Standing Senate Committee on Social Affairs, Science and Technology
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Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue No. 10 - Evidence - October 6, 2016


OTTAWA, Thursday, October 6, 2016

The Standing Senate Committee on Social Affairs, Science and Technology, to which was referred Bill S-211, An Act respecting National Sickle Cell Awareness Day, met this day at 10:30 a.m. to study the bill.

Senator Kelvin Kenneth Ogilvie (Chair) in the chair.

[Translation]

The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.

[English]

I'm Senator Ogilvie from Nova Scotia. I'm chair of the committee, and I'm going to invite my colleagues to introduce themselves, starting on my left.

Senator Eggleton: Art Eggleton from Toronto and deputy chair of this committee.

Senator Merchant: Hello and welcome. Pana Merchant, senator from Saskatchewan.

Senator Beyak: Senator Lynn Beyak from Ontario replacing Senator Neufeld.

Senator Frum: Linda Frum, Ontario.

Senator Seidman: Judith Seidman from Montreal, Quebec.

Senator Stewart Olsen: Carolyn Stewart Olsen, New Brunswick.

The Chair: Thank you, colleagues. I will remind us that today our meeting is called with one item on the agenda, and that is to deal with Bill S-211, An Act respecting National Sickle Cell Awareness Day. This bill was introduced into the Senate by Senator Cordy in December of 2015 and was referred to our committee on September 28, 2016.

We have with us today the sponsor of the bill, the Honourable Senator Jane Cordy, and she will be followed by Ms. Lanre Tunji-Ajayi, representing the Sickle Cell Disease Association of Canada.

Welcome to our committee and this meeting. Senator Cordy, it's my pleasure to offer you the floor.

Hon. Jane Cordy, sponsor of the bill: Thank you very much, chair. It's great to be here. The committee works very efficiently, since you were just given the bill last week. I thank you so much for holding your hearings on Bill S-211. It's a pleasure to have the opportunity to speak to each of you about the importance of Bill S-211, which will declare June 19 as national sickle cell awareness day.

I'm pleased that you've invited Lanre to join me this morning. She's the President and Executive Director of the Sickle Cell Disease Association of Canada. Lanre is passionate about improving the lives of Canadians who have sickle cell disease. I'm honoured to work with Lanre and the wonderful advocates like her whom I've had the pleasure of meeting over the past few years.

Honourable senators, sickle cell disorder is the most common genetic disease in the world. The World Health Organization estimates that sickle cell anemia affects nearly 100 million people in the world. It is estimated that 5,000 people live with sickle cell disorder in Canada. Many others are carriers of the sickle cell trait, and they are often not aware that they are carriers.

With sickle cell, the red blood cells become deformed. Normal blood cells are doughnut-shaped and move easily through the body's blood vessels to deliver oxygen to the organs. In patients with sickle cell, the red blood cells become stiff and sickle-shaped, and they do not function like healthy cells. A deformed cell does not flow easily through the blood vessels and can get caught up in the vessels and break apart. This can result in clogged blood vessels and low blood count, or anemia.

A sickle-shaped cell has a lifespan of only about 20 days, unlike a healthy cell with a lifespan of 120 days. The problem of clogged blood cells and low blood count hampers the body's ability to bring oxygen to the organs. This starvation of oxygen most commonly manifests itself as severe pain in the bones and can damage shoulder and hip joints or cause chest pain. There can also be damage to the lungs, heart, liver, kidneys and eyes.

A few years ago I had the pleasure of meeting a wonderful young man, Adeniyi Omishore, who recently has received a hip replacement because of a sickle cell disorder. He spoke last Thursday afternoon at advocacy day on Parliament Hill with parliamentarians, and he reflected on the challenges of living a so-called normal life as a teenager when you have sickle cell disease. He is a courageous young man who remains positive about his situation. He is truly an inspiration to others.

Honourable senators, sickle cell disorder is hereditary. The disorder is passed on when a person inherits a sickle cell gene from both their mother and their father. At this time there is no cure for sickle cell. Treatment consists of managing the symptoms. Research is showing that changes to a healthier lifestyle and diet have a positive effect on the quality of life. Of course, early diagnosis is the key.

So why should we have a national sickle cell awareness day? The United Nations, the African Union and the World Health Organization have all recognized sickle cell disease as a public health priority. They have also recognized June 19 as World Sickle Cell Day to help raise awareness of the condition worldwide. I am pleased that my province of Nova Scotia has recognized June 19 as World Sickle Cell Day.

