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Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology

Issue 14 - Evidence - October 22, 2010


OTTAWA, Friday, October 22, 2010

The Senate Standing Committee on Social Affairs, Science and Technology met this day at 8 a.m. to study 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]

We continue our study on pandemic preparedness and response. Today we will focus on the local level, community preparedness and response. We have three panels this morning and that will take us to 11 a.m. — one hour for each.

In our first panel we have, from the Canadian Medical Association, Dr. Jeffrey Turnbull, President. In addition to being a specialist in internal medicine, Dr. Turnbull was recently appointed to the position of Chief of Staff at the Ottawa Hospital and University of Ottawa.

Dr. Maura Ricketts is Director of the Office of Public Health for the Canadian Medical Association. She has 18 years of experience in design, implementation and management of public health surveillance systems, and in the development of public health policy for infectious diseases.

From the Canadian Nurses Association, Claire Betker is a member of the board of directors. She has worked in the public health field for over three decades and has been part of the Skills Enhancement for Public Health team of the Public Health Agency of Canada where she led the pan-Canadian consultation to develop core competencies for public health.

Joyce Douglas is a nurse consultant with the Canadian Nurses Association and has promoted high standards of nursing practice, education, research and administration to achieve quality nursing care in the public interest.

On the other side of the table, from the Canadian Public Health Association, Dr. Isra Levy was instrumental in the creation of an office for public health at the Canadian Medical Association. He was that office's first director and CMA's Chief Medical Officer. He was appointed Ottawa's Medical Officer of Health in 2008 and is also an adjunct professor of epidemiology and community medicine at the University of Ottawa.

Debra Lynkowski is Chief Executive Officer for the Canadian Public Health Association, which is an independent, non-for-profit voluntary association and a national public voice for public health for Canada.

Pamela Fralick is President and Chief Executive Officer of the Canadian Healthcare Association. She joined the Canadian Healthcare Association as President and CEO in February of 2008. The association is a leader in developing and advocating for health policy solutions that meet the needs of Canadians. CHA is a federation of provincial and territorial hospital and health organizations across Canada.

Each organization has five minutes to make a presentation. I am sorry; I wish it were more, but we are a bit rushed.

[Translation]

Dr. Jeffrey Turnbull, President, Canadian Medical Association: Mr. Chair, we are very pleased to appear on behalf of the Canadian Medical Association before this Senate committee as part of your study of pandemic preparedness and the H1N1 experience in Canada.

[English]

Earlier this year, the CMA collaborated with the College of Family Physicians of Canada and the National Specialty Society for Community Medicine to present a picture of lessons learned from the front lines of the pandemic. Together, we represent 80,000 physicians engaged in all aspects of Canada's health and public health care systems. This report includes recommendations that, if acted upon, will help ensure that a strong foundation is in place to protect Canadians from future health threats.

As president of the CMA, a practising physician and the chief of staff of one of Canada's largest hospitals, I am here to present my association's point of view. Physicians have a unique and critical role to play during public health emergencies. Many people turn to their physicians first for information and counselling. Physicians are on the front line of the defence.

As was the case during the H1N1 pandemic, this role was intensified by the confusion created by a great variation in mass vaccination programs across the country. Many physicians felt their urgent need for clinically relevant information was not well recognized by the Public Health Agency of Canada, the Public Health Network, and in some cases by provincial, territorial, regional and local levels. The lack of national leadership on clinical guidelines led to delays and the proliferation of differing guidelines across Canada.

Standard clinical guidelines adapted to local circumstances is the norm in medical practice. Nationally disseminated clinical practice guidelines on vaccine sequencing, use of antivirals, and hospital treatments would have created consistent clinical responses across the country.

We recommend that the Public Health Network seek advanced pan-Canadian commitment to a harmonized and singular national response to clinical practice guidelines, including mass vaccination programs during times of potential public health crises.

The CMA also recommends that the Public Health Agency of Canada work closely with the medical specialty societies as it did successfully with the Society of Obstetricians and Gynaecologists of Canada in the development of clinical guidelines for the care and treatment of pregnant women.

Many physicians and public health workers have complained that multiple levels of government provided similar but not identical advice. The differences led to skepticism among both physicians and the public, and an inundation of messages led to overload.

In situations where scientific evidence is changing rapidly, as was the case in the H1N1 pandemic, we need a national communication strategy targeted to physicians that can build on communication processes already in place. It is especially important during a health emergency to build on existing systems that work well and that can minimize the chances of conflicting messages.

It is also important that two-way lines of communication between public health and primary care are established. Embedding primary care expertise into public health planning at all levels will help us avoid problems and improve our response.

We believe that the H1N1 immunization process did not adequately engage physicians in planning and delivery. A number of difficulties such as the impact of bulk packaging, the sequencing of patients and the logistics of inventory management led to friction between front-line health practitioners and family physicians. These difficulties could have been avoided with strengthened consultation, interdependence and mutual understanding before the crisis.

A number of witnesses have noted the importance of surveillance. There is no doubt that greater use of electronic medical records, EMRs, in primary care could have facilitated surveillance and communications. Family practice clinics with EMRs were able to identify high-risk patients quickly, communicate with them to schedule vaccination appointments and collect the required data for public health.

Another aspect of pandemic planning that cannot be ignored is the possibility that physicians themselves may fall ill. Physicians have never hesitated to provide care to patients during times of crisis, but this obligation must be balanced by a reciprocal obligation of society to physicians.

Following the outbreak of severe acute respiratory syndrome, SARS, the CMA prepared a document entitled Caring in a Crisis, a policy paper that addresses the need to take into account, and plan for, what would happen when health care providers become part of the statistics of those infected. We urge the committee to consider this challenge in your deliberations.

My last point addresses the lack of surge capacity in Canada's health care system. To mount a response to H1N1, public health units pulled human resources from other programs, and many critical services were delayed, suspended or cancelled altogether. The resources of our critical care infrastructure were stretched to their limits in many hospitals, and front-line health care providers were inundated with telephone calls and visits from the worried well. There was an increase in visits from those with flu symptoms as well.

I can tell you parenthetically that at our hospital we were right at our limits. We had used up all our respirators and extracorporeal membrane oxygenation, ECMO, machines. We had no further capacity for that next patient. Fortunately, that next patient never occurred, but we were at our capacity.

If H1N1 had been the severe pandemic that was expected, and for which Canada had been preparing, our health care system would have been brought to its knees.

[Translation]

The CMA has been warning of the lack of surge capacity in our health system for over a decade.

[English]

Canada remains vulnerable to the risks presented by epidemics and pandemics. If we are to be prepared for the next emergency, a long-range plan to build our public health capacity and work force, and to address the lack of surge capacity in our health care system must be a priority.

We therefore very much appreciate the review of Canada's response to the H1N1 pandemic that has been undertaken by this committee, and we look forward to your report.

The Chair: Thank you very much, Dr. Turnbull.

Let me turn to the Canadian Nurses Association and Claire Betker.

Claire Betker, Member, Board of Directors, Canadian Nurses Association: Good morning. I am a registered nurse, a member of the Board of Directors of the Canadian Nurses Association and a past president of the Community Health Nurses of Canada.

On behalf of Canada's quarter million registered nurses, I wish to thank the members of this committee for the opportunity to speak to this important matter.

The H1N1 influenza pandemic and the unprecedented mass immunization campaign that was conducted in response were defining health issues in 2009. Registered nurses were involved in every aspect of pandemic preparedness and response, and we gained valuable insights into the health system's ability to respond to the pandemic.

We are here to share the knowledge we gained and to inform Canada's collective response to future epidemics. The brief we submitted highlights areas of concern and contains a broad list of recommendations, but today I will highlight a few.

As the largest group of health professionals in Canada, registered nurses felt the human resource strain that the H1N1 pandemic placed on our health system. As the country tried to cope with a shortage of some 11,000 full-time equivalent registered nurses, along came a significant threat to public health that meant nurses and other health professionals were suddenly in even greater demand. This situation resulted in a health workforce functioning beyond capacity in many cases, which tested our ability to meet Canada's public health and health care needs.

Nurses across the country rose to the challenge. Many worked long hours under less than ideal conditions in a public health role that was not always clearly defined. Those who did not directly join in the pandemic response supported the efforts in other ways, taking on more patients, extra duties and shifts as they covered for their colleagues.

This situation exacerbated existing personnel shortages and resulted in heavy workloads and nurse fatigue — factors that we know can threaten patient safety.

In mobilizing for the response, the need to enhance the surge capacity in our health system became evident. One way to enhance capacity is to have a sufficient number of registered nurses in place who are adequately supported and prepared to plan for, respond to and facilitate recovery during future public health emergencies.

To that end, CNA recommends that governments make additional investments in the public health nursing workforce so that we have in place the registered nurses with public health expertise we need to face the next pandemic.

