Health committee  Thank you for the question. I think the standards of care are set by professional associations in the country, which very much are creatures of provincial jurisdictions. We recognize that this is just the way in which the system currently functions. However, on many diseases, on many health issues, the federal government has weighed in on the available evidence to support practice and has encouraged the adoption and sharing of practices across the country as they've been developed locally in the country.

Health committee  Canada's guidelines are the same as those in the U.S. They are the guidelines established by the Infectious Diseases Society of America in 2008 or 2009. The Canadian guidelines were adopted by the Canadian association of clinicians.

Health committee  This year, the guidelines were based on the information available on Lyme disease.

Health committee  It's “Mister”.

Health committee  Thank you for the question. Essentially, as we've said, the two-step testing is not as effective in the early stages of infection, as antibodies are not necessarily developed early on in infections. It becomes more effective as the infection progresses, weeks and then months into the illness, which is why we talked earlier about not wanting to rely on them for the clinicians' diagnosis during that early, acute phase.

Health committee  It was started essentially in the last fiscal year, in the fiscal framework, but it's about a year ago now.

Health committee  The Public Health Agency went through, for example, a significant review of the information that we currently have on our public website. In reviewing it last night, we have over 14 pages, if you print them, of information for health care professionals, which really drives that point quite clearly.

Health committee  No. As I indicated, we view this building on our action plan, moving forward, and taking it to the next level of work.

Health committee  Thank you. I mentioned a few of the professional associations already. As an illustrative example, in the last six months, we worked with, among others, federal, provincial, and territorial officials involved in the surveillance of Lyme disease. They are involved in public communications and in raising awareness, and they are trying to develop ways in which we could leverage each other's opportunities and each other's messages.

Health committee  Certainly at the Public Health Agency we recognize that the delivery of care is the responsibility of the provinces and territories, of course, under our constitution. With regard to the development of best practices, the agency has, through the development of guidelines over a number of years, identified, articulated, and shared best practices and tools to help practitioners in the field adopt those practices.

Health committee  Since 2009, as I indicated, Lyme disease has been a nationally notifiable disease. That means that clinicians, when they do receive and make a diagnosis, report through their public health officials, through the provincial and territorial health authorities, and straight up to Ottawa, so we can compile the numbers and the statistics.

Health committee  —to date have felt to be very important.

Health committee  That's correct. So the current two-step testing focuses on one strain of the Borrelia, and is not as sensitive to picking up the many other bacteria that, of course, are carried by ticks. There's no question that there are multiple strains of Borrelia and multiple different bacteria that can be carried by a tick in wildlife.

Health committee  Of course. We very much view the action plan as working on the initial steps required, such as raising public awareness and shoring up our surveillance activities across the country so we can have the core set of data upon which you could build broader approaches, strategies, and frameworks in the country.

Health committee  It's a very difficult issue, of course. I'm not a clinician myself either. I think what we have identified in our action plan is the starting point for that discussion: raising awareness among health professionals and raising their understanding of where Lyme disease is in Canada.