The Ministerial Council On HIV/AIDS

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Annual Report April 1, 2003 - March 31, 2004

6.3 Effective and responsive structures and strategies to fight the epidemic, including an adequately resourced Canadian Strategy on HIV/AIDS

Overview
Funding levels for the Canadian Strategy on HIV/AIDS have not been increased significantly for almost a decade, despite an increase in the number of Canadians infected and the growing international epidemic. Inflation has eroded the value of the Strategy's $42.2 million annual funding to less than $34 million in 2003 (in 1991 dollars) despite the increasing number of people living with HIV/AIDS and the epidemic's spread to more diverse and harder to reach populations. Compared to other countries such as Australia and the United Kingdom, which have also invested strategically in HIV/AIDS, Canada is falling behind. The development of a renewed framework for the Strategy which is currently underway calls for increased funding and refocusing of effort.

6.3.1 Canadian Strategy on HIV/AIDS

The issue
During 2003-2004, all stakeholders engaged in intensive work on a renewed framework for the Canadian Strategy on HIV/AIDS, which has been in place since 1998. A Five-Year Review of the Strategy, initiated by the Minister of Health, was completed in 2003. The Five-Year Review was intended to document lessons learned, identify current gaps and recommend directions for the next five years. The Review also fulfilled a Treasury Board requirement to report by July 2003 on activities and achievements related to the $42.2 million in annual federal funding for the Strategy from 1998-2003. The Review called for increased funding from the present annual level of $42.2 million to a level of $85 million or $106 million, representing enhanced levels of commitment to managing or getting ahead of the epidemic. The Five-Year Review calls on the Government of Canada to have a single goal for 2004-2008: to align and direct Canadian efforts and resources so as to most effectively prevent the epidemic's spread, reduce the vulnerability of at-risk populations, enhance the capacity of Canadians to address the epidemic, ensure that appropriate treatment, care and support are equitably available and minimize the adverse impact of HIV/AIDS. Five-Year Review report, Getting Ahead of the Epidemic,

In a parallel initiative, a draft Strategy Action Plan was developed in 2003 by partners in the Strategy and following a consultation across Canada, a finalized Action Plan is expected by the summer of 2004. The draft Action Plan is the culmination of several years of development work on renewed directions for the Strategy by all stakeholders. The draft Action Plan incorporates much of the policy deliberation done during the earlier direction setting process, including a social justice framework and approaches to reaching vulnerable populations. The nine directions of the draft Action Plan are:

1. Raise public/political awareness of the impact of HIV on society, and of the social factors that contribute to the epidemic.
2. Address the social, economic, environmental and health factors that contribute to the epidemic.
3. Optimize the voice, involvement and meaningful participation of people living with and vulnerable to HIV.
4. Increase capacity to monitor and track HIV, and to develop, share and apply knowledge.
5. Re-invigorate primary prevention efforts.
6. Provide comprehensive, integrated prevention, diagnosis, support, care and treatment services.
7. Strengthen organizations that provide HIV-related services and increase their capacity to meet increasingly complex needs.
8. Ensure appropriate, sustainable investment in HIV programs and services.
9. Provide leadership in global efforts to combat the epidemic.

Draft Action Plan, Leading Together: An HIV/AIDS Action Plan for All Canada 2004-2008.

During 2003, the House of Commons Standing Committee on Health delivered a report on its review of the Canadian Strategy on HIV/AIDS. The report called for increased funding for the Strategy at an annual level of $100 million with targeted funding for initiatives involving inmates, Aboriginal peoples, and vaccine development. The report also called for a stronger coordination role for Health Canada as the lead federal department, targeted prevention activities for youth, Aboriginal peoples and those affected by stigma and discrimination, and harm reduction strategies for inmates. The report recommended that the Strategy be reviewed every two years so that funding and efforts could be most effectively directed. The report of the Commons Standing Committee on Health, Strengthening the Canadian Strategy on HIV/AIDS .

Health Canada anticipates that these reports will make a slid case for increased funding and a renewed framework for the Strategy with a clearly defined federal role. In order to secure changes to the Strategy, the Minister of Health would have to make submissions to the Treasury Board and to Cabinet.

