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View Ron McKinnon Profile
Lib. (BC)
I call this meeting to order.
Welcome, 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.
Appearing as an individual is Dr. Jillian Kohler, professor, Leslie Dan Faculty of Pharmacy, University of Toronto. Also appearing as an individual is Mr. Yanick Labrie, health economist.
Mr. Labrie will be joining us for both panels. He will be talking, actually, about the PMPRB, I understand.
We have, from Dan's Legacy Foundation, Ms. Barbara Coates, executive director; and Mr. Tom Littlewood, psychologist and program director.
I'd like now to invite the witnesses to make their brief statements.
Before we do that, I will note that I have cards—magic cards. I will display the yellow one when there's roughly a minute left in your time, and when your time is up, I'll display the red card. When you see the red card, you don't have to stop instantly, but do try to wrap up.
That being said, we will start now with Dr. Kohler.
Dr. Kohler, please go ahead. You have five minutes.
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:04
Thank you so much.
Honourable members, thank you for the opportunity to speak today.
I am going to focus on how a lack of transparency and accountability in the supply of COVID vaccines has impacted Canadians. The COVID-19 pandemic has amplified the vital importance of the role of governments to ensure access of their populations to safe and effective vaccines.
The deployment of COVID-19 vaccines illuminates the importance of transparency. The large sums of public funding involved in the research and development process, every country’s urgent need for the vaccines, and the need to enhance public confidence in them are reasons we need transparency. What is more, public funding has contributed to the development of the COVID-19 vaccines, earning the global public a right to have much more transparency around their procurement.
COVID-19 vaccines are a global public good. Everyone everywhere can benefit from them.
When information regarding the deployment and supply of these vaccines is not publicly available, there is an information vacuum. That creates fertile ground for public distrust in vaccines and may contribute to vaccine hesitancy, as well as allowing for misinformation to flourish.
Opacity in clinical trial reporting of adverse effects can contribute to vaccine hesitancy as well. According to a recent Gallup world poll, such hesitancy translates into about 32% of people worldwide who are unwilling to get a vaccine. This will put a critical dent in our efforts to end this pandemic.
Uncertainty and misinformation can only be tackled by the sharing of evidence often and clearly. The more this is done, the more likely we are to generate public trust and bolster our vaccine deployment efforts.
In “For Whose Benefit?”, a recent study my research team contributed to with colleagues from Transparency International UK, we found that Canada has done relatively well in making its clinical studies report available. Still, Canada has also participated in the alarming trend of governments censoring key details of their orders from drug companies, or not releasing them at all. This creates, and rightly so, a perception of asymmetric power between pharmaceutical officials and public officials.
Procurement in the best of times is a government function that is at the highest risk of corruption. During emergencies, these risks are amplified due to the need for speed and flexibility in the process. We need to move fast. That is why transparent and accountable public emergency procurement processes are vital during a pandemic.
Accountability helps to ensure that relevant institutions answer to those who will be affected by decisions or actions taken by them. It can also reduce the risk of abuses, assure compliance with standards and procedures, and improve performance and organizational learning. Institutions need to explain and justify their results to internal and external monitors or stakeholders and, when performance falls short, we need to let that be known.
We have witnessed a deficit of transparency and accountability on the part of the Canadian government, particularly in terms of its negotiations and purchasing agreements with pharmaceutical companies. Greater transparency will allow the public to know what prices were paid. This will allow for more informed decisions and can, over time, lead to greater purchasing power to negotiate prices with suppliers. Transparent pricing data can illuminate patterns and any outliers, such as overpayments, kickbacks, etc.
Procurement systems without accountability and transparency mechanisms create real risk in terms of credibility and trust in the process.
We know that this pandemic will only end when we are all safe. This means we, as Canadians, need to be concerned not only about our own vaccine supply but also about those of other countries, not only for health reasons but for humanitarian ones, as well.
