Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 12 - Evidence - September 30, 2010
OTTAWA, Thursday September 30, 2010
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 10:30 a.m. to examine Canada's pandemic preparedness.
Senator Art Eggleton (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
Today we continue with our study in the preparation of a recommendation to the Minister of Health with respect to pandemic preparedness. We will deal today with the federal family in this regard, federal emergency preparedness and coordination. The people who will lead us through that are at the end of the table.
Let me introduce them to you. We will start with Public Safety Canada, Daniel Lavoie, Associate Assistant Deputy Minister, Emergency Management and National Security Branch. We will then go to the Public Health Agency of Canada, Dr. Theresa Tam, Director General, Centre for Emergency Preparedness and Response. We will hear from Health Canada next. Dr. Paul Gully, Senior Medical Advisor, is here. Last, but not least, we will hear from Paul Mayers, Associate Vice-President of Programs for the Canadian Food Inspection Agency. For purposes of any questions senators may have, he is accompanied by Catherine Airth, Associate Vice-President of Operations.
Let me ask those of you who are speaking to make your opening comments in seven minutes, please.
Daniel Lavoie, Associate Assistant Deputy Minister, Emergency Management and National Security Branch, Public Safety Canada: Thank you, Senator Eggleton.
The Chair: We used to work together in the Treasury Board.
Mr. Lavoie: I would like to thank the committing for inviting me here today as it reviews the issue of pandemic preparedness.
Public Safety Canada has and will continue to take the necessary steps within its mandate to protect the safety and security of Canadians with respect to pandemics. As defined in the Emergency Management Act, the Minister of Public Safety's role in addressing an emergency such as a pandemic influenza outbreak is to provide leadership and coordination on the whole-of-federal-government response. This mandate does not take away the responsibility of the Minister of Health or the Minister of Agriculture for overall national coordination of the public or animal health response. In fact, it supports it.
Public Safety Canada exercises its role at three levels: federally, nationally and internationally. As early as 2006, the Government of Canada launched a whole-of-government strategy by establishing interdepartmental committees of deputy ministers and assistant deputy ministers on avian and pandemic influenza. It also established various supporting committees and a work plan. Public Safety Canada assumed a leadership role in managing this governance structure by establishing a secretariat, drawing additional resources from the Canadian Food Inspection Agency and the Public Health Agency.
[Translation]
During H1N1, Public Safety undertook several coordination activities at the federal level. The department coordinated the federal interdepartmental management of the crisis by chairing or supporting decision-making committees, and worked with institutions to identify their critical services. In September 2009, Public Safety asked Audit Services Canada to evaluate the pandemic annexes of the Business Continuity Plan of 78 federal institutions.
A follow-up assessment was conducted at the end of October. The department supported decision-makers and the emergency management community with daily consolidated situation reports. It also played an active role in the coordination of the federal public communications response. The department's Communications Branch provided support for a Directors General Communications Working Group on H1N1, to facilitate the sharing of information and communications products.
[English]
Nationally, the department had several important measures in place to support pandemic preparedness. These greatly facilitated our ability to respond effectively to H1N1. For example, in 2006, Public Safety Canada and the Public Health Agency of Canada launched a private sector pandemic working group, which we continue to co-chair together. Members are drawn from Canada's 10 critical infrastructure sectors. Its purpose is to ensure a consistent approach to pandemic influenza planning and preparedness.
During the second wave of the pandemic in the fall of 2009, Public Safety Canada worked with federal departments and agencies that are responsible for critical infrastructure sectors to produce daily situation reports on pandemic impacts. Thankfully, there were none, but the important point is that we had the processes in place to monitor and report on this.
The federal-provincial-territorial table of senior officials responsible for emergency management, what we call SOREM, collaborates on a range of emergency management initiatives. During H1N1, Public Safety Canada organized and chaired regular teleconferences of SOREM to exchange information with the provinces. Internationally, Public Safety Canada also laid the groundwork for effective pandemic preparedness.
Since 2007, Public Safety Canada has served as the Canadian federal lead for the coordinating body of the North American Plan for Avian and Pandemic Influenza. The plan was designed to be flexible in that the processes and procedures that it established worked for either an avian or a pandemic influenza. The plan also considers measures to take depending on whether the virus originates inside or outside North America, but even if the plan is sound, it can still be strengthened as a result of H1N1. We are now tackling this with our partners.
[Translation]
More generally, when reflecting on the H1N1 experience, there are areas that the Government of Canada can improve upon. For example, consistent and timely release of information to employees, the public, and the private sector proved to be a challenge. We will be reviewing our procedures to determine what steps could be taken to improve this challenging issue. Also, some federal departments and agencies implemented their pandemic plans during the H1N1 event, even though they had not been tested.
We encourage federal departments and agencies to look at opportunities to validate their plans in future exercises. These examples underscore the level of attention paid to pandemic preparedness in the federal government and the high degree of commitment to providing ongoing operations and delivering critical services to Canadians.
Thank you. I would be pleased to answer your questions.
[English]
The Chair: Next, we go to Dr. Tam from the Public Health Agency.
Dr. Theresa Tam, Director General, Centre for Emergency Preparedness and Response, Public Health Agency of Canada: Good morning, members of the committee. Thank you for the invitation and for this opportunity to participate in this study.
During the H1N1 response, I was the emergency manager who was sitting inside our state-of-the-art Emergency Operations Centre helping to coordinate all the various teams responsible for the federal public health response. The teams were drawn from both Health Canada and the Public Health Agency. We function together as the Health Portfolio. I believe we offered an opportunity for members to visit the EOC if the opportunity arises. We have multiple teams in different streams and colours, which I conducted during the response.
As my colleague Mr. Lavoie has indicated, Public Safety Canada is the overall lead for coordinating the whole-of- federal-government response to emergencies, while the health portfolio is focused on imagining events that might affect the health and well-being of Canadians.
Public health in Canada is a shared responsibility amongst local, provincial, territorial and federal governments. While most domestic outbreaks are managed locally, the Public Health Agency takes on a leadership role in coordinating our collective response to outbreaks that involve more than one province or territory, and we are involved whenever there is potential for spread of a disease into or out of Canada.
An influenza pandemic is a very good example of an outbreak that involves more than one jurisdiction and spreads internationally. During H1N1, we did take a leadership role in work on disease surveillance, antiviral and vaccine programs, infection prevention measures, collection of clinical care guidelines and public health communication, as well as in research and laboratory testing.
Outbreak response and emergency management are similar in that they use a bottom-up approach, meaning that local authorities prepare and respond to emergencies using their own resources and systems. When the local capacity is exceeded, provinces and territories, as well as the federal government, might become involved. Due to a significant investment by the Government of Canada and pandemic planning that occurred for many years prior to the outbreak of H1N1, the Health Portfolio was prepared to respond to this latest pandemic.
The 2006 Canadian Pandemic Influenza Plan for the Health Sector was the basis of our Canadian response. While this plan provided a pan-Canadian framework for preparedness and response, every jurisdiction has to develop their own plans and response structures.
For Health Canada and the Public Health Agency, we have a Health Portfolio Emergency Response Plan that operationalizes our joint response to any emergency. During H1N1, this plan was used to define our response structure and procedures for our staff.
Our plans, including the Canadian Pandemic Influenza Plan for the Health Sector, our Health Portfolio Emergency Response Plan and the North American Plan for Avian and Pandemic Influenza, were tested through a number of exercises prior to the H1N1 outbreak.
The Public Health Agency also manages and maintains a state-of-the-art Emergency Operations Centre on behalf of the Health Portfolio. This serves as the hub to coordinate our response to significant events. Our operations centre was rapidly activated in the earliest days of the virus being detected in recognition that such a virus would have a national and international scope.
Our agency is also responsible for maintaining a National Emergency Stockpile System, which we call the NESS. This system contains a reserve of medical resources, including hospital equipment, pharmaceuticals, including antivirals, and provides surge support to the provinces and territories when requested. Since 2004, after the agency was created, NESS has been enhancing its pandemic stockpiles.
Finally, our strong links to international, federal, provincial and territorial partners enabled us to have a successful response to this outbreak. We maintain a strong linkage to the World Health Organization as part of our commitment to the International Health Regulations. We also have international liaison officers placed in Ottawa and elsewhere in different countries who maintain our linkage to our international partners. From the earliest days, information was rapidly shared via teleconferences with our North American partners as well as our provinces and territories.
