generic manufacturers to operate in. Removing unnecessary regulatory hurdles should be a priority.
The third aspect of this is pricing levels. “How low can you go?” pricing does not build resilience. A review of Canada's current pricing regime is needed to ensure that it is economically feasible to manufacture medicines in Canada and to be sufficiently competitive to acquire finished products and other inputs on the international market.
The fourth aspect of strengthening the market is strengthening the domestic industry. If the percentage of generic drugs used in Canada matched the current levels of use in the United States, Canada would save more than $11 billion annually.
The fifth aspect is that we are arguing for a sustainable domestic market for biosimilars to be implemented. This would involve maximizing the use of biosimilar medicines through broad implementation of well-controlled switching policies by public and private drug plans in Canada, including federal plans.
A second key area of our focus of the blueprint is securing and enhancing Canada's role in the international pharmaceutical supply chain. This could include, for example, the development of an international pharmaceutical supply chain security agreement, which is something we have recommended.
The third and final key area of focus in the CGPA blueprint is identifying essential generic medicines to domestically produce and stockpile for Canadian needs. A coordinated approach is needed among federal, provincial and territorial governments to establish a list of high-priority medicines. Building a domestic stockpile of these products would also require guaranteed volume and price agreements with companies.
The CGPA and its member companies look forward to working with Canadian governments and other stakeholders to turn the objective of a sustainable supply of prescription medicines for Canadians into a reality.
Peter and I would be pleased to answer any questions you may have this morning. Thank you.
Thank you, Mr. Chair and honourable members, for the opportunity to meet with you today.
I'd like to start by acknowledging the efforts of the entire federal government to fight the spread of COVID-19 and to protect our economy. As a Canadian, I'm proud of how our government has risen to the challenge. I've spent most of my working life in the health care sector. I can honestly say that the degree of co-operation we are seeing across governments, our health systems, industry and civil society is something I've never experienced, and Canadians will be better off for it.
I'm here today on behalf of Innovative Medicines Canada. IMC represents not just 40 companies from the innovative medicine and life sciences sectors, but also the tens of thousands of Canadians who work for them. Day in and day out, they dedicate themselves to ensuring all Canadians have the medicines they need, when they need them.
I'm joined today by one of them: Dr. Dion Neame. Dr. Neame is a country medical lead for Sanofi Canada and country medical head for Pasteur, the vaccine arm of Sanofi. He's also a pediatrician working in urgent care clinics. He's here not as a company representative, but as an expert in the field of vaccines who can answer any questions you might have about some of the COVID-19-related developments taking place in Canada and around the world.
I mentioned that our membership consists of 40 companies. Together they contribute $19 billion annually in economic activity and support 30,000 high-value jobs across the Canadian economy. They also invest 10% of their revenues, or $1.2 billion per year, into research and development in Canada. Currently, there are more than 500 new products, medicines and vaccines in development in Canada, including therapies focused on some of the most devastating illnesses like cancer, as well as rare and infectious diseases.
Today, though, there is no greater priority than the fight against COVID-19.
Our members are collaborating like never before to accelerate the discovery and development of treatments for people infected with the virus and of vaccines to stop its spread. Our members are also providing financial support and in-kind donations to organizations on the ground in Canada and around the world. They're maintaining patient support and compassionate care programs put in place by industry to help keep Canadians out of hospitals and reduce the burden on health systems, and they're working with governments and other stakeholders to help ensure that patients, doctors and hospitals continue to have access to the medicines they need on a daily basis.
Dr. Neame will now describe the activities our members are undertaking towards a discovery of a vaccine.
I would like to shift to a topic that I know is on the minds of many, and that's the potential for drug shortages as a result of COVID-19.
