THE STANDING SENATE COMMITTEE ON FOREIGN AFFAIRS AND INTERNATIONAL TRADE
EVIDENCE
OTTAWA, Wednesday, April 29, 2026
The Standing Senate Committee on Foreign Affairs and International Trade met this day at 4:15 p.m. [ET] to examine and report on such issues as may arise from time to time relating to foreign relations and international trade generally; and to study Bill C-18, An Act to implement the Comprehensive Economic Partnership Agreement between Canada and Indonesia.
Senator Peter M. Boehm (Chair) in the chair.
[Translation]
The Chair: Good morning, honourable senators. My name is Peter Boehm. I am a senator from Ontario and the chair of the Standing Senate Committee on Foreign Affairs and International Trade. I wish to invite committee members participating in today’s meeting to introduce themselves.
[English]
Senator Adler: Charles Adler, Manitoba.
Senator Ravalia: Welcome. Mohamed Ravalia, Newfoundland and Labrador.
[Translation]
Senator Gerba: Amina Gerba from Quebec.
[English]
Senator Woo: Yuen Pau Woo, British Columbia.
Senator Wilson: Duncan Wilson, British Columbia.
Senator M. Deacon: Marty Deacon, Ontario.
Senator Coyle: Mary Coyle, Antigonish, Nova Scotia.
Senator Al Zaibak: Mohammad Al Zaibak, Ontario.
The Chair: Welcome, senators, and welcome to all who may be watching us today on ParlVu.
Colleagues, for our first panel, we are discussing the current public health situation in the Americas, but before we do so and before I introduce our witness, please ensure that notifications are turned off on your devices. Also, please be observant of the rules that we have for the use of microphones and earpieces. I thank you for your attention to that.
Today, we have the honour of welcoming to this committee, from the Pan American Health Organization, headquartered in Washington, D.C., Dr. Jarbas Barbosa da Silva Jr., Director. Welcome, Dr. Barbosa da Silva, and thank you for taking the time to be with us today. We are ready to hear your opening statement.
Jarbas Barbosa da Silva Jr., Director, Pan American Health Organization: Thank you, chair and distinguished senators. Thank you for the invitation to appear before this committee. It is an honour to do so in a country that has been a steadfast partner in hemispheric health for more than five decades.
Canada has been a member state of the Pan American Health Organization, or PAHO, since 1971, marking 55 years of partnership grounded in shared values and a common commitment to improving health across the Americas.
The PAHO was founded in 1902 on a principle that remains as relevant today as ever: Diseases do not respect borders, and collective action is the only effective response.
For Canada, the countries of the Americas are the closest neighbours, all connected by trade, travel and migration. The region’s health directly shapes outcomes here.
The Pan American Health Organization’s mandate is to support a safer, more stable, and more resilient hemisphere and, by doing so, to serve the interests of all member states, including Canada.
That is the perspective I would like to share today.
The global health landscape is undergoing profound change. Funding for multilateral health cooperation and international and humanitarian aid is declining, and the effects are already visible: Surveillance systems are under strain; vaccination efforts are slowing; and early-warning systems, our first line of defence against epidemics and pandemics, are facing growing gaps. The Pan American Health Organization, like many international institutions, is operating under this pressure while continuing to deliver.
This moment makes one thing clear: Multilateral health architecture cannot be taken for granted. It depends upon sustained political will and long-term investment. When that system weakens, the consequences are first felt by the most vulnerable but, ultimately, affect all of us.
The value of PAHO lies in what no country can do alone: a permanent presence in all 51 countries and territories in the Americas, trusted relationships with ministries of health, and shared surveillance and response systems that protect the hemisphere as a whole. These capabilities align directly with Canada’s long-standing priorities: stronger partnerships, diversified international engagement, shared security objectives and development cooperation focused on mutual benefit and resilience.
The Pan American Health Organization, which Canada has supported for over five decades, is a clear example of this trusted partnership. The core architecture of PAHO — surveillance, early warning and rapid response — is designed for threats no single country can manage alone. Its 24-7 monitoring system scans the hemisphere for emerging signals and shares information transparently with all 35 Member States, from Canada to Argentina.
When a pathogen emerges, time is critical.
In 2025 alone, PAHO’s system analyzed more than 2.1 million threats, detected 157 public health events, issued 27 epidemiological alerts and produced over 1,200 technical reports for Member States.
This is what enables early action.
Recent experiences underscore why this matters. In 2024, the Americas experienced the largest dengue fever epidemic in history — over 13 million cases and nearly 8,000 deaths, many of them children. Avian influenza spread across multiple countries into new animal hosts.
Since last year, we have had yellow fever cases in a non‑traditional area in Columbia and other countries, and Oropouche fever has expanded beyond the Amazon basin. We had measles outbreaks in Canada, the U.S., and Mexico and now also in Guatemala and Bolivia.
These are not distant risks. They move through the same networks that connect the Americas to Canada. We have seen this before.