There is a double benefit to that investment. When the public health nursing workforce is not dealing with an immediate threat, it is nonetheless engaged in activities that promote health and prevent illness and injury in the population, thus lowering acute-care treatment costs. Additionally, nurses are actively engaged in developing and strengthening those key relationships and partnerships essential to any emergency planning, response and recovery.

In times of crisis, expert information is vital. CNA appreciated the opportunities for communication with the Public Health Agency of Canada officials, and acknowledges the agency's efforts to be inclusive and collaborative. Our experience on the front lines of the response underscores the need for registered nurses to be involved in planning and deployment decisions that have a direct and profound impact on the populations and communities that we serve.

Because nurses, nurse experts and leaders know what issues to expect and how processes can be streamlined, it is absolutely critical that nurses be involved in planning at all levels. Registered nurses are in the best position to understand what kind of information our nursing colleagues require and how best to present that information.

A key planning area is communications. Involving nurses will reduce the duplication of effort that was experienced during the pandemic, as precious resources and time were needed to interpret and repackage information. It is vital that we build on the partnerships, collaborative relationships and consultative efforts that were undertaken during the pandemic to ensure governments, health authorities, health care professionals and associations work together to plan and implement better response strategies.

To ensure this collaboration, CNA recommends that the Public Health Agency of Canada establish policies and guidelines that engage nurses and other health professionals in all levels of pandemic planning, response and evaluation.

We further recommend that the Public Health Agency of Canada undertake an evaluation of communications during the H1N1 response and work closely with other stakeholders to develop a more coordinated communications plan with consistent and effective guidelines and tools.

Amidst the difficulties nurses encountered, however, were many positive experiences. Registered nurses who took on expanded roles were able to free up nurse practitioners and physicians for patients who needed them more. In Alberta, for example, some registered nurses took additional training to gain certification to prescribe and dispense antivirals. In some provinces, retired and non-practising registered nurses were able to work at vaccination clinics under temporary licensing categories. These and other innovations helped ensure people had greater access to both the vaccines and health care providers.

CNA recommends that governments and public health agencies partner with the relevant professional associations to evaluate the experiences where registered nurses had temporarily expanded roles.

Canada's registered nurses are encouraged to see stakeholders come together to share what we have learned in the H1N1 influenza pandemic. We now have an opportunity to better respond to the heightened demands on health care providers. As we prepare for the next public health emergency — and we all know it will come — Canadians can rest assured that nurses are rolling up their sleeves to secure a healthy future for us all.

The Chair: Thank you very much. Now I will move on to the Canadian Public Health Association, Dr. Isra Levy.

Dr. Isra Levy, Member, Canadian Public Health Association: I am the Medical Officer of Health for the City of Ottawa, but I am here representing the Canadian Public Health Association and that association's many thousands of members, doctors, physicians, nurses, epidemiologists and other disciplines. This association is a pan-Canadian group of like-minded people. We work at all levels of government and in non-governmental organizations, with a common vision of universal and equitable access to the basic conditions that are necessary to achieve health for all Canadians.

As my colleagues from other organizations have said, I want to thank you for providing an opportunity to look at how we performed as a community and as a society during H1N1. I will provide a perspective and recommendations from the local public health perspective. The local public health is that level where the science and policies of higher levels of government are ultimately operationalized into the direct services to and for the people of Canada.

For many years leading up to the H1N1 influenza pandemic, health agencies at all levels of government and in community organizations had worked collaboratively to prepare for this eventuality. As others have said, much had been learned from previous public health challenges, including the 2003 SARS crisis, and our capacity to anticipate and respond to a pandemic has clearly improved significantly since that particular event.

The response to the influenza pandemic of 2009 demonstrated that leadership, organization, coordination and cooperation had all improved since 2003. At the national level, we saw the systemic improvements under the leadership of the Public Health Agency of Canada, and they included development of guidelines, to some degree, for national, social marketing campaigns for clinical practice guidelines.

The pan-Canadian Public Health Network also provided a mechanism for different levels of government and experts to work together and to coordinate standardized responses. These responses were improvements over previous experiences.

In Ontario, a network of all local medical officers of health, led by the Ministry of Health and Long-term Care, helped to coordinate the response in the province from the time the virus was first identified until well after the vaccination campaign.

At the municipal level here in Ottawa, we found that the inter-agency partnerships and collaboration with partners in surveillance, case management, public communication of risk and vaccine delivery were all critical to the response. Our surveillance and our situational awareness was robust locally because of the strong channels of communication and partnerships that had been forged between municipal services, schools and community agencies, especially the local clinical care sector and the local media, too. Together, we found common purpose in emphasizing public education messaging, community connectedness and the need for resiliency during a period when we, as a society, could afford neither panic nor complacency.

Though successes were achieved, much was learned. As the lead coordinator at the local level here in Ottawa, I offer the following recommendations, particularly for your consideration as we examine the future opportunities.

First, I fully concur that there is a need for greater surge capacity at the front lines of the health care system and of public health. This issue was significant for us and our partners. It was felt most acutely at the vaccination clinics. The unprecedented community demand for the H1N1 vaccine quickly exceeded the capacity of local public health. We relied on the capacity from others at the municipal sector, especially in local Ottawa hospitals. As we have already heard, local Ottawa hospitals were having surge capacity problems of their own.

Innovative approaches to explore how federal investments in public health can reap ever better returns directly at local points of service are especially called for.

Further, as Canadian and provincial plans are reviewed and updated, it is our opinion that greater awareness and attention must be paid to the impact of policy decisions by higher levels of government on the logistical challenges that result at the front lines from those decisions. For example, we found that better criteria are needed to define priority groups for vaccination, and to communicate with the public how those priority sequencing groups will be managed. Another example is the activation and deactivation of initiatives like flu assessment centres, which aim to relieve pressure on hospital emergency rooms. There was great inconsistency across this province in how those assessment centres were opened and in response to what epidemiological criteria.

There is also a need for the pandemic response to be adaptable and responsive in light of quickly changing information. Both previous witnesses have pointed out this need. This pandemic was the first to be managed under the microscope of a 24-hour news cycle, with evolving scientific and communication information constantly scrutinized in real time. At the local level, that meant we were constantly challenged when policy decisions by other levels of government did not reach us as quickly as the news reached the public. This situation made it difficult for us to minimize front-line worker stress, and it created credibility doubts amongst the public as information appeared to change all the time.

In closing, I thank you again for your attention to the issue. The pandemic influenza response in 2009 stretched the capacity of the entire Canadian health system and required public health intervention unprecedented in scope and demand at the local level. Going forward, we look to use these challenging yet instructive experiences to help move us ever more from a just-in-time approach to one that is well-resourced, better prepared, and sustainable and relevant to the front lines.

The Chair: Thank you very much, Dr. Levy.

We will now hear from the Canadian Healthcare Association, Pamela Fralick.

[Translation]

Pamela Fralick, President and CEO, Canadian Healthcare Association: I will be making my presentation in English, Mr. Chair, but I will be happy to answer any questions you may have in French.

[English]

Thank you as well for the opportunity. I am honoured to speak to this group of people. I know a little bit about your backgrounds, having done the research. This group is a wonderful collective to examine this particular issue and hopefully, to move a few issues forward that we all find of concern.

It would be somewhat easy for me to sit here today and say ``ditto,'' because so many of the concerns are consistent across our organizations. That being said, I am grateful for the few moments to add perhaps a slightly different perspective from the systems view.

I have four issues to highlight and 12 recommendations for your consideration as you explore this issue.

The first one, as you have heard so much about, is communications. Our members, the Canadian Healthcare Association right across the country, have identified this issue as their number one concern throughout the pandemic. Dr. Levy spoke to this issue of messages coming out from one source. Messages might have started as single unified messages, but they displayed increasing inconsistency as they were rephrased at various levels of government and health.

From the perspective of the average Canadian, this inconsistency signalled different messages, not the same one being rephrased. This lack of agreement that was perceived among trusted sources, and inevitably a lack of trust in the messaging, was a significant issue. We feel this pandemic was not the time for various governments and their agencies to flex their independence muscles, but rather, this was the time for unified leadership in instilling confidence in our citizens through common messages.

Additionally, a segment of key partners, which could have been extremely helpful in sharing information, was not included. Since most health providers other than physicians and nurses operate outside the publicly funded health system, a key source of networking is through their professional associations. Despite efforts on their part to be included, dating back to post-SARS, there has been a lack of success in engaging this network in assisting with information sharing. Beyond primary care physicians, many Canadians visit their psychologists, dentists, dieticians, physiotherapists, massage therapists and all sorts of health providers, and these groups were left outside the formal information loop unless actions were undertaken independently by their associations, adding another level of potential interpretation of key messages.

We have four recommendations in this area. They are in the documentation. We feel the communications strategy needs to be evaluated and, in particular, efforts should be made to strengthen the relationship actively and meaningfully between the health care sector and the public health sector. These sectors often work as different worlds, and I do not think this situation was helpful during an emergency situation.

