Question Period Note: Access to Pediatric Care and Medicines

• Access to children’s health services across the continuum of care remains an issue in Canada, including lengthy backlogs for essential services such as surgical, diagnostic, mental health, and children’s rehabilitation.
• The Standing Committee on Health released a report on May 6, 2024, entitled Fostering Healthy Childhoods: A Foundation for Resilient Generations. Among other recommendations, the report calls for a national pediatric health care workforce strategy, the establishment of a national child and youth commissioner, and a national pediatric health data strategy.

• The Government of Canada is committed to improving the health and wellbeing of Canada’s children.
• Through the Government’s plan, “Working Together to Improve Health Care for Canadians,” the Government of Canada is investing close to $200 billion over 10 years for health care, including $44 billion in new funding to provinces and territories improve health care services for Canadians across the country. We continue to work closely with provinces and territories on our shared health priorities, including:
o Access to family health services,
o Supported health workers and reduced backlogs,
o Access to mental health and substance use services, and
Modernizing health systems.
• The Government of Canada also continues to work collaboratively with stakeholders through initiatives such as the Pediatric Drug Action Plan, to make sure that parents and caregivers have the drugs that are necessary to take care of their children.
• The Government is reviewing the recommendations of the Standing Committee on Health carefully.
IF PRESSED ON DETAILS ABOUT INCREASING AND MAINTAINING SUPPLY OF HEALTHCARE WORKERS
· $25 billion over 10 years will advance shared health priorities, including supporting our health workers and reducing backlogs, through tailored bilateral agreements with provinces and territories.
· In addition, funding of $1.7 billion will support hourly wage increases for personal support workers and related professions, as federal, provincial and territorial governments work together on how to best support the recruitment and retention of these workers.
· Budget 2024 proposes to provide $77.1 million over four years, starting in 2025-26, to address critical health human resource supply challenges. This funding will support the integration of internationally educated health care professionals (IEHPs) into Canada’s health workforce by reducing barriers and addressing critical gaps in training opportunities.
· These investments will accelerate efforts already underway with provinces and territories to support the recruitment and retention of health workers within the public health care system.
IF PRESSED ON WHAT THE HEALTH PORTFOLIO IS DOING TO MONITOR RESPIRATORY ILLNESSES AND HOSPITAL CAPACITY

· The Public Health Agency of Canada (PHAC) continues to closely monitor respiratory infections, including RSV and influenza in Canada.
· Since the 2022 surge in respiratory illnesses, Health Canada has taken steps to develop, with the help of the Canadian Institute for Health Information (CIHI), a mechanism to monitor pediatric bed and ventilator utilization in Canada.
· Since January 2024, CIHI has been receiving weekly data on ICU admissions from 9 pediatric hospitals, including British Columbia, Alberta, and Ontario. This data accounts for 68 per cent of pediatric intensive care beds across Canada. These reports and near real-time data on pediatric hospital capacity will allow us to better anticipate and react to respiratory virus surges.
IF PRESSED ON THE PEDIATRIC DRUG ACTION PLAN
· Health Canada’s initial priorities under the Pediatric Drug Action Plan include implementing a pilot for the submission of pediatric development plans and studies, and the development of a National Priority List of Pediatric Drugs (NPLPD).
· The pilot program was launched in February 2024 and is designed to encourage sponsors to submit pediatric development plans and studies to Health Canada. The purpose of the pilot is to collect data and to better understand the pediatric landscape in the Canadian context. Having this information will inform pediatric policy and help Health Canada make the appropriate regulatory decisions in the future.
· We are also working to develop a National Priority List of Pediatric Drugs, which will help us identify drugs with pediatric indications and formulations and address unmet pediatric drug needs in Canada. This initiative is being informed by pediatric medical practitioners and the pharmacist community across Canada.
IF PRESSED ON SUPPORTING THE MENTAL HEALTH OF CHILDREN AND YOUTH
· Our government recognizes the unique mental health needs of children and youth and is deeply committed to their well-being.
· We are working with partners, including provinces and territories, to ensure children and youth have access to mental health supports now and in the long-term where and when they need them.
· For example, in Budget 2024, we’ve committed to introduce a new Youth Mental Health Fund that will provide $500M over five years to help community health organizations provide enhanced care for younger Canadians.
· We are also supporting the development and expansion of Integrated Youth Services, which provide a “one-stop shop” of supports in the community for youth.
IF PRESSED ON THE HESA COMMITTEE REPORT ON CHILDREN’S HEALTH
· The Standing Committee on Health tabled its study on children’s health and adopted the report, titled “Fostering Health Childhoods: A Foundation for Resilient Generations”.
· Health Canada is grateful for the work of the Committee in studying this important issue and for the witnesses who participated and offered their expertise in support of this report.
· Our government acknowledges the issues highlighted in the report, including long wait times for surgeries and access to mental health services, access to pediatric drug formulations, and declining physical activity rates, among others. We are committed to working together to advance collective action to address these issues and improve children’s health across the country.
· Health Canada is reviewing the recommendations of the Committee carefully to inform our work, and will be developing a response to the recommendations.

