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F e bruary 8, 2021 | T he Hill T im e s
HEALTH
PO L I CY B R I E F I N G
24 MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES
Health Policy Briefing
Supply delay offers opportunity to get mass
vaccination campaign right, experts say
on Moderna shipments past the a little less than 250,000 Astra- to administer vaccines, in theory Prof. Ray said that winter tem-
With Canada’s week of Feb. 1 to Feb. 7. Zeneca vaccines, South Korea it should be easier to do than a peratures will act as a constraint.
supply of COVID-19 Prime Minister Justin Trudeau
(Papineau, Que.) was pressed in
will receive less than 2.6 million,
and Indonesia a little more than
mass vaccination campaign.
According to a vaccination
“Until May, indoor is perhaps
better. Perhaps by May there can
vaccines dropping Question Period on Feb. 3 on how
much the Moderna supply will be
13.7 million.
Canada is lagging behind most
tracker by University of Sas-
katchewan student Noah Little,
be more of an opportunity for go-
ing outdoors,” he added.
below initially affected in weeks to come, but he G7 countries on vaccination pace. 86.4 per cent of vaccines deliv- Accessibility will be another
didn’t offer a direct answer. Canada is only doing better than ered to the provinces have been major constraint, Prof. Nagarajan
expected numbers He was visibly frustrated by Japan, which has not begun its administered. That varies wildly said.
the questions. vaccination campaign yet. The depending on the jurisdiction, “You want to have an equitable
in the coming weeks, “I have already said this 15 country plans to begin vaccina- with Nunavut having adminis- measure. You don’t want people to
experts argue this times in Question Period today,
but I am happy to continue reas-
tions for health-care workers in
late February, and priority groups
tered just more than half of its
vaccines, while Quebec, B.C., and
be driving 40 miles to come to a
stadium,” he said.
period presents an suring Canadians. We will receive
the six million doses promised
like seniors in late March or early
April.
Saskatchewan have administered Many schools and major
upwards of 90 per cent. stadiums, like NHL arenas, will
opportunity to ensure by the end of March. We are on NDP health critic Don Davies The tracker shows that 871,323 only be available for mass vac-
track to receive 20 million doses (Vancouver Kingsway, B.C.) said Canadians have received at least cinations in the summer once the
the mass-vaccination in the spring and we will ensure he does not have confidence in one dose, while 129,664 Canadi- regular occupants are out, Prof.
that every Canadian who wants Mr. Trudeau’s statements that all ans are fully vaccinated. Ray said, but that shouldn’t stop
campaign runs it can be vaccinated by the end of Canadians will be vaccinated by For all Canadians to receive the planning from starting now,
smoothly. September 2021,” he said.
“The week of [Feb. 22] will also
September. at least one dose by Sept. 1, a Prof. Zwerling said.
Schools are particularly well
be impacted, but Moderna cannot suited, because the location is
confirm allocations for that week based on population density, Prof.
BY AIDAN CHAMANDY yet,” the PHAC document said. Zwerling said. Major sporting
Mr. Trudeau also previously arenas and concert venues are of-
I ssues with COVID-19 vaccine
manufacturing in Europe has
left Canada receiving fewer doses
assured Canadians that the first
delay won’t affect the total num-
ber of vaccines the country is sup-
ten only in major cities and might
not be in a place that is easily ac-
cessible, “so I’m not sure if those
in recent weeks than the federal posed receive in the first quarter. are really the best approaches to
government initially predicted, “This temporary delay doesn’t doing these mass vaccinations,”
but the drop in supply offers an change the fact that we will still she said.
opportunity for governments to receive two million doses of the Prof. Zwerling cautioned
get the planning right for when Moderna vaccine before the end against relying too heavily on big
mass vaccinations begin later in of March,” he told reporters at a buildings.
the year when supply ramps up press conference last week, in “Successful mass vaccina-
again, experts say. reference to the initial cutback. tions in the past have employed
“We should use this time, Canada is also set to re- and engaged pharmacists, family,
when supply is low and demand ceive far fewer doses of the doctors, local clinics, a much
is restricted to certain sectors of Pfizer/BioNTech vaccine after more decentralized approach, as
the population, to make ourselves the company began retooling its opposed to having one central-
ready for the mass vaccination,” manufacturing plant in Belgium ized facility that requires logisti-
said Saibal Ray, professor of to produce more vaccines. The Maj.-Gen. Dany Fortin, right, and Deputy Chief Public Health Officer cal support and infrastructure,
operations management at McGill company said the renovations Howard Njoo, pictured on Dec. 8, 2020, speaking with reporters about the which, unfortunately has not been
University. will cut Canadian shipments by government’s vaccine rollout. The Hill Times photograph by Andrew Meade developed,” she said.
“We have an opportunity now, around 80 per cent, but that the Another key component will
all governments, to learn the renovations will allow them to be the information technology
lessons from the initial rollout, produce around two billion total “Given that they have failed little more 200 days away, around infrastructure used to coordinate
see where the challenges are, but vaccines in 2021, up from the to meet any of the targets that 180,000 Canadians will need to scheduling mass vaccinations
really prepare for the summer initial promise of 1.3 billion. Mr. they’ve stated so far, and, frankly, receive at least one dose per day, and following up, Dr. Wilson
when we’re going to have to start Trudeau said he discussed the the fact that they’ve misled Ca- which far outstrips the current said.
administering millions of doses,” possibility of Canada receiving nadians and actually been wrong pace. In the past three weeks, “The ideal system will have the
said Kumanan Wilson, a professor more Pfizer/BioNTech vaccines so many times, that can’t give Canada’s daily vaccinations vaccine recipient, the health-care
of epidemiology at the University in the second quarter after Pfizer anybody confidence,” he said. peaked at just less than 40,000 on provider and the public health
of Ottawa and doctor at The Otta- CEO Albert Bourla told him in a “There’s a serious credibility Jan. 20 and have dropped to just provider with the same data in
wa Hospital. Dr. Wilson is also the call that the company could “move problem,” he added. more than 15,000 on Feb. 3, ac- real time and shareable. The in-
founder and CEO of CANImmu- up the delivery of some doses that The lack of vaccine supply is cording to the vaccination tracker. dividual has to be part of the solu-
nize, a digital logistics company were earmarked for later in the making is difficult to gauge how By the time the vaccine supply tion, they have to be able to have
that has helped some provinces year.” effective Canada’s actual vaccine steadies, the mass vaccination access to their vaccine records.
