March 1, 2022
Honourable Senators, I rise today to speak to Bill C-10, An Act respecting certain measures related to COVID-19.
The objective of Bill C-10 is twofold. It authorizes the Minister of Health to make payments of up to $2.5 billion out of the Consolidated Revenue Fund in relation to COVID-19 tests. This amount is in addition to the $1.7 billion that was announced in the 2021 Economic and Fiscal Update, which is currently provided for in Bill C-8. This means that the total sum of money to be spent on the procurement of COVID-19 tests adds up to $4.2 billion.
Bill C-10 also authorizes the Minister of Health to transfer the COVID-19 tests to the provinces and territories and other establishments.
Diagnostic testing remains a critical tool in our response to the COVID-19 pandemic. It enables early detection and isolation of infectious individuals, which helps to prevent the spread of the virus. It allows Canadians to take measures to not only protect themselves, but also those around them.
There are two types of diagnostic tests that are commonly used to detect the presence of SARS-CoV-2: molecular and antigen tests. There are clear differences between the two tests, and each serves its own unique purpose.
First, the polymerase chain reaction test is commonly referred to as a PCR test. This molecular test uses a specimen collected from an individual’s upper respiratory system to detect the presence of specific genetic material belonging to the virus. PCR technology is highly sensitive and specific. It is for this reason that a PCR test is often referred to as the gold standard for diagnosis.
However, the prompt analysis of a PCR test result depends on several factors: efficient transportation, laboratory capacity, complex equipment and highly skilled and trained personnel.
In addition, due to its high sensitivity to virus fragments of genetic material, PCR tests often continue to provide positive test results for weeks or months, even when an individual is no longer infectious. The use of PCR tests is neither always effective nor practical.
The second is the rapid antigen test, which uses a sample collected from a nasal swab to detect the presence of viral particles known as antigens. The value of the rapid antigen test is that it tells you if you are infectious with the virus now — on the day it is taken. A key feature of this test is its ability to produce a rapid result, often within 15 minutes.
The additional appeal of a rapid antigen test is in its practicality: they are more affordable than PCR tests and they use less health care resources because they can be self-administered at any preferred location.
At the onset of the pandemic, many health experts advocated for the use of rapid antigen tests in a variety of community settings, including long-term care homes, hospitals and classrooms.
In an opinion piece published in TIME magazine on November 17, 2020, Harvard epidemiologist and physician Dr. Michael Mina urged recognition of the fact that rapid antigen testing is an important tool, a tool that could lead us out of the pandemic. He wrote:
The point is to use these tests frequently so people are likely to know their status early, before they transmit to others. It is frequency and speed to get results, and not absolute sensitivity of the test that should take center stage in a public health screening program to stop outbreaks.
A question that is frequently asked is whether rapid antigen tests are effective.
From August to December 2020, the U.K. COVID-19 Lateral Flow Oversight Team analyzed the sensitivity and specificity of 64 antigen tests. Results from their experiment, which were published in May of 2021, showed that antigen tests “. . . have promising performance characteristics for mass population testing and can be used to identify infectious positive individuals.”
Data collected from seven of the most popular and reliable antigen tests showed that the likelihood that an infectious individual tests positive ranged from 96% to 99%, with one of the tests at 94%. The probability of a false positive result was less than 1%.
Even more importantly, the probability that an infectious person gets a false negative result ranges from 1% to 4%, with one — and only one — of the tests at 6%.
It is evident that rapid antigen tests are an effective and important public health tool which, used early and frequently, are highly reliable in detecting individuals who are infectious at the time the test is taken.
However, nearly two years into the pandemic, the understanding of the use and value of rapid antigen tests has been minimal. Their rollout across Canada, in comparison to other nations, has been slow. Their value as a public health screening tool to lower the risk of community outbreaks has not been adequately utilized.
