Proceedings - Science Advisory Board (SAB)

This content was archived on June 24, 2013.

Hampton Inn, Ottawa, Ontario
November 2-3, 2010

Table of Contents

Day 1

• Preliminary Matters
• Remarks from Karen Dodds, the Assistant Deputy Minister of Strategic Policy Branch, Health Canada
• Opening remarks from Frank Plummer, Chief Scientific Advisor - Public Health Agency of Canada
• One World, One Health - Rainer Engelhardt, Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada
• Terms of Reference, Renaldo Battista, Chair
• Blood safety: Risk management for a Potential new Viral threat- Xenotrophic Murine Leukemia Virus Related Virus (XMRV), Peter Ganz Director, Biologics and Genetic Therapies, Health Products and Food Branch, Health Canada
• Session D at the Health Canada Science Forum - Portfolio Science Priorities - Health Canada, Public Health Agency of Canada and the Canadian Institutes of Health Research

Day 2

• Multiple Sclerosis Research - Alain Beaudet, President, Canadian Institutes of Health Research
• Personalized Medicine - Hans Yu, Director, Bioethics, Innovation and Policy Integration Division, Strategic Policy Branch
• Designing a Path Forward for Healthier Canadians - From Strategic Insights to Action - Leah Soroka, Director, Foresight and Science Promotion Division, Strategic Policy Branch
• The Use of Human Subjects in Pesticide Testing - Peter Chan, Director General and Cheryl Chaffey, Section Head, Health Evaluation Directorate, Pest Management Regulatory Agency
• Closing remarks - Karen Dodds
• Members' Comments and Adjournment

Participants

SAB Members

Present

• Renaldo Battista
• Lori Sheremeta
• John O'Neil 
• Claire Franklin
• Lorne Tyrrell
• Ahmed El-Sohemy
• Jack Gauldie
• Annalee Yassi
• Stephen Bornstein
• Renée Lyons
• Chris Loomis

Regrets

• Marie-Élise Parent
• Yola Moride
• Jacques Simard
• Susan Kennedy

Ex-Officio Members

Present - Health Canada

• Glenda Yeates, Deputy Minister
• Karen Dodds, ADM, SPB
• Richard Aucoin, Executive Director PMRA
• Catherine Macleod, AADM, HPFB
• Pierre Charest, DG, SPD

Public Health Agency of Canada

• Frank Plummer, Chief Scientific Advisor
• Rainer Engelhardt, ADM, IDPCB

 Canadian Institutes of Health Research

• Alain Beaudet, President, CIHR
• Janet Storch - Research Ethics Board Chair

Alternates

• David Clapin - HPFB
• Gregory Taylor - PHAC

Observers

• Frank Welsh - PHAC
• Lori Engler-Todd - SPB
• Louise Bouchard - SPB
• Annie Bronsard - SPB

Regrets - Health Canada

• Anne Marie Robinson, Associate DM
• Michel Dore, ADM, RAPB
• Anne Lamar, ADM, PACCB
• Kin Choi, ADM, CSB
• Germain Tremblay, ADM, CFOB
• Meena Ballantyne, ADM, HPFB
• Paul Glover, ADM, HECSB
• Michel Roy, ADM, FNIHB

Regrets - PHAC

• David Butler-Jones, Chief Public Health Officer
• Jane Billings, Senior ADM
• Kathryn Howard - ADM, EMCA

Invited Participants/Presenters

• Leah Soroka - SPB
• Peter Ganz - HPFB
• Elwyn Griffiths - HPFB
• Pierre Chartrand - CIHR
• Hans Yu - SPB
• Mark Raizenne - PHAC
• Jun Wu - PHAC
• Purni Narayanan - PHAC
• Erin Leonard - PHAC
• Vanessa Di Cenzo - SPB
• Siham Yasari - CIHR
• Tanya Ramolo - SPB
• Sarah Topham - SPB
• Ryan Sigouin - SPB
• Peter Monette - SPB
• Peter Chan - PMRA
• Cheryl Chaffey - PMRA
• Sarah Chaffey (Grade 9 Student)
• Morag Park - CIHR Scientific Director - Institute of Genomics

