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Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:47
We now live in a world that has shifted. The industry is still operating like it did 25 years ago, when it concealed things. Again, though, in terms of information, we have a revolution that's been happening for a long time now. This is nothing new. The public wants to know. The public is much more invested in terms of finding out what drugs cost and how and why we determine, for example, research and development costs, which has always been very murky and can lead to some policies that are favourable to the industry without our really knowing why. I would say we need to turn the industry on its head.
The other point is that the industry is generally working with public institutions in order to do a lot of its work, so we have a vested interest as citizens who contribute to public institutions to find out what these institutions are actually doing. The old model of vertical integration, I would argue, is outdated. It might have allowed for secrecy. I'd say we need to think about who is actually contributing to the research and development and contributing to the outcomes we want. In order to do so, we need to think much more fully about getting full access to information.
View Don Davies Profile
NDP (BC)
Dr. Kohler, do you happen to know approximately what percentage of taxpayer dollars went into funding the COVID-19 vaccines? Is there a stronger case to be made for public transparency when the research that goes into producing the product is actually publicly funded?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:48
There absolutely is, and I don't know the exact numbers but we could refer to Operation Warp Speed, which, again, had huge amounts of money invested from the U.S. side. One could argue that this is just for U.S. citizens, but again, I was making the case that I think it's for the global public. I think that if we were to dig deeply—I haven't done the numbers, and I'm sure we could get to them—we would probably find mostly significant funding, even in areas that, again, we weren't aware of.
Given the existence of public engagement, involvement and resources, I would say, yes, we should be getting access to information.
View Don Davies Profile
NDP (BC)
I'm going to squeeze in one more question.
There's clearly a disparity in prices. Obviously, the pharmaceutical companies, I will just posit, as the monopoly sellers of the product, have an interest in keeping it secret. I don't know if the customer does.
The analysis you published in Transparency International said that upper middle-income economies, such as South Africa, paid an average 25% more per dose than high-income economies like the European Union. This committee saw in a document, which fortunately was unredacted at first, that there was quite a disparity in what various jurisdictions paid for AstraZeneca. In fact, Canada actually paid among the highest prices, significantly higher than what the EU, South Africa and other countries paid, which kind of belies the argument that we would have been paying a lower price in order to keep it secret.
How do you explain this pricing disparity? Is keeping this whole thing secret just something that benefits the pharmaceutical industry as opposed to customers in the end?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:50
Yes, it does. I'll keep it short here, because I know we're pressed for time.
I'll go back to my days working with the World Bank. I was in a program with a representative from a large pharmaceutical company. I asked him, “How do you determine prices?” He put his hands in the air and said, “Wherever the wind blows.”
There is a lot of variability in terms of how prices are negotiated, who does it, when, how and why. Again, I'm not saying that greater transparency is going to be the solution, but it's probably the beginning of getting to a better solution, in terms of more equity of access and more transparency in pricing.
View Don Davies Profile
NDP (BC)
Thank you, Dr. Kohler.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Davies.
That wraps up round one. We have a few minutes left. I'm going to propose to the committee that we do a snapper round. We have time for maybe one minute per party. With that in mind, I'll go to Mr. Maguire.
Mr. Maguire, please go ahead for one minute.
View Larry Maguire Profile
CPC (MB)
Thank you, Mr. Chair. I think we probably have a couple of minutes.
I just want to say in regard to my NDP colleague's comment just now, he is absolutely correct. We paid double what the Americans paid and three and four times what some of the European countries paid, even for some of the Pfizer vaccines we got early, and even throughout the period of time here.
To your comment, what kind of a premium did we have to pay on those and why? How will the rest of the world be looking at paying for these? I think it's roughly 80% that are not even vaccinated yet and do not have vaccines yet. What's Canada's role in that?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:52
To answer the question where I feel I can, again, this goes back to bigger questions like, why are we offering intellectual property? Why are we allowing for pricing to be so secretive?
The best thing we can do is expand access through the waiving of intellectual property rights, by allowing for technology transfer where it's needed, more manufacturing and more access for the global population. I will repeat again that when the global population has equity of access to COVID vaccines, we all win. It's not an “us versus them”. We all win if we are all getting equity in terms of access.
