Depleted national stockpile leaves Canada reliant on China for masks, gowns and other supplies during pandemic

More than two months into thecoronaviruspandemic, federal and provincial governments are usingextraordinary measures to supply health-care workers with personal protective equipment, including letting them use expired masks.

And with more than 61,000 cases ofCOVID-19 coast to coast, and the country reaching the milestone of more than 4,000 deaths on Tuesday, supplies are just trickling in from overseas suppliers.

In March, Ottawa passed aninterim orderthat allowsmasks, face shields and gowns to be imported and sold in Canadaeven if they do not meetHealth Canada's pre-COVID-19 standards.

Health Canada hasn't responded to questions from CBCNews aboutthe ways in which it has relaxed its rules, but the order's description says that the products must still be "manufactured according to comparable standards."

The United States appears to be taking a similar approach. The U.S. Food and Drug administrationsays that "for the duration of the pandemic,"it will allow the importation of KN95 masks, which are respirators manufactured according to Chinese standards.

As of April 30, Health Canada had ordered 1.8 billion units ofPPE,from masks to gloves to gowns.Of the 36 devices approved so far under the order,34are manufacturers in China, including Wuhan Orient Honest International Trade Co.,ShandongZhushiPharmaceutical Group Co.,and Peek-a-Boo! I A See U!.

Ottawa has not said whether it has yet placed an order with any of these companies.

Much of the global supply ofPPEcomes from China.

That makes Canada's situation even more complicated, as theChinese market is currently fraught with troubles, according toLynette Ong, an associate professor in the department of political science and China specialist at the University of Toronto. The chief difficulty, she said, "is sorting out the good and the bad apples."

Last month, China's own government revealed it had seized 89 million pieces of poor-quality product. Canada has also received at least one million masks from China that don't meet its standards since the pandemic began.

An 'unprecedented and urgent need'

Health Canada's interim order wasprompted bywhat the agency'swebsite callsan "unprecedented and urgent need for medical devices during theCOVID-19 crisis." That demand has caused critical shortages, it says.

The shortage is also leading some provinces to make unusual decisions.

For example,CBCNews has learned that the Saskatchewan Health Authority has decided to allow health care workers to start using expired N95 masks from its stockpile.

They were purchased during theH1N1outbreak in 2009-2010. The province says they expired after five years, meaning they've been expired for about five years.

The province toldCBCNews the masks were stored in optimal conditions and have been tested by an independent lab "where they passed both inhalation/exhalation and filtration tests."

The province pointedCBCNews toa Health Canada directive that saidwhile ordinarily, expired masks should be discarded,in such unusual times, "an expired mask can still be effective at protecting health care providers if the straps are intact, there are no visible signs of damage, [and] they can be fit-tested."

CBCrecently reported that last May,Ottawa threw two million expiredN95masks into the Regina landfill when it emptied its medical supply warehouse in the city. Those masks had also been purchased around the time of theH1N1outbreak.

Worried about 'substandard supply'

The president of the Canadian Medical Association, Dr. SandyBuchman, says such exceptional measures make some doctors anxious.

"That sends a signal, a message to us, that we're getting substandard supply, and that is putting us and our patients at risk," he said.

Buchmansaid he's been hearing from doctors from across Canada who are concerned about a lack of quantity and quality ofPPE.

"In certain regions, specifically like in Alberta, the doctors felt the supplies were substandard, and they couldn't be used,"Buchmansaid.

He said this highlights a failure of government planning.

"If we had planned properly and monitored these provincial and federalsupplies of the equipment, we wouldn't be scrambling," he said. "We would be stockpiled and ready to go."

'China is our only hope'

On April 22, Sally Thornton a vice-president with the Public Health Agency of Canada, which is responsible for the National Emergency Strategic Stockpile (NESS), told the federal standing committee on health that the stockpile was "doing well."

"The NESS had been actually monitored and stockpiled as it was mandated and funded to do," she said.

Thornton told the politicians that provinces and territories are primarily responsible for stocking their own supplies and Ottawa is merely there to provide "surge capacity" in a time of crisis.

ButWesleyWark, a national security expert from the University of Ottawa who's studied Canada's national stockpile,said the pandemic has exposed a gaping hole in Canada's supply chain that urgently needs to be filled.

"The NESS concept has failed Canada in this current crisis," he said.

PattyHajdu, the federal health minister, has publicly acknowledgedCanada "likely did not have enough"PPEin its national stockpile.

