Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue No. 53 - Evidence - February 21, 2019
Ottawa, February 21, 2019
The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill S-252, Voluntary Blood Donations Act (An Act to amend the Blood Regulations), met this day at 10:30 a.m. for consideration of this bill.
Senator Chantal Petitclerc (Chair) in the chair.
[Translation]
The Chair: Hello and welcome to the Standing Senate Committee on Social Affairs, Science and Technology. I am Senator Chantal Petitclerc, chair of this committee.
[English]
Before we hear from our witness, I invite my colleagues to please introduce themselves, starting on my right.
Senator Seidman: Judith Seidman, Quebec.
[Translation]
Senator Poirier: Welcome. Rose-May Poirier from New Brunswick.
Senator Forest-Niesing: Hello and welcome. Josée Forest-Niesing from Ontario.
[English]
Senator Ravalia: Mohamed Ravalia, Newfoundland and Labrador.
[Translation]
Senator Mégie: Hello. Marie-Françoise Mégie from Quebec.
[English]
Senator Manning: Fabian Manning, Newfoundland and Labrador.
Senator M. Deacon: Marty Deacon, Ontario.
Senator Dasko: Donna Dasko, Ontario.
Senator Omidvar: Ratna Omidvar, Ontario.
[Translation]
Senator Munson: Jim Munson from Ontario. I live in Ottawa.
The Chair: I want to welcome our guests. Today we are resuming consideration of Bill S-252, Voluntary Blood Donations Act (An Act to amend the Blood Regulations).
[English]
I would now like to introduce our witnesses. We have, by video conference from Toronto, Dr. Monika Dutt, Board Member of the Canadian Doctors for Medicare. We also have Madam Linda Silas, President of the Canadian Federation of Nurses Unions; and Madam Amanda Vyce, Senior Research Officer for the Canadian Union of Public Employees.
Welcome. I remind you that you have seven minutes for your opening remarks. It will be followed by questions from our colleagues. Let’s begin with Dr. Dutt on video conference, who will be followed by Madam Silas and Madam Vyce.
Dr. Monika Dutt, Board Member, Canadian Doctors for Medicare: Thank you very much.
[Translation]
Hello, everyone. It is an honour to be here today. Thank you for the opportunity to appear before the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I am glad to have the opportunity to present on Bill S-252, the proposed voluntary blood donations act. I’m sorry not to be there in person.
I am here today to present on behalf of Canadian Doctors for Medicare, or CDM, where I am both a board member and past chair. CDM is a national non-profit organization that supports universal, evidence-informed, publicly funded Medicare and represents doctors from coast to coast to coast.
I have worked as a family physician in communities across the country, from downtown Toronto; to rural and remote areas; to northern Ontario, where I live now; and also on several First Nations. I am also a public health physician and medical officer of health, where my job is to support and create policies that improve the health of both individuals and communities. All of that background is why I am glad that the issue of paying for plasma has come to your attention and why I support the proposed amendment to the regulations. There are four main reasons for that support.
Firstly, as a physician working within the public system and a board member of CDM, I am often asked to explain the fundamental importance of our universal single-payer public health care system and why the creation of a two-tiered system would put both the equity and quality of the care at risk. I look at the issue of voluntary blood donations and the decision before this committee of whether to allow the bill aimed at protecting Canada’s blood supply to move ahead and cannot help but see the parallels.
Most strikingly, there are fundamentally different institutional objectives between private for-profit companies, for example, such as Canadian Plasma Resources and Prometic Plasma Resources on the one hand, and non-profit organizations, such as Canadian Blood Services on the other. The business models of for-profit companies, like CPR and Prometic, are based on sales and revenue, while Canadian Blood Services base their plans and strategies on patients need and the security of our nation’s blood supply. Given that Canadian Blood Services has already put forward a strong business case for expanding voluntary blood donations significantly, it is unclear why such effort is being put into allowing for profit, pay-for-plasma companies to expand, particularly when their operations do not benefit Canadians.
Additionally, the beauty of universal systems is they allow for both management and change on a broad scale. Conversely, for-profit companies, such as CPR, are not managed by the public system. For example, if they find one of their clinic locations is not performing as they would like it to, they could simply close up shop, just like any Starbucks or any other franchise. Then what happens to those donors, some of whom may have become reliant on that income? How would this affect the supply of immunoglobulin and plasma-derived products for patients?
Additionally, when you create a new culture of being paid to sell your blood, it changes how people approach donating. Many European countries have experimented with paid plasma donations and are now trying to revive their public voluntary donation base and are finding it difficult. We’ve already seen the potential loss from the public system to the private in Saskatoon, particularly in the 17- to 25-year-old age group who may be more motivated by a need for quick income. The long-standing practice in Canada of paid plasma sites being situated, as well as in the U.S, near people at greater risk of low income or poverty, such as students or people living in shelters, also highlights disturbing approach that can occur when profit is a major factor.
With the introduction of unnecessary market competition from companies like CPR and Prometic, Canadian Blood Services now has to spend valuable resources advertising to distinguish threats from these companies. Those resources could be far better spent on public education and outreach on the importance of donation or research or other critical work in managing Canada’s blood supply. Our national blood supply should be considered a strategic resource. As a nation we should be looking at how to augment our self-sufficiency within the blood system.
Another aspect I think about often as a physician is the health care provider’s responsibility to ensure the appropriate treatments are being prescribed. More and more in medicine there is a push to minimize unnecessary interventions, both because it is better for patient care and because there are financial implications for the public health care system. As described by the expert panel on immunoglobulin product supply and related impacts in Canada:
. . . a significant proportion of IG use falls outside established criteria and guidelines.
Before further facilitating paid donations of plasma in Canada, we need to better understand use patterns and whether changes in practice can also help address the demand for plasma products. Just as doctors are now more conscious of prescribing fewer antibiotics or decreasing exposure to unnecessary radiation through imaging, we can look at how we can best use immunoglobulin and plasma-derived products to benefit patients.
Lastly, I’d like to touch briefly on safety considerations. As we all know, after the tainted blood scandal where over 30,000 Canadians were infected HIV and Hepatitis C. The Krever inquiry said that donations should be not be paid “except in rare circumstances.”
As well, the World Health Organization has also indicated that countries should aspire to 100 per cent voluntary blood and plasma donations. Thanks to steps taken based on the Krever Inquiry, Canada has had a strong blood safety record over the past 20 years, largely due to the actions of Canadian Blood Services.
We know that novel blood-borne pathogens can emerge and we must remain vigilant. Fragmenting the blood donation process and introducing a profit motive will limit our ability to prepare for potential risks.
In conclusion, we know that much can be done to promote and maintain the health of Canadians within our publicly funded health-care system. This includes ensuring access to immune globulin and plasma-derived products through a publicly funded institution. Doing so allows greater stability in our supply, more oversight over safety, and strengthens our capacity to meet patient needs. Given these considerations, I hope that you will decide to pass the bill. Thank you.
The Chair: Thank you very much.
Ms. Silas.
Linda Silas, President, Canadian Federation of Nurses Unions: It’s the first time I have appeared in front of you since you were debating Bill C-211, the PTSD framework bill. I want to thank you on behalf of the workers that Amanda and I represent for your observation note to include further than first responders. That was great.
Thank you to all the senators for inviting me here to attend on behalf of the Canadian Federation of Nurses Unions, which represents close to 200,000 working nurses and nursing students across the country. As stated, I’m Linda Silas. I’m President of CFNU and a registered nurse from New Brunswick.