CHA has a Guide to Canadian Healthcare Facilities, and if enhanced, the guide could be a significant conduit for information right across the country to all elements of the health system, particularly those that may be outside formal networks, such as long-term-care homes.

A third recommendation has to do with e-health elements that should be accelerated, as was already mentioned. These elements provide a valuable service in disseminating information and providing optimal care. The example might be the physician or primary health care centre electronic medical records.

Fourth, in response to my comment about this large network of associations that are not included, we should consider pan-Canadian networks such as the Health Action Lobby, which brings together 39 national bodies, and use them as a source of information dissemination.

The second factor I want to bring to your attention has also been mentioned, and it is people, health human resources, HHR. Several issues arose around this factor. The issues have been spoken to, but the information is worth repeating. Many health professionals and staff work in more than one setting, nurses in particular. They move through various hospital and care facilities. We raised this issue as the Canadian Healthcare Association on many occasions throughout the pandemic with H1N1, and never received a response from those in a position to come up with one. That factor is something that definitely needs to be looked at.

Health workers themselves are not immune. They will become sick. They may be called upon to provide care to their family members. Canada's surge capacity, the ability to respond to sudden drops in availability of staff, is fragile at the best of times, and at times of an epidemic, this drop can lead to overwhelming situations.

I will throw in the issue of labour mobility. It was not such a factor with H1N1, but certainly was with SARS. In the next situation, we need to ensure that this agreement for internal trade that affects labour mobility of health professionals needs to be accelerated and well looked after before it becomes an emergency situation again.

I have five recommendations in this area. One is about the Agreement on Internal Trade, AIT, and making sure that this is looked after so that it addresses labour mobility issues for the next pandemic. I suggest we need to include the issue of emergency preparedness in the existing pan-Canadian framework on health human resources, which is a federal- provincial-territorial agreement that could be looked at.

All national HHR strategies should be linked. There is this pan-Canadian one I referred to. There is a specific one for public health; there is another for Aboriginal HHR. These strategies need to be better linked around pandemic.

As a fourth item, we talk about a national observatory for health human resources. That idea has been bandied about for approximately four years. This observatory is an area that could provide leadership and guidance in dealing with surge capacity issues.

Finally, the Naylor report should not be forgotten. This report was a fantastic overview with recommendations that still have not been implemented, and speaks specifically to health human resource issues.

I will go quickly to my third and fourth issues, the third being the acute-care focus. This pandemic, H1N1, was focused on acute care. This committee and this panel is trying to look at the community role in pandemic. We applaud your work in that regard. We want to suggest that research be initiated immediately on how to establish effectively these linkages I referred to earlier between health care and public health, as a way of broadening the reach from the acute-care sector into the community. That is where transmission will take place primarily. As a second recommendation, in non-pandemic times we need to enhance and implement an educational program for the general public on prevention and immunization.

My final point relates to non-scientific responses — for example, voluntary quarantine, cancellation of public events and having flexible workplace practices, all issues on which the public can be educated and led to understand more about between epidemics rather than at a time of crisis.

Thank you again for this opportunity to bring forward not only some of our issues but also recommendations.

The Chair: Thank you for your opening comments. I heard three Cs here. First is capacity, that is, the stretching of the human resources in the H1N1 pandemic and the fact that the surge capacity was not there. If things had not stopped where they did, we could have had a far bigger crisis. Second, there is consultation. A number of you have mentioned the need to be more engaged at all levels in consultation. Third is communications, both ways, which continually arises.

Is there need for more mechanisms? We have heard about a lot of committees and a lot of plans to accomplish the kind of recommendations that you have made. Do you think we need more committees and more structure, or do we need to shrink them and reorganize them? Perhaps you can talk about that area briefly.

Dr. Turnbull, you mentioned the engagement of physicians in the planning and delivery and, particularly on immunization, the bulk-packaging problems; that is, secretive patients, logistics, and so on. We have heard a bit about that area. Can you expand on what you see as the solutions for that problem?

Dr. Turnbull: I will address the issue of engaging physicians.

The Chair: You can address both, if you like, but briefly, please.

Dr. Turnbull: I will address them both briefly.

There is a significant need to include physicians in the process of moving from public health guidelines to what is relevant in the coal face where physicians are seeing patients. There needs to be professional input, not only physician input but nursing input, going from what we need, and translating those guidelines from public health to what is applicable in a person's clinic. We found that many recommendations that were provided were difficult sometimes for clinicians to implement in their clinic because clinicians were not included in some of the earlier discussions. We have heard that, and that is a lesson all of us have learned.

Bulk packaging was another concern. If vaccines come in packages of 500 and we give them to a physician who is used to immunizing their community in certain circumstances, then bulk packaging of 500 may not be appropriate, especially if we are isolating immunization only for pregnant women or for smaller groups. Physicians would have too many vials for that particular circumstance. The circumstances as this pandemic was evolving did not permit us to be as flexible as we could have been, and we did not utilize the existing resources as well as we could have.

If you want me to answer on the issue of committees briefly, I would say perhaps not more committees but committees that had decisions and could work well together, and the coordination of those committees. As one individual, I received up to eight different messages from different organizations on a daily basis. It was hard for me to figure out which one of those messages to listen to because, while there were commonalities, there were also differences. I would have liked one message that I could have followed.

Dr. Maura Ricketts, Director, Office of Public Health, Canadian Medical Association: I want to point out that a couple of physician engagement activities that occurred worked well. For example, the Society of Obstetricians and Gynaecologists of Canada, as was already mentioned by Dr. Turnbull, approached the Canadian Public Health Association in August, or perhaps earlier than that, so between the first and second wave of the epidemic. It was successful, as a group of clinicians specializing in the area, in converting the information from public health into clinical guidelines suitable for use at the coal face. Additionally, the Canadian Paediatric Society was able to do that. The Canadian Medical Association highly recommends that physicians are used to develop the clinical guidelines for clinical treatment. We also all understand that there are nurse practitioners working at senior levels and would be involved in rural areas. They need to be included in that process.

The Public Health Agency was able to engage us, unfortunately only in September-October, in the development of a simple two-page guideline. It looked literally like a decision tree. That kind of thing, done way back when, would have been ideal. Again, the clinicians, especially family practitioners, need to be included in the development of these things so that we end up with something that physicians can use on the ground.

Finally, when systems testing is done on how effectively our pandemic system works, it needs to go right down to the level of the clinician. We have participated many times in round table exercises, yet we still do not know what proportion of physicians we will be able to reach during a pandemic. It would be great if those kinds of things could be tested and the systems put in place. Then, when we have a pandemic we do the same thing as we always do, but we do it a lot faster.

The Chair: Does anyone want to add anything?

Dr. Levy: I agree fully with the comments made and especially echo Dr. Turnbull's suggestion not to have more committees. The other dimension to the committee function to consider is some innovative way to bring in the front- line public health perspective as well as the front-line professional health care discipline perspective into deliberations at the FPT level. There is a challenge in terms of the policy decisions that are made, sometimes for logical reasons, and the logistical implications of those sometimes are not factored in.

The Chair: Good point.

Ms. Betker: I want to say, not more committees but those that will build those relationships, those mechanisms and those lines of communication. My experience is that when people come to the table and are able to discuss, from that front-line perspective, they will find commonality and they will find those solutions. We need not more committees but those that build those layers and enhance those working relationships.

The Chair: We have about four minutes for each one of you. For questions, answers or comments, we will start with Senator Braley, from Ontario.

Senator Braley: You talked about surges, and about surges in giving the vaccination. Did you think about using volunteers? My wife was a nurse; she has been retired for a few years. She called to offer her assistance. She did not want to be paid, but they did not use her. There were line-ups and but there was no need for the line-ups with the number of nurses that we know even locally. Many retire each year. Was that idea even considered?

Ms. Betker: From my personal experience, in the meningitis campaign about four or five years ago, we did not use volunteers in Winnipeg because we did not have the mechanisms in our regional health authority to engage them and train them; they were not part of the system. When it came to H1N1, we had those mechanisms in place and they were used in Winnipeg. Again, the issue was a systems issue that became apparent during the meningitis campaign. That is a good point. We also used retired nurses, and in multiples of different roles. Some were paid; some were not paid. That use was a consideration in a surge.

Senator Braley: Do you know if that use was across the country or only in specific areas?

Dr. Levy: I am sure it was not uniform across the country, but it was widely done. Here in Ottawa, we relied heavily on volunteers. In public health in general, probably 15 per cent of our budget locally at Ottawa public health is unseen because it is volunteer. We relied heavily on volunteerism. The challenge one has in an urgent situation is screening out appropriate versus inappropriate. Sometimes we had volunteer professionals who, on somewhat closer scrutiny, turned out not to have the required skills or qualifications, so using volunteers does not come without baggage from a management perspective, but volunteerism, in general, is a tremendous resource community.

