Question Period Note: Access to Pediatric Care and Medicines

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• Children’s hospitals across Canada have faced significant capacity issues, due in part to a surge in pediatric hospitalizations in the fall of 2022, combined with health workforce shortages, increased mental health hospital admissions, and gaps in access to family health services.
• Access to medicines for children has been a global challenge. Health Canada is working with national and international partners to improve both access to and the regulation of medicines for children. This includes work to address recent shortages of non-prescription pediatric acetaminophen and ibuprofen products.
KEY MESSAGES
· The Government of Canada recognizes that our children’s healthcare system has been under significant strain with a surge in pediatric hospitalizations in the fall of 2022.
· On February 7, 2023, the federal government announced an immediate unconditional $2 billion CHT top-up to address immediate pressures on the health care systems, especially in pediatric hospitals, emergency rooms and long wait times for surgeries.
· We will continue to work collaboratively with stakeholders to make sure that parents and caregivers have the drugs that are necessary to take care of their children.

Surge in respiratory illnesses
Viral respiratory illnesses are a recurring issue, with illnesses such as RSV and influenza usually causing epidemics and outbreaks in Canada annually, mainly in the Fall/Winter/Spring months. There are also periodic clusters of illnesses such as group A streptococcus and invasive group A streptococcus (iGAS).

This year, there has been higher than usual activity and healthcare demand due to many factors, including the interaction of COVID, seasonal flu and RSV, as well as increased susceptibility due to limited exposure to other respiratory illnesses during COVID-19.
• Higher than usual RSV activity in children was observed in early November, with 1,045 cases detected between October 22 – 29, 2022.
• So far this season, there have been a total of 1,543 pediatric influenza-associated hospitalization, affecting mostly children aged 2 to 9. Children under 5 years old have been particularly vulnerable to influenza-related hospitalization along with adults aged 65 and older.
• Approximately 12% of hospitalizations resulted in ICU admissions for children.

Due to the surge, children’s hospitals across the country were stretched beyond capacity. During the peak, pediatric hospitals reported volumes in excess of 120%-160% capacity in both inpatient and emergency departments.

Hospitals have indicated that this crisis has subsided, as the number of hospital admissions due to respiratory illnesses have abated, remaining higher than average levels compared to pre-RSV pandemic seasons, but within expected levels typical for this time of year. For the week ending January 21st, 2023, there were only 10 hospital admissions for influenza.

The Public Health Agency of Canada (PHAC) continues to closely monitor respiratory infections:
• At the national level, influenza activity continues to decline and is now at levels typically seen in late spring/early summer.
• RSV activity is within expected levels typical of this time of year compared to pre-COVID seasons.

Health system capacity
Despite RSV and influenza cases declining, pediatric hospital capacity for inpatient admissions continues to be strained due to factors such as shortages in health human resources (HHR), increased mental health admissions, and gaps in access to family health services:
• HHR shortages affect all sectors including pediatrics, with particularly severe shortages in highly specialized medical professions such as pediatric heart surgeon. CHEO alone faces about 450 vacancies.
• Children and youth are among the highest users of Emergency Department (ED) for mental health and substance use services. From 2020 to 2021, admissions for mental health conditions increased by 24.9% while overall hospital admissions increased by 4.8%.
• In 2021, 14.5% of Canadians 12 years and over lacked a regular health care provider.
• In 2020, 38% of Canadians reported their last emergency department visit was for a family health care treatable condition.

Family health services are the backbone of high-performing health care systems, as they serve a dual function in via the direct provision of first-contact services, and as a coordination function to ensure continuity across health care settings. However, Canadians are facing difficulties in accessing care, including marginalized communities.

• In 2020, there were 74 practicing pediatric surgeons in Canada. The median distance to the closest pediatric surgeon was 28km, with 22.7% (1.7 million or nearly 25%) of all Canadian children living more than 100km from surgical care.
• In 2019, there were 2973 Pediatric Physicians working in Canada, that is 8 physicians per 100,000 children and youth
• In 2016, 19.2% of Indigenous people reported that they did not have a primary family health care services provider compared to 15.8% of the non-Indigenous population.

The fall surge forced hospitals to pause other services, including surgeries, further exacerbating wait times. For example, across four pediatric hospitals in Ontario, 11,789 children have yet to receive necessary surgeries and about half of these children have been waiting beyond the clinically recommended wait times.