IMC's membership consists of the pharmaceutical companies that discover, develop and deliver innovative new medicines, that is, brand-name prescription medicines. Our members continue to be vigilant in identifying potential supply issues and are committed to working closely with Canadian governments to quickly identify solutions. We support the efforts of Health Canada in this regard. In the event of any anticipated delays in supplying the Canadian market with an approved medicine to meet expected patient demand, our member companies would, in full compliance with the law, report this to Health Canada, and it would be made public on the drugshortages.ca website.
If there is one area where the federal government could provide additional support, it is in the area of COVID-related hospital products. Specifically, there may be an enhanced role for the federal government to play in coordinating provincial requests for additional supplies of drugs to ensure that no province and no Canadian goes without the medications they need.
Speaking more broadly, we recognize that reliable access to medications depends on many factors. These include regulatory simplicity, timely approvals for new medications and the continued smooth functioning of global supply chains. In this regard, we support Health Canada's ongoing commitment to take steps toward a simpler regulatory regime. However, more needs to be done to quicken the approval of new medications. We applaud the efforts made by the federal and some provincial governments to protect medical supply chains serving Canada.
On the topic of regulations, we remain deeply concerned about the impact that amendments to the patented medicines regulations will have on Canadians' access to new medications. Industry's concerns have not been adequately addressed by the recently revised guidelines. Our concerns are supported by independent studies and by the delayed product launches as a result of the regulations. The regulations will also hurt Canada's ability to realize the Department of Innovation and Science's HBEST strategy and attract investment to our life sciences sector at a time when provinces such as Ontario and Quebec want to build capacity in this area.
Let me assure you that IMC members are sensitive to the increasing strain on health budgets. However, since the recent federal court decision removed a key pillar of the PMPRB's approach to price regulation, a fundamental rethinking of PMPRB's approach is now required. We remain keen to work with the federal government on alternative solutions to the proposed changes to the patented medicines regulations that would ensure that Canadians continue to have access to affordable, innovative medicines. It is not too late to find another solution to reach this objective.
To return to the industry's response to COVID-19, I'd like to leave you with three examples of my members' contributions.
First, some of our member companies are ensuring patients' continued access to the treatments they need by providing their medicines free of charge if patients cannot afford them or if they lose private prescription drug coverage due to COVID-related unemployment. On this point, I am able to report that based on feedback received from some of our members, there has in fact been minimal demand for free medication from patients. One of our members, for instance, reported that they have seen less than 2% of anticipated demand for free medicine. Others are reporting similar experiences. This suggests to us that there are far fewer people without access to the medicines they need than expected.
Second, with some provincial health care systems experiencing critical skills shortages, Innovative Medicines Canada member companies are stepping up to help patients and communities. Many of our members are providing paid leave to health professional employees, enabling them to volunteer in health care facilities, where the need is greatest.
Finally, IMC members have created a special COVID-19 fund. A key initiative created through this fund is the creation of a research chair in pandemic preparedness. This is industry's way of helping Canada prepare for the next health crisis.
Thank you again for the opportunity to talk with you about how Canada's innovative medicines and life sciences sector is responding to COVID-19. Like your other witnesses, we would be pleased to answer your questions.
Thank you very much for the opportunity to respond to that. I also have something to add to your previous question to Mr. Keon, if there is time.
We looked at Health Canada data—it isn't our data but Health Canada's data—and compared the data from Q4 2019. The regulations were passed on August 21, 2019. We looked at Q4 and how many new drugs were brought into Canada versus the previous three years. Depending on the year, there is about a 50% decrease on drugs being brought to Canada. I noted that Mr. Clark said that perhaps we don't have all the data, but if we don't, then I hope he would share that with us. Similarly, using Health Canada data, we've noticed that clinical trials have dropped between 38% and 47% in that same quarter, so the evidence is very clear to us.
Very recently, a literature review of about 49 papers that looked at the link between pricing and drug launches was released. It showed, clearly, that 44 out of these 49 papers that were reviewed found a significant negative relationship between drug price controls, or a significant positive relationship between drug price levels. There are more details on this. I know we don't have time, but I'm happy to share the information with you. The bottom line is that there is absolutely no question in our minds that there is a very clear link between pricing and drug launches, as well as investment and obviously, at the end of the day, access to medicines.