We're dealing with the pharmaceutical industry, which is often secret in order to protect its commercial interests. This has never been acceptable. As the saying goes, in times of crisis, there is opportunity. The global pandemic is an opportunity for the Government of Canada to insist on transparency from the pharmaceutical industry and, in doing so, heighten its accountability to the Canadian people. It needs to be forthcoming with how much it's paying, what it's negotiating and why, in order to boost public trust and confidence in our supply of COVID-19 vaccines.
Early on, prior to Health Canada’s authorization of any COVID vaccine, the federal government overbought doses for the Canadian population. In our study we found that we have, as Canadians, 11 agreements in place, which translates to about 16.23 doses per person. By comparison, the United States has eight total agreements and about 10.2 doses per person.
In Canada, despite this abundance, we failed to meet clear timelines in terms of when the deliveries from manufacturers would happen. As a result, supplies were erratic and uncertain in the first quarter of 2021, and this meant frustration and fear amongst Canadians.
Even though our government made agreements with manufacturers that far exceed our population needs, we also dipped into COVAX, which is the multilateral initiative for helping to ensure equity of access to COVID vaccines globally. Canada's standing as a global health leader is now in question, as it turned to COVAX when the majority of low-income countries globally are still struggling to have enough vaccine supply to vaccinate even their health workers.
In closing, what I will say is that it's essential to integrate better transparency and accountability measures in our agreement with the pharmaceutical industry if we hope to gain public trust. Canada has the opportunity right now to champion pricing transparency, become a global leader for clinical trial transparency, and also release full information about its vaccine negotiations with suppliers.
Thank you for your time.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Doctor.
Mr. Labrie, go ahead for five minutes.
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 13:10
Thank you, Mr. Chair.
Good afternoon, everyone.
First of all, I would like to thank the 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.
My name is Yanick Labrie, and I am a health economist. I have taught economics at various colleges and universities in Quebec. In the past 15 years, I have conducted more than 30 studies on pharmaceutical policy issues for various research centres. My presentation today is based in large part on research that I have conducted and published in recent years.
In March 2020, the PMPRB's executive director stated that the tightening of price controls under consideration would not have a negative impact on R&D investment or drug launches in Canada. It was a surprising statement, to say the least, and one that contradicted both economic theory and the empirical literature on the subject.
First of all, we know from economic theory and experience that pharmaceutical companies rank potential investment projects in descending order of each one's expected rate of return. Obviously, in the context of tightening price controls, with increasing uncertainty surrounding R&D projects and declining anticipated profits, one should clearly expect a drop in pharmaceutical R&D investment in Canada if the PMPRB decided to implement its regulatory reform. The entire life sciences ecosystem across the country, particularly in Quebec and Ontario, would be affected.
Furthermore, there can be no doubt that pharmaceutical companies will tend to prioritize launching their drugs in countries where anticipated profits will potentially be highest. Since stricter price controls decrease companies' anticipated profits, there will be less incentive to prioritize new drug launches in the Canadian market, which is relatively small in the global context.
These are not merely theoretical predictions. Last year, I conducted an exhaustive review of the scientific literature on the links between price regulation, pharmaceutical R&D investment and access to medicines. That peer-reviewed study was published in the June 2020 issue of Canadian Health Policy. Only 4 of the 49 academic studies surveyed established a significant link between price controls and delays in new medication launches, and only one found no evidence that price controls reduce pharmaceutical R&D spending. All the other 44 studies showed that price control policies discourage R&D investment and reduce or delay drug launches in countries that impose them. Small markets for pharmaceutical companies, such as Canada, are particularly at risk of seeing delays in the marketing of new medicines.
You also have to understand that delayed drug launches generate societal costs because they prevent many patients from enjoying the drugs' health benefits sooner. These delays increase the risks of complications and premature death and have negative effects on patients' quality of life. They also increase the economic burden that patients are very often forced to bear while waiting for a more effective drug.
