THE GLOBE AND MAIL

By Mina Tadrous, Tara Gomes, and Michael Law.

In this opinion piece, Dr. Tara Gomes, scientist at the Li Ka Shing Knowledge Institute and the Ontario Drug Policy Research Network, argues for the need to manage pharmaceutical costs in Canada as innovative, but pricey drugs come to market.

We are likely entering a golden era of drug innovation, with the rise of new drug development technologies and biologics. Over the past decade, we have seen several record-breaking years in terms of the number of new therapies being developed and approved. In 2019 alone, just before the pandemic, Health Canada approved 58 new prescription drugs, many of which were the first of their kind to treat several rare diseases. The COVID-19 pandemic has also focused further attention on the value of investing in drug treatments and vaccine development.

But this progress has, of course, come at a cost. In 2020, Canada spent $32.7 billion on medications. And this amount continues to grow: year-over-year spending on drugs for the past two decades has outpaced inflation threefold, averaging more than 6 per cent growth annually. In fact, drug spending is consistently the fastest growing segment in health care.

These were the striking findings of a recently released analysis, where we looked at medication purchases across Canada over the past 20 years. We also looked ahead to the future to see what was likely to come down the pipeline. What we saw was notable: in the future, this rate of growth will almost certainly continue, if not accelerate.

CBC Radio

There are an estimated 8,000 people in Canada living with HIV, but they don’t even know it. That’s why scientists and advocates are working to end HIV in Canada by introducing more testing and better access to resources. On World AIDS Day, host Jeff Douglas spoke with Dr. Sean Rourke, a scientist with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital in Toronto, and Dave Miller, the Atlantic HIV Stigma Index co-ordinator for REACH Nexus, about their efforts.

Listen to the interview here.

From the CBC News Article:

Toronto should decriminalize the possession of small amounts of drugs as a response to the worsening opioid overdose crisis, recommends a new report from the city’s medical officer of health.

Under the Controlled Drugs and Substances Act, the federal Minister of Health can provide municipalities and provinces with an exemption from the provisions that criminalize drugs if there is a medical purpose or if it is deemed to be in the public interest.

Supervised consumption sites, where drug users consume drugs under the supervision of trained health workers, operate legally under similar exemptions.

Jeanette Bowles, a postdoctoral fellow at St. Michael’s Hospital with the Centre on Drug Policy Evaluation, said decriminalization will help reduce the stigma associated with drug use.

“Stigma can lead to shame. Shame can lead to folks using drugs alone. Using drugs alone is a very high risk factor for overdose death, as there’s no one around to intervene,” said Bowles.

Unity Health Toronto

In Canada, an estimated 70,000 people live with HIV, the virus that causes AIDS, and 13 per cent of those are unaware of their status. Collaborative efforts are underway to end the HIV epidemic in Canada, with a strong emphasis on offering access, choice and support for HIV testing and care regardless of who patients are or where they live.

Dr. Sean Rourke is a Clinical Neuropsychologist and Scientist with MAP Centre for Urban Health Solutions at St. Michael’s Hospital. He’s also the Director of REACH Nexus, a national research group working on how to address HIV, Hepatitis C and other sexually transmitted and blood-borne infections. His career is laser-focused on an ambitious goal: ending HIV in Canada.

To mark World AIDS Day, we spoke with Dr. Rourke about his latest work, why a one-size-fits-all approach to help high-risk communities isn’t effective and why he believes ending HIV in Canada is “not just a fantasy”.

In June 2021, you launched the I’m Ready program, which is distributing 50,000 free HIV self-testing kits across Canada to reach people who are undiagnosed and get them connected to care. In its first quarter, the program identified three positive cases of HIV that otherwise may have gone undiagnosed. How does that feel for you?
It feels very promising to know that we’ve been able to successfully launch and reach this “proof of concept” stage. Knowing that three people know their status and can now begin their journey to testing and care shows I’m Ready’s real-life impact. I’m Ready and everything we have built works; now we need to have a laser focus on scaling it up so we can reach everyone in Canada who is undiagnosed or diagnosed but not yet on treatment. We also need to get everyone who needs it connected to care. This is only the beginning for us. We want to democratize HIV self-testing in Canada.

REACH Nexus is partnering with Esri Canada, who will be producing interactive data dashboards for I’m Ready. What does this mean for the I’m Ready program and for HIV in Canada? Partnering with Esri Canada, a company with a long history in data visualization and analytics, is going to give us valuable and actionable insights about where the I’m Ready HIV self-testing research program is working in Canada and where we need to boost our efforts. Learning from our data and adjusting our strategies as we go is going to be critical to our goals of reaching everyone in Canada who needs access to testing, prevention and care.

A large priority for your work is focusing on the Indigenous population. Why this is significant to ending HIV in Canada?
Because of colonization, Indigenous communities are disproportionately affected by HIV in Canada. Not only this, they face significant barriers to services that are culturally safe and appropriate for them. Working together with Indigenous leadership, and prioritizing Indigenous ways of knowing and doing, is so important in order for us to support Indigenous health and wellness, and to reach Indigenous people who have been affected by HIV.