Each and every day, nurses witness the need for Canada’s blood system. As we speak, nurses are working across the country to collect blood donations from volunteer donors, nurses are providing life-saving transfusions and caring for the tens of thousands of Canadians still suffering from infection contracted from the tainted blood three decades ago. Canada’s nurses know that blood products are not just another commodity to be bought and sold. They are scarce and difficult to collect. They save lives every day. When handled carelessly they can ruin and end lives. As health professionals on the front line of Canada’s blood system, nurses know that help, not profit, must be the only bottom line for our blood system. There’s a saying I heard recently in public health circles. The saying goes: Public sector delivers human rights while the private sector delivers commodities.
This sums up the questions before you on this bill. If you believe that access to safe blood products in Canada is a human right, then you must support Bill S-252. Because health care, education, democracy, and human — only the public sector can deliver human rights. Only a public system is exclusive and motivated to deliver blood products in the public interest. Only a public system can honestly claim that safety is paramount priority.
According to the UN Office of the High Commissioner of Human Rights, the right to health care is a fundamental part of our human rights and our understanding of life and dignity. As a signatory to the international convention, Canada is legally obligated — and I repeat — legally obligated under international human rights laws to treat the right to health as a fundamental human right. Having access to a safe and secure blood supply cannot be separated from the fulfillment of a person’s right to health.
There is no doubt that managing our blood system and ensuring its safety are complex issues. As nurses working within the system, we know this very well. The question before you today in Bill S-252 is not about that. The question is simple: Should Canada’s blood supply be treated as a human right or should it be treated as a commodity? This is the only question that this committee needs to answer in this legislation. As clinics such as those with the Canadian Plasma Resources that treat blood plasma as a profit-making commodity continue to pop up across Canada, you have a choice and a responsibility to stop it.
You have within this bill the legal tool to ensure that Canada treats our blood supply as a public resource and as a human right. As Dr. Dutt mentioned, this is what was recommended in the Royal Commission of Inquiry on the Blood System in Canada, the Krever inquiry. This is what motivates the Governments of Quebec, Ontario, Alberta and B.C. to pass their own voluntary blood donations act. This is why you must support this bill.
In previous meetings some of you asked whether we need profit-making blood companies to improve Canada’s self-sufficiency in IG protein, which are so central to our immune system. It is Canada’s nurses’ response that the path to increase our domestic supply is only achievable through the publicly accountable Canadian Blood Services. The plasma CPR buys from Canadians does not return to Canadian patients. Every Canadian who decides to sell their plasma to CPR is a potential blood or plasma donor lost to Canadians in need. As you will hear, Canadian Blood Services, our public agency, has ambitious plans to increase our supply, and this is where we should be spending our energies. Canada’s nurses say, let’s keep our blood system in the hands of the public.
On blood policy we must be guided by the evidence. The World Health Organization states: Unpaid blood donors are the safest group of donors. This position is supported by many other experts who do not have ties to profit-making interests, including the European Blood Alliance and Canada’s own Krever inquiry into tainted blood.
Bill S-252 provides Parliament with the pathway to uphold this WHO and Krever recommendation. Whatever the question, I urge you not to lose sight of the central issue. The blood of Canadians must not be for sale. Access to safe, secure blood supplies is a human right. Only the public sector can deliver that right. By supporting Bill S-252 this can be achieved.
Before I finish, I’d like to raise for the record one of my concerns of fair process of this committee. I have attended many parliamentary committee hearings and I have never known any committee to offer a key witness a question and answer period and not an opportunity to deliver an opening statement. It appears exactly what this committee has done with BloodWatch, Canada’s leading national advocate for a safe blood system. For the sake of due process and fairness, I invite the committee to reconsider its decision and offer BloodWatch at least the opportunity to provide an opening statement. Thank you.
The Chair: Thank you very much for your comment.
Amanda Vyce, Senior Research Officer, Canadian Union of Public Employees: I would like to thank you for allowing me to speak today in support of Bill S-252.
The Canadian Union of Public Employees, or CUPE, is Canada’s largest union with over 680,000 members. CUPE represents Canadian Blood Services workers in British Columbia, Alberta, and New Brunswick. They connect our country’s volunteer blood donors to Canadian Blood Services and help to ensure the country’s blood supply is safe.
CUPE recommends that the Senate support Bill S-252 because it will promote national self-sufficiency and ensure that Canadian blood remains a public resource for use by Canadian patients. Crucially, Bill S-52 will protect our publicly accountable and safe blood system that Canadians have come to trust.
Canadian Blood Services collect enough plasma to meet 17 per cent of the country’s need for immune globulin, or IG. The remaining plasma that’s needed is sourced from the United States. Health Canada granted licences to Canadian Plasma Resources under the false pretense that private, for-profit plasma clinics would boost our plasma self-sufficiency. However, the clinics do nothing to help us achieve this goal because the plasma they collect is sold to buyers in foreign markets. Introducing payment for plasma has also made it more difficult for Canadian Blood Services to recruit voluntary donors in Saskatoon and Moncton, especially among the 17-to-24 age group, which consists of the most desirable donors. The cases of Hungary, Germany and the United States show that when the civic-minded culture of voluntary, unpaid blood and plasma donation is lost, you cannot get it back.
Canadian Blood Services informed Health Canada that its plasma expansion plan does not include purchasing the plasma collected by Canadian Plasma Resources or other commercial sources because it’s:
. . . not reasonable or a sustainable mechanism to ensure a safe supply of IG for Canadian patients.
Without Bill S-252, Canadian Blood Services will lose control over the collection of plasma as well as control over the supply, safety and cost of plasma to Canadian Plasma Resources and other private companies.
Canadian Blood Services has built a safe blood system over the past 20 years that Canadians trust. Allowing that system to be sold and eroded by private shareholder interests won’t safeguard our blood system or the public interest. Pharmaceutical companies are not in the plasma industry for altruistic reasons or to save lives. They’re in it for the money. It’s possible to increase plasma self-sufficiency through unpaid voluntary donations. Between 2013 and 2018, Héma-Québec increased Québec’s plasma self-sufficiency from 14.5 to 21.5 per cent. The rate of self-sufficiency in France is 54 per cent, in Denmark it’s 81 per cent and in Italy it ranges between 70 and 96 per cent for all IG-based products. In all cases, plasma is collected publicly and solely from unpaid voluntary donors.
Their success is attributed to three simple key measures. First, each blood authority educates the public about plasma donations. Second, they find that when people are asked they are willing to donate. Third, they are focused on providing high-quality service to build and retain the donor base.
CUPE is confident that Canadian Blood Services can similarly increase Canada’s plasma self-sufficiency within our existing public, unpaid and voluntary donation system. Our members are ready to support their efforts. Countries across Europe are making self-sufficiency through unpaid voluntary donations a common strategic objective. Allowing private for-profit clinics into our blood system takes Canada in the opposite direction.
Finally, Canada’s dependence on plasma sourced from the United States poses a safety risk to security of supply and is not viable in the long term. There is a significant risk that the plasma supply could be disrupted or cut off due to production failures, regulatory actions taken by the United States — such as an America-first policy — or contamination from an emerging pathogen. If this happens, Canadian patients won’t be able to access needed treatments.
The threat posed by new pathogens that could enter the blood supply is real. A new infectious pathogen that causes chronic wasting disease, or CWD, has entered the deer family in Alberta, Saskatchewan, Québec, the Midwestern United States, countries in Europe and South Korea. There is no cure for CWD. It’s fatal to infected animals. Current research on macaque monkeys and mice shows the pathogen that causes CWD could cross the species barrier and impact humans through the consumption of contaminated agricultural products or meat that has been contaminated caught by hunters. There is no test to detect and no means to inactivate or destroy the pathogen if it enters the supply of blood and plasma, much like the case of HIV in the late 1970s and early 1980s.