and territories with information Maj.-Gen. Fortin later said that rollout has been, Dr. Wilson said. plans should already be in place And health-care providers need to
technology infrastructure associ- Pfizer is expected to send up to Canada’s limited vaccine supply “so that when we come to April know exactly which vaccine this
ated with the rollout. 335,000 doses the week of Feb. 15, “is making it really hard to judge and the most vulnerable have individual is given, that individual
Both Pfizer/BioNTech and which is 91 per cent of the initial right now how we’re doing. It’s already been vaccinated, and we needs to be able to report adverse
Moderna products, the only two allocation for that period. The apparent that the systems need to go to vaccinate a more general events as they would occur,” he
vaccines currently approved for shipment is expected to increase be further developed. It’s a bit of a population, we can do the mass said.
use in Canada, announced deliv- to up to 395,000 doses the week of double-edged sword, that the delay vaccination as quickly as pos- Dr. Wilson said one of the key
ery delays in the past weeks. Feb. 22. getting our vaccine is an opportunity sible,” said Prof. Ray. things he learned in running trials
Canada is expected to receive The Health Canada website to be better prepared,”Dr. Wilson said. Prof. Ray pointed to sites like using his CANImmunize platform
around 180,000 shots of the Mod- also removed the table outlining “We have not had the volume the Palais des Congrès in Montre- and from other jurisdictions is
erna vaccine in the second week Pfizer’s shipments. [of vaccines] that a country like al as prime targets for mass vac- that effective scheduling “is one of
of February, down from an initial The global vaccine-sharing ini- the United States has had where cinations. Quebec Health Minister the most important aspects. The
promise of more than 230,000. A tiative COVAX released a docu- we know how good our logistical Christian Dubé said the conven- scheduling processes really sped
Jan. 29 document prepared by the ment on Feb. 3 showing Canada systems are actually working,” tion centre is ready to administer up the clinic management.”
Public Health Agency of Canada will receive 1.9 million doses of said Mahesh Nagarajan, profes- more than 1,000 doses per day. “It helps from two perspec-
obtained by CBC News said the the AstraZeneca vaccine by the sor of logistics at the University Prof. Ray said in the com- tives. Booking online is easy, but
second shipment pegged for the end of June. The COVAX program of British Columbia. ing months, when winter is still you can also start to auto-popu-
week of Feb. 22 will also be af- was created with the intention of For Alice Zwerling, an epide- keeping temperatures low, indoor late the data needed at the time
fected, but the company cannot providing equitable access to the miologist at the University of Ot- sites that haven’t had much of vaccination when the person
confirm to what extent. The docu- vaccine for middle- and lower- tawa, the lack of transparency on traffic because of the pandemic, fills in that data. So the vaccina-
ment was signed by Maj.-Gen. income countries. Canada is one vaccination targets and how long like convention centres, malls, tion is so much quicker—there’s
Dany Fortin, who is in charge of of the wealthiest countries, and it has taken to vaccinate people in universities, hockey arenas, and not much data entry at the point
federal vaccine logistics. Moderna the only G7 country, listed as a priority groups, like those in long- concert venues will be extremely of vaccination, because already
was originally set to send 249,000 recipient in the document. It also term care homes, suggests the important. most of the information is auto
doses doses the week of Feb. 22. A shows other wealthy countries rollout “has not been ideal.” “Anything that is covered, populated,” he said.
table on Health Canada’s website are set to draw on the COVAX She said that given long-term empty, and accessible we should achamandy@hilltimes.com
no longer provides information supply. New Zealand will receive care homes provide a single site use,” he said. The Hill Times
26 MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES
Health Policy Briefing
No time to waste on health-care reforms
Green Party
leader Annamie
Paul, pictured,
says that
addressing
the structural
weaknesses in
health care,
rather than
merely reacting
to each crisis as
it arises, is the
best strategy
going forward.
Photograph
courtesy of the
Green Party of
Canada
outbreak. While we will be reckon- crisis affects both long-term care how to provide the right support addictions. We must also priori-
It is not too late for ing with this pandemic and its residents, staff, and the loved ones where it is most needed. tize the expansion of rehabilita-
accompanying health-care failures who provide essential care. This is If we are serious about ad- tion services. A harm-reduction
Canada to convene for some time, we must still begin a humanitarian crisis, and there is dressing health-care shortcom- approach is the only way to
an intergovernmental planning for the future. Modern-
izing our health-care systems
overwhelming consensus among
experts on what needs to be done.
ings in Canada more broadly, we
cannot overlook the skyrocketing
address this emergency and save
lives.
COVID-19 task force, should be high on the agenda, and
the federal government can and
The short-term solutions to
our LTC crisis are clear, imple-
costs of pharmaceuticals. Canada
is the only country with a univer-
A through-line of the conver-
sation about health in Canada
led by health experts, should lead the way. mentable, and would have an sal medicare system that does not is mental health. The COVID-19
As we continue to grapple with immediate positive effect on include doctor-prescribed medica- pandemic has negatively im-
to develop and Canada’s greatest health crisis in reducing deaths: accelerated vac- tion, and one in three Canadians pacted many Canadians’ mental
over a century, there is no time to cination, rapid testing, increased is forced to pay for their prescrip-
deliver a coordinated waste. The Green Party has asked staffing, improved training and tions. To achieve lifesaving goals,
health, straining an already
overburdened mental healthcare
national response to the prime minister to convene
an intergovernmental COVID-19
pay for workers, and four hours
of regulated daily care for each
and economies of scale, we must
establish a national universal
network. Establishing a national
mental health strategy is com-
the pandemic task force, led by health experts, resident. We need an urgent first pharmacare program, a bulk drug mon sense—we need to address
to develop and deliver a coordi- ministers’ meeting to agree on a purchasing agency, and shorter the very real stressors plaguing
nated national response to the plan to end the mounting deaths patent protection times for new Canadians such as inequality and
BY GREEN PARTY LEADER pandemic. Countries that have in long-term care that includes drugs. The drug assessment affordability, the precariousness
ANNAMIE PAUL been more successful in protect- the immediate implementation process must be free of conflicts of work and housing, the climate
ing their populations have adopt- of these recommendations. There of interest, and bulk purchases crisis, social isolation, and the
T he COVID-19 pandemic has
taught us painful lessons
about the weaknesses in Can-
ed such an approach, including
the new president of the United
States, who appointed a national
should not be one more death in
long-term care facilities caused
by inaction and lack of political
of prescription drugs must be
evidence-based.