From 2009 to 2018, it took an average of 690 days, nearly 2 years, for provincial governments to agree to cover new medicines approved for marketing in Canada. Unfortunately, the tightening of price regulation contemplated by the PMPRB could vastly undermine pharmaceutical innovation and force patients to go without drugs they need or to wait even longer for access thereto.
The regulatory changes proposed by the PMPRB are based on the idea that the rising influx of costly drugs in recent years would compromise the capacity of insurance plans to bear the increased costs associated with them. However, the data that the Canadian Institute for Health Information has published on changes in total spending on prescription drugs in the past 10 years show that this is not all the case.
In fact, despite the rising influx of more expensive drugs into Canada, we have seen slower growth in total pharmaceutical spending in the past few years, including distribution and pharmacy services. Adjusted for inflation, real per capita spending on medicines has experienced zero growth in Canada since 2010.
Spending in all other main health expenditure categories has risen faster than spending on prescription drugs in the past 10 years. In 2019, prescription medicine spending represented 13% of total health expenditure in Canada, a figure that had declined since 2010. Spending on prescription drugs across the country also fell as a percentage of GDP from 1.7% in 2010 to 1.5% in 2019.
This pharmaceutical expenditure actually tends to be overestimated as it does not reflect confidential discounts secured by federal, provincial and private drug insurance plans.
In conclusion, I do not recommend that the members of the Standing Committee on Health support the regulatory changes contemplated by the PMPRB. Contrary to what one frequently hears, spending on drugs and pharmaceutical services is not out of control in Canada. Spending on prescription medicines has represented a steadily declining segment of Canada's economy and health budget since 2010.
The tightening of price regulation that the PMPRB is considering could well have negative consequences for the Canadian public. It will not only delay the launch of new drugs in Canada and reduce their number but will also discourage R&D investment, which is essential to guaranteeing the development and availability of new medicines for Canadians in future.
Thank you for your attention.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Labrie.
We go now to Dan's Legacy, starting off with Ms. Coates.
Ms. Coates, please go ahead.
Barbara Coates
View Barbara Coates Profile
Barbara Coates
2021-06-11 13:17
Thank you, Mr. McKinnon.
Hello, everyone. I'm Barbara Coates. I'm the executive director of the Dan's Legacy Foundation. I'm joining you today with my colleague, Tom Littlewood. We thank you for this invitation to speak to the committee.
I'm Zooming in with you from Delta, British Columbia, which is on the traditional and unceded territory of the Tsawwassen and Musqueam first nations. Mr. Littlewood is joining us from Coquitlam, which is in Mr. McKinnon's riding and is, of course, the traditional and unceded territory of the Kwikwetlem First Nation.
My colleague, Mr. Littlewood, is a psychologist with over 45 years' experience in working with youth at risk in the community, and we're here today to offer both our testimony on how the coronavirus pandemic has affected the opioid crisis here in Metro Vancouver and our recommendations for harm prevention solutions.
I'd like to turn it over to Mr. Littlewood now.
Thank you.
Tom Littlewood
View Tom Littlewood Profile
Tom Littlewood
2021-06-11 13:18
Thanks, Barb.
Regarding COVID-19 and its effect on mental health, overdoses, self-harm and psychosis incidents have increased 50% with our youth clients. We serve about 300 clients a year currently, and that is about to double. Hospitalizations, because of this, cost $1,500 to $2,500 a day and up.
Anxiety and depression are widespread. These mental health issues paralyze young people, causing many to retreat and hide in their single-room occupancy, SRO suites, or basement suites.
The opioid crisis has worsened during the COVID-19 pandemic. We predict that the situation will only get worse, as there are thousands of young people in line to become the next wave of addiction to hit our streets.
Every year about 1,000 youth age out of care in British Columbia, and a further 1,000 hit the streets, running away from dysfunctional homes. Over 60% of these youths aging out of foster care will descend into entrenched addiction to numb their psychological pain.