I would like to take this opportunity to speak briefly to some of the challenges that the Health Portfolio faced. Since the SARS outbreak, we have indeed enhanced our ability to gather all of the resources from across our department to respond to emergency events. We adopted an incident management system that helped coordinate our logistics, operational, planning, administrative and communication teams during the response.
In the first wave of the pandemic, we started off with an exponential tempo and escalated our response rapidly, which then morphed into a marathon rather than a 100-metre sprint. Although we were able to sustain our response this time to both waves of the pandemic, activating our operations centre so quickly and running it 24/7 at full capacity for weeks put the agency and the Health Portfolio at risk of exhausting its human resources, especially our medical and technical experts, who were limited in number.
Pandemic H1N1 tested the agency's ability to respond to a pan-Canadian and international public health event. After close to a year of activation of the EOC, the agency is now one of the most well-rehearsed federal departments in emergency response. We have demonstrated our ability to work together as a Health Portfolio and have strengthened our coordination with Public Safety Canada and other federal departments.
We are seizing this opportunity to build on this experience and will continue to exercise, update and test our plans and protocols. We believe that the organizations that worked together during this experience now have a much better understanding of how we respond together in the future.
The Chair: We are coming out to see the Emergency Operations Centre. We have it on our schedule, so we look forward to you giving us the tour and telling us how it works.
I will now go to Dr. Gully, Senior Medical Advisor for Health Canada.
Dr. Paul Gully, Senior Medical Advisor, Health Canada: I would like to complement the presentations of my colleagues by giving you a description of some of Health Canada's key activities in emergency preparedness and response, both before and during the pandemic of H1N1, as it relates specifically to on-reserve First Nations communities.
The First Nations and Inuit Health Branch of Health Canada did receive $6.5 million of the Government of Canada investment over five years in order to strengthen federal public health capacity and surge capacity and to work with communities on emergency preparedness planning, training and integration with provincial health authorities. Thus, Health Canada was able to work directly with First Nations communities to provide pandemic planning support for several years prior to the H1N1pandemic. This included development of templates for community pandemic planning and testing, as well as mass immunization.
Approximately 80 per cent of First Nations communities had an influenza pandemic plan in place before the start of the pandemic. By the end of the first wave, 96 per cent of those communities had a plan in place; by the end of the second wave, 98 per cent have plans in place and 87 per cent of those have tested the components of those plans, such as for mass immunization.
In response to the SARS outbreak in 2004, Health Canada purchased personal protective equipment in order to protect the health and safety of health care workers providing services in First Nations communities. At the onset of the H1N1 pandemic, Health Canada distributed those supplies to First Nations communities, including those that are remote and isolated, and it purchased additional equipment during 2009 to meet the estimated surge capacity needs later in the pandemic.
Due to the outbreaks of H1N1 in Manitoba in May and June, the First Nations and Inuit Health Regions of Health Canada worked quickly with the provinces to preposition antiviral medications in remote and isolated reserves by July of last year.
Health Canada has been engaged in collaborative federal preparedness and response for a number of years and works collaboratively with provincial, regional and local entities to ensure that the considerations of First Nations are well integrated in overall planning efforts. Prior to the pandemic, Health Canada had developed a strong relationship with the Assembly of First Nations and the Public Health Agency of Canada through a three-year trilateral work plan on pandemic influenza preparedness. Together, we produced culturally appropriate posters, which were well received in communities and were reordered.
Starting in 2004, Health Canada participated in the federal-provincial-territorial pandemic influenza committee to develop Annex B for on-reserve First Nations of the Canadian Pandemic Influenza Plan for the Health Sector. This annex provides guidance to all levels of government in planning for pandemic preparedness in on-reserve First Nations communities. It was revised during 2009.
In June 2009, Indian and Northern Affairs Canada and the First Nations and Inuit Health Branch developed a joint H1N1 action plan which covers key areas such as standardized water accessibility, emergency and business continuity planning. The group also developed a communications protocol, which played a key role in the sharing of information between the two organizations and with First Nations.
Our collaborative efforts with provincial public health counterparts made a significant difference in our collective response, whether it was the completion and testing of the plans, the timely prepositioning of antivirals or the efficient rollout of vaccines for mass immunization.
Health Canada, in collaboration with the provinces and First Nations communities, achieved coverage of immunization of 64 per cent.
Health Canada will continue to assist First Nations communities in building and strengthening their plans by providing education tools, templates, workshops, teleconferences and tabletop exercises.
We will also continue to work closely with Indian and Northern Affairs to ensure that community-led pandemic plans are well integrated into the INAC-supported all-hazards emergency plans to support a cohesive and coordinated approach to planning, response and resource utilization. We will also facilitate the integration into provincial and regional health authority plans. We will work with partners and stakeholders to identify and further clarify the roles and responsibilities of all players involved regarding First Nations.
In conclusion, we will continue to build on our collective H1N1 experiences and apply them to our day-to-day public health initiatives. This was actually done in early July 2010 when a community in the Saskatchewan region suffered the consequences of a tornado. The community had adapted its pandemic plan to respond successfully to this emergency. The community's chief stated that the "extremely well-organized response," as he described it, can be attributed to that community's modified version of their pandemic plan being put in place immediately following the tornado.
As a result of H1N1, the level of preparedness on reserve has significantly increased. However, important work remains to be done to prepare First Nations communities for future pandemics and other public health emergencies. We will target the areas of improvement identified during H1N1 and are committed to helping First Nations communities prepare for any future pandemics or public health emergencies.
The Chair: We will now hear from Paul Mayers of the Canadian Food Inspection Agency.
Paul Mayers, Associate Vice-President, Programs, Canadian Food Inspection Agency: I wish to thank the committee for inviting the Canadian Food Inspection Agency to present an overview its work.
With regard to pandemic preparedness, the CFIA focuses its work on preventing, preparing for and responding to federally controlled diseases which threaten animal as well as human populations.
[Translation]
In 2007, the CFIA joined the Public Health Agency of Canada, Health Canada and Public Safety in planning for avian and pandemic influenza. The agency provided, and continues to provide, expertise on animal disease prevention, detection and control.
With its counterparts in the U.S. and Mexico, the CFIA contributed to the North American Plan for Avian and Pandemic Influenza (NAPAPI). The principal areas addressed in the plan were, among others, avian influenza and border monitoring and control.
The CFIA's focus was primarily on avian influenza as the more likely source and risk for pandemic influenza. This concern drove the development of significant CFIA programs, policies and scientific research.
However, the emergence of HIN1 and the identification of infected swine required further adjustment to existing plans.
[English]
In adjusting to H1N1, the CFIA developed an H1N1 policy in collaboration with international and domestic animal health, public health and industry stakeholders, and has entered into a memorandum of understanding with agriculture officials in Mexico and the United States that provides direction on effective disease notification and appropriate trade measures when the H1N1 virus is detected in swine herds.
Looking forward, public and animal health officials from multiple levels of government in Canada continue preparing with a document entitled, "Human Health Issues Related to Influenza in Swine in Canada," which addresses issues such as public health management strategies, infection control, vaccination and preventing virus re-assortment. The CFIA's measures in this regard fall within four broad areas: prevention and early warning, preparedness, communications, and response.
With regard to the first measure, prevention and early warning, our activities centre on animal surveillance, bio- security and import controls.
Our second measure is preparedness. Extensive emergency response plans and protocols have been developed to address a variety of scenarios. These plans are coordinated with our provincial and territorial partners, and include joint foreign animal disease emergency support agreements.
On the third measure of communications, the agency devotes considerable effort to ensure that the most reliable and recent information is available to decision makers, stakeholders and Canadians.
[Translation]
Our final measure is response. The plans that I mentioned earlier aim to achieve the following goals: quickly detecting newly infected livestock, halting the spread of the disease through movement controls, and rapidly destroying infected livestock.
During actual A1 and H1N1 diseases outbreaks here in Canada, the CFIA has provided rapid and effective protection to safeguard Canada's food supply and economy.
[English]
We constantly monitor the international situation and work closely with our trading partners. We also continue to guide our efforts based on the most current internationally accepted understanding of influenza viruses. The agency uses this intelligence to ensure continued preparedness in protecting Canadians and our animal resources.
