Your Constitution and the flu

Ottawa is responsible for supply while the provinces control the delivery

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by L. IAN MacDONALD
The Gazette, Wednesday, November 4, 2009

Beyond the anxiety in the country and the blame game in Ottawa over the availability of H1N1 vaccine, there's a fundamental issue of the constitutional division of powers.

It's both simple and subtle. Under Section 91 of the Constitution Act, Ottawa is responsible for "peace, order and good government." It is the central statement of the Constitution, and the ultimate trump of the federal government in running the country.

This means that Ottawa is ultimately responsible for the safety and well-being of Canadian citizens, including those standing in line waiting for flu shots. Except that the lines are run by the provinces.

Ottawa is also responsible for national health and safety standards, approvals for experimental drugs, and the purchase of drugs such as the H1N1 vaccine.

But the provinces, under Section 92 of the Constitution, are responsible for running the health-care systems across the country, including the distribution of vaccine and the determination of priorities.

In other words, Ottawa is responsible for assuring the supply, while the provinces are responsible for meeting the demand.

As the lineups across the country have demonstrated in the last week, this is a work in progress at both levels of government. The manufacturer, GlaxoSmithKline, is making the stuff as fast as it can, but the surge in demand exceeds the supply for the moment. In spite of all its precautions, Ottawa is playing catch-up. There's a lot of pent-up anxiety, and even some incipient panic.

But the media, which have played a role in this, would do well not to underestimate the capacity of Canadians for calm and patience, as long as they see that health-care professionals and providers are doing the best they can under trying circumstances.

For example, Quebec appears to have done a good job in publicizing priorities in at-risk groups and locations where they can be served across the administrative regions of the province.

For Quebec, the priority groups on the island of Montreal include parents of children under 6 months of age, who are asked to visit any one of 15 locations beginning this Friday.

Starting next Monday, it will be the turn of pregnant women and children between the ages of 6 months and 5 years. Beginning the following week, persons under 18 years old suffering from chronic diseases such as diabetes, will also be eligible. Beginning the week of Nov. 23, persons from 18 to 65 years of age suffering from chronic diseases are invited to the clinics, which by then will have expanded to 20 locations island-wide. Finally, from Dec. 7, children and adults over the age of 5 and in good health will be able to join the line.

But that's just on the island of Montreal. On the South Shore and in the Monterégie, the priority criteria appear slightly different, so check your local newspaper!

In Ottawa, the political class doesn't seem to be checking much of anything, except checking its common sense at the door.

For example, the production line at GlaxoSmithKline was stopped and restarted to enable the production of unadjuvanted vaccine for pregnant women, understandably concerned about the effects of the higher doses of the adjuvanted version on their unborn children.

But the World Health Organization, which had advised pregnant women to get the unadjuvanted shot, especially in the first term, reversed itself on Monday and declared there was no risk from the higher dosage.

But in the House, the blame game goes on. The Liberals asked for an emergency debate on the pandemic Monday night, and their leader, Michael Ignatieff, gave quite an impassioned address on the role and responsibilities of the national government. But while he was doing his job, his operatives were undermining him.

The national president of the Liberal Party, an Iggyite named Alf Apps, put out an hysterical missive comparing the H1N1 situation to Hurricane Katrina. Then one of Ignatieff's advisers named Mark Sakamoto turned up as an ordinary concerned Canadian in an interview on CBC's The National, which was not a good thing for either him or them.

This is a grown-up moment we're living in, one in which the Liberals are in need of adult supervision.

 
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