To protect the safety of supply we must be prepared for the emerging threat CWD poses. Legislating a national ban on payment for plasma is therefore necessary to avoid incentivizing high-risk donations that may irrevocably contaminate the plasma supply while we lack any safeguards against CWD. If we focus on increasing our national self-sufficiency through unpaid voluntary donations, we’ll reduce the risk of a supply shortage because our system won’t rely on plasma sourced from the United States and will ensure the blood supply is safe by encouraging the collection of plasma from the safest donors, those who are voluntary and unpaid.
Thank you very much.
The Chair: Thank you very much. We will proceed with questions from the senators. I remind all the senators that we have five minutes for questions and answers. Please direct your question to who you want the answer from and not forgetting our dear guest via video conference.
Senator Seidman: Thank you very much for your presentations.
Yesterday at our hearings we heard from patient organizations, not necessarily private industry. Patient organizations. The Canadian Immunodeficiencies Patient Organization and the Network of Rare Blood Disorder Organizations. They were very concerned about this legislation and the risk to their supply. What we heard yesterday is that plasma now being collected from the unpaid volunteer Canadian donors is down to 14 per cent. In 2016-2017 it was at 17 per cent but now it is down to 14 per cent and it is projected by 2021 to be down to 10 per cent.
Based on your research, how would you see Canada meeting the demand? Even if you look at Québec — people are saying look at what’s happening in Québec — the fact is, yes, Québec has supported Green Cross to establish a fractionation plant and will supply and export therapeutic plasma-derived products, but we know that Héma-Québec has agreed to purchase manufactured immunoglobulin products. Right now we’re bringing in plasma products from the U.S. and that’s paid. Those are paid donors.
There is hypocrisy in this. First of all, these huge shortages — that the demand will keep increasing and the supply will keep decreasing. I’d like to have input because you have such strong viewpoints on this. It would be good to hear how you reconcile these facts. I will start with you Ms. Silas.
Ms. Silas: I don’t want to say it has been a waste of two years because it’s never a waste to analyze all the options. The Canadian Blood Services — and Dr. Sher will be appearing in front of you — proposed a plan to fix this two years ago. In the last two years, we have been lobbying government, from provincial to federal and now the Senate to stop the for-profit aspect of fixing this issue.
We have to realize that in the 1980s and 1990s we had a diverse system on how we collected blood. We caused many problems. That was the big report. Today we’re asking you to continue bringing light to the problem that we might have a shortage of IG but to keep it in the public domain. That is the only thing this bill says. It says keep the Canadian Blood Services publicly accountable to make sure we have enough blood and blood products and that it’s safe. We need to work with the provinces and the federal government to lobby them. That’s what we as advocates should be doing is lobbying the provinces to fund CBS properly to do it.
Senator Seidman: If I could respond to this point, because I don’t really understand how we fix the problem. We had testimony yesterday from Whitney Goulstone, the executive director of the Canadian Immunodeficiencies Patient Organization, and she said:
. . . for the plasma plan to succeed, we need between 200,000 to 600,000 new plasma donors on top of that 100,000 . . .
— which is what we get now for donated whole blood —
. . . and then there will be plasma donors who drop out. For plasma you need donors who donate on a regular, ongoing basis, not the blood donors who come once every three months to once every year. You need donors who donate once a week to once every two weeks. They have to be ongoing. That’s a lot of donors to get in a very short period of time to meet our plasma sufficiency plans in the next five to eight years.
Ms. Silas: I am looking forward to Dr. Sher being able to explain their plan. It is public education. From what I read in your testimony yesterday, they said only 3 to 4 per cent of Canadians donate blood period. I used to be a regular donor. I travel internationally a lot so because of safety issues every time I call they say no, you can’t, you’ve just been —
Senator Seidman: But this isn’t like a regular blood donation where you go into a clinic for 10 minutes. We hear this is a three-hour process, with a very large needle. This is a whole different process. The person has to be totally committed and go once or twice over a two-week period.
Ms. Silas: They don’t have to. They can, because their blood — I’m sure Monika could explain the replenishing of your plasma in your own body. We can all go once if we want, but it’s part of the commitment and the public education of going more often.
Senator Seidman: These people are screened. We heard yesterday that it’s not just like being a voluntary blood donor. These people have to be screened. There is a long process, including physical testing and various things. This is a big commitment.
I’m just saying that to get between 200,000 and 600,000 new plasma donors with an ever-increasing demand from patients because of the so many diseases that rely on plasma . . .
I guess I have to put my answer to CBS ultimately and see what happens.
The Chair: Madam Vyce and Dr. Dutt want to add.
Senator Seidman: Okay, I’m sorry. Please go ahead.
Ms. Vyce: Like Linda, CUPE is also waiting to hear why Health Canada has yet to approve the strategic plan that has been submitted by Canadian Blood Services to expand collection across the country. We know the plan consists of opening 40 new centres across Canada, in addition to the seven plasma collection centres that currently exist, as well as recruiting 144,000 new plasma donors.
One piece of information I would like to share that contrasts with the information that was shared in testimony yesterday is that when Canadian Blood Services was developing its strategic plan, it crunched the numbers and determined it would need 600,000 donations, not 600,000 new donors, to reach its goal of achieving 50 per cent self-sufficiency by 2024. If you do the math, this would work out to 144,000 new donors who would donate approximately four to five times a year.
The number 600,000 is actually the number of donations that would be required to reach the 50 per cent target, not 600,000 donors.
Dr. Dutt: I wanted to speak to your point that you are bringing it back to the patients. I can’t speak for all of us, but I think what we’re speaking to is how to ensure a safe and consistent supply for the patients. In the end, that’s who we want to ensure receives the treatment.
I know you spoke to the amount of new plasma that we obtained from the U.S. I agree that, in some ways, it is a hypocrisy to do that, but at the same time, there is this proposal put forward to change that. The question is: How do we best address that? I would argue that we do so within this public system, where there is a plan to put that forward.
It is about the patients in the end. If the argument is that the supply is more secure with these private for-profit companies, given that, as of yet, there has been no benefit to people in Canada through these private for-profit companies, I don’t see that such an argument, at least at this point, makes sense, given that we do have a publicly funded process that could better create a secure supply.
Senator Munson: Thank you for being here. This is getting really tough. What seemed to be so simple a few months ago in a simple bill and the way it was presented, I was for it — the whole idea of getting paid to give your blood. There was something inside me that I didn’t like that.
Then yesterday, when you hear testimony — as mentioned by Senator Seidman — by Whitney Goulstone from the Canadian Immunodeficiencies Patient Organization, if she didn’t have a guaranteed supply, she says she dies. She receives it every day.
We are asked as senators to pass it without amendment or pass it as it is, or, as the gentleman from the Network of Rare Blood Disorder Organizations said, let it die. Kill the bill.
It’s a really difficult position to be in. Your arguments are very cogent. You talk about new programs, perhaps Canadian Blood Services and so on doing it, but there would be an interim there — it would take some time to build up that public awareness and say Canada, “Come on, Canada. Put your sneakers on. Let’s go do it.” That happened long ago when governments were really pushing the issue of good, strong physical health.
I don’t know if I can sit here and make a decision while people are trying to build up public awareness and public campaigns — whether we can afford to see, in a legal way, people die.
Do you have anything else to add to this conversation that we’re having this morning? It’s not just black and white. It isn’t. You can talk about people’s human rights and a resource. You can talk about it the other way around: The rights of a young person to be able to say, “If I’m giving blood, I’m doing it. It’s $30 or $50. I’m not going to get rich on it, but that’s a reality out there.”
I don’t know what the transition period is where people’s lives are at stake. Anyone can answer this or join the discussion.
The Chair: Would anyone like to answer that question?
