ST. JOHN’S, N.L. — When Canada’s provincial and territorial health ministers gathered for their annual meetings last year at this time, one topic dominated their discussions — that nasty flu bug called H1N1.

About a month after they met in Winnipeg in September 2009, the H1N1 vaccine was approved and the biggest immunization program in Canadian history was underway.

This year’s agenda features much more variety, though the ministers will spend some time talking about the successes and failures experienced in each of their jurisdictions in rolling out the H1N1 vaccine.

The health ministers meet here Monday, and on Tuesday with their federal counterpart — Health Minister Leona Aglukkaq.

There are numerous issues up for discussion over the two days but the one that is expected to generate a good deal of attention is multiple sclerosis and Ottawa’s decision to hold off on supporting clinical trials of the controversial procedure known as liberation treatment.

“I know there will be a lot of discussion around that,” Saskatchewan’s Health Minister Don McMorris said in an interview last week.

The MS debate is of particular interest to Saskatchewan, which has the highest rate of the debilitating neurological disease in the country. The province has committed to backing clinical trials — with or without the federal government’s support — of the liberation treatment pioneered by an Italian doctor that is only offered in a handful of countries.

Canadian patients, desperate for some relief, have been travelling abroad for the operation, which involves inserting small balloons or stents into blocked veins. An expert panel convened by Ottawa, led by the Canadian Institutes of Health Research, reported last month there isn’t enough scientific evidence on Dr. Paolo Zamboni’s procedure to prove that it’s safe or effective.

Aglukkaq accepted the panel’s recommendation that the government wait for more evidence on Zamboni’s theory linking blocked veins to MS before proceeding with clinical trials.

Representatives from CIHR and some specialists in MS are expected to attend the meeting to discuss the issue with the health ministers.

McMorris said Saskatchewan still wants to partner with the federal government, or with other provinces, to test the treatment in Canada.

“From my perspective, yes it needs to be proven or it needs to be disproved,” he said. “I think that helps families with MS just as much so that perhaps they’re not spending dollars to go have a procedure done that doesn’t have any scientific basis. We need to know that ourselves.”

Another issue the provinces are expected to raise with Aglukkaq is the added costs they incurred for medical isotopes during the year-long shutdown of the Chalk River, Ont., nuclear reactor. Its closure prompted a worldwide shortage of the isotopes required for diagnostic imaging and some medical treatments, driving up the price and causing logistical nightmares for nuclear medicine specialists and hospitals.

Some provinces are seeking compensation from Ottawa, whose responsibility it is to ensure a stable supply of isotopes. They are also concerned about the country’s future supply of isotopes because the reactor’s lifespan is quickly coming to an end and there is no clear plan for replacing it.

Health promotion initiatives will also be talked about and a co-ordinated strategy to enhance healthy living among Canadians could be announced by the federal government and provinces by the end of Tuesday, Postmedia has learned.

Rising health-care costs are another major concern for the provinces and the health ministers will also discuss the agreement reached by their premiers last month to pool their purchasing power for drugs.

“The sharpest increase in our budget is with respect to pharmaceuticals,” Alberta Health Minister Gene Zwozdesky said in an interview. “I want to hear how other provinces are dealing with that.”

A national pharmacare program to cover prescription drug costs for Canadians has been talked about for decades but no federal government has made a serious effort to establish one, and the Conservative government has little interest.

The provinces are now taking it upon themselves to start co-ordinating their efforts to buy drugs and other medical supplies in bulk, though getting a pan-Canadian approach off the ground will take some time.

The ministers’ discussions Monday about tackling drug costs coincide with the release of a report from the Canadian Centre for Policy Alternatives that says a publicly funded pharmacare program could save billions of dollars.