Health System Capacity
The children’s healthcare system is drastically undersized to deal with the increased demand placed on children’s health services. Access to children’s health services across the continuum of care remains an issue in Canada, including lengthy backlogs for essential services such as surgical, diagnostic, mental health, and children’s rehabilitation. Children now wait longer than adults for many essential and time sensitive healthcare interventions.
Children and youth have unique health needs that must be considered and measured, requiring system-wide solutions, investments and planning across all levels of government to ensure the best possible outcomes for children’s physical and psychological health and development.
Surges in Respiratory Illness in the Pediatric Population
In 2022, there was higher than usual activity and healthcare demand due to many factors, including COVID-19, seasonal flu and RSV, as well as increased susceptibility to illness due to limited exposure to other respiratory illnesses during COVID-19. Higher than usual RSV activity in children was observed in fall 2022.
During the surge, Canada saw an increased use of emergency care due to the uptake of respiratory illnesses in children. The 2022 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.

Trends observed during the 2023-2024 indicated COVID-19, seasonal flu and RSV were co-circulating. However, influenza-associated hospitalizations remain in the low activity range. This season (from October 1, 2023, to April 27, 2024), 1,084 influenza-associated pediatric hospitalizations were reported.

The Public Health Agency of Canada (PHAC) continues to closely monitor respiratory infections:
• As of mid-April 2024, most COVID-19 indicators remain at low levels in Canada.
• At the national level, indicators of influenza activity are decreasing and are within or below expected levels typical of this time of year.
• RSV percent positivity is stable and below peak levels recorded in December 2023.

In anticipation of the 2024-25 respiratory illness season, the Public Health Agency of Canada continues monitoring current respiratory virus trends in the southern hemisphere to anticipate potential trends for Canada's next respiratory season.

Monitoring of pediatric health capacity
Since the 2022 fall surge, the Government of Canada has been working collaboratively with children’s health leaders and the Canadian Institute for Health Information (CIHI) to address significant data gaps in pediatric health capacity monitoring. As of January 2024, CIHI has been receiving weekly data on ICU admissions and occupancy from 9 pediatric hospitals in BC, AB, and ON. This accounts for activity across 173 pediatric intensive care unit (PICU) beds or 68% of PICU beds across Canada. These weekly summary reports are intended to support: provision of near-real time data on PICU capacity and utilization across Canada; information sharing amongst participating pediatric hospitals; trend analysis and predictive analytics; emerging priorities for pediatric populations; and rapid response to inquiries related to utilization and capacity issues across multiple hospitals. The near-time data can function as a signal for in-depth analyses to better anticipate and react to respiratory virus surges.

Supply of Pediatric Medications
Since the 2022 respiratory surge, the supply of pediatric analgesics products has stabilized, and products are readily available at community and hospital pharmacies. As a result of challenges related to enabling access to safe and effective pediatric drugs in Canada, many drugs are being prescribed to children off-label, meaning they are prescribed outside of their approved use set out in the drug’s product monograph.

Pediatric Drug Action Plan
In 2020, following consultation with stakeholders, Health Canada developed a Pediatric Drug Action Plan (PDAP) to address the prescription of off-label drugs to children, with the ultimate vision that children and youth (0-17 years) in Canada have access to the medicines they need in age-appropriate formulations.

The three main goals of the PDAP are:
o Increasing the development of pediatric medicines and formulations;
o Improving access to pediatric medicines and formulations; and
o Providing more information to Canadians.

Implementation of the PDAP is expected to continue over the next five or more years. Current priorities include:
o Implementing a “pediatric pilot” to help bring Health Canada into alignment with other jurisdictions in requiring pediatric studies to be completed and submitted when it is expected that a drug will be used in the pediatric population. This pilot was launched on February 26, 2024, and will be used to collect data and to better understand the pediatric drug submission landscape in Canada;
o Working with pediatricians across Canada to develop a National Priority List of drugs that are needed for the pediatric population.
o Identifying the regulatory pathways and flexibilities that can be offered to bring these products to Canada.