View Larry Maguire Profile
CPC (MB)
That's actually—
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Maguire.
We'll go now to Ms. Sidhu.
Ms. Sidhu, please go ahead for one minute.
View Sonia Sidhu Profile
Lib. (ON)
Thank you, Mr. Chair.
Before my time starts, I have a point of clarification. We need to clarify that there's never been a contract between CanSino and the Government of Canada. I believe it was suggested earlier that there was one. This is not correct.
My question is for the witnesses from Dan's Legacy.
As many young people are going back to school, or will be going back in the fall, we know that all levels of government are looking at how to support our return to normal. Where do you think the federal government can be most effective in supporting youth as we reopen, particularly youth in similar circumstances to those your organization supports?
Tom Littlewood
View Tom Littlewood Profile
Tom Littlewood
2021-06-11 13:53
As I mentioned, thousands of young people have gotten CERB fraudulently. There were websites that showed them how to do it and what to say. These kids are not self-regulated, so they responded to this in droves. If we keep that repayment program that's in place now, we're going to see...I think it was 48 million that went to high school students. That doesn't count the kids that are not in school or anything. We really need to look at that as a potential way to solve a problem, rather than creating a barrier.
This is going to affect thousands of young people, and we're not going to get the money back anyway. We could encourage them to engage in things that will help them, like going back to school, working, recovery, etc.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Ms. Sidhu.
Mr. Thériault, go ahead for one minute.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 13:54
Thank you, Mr. Chair.
I'd like to speak to Mr. Labrie.
We have to find solutions. I know you'll be making another statement shortly, but first I want to discuss a proposal that Research Canada is also attached to.
Rather than postpone the reform, as was previously done on two occasions, the proposal is instead to implement it in stages. First of all, there appears to be a consensus that the reference basket of countries with substantial economies should be redefined. Then all it would take would be for all the players to sit down at the same table and discuss solutions related to pharmaco-economic factors.
Would that be a desirable solution? Would it be a promising point that we could agree on to begin the discussion and come up with win-win solutions?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 13:55
Yes, absolutely.
I mentioned in my remarks that this reform wouldn't likely generate long-term benefits for Canadians. On the contrary, there's considerable risk for access to new drugs. Access could be delayed or R&D investment undermined. You know the rest. I won't repeat it all because I've already said it.
One thing is certain, and that's that the various industry stakeholders could sit down around the same table and show that drugs aren't just pills. They're backed by an ecosystem, a body of knowledge and research, both basic and applied. It's very important that all those people, including patient groups, have a voice in that discussion.
You definitely have to be transparent and honest with Canadians. It's not true that this reform doesn't offer benefits; it entails not negligible costs. That's what you have to present to people in order to reach informed decisions.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Thériault.
We will go now to Mr. Davies.
Go ahead for one minute, please.
View Don Davies Profile
NDP (BC)
Thank you.
Mr. Littlewood, you touched on the impact on indigenous youth in particular. I think I can fairly safely assume that there's probably no group in Canada that has suffered more trauma than indigenous youth, on a variety of factors.
I've read a lot of Dr. Gabor Maté and his theory that one of the foundations of addiction substance use is rooted [Technical difficulty—Editor]. I'm just wondering if you have an opinion on criminalization of drugs, whether or not that serves to reduce or exacerbate the trauma. Would you support a move to decriminalize drugs and move to a health-based approach to dealing with substance use and addiction?
Tom Littlewood
View Tom Littlewood Profile
Tom Littlewood
2021-06-11 13:57
I would, absolutely. Even though there have been some changes whereby small amounts are legal or are not criminalized, the police still intercept it and take it away from clients. A lot of my clients who are indigenous basically wait for the next beating. It is not a good situation for them, and the more stigma there is around drugs, the less we're going to see progress and reform.
Reform has to happen. Even if it's made legal, it's still a lethal dose, so whether it's legal or not, it's not going to be a good thing. There needs to be a safe drug supply as well. They're not going to stop using them because we want them to stop. They need to get through a therapeutic process. Yes, I think it would be good, not only to legalize drugs but also to make sure there is a safe supply.
