I call this meeting to order. Welcome to meeting number 56 of the House of Commons Standing Committee on Health.
Today we meet with witnesses on our study of children's health. We'll then move to committee business at 12:30. One of the items we will consider is Bill and any other items that will come before the committee.
Today's meeting is taking place in a hybrid format pursuant to the House order of June 23, 2022.
To the witness we have via video conference, you will notice on the bottom of your screen that you have the choice of floor, English or French for interpretation. For those in the room, you have your earpiece and you can choose the desired channel.
Screenshots or taking photos of your screen is not permitted.
The proceedings today will be made available via the House of Commons website.
In accordance with our routine motion, I inform the committee that all witnesses have completed the required connection tests in advance of the meeting.
We'd now like to welcome the witnesses who are with us this afternoon.
I will now welcome Dr. Anne Monique Nuyt, chair and chief, department of pediatrics, faculty of medicine, Université de Montréal and Centre hospitalier universitaire Sainte-Justine, and Dr. Caroline Quach‑Thanh, pediatrician and infectious diseases microbiologist, Université de Montréal and Centre hospitalier universitaire Sainte-Justine.
We have Cindy Blackstock, executive director of the First Nations Child and Family Caring Society of Canada.
Thank you all for taking the time to appear today.
Each witness has up to five minutes for an opening statement.
Welcome, Dr. Nuyt.
You have the floor.
Good morning, everyone.
I'm going to give my presentation in French, but I can answer questions in English or French.
Thank you for having invited me to appear before you to discuss subjects of particular importance for us and our country. I'm a pediatrician who specializes in neonatal intensive care, and a clinician investigator. I also hold a tier 1 Canada Research Chair. As you pointed out, Mr. Chair, I am here before you as the chair and chief of the department of pediatrics, in the faculty of medicine at the Université de Montréal and Centre hospitalier universitaire Sainte-Justine.
I am also the president of Pediatric Chairs of Canada, an organization that represents 17 university pediatrics departments in Canada. Our mission is to train all of Canada's pediatricians and, for some of our departments, those health professionals called “subspecialists”, such as pediatrician-cardiologists and respirologists. Our mission also includes furthering knowledge through research, establishing best practices in pediatric medicine and enhancing the quality of care in our hospitals.
I'd like to speak to you more specifically about three key issues that affect children, for which we need your commitment.
The first of these issues is the number of subspecialists in pediatrics. I know that my colleagues have already appeared and mentioned the major problem of access to community care from nurses, family physicians and general pediatricians. But even if that problem were addressed, many children would continue to require specialist and subspecialty care. Unlike adult medicine, most subspecialty care is provided at university pediatric hospitals, because that's often where the small teams of doctors with the required expertise are concentrated, and able to provide and continue to provide a high level of care. As department heads, our role is to find, recruit and retain these specialists.
Most of our pediatric hospitals encounter major challenges in fulfilling this mandate. Of course, the places available in pediatric subspecialty training programs are a provincial jurisdiction. This means that there are a few programs in a number of provinces that train subspecialty doctors for the whole country. Without a national coordinated and collaborative workforce plan, it will be impossible to train enough specialists to deal with the needs of Canada's children. That means that we often look beyond our borders to recruit subspecialists.
For example, at the moment, 25% of the subspecialty doctors in my department at Sainte-Justine were recruited internationally. That in itself allows for rewarding exchanges of knowledge and experience that are beneficial to everyone. However, credential recognition can vary from one province to another, even in countries that provide recognized training, like Belgium, France and the United States. The immigration process around the world is, of course, slow and burdensome. That's why it will be important to adopt a coordinated interprovincial approach under national leadership.
The second issue I would like to point to on behalf of the entire Canadian university pediatrics community relates to the importance of access to quality data to accomplish our missions. We need data to support research into pediatric illnesses. We need data to set pediatric priorities for vaccination rates, obesity, developmental disorders and mental health in adolescents. And we also need data to monitor the quality of our specialist and subspecialty care
Every centre must, of course, compare itself to others to continue the provision and enhancement of care. Since we do not have many pediatric hospitals and because each specialty treats only a small number of children, it's often impossible to do comparisons between provinces, even the most populous among them. We believe that access to national data is a priority, particularly for quality pediatric care.