SAB Secretariat - SPD

• Laird Roe
• Jean Sharp
• Line Rathier

Key to Acronyms

HC

Health Canada

SPD

Science Policy Directorate

SPB

Science Policy Branch

CFOB

Chief Financial Officer Branch

HPFB

Health Products and Food Branch

PACCB

Public Affairs, Consultation and Communications Branch

PMRA

Pest Management Regulatory Agency

HECSB

Healthy Environments and Consumer Safety Branch

FNIHB

First Nations and Inuit Health Branch

PHAC

Public Health Agency of Canada

IDPCB

Infectious Disease Prevention and Control Branch

EMCA

Emergency Management and Corporate Affairs

CIHR

Canadian Institutes of Health Research

Day 1, November 2, 2010

1. Preliminary matters

Opening / welcoming remarks provided by Renaldo Battista and introductions of Board Members, ex officios, invited guests and the SAB Secretariat.

2. Remarks from Karen Dodds, the Assistant Deputy Minister of Strategic Policy Branch, Health Canada

Main points -

Karen Dodds welcomed all the members and expressed her pleasure at having Frank Plummer present to address the SAB.  She noted that this participation represents the Public Health Agency of Canada's (PHAC) commitment to more engagement with the SAB.  She recounted that recently the Deputy Minister, Glenda Yeates and the Chief Public Health Officer, David Butler-Jones sent out a very strong message on the importance of ensuring that the two organizations work together very closely and that there is clear communication of expectations on that matter.

As well she pointed out that the CIHR will be presenting an item to the SAB and that we are going to be working closely with CIHR in the future and that they will be attending future meetings on a more regular basis.

She briefed the SAB on what Health Canada is doing to fulfill our mandate and help make this country's population among the healthiest in the world.  Precisely, Health Canada is focussing on three priorities: Keeping Canadians healthy; Keeping Canadians safe; and Sustaining health programs and systems. 

Dr. Dodds went on to describe in detail, presentations that would be presented to the SAB in the next two days.

3. Opening remarks from Frank Plummer, Chief Scientific Advisor - Public Health Agency of Canada

Main Points -

Frank Plummer gave an update on activities at the Public Health Agency over the past five months. Most notably he spoke of the renewal of the SAB to officially include PHAC; dealing with H1N1; and a few science and policy changes. He reinforced Karen's comments on the fact that PHAC wants to work closely with Health Canada and the SAB and wants to hear from the SAB on how to facilitate that. He wants the SAB to know that the Chief Public Health Officer is looking forward to working with the Board in the future.

The three main challenges that the agency faced this past year were H1N1, assisting the RCMP with security during the Vancouver Olympics, and security during the G8/G20 meetings. There is a "lessons learned" document coming out from the Health Portfolio on H1H1 in the near future and it will be made available to the SAB at that point.  Although PHAC's handling of these situations went well, they know that they can learn from these events.

The Senate committee on Social Affairs has just completed a review of the Health Portfolio's response to H1N1.  As well PHAC was involved in the deployment of a new HPV vaccine; is continuing to work on initiatives such as tuberculosis, maternal and child health, HIV/aids, and obesity.

In the coming year, the major policy task will be to conduct a review of strategic planning around science and research in the Agency, with the target of June 2011 for the release.

Recent events:  
The government tabled the Chief Public Health Officer's annual report to Parliament which documents PHAC's work with the main focus on its work with seniors (the Secretariat will provide a link to this document).

Discussion -

Topics discussed included the severity of the H1N1 flu and communication tools used to inform the public; surveillance tools/networks; success of the interventions (i.e., vaccines, hygiene); the role that media (social and conventional) played; and research gaps on long and short term outcomes.