We look forward to your questions.
The Chair: I would like to welcome Senator Wallace from New Brunswick, who is here today substituting for Senator Martin. Also, Senator Dickson substituting for Senator Eaton. Thank you for joining us.
Mr. Lavoie, in your statement you talked about the need to improve the challenging issue of reviewing procedures and improving communications. In particular, you mentioned the release of information to employees in the public and the private sector as being very important. You also said that you encourage federal departments and agencies to look at opportunities to validate their plans in future exercises. That last statement seems to be a soft approach as opposed to compelling them to do that. If maintain a soft approach, it may get shovelled to the back of the line in terms of receiving the important attention it deserves.
With respect to H1N1, we had a mild pandemic, but what if it gets more severe? What if it becomes a moderate or severe pandemic? A soft approach does not sound like enough.
Perhaps you could comment on that, as well as this whole question of communications. I think we will spend a lot of time on communications with the public because we found that many people came to the conclusion that it was not necessary to get the vaccination. In fact, they were getting mixed messages; they were reading the negative information in the press. We could not seem to get the message out strong enough, and there were even suggestions that the federal and provincial messages were not coordinated well enough. Communications will be a big issue for us to deal with going forward.
Given your comments, you said it does need a review and you spoke about encouraging federal departments. Can you comment further?
Mr. Lavoie: Absolutely.
During the response phase, when we had the first phase in the spring, over the summer, right away, Public Safety Canada designed an exercise that we made available to departments and agencies. My deputy minister wrote to them and told them that they needed to exercise their pandemic plan based on this information.
We followed up and did a first assessment in August and found that approximately 70 per cent of the departments were complying with the exercise and the rest of the standards they needed to have in their business continuity planning. We did another round, and by the middle of the second phase, about 90 per cent of them were complying and had done an exercise.
Now we are going back to them with a much clearer set of guidelines about how they need to plan for emergency management. The Emergency Management Act tells them that they must identify the risks, plan, exercise and adjust.
You may remember that the Auditor General did an audit of our activities last fall. One of her comments was that we need to have — she did not say that — a little bit of a stick, and we will assess the level of preparedness of departments. We will start in 2011 with the departments that we consider have a key role in supporting the continuity of government and those that we figure have an emergency support function. We are talking about the Department of Industry, the Health Portfolio, Transport Canada, the RCMP, those kinds of organizations. We want to ensure that they meet the exercise requirement, the planning, the actual evaluation of their plan, and we will then expand that to other groups.
The Chair: You said 70 per cent have responded. What about the other 30 per cent?
Mr. Lavoie: No, 70 per cent were in compliance, and by the middle of the second phase, over 90 per cent were in compliance.
The Chair: It sounds like you are compelling them to do this as opposed to the softer words you used here. That is good to know.
Let me ask a question of the Public Health Agency, and the question will be similar to one I will ask of the Canadian Food Inspection Agency.
Dr. Tam, you said that the Emergency Operations Centre was activated quickly and was up and running 24/7 but that this put the agency at the risk of exhausting its human resources. That was a mild pandemic. Do you have the resources now to deal with not only a repeat of the H1N1 scenario but something more severe? Do you have the resources that you need?
I ask the same of the Canadian Food Inspection Agency. You tell us about all the expertise you have here, but do you have enough of it? When we went through the listeriosis controversy, there were many questions about whether you had the resources to deal with it.
I would ask Dr. Tam to respond to the issue of resources and then Mr. Mayers.
Dr. Tam: From my perspective, I have seen an enhancement since SARS. During the SARS crisis, small groups of Health Canada employees were working flat out trying to respond. During this event, with the emergency response platform — the portfolio — in place, and by adapting our management structure, we managed to pull human resources from across the multiple different branches of the agency.
This works for certain positions, mainly many supportive functions such as logistical, administrative and some of the planning and policy positions, not to forget that just briefing the machinery of government takes a huge team almost as large as the expert groups that one needs. Our Chief Public Health Officer indicated that this was the priority and that everyone would focus on it. If you are summoned to work, you come to work as part of the response and you can reprioritize other work later. This was a really good approach.
However, there are definitely certain key positions amongst leadership positions and some of the technical expertise where I feel we do need to enhance this in the future. Dr. Skowronski alluded yesterday to the fact that it takes time to train influenza epidemiologists and influenza experts. I spent about 10 years working on influenza to feel comfortable in being able to manage an event, and we need more people who have been in the field for a long enough period of time.
Many enthusiastic epidemiologists came forward to help, but training them in the middle of an outbreak is definitely a challenge. I think we met the challenge. There is no exercise as big as the one we just had. We will be able to use this event to train more people on a more continuous basis.
The Chair: This is a problem going forward. You are telling us your experiences with the H1N1 pandemic, but I am trying to look forward. Do you have the resources you need, particularly if the outbreak is more severe?
Dr. Tam: If it is more severe, we would need more resources, particularly in subject-matter expertise in some of the technical positions.
We will continue to train people to function in an emergency response organization, but I think this speaks to some of the previous recommendations from the SARS experience about building public health capacity. We have put in place many programs to build up public health capacity in Canada, but it does not happen overnight. This is what I would consider a 10-year project plan.
The Chair: Mr. Mayers, with respect to the way forward, do you have the resources you need or do you need more?
Mr. Mayers: In terms of resources in this area, because of avian influenza and our previous experiences with avian influenza since the 2004 initial outbreak, the government has invested quite significantly in terms of preparedness. As a result, the agency is well positioned in terms of its resources. We have learned in exercises and real application in response to such outbreaks that we can move expertise and on-the-ground capacity to the areas that are responding to animal disease outbreaks in a rapid and efficient manner. In each case where we have had live exercise, if you will, dealing with real avian influenza outbreaks, we have been able to mobilize the resources necessary to control, contain and ultimately eradicate those diseases. We are satisfied that we are in a position to respond appropriately.
Senator Merchant: I will follow the same line of questioning because I would like to probe some of the realities. We heard from you this morning that you had gone through years of preparedness and that you have state-of-the-art facilities, but I would like to know why the vaccination rates were so low. I think the government had a target of about 70 per cent, and in the end we saw that around 40 per cent of the public felt the need to be vaccinated.
With respect to some of the reasons that are known to you, first was the failure to communicate the risk of the pandemic and the safety of the adjuvant. I think that has come across clearly.
Second, there was difficulty with the sequencing guidelines that gave priority to high-risk groups, but sometimes that was not followed on the ground in the different areas of the country, which confused the public.
Third, there was an inability from Ottawa to fully inform the provinces of the weekly vaccine supply, which impeded their planning.
What would you do differently if you had another chance? You mentioned that this was a mild form of the virus. You talked about the strain felt by staff in your departments. What would have happened if the outbreak had been more severe and if another public health issue had come up at the same time? There was terrible confusion. People were confused about the vaccine.
Dr. Tam: To finish the comments on capacity, I think we are rapidly building our abilities to harness capacity across our agency and the portfolio. However, I think in many other events, we can leverage the public health agencies in provincial jurisdictions, such as the BC for Disease Control and the agencies in Ontario and Quebec as well. A pandemic is more challenging because the issue is coast to coast. However, we still had panels of experts come forward to help. This was very much a provincial-territorial as well as a federal response.
We managed to deal with this pandemic situation together with preparedness for the Olympics, the Vancouver 2010 games. We had to modify our emergency response so that we managed both. At the Vancouver games, we did exercises in another room alongside our pandemic response, which was occurring in the main theatre. We were able to, in real life, manage two simultaneous events. We even thought, "What if another event were to occur?" I think we are increasingly able to manage a situation such as that.
With respect to communication, I do not want to underestimate the amount of preparedness that was done ahead of time from all levels of government. We did have communication networks in place, an annex in our plan that was tested ahead of time.
Our federal-provincial-territorial communication leads participated in teleconferences every day. Their aim was to inform the public and to provide clear and harmonized messages. They tried very hard to do that. They agreed on key messages. Again, the communication environment is very complex in Canada, and people adapt those key messages to their local and other needs.
I would agree with some of the panel members yesterday that you can do everything you can, but in the end, it is still a complex situation.
