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The Current Transcript for December 10, 2020

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

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SOUNDCLIP

VOICE 1: Can you explain to us how you beat the FDA today.

VOICE 2: Sure, we're just better.

MATT GALLOWAY: A year ago, no one really knew of covid-19. Now a vaccine for it has been developed and approved for use in Canada and more are on the way. In a moment, the CEO of Pfizer, Canada, on how we got here, why some are concerned with that path and what happens now. Also this morning. One of the effects of this scientific rush will be felt not by us, but by an animal often called a living fossil.

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Essentially, you have this milky blue blood of this ancient animal has made it into a modern medical marvel.

MG: In 30 minutes, how the fate of the horseshoe crab is tied up in our push for treating covid. Plus.

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It's like mourning a family member that's not even dead yet. And it's disgusting. I wish this on nobody.

MG: Long term care again finds itself in crisis as covid continues to spread and some of those homes are paying dividends while receiving government help. And many are pointing the finger at for profit care. A look inside the business of long term care in an hour. But we start with a win for science. The vaccines are coming. Good morning. I'm Matt Galloway and this is The Current.

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Need to 'walk before we can run' with vaccine rollout, says Pfizer Canada president

Guests: Cole Pinnow

MG: Now, I know it may feel like this pandemic is dragging on and on, and in many ways it is, but vaccine development has moved at lightning speed. In the U.K. On Tuesday, the first patient started receiving their shots. And it looks like we will be seeing similar scenes in Canada very soon. Yesterday, we got the news that the first covid-19 vaccine has been approved by Health Canada.

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The geek in me is amazed that we no one would have thought. I think, you know, even when we looked back at the first discovery of the of the virus, that less than a year later we'd be authorising and then distributing a vaccine.

MG: That's Dr. Supriya Sharma, chief medical adviser to Health Canada, speaking shortly before the vaccine's approval. The vaccine is produced by Pfizer and BioNet, and it uses a brand new MRNA technology in clinical trials. It showed efficacy rates close to 95 percent. I spoke with Cole Pinnow, president of Pfizer, Canada, yesterday.

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MG: What is this approval mean to you?

COLE PINNOW: This is historic. We couldn't be more proud that Pfizer and BioNet Tech were able to bring to Canada the first covid-19 vaccine. We think this represents a monumental change in the way that we are fighting the pandemic and hopefully represents the first big step towards normalcy.

MG: What people want to know is the timeline. And so an executive from biotech, your partner on this vaccine, told CBC that vaccine doses could start to ship into this country within 24 hours of Health Canada's approval. Is that the timeline that we are looking at?

COLE PINNOW: Yes, we're going to ship product tomorrow and then it'll be in Canada here in a few days.

MG: What happens then?

COLE PINNOW: So we're going to start with a phased approach where we have fourteen point of view sites where the product will be administered. This is the most valuable product in the world right now. And it would be a shame to lose a single drop because of the newness of handling the product. There are some special requirements for a product that requires storage at minus 70 degrees for transportation. So we want to walk before we can run and make sure that these initial sites have comfort in the way in which they're receiving, storing and handling the product, that our training has been successful in how the product should be administered to patients. And then we'll quickly expand through a phased approach to additional point of view sites.

MG: I want to talk more about that distribution in a moment. But you said that this is, you know, in many ways one of the most, if not the most valuable commodity in the world right now. People have been waiting for this vaccine and there are a lot of people in a lot of different countries who want this vaccine right now. How is Pfizer managing those demands?

COLE PINNOW: We're really working on an equitable model. So we've entered into a number of contracts with different governments all over the world. Over 30 different countries have signed a commercialisation agreement to receive this product. We are trying to be as responsive as possible after those individual countries apply regulatory approval. And then we have an equitable distribution model where we're honouring our commitments in the contract and then providing as much product as soon as possible based upon readiness.

MG: And so what does that mean? You honour the commitments in terms of when the contracts are signed.

COLE PINNOW: No, we honoured the specifics that are in each contract, so each government negotiated a different contract based upon the anticipated timeline associated with that country's review, and those have been changing. And I think we've seen that story here in Canada where when we originally signed our contract back then back in August, we anticipated that Health Canada was going to be in a position to make a decision on the vaccine in the first quarter. It became apparent to us in the middle of November that based upon Pfizer's data availability, along with the interim order authorisation, that Health Canada has to be able to look at data that has been submitted to other regulatory agencies. We were going to be able to pull forward the decision to December. And so in partnership with the government, we've worked to make that a reality and we couldn't be prouder.

MG: So there are questions about this. Did Canadian government. Come back to Pfizer to renegotiate some of this, because the government has been fiercely criticised, people wondering when the vaccine was going to arrive. And then suddenly the prime minister says that there would be close to 250000 doses coming before the end of the year. A lot of people were surprised by that. Did the government come to you to try to accelerate the delivery?

COLE PINNOW: So the government came to us based upon our data availability. They said that based upon that, they viewed a different timeline than we had originally projected. We were focussed first and foremost on the regulatory pathway and based upon a very robust ability of all of our data to be submitted to Health Canada in an ongoing basis, what we call a rolling submission to be able to have the dialogue with Health Canada about the detailed level of questions that they had in regard to that data. We felt very confident that we could move forward the timing of approval without compromising the scientific integrity and regulatory oversight that Health Canada was providing. With that in place, we then had a conversation with the procurement office to talk about what conditions would be necessary for us to change the timeline and be able to accelerate that to a December delivery.

MG: President of the United States signed an executive order earlier this week that was meant to ensure that American citizens were going to get first priority for American vaccines. What impact is that going to have on your distribution plans?

COLE PINNOW: We don't believe there will be any impact in Canada. We're still assessing the executive order, but we are committed to honouring our contractual commitments to Canada.

MG: So you don't believe that that executive order is going to prevent vaccines from coming to this country?

COLE PINNOW: Now, we're shipping this product from Belgium, and so we feel confident that we can provide this product in December to Canadians.

MG: How much money does Pfizer stand to make from this vaccine?

COLE PINNOW: I can't speak to the confidential terms of our contract, but I believe that our global CEO has been public around his expectations that this product is not designed and built on its traditional economic model. We recognise that the world values this tremendously, and we want it to be a fair set of terms that are independent of the supply and demand that normally applies to most pharmaceutical products.

MG: Do you think it's appropriate for drugmakers to profit from the sale of vaccines in the midst of a global pandemic?

COLE PINNOW: So Pfizer is a company that honours innovation and the risk and reward that comes with innovation. We've worked really hard and took on billions of dollars of risk up front, not accepting government money until we approach the stage of commercialisation. And so taking on those billions of dollars of risk should include some profit as a reward for that.