The SARS outbreak in 2003 cost an estimated $1.1 billion Canadian in economic activity for the City of Toronto. Zika reached Canada within months through travel-related transmission.
A strong partnership with PAHO strengthens the systems that protect Canadians while reinforcing Canada’s leadership across the hemisphere.
Canada’s engagement in the Americas is grounded in clear strategic, social and economic interests.
Trade with Latin America and the Caribbean has grown significantly, reaching $95 billion. The region now accounts for approximately $475 billion in Canadian outward investment.
These are not abstract figures. They represent jobs, supply chains and long-term economic stability, all dependent on healthy partner countries.
Millions of Canadians also travel to the region every year. Health risks encountered abroad do not stay abroad. As Canada co-hosts the FIFA World Cup 2026, bringing unprecedented mobility across the hemisphere, these links will deepen further.
At that scale, strong regional health systems are not optional — they are essential.
PAHO also creates direct economic opportunities. In 2025, its Regional Revolving Funds — procurement mechanisms that have been working for more than 40 years, procuring vaccines and other medical supplies on behalf of countries in Latin American and the Caribbean — procured over $900 million in U.S. dollars in vaccines and health supplies, much of it sourced within the Americas, strengthening regional production capacity and supply chain resilience.
Taken together, the case is clear: investing in health in the Americas advances Canada’s economic interests, strengthens security and supports humanitarian goals.
Canada’s partnership with PAHO demonstrates what investment delivers in practice.
Since 2021, Global Affairs Canada has committed more than $175 million to initiatives supporting equitable access to health services, women’s and adolescent health, local and regional manufacturing and disease elimination.
The results are tangible: more than 64,000 health workers trained in maternal and neonatal care, adolescent health, and gender-based violence response; over 130 clinical protocols and guidelines developed across six countries; and more than 9,000 women and adolescents engaged in health decision making.
Canada’s vaccine equity investments have supported 37 countries and territories in immunization planning, enabled nearly 2.4 million vaccine doses, and expanded cold-chain systems in 32 countries. More than 221,000 health workers were trained, and electronic immunization registries have expanded from 19 to 28 countries, strengthening regional health security.
In innovation, Canada is supporting regional self-reliance. With its support, the first government-selected avian influenza mRNA vaccine candidate in the hemisphere was launched in Argentina, and the first GMP-compliant mRNA batch in Latin America was produced in Brazil.
In disease elimination, Canada’s trachoma partnership is active in 11 countries, reaching more than 16,000 people and supporting sight-saving surgeries, particularly among Indigenous women.
Several countries, including Paraguay and El Salvador, are now very close to receiving the certificate of elimination of trachoma, the main cause of blindness among poor people in Latin America and among Indigenous populations. This is a very good example of how productive it can be: the support that they are receiving from Canada.
Canada’s contribution also extends beyond funding. Through 23 PAHO/WHO Collaborating Centres in Canada, it supports the science, standards, and systems that underpin regional health strength.
In this way, Canada’s contribution goes beyond financing. It is embedded in the systems that make regional health cooperation work and deliver results on the ground.
Chair and distinguished senators, the multilateral health architecture that Canada has supported for more than five decades is facing one of its most significant tests.
Across the Americas, countries are managing overlapping health, economic and humanitarian pressures.
In this context, Canada — situated at the heart of the hemisphere, trusted across political divides and guided by shared values — is well positioned to provide sustained, principled engagement.
At the same time, this is not only a moment of challenge, but also a moment of opportunity.
Canada’s engagement through PAHO continues to show stability, reliability and long-term commitment.
Canada and PAHO have built 55 years of partnership on a simple conviction: health and security in our region are shared, and no country can achieve it alone.
As we look ahead, our task is not only to sustain this partnership, but to deepen it — so it continues to deliver equity, resilience and opportunity across the Americas, while supporting the safety and prosperity of Canadians at home and abroad. Thank you. I look forward to your questions. Thank you, Mr. Chair.
The Chair: [Another language spoken]
Colleagues, as per usual, we will have three minutes for questions and answers, so I would encourage you to keep your preambles short, be concise in your questioning, and if there is time, we will have a second round. We will begin with Senator Deacon followed by Senator Ravalia.
Senator M. Deacon: Thank you for being here today. Greatly appreciate that.
I’m going to start off with something around working together, and so one of the core values of the Pan-American Health Organization is solidarity, and that is to say, having countries work together to improve quality of life and health levels across the Americas.
My question for you today is where, in your experience, does Canada have room to strengthen our collaboration with the PAHO and its member countries to help achieve our collective goals?
Dr. Barbosa da Silva Jr.: Thank you, Senator Deacon, for this very important question. As I mentioned, and it is important to highlight, Canada is not the only member of the organization. Canada is a very important partner of the organization, providing financial support through the grants that you receive through GAC, and I mentioned some of them. But there is also Canadian expertise through the collaborating centres that are supporting the development of several different activities.