As for the third issue, I'd like to speak to you about access to children's medicine. As was clearly demonstrated by the work of the Goodman Pediatric Formulations Centre, under scientific director Dr. Litalien, Canada's regulatory arsenal is lagging well behind in promoting access to drugs for children in Canada, compared to other authorities like the United States Food and Drug Administration, the FDA, or the European Medicines Agency. The Goodman Pediatric Formulations Centre and the Institute for Safe Medication Practices Canada have in fact submitted a document on this topic to your committee.
There are two problems. The first is access to drugs, whether new or old, that could be used to treat children. For these to be available to children, companies have to request permission from Health Canada. Of course, the administrative burden of the process, combined with the small market represented by children, is not very attractive to the companies in question.
To address this, agencies like the FDA and the European Medicines Agency have, for more than 10 years now, introduced regulations requiring companies to submit an application for pediatric use, or to conduct studies on children, whenever they apply for approval of a new drug that might have a pediatric use.
We would like to point out that Health Canada has just set a priority on developing an action plan for pediatric drugs, and we are very grateful to them for this. We keenly hope that the experience of our international colleagues will be put to good use on behalf of Canadian children.
The second problem with medicines has to do with access to pediatric formulations—the syrups, if you will—of drugs that have already been approved for children.
It is of course important to have access to pediatric formulations for the treatment of children, and also important for the drug itself to have Health Canada approval, but it's equally important for the pediatric formulation to be tested, in terms of its concentration and stability, for example, in the syrup.
Here again, Canada lags far behind in its approval of pediatric formulations. To give you just one example of the scale of the problem, the pharmacy at our hospital, CHU Sainte-Justine, has to prepare its own in‑house formulations for approximately half of the drugs, meaning that it has to crush the pill into a syrup. A formulation for this already exists commercially and has the approval of the FDA or the European Medicines Agency.
The pediatric community is therefore requesting that the regulatory structure based on decisions from trusted countries, and also currently being studied by Health Canada, be considered a priority for children's medicines, and in particular for pediatric formulations. Drug needs for children are different than those for adults, and deserve special regulatory attention, and a more rapid system for introducing regulations.
Thank you once again for your invitation, for hearing us out and particularly for your attention to this issue in your study. We believe that it is essential to have frank and open communications between you as the decision-makers and the pediatrics community working in primary care and specialty care. Right now, the health and care of children need your special attention. We, the clinicians and researchers, simply want to make you aware of the circumstances in which we operate and to provide you with the reliable data you need to make the best possible well-informed decisions.
I'd like to thank the members of the Standing Committee on Health for having invited me to appear in connection with its study on public health and the prevention of childhood illnesses.
I'm a pediatrician, infectious diseases microbiologist, and clinician investigator at the Centre hospitalier universitaire Sainte-Justine, and a full professor of microbiology and pediatrics at the Université de Montréal. I also hold the Canada Research Chair in Infection Prevention and Control: from Hospital to Community, a tier 1 chair.
I'm the director of the POPCORN network, which the Canadian Institutes of Health Research funded in 2022 for a two-year period. The purpose of the network is to make it possible to monitor the progress of a child's care in Canada's 16 pediatric hospitals with a view to strengthening national infrastructure, expertise and human capital in pediatric research, and studying the repercussions of interventions or events on the mental health and development of children in Canada.
The Canadian Institutes of Health Research had asked the network to study the impact of COVID‑19 on children, and an initial national conference is scheduled in May 2023 to communicate preliminary results and plan the next steps.
I acquired my expertise as a clinician and researcher in the field of infection prevention and vaccination. I will therefore focus on these areas, to avoid hearing my children say, “Stay in your lane, mom.”
Although we all take vaccination for granted and have the impression that vaccine-preventable diseases are a thing of the past, it's important to realize the extent to which today's world is still experiencing a resurgence of illnesses that we thought had disappeared.
One example is poliomyelitis. Until last year, no one would have thought that a case might occur in the state of New York. But wastewater surveillance, here and elsewhere, has shown that the virus is being shed and that in the absence of vaccination, people are still exposed to the risk of infection. Most of us are too young to remember the harm caused by polio, and the deaths and paralysis suffered by children who had otherwise been in perfect health.