Honourable senators, over the course of this pandemic I have repeatedly and persistently raised the issue of rapid antigen testing in this chamber, particularly during Question Period. At the beginning of October 2020, I inquired about the distribution process of rapid antigen tests across Canada. Just a few weeks later, I asked about the numbers of rapid antigen tests that had been allotted to long-term care settings.
As Canadians continue to confront the challenges of the COVID-19 pandemic, access to rapid antigen tests remains limited. Canadians have been forced to scout various locations in search of test kits. Many have waited in long lines from dawn to dusk, only to be turned away empty-handed.
Some provinces have creative and effective distribution mechanisms in place. Rapid antigen tests can be readily found in a number of locations, such as public libraries, family resource centres, grocery stores, gas stations and COVID-19 testing sites; whereas, in other provinces, rapid antigen tests have been scarce and difficult — if not impossible — to find.
While the distribution and deployment of rapid antigen tests do fall under the jurisdiction of the provinces and territories, this does not absolve the federal government of their responsibility to show leadership on this matter. The shortage of rapid antigen tests across Canada is a direct result of the federal government’s reluctance to approve them at the beginning of the pandemic. It demonstrates a lack of communication about their importance and value.
It is important to note that these challenges are not new. The federal government has struggled to communicate clearly and effectively on matters concerning public health for years.
In June of 2010, former Minister of Health Leona Aglukkaq asked the Standing Senate Committee on Social Affairs, Science and Technology to review and report on Canada’s response to the 2009 H1N1 influenza pandemic. At the time, I was a member of this committee and had the opportunity to participate in this study.
Over the course of 10 meetings, my Senate colleagues and I heard witness testimony from representatives of the federal government, several provincial and territorial governments, and representatives of health care professions, First Nations and Inuit organizations and the research community.
In December of 2010, our committee tabled a report entitled Canada’s Response to the 2009 H1N1 Influenza Pandemic, which summarized our findings and provided 17 recommendations to strengthen Canada’s future pandemic preparedness plan. Our committee heard considerable testimony that expressed concern about the lack of effective and clear communication and messaging.
The report found that:
Despite the fact that communications was handled much better than it was during SARS and that our CPHO was complimented on his performance by many witnesses, communications and messaging were the most frequently criticized issues during the study. This issue is vast and includes the federal government’s communication and messaging to the Canadian public, their communication with the P/T governments, their role, if any, in the messaging available to Canadians via different media, and the responsibility for two-way communications, whether possible or helpful.
The report also highlighted the distinct roles and responsibilities of the federal, provincial and territorial governments in public health.
While there was an indication that the federal government took a leadership role in several areas such as disease surveillance, antiviral and vaccine programs, infection prevention measures, collection of clinical care guidelines, public health communication, research and laboratory testing during the H1N1 pandemic, some witnesses stated that:
. . . the federal government should have been more emphatic about its leadership role. That is, some front-line workers felt that the shared responsibility for public health should come under explicit federal leadership.
Witnesses proposed different mechanisms by which a uniform national approach could be achieved. These ranged from:
. . . further nurturing the current approach of consulting with provinces and territories, to establishing mutual agreements among the jurisdictions, to harmonizing legislation between the provinces and territories, to utilizing the peace, order, and good government head of power granted under the Constitution.
To that end, it was agreed, “. . . the goal of a pandemic response should be to have a uniform national response.”
Honourable senators, I recognize and fully support the need to increase the supply of rapid antigen tests in Canada. However, an initial analysis of Bill C-10 leaves me with a number of concerns.
The first concern pertains to the language used in Bill C-10. The bill states that the authorized payments of up to $2.5 billion are in relation to the COVID-19 tests. The bill, however, does not specify the type of COVID-19 tests that will be purchased.
Yet, in a news release recently published on January 31, 2022, the federal government explained that Bill C-10 authorizes Health Canada, “. . . to purchase and distribute across the country up to $2.5 billion worth of COVID-19 rapid tests.”
The difference in the language used in Bill C-10 and the federal government’s news release creates confusion and leads me to ask why Bill C-10 omits the specification of the type of COVID-19 tests that will be purchased.