The opioid crisis is a national
trauma and anxiety the pandemic
has caused. A suicide prevention
plan and immediate investments
ada’s health-care system. Low- COVID-19 coordination team on leadership. tragedy that has skyrocketed in both community-based service
income and racialized communi- his first day in office. It is not too Throughout the past year, we during the COVID-19 pandemic. organizations and provincial and
ties have been disproportionately late for Canada to do the same. have been reminded of the impor- From 2016-2020, nearly 18,000 municipal mental health services
impacted, as have seniors and the When we search for answers tance of evidence in guiding public Canadians died from opioid are a critical first step.
disabled. on why the pandemic’s death toll health decisions—a standard that overdose, many of which were The COVID-19 pandemic has
More than ever, the current cri- in Canada continues to rise, one should be adopted well beyond due to fentanyl contamination. We highlighted health issues, but
sis demonstrates why preventive answer stands out: conditions in this pandemic. Science and data need to declare a national health they are unfortunately not new.
health care plans are best made in long-term care facilities. More than have been critical to understand- emergency to address the opioid Addressing the structural weak-
ordinary times, rather than in the 80 per cent of Canada’s COVID-19 ing how different communities crisis as a health-care issue, not nesses in health care, rather than
middle of a crisis with all the ad- deaths have been in long-term are impacted by the pandemic. We a criminal issue. Drug posses- merely reacting to each crisis as it
ditional pressures it brings. Health care, and Canada ranks second must collect socio-demographic sion should be decriminalized, arises, is the best strategy.
promotion and disease prevention amongst wealthy countries for the data in government-funded re- and users should have access to a Annamie Paul is the leader of
in times of stability are the best proportion of COVID-19 deaths search moving forward in order to screened supply and the medical the Green Party of Canada.
preparation for times of crisis or in long-term care facilities. This make evidence-based decisions on support they need to combat their The Hill Times
THE HILL TIMES | MONDAY, FEBRUARY 8, 2021 27
Policy Briefing Health
Why healthy aging must be the
upshot of the COVID-19 pandemic
In contrast to a common misperception, days of the pandemic inadvertently fuelled volunteer work. Those aged 65 and up
It would be in everyone’s best aging alone isn’t what sidelines older people— ageist attitudes. In its most extreme form, volunteered 223 hours a year, well above
frailty is. While aging is inevitable, frailty is not. some people wrongly concluded that the the national average of 156 hours. In 2012,
interest to focus now on ways Frailty is defined as a medical condition economy should not have to shut down just baby boomers and senior adults clocked
to prevent frailty by investing of reduced function and health; it becomes
more common as we age. Frailty increases
to prevent the virus from killing the eldest
members of society. After all, this demo-
one billion volunteer hours.
This informal support is a gift to commu-
in policies that ensure healthy vulnerability to disease, resulting in the graphic contributes the least, right? nities and is especially true in rural Canada
need for intensive and costly health-care From both a moral and economic stand- where the loss of a community-minded el-
aging for all Canadians. interventions. Today, 1.6 million Canadians point, this is a deeply flawed viewpoint. ders often leaves an unrepairable social gap.
live with some form of frailty. In 10 years, More and more, out of choice or In strictly fiscal terms, Canadians aged
it will be 2.5 million. necessity, healthy older Canadians are 65 and older also have money to spend.
Living within the guardrails of a pan- remaining engaged in paid labour beyond Many continue to benefit from earnings-
demic has aged everyone. And we are get- conventional retirement age. In 2010, 14 based retirement plans and other progres-
ting a glimpse into how the seeds of frailty per cent of people 55 and over were active sive senior-focused social and financial
are sown—through loneliness and isolation, in the labour force. By 2031, this number is policies launched in the late 20th century.
loss of structure and routine, mental and expected to rise to almost double. Older Canadians are an economic pil-
emotional stress, physical exhaustion, loss More recently, we also saw experienced lar, one that will crumble in the absence
of freedom and a sense of control, disrup- health-care workers risking their lives by of supports for healthy aging that enable
tions in eating and sleeping habits, weight coming out of retirement to work on the people to remain active and engaged in
gain, muscle loss and deferring routine front lines of the pandemic. their communities.
John Muscedere medical appointments to avoid the virus. The unpaid labour of this age-group The past year has been a valuable lesson
Opinion Our response to the global pandemic often goes unrecognized. A life of accu- on the importance of nurturing our func-
now, and in the coming years, should mulated skills and knowledge is poured tional ability, especially in older people. Let’s
include robust policies for healthy aging freely into raising funds for community turn insight into action. It would be in every-
L ast month, while the world was distracted by
political turmoil and the pandemic’s roaring
second wave, a very significant proclamation
which in large part are composed of strate-
gies to address these contributors to frailty.
Most COVID-related deaths in Canada to
projects and organizations, coordinating
events, caring for children in the absence
of childcare options, coaching sports and
one’s best interest to focus now on ways to
prevent frailty by investing in policies that
ensure healthy aging for all Canadians.
came and went with little fanfare.The United date have occurred in people over the age of passing knowledge and skills on to young John Muscedere is the scientific director
Nations General Assembly launched 2020-2030 70. It’s a glaring statistic—one that, left unfil- people. Or even worse, we sideline these and CEO of the Canadian Frailty Network
as the Decade of Healthy Ageing, calling for a tered, might prejudice people’s understand- skills by not putting in place ways that we (CFN) and a professor in the School of Med-
decade of concerted global action to extend the ing about this age group and its capacity. can better harness this experience. icine at Queen’s University and an intensiv-
health and well-being horizons of the world’s Persistent news coverage about the Statistics Canada reported that, in ist at Kingston Health Sciences Centre.
one billion people over the age of 60. vulnerability of older people in the early 2013-14, 36 per cent of seniors performed The Hill Times
WHY NOT
CHIROPRACTORS?