Similarly, measles is still affecting people, even in developed countries, when the vaccination rate falls below 95%. Almost 20,000 people were recently exposed to a case of measles in Kentucky. There is a risk that a case could enter the country, and young children are most at risk of experiencing a serious illness as a result.
Why is immunization coverage so low? In 2019, a survey of immunization coverage by the Institut national de santé publique du Québec showed that by the age of 15 months, approximately 95% of children had received all their vaccinations against poliomyelitis, measles and pneumococcal diseases. However, the vaccination records show that immunization coverage for measles is closer to 85%. The actual figure is likely somewhere between the two, but the assessment of how the pandemic affected immunization coverage remains to be carried out.
It would appear that concerns about the efficacy and safety of COVID‑19 vaccines probably eroded the confidence of some parents in other vaccines that have been used for decades. This trust needs to be restored or we risk seeing a resurgence of these vaccine-preventable diseases and all the complications that come with them: meningitis, encephalitis, deafness, long-term side effects and deaths. Infectious diseases are also democratic: they will affect everyone, but will have more of an impact on those who are medically and socio-demographically most vulnerable. Health inequities are also reflected in infectious diseases.
A child who goes to a day care is expected to catch 8 to 12 colds a year. The pandemic led to the reappearance of many different respiratory viruses, the end result of which was a significant increase in secondary bacterial infections, such as orbital cellulitis, mastoiditis, pulmonary abscess, meningitis and intracranial abscess.
To date, the antibiotic resistance of these bacteria has remained relatively stable in Canada, but inappropriate use of antibiotics, the difficulty of diagnosing and differentiating a viral infection from a bacterial infection, combined with globalization, could be a threat to treatments that we now take for granted.
Antibiotic resistance is potentially the next pandemic we will have to face. Not only that, but more and more studies are beginning to reveal a link between exposure to various environmental contaminants and lowered immune response. This research needs to be continued from the standpoint of a concept based on a “one health” approach that promotes an integrated, systemic and unified approach to human, animal and environmental health.
Efforts are currently being made to determine whether the recent increase in viral infections is due simply to a cohort effect, with serious bacterial infections simply the outcome of the larger number of viral infections in circulation, or rather due to the emergence of more virulent bacterial clones.
It's therefore critical to establish surveillance programs, including genomic surveillance, for infectious diseases across Canada.
One of the cornerstones of infection prevention is ensuring that measures introduced do not cause any serious collateral damage. The subtleties involved are often difficult to communicate to the public. Research and evaluation are therefore essential in support of public health decisions. The POPCORN platform could answer these questions, but the best option would have been to factor in and assess child health earlier on during the pandemic.
I'll conclude by saying that it's impossible to overstate the importance of infection prevention, as well as the data and research required to maintain the current health status of children. More investment in this key sector would save lives and public funds.
It's important for us to understand and measure the impact of the pandemic on immunization coverage and to restore parental confidence, where needed, by using open and valid data.
It will be important to ensure that effective surveillance programs, including genomic surveillance programs, can measure the burden of infectious diseases and vaccine-preventable diseases, and to make the results available to everyone.
It's essential to make sure that children's health is factored into research priorities and that there is more than just short-term funding for networks.
The resources and measures required to prevent the emergence of antibiotic resistance must be allocated.
The “One Health” concept needs to be promoted in health decision-making and research with respect to children.
Thank you for your attention.
I'd be happy to answer your questions.
Thank you, and a very good morning, Chair and members. I would like to recognize that this testimony is occurring on the unceded and unsurrendered territory of the Algonquin nation.
In 2008 the World Health Organization said inequality is killing on a grand scale. There are all kinds of inequality flowing from capitalist markets and other things, but there's also inequality that is directly sourced to the decisions that are made in this House and made in the Senate. That's the story I want to talk about today: how that inequality has killed first nations children, how it's contributing to the deaths of first nations children today, and, most importantly, what you all can do about it.
In 1907 there were headlines across the country such as “Absolute Inattention to the Bare Necessities of Health” and “Startling Death Rolls Revealed”. What were they talking about? Canada's own medical inspector for the Indian department had found that the federal government was underfunding health care for first nations children in those schools. “By how much?”, you might ask. Well, the people living here in Ottawa received three times the amount of health care funding that all “Indians” across the country did. That gross inequality, coupled with poor health practices, was resulting in death rates of 25% per year, growing to 50% over three years.