The second concern pertains to the equitable distribution of COVID-19 tests across the provinces and territories. According to the federal government’s Economic and Fiscal Update 2021, as of November 26, 2021, Canada has purchased 95 million rapid antigen tests and distributed 86 million of them to provinces, territories and Indigenous communities.
At the beginning of January of this year, the federal government promised an additional delivery of 140 million rapid antigen tests to the provinces and territories. However, a number of provinces have reported that they have not yet received the full amount of rapid antigen tests allocated for January.
According to an article published by the Toronto Star on February 9, 2022, a spokesperson for the Ontario Minister of Health said:
. . . the province has received 36.4 million rapid antigen tests from Ottawa, and expects the remaining 17.93 million tests to be delivered this month.
In fact, on February 9, 2022, the Government of Ontario announced that they, themselves, procured 44 million rapid tests to be distributed to Ontarians over the course of eight weeks. Each week Ontario will distribute 5.5 million tests to participating grocery and pharmacy locations. Every household will be eligible to receive one box, containing five rapid tests, per visit.
Moreover, the Government of Quebec reported that they have received 24.2 million tests in January, noting that they are waiting for an additional shipment of 5.8 million tests. In lieu of the absent tests, the Government of Quebec has taken the initiative and ordered 100 million tests on their own.
Honourable colleagues, it is evident that we cannot continue to spend money on the procurement of rapid antigen tests without clear leadership and a plan to ensure their equitable distribution across the provinces and territories.
According to the federal government’s website on COVID-19 testing, as of February 18, 2022, a total of 327 million COVID-19 rapid tests have been shipped to Canada. Of this number, a total of 296 million tests have been shipped to the provinces and territories. However, data specifying the number of rapid antigen tests that have been distributed to their final point‑of‑care settings and administered to patients is not clear. As the website indicates, this data has not been updated since December 31, 2021, and much of it remains missing.
Given the lack of data shared by the provinces and territories, how can we be sure that the total number of rapid antigen tests that have been distributed to the provinces and territories have reached their final destinations?
It is important to note that there is no provision in Bill C-10 for parliamentary oversight. Indeed, the Minister of Health has made a commitment in the other place to provide a report to Parliament every six months on the procurement, distribution and use of rapid antigen tests. However, this commitment was merely a verbal one; there is no guarantee that these reports will be published.
The federal government’s press release from January 31, 2022, stated that the funding authorized by Bill C-10 would allow the government to:
. . . put in place critical contracts in a highly competitive global market, to purchase sufficient quantities of rapid tests to meet the continued demand across the country.
According to the federal government’s website on Canada’s procurement of COVID-19 rapid tests, Canada has established agreements with 16 suppliers of rapid tests. In an attempt to learn how many of these rapid antigen tests are manufactured by Canadian companies, I found incomplete and confusing data. As best as I could decipher, of the 16 approved rapid tests, fewer than half are manufactured by Canadian companies. The rest are foreign-made.
This leads me to ask: Can we not produce these tests at home? And why are we not supporting critical innovation and investment in Canadian companies?
There is a striking pattern in the way that the federal government has chosen to respond to the COVID-19 pandemic. I will remind my colleagues that at the outset of the pandemic, the federal government failed to secure domestic production and supply of a COVID-19 vaccine.
The federal government’s neglect of Canadian-led industries and reliance on foreign-made medical supplies such as vaccines and rapid antigen tests has undermined our ability to effectively respond to the COVID-19 pandemic. It has become evident that the discrepancy in the availability of rapid antigen tests across Canada necessitates urgent leadership from the federal government.
Perhaps it is time for the federal government to reshape their strategy and find new and creative ways to distribute rapid antigen tests to Canadians. As an example, Canada can look to the United States, whose new government website allows every American household to order up to four free rapid antigen COVID tests to be delivered by the United States Postal Service.