However, there is a critical period between the ages of 15 and 25, when these young people usually ask for help. If trauma-informed therapy is provided to them for free and without a waiting list, up to 75% of these youth will respond and achieve success in school, work, recovery, housing and job-skills training. They can be diverted from the path towards homelessness, entrenched addiction, overdose and suicide and on towards lives they will enjoy living.
The initial effects of past trauma, which include physical abuse, mental abuse, sexual abuse, poverty and intergenerational trauma experienced by our indigenous clients, are normally expressed, to begin with, as anxiety, depression, eating and sleeping disorders, and self-medicating behaviour.
Our therapeutic intervention of four months of trauma-informed counselling costs approximately $2,500. Once the youth descends into entrenched addiction, it costs the community millions of dollars when police services, first responders, hospitals, corrections system, etc., are factored in. This does not even begin to take into account what the addict has to steal, or the sex acts they have to perform in order to get the money to buy the drugs they need.
Harm prevention, specifically trauma-informed therapy, can divert a youth's path away from addiction and homelessness, which not only saves valuable lives but saves millions of dollars in costs to the community.
Trauma-informed recovery is a new idea, and it's still controversial. Rather than the 12-step abstinence recovery programs, which are not best practices with youth, especially regarding opioid addiction, trauma-informed recovery involves a doctor, a therapist and a client agreeing to a contract whereby the physician prescribes an opioid replacement for the client while the client is undergoing trauma counselling.
When working with a therapist, typically over a period of four months, the client first learns self-regulation techniques. This is followed by the counselling trauma work, to help youth gain insight into their past trauma.
Once the trauma work is complete, the client has no need to self-medicate for the psychological pain, and this is when the physician steps in to provide something like an opioid replacement of Suboxone to help them come down without the drug sickness.
This approach is new and controversial, but it is becoming the best-practice model for young people with opioid addiction. Using prescribed stimulants as a replacement for street drugs like crack or meth is also being explored.
The side effect of the opioid crisis and the overdose crisis is the growing number of permanent brain damage situations caused when someone is brought back using Narcan or Naloxone. Some youth brag about how many times they have recovered using Naloxone; however, as therapists we can see the gradual deterioration of cognitive function after multiple applications of Naloxone over multiple overdoses.
A practical harm prevention idea that you can take from this is a CERB forgiveness program for young people who engage in recovery, education, work or training for a year. The money is gone; it's not going to be recovered. These kids don't have this, but it will create an insurmountable obstacle for these young people and cause thousands to give up and go underground to the street, speeding up the path to addiction and homelessness. I have had a youth end their life by suicide when faced with $1,000 in transit fines, which come due when they are about to get their first driver's licence. Imagine the chaos we're going to find when thousands are asked to repay the thousands of dollars they received from CERB fraudulently.
In summary, our goal is to get ahead of the curve of both COVID-19 and the opioid crisis by employing harm-prevention strategies of trauma-informed therapy, training and recovery.
Thank you.
View Ron McKinnon Profile
Lib. (BC)
Thank you all.
We will now start our questions with Ms. Rempel Garner.
Please go ahead, Ms. Rempel Garner, for six minutes.
View Michelle Rempel Garner Profile
CPC (AB)
Thank you, Chair.
My questions will be for Dr. Kohler.
Dr. Kohler, our committee has had a great degree of difficulty obtaining details around the contracts that were signed by the federal government with vaccine manufacturers. One small example would be that I don't think Canada has received a single dose of vaccine from AstraZeneca, in spite of our bilateral contracts.
Based on your research, is there any reason why we as parliamentarians shouldn't be getting access to that?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:24
The short answer is that there should be absolutely no reason why you can't get access to that. What I was advocating for—and I had to shorten my presentation—was that the public as well as our representatives in Parliament should know.
What was interesting was that in our research we were looking globally, but we found it was very hard to get access to these contracts. Again, don't cite me—I can give you the proper numbers—but I think we looked at about 182. We could get good information for only—
View Ron McKinnon Profile
Lib. (BC)
Dr. Kohler, could you lift your mike, please?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:25
I apologize. I'm using my own microphone. Does that work better?