The Government of Canada accepted those statistics; they did nothing about the inequality.
Where does that inequality come from? It comes from the Indian Act, under which the federal government funds public services on reserve—everything from water to health to education to child care—and the provinces fund those for everyone else. Since Confederation, they have underfunded those services, creating a cascade of poor health outcomes for first nations children.
Now, that decision—it was a decision rather than a failure—by Canada to not remedy those inequalities created ripples that we saw, sadly, in the headlines of 2021 and 2022 about the children in unmarked graves.
In 2005 Jordan River Anderson was in the hospital in Winnipeg. At the age of two he would have gone home. His pediatrician said it was time, but he didn't go home, because he was a first nations child and there was a dispute between the Government of Canada and the Government of Manitoba about who should pay for his at-home care. Make no mistake: If he had been non-indigenous, he would have gone home. He died in the hospital because of who he was, having never spent a day in a family home.
In 2007 all members of the House of Commons—and I want to thank all members of all parties—stood in unanimous support of Jordan's principle, which is about first nations kids getting the help they need when they need it. It's something every Canadian could get behind, but it has taken now 16 years of litigation and 25 non-compliance orders to get the Government of Canada to a place where it's beginning to put a proper label on Jordan's principle. In the wake of that—in the non-compliance period—the deaths of two children have been linked to Canada's non-compliance as it refused to provide medical care for mental health to two children who later died by suicide at the age of 12. We don't know if those deaths could have been prevented, but we know that there would have been a chance to prevent those deaths of those sacred children had those children received the types of supports they could have had.
Jordan's principle is a very basic principle of Canadian health. We talk about universal health care, but actually when we get down to it, we really don't have that in Canada.
We've done some work to decide what can be fixed about Jordan's principle. What we're finding now, thankfully, due to the tribunal and the collective work of first nations leadership, is that we're now giving out about $2 million in services resulting from Jordan's principle—which is a good thing—in health, education and other social supports, but we're also finding that it's funding gaps in these other underfunded services. You see, since Confederation there hasn't been a comprehensive plan to cost out all of those inequalities and remedy them all.
We know governments are capable of doing this. In fact we, along with allies, did this in the Second World War with the Marshall Plan. We rebuilt Europe by creating a multidisciplinary plan. Surely this is something we can do here, and the Spirit Bear Plan is the way to do that. We want to put the hands of that calculation out in the public parlance and get someone like the Parliamentary Budget Officer to cost out all of these inequalities and put to bed for all time what amounts to an apartheid public service system with respect to first nations kids that contributes to their poor health outcomes.
In the case of Jordan's principle, a large majority of the requests that come in are actually for low dollar-value items. They are huge dollar-value items to that family but low dollar-value items for the government, yet a request for a 150 bucks to buy baby formula is put through the same red tape as a request for $5 million. That's not a good use of public servants' efforts.
We'd like to see that calibrated so that, like any business you might run, you have a certain dollar threshold below which it's nominally approved as long as there's a professional note saying the child needs that service. It's not without any check systems. These types of things would create vast efficiencies.
The other thing we're looking for is.... The litigation is ongoing, but we still don't have an answer for what is going to happen for Jordan's principle beyond year five. The agreement in principle is a positive thing, but we need to know that this discrimination is never going to happen again for any child in this nation.
When we all saw the children in unmarked graves and when we all wore the orange T-shirts, we were making a promise to the residential school survivors to make sure that what happened to them doesn't happen to their grandchildren. We have solutions on the books to be able to remedy this. This is not a problem without a solution. This is a solution without, so far, the political will to implement it. With all of you, I'm sure we can get that done.
Thank you to the witnesses for being here today.
Thanks to all three of you for appearing here today.
Dr. Nuyt, I won't have time to ask you questions, but I appreciate your recommendations. They echo those of some of our witnesses earlier in the study, as well as in our important workforce crisis study.
Ms. Blackstock, it's pleasure to meet you. I know that you've been in the Yukon many times. I appreciate that you have never been one to mince words and I appreciate your frankness in this room as well.