MG: I guess I ask in part because Johnson and Johnson and AstraZeneca both have promised to take what they're saying is a not for profit approach in pricing the vaccines, at least during the pandemic. And I wonder why Pfizer took a different approach.

COLE PINNOW: Yes, I believe that those companies took a different approach in their investment model and their risk tolerance to developing the vaccine. So I think different business models justify different profitability models as well.

MG: 36million more doses are expected as an option. There are 20 million more doses coming as part of this deal in the wake of the initial batch that will arrive later this year. When does the rest of the order, do you think, shipped to Canada?

COLE PINNOW: Yes. So we're working with the government to outline our commitment to deliver, at a minimum, 20 million doses between now and the end of 2021. There are expectations in the contract on one of those doses will be delivered. And then, as you alluded to, we could deliver up to seventy six million doses. And the discretionary range is really dependent upon how other markets are able to approve the product, the timing of those approvals and whether or not they're willing to be able to receive that product. So we wanted to have some flexibility in each of the contracts, realising that, again, our spirit of equitable distribution will fluctuate as this pandemic continues to unfold.

MG: And on your end, will you have the pieces in place in terms of the supply chain to produce that number of vaccines?

COLE PINNOW: Yes, we are very confident in our ability to deliver a minimum of 20 million doses to Canada.

MG: This is a tricky product to handle. What are the big challenges in terms of logistics and getting this out across a country like Canada?

COLE PINNOW: So I want all Canadians to know that from a distribution perspective, this type of handling is something that we as Pfizer and many in the industry are very accustomed to. We shipped frozen product every single day. What's unique about this product is that instead of being stored at minus 20 degrees, which is a frozen state, we're shipping at minus 70 degrees, the tolerances of plus or minus 10 degrees around that are the same and frozen is really frozen to some degree. It's really around having specialised freezers that aren't typically in the supply chain to be able to safely store this product long term. Our product requires minus 70 degrees. And right now we have a six month shelf life. We're continuing to collect stability data to look at expanding that shelf life. The product will be shipped in specially designed shipping containers that can also be used as interim storage devices. They have data loggers that monitor the temperature and also GPS trackers so that we know wherever they're located.

MG: Is your anticipation that they will need to be shipped just to distribution sites again in the list of of priority communities who are at the top of the list in terms of getting this vaccine, there are people in long term care and the understanding from some is that this vaccine won't be going directly to those long term care homes. There are also indigenous communities where the health care system is particularly fragile and it might be difficult to get there. Does it need to go to these distribution sites or can it go wider than that?

COLE PINNOW: It's going to go wider than that. But we're going to start with a walk before you can run approach. So it will be phased. The initial 14 sites that we're going to be shipping to are focussed on point of use readiness that is not specifically designed for nursing homes today, but we do anticipate expanding that to nursing homes in the future and to other more remote sites going forward.

MG: This is a new type of vaccine using MRNA technology. Can you explain in simple terms that the average person could understand how that works?

COLE PINNOW: Yes, so most traditional vaccines typically take the virus itself or a part of the virus inactivated to make it safe and then inject that to induce immune protection in the body. What MRNA does is it takes a genetic sequence, transposes that into the body, and then the body produces the protein to develop an immune response to. So it's a little bit different approach. The advantages to it or really speed of development. We have the ability to modify the genetic sequence that results in changes to the protein. So if the virus were to mutate going forward, we could again, in partnership with Health Canada, amend our application to modify the protein sequence that needs to be expressed in the body.

MG: There are concerns that are out there around the fact that this is a new form of vaccine technology. There's a petition that's been sponsored by Conservative MP. It's circulating talking about the risk of injecting, in the words of the petition, authors manufacture genetic materials. What do you say to people who may feel hesitant about this because it's new?

COLE PINNOW: I would reassure Canadians that the scientific rigour and regulatory oversight that went into this product is as robust, if not more robust, than any other vaccine that's been brought to market. We conducted clinical trials on 44,000 patients and the results showed a tremendous strength in both efficacy and safety. The vaccine reacts in the body, as we've observed, very similar to any other vaccine. There's going to be a little bit of pain on injection, some soreness, maybe some mild temperature, maybe a headache. But that's very common with all vaccines.

MG: In the documents that Pfizer submitted to the US Food and Drug Administration four out of about 18000 people in the vaccine group reported experiencing Bell's palsy, which causes a weakness or paralysis in the muscles in the face. How big of a worry is something like that?

COLE PINNOW: I can appreciate the concern, but I'm going to defer to scientific experts that look at the data in totality, and from what I understand, they say that that incidence is on par with the normal population and therefore isn't considered to be statistically significant.

MG: One of the concerns or one of the reasons why concerns like that are being raised is just because of the speed of this. Vaccines, as you will well know, take a long time to develop and get to market if they ever get to market. This is a vaccine in less than a year for a virus that we didn't even know existed at this time last year. So how was Pfizer able to bring this to market so quickly?

COLE PINNOW: It's a great question and something we're extremely proud of. So first, we did make a conscious decision to accelerate our formulation development work, to be able to bring it to clinical testing as soon as possible. So I mentioned earlier that the product requires storage at minus 70 degrees. If we had spent more time up front, we could have formulated the product to be a little bit easier to handle and store in more ambient conditions. But we decided to work on that formulation and we're continuing to work on that formulation after approval. But by getting into clinical studies with this Amarone technology sooner than a traditional approach, we were able to collect just as robust data as we would for any other vaccine development programme. And then we went through all of the scientific review that is typically involved in this.

MG: Weren't you able to do in the accelerated time frame?

COLE PINNOW: So I mentioned that the formulation work, it was one piece that we would have liked to have done and the long term storage conditions. So right now, our product has a shelf life of six months at minus 70 degrees. Normally, we would launch a product with two years of shelf life. So those are two areas that we had to postpone. But we'll continue to collect data as we go forward.

MG: We also don't know about long term effects or the impact on specific groups such as pregnant women, on young children. Why is it, in your view, worth the risk for people to get the vaccine despite those big unknowns?

COLE PINNOW: So most products are approved without those areas fully tested at the time. And so our product will be indicated for 16 and over. We're continuing to conduct clinical studies on 12 and over at the time. But what you mentioned, those population groups are very special and those are monitored, are typically studied and evaluated after approval.

MG: Pfizer has had to withdraw medications from the market before because of safety concerns. And there have been allegations in the past that Pfizer concealed safety risks from regulators and that Pfizer had paid multimillion dollar legal settlements. Given all of that, why should Canadians trust that you're being 100 percent forthcoming now?