Even with the contracts we found, there were a lot of redactions. Even if they are publicly available, oftentimes the information is limited. I'm speaking generally now.
My point is that I think this is a political decision. This is about the government not standing up to its suppliers and saying, “We need to have transparent contracts in place.”
The other point I want to raise here is that Canada, as we all know, has done prepurchases with suppliers that far exceed those of pretty much any other nation in the world.
View Michelle Rempel Garner Profile
CPC (AB)
Can I just get in on that?
Do you think that happened because they came late to the table? Once upon a time I used to work in something like that space, and that's really the only reason I can surmise.
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:26
Again, I defer to you on that.
I would say, though, that it in fact gives Canada a lot of power to negotiate. When we purchase so many doses, we can say, “We're going to be a big purchaser, and this is what we want: We want transparency.”
View Michelle Rempel Garner Profile
CPC (AB)
I'm sorry to cut you off, but I have a very short period of time.
I've read some of your work, and I know you do a lot of work on anti-corruption and accountability. Do you have any comments on what potentially went wrong between CanSino and the federal government on that vaccine contract?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:26
It's a big question. I would argue that we're talking here about bigger issues. We're talking about foreign affairs. We're talking about geopolitics here, so I don't think we can look at that as simply a contract between the Canadian government and one supplier. I think we're looking at the global political context, in that light.
View Michelle Rempel Garner Profile
CPC (AB)
The other thing the committee is looking at right now, in the context of both PMPRB reform and access to vaccines, is the concept of the government's role and what the government has done in terms of supporting research and pharmaceutical research, particularly in the private sector in Canada, and then what the trade-off should be.
In bullet-point format, in 30 seconds or less, what are the types of subsidies that government would give to pharma right now, including intellectual property protection frameworks?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:27
I'm going to speak to what I know, which is intellectual property. I'm not an economist; I'm a political scientist.
I'm going to actually say we don't need to be giving IP protection. In fact, I think if anything, we need to be rethinking the IP model. That is one of the major issues we have in terms of access to COVID-19 vaccines. We've seen that, historically, the United States is actually saying we should be waiving intellectual property rights.
I would say we need to be negotiating differently with the industry. These are different times and bigger crises, and the same old doesn't work. That doesn't quite directly answer your question, but I'm hoping—
View Michelle Rempel Garner Profile
CPC (AB)
No, no; it's good. I think we have to talk about intellectual property rights in a broader context here.
In that context, I know that therapeutics for infectious diseases and vaccine development are normally on the low end of the priority list for pharma development. What are the incentives, and what are the reasons for that? Is it our IP protection model or what?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:28
It's about where the market is, quite frankly. The industry will be the first to say that it will invest where there are markets and where profits are greatest.
I know I'm sounding extreme here, but I've been working in this area for 25 years as a policy person and as an academic, so I've worked on many sides of this issue. The reality is that we can't rely on the industry to fill all our needs. There needs to be a rethinking in terms of the role of government—
View Michelle Rempel Garner Profile
CPC (AB)
I have just a last question. I'm sorry. I'd love for you to table any recommendations that you have with our committee.
It's on a different subject, but it's related. The COVID Alert exposure app has only been downloaded a few million times. One expert called this ludicrously low, but a lot of government resources have been attached to it.
You talk about value for money. Do you think additional resources for this app at this time are a good idea? This is another thing that is before our committee in terms of supplementary estimates.
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:29
Absolutely not. In the development world, we look at value for money and the biggest bang for the buck. If there's not a bang for the buck and it's not working, then shift resources elsewhere. Maybe it's more about public health education and information strategies, etc.
In terms of recommendations, we should be waiving intellectual property rights, one hundred per cent. That is my strongest and probably most passionate recommendation.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Ms. Rempel Garner.
We go now to Dr. Powlowski.
Dr. Powlowski, go ahead, please, for six minutes.