You recently published a paper in the International Journal of Environmental Research and Public Health that explored the health-related quality of life for people living with HIV in Ontario. What were the findings? The paper showed how people living with HIV in Ontario, despite most having access to care and treatment, have significant unmet basic needs with food security, clothing and housing – and that these survival challenges have significant impacts on the quality of life of people living with HIV, especially as they get older.

Our work as scientists is to not only show how the social determinants of health have links to health and wellbeing – and but it also raises questions about basic health and social policy (and what we need to do as advocates and social entrepreneurs). We can create medicines that will keep people alive and build health systems to deal with some serious and life challenging health issues like HIV, but if you want those people to thrive (and especially as people with HIV age), we need action on the policy side so that they don’t have to live in poverty and be able to have access to the basic needs of life for their wellbeing.

If you had a magic wand and could solve one problem tomorrow in the context of HIV in Canada, what would it be?
My magic wand moment would be for everyone to have a way to know their status, along with the information that’s appropriate for them about what to do with that knowledge! This is in effect what we’re trying to accomplish with I’m Ready. Ending HIV in Canada is within reach, that’s not a fantasy. If we can work together to get to communities who need access to testing and care and break down the barriers that are in place, and the stigma and discrimination that is still there, we can get there.

What should Canada be proud of in terms of HIV progress and where are our opportunities for improvement?
Canada should be proud to have so many dedicated people with lived experience, policy actors, community members and scientists who are committed to the work of ending HIV stigma, supporting people living with HIV and getting testing and care to those who need it to end Canada’s HIV epidemic. This is a team effort; luckily, there’s so much great work happening.

For improvement, we absolutely must prioritize those communities who are disproportionately affected by HIV and at higher risk: African Caribbean and/or Black; gay, bisexual and other men who have sex with men, people who use and inject drugs; and Indigenous Peoples (First Nations, Métis and Inuit). We can’t use a one-size-fits-all approach; we have to meet people where they are to have the real-life impact that it’s going to take to end Canada’s HIV epidemic.

Any final thoughts?
We have the science and tools to end HIV in Canada. Now it’s all about leadership and execution of the solutions, and we are going to make it happen. Visit readytoknow.ca to learn more about the I’m Ready HIV self-testing research program, our anti HIV-stigma website The Positive Effect and REACH Nexus to learn more.

From the Chatelaine article

If you’ve ever shut down a case of the sniffles with cold medicine, had an antibiotic prescribed for an infection or hiked up your sleeve for a vaccine, it’s only because that treatment endured a long, thorough research process. Clinical trials are the gold standard for determining the benefits and harms of any health intervention, says Dr. Jonathon Maguire, a pediatric scientist in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto. “We want the health care system to be as strong as it can be and for the risks of health interventions to be as low as possible—and for that, we need clinical trials.”

Lire cet article en français

Global News AM 640 Toronto – The Kelly Cutrara Show

MAP Investigator and St. Michael’s Hospital pediatrician Dr. Shazeen Suleman spoke with AM 640 Radio about Ontario’s pediatric COVID-19 vaccine rollout.

“When we are thinking about vaccines, we want to make sure that every single child and family who wants to get them, can get them. And that means we need to think about accessibility for both the child and their caregivers… Making sure that parents and providers can actually get their child to vaccine sites. So, for example, thinking about how paid sick days are important for parents and caregivers to be able to stay home with their child, after they’ve had their vaccine, or take them to the vaccine clinic. Making sure that clinic hours are perhaps extended, or after hours or on weekends. Thinking about having childcare onsite – we’ve got lots of families that are single parents, and have multiple children, what are they going to do when they have other children that they need to take care of, and take their child to get vaccinated? And also thinking about how we can convey our information in an accessible and equitable way. Making sure language and our communications are done in a way that all families can understand, and interpreted in languages that families may use… Making sure its accessible to families that don’t have health insurance. These are some ideas – and I’ve given you a lot – to think about how we can make it more equitable.”

Il est désormais possible de prendre rendez-vous pour obtenir le vaccin pédiatrique contre la COVID-19; comment pouvons-nous assurer un déploiement équitable?

Global News AM 640 Toronto – The Kelly Cutrara Show

Chercheuse au MAP et pédiatre à l’hôpital St. Michael, la Dre Shazeen Suleman a accordé une entrevue à la radio AM 640 au sujet du déploiement du vaccin pédiatrique contre la COVID-19 en Ontario.