COLE PINNOW: We have been extremely transparent. Sharing our data is available. It's been evaluated by a number of independent boards. The clinical studies were conducted by an independent data review committee and the experts at Health Canada FDA, MHRA are some of the world class leading scientists. And so providing that data in a very transparent way hopefully will give everyone the confidence they need to feel comfortable using the product.

MG: What to you is most promising here? This has been an incredibly difficult year for so many people. And I just wondered at the centre of this, knowing what you know now, what is most promising to you about what you're talking about?

COLE PINNOW: I think what we're most excited about are being able to provide relief to the nursing homes and the frontline workers who have been most at risk. And when I think about the frontline workers and the sacrifices they've made personally over the course of this pandemic, it's just heart wrenching. I mean, we've all, as you said, been personally impacted by covid-19 in one way or another. But to bring them nearer term relief, to help them have the confidence of protection going forward as they continue to battle this disease, as we scale up distribution, that really is the most heartwarming to me.

MG: Over the course of this pandemic, I mean, that the timelines for a vaccine, if a vaccine were to appear, were this could be years, this could be we may never get a vaccine. Could you have imagined that there would be a vaccine within the calendar year that covid-19 appeared?

COLE PINNOW: I cannot. I honestly, when we all went into lockdown in early March, I envisioned that this was going to be a very prolonged pandemic. And I looked back to 1918 and the lessons learnt from the years of enduring different waves of infection rates and thought that we as a global community would be going through that together. But to now know that an end to the pandemic is on the horizon and that we are taking a very meaningful step towards ending the lockdown's, I couldn't be more excited.

MG: When do you intend to get the vaccine yourself?

COLE PINNOW: After those that are most vulnerable are treated so on. The general Canadian population has access to the product and I will certainly get in line and get my Pfizer shot.

MG: And when do you expect that to be?

COLE PINNOW: So I don't know, because we're going to play we're going to roll this out and a phased approach and we're really taking it week by week with each of the point of view sites expanding the number of point of view sites from there and trying to accelerate deliveries as soon as where we're able to. So there are a lot of interdependencies that are going to determine ultimately when I'll receive my vaccine. But I look to the prime minister who is trying to shift the focus away from the first days to the point at which the last Canadian has had an opportunity to receive the injection. And I think he's quoted as September. So I'm going to say that no later than September I'll have received my injection.

MG: Cole Pinnow, it's great to speak with you. I appreciate this. Thank you very much.

COLE PINNOW: Thank you.

MG: Cole Pinnow is the president of Pfizer, Canada. Your CBC News is next. And then the medical marvel found in the blood of horseshoe crabs is helping to develop the treatments and vaccines we need to beat covid-19. But conservationists worry that the already struggling crab population will hit a tipping point in a moment, helping the crabs that are helping us. I'm Matt Galloway you're listening to The Current. We're back in six minutes. Stay with us.

Vaccine research threatens the health of a 'modern medical marvel' — horseshoe crabs; Toronto home brings holiday cheer with hundreds of lights;

Guests: David Wheeler, Jay Bolden, Karen Martin, Trevor Walker

MG: Good morning, I'm Matt Galloway. You're listening to The Current.

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MG: Still to come, we go inside the for profit long term care homes where the second wave of covid-19 is proving to be deadly, just like the first. But first, the sea creatures helping us beat covid-19.

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[Bird noise]

MG: That is the sound of a feeding frenzy every year, shorebirds travel from the southern tip of South America all the way to Canada's Arctic. And that flight, as you can imagine, burns a lot of calories. So to fuel up the birds stop along the beaches of the eastern United States to feed on the eggs of horseshoe crabs. But over the years, crab numbers have been dropping, in part because of a unique trait in their blood, which means that it is used in medical development, including the surge of covid-19 research being done right now. We'll get to the pharmaceutical science of all of this in a moment. But first, conservationists are worried that this drop in the crab population will only get worse thanks to the pandemic. And without enough crabs, the shorebirds will also suffer. David Wheeler is executive director of the Conserve Wildlife Foundation. David, good morning.

DAVID WHEELER: Good morning.

MG: Start us off by describing what a horseshoe crab looks like.

DAVID WHEELER: Well, the horseshoe crab is very unique in the animal kingdom and its appearance, you know, really belies that fact. This is a species that isn't a true crab. It's actually more closely related to spiders and scorpions. And this creature that's about one one to two feet. If you picture a shield or a helmet, kind of a medieval shield with a tail that looks like a spear, it's actually called the Telson and it sticks out about another foot or so from the creature. It's very primal looking. And when you see it for the first time swimming along the coast and it's found along the for the most part, the entire east coast of the U.S., when you see it for the first time, it's certainly a memorable sighting. It's a living fossil,.

MG: A living fossil. I was going to say that's how I've heard them, described it as a living fossil.

DAVID WHEELER: Absolutely. They've been swimming in the seas nearly unchanged since the time of the dinosaurs.

MG: So the sound that we heard at the very beginning is from the springtime when the crabs and the shorebirds collide. If you've never seen something like this before. What does it look like on those beaches?

DAVID WHEELER: Well, during certain high tides in the month of May on beaches along the Delaware Bay, both in New Jersey and Delaware, you have these mass gatherings of horseshoe crabs spawning. And if you picture these these large crabs kind of swimming up one after another and kind of forming a chain of six to to far more horseshoe crabs lined up in all directions during their spawning period. And this is something that's happened every May for time immemorial. And it's it's farther followed by shorebirds that are gathering in similar massive numbers. And they're there to feast on the eggs of the horseshoe crabs. So during the during the spawning, the crabs, like many thousands of eggs and and to picture the eggs there, they're tiny, almost caviar in appearance, tiny light green eggs that they lay in masses, kind of these masses of these tiny, tiny eggs. And they're buried to a degree under the sand. But but they really not only support the horseshoe crab population reproducing, but they support these migratory shorebirds and a number of fish species and diamondback terrapins. Really, the whole ecosystem in many ways uses this as a base.

MG: So they're really important in that ecosystem. How have the numbers of those crabs changed over the last 10 to 20 years?

DAVID WHEELER: Well, for the last few decades, unfortunately, the crab population has really been decimated and and there's a number of factors. Historically, they were used as fertiliser and massive numbers of crabs were brought off beaches and trucks, you know, used as a cheap, basically free source of fertiliser. More recently, they became a popular bait for eel or whelk. And it was only in the last, say, 15 years that there are some limits started to be put on bait in New Jersey, for instance, stopped that practise. Other states still allow it, but there are limits and all of that combined to certainly hurt the horseshoe crabs populations. What we're looking at now is populations roughly a third of what they were as recently as the early 1990s. So it's been a major decline and that doesn't even get into other factors like climate change or the biomedical use. But certainly a number of factors- and I should say too the crab decline has really been mirrored by the decline of the migratory shorebirds, red knots and others that that depend on the horseshoe crabs as well as weak fish is likely tied to their decline as well. These shorebirds, just to put it into perspective, they fly from as far away as the southern tip of South America, Tierra del Fuego, all the way up to the Delaware Bay. Spend a few weeks here fattening up on the the high calorie energy of the horseshoe crab eggs and then, as you mentioned, head up to the Canadian Arctic. So and that's just the one one leg of the journey. Then, of course, they head back each year. So these journeys, these kind of hemisphere wide journeys are absolutely dependent on the horseshoe crabs. And they've declined it at a similar rate, about a third now of what they once were.

