Health Canada ignored warning signs before Ottawa spent billions on BTNX rapid tests

By Patti Sonntag Global News
Posted January 11, 2024 

Health Canada ignored critical warnings about a rapid-test supplier before approving its COVID-19 kits for distribution nationwide, Global News has found.

A year-long Global News investigation into federal procurement revealed that BTNX, a Toronto-area rapid-test supplier that buys the devices from China, deleted dozens of specimens, or samples, from a study it submitted to Health Canada in October 2020. Deleting the specimens increased the estimate of the rapid test’s ability to detect the virus.

In October 2020, BTNX submitted an application to Health Canada as it sought approval to sell its rapid test for COVID-19. One of the studies in the package was a study that suggested the test would detect 94.55 per cent of infections, among people who had symptoms for less than 14 days.

However, two months earlier, BTNX told authorities in Peru the same test detected 80.2 per cent of infections overall, according to records that government published online.

The lower detection rate of 80.2 per cent of infections is the estimate that the kit’s Chinese manufacturer, Assure Tech, gave to every business selling the test worldwide. It was based on a study of the test’s ability to detect the virus carried out at two health-care facilities near the company’s Hangzhou headquarters.

Though an assistant deputy minister at Health Canada had already flagged possible issues with another BTNX application, federal employees reviewing BTNX’s file did not challenge the company about this improvement or ask for an explanation, according to correspondence Global News obtained via freedom of information request.

BTNX admitted that it had deleted specimens. The company “worked with the data provided to us,” BTNX wrote to Global News in December 2023, making changes to “focus the data on the intended use of the product.”

In the wake of Global News’ reporting, BTNX added in a letter that the changes to the study were “based on the US FDA EUA template” and, in a press release, in “accordance with industry standards.”

The leap in the product’s accuracy was one of at least three red flags that Health Canada appears to have either missed or ignored as BTNX applied for a licence to sell the test kit in the fall of 2020. This included a warning from a senior Health Canada official about the veracity of the company’s public statements; data missing from a second study in BTNX’s application; and what researchers called elevated test results.

BTNX and Health Canada have stated that BTNX’s device works as promised, and regulators had all the information they required. Health Canada told Global News last month it will not re-examine BTNX’s licence to sell this test.

Dr. Stephen Ellis, member of Parliament for Cumberland-Colchester and the Conservative shadow minister for health, told Global News that his party will “hold the Liberals to account” and follow up on this “very serious concern regarding rapid test approvals.”

When Global News asked Mark Johnson, a Health Canada spokesman, what guidance applies to suppliers editing studies, he quoted the Food and Drugs Act.

“No person shall knowingly make a false or misleading statement,” he wrote.

Regardless, the federal government awarded BTNX a series of contracts in 2021 and 2022 that became Canada’s largest pandemic deal for medical supplies.

A wartime effort

When borders closed in the spring of 2020, with COVID-19 infections spreading, no vaccines, and entire nations in lockdown, workers at Health Canada and other federal offices faced a daunting task in finding the medical supplies Canada needed.

Government employees in Ottawa found themselves caught up in a global competition for rapid tests so fierce that a Health Canada official called it the “Hunger Games.”

Global News began looking into procurement while rapid test purchases were still underway. Federal ministries permitted some of the workers who evaluated rapid tests or procured them to participate in a rare group interview on the condition that Global News would not name employees or ask about contractors.

The interview took place in November 2022. Certain disparities in statements by BTNX executives a few weeks later led Global News to further investigate how and why BTNX received its contracts.

Six officials joined the interview, almost all of them at director level and above, in the interest of sharing their experiences during the public health emergency.

“The desperation can’t be captured in words,” recalled a senior official from the Public Health Agency of Canada.
Her voice broke as she shared the group’s fears that “we might not be able to get our hands on […] enough supply.”

All the world’s manufacturing plants were only able to meet a fraction of global needs. And Canadian officials could not match the purchasing power of their U.S. or European counterparts or the scale of their orders.

With few options, Canada turned inward. Prime Minister Justin Trudeau called on Canadian manufacturers to produce medical supplies, from face shields to ventilators.

Authorities preparing to launch mass screening pinned their hopes on a test manufactured by Spartan Bioscience, a company based in Ottawa. This DNA-based “lab-in-a-box” solution attempted to solve the problem of accuracy.

Health officials around the world had concerns about the reliability of the obvious alternative to lab tests, which were cheaply made rapid tests. In many markets these had never been regulated — and the World Health Organization would issue two warnings about them within the next six weeks.

Health Canada hired new employees, set up an emergency authorization process for health care equipment, and cut wait times on licences to sell medical supplies.

Over at Public Services and Procurement Canada, the invocation of the National Security Exemption empowered employees to skip most processes.

According to a CBC report published on April 12, 2020, exploring why Health Canada was lagging behind U.S. and European regulators, a BTNX executive said in an interview that the company was disappointed with the amount of time Health Canada was taking to approve its antibody test.

“We’ve seen the speed in which other, other health agencies around the world have been able to take these decisions,” BTNX’s CFO Mitch Pittaway said. “We think that Canada will hopefully be in a position to take a well-informed decision quite quickly.”

Pittaway was pitching an “antibody” test that detected the body’s reaction to the presence of COVID-19. Antigen tests, released soon afterward, detect the virus itself.

He noted that the company was selling the tests in the U.S. through an emergency program.

The next day, Pierre Sabourin, who was then an assistant deputy minister at Health Canada, flagged to Stephen Lucas, deputy minister, that he thought BTNX was misleading the public. Global News obtained correspondence between federal workers from a government website and freedom-of-information requests.

“Some manufacturers/importers claim falsely” that U.S. health authorities authorized their antibody tests for sale, Sabourin wrote. “For example, BTNX.”