Our FPT communication networks discussed both social marketing and our public communications in two separate subgroups every single day. That is how much effort people put into this. Still, of course, it appears there is room to actually do better next time.
I would also suggest that the details about the vaccination program would probably best be discussed in the session you have to look at the immunization program itself. In any case, the outcome is a collective, national result.
Dr. Gully: I am aware that you will specifically examine the issues relating to First Nations, but I will make two comments.
First, in terms of the mobilization of staff, leadership within the organization is extremely important. I was at WHO when the pandemic started, and one of the important factors then was the recognition of the fact that this was to be a marathon, not a sprint, and that we would look after our employees, which was extremely important for staff to know. As Dr. Tam said, this was the case in the Public Health Agency. It is a question of trying to utilize and support the staff you have, especially those experts, which I think is extremely important.
Second, as you had heard me say, the immunization rates amongst First Nations communities was higher than in the general population. In fact, some of those communities reached 80, 90 and greater than 100 per cent coverage given that some people went back to the reserve to be immunized because they thought they had greater accessibility there than where they were living in the urban centres.
However, my impression was there was a high level of immunization because of the sense of threat as a result of what happened in Northern Manitoba at the beginning, where the disease went through First Nations communities, probably for good reasons in terms of socio-economic status, high rates of disease and other factors, and resulted in high rates of morbidity in terms of sickness and some mortality. Where that threat existed, the community responded. That threat was not in place in Southern Canada, apart from perhaps certain circumstances where individuals died and the threat then increased.
We in public health always have to deal with perceptions that are communicated in a whole variety of ways through social media. We have to contend with them. It will be a continuing challenge, but certainly if the threat had been perceived to be greater, then those immunization rates would have been much higher and we would all have had to deal with them.
Senator Callbeck: Dr. David Butler-Jones appeared before this committee yesterday. He talked about a review being done by the Public Health Agency and Health Canada, saying it is nearly complete. Have all of your agencies and departments been consulted on this? I know that certainly the Public Health Agency and Health Canada would be, but I wonder about the rest of you. Have you been consulted?
Mr. Lavoie: From the public safety perspective, we have been consulted not on the medical side but on the connection back to government, which is where we were active. At Public Safety Canada, we are also looking at our own lessons learned, which is what we call them. We are looking not only at our relationship with the Health Portfolio, but we are looking at the internal systems we have in place and the lessons learned.
Senator Callbeck: What you are doing is really separate from what Health Canada and the Public Health Agency are doing; is that right?
Mr. Lavoie: I would say it is complementary. We contribute to theirs and they will be part of ours.
Senator Callbeck: What about the Canadian Food Inspection Agency?
Catherine Airth, Associate Vice-President, Operations, Canadian Food Inspection Agency: From our perspective, we too activated a national emergency operations centre. We conduct lessons learned as part of our process, a way of continuous improvement.
The other piece we have traditionally followed in the last five or six years is that we embed a person from CFIA in the national emergency operations centre with the Public Health Agency and vice versa so that we are able to ensure we are making the connections between the two. That would extend to the lessons learned exercises in making sure that both sides are informed in terms of respective responsibilities.
Senator Callbeck: Are you part of the evaluation, then?
Ms. Airth: Yes, we would be.
Senator Callbeck: With respect to the emergency response plans, as I understand it, the Health Portfolio Emergency Response Plan is prepared by the health agency and Health Canada. Then you have the Federal Emergency Response Plan under the Minister of Public Safety, and both plans work side by side. Who is really in charge here? Is it the Minister of Public Safety? Is it the Minister of Health?
Mr. Lavoie: There is an integration. As the federal government over the years has dealt with various emergencies, such as H1N1, the blackout, the ice storm, returning people from Lebanon and so forth, we have learned that we need a common way of responding to emergencies so that we do not reinvent the wheel whenever something happens. We can fall back on a system that people know and have tested, with well-defined roles. That is the Federal Emergency Response Plan.
The Public Health Agency and Health Canada have worked with the provinces to develop the Canadian Pandemic Influenza Plan, and through that we connect the Federal Emergency Response Plan at the federal level. Just as Health Canada, the Public Health Agency and CFIA have their partners in the provinces, we have our emergency management partners in the provinces. That plan allows us to keep a sense of cohesion.
With respect to who is really in charge, if it is a health emergency, it is the Minister of Health. If it is an environmental disaster, it is the Minister of the Environment. Public Safety Canada comes into play if the emergency involves the provinces or if it involves many departments. We come in with a process and we assist.
Senator Callbeck: You have to be asked by the provinces to go in; is that right?
Mr. Lavoie: If we are to deploy resources in a province, yes, we have to be asked, or if the event is solely under federal jurisdiction, then we can go in. For example, a nuclear incident would require an immediate federal response, but a health emergency is a shared responsibility.
Senator Callbeck: The plan that is under the Minister of Public Safety is the Federal Emergency Response Plan, and a special committee of cabinet is under that; am I right?
Mr. Lavoie: The value of that plan is that it works no matter what. For example, during the Olympics, a group of ministers was preoccupied with the games and we were supporting that process. In the case of the return of Canadians from Haiti or Lebanon, another group of ministers might be interested, but the same process supports them.
Senator Callbeck: What about interacting with provincial counterparts?
Mr. Lavoie: Do you mean at the ministerial level or at the level of officials?
Senator Callbeck: Either.
Mr. Lavoie: At the level of officials, which is my area of expertise, I have a monthly federal-provincial-territorial meeting with my counterparts. Most of the time the meetings are conducted over the phone. Since 2004, we have built the framework for emergency management in Canada, which guides how we approach emergency management. We develop common tools and we talk about collaboration. During the H1N1 pandemic, we kicked that down to the operational level. For example, in Quebec the emergency management group was a key player. The Minister of Public Safety was the lead over there because their premier had decided that.
In Alberta, when they started having problems with the vaccine distribution, they called in emergency management and gave them a major role. At the federal level, we got that community together, allowed them to share information so they could be on top of the information that was coming along.
The Chair: Did a special cabinet committee coordinate all of this during the H1N1 pandemic?
Mr. Lavoie: In the case of H1N1, I do not remember whether there was a special committee, but I believe it was under OPS. I can check, but we did report to ministers.
The Chair: We have a silo system here, so we have to see whether it is all coordinated, and that is the nature of the questions being asked.
Senator Seidman: I will continue to pursue this line of questioning because I am finding it a difficult to understand who is really in charge. There are so many levels of jurisdiction and so many different agencies that it sounds very complicated. It reminds me of the oil spill in the Gulf of Mexico, trying to figure out who was in charge and how it would all work.
I want to ask you about the Emergency Management Act and the Emergencies Act themselves because we were heading there with Senator Callbeck's questions about committees.
Some are calling for changes to the federal legislation around emergency preparedness. They say that the Emergencies Act and the Emergency Management Act do not effectively overlap. Indeed, there are all kinds of issues around getting the consent of the provinces. The municipalities are ultimately in charge.
People have called for a new agency to handle the pandemic mandate and all the resources needed to intervene at all levels of government. Could you comment on that, please?
Mr. Lavoie: Would you like me to comment on the creation of a new agency?
Senator Seidman: Could you discuss how effectively the Emergency Management Act and the Emergencies Act allow the multiple levels to coordinate things and then comment on the idea of creating one agency that would coordinate everything to do with pandemic issues, giving that agency the mandate on every level of government and the resources?
Mr. Lavoie: I believe the Emergency Management Act was enacted in 2007. We have made great strides with that. It has modernized the thinking about emergency management.
Back in the mid-1990s, Treasury Board issued a list of 10 or 11 departments and said, "You are responsible for this, and you need a plan." That was the end of it.
Now, the Emergency Management Act says that the Minister of Public Safety is responsible for coordination, and if there is a void, the minister steps in until something happens.
It also says to all other ministers that they are responsible for identifying within their area of legislative mandate the threats and risks, and they must develop plans accordingly. It is clear that we still need to live with it for a few years, but ministers now know that they must be ready. For example, if they deal with natural resources and the supply of something and there is a breakdown in that supply, they must be ready to act. Public Safety Canada is there to support them. We cannot be the expert in everything.