MG: So as you mentioned, I mean, there are a number of different reasons why that population would be decimated. What is the biomedical use of these horseshoe crabs?

DAVID WHEELER: Well, because they are species that have changed so little, you know, essentially you have this the milky blue blood of this ancient animal has made it into a modern medical marvel. It's really extraordinary. And they're so unique in the animal kingdom because they've changed so little and because there are no real close relatives, amongst other species nowadays. Essentially, you have this component, Lysate. It's a Limulus Amebocyte Lysate, which detects bacterial endotoxins. And to put it another way, if there's some kind of toxin in in some kind of vaccine or medicine or implant that's being tested, anything that gets injected into our bloodstream, this will pick it up. The concern now, of course, is at some point we would really like to see it shift to a synthetic alternative rather than continuing to only use the crabs for that.

MG: The pharmaceutical companies have argued that they only use 30 percent of the crabs blood and then they return the animal to the ocean, that they're not killing the crabs there. I mean, the phrase that's been used is that they're in some ways milking the crabs for the blood. Tell me more about your response to that argument.

DAVID WHEELER: Well, our concern is, you know, and while they do only use like around 30 percent of the blood, you know, the industry claims there is only that. There's only around, I think, three to five percent mortality. The Marine Fisheries Commission, the the Atlantic Marine Fisheries Commission says it's probably closer to 15 percent. And there's been other studies that have shown that it could be up as high as 30 percent actually die. Our concern is simply that there's just not a heck of a lot of transparency in this process. And so as a result, there's not nearly enough data for, I think, all the scientists studying this to feel confident that the rates are as low as you know, as they're saying they are. And if they are that, then that's great news. But nonetheless, you know, no matter how you look at it, it's still, you know, hundreds of thousands of horseshoe crabs, I think roughly a half a million a year are bled. And so that small differences in the percentage mean differences in many thousands of horseshoe crabs surviving to reproduce or not.

MG: How close is the species to becoming endangered? If you're saying that the population has been decimated, how close to the edge is it?

DAVID WHEELER: Like I said, it's about a third of its population in just a few decades ago. But a better way to put it into perspective is it's just simply much more vulnerable now. And I'll give you an example. When hurricane or Superstorm Sandy ravaged the East Coast, here in Delaware Bay, we nearly lost all of our horseshoe crab spawning beaches overnight. And had it not been for a major public private partnership that pushed to restore the beaches in advance of the roughly six months later the mass gathering of horseshoe crabs in the shorebirds that depend on them, we very well could have lost them entirely. And so, to have the population decline to that rate, it has it just makes it that much more susceptible to some of the threats, like the major storms increasing in climate change, any of the any of the issues that are become much more pronounced when you're talking about an already declining population that has reached a much more vulnerable state.

MG: We're in the midst of this frantic push for covid-19 vaccine, and it's starting to be deployed in some parts of the world. But there are other vaccines that are still in development. How concerned are you given that and given the intensity of that push for the crabs and the shorebirds and the well-being of them in the long term?

DAVID WHEELER: Well, I think a way to frame it know for me is that when we're talking about a global pandemic, it would be with the incredible advances of our biomedical industry and, you know, medicine in general, I just think it would feel a lot more comfortable if it wasn't ultimately dependent on a single species , that if that species has an even sharper downturn, that essentially we have all of medicine, all of all of the vaccines and injectable drugs and implants and any kind of medical devices like that that we depend on, we're kind of in limbo because we're just relying on this one species. I look at looking at it just from a kind of a best management practises. We'd be much better served to to get those synthetic alternatives approved as quickly as we could. And in the meantime, to just get a better sense through a little bit more transparency, the industry get a better sense of what are the impacts to horseshoe crabs. And maybe there are additional ways we can mitigate that, in the way they return to the wild and the places that returned and kind of that that process. So, you know, that's the way we look at it.

MG: Is it difficult to fight for that in the midst of a pandemic when everybody's trying, you know, moving it a thousand miles an hour or two to find a vaccine that would help us get our way out of this nightmare?

DAVID WHEELER: Well, it's to me, they're complementary. They're certainly not in opposition. You know, we we applaud the use of the horseshoe crab blood, the Lycate, as it stands right now in the push for this. And no one's claiming on any level that that should stop. But rather, you know, let's let's move forward longer term and just kind of getting a better handle on the industry practises and and in the long term approval of a synthetic alternative. So we don't need to continue impacting this population and also making ourselves vulnerable by relying on just one species for it, for kind of the answer to all our prayers.

MG: David, it's great to talk to you about this. Thank you very much.

DAVID WHEELER: Thank you. Appreciate it.

MG: David Wheeler is executive director of the Conserve Wildlife Foundation. He was in East Brunswick, New Jersey. While horseshoe crab blood seems to be the only natural way of getting this vital compound known as LAL. There is an alternative. The pharmaceutical company, Eli Lilly has made the choice not to use horseshoe crab blood in their products. Jay Bolden is a biologist and he's a big reason for this decision. Jay, good morning to you. Good morning. David talked a bit about this. From your perspective as a biologist, what exactly is in, as he was describing it, the milky blue blood of these horseshoe crabs that makes it so important and desirable for medical research?

JAY BOLDEN: So the amoeba sites are cells within the horseshoe crab blood, and it's its defence mechanism against bacteria. So horseshoe crabs live in the water and there are water borne bacteria called gram negative bacteria. And those gram negative bacteria have endotoxins in their cell wall. And the horseshoe crab has developed a defence over time against these endotoxins. And it turns out that humans and other animals are very sensitive to endotoxins as well.

MG: So what would happen to a human if they were injected with a vaccine that had endotoxins in them?

JAY BOLDEN: If it was in high enough concentration, you would get a fever. And certainly back before we knew that you needed clean water to to manufacture medicines back in the 1920s, people used to get very ill and it certainly can cause death. So if it's in high enough concentration, it's bad news.

MG: That sounds like it. And so the this substance is is the only thing that we have that would allow us in that process to test for those endotoxins?

