Health & Technology

Background

In April 2020, the United States Department of Homeland Security (DHS) Cybersecurity and Infrastructure Security Agency (CISA) and the United Kingdom’s National Cyber Security Centre (NCSC) published a joint alert that proved a litany of attacks on information related to COVID-19. These attacks came in the form of cyber-attacks perpetrated by cybercriminals and advanced persistent threat (APT).

Threats observed include:

• Phishing, using the subject of coronavirus or COVID-19 as a lure;
• Malware distribution, using coronavirus- or COVID-19- themed lures;
• Registration of new domain names containing wording related to coronavirus or COVID-19, and,
• Attacks against newly—and often rapidly—deployed remote access and teleworking infrastructure.

Today, some of the most significant threats include attacks on research and development, clinical trials, manufacturing, and distribution. These attacks are jeopardizing economic recovery due to delays, stolen IP, and reduced public trust in the vaccines. COVID-19 vaccine supply chains must be protected. While pharmaceutical companies should make every effort to secure the supply chain, the distributors of the vaccine must also be secure as sensitive data
can be leaked at any moment leading to cascading negative impacts. As the primary distributor of the vaccine, Governments at the Federal and Provincial level must align themselves with security measures that are being undertaken by the pharmaceutical industries. Government should also ensure that vaccine producers are securing their supply chain before purchasing more doses. Some of these measures include:

1. Prioritizing privileged access management across the vaccine supply chain;
2. Assess every supplier’s security readiness in vaccine supply chains and having a unified security
model across all companies;

3. Taking a Zero Trust-based approach to secure endpoints across the vaccine R&D, clinical trials, manufacturing, distribution networks, and all phases of vaccine development cycles;
4. Incorporating multi-factor authentication across the vaccine supply chain; and,
5. Provide a mechanism of funding for pharmaceutical producers to implement enhanced cybersecurity measures.

THE CHAMBER RECOMMENDS
That the Provincial and Federal Governments:
1. Ensure that vaccine manufacturers implement enhanced cybersecurity measures to protect supply chains by ensuring they:
a. Prioritize privileged access management across the vaccine supply chain;
b. Assess every supplier’s security readiness in vaccine supply chains and have a unified security model across all companies;
c. Take a Zero Trust-based approach to secure endpoints across the vaccine R&D, clinical trials, manufacturing, distribution networks, and all phases of vaccine development cycles;
d. Incorporate multi-factor authentication across the vaccine supply chain; and
2. Provide funding to vaccine manufacturers so that they can implement these enhanced cybersecurity measures.

Background

COVID-19 has had ripple effects on the healthcare system. Mental health has deteriorated in the form of increased anxiety and levels of depression. There are more people that are no longer eating healthy due to cost. Closures of gyms and exercise facilities has resulted in many individuals leading sedentary lives.

The evidence and research to support that exercise is medicine is overwhelming and compelling – Canada has even been a leader in publishing this research. While many gyms have been ordered to close, there are some that can operate with reduced patrons. However, the number of people going to the gyms is not enough due to the cost of membership fees. In order to remain open, gyms need to charge their membership fees. The Canadian Government can help subsidize the cost of membership fees by allowing people to claim fitness memberships and services as medical expenses when filing taxes.

This action can provide the federal government with a return on investment by reducing the overall health care burden. The fitness industry currently has the capability to support attendance records and payments for audit purposes. The Prescription to Get Active program would support this action plan – the fitness industry is primed to roll this, already established, program out across the nation. This action plan and initiative would inspire Canadians with the promotion of their health and wellness and put Canada as a global leader in health care management and prevention.

Professionals across the country are ready, willing, and able to provide both in-person and remote services to support this action plan and the public health orders. The fitness industry employs 150,000 Canadians, with the majority of those under the age of 30.

In order to be a part of the solution, the fitness industry would like to partner with the government. The federal government could create an immediate economic impact by including fitness memberships and services as a medical expense on tax returns. Workers who access fitness services will ultimately be healthier, contributing to increased productivity in the workplace.