I would like to congratulate and thank Premier McNeil and Health Minister Leo Glavine and Rugi Jalloh, President of the Sickle Cell Disease Association of Nova Scotia.

Bill S-211 would add Canada's voice to this important cause by marking June 19 as national sickle cell awareness day in Canada.

We are a diverse country and many Canadians can trace their roots to sub-Saharan Africa, India, Saudi Arabia and the Mediterranean — all regions where the sickle cell trait is common. It is important that Canadians learn more about this disease.

I have been fortunate to meet many wonderful, courageous people who live with sickle cell. They would like Canadians to be more aware of the sickle cell disorder. They would like newborn screening to detect sickle cell at birth so that suitable treatment can begin immediately. They want treatment that will improve the quality of life of those with sickle cell disease and their families. They would like more sickle cell education of health professionals, caregivers and school personnel. Honourable senators, they would like to see a national strategy for sickle cell disease.

Honourable senators, Bill S-211 would recognize June 19 as national sickle cell awareness day. It is just a start, a small start on the road to making things better, but last week when I attended the sickle cell awareness day on Parliament Hill, those present were excited and hopeful about this bill. They are excited because it means that people, particularly parliamentarians, are listening. It means that on June 19 of every year there will be an opportunity to raise awareness about sickle cell disease to all Canadians.

Committee members, I thank you for your interest in Bill S-211 and look forward to your questions.

The Chair: Thank you, senator. I will now invite Ms. Tunji-Ajayi to make her presentation.

Lanre Tunji-Ajayi, President and Director General, Sickle Cell Disease Association of Canada SCDAC: Good morning, honourable senators. I'd like to thank you for inviting me as a witness this morning, and I'd also like to thank Honourable Senator Cordy for introducing Bill S-211.

Sickle cell disease is a multi-system genetic blood disorder. It affects every organ of the body, including the eyes, kidney, liver, spleen, brain. We've witnessed stroke in children as young as two years of age, and we've seen blindness caused by this disorder. Premature death continues to happen.

Worldwide, sickle cell disease affects many children. Over 300 babies are born every year with this disease. We also have over 100 million that carry the trait for sickle cell disease. When you have the trait, you have one form of this defective gene, and this means there are no symptoms and you continue to live life as if everything is okay. This is why many individuals with the one form of the gene continue to procreate and have children, and many realize their sickle cell status only when their children are born with the disorder.

These, among many other reasons, were why the United Nations encouraged its member countries, member organizations and their agencies to raise awareness. They designated June 19 as one day that every member country and their agencies can raise awareness around sickle cell disease. They also encouraged these nations to have national programs supporting individuals with sickle cell disease.

In our country in Canada here, just a few years ago we estimated the number of affected to be about 2,500 based on our centres of excellence. Again, there's no national registry, but this is based on those that go to the designated centres. But I can tell you, as of today, the number has quickly grown to 5,000 individuals.

I can also say that I was in Nova Scotia in June to celebrate World Sickle Cell Day, and in 2014 Nova Scotia approved babies to be screened in that province for sickle cell disorder. Their one-year report card showed three babies were flagged with sickle cell, but 63 babies were flagged with the traits. It is these babies who will grow up without awareness, will procreate and have more babies with this disease.

Bill S-211 will support awareness. It will support education around sickle cell disease. Individuals who carry one form of the gene and thereby have no health issues and no way to know will now be aware and get tested. They will be able to make informed decisions before having their own children who may end up being born with sickle cell disorder.

Honourable senators, I implore you that this bill would not cost the government a dime, but it will help to increase awareness and education around sickle cell disease in our country. It will help to reduce the number of babies born in Canada with sickle cell disease. It will also help to improve the care and treatment.

Currently in Canada, many of the care providers are ill-equipped in terms of taking care of individuals with sickle cell disease. As Senator Cordy pointed out, sickle cell disease affects every one of us. It affects mainly those whose ethnic background is Caucasian from southeastern Europe, South Asia and Middle East. This is the face of Canada. It is that diversity. We need to ensure that Canadians receive adequate care. This will start with raising more awareness about sickle cell disease.

I implore you to help make sure that Bill S-211 moves and passes into law in Canada before the end of this year.

The Chair: Thank you. We will open the floor up initially to questions from the committee and follow that with clause-by-clause consideration.

Senator Eggleton: Thank you very much for your presentations, and thank you for sponsoring this kind of bill, Senator Cordy.