View Marcus Powlowski Profile
Lib. (ON)
My question is for Dr. Kohler as well. Let me begin by saying that I absolutely agree with waiving the intellectual property rights on vaccines so developing countries can get greater access to them.
I wanted to comment or question you about your article in The Globe and Mail in February, entitled “Developing countries won't forget Canada's 'me-first' approach to vaccines” , in which you talk about a “my-nation-first” approach to vaccines.
An article just came out in the Globe, I think, suggesting that we're committing 100 million doses to developing countries. I think you realize we are one of the biggest contributors to COVAX.
I think the question is going to be when we start sending those doses of vaccine. Let me ask you this. I'm a member of Parliament for Thunder Bay—Rainy River. I have an obligation to my constituents. I have spent seven years working in developing countries for $1,000 a month, when I obviously could have made way more money here. My kids got malaria; I got malaria and our kids got dengue, but I absolutely believe that global equality in health care ought to be one of our society's greatest goals.
Having said that, if we're advocating starting to give vaccine doses now, when Canadians haven't been fully vaccinated.... For example, my parents, who are in their 80s, have only gotten one dose. If we get the delta variant, apparently one dose decreases incidences of symptomatic disease by only 33%. It's not that good.
What can you say to us as MPs? How should we balance those two important considerations and the fact that people in my riding would probably say that they agree with giving these vaccines, but let's protect our own population first?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:32
Thank you. That's a very good comment.
I'm going to go back. The world has changed since I wrote my op-ed.
I don't think it should be an us or them proposition. I want to stand very clearly on that. Of course, I don't want to be accused of saying that I'm trying to take vaccines away from Canadians. Of course I'm not. I don't think it's us versus them. That's my main argument. We're all in it together. That's a cliché; we're not really all in it together if you look at the inequities, but let's use that as our framework.
While we're working towards getting all Canadians vaccinated, we need to think about what we can contribute, whether it's funding, perhaps providing other medical supplies or, when we're able to, providing the doses, as you said. It just came out in The Globe and Mail. I did see that this morning, as well, which obviously makes me very happy.
I think we need to look at this differently. It's not about us versus them. It's about how we all work on this.
As the head of the WHO has repeatedly said, we're dealing with a global pandemic, so the reality is that even if you don't buy into the need to address other countries' needs, this will never be resolved unless everyone gets access to a vaccine. This is putting the need for more equity in terms of vaccines, medicines and other supplies into the spotlight.
I would say we need to make sure we don't frame it as taking away from us for them. That's not the right approach. I think it's more about how we can help as best we can and when we can.
View Marcus Powlowski Profile
Lib. (ON)
My second question is also for you. You talked about our vaccine supply being erratic and uncertain. I am a Liberal, so obviously I'm going to try to defend our own position, although I don't always do that.
I would suggest, however, that we've been told by vaccine makers that orders were made on a quarterly basis by pretty well every country, and that this is the way it's done. Although we couldn't predict exactly whether we were going to get supplies in February or March, we knew that by the end of March, we were to get so much. Most of the vaccine producers have been pretty good.
The other reason for some uncertainty has been manufacturing difficulties, like when Pfizer had to decrease production in order to revamp its production facilities to increase production, which it really did.
Doesn't this account for at least part of that uncertainty, and things that are kind of beyond our control?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:35
Those are fair points and absolutely true. Vaccines are very complex to manufacture. There are always going to be delays, but this goes back to my main message regarding the lack of transparency.
What Canadians needed to know.... Again, I'm not assuming that every Canadian was going to be interested, or wanted to know, about the nuances or the details of the supply system. However, it just wasn't clearly articulated. There was fear, and there were concerns. If people had been informed that this was not going to be necessarily a smooth process—that we would have to deal with unknowns and, perhaps, with manufacturing glitches, which was what we experienced—that would have been better.
The messaging was that we're all going to get it at certain dates, which was done in order to appease people's concerns, but at the same time the full story was not provided. There wasn't enough about what the government did, or the how and why. Again, keeping Canadians better informed would have led to a lot less anxiety. Speaking just about people I know and my own personal experiences, it was really stressful to understand when and how people would get supplies.