THE CHAMBER RECOMMENDS That the Federal Government:

1. Include fitness memberships and services as a medical expense on tax returns

BACKGROUND

The ineffective war on drugs initiated in the 1970s by United States President Richard Nixon has resulted in a monumental waste in resources. It has caused large numbers of unnecessary incarcerations, caused pandemics and has initiated the stigma associated with addiction that we as a society are grappling with today.

COVID-19 has exposed the shortcomings of our healthcare system. Ranging from inadequate worker’s rights and compensation when in times of crisis to the revelation of the impact a pandemic can have on an economy and our governance system. COVID-19 is not the only pandemic that is impacting our healthcare system – the addiction and war on drugs has led to incredibly negative implications for our workforce, our economy, and our society.

Efforts are being made to combat 40 years of failure. Many countries have decriminalized and regulated non-medical use of drugs. In 2001, Portugal became the first European country to abolish all criminal penalties for personal drug possession, under Law 30/2000.1 In addition, drug users were to be provided with therapy rather than prison sentences. Research commissioned by the Cato Institute and led by Glenn Greenwald found that in the five years after the start of decriminalization, illegal drug use by teenagers had declined, the rate of HIV infections among drug users had dropped, deaths related to heroin and similar drugs had been cut by more than half, and the number of people seeking treatment for drug addiction had doubled.2

A ballot measure in Oregon to decriminalize drugs passed in November’s U.S. election with strong support.3 Norway is also proceeding to roll back penal sanctions for the consumption of substances.4 It’s time for Canada to follow suit and decriminalize drugs now.

Canada has legalized the cultivation, personal use, and possession of cannabis.5 Although the cannabis industry has been met with many regulatory burdens, we still do not know whether legalization has met its policy objectives. Legalization has increased tax revenue, provided for more businesses to open, and has led to more associations calling for the decriminalization of other drugs.6 The Canadian Associations of Police Chiefs,(7) the Premier of British Columbia John Horgan, Dr. Bonnie Henry, and other officials have all indicated their support. Vancouver Council has sought exemption from the Controlled Drugs and Substances Act from federal officials.8

The Business Case

The criminal justice system is overburdened. Our healthcare system is at capacity. Our labor force is in short supply. Decriminalization and regulation of non-medical drugs can alleviate these pressures and more. By decriminalizing and regulating the illicit drug supply, overdoses can be managed. By ensuring that possession of non-medical drugs and being under the influence does not result in criminal charges, our workforce is not reduced. But there must be a rehabilitation aspect included in decriminalization and regulation. Rehabilitation coupled with work placing programs will increase our labour supply, reduce the toll on our healthcare system in the long run, and lead to fewer deaths.

THE CHAMBER RECOMMENDS

That the Federal Government work with Provinces and Territories to:

1. Decriminalize and regulate all non-medical drugs;

2. Create rehabilitation programs by working with relevant not-for-profit organizations to build their capacity; and,

3. Work with businesses to create work-placement programs for those that have completed rehabilitation programs by subsidizing a portion of the wages.

Background

It is well known by all that COVID-19 has created extraordinary circumstances and responses worldwide. These range from the complete shutdown of economies, borders, businesses, travel, and the ban of gatherings. The reason for these extraordinary measures was to ensure that our global healthcare infrastructure was not overloaded with an explosion of COVID-19 cases resulting in unimaginable deaths.

Many individuals heeded the requests – and threats – to stay inside, limit travel, and reduce physical interactions; some did not and the spread of COVID-19 continues. This has led to more stringent measures to reduce the curve of infected. The measures, in essence, shut down economies, increased debt to unimaginable heights, created unemployment and poverty the likes of which we have never seen since the Great Depression.

As governments urged people to stay home, concurrently, investments into vaccine research were increased. Vaccine research usually takes years to accomplish – from proof of concept, lab trials, to human trials, production, and until the finished product arrives at hospitals and doctors’ offices. With the global effort and urgency required as a result of COVID-19 and its impact, many vaccines are in human trials a month after research began, which is unprecedented.