When you see a statistic that says this is the most common genetic disease in the world, affecting some 100 million people, you can see why a bill like this is needed, because I don't think enough is known, certainly by people in our country, about this disease. Creating an awareness day, with awareness programs growing out of that, will certainly help.

To get a little better knowledge about sickle cell disease, let me ask you, first of all, how is it detected? One could imagine that a simple blood sample would be able to detect it, but it's more than that, I take it.

Senator Cordy: It's certainly a blood sample, and that's why many provinces, including Ontario, and it used to be just Montreal and Laval, but now, fortunately, it's the whole province, and New Brunswick, Nova Scotia, British Columbia — I may be leaving a province out — have initiated a simple blood test for every child that is born. The simple blood test only costs a couple of dollars and then immediately they're able to determine whether or not the child has sickle cell.

Early intervention, of course, in providing care for the child makes a huge difference. You've said not enough is known. I spoke to the parents last Thursday but I also heard their story a year ago. They brought their young child to the hospital with severe pain in his arm. The doctor on duty in the emergency department said, "Your child must have fallen. I'm going to give you Tylenol." So the parents went home and treated the child with Tylenol. Three or four days later, the child was still in excruciating pain, screaming. They went back to the emergency department again. They were most fortunate because the doctor who was on duty had just come back from a session dealing with sickle cell and decided to give a blood test to the child. They found out then that the child had sickle cell and they were able to start a treatment program.

Neither parent realized they were carriers, and of course both mother and father have to be carriers for the child to have the disease because it is genetic. So your point about not enough being known is absolutely true.

Senator Eggleton: There are some symptoms that a physician would attribute to this kind of a disease, and that would be the first trigger to then get a specific blood test to determine whether the person has it or not? That's how that works?

Ms. Tunji-Ajayi: Yes. There are many provinces now screening newborns. So for those babies born in those provinces moving forward, they will be screened and they will know they have the disease. Again, for those children who were born prior to the newborn screening, depending on when it started in each province, it will be based on symptoms or on doctors who may be enlightened and think if this child has swollen hands and arms and they didn't think this child fell, or this child is crying and nothing is pacifying this child, it could be the child is having a vaso- occlusive crisis. Again, it's the symptoms, but for adults who maybe carry the traits and don't know, we're encouraging them to go to their family doctor.

When you go to your family doctor, you get a requisition for the lab to do blood work. A simple mark on the same requisition for sickle cell test will show you if you have sickle cell disease. In provinces like Ontario and others that have provincial health programs, there's no additional cost. It's all covered by your provincial card to get tested for sickle cell disease.

Senator Eggleton: I take it that most of the people who are susceptible to this disease are people because of origins in places like India, Saudi Arabia, and the Mediterranean or Sub-Saharan African countries. So the vast majority would be people from there?

Ms. Tunji-Ajayi: Yes. Again, there's a connection between malaria and sickle cell that is directly found in areas of the world where malaria-born mosquitoes are prevalent. Those areas have sickle cell disorder. It's been explained that it is *mother nature trying to prevent itself against malaria and mutate one of the genes. So if you have just one of the genes, you find that you actually have some kind of a protection against malaria. But if you now have two forms of the gene, that's when you have a big problem with the disease. Again, you're accurate.

We're always saying sickle cell disease has no colour, because it affects Caucasians from Europe. So getting all Canadians tested for sickle cell will be the best way to move forward.

Senator Eggleton: Is there a cure?

Ms. Tunji-Ajayi: There is one form of cure, which is stem cell transplantation. That comes with a high price and also finding a compatible donor. It's not viable for everyone.

We're thinking at this point prevention, preventing more babies is the way to go, and by awareness and education we can achieve that. Once we have that in place, again we can see that more health care providers will be more educated around this disorder. They will have more interest and again treatment will improve. And there will be a better quality of life for those affected by sickle cell disorder.

Senator Stewart Olsen: Thank you for your presentation. It was very enlightening on the new things. I just wanted to encourage you on the awareness aspect, because I've actually seen patients coming into emergency departments in pain, either undiagnosed — and they're sickly. But even diagnosed, often they are looked upon as simply after pain medication or drugs.

That's pretty horrifying when so many of these people are in acute pain and sent home, not being believed. Sometimes they're not even diagnosed. But in some cases, they are diagnosed and there's still that kind of —

Do you have any experience with that?

Ms. Tunji-Ajayi: That is very accurate, Senator Stewart Olsen. That's actually what we're dealing with: The stigmatization of patients as drug-seekers. I don't think it's because they're wicked; it's because they don't know. It's ignorance.

