To test or not to test—that was the question. And while on the surface it should not have been difficult to answer, it took more than a federal government task force, a group of medical specialists and constant pressure from Canada’s dental community to arrive at the decision. At length it was determined that all Vietnamese refugees arriving in Canada would be tested for hepatitis B.
The decision made early last month by Health Minister David Crombie seems to have been as much a political move as a medical precaution. The United States health, education and welfare department indicated to certain Canadian officials in early October that it was going to begin a program of hepatitis B screening on Indo-Chinese refugees entering the U.S. That was the pivotal point as far as the Canadian government was concerned even though, as one senior medical officer put it, “The evidence against this form of screening was emphatic.”
The go-ahead to test all Vietnamese refugees for the serious virus came before the last round of Red Cross statistics was released. The Red Cross had tested a group of Vietnamese refugees
in Edmonton. Its most up-to-date figures show that out of 719 refugees tested, 13.8 per cent were carriers or
had been infected with hepatitis B, a viral infection which can cause permanent liver damage, has been linked to cancer of the liver and is fatal in between two and five per cent of all cases.
Medical experts are neither surprised nor shocked by the Red Cross findings. Southeast Asia has one of the highest hepatitis B rates in the world; about 13 per cent of its population has some form of the disease, compared with the normal carrier rate for Canada of about 0.3 per cent. It was only because of the influx of the Southeast Asian refugees (Canada is committed to take in 50,000 by the end of 1980; more than 13,500 have already arrived) that the problem of hepatitis B created confusion and controversy.
Though a serious virus, hepatitis B is also a very fragile one—not easily spread. Of the 719 Vietnamese tested, “less than half would pose any threat in spreading the disease,” says Dr. Scott Leslie, a senior medical officer with the federal department of health. The potential danger, he says, lies in the hepatitis carrier—the person who does not show symptoms of the disease himself yet can spread it to others. There could be as many as 1,500 “silent carriers”— people who don’t know they can spread the disease—already here among the boat people, says Leslie.
Before entering Canada, the refugees receive full physical examinations, chest x-rays and urinalysis (which would indicate such conditions as tuberculosis and venereal disease). But it takes time to get results from the simple blood test for hepatitis B and with overcrowded and overextended facilities in Hong Kong and Singapore, testing has been almost impossible. In Canada it would cost about $10 a person to administer the test. Since the virus is spread through saliva (as well as sperm
and blood), people running a risk of infection include dentists and dental nurses. Another area of less risk but some concern involves children, who have shown a greater incidence of the virus. There exists the slim possibility that a Vietnamese child who is a hepatitis B carrier could spread the disease to a Canadian child or adult living in the same household. But even in close contact, the disease would have a slim chance of spreading under normal healthy sanitary conditions.
The real risk of hepatitis B to the Canadian public is practically nil.
That’s the general consensus of a government task force set up late last spring to deal with the problems of Indo-Chinese refugees. The 25-member body of national defence, immigration and national health and welfare personnel and medical experts first met on June 6. Since then the hepatitis B debate has taken a jaundiced turn.
Two of the task force’s leading debaters, Dr. Franklyn Hicks, a federal health department official, and Dr. Murray Fisher, a liver specialist from the Sunnybrook Medical Centre in Toronto, are at odds. Hicks has said repeatedly that
U.S.—to set up special treatment centres just for these cases. The cost to the government would be about $40,000, says Main, and the idea remains a pipe dream.
the refugees don’t pose a threat to the community. But according to Fisher: “The risk of spreading the disease is real. It’s probably small but we don’t know how great it is.”
Dr. James Main, head of oral pathology at the University of Toronto, is the spokesman for the dental community, which is asking that all the refugees be screened for hepatitis B. Main said the government called his view “alarmist” when it was first presented. As a group directly affected by the disease, the dentists wanted to follow practices already established in Britain and the
The task force, which has met at least four times since last June, couldn’t agree on what should be done about hepatitis B. So in September a bevy of medical experts was convened to try to evaluate the situation. The result? A list of recommendations to advise dentists on the proper procedures and precautions. The dentists, perturbed at what they felt to be a lukewarm approach to a serious health hazard, sent a communiqué and letter to Health Minister David Crombie, asking for mass screening of all Indo-Chinese refugees at their point of entry into Canada.
Hicks, spokesman for the task force, says it feared mass screening would brand the boat people as “pariahs or undesirables.” Once the government knew who was a carrier, he wanted to know, what would be done with that information? The task force did prompt the Red Cross testing of refugees at a Canadian Armed Forces base near Edmonton. Press reports in August confused this sample testing with universal screening and announced that comprehensive screening of all refugees would take place, though that was not the case—at that time.
Meanwhile in his fifth-floor House of Commons office, Health Minister Crombie was making his own decisions. He had read the dentists’ communiqué. He had met privately with Fisher, who had received telegrams from respected American liver specialists, further convincing him to push for universal screening. Crombie had met with other task force members and experts, too. He had almost made up his mind. “I was trying to make a judgment as to what the Americans would or would not do.”
Strong indications from the U.S. that it was going ahead with comprehensive testing of Vietnamese refugees reinforced Crombie’s own view and provided him with just the right political antidote to combat the advice of his reluctant task force.
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