Dr. Dutt: I’m thinking about the starting point of there being a better system in place that’s moving more quickly to support the patients that so need the medications — the plasma-derived products. Right now, that system isn’t in place. Even as there are now paid donations, they’re not benefiting those patients.
I understand there may be a transition, period, but we’re also starting with not being able to access those products from the paid plasma market now as it is. By not giving the opportunity for a cogent, publicly funded plan to be put into place, there is no transition because as it is those products don’t go to Canadians.
The premise of saying there would be a transition, yes, there might be, but we’re not going to lose our supply right away. We’re not losing it at all. We’re creating a process where, over time, we would become self-sufficient. We’re not going to stop purchasing from the U.S. tomorrow. It’s going to continue.
It makes much more sense to support a process that will ensure these patients will continue to have access, rather than changing a system for companies that are not benefiting those patients right now.
Senator Munson: The argument yesterday was that this is a global industry; there are no borders when it comes to giving blood. It’s out there. It is a global industry, and Canada cannot survive on its own under a purely voluntary system.
Ms. Silas: I feel for you, senator, because this morning I read quickly the outline of yesterday’s testimony, and I thought, “Ugh. And we have to pass after them.”
It’s hard to pass after patient groups. I’m a nurse. Monika is a doctor. We understand that. We’re here as true believers in our public health system. We’re here to protect the integrity of our public health system, of which the Canadian Blood Services is a part. We keep it public so we keep it safe. It’s one principle that we’re trying to defend. We’ve been working at it for two years.
All that energy, as I said earlier, could have been spent expanding the CBS plan to make sure the concerns of our patients will be answered in two, four or 10 years. It’s that process that we’re trying to protect.
Senator Munson: Thank you.
Senator Ravalia: I will approach you from the perspective of a practising physician who cared for a significant proportion of people with rare diseases who were entirely dependent on plasma-derived products.
This illusion that we have of a publicly funded system is really a myth. We pay for physiotherapy, massage, dental care, our drugs. We have incredibly long waiting lists. Rural Canadians are significantly disadvantaged in the system. The myth that we live in this utopia of health care is far from the truth. Talk to people who are waiting two years for an MRI, 18 months waiting for a hip replacement and cannot access vital drugs because the costs of these drugs are such that they can’t get the care.
For me to say to the mother of a six-month old who needs immunoglobulin, however it is sourced, it’s no different than purchasing insulin or chemotherapy or drugs that are all from profit.
Eighty-six per cent of Canadians have been disqualified from donating blood. The 14 per cent that are paid for their plasma — and let’s clarify this issue. Whole blood donation versus plasma collection is an entirely different process. Young people are thinking in their minds this is a commodity. If I’m going to spend three hours and be screened and provide my plasma for life-saving products and I get back $30 or $40, often times it’s less than minimum wage you’re making to donate this. There is still a sense of altruism. When many of these individuals become independent and are working and will hopefully continue to provide whole blood or plasma in whatever way they choose.
To put these groups of individuals that I have had daily contact with in my life, where we run into situations where there was a shortage of immunoglobulin and a young individual, a baby’s life was threatened because, sorry, CBS couldn’t provide the plasma.
If we were to abruptly cut off the source, in the next 15 to 25 years, yes, CBS go ahead and make sure you provide us with plasma. But if you’ve donated plasma, it’s an awfully difficult process. It takes screening, a huge needle, it takes two to 2.5 hours. It takes a long list of things that you need to do to follow up, maintain your hydration, have your blood pressure checked, et cetera.
That level of altruism may exist in Canada. It’s going to take a long time before we reach that point. I struggle with this, because I am inherently altruistic. My life’s work has been in health care, in a rural community, very much on the margins, and we have been dependent on these agents. This myth that we’re this wonderful publicly funded country with a global health care service is nothing more than a huge illusion.
I’d like you to take that into consideration as well. Like Senator Munson, I have had many sleepless nights over this issue. At the end of the day, to me, these products are required for 50-plus rare diseases, small numbers, often concentrated in small communities or areas of the country that are vulnerable anyway, transitory health care, shortage of nurses, physicians passing through, the most vulnerable Canadians will be more vulnerable. I’d like you to think about that.
The Chair: Do you have a specific question?
Senator Ravalia: My question is that unless we can be assured that CBS can provide us with these plasma products, while your arguments are extremely strong, coherent and make sense in an ideal world, I think the questions and points you’ve raised don’t really match the reality that’s out there. I would appreciate some comments on that.
The Chair: Dr. Dutt, I think you have a comment?
Dr. Dutt: First, I agree with a lot of what you said. I don’t want to come across as making it sound like our system is a utopia. We have a very limited amount of hospital and physician services that are covered by Medicare that are not always easily accessible. My practice has been in rural and remote communities where medevac to get a patient out can mean life and death for that patient. I in no way want to make it sound like it is a utopian system.
Something like national pharmacare is an area that a lot of us presenting have worked on. It is the idea that if we can have a more expansive health care system in a way that benefits patients and also provides care to everyone based on their need, it would make our system stronger.
I appreciate your thoughts. I agree with you; there is much that can be improved in the system. I think we’re leaving it to Canadian Blood Services — or at least I am — to explain their process, but from what I’ve read and I’ve heard, it is not an abrupt stop; it is a process to increase our self-sufficiency. It’s not getting to 100 per cent right away. It’s moving up to 50 per cent. There is not a plan, as far as I’ve seen, to cut off anyone abruptly. I know you have the clinical expertise I don’t have in dealing directly with patients using these products. I in no way want to precipitate that type of situation.
However, I think there is a plan in place that looks like it would create the sufficiency, be within a public system, be accessible to patients who are in smaller communities. We have seen in other situations that when you are introducing for-profit care, it is often the smaller and vulnerable communities that don’t get the care because they are less profitable. A system that will benefit everyone is the way we should be looking at this.
Senator Ravalia: Thank you very much for that. While I struggle with all is of this, I feel it’s important we continue to be part of that pool of a global supply chain of plasma, paid or not paid, so we maintain contact with our suppliers in the U.S., Europe, wherever so that we don’t we remain additionally vulnerable to the source of these plasma proteins that are critical to the health care so many vulnerable marginalized Canadians.
The Chair: Thank you, Senator Ravalia, for this input.
[Translation]
Senator Mégie: I would like to expand on Senator Ravalia’s question. Dr. Dutt, you said there was a plan for us to become less dependent on the United States that might even make Canada self-sufficient. That means many people and organizations have been thinking about this for a long time. Have you considered a system that could ensure both the collection of plasma and supply of plasma-based drugs? How much would that cost? What organizations or governments could contribute more to funding such a system?
Dr. Dutt: Thank you for the question. As I said, I understand questions in French, but I will answer in English. I try to practise my French, but I cannot answer technical questions in French.
[English]
For the specifics of the plan, I think that is Canadian Blood Services to be able to put forward where they are in the planning and what is happening with requests for funding from the provincial and federal levels. I can’t speak to that directly because that is not my area to design the system. There has been enough published, put out and spoken to know that there is a proposal in place. There are financial considerations that need to be of course accounted for, but I can’t speak to where exactly that is in the process and who is paying how much.
The Chair: I want to point out that we’ll have Héma-Québec and CBS, and they have some well-articulated plans — I am aware of that — to increase sustainability. It will be interesting to ask the specifics of these plans when we have them here.
Senator Poirier: Thank you all for being here and for your presentation. I agree with some of my colleagues. This has been a very educational process for a lot of us. I’m sure this educational process, if we could have it for all Canadians out there, it would probably show a different picture that a lot of us don’t understand this whole system.