On health equity, on the development of more new tools, new instruments, training and providing technical guidance to support the advancements in several different areas.
The Americas lead in global health. I launched this week with the Minister of Health of Canada, Minister Michel, Vaccination Week in the Americas.
We are the fifth region that has recovered better from the pandemic. So now we are not only better than we were before the pandemic, but we are not yet at the optimal coverage that you need to achieve.
Working together to respond to misinformation, for instance, is a crucial priority both for Canada and the entire region.
At the same time, we have several concrete results that I mentioned. Some of them, like receiving support from Canada for the elimination of tropical diseases, including trachoma and other diseases, providing better support for countries in Latin America to develop their production capacity. And other important contributions for Canada have measurable results that we are very happy to share with the government, with the Parliament, but also with the partners and institutions that you have here in this country.
Senator M. Deacon: Thank you.
The Chair: You’re almost out of time. We can pick up on round two, senator, if you wish.
Senator Ravalia: Thank you very much, Dr. Barbosa da Silva. I wanted to take a moment, before I ask my question, to acknowledge Dr. Alison Krentel, who is present in the room with us, who has been a key partner for us with respect to the file on neglected tropical diseases.
Dr. Barbosa da Silva, would you be able to outline your key health priorities in the region, particularly in the context of the global reduction in aid programs?
Dr. Barbosa da Silva Jr.: Thank you, Senator Ravalia, for this very important topic. As I mentioned, PAHO’s headquarters is in Washington, D.C., but we have a very strong in-country presence. We cover all the countries and territories in the regions, Latin America and the Caribbean. We do not have one in Canada and the U.S. because our deputy director serves as PAHO’S representative to these two countries, but in all the other countries in the region, we are present, and we are working with countries to advance the public health agenda to implement their priorities.
In a very comprehensive package of priorities, from strengthening primary health care and eliminating communicable diseases, to promoting digital health transformation and reducing preventable deaths from communicable diseases.
Of course, we are living in challenging times, and I need to mention that the U.S. is a member of the Pan American Health Organization, and it is a very important one. We have at least four main sources of funding, and one of them is the contribution that all the countries in the region pay to PAHO. We use the same scale of contributions that is used by the Organization of the American States, or OAS, our sister organization. And the U.S. is a very important contributor for PAHO and for OAS. The U.S. is a member, but they are still not making their financial commitment to pay the contribution.
At the same time, we had, last year, a very important problem; that was the termination of the USAID. The USAID was the main contributor of the Pan American Health Organization, as a voluntary contributor. We have several different projects in the region — elimination of malaria, reducing maternal mortality and providing better preparedness for pandemics — that are funded by the USAID.
With this, we had to adopt several measures to be more efficient and to implement some cost-saving activities. We presented last year, and our member states approved, reducing the budget for this biennium.
We are preserving our country’s offices. The cuts we made were mostly in our headquarters in Washington, and mostly applicable on administrative activities in order to preserve technical capacity.
We are also looking to bring other partners to the region. So we are now receiving some support from Japan to implement additional transformation. We are received a donation through Japan to support humanitarian aid in Venezuela.
The Chair: Dr. Barbosa da Silva, I’m sorry I’m interrupting you, but we’re over time on that segment. I know it will come up again in terms of alternative funding sources.
Senator Coyle: Thank you so much, Dr. Barbosa da Silva, for being with us. My question is on the topic, which was raised by our colleague, Senator Kutcher, while you were in the chamber, and that is around vaccine hesitancy and disinformation associated with that, in the Americas, particularly, let’s say beyond Canada and the United States. Could you speak to the prevalence of this problem?
Dr. Barbosa da Silva Jr.: Thank you, senator, for this very important question. Indeed, misinformation and vaccine hesitancy are one of the main problems that we need to address. Of course they have different dimensions, so in Bolivia or Panama it is different. But I do believe there are some surveys showing us that people do not trust their governments as they did in the past.
We have some surveys clearly showing that the main source for families to make decisions about vaccination is health care workers. We really need to work with physicians and nurses because they need to develop the skills and have the information in order to listen and respond to the doubts of the families. They need to provide information when they are being asked questions like: Why do I need to continue vaccinating against polio if you haven’t had it for several decades now? Do I really need to give three doses of this vaccination, or only one dose is enough? Do I really need to give three vaccines on the same day to my baby, or can this produce a fever, or hear them crying in the night? Clearly, health care workers need to have more tools and develop new skills.
We also need to mobilize academic institutions, scientific communities and religious leaders so that everybody can reinforce the message that vaccination is not only an individual decision but a protection for the entire community.
Senator Coyle: My next question is about what you are seeing with the impacts of climate change — particularly in Central and South America — on people’s health and on disease spread, new diseases coming into different areas, et cetera. Could you speak briefly about that?