Work done during 2003-2004

• The Ministerial Council participated actively in the processes that developed the Five-Year Review and the draft Strategy Action Plan.
• The Ministerial Council was represented on the Five-Year Review Advisory Committee and at a focus group convened to provide input on the Review. Council members participated in a teleconference and in e-mail consultations on the Review. The Council also provided comments on the final report and communicated its advice to Health Canada, stressing the need for stakeholder input on the Review.
• The Ministerial Council wrote to the Minister in September 2003 in response to the Five-Year Review report. In its letter, the Council supported the vision, goals and principles outlined in the report. The Council stressed the importance of federal leadership on the Strategy and in fostering inter-and intra-departmental collaboration and inter-governmental collaboration at the federal/provincial/territorial level. The Council also advised the Minister that an effective response to HIV/AIDS requires working with specific communities, commitment to research and a social justice approach to all issues. The Council supported the Review's proposed annual Strategy funding level of $106 million.
• The Ministerial Council participated in the process of development and review of the draft Action Plan 2004-2008 and in the development of the national consultation process. The Council was represented on the Action Plan Steering Committee.
• The Ministerial Council had special presentations at its June and September 2003 meetings and regular briefings throughout the year on the Five-Year Review and the development of the draft Action Plan and its consultation strategy. The Council provided its perspective to Health Canada officials.
• In its message in the 2003 Health Canada Annual Report released on World AIDS Day, the Ministerial Council stated its support for an increased investment in the Strategy and the development of the Action Plan. The Council stated its support for strengthening and expanding the engagement of new players and recognizing the importance of inter-departmental, inter-governmental and multi-sectoral collaboration on HIV/AIDS. The Council called for a fuller alignment of the Canadian domestic and international responses to HIV/AIDS.
• The Ministerial Council wrote to the Minister expressing support for the recommendations of the report of the Commons Standing Committee on Health.
  In her reply to the Ministerial Council, the Minister stated that the Committee's report, together with the Five-Year Review and the United Nations General Assembly Special Session on HIV/AIDS' Declaration of Commitment (to which Canada is signatory) form the basis for discussions about the renewed framework and appropriate funding levels for the Strategy.

Future activities
The Ministerial Council will continue to be involved in the process of developing a renewed framework for the Canadian Strategy on HIV/AIDS and will provide advice to the Minister.

6.3.2 Social justice framework and determinants of health

The issue
A social justice framework for dealing with HIV/AIDS addresses the social, economic and political factors that worsen the epidemic, such as gender-based inequalities, racism, poverty, discrimination, lack of affordable housing, social conditions and legal and government policy. It looks at the range of social determinants and their impact on health and recognizes that protecting, promoting and fulfilling human rights are fundamental to realizing social justice. Moving to a social justice framework was one of the 10 directions set for the Canadian Strategy on HIV/AIDS at a national stakeholders' meeting in 2000. There was recognition that the socio-economic conditions affecting Aboriginal peoples and communities need to be included in the social justice framework for dealing with HIV/AIDS.

The development of a social justice framework based on human rights concepts and principles, and linked to the determinants of health, builds on the work of HIV/AIDS pioneer Dr. Jonathan Mann. Support for this approach also derives from international human rights law and the positions that form part of the Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in June 2001, to which Canada is a signatory (see section 6.5.2).

Extensive work was done on the development of a social justice framework during 2002-2003 and 2003-2004 by Health Canada and stakeholders. The draft Action Plan for a renewed Canadian Strategy on HIV/AIDS incorporates this work. One of the five goals of the draft Action Plan is to influence the broad determinants of health and the underlying causes of HIV. The draft Action Plan's overall strategic approach is a commitment to social justice. This approach recognizes that past HIV prevention efforts have focused on changing individual behaviour whereas research has show that social environments have a stronger impact on people's health than individual behaviour. One of the draft Action Plan's nine strategies for the next five years is to address the social, economic, environmental and health factors that contribute to the epidemic. The commitment to a social justice framework necessitates the strong involvement of all stakeholders and the collaboration of a wide range of government and community partners.

Work done during 2003-2004

• The Ministerial Council actively disseminated its 2002 report on the determinants of health.
  • The Council sent a copy of the report to the Minister, encouraging her to use the report when engaging her Cabinet colleagues in dialogue on building partnerships between departments. The Council offered its support to the Minister on this issue.
• The Ministerial Council also sent the report to Canadian Strategy on HIV/AIDS partners. In its covering letter, the Council encouraged organizations to use the paper as a tool for analyzing and developing policies, establishing relationships between diverse sectors and encouraging all levels of government to work in collaboration in addressing the HIV/AIDS epidemic in Canada.
• The Ministerial Council worked actively with Health Canada and stakeholders on the development of the social justice framework and the draft Strategy Action Plan.