View Don Davies Profile
NDP (BC)
Thank you.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Davies.
Thank you to all the witnesses for sharing your time with us today and helping us with our study. Thank you to the committee for all your great questions.
With that, we will suspend and bring in the next panel.
Thank you all.
View Ron McKinnon Profile
Lib. (BC)
We are now resumed. Welcome back, everyone, to meeting number 43 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic.
I'd like to welcome the witnesses. We have as an individual, Mr. Yanick Labrie, health economist.
As an individual, we have Dr. Joel Lexchin, medical doctor. From Jacobs Engineering we have Mr. Ansar Ahmed, vice-president.
With that, I will invite the witnesses to give statements.
I will point out to witnesses and everyone that when your time is nearly up I will display a yellow card, and when it is actually up I will display a red card. When you see the red card, you don't have to stop instantly but do try to wrap up in good order.
Thank you all.
With that, I will invite Mr. Labrie to make a statement. Go ahead, please, sir, for five minutes.
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:01
Thank you, Mr. Chair.
I would like to thank members of the Standing Committee on Health for the opportunity to testify today as an individual on the regulatory changes contemplated by the Patent Medicine Prices Review Board, the PMPRB.
Earlier this afternoon, I showed that spending on prescription drugs was not out of control in Canada, despite frequent statements to the contrary. In fact, spending on prescription medicines represents a steadily declining share of Canada's economy and health budget.
I also noted that there is a risk that the tightening of price controls that the PMPRB is considering may force down the number of new drugs launched in Canada or delay their launch, in addition to discouraging pharmaceutical R&D investment.
Now I intend to address the issue of drug prices and value.
In the past two years, the public debate on the regulatory changes the PMPRB is contemplating has largely focused on the launch price of new medicines.
According to one idea that is making the rounds, Canadians pay more for their drugs than citizens of other countries. For example, the most recent annual report published by the PMPRB contains a comparative analysis showing that the average price of all patented drugs in Canada in 2017 was 19% higher than the average of the OECD countries. However, that excludes manufacturer discounts. The PMPRB's data on medicines for treating rare diseases show that current prices in Canada in 2019 were 3% higher than median prices in all OECD countries.
However, you must take care in comparing prices of Canadian pharmaceutical products with those in effect in countries with much lower standards of living, such as Greece, Chile and Turkey, to name only a few. An international comparison of drug prices is a complex undertaking, since many factors must be considered, including differences in products consumed in each country, respective market shares of generic and innovative drugs, distribution costs and retail sales, exchange rate fluctuations and purchasing power of the various currencies.
In addition, information on real prices is limited in most countries. Where available, it paints a misleading picture that fails to reflect the actual prices of medicines as a result of confidential discounts that pharmaceutical companies offer payers. Those discounts or rebates are generally required by public drug insurance plans in Canada under agreements respecting registration on provincial drug plan forms. For example, the Quebec government has received a total rebate of more than $1 billion from innovative drug manufacturers over the past four years.
The situation regarding drug prices also cannot be analyzed in isolation without considering the value attached thereto.
In recent decades, major advances have been made in the treatment of many health problems through the use of innovative medicines. Those new-generation drugs have revolutionized the world and medicine by responding more effectively to patient needs than previous drugs.
In the case of rare diseases, the PMPRB itself has established that 35% of new drugs launched in Canada in 2019 resulted in modest or major improvements and that 27% represented major discoveries relative to existing therapies. The rising influx of these innovative molecules both intensifies competition and affords patients new and better therapeutic options.
For example, researchers at McGill University recently considered the long-term impact of biological treatments for Quebec patients suffering from ulcerative colitis. They showed that the risks of having to undergo a colorectal procedure considerably declined after biological drugs arrived on the market. In the year when those drugs were first used, the mortality rate among Quebec patients requiring colectomies declined by more than half from the previous year. The reduction in the number of surgical procedures and hospital stays thus helped reduce the burden of medical expenses associated with ulcerative colitis in Quebec by 25%.
