HealthCareCAN

HealthCareCAN is pleased to report we have successfully persuaded the federal government to increase the maximum eligibility period for the Canada Research Continuity Emergency Fund (CRCEF) wage subsidy from 12 to 24 weeks. This will provide up to $84 million in extended support for research personnel affected by the COVID-19 pandemic at health research institutions and universities. This increase will be delivered in Stage 4 of the program.

This achievement has come after months of relentless advocacy work and virtual consultations between HealthCareCAN representatives and federal leaders. The federal announcement can be found here.

For more information regarding HealthCareCAN’s advocacy efforts throughout the COVID-19 pandemic, please visit our Mobilizing to respond to COVID-19 webpage.

The COVID-19 pandemic was a one-two punch to the gut of our beloved health system. As healthcare institutions and researchers geared up to care for Canadians and seek out a cure, non-COVID-related research was stalled due to the necessary lockdown. With labs closed and research postponed indefinitely, layoffs for research personnel loomed. With the federal government’s decision to exclude research institutions from the Canada Emergency Wage Subsidy, our nation’s health research enterprise teetered on the brink of collapse. Click to read the full post

HealthCareCAN has partnered with the International Hospital Federation to present an hour-long webinar to discuss current and past challenges concerning COVID-19.

Panelists will include:

• Professor Helmut Kern, Former CEO Hospital of St-John of God (Vienna), Austria
• Mr. Cédric Lussiez, CEO Nord-Essonne Hospital Group (Paris Region), France
• Dr. Jordi Altés, CMO at Hospital Plató (Barcelona), Catalonia – Spain

The 60-minute event will take place on Thursday, July 9 at 10:00 AM ET.

International health leaders will discuss issues such as:

• Health human resources
• Managing case backlogs and restarting services
• How best to prepare for a second wave

This event is filling up quickly! Contact us today to receive the registration link and reserve your space.*

*Members must register in advance to join the webinar.

COVID-19 is spread through contact with the respiratory droplets produced by infected individuals when they cough, sneeze, or even when they laugh or speak, including by individuals who have not yet or who may never develop symptoms.

Strategies to re-open sectors and societal activities need to take into account the role of both symptomatic and asymptomatic individuals in spreading COVID-19. This challenges us to consider additional strategies to reduce transmission by whatever means available.

As we move forward, it is critical that we continue to practice the behaviours that we know are effective in preventing the transmission of COVID-19:

• staying home and away from others if you are ill
• washing your hands frequently
• covering your cough with tissues or your sleeve
• practising physical distancing
• cleaning and disinfecting your surfaces and objects
• protecting those most at risk from the virus

Modifying our environments or changing our routines can also reduce transmission of COVID-19. Measures such as using physical barriers (e.g., plexiglass/transparent barriers), changing workflow, and using spacing aids such as taped visual cues are examples of important and effective means of preventing the spread of COVID-19 in public spaces and or work environments.

The wearing of non-medical masks or cloth face coverings is an additional personal practice that can help to prevent the infectious respiratory droplets of an unknowingly infected person from coming into contact with other people outside the home.

Read the full fact sheet

On Wednesday May 6th, HealthCareCAN President and CEO, Paul-Émile Cloutier, and the University Health Network’s (UHN) Vice President of Research, Dr. Brad Wouters, appeared before the House of Commons Standing Committee on Health to advocate for federal support for the health research community.

Remarks by Paul-Émile Cloutier

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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:

1. 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.
2. 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

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As Paul-Émile mentioned, on March 15^th, 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 4^th 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 1^st 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.

Thank you.

April 2020

During our conversations you expressed an interest in receiving additional information about the financial implications of the pandemic for healthcare-based research institutes in order to help inform the government’s response.

You will find enclosed with this email the best estimates we have been able to model on short notice. In keeping with the spirit of our conversations, I have included estimates of:

• One-time shutdown and restart costs ($231M)
• Ongoing costs for maintenance of research infrastructure ($77M)
• Costs of wage supports for at-risk researchers if offered eligibility for the Canada Emergency Wage Subsidy ($354M)

These amount to a conservative estimate of $663M in unfunded costs over 3 months.

I have just concluded a call with leaders in hospital-based research institutes from across Canada who advise me this is the best possible estimate given the timelines we have.

I would note in passing that these estimates differ somewhat from less mature numbers I provided earlier. Our earlier estimates were based on a partial survey of HealthCareCAN members, rather than a model of projected losses for the sector at-large. They also covered a period of 6 months, which we have revised to three months in order to align with the legislative criteria underpinning the Canada Emergency Wage Subsidy. It will not surprise you that the numbers are not totally compatible given the different methods employed. For the purposes of any modeling or policy work you may undertake in response to the sector’s needs, you may consider the numbers
enclosed here to be more valid and reliable.