The more interconnected our economies become due to globalization the more likely we will experience pandemic explosions like this. Countries have been impacted by other diseases such as SARS, MERS, Ebola, the Spanish Flu, and others. Each of them affected the global economy in various ways. The impact was curbed by timely responses and containment measures; however, we have seen that some diseases spread quicker can cannot always be stopped. Until a vaccine or cure is found, economies will continue to be impacted.

Canada should lead an international effort to create a global fund to reward medical products developed in the private sector that treat or prevent viruses. Pooling resources among developed countries will allow for a large fund that would reward effective diagnostics, treatments and vaccines for any vaccine created. The fund could distribute rewards for new medicinal products according to their contribution to resolving health and economic harms caused by diseases. For example, a novel diagnostic test that could identify immunity, and allow people to return to work, could accelerate economic recovery.

In exchange for access to this large, multi-billion-dollar international impact fund for disease solutions, innovators would agree to price their approved medical products – vaccine, drug or otherwise – at the manufacturing cost to every purchaser in the world. The allocation of the fund would be delegated to an international commission, whose job would be to determine and show the health and economic benefits of different products in an open, transparent manner. If it is priced too high and there are no public health care mechanisms in place for distribution, then we will see the majority of the population unable to vaccinate and therefore a large drop in GDP and economic growth.

The Government of Canada could make an initial contribution to the fund of, say, $3 billion and encourage other countries to follow suit. The COVID-19 pandemic, according to most estimates, is cutting GDP by at least 25 percent, which translates into economic losses of $1.6 billion per day in Canada. Scaled up to include other OECD countries, on a GDP-weighted basis, such a fund would be in the order of $150 billion, enough to motivate an enormous investment in medical innovations. Such a fund would mitigate some of the current risks facing innovators in disease-related technologies, and that would allow them to attract investment to accelerate development. Such a fund would pay off even if it gets us back to normal just two days earlier than otherwise.

Vaccines are seen to be a common pool good. The governance of the fund could include clauses that allow for fair, equitable and speedy access to new innovations for all participant countries, making this a major multilateral effort. If we have large access to funds, we can ensure productivity is preserved in times of global pandemics.

In order for effective and efficient access to any vaccine there needs to be a national vaccine distribution infrastructure strategy.

the chamber recommends

That the Federal Government:

1.  Lead an international effort to create a global fund to reward medical products developed in the private sector that treat or prevent viruses;
   1. in exchange for access to this large, multi-billion-dollar international impact fund for disease solutions, innovators would agree to price their approved medical products – vaccine, drug or otherwise – at the manufacturing cost to every purchaser in the world;
   2. the allocation of the fund would be delegated to an international commission, whose job would be to determine and show the health and economic benefits of different products in an open, transparent manner; and
2. Create a national vaccine distribution infrastructure strategy.

A healthy population is an efficient and productive population. Cardiovascular disease, stroke, diabetes, and cancer are among the main diseases that affect Canadians[1]. These diseases manifest over time and need to be appropriately managed in an efficient way before they become detrimental to our economic production capacity. A healthier population now also means that down the road – with the current trend of an aging population in Canada – society will observe fewer costs in the healthcare system.

As it stands, cardiovascular diseases, stroke, diabetes, and cancer are managed by acute intervention (via surgery). Acute intervention accounts for 80% of the money invested by the public and helps 20% of the population, many times when it is too late. This area of intervention is handled solely by doctors, and we are seeing a decline in the total number of patients that general practitioners in BC see day-to-day[2]. At this point, doctors are stressed, overworked, and in need of assistance.

India has an enterprise known as Apollo Hospitals Enterprise Ltd that delivers a single point of access that provides the care for and management of chronic diseases. It includes a pharmacy, physicians, dental physicians, physiotherapy, and telemedicine[3]. This innovative hospital also provides patients with access to healthcare in the form of including community and social networks, which can be your priest, your family, and your friends. By including all of these aspects in one area, patients can consult with many experts and it will alleviate the pressures on the primary care provider, the Family Physician.