I would like to make one other comment vis-à-vis your question around investment, because that really was more about our members and the commitment with PMPRB to invest 10% of our revenues. The definition that was reflected in the PMPRB agreement was a very particular program, SR and ED, which you are probably familiar with, a tax credit program. At that time, the industry did commit to 10%, and for many years it increased its investment in that program. The problem is that the industry has changed. The world has changed in 30 years, so while it is accurate that the industry only contributes now about 5% rather than 10% in SR and ED, it does commit at least 10% of its revenue to R and D in this country.
One example...and we've been talking about this throughout the morning. Clinical trials are a critical piece of the research process. At any given time, there are about 4,500 going on in Canada. They are funded by this industry. Health Canada does not consider that research. Many of you will be familiar with MaRS in Toronto, and JLABS, which is an incubator for new research, with millions of dollars poured into that annually. That is not included.
The Government of Canada has recognized that the definition of research and development does need to be modernized. ISED and StatsCan have a project with the industry where we have redefined what R and D means, and the data is being calculated as we speak. Ernst and Young did a study a couple of years ago, and that's why we've come up with the 10%—it's actually 9.97% of revenue. The industry is a very strong contributor to R and D in Canada and would like to do more if circumstances and the situation were more amenable to that.
I'm sorry for going on at length, but I felt you deserved an answer to those questions.
The meeting has resumed.
I'd like to welcome back everyone to meeting number 31 of the House of Commons Standing Committee on Health. Pursuant to the order of reference of May 26, 2020, we are continuing a briefing on the Canadian response to the outbreak of the coronavirus.
I'd like to make a few comments for the benefit of the new witnesses. Before speaking, please wait until I recognize you by name, except during questioning. I'll ask the questioners to indicate whom they wish to respond to the question. When you're ready to speak, you can click on the microphone icon to activate your mike. I remind you that all comments should be addressed through the chair.
Interpretation in this video conference will work very much like in a regular committee meeting. You have a choice, at the bottom of your screen, of floor, English or French. As you are speaking, if you plan to alternate from one language to the other, you will need to switch the interpretation channel so it aligns with the language you are speaking. You may want to allow for a short pause when switching languages.
When you're not speaking, your mike should be on mute.
I'd like now to welcome our second panel of witnesses. Appearing as an individual we have Mario Possamai, who was senior advisor, Commission to Investigate the Introduction and Spread of Severe Acute Respiratory Syndrome, 2003-07; for Mapsted, we have Paramvir Nagpal, founder and chief executive officer; for Medtronic Canada, we have Patrick Hupé, senior director, health systems strategies.
I will ask the panellists to make their statements. Each group will have up to 10 minutes.
We'll start with Mr. Possamai. Please go ahead.
Good afternoon, Mr. Chair, and members of the committee. Thank you for the opportunity to brief you on how COVID-19 has revealed that the system to protect Canadian health workers during a public health emergency is broken, and must be fixed urgently before the expected second pandemic wave.
From the start of the outbreak, the Public Health Agency of Canada has said that droplet precautions, including surgical masks, are sufficient protection for our health care workers, because COVID-19 could not spread through the air, and only spreads through large droplets.
In those early days, Canadian experts who supported the agency's position said that if COVID-19 was airborne we would see outbreaks in places adhering to droplet prevention. One expert said that if this was airborne, all those health care workers would be getting sick.
Here's what's happened since. Nationally, Canadian health care workers comprise nearly one in five of all COVID-19 infections in Canada. That is almost three times the global average as reported by the International Council of Nurses.
It is also approximately four times the rate in China where there was a requirement for the use of airborne precautions, including N95s, in late January. Most health work infections in China occurred before these higher precautions were implemented. This troubling situation is why I have been retained by the Canadian Federation of Nurses Unions to use the lens of the SARS commission to investigate why so many Canadian health care workers are being infected. While the investigation is at an early stage, I would like to share some preliminary findings and recommendations.