Healthcare-based research institutes have worked with their respective organizations to mitigate against financial stress related to COVID-19 over the past month, but the situation is now at a tipping point where financial viability is not sustainable. I am advised that massive job layoffs in Canada’s hospital-based research institutes are scheduled to begin May 1st. We are therefore requesting $663M of support over 3 months starting March 15th to avoid those layoffs and sustain this sector crucial to Canada’s economy.

Thank you very much for taking the time to discuss the matter with me on Wednesday and for any support your department may be able to offer. If you have any questions in connection with the estimates I have provided here, please do not hesitate to connect with me.

Yours sincerely,

Paul-Émile Cloutier
President & CEO

April 23, 2020 (Ottawa) – New information on COVID-19 emerges every day. Researchers and scientists in Canada and around the world are working hard to better understand the virus, and its impacts on people and communities. By keeping pace with this information, we can better protect the health of Canadians and set our country on the path to recovery.

The Prime Minister, Justin Trudeau, today announced more than $1 billion in support of a national medical research strategy to fight COVID-19 that includes vaccine development, the production of treatments, and tracking of the virus. This new funding builds on the $275 million investment for coronavirus research and medical countermeasures announced in March.

The Government of Canada will invest in new medical countermeasures to better understand COVID-19, and develop the infrastructure needed to fight the virus here in Canada. This includes:

• The establishment of the COVID-19 Immunity Task Force that will operate under the direction of a leadership group, which will include Dr. David Naylor, Dr. Catherine Hankins, Dr. Tim Evans, Dr. Theresa Tam, and Dr. Mona Nemer. The task force will establish priorities and oversee the coordination of a series of country-wide blood test surveys that will tell us how widely the virus has spread in Canada and provide reliable estimates of potential immunity and vulnerabilities in Canadian populations.
• $40 million for the Canadian COVID-19 Genomics Network (CanCOGeN), led by Genome Canada, to coordinate a COVID-19 viral and host genome sequencing effort across Canada. This research will help track the virus, its different strains, and how it makes people sick in different ways, providing valuable information to public health authorities and decision-makers as they put in place measures to control the pandemic. The results of this work will be available to researchers globally to support additional research, including Canadian vaccine development efforts.
• $23 million for the Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac) to accelerate development of a vaccine against COVID-19. This funding will support pre-clinical testing and clinical trials of a potential COVID-19 vaccine, essential steps to ensuring that vaccines are effective and safe for human use.
• $29 million for the National Research Council of Canada to begin the second phase of critical upgrades to its Human Health Therapeutics facility in Montréal. Building on ongoing work to ready the facility for the production of vaccines for clinical trials, this funding will support operations to maintain the facility, as well as provide infrastructure to prepare vials for individual doses as soon as a vaccine becomes available.
• $600 million, through the Strategic Innovation Fund, over two years to support COVID-19 vaccine and therapy clinical trials led by the private sector, and Canadian biomanufacturing opportunities.
• $10 million for a Canadian data monitoring initiative so we can coordinate and share pandemic-related data across the country to enhance Canada’s response to COVID-19.
• $10.3 million over two years, and $5 million ongoing, to support the Canadian Immunization Research Network in conducting vaccine-related research and clinical trials, and to enhance Canada’s capacity to monitor vaccine safety and effectiveness.
• $114.9 million through the Canadian Institutes of Health Research for research projects that will accelerate the development, testing, and implementation of medical and social countermeasures to mitigate the rapid spread of COVID-19, as well as its social and health impacts.

Separately, the Government of Canada is providing over $675,000 through the Stem Cell Network to support two new research projects and one clinical trial. The clinical trial will evaluate the safety of a potential cell therapy to reduce the impacts and severity of acute respiratory distress associated with COVID-19, and the two projects will generate critical information about how cells in the airway and brain are affected by the virus.

By supporting COVID-19 research, the critical work being done by our country’s scientists, and vaccination efforts, we will be able to better protect the health and safety of Canadians and vulnerable populations around the world.

Read the full release

April 10, 2020 (Ottawa) – Canada’s Academic Health Sciences Centres and Health Research Institutes are desperately seeking emergency support from the federal government to keep healthcare professionals and researchers across Canada employed in the midst of the COVID-19 crisis.

In early-April, the federal government announced eligibility criteria for the Canada Emergency Wage Subsidy, a key plank of its economic response to the COVID-19 Pandemic. Canada’s hospital-based research institutes later learned that their employees would not be eligible for relief for the subsidy.

This decision risks setting back health research in Canada by 20 years and will have catastrophic implications for Canada’s capacity to respond to COVID-19 and for Canada’s health research sector more generally.

Right now, all research and clinical trials in Canada that are not related to COVID-19 have recently been either suspended or cancelled. If trends hold, the pandemic will cripple Canada’s overall research capacity, generating mass layoffs of critical research staff. A rapid census of a selection of 24 Canadian health research institutes indicates that they expect to lose almost $500 million over the next 6 months.