As to the creation of an agency, that is pretty much what the government did in 2003 following the SARS outbreak. Dr. Tam was part of the team that responded to SARS. I think that was the focus when Public Safety Canada was created and the Public Health Agency was created as a separate agency. Dr. Gully was also there at the time, so I will defer to them.
Dr. Tam: Certainly from the perspective of pandemic response, the Public Health Agency has a very clear leadership role. The Minister of Health is the lead minister when it comes to health events such as this. I think that is clear.
We work under the Federal Emergency Response Plan as one of the 13 essential support functions. We know what we have to do and we have committed to doing the risk assessments, including the risk for a pandemic. We have committed to getting our plans in place. The Health Portfolio plan is really our organization's response to the requirements of the Federal Emergency Response Plan.
We do our own exercises. We link with the federal-provincial-territorial counterparts on health, and the Public Health Network Council was created to do that. The system and mechanisms are in place.
It is difficult to think of all these plans, but there are overarching plans and there are specific plans to do with departments and specific risks. We look at them as a series of nested plans.
Senator Seidman: To continue along this vein, the Canadian Medical Association conducted an analysis of physicians' legal duty of care and legal right to refuse to work during a pandemic. Physicians have historically believed that they have absolute autonomy with respect to the work they are engaged in and that they cannot be forced to work. Would you please comment on that?
Dr. Tam: I will reiterate that health is a provincial-territorial jurisdiction and that the licensing of physicians is a provincial responsibility. The federal role is to coordinate communication. We communicate with the CMA during a pandemic, but we do not have specific jurisdiction over physicians.
Senator Seidman: Would someone at the federal level have the authority to order physicians to work in a pandemic situation? We talk about taxing resources, and that is understandable, but again it becomes a question of jurisdiction. Who is in charge if there is a manpower issue and how would one deal with it?
Dr. Gully: Health Canada as well as the Public Health Agency do employ physicians, and Health Canada physicians actually do work in the regions and then do support communities at the local level. However, those physicians are licensed by the province in which they work and would therefore be bound by the licensing requirements of those jurisdictions. As federal civil servants, one could certainly encourage them to take that responsibility seriously, but as physicians, they would still have to make that decision. This applies to nurses as well.
However, that issue certainly did not arise during this pandemic. The physicians and the numerous nurses who work for us felt encouraged by the support they received and the provision of personal protective equipment to enable them to do their job.
The Chair: We have talked about a lot of plans. Yesterday Dr. Low quoted Dwight D. Eisenhower as saying, "In preparing for battle I've always found that plans are useless, but planning is indispensable." One may agree with that or not, but I think that one thing we need is a list of these plans. The deputy chair and I have asked our researchers if we could get a list of the plans in order to get a sense of the relationship between them and their pecking order. I think that would help us to sort things out. We are hearing a concern from people that all these plans, jurisdictions and silos that we all know exist in the federal field — not to mention in other governments — do not end up tripping over each other, particularly if we get into something more severe than the H1N1 pandemic.
Senator Cordy: Thank you for being a part of our study on the preparations for what will inevitably be the next pandemic, a study we were requested to undertake by the Minister of Health.
I am interested in the National Emergency Stockpile System. I am not sure if the Office of Critical Infrastructure Protection and Emergency Preparedness, OCIPEP, is still around. It was established to deal with emergencies that might take place within Canada.
Do the Public Health Agency, the Department of National Defence, and Public Safety Canada have national emergency stockpiles, or is there one stockpile to which everyone contributes?
Mr. Lavoie: I will give you the short answer and then ask Dr. Tam to respond.
OCIPEP has been pulled out of the Department of National Defence and merged with the Department of Public Safety. My area of responsibility encompasses more or less what the old OCIPEP used to do, and we have no stockpile.
Senator Cordy: So there is only one national stockpile?
Dr. Tam: Yes. The National Emergency Stockpile System is managed and coordinated by the Public Health Agency of Canada and is primarily focused on providing surge capacity to the provinces and territories in the areas of health and social services. The stockpile has been around for a long time, but for pandemic purposes we have really built up surge capacity since 2004, after the agency was formed. We maintain that in order to support the provinces and territories.
In contrast, the Department of National Defence has a different mandate, which is to support Canadian Forces members. They do exist under a different system in terms of how they take care of their members under the Canada Health Act. They have a separate stockpile geared toward their membership, which is essentially comprised of young, healthy persons working in the Canadian Forces, meaning that they do not have the volume or do not have to take care of the very young or the very old. Our stockpile is much more comprehensive and larger in volume and can be mobilized across the country.
However, DND is very much part of our planning and discussions and, wherever possible, sharing of certain things is important. For example, even with the vaccine supply, there were negotiations and discussions in terms of mobilizing a vaccine. If the Canadian Forces do not use it, the provinces get it. There is constant communication regarding supplies, but DND is different.
Senator Cordy: Thank you for that.
When OCIPEP had stockpiles, they were in a number of locations across the country. Do you have just one location at headquarters in Nepean, or are there stockpiles across the regions of Canada?
Dr. Tam: The National Emergency Stockpile System has 10 federal-reserve warehouses. We also have 1,300 other sites across Canada. They are distributed by agreements with the provinces and territories and can be accessed immediately should they be needed. The sites are dispersed because when things happen locally, you need quick access. We also have the capability — even from our largest stockpile, which is located in Ottawa — to deliver what the provinces need within a 24-hour time frame.
Senator Cordy: How do you stockpile pharmaceuticals? They have a best-before date. Do you continuously give them back to pharmaceutical companies, or do you have agreements with those companies so that you have access to pharmaceuticals? Are the pharmaceuticals actually located in your stockpiles, and how do you deal with the best- before dates?
Dr. Tam: There are different strategies, depending on the medication and on the arrangements with manufacturers. In a pandemic situation, antiviral medication is a key pharmaceutical. We do stockpile that inside our warehouses. Also, there is the National Antiviral Stockpile, which is cost-shared and distributed amongst provincial-territorial warehouses.
That is a good question because we are constantly looking at new ways to manage, in the most cost-efficient manner, a rather large piece of investment. We are looking at this in multiple ways. Science is always changing. Essentially, the regulatory piece on the drugs could change based on data as well, so shelf life can change. We are constantly trying to look at how to extend the stockpile.
With certain pharmaceutical companies, including those that produce antiviral medication, there were opportunities for us to send some back and then get a fresh supply. There are different arrangements, depending on what we are talking about. Vaccines are different, though. The pandemic vaccine is maintained by the manufacturers. We do not stockpile that inside our warehouses.
Senator Cordy: It is always a challenge when you are looking at something that has a shelf life.
Dr. Gully, I am interested in your comments concerning on-reserve First Nations communities. For 80 per cent of the communities to have pandemic plans before the start of the H1N1 pandemic is excellent.
You talked about some of the things that you did within the communities, posters that were put up and those kinds of things. I was on a committee that conducted a study on seniors. We talked about how to get information to seniors on First Nations reserves because many of them often are not aware of available programs. One of the recurring issues was posters, training and forms to be filled out in the language of the people on the reserve. Is that part of your planning? Do you actually deal with the language of the people on the reserve?
Dr. Gully: Yes is the answer to that question. That does not just apply to information in terms of promoting antiviral use or immunization or personal hygiene. It applies to other programs as well. It is very much dependent on the wishes of the community. The H1N1 pandemic demonstrated that if the community felt empowered and took responsibility for responding, then the ability of that community to have a successful response was great.
I think this also applies to the situation that we are referring to here as well. If the chief and council, the director of health and the health committee are fully engaged in the issues to which you refer, then that is good for the whole community. They would identify the issues and then the First Nations and Inuit Health Branch would respond in a variety of ways.
It is complicated because of the different levels of transfer. Some communities are supported directly; for example, our nurses are in some communities. However, for many other communities, the responsibility for primary care and public health is transferred to the community. It is even more important for that community to identify those issues because then we would be responsive.
Senator Cordy: It would be great if we could have the immunization rates and the information given to the rest of Canada as it was given to the First Nations communities.
You also said that we still have a lot of work to do. What kinds of things? Where should we look for improvements?
Dr. Gully: We have all had the "lessons learned" that we referred to. Clarification of roles and responsibilities, especially at the level of the regions, continues to need to be worked on because of the complex nature of the inter- relationship between the First Nations and Inuit Health Branch, Health Canada and the First Nations communities and the provinces. We work closely together. For those communities that are remote and isolated, it is more straightforward. For the ones that are in contact by road, for example, then it becomes even more complex.