« Quand nous pensons aux vaccins, nous voulons nous assurer que tous les enfants et toutes les familles qui le souhaitent peuvent y avoir accès. Nous devons donc envisager l’accessibilité, tant pour les enfants que pour les personnes qui s’en occupent… Veiller à ce que les parents et les dispensateurs de soins aient la possibilité d’amener leur enfant sur les lieux de vaccination. Par exemple, nous avons réfléchi à l’importance des congés de maladie payés afin de permettre aux parents et aux dispensateurs de soins de rester à la maison avec l’enfant après la vaccination ou de l’emmener à la clinique de vaccination. S’assurer que les heures d’ouverture des cliniques peuvent être prolongées, voire en dehors des heures d’ouverture ou pendant les week-ends. Envisager la mise en place d’un service de garde sur place; nous avons beaucoup de familles monoparentales qui ont plusieurs enfants, que vont-elles faire lorsqu’elles ont d’autres enfants dont elles doivent s’occuper et qu’elles doivent emmener l’un d’eux se faire vacciner? Nous réfléchissons également à la manière dont nous pouvons transmettre nos informations de manière accessible et équitable. S’assurer que la langue et nos communications sont formulées de façon à ce que toutes les familles puissent les comprendre, et qu’elles sont traduites dans des langues que les familles sont susceptibles de maîtriser… S’assurer qu’elles sont accessibles aux familles qui n’ont pas d’assurance maladie. Ce sont là plusieurs idées auxquelles nous pouvons réfléchir afin de rendre le processus plus équitable. »

Lire cet article en français

Dr. Sharmistha Mishra’s research has shown deep inequities in the spread of COVID-19 and the response to the virus. For her, it’s personal.

“You can see your uncles and aunties in the patients you look after, in the data that you’re working with,” she says. “With most of my family living in India and also affected, the underlying social and structural context of transmission was hard to miss.”

Dr. Mishra, a scientist at MAP Centre for Urban Health Solutions and an Infectious Diseases physician at St. Michael’s, works with her team to get at the “why” of the COVID-19 pandemic. Why is transmission more prominent in some neighbourhoods and networks? Why do some forms of essential work correlate with higher rates of COVID-19? Why have the impacts of the pandemic and the benefits of public health measures been inequitably distributed?

In three recent studies, one about COVID-19 cases and deaths among essential workers in Toronto; one about how variants of concern concentrated where previous variants had similarly clustered; and a third about increased cases of COVID-19 by socioeconomic factors and geography, Dr. Mishra and her colleagues tackle the role of social determinants of health in the pandemic and its response head-on.

To that end, the team has also developed methods to help generate more nuanced mathematical models. These models aim to capture the sources of similarity and of differences between transmission contexts and the extent to which a failure to address underlying context undermines the anticipated impact of a public health response.

Questions à un scientifique du MAP : Qu’est-ce qui est à l’origine des pandémies et quelles sont les raisons de leur apparition?

Les recherches de la Dre Sharmistha Mishra ont révélé de profondes inégalités dans la propagation de la COVID-19 et dans la réaction au virus. Pour elle, la question est personnelle.

« Vous reconnaissez vos oncles et vos tantes dans les patients dont vous vous occupez, dans les données avec lesquelles vous travaillez », dit-elle. « Comme la plupart des membres de ma famille vivent en Inde et sont également touchés, le contexte social et structurel sous-jacent de la transmission me semblait évident. »

Scientifique au Centre MAP pour des solutions de santé urbaine et médecin spécialiste des maladies infectieuses à l’hôpital St. Michael, la Dre Mishra travaille avec son équipe à comprendre le « pourquoi » de la pandémie de COVID-19. Pourquoi la transmission est-elle plus importante dans certains quartiers et au sein de certains réseaux? Pourquoi y a-t-il une corrélation entre certains types de travail essentiel et des taux plus élevés de COVID-19? Pour quelles raisons les impacts de la pandémie et les bienfaits résultant des mesures de santé publique sont-ils répartis de manière inéquitable? Selon trois études récentes (l’une portant sur les cas et les décès de COVID-19 parmi les travailleurs essentiels à Toronto, l’autre sur la manière dont des variants préoccupants se sont manifestés là où les variants précédents s’étaient regroupés de manière similaire, et la troisième concernant l’augmentation des cas de COVID-19 selon les facteurs socio-économiques et géographiques), la Dre Mishra et ses collègues abordent de front le rôle des déterminants sociaux de la santé dans le contexte de la pandémie et de ses conséquences.

From the Toronto Star article

Is it time to go back to the doctor’s office?

“If you have a chronic condition like high blood pressure or diabetes, it’s important to measure your blood pressure on an ongoing basis,” said Dr. Tara Kiran, an associate professor at the Temerty School of Medicine and a family doctor at St. Michael’s Hospital. “Even if you have your own machine at home, it’s really important to come and see your doctor every year so that we can make sure the readings are the same as the ones in the office.”

“In my own practice, I’ve found it helpful to see people in person if they have mental health concerns,” said Kiran. “Sometimes you can have a good therapeutic relationship over the phone or on video but part of the recovery process is building that relationship and connecting with people.”

She continued: “I think your doctor is more likely to be there, paying attention and connecting with you, if you’re in person, just the way all humans would be.”