This is why education is important, even among the care providers. Someone walks in and says, "I'm on morphine and I'm in pain." The red flag goes on and one thinks this person is a drug-seeker — "problem here." Even the patient says, "No, I have sickle cell. This is what I've been given, this is what I take. This is my medication." They flag them.

I remember a few years ago a young man who goes to school in the Niagara Falls area called me at 2 a.m. and said, "They won't treat me at the hospital. I'm in pain, and I don't know what to do." I said, "I'm in Barrie, Ontario. You're in Niagara Falls, Ontario. It's two o'clock in the morning. Can you go to a different hospital and see, and we'll deal with this after?"

Again, it's a big problem, and we see that every day. More awareness will lead to more education and improved care, even in this area.

Senator Stewart Olsen: And mainly in emergency departments and local family medical centres, because these people present looking very healthy. You look good, and you say, "I have this terrible pain" and people kind of go, "Yeah, okay."

Senator Cordy: On that point also, I heard from parents of teenagers, and it's particularly true when it's a teenager who is presenting at the emergency department with excruciating pain. Immediately, as Lanre said, the red flag goes up that they are just seeking drugs.

Senator Stewart Olsen: Because they ask for the medication.

Anyway, could you tell me how you got involved with the sickle cell, and how did you become such an active person?

Ms. Tunji-Ajayi: Thank you for the question. Again, I have parents who had medical backgrounds, but they were both healthy, they both carried the trait and they didn't know. So they got married, they had me, and I did not even have the trait, let alone the disease. But they had my brother who had the full-blown sickle cell disorder, and I have other siblings who have the disease as well.

Unfortunately, my brother passed away in 1999 at the age of 30. He was an engineer. He wanted to live life and do things. He went to school to do that, but his life was cut short.

For myself, I am healthy; I don't have the disease. I feel that I could be the voice and help those who have the disease. Many times they are too sick to advocate for themselves or put their points across because of the disease. We can be the voice for them, and that's what I've chosen to do. That's my reason for being an advocate for sickle cell disorder.

Senator Stewart Olsen: Thank you, and thank you, Senator Cordy, for bringing this forward.

Senator Merchant: Welcome. Senator Cordy, I also thank you for helping to raise awareness, because I know very little about it. I don't know anyone personally; somebody that I know may have it, but I'm not aware of anybody who has it. So I don't understand a lot about it.

I gather that this bill will raise awareness, which is important. You said the UN is encouraging its members.

First, maybe in your questions you could tell us how many countries have declared the day. Second, how are you going to promote it on that day? There are many other days where we wear a ribbon or do something to have other people ask us why we are wearing it, what it means and what the pink ribbon is about.

You said it doesn't cost anything and that prevention is what you're aiming at. How do you prevent the disease? You mean that people who are carriers ought not to have children? Are there some things they can do?

Exactly what is the cost of the treatment for people who have it? How costly is it?

Ms. Tunji-Ajayi: You've asked a few questions. I'll take one at a time.

How do we prevent sickle cell disease? By people knowing that they carry the trait. I've heard parents say, "If I had known that I'm a carrier and my partner is a carrier, perhaps I would choose a different partner." I've had parents say that when they go through the pain that their child goes through with this disorder, they realize it's not worth it.

Again, we ask people to get tested and make their own informed decisions. Even if you still want to be with this person and possibly end up having a child with sickle cell disease, knowing ahead of time and educating yourself as to what treatments are available, what has to be done — these can help reduce the heartache and confusion that comes with being told out of the blue that your child has sickle cell disease.

Again, there are ways that people can know that, "Okay, if I have the disease, I will make this decision or that decision." I always say that having a child with sickle cell disease is such an expensive situation that should not be imposed upon you due to ignorance — not being known ahead of time. Again, having that knowledge is key; it is important.

Second, you also asked how it would be promoted in Canada. A lot of activities — the United Nations is encouraging a lot of awareness activities and education activities. We will of course have pins and stuff that will be worn.

We will raise awareness all across the country. This year, as a matter of fact, we did a national drive to support the national awareness day. Even though it's not the law yet, we did this all over the country, because many of the individuals with sickle cell disease are on continuous blood transfusion and they need to get blood from their own community to be best matched. We call that phenotype-matched blood. To ensure we have adequate supply for them, we used that as a national activity that we did.

So we have those kinds of activities, as well as other activities. There will also be bracelets worn and distributed nationally, and the pin and everything.

Those are some of the activities we will do to promote that day.