JAY BOLDEN: So interestingly, the the original tests to look for these hybrids and so pathogens are these endotoxins are one type of hydrogen. The original test was a full on animal test. So back in the 1940s, they would inject rabbits with the medicine and then they would monitor them for a fever. And that qualitatively would determine whether your medicine was good or not. When LAL was discovered and then implemented in the late 1970s and 1980s, really, I mean, it was a really welcome replacement for a very expensive, ethically questionable rabbit test. What we do have now and what's been on the market for some time is a synthetic version called recombinant factor C, so it's the exact same protein that is in the horseshoe crab. It's just produced by modern recombinant biotechnology processes.

MG: And it would do the same thing as this crab, but it would test that product for those biological contaminants.

JAY BOLDEN: Exactly. It does. And we've got lots at this point. We've been using it quite extensively for the past four years. I want to say, and we've got a lot of experience and we have found it to to test to be equivalent to LAL.

MG: How widely used is this product right now?

JAY BOLDEN: It's not widely used because the test for endotoxins is described in what are called pharmacopoeia. So every country has we'll call it a big book of methods, how you test for medicines. And right now, those chapters say you have to test for endotoxins and you have to do that using LAL, the horseshoe crab blood. But fortunately, in in Europe this year, the European Pharmacopoeia published a test method that says you can use recombinant factor C to test for endotoxin.

MG: Is part of this about patient safety as well. I mean, that's with any if you're developing any new drug, that's the determinant as to whether this is going to go forward or not. And if people are familiar with using one thing and there's something else that's on the market is patient safety. One of the things that's keeping other companies from making that switch?

JAY BOLDEN: Yes, patient safety is paramount in in everything that we do. But again, we make data driven decisions. There's a lot of peer reviewed scientific literature out there that shows the comparability of [unintelligible] to LAL. We've generated that data in-house ourselves. And then we've had that conversation with global health authorities as we have successfully applied to use RFC on several of our new products. And the global health authorities have agreed with us that, in fact, it is safe, it is equivalent, and that we can do that. We have a covid-19 antibody therapy that we've received emergency use authorisation to use in several countries. And so this product, [unintelligible], is no different than other compounds in our pipeline. And that so we use our SI on on that covid-19 antibody. You know, during the manufacture of that,.

MG: Why personally did you draw that line? I mean, why is this important for you?

JAY BOLDEN: I'm a birder. So as a hobby, I began birding in about 2000, right when I started at Lily. And I was made aware early on that, in fact, we were using horseshoe crab blood to test for endotoxins, but that we may not have access to it someday, either due to the crabs or the birds that rely on them. And so as a birder, I was attuned to that. So kind of been watching that for a long time. We didn't have regulatory clarity as to whether we would be successful trying to use it, but we got some of that regulatory clarity around 2012. And then in 2013, we started building a new manufacturing facility in China. And at that time I became aware of the situation of those horseshoe crabs in Asia and the dire situation they were in. So a lot of things transpired all around that time to say, hey, you know what? We should probably take a serious look at that. And that's what we did.

MG: Just finally I mean, you're in the position of, you know, working at a big pharma company, but you're also, as you said, an amateur birder. Do you find yourself in a position of, you know, moral conflict or some sort of greater conflict here where on the one side there's this real push for these vaccines and for cutting edge treatments to get us out of the pandemic that we're in. But there's a cost to that as well. And we heard it from David where he talks about the decimation of these populations. So do you find yourself conflicted in this work?

JAY BOLDEN: I see it as an evolution. I mean, we started with a full on animal test and then we got to something better with LAL. And now we have something that's better than LAL, and that's what we should strive to work towards. So the reality is the horseshoe crab blood has protected human health for 40 years. And certainly I can appreciate that. I realise there's a cost to it. But I also realise there's there's a better way of doing that. And that's that's exactly what we're trying to do.

MG: This is fascinating. Jay, I appreciate speaking with you. Thank you very much.

JAY BOLDEN: Thank you.

MG: Jay Bolden is a biologist with the pharmaceutical company Eli Lilly. He was in Indianapolis. This is The Current on CBC Radio One. My name is Matt Galloway. For nearly two decades, Karen Martin and her husband, Trevor Walker, have covered their home in Toronto with Christmas lights and decorations. Each year they add a little bit more on and they are now running out of room. Our producer Kate Cornick went to visit them while they were in the midst of finishing their holiday display to see and hear the Christmas magic come together.

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KAREN: Hi, I'm Karen Martin at 27 Glen Lake Avenue in Toronto, Ontario, which is the High Park area. My husband, Trevor Walker and I have been doing this for 18 plus years. We live in a three story house with a very steep roof and he gets up there in freezing rain, snow, sleet, does lays in the roof line.

TREVOR: It's terrifying up there. And we weren't meant to be up there.

KAREN: We have a lot of vintage blow moulds, probably about 30 candles, Santa and his reindeer. And then we have the Grinch, who's about 25 feet, I believe. I'm going to guess we go through about 2000 electrical ties. A 100 extension cords we don't like is in the yard. For that reason. We have a 20 foot Christmas tree. We have Christmas lights running the entire length of our walk and our fence line. We have a large chestnut tree that's covered in lights. We have our homage to a Christmas tree lot at the back. We have about 30 Christmas trees all set up that we're still decorating. We have probably about 20 global Santas. There is a lot going on. It takes us a full month to get this going.

TREVOR: I hear this in my sleep. Electrical ties. They're everywhere. It's like, it's like the glitter of Christmas. You have to work on this every day, every day. Something needs to be tweaked, something needs to be fixed. It's a much bigger than you would think.

KAREN: You know, it's a lot of swear words happened, a lot of grumbling in the whole month. But every single night, as soon as it gets dark, the music gets turned on and all the lights get turned up. That's when he and I we will grab our drinks and go out to the sidewalk anonymously and just stand across the street and stare back and go, there we go and just listen to the kids, because hearing their words is what makes it all worthwhile. We get told a lot that we are a tradition, which is kind of weird. I mean, I feel young. How the hell can I be a tradition? You can't be a tradition and be mid fifty! Traditions are like 200 years old. Yes, the neighbourhood loves it. And it's not our house alone. When you come around here in December, you'll see every single house is decorated. It has become a whole neighbourhood event. Last night there was at least 25 cars outside. So, yeah, it's made it loud and clear that people want to get out. They want to do something. They want to socialise, but they want to be responsible about it all.

TREVOR: It's become a pretty cool place to meet, you know. I mean, obviously with safety now in mind, but people are always talking to each other out there or, you know, it's, uh, it's pretty cool. It's much bigger than me now.

[Music]

MG: Trevor Walker and his wife, Karen Martin, at their very well decorated home in Toronto, your regional update is next. And then long term care homes have been ground zero during this pandemic, but some for profit homes are reporting particularly high numbers. In a moment, we'll hear about conditions in these homes and find out why things there are so bad. I Matt Galloway. This is The Current. We're back in 90 seconds.