The first preliminary finding is regarding the precautionary principle, and the question of airborne transmission. When your committee met on April 7, dedicated Canadian experts, with the best of intentions, said that COVID-19 only spreads through large droplets and contaminated surfaces, and that surgical masks were sufficient protection. N95s, they said, were only needed for high-risk procedures. Since then, the science has evolved. The researchers in Hong Kong, who first identified SARS airborne transmissibility in 2004, have recently published a peer-reviewed article suggesting that large droplets are a negligible transmission route compared to airborne.
The CDC in the U.S. is now suggesting that infected surfaces may only play a minor role in COVID-19 transmission, and most importantly, an open letter published today by 239 scientists from 32 countries, the WHO and public health agencies, states that studies have demonstrated beyond any reasonable doubt that the viruses are released during exhalation, talking, and coughing in microdroplets, small enough to remain in the air, and impose a risk of exposure at distances beyond one to two metres.
Time will tell who is right and who is wrong in this debate though I believe the scales are increasingly tipping toward the growing evidence of airborne transmission. This is precisely the kind of situation where the precautionary principle and the findings of the SARS commission should be invoked. When there's uncertainty about a new pathogen, it calls for erring on the side of safety, and protecting health workers with the higher protections of airborne precautions, including N95s or higher, until the science is clarified. This is what China has done so successfully, and that is why the WHO has concluded that the transmission of COVID-19 among health workers and in health care settings is not a factor in China.
Keep in mind that it was not until a year after SARS that the best evidence of its airborne transmissibility under certain conditions was published. Justice Archie Campbell, who led the SARS commission, found that this was strong validation of the prudence of taking a precautionary approach until the science was settled.
Having regard to growing evidence of airborne transmission and with news that domestic production of N95s is coming on stream, I recommend that the Public Health Agency of Canada invoke the precautionary principle and require airborne precautions, including fit-tested N95s for all health care workers in all health care settings with suspected and confirmed COVID-19 cases. I also recommend that the federal legislation be amended to require the agency to take a precautionary approach to all worker safety guidance.
The second preliminary finding is with regards to our severe shortage of N95 respirators. Even though the SARS commission recommended stockpiling this vital piece of equipment, the federal and the chief medical officer of health have claimed stockpiling was a provincial responsibility. I respectfully disagree. Ottawa destroyed two million N95s last year. It should have replaced them and purchased more, as the now seems to concede. Remember the federal stockpile had only 100,000 N95s entering the pandemic.
But setting this aside, I believe the chief medical officer of health and her immediate predecessor failed in their responsibility under section 12 of the Public Health Agency of Canada Act to warn Parliament and Canadians that we weren't ready, that we didn't have enough personal protective equipment, especially N95s.
When Dr. Tam's office and that of her Ontario counterpart were being established in 2004, Justice Campbell advised both governments to make chief medical officers of health the public guardian by giving them the rights, duties and independence to speak out on public health risks. Both levels of government listened and the wording of section 12 of the federal act and the equivalent section 81 of the Ontario act are virtually identical. Over the past five years Dr. Tam and her immediate predecessor have issued seven reports to Parliament and the public on a variety of important public health issues, including on alcohol and substance abuse. None, however, examined whether we were ready for an existential public health threat like the pandemic, including whether we had enough N95 respirators, despite the explicit intent of the act.
In view of the systemic failure I recommend that Parliament consider amending the Public Health Agency of Canada Act on an urgent basis to require the chief medical officer of health to report in detail each year on the state of Canada's preparedness for the future of public health emergencies and to request that the Auditor General of Canada independently evaluate on a regular basis the Public Health Agency of Canada's ability to monitor and evaluate our public health emergency preparedness.
Thank you, Mr. Chair and members of the committee.