At the time, the U.S. regulator was experimenting with pre-authorization sales, allowing rapid test suppliers to sell their products while they waited for officials to process their applications. BTNX was among that group.

BTNX’s application to Health Canada for authorization to sell the antibody test was “poor quality,” Sabourin added. The supplier had not submitted clinical data that backed up its claims, he wrote.

In response to Global News’ recent questions, BTNX wrote that it has always been transparent with regulators and the public.

 

Prime Minister Justin Trudeau addresses Canadians from Rideau Cottage in Ottawa on April 29, 2020, the same day that he spoke about rapid test suppliers in the House of Commons. 

THE CANADIAN PRESS/Sean Kilpatrick.

On April 29, 2020, in a House of Commons debate, Prime Minister Trudeau called BTNX an “innovative Canadian company that has moved forward with a world-class product.”

Health Canada did not respond to Global News’ questions about whether the ministry informed the Prime Minister’s Office about Sabourin’s concerns.

In a statement issued after this article was published on Jan. 11, 2024, the Prime Minister’s Office wrote that BTNX’s antigen “rapid tests work well and have been successfully used by millions of Canadians” to fight COVID-19. A spokeswoman described Health Canada’s decision-making as “independent.”

A priority application

Six months later, Spartan’s device had not proven reliable enough, according to Health Canada’s evaluation. And any obstacles to BTNX’s applications had seemingly vanished.

David Boudreau, director general of Health Canada, emailed Sabourin and Manon Bombardier, assistant deputy minister, on Oct. 14, 2020, to announce that, after discussions, BTNX had applied for authorization to sell an antigen test for COVID-19.

Given the emphasis on finding antigen tests, he wrote, Health Canada would review the file “in priority, as soon as possible.”

It is unclear why Health Canada prioritized BTNX’s application.

Assure Tech, BTNX’s supplier in China, had already applied separately to Health Canada for authorization to sell exactly the same product.

Sabourin did not reply to Boudreau in writing.

(Sabourin declined Global News’ request for comment. He retired in December 2021.)

Federal employees set to work.

In Winnipeg, workers at the National Microbiology Lab evaluated sample tests BTNX provided.

In Ottawa, an employee with a PhD in biochemistry supervised the examination of BTNX’s and Assure Tech’s nearly identical application packages, which workers paired together, according to federal records.

One of the evaluations in BTNX’s package, but not in Assure Tech’s, was the edited version of the study of the test’s ability to detect COVID-19.

It was not immediately apparent that the two documents described the same study. Global News’ analysis showed that in addition to omitting data, BTNX had renumbered the locations at which the evaluation took place and the specimens’ identifying numbers.

According to Health Canada, its employees did not notice that 132 out of the study’s original 348 specimens were missing and found no “reason to question [the studies’] scientific integrity.”

A quick scan of Canadian distributors’ websites would have shown that another business was marketing the same test to customers overseas with the overall 80.2 per cent sensitivity estimate. Yet in BTNX’s application to Health Canada, this figure jumped to nearly 95 per cent.

“There was no switching of sites,” the company’s spokesman wrote. BTNX provided a “reliable testing tool for Canadians.”

One of the changes involved removing “retrospective positives.” This refers to specimens that have been frozen.

BTNX said Canadian and U.S. health regulators recommended using fresh samples.

In fact, Health Canada advised the company that it could use frozen specimens in its correspondence with BTNX. The U.S. FDA said the same.

Global News’ examination of the data also revealed that BTNX did not delete all of the frozen specimens, only those that tested positive for COVID-19. Those deletions improved the outcome for the nasal test by nearly 10 percentage points.

Examining clinical studies posted to Health Canada’s website, Global News found that other rapid test suppliers used retrospective samples and described the results from unusable specimens.

In response to questions about whether editing data was common among Canadian rapid test companies, Cenk Ozkan, vice president of Artron Laboratories, based in Burnaby, B.C., told Global News that deleting data would risk “loss of credibility and legal actions.”

Health Canada, for its part, has defended its decision to approve BTNX’s application. The approval relied on the full package, a spokesman wrote in December, including a second study of the test’s sensitivity that was carried out in the United States and managed by Assure Tech, BTNX’s supplier.

Global News discovered BTNX’s version of this second study was different from Assure Tech’s as well.

View image in full screen

This table presents all known versions of studies in Assure Tech’s and BTNX’s Health Canada applications. Global News

The version of this second study Assure Tech submitted to Health Canada cited 230 specimens. BTNX’s version cited just 82, suggesting that an unknown person omitted the majority of the specimens.

Assure Tech did not respond to Global News’ requests for comment. BTNX told Global News that Assure Tech provided only 82 specimens to BTNX.

“AssureTech did not advise BTNX that it had additional specimens from another site or that it was submitting a broader study to Health Canada,” the company’s spokesman wrote on Jan. 5. Health Canada’s approval of the test for consumers relied on a third evaluation in the package, he stated.

The deletions have raised questions among Canadian researchers about why the regulator approved BTNX’s application.

Trudo Lemmens, a professor of health law and policy at the University of Toronto, said, “The fact that Health Canada didn’t see it or ignored it” suggests “regulatory failure.”

Lemmens called on the federal government to launch an investigation that also allows for “scrutiny by independent researchers outside of government, outside of industry, to be able to see whether the data supports the claims.”

New questions about the application

In the November 2022 interview, a Health Canada official recalled federal workers’ sense of unity as he looked back on those terrible days.
“We were all rolling up our sleeves,” he said, “trying [to protect] the health and safety of Canadians.”

He and his colleagues seemed confident that they had weeded out less reliable suppliers.

“We came to realize which companies were able to have quality applications” with “data that would support the claims,” he explained to Global News.