It is much more straightforward in some jurisdictions. In Alberta, for example, most of the communities are not remote and isolated. They are connected by roads. Their inter-relationship with the province is somewhat easier. For others, we must continue to move further. As we move towards, hopefully, what is happening in British Columbia where there will be a tripartite agreement between First Nations and the provinces, supported by the Government of Canada, those relationships would have to be further clarified. That is an ongoing issue.
Senator Cordy: Mr. Mayers, do you come under the Department of Agriculture or the Department of Health? When a pandemic is declared, how do you fit within the Public Health Agency? You did an excellent job of telling us the kinds of things that you do, but what do you do on day one?
Mr. Mayers: The Canadian Food Inspection Agency is part of the agriculture portfolio. We are not part of the department. We are a separate agency, but we report to the Minister of Agriculture and form part of the agriculture portfolio.
With respect to both preparedness and response as they related to the pandemic, as noted, the Minister of Health led in the area of human health, and we supported that response in terms of information regarding the animal-human interface. The direct response concerning infected herds remained in the agriculture portfolio.
As my colleague noted, in order to facilitate that ongoing engagement and collaboration, we embedded an officer in the Emergency Operations Centre of the Public Health Agency so that there was an ongoing exchange of information to ensure that coordination. Furthermore, we participated in the broader coordination process led by Public Safety Canada.
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Senator Champagne: We are all well aware that Health Canada, Public Safety Canada and all of the partners and 13 agencies involved, which Dr. Tam was referring to earlier, did an excellent job of monitoring and implementing a meticulous intervention plan, as the chairman said, to see to it that Canadian men and women were affected as little as possible by this expected pandemic. Clearly a lot of experience was acquired during the SARS epidemic, the apprehended avian flu, and the emergence of the H1N1 flu after that.
I have a two-part question. We know that there were also some shortcomings when H1N1 emerged. We talked about communications, availability, the distribution of the various vaccines. I would like to know what the government could have done at that time to help you minimize these problems.
And looking to the future, now, what would be the most urgent needs to be met so as to optimize your preparedness? I doubt that it is strictly a matter of financial resources. There are surely other things. Does there need to be someone at the top of the pyramid?
What could we have done during the pandemic, and in the best of all possible worlds, what would you like to see, what would you like the government to do to make your job easier, should we be faced with an even more serious pandemic than what we have seen in the course of the past two years?
Mr. Lavoie: Those are two very difficult questions.
Senator Champagne: I never ask easy questions. It is not in my DNA.
Mr. Lavoie: Concerning what the government could have done following SARS, I think that it made good decisions: it created the Public Health Agency of Canada and Public Safety Canada. This was the first real national crisis we had to manage using the new structure.
Perhaps things did not get off the mark quickly enough. Perhaps our elected representatives, who can usually see things coming from quite a distance, did not whip us into action soon enough. That might be the only thing. In my opinion the government reacted very well by giving us the attention we needed. We were able to send information to cabinet very quickly. The usual turnaround times were shortened. The government really understood that this was a crisis, and I believe the ministers adjusted very well. But perhaps things did not get going quickly enough, and they did not get on our case fast enough. I think that was one of the reasons.
I must add that it is not just a matter of funding, it is also a matter of attention. We often hear that that which is measured will move forward. I think, as the chairman was saying, that people are going to have to be somewhat firmer with regard to our level of pandemic preparedness. And I mean within the federal apparatus. I think that there are situations that may be harder to manage at the federal and provincial levels when there are shared legal responsibilities.
Senator Champagne: You say that they did not get on your case fast enough. Were they made aware of what was going on soon enough? Because our cabinet colleagues are not epidemiological experts. In fact, you had to sound the alarm, or one of the 13 agencies had to do so.
Mr. Lavoie: That was done but we did not get going quickly enough overall. That said, in Canada we did get off the mark quickly, very quickly if you compare us to other countries.
If you look at what happened in Mexico and the United States, as soon as there were indications that something was going on, there were messages in airplanes, and border monitoring was increased. They made sure that people who had symptoms were advised.
At the very beginning, this was the first time that the whole system worked together; but we very quickly reached our cruising speed.
Senator Champagne: And what about the future, Mr. Lavoie?
Mr. Lavoie: For the future, I think we have learned a great deal. Earlier Dr. Tam was saying that this was the best exercise we could have had. Fortunately it was not too deadly, the virus was not too virulent. We learned a lot through this. And what we had put in place proved to us that we have some good foundation blocks to build on.
Decisions were made through consultation. You asked if someone should be in charge of everything. That is something that needs to be assessed once all of the lessons learned have been absorbed. However, I can tell you now that throughout the process, I knew who was in charge and I knew whom to support. And when I was asked for assistance, I provided it if it was in my area, and if it was not, I found a solution because it was my minister's mandate to find solutions. And so, given that, the operational structure worked well.
Senator Champagne: Does anyone else want to answer for yesterday and tomorrow?
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Mr. Lavoie: I would agree with my colleague that this is the biggest "exercise" we would ever get. This kind of opportunity does not come around frequently, thank goodness. However, the plans were there and we utilized the plans. It is really the process of planning that helped us identify all our partners and helped us prepare ahead of time.
It is really important to capture our experience this time. When we did our planning for the vaccine strategy or the antiviral strategy, it did not get all the way down to the absolute minute details of how you get a pill into someone as fast as possible. This experience will be extremely valuable for the next time. How do you get medications quickly? How do you get vaccine programs running really fast?
I do believe that all authorities worked diligently, with a single goal in mind, which was protecting the health of Canadians. Antivirals are not used very much for seasonal flu in Canada. We do not know how to dispense antivirals in the timelines that were required. Now we do know, and the next time we had better be using the experience that we have just gained, because there is no exercise that I can design between now and the next pandemic that will be better than the one we just had.
With regard to what the other witnesses have already mentioned in terms of desirables and augmenting our abilities, communication always comes up at the end of any event as being an area for improvement. I do not think there is any doubt that we can do better.
However, I want to emphasize that a tremendous amount of work was done. There were some tangible, positive results in terms of Canadians hearing the right messages about personal hygiene, coughing into your sleeve, et cetera.
The vaccine is very complicated given the environment we are in, and we had better capture how some of the jurisdictions did a really good job mobilizing. Perhaps others who had more difficulties could learn from the shared experience.
Surveillance underpins much of the decision making in terms of evidence, so we know that this can always be improved. Everyone shared information really fast. I have to emphasize that when I looked at the first days of this pandemic, with Mexico sharing information very quickly with the United States, we could not have had a much better heads-up to this event. We activated really quickly. There was no slowness as far as the Health Portfolio was concerned. Our operations were ramped up in a matter of hours to deal with the situation, in anticipation that it could be worse.
I think that a better ability to share clinical, laboratory and surveillance information is always desirable, but our labs did very well.
Lastly, you will, I think, examine the vaccine program carefully. This program is the biggest mobilization of a mass vaccination campaign in this country, and we must not lose the opportunity to really capture that.
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Senator Champagne: What would you like to see us convey to the various ministers in the core of our report?
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Dr. Tam: I am sure I can wish for many things.
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Senator Champagne: The report will be long enough to include a number of things.
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Dr. Tam: I want to emphasize that our "lessons learned" is in consultation not just with other federal departments but with other stakeholders, Aboriginal leaders and others with whom we have interacted over this response. Much of our focus would concentrate, of course, on the federal response and how we, as the portfolio, could do better the next time.
Senator Ogilvie: I have a request of the chair and I on behalf of the committee, and then I have two specific questions.
It is my understanding that we have attempted to get a flow chart of the organizational structures and that both PHAC and Health Canada have been asked for such a thing and nothing has arisen. Having read the documents on the nature of our Confederation as well as the structural organizations we have throughout at the federal, provincial and other levels, I am not sure anything short of a hologram or 3D glasses would be helpful, but it would be tremendously useful to the committee.
Mr. Lavoie, given your title and that of your organization, on behalf of the committee, I would ask if you could come up with a flow chart. I realize that you may need to use different colours to show the various jurisdictions, but could you give us something so that would help us visualize the organizational structure? The acronyms, et cetera, are there. I will leave that issue with you.