Future activities
The Ministerial Council will continue to participate in the development of the social justice framework as a fundamental approach to renewing the framework of the Canadian Strategy on HIV/AIDS and will provide advice to the Minister.

6.3.3 CSHA funding adequacy

The issue
Funding levels for the Canadian Strategy on HIV/AIDS have not increased since 1994, when they were set at $42.2 million. In the early 1990s, 30,000 Canadians were living with HIV; today that number is more than 50,000. Inflation has eroded the $42.2 million to $34 million in 1991 dollars. As a consequence of this erosion, most HIV programs and services have had to cut programs and increase staff workloads which has led to burnout and turnover. New needs have also arisen that require adequate support, including those of new vulnerable populations and the continuing needs of the populations originally infected.

The Minister in 2002 reiterated the commitment made by her predecessor to seek additional funding for the Strategy provided that the results of the Five-Year Review and the Action Plan for 2004-2008 make a sound case for more funding. In the interim, the Minister allocated one-time funding of $500,000 to the Strategy in 2003. These funds were used on three priorities identified by the Ministerial Council: engaging vulnerable populations; developing an inter-departmental action plan; and conducting public opinion research on HIV/AIDS awareness.

During 2003-2004, several influential studies called for increased funding for a renewed Strategy. The report of the House of Commons Standing Committee on Health recommended in June 2003 that Strategy funding be increased from $42.2 million per year to $100 million per year. For a fuller description of the recommendations of the Standing Committee's report, see sections 2.0 and 6.3 (overview) and 6.3.1 of this report. The Five-Year Review of the Strategy, Getting Ahead of the Epidemic, recommended that Strategy funding be increased to $85 million per year in order to manage the epidemic, and to $106 million per year to get ahead of the epidemic and prevent its spread. For a fuller description of the Five-Year Review, see sections 2.0 and 6.3 (overview) and 6.3.1 of this report. An EKOS research survey conducted for Health Canada in 2003 showed that nearly two thirds of Canadians support spending more on HIV/AIDS. The draft Action Plan 2004-2008 (see sections 2.0, 6.3-overview and 6.3.1 for more details) calls for per capita spending on HIV in Canada to be comparable to that of developed countries with lower rates of HIV infection (e.g. the United Kingdom and Australia).

A further issue during 2003-2004 was the levy on Strategy funds applied by Health Canada in order to support corporate services at the departmental level. Although a levy is applied each year, the levy in 2003-2004 was substantially higher than in the past. This led to a $1.3 million reduction in grants and contributions under the Strategy, resulting in a lack of funding for some community-based programs and delay or cancellation of requests for proposals in some national programs, including Community-Based Research (see section 6.4.1 of this report). In addition, a government-wide reallocation exercise began early in 2004 to find $1 billion in savings by March 31, 2004 to be reallocated to other areas of the federal government. As a result, the Centre for Infectious Disease Prevention and Control, which includes the HIV/AIDS division, was asked by senior management to impose strict limitations on expenditures. This resulted in the cancellation of several meetings, including a face-to-face meeting of the Ministerial Council, which was held instead by teleconference in February 2004.

The Ministerial Council monitors and evaluates the implementation of the Canadian Strategy on HIV/AIDS, including reviewing and recommending financial allocations and the reallocation of surplus funds or deficits in each year. The Ministerial Council has consistently advocated for increased funding for the Strategy.

Work done during 2003-2004

• The Ministerial Council wrote to the Minister in support of the Five-Year Review of the Canadian Strategy on HIV/AIDS and the Commons Standing Committee on Health report, both of which had made the case for increased funding for the Strategy. In its letter, the Council asked requested the Minister to inform them of her plans to approach Cabinet for more funding for the Strategy.
• The Ministerial Council expressed its strong concern to the Minister and to Health Canada officials about the effect of the Health Canada departmental levy on Strategy programs.
• In its September 2003 meeting with the Minister, the Council:
  • thanked her for her support in securing one-time funding of $500,000 for the Strategy
  • expressed their pleasure at the Minister's endorsement of the recommendation of the Commons Standing Committee on Health's report with respect to increased funding
  • reiterated its support for the Five-Year Review recommendations for increased Strategy funding
  • offered to assist the Minister in her efforts to champion the need for increased funding with Treasury Board and Cabinet
  • expressed its concern about the departmental levy that has affected Strategy programs.

The Minister restated her intention to go to Cabinet for new money for HIV and said that increased funding should help to alleviate the impact of levies on grants and contributions.