I am from New Brunswick which has a clinic. I am also from a province where a lot of people had a lot of concerns over this clinic when it opened. It kind of died down for a while. It seems to be back in the media. Lately we are still hearing from people who have concerns about the clinic. The testimony we are getting is important to understand the pros and cons and what are the reason and the needs out there.
Do you have any statistics showing what the impact is of having the private clinics in the provinces of New Brunswick and Saskatchewan? Can you compare it to the three other provinces who have banned the practice? What percentage of the plasma that was taken from these clinics? How much of it is actually staying in Canada and supplying a need for Canadians?
Ms. Vyce: Thank you for your question. I don’t know if Canadian Blood Services has been collecting cold, hard data and has specific numbers to show you to answer this question more specifically. Yesterday at the hearing it was mentioned that there is some anecdotal evidence that is available.
CBS tells us there has been brand confusion; individuals who want to donate plasma are walking into Canadian Plasma Resources thinking it’s Canadian Blood Services. They’re confused about who is operating the clinic.
CBS has also indicated that they’ve had to drastically increase the amount of money that they’re spending on advertising in order to rebuild the voluntary donor base, particularly in Saskatoon and New Brunswick where they have noticed a fluctuation in the number of plasma donors. This, of course, is very expensive for CBS. CBS has provided Health Canada with a specific warning that donors amongst the 17 to 24-year age group has declined, which I mentioned before is the group of most desirable donors.
Senator Poirier: All three of you express support for Bill S-252. You have outlined a few of the reasons why.
For clarification, is the main reason you support it based on its cash for blood practice or are there other concerns that it may weaken the voluntary system in Canada? In order to have the supply we need in Canada, we are buying a lot from the United States, which are coming from paid donors. How do you feel about that?
Ms. Silas: For me, senator, it’s not the cash for blood which makes me uneasy; it’s the accountability piece. We know that Canadian Blood Services is a Canadian identity response to the public. We have problems with CBS all the time. We go directly there, and if that doesn’t work, we go directly to the Health Minister because that’s the public accountability. They’re not worried about profits or who is going to buy what. They’re worried about ensuring a quality service to Canadians. It’s that public accountability.
The other company, CPR, is not even giving our plasma to Canadians. It’s going somewhere else. Even if we believe that we need money for blood, what we’re doing now is going somewhere else.
My issue with nurses is to make sure the accountability is ours, that the Minister of Health can call up Dr. Sher right now and ask for answers. You can’t call up a private company: Your profiteers and stakeholders can, but a Health Minister can’t. That’s the accountability piece.
We all want to fix this potential problem. Right now it is a potential problem. Right now the resources are going down. We’ve been spending a lot of energy fighting the for-profit aspect of it.
The Chair: Ms. Vyce wanted to add something to your first question.
Ms. Vyce: The question before you is whether Canada’s blood system should be public and exclusively accountable to Canadians or controlled by private for-profit companies who are only accountable to shareholder interests. CUPE doesn’t support paying people for their plasma, but we need to protect plasma as a public resource for the good of Canadians and Canadian patients.
This issue is about controlling the supply of plasma. Health Canada permits 60,000 litres of plasma per clinic to be exported outside of Canada. That’s 60,000 litres per clinic that does not stay in Canada to serve the needs of Canadian patients.
The people who are selling their plasma at Canadian Plasma Resources are people who are now lost from the voluntary donor base. We have lost control over that plasma to the private companies and foreign interests.
There are two interesting cases we can look to. Germany used to have two private pay-for-plasma clinics that the German Red Cross purchased and now operates. They were not able to retain the donor base without continuing to pay people to sell their plasma. The German Red Cross has continued this process of paying people for their plasma. It is extremely expensive. As noted yesterday by the witnesses, the donation rates in Germany have now stagnated.
The other interesting case is Hungary. Hungary has a private pay-for-plasma system in place. As a result their voluntary donations for whole blood declined drastically. Hungary’s response was to legislate that anyone who donates their plasma to a private company is legally required to make one annual donation of whole blood per year.
Senator Omidvar: This is truly a challenging bill. We’ve had very compelling witnesses on both sides of the argument. I see where this panel is coming from; a public health approach within a publicly funded health-care system is an ideal which I think most of us would subscribe to. However, most of us are practical enough to understand what Senator Ravalia; it’s an ideal, not a reality yet. Hopefully one day it will be.
In the meantime, we’re trying to figure out what to do. One of my principles as a legislator is that I should do no harm. Harm is embedded in almost every piece of legislation because of unintended outcomes. There is no signal of an unintended outcome here. There will be a very severe outcome to patients.
We heard from the patients. We have the institutions ranged on one side and the individuals, or the patients on the other. We’re trying to come to grips with this.
The way I observe it, we have a mixed model in Canada. Some provinces you’re allowed to donate plasma and get paid for it. In other provinces, you’re not allowed to do that by law. Some of the plasma comes from inside Canada. Some of the plasma comes from outside Canada. This is a mixed model.
I’m struggling to understand whether Canada has the capacity to go where no country has gone before, which is to meet the plasma needs solely on a voluntary basis. There is no country in the world that has done that. Am I right in concluding that? No country in the world at this point is able to meet their plasma needs solely on a voluntary basis.
I need to hear the Hungarian example again.
Ms. Vyce: In Hungary, they have a private payment for plasma system in place. As a result, the rate of voluntary unpaid donations for whole blood declined, so the state introduced legislation that compels individuals who sell their plasma to donate whole blood once per year.
Senator Omidvar: My second question, or my primary question, if anybody can answer that: You talked about jurisdictions that have made progress — Italy and others — but is there any jurisdiction that has successfully gone the whole nine yards?
Ms. Vyce: The closest case, as I mentioned earlier, is Italy. Depending on which IG-based product we are looking at, they have reached between 70 to 96 per cent self-sufficiency. They’re not at 100 per cent. The remaining plasma they purchase from the United States.
Senator Omidvar: They have a mixed model as well. How long did it take them to get to 70 per cent?
Ms. Vyce: That’s a good question. I don’t know the answer to that. However, I’m certain the Italian blood authority would be able to answer that question for you.
Dr. Dutt: I’m not saying we’re going to get to 100 per cent voluntary. That is the goal that has been put by the WHO, that ideally, by 2020, it is a voluntary base. I think that, starting from where we are now, that isn’t realistic.
I think what is realistic is looking at how do we both maintain a diverse supply — because I think that is part of the supply question too, that you don’t want everything to only be coming from one place. Because, as we’ve seen, if something goes wrong with that supply, it throws off the entire system.
If we’re not saying we’ll be at 100 per cent by 2020, what can we do — taking all the factors into account, from the cost to the processes that need to be put in place? Going from, whether it’s 14 to 17 per cent, to 50 per cent, I think that the sounds like a reasonable starting point. Of course, that’s what CBS is putting forward in terms of what they can propose and plan.
I think it’s important to look at diversity of sources, and at least for the short, and probably long term, it will include some aspect of paid donations from outside of Canada. It seems like there isn’t a compelling argument at the moment to change it within Canada, given the changes we have seen already in the provinces, which have been talked about are not for the benefit of Canadians. We’re changing things to solve a problem that isn’t actually solving the problem.
Senator Omidvar: The bill is fairly categorical that you shall no longer be allowed to gather plasma for payment. there is no mention in the bill — and maybe we’d have to wait for regulations — of a phasing-in period to allow the capacity of the sector to increase, the understanding of the public awareness, so that we go out arms rolled up to donate plasma.
It’s pretty tight language in the bill that, if this bill is passed, once it’s implemented — and I’m struggling with the fact that people yesterday said, “Kill the bill.” Here you are, very articulately and knowledgeably, saying this is a good bill. There seems to be no middle ground here. I find that a bit of a problem.