I want to come back to the communication issue. I realize that you do not and do not wish to control the free press in any way. I saw some creative things both in headline form and in the explanations within our free press and our visual press that clearly caused difficulties for the public and that probably caused you difficulties in trying to manage communication.
Leaving that aside, I wish to ask a specific question. Suppose there is an issue with getting out a comment on the safety of the vaccine. Which of these many boxes has the responsibility of coming up with the final statement on the safety of the vaccine, and then which box issues that message to us?
Dr. Tam: I will respond first, and then Dr. Gully will respond.
There is a regulatory component as well as the overarching public health message. On the overarching public health message about the safety of vaccine, the Public Health Agency would put out that message.
Having said that, the message that is put out would undergo extensive analysis based on the information that is collected, collectively, from the local level up. There would be a reliance on the special studies and the special surveillance systems that were set up. We would then discuss those messages with the provinces and territories and the experts in our pandemic vaccine task groups and our vaccine safety committees, et cetera. They would be consulted before drawing a conclusion on the vaccine, but the message itself would come out of the Public Health Agency through our Chief Public Health Officer.
Dr. Gully: Health Canada has regulatory responsibility in terms of determining safety and efficacy. Health Canada would then advise the minister, and the minister would make that decision in terms of "licensure." As Dr. Tam said, I think the public messaging about that safety in this event would come from the Chief Public Health Officer.
With respect to the issues of the evaluation of safety and what happens after the distribution phase, the surveillance system for that is within the Public Health Agency of Canada. The regulator would have access to the information and would consider it in terms of whether the requirements for licensure and continued distribution need to be changed. However, the public messaging would come from the Chief Public Health Officer.
Senator Ogilvie: My second question deals with an aspect that did not arise in this pandemic but could well with regard to certain agents, particularly if they were far more virulent or in another area. That is the issue of quarantine. Who would make the decision? If it is a minister, who would make the recommendation to the minister with regard to a quarantine on a community or individual travel restrictions within the country or on entry into Canada?
Dr. Tam: The Public Health Agency of Canada has a quarantine service, and we essentially oversee the Quarantine Act. There is a Quarantine Act. We partner with Health Canada, which is in charge of actual vessels, if you like, the ships and the planes. We are in charge of the people inside the ships and the planes.
The Quarantine Act has quite broad powers regarding the ability of our quarantine service to stop travellers at the international border, people moving in and out of Canada in terms of whether they pose a threat to the safety of Canadians. We do already have that power.
The quarantine service was operational at the very start of this outbreak. When we knew that the cases in Canada may have been related to travel to Mexico, for instance, we worked with the Canada Border Services Agency and others to screen, to put out health alert notices at the borders, to meet planes that were coming from Mexico, with the idea that we could potentially stop symptomatic people from moving on.
Quarantine at the individual and community level is the responsibility of the local medical officer of health. They have broad powers, as you have seen with the situation of SARS, in being able to quarantine people in their own jurisdictions. I will not comment on that specifically, but the federal government does have jurisdiction at the international border.
Senator Braley: I wish to make a comment and then ask for your thoughts.
You could not convince me to be vaccinated. I assume you thought everybody in Canada should be vaccinated. You could not convince 75 per cent of my employees across Canada to be vaccinated, but only 25 per cent did. There must be a communication problem with the customer.
I manage technical companies, and we have great technical people who do all sorts of beautiful operational things. We design things, build them and then sell them to car companies and what have you. However, if we do not convince the customer to use what we are producing, we are failing in some form. I understood it was around 40 per cent.
We have to reach out and touch the customer. Theoretically, that should be done under one spokesman. If the same message is delivered and if something comes up, he or she corrects that message. Has that been developed in the overall plan or tent for managing operations and delivery? Who is in charge? That is what it comes back to. It is a simple thing, but we want the customers, the people of Canada, the public, to be safe. How do we improve on that performance?
We must ensure that this gets the same attention as the operational side. It takes fewer people, but equally brilliant people, as it does on the operational side.
You have done a great job in the test. I know about the amount of work that has been done at McMaster University on infectious diseases, but we could not convince the people in my community to use the vaccine. That is a problem. I would like your comments on how we can fix that.
Dr. Tam: We would certainly accept any findings from your study to improve the situation.
I think that, recognizing all the difficulties, we did have among the best coverage in the world. That is the bottom line. If the pandemic had been more severe, I am sure the interests of the public would suddenly escalate and then the issue would be coping with the rush of people who would want the vaccine. The virus is unpredictable, and that could actually change public perception. Vaccine coverage rates could change overnight, depending on what happened the day before. It is quite a challenging thing to actually get a handle on.
Having said that, yes, we do have to understand the customer and our audience, the general public, which can be divided into high-risk groups and those that are not. How do you target high-risk groups versus people who may not care quite so much if they do not get vaccinated?
Health care workers represent another group that we think about on a seasonal basis as well as on a pandemic basis. The Health Canada statistics released this morning, which you probably will get copies of, indicated that overall vaccine coverage was over 40 per cent. The vaccination rate for health care workers was 66 per cent. It was higher, but could it have been higher still? Yes, it could have been higher. The provinces and territories have looked at many different methods for trying to convince health care workers to be vaccinated, but that is a key area that we need to have a further look at.
The vaccination rate for people with chronic medical conditions was 55 per cent. However, 76 per cent of the people who normally get seasonal vaccines received the H1N1 vaccine. This means that we have an opportunity every single year to help improve that rate. People who regularly get vaccinated, who recognize the importance of the influenza vaccine, seem to get the message during a pandemic.
Again, every pandemic will be different. How we scale up, scale down or remain flexible to the situation is definitely one area that will be looking at.
Senator Braley: Instead of calling it public relations, maybe you just need a great salesman who is the spokesman.
Dr. Tam: Great spokespeople are very important, for sure.
Senator Braley: You are brilliant people. The question is that you are dealing with silos all over the place, and the message to the masses was not there.
My family discussed at some length whether the vaccine was safe and whether it had been tested enough, and we did not have the sense of comfort that it had. The lineups were gone in two days in my community. We thought it was probably not important because most people did not think they should be vaccinated. When my general practitioner called and asked if we wanted to be vaccinated, we made the decision not to be. My wife is a nurse and she was not vaccinated.
How do you convince the general public? You need a spokesman. I am just trying to respond to what you said. As much time must be spent on communications as is spent on the operations side — the testing and all the things that have to be done — because if it is not, your customers will not use the vaccine.
Dr. Gully: The context is important in relation to immunization in general. You would have seen in the last number of years — not necessarily in this country, but the information does travel — concern about the polio vaccine in certain parts of the world, the whooping cough and the measles vaccines in the United Kingdom, where those in the medical community who are against the vaccines were highly influential in creating a sense of real concern and skepticism about the safety and the means of assuring safety. That is very much in the background.
I agree with Dr. Tam. During a pandemic, if the threat is there, which was certainly the case in First Nations communities, then people would get the vaccine.
We are continually promoting immunization, battling against a fact of life where the anti-vaccine lobby can get information out very quickly through the social media, which can then quite rightly make people think.
Senator Braley: I agree with you, but are we putting into operation something to deal with it?
Dr. Gully: We attempted to do that during the H1N1 pandemic, but as we see from the figures, we collectively could have done better.
Senator Braley: We need to improve and spend time on that. For example, was there one spokesperson or did each department speak on its own?
Dr. Gully: There was one spokesperson — the Chief Public Health Officer.
The Chair: You also have other levels of governments to deal with in this context too, provincial governments and what happens at the local level. How do you pull that together to create what Senator Braley is looking for in terms of one spokesperson? Is it the federal level or the provincial level?
Mr. Lavoie: The Minister of Health actually did a very good job, and Dr. Butler-Jones, the Chief Public Health Officer of Canada, did very well. They travelled extensively and were criss-crossing the country.
I will be more blunt than Dr. Gully. When the government puts out information, every single radio station and TV station across the country finds its own specialists to say what is wrong with what the government just said. That gives people information from two different sources. The credibility of these two sources is not necessarily the same. I am not taking away from the credentials of the individuals, but extensive research and discussion has been done at the federal-provincial level and then the critics get the same amount of airtime. That is a reality we deal with in society and that is fair.
