Hepatitis C Package Controversy

From the moment he first stood in the House of Commons in 1993 as a rookie MP and cabinet minister, Allan Rock claimed to be repulsed by the Kabuki ritual of parliamentary Question Period. "I've never been comfortable with heckling or name-calling or finger-pointing," he explained last Friday after the last stormy exchanges of a long, exhausting week in the House. But as Rock sat back in the relative serenity of his Parliament Hill office, in the wildest stretch of a political career that has been anything but sedate, he knew he had dished it out as good as he got it.

After a month of being on the receiving end of an excruciating beating over the limited federal-provincial compensation package for Canadians infected with hepatitis C through tainted blood, Rock had dropped his cool, impassive mask. The turning point came when he thrust a finger into the air as he roasted Independent MP John Nunziata for striding across the Commons to try to pin a victim-support ribbon on his lapel. Later, he lashed out at provincial health ministers for the "empty, hollow, cynical exercise" of agreeing to the deal - which limits compensation to what Ottawa estimates are 22,000 people who contracted the virus between 1986 and 1990 - then asking the federal government to compensate all victims without coughing up more cash themselves. Finally, he retired to his office, removed his suit coat and warned - the defiance evident in his voice - that no matter how long the hepatitis C fight drags on, "I'll be there."

It may be a long time. By week's end, Rock thought he had a deal - again - with nine of the provinces, Quebec being the sole exception, to stick to the original compensation package. But the controversy has been supposedly buried before, yet still manages to return to haunt the Liberal government. Prime Minister Jean Chrétien thought he was bringing closure by whipping the Liberal caucus into voting en masse against an opposition Reform party motion earlier in the week urging compensation for all.

The government won the vote and lost the public relations battle in the uproar that followed. "The file is closed," Rock declared, igniting a further wave of outrage from people with hepatitis C - among them 15-year-old Joey Haché of Russell, Ont., who, along with others, demonstrated on Parliament Hill. Haché contracted the disease through frequent transfusions necessitated by a rare blood disorder, and may in fact be eligible for compensation. But, he said last week, "there are other people out there who need it."

Others accused Rock of overstating the total number of cases in an effort to exaggerate the potential cost of compensation. Weeping victims had to be strong-armed out of the House of Commons visitors gallery; Liberal caucus members groused publicly about being forced to back their Prime Minister. And as the public backlash grew throughout the week, provincial governments began to slip away from the Feb. 17 deal in which Ottawa pledged $800 million and the provinces $300 million for those who contracted the virus between 1986 and 1990. Last week, Quebec, British Columbia and Ontario, after originally signing on to Rock's pact, were suddenly calling for the federal government to compensate all hepatitis C sufferers, no matter when they contracted the disease, while the Quebec national assembly unanimously passed a resolution by then-Liberal Leader Daniel Johnson calling for Ottawa to pay for aid to all as well. "This deal has to be reopened," gloated Reform party strategist Rick Anderson after watching the party's MPs spend yet another Question Period pounding at Rock's open political wound. "This is a government on the ropes."

The Grits made it back to their corner - but just barely. For a party that prides itself on a reputation for compassion, it was grating for them to see hard-hearted Reformers looking like the sympathetic ones. But the government position was formed out of a fear that helping all victims - Ottawa delayed until 1990 the implementation of a new screening test that the United States began using in 1986 - would open the federal government to countless legal actions by others who felt betrayed by Canada's medical system. It was a hard position to rally around with enthusiasm, and the Liberal caucus meeting last week was a dispirited gathering. At one point, Chrétien criticized other front-bench ministers for failing to rally to Rock's aid (later, several Liberal MPs indicated they would continue to fight).

All the pent-up anger and frustration came pouring out at the provinces, who now suddenly wanted to broaden the package with only Ottawa covering the bills. The Prime Minister, fresh off the plane from an official trip to Cuba and anxious to give Rock some much-needed support, laced into Quebec for "passing the buck to the federal government," and chided Ontario Premier Mike Harris in person, during a Toronto celebration to mark the 50th anniversary of the state of Israel, for his province's about-face.