I’d like to start off by giving you some background about our company, Mapsted. We have been in business since 2014. We’re an award-winning Canadian technology firm that provides highly scalable and accurate location-based solutions inside and outside any building without the use of additional external hardware such as Bluetooth beacons or Wi-Fi connectivity. Instead, our technology uses innovative, adaptive, data-fusion and self-learning algorithms to deliver an accurate and scalable positioning using any off-the-shelf smart phone. This means our technology can work anywhere, including in areas that are usually thought of as “dead zones”, like underground locations or skyscrapers.
We further expanded our core technology and developed an extensive location-based service platform, which includes seamless outdoor-indoor wayfinding, asset tracking, targeted alerts and notifications, analytics, location intelligence and secure contact tracing. We work with a wide variety of businesses and industries, including retail, health care and higher education. Our technology has been recognized as one of the most advanced location-based technologies in the world, with 62 patents granted to date. We have deployed our technology across 255 million square feet worldwide.
Over the last few months, we have seen an unprecedented response from the technology sector to the global spread of COVID-19 in our communities. Most countries have focused on developing technologies to help with contact tracing to try to flatten the curve and also prevent the health care system from becoming overwhelmed.
Singapore was an early adopter of a community-driven contact-tracing app, and now European member states are adopting a decentralized Bluetooth model for contact tracing. In this model, no data is stored centrally, ensuring that it's not possible to reconstruct an individual’s relationships or identity. They are planning an international “roaming” feature that could help revive travel and tourism across the area. Each country would have its own app, but the apps could “talk” to each other and help make travel across the region safer.
Other countries like China went beyond contact tracing and developed additional uses for location technology to help people access products and services during this challenging time by helping them check store levels for masks, sanitizer and gloves at nearby stores and also moving a significant portion of their everyday health care to online consultations.
In addition, they adopted the use of health QR codes to ensure that workplaces that had to remain open were safer. If an employee received a green QR code, they were able to work. A yellow or red code would require self-isolation. Population density maps have also been used to help pinpoint vulnerable populations, large gatherings and, along with some real-time data related to health and travel, to provide citizens with a visual representation of where potential hot spots are likely to occur, helping them to reduce their risk by avoiding those areas.
As we have seen recently, there have been some challenges and concerns with this type of technology, one of the main ones being privacy. Canada is looking to adopt a decentralized model of contact tracing moving forward, which will help address many of the privacy fears that currently exist, but right now, this concern has led to poor adoption rates of the apps, making them less effective. Alberta’s app, for example, has been downloaded by just 200,000 people out of a population of approximately 4.4 million. We need to have approximately 60% of the population using this type of app for it to be effective.
As the country moves to reopen in stages, we need a way to ensure that we can keep our population safe while allowing for Canada’s economic growth to move forward again. Essentially, we need to find a way to safely function in a society with the virus, as we wait for a vaccine to be developed. Location-based technology will play an important role in this process.
First, integrating the digital contact-tracing technology with traditional contact tracers can prove to be more effective in stamping out the virus hot spots and tracking the spread of the disease. Integrating these two approaches ensures that we address the issues inherent to each method. For example, traditional contact tracing has limitations of scalability, notification delays, and contact identification in public spaces. And even if we don’t have full adoption of the digital contact-tracing technology, many of the gaps could be filled by traditional methods, ensuring greater effectiveness overall.
As we get back to using many non-essential services, additional location-based technology can keep us safer. It’s not enough just to ensure that our health care system doesn’t get overwhelmed by COVID-19 cases. We need to work to accommodate patients who need diagnostics and care for other conditions and help them safely and securely access the services they need. Patients must have access to timely cancer screenings, and people with compromised immune systems need a way to safely plan their hospital or clinic visit for treatment so they don’t unnecessarily expose themselves to the virus by coming into prolonged contact with members of the public.