Dr. Barbosa da Silva Jr.: Yes, of course. We are also providing technical cooperation through our member states on the climate change impact; several diseases that you have from food insecurity due to drought; new, non-traditional areas where we have vector-borne diseases.
We are working with countries in Central America and the Caribbean to strengthen their capacity to prevent, detect early and respond.
In the region we now have, senator, the work of genomic surveillance; that was a dream before the pandemic. Only Canada and the U.S. had this capacity. Now we have 30 countries in the region that are connected to a network that PAHO is leading. It is monitoring all the viruses in the region: flu virus, dengue virus, Zika virus, measles, and other viruses that can evolve or can change, or new viruses. So we are bringing all of them together.
The Chair: Thank you, Dr. Barbosa da Silva.
Senator Ataullahjan: Dr. Barbosa da Silva, as someone who is very interested in maternal, newborn and child health — and I have done a lot of work internationally — I know that Canada has partnered with you in multiple programs. I would like to know, since COVID, we have heard — I just came back from the Inter-Parliamentary Union, or IPU, where we heard about young adolescent girls being married off earlier because during COVID they stayed home. We heard of an increase in deaths during childbirth. I would like an update of what you’re seeing. The numbers that we are hearing, are those correct?
Dr. Barbosa da Silva Jr.: Thank you for this very important question.
We have two problems that Canada has been supporting for several years, and they are very important for the region. The first one is pregnancy among adolescents. In Latin America, we have the highest rate of pregnancy among adolescents — almost as high as the figures they have in Africa. With the support of the Canadian government, we are working with these communities to empower girls, adolescents and women; to provide more access to information to health services; and to create new tools that can support them to thrive and to not have a child when they are 12, 13 or 14, because it would be very important for their health, life, family and community.
Also, we need to think about maternal mortality. It almost doubled during the pandemic. We are working and implementing several technologies that we developed in our centre that we had in Uruguay. We had already achieved there a very important reduction in maternal mortality. We are focused on the 10 most important priorities in the region, but the results are very promising, indeed.
Senator Ataullahjan: We also find that numbers in urban areas compared do rural areas are different. Are you seeing that, too — that there is more happening in rural areas — more adolescent girls being married off and more maternal deaths?
Dr. Barbosa da Silva Jr.: In rural areas and, most importantly, among Indigenous communities that sometimes have cultural barriers to access education and health services; those are higher. Even in the cities, when we look at the biggest slums that you have in some cities in Latin America, they also present rates that are not proportional to the rates you have in the better neighbourhoods.
So, inequality is a very important characteristic of our region, not only among Latin countries, but even in provinces or states and cities.
The Chair: I’d like to note that Senator Hébert of Quebec has joined us.
Senator Woo: Thank you for your testimony. You said some very nice things about Canada’s contribution to PAHO and to public health in central and South America, in general.
Are you worried that Canada might be backing off in its support for public health initiatives in the region?
Dr. Barbosa da Silva Jr.: Thank you, senator.
Let me tell you that it is on the contrary. Now, I can tell you that I received from the Minister of Health and from the Minister of Foreign Affairs, I think — sometimes I’m not getting the proper names of the positions — but I think that there is a very strong commitment. Canada is one country that really understands.
The Pan American Health Organization, working together with Canada, can provide two important things. The first is to protect the entire region. It is about bringing together all the countries, sharing information in a transparent way and preparing them for early detection and response. That protects all the areas.
At the same time, we are also supported by Canada to deliver support to countries in Latin America to improve their health conditions. From those views, I am very happy to confirm this very important commitment from Canada.
Senator Woo: We have it on record now that we’ve heard that the government has given you positive assurances. That’s very encouraging to know.
On a slightly different track, I want to ask you if the humanitarian crisis in Cuba has affected the contributions of Cuban medical assistance to central and South America. Has it had a material impact on public health in some countries in the hemisphere?
Dr. Barbosa da Silva Jr.: Yes, senator. Unfortunately, Cuba has faced some complex social scenarios, and they are affecting the health sector. Several professionals have left the country. They have electric power outages, so some hospitals cannot perform surgeries. It’s also difficult to get medicines and medical-health technologies.
We acknowledge the support that Canadian provided recently via $5 million through PAHO. PAHO, using this procurement mechanism you have, use those funds and purchase for a very affordable price essential medicines, medical equipment and health supplies, and we deliver directly to hospitals and health centres, guaranteeing that they will be used to reduce the very important challenges the health system has in Cuba now.
[Translation]
Senator Gerba: I’d like to thank Dr. Barbosa da Silva Jr. for his introduction and the work he is doing.
I am somewhat interested in the situation in Haiti, which has faced a series of political, social and economic crises since 2018. In the Pan American Health Organization’s latest 2026‑2027 budget, we see that Haiti will receive the largest share of the funds.
Given the current situation in Haiti, are you convinced that this money will be put to good use, for one thing? I would also like to understand how PAHO determines the allocation of these resources.