In the Yukon, just last month we celebrated the 50th anniversary of “Together Today for our Children Tomorrow”. That was the beginning of the modern treaty process, not just for Yukon but for the country. Over the next few decades, we came to realize self-governance in 11 out of the 14 first nations. I think the agreements on self-governance and the progress we've made so far in the Yukon in child health and well-being are not coincidental.
I want to pay a bit more attention to Jordan's principle. As an example of the many areas of progress since Jordan's principle—admittedly driven by the courts, but now we do have it—I was in Haines Junction just this past week at the Shäwthän Näzhi recovery support program, an amazing family support program for recovering adults to support those families in recovery. They said that this would not have been possible without Jordan's principle.
As we contemplate your recommendations on the Spirit Bear plan, do you see the ongoing Jordan's principle and the extension of it as a transition to something more comprehensive and enduring to continue to right the wrongs?
Yes. Thank you very much, member.
The type of story you're telling is something that echoes across the country in terms of the wonderful outcomes that can come from remedying these inequalities and getting services for kids. We know, for example, from the Nobel Prize-winning economist James Heckman, that for every dollar government spends on a child, it will save many times that number downstream. This is something that I know my colleagues will agree with.
Although we're spending money on Jordan's principle now, we can expect to get savings in the public purse downstream, but more importantly, this could be the first generation of first nation kids who never have to recover from their childhoods. That's the importance of Jordan's principle and the equality measures that it represents.
Jordan's principle is a legal requirement now in the country and is something that should be embraced. Especially those who are really fiscally prudent should embrace it and preserve it, but if we're able to continue on with it as a measure, we need to plug the holes in the other underfunded services, because that's really the answer, right? It's to make sure that when a first nation child goes into a school, it doesn't have black mould and that there are a number of teachers there who can support that young person. Also, as you're pointing out in terms of the tie to self-government, we need to make sure the services are culturally appropriate and take into context the culture and language of that particular student.
Thank you to the translator for being so good. I know I speak quickly.
Just to set the stage, antibiotic resistance occurs when a type of bacteria that we were able to treat with a regular antibiotic is not treatable any more. In some countries, we're seeing more and more death associated with it because a urinary tract infection, which is something quite common, could be non-treatable and lead to death, which should not be seen nowadays.
The policy steps that have been taken and that we still need to keep on taking include, first of all, having data on what antibiotics are being used and what antibiotic resistance we're seeing with various infections. Again, as Dr. Nuyt was saying, it's not that easy to have access to data across the country.
There are a few programs that exist at the federal level. CNISP is one of those programs. It looks at nosocomial infections or health care-associated infections. We're able to follow antibiotic use and antimicrobial resistance. However, this program is limited to only 65 hospitals out of the 600-and-something that exist in Canada, so again, as Anne Monique said, particularly in pediatrics, if we want to have data that we're able to compare to, we need something that is national and not just provincial. That is the first step.
The second step, when we're talking about One Health, means that whatever you use or you see in animals will eventually end up in humans, whether that be through food or through close exposure. When we see antibiotic-resistant organisms arise in, let's say, chicken farms, it's very possible that people who are close to those chickens will acquire those organisms. Eventually there will be transmission between humans and we won't be able to treat those any more, so surveillance in both the veterinary world and the human world is necessary, and we really need to have the possibility to do genomics to understand if one strain is related to another or not.
At this point in time, these programs exist, but they are in specialized laboratories, in public health laboratories. We need to have better access to those and make sure that those programs are well funded across the country at the federal level and in the provinces, as well as in the national microbiology lab.
The last thing is to promote innovation in terms of new antibiotics. You are not going to see a lot of new antibiotics come up. Manufacturers and pharmaceutical industries are not tempted to put new antibiotics out on the market. It costs them a lot of money. It's labour intensive. Again, when a new antibiotic comes out, the last population that has access to it is pediatrics, so that's coming around to what Dr. Nuyt was saying in terms of the availability of drugs.
We are privileged to have such knowledgeable witnesses with us here this morning. It would be extremely interesting to be able to speak to them for hours, but I have only six minutes.
First, Dr. Nuyt, my colleague Mr. Ellis asked you some of the questions I would have asked. I'll get back to you if I have time later, on your research into the impact of premature births, particularly on child health.