Seamless outdoor-indoor navigation technology, combined with location-based notifications and analytics, can help these patients plan optimized routes, from finding the closest hospital entrance to their appointments to planning the shortest route through the building to multiple appointments in different sections of the hospital. It can further help by sending notifications telling them when it’s safe to enter a waiting area, and giving them instructions detailing any safety precautions that must be followed. Heat maps could also be used to prevent bottlenecks and show the busy areas, so vulnerable patients could avoid walking into a situation that would increase the risk to their health.
This approach would also allow appointments to be spaced out, allow ample time for cleaning before and after patient visits, and help ease the anxiety of such visits significantly, helping to ensure that fewer people put off potentially life-saving tests and treatments because of the fear of getting infected.
Ontario’s upcoming cloud-based case management system, which will connect the lab system with the public health system, is another example of where location-based technology could complement a service to make going to appointments for tests and diagnostics safer. This technology would send patients to labs close to where they live, and use targeted notifications to let patients know when the doctors and technicians are ready for them, so they don’t need to wait with others in a room, potentially increasing their risk of exposure. To address any privacy concerns, all data should be stored locally on each device for a limited period of time, and would be anonymized.
Using location technology in this way would allow people to continue to practise effective social and physical distancing, while allowing them to access the needed services. This type of approach would also work well in malls and big box retail stores. This type of navigation technology would not only give customers the shortest or the most optimized route to the department they need, but it would also lead them directly to the product they are looking for, eliminating the need to wander around the store aisles in frustration trying to locate it. This would help reduce the time people spend inside around groups of other shoppers, reducing their exposure risk.
Many stores, including grocery chains, face problems with lineups as fewer shoppers are being admitted into the store at once. These lines put people in contact with others for longer periods of time as they wait outside. This is especially true ahead of holidays and long weekends. This is where the location-based solutions really shine, by ensuring that essential services like grocery stores can create a safe shopping environment for their customers, enforcing physical distancing measures and reducing the possibility of the spread of the virus. Stores can use this technology to set up a geofence around their location and control foot traffic into the store without any lineups, preventing crowding and bottlenecks.
This technology will continue to play a critical role as we move past the initial measures to help slow the spread of the virus and start to ease restrictions and open more businesses in the transition back to a new normal.
The uses of this technology go far beyond health care or retail applications. Contact-tracing apps can be a trade-off between privacy and effectiveness, but if we integrate this technology with traditional methods, and supplement it with additional location-based products and solutions such as indoor navigation, targeted notifications, geofencing and tagging, they could help more Canadians safely return to work, attend medical appointments, events or extracurricular activities, and much more, as we wait for a vaccine or an effective treatment for COVID-19 to be developed.
My thanks also to the members, the witnesses and the guests.
Thank you for giving us the opportunity to share with you our comments on the Government of Canada's reaction to the pandemic.
I would first like to congratulate the government for taking the following measures to date. It actively recognized the importance of maintaining international relations and the integrated global supply chain in order to make sure that infected patients have rapid access to medical technologies. That was critical. Canada played a key role in that regard, especially within the G20. It also established an action plan to mobilize industry in order to meet the challenges of the pandemic. It centralized the procurement of essential supplies and, lastly, created financial support for people who had lost their jobs in order to lighten the burden of the pandemic.
If I may, I would now like to give you a modest introduction to Medtronic Canada.
In fact, we are the largest medical technology and medical solutions company in the world. We have 90,000 employees globally, including 1,000 employees in Canada. We have a presence from coast to coast and our activities include marketing, research and development, production, education and training. The company focuses on five key areas: cardiac and vascular diseases, diabetes, minimally invasive therapies, neuroscience, and consulting services, which help healthcare systems to reduce wait times and improve the patient and caregiver experience.