Since Global News’ report was published, Health Canada has argued that the National Microbiology Laboratory’s evaluation of BTNX’s kit supported BTNX’s stated sensitivity.

View image in full screen

A passer-by walked past a COVID-19 testing clinic in Montreal, Friday, Oct. 16, 2020. 

THE CANADIAN PRESS/Ryan Remiorz

Global News obtained the NML’s results and the lab report, which called the device a “less-sensitive” test. The technicians attributed its lower outcomes to storage issues.

Unknown to Health Canada, researchers for the German, Spanish and British governments were separately reaching the same conclusion in the fall of 2020 and winter of 2021. (To learn more, you can read our Dec. 21 story online.)

Researchers Global News asked to review the data said the contrast between the governments’ results and the outcomes BTNX reported to Health Canada were eye-catching.

Dr. Larissa Matukas, head of the microbiology division at Unity Health Toronto, St. Michael’s Hospital, explained, “You’re not going to score 100 per cent […] all the time for every single patient.”

The ministry approved BTNX’s and Assure Tech’s applications on Feb. 19, 2021.

Over the next year and a half, the federal government bought 404 million test kits from BTNX for an estimated $2 billion. Global News’ reporting indicates that this was the biggest order any government placed with any supplier of Assure Tech’s device worldwide.

Bell: Top Alberta doc to Danielle Smith — 'We don't need more chaos'

Opinion by Rick Bell • 

Health Minister Adriana LaGrange, Dr. Paul Parks and Premier Danielle Smith provided an update on the status of ongoing joint work to stabilize primary health care in Alberta at the McDougall Centre in Calgary on Thursday, December 21, 2023.© Provided by Calgary Sun

Dr. Paul Parks, the Alberta Medical Association president, is in the trenches this day in the emergency room in Medicine Hat and he’s busy.

When he finally has a minute your scribbler wants to know what he has to say about Premier Danielle Smith’s latest comments on the state of health care in Alberta.

Over the holidays, eyeballs sizzled over Smith’s words, no matter the political stripe of the reader.

The premier was not holding back. She saw layers and layers and layers of middle managers at Alberta Health Services and saw a problem.

She saw some managers not solving the problems in the delivery of health care.

She saw people wanting more dough for more than a decade to improve care, getting the cash and then care decreasing.

She said her health minister, Adriana LaGrange, will tour the province’s hospitals, go to the front lines and listen to the workers, find the problems and fire the managers who haven’t been solving those problems.

Smith is not afraid to use the word “fire.”

The premier said she’d seen page after page of managers, 40 pages in Edmonton zone alone.

AHS managers who hadn’t seen the eyeballs of patients in a number of years will have to “pick up their game” and “demonstrate their value.”

For Smith there were bosses and bureaucrats preventing front-line workers from helping people, leaving those workers to deal with a worsening situation.

Smith went on to say she gave managers a year to make some progress and they started moving in that direction but then after the election last year they started back-sliding.

Dr. Parks agrees it is critical to do things differently.

He says if you polled docs about whether they thought something major had to change in AHS operations, 70% or 80% would fully agree.

But Parks adds some of the reason the system “is still going, even though we’re on the brink of collapse, is because we have some amazing people in AHS really keeping the ship afloat in an unbelievably difficult situation.”

“The system is really, truly being stressed. It’s so fragile,” says Parks.

Bell: Danielle Smith to Alberta Health Services managers — shape up or ship out

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Alberta Medical Association hopeful AHS overhaul is better for doctors and patients

Alberta breaking up AHS, creating new agencies in health care overhaul

What he hears is the idea of “looking for heads to roll” leads to no managers wanting to “be creative and stick their neck out or pop their head up enough so they’re a target.”

This “paralyzes a lot of key decision makers.”

So, on the one hand, Parks agrees something needs to be shaken up.

“But on the other side, now in a climate where you have the premier saying heads are going to roll do you think there are going to be many in management jumping up and down and making themselves targets even if they have really good ideas?”

Parks says many in the system have frustrations but …

“You can’t just go in and chop off a whole bunch of heads without a real, solid concrete plan as to what you’re going to do to replace them or enable new leaders to fill the void.

“If you’re going to go in and shake up the system then have a plan to replace it when the dust settles.

“We don’t need more chaos.”

Decisions can’t be made and announced with the details left hanging in uncertainty.


Dr. Paul Parks at the McDougall Centre in Calgary on Thursday, December 21, 2023.

Parks urges a sit-down with himself and the new AHS boss and the highest level of the government’s health ministry, among others, to hammer out “an evidence-based and expert-informed plan” to make big changes.

The Alberta Medical Association president wants to make sure two things are crystal clear.

“There are some really good managers who are very constrained by the way Alberta Health Services operates and the way the system currently exists,” says Parks.

“Breaking that logjam and freeing them up to really make local decisions and be creative and really think differently is exactly the goal we share and we want.”

But … there is a but when it comes to finding the good people.

“But coming in with a guillotine and heads will roll is going to make it hard to identify who those people are,” says Parks.

We will see where this goes.

Remember the premier won the leadership of the UCP vowing to fight the Liberal government in Ottawa while, with equal passion, slamming those running the health-care system during the COVID pandemic.

When Smith was asked if what she’s talking about would end up being a big deal her answer is one word.

“Exactly.”

rbell@postmedia.com

Alberta emergency doctors sometimes work for free, medical association says


© Provided by The Canadian Press

EDMONTON — The new president of emergency medicine for the Alberta Medical Association says ER physicians already coping with long hours, staff shortages and jammed waiting rooms are also being obligated, in some cases, to work for free.

Dr. Warren Thirsk says Premier Danielle Smith’s government has yet to follow through on a promise to reimburse emergency room doctors for so-called "good faith" payments.