Ms. Silas: I think the bill gives you the middle ground because it says “other than Canadian Blood Services.” Again, it’s bringing the accountability. Even if personally I’m against the pay for plasma or blood, the bill is saying: Give our public identity, our public office, their right to establish their plan on how we’re going to meet our target. It’s very clear in supporting our public agency here.
Senator Omidvar: It actually says no remuneration or benefit for the collection of plasma other than Canadian Blood Services.
Ms. Silas: Who knows what they will do? But they will be under a public accountability.
Senator Omidvar: Thank you. I will think about that a little.
Senator M. Deacon: Thank you for being here today. I would concur with my colleagues. This whole issue is something we have been thinking about for the last 15 months after some of the initial conversations. Today I feel more uncomfortable, perhaps, as we dig deeper and deeper, which is a part of the work we need to do.
Correct me if I’m wrong, but as we dig into this deeper, I’m feeling like blood and plasma are cousins. I say that in the sense that it’s hard to have the blood conversation in the same way as we’re having the plasma conversation. As we dig deeper, there are such different stories and clarifications and information we seek. Yes, we have two very articulate but different presentations, we acknowledge, one day to the next.
Dr. Dutt, in your opening remarks, you said that before we look at this, we need to dig deeper into use patterns and changes in existing practice. I would like to ask if you could elaborate on that and perhaps what you’re thinking or meaning, or even some of your initial thoughts in those areas, before we do look deeper at this?
Dr. Dutt: As a family physician, this is an area where I am not specifically doing much, or any, prescribing. I do want to put that out. It’s mainly from my reading around the topic. Even the expert panel summary, the report that was put together, noted that Canada has the second-highest per capita use of immunoglobulins and plasma-derived products globally.
In my research, I’ve been looking at what other hematologists are saying and what is the research there in terms of our use, knowing that a lot of use in Canada right now is not in line necessarily with existing guidelines. That doesn’t necessarily mean it’s inappropriate use; it may just mean that it’s being used in an effective way that perhaps isn’t in line with guidelines.
Perhaps others can speak to this, senators themselves, who have more clinical experience in this area. From what I have read, that’s an area that needs more exploration, given that the U.K., through the expert panel, has been able to put in place practices and policies that have decreased the use.
Has that impacted patients for better or worse? Could we be doing something differently in Canada that would look at the demand and whether that needs to be changed? There are some indications that are very clear and there are other indications that may be less clear, but it may just be that the research and evidence needs to catch up. Or is it that we could be using other treatments or they’re not appropriate? It’s an area that’s been flagged by the expert panel and an area that, given our use in Canada, is worth looking at in terms of demand for products.
Senator M. Deacon: You started with two. Do we know why we are in the top two? Do we have any understanding why we are, with all these countries in the world, one of the top two countries?
Dr. Dutt: I don’t know the breakdown of how we’re using it and how that compares with other places.
Ms. Vyce: This is an appropriate and excellent question that could underline part of the study and work of the committee. This came up, for example, when we were looking into the current opioid crisis in Canada. Canada is also globally one of the highest users of opioid medications, and this has, in part, contributed to the current opioid overdose crisis in Canada.
There have been significant investigations into looking at prescribing patterns and how Canada has come to be one of the top global users of opioids. This type of investigation could similarly be undertaken with IG-based drugs in Canada to get at answers to that question.
Senator M. Deacon: Were you consulted by the sponsor of this bill on the front end?
Ms. Silas: Yes.
Ms. Vyce: I was not.
The Chair: We have lost the audio of Dr. Dutt.
Dr. Dutt: I was saying I wasn’t consulted. The organization I’m with, Canadian Doctors for Medicare, wasn’t either.
Senator Seidman: I do have to intervene on behalf of the patient organizations that we heard from yesterday. I’ve had a distressed reaction to what you’ve just said, Ms. Vyce. How you could possibly compare the needs of patients for plasma to survive, to live, with an opioid crisis of addiction? I’m sorry, I have so much trouble with you putting those things side by side. I really have to say that in defence of all these patients who depend on plasma for their lives. It has nothing to do with an opioid crisis.
The Chair: Thank you, Senator Seidman.
Ms. Vyce: I would like to respond and say that in absolutely no way was I comparing the opioid crisis and patients who are prescribed opioids to patients who are prescribed IG-based drugs. I simply wanted to make the point that in Canada, significant research has been conducted into understanding why prescription rates for opioids are so high. A similar type of study could be undertaken to investigate why prescription rates for IG-based drugs are also very high in Canada.
The Chair: Thank you for that clarification.
Senator Dasko: Like my colleagues, I’ve listened to the testimony yesterday. I’m listening to your testimony today. We’re hearing, obviously, very different arguments about the issue at hand.
Ms. Silas, something you said concerns me. You said that for-profit organizations who are supplying services into the medical system are not publicly accountable, and yet, Senator Ravalia gave us a long list of organizations, institutions and so on that are supplying services to the health care system, in some cases on a for-profit basis.
It is my understanding that every supplier of services into the health care system is publicly accountable because they have to, in the case of the suppliers we’re talking about. Now people are tested, screened and examined. The products are tested and deemed to be safe. They are actually publicly accountable in just about every way.
Why couldn’t the minister call one of these people if she wanted to? I’m a little flabbergasted by this.
In my view and understanding, they are publicly accountable because they provide services to the health care system, which are scrutinized. In my understanding, in most cases they are very well scrutinized. I’m not sure how you can say that. Our system is highly developed.
As Senator Ravalia said, we have many services that are provided by the private sector into our health care system. Whether that’s good or bad, I don’t know. I just know that that’s the way it is. Whether it will change and maybe in the future everyone is going to be in the public system, I don’t know. All I know is a significant proportion of our health-care services are provided by private people, in many cases for profit.
That’s my question. I don’t want to sound like I’m being aggressive. I just don’t understand why you said that.
Ms. Silas: I think it’s clear where my organization and I are coming from. We’re defenders of our public health care system. We defend it because we work in it, regardless if it is Dr. Dutt or a senator.
As a nurse, I practise in the system. The system paid my way and also made sure I could practise freely. The suppliers get a licence or some kind of registration from Health Canada, for sure, so there is a link of accountability.
Senator Dasko: Of course there is.
Ms. Silas: Their main goal is to make money.
Senator Dasko: They have to provide a product that is safe, strong, scrutinized and tested time and again. How can you say they are not publicly accountable?
Ms. Silas: If I go back a bit in history and not that far, let’s just look at the Romanow Commission. When Mr. Romanow did his report, it was clear that for profit had no place in our health care system. That was a year, funded, thousands of witnesses, et cetera. That supported our view of our public health care system and the services around it.
I agree with the senator that physio, dental and medication should be part of our public system. If you read any of our material or CUPE’s or Canadian Doctors for Medicare’s material, we believe that prescription drugs should be part of our public system. It’s nonsense that as soon as you leave the hospital, whatever your physician prescribed to you, either medication, physio, dental or psychology — and you have done a big study on mental health — it’s not covered.
It’s nonsense to us as nurses that if you need blood products, the source will not be protected like everything else.
Senator Dasko: You stick with your claim that they are not publicly accountable in any way to those who contract their services? They have no accountability.
Ms. Silas: I will say they are not as publicly accountable because they are run by stakeholders.
Senator Dasko: They’re not as accountable.
The Chair: Did you have something to add, Dr. Dutt?
Dr. Dutt: I will try to be quick. I wanted to differentiate between administration and delivery of health care. My support, and Canadian Doctors for Medicare, we are constantly looking at ways to strengthen public administration of health care, which can include national Pharmacare, Canadian Blood Services, and institutions and bodies that provide care to everyone across our province and country.