Like many companies in the medical devices sector, we were significantly affected by the pandemic. First, there was an increased demand for our ventilators, pulse oxymeters, extracorporeal membrane oxygenation machines, and other devices used in respiratory care. That had two key consequences. First, we went into humanitarian mode, in the sense of delivering our devices that were in high demand to where the need was greatest. We were no longer in a conventional business mode, where we receive orders and process them on a first-come-first-served basis. In addition, we provided free access to our intellectual property in the case of a portable ventilator, so that other specialist partners, including Ventilators for Canadians, could manufacture more ventilators locally.
Lastly, our maintenance technicians and our clinical trainers had to work tirelessly to coordinate installation and maintenance and to train caregivers, particularly with regard to those ventilators. The cancellation of air routes made the task particularly difficult. Despite the crisis, our clinical teams continued to support essential surgeries all over the country.
Second, given that we provide technologies and services for more than 70 diseases, the cancellation and postponement of non-essential surgeries forced us to suspend our activities for a number of months. Despite the financial repercussions that ensued, we laid no one off because of the pandemic. Instead, we made preparations to support the resumption of surgeries by putting our experts and our products at the disposal of health care systems. We provided our expertise in clinical care pathways, in analysis, and in reducing wait times in order to redefine patient triage protocols, to optimize processes, and to shorten the time before discharge following a procedure.
Now we are at the point of considering the resumption of surgical procedures, we sincerely believe that Medtronic Canada and some members of the industry, given the international experience and the ingenuity of Canadian SMEs in our field, can be part of the solution rather than being simply restricted to the role of suppliers operating only in a purely transactional business relationship.
I would like therefore to focus my comments today on three areas. They are where we can provide tangible, proven and time-tested solutions so that procedures can be quickly resumed and the health and welfare of our fellow Canadians can be assured. These are the quickest possible transition from hospital to home, the procurement system, and the improvement of clinical care pathways. The pandemic has certainly highlighted the importance of keeping patients out of hospital once they have received appropriate care. Digital health care can certainly play a major role in that regard.
First, in a hospital setting, it allows physical distancing measures to be observed, thereby reducing the risk of infection. Moreover, this component of medical technology means that patients can be monitored at home, thereby reducing their number of hospital visits.
Clearly, health is essentially an area of provincial jurisdiction. However, the federal government has the opportunity to make better use of digital health care for the veterans and the indigenous population it serves, thereby becoming an example of health care innovation for the provinces of Canada.
Technologies that allow remote monitoring and virtual visits have been available for more than 10 years, but, because of the pandemic, we have seen those technologies adopted more quickly in the last three months than in the last 10 years. This is a tipping point and we cannot allow ourselves to turn back. Canadian companies are pioneers in this regard. According to Canada Health Infoway, before the COVID-19 pandemic, only between 10% and 20% of health care visits in Canada were done virtually. Today, that figure is closer to 60%. The federal government and each of the provincial governments have the opportunity to continue virtual visits, once the pandemic has been stamped out.
Let me illustrate all this with very specific examples. Digital health care does not just allow physical distancing, it is also an incredible tool for communicating with patients in remote locations. For example, a patient, a veteran or a member of a First Nation, who wears a pacemaker must have a check-up several times a year, with each appointment taking about 10 minutes. If that patient lives in the far north or in a remote region of our country, it can take him hours, even days, to get to the clinic. Using a form of digital technology that has existed for years and that involves an examination done remotely, reduces the risk of infection, reduces costs, and increases the efficiency of the services. Until now, that option was limited, because physicians could not bill for their services or because patients had no access to a stable Internet connection. Those two concerns can certainly be fixed with the support of the federal government.
Furthermore, in order to have access to the technologies and the solutions that help patients to obtain better care in a timely fashion, the government must focus on procurement. The pandemic actually proved beyond any doubt that procurement is not just a menial job that is simply about acquiring things. It requires men and women with a strategic vision, with a good understanding of the technologies that are needed, and with a solid foundation in new value-based procurement concepts. Those concepts, after all, have been adopted elsewhere in the world, particularly in Europe.
