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Pandemic creating potential for drug shortages that Canada isn't equipped to deal with – CBC.ca

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This column is an opinion by Dr. AbdulGhani Basith, an emergency physician in Toronto and a faculty member at The Schulich School of Medicine & Dentistry. He is a co-founder of The Critical Drugs Coalition, a group of pharmaceutical experts, physicians and others working to prevent future drug shortages in Canada. For more information about CBC’s Opinion section, please see the FAQ.

For months now, Canadians have been sacrificing things we never thought we would have to and giving up more than we ever thought we could. Those sacrifices are paying off — they’ve helped flatten the curve, and our hospitals are able to keep up with the burden of this terrible virus.

However, while we have survived this leg of the race, we must recognize that COVID-19 is a marathon that will continue to tax our health care system, and that it is creating the potential for drug shortfalls on a level that we may not be prepared to deal with.

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This applies to critical medications as well as potential COVID-19 treatments and vaccines. The federal government needs to publicly and openly take action now to secure our supply of critical care drugs, so that front-line health care providers can continue the work of tending to the sickest patients.

Part of taking care of critically ill people depends on medications that are routinely used in emergency departments and intensive care units all over the world. Medications such as norepinephrine can help support a patient’s blood pressure, while others such as propofol and fentanyl help sedate patients on ventilators or undergoing painful procedures.

Without these medications in my ER, we would not have been able to save the life of an otherwise healthy female patient recently whose respiratory system could no longer handle the damage done by COVID-19. We also would not have been able to honour the wishes of an 85-year-old grandmother who was not able to be with her family during her final moments from pneumonia, and who wanted to die with dignity and comfort.

Although these medications are not currently in short supply, the long-term situation is tenuous due to issues with global supply chains as the pandemic rages on.

In fact, over the past few months Canada has had numerous supply issues, many of which have been identified on the Tier 3 drug shortages list run by Health Canada that details those which could have serious consequences for the health care system.

Currently, the vast majority of the drugs on the Tier 3 list (24 of 32) are essential for treating COVID-19. Recently, for example, the drug propofol has had to be imported in non-traditional concentrations. The implications for errors are obvious, and have led to alerts from pharmacists to ensure that physicians are taking care with the new concentrations.

The anesthetic propofol is often used to sedate COVID-19 patients when they are put on ventilators. (Richard Vogel/The Associated Press)

We have also been facing shortages of non-injectable drugs — ventolin (the “blue puffer” as it’s known to many of our patients) and dexamethasone, a steroid showing tremendous promise for treating the inflammation from COVID-19, being prime examples. Health Canada has been urgently importing ventolin puffers from abroad to fill domestic demand.

Why we face potential shortfalls of these types of drugs is multifaceted. Two of the biggest reasons are the hoarding of drugs by some nations, and the fact that we rely on imported active pharmaceutical ingredients (APIs) with ambiguous supply chains. APIs are the actual precursors for drugs, and their shortage means manufacturers are unable to produce needed drugs in their final form — be it a tablet, an injectable or an inhalable formulary.

Canada relies almost exclusively on imported APIs, and China and India are the leading producers. The supply issues mirror the shortages of personal protective equipment (PPE) that we have all become familiar with over the past few months. We relied heavily on China for vital PPE supplies, and when the COVID-19 pandemic overwhelmed both their own health care and PPE production systems, exports became limited.

Lack of communication

Compounding this is a long-standing lack of information about issues in the global pharmaceutical supply chain.

Drug shortages have been the norm for many years for pharmacists, and they often aren’t given advance notice of pending international supply problems. They find out about specific drug shortages only when trying to order more medication from a manufacturer, and are often forced to put together bits and pieces of information as they try to figure out a solution because they aren’t privy to the full global supply-chain picture.