Dr. Quach‑Thanh, you said something that struck me. You said that antibiotic resistance was potentially the next pandemic we would be facing. That's a rather chilling prospect.
Can you tell us more about this? I'm sure there are some facts we need to know about from the clinical, socio-demographic and socio-economic standpoints.
What do we have to do to prevent this from happening?
Thank you for the question, Mr. Thériault.
I think I may have partly answered it earlier, but I would add that the World Health Organization, the WHO, did in fact put antimicrobial resistance on its list of 10 threats to global health. When a human being or an animal is exposed to antibiotics, the so‑called “good bacteria” can develop resistance and transmit these genes to pathogens that will no longer be treatable.
Let's look at children, for example, particularly those who get frequent urinary infections because their urinary system is somewhat tangled and complex and there is reflux from the bladder to the kidneys. These children tend to be treated recurrently for urinary infections. As their care progresses, often even in their first year of life, they will be dealing with a bacterium that can't be treated with the usual orally administered antibiotics. So a urinary infection that should be easy to deal with will require hospitalization and the administration of very broad spectrum intravenous antibiotics for 10 to 14 days, and these may continue to contribute to antibiotic resistance.
It's therefore important to understand when to use antibiotics and when not to because it's a viral infection. Access to diagnostic tools, even remotely, is essential in family doctors' offices and in clinics, in order to be able to differentiate between bacterial and viral infections. Primary care doctors are very good, but they have to rely on their clinical experience. They may think it's a bacterial infection when it's only a viral infection. As I was saying, children may experience fever from 8 to 12 times a year because they will contract 8 to 12 viruses a year during their first years in a day care centre.
In that kind of context, you need to have supporting data to explain things so that people understand the repercussions of our recommendations.
Let's use Quebec as an example. On March 3, 2020, a decision was made to close all schools, and most of us wondered whether that was the right thing to do. Of course, at the time, there were no other options. We didn't have any data; there was no reliable information that would allow us to know whether it was serious or not, and the schools were closed.
But then without knowing what the impact of closing schools would have on students, how long can they be kept closed? How do we make up for the lost time at school afterwards?
The POPCORN platform includes all of the 16 pediatric hospitals in Canada except for the one in Thunder Bay. The members of this network can look at administrative data to see the impact of public health measures on the mental health of children following the pandemic.
They could potentially provide convincing data and make recommendations to decision-makers, who in turn could take steps to ensure that if there were a future pandemic—and there will be one—with people wondering what to do, it would be possible to assess the risks and benefits. Based on the assessment, decisions could be made about what has to be done, not only to prevent transmission, because we certainly don't want to clog up the hospitals, but also to address the potential consequences of the measures.
To get back to the educational side of things, tutoring would appear to be a highly effective option for making up the missed time at school. Professor Catherine Haeck may have spoken about this to you.
Being able to understand what's going on would allow us to make such recommendations.
Dr. Nuyt, you talked about the delays in getting approval for pediatric medications that aren't approved here but are already approved by the FDA, and I think you said EMA is the comparable organization in Europe. You also talked about accessing pediatric formulas.
In COVID we saw jurisdictions around the world all independently having to decide on approving different vaccines and different treatments for COVID, which would seem to me to be a rather inefficient process. I don't know about you, but working as a doctor, one of the wonderful things I've found about medicine is that it's universal. People all around the world suffer from basically the same problems. When you open someone up, they're exactly the same.
Now I'm going to ask you a bit of a political question.
Given the delays in getting approval, and delays in smaller countries like Canada, which fall behind bigger countries.... The FDA, for instance, has more people and probably more ability to rapidly assess which drugs should be approved. Does it make sense that every country has its own regulatory process? Do you think we ought to be considering more of a global approach in terms of an international regulatory system to test and approve new vaccines and drugs so that when we have something like COVID again or when there are new outbreaks of antimicrobial resistance, we're better able to respond rapidly to these problems globally?
I'm so impressed. The panel we have here today is just amazing. Their answers are so succinct, so clear, and they're much appreciated by the committee.
In doing a study on children's health, where do we begin? There are so many avenues to touch on. How do we do that?
Hopefully, I can get a couple of questions in here.
Dr. Quach, thank you for your work with NACI and for your presentation to the committee in the past. We really do appreciate that.