 

• The Ministerial Council wrote in December 2003 to the Minister of Finance and to the President of the Treasury Board expressing the Council's strong support for increased funding for the Strategy to the level of $100 million annually as recommended by the Commons Standing Committee on Health report.
• The Ministerial Council expressed its strong concerns to Health Canada about developments in the federal government and at Health Canada in early 2004 which appeared to have taken the focus off seeking increased funding for the Strategy while the new Public Health Agency is being established (see section 6.4.5 of this report).
• The Council expressed concerns to Health Canada about: uncertainties and delays in funding for national stakeholder organizations; and the lack of funding for the annual national stakeholder face-to-face meeting.

Future activities
The Ministerial Council will champion the securing of additional funding for the Strategy and will provide advice to the Minister.

6.3.4 CSHA resource allocation

The issue
The $42.2 million annual funding for the Canadian Strategy on HIV/AIDS is allocated to a number of specific programs. The original allocations were determined in 1998. They are:

• Prevention: $3.9 million
• Community Development and Support to national non-governmental organizations: $10 million
• Care, Treatment and Support: $4.75 million
• Research: $13.15 million
• Surveillance: $4.3 million
• International Collaboration: $0.3 million
• Legal, Ethical and Human Rights: $0.7 million
• Aboriginal Communities: $2.6 million
• Consultation, Evaluation, Monitoring and Reporting: $1.9 million
• Correctional Service of Canada: $0.6 million.

Health Canada reports annually to the Treasury Board and has created a process for reviewing Strategy allocations as part of its accountability framework. Ongoing work is needed to assess whether the allocations established in 1998 are still relevant and whether reallocation is needed to existing or newly-created components of the Strategy.

An annual accountability report on the Canadian Strategy on HIV/AIDS is produced by Health Canada and released by the Minister of Health on World AIDS Day, December 1. The 2003 report, Looking Forward: Focussing the Response.

Health Canada uses a Quick Response Reallocation Mechanism (QRRM) to reallocate surpluses within the fiscal year. The QRRM reallocates funds in four stages:

• redirect funds in line with their intended use
• redirect funds in line with their intended client group
• redirect funds to address pressures
• redirect funds to enhance other HIV/AIDS-specific activities in Health Canada.

The Auditor General recommended in 2001 that all funding for projects be decided through a competitive process. As a result, Health Canada has discontinued directed funding for projects which has had the effect of lengthening the time cycle for awarding some contributions. The new environment has an increased focus on accountability, performance management, results and measurable outcomes, transparent processes and audits. All funding for grants and contributions is now competitive through an open bidding process. The former environment had allowed Health Canada to direct funding and use amendments to contribution agreements to add on specific initiatives. This gave Health Canada the flexibility to respond to needs quickly. The new government-wide environment is more transparent but also creates more work for both funders and recipients of funds who report that they have less time to do the work of the project because more time is spent on completing reports.

The Five-Year Review of the Strategy proposed that Strategy initiatives under the recommended new categories of leadership, equitable access, international collaboration and prevention be allocated greater resources than at present.

The House of Commons Standing Committee on Health 2003 report on the Canadian Strategy on HIV/AIDS (see sections 2.0, 6.3-overview, 6.3.1 and 6.3.3 of this report) recommended that an increased proportion of Strategy funds be allocated to prevention, harm reduction strategies in prisons and research.

Work done during 2003-2004

• The Ministerial Council had a special presentation at its June 2003 meeting from Health Canada on the new environment for grants and contributions in government following the Auditor General's 2001 report.
  
  Council members dialogued with Health Canada officials and followed up on this presentation with a letter to Health Canada which highlighted the following needs:
  • Resources need to be allocated to community-based organizations in order to assist them with increasing administrative demands.
  • Stakeholders should be provided with a longer turn-around time when asked to provide input on documents.
  • Community-based organizations need funding in order to develop their capacity to undertake evaluations that require both qualitative and quantitative indicators.
  • It is important to ensure flexibility within the funding structure to address emerging issues.
  • It is critical to sustain and build on what is already in place.
  • The HIV/AIDS Policy, Coordination and Programs Division of Health Canada must communicate in a clear and consistent manner with stakeholders and community-based organizations about its funding programs.

The Council acknowledged Health Canada's commitment to transparency.

• The Council reviewed Strategy expenditures during the year and raised questions about the Health Canada departmental levy that was affecting program funding (see section 6.3.3 of this report).
• The Council asked for more detailed reporting on Strategy expenditures by the Correctional Service of Canada and the Canadian Institutes of Health Research.
• At its meeting with the Minister, the Council advised that any reallocation of new funds, in the event that the Strategy receives increased funding, should be guided by appropriate consultation with the relevant stakeholders.