Pharmacists often find out about specific drug shortages only when trying to order more medication from a manufacturer. (Sue Ogrocki/Associated Press)

This concern has only become worse as COVID-19 limits the export of many drugs from major manufacturers abroad. This is why the Canadian Pharmacist Association placed 30-day limits in March on prescriptions that normally may have gotten 90-day supplies, to ensure all patients would have the medications they needed on a daily basis. This limit is now being lifted as China’s API production picks back up.

The federal government has created a website, drugshortages.ca, to help streamline the communication of this kind of information, but many pharmacists feel it is not user-friendly and it does not provide alerts about pending shortages.

Until we have a reliable domestic supply of these types of drugs, the government could achieve better transparency by instituting public policy that mandates disclosure of all aspects of the logistics of API imports.

However, on a global scale the distribution of medications often goes to the highest bidder. With the advent of novel therapies for COVID-19, we are seeing hoarding of some essential medications. Hydroxychloroquine was an early example, and most recently, the U.S. Government purchased 100 per cent of the world’s supply of the antiviral drug Remdesivir from Gilead Pharmaceuticals, a medication that may have some benefit for the treatment of COVID-19.

The U.S. has bought the global supply of remdesivir, an antiviral drug that has been found to help certain patients recover more quickly from COVID-19. 4:20

Ideally, many of these critical-care drugs should be part of Canada’s National Strategic Emergency Stockpile, but it’s clear that we simply do not have enough medications sequestered to meet the demand during the COVID-19 pandemic. Part of this may be due to funding cuts to the maintenance of this stockpile prior to the pandemic. However, it remains that a stockpile is only a temporary measure in the face of a crisis; we need to put systems in place for self-sufficiency around critical health care resources such as the production of important pharmaceuticals.

Unfortunately, Canada is quite limited when it comes to domestic generic drug production. The Sandoz Pharmaceuticals facility in Quebec is the only one in the country that can make injectable drugs, for example, and it is likely not large enough to meet our domestic requirements. Just as we’ve started producing PPE in Canada, we need to create a stronger domestic drug manufacturing sector.

As a country, we have the knowledge and the skills required to manufacture our own pharmaceuticals, and the payoff for the health care system is well worth it.– Source

Bringing pharmaceutical production back to Canada is not easy, nor would it be without consequence. We should expect to see drug prices increase. But while this is a complicated process, it’s not insurmountable. As a country, we have the knowledge and the skills required to manufacture our own pharmaceuticals, and the payoff for the health care system is well worth it.

The lessons of Connaught Labs, the Toronto-based non-profit maker of Frederick Banting’s insulin that also made vaccines, are highly applicable today. Connaught Labs was privatized and sold to Sanofi in the ’80s. The tragedy of this was aptly described in a recent Toronto Star op-ed, as we could have used Connaught Labs for our domestic COVID-19 vaccine supply today, if not for our drug supply.

Nonetheless, we do have a chance to restore domestic manufacturing now. Government support is essential to doing this successfully, and the Critical Drugs Coalition, which I am a part of, is advocating for this as well as for better stockpiling and increased transparency about the drug supply chain. Domestic manufacturing is the most definitive long-term solution to ensure Canada is not in a position where we are reliant on other countries for necessary medications.

The need to ensure a domestic drug supply also extends to vaccines. Eventually we will have a vaccine for COVID-19, and its distribution will be crucial to rebuilding our economy and restoring normalcy to our daily lives.

Gene-based vaccines, which target DNA or RNA, are being tested on humans in the hopes of finding a COVID-19 vaccine. Researchers are optimistic as trials prove successful so far, but they have a long way to go. 2:01

However, when a vaccine comes to market it will strain supply chains to a degree we haven’t seen before. This will be a product that every country will need to restart their respective economies. We cannot afford to be without a robust supply of our own.

The federal government has made investments around research and production of a COVID-19 vaccine, but Canada needs to absolutely ensure we will have the ability to produce vaccines at home. Just as domestic production of APIs allows for self-reliance when global drug shortages occur, the ability to produce vaccines in Canada will also afford us a similar safety net.