During the pandemic, the federal government took two steps in procurement. First, it centralized procurement, especially for ventilators and personal protective equipment. Once free from a part of that burden, hospitals and industries were therefore able to concentrate on what they do best, which is taking care of patients. Then, the government began to implement innovation policies focused on demand.
Historically, the federal government has focused on the supply of innovation rather than on the demand. For more information on this subject, you can read the article by Neil Fraser, the president of Medtronic Canada, in Longwoods. Right now, I can tell you that innovation policies focused on demand involve asking for and obtaining solutions, not just products. That is exactly what the federal government did when it launched Canada's Plan to mobilize industry to fight COVID-19.
By implementing innovation policies focused on demand, the government was beginning to follow the recommendations of the Economic Strategy Table for health and bio-sciences that the government established in 2017, with the Department of Innovation, Science and Economic Development collaborating with Health Canada. This crisis has shown us all the importance of having a more advanced manufacturing sector in Canada. I would say that the government can achieve that by re-examining the recommendations of the Economic Strategy Table for health and bio-sciences.
I would like to end with integrated health solutions.
In our search for solutions to improve our health care system, one of the greatest challenges facing the federal and provincial governments is to find a solution to eliminate the incredible delay in surgeries and diagnostic procedures, and to avoid other deaths because of those delays.
Before the virus emerged in Canada, hospitals were already operating in a complex environment. The way forward will be increasingly difficult if we do not act quickly. Hospitals also have to adapt to the new expectations of patients who have seen the advantages of virtual care, as opposed to being afraid to stay too long in a waiting room.
Despite everything, there is hope and a huge amount of optimism. Let me give you some specific examples. One is the Fraser Health Centre in British Columbia, which now conducts patient evaluations virtually, before they are admitted. In Ontario, virtual care is used for more than 50% of the patients at the Peter Munk Cardiac Centre. In New Brunswick, the Vitalité Health Network has established a specialized drive-through clinic for pacemakers, in order to reduce the growing number of patients waiting to have their cardiac devices checked.
Medtronic Canada has the expertise and the tools needed to help the government to develop those kinds of new protocols and thereby to create patient-centred health care pathways. These will help health care systems meet the new challenges and the new expectations. We are determined to deliver the results that we have promised.
On behalf of Medtronic Canada, I would like to thank you once more for making it possible for me to share my comments. I hope that this session today is just the beginning of a concerted initiative that will call on the leadership and the courage of our governments, the expertise of our academia, and the resilience, experience and ingenuity of Canadian companies and their international affiliates that have chosen to invest here in Canada. The benefits will be seen in the health of all Canadians.
Thank you, everybody, for your presentations. They are greatly appreciated.
Dr. Possamai, I really appreciate your being here and the work you did with the SARS Commission, because that facilitated the start of PHAC, as you mentioned a little earlier today, and the setting up of protocols and policies to deal with pandemics. We've seen that not only has Canada done that, but other parts of the world did that at that time.
Taiwan did exactly the same thing, and they implemented those policies and procedures from day one, right from the very start. My colleagues and I brought forward, a number of times, with the minister as well as the government, the issues of shutting down the borders, using face masks, testing, etc. As I said, Taiwan closed its borders and utilized masks and temperature screening from day one, and they've done a tremendous job in reducing the impact of COVID-19 and the number of deaths.
I have a question on the issue of temperature screening. Last month, the committee questioned officials from Transport Canada regarding the effectiveness of temperature screening for travellers during the COVID-19 pandemic, specifically at airports. Dr. Tam herself has said that when it comes to SARS, temperature screening was ineffective. My colleagues and I asked the Transport Canada officials to provide us with new, scientific evidence that would support the effectiveness of temperature screening. However, they've only provided what seems to be an opinion piece, without any scientific paper. They state, “The greater number of COVID-19 cases increases the likelihood of temperature screening effectiveness”.
From your experience and your review of the SARS epidemic, I'm wondering what scientific data proved the effectiveness of temperature screening.