There was a fulsome discussion on issues surrounding the challenges faced by government departments on how scientific data, information and conclusions are disseminated to the public; the lack of credible science reporters; the decrease of scientific literacy in Canada; and how CIHR is starting to work to educate journalists on science reporting.  PHAC will be working with its federal, provincial and international partners on common communication messages. Speed is an issue and that can be problematic - getting consistent and credible messages out to the provincial bodies in a timely fashion.

A future SAB agenda item was proposed: Science communication / transparency / lack of scientific literacy in the media/press / with the Canadian public / health partners during a public health crisis.  

4. One World, One Health - Rainer Engelhardt, Assistant Deputy Minister, Infectious Disease Prevention and Control Branch, Public Health Agency of Canada

Main Points -

The presentation on One World, One Health (OWOH) provided an introduction to the concept, described some of the drivers that affect the emergence of infectious diseases, highlighted a few Canadian examples and detailed activities undertaken by the Public Health Agency of Canada.  The main objectives of the presentation were to inform the SAB of the OWOH concept and PHAC's activities as well as to stimulate discussion on how One Health can be applied in Canada. 

Discussion -

The OWOH concept takes the determinants of health approach and extends and integrates it further to deal with burdens of specific diseases, such as poor housing, low income and poor diet.  It was noted that this approach has changed PHAC, with many different disciplines or systems having been brought together into a new centre (food borne, environmental and zoonotic diseases) to drive this approach forward.

The discussion centred on pin pointing which communities (First Nations reserves, social housing areas, urban ecosystems, etc.) would most benefit from this approach. There is a lot of similar work being done at several universities (but not mentioned in the presentation). Most of the members applauded PHAC's participatory/community-based / community health approach.  The next few years will be a challenge as, although this approach has the potential to lower public health costs, it requires upfront resources, is not mainstream and has yet to be proven.  PHAC needs to balance funding for populations at risk and the overall concept of health equity for all Canadians and is looking to integrate chronic and infectious disease approaches. It will not replace activities; rather it will tie them together for greater value.

Summary/Advice  -

• The Board liked the One World, One Health concept but cautioned against using only this lens (animal borne diseases where we have moved past the animal to human transmission stage, i.e., HIV, H1N1) to look at health at the expense of other factors such as human to human infection, environmental, and the social determinants of health - perhaps more tangible/high profile emerging examples (chronic and infectious) would get more support. The Board encouraged PHAC to develop more specific political/economic examples of how the concept would be applied and encouraged them to build capacity through training and development of a long term perspective.
• The Board encouraged PHAC to develop links with, and take advantage of, a body of researchers working out of five universities across Canada and at the International Development Research Centre working on the "Ecosystem approach".  They stressed the importance of nurturing methodological research rigour, science and discovery-based research, long term resource/capacity commitment (at least ten years) - perhaps funding university-based researchers, and moving forward on supporting a trans-disciplinary approach and information system (working with Provincial and Territorial partners).
• OWOH could be an umbrella concept for chronic disease as well as infectious disease looking at "people at risk for multiple health issues".  As well, the presentation did not stress airborne disease although it was implied; it needs to be better illustrated.
• More attention needs to be paid to outlining the next steps involved in the implementation of this important approach.
• Health Canada and PHAC should work to be better equipped to deal with social health issues.

5. Terms of Reference, Renaldo Battista, Chair

Main Points -

The SAB Secretariat, as part of Health Canada's move to facilitate the running of external advisory boards, has integrated the SAB ToRs into the Health Canada template. The SAB members were asked to review the ToRs and provide comments. They have been given two weeks to submit comments after the meeting.

Discussion -

2.0 Mandate:

• second sentence, should read "The Department and Agency..."
• "recommend, for approval of the Minister" should read "recommend to the    Minister"

List of experience and expertise too focussed -needs to be more broad. Population health services and research - leading experts - tidy up lists, have at least three different examples.

Action   -

The SAB Secretariat will revise the ToRs accordingly and send them out to the members for concurrence.