We have all lost something during this pandemic, through the innumerable sacrifices made or loved ones who we will never hold again, but we will come out of the crisis stronger. That is who we are as a nation. To ensure our losses and sacrifices haven’t been in vain, and to prepare for future crises, we must fix the cracks in our health care system and become self-reliant in developing and supplying our own domestic pharmaceuticals and medical technologies — not only for the Canadians of today, but also for those yet to come.


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Child care in Canada: Trudeau unveils new help for providers – CTV News

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The federal government is launching a new loan program to help child-care providers in Canada expand their spaces, and will be extending further student loan forgiveness and training options for early childhood educators, Prime Minister Justin Trudeau announced Thursday.

The prime minister unveiled a trio of child-care-centric commitments that will be included in the upcoming federal budget, with the aim of opening up more $10-a-day child-care spaces across the country, as the Liberals continue to work towards creating 250,000 new spaces by March 2026.

Specifically, the Liberals are vowing to offer $1 billion in low-cost loans and $60 million in non-repayable grants to public and not-for-profit child-care providers, so they can build or renovate their care centres. 

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This funding will be administered through the Canada Mortgage and Housing Corp. (CMCH), which Trudeau called “a common sense approach that will help child care be developed alongside housing.”

An additional $48 million is being earmarked for the next four years to extend student loan forgiveness — similar to the program offered to rural doctors and nurses — to early childhood educators, in an effort to incentivize more teachers to work in smaller communities. 

The federal government is also promising $10 million over the next two years to train more early childhood educators.

The prime minister, speaking in Surrey, B.C., alongside the minister currently leading the file, Jenna Sudds, touted the bilateral child-care agreements in effect across the country for seeing thousands of children placed in affordable spaces.

However, in recent months Canadian parents and care providers have sounded alarms about increasingly long daycare waitlists. And, operators in some provinces have threatened to withdraw from the lower-cost program because they’re struggling to make ends meet. 

Trudeau said while the government has funded 100,000 spaces so far and is aware of the challenges in rolling out this new national program, not enough families have access and not all provinces are moving as fast as they should. 

“I want to take a moment to talk to young moms, many of you millennials. You’ve grown up with so many pressures in this economy, the 2008 recession, COVID, climate change … and we want to make sure that everyone — especially moms raising kids — has the best chance to succeed and thrive,” Trudeau said.

“As Canada grows, as families grow, we want to make sure more kids can access high-quality child care… That’s what fairness for every generation is all about.”

The prime minister also got political, accusing Conservative Leader Pierre Poilievre of opposing the program, despite the Official Opposition voting in support of a recently passed Liberal piece of legislation meant to enshrine in law a commitment to the Canada-wide early learning and child-care system, and the long-term funding needed to maintain it. 

Reacting to the news, NDP MP and critic for children, families, and social development Leah Gazan said the announcement was a “direct result of advocacy” by her party, care workers, unions, and women’s organizations.

She also pointed the finger at the Conservatives, accusing them of trying to stall the program and push for a “for-profit private system that parents can’t afford.” 

Liberal pre-budget strategy

Similar to how Wednesday’s rollout of renter-fairness-focused pre-budget news went, cabinet ministers are making echo announcements of the new child-care affordability measures across the country Thursday afternoon. 

This is all part of a new communications strategy the Liberals are employing in the lead up to the release of the April 16 federal budget.

Practically every day between now and when Deputy Prime Minister and Finance Minister Chrystia Freeland releases the massive economic document, the Liberals are expected to tease out bits and pieces of the budget.

In an effort to stretch out their ability to market the measures within it, Trudeau as well as members of his cabinet will unveil new initiatives over the next two weeks, to the point that the vast majority of the budget will be public prior to budget day.

Traditionally, governments have held budget news — save for some pre-tabling leaks — for the day the document is tabled in the House of Commons post-daylong reporter and stakeholder lockup.