"There's been lots of excuses, but the bottom line is no one has actually received a penny for those suspended good-faith payments," Thirsk said in an interview.

"On average, every emergency physician in this province is out thousands of dollars for free work."

Good-faith payments reimburse ER doctors when they see patients who don’t have identification and can’t prove an Alberta Health Care Insurance Plan billing number.

Thirsk said the United Conservative government stopped those payments when it ripped up the master agreement with the AMA in early 2020. He said it promised to bring back those payments when the two sides agreed to a new deal in September 2022.

But to date that hasn’t happened, he said.

"I'm legally and morally bound to look after you (if) you’re unidentified (as a patient)," said Thirsk, an emergency room doctor at Edmonton’s Royal Alexandra Hospital.


"(And) I’m going to look after you because it’s the right thing to do no matter what the problem is."

He said ER doctors are paid per patient, and the amount also depends on the diagnosis.

"When the contract was signed (in 2022), one of the conditions was they were going to fix the good faith (payments) right away," said Thirsk.

“And then they found red tape.

“Even now we haven't been paid for good-faith billings.”

Andrea Smith, spokesperson for Health Minister Adriana LaGrange, said the province remains committed to reinstating the good-faith payments.

"Alberta Health has been working on system updates to allow for retroactive payments and this policy is expected to be implemented in the near future," said Smith in a statement.

Provincewide delivery of medical care is handled through Alberta Health Services, with an annual budget close to $17 billion.

AHS, in a memo to staff made public this week, said it is forecasting a budget deficit and is seeking 10 per cent cuts to overtime and outside service delivery to help balance the bottom line.

Alberta, like other jurisdictions, is facing long waits for care and overcrowding in emergency wards.

Thirsk, an emergency room doctor for 25 years, said the problems are founded in a system that views health workers as costs rather than investments.

He said emergency doctors are routinely asked to cover off vacancies and shortages in other jurisdictions, particularly at the hospital in Red Deer.

"It's become a regular thing. We probably get once a month an AHS email asking us to cover a shortfall in Medicine Hat, in Lethbridge, in different cities," he said.

"I think that all the emergency departments across the province are stressed out and are just overcapacity. And I think that that's unfortunately the new situation normal.

"There's probably very few emergency physicians who haven't seen a patient seriously harmed or even die from the gaps in the system, and it's frustrated all of us. There's nowhere to take this."

Asked about the general sentiment he hears from ER colleagues, Thirsk replied: “They want out. Everyone wants out. People are desperate to get out. (They ask) 'How can I get out? What else can I do? This isn't fun anymore.' Those are the quotes I hear right now.”

He said he has little faith a massive restructuring of Alberta Health Services will solve the problem.

This year, Smith’s government aims to dismantle Alberta Health Services to create four agencies linked to specific areas of care — such as acute care and primary care — all answering to LaGrange and cabinet.

Thirsk said the province is creating silos in what needs to be an interdependent system linked to patients rather than specialties.


“As a front-line worker who has no resources to look after the patients in front of me and is apologizing for that every day, I find it incredibly frustrating that we will drop $80 million into an administrative reshuffle,” he said.

“Giving four silos just means you’ve got four different ways to say, 'It’s their problem, not mine.'

“We're on the Titanic, and we're rearranging the proverbial deck chairs.”

This report by The Canadian Press was first published Jan. 11, 2024

Dean Bennett, The Canadian Press

Health reform a 2024 priority for Alberta premier

Premier Danielle Smith says she is set to make major changes to Alberta's health system in 2024. In a year-end interview, Smith says she is going to reform the structure of the health system while at the same time trying to keep and find more family doctors. (Dec. 30, 2023) 

IMMUNIZATION IN AN ANTI-VAX PROVINCE

Alberta's immunization campaign raising questions | Watch (msn.com)

Critics of the Alberta government say new documents show the province interfered with this fall’s vaccination campaign. Papers obtained by the Global and Mail say the province told health officials not to mention COVID or influenza, and later a provincial news release removed references to vaccine efficacy and an encouragement to get vaccinated. Now some doctors say the approach has hurt Albertans as hospitals have filled up with sick people. Sarah Komadina has more. 

Opposition calls for Alberta to dump imported fever medicine amid health concerns

The Canadian Press

EDMONTON — Alberta’s Opposition says it’s time to dump once and for all the remaining bottles of imported Turkish children’s fever medicine, given new reports state the liquid clogs hospital feeding tubes and can put newborns at risk of severe illness.

NDP health critic Luanne Metz says Premier Danielle Smith’s government should check with health specialists to see if the medicine can safely be put to use somewhere else in the world but says regardless it's time to end the experiment in Alberta.

“We really should not be using this in our emergency departments,” Metz, who is also a physician, said Wednesday in an interview.

“It's certainly not preferred for a parent, who would get rid of it for sure, and we definitely should not be using it in (feeding) tubes.

“So where might there be a place that this would be a preferred treatment? I can't see it.

“We probably should get rid of it.”

Metz made the comments in light of a Globe and Mail newspaper report published earlier Wednesday.

The story, citing internal government documents, illuminated concerns the imported Turkish acetaminophen, with its higher viscosity, risked clogging feeding tubes for fragile patients.

Also, with its comparatively lower dosage and higher volumes, it put newborns at risk for necrotizing enterocolitis, which can cause damage to their intestines.

Alberta Health Services, in a statement Wednesday, confirmed the acetaminophen, known under the brand name Parol, was banned in neonatal intensive care units last spring and was used for only two months in total before hospitals reverted to the regularly used medicines.

Related video: Alberta's immunization campaign raising questions (Global News)

Duration 2:15   View on Watch

“No patients, including infants requiring neonatal intensive care, were injured or fell ill as a result of its use,” said AHS in the unsigned statement.