Senator Braley: I assume most nurses know how to give an injection and give injections on a regular basis. They would not too hard to train if they are only one, two or three years out of the profession.

Dr. Levy: I will let the nursing association speak to professional standards, but the simple act of giving a vaccine is much more complicated than it may appear, in terms of clinical safety and professional regulatory perspectives.

Dr. Turnbull: If I can highlight one thing, where there is a need for us to give some consideration on the issue of volunteers is whether they are still licensed and whether they are indemnified.

Senator Braley: All the ones I called in my neighbourhood were.

The Chair: That qualification would have to be checked.

Dr. Turnbull: Not only do we need to check, but if we really need volunteers, if we go beyond where we were, we will have to call people who are not indemnified and not licensed, and we may have to look at fast-tracking professionals through our regulatory authorities, and ensuring our regulatory authorities are prepared to fast-track individuals and give them intermediate licences of some form or another.

Senator Callbeck: Thank you all for coming this morning. I was looking at the brief from the Canadian Nurses Association, and you talk about how, during the pandemic, CNA joined forces with nurses, health care organizations and governments too, and you list a number of things that you worked on together.

However, your first recommendation is that ``the Public Health Agency of Canada establish policies and guidelines that engage nurses and other health professionals in all levels of pandemic planning, response and evaluation.'' Were you not engaged in establishing the policies?

Ms. Betker: The nurses that CNA talked to did not feel they were engaged, no. They did not feel they were engaged in the planning and in the decisions that were made, not adequately.

Senator Callbeck: Not adequately: You provided input on the issues, but you did not have any real say in the policies?

Ms. Betker: I would agree with that, yes. That was their sense. Leadership, the access to nurse expertise especially around how things would work, what the policies would be, how to organize; no, I think that nurses did not feel at that time that they had a voice.

Senator Callbeck: Communication is something that has come up with so many witnesses. Doctor, I think you said a few minutes ago that you wanted to receive only one message and in one case, you received eight different messages. How do we deal with this situation? What do we recommend?

Dr. Turnbull: I think that all of us are of the same mind here, that we need a communication network, so we need to be able to communicate to all health providers. You might think that solution is simple, but we do not have an easy and verified ongoing communication system. We do not know how to connect to every doctor in Canada, so that is one thing. We need that system and we need it verified and updated.

Second, we need a consistent message that begins from the experts, has input from clinicians — whether they be nurses or doctors — and is easily applicable and regionally adjusted. Think about a national response coming down to a regional responsibility so our regional public health officials talk to, and have clinical input from, nurses and from doctors, and we receive one message.

Senator Callbeck: Is that message regionally adjusted? Is that where some of the problems came in? The agency said one thing about the priority list, for example, but different provinces decided not to go with what the agency had suggested.

Dr. Turnbull: When I think of regional adjustment, if you will permit me to continue, I would receive something from my hospital and something from my public health organization, all in the region; I would then receive something from my local Ontario Medical Association; and then I would receive something from someone else, my local integration network, LIN. All these communications would have slightly different variations but the same theme. Even at the local level we had a lot of different people and voices, and I might receive those communications every day. You can imagine the confusion that is conveyed to practitioners. Who is running the show?

Ms. Fralick: I want to add that this situation was a learning experience, and we felt that, from the perspective of the Canadian Healthcare Association, the Public Health Agency emerged and grew into its role, I suppose. That learning was helpful, but it was a little bit too late; too little, too late, one might say. However, throughout the crisis, the Public Health Agency became the go-to place, but it did not start as the go-to place, and so it is a lesson learned.

The other piece, consistent with what Dr. Turnbull mentioned, is the need for that network of rollout. I cannot help but think of time that I spent working for the Canadian Forces in Europe. That was in the 1980s. There were no telephones, and yet they had emergency exercises. There was a most amazingly efficient network that rolled out from trucks rolling through the communities saying, ``Snowball, snowball, snowball. There is a CFE snowball in effect.''

I am getting into too much detail, but the military had a tremendous approach to how to communicate from one level to the next, and there was buy-in at every level that this approach was the way to go. As I mentioned in my recommendations, a time of calm is when we come up with that network of communication steps that everyone buys into — federal-provincial-territorial levels, Health, you name it — so that when we are in an emergency, communication can be implemented more effectively and simply.

The Chair: I must now move on to Senator Ogilvie from Nova Scotia who is also deputy chair of this committee.

Senator Ogilvie: Thank you, chair. It has been interesting this morning. We have heard repetition of many issues that were current across jurisdictions throughout this situation and the recognition that communication, preparedness and so on are all important. We also heard about the concept of surge and what it means, and potentially means, under other circumstances.

When one looks at a number of things you have mentioned this morning and the legal basis under which we operate in this country, the various acts, I am astounded that we were able to put together, since SARS, a program that worked to the degree of efficiency that it did, based on the degree of cooperation between the federal, provincial and municipal levels because all three have rights under constitutional law and responsibilities in these areas. Many issue you talked about in terms of conflicting communications fall within the rollout that is within the provincial and municipal areas. Clearly, those areas need to be looked at, and we have to keep in mind where the responsibility for those areas lie.

When you mention more committees, I could imagine more committees as we prepare between pandemics, but I was delighted with some of your response suggesting we need fewer committees. Presumably, by the time we are into the pandemic, we want to be in full-action mode, and in my experience a committee is not considered full-action-mode response. However, I take your point in that regard.

The other situation is that most of the groups appearing, and who will appear, have provided us with documents indicating that the issues they felt were important were more supplies and more access. These issues include people from front-line providers, such as the firefighters, right through to nurses dealing directly with the patients.

Dr. Turnbull, I was a little surprised in one of your documents — I am not suggesting that the CMA does not have a right to put this issue forward — that from one of the highest paid and highly insured professional groups in the country, your recommendations during a pandemic include that physicians be compensated for lost clinical earnings to cover expenses — lost group earnings, overhead, medical expenditures and so on, and that a family should receive additional financial compensation in the case of a family member who dies and so on. I am simply saying that I was surprised to see these kinds of reactions, including urging us not to provide legislation where physicians are conscripted.

The issue is, we had a mild pandemic. If we are hit by an unusual agent, an unusual virus — one that takes us to the next level of pandemic — or even a substantial epidemic that could occur in this country versus elsewhere, it seems to me that it would not be unreasonable, under those circumstances, given what all of you are saying in terms of the need to marshal forces to deal with it, that the Emergency Measures Act might be invoked under those circumstances.

I repeat, you have the absolute right to put these recommendations forward and they probably should be considered, but in listening to the response to all of those engaged in the pandemic, I am surprised to see this recommendation coming from physicians.

Dr. Turnbull: One difference is that physicians are independent practitioners, so they do not have employment benefits. That was where I think that recommendation originally came from. Physicians will be there; they will participate and give it their all. At times, they put their well-being at risk to serve their communities, and they will continue to do that always.

Senator Martin: Thank you very much for your insightful and helpful recommendations. It has been quite a process of bringing together different associations and stakeholders that perhaps may not have had an opportunity to come together like this and hear what one another has to say, as well as having themes emerge, and for us to know what the key priorities are.

I want to address the communications point that you have all raised, and that we have heard repeatedly from other witnesses.

If we are able to identify clearly the entire network or networks of health professionals, as you point out, if they are engaged and have the right information, they can be helpful to the entire roll-out because they are in direct contact with the patients and their clients that they see on a regular basis. This entire network that is extremely complex exists; it is intricate and interwoven. I was thinking about the matrix. It is complex.

There is a website for the federal government that plays this national role, and the pandemic plan, which is a Canadian plan. Once that network is clearly identified — and we are starting to do that; this committee is one effective way of doing so — rather than having Health Canada or one place going to all these other networks, I wonder whether it is as simple as having one place where information is shared and posted during a pandemic outbreak — an entire process, rather than having the centre go out to every remote place, that network, once it is identified, in terms of the communication being consistent and clear, and the messaging being absolutely clear, as you call for — it is a matter of coming back to that centre.

Perhaps I am simplifying the issue because I know how complex it is. In hearing about it, we know that there can be a website or a separate online source and that is where we all go for information. I wonder if it is ``as simple as that.'' I am putting it in quotation marks because of the complexity of the entire network.

Ms. Fralick: Nothing is that simple, although I love the concept. The one thing I will add is that you need the buy-in and acceptance of the other pieces that they want to go to that source, which involves agreement of governments and all the other players we have been talking about.

Senator Martin: We heard about federal-provincial-territorial collaboration and agreement. I am saying, in identifying the network, if that agreement can be reached, that solution can be simple, using the term ``simple'' completely within the context of what I am talking about.

Dr. Ricketts: I often said with surveillance issues that if you think surveillance is easy, it is easy to play a flute; blow in one end and move your fingers over the holes. It is not easy to do this kind of thing, I am afraid. I will give you a couple of examples.

The audience must be defined carefully. I received more information from André Picard in the newspaper than I did from any other resource. Unless we make the clinician a target of our communication system, and recognize what has to happen for them to be communicated to, we will not be successful.