Working with medical professionals, Apollo has endeavoured to advocate for a system that would alleviate the pressure on the current healthcare model. In addition to the GP and nurses within the current acute intervention model (i.e. hospitals), they have many healthcare providers working in tangent to ensure that patients have well-rounded support systems. Apollo envisions a reform where care is delivered in a continuum. The patient is empowered to involve their social network with other professionals in the healthcare industry.

In this innovative approach, the GP and patient would be central to the chronic care management/primary care system. The government would work with regulators to provide funding, research, and incentives; they would also ensure accountability. A pillar supporting the GP and patient would be the resources – this would include many NGOs, other care deliverers, and the local healthcare regulators (i.e. Fraser Health). The other pillar of support would be the community and social network of the patient. Finally, there would be the technology industry providing innovative approaches to care delivery. The system is illustrated by figure 1 below. The arrows indicate that government and regulatory bodies provide funding and incentives to the various actors within the system. At the same time, feedback and monitoring must be persistent in the entire system and so the program can adapt to changing circumstances. The system and its actors would work collaboratively and congruently to ensure that optimal care is delivered to the patient.

Figure 1

Actions we can take now and why health care matters to business:

The failure of our system to adapt to Canadians’ changing needs has left us with a very expensive health-care system that delivers mediocre results. Canadians should have a health-care system that is truly worthy of their confidence and trust. There are four clear steps that could be taken to achieve this:

1. Integration and innovation

Health-care stakeholders in Canada still function in silos. Hospitals, primary care, social care, home care and long-term care all function as entities unto themselves. There is poor information sharing and a general failure to serve common patients in a coordinated way. Ensuring that the patient is at the centre — regardless of where or by whom they are being served — will lead to better, safer, more effective and less expensive care. Investments in information systems will be key to the success of these efforts.

2. Enhanced accountability

Those who serve Canadians for their health-care needs need to transition to accountability models focused on outcomes rather than outputs. Quality and effectiveness should be rewarded rather than the amount of service provided. Alignment of professional, patient and system goals ensures that everyone is pulling their oars in the same direction.

3. Broaden the definition of comprehensiveness

We know many factors influence the health of Canadians in addition to doctors’ care and hospitals. So why does our “universal” health-care system limit its coverage to doctors’ and hospital services? A plan that seeks health equity would distribute its public investment across a broader range of services. A push for universal pharmacare, for example, is currently under way in Canada. Better integration of health and social services would also serve to address more effectively the social determinants of health.

4. Bold leadership

Bold leadership from both government and the health sector is essential to bridge the gaps and break down the barriers that have entrenched the status quo. Canadians need to accept that seeking improvements and change does not mean sacrificing the noble ideals on which our system was founded. On the contrary, we must change to honour and maintain those ideals. Our leaders should not be afraid to set aspirational goals.[1]

THE CHAMBER RECOMMENDS:

that the Provincial and Federal Governments:

1.     Continue investment in health care infrastructure in a timely manner that also accounts for continued population growth over the next 30 years;

2.     Implement a pilot program in BC where chronic care is managed by a system of support that includes: Family Physician, nurses, the patient, community and social support systems, and technologically innovative organizations; and,

3.     Work with the Federal government in implementing a universal single-payer pharmacare system.

[1] https://theconversation.com/how-healthy-is-the-canadian-health-care-system-82674

[1] https://www.canada.ca/en/public-health/services/publications/healthy-living/how-healthy-canadians.html
[2] https://vancouversun.com/news/local-news/number-of-b-c-doctors-growing-but-work-life-balance-means-fewer-patient-visits-worsening-access
[3] https://www.who.int/goe/publications/goe_telemedicine_2010.pdf

[1] https://www.canada.ca/en/employment-social-development/programs/seniors-action-report.html#tc2a