Similar benefits are observed in cancer cases, which impose a substantial financial burden on patients and society as a whole. Many innovative drugs developed in recent years have completely revolutionized the treatment of cancers and improved patients' quality of life and life expectancy. Drug therapies now more accurately target the genes and proteins responsible for cancerous cell growth, thus vastly improving patients' chances of survival, while reducing the secondary effect generally associated with chemotherapy. By helping to reduce the number of hospital stays and thus work absenteeism and to minimize productivity losses, these innovative drugs thus generate major cost savings to society.
In conclusion, the situation regarding drug costs should not be analyzed in isolation from consideration of related benefits.
Once again, I would like to inform the members of the Standing Committee on Health of the negative impact on the people of Canada that could result from the stricter price controls being envisaged by the PMPRB. This kind of reform would not only reduce the number of new medicines launched in Canada, or slow their launch down, but also discourage research and development investment, which is nevertheless indispensable for the development and availability of new medicines for Canadians in the future.
Thank you for your attention.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Labrie.
We go now to Dr. Joel Lexchin.
Go ahead, Doctor, for five minutes, please.
Joel Lexchin
View Joel Lexchin Profile
Joel Lexchin
2021-06-11 14:07
Thank you for the opportunity to appear before the committee.
I work as an emergency physician in downtown Toronto. Between 2001 and 2016, I taught health policy at York University. Over the past 40 years, I've been involved in researching and writing about pharmaceutical policy issues.
I want to address the question about proposed reforms to the Canadian regulatory system, although I will also touch on some points that Mr. Labrie made.
When the pandemic started, Health Canada brought in an interim order to allow for a more rapid introduction of products to treat and prevent COVID-19. More recently, it's produced a discussion document about what it terms “agile regulations”, which are supposed to decrease regulatory burden and get new drugs onto the market in Canada faster.
The first point to make is contrary to Mr. Labrie's. Independent research has shown that only about 10% of new drugs that are introduced into Canada—or, in fact, in other markets—offer any substantial therapeutic gain over what already exists. This applies to drugs that are approved in general. It applies to drugs that are approved through Health Canada's priority review process. It applies to drugs that are approved with limited data through the notice of compliance with conditions process.
Even if you look at what are called first-in-class drugs—drugs that are unlike anything else on the market—the proportion of those that are innovative is only about one in six. When you look at drugs for orphan diseases, about one in five of these are substantial therapeutic improvements. This is not based on my assessment. This is based on independent assessments by organizations that have nothing to do with the pharmaceutical industry.
When we think about changing the regulatory system, we also need to think about the safety of drugs that are on the market. The push for agile regulation makes mention of safety, but it seems to put safety second to reducing regulatory burden, which is a mistake. It ignores what we know about the safety of drugs that come on the market based on how long they are reviewed by organizations like Health Canada.
If a drug goes through a standard review process, eventually about one in five of those drugs will acquire a serious safety warning. If it goes through a priority review process, which is shorter—instead of the standard 300 days, it's 180 days—one-third of those drugs will acquire a serious safety warning, up from one in five. If you look at drugs that go through a notice of compliance with conditions process, about one in four of those drugs will acquire a serious safety warning.
There are consequences to changing the regulatory system in terms of safety. Currently, in any five-year period, if you look at the drugs that are withdrawn from the Canadian market, about one out of every 20 will eventually be pulled from the market for safety reasons. If we go ahead with changes in the regulatory system, that percentage may increase.
In conclusion, it's reasonable to change how we get drugs on the market in response to a pandemic. As a doctor in the emergency department, I recognize that. If you're talking about making long-term permanent changes, then you have to look at whether that results in better, more effective drugs reaching the market and in the increased or decreased safety of the products that come onto the market.
Until Health Canada can come up with good data to show that we'll get more therapeutically efficient drugs and more safety, we should not be going ahead.
Thank you.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Doctor.
We'll go now to Jacobs Engineering. I need to apologize to Mr. Ahmed. I think I skipped over his name when making introductions. If that's the case, I certainly apologize.