Chrétien's aggressiveness emboldened Rock, who painted his provincial counterparts as callous hypocrites. "I was the one who was in the room last summer when the minister of health for Ontario said he would not discuss compensation for any victims under any circumstances," he told the Commons. "I was in the room when the minister of health from British Columbia said compensation for nobody."

The tongue-lashing seemed to work. After a lengthy conference call on Friday afternoon, provincial health ministers agreed that they would, in the words of Saskatchewan Health Minister Clay Serby, "continue to support our agreement" and would not call for extending the compensation package. Quebec, although remaining a signatory to the deal, still wants to extend compensation to those infected before 1986. As for those who contracted the disease pre-1986, the provincial ministers agreed that they would have to be content with enriched benefits and improvements in the existing health-care service.

The same day his government reaffirmed that it would stick with the original package, Harris still managed to lob a grenade in Ottawa's direction. The Ontario premier announced that he would join victims in a lawsuit against the federal government to get compensation for all those infected. "I'm fed up with a federal government that's shirking its responsibility," Harris said at an auto-plant photo op near Toronto - also attended by Chrétien.

The hepatitis C war, in other words, is far from over. At the very least, last week's events showed that peace in the federal-provincial battles that color the Canadian federation remains little more than a fond wish. A dejected Rock, who has always been portrayed as one of the Chrétien ministers prepared to work with, rather than against, the provinces, told Maclean's that the experience has been "discouraging". Added Intergovernmental Affairs Minister Stephane Dion: "It's necessary that the provinces treat the federal government with respect if they expect to be treated in that way."

And respect for the Liberals on this issue is in short supply these days. One of the main reasons: the success of the Reform party, which has been busy trotting out hepatitis C sufferers in the House of Commons visitors gallery and pummelling Rock during Question Period. The upshot is an ironic role reversal. Reform, a party that has always labored against a reputation for lacking compassion, has emerged as the primary defender of hepatitis C victims, in the process managing to torment Rock, the darling of left-leaning "social liberals." Admits a high-ranking Rock aide: "Reform has been masterful."

A case in point: the way the party continues to hammer away on the question of just how many hepatitis C sufferers would have to be compensated if the deal covered those infected before 1986. "For weeks, the health minister has been exaggerating the number of hep C victims who were infected before 1986," said Reform MP Reed Elley in one fiery Question Period exchange. "He does this to scare Canadians, to make them think we had to throw these sick people out of the compensation lifeboat." In fact, in an interview late last week with Maclean's, Dr. Sam Lee, president of the Canadian Society for the Study of the Liver, argued that the number of those needing compensation may not be as great as official Ottawa believes and suggested a plan for stipends, instead of lump sums.

Rock says the fight is all about principles, not accounting. "Ultimately, it is not an issue of numbers," he said. "Whether there are 10 people, the issue is the same." He insists the point is not to save money, but to stick to the guiding tenet that the government should compensate people for a breakdown in a publicly regulated blood system - not simply in response to sympathy for the victims of a health crisis. His point, repeated doggedly throughout the debate, is that to compensate everyone would open the floodgates of demands for cash payments every time injury or disease unexpectedly strikes a portion of the population.

If Rock can weather this storm, he might seem due for a break in the clouds. But blue skies appear to be nowhere in sight. Later this month, he must table his department's newest attempt at anti-tobacco regulations to cover everything from cigarette packaging to the thorny issue of tobacco company advertising at sports and entertainment events. And Maclean's has learned that Rock has also begun discussions with provincial health ministers about launching a legal action to claim damages from the big tobacco companies, a measure similar to the $500-billion case that the Clinton administration is trying to bring against tobacco companies in the United States. That could pit him against MPs from Montreal, where the tobacco companies enjoy strong support. Rock also faces opposition from several provinces for his plan for a national home-care system. "The next 18 months," concludes a senior aide, "are critical to his future."