Future activities
The Ministerial Council will continue to monitor allocations under the Strategy and provide advice to the Minister and to Health Canada.

6.3.5 Health care reform

The issue
The Commission on the Future of Health Care in Canada (the Romanow Commission) released its report in late 2002. Following the release of the Romanow report, the First Ministers' Accord on Health Care Renewal was reached in February 2003. The Accord focuses on primary health care, home care, catastrophic drug coverage, access to diagnostic/medical equipment and information technology, and electronic health records. At issue in the debate about health care reform is the future of public health care in Canada, and specifically the Canada Health Act. The public health system is a vital support for all Canadians, and particularly for vulnerable populations and people living with HIV/AIDS.

In 2003, the Government of Canada announced its plan to create a new Public Health Agency to address public health issues. It appears at present that the Canadian Strategy on HIV/AIDS will be within the new Agency.

Work done during 2003-2004

• The Ministerial Council communicated its advice to the Minister on the Romanow report and the 2003 First Ministers' Accord. In its letter, the Council stressed:
  • the need for any health care reform to uphold the principles of the Canada Health Act
  • the Accord's commitment to enhancing transparency and accountability; the Council urged the government to enshrine accountability as the sixth principle of the Canada Health Act.
  • the need for the government to affirm that privatization of health care delivery is prohibited by the Canada Health Act and that breaches will be vigorously enforced
  • its support for the five pillars of the Romanow report: primary health care; diagnostic services; rural and remote care; acute home care; hospital care; and catastrophic drug coverage
  • its support for the primary health care emphasis on wellness, while assuring a continuum of care by a multidisciplinary team, which is particularly important in HIV prevention and care
  • its support for the Romanow and Accord provisions for a new approach to Aboriginal health
  • its support for the Romanow report's recommendations on drugs: catastrophic drug coverage; a new National Drug Agency; patent law review; and a continued ban on direct-to-consumer advertising. The Council also expressed its strong support for: the creation of a national prescription drug formulary based on state-of-the-art prescribing rather than the lowest common denominator; and a new medication management program for chronic and life-threatening illness that would be part of primary health care. The Council would see a new agency's role as including the price control functions of the Patented Medicine Prices Review Board plus responsibility for generic prescription drugs in order to ensure fair prices to consumers.
  • its support for the catastrophic drug provision of the Accord and its disappointment that the other drug recommendations of the Romanow report (listed in the previous bullet) were not included in the Accord
  • its support for the Romanow recommendation that the health care system be protected from international trade agreements. The Council encouraged the Minister to raise these concerns with her Cabinet colleagues responsible for Canada's trade policy. The Council pointed out that these issues are not addressed in the Accord.
  • the need for safeguards for patient confidentiality in the health data collection and electronic health records proposed in the Accord
    
  • its disappointment that the dangerous shortage of physicians and nurses in Canada was not addressed in the Accord
  • its support for the creation of a Health Council with meaningful representation from consumer-driven groups which takes into account the diversity of race, gender, sexual orientation, socioeconomic status and disability. The Council expressed its disappointment that the Accord provides for the Health Council to report to the ministers of health rather than to Parliament, as the Romanow report had recommended. The Council stated that the reporting relationship proposed by the Accord would subvert the purpose of the Health Council and urged the federal government to amend the Accord to make the Health Council accountable to Parliament.
  • its strong concern that some provinces are refusing to accept the principles enshrined in the Romanow recommendations; the Council stated that the status quo wherein provinces receive health care transfers from the federal government with no conditions attached is one of the principle causes for the decline of our health care system.
  • its support for increased, adequate funding to the provinces for health care with accountability to measure health outcomes. The Council urged the Minister to ensure that funding to the provinces be conditional on that funding being spent within the five pillars proposed by the Romanow report and that any flexibility in the use of funds be limited to shifts within those pillars depending on the needs and gaps in each province.

The Council offered to meet with the Minister to discuss these issues in more detail.

• The Ministerial Council did further work on reviewing the recommendations in its letter to the Minister in order to refine them in the light of which parts of the reform were particularly relevant to HIV/AIDS and require input from HIV/AIDS stakeholders (e.g. the proposed National Health Council).
• During its meeting with the Minister, the Ministerial Council expressed support for the Minister's endorsement of a new National Health Council.
• After the members of the National Health Council were chosen, the Ministerial Council requested more information on the Health Council for further review.
• The Ministerial Council studied the discussion paper issued by the Minister of State for Public Health regarding a new Public Health Agency with a view to providing input to the consultation process. In its meeting with the new Minister, the Council raised its concerns about the potential impact that the new Agency could have on the Canadian Strategy on HIVAIDS. The Minister offered to arrange a meeting for the Council with the Minister of State (Public Health), who is responsible for developing the new Agency.