From Jacobs Engineering, we have Mr. Ansar Ahmed, vice-president.
Mr. Ahmed, please go ahead, for five minutes.
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:12
Thank you, Chairman McKinnon, and thank you, Vice-Chairs Rempel Garner and Thériault, for the opportunity to speak to the committee today.
I'm pleased to be here today representing Jacobs Engineering. First of all, on behalf of all of us at Jacobs, I'd like to extend our deepest condolences to the families of the nearly 26,000 Canadians who have lost their lives during this pandemic.
As engineers and architects, we approach problems from a very simple perspective of an unbiased lens. We examine the causes, and we identify what needs to be done differently in order to achieve more favourable outcomes in the future.
I'd like to focus my remarks today on the impact of COVID-19 in our long-term care homes.
In January, Jacobs hosted an industry round table to examine how the built environment—the actual interior and physical space—may have contributed to the disproportionate impact of COVID-19 within our long-term care homes. The round table report outlined a series of nine recommendations, and I'd like to speak to two of them today.
Many jurisdictions have design standards for long-term care homes that have not been updated for years, and in some cases decades. In homes designed to those outdated standards, residents were confined, for the most part, to their rooms. They had little, if any, physical or social interaction with others, simply because the facility was not designed, or improved over the years, to meet the challenges of containing the spread of COVID-19.
It was acknowledged in the round table that the built environment is as important an element of health care as any other medical or clinical intervention. There needs to be a legislated framework that mandates regular updates to design standards, so the built environment within our long-term care homes keeps pace with the latest clinical research on caring for those with physical or cognitive impairments.
A second recommendation involved evidence-based decision-making and value-based procurements. Following the January round table, Jacobs and the Ontario Association of Architects, in consultation with the Ontario Ministry of Long-Term Care, have funded a research study by the University of Toronto’s Centre for Design + Health Innovation to conduct performance assessments of long-term care homes. This is the type of experiential data that governments need to have access to in order to ensure they are making the right investments in the right areas at the right time.
The findings of such work must become the basis for value-based procurement. In a sector as sensitive as long-term care, seeking out the lowest-cost and technically compliant bids should not be the benchmark we are striving to achieve. Rather, it should be about value creation in design, construction, maintenance and operations to help secure the best outcome for our most vulnerable citizens.
The COVID-19 pandemic has challenged governments at all levels to respond with urgency to its devastating outcomes, including the loss of over 15,000 lives in long-term care homes. In examining the root causes of these losses, it's important to recognize the pre-existence of structural and systemic vulnerabilities that heightened the risk of such outcomes occurring in our long-term care homes.
To make the most of proposed investments in long-term care, it's vital that governments first identify and, through updated standards and guidelines, resolve those structural and systemic vulnerabilities. Without this first critical step, we miss an important opportunity to ensure the best results for the investment of public funds.
If I had three recommendations to make, they would be that governments at all levels need to come together: first, to establish grant-based funding programs to vigorously re-engage Canada in public health research and development; second, to activate and mobilize Canada’s manufacturing sector to produce vast supplies of PPE and other mission-critical supplies and equipment; and lastly, to mandate regular updates to design and operating standards governing long-term care homes, to ensure these remain resilient places of care for our most vulnerable citizens.
In closing, I'd like to make one last observation with respect to mental health. This pandemic has raised awareness of the importance of mental health. As we emerge from this pandemic, it's my sincere hope we do not lose the momentum that has been created, and that the attention drawn to mental health does not fade away. All levels of government have a role to play in ensuring that hospitals across the country have access to stable and long-term funding for mental health programs, and that local non-profit organizations, delivering invaluable intervention programs, similarly have access to predictable and long-term government funding and support.
Thank you very much for your time and attention today.
View Ron McKinnon Profile
Lib. (BC)
Thank you.
We will start our rounds of questions now, with Mr. d'Entremont.
Mr. d'Entremont, go ahead, please, for six minutes.
View Chris d'Entremont Profile
CPC (NS)
Thank you very much, Mr. Chair.
To our witnesses today, welcome to the health committee.