[English]
Dr. Barbosa da Silva Jr.: Thank you, senator, for this very important topic. Haiti is really a problem that we need to address as a hemisphere, because it’s totally unacceptable that Haiti has been living for several years now with a very critical situation. We are there. The second-largest country in the region is Haiti. We are providing technical cooperation to the minister of health and are working with civil society and other partners.
Our support to Haiti has a very broad range of activities. We have a warehouse where we store all the vaccines that are used in the country. At the same time, we are working with civil society and the government to keep the cholera outbreak controlled; we are working on the ground with the communities. We are also working to keep the only hospital that has emergency rooms, surgical capacity and blood transfusions open in Port-au-Prince. Now, with support from the Inter-American Development Bank, we are starting the renovation of another hospital in Cap-Haïtien in order to have more alternatives.
We are concerned that these funds need to be used very well, so, in a totally transparent way, we share with donors and the international community. We don’t give the money to the government; we transform the funds in helping health professionals in purchasing vaccines and medicines, and deploying them directly to health centres and hospitals.
[Translation]
Senator Gerba: You raised the issue of the cholera outbreak. What is the current situation in Haiti in terms of cholera outbreaks?
[English]
Dr. Barbosa da Silva Jr.: It is controlled, but it has not yet been eliminated, as I would like because the availability of the vaccine for cholera is very limited in the world. However, it’s controlled. There are very innovative ways, such as motor labs, which are motorbikes with small labs. When there is a case, the motor lab goes to the community, provides testing and immediately gives treatment to the person. For this reason, with a lot of support from communities and community health organizations, we are keeping the cholera outbreak controlled.
This also protects the Dominican Republic, the countries in the Caribbean, the countries in the Americas and maybe the entire continent.
The Chair: Dr. Barbosa da Silva, I have two questions to ask you. One is a bit more general and is basically a continuation of the question that Senator Ravalia, who happens to be a doctor, asked earlier, which is on budgetary sources.
You mentioned the withdrawal of USAID voluntary funds as being serious. I’m wondering if you’re looking at the multilateral development banks or the World Bank in that context.
My second question is much more specific. We are seeing an increase in Lyme disease in our country, and it’s a horrible image, but it seems like the ticks are marching north. I notice in your native country, in Brazil, there is a new Lyme-like disease that has emerged that really wasn’t known before. Could you offer a comment on that as well?
Dr. Barbosa da Silva Jr.: Thank you, senator. We are looking at both sides of the coin. First, we are taking some tough decisions. I had to close 220 positions, including 180 field positions. I tried to protect the country offices, but we need to have financial stability for the biennium. We are reducing operating costs; we are trying to be more efficient. We are opening a shared service centre in a low-cost country — moving some administrative activities that you have in Washington, D.C., to a country in South America. At the same time, we are looking to expand the source of funding, looking for new partners, new countries that will be voluntary contributors but also private companies, like supporting the suicide prevention initiative that you have in the region, like the Gates Foundation, which is working with us to support the elimination of malaria.
At the same time, we need to receive a fairer distribution from the WHO in Geneva. Our countries have been strong advocates that the Americas need to receive a fair share of global resources.
Lyme disease is a problem in the U.S. and Canada, and it is clear that this is a disease that if you don’t work together in the environment of animal health and public health, we cannot fight outbreaks at the beginning.
The good news about Lyme disease, senator, is that there is a vaccine candidate in the final stage of clinical trials. Sometimes scientists are more optimistic than I am, but they have promised that we will probably have a vaccine available in a couple of months or years.
The Chair: What is that new strain in Brazil?
Dr. Barbosa da Silva Jr.: We don’t have Lyme disease in Brazil, but we have several vectors in Brazil and the tropical area of the Americas. We have dengue fever, Zika, chikungunya, and Oropouche virus. We have constant vigilance about the vectors because these diseases can now be transported by migratory birds. West Nile fever and Lyme disease. We also have several sites that are monitoring while animals are moving to detect when they arrive in a new country.
The Chair: Thank you very much.
Senator M. Deacon: My question is tied to gender-based access to health care. We know that gender can significantly affect access to health services and individual autonomy of the care they receive both through prevailing gender norms and inequities within different regions. Can you speak to how widespread this issue is across the PAHO region and the measures or actions you’re taking to try to address it?
Dr. Barbosa da Silva Jr.: Thank you very much, Senator Deacon. An important part of our approach is promoting equity among different social groups; including gender equity, because women are disproportionately the most affected by several diseases, and sometimes it is due to the fact that they have a double or triple burden. For more than 50% of the poorest families in Latin America and the Caribbean, only one adult has some kind of income, and this adult is a woman. Sometimes they have to work in the informal economy and work long hours, and they have to take care of the family and the children. Sometimes they do not have access to health services like they should have.