Over the years since COVID-19 started, there have been lots of things. Today you touched on one thing that's of interest to me.
You mentioned polio being back in the U.S. for the first time. I've been to the polio centre in Islamabad, Pakistan, and I've seen the great work that they're doing and the great work that all Rotarians do in Canada in helping to fund some of that programming to deal with the polio vaccinations. We have measles. We're seeing parents who are not having their children vaccinated for measles. We're seeing tuberculosis back in Canada, and that's something that lots of Canadians don't even understand. In my hometown of Estevan, we had tuberculosis in the southeast corner of Saskatchewan. Most people think it's just in the north, and therefore they don't have to think about it; it's there, and we need to be touching on these things.
The concern we have is that when COVID-19 came, unfortunately, it was such a scramble. We got so much misinformation at the time, and there were so many decisions made in haste that were then retracted, etc. For example, the Public Health Agency of Canada was coming up with certain points and then changing those points.
My question to you, Dr. Quach, is this: What can we do to rebuild that trust? What would be one of the first steps we need to take to rebuild that trust with Canadians? They need to see that trust so that they can start recognizing the great value of vaccinations.
That's the million-dollar question. If I had the answer, I would give it to you.
The first thing is for people to understand what decisions were made based on science and what decisions were made for political reasons. I don't know how easy that is. I don't know how to rebuild, except to start discussing and talking and be able to say that there are some things that we don't know but there are other things we have good evidence for.
One thing that is not about trust is the storytelling. As you said, you've seen polio cases, but most of us have not. Grandparents who used to go to the pool in the summer and not come back in the fall to school are not there anymore. How do we ensure that parents understand that we have the data to prove that vaccines are safe, but that on top of that they are a great help to our health and that in fact they save our health?
I think with the pandemic we were seeing more and more meningitis and other bacterial cases. Some of them are vaccine-preventable and some are not. It's just understanding that we still face infectious diseases. You're saying measles is back and syphilis is back. We're seeing congenital syphilis cases that we weren't seeing before. That's not a vaccine-preventable disease, but it's just a matter of understanding that these diseases are back and if you don't maintain a good vaccination coverage, they will be back and will have deadly consequences.
I don't know where to start to rebuild trust except to discuss and have frontline doctors and nurses discuss with their patients and make sure that those who are in contact with parents are able to have all of the knowledge they need to have that conversation and to ensure that in medical and nursing schools we do have those conversations and those classes to make sure that people feel well tooled—or outillés, I'd say in French—to be able to answer those questions parents will have, because in the end those people who we listen to mostly—“we”, as in parents—are the people who take care of our children.
I trust my physician. When my doctor asks if I've read about this and that for my child, I say, “No, I trust you. If you tell me that my child needs whatever medication, I will trust you.” Trust starts there with our health care workers.
Thank you so much to our witnesses.
It strikes me, actually, as a little bit unfortunate, with such expertise in front of us, that we only had an hour and a half with you, but it was absolutely quality if it wasn't quantity. Thank you so much for being with us. I'm sure you can feel the appreciation in the room for your experience and expertise and the manner in which you answered the questions. It will undoubtedly be of great value to us, as I think we have one more panel—or is this it?
A voice: We have one more.
The Chair: There's one more panel before we issue drafting instructions, so we're almost there.
Thank you all. You are excused.
To the members of Parliament in the room, we have half an hour of some other business that we need to cover, so we're going to suspend now, but for probably just three or four minutes.
Thanks again so much to our panel.
A motion to challenge the chair is not debatable. We're going to proceed directly to a vote. Just so we're all clear on what we're voting on, I have ruled that the motion has not been adopted and that Mr. Thériault is to have the floor to move his amendment. That ruling has been challenged.
The question for you is whether the ruling of the chair shall be sustained.
Do we need to do a standing vote on something like this? No?
By a show of hands, on the ruling of the chair that Mr. Thériault is now allowed to present an amendment and the motion has not yet passed, is it the will of the committee to sustain the ruling of the chair?
All those in favour of sustaining the chair...one, two, three, four, five.
All those opposed...one, two, three, four, five.
Madam Sidhu, did you vote in favour or opposed?
I suppose the easiest way to deal with this, with the greatest respect to my colleague, is that the one and only and paramount reason he's giving for not hearing from Mr. Clark is factually incorrect. Mr. Clark was there the whole time. He's still there, as a matter of fact.