Welcome for the second time, Mr. Labrie.
My first question is for Mr. Ahmed.
When it comes to long-term care, it continues to interest me to see how different provinces look at long-term care standards. There was a tremendous move in Nova Scotia a number of years ago to come up with a standard that makes sense. It's not necessarily included in the building codes, but it was knowing their square footage per patient and making sure there isn't an opportunity for different pathogens to go from one patient to another.
Have you looked across Canada to see who is doing this and what other provinces may not be doing it?
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:18
One of the findings that came out of our round table, frankly, was the absence of exactly that sort of evidence to support decision-making.
I don't believe a lot of research has been done pan-Canada and from coast to coast in terms of looking at how different jurisdictions manage long-term care, or the standards they use or mandate within their facilities. If anything came out of our round table, it was a desire to push governments to make sure this type of research is done. We are hoping, for example, through our partnership with the University of Toronto, to obtain that sort of information and evidence, which we can then share with governments to ensure they're making the right investments in the future.
View Chris d'Entremont Profile
CPC (NS)
Thank you.
Ultimately, if we're all doing sort of the same things, then hopefully infection control will be maintained across the system. Whether each has an individual room and an individual bathroom—those kinds of things make a big difference to what infection control actually is within our long-term care facilities.
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:19
They do, absolutely. That's why our focus during our round table was on looking at the built environment and all aspects of the long-term care facilities, not just, for example, the number of beds assigned per long-term care home. It was looking really at how the entire long-term care home operates and how it functions.
View Chris d'Entremont Profile
CPC (NS)
Thank you very much.
I'm going to move on to ask a few questions on the PMPRB.
Mr. Labrie, were you involved in the consultations held by the PMPRB over the past few years?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:20
Thank you for the question.
I was not. My involvement was more through the studies I conducted and published, which are in the public domain.
View Chris d'Entremont Profile
CPC (NS)
When they appeared before our committee, various patient associations told us that the PMPRB collaboration was neither satisfactory nor sufficient.
Did you have an opportunity to pay close attention to it?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:21
No, I did not pay close attention to any collaboration between the PMPRB and patient groups. I kept my distance. I'm an independent researcher. To be sure, I paid special attention to the reform being considered and to everything in the public domain. On the other hand, I'm not up to date on any meetings that may have been held between members of that organization and patient groups.
View Chris d'Entremont Profile
CPC (NS)
In your research, did you see any forms of collaboration, or anything else, that we could draw upon to ensure that all parties are sitting at the same table and can have a useful discussion?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:22
Based on my own experience, when the regulatory organization, in this instance the PMPRB, maintains a climate of trust with the other stakeholders, things go much more smoothly. A dialogue on both sides is established. When people are transparent and acknowledge that the proposed regulatory reform has advantages, but also some potential costs, that allows for dialogue.
What I have noticed at the moment is that there is a conflictual climate between the various parties, and I find that unfortunate. That would be harmful not only to Canadian patients, but the entire Canadian population, because they are the ones who would pay the price.
View Chris d'Entremont Profile
CPC (NS)
The pharmaceutical companies told us that they had already had the launch of some medicines sidelined or at least slowed down by a few years.
Is that because of the regulations being considered or the uncertain outcome of the discussion that has been going on for three years already?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:23
It's a bit of both of these factors, but mainly the uncertainty. As you know, uncertainty is the worst enemy of investors and companies, particularly pharmaceutical companies, which don't know what to do at the moment. They are very much afraid that the reform would reduce expected profits, which would make it more difficult to launch medicines in a timely manner in Canada.
Of course, as I mentioned in my first address, Canada is not the only potential market. We only have a very small share of the global market in pharmaceuticals. The companies will very likely focus on other places where the conditions are more conducive to the launch of new medicines.
View Chris d'Entremont Profile
CPC (NS)
Thank you.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. d'Entremont.
We go now to Mr. Van Bynen.
Mr. Van Bynen, go ahead, please, for six minutes.
View Tony Van Bynen Profile
Lib. (ON)
Thank you, Mr. Chair. I'll be sharing the second two minutes of my time slot with Ms. Sidhu, who also has an interest in long-term care.