Government Supports

In Budget 2022, The Federal Government announced investments to enhance access to family health services including $115 million to help internationally trained health providers get their credentials recognized. The Government has also committed to expanding the list of eligible professionals under this program in order to help bring more health care workers to the communities who need them most, including rural and remote communities. The government also plans to increase family health services in these areas by making targeted investments to attract more doctors and nurses through incentives, including increasing the maximum amount of forgivable Canada student loans for doctors and nurses who work in underserved areas by 50%. This will mean up to $30,000 in loan forgiveness for nurses and up to $60,000 for doctors working in these communities

Most recently on February 7, 2023 the Government of Canada has announced a new health funding through the Canadian Health Transfer (CHT). There will be an increased health funding to provinces and territories by $196.1 billion over ten years, including $46 billion in new funding.

The incremental investment will support improvements to the health care system that will have benefits for the outcome of children’s health through shared health priorities:
· Access to family health services
· Supporting health workers and reducing backlogs
· Improving access to mental health and substance use services
· Modernizing the health system

This builds on previous CHT top-ups that total $6.5 billion provided throughout the pandemic. The funding includes an immediate unconditional $2 billion CHT top-up to address immediate pressures on the health care systems, especially in pediatric hospitals, emergency rooms and long wait times for surgeries.

In addition, the Government of Canada is working collaboratively with children’s health leaders to address significant data gaps through the establishment of ongoing monitoring mechanisms to obtain timely information on pediatric health system capacity and utilization moving forward, including bed and ventilator utilization and capacity to be in a better position to anticipate and react to the surges.

The Government has also established a Coalition for Action for Health Workers, a team of health workers dedicated to identifying concrete actions to drive pan-Canadian progress on addressing the health work force crisis. The Chief Nursing Officer position has also been reinstated to provide strategic advice from a nursing perspective to Health Canada on priority policy and program areas.

Pediatric medicine
Along with the increased use of emergency care due to the uptake of respiratory illnesses in children, families and children are also being affected by the pediatric analgesics shortage.

Health Canada has taken action to address the shortage of children’s analgesics by working closely with key stakeholders, including industry and health care system partners, to implement shortage mitigation measures to increase supply and monitor their distribution across the country. The Canadian supply is at a record high, with some companies producing about 100% more than they were at the same time in 2021. Domestic suppliers have ramped up production as they released 3.8M units of ibuprofen and acetaminophen into the Canadian market in November and December 2022. Health Canada also approved the exceptional importation of over 2.3M units of foreign-labelled product for hospitals, retail, and community pharmacies as of January 23, 2023.

Up to 80% of drugs prescribed to children in Canada is done off-label (i.e. without safety or efficacy data in the pediatric population). To address this gap, the Department launched the Pediatric Drug Action Plan (PDAP) in June 2021 with the ultimate vision that Canadian children and youth (0-17 years) have access to the medicines they need in age appropriate formulations. Work is underway to develop regulatory amendments (a “pediatric rule”) that would allow Health Canada to require pediatric studies to be completed for products expected to be used in the pediatric population. This would include the development of pediatric formulations. The development of the regulation is ongoing as a “Pediatric Policy Pilot” to be implemented in the later half of 2023.

Health Canada is also working closely with the Canadian pediatric medical community to develop a draft list of priority medicines to include in Canada’s first National Priority List of Pediatric Drugs.

HESA Study on Children’s Health
The Standing Committee on Health (HESA) passed a motion on February 9, 2022 to undertake a study on children’s health and the impact of the pandemic on children’s health outcomes. So far, the committee has reviewed and engaged with stakeholders from a broad range of sectors committed to improving children’s health. Children’s health is an issue of concern now more than ever, in light of the severe and unique impact of the COVID-19 pandemic, and recent surges in viral illnesses in children. HESA is expected to issue a study report with recommendations in the coming months.

• On February 7, 2023, the federal government announced an immediate unconditional $2 billion Canada Health Transfer (CHT) top-up to address immediate pressures on health care systems, especially in pediatric hospitals, emergency rooms and wait times for surgeries.

• This new funding is expected to help pediatric hospitals address the important surgical backlogs they are facing, which have been exacerbated by the COVID-19 pandemic and by the surge in respiratory illnesses in the fall of 2022.