Then there is the delivery side. As has been said, there are a number of different models on the delivery side that are not-for-profit, that are for profit. I think there is accountability in that contracts can be made with for-profit companies. At the same time, there is always that for-profit motive, whereas a not-for-profit company doesn’t have that.
Things like dental and physio, we see clearly that there are many who can’t afford dental because it’s not included within our publicly funded system. When you have to pay out-of-pocket, it’s the people who are least able to afford it who aren’t able to pay the higher prices of what is essentially a for-profit enterprise where people are able to charge costs that are higher than what people can afford.
As Linda said, there is not as much accountability in some ways, because you have a separate entity, whether it’s your own business or shareholders. It isn’t just the accountability to the public system that you need to be accountable to.
Senator Dasko: If we decided to publicly pay for dental, it would still be provided by dentists working in that way. They would still be provided by private providers and suppliers.
Dr. Dutt: Right. Physicians are private providers for the most part.
Senator Dasko: Yes, of course, they are. We may decide to pay for it publicly, but it is still provided that way.
Dr. Dutt: Yes. I think that’s a good model.
[Translation]
Senator Forest-Niesing: I’m in the same dilemma as my colleagues between support and disdain for this bill. I have a much better understanding of the distinction between collecting blood and collecting plasma.
I also understand that the process of collecting plasma and converting it into immune globulins happens over an impressive number of years. It takes several plasma donors to support just one patient.
This leads me to the observation that seemed quite obvious to us in listening to the witnesses yesterday. Demand far exceeds the available supply. With growing demand comes the very serious risk of inadequate supply, which could translate into the loss of lives in Canada. That is very important.
I think it’s a shame we did not hear Dr. Sher present the plan he is proposing. I get the impression that our discussion is a bit premature, given that we do not know what is being considered as an alternative. If we leave it to the public system to collect plasma I suspect — and yesterday’s arguments convinced me — that supply will drop and we will be in a crisis situation in terms of meeting demand. As impressive as the plan is, it cannot immediately meet demand given the time it takes to convert the plasma and build a bank of donors. I believe that as more details come out, we will see that it will still take quite a few years before this plan achieves the desired results.
What do we do in the meantime? If the bill passes, I understand that the three companies that are paying donors for plasma, in the three provinces where that is allowed, will simply cease operations to comply with the ban. What do we do in that case? What can we do in the meantime? Do you have any thoughts on that?
[English]
Dr. Dutt: I would just point out — and I know it has been mentioned before — that right now we are not gaining plasma products from the for-profit companies that are currently operating. If they stopped operating, it does not change our current needs.
If the point is to look at how to ensure our supply, it still comes back to saying publicly how do we support the system? It seems like the plan going forward would be increasing our capacity for voluntary blood donations. There are voluntary plasma donations. Domestically we would still likely continue for some time to continue to purchase plasma from other places.
However, given the system that we have right now does not benefit us, it doesn’t change anything. It has been said that the proposed bill leaves the door open should Canadian Blood Services ever at some point think they needed to go down the paid donation route. Right now they don’t plan to, and they don’t plan to buy from Canadian Plasma Resources. I would say nothing changes by not having those operations now be in place. What could change is having a system over time that gives us that domestic supply.
The Chair: Thank you.
Ms. Vyce, did you want to add anything?
Ms. Vyce: I was going to echo what Monika just said. I will add that we often mention that there are three pay-for-plasma clinics operating across the country.
We have to keep in mind the one in Winnipeg is very unique and different from Canadian Plasma Resources. It was allowed to operate by Krever to collect plasma for a very rare blood phenotype called RH negative blood. It’s only under these rare circumstances that Krever allowed the payment for this particular plasma type.
I would also like to hear what Graham Sher has to say and what is included in his plan. I suspect the plan would include allowing this particular centre to continue to operate to collect this rare blood type.
[Translation]
Ms. Silas: I know that Héma-Québec will be testifying. It should be noted that Quebec was the first province to ban payment to donors. It is also the only province where plasma donation has increased when you compare the numbers from Canadian Blood Services. It would be very interesting for you to compare the two situations. How is it that plasma donation is on the rise in Quebec, where donors aren’t paid, while there is a decline in donation in the rest of Canada?
[English]
Senator Kutcher: I think our vexatious challenge is that part of our job in protecting vulnerable Canadians in this bill is to help ensure that we have a robust and continuous supply of plasma for those people who are life-dependent on the product. This is a life-dependency issue, as has been eloquently spoken by my colleagues.
I’m concerned about two comments that have been made in the discussion. I would like to get more information about them. One is that public equals safe. Many people who are aware of what’s happening in our publicly funded health-care system — the hospital sector, which is a completely publicly funded system — are very aware that safety is a major concern. In the hospital sector, public does not equal safe: distribution of drug and medical errors, iatrogenic interventions. Public does not equal safe, as far as I can see. I’d like to hear more about how you feel public means safe.
Let’s run with that concern. Can you suggest to us or give us data that shows that the current plasma supply system, which comes from donors — often from outside this country — who are paid for their donations is not safe? Could you share with us all the data that has shown the current plasma supply system has not been a safe system and that Canadians have had problems with it in terms of safety, that they have died from it or had unintended consequences because the supply is not safe? I would like to hear that data.
The second thing I just heard from the last discussion was that “the source is not protected.” We heard yesterday in testimony there was a tremendous amount of analysis, processing and continuous testing so that the product, when it comes to reach the patient, has been well protected. The question is not whether the source is safe; the question is whether the product is safe.
I’d like to get information from you on two things. One, do you have specific concerns that the product Canadians receive is not a safe product because of the way the processing occurs or some other way?
Second, I’d like to know the data that shows us that the current plasma supply has damaged patient lives. Please help us with that.
Dr. Dutt: I’ll say a bit about safety, which is something I didn’t focus on because you have a good point that for the last 20 years, our immunoglobulin and plasma product supply, there hasn’t been the safety issues that some have spoken to in terms of potential safety concerns from pay for plasma.
I tend to not focus on that because of actions by Canadian Blood Services as well as all what you’ve mentioned in terms of screening processes. I don’t think the safety issue is the primary one to think about.
I do consider emerging pathogens and things we need to worry about when there needs to be broader action. I work in public health, for the most part, and public health is the kind of work where it is often quiet until you have a measles outbreak, or something where you need to quickly mobilize many public resources.
It is not so much that I don’t have data to say that it’s been unsafe in the last 20 years and that patients have been harmed for that, because I don’t think that the primary consideration, at least with this bill, I think the bill is about the publicly funded systems being able to have the management over the blood supply.
I don’t necessarily think public always equals safe. There are always ways to improve within a publicly funded system. I would never say it’s perfect. Often, though, it’s done in a more transparent way than you would see in a private for-profit company where you might not be able to access their records and the information they are using to make these decisions.
I agree with both your points. Public doesn’t necessarily equal safe, but it does often equal more transparency. Safety isn’t necessarily the main question for me when looking at this bill because we haven’t had any serious patient impacts in the last 20 years.
Ms. Vyce: At CUPE we tend not to focus on the safety of the supply in terms of whether there is a risk for contamination amongst patients. What we tend to focus on, in terms of safety, is the issue that I mentioned when I delivered my presentation — the security of supply. Globally there is a very heavy dependence on paid plasma that’s sourced from the United States.
If, for some reason, the United States supply was cut off or disrupted, this would pose a safety risk to patients around the world because that supply would no longer be available to patients in other countries.
Senator Kutcher: If safety is not a concern, then the discussion I’ve heard about safety is a red herring.
You’re asking us to pass a bill that has nothing to do with the plasma supply safety but potentially could put many vulnerable Canadians with life dependency on the product lives at risk because of a potential supply chain problem globally which can’t be fixed by Canada anyway. I don’t get it. Help me with my dilemma. What have I gotten wrong here?