I agree that we need to do more and get more into the social media. We need to be able to harness what is out there. Your comment is good, but that is part of the challenge we are facing.
Senator Braley: In our business we find the best people to market, even though we call it public relations. We need real strength in that department because you have to take competitors head on or you lose.
You were successful; you did a lot of good things. Thank goodness it was not a horrific pandemic with thousands of people dying every month.
The Chair: We are dealing with multilayered government as opposed to business in this case. There may be lessons from business practices, but government is much more complex and divided.
Senator Dickson: I support the previous comments of senators regarding the issue of communications. I will refer in some detail to Dr. Low's paper. Hopefully you have read Dr. Low's presentation from yesterday. He was one of our witnesses, and I think Dr. Tam referred to Dr. Low.
In his paper he said that communications poses one of the greatest challenges, and it seems to me that we just were not on the ball. We were not up to date with the new way of communicating, which I find that shocking, to be honest.
I have a couple of questions arising from Dr. Low's paper. We have heard a great deal about the effectiveness of plans, that they were tested and that it was planned perfectly. At page 9 of Dr. Low's paper, he writes:
. . . much of our planning for pandemic vaccination was incomplete, and that even the best-intentioned program can be undermined by unanticipated internal and external events.
He said that much of our planning was incomplete.
Would anyone like to comment on that? How do you rationalize this? It was all tested and was all at 100 per cent, but yet a person outside of government — I have great respect for government and the effectiveness of your work and your programs. Dr. Low said people probably do not realize that we got value for money. However, on the other hand, with all the planning that was done, the plan was incomplete. I would be interested to get your reaction to that remark.
Dr. Tam: No plan is ever complete and every day you are probably building on it. Having said that, I will reiterate that this experience must be captured because before a pandemic actually arises, all the little details related to how you get vaccines out and delivered into someone's arm may not all be in place. We have a vast country with numerous local levels and organizations that are not always at the same stage of readiness.
At the federal level, we have our roles which ensure that we have a vaccine contract and that we can get vaccine out as quickly as possible. We will be looking at how to get it out faster. There are many details at different levels, which is why you get these different plans. You get nested plans because a single plan will not deal with every detail that is required to actually get the vaccine into someone's arm.
Having realized that a vaccine is central to any pandemic program, there is a really good opportunity to capture all of that at every level. Unfortunately, as the federal government, you cannot have one plan that suits everyone. Everyone has a responsibility in order to make this work.
Since SARS, with the creation of the agency, we do have a Chief Public Health Officer. Before that, we did not have that lead. He went out and did many media events and daily interventions at every radio station. There were ads in everything. We will certainly be capturing that experience to see how much more we can do.
We also now use new social media such as Twitter, Facebook and Google. Our website was accessed frequently. We are trying to keep up with the new technologies as well.
Dr. Gully: I accept that there was a lack of understanding that one could translate into planning in terms of the procedure for licensing of vaccine and for bringing it into the arms of Canadians. I believe you will be examining that with other witnesses from Health Canada. I think that was part of it, and I presume you will pursue that further.
The Chair: We have scheduled one whole session to deal with issues such as vaccines and antivirals.
Senator Dickson: Does Canada have any membership on the WHO pandemic review committee, and if so, who?
Dr. Gully: Yes. I am being cagey because I am not sure whether that list of members is in fact public, so I think we would have to check that. Sorry for being so bureaucratic, but I know the WHO was concerned about releasing the membership of its emergency committee, as well as the membership of the review committee. Certainly the chair was concerned.
If that is public, and Dr. Tam would be able to obtain it through WHO, we could certainly let you know. I do know there is a Canadian on the panel.
The Chair: That is not a Canadian government issue.
Dr. Gully: No, an expert from Canada is in fact on that committee.
The Chair: You are saying that for sure, and you do not know whether you can divulge it because of WHO rules; is that correct?
Dr. Gully: Correct.
Senator Dickson: Referring to page 1 of Dr. Low's paper, he writes:
An article published in the British Medical Journal alleged that some of the experts advising the WHO on the pandemic had declarable financial ties with drug companies that were producing antivirals and influenzal vaccines. It is claimed that as a result, the WHO was unduly influenced to declare a pandemic and to exaggerate its potential severity . . . .
Whether there is substance to these allegations is being investigated by the WHO pandemic review committee chaired by Dr. Harvey Fineberg, president of the United States (U.S.) Institute of Medicine.
I am curious as to whether Canada is actively involved in that review — forget the person for a moment — as much as the United States. Is there any substance to these allegations?
Dr. Gully: I did work at the World Health Organization for three and half years and was there when the pandemic was declared. These findings in the British Medical Journal are certainly being examined by that committee. The Government of Canada's Public Health Agency has, I believe through the minister, submitted a report to that committee in terms of its own experience but also then in terms of its relationship and, I believe, support for the World Health Organization. I know that this particular subject is being examined very carefully by the committee.
If I might point out that the co-chair of that committee, Dr. Fineberg, also authored the review of the 1976 swine flu activity in the United States, which I know Dr. Skowronski referred to yesterday. There is some connection between him in terms of past experience and what he is doing now in relationship to the World Health Organization.
Senator Wallace: Mr. Mayers, you referred in your presentation to the H1N1 policy developed by the Canadian Food Inspection Agency. Following on that, a memorandum of understanding has been entered into with Mexico and the United States involving effective disease notification and appropriate trade measures, measures that I take would be relevant when the virus is detected in swine herds.
In terms of our trade and the impact it has on our agricultural industry — it can obviously be significant — would this be something that your agency deals with in isolation in developing the terms of these memorandums of understanding, or are you required to deal with, for example, the Department of Agriculture and the Department of International Trade and Commerce?
Mr. Mayers: Indeed, we work very closely with our colleagues within the agriculture portfolio and as well with the Department of Foreign Affairs and International Trade around these issues because the economic implications of border closures to Canadian products are significant in terms of their ramifications both for the industry and for rural communities. It is a collaborative effort.
This is one of the areas of learning for us. We have seen, not only in relation to H1N1 but in relation to other diseases, that when countries around the world take very different approaches to responding to an animal disease event, that can then translate into consumer confusion and significant economic impacts.
With H1N1, we worked very hard not only in terms of response and preparedness but as well in terms of engagement in the international context to pursue a return to normalcy. It was very clear right from the beginning that pork was not a concern in terms of transmission of the disease. Getting that message out to Canadians and to the international community was important in order to avoid border closures to Canadian pork products.
The MOU that we pursued with the U.S. and Mexico was intended to bolster that thinking by ensuring that we were responding to each other within the North American context. We anticipated that the U.S. and Mexico would see similar outcomes to those that we were observing in Canada. Our response to each other had to be consistent so as to reduce the potential for confusion in the marketplace. If we were responding to each other differently, we may not have had a good result.
Absolutely, it is a collaborative effort and an important one in terms of protecting Canadian agriculture.
Senator Wallace: Right, but are you required to consult and have their input? With respect to the U.S. departments of industry, commerce and agriculture, are you required to have their input and their okay before you entering into a memorandum of understanding? I can see that on the health issue everything you say makes complete sense, but dealing with the economic impact of something like this more properly is the focus of other departments. I want to make sure that they have to influence what goes into these memorandums.
Mr. Mayers: In terms of requirements, the memoranda focus on the animal health dimension, which is the jurisdiction of the CFIA. The reason we engage our partners is not as a requirement from an obligation perspective; it is government practice and policy to work collaboratively across the agencies involved.
Within the agriculture portfolio, of course we report to the minister, and as a result it is an automatic event on which we collaborate closely. Our interaction with DFAIT is equally a normal part of our practice, as opposed to any written obligation.
Senator Wallace: Memorandums were entered into with the United States and Mexico. Was there any need for agreements with other trading partners?
Mr. Mayers: In terms of a bilateral approach, for example, China did close its border to Canadian pork for a period of time. We entered into bilateral negotiations with China to resolve that issue. It did not require an MOU, but we pursued a similar resolution of that border closure in order to get Canadian product flowing again.
The Chair: That brings this session to a close. We appreciate very much the contribution that all of you have made to our desire to find out about pandemic preparedness and to be able to make recommendations on how we can improve the way forward.
(The committee adjourned.)