Kicking off this strategy on Wednesday, Trudeau issued a video across social media platforms indicating the overall theme for the 2024 budget will be “generational fairness,” a message meant to speak to millennials and Generation Z.

“When I first decided to run for office, one of my biggest motivations was working to create a Canada that young people saw themselves… As prime minister, I’ve never lost sight of that,” Trudeau said in the clip.

“You as a young Canadian are the heartbeat of our economy. You power our growth and you deserve an economy that gives you a fair shot at success. But, this moment we’re all living in is throwing big challenges your way… So we’re going to roll up our sleeves and work like hell. And we’re going to tell you about what we’re doing to fix it, over the next two weeks.”

While Trudeau’s 2015 election victory was credited in part to a historic surge in young people turning up at the polls, Poilievre has been chipping away at that Liberal voting bloc of those aged 43 and under, seeking to appeal to their current struggles to get ahead with his “powerful paycheques” and housing affordability arguments.

In November 2023, Trudeau tapped Max Valiquette, a marketing guru with self-described expertise in understanding younger generations, as his new executive director of communications.

“We’re witnessing a different communication strategy from the government. They’re implementing something they’ve not tried before. We’re not going to have a budget day on April 16. We’re going to have budget days between now and April 16,” said political commentator Scott Reid in an interview on CTV News Channel.

“Frankly, this government knows that it needs to break through, it knows that it needs to connect with Canadians… Is it going to turn around the polls overnight? No. Might they get a little bit more of a hearing than they otherwise would have been? Probably.” 

With files from CTV News’ Vassy Kapelos and Annie Bergeron-Oliver

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Ontario releases 2023 Sunshine List, top earner made $1.9M – CBC.ca

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Five employees at Ontario Power Generation are in the top 10 earners on the province’s so-called sunshine list for 2023, with the province’s highest salary nearing $2 million.

The annual sunshine list documents public sector employees with salaries over $100,000. In this year’s edition, there are 300,570 names, more than 30,000 higher than last year.

Kenneth Hartwick, CEO of the electricity Crown corporation, is in the top spot again with a salary of $1.93 million.

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Two other executives at the organization — chief strategy officer Dominique Miniere and chief projects officer Michael Martelli — made nearly $1.2 million and nearly $1 million, respectively.

You can find a list of the top 100 earners below.

The presidents and CEOs of the Hospital for Sick Children and the University Health Network are also in the top 10, earning around $850,000 each. So is Phil Verster, who is president and CEO of the provincial transit agency, Metrolinx, with a $838,097 salary.

Caroline Mulroney, president of the Treasury Board, highlighted other high growth areas in a release.

“The largest year-over-year increases were in the hospitals, municipalities and services, and post-secondary sectors, which together represented approximately 80 per cent of the growth of the list,” she said.

The list shows 17 professors or associate professors at the University of Toronto had earnings of $500,000 or more.

A statement from a University of Toronto spokesperson said the school competes with top universities and private-sector employers around the world for faculty members.

“This occasionally results in salaries above the usual range for a small number of faculty members.”

An Ontario Power Generation building.
Five employees at Ontario Power Generation are among the top 10 spots of the annual sunshine list for 2023. (Cole Burston/The Canadian Press)

Premier Doug Ford earned $208,974 last year. His chief of staff, Patrick Sackville, earned $324,675.

Matthew Anderson, CEO of Ontario Health, a provincial agency the Ford government created in 2019, earned $821,000. Meanwhile the public servant leading the Ministry of Health, deputy minister Catherine Zahn, earned $477,360, and Health Minister Sylvia Jones, $165,851.

There are more than 25,000 registered nurses on the list, including seven who earned more than $300,000 last year.

Chief Justice Sharon Nicklas, who was appointed to the top post in the province’s judiciary last May, earned $388,960.