Timeliness is an extremely important issue. Passive information, which is what you are talking about, asking me to go to a website, is not effective for extremely busy clinical-placed professionals. The information needs to come to them at their site and their convenience, and it must be found easily. I have no doubt that a website will also be useful, but I do not want to suggest that I know what the full answer is.

In our case, the federal-provincial-territorial processes slowed down the information quite a bit. There was a lot of talk and consensus-building taking place at the bureaucratic level while everyone else waited for the information to come through. I hate for it to sound like a criticism but, unfortunately, that issue would be a great one to address, how to speed up that information through to the clinical level as quickly as possible.

Finally, I will point out that the Infection Control Guidelines are excellent guidelines. When I worked for the agency, I used to produce these things, and was always proud of them. At 66 pages long, we cannot expect a doctor or a nurse in a busy practice to understand what they are supposed to do. That process is called knowledge translation, and we need the clinicians involved in preparing the knowledge translation. That means they need the information even when it is not fully formed. We have to trust the professionals to be able to deal with uncertainty. I want to make those points.

Ms. Betker: I think one of the themes around communication is two-way, so a website, although it is a good idea, does not have that two-way piece.

The other thing is not to assume every practitioner has access to, or skill even, with some of the most basic kind of Internet communication because technology is not necessarily always a tool of our trade out there in public health.

The other thing not to forget is around language, with respect to the multiple languages our citizens speak. I think that point speaks more to knowledge translation, but for information to be there at the front line in a way that is interpreted for the people that it is being used for.

Senator Cordy: I think it is extremely important that we have the front-line workers here. Thank you very much for your input today.

Ms. Fralick, I was interested in the labour mobility issue that you raised. Are you suggesting that health professionals cannot transfer from one province to another?

Dr. Turnbull, you talked about the sequence of patients. I assume you mean prioritizing?

Dr. Turnbull: Yes.

Senator Cordy: Who was in charge of prioritizing? We heard from the Aboriginal Nurses Association of Canada and others that they also, because of their culture, had a problem with certain groupings before their elders in the community. Also, with the overcrowding, what was the point of immunizing one age group within the family when they had three, maybe four generations living in the same household? It made more sense to immunize a household at a time. Why, particularly in remote areas, would you go on four separate occasions to bring the four different age groups to a clinic? Who was in charge of making up the priority list?

Dr. Turnbull: The priority list was set up on an evidence base of those individuals at the greatest risk. It made good public health policy with respect to the sequencing and the prioritizing. It did not make good practical sense right in a clinic where the providers were, and that is why we probably should have put both groups together to help us make those practice guidelines. Clinicians could have said that it would not work in their particular circumstance.

Ms. Fralick: In terms of the Agreement on Internal Trade, yes, and in the interests of time, we would be prepared to follow up with information to you. There are still difficulties in labour mobility. It was a huge issue for SARS where exhausted health care workers could not request other provinces to help because of licensing issues. There is an agreement in place and the provinces have signed on, but there are still issues.

Senator Cordy: That amazes me.

Dr. Levy: I agree fully with Dr. Turnbull's answer. The Public Health Agency led the development of the sequencing groups during the summer and early fall. There was significant engagement at the provincial level. There was not an ongoing engagement at the front-line level, but the agency was solid from an evidence-based perspective, as we have heard, although maybe not from a logistical implementation perspective.

That point speaks also to one I will make regarding communications: invest in two-way infrastructure for sure, so that the audiences can receive push-out technology and respond to it in real time.

The other piece is clarity of role, because each of those eight organizations had a legitimate reason and obligation to provide information, but the coordination and absence of clarity of role in a reflective way complicates the communications dilemma greatly. Leadership on clarity-of-role definition would be a significant help.

Senator Dickson: Thank you very much for your excellent presentations. Notwithstanding there are weaknesses, overall, with your help, the Public Health Agency of Canada has done an excellent job in the rollout.

Ms. Fralick mentioned that the idea of who was in charge, and when you learned that person was in charge. Who really was in charge? Does the person have a name, or is it another silo? If so, which one of the silos was it? When did you learn this phantom was in charge?

Ms. Fralick: Frankly, this is from my members, but it is a personal observation. When Dr. Butler-Jones started appearing on the television screens in our bedrooms and living rooms across the country, that appearance put someone in charge. It was a unique move in Canada to have a deputy minister lead, as opposed to a minister. However, he is a physician. He gave credibility and confidence to the population. From my perspective, that appearance was a turning point.

However, I take into account all the other comments. That move did not solve all of the issues. We were still in the middle of a crisis. All the issues we brought forward still need to be addressed. The Public Health Agency of Canada has a role to play and could be a go-to place for many of the elements we are talking about if everyone agrees and does not feel the need to reshape and rephrase all the messaging so it feels like different information.

Senator Dickson: I understood there were tabletop exercises. Did any of your groups participate in those tabletop exercises?

Dr. Ricketts: Yes, I referred to them earlier. I have been a participant as a member of the Public Health Agency, and Jill Skinner, who also works for me now in my role at CMA, has participated in them. The stakeholder groups are put at a table off to one side, and it is not an effective tool. That is an important point. We have to test the system right down to the grassroots.

The Chair: That is the end of this panel, because we have run out of time, which I am sorry about because there is so much more we could explore. Thank you all for participating.

This second panel will deal with front-line workers. The first person to introduce is the President of the Canadian Association of Fire Chiefs, Robert Simonds. The mission of the Canadian Association of Fire Chiefs is to represent the Canadian fire service on public safety issues. Mr. Simonds has worked towards increased federal involvement in, and financing for, preparation for major emergencies.

From the Canadian Teachers' Federation, we have Mary-Lou Donnelly, President. The Canadian Teacher's Federation is the national alliance of provincial and territorial teacher organizations. The federation represents nearly 200,000 elementary and secondary schoolteachers across Canada. Ms. Donnelly has been a teacher and administrator for over 25 years.

Myles Ellis, Director of Economic and Member Services for the Canadian Teachers' Federation, is also here. He holds a master's degree in education from Saint Mary's University in Nova Scotia as well as a certificate in industrial relations from Queen's University. He is the Director of the Canadian Association for the Practical Study of Law and Education.

From the Federation of Canadian Municipalities, we have Claude Dauphin, Third Vice-President, currently the mayor of Lachine, Quebec, and Chairman of the Montreal City Council.

Alain Normand is also here from the Federation of Canadian Municipalities. He is a member of the Pandemic Preparedness Working Group. He is an author, a lecturer, a teacher and an expert in emergency management.

From the Paramedic Association of Canada, Greg Furlong is an advanced care paramedic with the Ottawa service. He has also served on the board of directors with the Professional Paramedic Association of Ottawa. That is our panel.

First up is Robert Simonds. Chief Simonds and those of you who are speaking, can you make your introductory remarks in five minutes please.

Robert Simonds, President, Canadian Association of Fire Chiefs: Thank you, chair. I will preface my formal comments by making a note that, in my prepared text, I reference a survey. There is an updated iteration of that survey. That is the only deviation from my formal submission to you.

Good morning. I am the fire chief in Saint John, New Brunswick. I appear before you today in my capacity as the President of the Canadian Association of Fire Chiefs. CAFC is a national organization representing some 1,000 fire chiefs and other chief fire officers located in every province and territory. Our members are drawn from both the fire departments in major urban centres with full-time firefighting personnel and those in rural and often remote areas served by volunteer personnel.

Since receiving your kind invitation last week to appear today, we conducted a mini-survey of our board and executive committee as well as the members of our government relations committee and a group of fire chiefs from large metropolitan areas. Given the targeted scope of our survey, we do not purport that the data has statistical purity. However, we absolutely believe it serves to confirm the anecdotal remarks and observations that have been making their way through the fire service since last year's pandemic.

Responses to our survey came from 19 chief fire officers whose departments collectively protect over 7.3 million Canadians, or about 21 per cent of the total population. About 10,600 firefighting personnel are in those departments. Of that total, 2025 were men and women from volunteer fire departments. The 19 replies came from eight provinces and one territory.

From the perspective of pandemic preparedness, it is important that the committee bear in mind these important facts. First, CAFC estimates that there are 3,492 fire departments in Canada. Of these, 3,184 are volunteer departments. Those departments amount to just over 91 per cent of the total. Second, of the 108,000 total firefighting personnel in Canada, almost 79 per cent are volunteers. In most of the smaller communities, the volunteer fire departments are the only locally situated emergency first responder service available, with police and emergency medical services often responding from other communities.

The Public Health Agency of Canada's Pandemic Influenza Plan for the Health Sector says that, traditionally, ``the responsibility to deal with emergencies is placed first on the individual and then on successive layers of government, as the resources and expertise of each are needed.'' The plan goes on to note, however, that ``emergencies that are large and/or complex that transcend provincial or international boundaries, such as pandemic influenza, call for shared responsibilities.''