Improving access to medicines for pediatric populations is a global issue requiring international collaboration. Health Canada is also working across the health portfolio, other government departments, and with our external national and global partners, including the Regulatory Cooperation Forum and the World Health Organization Pediatric Regulatory Network, on key initiatives related to pediatric drugs.

Federal Investments in Healthcare
Budget 2024 confirms the federal government’s plan to provide close to $200 billion over ten years in health transfers to provinces and territories. This includes $44 billion in new funding through new Canada Health Transfer measures, tailored bilateral agreements to meet the needs of each province and territory, funding for personal support workers, and an increase to the Territorial Health Investment Fund.

Budget 2024 also proposed $77.1 million over four years, starting in 2025-2026 to effectively integrate internationally educated health care professionals into Canada’s health workforce by creating 120 medical residency training positions, increasing assessment capacity and providing support to navigate credential recognition systems.
Canada Health Transfer Top-Up: In June 2023 the federal government provided provinces and territories $2 billion to address urgent pressures in emergency rooms, operating rooms, and pediatric hospitals, building on $6.5 billion in top-ups provided throughout the pandemic.
Canada Health Transfer Growth Guarantee: A 5% CHT growth guarantee for the next five years, resulting in a permanent funding increase (expected value of %15.3 billion over 10 years).
Tailored Bilateral Agreements: The federal government will provide $25 billion over ten years through a new set of bilateral agreements to address individual provincial and territorial health system needs, such as expanding access to family health services, supporting health workers and reducing backlogs, increasing mental health and substance use support, and modernizing health systems.
Federal Investments in Access to Mental Healthcare
Across Canada, children and youth are reporting decreases in their overall mental health. In 2020, over 35,000 children and youth were hospitalized for mental health disorders – almost 1 in 4 of all hospitalizations for children and youth. Children and youth are among the highest users of Emergency Departments for mental health and substance use services.
$500M for the new Youth Mental Health Fund was announced in Budget 2024. The Fund will be designed and delivered in a manner that complements other investments in youth mental health and mental health more broadly.
Significant progress has been made in expanding the availability of Integrated Youth Services hubs across Canada. There are now approximately 90 hubs across Canada with over 50 more in development. All 13 provinces and territories have developed or are developing an Integrated Youth Services network and a pan-Canadian Indigenous IYS network in progress.
In November 2023 the Government of Canada announced Canada’s new, national three-digit number, 988, for suicide prevention and emotional distress. Funded by the Government of the Government of Canada and led by the Centre for Addiction and Mental Health, 988 will be available to everyone by phone and text, in both official languages, and accessible 24 hours a day and seven days a week.

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. HESA completed a study report in the spring of 2024 titled “Fostering Health Childhoods: A Foundation for Resilient Generations”, detailing recommendations for the government. The report outlines the committee’s findings and offers 27 recommendations on how the federal government can take immediate action, in collaboration with provinces, territories and stakeholders, to foster healthy childhoods in Canada.

Key initiatives recommended in the report include: developing a national pediatric health care workforce strategy; implementing policies to improve access to pediatric drug formulations; expanding access to mental health and substance use services for children, adolescents and young adults; investing in programs that encourage healthy eating and physical activity among children; ensuring full implementation of Jordan’s Principle and the Spirit Bear Plan; establishing a national child and youth commissioner; and developing a national pediatric health data strategy.

Health Canada is reviewing the recommendations of the Committee carefully to inform our work towards a Government response.

• As of July 2023, two-thirds of patients at Ontario’s children’s hospitals have surpassed recommended wait times for surgery. The situation is similar across the country. In Nova Scotia, 2,500 pediatric patients are waiting for surgery, with 40% waiting beyond the recommended window.
• There are not enough health care workers to meet the current demand for services. Nearly 14.5% of Canadians do not have a primary health care provider. Without a primary health care provider, emergency rooms become the only accessible option for children and youth seeking health care.
• Almost two thirds of mental health disorders emerge before the age of 25, with nearly half emerging before 18. Children and youth are among the highest users of Emergency Departments (ED) for mental health and substance use services.
• Children are waiting longer than medically recommended for surgical procedures and mental health supports, causing delays that can lead to short-term and long-term complications, including a worsening of symptoms, more complicated procedures, disabilities and developmental changes.
• Experts and advocates like Children’s Healthcare Canada are calling for a national child health strategy, a national children’s health officer and dedicated funding for child health, as well as funding for robust maternal, child, and youth health research. Most recently, the Standing Committee on Health released its Fostering Healthy Childhoods report, which reiterates many of these recommendations.