Thank you especially to all of our witnesses, and to Mr. Ahmed for accepting our invitation to join us today and for sharing his experience and learnings on long-term care from his round table discussions. My questions will be for him.
Mr. Ahmed, earlier this year, Jacobs brought together health care leaders from across the province, including the Southlake Regional Health Centre's CEO, Arden Krystal, for a productive discussion on long-term care.
I have some questions about the report produced following this round table, but first I would like to ask you to table it with the committee so we can consider it in our study. Would you be prepared to do that for us?
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:25
I absolutely would. We will circulate that through the committee clerk's office.
View Tony Van Bynen Profile
Lib. (ON)
Thank you.
Can you share with the committee today, though, some of the key findings from this discussion? You alluded to two major discussions, but there were nine recommendations. Could you let us know what was in the report that followed?
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:25
The report itself focused on Ontario, just because that was where people's experience was in terms of both residing here in Ontario and being active in the long-term care space, but I think the findings were, frankly, applicable to any other province or territory in Canada.
There were nine recommendations that came out of that report, and they've been shared with officials in different jurisdictions. I can tell you right now that one of the first recommendations—and I think one of the drivers for this study, based on the fact that we saw a number of investment plans being tabled and being set into motion—was based on a concern amongst those who attended the round table about over-building.
Obviously we've never come across a global pandemic like this, but in circumstances like that, you tend to throw money at a problem and it can result in over-building. Until you analyze what some of the shortcomings are within these facilities—the structural vulnerabilities I spoke to in my comments—you're really throwing good money after bad. One of our recommendations was essentially to put some brakes on, take the time to do some research, figure out what these structural vulnerabilities are and address those, and then fuel the recovery in these long-term care homes through the planned investments across governments.
The other recommendation centred around making sure they consulted with stakeholders, both residents and those who are active in the long-term space, and then also ensuring there was a robust program for accreditation of these facilities, as well as ongoing monitoring and compliance. Once the standards have been modernized, they have to make sure there is a program executed either at the provincial level or through local health authorities, so that these long-term care homes are frequently visited to ensure they are meeting the planned objectives of the provincial ministries of long-term care and health.
View Tony Van Bynen Profile
Lib. (ON)
You've had a round table and you've produced a report with a lot of insight and good findings. What's next?
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:28
I think one of the most important steps we've taken is through the University of Toronto and through our partnership with the Ontario Association of Architects, getting that initial research under way.
The University of Toronto is planning a three-month research study that they're undertaking. I believe it's due to start in the coming weeks. It's going to focus on gathering the experiential data I talked about during my remarks.
We're hoping it will then set the groundwork for a larger, broader, more comprehensive study that we hope to move forward. We are in conversation with the Ontario Ministry of Long-Term Care to ensure that we hit that research in the right spot, where it has the most optimal benefit to the public.
View Tony Van Bynen Profile
Lib. (ON)
That's a probably a good segue to Ms. Sidhu.
View Sonia Sidhu Profile
Lib. (ON)
Mr. Van Bynen, thank you for sharing your time. I also have a question for Mr. Ahmed.
We can all agree that one of the great tragedies of the pandemic has been the situation in long-term care homes across the country. My caucus colleagues, including my fellow committee member Ms. O'Connell, rang the alarm during the terrible tragedies in long-term care in Ontario.
We know that delivering these services falls to the provinces and territories, but there is a role for the federal government to play in ensuring consistent quality of standards across the different provinces and territories. Would you agree that a national standard for long-term care would be an important step to ensure the safety and dignity of those living in long-term care?
Ansar Ahmed
View Ansar Ahmed Profile
Ansar Ahmed
2021-06-11 14:29
Absolutely there is room for a national standard to be developed and to be adhered to from coast to coast.
I think back now to when the federal government instituted municipal gas tax funding. There was a lot of disparity amongst different municipalities across Canada in terms of how they managed their assets.
I remember that the Public Sector Accounting Board put forward regulations that mandated certain standards for asset management.