The medicine was part of a deal Alberta signed with Istanbul-based Atabay Pharmaceuticals for five million bottles of Parol and the ibuprofen known as Pedifen.

Smith herself announced the purchase at a news conference in late 2022, promising to alleviate a domestic shortage of children’s fever medication.

The purchase was immediately beset by delays as the province sought regulatory approval from Health Canada and sorted out packaging and warning labels.

By the time most of the first shipment of 1.5 million bottles had arrived in the spring of 2023, the domestic fever medication shortage was over.

The rest of the shipment never arrived.

Of those 1.5 million bottles, only about 9,000 were sent to hospitals and 4,700 to pharmacies in what critics have labelled a $75-million boondoggle, with taxpayers out tens of millions.

As soon as the medicine arrived, there were concerns that the comparatively lower dosage concentration of the Turkish medicine increased the risk of dosage errors. Pharmacists had to keep the medicine behind the counter to make sure customers who bought it were aware of the dosage change.

By the summer of 2023, AHS had already advised staff to switch back to the pre-existing medicines. However, last fall Health Minister Adriana LaGrange said Parol and Pedifen were not on the scrap heap, but would be kept in reserve for future emergencies.

LaGrange, asked Wednesday in an email if the Turkish medication could still be used in an emergency, declined to answer.

Instead she directed questions to Alberta Health Services.

AHS, in its statement, also declined to confirm the future of the two medicines while referring to them in the past tense.

“The additional supply of children’s pain medication provided assurance, long-term, for our stock of acetaminophen in AHS facilities at a time of a global shortage and high demand,” it said.

The clock is already ticking on the remaining supply. The Pedifen is set to expire in November 2025 and the Parol two months after that.

LaGrange, in her statement, reiterated past comments that the province bought the medicine with the best of intentions.

“We acted out of compassion and concern at a time when you could not find children’s medication on the shelves,” LaGrange wrote.

This report by The Canadian Press was first published Jan. 10, 2024.

Dean Bennett, The Canadian Press

‘Waiting 20 hours’: Overwhelmed ERs causing patients to suffer, CMA says

Story by Katie Dangerfield • 

Paramedics transfer patients to the emergency room triage but have no choice but to leave them in the hallway due to an at capacity emergency room at the Humber River Hospital during the COVID-19 pandemic in Toronto.

© THE CANADIAN PRESS/Nathan Denette

Global News
‘The waiting room was packed’: Canada’s ERs overflow as wait times surge
Duration 2:00   View on Watch

Patients in some parts of the country are waiting more than 20 hours to receive emergency room care and the Canadian Medical Association (CMA) is warning that unless major systemic changes are made, the problem will keep unfolding.

In a statement released Thursday, the CMA warned that Canadian emergency rooms are experiencing overflow due to a combination of staffing shortages, overcrowding and inadequate access to team-based primary care. This situation, it said, is leaving hospital emergency departments inadequately equipped to handle the surge of patients with influenza, COVID-19, or respiratory syncytial virus (RSV) during this time of the year.

"As a physician practicing in Canada, I'm deeply concerned about the crisis we're seeing in our emergency departments," Kathleen Ross, president of the CMA told Global News. "Long wait times, increasing surges in respiratory illnesses, staffing shortages across the country are really making it hard for Canadians to access urgent care when they need it."

Global News

Kids’ emergency rooms are crunched in Canada, here’s what parents should know

Duration 2:01   View on Watch

Emphasizing that emergency rooms should not serve as replacements for walk-in clinics or family doctors, the CMA highlighted the pressing need for solutions due to Canada's ongoing primary care crisis.

A CMA survey released in August found that one in five Canadians said they don’t have a family doctor. As a result, many of these people have had to resort to seeking care in emergency rooms, exacerbating the issue of overcrowding.

And now that it's the heart of cold and flu season, Ross warns that crowded emergency rooms will only intensify.

"There has been a rise in the crisis in our emergency departments over the last several weeks, with our holiday season and the rise in incidents of respiratory illnesses," she said. "We have to take into account that physicians and nurses working in these departments are also susceptible to illnesses, and we are facing increased staffing shortages."

On Wednesday, British Columbia's health minister, Adrian Dix, said 10,435 patients — a record number — were in hospital Tuesday night, many of them with a respiratory illness.

Emergency rooms elsewhere in the country were also over capacity as rates of influenza and respiratory syncytial virus, or RSV, which can be serious for infants and older adults, have climbed steadily.

In Quebec, emergency rooms were at 137 per cent capacity on average, with Health Minister Christian Dubé saying about 1,900 people a day were visiting ERs, double the number compared to last year.

Video: Crisis in Quebec hospital ERs not expected to improve anytime soon

Dubé said almost half of the daily emergency room visits are for non-urgent ailments that could be treated at a primary care clinic or doctor's office but that it may be tough to get an appointment.

‘No way’ Canada will allow U.S. to endanger domestic drug supply: Holland

"During respiratory illness season, (we) see surges in crisis in our emergency departments with more patients than we can treat at any given time," Ross explained. "However, this crisis across Canada, with sustained pressures, sustained challenges with staffing and increased numbers of respiratory illnesses... is also contributing to a situation that is clearly unsustainable and quite frankly, dangerous."

She said not only have patients had to wait more than 20 hours, but also some Canadians have died waiting to be seen in emergency rooms.

In its Thursday statement, the CMA said it believes it is well past time to transform and rebuild Canada's health-care system, including investing in team-based primary care.

Team-based primary care involves a group of health-care professionals, such as doctors, nurses, pharmacists and social workers, who collaborate closely to provide comprehensive and patient-centered care.