When we implement any kind of program in the Americas, we say that we need to use equity lens. We need to identify the populations that do not have the same type of access — the vulnerable groups. Then, in order to change this, we work to remove the barriers to access experienced by vulnerable groups, to guarantee that they have access. Clearly, women are a very important group for us.
Senator M. Deacon: Thank you for that response. In thinking about that region, are there pockets or areas where this is a more significant issue than others?
Dr. Barbosa da Silva Jr.: Unfortunately, Latin America has some specific problems, like gender-based violence, that need to be addressed. For instance, it is part of our priorities. Often, health centres are the first point of contact when a woman is a victim of gender-based violence. We provide training and support for health professionals so they know how to better handle this kind of situation to provide the proper support for the victim but, at the same time, to connect with the other sectors of the government to protect that woman.
This is one example in several activities we are working on to increase access to sexual and reproductive health for women in this region in order to reduce inequalities.
Senator M. Deacon: Thank you.
Senator Ravalia: Dr. Barbosa da Silva, could you outline for me your sources of vaccine procurement? Are there any supply chain issues, particularly for more rural communities? What are some of the technical challenges you may face, including refrigeration?
Dr. Barbosa da Silva Jr.: Thank you. These are very important topics, senator.
First, it is important to highlight that when you provide technical cooperation to the countries, you provide a kind of broader technical cooperation. For instance, we talk about the vaccines; we are talking about giving them access to the vaccines through procurement mechanisms, but also the quality standards they need to achieve to have capacity and training for health care workers.
Our procurement mechanism procured more than $900 million last year, around 260 million doses of vaccines. If we think about the number of doses, the main supplier is the Serum Institute of India. They are a WHO prequalified producer, but when we look at the value of the vaccines, two producers, Merck and Pfizer, are the most important sources of vaccines.
We only procure vaccines that are WHO prequalified, and the fact that the regional demand is predictable and consolidated allows us to offer these vaccines at a very affordable price. For this reason, the Americas are the first region to introduce new vaccines. The new pneumococcal vaccine, PCV20, is now being offered to all countries in the region. They pay the same price they pay for PCV13 through agreements that we have with the producer.
Senator Ravalia: Are there any production centres within South America and Central America with respect to vaccines, or is all the procurement coming from outside?
Dr. Barbosa da Silva Jr.: We increased a lot, senator. We are now using the revolving fund to leverage regional production capacity. Last year we signed an agreement between Pfizer, the American producer, Sinergium, an Argentinian producer, the Government of Argentina and PAHO to produce the PCV vaccine that I mentioned. Five years ago, only 1.5% of the flu seasonal vaccines came from producers in Latin America. Now we are reaching 25% and probably 40% in one year.
Next week, I will sign an agreement between the most important producer of the pandemic flu vaccine, CSL Seqirus. That is also a source for the Canadian government for flu pandemic vaccines. We signed an agreement with this producer and an Argentinian producer, so we have a stockpile of these vaccines if there is a flu pandemic in the region. We are strengthening the capacity, the national health regulatory authorities and also the production capacity we already have in Latin America to be less vulnerable when there are procurement measures.
The Chair: Thank you very much.
Senator Woo: You gave a very good answer to my first question. It wasn’t the question I was asking. It should have been the question I asked because it is very important to understand the health crisis in Cuba, and I thank you for that answer. Cuba is known to be an exporter of medical services, and I wanted to ask you if the current crisis in Cuba, which of course affects Cubans first and foremost, is also affecting Cuba’s contribution, however large that may be, to public health in Central and South America.
Dr. Barbosa da Silva Jr.: Yes. Thank you, senator. Cuba has several bilateral agreements between the Cuban government and governments in the Caribbean region, Mexico and South America. They have several of them. This will probably be affected soon because several doctors have left Cuba. They work in primary health care in Chile, Argentina, Mexico, Spain and other countries. Nurses and physicians have left the country in the thousands in recent years due to the economy. This is affecting both the capacity of the Cuban public health system to run health services, health centres and hospitals. Probably, it is also affecting the bilateral agreements that Cuba has with several countries in the region.
[Translation]
Senator Gerba: You’ve already answered my question, but I will ask another one about the budget. You stated that the partnership with Canada has been very helpful, particularly on issues related to gender, women and adolescents. Are there other areas where more could be done, especially since PAHO’s budget has been cut by about 7%?
[English]
Dr. Barbosa da Silva Jr.: Thank you, senator. I think that Canada has provided support for PAHO in several different areas. I mentioned some of them. We are working together with the Canadian government to find common priorities because I think that these kinds of partnerships and international support work better when there is a match between the priorities of one party and the priorities and expectations of the donor country.
For this reason, you are working together in this very broad range of issues. With neglected tropical diseases, I know that senators here played a very important role in putting this on the table, and it is already showing results. Also, to strengthen regional manufacturing capacity, the mRNA project is receiving very significant support from Canada, but also how we can strengthen the national capacity to respond to public health emergencies.