CAFC agrees with that observation as far as it goes but recommends following the words ``shared responsibilities'' with the words ``under federal leadership.''

The Public Health Agency has said that fire chiefs will be among those designated to receive initial doses of vaccine in an influenza pandemic because they are persons whose decision-making authority will be necessary at the time of the pandemic to minimize societal disruption. Firefighters also will be eligible because they are persons who are trained or primarily involved in the provision of an essential service that, if not sustained at a minimal level, would threaten public health, safety or security.

Despite these good intentions, shared responsibility seems to have been to blame for the fact that 15 of the 19 responding fire departments confirmed that neither their chief nor other personnel received any priority for an early round of inoculations. An important reason for this breakdown is that 10 of the 19 responding chiefs stated they believed their municipality's' public health authorities were unaware of the priority that the Public Health Agency had assigned to the early inoculation of all firefighting personnel. Clearly, it can be argued that the phraseology utilized could have been more direct and emphatic so that misinterpretation of the need for firefighters to be inoculated could not have occurred.

Your committee has asked about lessons that should be learned from the response to last year's pandemic virus. Our recommendations follow.

The Public Health Agency of Canada must ensure that all of its provincial and territorial counterparts are aware that fire services personnel are to receive a high level of inoculation priority and why this is important.

All municipal public health authorities need to know that fire services personnel are to receive a high level priority and why.

In larger communities with their own fire, police and emergency medical services departments, dedicated clinics should be established apart from clinics available to the general public.

Since volunteer firefighting personnel are so important in smaller communities, additional efforts are required to ensure firefighting personnel are inoculated quickly.

Queue-jumping should not be permitted. High-profile queue-jumping last year led to widespread disregard for the orderly dispensing of inoculations. The committee should pay special attention to the Algoma Public Health Agency, which required all of those wishing to be inoculated to make appointments.

I look forward to taking part in the question-and-answer portion following these presentations.

Mary-Lou Donnelly, President, Canadian Teachers' Federation: Good morning. Thank you for the opportunity to appear before this committee. I am President of the Canadian Teachers' Federation. The federation is the national voice for teachers in Canada on education and related social issues. We represent upwards of 200,000 teachers through 16 provincial and territorial teacher organizations across the country.

I want to address the issues being examined by the committee through a brief analysis of the federation's teacher survey on H1N1 preparedness conducted in October 2009.

By the end of August 2009, the statistics were telling a frightening story about the H1N1 influenza virus: 1,454 people hospitalized in Canada in confirmed cases, and 72 deaths to the end of August. Earlier that month, Dr. David Butler-Jones, Canada's Chief Public Health Officer, said that schools, daycares and post-secondary institutions can play a critical role in our pandemic response. He said keeping schools open is an excellent way to educate and inform students and their families, minimize the impact of the virus on society and the economy, and offer a good environment in which to administer the pandemic vaccine.

The Canadian Teachers' Federation then began an action plan to access the best information available on the pandemic and to share it with members. One aspect of the plan was to develop and conduct a survey of Canadian teachers on preparedness levels in their schools. The report we have provided to you is a summary of the findings of the survey conducted October 23 to 30, 2009. I want to talk about some of the findings.

The first question addressed awareness. Not surprisingly, the highest level of awareness was reported at the school board or district level, with 85 per cent being aware. Over 9 in 10 educators surveyed reported that they had received handouts or material posted or delivered electronically, making this material the primary form of H1N1 information or training that they received at school. Sixty per cent of educators received H1N1 preparedness training at a regular staff meeting followed by training after school, but only 47 per cent of educators surveyed indicated that their school had a communication plan in place to advise parents and other members of their school community in the event of a H1N1 outbreak at their school.

In what was considered to be the most important question on the survey, two thirds of educators surveyed felt comfortable with their school's level of preparedness. Educators were asked then to explain briefly the rationale for their comfort level. The response raised interesting issues and concerns, not the least of which was a broad range of perceptions regarding school-level readiness for a pandemic.

Several comments reflecting sentiments that appear across various educator comfort levels addressed the tension between the development of a pandemic policy or plan, and implementation of the plan in the school. Some respondents highlighted the important role of parents in helping to control the spread of the illness by keeping their sick children at home. At the same time, there seemed to be an awareness of the challenges many parents face in caring for their sick children at home.

A few responses made reference to teachers feeling they were on the front line of the H1N1 pandemic in terms of potential exposure to the virus in the school environment, and the vulnerability they felt as a result.

A number of comments spoke to the impact of the H1N1 outbreak on working conditions in classrooms and schools, and general health and safety issues. Some respondents expressed concern about the need for specific measures and precautions to safeguard pregnant teachers, as they were identified as being among the high-risk groups.

On the positive side of the survey, two out of three teachers indicated that they were ``very'' or ``somewhat'' comfortable with the preparedness in their schools. They outlined in their comments their satisfaction with communication efforts to staff and parents, policy and strategy development, the hygiene education plans in schools and the dissemination of print and audio-visual resources.

However, there were concerns as well. One out of three teachers were not comfortable with the pandemic preparedness in their schools. In particular, almost four in ten female educators were not comfortable, and 70 per cent of Canada's teachers are female. This finding may be explained partly by the fact that pregnant women were one of the identified at-risk groups, and that elementary teachers, where there is an even greater percentage of female teachers, were generally less comfortable than secondary teachers. Elementary teachers may feel that they work in a veritable petri dish of germs surrounded as they are by young children, more so than secondary teachers. The degree to which teachers are aware of pandemic preparedness at a national level is also troubling.

We have recommendations to consider. Plans must be put in place to protect those most vulnerable, that is, pregnant teachers, in the case of H1N1. Consideration must be given to making teachers and students a priority group for receiving vaccination. Efforts to communicate with parents and the community at large must be enhanced. There must be support and coordination of effort from and between emergency measures service providers and schools. Finally, much more thought and planning must go into preparedness for schools if it is anticipated that in subsequent pandemics schools will remain open regardless of infection levels.

The responses to and outcomes from the H1N1 pandemic have taught us much. It is important that we apply what we have learned. Complacency is not an option. At CTF, we need a second survey of teachers now to determine how views have changed as a result of the H1N1 experience. We will be happy to share that information with the committee, should results be available before your work is completed.

The Chair: Thank you very much. We will now hear from the Federation of Canadian Municipalities.

[Translation]

Claude Dauphin, Third Vice-President, Federation of Canadian Municipalities: Mr. Chair, we are very pleased to be here this morning on behalf of the Federation of Canadian Municipalities, and in particular its President, Mr. Cunningham. As you pointed out, I am joined today by Mr. Alain Normand from Brampton, Ontario. He is an expert on this subject.

FCM's 1,900 members represent virtually 90 per cent of Canada's population living in large cities as well as in small urban communities. You yourself were formerly mayor of a large city.

One of the lessons we have learned is that to deal successfully with and be well prepared for a pandemic, all levels of government in Canada — federal, provincial, territorial and municipal — we must work together. For a number of years now, FCM has been stressing the message, when different issues arise, that the only way to meet challenges is for governments to be well prepared and to pool their resources.

We recognize that we have made considerable strides when it comes to pandemic preparedness. In fact, last year, we appeared before a House of Commons committee to discuss Canada's pandemic readiness.

We told the House of Commons committee at the time that in order to keep key municipal services operating under the most difficult conditions, we were calling on the federal government to design and implement a national plan, with municipal input, to keep critical front-line workers safe and on the job.

Measures must be put in place to ensure the safety of critical front-line workers like firefighters and paramedics and to ensure that they are first in line to receive any anti-viral vaccines.

Included in this group are, of course, police officers, firefighters and wastewater workers. As the former head of the Société de transport de Montréal, I would like to cite Montreal as an example. Approximately 500,000 people use public transit daily. Transit operators come into contact daily with the public. Buses drop off riders at metro stations. Over 100 million people take either the bus or the metro every day. Transit operators must be protected and must be able to remain on the job in order to stop municipalities from erupting in chaos.

Are we prepared for a pandemic? Notwithstanding the strides that we have made, FCM believes that we are not yet ready for one. That is why we are here this morning to deliver two important messages. First, it is critically important that all levels of government work together. To that end, we need a national emergency measures plan that would kick in should a pandemic strike. Second, front-tine workers must be able to do their job safely if we are to succeed in our mission.

[English]

About 270,000 front-line workers need safety and security, and more than 3,600 municipalities are involved.

[Translation]

I realize I do not have much time left, but I must emphasize that municipalities, territories, provinces and the federal government must all work together.

I would like to wrap up with our recommendations. Before the next pandemic hits, FCM is calling on the Government of Canada, firstly, to ensure that front-line workers across Canada have access to the equipment, training and vaccines they need in a timely fashion; secondly, to ensure that sufficient quantities of vaccines are available, if needed, for essential municipal workers; and finally, to provide the provinces, territories, municipalities and the general public with the details of this strategy.