You also asked the question about how many countries in the world currently recognize that day. I believe that it's in the Sickle Cell Treatment Act in the United States; recognizing June 19 is part of that act. There is a law in the United States of America. I believe the U.K. is also in line with June 19. Many African countries and other European countries as well support the UN on this initiative. Did I answer all your questions?

Senator Merchant: I'm not sure. I asked so many questions. I think you did answer the one about whether it is an expensive disease to treat. Is it because of the transfusions, or where is the expense? Is it the medication?

Ms. Tunji-Ajayi: When you have a child with sickle cell disease, many parents have to miss many days of work and so end up losing their job. If you say to your employer, "Well, my child is sick and I'll be away," and you're away for two weeks, then you go back to work. Then in two weeks, again your child is sick. It's gets to the point where maybe the employer feels that you should stay home with the child.

Many parents are not working because their child is sick. So it's very expensive, even to the system. At the end of the day, unfortunately — and I'm not sure if this is politically correct — but we find that when you look at the statistics in Canada, many marriages get broken, partly from the stress associated with having a child with sickle cell. We find that number to be very high. As a matter of fact, I was in a summit on sickle cell disease in Austria last year, and I was saying, "Maybe I will put the divorce rates or marriage breakdown to about 95." This lady from the U.K. said, "I would put U.K.'s rate at about 99." So it's really high.

It's an expensive situation to be in, so families really need to think carefully about what it entails, what it will cost as a family, and what it will cost the child. Senator Cordy was talking about Mr. Adeniyi Omishore with sickle cell disease. At the age of 17, he's had two hip replacements. That is debilitating for a young adult. So again, families go through a lot of stress, marriages break down, people lose jobs and everything.

Knowing your traits, making an informed decision, knowing what this will mean if we're both carriers and want to go ahead, knowing what the other medical options are, what we can do in pregnancy — can we check — and what we can do about that, there are so many options that individuals can discuss with their doctors before having a child with sickle cell disease.

Senator Meredith: Thank you so much, both of you, for being here this morning.

I also wanted to be on record to lend my voice to Senator Cordy as she introduced this bill in the Senate. It affects so many Canadians. We need to do this for all Canadians, and to have this day in Canada is so important.

I want to thank you again for your advocacy and for not standing by the sidelines and allowing this disease to continue. You have been personally affected by this, so I thank you for your advocacy as well.

I have also had family members or family friends who have been affected by this disease, and that's why I'm also personally connected to this bill. To see the suffering that they've gone through —

My question to you will be about the crisis that victims find themselves in and how they deal with that in terms of coping. In terms of families who have been affected, I know family members who thought of just taking the lives of their own children simply because of the pain that they were in, and friends have lost friends who have had this disease. So talk to me about the support for those who are in crisis and how they deal with this disease.

Ms. Tunji-Ajayi: Thank you, Senator Meredith. It is a very important question you have asked.

I am going to go back to my own experience. In those days, my brother would be in excruciating pain, and he would say, "I'd rather die than continue with this pain." I would be, "Who would want to die? Life is so good." He said, "You don't understand. Be in my shoes for one day, and you don't want to be here."

I remember he would ask us to walk on his back, and that would be painful. He said, "Honestly, I would like to distract myself from this pain and have any other pain."

I have also spoken to a five-year-old in Canada, to say, "Honey, can you describe your pain to me?" She said, "It's like someone breaking bottles on my back. I'm asking them to stop, and they won't stop. And I'm crying and saying, 'Please stop; the bottles hurt,' and they would not stop."

So yes, I have also asked my own sister who lives with sickle cell disease and is still alive. She's also gone through childbirth. How would you consider sickle cell pain and childbirth? She said, "I would give birth to babies every day rather than the painful crisis."

Individuals with cancer have expressed that cancer pain is far better than sickle cell pain.

This is why, as Senator Stewart Olsen said, when they present and say, "This is what cuts my pain," Tylenol doesn't cut it. It's morphine and other such drugs. The health care providers don't understand that if they're not in tune with sickle cell disease as they should be and think that you're seeking drugs.

How do we support those with sickle cell disease? One of the things that we do is what we call "lunch and learn." We go to the hospitals and put up education sessions, but again, while it's great, it's not 100 per cent effective. I'll tell you why. Not every care provider in the hospital will have access to those medicines because they are there serving patients and families. So, again, it's not enough, but we're trying to educate and raise awareness to support the patients.

I've personally gone to many hospitals with many of my patients to meet with the directors in the emergency rooms and to say, "This patient came and was put aside for 12 hours. You didn't believe he was in pain?" And they have to be self-medicating while they are in a Canadian hospital? It's not acceptable.