Happily, things are better now, but as Canadians we went through a lot of uncertainty. If we had just been prepared for that, it might have been a little easier. I'm not saying fully easier, but slightly easier.
View Marcus Powlowski Profile
Lib. (ON)
View Ron McKinnon Profile
Lib. (BC)
Thank you, Dr. Powlowski.
We now go to Mr. Thériault for six minutes.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 13:36
Thank you very much, Mr. Chair.
I'd like to thank all the witnesses for their testimony today.
We parliamentarians are here to find solutions and make recommendations. Your remarks are interesting and can help us in that effort.
My question is for Mr. Labrie.
Health Canada boasts on its website of the regulatory relief it has introduced to make Canada an attractive place for research and clinical trials on COVID‑19 vaccines and drugs. It seems to me that contradicts the reform and regulatory tightening the PMPRB is proposing. Many stakeholders have come and told us the contrary: that this tightening will have an impact on new drug launches and clinical trials. I wanted to know if the same regulatory relief would be available for other diseases, and it appears it won't. In addition, the coming into force of the reform, which is scheduled for July 1, will not be postponed.
Consequently, I see a contradiction here in your saying that this reform will have an impact on the life sciences ecosystem, R&D and new drug launches. The PMPRB seems to be flying blind. On the one hand, it tells us these consequences won't occur and that that's just an illusion. On the other hand, witnesses have told us in committee that, in five years, the PMPRB has conducted no studies to determine what the negative effects on the life sciences ecosystem might be.
What do you think of that omission from a methodological standpoint?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 13:38
Thank you for your question, Mr. Thériault.
First, you're entirely right to note the contradiction. It's obvious.
In fact, the PMPRB admits, through its actions and regulatory relief for vaccines, that its reform will indeed cause launch delays and problems. If it were consistent, it would continue this trend and do the same thing, which is to tighten price controls for vaccines as well. You're entirely right in saying that the fact it's currently loosening them is contradictory. That confirms what I'm saying.
You noted that the PMPRB hadn't even conducted an impact study to determine what consequences the regulatory reform might have on the life-sciences ecosystem. You're entirely right. I was able to lay my hands on only one simple—I'd even say simplistic—analysis. It's a correlation analysis involving a few variables and a number of countries, but no confounding factors. However, it's extremely important in science to have this type of study. Economists and other researchers in the social sciences will tell you it's very important, when you conduct this kind of study, to try to assess not only the correlation but also causal links. A study is virtually worthless without them.
Consequently, I'm not surprised there's been no impact study. The study I got my hands on isn't a very rigorous one for a public body such as the PMPRB.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 13:40
Earlier you said there were 44 studies that demonstrated the opposite of the claims made by the PMPRB, which, in your own words, relies on a simplistic methodology.
I've often heard people cite, as a counterexample, Belgium, a country where there's a lot of R&D and drug prices are low.
Could you explain that counterexample to me? Do you think it's valid?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 13:41
Actually, the PMPRB people cited that example in public debate. It's an example of what you shouldn't do when you want to advance an argument in science. It's anecdotal. They took a suitable country that exhibits in several respects what they wanted to demonstrate, but it's a small, two-country correlation. I'm sure you'll agree the sample is very small. They also disregarded many factors. They may have omitted many factors that are responsible for the fact that there's no more investment in Belgium, for example.
They could have presented a counterexample such as Switzerland, where prices are higher and there's an extremely high level of spending, private pharmaceutical R&D investment and extremely enviable access, for the Swiss, to new medicines.
So this kind of example is of little value in practice because it's anecdotal.
View Luc Thériault Profile
BQ (QC)
View Luc Thériault Profile
2021-06-11 13:42
You told us that the growth in spending on prescription drugs was under control in Canada. That's not really what the PMPRB is saying with [Technical difficulty]. Are you questioning its analysis and figures?