Hundreds of thousands of
Canadians rely on chiropractors
to assess, diagnose, and treat
spine, muscle and nervous In December 2018, the House of Commons
system conditions. This includes Standing Committee on Finance acknowledged this
back, neck, and knee pain, as oversight and recommended that the government
well as osteoarthritis. But unlike address it by amending the Income Tax Act.
other primary care providers,
chiropractors are not authorized Budget 2021 offers an opportunity to close this
to assess and certify the gap and streamline access for eligible patients.
Disability Tax Credit.
That needs to change.
28 MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES
Health Policy Briefing
Vaccination, trust in science and patience
is the only way out of this pandemic
As Canada's vaccine when they become eligible. We
nurses, we also urged governments across Canada to
want to speed up the rollout of the vaccine, espe-
encourage all cially to those most likely to experience
those living severe illness, such as seniors, Indigenous
in Canada people and racialized people—all of whom
to receive have been shown to be most at risk of
the vaccine infection.
as soon as Nurses have also signalled that they
they are able. are ready and willing to step up and help
Together, we the government with the vaccine rollout
can contain by joining health care teams at vaccina-
this virus, end tion clinics across Canada. While the news
the pandemic of some delays in delivery of the Pfizer
and take part vaccine may give us pause, governments
in Canada’s must strive to speed up the immunization
post-pandemic and rapidly increase the number of clinics
recovery, writes where the vaccine is available. This is how
Linda Silas. we will contain this virus and counter its
Image courtesy spread.
of Pixabay What’s also been lacking in Canada’s
vaccine delivery program is evidence-
based information. Within this vacuum,
misinformation, vaccine myths and mis-
trust have thrived. Sadly, many Canadians
are hesitant to get vaccinated, particularly
among marginalized communities who, we
recognize, have all too often experienced
negative interactions with the medical
community.
As nurses, we believe that any risk
posed by the vaccine is far outweighed
by the benefits in being protected from
COVID-19.
As with any other medical treatment,
informed consent is required. It’s our job,
We will need Canadians to as health professionals, to provide facts—
Novel roll up their sleeves and and yes, empathy—when patients express
concerns about being vaccinated. Every-
Diagnostics get vaccinated. But we will one who gets the vaccine must understand
the benefits of immunization, as well as
also need to be patient. any potential risks. All Canadians should
be empowered to make an informed deci-
Immunizing the country sion.
Some individuals have expressed con-
Therapeutics won’t happen overnight. cerns about the record turnaround time
It will be an incremental for these vaccines. Producing multiple
vaccines in less than a year was the result
process informed by science of a momentous global effort, harnessing
the ingenuity of a scientific community
and one that seeks to united in a common objective. Large-scale
trials on the efficacy of vaccines involved
Canada’s Vaccines immediately stem the loss tens of thousands of participants, includ-
ing many from diverse backgrounds. The
life sciences of life. trials resulted in high rates of protection
with few or no reported serious adverse
companies. events. Despite the compressed time-
lines, no shortcuts were taken: the same
standards were applied to these vaccines
Where discovering as for any other vaccines that have been
developed.
solutions essential to In Canada, we know the approval
process by Health Canada is safe and ef-
our health and economy fective; their assessment of scientific and
clinical evidence is done independently
is the new normal. Linda Silas
and is known to be stringent. We also know
that historically, immunization programs
Opinion have saved countless lives worldwide.
The COVID-19 vaccines approved thus far
The research Canada’s life sciences companies are doing is have the potential to provide much-needed
laying the groundwork for novel diagnostics, vaccines and A COVID-free future is within our reach,
a future where it’s safe to hug again
protection against the continued spread
of the SARS-CoV-2 virus but this will only
therapeutics. Canada has built an extraordinary knowledge and where our smiles no longer need to be
hidden behind a mask. To get there, we will
happen if sufficient numbers choose to be
vaccinated.
infrastructure, and we must not lose momentum in making need a robust vaccination drive. We will As Canada’s nurses, we want to encour-
need Canadians to roll up their sleeves and age all those living in Canada to receive
our country a global life sciences leader. get vaccinated. But we will also need to the vaccine as soon as they are able.
be patient. Immunizing the country won’t Together, we can contain this virus, end the
Get updates about our happen overnight. It will be an incremental
process informed by science and one that
pandemic and take part in Canada’s post-
pandemic recovery.
essential work at seeks to immediately stem the loss of life. Linda Silas is a nurse and president of
Earlier this month, the Canadian Fed- the Canadian Federation of Nurses Unions,
canadalifesciences.ca eration of Nurses Unions encouraged all representing nearly 200,000 nurses and
health-care workers, all essential work- student nurses across the country.
ers and the general public to receive the The Hill Times
THE HILL TIMES | MONDAY, FEBRUARY 8, 2021 29
Policy Briefing Health
What’s up (or down) with drug shortages?
portation of drugs that may not fully meet effectively legislating a rollback in income. a statement recommending several actions,
Our chronic shortages and regulatory requirements in order to protect The policy eventually melted away. including more domestic production.
the current vaccine situation supplies of threatened medications. Why
is the Canadian medication supply chain
Unlike more than 100 other countries,
Canada still does not have an essential
Our chronic shortages and the current
vaccine situation remind us to ask why
remind us to ask why must so fragile that we needed this stop gap
measure? Another interim order came in
medicines list (EML)—critical medications
for which the government is mandated to
must we be buffeted about by unpredict-
able shortages, originating elsewhere
we be buffeted about by late November 2020 to protect vulnerable protect supply, much in the same way as and often impacting well-established yet
stocks from American poaching the recent interim orders aspire to do. At critical products, the recipes for which are
unpredictable shortages, Without a national strategy for respond- least one Canadian team is working on neither secret nor protected. In the face of
ing to shortages, pharmacists initially resort- developing an EML, but the effort is not yet pandemic threats to our medication supply,
originating elsewhere ed to invoking the tried-and-true mechanism recognized by our government. Nor does Canada has shown it can take temporary
and often impacting well of restricting dispensed quantities to 30 days.