Honourable senators, it is imperative that we continue to invest in tools that will allow us to mitigate the effects of the COVID-19 pandemic.
Many may question the need for rapid antigen tests at this phase of the pandemic. I remind my colleagues that the value in these tests lies in their ability to detect the virus at the peak of infectiousness of an individual. They have great importance as a public health screening device to prevent community spread.
With time, the COVID-19 virus will inevitably transition from a pandemic state to an endemic one. We will continue to find that the power of rapid antigen tests as a public health tool is in their effectiveness to manage community and workplace outbreaks by identifying cases at the time they are infectious. Ultimately, this will ensure our safe return to a new “normal” way of life. Thank you.
Hon. Dennis Glen Patterson: Would the senator take a question, please?
Senator Seidman: Yes, certainly.
Senator Patterson: I’m weary of important bills being rushed through the Senate by government fiat, no matter their merits. You’ve just described the important role that a committee can play — and has played — in dealing with an issue like this, and you’ve thoughtfully expressed some concerns.
I know you’re the critic, but could you tell me what is the anticipated time frame for committee study and consideration of this bill? And do you agree that the committee should have adequate time to do its job properly?
Senator Seidman: Thank you, Senator Patterson, for your question. I am afraid I cannot tell you what the committee timeline is. I am not certain of that. I do know that as soon as this bill is referred to committee, which hopefully is today, the committee will be seized with it; they will, of course, determine the witnesses they want to hear from and the role they feel they need to play.
Hon. Frances Lankin: Will the senator take another question, please?
Senator Seidman: Yes.
Senator Lankin: I want to thank you for your contribution to our understanding of this bill, Senator Seidman, and I’d like to thank Senator Marshall as well. Both of you have such deep expertise that you bring to the consideration of a bill like this. It is helpful, and you play an important role as critics.
With regard to the concerns you raised, could you parse for me which ones you would want to move forward as amendments to this bill and which ones you think are the sorts of things that we might append in observations, for example?
My understanding is that there were discussions, though not necessarily agreement, that this might move quickly through committee.
Could you help us by telling us, from your own understanding, what you think could be accomplished through observations versus what would be a critical amendment to this bill? Thank you very much.
Senator Seidman: I would say that probably there are observations that could be appended. I would suggest that perhaps one of the most important amendments we could make has to do with the accountability issue. Given the fact that very little data is posted on the government’s website and some of the data is as long ago as December, I would think that the minister should report, and it should be in the bill so that we’re certain of reporting as opposed to just his word given in the other place.
I would like to see perhaps an amendment that builds in accountability and reporting so that we have more information about how the tests are distributed and exactly what the distribution process has been.
I will say, Senator Lankin, that one of the biggest issues has been the lack of coherent and consistent reporting from the provinces to the federal government, which inhibits our ability to understand whether these tests actually arrive at point-of-care services.
My concern still would be in terms of accountability. The rest of the issues can probably be dealt with in observations.
Senator Lankin: Thank you, senator. Those are issues that we can explore at committee when officials and, hopefully, the minister appear; and I undertake that I — and others, I’m sure — will. I have no supplementary. Thank you.
Hon. Stan Kutcher: First of all, I want to thank you for the master class in the discussion on the testing. Outstanding. Thank you so much for that.
I completely agree with the accountability issue that you raised. I’ve been struggling with that, and I wonder if you could think more loudly about it. We have accountability for the federal government with exactly where the tests came from and the accountability of what the provinces are doing with the tests when they go to the provinces. Some provinces sat on them for months and months. Then there’s the accountability from the province to the citizens. Are the citizens getting the tests they need? I happen to live in Nova Scotia. We’ve actually done a really darn good job at rapid testing. If we can do it, other provinces should probably be able to do it as well.
How would you address it? I’m with you on that accountability thing. How do we address that?
Senator Seidman: That’s a really good question because it’s an age-old issue in terms of data collection and different provincial and federal jurisdictions. So it’s challenging. There is no question. We all know that in so many ways we don’t get consistent data from the provinces to the federal government. That’s the problem they have, and I empathize with them on that score.