Rock's future was the subject of heated discussion in official Ottawa, remote as it seemed to those fighting for compensation for years of botched handling of blood policies. Controversy has been Rock's burden and blessing from the moment he was catapulted into cabinet as justice minister and attorney general in 1993. During his tenure, he was tarnished by the justice department's investigation into allegations of financial misconduct in the 1988 Air Canada purchase of Airbus jets. That resulted in a $50-million lawsuit by Brian Mulroney and a settlement early last year in which the government agreed to pay $1 million to cover the former prime minister's legal costs. And some Liberals still have not forgotten how Rock's gun-control bill cost their party rural seats in last year's federal election.

Rock's advisers were relieved to see him head for the health portfolio and a clean slate for the start of the Chrétien government's second term. Health, after all, seemed about to become the government's central focus in the post-deficit era. What better position for Rock to portray himself as the only viable candidate from the Liberal left capable of challenging Finance Minister Paul Martin, the right-of-centre heir apparent, to become leader when Chrétien goes?

Now, though, insiders are wondering how severely Rock has been hurt by the hepatitis C controversy. The argument that he has fumbled the file cannot be dismissed. Some of the criticism that the government was abandoning thousands of Canadians might have been blunted if he had negotiated to give the pre-1986 group free drugs, early access to disability insurance or other measures short of cash payments. The Liberal back-rooms are full of second-guessers, who maintain that Rock should have pinned the blame for the limited deal on the provinces from the outset. After all, the provinces agreed to throw just $300 million into the package, compared with the federal government's $800 million. And when provincial governments broke ranks last week, federal Liberals were even more inclined to wonder if Rock should have claimed the high ground for Ottawa earlier - and louder.

But few are ready to write Rock's political obituary just yet. "If the leadership race were being held tomorrow, this would hurt him," stresses one high-ranking Liberal strategist with ties to Martin. "A couple of years from now - well, the jury is very much out." So far, party strategists say there have been few calls and letters to ordinary MPs on the issue - unlike, for example, the phone and fax campaign over the gun-control legislation that worried the Liberal caucus and plagued Rock.

Some Liberals even think Rock can emerge stronger than ever from the latest controversy. Many acknowledge that any deal short of compensation for all hepatitis C sufferers was going to be roundly criticized anyway. But Rock's single-handed defence of the deal during Question Period has converted some of the doubters who felt he lacked the toughness necessary to lead. And his currency remains strong as ever among social liberals who say he would have offered more to hepatitis C sufferers had the Liberal cabinet not balked at upping the federal ante. "What most people who are supportive of Allan are saying now is that he just has to weather this storm and he'll be all right," notes one party strategist.

Maybe better than all right. By the end of last week, Chrétien, after keeping mostly silent on the issue, was rising in the House to defend Rock, all but confirming that the Prime Minister appreciated his minister's good soldier routine. Will that translate into funding for a major home-care initiative? Too early to say, perhaps. For now, Rock and his fellow Liberals only want to get past the hepatitis C issue. And after last week's raucous events, that day still looked far away.

What is hepatitis?

Although variants of liver disease known as hepatitis have been recognized for centuries, it is only within the past 50 years that their transmission by blood or blood products has become a significant concern. The current controversy swirls around a potentially fatal variant, hepatitis C, unidentified until 1989. It is a viral infection, spread by direct blood-to-blood contact. Since screening has kept it out of Canada's public blood supply since 1990, the main sources of infection include injection drug use or sharing personal hygiene items such as toothbrushes, dental floss and razors, or body piercing such as tattooing. There is no vaccine. Most of its victims never show symptoms, and some suffer just minor flu-like illness. Others experience mild to severe tiredness, appetite loss, vomiting, fever and soreness in the abdomen and joints. Beyond that, an estimated 15 to 20 per cent will develop cirrhosis, or scarring of the liver, within two decades of infection's onset, and half of those will develop liver cancer. Other types:

Questioning the Numbers

Behind the political uproar over hepatitis C and tainted blood is a numbers game that just about nobody wants to play: how many people were infected with the virus, and how many of them will get so sick they will need compensation? Just asking can seem callous to those who are suffering - which leaves many experts wary about wading into the debate. Dr. Sam Lee, president of the Canadian Society for the Study of the Liver, says far fewer of those infected with hepatitis C are doomed to become gravely ill than is now widely thought. But he is worried about how his own patients would react to hearing him advocate a go-slow approach to awarding compensation. "From their perspective," Lee told Maclean's, "I'm a rich doctor saying some poor patient doesn't deserve compensation. How's that going to play?"

Lee says the best estimate is that out of about 300,000 Canadians currently infected with hepatitis C, some 20,000 to 60,000 could have contracted the virus from tainted blood. But the federal government's Laboratory Centre for Disease Control puts the number considerably higher - estimating that up to 82,000 Canadians were infected through the blood system. The centre's deputy director general, Dr. Paul Gully, said that includes 22,000 infected from 1986 to 1990, the period for which the government wants to pay compensation, and up to 60,000 before then.

Details of the research that came up with those numbers will be made public "soon," according to federal officials. But that explanation will probably be greeted skeptically by hepatitis C activists. "There is no question that the claim of 60,000 victims [infected before 1986] is way inflated," said Jeremy Beaty, president of the Hepatitis C Society of Canada, who accuses Ottawa of pumping up the figure to suggest that opening up the compensation package would be hugely expensive. He estimates, based on preliminary results of surveys of blood transfusion recipients in British Columbia, Saskatchewan and Nova Scotia, that only 10,000 to 15,000 victims who contracted the virus before 1986 remain alive and would be eligible for compensation if Ottawa opened the package up.

While experts argue over the total number of Canadians infected, they agree that many of those who carry the virus will probably not become seriously ill as a result. "It doesn't cause symptoms in the vast majority of people," Lee says. "There's no way they'd know they have it unless they went for a specific blood test." For a minority, though, the prospects are grim: 20 years after being infected, 20 per cent develop cirrhosis of the liver. One to five percent are expected to get liver cancer. Many others will have their energy sapped by the virus. But the good news is that drug treatment now available can wipe out an estimated 15 to 20 per cent of hepatitis C cases caught before liver disease sets in. And, Lee says, new drug therapies now being developed, which aim to block the activity of the enzymes that allow the virus to spread, show promise of curing many more patients within the next few years.

With many hepatitis C victims hopeful of a cure and many more unlikely to get seriously ill, governments are not sure what proportion will need compensation. A plan for allocating the $1.1 billion that Ottawa and the provinces have promised to ante up will be worked out in negotiations with hepatitis C groups, and ultimately ratified by a judge. Lee favors compensating only those patients who develop serious symptoms. "I would pay them a stipend, not a lump sum, with the idea that this would stop if better therapy became available and their disease was eradicated." As for how that suggestion might be received, Lee is uneasy. "I had a patient in my clinic the other day literally shaking with rage about the fact that she was excluded from compensation," he said. "Some of these people are suffering - and almost all of them are angry."

A Tainted History

Infection and Compensation: The Key Dates

1971: Test for hepatitis B in blood introduced in Canada. Red Cross discontinues collecting blood from prisons, where hepatitis rates are higher than in general population.

1974: First cases noted of transfusion transmission of what was then called non-A, non-B hepatitis (most of which would eventually be identified as hepatitis C).

1978: American Red Cross official informs Canadian Red Cross that non-A, non-B hepatitis is present in four to nine per cent of blood in several centres.

1981: Canadian Red Cross rejects "surrogate" tests (meaning testing not for a condition itself but for indicators generally associated with it) being developed for non-A, non-B hepatitis in blood. It cites controversy over their reliability and the lack of Canadian data, but no Canadian studies are undertaken.