But they encountered outrage and political
Canada do much to understand the extent
and impact of shortages. It does not ana-
steps to protect our most critical medicines.
Shouldn’t we now move to properly and
established yet critical interference. Citizens, especially those out lyze the shortages, year-by-year, month-by- permanently secure our supply with a na-
of work, objected to paying extra dispensing month, or by type, to uncover whether or tional essential medicines list and revival
products, the recipes for fees and to the inconvenience and risk of not its feeble policy gestures are making of our own industry?
more frequent trips to the pharmacy. Some any difference. And, as the public has be- Jacalyn Duffin, MD PhD, is professor
which are neither secret nor provinces opted to cover the extra fees, but come painfully aware, Canada lost its own, emerita at Queen’s University, and Jon
protected. pharmacists were shocked when various
provincial governments intervened, ordering
once robust drug- and vaccine-making
capacity long ago. Even the Ontario Medi-
Pipitone, MD, MSc, is a resident in psychia-
try at Queen’s University.
an end to the practice or canceling extra fees, cal Association has exceptionally released The Hill Times
BY JACALYN DUFFIN & JON PIPITONE
W ith complaints and fears swirling
around COVID-19 vaccine supply, we
take up our devices once again to report on
drug shortages in Canada. When we last
communicated in Hill Times back in April
Mental Health and Economic Parity for Canada
2020, Canada had already spent a decade
facing severe shortages of prescription
drugs. We argued that COVID-19 might ex-
T
acerbate those shortages and, at the same
time, serve as a wake-up call to get to the
bottom of the problem. he COVID pandemic has exposed our vulnerability -- This past year, the pandemic has touched the lives of every
Alas, nothing much has happened. not just to the threat of emerging pathogens, but also single Canadian. Through this, we have witnessed global
Today, Canada reports more than 1,500 to our inability to face the threat while maintaining the suffering matched by rapid responses from governments
actual drug shortages. The good news is economic and mental health of our nation. around the world. This has also highlighted the lack of pre-
that this number is 400 fewer than last
Social workers see it every day: even prior to the COVID emptive action on behalf of Canada’s government to move on
April. The bad news is that no matter how
you look at it, it is still a shocking number, pandemic, the mental health of our nation was steadily the desperate need for universal economic and mental health
and worse, it is misleading. Our national declining -- and without visionary leadership by all political parity.
shortage database is woefully thin, as it parties, the road to recovery will leave many behind. The The Canadian Association of Social Workers (CASW),
doesn’t account for provincial, regional or
hospital-level shortages. We also wonder
time has come to stop reacting with short-term solutions alongside many of our colleagues from other health and
if the decline since April is more apparent and to make the permanent changes necessary to meet the social professions, are bitterly disappointed that the federal
than real. After all, in that same time, 197 challenges of this new normal. Canada must lead the world government has failed to provide the visionary leadership so
drugs were reported to be discontinued, by adopting a Universal Basic Income and legislating Mental many Canadians call for, and are dismayed -- and, frankly,
and 330 drugs were cancelled post-market. Health Parity, so we may not only recover, but thrive. mystified -- that the official opposition has not used this
If a drug is no longer on the market, it opportunity to present the kind of bold ideas required to actually
is not “in shortage”—it remains utterly Even at the best of times, it is illogical and ineffective to rely
on corporate Canada to lead the way on mental health. Long change conditions in our country.
unavailable. Additionally, over the last
two years, nearly a third of our shortages before COVID, cracks were showing in Canada’s piecemeal The time has come to no longer rely on corporate Canada
involve medications that we would deem and largely privatized mental health services: individuals to lead the way. To truly end stigma and the lack of access
critical or “essential”, priority medicines and associations, like ours, have been urging the federal to mental health services, the Government of Canada, in
needed for effective function of a basic
government to make change. collaboration with all national political parties and Indigenous
health-care system: items such as antibiot-
ics (cefalexin, amoxicillin), common heart And now, COVID has only intensified the existing ‘shadow leaders, must lead the way and champion mental health and
medications (amlodipine, ramipril, can- pandemics’ of skyrocketing opioid-related deaths, escalating economic parity.
desartan). These individual shortages are domestic and intimate partner violence, and growing income
numerous and long-lasting.
inequality. Social Workers have consistently called for a
Early in the pandemic, Canada did ex-
perience temporary shortages of drugs for Universal Basic Income and for Mental Health Parity in Canada
managing COVID-19 symptoms and ICU because they know how gaping the holes in our ‘safety net’
patients needing intubation—epinephrine, really are. Now, they are witnessing, and experiencing first
midazolam, propofol, phenylephrine, etc. hand, the compounding effects of the COVID pandemic on
And like the hydroxychloroquine example their clients’ and their own families and communities.
of last spring (when Donald Trump’s
evidence-free claims spawned panic buy- Mental Health Parity requires creating a system that supports
ing and shortages for those who relied on mental health care equal to physical health care. Adopting
it), shortages have emerged in Canada (and Mental Health Parity right now will force the system change
elsewhere) for every remedy, old or new, required to support the long-term recovery of our nation with
thought to be helpful in the pandemic: rem-
the same urgency and resources as we have for physical
desivir, dexamethasone, ivermectin and os-
eltamivir. Possibly we’ll soon see the same health.
for the ancient gout treatment, colchicine,
recently reported effective by researchers
at the Université de Montreal.