The CMA said it believes this approach to healthcare will help offset crowded emergency rooms, as these care teams will be able to see more patients and provide optimal care.

Another critical change required, Ross said, is for all provinces to sign on to the bilateral health-care funding agreements.

Global News

Federal government signs agreement to commit $355 million to Nova Scotia’s health-care system  Duration 2:15    View on Watch

In February 2023, Ottawa announced a health funding deal worth $196.1 billion over 10 years to the provinces and territories, including $46.2 billion in new money. So far, only a few provinces have signed onto the deal, including B.C., Alberta, Prince Edward Island and Nova Scotia.

"It is critically important at this time that governments across the country work together and sign on to the bilateral agreements that we heard about over the last year. Get additional dollars on the table," Ross expressed. "I would like to see every bilateral agreement between provinces and territories in Canada signed by the end of January. So the dollars that we need to improve our health-care system get out the door."

-- With files from Global News' Katherine Ward and the Canadian Press

Canada finance minister, Honda met on potential EV project


FILE PHOTO: An employee works on the Honda CR-V vehicle on the assembly line at the production facilities of Honda Canada Manufacturing in Alliston, Ontario, Canada March 16, 2022. 

Cole Burston/File Photo© Thomson Reuters

By Ismail Shakil and Steve Scherer

OTTAWA (Reuters) -Canada's Finance Minister Chrystia Freeland said on Thursday she met with Honda Motor representatives about locating a potential almost 2-trillion-yen ($13.7 billion) electric vehicle plant in the country.

"I had a meeting with Honda and it's a company that has been a very important investor in Canada," Freeland told reporters in Toronto, adding that other government officials also had meetings with the Japanese automaker.

"That's a very important relationship, and our work with them is ongoing," Freeland said, without specifying when the meetings took place.

Freeland added that there had been various meetings between Honda and government officials in different departments.

On Sunday, Japan's Nikkei news group reported that Honda is looking at multiple potential sites for the plant, including next to an existing automobile factory in Alliston, Ontario.

The report said Honda expects to make a decision by the end of 2024 and bring the new facility online as early as 2028.

Canada has wooed companies involved in all levels of the EV supply chain to safeguard the future of its manufacturing heartland in Ontario as the world seeks to cut carbon emissions.

Prime Minister Justin Trudeau last year said that Canada was looking for more "targeted" investments after the government gave hefty subsidies to Volkswagen and Stellantis-LG Energy Solution for their planned battery gigafactories.

Honda, Japan's second-biggest car maker, announced on Tuesday plans to launch a new electric vehicle series from 2026, as it plays catch-up with global rivals in the shift to battery-powered cars.

Honda has been slow to step up sales of electric vehicles. The automaker, with partner LG Energy Solution, in 2022 announced Ohio as the site of a planned $4.4 billion joint venture battery plant.

(Reporting by Ismail Shakil, Promit Mukherjee and Steve Scherer in Ottawa; Editing by Chris Reese and Nick Zieminski)

World added 50% more renewable energy but more needed: IEA

Story by AFP  • 

A field of solar panels in China, which the IEA dubs 'the world's renewables powerhouse'

The world added 50 percent more renewable energy capacity in 2023 over the previous year but more is needed in the battle against climate change, the International Energy Agency said Thursday.

The increase was the fastest growth rate in the past two decades and the 22nd year in a row that renewable capacity additions set a new record, the Paris-based IEA said.

The rise was driven by China, the planet's biggest emitter of greenhouse gases but also what the IEA called "the world's renewables powerhouse".

Massively scaling up the deployment of solar and wind power while winding down the use of fossil fuels is crucial to achieving the goal of limiting global warming to 1.5 degrees Celsius from pre-industrial levels.



Renewable energy: development accelerating but still insufficient© Anibal MAIZ CACERES

But the world is not on pace to reach the goal of tripling renewable capacity by 2030, a target agreed by nearly 200 nations at the UN's COP28 climate summit in Dubai last month, the IEA said.

The COP28 agreement also called for "transitioning away" from fossil fuels, but without setting a timeline and short of a "phase-out" demanded by many nations but opposed by oil giant Saudi Arabia.

Global renewable capacity is expected to increase 2.5 times from 2022 levels by the end of the decade, the agency's annual report on the sector found.

"It's not enough yet to reach the COP28 goal of tripling renewables, but we're moving closer –- and governments have the tools needed to close the gap," IEA Executive Director Fatih Birol said.

Birol said onshore wind and solar panels were less expensive now than fossil fuel plants in most countries.

"The most important challenge for the international community is rapidly scaling up financing and deployment of renewables in most emerging and developing economies," he said.

"Success in meeting the tripling goal will hinge on this," Birol added.

- All-time highs -

The agency, which advises developed countries on energy policy, said renewable capacity reached almost 510 gigawatts last year, with solar photovoltaics (PV) accounting for three-quarters of additions worldwide.

China commissioned as much solar PV last year as the entire world did in 2022, while the country's wind power additions rose by 66 percent year-on-year.

Increases in Europe, the United States and Brazil "also hit all-time highs", the energy watchdog said.

Prices for solar PV devices fell by 50 percent in 2023 compared to the previous year.

The IEA said costs are expected to fall further as global manufacturing capacity is forecast to significantly exceed demand by the end of 2024.

The wind industry, however, is facing "a more challenging environment due to a combination of ongoing supply chain disruption, higher costs and long permitting timelines", the report said.

- 'Not fast enough' -

Dave Jones, global insights programme director at the Ember think tank, said the sector's 2023 growth "makes it clear that a tripling of renewables is entirely achievable".


"We are increasingly on track not only for a peaking of fossil fuel use this decade, but for sizable falls in fossil fuel use," Jones said.

"2024 will be the year that renewables changed from a nuisance for the fossil fuel industry, to an existential threat," he added.