Healthcare organizations and research institutes across Canada are doing everything possible to mitigate job losses in these conditions in the face of extremely limited options. The categories of staff most under threat of layoffs are clinical research associates and coordinators, research nurses, laboratory technicians, biostatisticians, data mangers, graduate students, and postdoctoral fellows numbering in the thousands. Their knowledge and talent will be wasted in this crisis if the health sector cannot employ them, an outcome that would also pose a dire threat to morale across the health sector, which is already desperately low in Canada.

For these reasons, we urge the federal government to reconsider its decision and render Canada’s health research institutes eligible to apply for the Canada Emergency Wage Subsidy. This would demonstrate solid public policy and consultation in the midst of crisis. It would also be an expression of good faith to Canada’s healthcare and health research communities who are working tirelessly to move Canada past this challenging and chaotic time.

– Paul-Émile Cloutier, President and CEO

HealthCareCAN is the national voice of healthcare organizations and hospitals across Canada. We foster informed and continuous, results-oriented discovery and innovation across the continuum of healthcare.

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Workers and employers from across Canada breathed a collective sigh of relief at your announcement of the Canada Emergency Wage Subsidy. As an employer in the charitable sector myself, I can tell you how urgently necessary these measures are, and how profoundly they are appreciated by Canada’s business and non-profit communities.

At the same time, I must tell you that stakeholders from across the health sector are disquieted by the possibility that the program may exclude applications from Canada’s health research community. Without equal access to these supports, Canada’s research hospitals will be forced to lay off researchers and highly qualified personnel in droves. This would in-turn jeopardize Canada’s capacity to contribute to the global research effort to combat the COVID-19 pandemic and impoverish Canada’s health research potential for years to come.

Dr. Bradly Wouters, Executive Vice-President of University Health Network (UHN) was recently interviewed by iPolitics to describe what that might look like in his own institution. UHN is losing a projected $6 million per month that currently employs 650 people, including clinical research associates and coordinators, research nurses, laboratory technicians, biostatisticians, data managers, graduate students, and postdoctoral fellows. As Dr. Wouters notes, that workforce can be redeployed to help carry out the clinical research that is so desperately needed in the time of COVID-19. Yet if health research staff are excluded from eligibility for the Canada Emergency Wage Subsidy, there is every possibility that UHN will not be able to retain them. This same quandary is playing out in academic health sciences centres across the country.

HealthCareCAN and our members have lauded your government’s commitment to mobilizing heath research to combat the pandemic; a commitment exemplified best by the $275 million your government has devoted to that cause. It would be a horrible outcome to see many researchers lose their jobs for want of access to a key federal program given the priority you have personally assigned to the role of researchers in our national response. I am certain that this is not the scenario that you and your Ministers are envisioning, and I am confident that you will act quickly to prevent it from coming to pass.

With all of this in mind, I appeal to you to ensure that health researchers are extended eligibility for the Canada Emergency Wage Subsidy when the program’s criteria are unveiled later this week.

Yours sincerely,

Paul-Émile Cloutier
President & CEO

Cc:

• Hon. Bill Morneau Minister of Finance for Canada
• Hon. Patty Hajdu, Minister of Health for Canada
• Hon. Navdeep Bains, Minister of Innovation, Science, and Industry for Canada
• Mr. Paul Rochon, Deputy Minister of Finance for Canada
• Dr. Stephen Lucas, Deputy Minister of Health for Canada
• Mr. Simon Kennedy, Deputy Minister of Innovation, Science, and Industry for Canada
• Mr. Rob MacIsaac, Chair of the Board of Directors, HealthCareCAN; President and CEO, Hamilton Health Sciences

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The recent pandemic has prompted a swell in the use of unproved medications for treatment or prophylaxis against COVID-19, infections with examples including: lopinavir-ritonavir, hydroxychloroquine/azithromycin, tocilzumab, and demisivir.

This increase has occurred even though the evidence for any of these treatments is extremely thin and their side-effects are not to be underestimated. Federal and provincial governments, as well as various professional associations and regulatory colleges, are also issuing warnings against the improper use of these agents in the COVID-19 response.

HealthCareCAN is adding our voice to this cause, with the request that its member institutions do everything in their power to halt the use of these agents as treatment for COVID-19 outside the context of a clinical trial. Using these medications on the basis of such a thin evidence base is harmful for several reasons:

• A run on these medications may generate shortages that deprive patients of the medications they need, as has already proven to be the case with hydroxychloroquine;
• The widespread use of unproved medications will hinder research efforts because the evolving standard of care will make it impossible to assemble control groups;
• The demand for antimicrobials in the absence of good evidence to support them could turn the pandemic into a breeding ground for antimicrobial resistance, serving as a catalyst for more casualties while doing little to help patients.

HealthCareCAN is not asking that any effort of clinical investigation that serves the world’s interest in finding an effective treatment for the virus be suspended.  Rather, the goal is to discourage the use of unproven medications in the treatment of COVID-19, outside of the context of a clinical trial.

For further information, this  letter to similar effect signed by senior clinical leaders from Sinai Health System in Toronto.