Numerous American and European
studies have documented the negative
Joan Davis-Whelan,
impact of shortages on patient outcomes
and health-care budgets. But the reasons MSW, RSW
for shortages, according to manufacturers, President
reveals a pattern, dominated by manufac-
turing disruptions, that has gone basically Canadian Association
unchanged during the pandemic. of Social Workers
In March 2020, the minister of health
signed an interim order to monitor poten-
tial and actual shortages and allow im-30 MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES
Health Policy Briefing
If the disaster and sustain the data analytics
that has infrastructure needed to lever-
befallen long- age AI. Believe it or not, patients
term care in who go to these hospitals already
Canada during benefit from the use of data ana-
the COVID-19 lytics tools that aren’t available
pandemic elsewhere.
has taught us It may surprise some to learn
anything, it is there are hospitals where AI is
that we must already in use. These are research
demand greater hospitals though, so we should
oversight and expect that they will take risks
accountability as they try to innovate. What we
in health care, need to focus on now is ensuring
particularly that these AI tools can be equi-
when already tably integrated across different
disadvantaged sites. Failing to ensure equitable
communities access to these tools that can help
might be us to personalize health care will
impacted by only serve to exacerbate already
our decisions, existing inequalities.
writes Ian Because we do not yet have
Stedman. Image an explicit regulatory pathway in
courtesy of place, health-care AI in Canada
Pexels.com is being developed and deployed
in an ad hoc, site-by-site man-
ner. Hospitals are taking it upon
themselves to determine what
AI is needed and how to conduct
fairness assessments, mitigate
risk from bias, ensure equitable
access, demonstrate accountabil-
ity to stakeholders, integrate AI
tools into care, and generally earn
the public trust needed to deploy
AI in the hospital.
Recognizing that a laissez-
fair approach to health-care AI is
inadequate, a task force convened
by CIFAR published a report
in July 2020 called, “Building a
Learning Health System for Ca-
nadians.” In this report, the task
force calls for the development of
a national strategy and a “col-
laborative vision for AI for health
Maybe artificial intelligence
in Canada.” A national strategy
is needed to address things like
inter-provincial data sharing,
ethical protocols for developing
and deploying AI, and consen-
will drastically change health
sus frameworks that can help
accelerate the design of regula-
tory standards in order to ensure
accountability for how healthcare
AI is implemented. Meaningful
care, but who will benefit?
oversight could also help us focus
on ensuring that healthcare AI is
deployed across many different
sites, rather than only being able
to benefit patients at a select few
hospitals.
If the disaster that has befallen
privacy, but if governments want printing, and genome editing. The long-term care in Canada during
Our federal and provincial governments taxpayers to buy in to the great question should no longer be if, the COVID-19 pandemic has
hope of an advanced AI economy, but how can we use AI to help us taught us anything, it is that we
have proven they can unite around issues of then they also need to be clear effectively and equitably person- must demand greater oversight
about what that economy might
national importance in health care and they look like and how Canadians
alize our health-care systems?
To build a personalized health-
and accountability in health care,
particularly when already dis-
must do so again if we are going to have any stand to benefit. The content of
our modernized privacy laws will
care system we will need to
collect, store, and analyze more
advantaged communities might
be impacted by our decisions.
chance of AI playing the role many believe it send clear signals about where data than we ever have. Not just It is not good enough to allow
our governments think AI has the patients’ personal health infor- health-care AI to develop in what
can in helping us move toward personalized most potential to benefit society. mation, but also data about how is effectively a leadership and
At present, the idea that AI socio-economic factors can have regulatory vacuum. Our federal
health care. has the potential to improve our an impact on patient experiences and provincial governments have
everyday lives is perhaps most and health trajectories. We will proven they can unite around
the country’s economic future. widely acknowledged within the also need to make deeper invest- issues of national importance
Major investments have attracted health-care space. We have long ments into building and sustain- in health care and they must do
more computer scientists to our heard from people affected by ing the infrastructure, the talent, so again if we are going to have
post-secondary institutions and rare diseases, for example, that the tools, the policies, the regula- any chance of AI playing the role
have benefitted the private sector we need a more personalized tory oversight, etc., needed for many believe it can in helping us
by opening up a growing pool of approach to health care because a personalized, learning health- move toward personalized health
AI talent. If we want to build this one size does not in fact fit all. care system. care.
data-driven economy in a respon- By using AI in health care we But did you know that artifi- Ian Stedman is an assistant
sible manner, however, then we will be better able to predict and cial intelligence is already being professor of Canadian public law
also need to protect Canadians by prevent disease, to make quicker used in some Canadian hospitals? & governance in the School of
Ian Stedman modernizing our information and diagnoses, to understand disease Many computer scientists Public Policy and Administration
Opinion privacy laws. progression and even to discover who were inspired to pursue an at York University. He also serves
But as we move to strengthen new therapies that could improve education and build their career on York University’s Artificial
our privacy laws, we must also patient outcomes. It may also in Canada are working in labs Intelligence & Society Task Force
G overnments across Canada
have signalled that they
believe artificial intelligence
pay close attention to the impact
those strengthened laws have on
AI innovation. We should not pri-
be possible for AI to operate in
conjunction with other new and
emerging technologies like DNA
that are connected to research
hospitals. Some of these hospi-
tals also have foundations that
and sits as a legal member of the
research ethics board at the Hos-
pital for Sick Children in Toronto.
will play an important role in oritize unbridled innovation over sequencing, gene therapy, bio- are fundraising in order to build The Hill TimesTHE HILL TIMES | MONDAY, FEBRUARY 8, 2021 31
Policy Briefing Health
Aging? What’s to be done?
much less expensive health-support services nomic circumstances, continuing with the
The pandemic is exposing needed to meet the needs of most seniors. same policy choices defies comprehension.