6. Blood safety: Risk management for a Potential new Viral threat- Xenotrophic Murine Leukemia Virus Related Virus (XMRV), Peter Ganz Director, Biologics and Genetic Therapies, Health Products and Food Branch, Health Canada

Main Points -

An article published in the journal Science has shown that a gamma retrovirus, namely, Xenotrophic Murine Leukemia Virus Related Virus (XMRV) is found associated with individuals diagnosed with chronic fatigue syndrome (CFS). Given that this infectious virus has been associated with peripheral blood cells, there is concern that perhaps this virus could be transmitted by blood. Some other laboratories have not been able to confirm these findings and to date, there has not been definitive data published to show that XMRV is a causative agent for CFS. A number of measures have been recommended by Health Canada as a precautionary approach to protect Canadians and their blood system. These strategies were reviewed and the SAB was requested to provide further risk management approaches in the regulatory and broader health contexts.

Discussion -

The issue of whether there is one blood system or two in Canada was discussed. Canada has a national blood system and blood is regulated as a drug - Health Canada sets the minimum safety requirements - in some cases the blood agencies can implement stricter requirements. In this case, Canadian Blood Services (CBS) went ahead and took Health Canada's advice to implement a more active deferral position than Hema Quebec. This is a sensitive issue and needs to be dealt with carefully not to undermine public confidence in the blood supply.  Health Canada was seeking the SAB's advice on the proposed deferred approach for people with CFS. The Department has formulated a position but has not implemented it yet.

The Board questioned Dr. Ganz on specific issues regarding the research data used to formulate Health Canada's strategy to deal with this issue.  The Board was concerned with the large inconsistencies in the data results between the studies used to formulate the decision. This could have something to do with the difficulties in diagnosing CFS to begin with, however this has been recently standardized.

Summary/Advice -

• This presentation underlined the need for the SAB to receive better contextual information, before the meeting to allow them to better understand possible implications beyond science, and potential benefits and risks in order to frame their advice.
• The Board noted that this was a complex case of decision-making in the face of limited scientific knowledge and considerable scientific uncertainty and that the Department's approach seemed disciplined, reasonable, logical and ethical. The Board felt that moving in the direction of prudence is the path to take.  
• Although both blood agencies meet the national safety standards, the Board expressed concern that there exists a different stance from the two major donor blood services in Canada on this issue - they encouraged and supported the Department in its actions to deal with this issue in a timely fashion.
• Although Health Canada's position states that CSF patients be deferred, it was suggested that CSF patients not be deferred indefinitely (during this period of uncertainty and until the etiology of this disease is better established).  The SAB encouraged Health Canada to make every effort to collect evidence to determine whether this precautionary approach is necessary, since the risks have not been concretely established and stigmas against these patients may develop.

7. Session D at the Health Canada Science Forum - Portfolio Science Priorities - Health Canada, Public Health Agency of Canada and the Canadian Institutes of Health Research

Main Points -

SAB members attended the session at the Health Canada Science Forum on the Science Priorities of Health Canada; the Public Health Agency of Canada; and the Canadian Institutes of Health Research.  SAB members then engaged in a discussion of the various sets of priorities. CIHR funds university-based research and, in doing so, has some capacity to influence the directions of health-related research in Canada.  HC has a broad policy and regulatory mandate related to protecting and promoting the health and safety of Canadians, and PHAC has a mandate for public health. This provided an opportunity for the SAB to offer advice on the science priorities of these three key organizations at the same time and to consider the three as a set.

The science priorities of the three organizations are at different stages of development - CIHR released its strategic plan in 2010; HC and PHAC are in the process of finalizing their science priorities.  This is an excellent opportunity for HC and PHAC to get a "signals check" on their processes and to fine tune as necessary.
SAB members were encouraged to provide input on questions such as:

• Do the three sets of priorities, taken together, represent a coherent health research agenda for Canada?
• Are the priority sets complementary?
• Do you perceive gaps overall, or between the three agencies?
• Do you perceive gaps in the priorities of the individual organizations?   