Mr. Chair, that is the gist of our message to you this morning. First, we need a national plan. Second, everyone must work together. And finally, we must protect our workers who find themselves on the front line when a pandemic strikes.

[English]

Greg Furlong, Director, Paramedic Association of Canada: Good morning, honourable senators. I am a superintendent with the Ottawa Paramedic Service and current President of the Paramedic Association of Canada, but I am here today as a director with the Paramedic Association of Canada.

I thank the Senate committee members for giving the Paramedic Association of Canada and paramedics an opportunity to speak about Canada's pandemic preparedness as it relates to the paramedic profession. This is the first occasion that paramedics have been invited to speak at a Senate committee, and we are honoured to be involved in this important dialogue on pandemic planning.

We are here today to offer the service and assistance of paramedics to our communities across Canada. We recognize that a pandemic event requires the mobilization of all health care professionals and communities. We are here to help.

The Paramedic Association of Canada represents the 23,000 paramedics from across Canada, and advocates for enhancements in patient care and patient safety. The association owns and maintains the National Occupational Competency Profile, which defines the competencies that shape our professional practice within Canada. The competency profile is a reference tool for the education and training of paramedics. It outlines the treatment, intervention and care that we perform on a daily basis.

For many patients in Canada, paramedics act as the gateway and first point of contact into the labyrinth of our health care system. For example, 15 per cent of all patients received by hospital emergency departments in Ontario are transported by paramedics. We are entrenched in communities as part of the continuum of care within the health care system.

Paramedics are highly trained health care professionals working on ambulances, fixed-wing aircraft and helicopters. We also work as part of community health care teams and in settings throughout Canada. Our professional practice is flexible to the current demands of the health care system. We are part of the health care team.

Let me state a fact that is not well known. Paramedics have the knowledge, skill and ability to vaccinate Canadians. A look back at SARS in 2003, and more recently the H1N1 pandemic last year, revealed valuable lessons and highlighted successes. Paramedics are often an untapped resource in public safety and in emergency management for preparedness, mitigation, response and recovery during a pandemic.

We can provide service in all these domains, as the competencies associated are captured within the National Occupational Competency Profile. I will speak briefly to a few of them. The first is preparedness.

Paramedics are educated annually on seasonal and pandemic influenza. In Canada, emergency medical services are operated in various forms; municipal and provincial to name but two. Unfortunately, paramedics are considered an unregulated health profession in all but three provinces. Involving paramedics in the early stages of pandemic planning would highlight our diverse skill set and abilities. While at the local level, pandemic plans often consider the valuable contribution of paramedics, the provincial and national plans and planning make sparse reference to our valuable service to Canadians.

The second is mitigation. During the H1N1 outbreak, paramedics were called upon by many public health organizations to provide a surge capacity for vaccination clinics. Paramedics already possessed the required competencies to work in this hectic and dynamic environment. We demonstrated our abilities, professionalism and knowledge while delivering the H1N1 vaccine to thousands of citizens in Ottawa and many other communities throughout Canada. We proved to public health agencies our ability to respond and provide a critical service to the community.

Finally, I will speak about response. SARS taught us the need for better infection control practices and personal protective equipment to help stop the spread of infection throughout communities. Since then, strict screening processes have been introduced for all patients who require in-facility transfer, and all 911 calls are screened over the phone for febrile respiratory illness. This screening allows paramedics to take the necessary precautions prior to making patient contact.

Improvements to infection protection and control guidelines have allowed paramedics to isolate a patient from the onset of a 911 call and alert the receiving hospital that patient isolation is required, thus minimizing the spread of infection.

In many regions in Canada, paramedics are often the first health care providers to see the effects of an outbreak and its impact on our communities. We need current and accurate information on the influenza status so that paramedics can be protected and therefore can protect the public. We do not want to be a vector for influenza while providing care.

We highlight the need for greater interoperability and communication between decision makers; public health agencies, hospital and government officials and the care providers, namely physicians, nurses and paramedics. The information and data gathered by paramedic dispatch centres on call types and geographic locations could prove beneficial for the monitoring of patient volumes, as well as the spread of disease processes across communities.

In closing, paramedics are medical professionals with competencies that are highly adaptable to a variety of situations. We are here to provide service to the community, be it during a 911 call for help or in the community delivering vaccinations. We believe we are an integral part of the continuum in patient care. We are an integral part of the health care community and offer surge capacity in events similar to a pandemic.

On behalf of the Paramedic Association of Canada and the profession, I wish to thank you for this opportunity.

The Chair: Some of you have provided copies of your opening comments but not all of you have. If some of you want to provide copies that we would be happy to receive them.

My question will focus on the question of vaccinations. Chief Simonds, particularly, raised that question when he said that the Public Health Agency of Canada recognized that firefighters should be amongst those who, because of their work with safety and security, and as an essential service, should be vaccinated at an early stage but somehow that recognition broke down. He thought that maybe the municipalities and the public health authorities were unaware. Maybe he can expand on that point further — because, of course, there is the province in between — as to how this communication broke down and what he was doing about it to try to ensure that priority was recognized.

Let me also ask all the different organizations for quick responses as to how they see the vaccine prioritization list being worked on, and what their organization's position is on that list.

Mr. Simonds: In my comments I said that it was recognized at the outset that the fire service ought to be included in terms of that prioritization. However, a healthy degree of ambiguity existed across this country with respect to the interpretation of that recognition.

While I can speak of the New Brunswick experience where I work in a career department, our medical health officer was prepared to support the inoculation of personnel, only to find out there was inconsistency of messaging between his office and the office of the provincial authority. I know that situation was not an irregularity across the country and that it was happening throughout a number of jurisdictions. In terms of the cascading information that came from the federal government down through the provincial government and into the municipalities, along the way some of the clarity of that message was lost. As a result, we had a significant degree of ambiguity and information going back and forth.

For many of us in our local jurisdictions, we were literally driving and meeting with the members of the health agencies within our provincial jurisdiction to reiterate the importance of this inoculation, and in the fullness of time we were able, in many jurisdictions, to overcome it, but the time horizon from the time we were left out to the time we brought closure to it was too extensive.

When you speak about ways in which we could perhaps expedite the process — and I think my colleague, Superintendent Furlong, spoke about this issue — we have many talented individuals across the Paramedic Association of Canada and we have a resource there that absolutely could support us when we had that surge capacity issue and we needed it be more robust. In some jurisdictions across the country, in particular in those integrated fire and emergency medical services operations, we saw those clinics being established within the department so as to expedite the inoculations for emergency services personnel. However, as my colleague indicated, that process could be extended to the broader community as well.

Mr. Furlong: I will echo that comment. The majority of paramedic services across Canada receive their own shipments directly from public health because it falls within the scope of practice of a paramedic. Therefore, we inoculated each other. In some areas, that inoculation was then extended to the tri-services, so to police and fire, as they are often involved in tiered response, safety and security of the public.

Depending on how widely available the vaccine is and how the priority list is rolled out, it was seen in many places in Canada but availability becomes an issue in smaller communities.

The Chair: Are there any other comments on the prioritization list and how it should be designed?

Ms. Donnelly: We felt at the Canadian Teachers' Federation and our member organizations of course, that if schools were to be kept open, students and teachers should be a priority and the vaccine should have been given at the school to ensure that all our students and teachers receive that vaccine, especially if the schools were to be kept open. I venture to say that not all of our children have even yet received that vaccine.

The situation was inconsistent across the country. In some jurisdictions, it happened that students and teachers were a priority, but in most jurisdictions, they were included with the rest of the public. We felt that students and teachers should have been a priority.

Mr. Dauphin: We are totally in agreement with paramedics, firefighters and teachers, but one important message we have this morning is to include all the others, such as bus drivers and public works. They are in contact daily.

The Chair: You will put everyone into the priority list at this rate.

Mr. Dauphin: We agree with the health workers, of course, and all the people with us today, but I think it is important for us, too.

Senator Ogilvie: I am delighted to see this group this morning. Well before we started to launch this study, most of us were aware of the critical role that you all play as the front line in our communities in these issues. You have articulated very well the significant aspects of your role. Mr. Dauphin, you succinctly outlined the principal issue, the need for organized cooperation from the federal, provincial and right down to the municipal and community level as being critical.

One thing that seems to be emerging is that the intent to do that has been there since SARS, in spite of our complex jurisdictional issues. Many issues that you have all identified this morning seemed to me to be relatively straightforward to implement within the existing framework. It is a question of setting up the system such that it responds. Whether the bus drivers are on the front line or not probably depends on the type of pandemic. In some cases, it should be obvious; in other cases, perhaps it is a different kind of thing.