However, in this case, I think, the federal government can be better at their data collection and transparency on their website. It was very evident that a lot of the data hadn’t been updated since December, and that makes it very challenging to get a better idea of equitable distribution in the provinces, for example.
I think it’s interesting to note that the U.S. government has decided to take responsibility for ensuring that these rapid test kits are distributed to all the citizens in the country. All you have to do is go on the U.S. national health website and order your kits, and they’re delivered by the postal service.
That’s another approach to accountability.
Hon. Renée Dupuis: Would Senator Seidman agree to answer another question?
Senator Seidman: Certainly.
Senator Dupuis: Thank you, Senator Seidman.
I’m listening to you and taking notes, but I have a lot of blank spaces because your presentation was so complete that some of the information escaped me.
My first question is on the test specifications that were not included or were not specified. Could you come back to the explanation you provided? Do you think that these specifications should be subject to observation or that the bill should be amended?
Senator Seidman: No, I don’t think this bill can deal with sensitivity and specificity issues. Those are the characteristics and features of the tests that are being used in North America and probably all over the world. In fact, the tests are very highly sensitive and very specific. I did give you the data of the most common tests. Seven of them are being used most commonly in this country, and their sensitivity and specificity are pretty impressive.
I’m going to now go back to my notes, if you want the absolute numbers. These numbers were determined from the U.K. COVID-19 lateral flow oversight team. They analyzed 64 antigen tests. They published May 2021, and they showed that these tests really had very promising performance characteristics. As I said, these are the characteristics of the tests, so there’s nothing you can do to change that. It is what it is. But the most popular — the best seven and most reliable — showed, and here are the numbers for you, that the likelihood that an infectious individual tests positive ranged from 96% to 99%. For one of the tests — one of the seven — the likelihood was 94%. The probability of a false positive result was less than 1%, so you understand that it’s highly unlikely you get a false positive result.
Even more important is that the probability of an infectious person getting a false negative result is very low — 1% to 4%. That means, again, that the tests are sensitive and the tests are specific.
I hope that answers your question.
Senator Dupuis: I have a supplementary question, if Senator Seidman agrees to answer it.
Senator Seidman: Of course.
Senator Dupuis: Senator Seidman, you spoke about the need for accountability on the part of the federal government, and you said that perhaps there were observations that could be appended or amendments that could be made. Can we agree that that is something we want to look into? What we want to know is how many tests the federal government distributed, how fast it distributed them and to which provinces and territories.
In other words, we don’t want to get caught up in the problem that you very clearly described, namely, the fact that we don’t know what the provinces themselves did with these tests and we have no way of verifying what the provinces did once they received the tests.
Do we agree that the only accountability we care about here is what the federal government did, how it did it and how fast?
Senator Seidman: To some extent, I think you’re right that we are concerned about the ability of the federal government to procure the tests — that is to get the tests from the manufacturers — and then distribute them to the provinces. However, it is clear that they do have a website — and I’m just looking now so I can be really clear — that specifies the number of rapid antigen tests that have been distributed to their final point-of-care settings and administered to patients. The unfortunate part is that aspect of their website hasn’t been updated since December 31.
There is clearly a way they have to track the final arrival of these tests at point-of-care settings in the provinces. If they do, they can be transparent and accountable for that.
Hon. Rosa Galvez: Would Senator Seidman take a question?
Senator Seidman: Yes, of course.
Senator Galvez: Thank you so much Senators Seidman and Marshall for all this information. What you are raising is very concerning — being very ineffective to double monies and this amount — we’re talking about billions of dollars. It worries.
We know that these antigen tests have not stayed static. They are evolving, and they are becoming more and more precise. If we compare with the early ones that had greater failure rates, we know that this has been improved today.