Discussion -

After the Health Canada Science Forum presentations, the SAB discussed Portfolio Science Priorities with the three organizations. PHAC and HC have different mandates that drive their research, and it is not clear if there is a common meeting space for them to overlap.  Could they get together and interact, not during a crisis, rather in a purposeful way?  Currently there are no systematic mechanisms to cooperate on science issues at the operational level; there is a need to maximize the interactions.   PHAC and CIHR are relatively young organizations; it is only in recent years that their policy and business systems have matured enough to support innovative relationships with each other and Health Canada.  

It was noted that there seems to be a lack of long term commitment from the three organizations to tackle major health issues such as First Nations health, diabetes. It would be nice to have the agencies come together for the next 10 to 15 years, work on a top health issue and move it along, measure the success and really change the health outcomes.  CIHR noted that this would not be a bad idea, but it might focus resources to that one issue and make all the others wait, which could have a negative effect on new investigations. Access, safety (product safety and medical errors) and sustainability to health care are on the minds of Canadians. 

The SAB discussed the issue that all organizations (governmental, non-governmental, and academic) grapple with, which is the lack of qualified personnel to fill positions. It is not that there isn't the talent available in Canada; but filling certain positions in Health Canada is a challenge - not at the entrance level - more upper level experience is needed.  There is work being done to fill these needs through interchanges, science policy fellowships, and curriculum development at universities.

Summary/Advice  -

• Although the mandates of Health Canada, the PHAC and CIHR differ, the SAB is again encouraging the three organizations to work together and strengthen their relationships - on an informal basis, not necessarily, through formal committees.
• Where there is an overlap in their priorities, resources from all three could be used to support the different mandates and maximize common interests.  For example, CIHR could realign the apportionment of their open and targeted competitions towards science research priorities that relate to Health Canada and PHAC, given that CIHR has the most funding available of the three organizations. Although there is this cooperation happening (i.e., isotopes, food safety), efforts could be made to focus on funding in common research priority areas.  And, perhaps additional resources (money and researchers) from all three organizations could be earmarked on a yearly basis to fund specific targeted peer reviewed collaborative research projects/teams.  Don't wait for a crisis to arise to mobilize these collaborations.
• The SAB is encouraging CIHR to assist young researchers in establishing their research capacity and their careers, to ensure the maximum benefit for the money being spent.
• Health Canada, PHAC and CIHR need to communicate/collaborate on what types of research/ clinical capacity needs to be supported or developed for future regulatory decision-making needs and to deal with strategic patient orientated research.

Day 2, Tuesday, November 3, 2010

Recap from Day 1 -

Dr. Battista thanked the Board for their thoughtful and careful recommendations from yesterday and made a few points to improve the advice generated in future meetings.

• For clarity/contextual sake, the Chair and Vice-chair have a conference call with Karen Dodds and the SAB Secretariat at least a week before each meeting to discuss the agenda items and potential organizational, resource and political implications involved (it was noted that the SAB will make their recommendations based on science, not politics);
• One or more Board members with specific expertise on the subject will be tasked with reviewing, in greater detail, one agenda item before the meeting.
• Several Board members have shown their desire to be more involved in priority setting processes and we will pursue this.

8. Multiple Sclerosis Research - Alain Beaudet, President, Canadian Institutes of Health Research

Main Points -

The Board was provided with an overview of recent research activities on multiple sclerosis and the proposed treatment by the Italian physician, Dr. Zamboni.  There was then an opportunity to discuss CIHR's proposed course of action, its recommendations to the Minister and the rationale for requiring additional scientific evidence before pursuing with an interventional clinical trial.    

Discussion -

The Board was very interested to find out more about the circumstances surrounding the conclusions reached by the working group. Dr. Beaudet provided clinical descriptions of the operation and the risks involved with not only the procedure but the holding of clinical trials, i.e., "no surgical procedure is harmless".  Even before a clinical trial is undertaken, more evidence is needed.  There was also an acknowledgement of the intense public pressure through social media that the government has had to deal with.