Ms. Vyce: The supply chain issue is the issue that we’re trying to get at in terms of self-sufficiency. This is why we argue there is a definite need for Canada to do everything it can to increase our self-sufficiency so our reliance on the United States goes down such that if the market in the U.S. was disrupted or cut off, the impact on Canadian patients would be minimized.
Senator Kutcher: Is the only way to increase self-sufficiency this way and not that way?
Ms. Vyce: Could you clarify what you mean?
Senator Kutcher: The way that the bill says and not alternative methods?
Ms. Vyce: We believe that Canadian Blood Services is best positioned to grow the plasma supply outside of Quebec and to have a single entity accountable to the public to monitor that supply as well.
The Chair: I want to thank our guests. As you can see, the bill itself is not complex, but its impacts are very complex. We are working very hard to understand it. There are some tough questions, and I appreciate you answering them, with all your expertise.
Senator Seidman: I will reiterate that all of us are taking our role and responsibilities extremely seriously because senators find their role is to speak for those who have no voice and are most vulnerable. It is a concern, and we’re struggling with this, as you see. It’s very evident.
Something that concerned me yesterday, and I’d like to hear your response: We heard from representatives of the patient groups that there were no patient groups consulted in developing this piece of legislation. I’m wondering, one, if any of your organizations were consulted; and, two, how you would respond to knowing that there were no patient groups consulted in developing this legislation.
Dr. Dutt: As I said, I haven’t been consulted. Canadian Doctors for Medicare wasn’t consulted. I agree that patient groups are a valuable and necessary group to be speaking with. It speaks to the value of the process that you’re going through now that you have this opportunity to incorporate a vast array of different opinions into your considerations.
Senator Seidman: Thank you. What about you, Ms. Vyce? Was your organization consulted in developing the legislation?
Ms. Vyce: No. Neither I myself, as an individual, or the union were consulted in developing the legislation. I would agree with Monika that including patient voices in developing this legislation is useful and something that should be taken into consideration.
Ms. Silas: Yes, we were consulted and part of the press conference with Senator Wallin. Also was BloodWatch, not a patient group, but an advocacy group protecting patients after the Krever inquiry.
Senator Seidman: I am asking about patient groups, literally patients who depend on blood plasma products were not consulted?
Ms. Silas: No.
Senator Poirier: Since most of my questions have been posed and answered. I will take this opportunity to thank you for being here. As I said, this is an educational process, and it’s not easy. It’s going to be a hard one, but I do appreciate all of your comments. Thank you for coming.
[Translation]
Senator Mégie: I understand the principle of universal health care and I strongly support it. I also understand the principle behind banning the sale of organs, including blood. However, would you be receptive to the idea of compensating Canadian plasma donors in some other way, with a day of paid leave or a tax cut for example, instead of the outright sale of plasma? I heard that sort of suggestion from some of our guests yesterday. Would you be more comfortable with that sort of measure instead of paying donors money for plasma?
[English]
Ms. Vyce: We don’t support paying people for their plasma. What we do advocate is that locals negotiate for paid time off into their collective agreements at the bargaining table to donate blood and plasma. Employers must ensure that employees have time on election day to vote, and bargaining time off to donate blood and plasma would similarly encourage civic engagement in giving.
Senator Omidvar: I want to add my voice to the others. We respect your knowledge, competency and experience. The reason we’re asking tough questions is because this is a tough issue.
You clarified for Senator Kutcher that, in fact, safety is not an issue, whether it’s paid or not paid. The safety of the supply is not an issue.
I read the bill again — it’s a short bill — am I right in concluding that it is not per se the selling of plasma that is an issue but who gets to buy it? Because the bill says quite clearly that Canadian Blood Services can in fact buy, but they are ones under the bill who will be able to buy, no one else.
It’s not security. It’s not the sale. It’s really about one sentence in the preamble. Which is confusing for me, because it’s the one sentence that’s valid, that it’s the sustainability of the blood system. Am I right? We’ve heard from a lot of people that thou shalt not sell blood, but the bill doesn’t say thou shalt not sell blood. It says only Canadian Blood Services can buy blood, no one else.
Dr. Dutt: I will clarify. I wouldn’t necessarily go so far as to say safety is not an issue. From what I’ve seen it looks like for the last 20 years there have not been major safety concerns. Safety is always an issue that needs to be looked at. But, yes, I think I agree with your second point. From the perspective of looking at evidence around publicly funded health care, to me it is about the sustainability of the supply.
Right now, Canadian Blood Services isn’t looking at paying for plasma. There is that option there, though, should it be needed in the future. It is about the sustainability of the supply. It is about who is purchasing.
Senator Omidvar: If I was cynical — and I can be — I would conclude it’s really about a sole supplier.
Dr. Dutt: Sorry, it’s —
Senator Omidvar: I’m done. I was just thinking out loud.
The Chair: It is a good question that we will ask again, I am sure.
Senator Forest-Niesing: I have two questions. Hopefully I have time. I want to hear you expand, if you can, about your earlier indication that the concern was the security of the supply. You spoke to the risk of the current American source, the paid donor source, of plasma potentially being at risk. What are the risk factors? What are your concerns in that regard?
Ms. Vyce: There are three possible factors that could either lead to a disruption or a cessation of supply from the United States. It could be production irregularities, so something happening to the machinery processing plasma into IG-based drugs. It could occur from regulatory policies put forth by the United States government. For example, if they decided to implement an America-first policy which would cut off supply to other countries, meaning the supply would remain only in the United States for use by American patients.
The third issue is a safety issue. I concur with Dr. Dutt that it’s not to say that safety is a non-issue because, as we know, there is the risk that new pathogens such as CWD could potentially enter the blood supply and lead to contamination.
If there was an outbreak of CWD or another emerging pathogen in the United States that entered the blood supply, then we could no longer purchase that blood supply from the United States.
The Chair: Anyone want to comment?
Senator Forest-Niesing: If there was support for this bill — we’ve heard very clearly that Héma-Québec was somehow neglected or omitted — would you support an amendment to include Héma-Québec? Do you agree that it’s an oversight or that it ought to have been included?
Ms. Silas: The key issue arrived outside of Héma-Québec. That is my understanding of why the Canadian Blood Services is more targeted. We have two systems that are working well in Canada. We recognize that Héma-Québec, on the plasma issue, has done better. Is it because it’s smaller and more independent than the Canadian Blood Services working with the rest of the provinces and territories and the federal government? Dr. Sher will be able to explain. Two years ago we should have started answering that problem.
One of the questions from the senators in the transcript was, why didn’t you start earlier? That’s a question Dr. Sher has to answer. You have heard the experience of the senator from Newfoundland and Labrador that this has been a supply issue for a long time. Why is the plan just coming out now? The senator from New Brunswick said it’s back in the media because you’re meeting. As much as we as advocates try to keep it as a media issue, unless there is a big committee meeting, it’s hard. It’s not the 50 clients they get a day that will make a difference.
Ms. Vyce: I noted earlier that CUPE wasn’t consulted in drafting this legislation. I don’t know if Héma-Québec was consulted either. I wonder if an assumption was made because Québec already bans paying people for plasma and that is why they were left out of the equation. I’m not sure. I am certain if you invited someone in Héma-Québec to come and speak to you they would have a lot of valuable knowledge to share.
The Chair: Thank you for the question. I don’t see any more questions. I will once again give a very warm thank you for being here and your answers. It has been very valuable and it will help us continue. If you wish to add answers at any time, because I know they were tough and complex questions, we always welcome written testimony, and we always consider it. Please feel free.
(The committee adjourned.)