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 13:42
Absolutely. It really surprised me. When I look at the PMPRB's annual reports, I'm always surprised that it fails to adjust for inflation, for example, in presenting chronological data on changes in drug spending. It's an amateur mistake. In fact, you can't make that kind of mistake when you present data to the general public. You also can't fail to take into account demographic changes and population growth. That's another frequently committed error. You obviously have to conduct rigorous analyses. That's extremely important.
When you carefully consider data from the Canadian Institute for Health Information, which is a parapublic, independent and unbiased body, you see, after adjusting for inflation and population growth, that there hasn't been a sharp increase in spending on prescription medicines. In fact, this is the health expenditure category that has risen the most slowly. It's [Technical difficulty]. In addition, the main reason for this growth in drug expenditure isn't higher prices but rather an increase in consumption. There's a larger quantity of prescription drugs…
View Ron McKinnon Profile
Lib. (BC)
Pardon me, but time is already up. Thank you.
Yanick Labrie
View Yanick Labrie Profile
Yanick Labrie
2021-06-11 13:44
Thank you.
View Ron McKinnon Profile
Lib. (BC)
Thank you, Mr. Thériault.
We'll go now to Mr. Davies.
Mr. Davies, please go ahead for six minutes.
View Don Davies Profile
NDP (BC)
Thank you.
Dr. Kohler, federal procurement minister Anita Anand has told this committee that Canada's vaccine contracts are subject to confidentiality clauses in their entirety. She even claimed that the confidentiality clauses themselves are confidential.
I just want to make sure I understand your evidence. Is it your evidence that this secretive approach to Canada's vaccine contracts does not serve the public interest?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:44
That is absolutely what I'm saying. As I said, I'm referring to research I did. Canada was a small part of a pool of countries that we looked at, including countries within the European Union, as well as Brazil, the United States, etc. The bottom line is that we should know what are in the clauses—
View Ron McKinnon Profile
Lib. (BC)
Dr. Kohler, could you hold your mike up?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:45
Again, I apologize for my lack of technology skills here.
My point is that, yes, we in the public domain should have access to information contained in these reports. As I mentioned earlier, when we did our studies—I'm not just referring to Canada here, just to be clear—we found, interestingly enough, that even public agreements were redacted; they had lots of black lines on them, so that the information was limited. We need to know more.
I'll stop there.
View Don Davies Profile
NDP (BC)
Thanks.
In a May 25 article in the Toronto Star, you were quoted as saying, “The government is not being forthcoming with how much it's paying, what it's negotiating and why.” You also said, “There is no barrier in terms of making this public. It's just a political decision to do so.”
Why do you think that's a political decision? Do you see any reason why the government couldn't take a different approach to disclosing this information to Canadians?
Jillian Kohler
View Jillian Kohler Profile
Jillian Kohler
2021-06-11 13:46
I still stand by my quote, happily, and I would say that the government indeed can take a stand. Oftentimes, the argument is made—and I know this happens usually behind closed doors—where the industry will say they're going to give you a better deal, but they don't want others to find out about it, because if they give you a better deal, they're going to have to negotiate the same deal with country X, Y or Z for less, so it's in your best interests to keep this quiet and to keep this confidential.
I don't buy that. I don't think that's a valid reason. Just so you know, but in case you're not aware, I'm sure many of you know that the World Health Assembly in 2019 came out with a resolution demanding pricing “transparency”. It was the beginning of global efforts to demand much more transparency in terms of research and development and in terms of contract negotiations with the industry.
I do believe, still, that it's a political decision. I think that if the government were standing a little more strongly with its suppliers, it could make some of this information public.
View Don Davies Profile
NDP (BC)
Let me drill into that. In that same article, you said, “The pharmaceutical industry tends to be a secretive industry and that's because of market dynamics, concerns about their branding, et cetera. But that's an outdated model that doesn't work for building trust.”
Can you explain why that model doesn't work for building trust and perhaps how you would recommend that it be reformed?
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.
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