Watch: Health Minister PattyHajduaddresses the need for personal protective equipment:

'We likely did not have enough': Hajdu

4 years ago

Duration 1:58

Health Minister Patty Hajdu says that successive federal governments have for decades underfunded public health preparedness, resulting in an insufficient amount of personal protective equipment in the federal pandemic stockpile.

Warksays Canada has made efforts to spur domestic production ofPPE but says that's more of a long-term solution.

"We find ourselves in a position where China is our only hope," he said.

'A Wild West market'

The Public Health Agency of Canadais co-ordinatingthe purchasing ofPPEfor the provinces and territories.

"Over the coming weeks, some companies that required time to scale up their operations will begin delivering supplies on a regular basis," said an explanatory note attached to the May 1 update on Public Services and Procurement Canada's website.

"Given the high global demand for these goods, there is a possibility that not all contracts will be entirely fulfilled."

Thorntonsaid once a supplier has been chosen, the products are visually inspected in China. Once they arrive in Canada, they're given morerigoroustesting ina lab.

She says Canada will need to exercise great due diligence in such an uneven market.

"I know what a Wild West market it is out there. It's very complicated," she said.

There have been a host of concerns aboutPPEfrom China.

• Sub-standard Chinese N95 masks being considered for non-medical use

In a meeting of the standing committee on government operations last month, BillMatthews, the deputy minister of public services and procurement, confirmed the government had received a shipment of one million masks from China that, when tested, were deemed to be substandard. He said the manufacturer "is going to provide replacement product."

On its list of received supplies, Canada notes that while it has received more than nine millionN95respirators, "a significant portion of these remain under testing."

On April 18,CBC reported that health care workers in Albertaare complaining about the quality of masks brought in from China.

• Alberta Health Servicescreating focus group to addressworkers' PPE concerns
• Alberta health-care workers say new masks don't seal, cause rashes and headaches

According toan April 27 report in the state-owned China Daily, market regulators seized 89 million masks and 418,000 other protective supplies.

The country'svice-minister of the state administration for market regulation,GanLin, is quoted as saying "we mainly clamped down on those producing or selling fake, expired or [low-quality]protective materials, including masks and disinfectants, and people who falsified others' trademarks to mislead consumers."

On its website,MakriteIndustries, one the manufacturers recently approved under the government's interim order to fast-trackPPEto Canada,has sounded the alarm about fraudulent products.

"Please be warned that the 9500-N95particulate respirator shown in the pictures is a counterfeit product. It is not manufactured byMakrite," the company said in an April 8 news release.

Ong, the China specialist,said that in normal times, China had well-established companies that provided the world with qualityPPE. Butthe global pandemic has spurred many new entrants to the market, she said.

"It is only by going to the factory, looking at their quality and looking at the certification one by one, that you're able sort that out."

Canada is 'vetting suppliers' in China

Canada says that's exactly what it's doing. AnitaAnand, the federal minister of public services and procurement,told the standing committee on health that Canada has retained the accounting and auditing firmDeloitte, which "plays a role in vetting suppliers and helping us with our supply chain."

When asked why Canada doesn't get the supplies tested in China, Thornton said "we do prefer to do them here. It's good to have our National Research Council, our own testing and our own engineers taking a look at it. [We are] very cautious about what we'd send out to health care workers."

• Canada building its own PPE network in China

While there will be some challenges,Warksays, the Chinese government will work hard to ensure Canada gets quality products.

"China wants to be able to retain a reputation not just as a mass supplier of goods but as a supplier of goods that work and of sophisticated goods," he said. "That's important to China's self-reputation."

A lack of co-ordination

Thornton said while Ottawa is playing the role of co-ordinatorin the ordering ofPPEinternationally, early on in the pandemic response, it was flying blind. There wasn't a clear picture of what supplies were held by each province and where the shortages might be.

"We are not that familiar with what provinces had in their respective stockpiles," Thornton told the committee. "So, very quickly, we got a heads-up in terms of where there would be national gaps."

She said in early February, provinces were asked to fill out a survey indicating what supplies they had and what they needed.

Warksaid if Ottawa doesn't know what the provinces have, then "you can't build NESS on the basis of being sure it's complementary to provincial stockpiles."

In addition, he pointed out, the provinces have no idea what Ottawa has in stock.

"That is, it seems to me, a huge strategic problem," he said.

He said it's a problem politicians had better fix because public health officials are predicting multiple waves ofCOVID-19 infections, which means this crisis could go on for years.