Sometimes we can think that we are talking about a future pandemic. No. We are also talking about the present challenges, from measles outbreaks to dengue fever outbreaks and hantavirus outbreaks, things that are happening every day in countries. They need to be prepared to respond themselves.
PAHO does not want to replace the ministers of health. We are in countries to strengthen their national capacity to be able to respond to the challenges that they have.
The Chair: Okay.
Senator Coyle: Senator Woo asked you, Dr. Barbosa da Silva, about the health care supports that might have come out of Cuba at one time, and you have mentioned that Cuba has lost some of its workforce, and probably some of the bilateral agreements have been weakened by the current situation. I am interested more broadly in the workforce and the health care workforce, particularly in Central and South America. What are the current challenges with the workforce, and what is PAHO doing about that?
Dr. Barbosa da Silva Jr.: Thank you, senator, for this very important question. Without sufficient numbers of qualified health care workers, we cannot have a resilient health system. This is a very important piece of technical collaboration that we provide to countries. We estimate that there will be a shortage of health professionals in the Americas by 2030 in the range of 600,000 to 1 million. We are working with countries to identify not only how many doctors or nurses per 1,000 inhabitants they have, but to clearly identify what the training gaps are. For instance, if they have physicians prepared to work in primary health care or if they are needed in some specialties. This is different from one country to another. To have a health professional, we cannot have them in six months or one year. We are working with them to map the situation, find the gaps and develop a policy — together with medical and nursing schools — in order to prepare the health professionals they need now to face the rapid demographic transition that they are having.
We have supported some very interesting initiatives. For example, working together with a Collaborating Centre in Brazil, 1,000 nurses and nursing technicians are now being trained using a hybrid process in simulation centres in Guyana. These provide the countries the nurses that they need today and for the next 10 years.
Senator Coyle: Thank you very much.
The Chair: Thank you. I have two more questions. One is are you working to look ahead on possible other forms of avian flu that are developing? It is a concern, certainly, in North America. And then related to that is the state of preparedness of PAHO and of your organization. Are there lessons that you have learned or best practices from the big pandemic that hit us in 2020?
Dr. Barbosa da Silva Jr.: Thank you, chair, for this important question. Avian flu has been a challenge because since last year, we have had several outbreaks in North America, but they are not spreading in a traditional way for avian flu. We had several cases on farms that did not produce specific cases in humans. We need to monitor it. We are working with our partners in the agricultural sector and with the private and public sectors to follow up.
Last week, we received a report from Chile about an outbreak of avian flu. Three years ago, Chile had an outbreak of Avian in the south. We really need to work together. This is a clear area that we need to walk the talk about one health. If you do not bring together the environmental health, environmental sector, the animal sector and the human sector, working together, we are not able to monitor the situation.
About preparedness, PAHO was one of the first international organizations to establish an external committee to perform an assessment of our response to the pandemic. This report is public. Since I initiated my mandate, all the external evaluations have been transparent — totally public — for donors and member states. And we implemented a plan of action with more than 80 changes in emergency procedures and system surveillance in order to be better prepared.
I would say that we are better prepared now, but you can never think that we are totally prepared because we always have some margin to improve.
The Chair: Well, thank you very much, and on behalf of the committee, Dr. Barbosa da Silva, I would like to thank you for being with us today. I think we are all pleased that you had very good meetings with Minister Michel and Secretary of State Sarai.
We have learned a lot from your testimony today. You lead a very important and interesting organization — important to Canada as well as to the rest of the hemisphere. You have very dedicated people with you — some of them with you right now in your delegation — but please take our best wishes back to Washington when you return.
We are now going to begin the second portion of our meeting, which is proceeding to the clause-by-clause consideration of Bill C-18, An Act to implement the Comprehensive Economic Partnership Agreement between Canada and Indonesia.
Before we begin our clause-by-clause consideration of Bill C-18, I would like to remind senators of a number of points.
If, at any point, a senator is not clear where we are in the process, please ask for clarification. I wish to ensure that, at all times, we all have the same understanding of where we are in the process.
In terms of the mechanics of the process, when more than one amendment is proposed to be moved in a clause, amendments should be proposed in the order of the lines of a clause. If a senator is opposed to an entire clause, the proper process is not to move a motion to delete the entire clause but, rather, to vote against the clause as standing as part of the bill.
Some amendments that are moved may have consequential effects on other parts of the bill. It is, therefore, useful to this process if a senator moving an amendment identified to the committee other clauses in this bill where this amendment could have an effect. Otherwise, it would be very difficult for members of the committee to remain consistent in their decision making. Because no notice is required to move amendments, there can, of course, have been no preliminary analysis of the amendments to establish which may be of consequence to others and which may be contradictory.
If committee members ever have any questions about the process or about the propriety of anything occurring, they can certainly raise a point of order. As chair, I will listen to arguments, decide when there has been sufficient discussion of a matter or order and then make a ruling. The committee is the ultimate master of its business within the bounds established by the Senate, and a ruling can be appealed to the full committee by asking whether the ruling shall be sustained.