Government money and questions over spending at long-term care homes

Guests: John Lancaster, Dr. Bob Bell, Colleen Flood

MG: Hi, I'm Matt Galloway, you're listening to The Current.

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It's like mourning a family member that's not even dead yet and it's disgusting. I wish this on nobody.

MG: There are families across this country who feel the same way. As the second wave of covid continues, long term care homes are once again hot spots of covid-19 outbreaks. Sara Bateman's father lives in a Mississauga, Ontario home, a for profit home, and he got covid during the first wave.

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They put my dad in every room knowing full well that his roommate was positive for covid and they pretty much left my dad to die in that room. And they're asking for 3000 dollars a month now, even when my dad's pretty much on his deathbed. I mean, that's not okay. I mean, nobody should be going through that.

MG: Thankfully, he survived. But Sarah still worries about the care that he is receiving. A study from the Canadian Medical Association journal from July found that for profit homes in Ontario had worse outbreaks and more deaths during the first wave of covid than not for profit or municipal homes. Now, CBC News is reporting that some for profit operators have been paying dividends to their shareholders. John Lancaster has been looking into this. He's a senior reporter with CBC Toronto. John, good morning.

JOHN LANCASTER: Good morning, Matt.

MG: Tell me about the companies you looked at.

JOHN LANCASTER: Sure. Well, this was part of a project called The Big Spend, where several colleagues and I were tasked with looking at how the billions of dollars of public money that's been spent during this pandemic where it's gone and who received it. As far as these two companies, starting with covid, while these two companies have lost at least 480 residents and staff so far due to college in Ontario alone, according to provincial data, we looked Extendicare and Sienna Senior Living, both Toronto area based for profit long term care providers. And they're big. They own or operate dozens of care homes in Ontario and other provinces. And they've had covid outbreaks, like a lot of other care facilities in Canada. Financially faring, we wanted to find out that because neither the federal nor the provincial government in Ontario has offered detailed information about who they gave money to and how much went for two for profit care companies. And also because these two companies, we learnt, got 157 million dollars of the public's money, while at the same time also paying out tens of millions of dollars to their corporate shareholders.

MG: Tell us more about that. What do we know about where that money is, you said the millions of dollars in government relief, where that money has gone?

JOHN LANCASTER: Sure. So of that one hundred and fifty seven million dollars these companies received. We found that in part to looking to the public financial disclosures. Extendicare got the bulk of that, 157 million dollars, approximately 104 million dollars. And that 104 million came from both federal and provincial coffers. As abour Sienna, they didn't get any federal money, but the company did get 53 dollars million from provincial covid-19 relief programmes. All this public money, of course, was aimed at helping these companies navigate the pandemic. But again, what we found was that the two companies got the substantial amount, 157 million dollars of public money while paying out 75 million million to shareholders so far this year.

MG: Do we know whether any of that money in the dividends to shareholders came from those subsidies, subsidies?

JOHN LANCASTER: Well, both companies added, they say that no public funds were used to pay their shareholders. What we do know is that extended care, for instance, they got just over 82 million dollars from a federal programme called CEWC that Canada Emergency Wage Subsidy Programme and Extended Care says all of that went for exactly that. Wage subsidies that a company owns called Pyramid. Pyramid provides care to people who are still able to live at home. They're not in long term care facilities. The other 22 million extended care got with provincial money and the company says all of it, about 20 million dollars more of its own money was used to fight covid-19, this time at its long term care facilities. Things like sanitisinge PPE, infection control measures. Sienna, well, they got all their funding, the 53 dollars million from provincial programmes, and they say they spent all of that and more of company money on its pandemic response. And again, both companies saying that no public funds went directly to their shareholders.

MG: These are for profit companies. Do we know what sort of profits they made over the course of this year?

JOHN LANCASTER: Yes, well, I mean, it's hard to know exactly, but, you know, if they're pairing up, paying out dividends, the company argues that's because they need to pay their investors for a lot of projects.

MG: What sort of response has there been from the families who have loved ones at the homes operated by these companies?

JOHN LANCASTER: We spoke to several families in our online store yesterday. We featured a couple of them. One was the Los Angeles family who lived just north of Toronto and in Aurora. And particularly disturbing story, essentially their mom, Luisa Dosanjh. She lives at a place called Extended Care Hulton Hills in Georgetown, Ontario. And the family said, you know, they visited her often. But like many facilities, this care home brought in measures to protect residents, including preventing visitors, you know, they fear could potentially bring the virus with them. So in October 16th, they say they got a call from the care home saying, you know, we got some bad news. Mum's toe wasn't looking so good. They were like, her big toe, the one that gives her problems. And they were told, no, it's a baby toe. So the mother was taken to hospital. The family went to see the doctor and they were told that this toe was black and gangrenous and they were told not to get too graphic. But the toe would eventually sort itself out and die off type thing. But after returning to the care home, the family says the infection continued to spread to the point it actually destroyed her heal area as well. They say that none of this would have happened overnight and wonder if the facility may not have been keeping close tabs on the situation. Well, on Tuesday, this kind of came to a head. The family spent the day at a hospital in Ontario again, but this time their mother's leg was amputated below the knee due to that infection. And they're furious. They say after learning of this original infection back in October, they set up cameras in their mother's room. They say they observed what they claim were more care problems. You know, the videos, video cameras have also captured their mother in considerable [unintelligible] they say. Here's what her daughter, Tammy Fisher, and son microsurgeons.

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TAMMY: Oh, it's it's terrible.

MIKE: Yes. I mean, we we see her on video at night. We just monitored her and she wasjust tossing and turning, yelling, just in pain from her foot.

TAMMY: Yes.

MIKE: It's it's heartbreaking to see that. Like to see them suffer, your mom especially, and then you can't be there to comfort her.

TAMMY: They're not home and we think that she's going to be well looked after. Right. And this happens. And then what happens to my mom now? She's full weak right now.

MIKE: She's gonna lose a limb.

TAMMY: We don't even know what her progress could be.

MG: We ask extended care for comment on the dividends. Here's part of what they had to say in a statement: Investments of our shareholders enable us to secure capital, stable ongoing dividends, enable our investors to provide us with the capital to build these new homes as an interest bearing bank loan or a mortgage for a not for profit operator. What have we heard from the federal or provincial governments about this? Do they want to see more transparency in when it comes to these for profit companies, especially if they are receiving federal or provincial funds, John.