Mr. Clark has given notice of resignation. He was with the PMPRB throughout the entire process. He is there today, were you to phone over. His resignation is effective in June. I may have what he's doing today wrong, but he was, throughout the entire exchange of documents and letters, the executive director of the PMPRB.
Second, the reason he's an essential witness is that as the executive director of the PMPRB, there is no one who is better placed than he to answer questions that may come from this committee about what was happening at the PMPRB. He's appeared before this committee before. He's encyclopaedic in his knowledge. He's extraordinarily fair. He has no axe to grind, and he would be a resource.
This committee, when we schedule witnesses, just about always schedules four witnesses. It's my motion that I put forward, and these are the four witnesses I want.
This committee is always better served by hearing more evidence than not enough. If my colleague Mr. Thériault doesn't want to direct any questions toward Mr. Clark, he doesn't have to. He can focus his questions on whomever he chooses, of course, but Mr. Herder and Ms. Forcier will be there.
Mr. Clark is an indispensable source of knowledge about what's going on at the Patented Medicine Prices Review Board, and I think he would be an indispensable witness for all members here to question.
The last thing I'll say is that you have some contrary opinions about what happened. To have someone who was the executive director of the board and responsible for the daily operations be there to answer questions and to have a person who is not intimately involved in the exchange of positions perhaps help us resolve this is, in my view, indispensable.
I would defeat this amendment and invite the four witnesses.
I just want to mention a few things.
Mr. Clark also resigned, so we have three resignations from the PMPRB. It's immaterial whether he disclosed the letter in public or not.
There have been three high-profile resignations from the PMPRB, and the letters that have been sent out show that there are some issues we need to look at. I think trying to find out why the executive director of the PMPRB resigned in this context is relevant.
Second, we are not here to determine the merits of the substance of the PMPRB reforms. That's what Mr. Clark came to testify on before. That's not what we're looking into in this matter here; we're looking into the matters of the functioning of the board and potential issues of propriety.
My final point is this: The reason we almost have to have him is that he is referenced in Madam Bourassa Forcier's resignation letter twice.
I'm sorry; I just lost the quotes, but she makes specific reference to Mr. Douglas Clark, so it would be fundamentally unfair to hear from Mélanie Bourassa Forcier as she puts into evidence comments on Mr. Clark without Mr. Clark being here to hear that and respond.
I'll read you excerpts from her letter: “Following these two letters, I asked the executive director, who recently resigned from this position, if we had taken the time to meet with these stakeholders to understand their concerns in relation to the proposed guidelines, concerns that had not been brought to my attention as interim president. I therefore believed wrongly that our proposed guidelines posed no real problem. I then understood from the response of the executive director that he had met representatives of certain pharmaceutical companies and that he had never had any discussions with Health Canada in relation to the proposed guidelines.”
The very subject matter before us, which is going to be how the decision came to be—and it had to do with whether pharmaceutical industry pressure did or did not play a role—involves the executive director, who is intimately involved in the discussions with the board members, and Madam Bourassa Forcier herself refers to these in her resignation letter. Not only is he an appropriate witness; he's an essential witness.
Mr. Chair, we spent some time organizing our work at our last in camera meeting. We only received your notice to the effect that Bill would be on the agenda at 10 a.m. Do you think it's acceptable, at only an hour's notice, to add an agenda item to study a bill for 15 minutes when a political party is trying to introduce some amendments? Do you believe that's acceptable?
You assumed, on the basis of information from I don't know who—surely not an official representative—that there had been an agreement between the parties, which is not the case. What I am challenging is not the outcome of the agreement, but the fact of introducing a clause-by-clause item on the agenda of the committee meeting at only one hour's notice. I've never seen that.
It has nothing to do with obstruction. I know that Mr. Lake is keen on this bill. I think that if we were to begin this study on Tuesday, when we return from the break, there would be enough time for him to achieve his goal, which is to have his bill adopted prior to World Autism Awareness Day.
However, I disagree with the fact that we should have taken time to organize our work, only to find that on only an hour's notice, after having been contacted unofficially, you should ask us to begin a clause-by-clause study. That's not in keeping with the usual practices.