Executive Summary

On June 15, 2010, the Honourable Leona Aglukkaq, Minister of Health, requested that the Standing Senate Committee on Social Affairs, Science and Technology undertake a review of Canada’s response to the 2009 H1N1 influenza pandemic.  The committee heard from representatives of the federal government, several provincial and territorial governments, healthcare professions, First Nations and Inuit organizations, and the research community as it focussed its review on the federal government’s role in the pandemic response.   The committee also heard from first responders and front-line workers,and would like to express its appreciation for their hard work and dedication in contributing to community preparedness. This document contains the committee’s findings as well as 17 recommendations and is intended to complement other ‘lessons learned’ exercises in Canada.

Overall, the committee found that the planning that began many years ago and that had been ramped up in recent years proved successful. Canada’s response as a result of years of planning effectively reduced the impact of the H1N1 influenza pandemic.  However, the committee would like to emphasize the importance of pandemic readiness and the need to maintain a focus on pandemic planning. In this regard it is recommending that the Government of Canada renew the funding for Pandemic Preparedness in Federal Budget 2011.

In addition, several themes emerged with respect to those areas that could be further strengthened. These  themes are as follows:

• Roles of the federal, provincial and territorial governments in public health
• Canada’s Pandemic Influenza Plan for the Health Sector
• Communications and messaging
• Vaccines and antivirals
• Data collection, surveillance and analysis
• Capacity for public health service delivery
• Collaboration and consultation
• First Nations and Inuit
• Research

In the context of the roles of the various levels of government, the committee is calling for greater use of federal/provincial/territorial agreements as a means to create more uniformity between and among jurisdictions in their respective responses to pandemics. With respect to Canada’s Pandemic Influenza Plan, the committee finds that future revisions should be regularly and rigorously tested.

The committee heard considerable testimony expressing concerns and challenges with respect to communication and messaging. In this regard, the committee is calling for the communications annex to Canada’s Pandemic Influenza Plan to be updated so as to clarify the roles and responsibilities of the different levels of government. It is also recommending that the Public Health Agency of Canada consult widely on how best to communicate real-time policy decisions as well as how to harmonize messaging. The committee also recommends that the use of social media and the consultation  of health professionals be included as it moves forward with its examination of communication policies. Finally, the committee is calling on the Public Health Agency of Canada to launch public awareness campaigns, including the use of social media, which are aimed at various aspects of public health such as vaccine safety and effectiveness.

The Pandemic vaccine was another issue for which several concerns were raised. In response to these concerns the committee finds that the next ten-year federal/provincial/territorial contract that is to be established in 2011 must include a backup supplier and that the government must take steps to ensure that the backup supplier will add to Canada’s ability to ensure access to a safe and sufficient supply of pandemic vaccine. In addition, the committee heard that the packaging chosen for the vaccine, that is the number of doses per vial and the number of vials per box, should be more relevant to the end user. Therefore, the committee recommends that the manufacturer consult the Public Health Agency of Canada prior to making this determination.  Finally, the committee is concerned that the logistics of implementing the necessary vaccination programs for expedient inoculation of all Canadians who want to be vaccinated was not fully appreciated. As such, it is recommending that mass vaccination programs be more thoroughly explored and tested.

With respect to data collection, surveillance and analysis, the committee would like to see greater use of electronic resources. As such, it is recommending implementation of electronic public health surveillance applications as well as electronic health records systems. In terms of capacity for public health service delivery, the committee is calling for the Public Health Agency to monitor the scope of practice of paramedics and pharmacists in jurisdictions across Canada in order that they be included wherever possible as a valuable resource during public health emergencies. In addition the committee would like the Public Health Agency of Canada to work with the provinces and territories to encourage greater interconnectivity between the different health care infrastructures, namely acute care, primary care, clinical care and public health care. It notes that these measures will contribute to increased surge capacity in hospitals.

In terms of collaboration and consultation, the committee is calling for broader inclusion of health professionals. It is also recommending that the Public Health Agency of Canada establish formal collaborative arrangements with provincial public health agencies so as to make efficient use of resources and expertise.

The committee would also like to make recommendations specific to First Nations and Inuit populations. While the committee commends the efforts made to ensure that remote communities and on-reserve First Nations received necessary interventions such as antivirals and vaccine, it is concerned about public health infrastructure in general. The committee is calling for Health Canada’s First Nation and Inuit Health Branch, the Public Health Agency of Canada and Indian and Northern Affairs Canada to identify those communities where unhealthy conditions exist, such as poor access to clean water and overcrowding, that make the residents vulnerable to communicable disease and to address these public health concerns. The committee is also calling for improvements to the reporting systems for data collection and surveillance for aboriginal groups. Finally the committee recommends that the federal government enter into discussions with representatives from First Nation and Inuit organizations and communities with the aim to clarify its role in a public health emergency.

The final area of concern identified during this study was that of research. The committee recommends that research be included in the ongoing focus on pandemic preparedness, In this regard the committee recommends that the infrastructure must be maintained for influenza research and is calling on the federal government to provide dedicated and sustained funding in this regard.

The committee commends the Public Health Agency of Canada for its role on the international stage and acknowledges the leadership role that Canada played in collaborating with various jurisdictions as well as providing assistance and certain expertise to those countries that were less well-equipped. The report examines the key areas of concern and includes recommendations to strengthen Canada's pandemic preparedness plan for the future.