JOHN LANCASTER: Well, you know, yesterday, Matt, this issue was raised in the House of Commons, but there wasn't any clear response from the government as far as transparency, accountability for these public funds or strings attached to them. The government did warn companies that any company in general wasn't to use public money to pay dividends. But we do know that a lot more money is coming for long term care providers, at least from Ontario's government. Last month's budget, the province pledged to dish out at least another 500 million dollars for long term care homes.

MG: John, thank you very much.

JOHN LANCASTER: My pleasure.

MIKE: John Lancaster, senior reporter with CBC Toronto. Sienna Senior Living, also sent us a statement that reads in part: Sienna Senior Living is committed to protecting the health and safety of residents and team members in all of our residences for the nine months ending September 30th, 2020. We have incurred pandemic related expenses totalling 73.7 million dollars. At no time was government funding used to pay dividends. Revera is another for profit home that has come under scrutiny during this pandemic. The companies owned by the federal Public Sector Pension Investment Board and operates more than 70 long term care homes across this country. Last month, its Westside long term care home in Toronto saw an outbreak of more than 150 infections and 12 deaths. They also run Manitoba's two hardest hit facilities. Revera has just conducted an internal review after nearly 300 of its residents have died during the pandemic. Dr. Bob Bell chaired that review. He is a former deputy minister of health and long term care in Ontario, a former CEO of the University Health Network in Toronto. Dr. Bell, good morning to you.

DR. BOB BELL: Good morning, Matt. How are you?

MG: Well, thanks. Rivera was not part of John Lancasters report. It's no longer a publicly traded company, but what did you make of what you heard from John Lancaster?

DR. BOB BELL: I think John's story is very important. I think it reminds all Canadians of the importance that we need to focus on better care for the most vulnerable Canadians, seniors living in long term, long term care facilities across the country. And that's why that's why Revera conducted this study and asked us to do this report.

MG: The report was called A Perfect Storm. What does that mean?

DR. BOB BELL: Well, you know, the number of features that came together meant to cause the experience that Canadian seniors have suffered in long term care can certainly be termed a perfect storm, the number of factors that are operative here. And the fact, especially the one thing that we've learnt from this study, the fact of the importance of surveillance, testing and reducing the risk that our seniors have, that's certainly something. Premier Ford in Ontario put this in place back in May, to his credit, with testing being done for workers, for staff and long term care in Ontario every two weeks. Minister of it, to her credit, increase that in the hot zones in Ontario, areas where the virus is spreading in the community to once a week, about two or three weeks ago. And the thing that needs to be understood, this is a very sneaky virus. We understand now something we didn't understand back in April and May. And certainly Revera opened all their data to us. Volunteer members of this expert panel really looked at the Revera data that they provided allowed us to do our own analysis that allowed us to ask questions. We had the pen on writing this report. There was no editorial influence from the right and the most significant features, one that's probably more significant today even than it was a couple of days ago. Because we're learning now that probably the earliest vaccines that are coming, certainly to Ontario probably won't be able to go to residents of long term care. They're going to be focussed on health care workers, probably because of the fact these vaccines can't be moved around too readily, including long term care staff. But the number of vaccines certainly will not be sufficient to vaccinate all the staff to work on long term care. Understanding that this virus, it really is infectious the first couple of days before people actually get symptoms, staff unknowingly brought this virus into long term care homes, in the best of intentions, coming to work and without surveillance testing of staff, we're going to continue to see the virus getting into long term care.

MG: Let me ask you a couple of questions about Revera in particular. Rivera is a for profit home. What is the role of for profit, long term care homes in Ontario, do you think?

DR. BOB BELL: Well, Matt, you know, I'm more interested in the health care aspects here. I'm not a corporate person. I'm not somebody who knows about dividends.

MG: But you know a lot about you know a lot about the public health care system. I mean, you were a deputy minister. You were also the CEO of one of the largest health care networks in this country. So what I'll ask you again. Right. What is the role of for profit, long term care homes?

DR. BOB BELL: Let me let me give you an example of what Revera has brought to bear in the battle against covid across the country, the western provinces, Manitoba, Alberta and British Columbia, where Revera operates long term care homes and seniors, retirement living homes. Those provinces, unlike Ontario, have not introduced surveillance testing. So their workers are coming to work and most of their homes without any testing, unknowingly bringing the virus into the homes. Revera because of the fact that it is capable of introducing innovation that is capable of paying from corporate funds for testing, has introduced surveillance testing in their homes out west. And just yesterday, when we learnt that vaccination won't be coming to Ontario's long term care homes in the near future. Ontario is excellent. Medical team and their technology innovation team are right now looking at ways we can actually bring to bear in Ontario long term care homes, the same kind of protection for long term care residents that NHL players had when they were playing in the bubble in Toronto. Remember they were getting tests daily to ensure that the players, healthy young men didn't get infection. Why can't we bring that level of surveillance to bear and vulnerable Canadians living in long term care homes? Revera is trying to do that.

MG: Well, let me go back to something that was raised in John's report, which is we're not entirely sure where the money is going in these companies. I mean, Rivera is a privately held company, doesn't disclose financial information. Do you think it's appropriate for long term care companies to take money from governments and not be 100 percent transparent and where that funding goes?

DR. BOB BELL: Well, I know there are various investments in personal protective equipment and extra testing, as I just mentioned, and paying for agency staffing and situations where their staff are having to isolate are being quarantined. That is added tens of millions of dollars to the cost Revera has has experienced. Now that I don't know that from studying their financials, that is not what this report was about. Let me be clear. We looked at the impact of infection prevention and control personal protective equipment and crucially, on the importance of surveillance tests.

MG: That's right. But do you think it's appropriate for a long term care companies to take money from governments and not say where that money goes?

DR. BOB BELL: I think probably, you know, the funding that's provided to long term care companies, whether they're not for profit companies or companies that are privately held, is tightly, tightly regulated in Ontario. You know, the amount of funding, for example, is provided to staff is is reconciled at the end of every year. If there's a single penny that's provided for staffing or for feeding residents or for recreational facilities or for other rehabilitation features for residents, if that money isn't totally spent on those concerns, that money goes back to government. This is really a tightly regulated, tightly constrained part of the health care system. That and whether they're not for profit providers, for profit providers, you know, all that money is tightly, tightly reconciled at the end of each year.

MG: Your report has faced severe criticism. Take a listen to Michael Hurley, who's president of the Ontario Council of Hospital Unions at CUPE, the Canadian Union for Public Employees.

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The report really dodges, you know, one of the essential criticisms of Revera, the lion's share, 75 percent of the deaths that occurred in long term care occurred in for profit facilities. And one of the reasons that this happened, we believe, is because the for profit operators spend less on stopping, on cleaning, on feeding residents, for example, on supplies like protective equipment than the charitable and not for profit and municipal long term care facilities do.