That Canadians are living longer is good First, as COVID-19 has made clear, care-
many cracks in Canada’s news. What’s not to like about living to a ripe homes are both expensive and dangerous
already porous seniors’ care old age provided you can age well—happily
settled in housing appropriate to your needs,
places; some 80 per cent of deaths in the first
wave in Canada were in LTC-homes. Second,
system. We don’t have much with a stimulating social life with old friends they are not where our senior citizens want
and new, where you can pursue an active, to be. Third, the numbers make it clear that
time to fix the problem, so lifestyle, and have available the reliable sup- continuing with our warehousing propen-
port and care needed to maintain the activi- sity is just not on; the care-home beds that
we better get started. ties of daily living and robust good health? would be required is simply beyond what we Minster of Seniors Deb Schulte, pictured on the
The problem is that it is not easy to meet could afford. And fourth, adding together the Hill on Sept. 25, 2020, is tasked with working with
those provisos in Canada. Relative to many capital and ongoing operating cost of institu- provincial and territorial governments to manage
other countries, notably Japan, Denmark, tional accommodation and care to the resi- long term care issues stemming from the pandemic.
and others noted for enabling seniors to age dents, their families, and to the public purse, The Hill Times photograph by Andrew Meade
happily and well, Canada and its provinces exceeds by far what it would cost to provide
and territories do not score well. We spend an extended range of seniors’ needs through the 2017 budget in which it was proposed to
far less on long-term care overall and dis- beefed-up home and community support invest $6-billion over 10 years for home care
proportionally much more on institutional services. That will be expensive too, but it’s and the fall 2020 fiscal statement with its
($6) than on home and community ($1) care, an approach that would both help seniors offer under conditions of $1-billion between
the reverse of comparable ratios in Den- age well, certainly better than at present, and this year and next for long-term care. The
mark and other leading nations. There, the one that our country could afford. provincial and territorial governments at
Don Drummond & Duncan Sinclair predominant policy thrust is not to institu- What do we need to do to get to it? the very least have to refocus their policy
Opinion tionalize or, crudely,“warehouse” seniors, but Governments have to work together, objectives from institutionalization to ageing
to facilitate their “aging in place.” Canadian federal, provincial and territorial, and in place and work with one another and the
seniors, like others, strongly prefer to retain municipalities, given latter’s funding of federal government, with the provinces and
S ome 60 years ago, about the time the last
of the baby boomers were being born,
people over 65 made up about 7.5 per cent
their independence and to age in place for
as long as possible in their own homes and
communities with the support of an ex-
so many community services out of the
property tax base and the charitable giving
of the residents.
territories, on the development of appropriate
national standards and with municipalities on
their implementation and enforcement.
of Canada’s population. Now they are 17.5 panded range of home care and community Solutions and their implementation are And we have to hurry! The problem is
per cent and will be nearly 25 per cent (10.8 support services with which they are familiar primarily under provincial and territorial real, here right now, and time is short.
million) in twenty years. And they are living and comfortable. Ironically, meeting their ownership, apart from our Indigenous com- Don Drummond is the Stauffer-Dunning
longer. Currently the fastest growing cohort preferences would be much cheaper for both munities where the feds are on the hook. The Fellow at Queen’s University. He is a former
are centenarians, people over 100. Soon the the affected seniors and for the public purse; federal government must decide what role senior official at Finance Canada and the
majority will be 75 and over, at ages when daily care in a hospital costs upwards of $850 it wants to carve out in facilitating a coor- chief economist at TD Bank. Duncan Sinclair
the manageable but incurable chronic dis- to $950, in an LTC-home $150 or more, and dinated response to a problem that is both is an adjunct professor and distinguished fel-
eases of old age make necessary more costly with support and care at home about $45. bigger and will extend well beyond what was low at Queen’s University and a member of
and frequent hospitalizations and physi- Given the still building wave of aging foreseen in the 2015 election platform and the Canadian Medical Hall of Fame.
cians’ services, health care as opposed to the seniors and the Canada’s foreseeable eco- its promise of $3-billion over four years, and The Hill Times
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Health Policy Briefing
Pandemic exposing critical gaps parliamentary standing commit-
tee recommended a designated
health workforce agency, and this
call was endorsed across all par-
in health workforce planning
ties and by several stakeholder
organizations that provided
testimony to the committee. Since
then, almost nothing has hap-
pened on this front.
the population. Increasingly, human resource. We need to ad- in older adult care and mental The absence of central coor-
Burnout was far health workers are significantly vance health workforce science in health care—two sectors heavily dination and implementation of
reducing their hours worked, Canada now. impacted by the pandemic.
too common in the just to cope, or leaving their jobs Canada lags behind compa- What we need are a standard
integrated health workforce data,
analytics and planning activities,
healthcare workforce altogether.
That was before the pandemic.
rable OECD countries, including
the U.K., Australia and the U.S.
set of data across a broader range
of health workers in support of
combined with diffuse governance
responsibilities inherent in a fed-
before the pandemic. With COVID-19, we are witness- on big data analytics and a digital inter-professional and inter-juris- erated health system leave us with
ing levels of stress, overload and research infrastructure that dictional planning. blurred lines of responsibility and
COVID-19 has made burnout among health workers would give us vital information Ideally these data would be poorly coordinated efforts.
previously unimaginable. for health workforce planning. collected uniformly, include diver- Other countries have managed
it much worse. Poor Downstream responses of Significant gaps in our knowl- sity (racial, Indigenous and more to overcome these challenges.
mindfulness and free access to edge have caused serious system-
health workforce psychotherapy, albeit helpful, ic risks for planners to manage
inclusive gender identity), and
address practice characteristics
Now that the pandemic has made
the need crystal clear, Canada no
planning is to blame. are at best band-aid solutions.
We have to look upstream to the
during this health crisis.
Absent timely and relevant
(e.g., setting, scope and service
capacity). These data should
longer has any excuse.