In that same [Technical difficulty—Editor] for the federal government and for federal agencies to set up those sorts of basic standards to ensure that there is a level playing field across all long-term care homes across Canada.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Ms. Sidhu and Mr. Van Bynen.
Mr. Thériault, over to you for six minutes.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 14:30
Thank you very much, Mr. Chair.
Mr. Labrie, tell me if I've understood correctly.
Several witnesses came here to tell us that the PMPRB was flying blind. On the one hand, they told us that drug prices were too high and that this would have consequences. On the other, they did not have all the tools they needed to tell us exactly how much too high people were being charged for their medicines.
And there doesn't appear to be that much of a lack of transparency, since you just told us that it had been possible to determine that the government of Quebec had received a total rebate of $1 billion. So we know the actual price of the medicines.
It's all a bit difficult to understand. There appears to be some doublespeak. We're complaining that it's too expensive, but we can't say by how much.
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:32
Personally, I've lost confidence in the PMPRB's ability to make accurate international price comparisons.
And of course it's also related to the discounts and rebates that manufacturers offer to different clients, which are confidential. These types of discounts exist in Canada, but also in other countries.
As for transparency, I know that this was addressed in the first part of today's meeting. Transparency does exist at the global level, by which I mean that we can have access to some types of aggregated data. I revealed how this worked for Quebec, when I presented the numbers that you've just quoted. Innovative pharmaceutical companies gave a rebate worth more than $1 billion to the government of Quebec over the past four years.
This should be taken into account, at least when providing an overview of pharmaceutical spending trends. At the moment, the situation is being depicted as out of control, when this is not the case. To begin with, the population is aging and needs more medicines. Inflation also needs to be taken into account, which the PMPRB does not do. We also need to factor in the discounts I mentioned, and our ability to pay, which is based on our economy and the wealth generated. When all these factors are combined, it becomes clear that spending on drugs in Canada's economy and health budget has been decreasing over time. So there's no need to panic.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 14:33
I'd like to hear you talk about another point you raised, a very important one. It's about the value, over the next 10 years, of innovative drugs in oncology and immunology. Therapies are becoming more narrowly focused, and even individualized. Innovative molecules and drugs are going to become important.
Can you tell us more about this value?
It's as if we were looking at medicines strictly from the cost standpoint, when what we should be looking at is the therapeutic value and positive impacts not only on the patient, but also on the economy, system costs, and society as a whole.
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:34
Yes, that's right. It's a part of the debate that remains completely hidden. We focus a lot on prices, but the other side of the story is the benefits in all spheres of the economy. We shouldn't look at prices alone, but rather at what we get in exchange. In the case of drugs, as you mentioned, the progress made over the years has been extremely positive.
Dr. Lexchin alluded to the fact that sometimes there are only minor improvements. However, it's important to understand how innovative processes work in the pharmaceutical world. Generally speaking, technological process comes as a result of many gradual improvements in methodology and existing products. It's the same in all sectors, and even more so in pharmaceuticals. In other words, sometimes we only become aware of the progress that has been made after several years.
The development of the COVID‑19 vaccines was based on other drugs that had been developed and on other research efforts conducted in the past, including efforts to find an HIV vaccine. We are now benefiting from this work.
If we fail to cover drugs on grounds that they are too expensive, we risk depriving ourselves over the longer term of drugs that are extremely valuable to Canadians.
In this debate it's important to have a vision that is much more dynamic than static .
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 14:36
It also represents savings for the system. It's important to consider not only the patient's quality of life, but also the costs of drugs. You gave the example of colorectal cancer, which generates significant costs to the system, but we don't appear to take this into account when determining a drug's beneficial effects.
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 14:36
We often neglect these aspects. And yet, the drugs were able to replace much more expensive surgical procedures. Not only do patients benefit directly in terms of health and quality of life, but hospitalizations and operations that are often much more expensive are avoided. It also means workers can return sooner to the labour market. There are gains in productivity and income for these patients. Society as a whole benefits. It has to be taken into consideration.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 14:36
Thank you.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Thériault.
We go now to Mr. Davies for six minutes, please.
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