Dean Cooper, global energy lead at conservation group WWF, said renewable energy generation was increasing "fast but not fast enough".

"We will not avert climate catastrophe while fossil fuels continue to be burned," he said.

"Those who want to see a liveable planet should increase pressure on their government to convert words into action by demanding they urgently transform their energy systems," he said.

cho/lth/js

ALBERTA

First Nations, Métis settlements join forces for deal backed by Indigenous Opportunities Corporation

PETRO POLITRICKS

The Alberta Indigenous Opportunities Corporation (AIOC) has expanded its reach into northern Alberta with oil and gas infrastructure assets.

The newly-formed Wapiscanis Waseskwan Nipiy (WWN) Limited Partnership comprises nine First Nations and three Métis settlements that are participating for the first time in a transaction backed by AIOC.

The $150 million loan guarantee, which is AIOC’s second largest commitment in its seven deals to date, was announced Dec. 13. It will allow WWN to acquire an 85 per cent non-operated working interest in Clearwater Infrastructure Limited Partnership for a purchase price of $146.2 million.

Clearwater is a partnership between WWN and Tamarack Valley Energy Ltd. Tamarack owns an interest in midstream assets, such as strategic oil batteries, gas process facilities and key in-field pipelines located in Nipisi, West Marten Hills, Marten Hills and Perryvale in Alberta.

According to law firm MLT Aitkens, which is representing WWN, this is the first time an AIOC transaction has been with an exploration and production company and the first time an AIOC transaction has been involved in the acquisition of a majority interest in infrastructure assets.

Tamarack says it will transfer $172 million of “certain Clearwater midstream assets” to the Clearwater partnership. Under the terms of the agreements, Tamarack has made a 16-year take-or-pay (TOP) commitment for average volumes of 29,000 barrels of oil per day.  TOP is a provision in a purchase contract that guarantees the seller a minimum portion of the agreed-on payment if the buyer does not follow through with buying the full amount.

The nine First Nations to form the partnership are Driftpile Cree, Peerless Trout, Kapawe’no, Sawridge, Sucker Creek, Swan River, Whitefish Lake 459, Loon River and Duncan’s, along with the Métis settlements of East Prairie, Peavine and Gift Lake.

Sucker Creek and Duncan’s First Nations were also included in a second AIOC deal announced in December. They joined with Sturgeon Lake and Horse Lake First Nations and Aseniwuch Winewak Nation of Canada to form the Niyanin Nations LP.

Niyanin Nations received a loan guarantee of about $20.5 million to partner as investors with NuVista Energy Ltd. in a 15-megawatt cogeneration unit at the Wembley Gas Plant in the County of Grande Prairie. The Niyanin and NuVista partnership will own a majority interest in the cogeneration project, which will generate electricity and useable heat.

Chana Martineau, CEO for AIOC, would not disclose the projected revenues for either deal, saying only that the “revenue needs to be meaningful for the communities.”

She also would not disclose whether the two new partnerships had the Indigenous nations sharing equally in the revenue.

With AIOC providing more than $680 million in loan guarantees directly impacting 42 Indigenous groups, Martineau says projected revenues for total projects are “north of $30 million” annually. However, she cautioned that there were a number of factors that go into projections.

“I’m thrilled for these new nations to join the AIOC family of supported communities. These ones (were) very special to me, especially after the wildfires in the spring in this region. To be able to support two deals in this sector is very, very important,” said Martineau.

Many of the communities that are part of the two deals declared local states of emergency during the spring wildfires and were impacted by evacuations, loss of homes and structures, and electricity.

That AIOC announced two loan guarantee deals within days of each other in December was coincidental, says Martineau, as negotiations can take anywhere from six months to a full year.

“We’ve got more deals in the funnel,” she added, but wouldn’t disclose how many deals or in what sectors. “These are similar to mergers and acquisitions type transactions (and) sometimes they fall apart at the last minute.”

Martineau, who joined the board in November 2021 before becoming CEO in July 2022, wouldn’t say how many potential deals have fallen apart, only that AIOC has been “pretty fortunate” to have committed partners on both sides of the table.

What helps the process, she adds, is that AIOC is involved from the beginning and able to “give our views about the credit worthiness of the transaction.”

As for money Indigenous nations may have lost on deals that didn’t come to fruition, Martineau notes that AIOC provides capacity grants for things like legal support, due diligence work and tax structuring so Indigenous nations can participate without a lot of upfront cash.

In 2023, three deals were closed. That’s the most in a single year since the AIOC was formed in 2019 to support Indigenous participation in natural resource projects. The Crown corporation was an election promise made by former United Conservative Party premier Jason Kenney.

Martineau says it took time to set up the AIOC infrastructure, including developing policies, procedures, and finance functions.

In February 2022, AIOC’s mandate was expanded to include projects and related infrastructure in the agricultural, transportation and telecommunications sectors. However, none of the projects supported to date include those new sectors.

Martineau says she is asking partners to be patient.

“When you're looking at investing in new sectors, you need to learn the sectors. You need to understand the corporate partners, you need to understand what the opportunities are, what the risks are… because (with) each deal, we're breaking new ground here. These are new types of partnerships,” she said.

“We need to look at and see ‘how do we do this in a way that works for all three parties—the corporate partner, the Indigenous partners and the government of Alberta loan guarantee’. It takes some, I'll call it corporate creativity, to come to the table in a way that makes sense for all three parties. It's not a cookie cutter approach.”

But more than time is needed, says Martineau. Personnel is also required, especially as AIOC’s loan guarantee capacity of $1 billion was doubled earlier this year and will rise to $3 billion as of 2024-2025.

