Remarks by Paul-Émile Cloutier
My thanks to the Committee for the opportunity to present to you today with my colleague Dr. Bradly Wouters of UHN, with whom I will split HealthCareCAN’s presentation time.
Le milieu de la recherche, les autorités régionales et les instituts de recherche en santé du Canada ont activement contribué aux réponses apportées à la pandémie de COVID-19.
The COVID-19 crisis has clearly exposed the gaps in the public health system and the health care system more broadly.
One of those gaps is the fact that Canadian health care facilities, designed for another time and place, are among the oldest public infrastructure in use today with approximately 48 percent of facilities being over 50 years old. The picture is worse in big cities, where 69 percent of health care institutions are over 50 years old.
Nos hôpitaux font face à d’énormes contraintes budgétaires qui les forcent très souvent à différer les importants travaux d’entretiens dont ils ont pourtant grand besoin pour assurer des soins de qualité aux patients. Nous n’avons pas financé comme il se doit l’entretien de nos établissements de santé.
Once COVID-19 is behind us, we must complete the unfinished business of Medicare by closing the gaps in long-term care and our traditional institutional health care system.
As health care leaders now turn to addressing the backlog created by the huge numbers of cases and procedures delayed in the face of the pandemic, our focus must be on building surge capacity into health care.
This will require much more strategic support from the federal government as we work to address the coming surges of patients waiting for different types of care due to COVID-19.
Another area of deep concern for Canada’s healthcare organizations is the very fragile state of Canada’s health research enterprise.
Much of Canada’s health research talent is employed by research institutes based in healthcare facilities. That talent drives a $3B annual sector of our economy, employing nearly 60,000 highly skilled researchers and staff nationwide.
This not-for-profit sector accounts for the majority of the biomedical research that is conducted in Canada, including current essential research and clinical trials around COVID-19.
Hospital-based research drives improvements in disease prevention, diagnosis, treatment and care for Canadians, for example:
- Vancouver Coastal Health’s Research Institute has nine major centres known internationally for their research excellence. It employs over 1,500 personnel engaged in research, 900 principal investigators, and graduate and post-graduate trainees conducting clinical and discovery science.
- The Research Institute of the McGill University Health Centre is also world renowned, with over 1,200 graduate and post-graduate level trainees, 440 researchers, and staff. It is recognized for ground-breaking work relating to health outcomes in transplantation, infectious diseases, patient self-monitoring applications among many others.
That workforce is paid through a combination of public and private research grants, charitable donations, allotments from foundations, and contracts for clinical trials which are almost all funded privately by biotech or pharmaceutical companies.
That revenue base has all but evaporated in view of the COVID-19 pandemic. All research and clinical trials not related to COVID-19 have been either suspended or canceled, with severe implications for the sector’s capacity to employ essential research staff and contribute crucial research improving Canadians’ health outcomes.
Les instituts de recherche en santé ont accueilli avec enthousiasme l’annonce du programme de la Subvention salairial d’urgence, mais ils ont été extrêmement déçus d’apprendre qu’en vertu du projet de loi C-14, ils n’y auraient pas accès.
Last Friday, Dr. Kevin Smith, the CEO of UHN in Toronto, testified to the Standing Committee on Government Operations and Estimates, warning Canada’s research hospitals would likely to see 10 – 15 thousand job losses in the next two weeks if they are not granted access to federal support.
The federal government can avoid those layoffs by granting research institutes based in healthcare organizations access to the Canada Emergency Wage Subsidy on the same terms as other industries. This is what we are urging the government to do today – treat us equally.
This could be done by a simple change of regulations; a minor change that would give Canada’s health researchers the security they need to weather the storm of the present crisis.
Remarks by Dr. Brad Wouters
As Paul-Émile mentioned, on March 15th, nearly all hospital-based non-COVID-related research was suspended by order of the federal government.
To that point, UHN had budgeted $460M for our hospital’s research operations in 2020/2021; a sum that would employ 1000 scientists and 4000 skilled research staff, including: clinical research associates and coordinators, research nurses, laboratory technicians, biostatisticians, data managers, graduate students, and postdoctoral fellows.
UHN is the largest research hospital in Canada and one of the top centres in the world. It includes the Princess Margaret Cancer Centre, ranked within the top 5 cancer centres in the world. It includes the Toronto General Hospital, ranked this year by Newsweek as the 4th best hospital in the entire world.
We perform more transplants than any hospital in the world and have over a century of accomplishments that include the first application of insulin and the discovery of stem cells. Never in our history, has our research future been more at risk.
Industry revenue has dried up because the clinical trials and research projects they support have been suspended. Charities have also begun to cut their giving in half, resulting in losses of $10-15 million a month for my institution alone.
UHN managed to stretch our resources from mid-March to early-May without layoffs in the hopes that the federal government might provide access to the Canada Emergency Wage Subsidy.
We operate in an extremely competitive environment with other academic health science centres around the world, and it has been important to us to keep our staff engaged, part of our institute, and ready to relaunch and compete for funds when we come back.
Many of our researchers and scientists have also jumped in and contributed to a rapid response to COVID-19, bringing unique skills and talents to the treatment and prevention of this disease.
We have launched new clinical trials in patients, we are exploring the fundamental biology of the virus, and we are developing new vaccines and therapies.
However, 80% of our staff remain unable to continue essential research into cancer, cardiovascular disease, alzheimer’s, diabetes and many other key diseases that kill the majority of Canadians.
Since the suspension, we have had numerous contacts with officials in several government departments, all of whom have been extremely responsive.
We have asked to have the same opportunities as other businesses and not-for-profits, but have been excluded because we are located within a public hospital. Despite our best efforts, we have not been offered access to the Subsidy.
On May 1st we were forced to begin the process to identify staff for a first round of layoffs of roughly 1500 staff because we lacked the funds to pay them. If trends continue as they have without access to federal supports, we will face large in-year operating deficits, additional layoffs, and insufficient revenues to support our space costs and other overhead costs.
We need support now to protect our crucial research enterprise, much of which will help improve health outcomes for Canadians.
Honourable Members, institutions like mine are ineligible for the Wage Subsidy based on a technicality. Because health research institutes are physically based in hospitals, they are designated as “public institutions” and excluded from eligibility. This is false.
Our hospital and the care of patients is funded by the provincial ministry of health. However, we are legislatively prohibited from using any of this support for our research. Instead, our research is funded by a wide mix of 900 different organizations.
For the most part we are not funded out of public sources, and to the extent that those funds come in the form of competitive research or innovation grants they have stalled since March.
I would also mention that eligibility will come at marginal cost to the government. Staff we lay off for lack of access to the subsidy will draw on the Canada Emergency Response Benefit. It is clear that it would be much more effective to keep our employees part of UH, which compensates them at a rate of about $350 less per-week.
But those staff will be unproductive for as long as they are laid off, and I have no sense of if or when we will be able to rehire them or if they will depart to opportunities in other countries.
Without urgent support from the federal government we run the risk of setting back health research in Canada by decades and undermining patient outcomes in the future.
A full transcript of the appearance will be available shortly.