1983: First compulsory reporting of non-A, non-B hepatitis across Canada identifies 134 cases.

1985: Canadian Red Cross starts screening blood for HIV, the AIDS virus.

1986: U.S. blood banking organizations start surrogate testing for non-A, non-B hepatitis based on research indicating it can drastically reduce the incidence of transfusion transmission. Canadian Red Cross remains unconvinced, estimating surrogate testing would prevent only a small number of cases, at a cost of up to $20 million in the first year.

1989: Hepatitis C virus identified, allowing scientists to test blood directly for its antibody. Most of Western Europe starts direct testing. On compassionate grounds, Ottawa awards $30,000 a year for four years to the 1,200 people affected with HIV through the blood supply. The program is later extended by provinces to provide the same amount annually for life.

1990: Canadian Red Cross (and U.S. organizations) start direct screening for hepatitis C virus. But unscreened plasma in blood products still reaches some patients, possibly for as long as two years.

1993: Federal government appoints Ontario appellate court Justice Horace Krever to investigate the contamination of the public blood supply in the 1980s.

1996: First of what now total seven major class action or group action lawsuits are launched across Canada, the most ambitious seeking $3.8 billion in compensation for hepatitis C sufferers.

Nov. 21, 1997: Krever releases his report, slamming the Red Cross and governments for ignoring warnings and acting irresponsibly as HIV and hepatitis C transmissions continued. He calls for prompt no-fault compensation for "all blood-injured persons." Krever concludes that 85 per cent of the approximately 28,600 hepatitis C infections from the blood supply from 1986 to 1990 could have been avoided.

Feb. 12, 1998: The RCMP launches a criminal investigation into the tainted blood scandal.

March 27: Federal Health Minister Allan Rock and his provincial counterparts announce a compensation package of $1.1 billion ($800 million from Ottawa, $300 million from the provinces), available only to those infected between 1986 and 1990, when screening could have been in place. Details of individuals' compensation are still to be worked out.

April 28: Invoking strict party discipline, the Liberal government defeats a Reform party motion calling for compensation for everyone who got the disease from tainted blood, regardless of when the infection occurred. "The file is closed," declares Rock.

May 1: Amid hints of second thoughts on the part of several provincial governments, Saskatchewan Health Minister Clay Serby insists they all still support the March 27 deal. "We are not calling on Ottawa to extend the compensation package," says Serby after consulting fellow ministers. But in British Columbia, Ontario and Quebec - and in the opposition ranks in Ottawa - politicians continue to press Rock to include all the victims of tainted blood.

Maclean's May 11, 1998

Hepatitis A:

Formerly known as infectious hepatitis, it is transmitted through contaminated food or water or improper hand washing after a bowel movement. About 1,500 cases a year are reported in Canada, causing weakness, headache and fever, stomach cramps, loss of appetite, diarrhea, darkened urine, and jaundice (yellowing of the skin and eyes). Most people recover fully and develop immunity. About three per cent over age 40 die. It occurs in small outbreaks and can be prevented by a vaccine.

Hepatitis B:

Formerly known as serum hepatitis (because it was sometimes transmitted in blood products before a screening test for that variant was introduced in 1971), it is spread through sexual contact, sharing needles and syringes or personal hygiene items. There are approximately 100,000 carriers in Canada and about 3,000 new cases reported each year. When symptoms occur, in a minority of victims, they are similar to those of hepatitis A. About one per cent of those with acute cases die, and 15 to 25 per cent of carriers die from cirrhosis or liver cancer. Hepatitis B, too, can be prevented by a vaccine.

Hepatitis D:

Rare and found only in patients with active hepatitis B, mostly injection drug users. Symptoms, when they occur, are similar to those of other forms of hepatitis.

Hepatitis E:

Caused by poor sanitation, it is not found in Canada, except among travellers to countries with a high incidence. Symptoms are similar to those of hepatitis A.