Just like you said, Senator Stewart Olsen, they look okay. They're in pain. They are screaming with pain, but, "Well, you sound okay to me apart from the pain that you're screaming about. How do I really believe you?"

So more education is needed. Yes, some work is being done, but it's not enough. I believe the national awareness day will help increase awareness and thereby encourage more health care providers to seek more education around sickle cell disease and treat the patient not only with dignity but also on time. It's been researched and said that if you present with sickle cell pain, you need to start getting medication within 30 minutes of that pain presentation. If you're kept for 12 hours without being taken care of, what happens is you will end up spending a longer time on admission in the hospital. That is cutting into the health care costs.

There's a cost affected here. So, with more education, there is a reduction of cost that goes into taking care of the patients as well. I have put together a simple health economics around sickle cell disorder, and we said that, on average, a patient will have about six admissions a year minimum. Each admission — and this is non-ICU admissions — will cost the system about $20,000 each time. In a year, it is about $120,000.

Having better care can reduce admissions to one to two. There is a simple drug called hydroxyurea. I'm sorry if I'm going a little bit off topic. It's a very cheap drug relative to admissions in the health sphere. Even without any provincial plan, it is about $300 a month per patient. It can save five to six admissions a year. That's part of what we're talking about when we talk about national strategy, but we want to start with having this day recognized to raise awareness and improve education and thereby improve treatment and care and improve the quality of life of those who are affected. Fewer admissions.

Senator Meredith: I have another question, Mr. Chair, with respect to this national day, which I fully, 150 per cent, support and hope the rest of the committee members will support as well. I had an opportunity to present an award to last year to Lillie Johnson of the Sickle Cell Association of Ontario, when she was on the Hill. What is your collaboration with the national agency and the local agencies in terms of promoting this day?

Ms. Tunji-Ajayi: The national association has six member organizations in Canada, across five provinces, currently, and Lillie Johnson's group, the Sickle Cell Association of Ontario, is one of the member organizations. Whatever we do at the national level, every member group will support their localities. In Nova Scotia, we have the Sickle Cell Disease Association of Nova Scotia. In B.C. we have the Sickle Cell Association of British Columbia. In Ontario, we have two member groups, the Sickle Cell Association of Ontario and the Sickle Cell Awareness Group of Ontario. We also have the Sickle Cell Anemia Association of Quebec and so on and so forth. So all of these member groups will support the national awareness day.

We all came to Parliament Hill. I know you were not around, but we all came to Parliament Hill last week and raised awareness on Parliament Hill.

The Chair: Thank you to our witnesses. I think you've given us a very clear illustration that's helped us to understand, to a larger degree, the nature of the disease, its cause and the impact. That is very clear.

At this point, I move into the next stage, and, colleagues, would you agree to invite the witnesses to stay through clause-by-clause consideration?

Hon. Senators: Yes.

The Chair: So you are welcome to stay for the clause-by-clause portion. With that, I will move to clause by clause.

I will put each question to you, and you will either agree or disagree with each clause.

First, is it agreed that the committee proceed to clause-by-clause consideration of Bill S-211, An Act respecting National Sickle Cell Awareness Day?

Hon. Senators: Agreed.

The Chair: That's agreed.

Shall the title stand postponed?

Hon. Senators: Agreed.

The Chair: Shall the preamble stand postponed?

Hon. Senators: Agreed.

The Chair: Shall clause 1, which contains the short title, stand postponed?

Hon. Senators: Agreed.

The Chair: Shall clause 2 carry?

Hon. Senators: Carried.

The Chair: Carried. Shall clause 3 carry?

Hon. Senators: Carried.

The Chair: Carried. Shall clause 1, which contains the short title, carry?

Hon. Senators: Carried.

The Chair: Carried. Shall the preamble carry?

Hon. Senators: Carried.

The Chair: Shall the title carry?

Hon. Senators: Carried.

The Chair: Carried. Shall the bill carry?

Hon. Senators: Carried.

The Chair: Carried. Does the committee wish to consider appending observations to the report?

Hon. Senators: No.

The Chair: Thank you. That was a "no." Is it agreed that I report this bill to the Senate?

Hon. Senators: Agreed.

The Chair: Agreed. I would say the mover of this bill and the witness have done a magnificent job of convincing this hard-nosed committee to support with such speed the motions. I will definitely, on behalf of the committee, report this to the Senate.

There being no other business, I declare the meeting adjourned.

(The committee adjourned.)