I wish to remind honourable senators that if there is ever any uncertainty as to the results of a voice vote or a show of hands, the most effective route is to request a roll call vote, which, of course, provides unambiguous results. Finally, senators are aware that any tied vote negates the motion in question.
Are there any questions on any of the above? If not, we can now proceed.
[Translation]
Colleagues, before we begin, I would like to mention that we have officials from Global Affairs Canada in the room who are available to answer questions as needed.
[English]
Those witnesses are Lucas McCall, Mary-Catherine Speirs and Pierre Malhamé. I think they also have some back-up in behind; I see some familiar faces back there.
Colleagues, is it agreed that the committee proceed to clause-by-clause consideration of Bill C-18, An Act to implement the Comprehensive Economic Partnership Agreement between Canada and Indonesia?
Hon. Senators: Agreed.
The Chair: Shall the title stand postponed?
Hon. Senators: Agreed.
The Chair: Shall clause 1, which contains the short title, stand postponed?
Hon. Senators: Agreed.
The Chair: Is it agreed with leave that the remaining clauses be considered in groups of 10?
Hon. Senators: Agreed.
The Chair: Shall clauses 2 to 11 carry on pages 1 to 4?
Hon. Senators: Agreed.
The Chair: Shall clauses 12 to 21 carry on pages 4 to 8?
Hon. Senators: Agreed.
The Chair: Shall clauses 22 to 31 carry on pages 8 to 11?
Hon. Senators: Agreed.
The Chair: Shall clauses 32 to 41 carry on pages 11 to 17?
Hon. Senators: Agreed.
The Chair: Shall schedule 1 — did I miss one? How could that be? Oh, there it is. It’s at the top of the page. Sorry. I do have good vision, but sometimes I miss. Yes. Shall clauses 42 to 45 carry? That’s pages 19 to 20.
Hon. Senators: Agreed.
The Chair: Thank you.
Schedules. Shall schedule 1 carry?
Hon. Senators: Agreed.
The Chair: Shall schedule 2 carry?
Hon. Senators: Agreed.
The Chair: Shall clause 1, which contains the short title, carry?
Hon. Senators: Agreed.
The Chair: Shall the title carry?
Hon. Senators: Agreed.
The Chair: Shall the bill carry?
Hon. Senators: Agreed.
The Chair: Does the committee wish to consider appending observations to the report? Yes or no.
Senator Wilson: Yes, I would like to move an observation. I will do my best to channel Senator Harder, although I’m quite sure I do not have his gravitas. This is the same observation we adopted in clause-by-clause last week on Bill C-13. As Senator Harder said at the time, the observation is consistent with our report on the Foreign Service, which was tabled a year ago, and is also consistent with discussions that have been had around this table.
In a nutshell, the observation is that the committee urges the government to ensure adequate resourcing of the Foreign Service, Trade Commissioner Service and locally engaged staff to support effective implementation of this and other free trade agreements. So I move this observation, which is being circulated dans les deux langues officielles.
The committee urges the government to ensure adequate resourcing of the Foreign Service, Trade Commissioner Service and locally engaged staff to support effective implementation of this and other free trade agreements.
[Translation]
The Chair: Could you read the French version?
Senator Wilson: The French version states that the committee urges the government to ensure adequate resourcing of the Foreign Service, Trade Commissioner Service and locally engaged staff to support effective implementation of this and other free trade agreements.
[English]
The Chair: Colleagues, are there any concerns on the observation as read by and introduced by Senator Wilson? No concerns?
Senator Hébert: Does the definition of “Foreign Service” and “Trade Commissioner Service” include the new structure that will be put ahead, which is the Strategic Export Controls Bureau, or something like that? Do we know if that’s included in this?
The Chair: I think what is meant here is the Foreign Service in the context of the global sense, so certainly, the Trade Commissioner Service because it is — in some missions, it will be locally engaged staff that are working on this. There will be trade commissioners, certainly, on the implementation side, and others. I think it’s kind of an omnibus reference, would be my interpretation, if the committee and you agree, senator.
[Translation]
Senator Hébert: Yes, thank you.
[English]
The Chair: I detect that we have agreement, so there is no need to go in camera to discuss this again. It is essentially the same point and observation that we had on Bill C-13, which has successfully passed the Senate as well.
Is it agreed to add that observation?
Hon. Senators: Agreed.
The Chair: Thank you.
Is it agreed that the Subcommittee on Agenda and Procedure be empowered to approve the final version of the observations being appended to the report, in both official languages, taking into consideration today’s discussion and with any necessary editorial, grammatical or translation changes as required?
Hon. Senators: Agreed.
The Chair: Thank you. Is it agreed that I report this bill, with its observation, to the Senate in both official languages?
Hon. Senators: Agreed.
The Chair: Thank you.
(The committee adjourned.)