Thank you, Mr. Chair.

Good morning, everyone.

I'm going to give my presentation in French, but I can answer questions in English or French.

Thank you for having invited me to appear before you to discuss subjects of particular importance for us and our country. I'm a pediatrician who specializes in neonatal intensive care, and a clinician investigator. I also hold a tier 1 Canada Research Chair. As you pointed out, Mr. Chair, I am here before you as the chair and chief of the department of pediatrics, in the faculty of medicine at the Université de Montréal and Centre hospitalier universitaire Sainte-Justine.

I am also the president of Pediatric Chairs of Canada, an organization that represents 17 university pediatrics departments in Canada. Our mission is to train all of Canada's pediatricians and, for some of our departments, those health professionals called “subspecialists”, such as pediatrician-cardiologists and respirologists. Our mission also includes furthering knowledge through research, establishing best practices in pediatric medicine and enhancing the quality of care in our hospitals.

I'd like to speak to you more specifically about three key issues that affect children, for which we need your commitment.

The first of these issues is the number of subspecialists in pediatrics. I know that my colleagues have already appeared and mentioned the major problem of access to community care from nurses, family physicians and general pediatricians. But even if that problem were addressed, many children would continue to require specialist and subspecialty care. Unlike adult medicine, most subspecialty care is provided at university pediatric hospitals, because that's often where the small teams of doctors with the required expertise are concentrated, and able to provide and continue to provide a high level of care. As department heads, our role is to find, recruit and retain these specialists.

Most of our pediatric hospitals encounter major challenges in fulfilling this mandate. Of course, the places available in pediatric subspecialty training programs are a provincial jurisdiction. This means that there are a few programs in a number of provinces that train subspecialty doctors for the whole country. Without a national coordinated and collaborative workforce plan, it will be impossible to train enough specialists to deal with the needs of Canada's children. That means that we often look beyond our borders to recruit subspecialists.

For example, at the moment, 25% of the subspecialty doctors in my department at Sainte-Justine were recruited internationally. That in itself allows for rewarding exchanges of knowledge and experience that are beneficial to everyone. However, credential recognition can vary from one province to another, even in countries that provide recognized training, like Belgium, France and the United States. The immigration process around the world is, of course, slow and burdensome. That's why it will be important to adopt a coordinated interprovincial approach under national leadership.

The second issue I would like to point to on behalf of the entire Canadian university pediatrics community relates to the importance of access to quality data to accomplish our missions. We need data to support research into pediatric illnesses. We need data to set pediatric priorities for vaccination rates, obesity, developmental disorders and mental health in adolescents. And we also need data to monitor the quality of our specialist and subspecialty care

Every centre must, of course, compare itself to others to continue the provision and enhancement of care. Since we do not have many pediatric hospitals and because each specialty treats only a small number of children, it's often impossible to do comparisons between provinces, even the most populous among them. We believe that access to national data is a priority, particularly for quality pediatric care.

As for the third issue, I'd like to speak to you about access to children's medicine. As was clearly demonstrated by the work of the Goodman Pediatric Formulations Centre, under scientific director Dr. Litalien, Canada's regulatory arsenal is lagging well behind in promoting access to drugs for children in Canada, compared to other authorities like the United States Food and Drug Administration, the FDA, or the European Medicines Agency. The Goodman Pediatric Formulations Centre and the Institute for Safe Medication Practices Canada have in fact submitted a document on this topic to your committee.

There are two problems. The first is access to drugs, whether new or old, that could be used to treat children. For these to be available to children, companies have to request permission from Health Canada. Of course, the administrative burden of the process, combined with the small market represented by children, is not very attractive to the companies in question.

To address this, agencies like the FDA and the European Medicines Agency have, for more than 10 years now, introduced regulations requiring companies to submit an application for pediatric use, or to conduct studies on children, whenever they apply for approval of a new drug that might have a pediatric use.

We would like to point out that Health Canada has just set a priority on developing an action plan for pediatric drugs, and we are very grateful to them for this. We keenly hope that the experience of our international colleagues will be put to good use on behalf of Canadian children.

The second problem with medicines has to do with access to pediatric formulations—the syrups, if you will—of drugs that have already been approved for children.

It is of course important to have access to pediatric formulations for the treatment of children, and also important for the drug itself to have Health Canada approval, but it's equally important for the pediatric formulation to be tested, in terms of its concentration and stability, for example, in the syrup.

Here again, Canada lags far behind in its approval of pediatric formulations. To give you just one example of the scale of the problem, the pharmacy at our hospital, CHU Sainte-Justine, has to prepare its own in‑house formulations for approximately half of the drugs, meaning that it has to crush the pill into a syrup. A formulation for this already exists commercially and has the approval of the FDA or the European Medicines Agency.

The pediatric community is therefore requesting that the regulatory structure based on decisions from trusted countries, and also currently being studied by Health Canada, be considered a priority for children's medicines, and in particular for pediatric formulations. Drug needs for children are different than those for adults, and deserve special regulatory attention, and a more rapid system for introducing regulations.

Thank you once again for your invitation, for hearing us out and particularly for your attention to this issue in your study. We believe that it is essential to have frank and open communications between you as the decision-makers and the pediatrics community working in primary care and specialty care. Right now, the health and care of children need your special attention. We, the clinicians and researchers, simply want to make you aware of the circumstances in which we operate and to provide you with the reliable data you need to make the best possible well-informed decisions.

Thank you.

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