MG: So, Bob Bell, we're almost out of time. But before I let you go, isn't there an inherent tension in maximising returns for, in this case, pension holders? This that's who owns Rivera and providing the best care for residents, which would cost more money?

DR. BOB BELL: Absolutely not. What Michael says, it is simply not true if Revera doesn't spend the staffing, that's the staffing funding that's provided to them on staffing. That money is taken back. It's literally impossible for any provider in Ontario to not pass through all the dollars received for staffing, for food, for cleaning the features that Michael is describing. I know from my experience as deputy minister, all that money has to be spent on the purposes to which the government provides it. There's no money that goes from that funding from the government to profit or any other purpose other than the purpose to which is designed to be provided for barbel.

MG: It's good to speak with you about this. I appreciate your time this morning. Thank you.

DR. BOB BELL: Thank you, Matt.

MG: Bob Bell as a former deputy minister of health long term care in Ontario. As a doctor, he was a former CEO of the University Health Network in Toronto and the lead author of the investigation into how Revera Holmes was handling the pandemic thus far. Colleen Flood has been listening in. She is the university research chair in Health Law and Policy at the University of Ottawa calling. Good morning to you.

COLLEEN FLOOD: Hi, Matt.

MG: What do you make of what you've heard from Dr. Bob Bell?

COLLEEN FLOOD: And so if we, you know, go right to the point of it, the nub of it, the difference between for profit and not for profit and municipal hands, I think it is, you know, very clear from from the evidence that there's been a stark difference and the death rates between those homes. And so we have to figure out what happened here. And I think the best account of that is there is a significant difference between these homes in terms of the professional staffing that they have. So municipal homes more likely to have registered nurses or health professionals than for profit homes. And Dr. Bell makes the point sense. Government does. Ontario government does put boundaries around some of the funding that comes to homes, whether they're for profit or not, for profit. But that's not the only funding they receive. Of course, they receive funding directly from the residents themselves, which are kind of the board and lodging funding.

MG: Is there any real is there is there any transparency in terms of where those funds go and how those funds are used?

COLLEEN FLOOD: Oh, no, no, no. As I understand it, so, you know, this is where obviously when you have for profit entities in the system, it is expected that there would be profits, of course, to return to shareholders. So there has to be some means by which that can happen, you know, so not every dollar that comes in, some of those dollars have to go for profit. But I think Dr. Bell raises, you know, in the report that they've done for Rivera, it is a very good report in many ways because it does talk about the perfect storm of things that happened to result in the carnage we've seen in long term care homes, whether you're talking for profit or not, for profit or municipal, still far too many deaths and infections across these places, although it's definitely worse and for profit settings. So there are a bunch of different things that happened. You know, I sort of think of it as the ism's really how we could let this happen, you know, ageism and sexism and our responses to disability and mental illness, because most of the people, unfortunately, who live in these nursing homes are older women, often at the end towards the end of their lives with living with dementia and Alzheimer's, you know, some of the most vulnerable people in society. And I think we just have for too long ignored this problem with that have been we've known for at least a decade the extent of what has been happening in these long term care homes. And we've collectively chosen to sort of hide our heads in the sand.

MG: John mentioned earlier that these for profit homes, some of them the companies, are paying dividends to to shareholders. What is the message you think that sends to families who have loved ones in these homes and who, you know, in some ways live in terror about the health of their loved ones as a pandemic rips across the world?

COLLEEN FLOOD: Well, I personally think, you know, this is just my personal opinion that that's unfortunate messaging and the wrong message. And I think it will backfire. This is not the time to be doing that sort of thing. But each corporation has to make their own trade-offs and decisions. But I think what we have lacked in this space. I disagree with Dr. Bell that this is a space that is appropriately regulated. There is lots of regulation, but it's the wrong kind of regulation. So we don't have, you know, the regulation around staffing, for example, which is key to the quality and safety of care that patients receive, the regulation in Ontario is you just have to have one registered nurse no matter the size of the institution. So you can have hundreds and hundreds of residents in an institution. You only have to have one registered nurse. So that's pretty bare bones and I think relatively pathetic. There's no regulation around a number of care hours that people have different acuity should receive. There's no regulation requiring the delivery of palliative care in these in these institutions. There's a lot of things that I think absolutely key for quality and safety that is actually missing from the regulations and a lot of other stuff that probably doesn't need to be there.

MG: Would it make a difference if, as many people have said, this is about the the for profit nature of these homes. The leader of the NDP, Jadmeet Singh, has called on the government to transfer the facilities of Revera to public management. There are other people who have been calling for, you know, many, many months, years for an end to for profit long term care in this country. Would that make a difference in terms of the care that those residents get?

COLLEEN FLOOD: It would seem to from the evidence, but there's also evidence that if you're appropriately regulated, then you could, you know, ameliorate some of the problems that we face. And we shouldn't forget that the concerns of the long term care are not just in for profit homes. They are across the board. The problems are worth and for profit homes. So, it won't be magically solved by shifting everything to not for profit or municipally owned homes, but certainly in a time of covid what we have seen that with the perfect storm hitting the homes, the ones that have done best by far the best are those that are actually publicly owned. If we're back to a normal sort of status, then I think what we have to do is, is properly regulate. The trouble is that I don't know whether it's because of the corporate interests involved, but governments have not in Ontario at least, have not sufficiently regulated the space. They haven't had proactive inspections. And the conservative government here in the last couple of years actually largely did away with those kinds of inspections. So, we tell them that we're coming now. Of course, everything will look fine then as opposed to unannounced, very fulsome and complete inspection. Ontario, a much higher percentage of homes that are for profit, some 60 per cent of homes are for profit compared to the Canadian average of about 30 per cent. So it would seem that perhaps a wise course would to be to reduce our reliance on those kinds of homes over time and shift more to municipal municipally owned home.

MG: Just before I let you go, we only have a few seconds left. But is your sense that this perfect storm will will lead to that change?

COLLEEN FLOOD: I sure hope so. I think that, we've had 150 reports on the state of long term care over the last 10 years and we haven't acted. I hope that the tragedy that has unfolded there and the lives lost will not be for nought and that we will finally get our act together and fix the problems that are there and make this a place where people can live out the end of their life with dignity and have a good death.

MG: I really appreciate speaking with you about this calling. Thank you.

COLLEEN FLOOD: My pleasure.

MG: Colleen Flood, the university research chair in health law and policy at the University of Ottawa. That is The Current for today. Coming up next on CBC Radio on its Q Topower speaking about dance with the legendary choreographer Twyla Tharp. You will not want to miss that. In the meantime, that's it for us. I'm Matt Galloway. Thanks for listening to The Current. Take care. We'll talk to you tomorrow.

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