Future activities
Following its review of the implications of health reform for HIV/AIDS, the Ministerial Council will request a meeting with the Minister to discuss its recommendations and obtain an update on the progress of the reforms. The Ministerial Council will continue to monitor health reform issues and provide advice to the Minister.

6.3.6 Drug review process

The issue
Health Canada is responsible for the approval of new drugs and the post-approval surveillance of drugs. The HIV/AIDS community has consistently pressed for a more efficient review and approval process, and for more extensive post-approval surveillance of drugs. The Common Drug Review Process was established in 2002 by federal/provincial/territorial ministers of health (except Quebec) to harmonize drug review and formularies (list of drugs reimbursable under the public health plan). This process is being coordinated by the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) and is still in development. During 2003-2004, national stakeholders sought consumer representation on the committees and board of the CCOHTA and were refused. Stakeholder concerns centered on: timeliness of access to new drugs; accountability; an objective and informed process; an appeal process; the use of best clinical data; and the inclusion of relevant stakeholders in the Common Drug Review process.

Work done during 2003-2004

• The Ministerial Council monitored the Common Review Process through its own review and through its links to FPT-AIDS and concerned national stakeholder organizations. The Council's review focused on access to new drugs, inclusion of drugs on provincial formularies, post-approval surveillance, and consumer representation in the drug review process.
• The Council wrote to the Minister expressing serious concern about the process of constituting the Common Drug Review structure and the unwillingness of those responsible to consider the involvement of affected communities in its structure and processes on an ongoing basis. The Council offered to meet with the Health Canada official who is coordinating the initiative, preferably before the expected September 2003 launch of the Common Drug Review.
• The Council wrote to the Minister concerning the need to monitor the long-term effects on women and children of antiretrovirals used during pregnancy and after the birth of the child (see section 6.2.2 of this report for further details). This would fall within the scope of the drug review process as part of post-approval surveillance. The Council offered its assistance in working through potential obstacles in establishing this surveillance program.
• A member of the Ministerial Council attended a multi-stakeholder session on improving Canada's regulatory process for therapeutic products in June 2003 and reported back to Council. The Council discussed the issues raised, including:
  • the lack of consumer involvement in the development of the Common Drug Review process which runs contrary to the federal government's to involve consumers more in governmental processes
  • the lack of transparency
  • concerns that the Common Drug Review will not improve formulary coverage, but will slow it down because some provinces may not participate in the Common Drug Review while others will participate and still maintain their own review procedures.
    
• The Ministerial Council studied copies of the provincial formularies in order to help identify gaps in coverage of HIV/AIDS drugs.
• The Ministerial Council examined the question of drug pricing and the effect of the Patented Medicine Prices Review Board policy on the willingness of pharmaceutical companies to launch new drugs in Canada until they are assured of sufficiently high prices. The Council decided to study this issue in greater depth as part of its consideration of the larger question of access to treatment.
• In its meeting with the Minister, the Ministerial Council raised the questions of the drug review process, the Common Drug Review and drug pricing. The Council requested the Minister to discuss this issue with her provincial counterparts to ensure the development of an effective process consistent with the federal government's policy of citizenship engagement and transparency. Since many cross-border issues involve inter-departmental collaboration with Industry Canada and the Department of Foreign Affairs and International Trade, the Council requested a meeting with the appropriate federal departments to discuss strategies to ensure that pharmaceutical companies are not restricting access to drugs due to cross-border internet sales (from Canada to the U.S.) and other practices. The Council also expressed its support for maintaining the government's prohibition on direct-to-consumer advertising of drugs.
  The Minister agreed with the Ministerial Council that the drug review process needs improvement and that Health Canada is working to achieve this. She asked her staff to follow up on the issue of citizen engagement in the process. The Minister further said that drug pricing and cross-border sales are difficult issues because of jurisdictional questions and that Canada would need to remain vigilant.
• The Council monitored the issue of internet pharmacies, which are creating concerns about access to drugs, quality, physicians prescribing without seeing patients, and increases in drug prices.

Future activities
The Ministerial Council will continue to monitor these issues and provide advice to the Minister.

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