Summary/Advice -

• The Board welcomed the opportunity to hear some of the scientific evidence behind this highly visible file and to hear the rationale for the federal government's decisions.  Faced with this evidence, the Board felt that CIHR and the Minister of Health reached the only scientifically reasonable decision in recommending against a clinical trial at this time, but supporting continued monitoring of both the science and the outcomes from other jurisdictions.

9. Personalized Medicine - Hans Yu, Director, Bioethics, Innovation and Policy Integration Division, Strategic Policy Branch

Main Points -

Personalized Medicine refers to the tailoring of medical interventions to individual characteristics of each patient. The Personalized Medicine Working Group (PMWG) was established in December 2009 to address the priority identified at the meeting of the Deputy Heads in February 2009, which recognized the need for a concerted Portfolio policy approach to Personalized Medicine. The following advice was asked of the SAB:

1. To seek strategic advice on future priorities for Health Portfolio work on this emerging health science issue.
2. To seek comments on issues and recent commentaries on Personalized Medicine.

Discussion -

The discussion brought up considerations such as the possible diversion of resources away from social and environmental factors - classifying populations on their genetic susceptibility to disease only. CIHR is working on other aspects of a business plan to address these issues, such as knowledge transfer to the health care providers and health services.

What is involved in the possibility of using this technology for prevention as well as treatment; nutritional interventions to deal with chronic illness and obesity?  There was also concern about the regulatory aspects of this new technology - does Health Canada have the capacity to deal with the drug approval process?

Summary/Advice -

• The Board noted that this was an important global trend, but that it should not replace the doctor's role in treating each person as an individual.  There was discussion of an appropriate term to describe the field - the Board did not feel that "personalized" was reflective of the real context and preferred some of the terminology used elsewhere - in particular "precision medicine" or "targeted medicine".  The Board further cautioned against too much dependence on the role of genomics in health, noting that genomics does not play the only role in disease expression and health outcomes.
• It was recommended that Health Canada get involved with the International Congress on Harmonization (ICH) earlier rather than later - this could help with the capacity issue and the harmonization of terminology internationally so as to avoid confusion where possible.

10. Designing a Path Forward for Healthier Canadians - From Strategic Insights to Action - Leah Soroka, Director, Foresight and Science Promotion Division, Strategic Policy Branch

Main Points -

The presentation provided information and an update on Health Canada's foresight agenda, activities and key findings to date.
The following was requested from SAB:

1. Provide input on Health Canada's foresight agenda
2. Provide insights / ideas on how the SAB sees S&T enabling the long-term health of Canadians
3. What are the SAB's thoughts on Health Canada's S&T foresight analysis, insights and key findings?
4. Are there other focal questions, S&T trends or health related areas that Health Canada should be considering?

Discussion -

The discussions expanded the SAB's insight into Health Canada's work on S&T foresight activities. The tools being considered to get information to Health Canada and PHAC will be a series of workshops and seminars.  Getting healthy in one generation is the aim, focusing on, for example, child and maternal health and vulnerable populations, life expectancy, investment in health and the digital world (data gathering).  This new way of analyzing existing data could improve health outcomes and hold down healthcare costs.

The engagement of stakeholders such as Federal/Provincial/Territorial partners needs to be considered in order to expand this work to look at the strata of the Canadian population.

There will be a report coming out soon from the Alberta Innovates Technology Futures foundation on "How to make Canadians Healthier in one year".  When a copy is available, the Secretariat will forward it to the SAB members

Summary/Advice -

• The Board enjoyed this future-looking and mind expanding perspective but cautioned that it seemed too focused on individual health/behaviour and S&T at the expense of population health and broader social determinants.  The Board suggested that the foresight approach would have more impact if it were applied as a model to specific health issues such as childhood obesity.
• This work seems to target better-off, better educated Canadians, around 60% of the population, this is not a bad thing, but it should not be done at the expense of the other 40%, who perhaps have more of a need of new and innovative therapies and treatments.
• It was noted that the implementation plan was not clear; however the SAB is confident that the Foresight team will be able to move forward on this issue in the coming months and will look forward to an update at the next meeting.  