“We've asked the government for some more resources. We don't know if that'll get approved,” said Martineau, noting that the 15 full-time employees AIOC currently has “will be just fully deployed coming up here in the next two months.”

The government’s new fiscal year with a new budget begins April 1.

Presently AIOC has a posting for a director of talent management, who will work on recruitment strategies. As well, experts have been contracted for short-term service.

“We can contract experts to help us, but we have a very small budget where we are very mindful of taxpayer dollars and so we try to do this as efficiently as we can. We've been measured in our growth,” said Martineau.

Martineau anticipates green energy development will come onto AIOC’s radar once the province lifts the moratorium imposed last August on approvals of projects in the sector. The Alberta Utilities Commission is expected to make recommendations in March on how to move forward.

Once more Martineau wouldn’t say if there are any existing applications for renewable energy projects on the books.

“We are looking to broaden our impact in in all ways, so different types of industries even and different types of energy projects… We have a lot of latitude.... We have sectors, but we have a broad reach across those sectors and so we'd like to help expand our scope. We are building out our team and our capacity in order to do that,” she said.

“We're supporting the industries that Indigenous communities are looking to invest in to the best that we can.”

Windspeaker.com

By Shari Narine, Local Journalism Initiative Reporter, Windspeaker.com, Windspeaker.com

Panama Canal drought forces Maersk to start using 'land bridge' for Oceania cargo


In an advisory to clients, Maersk informed shipping customers that vessels that use the Panama Canal will no longer be traversing the canal with freight from Oceania (Australia and New Zealand) because of the ongoing water situation.

The latest water level issues for the canal come as it is expected to receive additional vessel traffic as ocean carriers avoid the Red Sea due to the ongoing Houthi attack risk.

Forty percent of all U.S. container traffic travels through the Panama Canal every year, which in all, moves roughly $270 billion in cargo annually.


View of stranded boats at Alhajuela Lake during the summer drought, in Colon province, 50 km north of Panama City, Panama, on April 21, 2023. The Alhajuela lake is one of the main lakes that supplies water to the locks of the Panama Canal and is at its lowest level of recent years.© Provided by CNBC

The Panama Canal drought conditions have led shipping giant Maersk to inform clients this week that vessels with freight from Oceania (Australia and New Zealand) will no longer traverse the canal because of the ongoing low water levels. Maersk will be servicing the client's containers by using a "land bridge."

Instead of going through the Panama Canal, the vessels would call the Ports of Balboa, Panama, on the Pacific side — dropping off cargo heading for Latin America and North America and picking up cargo heading for Australia and New Zealand. The Port of Manzanillo, Panama, on the Atlantic side, will be used for dropping off cargo heading for Australia and New Zealand and picking up cargo heading for Latin and North America. Once at the port, containers would be loaded or unloaded and would then move via an existing rail over a distance of 80 kilometers across Panama to be picked up by another vessel. The change in service covers two transits per week, according to Maersk.

A severe drought has led to water depth and weight restrictions on ships passing through the Panama Canal, and additional container surcharges imposed by ocean carriers on shippers for months.

"Based on current and projected water levels in Gatun Lake, the Panama Canal Authority (ACP) has needed to make reductions to the amount and weight of vessels that can pass through the canal. Whilst we continue to work closely with the ACP, moderating and aligning our operations to fit the changes, we have made changes to services to ensure that our customers are impacted as minimally as possible," Maersk's client advisory stated.

Maersk emphasized there would be no delays for Northbound cargo stopping in Philadelphia and Charleston. Companies like McDonald's import their Wagyu Beef from Australia and use this route to import their beef into the East Coast.

For the Southbound vessels, Maersk cautioned customers may experience some delays.

The company is also eliminating the shipping route to Cartagena, Columbia.

The Panama Canal Authority has increased the number of transit slots to 24 daily this month after first announcing a reduction of vessel transits to 18 in February. But this is far below the daily transits of 36.

The Panama Canal is popular for East Coast trade because it is faster than other options. The shipping time for ocean cargo from Shenzhen, China, to Miami, Florida, using the Suez Canal takes 41 days. Traveling through the Panama Canal takes only 35 days. The latest water level issues for the canal come as it is expected to receive additional vessel traffic as ocean carriers avoid the Red Sea due to the ongoing Houthi attack risk, with Maersk among shippers that recently had to halt Red Sea traffic.

Forty percent of all U.S. container traffic travels through the Panama Canal every year, which in all, moves roughly $270 billion in cargo annually.

Late December to April is traditionally Panama's dry season.

According to the PCA, it takes around 50 million gallons of fresh water to move a vessel through one of the locks. The Panamax locks lose more water compared to the Neo-Panamax lock. The Neo-Panamax locks have a water recovery system which can reclaim 60% of the water used during a vessel's transit through the locks. The Panamax lanes do not have the water-recapturing ability of the Neo-Panamax locks.

Maersk stressed that as a whole it is not bypassing the Panama Canal, but its decision related to the Oceania freight will impact the declining cargo volume passing through the Panama Canal. In 2023, it was reported 510 million tons of cargo traversed the canal, which was eight million tons less than 2022. Even with the decrease in volumes, the Canal Authority reported record revenue from October 2022 to September 20, 2023. Surcharges and other charges added to cross the canal fueled the revenue increase. From October 1, 2022- September 30, 2023, the PCA received $3.3 billion. That was $319 million higher than a year earlier.

The Panama Canal Authority said its multimodal transportation system is a way that maritime customers, such as Maersk, and the PCA itself can cope with the impacts of climate variability worldwide and the current water shortage at the canal. "We will continue to support Maersk's operations. ... We are focused on delivering both short- and long-term solutions for our customers, for when climate anomalies affect our operations," it said in a statement to CNBC.


CNBC VIDEO
What the Panama Canal is doing to fight a severe drought challenge