The federal ministers of health,
source of the crisis. health workforce data, decision- also be linked to relevant patient labour, and innovation need to
Health worker burnout is makers cannot optimally deploy information, including healthcare make the health workforce data
directly linked to poor health health workers to where, when utilization and outcome data. infrastructure a top priority. The
workforce planning. That we and how they are most needed. As Robust data would allow us to pandemic may be the impetus
continue to operate our health a result, health workforce plan- better understand the range and that enables us to make necessary
system blindfolded to very basic ning activities across Canada re- characteristics of health workers significant advances in health
data about our systems key main ad hoc, sporadic and siloed, caring for patients, the types of workforce data infrastructure.
resource—its health workers—is generating significant costs and care they provide and the out- We need to stop simply clap-
remarkable. inefficiencies. The consequences comes experienced by patients. ping our hands in support of
Health workers account for include everything from sub-opti- Right now, we are making deci- health workers—and start plan-
more than 10 per cent of all em- mal health workforce utilization sions in the dark, without using ning to create better workforce
Ivy Lynn Bourgeault ployed Canadians and over two- and poor population health out- essential data that most other de- conditions for them. Let’s make
Opinion thirds of all health care spending, comes to health worker burnout. veloped nations have had for years. improved health workforce sci-
not including the personal and What data do we have? So how do we get there? ence in Canada a key legacy in
public costs for their training. The data we have are profes- Canada needs a more robust support of our health care work-
H ealth workers in Canada
experience endemic levels
of burnout directly related to
This amounts to $175-billion
(2019) or nearly eight per cent of
Canada’s total GDP.
sion-specific and say little about
how health workers function
as teams in ‘real world’ patient
and centrally coordinated health
workforce data, analytics and sci-
ence infrastructure. This would ad-
ers.
Dr. Ivy Lynn Bourgeault is a
professor of sociological and an-
understaffing and work overload. Health workforce science— care pathways. The data are also dress a critical gap that has held us thropological studies at the Uni-
Leaves of absence from work for and the data research infra- collected differently by various back, and which has become only versity of Ottawa and the lead of
mental health and stress related structure necessary to support stakeholders, so are not easy more apparent, since COVID-19. the Canadian Health Workforce
issues are 1.5 times higher among it—is critical to making the best to analyze across jurisdictions. We can’t claim to have been Network.
health workers than the rest of decisions about this essential Notable absences are workers blindsided. Already in 2010, the The Hill Times
Vaccines give long-term care crisis a brief more than just an ask for “nice
things to have.”
Rather these calls foreshad-
reprieve, but cannot stand as the solution
owed the reality we know today,
that we have been playing a
dangerous game of Jenga in the
care of our older citizens within
As we do in the aftermath of Ontario patients’ ombudsman, the long-term care sector. In defi-
Returning to normal cannot be an option because any disaster, we seek emergency Nova Scotia’s first wave review, ance of evidence, we continue to
relief. In this case, relief arrived Quebec’s ombudsman report. undervalue care work, maintain
the normal we operated within in delivering long- in the form of a vaccine—which The list goes on and the refrain is outdated staff levels and models,
term care was not only unjust, but unsustainable. has prioritized long-term care
residents to be among the first
consistent.
The reports’ call to immediate-
ignore sector pleas for support
while continuing to add more
The vaccine is a reprieve, a gift that will step in to recipients. To be clear, vaccines ly address staff needs—including stress and pressure by admitting
are an absolute necessity, but we more direct care staff, increased higher acuity residents , relying
protect older Canadians after we failed to live up cannot fool ourselves into believ- training, better pay, stronger fo- only on a whim and a prayer that
ing they will address the horren- cus on recruitment and retention, the whole thing won’t crash to the
to the job; but it is just that, a reprieve. dous shortfalls we bore witness to and mental health support. ground.
throughout the pandemic. The reports’ highlight the sig- The façade has indeed
our current challenges in long-term Vaccines are not the panacea nificant gap in mandatory infec- crumbled.
care (LTC) in Canada,” I noted in that will fix the long-term care tion control and prevention prac- Returning to normal cannot
that opinion piece.“It is the cumula- system; yet, I worry we will tell tices, the need for comprehensive be an option, because the normal
tive effect of years not prioritizing ourselves it is. plans to prevent and to manage we operated within in delivering
resources to support quality of life SALTY (Seniors Adding Life to infectious disease outbreaks, as long-term care was not only un-
for older residents. Consequently, Years), a research initiative I lead well as access to supplies (PPE just, but unsustainable. The vac-
LTC is not prepared for or equipped alongside some of Canada’s most and safe work). cine is a reprieve, a gift that will
to meet the complex care realities of acclaimed researchers and aca- In addition, the Royal Society step in to protect older Canadians
today’s and tomorrow’s residents.” demics, has evidence on how we report and others have called for after we failed to live up to the
In reading this today, after we can improve the quality of life of the development and implemen- job; but it is just that, a reprieve.
Janice Keefe have seen what we have seen, long-term care residents. Moreover, tation of national standards in “LTC is not adequately pre-
Opinion these words relay an eerie premo- I was privileged to work on the LTC, as well as allocating addi- pared or equipped to meet the
nition of the chaos and havoc that Royal Society of Canada’s report tional, and targeted, LTC fund- complex care realities of today’s
would soon rage through long- ‘Restoring Trust: COVID 19 On ing to provinces to execute the and tomorrow’s residents.” I said
T his time last year, I had the
great privilege of authoring
another editorial for The Hill
term care residences from one
coast to another.
I would argue that for most
the Future of Long-Term Care in
Canada,’ which provided thorough
recommendations on how we can
recommendations above.
There should be no doubt that
this collaboration among govern-
this a year ago, and I will repeat it
again today.
Changing this truth is entirely
Times in an effort to amplify the people reading that piece, there address the gaps in how we ap- ments is needed. up to us and the policy decisions
call for change within our na- would be tacit agreement to the proach care for older Canadians in To date, over 70 per cent of we must be bold enough to make.
tion’s long-term care sector. Like position I was asserting. I am both the short and long-term. COVID-19 fatalities have taken Janice Keefe is professor of
others, I struggle to reflect back equally as confident that this base These recommendations have place in our long-term care facili- family studies and gerontology,
on the relative innocence of 12 acknowledgement in no way pre- been followed by countless other ties. This reflects the precarious the Lena Isabel Jodrey Chair in
short months ago, in the “before pared Canadians for the horror reports, a number of them written state of the sector in Canada, Gerontology and director of the
times” of the pandemic. that was about to unravel when as part of provincial inquiries and that the calls to action being Nova Scotia Centre on Aging at
“The sheer number of individu- the pandemic made a landing in conducted following the first repeated like a broken record Mount Saint Vincent University
als turning 65 is not the cause of these long-term care facilities. wave of COVID-19, including: the by advocates such as myself are The Hill TimesYou can also read