Glenda Yeates, Health Canada's Deputy Minister, joined the SAB meeting during lunch hour for an informal conversation.

11. The Use of Human Subjects in Pesticide Testing - Peter Chan, Director General and Cheryl Chaffey, Section Head, Health Evaluation Directorate, Pest Management Regulatory Agency

Main Points -

The Pest Management Regulatory Agency's (PMRA) position has been that systemic toxicity studies in humans are not condoned nor used in determining the risk of a pesticide. This position has never been formalized or communicated broadly to stakeholders. In light of PMRA=s international collaboration as well as its interest in enhancing the integrity of Canada=s regulatory system, it became necessary for the PMRA to review its policy on the use of human studies.   

The Board was asked to comment on whether the issue has been clearly explained in proposed document entitled The Use of Human Subjects in Pesticide Testing and if they concur with the approach to analyzing the issue; to identify any considerations that they believe have not been addressed in the document; to comment on their level of support for the proposed recommendation in the document.

Discussion -

The discussion centred around clarifying PMRA's confidence in available data; studies and survey reports, ethical considerations; what products this policy will cover and the human subjects that are covered. 

Summary/Advice -

• The Board felt that the PMRA's suggested course of action (accepting human studies except those that are done to assess systemic toxicology) was appropriate and measured, and voiced strong support, even though it is not fully harmonized with the US approach.
• The proposed document would benefit from better articulation on what groups are or are not actually being considered (i.e., children, pregnant women).  To help avoid confusion on the types of studies chosen for regulatory purposes, it was suggested that the word "observational" be replaced by "experimental".
• The SAB encourages PMRA to develop a clearer consultation and communications plan and would be pleased to assist in that process.

12. Closing remarks - Karen Dodds

Dr. Dodds expressed her view that this had been a very good meeting in terms of the content, and the quality and variety of presentations.  Improvements for next meetings include involvement in interim activities such as the priority setting exercise of PHAC.

• There have been ongoing talks within the Health Portfolio and mainly due to budget constraints it has been decided that, for now, the SAB membership will not be increased beyond the current 15 members. However, in the future there may be a member from the regulatory side, perhaps from the US FDA, joining the board.  If the SAB can recommend such a person, please let the Secretariat know.  It was also suggested that an expert from the Centre for Disease Control would be a suitable fit.
• She supported the development of indicators to monitor the SAB's impact, i.e., using the advice given: how did Health Canada, PHAC and/or CIHR revise or restructure their thinking on a topic brought before the Board? How did the discussion change the thinking?  Evaluations completed by the members will assist in developing these indicators. The Secretariat will develop a short set of impact indicators.
• Communications seem to be a common issue throughout all the presentations - getting our messages out to Canadians.  The academic science community needs to know what Health Canada and PHAC are doing and the SAB could assist in that effort.
• Appears that this meeting was very successful in terms of what the mandate of the SAB states - this bodes well for the future.  The varied perspectives that the SAB brings to the table provides a good well rounded discussion.

Agenda for next meeting: The Chair encouraged the SAB to put forward potential agenda items for the next meeting, some put forward by the SAB were: Recommended Approach for Immunization; Health Technology Assessment; Nanotechnology; Science Communication/Science Literacy; Health Accord.  The Secretariat will follow up.

13. Members' Comments and Adjournment

It would be informative to have scientific Directors from relevant CIHR institutes attend the next meeting around a particular agenda subject, i.e., First Nations peoples' health.

Most members found this meeting to be one of the best SAB meetings they have attended to date. The presentations were clear; the discussions were fulsome and meaningful, and the issues raised were the right ones.  A smaller board is more effective and appears to be the right size. Now that they are advising the senior advisors to the Minister they feel much more comfortable offering advice. They acknowledged that they are now are talking to the people that are doing the work and that the advice will be utilized. 

It was suggested that it would be nice to see a presentation on the issues that the Provinces are addressing at the grassroots in terms of what the Canadian public deals with in healthcare access, sustainability, and quality.

Next meeting: May 4-5, 2011