The police chiefs of Thunder Bay, Daniel Taddeo, ($376,428) and Hamilton, Francis Bergen, ($374,492) were paid more last year than OPP Commissioner Thomas Carrique ($373,472). Taddeo retired in April 2023. 

Toronto police Chief Myron Demkiw, who took over the post in late 2022, earned $353,411. 

Organizations that receive provincial government funding are also required to disclose salaries for the sunshine list, so it includes top earners at some registered charities.

The chief executive of the True Patriot Love Foundation, Nicholas Booth, earned $421,149. The foundation funds support programs for veterans and military families. 

The president and CEO of the Canadian Red Cross Society, Conrad Sauve, earned $412,970, while the YMCA of Greater Toronto’s chief executive, Medhat Mahdy, earned $394,057.

Salaries of other key Ontario public figures include:

  • $826,539 for Ontario Pension Board CEO Mark Fuller.
  • $709,581 for Ontario Lottery and Gaming Association president & CEO Alfred Hannay.
  • $601,376 for Registered Nurses Association of Ontario CEO Doris Grinspun.
  • $596,392 for Dean of Ivey Business School, Western University, Sharon Hodgson.
  • $563,291 for LCBO president & CEO George Soleas.
  • $546,053 for Dean of the Faculty of Health Science, Queen’s University, Jane Philpott.
  • $533,112 for Royal Ontario Museum president & CEO Joshua Basseches.
  • $486,192 for University of Toronto president Meric Gertler.
  • $464,148 for Chief Medical Officer of Health Dr. Kieran Moore.
  • $455,091 for Chief Coroner Dr. Dirk Huyer.
  • $404,003 Art Gallery of Ontario director and CEO Stephan Jost.
  • $395,974 for former auditor general Bonnie Lysyk.

Adjusting sunshine list threshold

The sunshine list has been around for almost 30 years, always set at six figures and up. 

At Queen’s Park on Thursday, some members of provincial Parliament faced questions on whether the $100,000 starting point should be adjusted.

Green Party of Ontario Leader Mike Schreiner said it should be pegged to the rate of inflation, but others disagreed.

“I think that people think that $100,000 is still a lot of money, especially in an affordability crisis,” said NDP MPP Catherine Fife, who’s also the finance critic.

Government House Leader Paul Calandra said the government has no plans at this time to change the threshold on the sunshine list.

“I think it’s an important document that serves the people well in highlighting the salaries of our public employees.”

The Public Sector Salary Disclosure Act, enacted by former Progressive Conservative premier Mike Harris in 1996, compels organizations that receive public funding from the province to report the names, positions and pay of people who make more than $100,000.

The interactive chart below shows the top 100 earners on the list, based on both salary and benefits.

Search the complete Sunshine List for yourself here.

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1 dead, 2 critically injured after car crash in Montreal

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Montreal

Three people are in hospital with critical injuries after their vehicle crashed into a tree. Police believe they might be connected to two drive-by shootings that took place early Thursday morning.

2 drive-by shootings also took place overnight

an SPVM car near a taped-off crime scene
Montreal police are investigating a car crash possibly linked to two drive-by shootings. (Mathieu Wagner/Radio-Canada)

Urgences-santé say one person died and two others were critically injured after their vehicle hit a tree in the Rosemont neighbourhood.

Montreal police believe the crash may be linked to two drive-by shootings early Thursday morning.

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The first happened around 5 a.m. on Pie-IX Boulevard. Police say a car was shot at repeatedly and the driver, a 41-year-old man, was injured in the upper body. He was transported to hospital, but his life is not in danger, say police.

Shortly afterward, shots were reported in the Plateau Mont-Royal borough, near the intersection of Saint-Joseph Boulevard and Henri-Julien Avenue. No one was injured.

Police say they are investigating to determine if there is a connection between the collision and the shootings. Montreal police spokesperson Jean-Pierre Brabant says it’s possible those in the vehicle were involved in the shootings.

The province’s independent police watchdog is now involved.

with files from Chloë Ranaldi

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