I see that there are two issues here, Senator Seidman. On one hand, there’s the money we’re paying for tests that evolve over time, and we don’t know exactly which type they are and how they are getting to the population. On the other hand, is this a duplication of money and tests? It’s a problem of effectiveness.
I can tell you that when I was in Glasgow during COP26, these tests were being distributed at the pharmacies, the train stations and the metro stations. In my province of Quebec, there were moments in which my colleagues and friends were trying to get these tests at the pharmacy, and they were simply not available. Now, they are available, but there are very few and they come at a cost.
We know that the provinces bought these tests, and they are distributing them in a way. We have both provincial and federal ways of getting these tests.
I want to ask you: At which level do you want to see accountability? Should we be asking what type of tests are being ordered, what the performance of these tests are and how they are getting to the people? Because I’m on the National Finance Committee, and you said you’re not, so we’re going to discuss this. I’m wondering for which level you will be interested in having this information given. Thank you.
Senator Seidman: Thank you, Senator Galvez.
It’s clear that the provinces — and I did talk specifically about the Government of Ontario and the Government of Quebec, who desperately wanted these rapid antigen tests — had some millions delivered by the federal government, but they didn’t get the tests they were promised. Ontario went out and purchased, independently of the federal government, an additional 44 million rapid tests. Quebec also took the initiative and ordered 100 million rapid antigen tests. I presume these come out of the provincial budget. The provinces don’t come back and try to bill the federal government for those tests. If the federal government is procuring rapid tests worth more than $4 billion, they need to be accountable for where these tests end up.
As far as the type of tests that are used — and Senator Galvez, you’re right. They’ve evolved over time. There is no question — the ones being used now are far more sensitive and specific than they were originally.
You will note in my presentation I was quite disappointed that we haven’t encouraged more Canadian companies to develop and manufacture these tests here at home, because that would give us more control over our ability to procure and distribute them. I do have a list here of the manufacturing companies and suppliers. There are two Canadian companies authorized by Health Canada to sell and produce them, one in Ontario and one in British Columbia. Then, there are Canadian companies that supply foreign-made rapid antigen tests. That means only two Canadian companies are actually manufacturing, producing and, obviously, sending tests to the Canadian government.
The Canadian government is procuring them from these two companies. Though, there are three companies, as I said, that get these tests from outside the country but then distribute them here.
There are seven international companies manufacturing COVID-19 rapid tests, and Canada is procuring tests from the seven companies in the United States. Then, there are four international companies outside the United States in other places that we are also procuring tests from and having delivered to this country.
That gives you an idea of the vast number of tests. When it comes down to it, there is no question that we should be looking at the tests that are the most sensitive and the most specific and that give us the best certainty that we’re getting the information we want.
As I said — and I think it’s ultimately the most important thing to remember about these tests — their value as a public health screening tool is enormous, because a rapid antigen test tells you whether or not you’re infectious today. That isn’t the case with the PCR tests. That’s why we need to understand the value of the rapid antigen tests and that they should be available right across the country.
The Hon. the Speaker pro tempore: Are senators ready for the question? Senator Wallin, do you have a question?
Hon. Pamela Wallin: I do if we have another couple of minutes.
The Hon. the Speaker pro tempore: We have three minutes.
Senator Wallin: Quickly, I have the two points. First, do we need to be spending this amount, the billion dollars in spending, given that the provinces have already purchased these tests on their own and we have duplication with two bills with an equivalent amount of spending? Do we need all that money at this point if the provinces are doing it? Second, in terms of these tests, is the data collection you referred to as poor when it comes to other issues, like impacts of the vaccine, impacts of the disease, et cetera?
Senator Seidman: I’ll be quick. As far as the finance part of it, I’ll leave that to my colleagues who are much better skilled at understanding those numbers and have that expertise.
I would suggest that we can’t forget the importance of rapid antigen tests. I do think that’s the key thing here going into the future. We need them.
What was your second question? I’m sorry.
Senator Wallin: About data collection and its —
Senator Seidman: I will say we’re terrible at data collection and a whole lot of other areas.