I want to address a specific issue to Chief Simonds, partly because I live in rural Nova Scotia and I am enormously appreciative and deeply aware of the critical service that you and, of course, the paramedics association with you bring to our entire region. Most of you in the fire service throughout the region are volunteers. The services you provide not only ensure we have front-line providers of health but that we have things that we do not even think about, such as the ability to obtain insurance in parts of the country. I want to state unequivocally the awareness that I and, I am sure, my colleagues have, for your roles. It seems to me that attaching that kind of importance will ensure the kind of recommendations that all of you have made with regard to the need for the system that presumably is set up to be refined to the point where all these issues, having been decided that they should be implemented, in fact will be.

The school system is an issue that is critical again, like bus drivers, in the context of the type of pandemic. In certain cases, clearly schools will be kept open. In other circumstances, such as a 1918 flu epidemic, we know it would be the worst thing in the world to keep the schools open because that is where the disease spreads so rapidly. The issues you raise are critical, but it should be easy for us to recommend their awareness within the general framework that is there, and to implement solutions. It is only a comment.

The Chair: Are there any quick responses to the comment or can I go on?

Mr. Dauphin: They are good comments.

Senator Callbeck: Thank you all for coming this morning. I, too, agree that it is important to have the front-line workers present because you are where the action is and where it is taking place.

Mr. Simonds, you say that the Canadian Pandemic Influenza Plan for the Health Sector identified firefighters as a priority, and that priority designation was ignored. Was that the case across Canada or only in certain provinces and cities?

Mr. Simonds: When we completed our analysis, we found that situation occurred in over 50 per cent of the cases. In some instances, I would not suggest it was outright ignored, but there was ambiguity and misunderstanding. In light of that situation, many decisions were left up to interpretation. As a result, without having been more emphatic, or without having some type of audit process or some means in which the federal government could ensure that the intent of the plan was being fulfilled, those measures perhaps could have ensured that the intent had been achieved.

Senator Callbeck: The Federation of Canadian Municipalities is asking the minister for a national plan or for guidelines. If that plan had been in place, do you feel that this problem would have existed? Would it have made a difference?

Mr. Dauphin: In our case, yes, it would have. I know Mr. Normand had the experience in the field, but we were discussing this morning that in the province of Quebec, for example, the provincial workers were much involved in terms of the vaccination. In Ontario, it was totally different. The municipalities were much more involved. I think we should have a national plan. Even if we have our own provincial jurisdiction, in a matter such as we are discussing today we need a national plan. There are no borders in the case of a pandemic; it is international. At least, if we have national guidelines, in our opinion, it will help in a situation like a pandemic. It is a must. We should have a national plan.

The Chair: May I add that if the other people at the table who are not the initial presenters want to say something, they can also be part of the dialogue.

Ms. Donnelly: I agree with those comments. In the schools, there was a lot of inconsistency, not only across the country but within provinces, because it was up to the boards to look after the communication plans. That responsibility was put upon the schools as well to communicate with their parents. We would hear different things from different boards within a province or territory, as well as across the country. That inconsistency created much confusion and angst. Some were doing it this way and others were doing it that way; what was the best way?

I think that the comfort level with people is important. If there was a national plan where everyone was on the same page, it would give them more of a comfort level.

Senator Callbeck: You want a national plan for the schools as well?

Ms. Donnelly: Yes, we support a national plan; how to roll out the preparedness in terms of how everyone can be prepared and in terms of the vaccination as well. That plan would provide that comfort level. When the plan reaches down to the board and school level, perhaps it has to be tweaked to the community, but if there was the basis of the plan in place, that basis would provide the comfort. As I said, then we would all be on the same page.

Senator Callbeck: Where did you receive your information?

Ms. Donnelly: We received our information from our member organizations. We have 16 member organizations representing the provinces and territories across the country. They receive their information from their teachers within their schools. Our members are involved, of course. We receive our information directly from our teachers as well. We surveyed the teachers so we received a lot of the information there, and they are directly involved in that survey.

Senator Callbeck: You played a part in advising the schools, did you not, and the school boards?

Ms. Donnelly: We did not advise the school boards. We do not represent the school boards. We represent the teacher organizations. We put together recommendations for our teacher organizations. All the teacher organizations, I might add, also provided information to the teachers in their schools. The boards provided information as well.

Senator Cordy: Your comments on the need for vaccination and preparedness for front-line workers are extremely valid. I am sure, Chief Simonds, you were frustrated when you saw what you referred to as the high-profile queue- jumping. I know in Nova Scotia the sports teams would be frustrating for front-line workers such as yourselves.

As a teacher, I have to ask Ms. Donnelly the first question: Once a teacher, always a teacher. You comment that elementary teachers feel they are in a petri dish. I used to be an elementary school teacher, and indeed that is exactly true, with coughing and sneezing, and not necessarily in their sleeve, as we were taught to do.

One of the things you talked about was the role of the parents. For the schools to be open, schools need full cooperation. That is, parents should not send their sick children to school. In theory, which sounds absolutely wonderful, that should not happen. However, the reality is that times have changed from 30 years ago when, in 99 per cent of the cases, a parent would be at home. That is no longer the case. In fact, that is a rarity. It was a rarity 10 years ago when I was in the classroom and it continues to be a rarity.

In every elementary school that I taught in, there was no place in the school for a sick child. They would end up sitting in the principal's office or outside the principal's office and waiting until someone came to pick them up. Is there a plan by municipalities as to what to do with sick children in a pandemic? We were lucky with this pandemic; it was not as bad as it could have been, or as bad as perhaps the next one will be. Are teachers part of the planning process for pandemics within the region including such things as what to do with sick children when schools are open? Theory is one thing, the practicalities are quite another.

Ms. Donnelly: Thank you for the question. You are absolutely right; we continue to send our sick children to school. We understand that we cannot keep them home for every little sniffle but, when something like this pandemic is happening and it is a nation-wide phenomenon, we need to educate the parents and say, they must have a plan in place to keep their child home. Something as serious as this virus spreads continually, and that is how it spreads. We must do a better job of educating our parents as to the seriousness of a pandemic. It is not only a little sniffle; it is something bigger.

To your question of are there places in the schools, sometimes there are. Once again, that situation is inconsistent from school to school, board to board and province to territory. Some schools will have the space for a sick room where the student can go, but if there are a whole lot of sick children there, then they are running a health centre. That is not the job of schools. It becomes difficult because the personnel are not there to oversee all those sick children.

Are we part of that plan? We are part of the plan within our school boards or within our own schools. We are not part of a greater plan. I think that plan is, perhaps, what Mr. Dauphin was talking about when he said that there needs to be that consistency and communication among the different levels.

We would be absolutely thrilled and happy to work with municipalities in terms of putting together a plan for the situation you describe. Right now, we are not part of the plan. Right now, every school does not have a place where sick children can go. We do not have the personnel to oversee those sick children there.

Senator Cordy: Mr. Furlong, I did not know paramedics could give vaccinations, so thank you for that information today. You said that the paramedics in Ottawa were part of the vaccine distribution program. Was that the case across the country?

Mr. Furlong: It occurred in various jurisdictions across Canada. Ottawa forged the way forward with that plan when we saw public health clinics in this region becoming overwhelmed with the vaccination program.

We inoculate each other annually, whether it is for seasonal influenza or pandemic influenza. The Public Health Agency called and said, we need help; can you handle this? We said yes and off we went.

That was the reaction we heard at the public health clinics, namely, ``We did not realize paramedics did this.'' The challenge is the lack of regulation for paramedics to step in. We heard that challenge from the first panel as well.

Senator Martin: My question builds on Senator Cordy's question. First, thank you very much for the work that you do, and for the level of trust the public has in you. We appreciate all your associations and members.

My question is about what you said in your presentation, Mr. Furlong, about being underutilized, about the surge capacity and about whether we are optimizing the resources that we have and how best to do that. In some respects, you have already answered and addressed that question. For any of your associations represented today, how can we utilize the existing resources better? What needs to happen? Are we taking those steps already? Surge capacity was raised in the previous panel. How can we strengthen that capacity, and what measures might we think about taking in preparation for the next pandemic? I open up that question to all of you.

Mr. Furlong: From a paramedic perspective, it is a change in the rapid growth within the profession and the skill set. We went from driving someone to a hospital 15 years ago to undergoing three years of education and a dynamic skill set that is portable and can be taken with us. With that kind of rapid change in a short period of time, it takes a long time for the public to become educated as to what that profession entails. That is probably why you see some of the catch-up taking place now, where people say, ``They do have a unique skill set. They do have a defined scope of practice and a specific competency set that we can utilize.''

That skill set has never been requested before. At the municipal level, we are seeing it in the involvement with public health because at that point, the working group is small. As we go to a provincial and a national level, the group is bigger and our involvement falls by the sidelines. The biggest adjunct is probably in that surge capacity role because at the same time, we are cognizant of the daily 911 calls. No matter what happens, whether there is a national disaster or a pandemic, someone will still have a heart attack and a baby will still be born. Those things will happen on a daily basis. We need to mitigate that need as well as still provide the surge capacity.

Mr. Dauphin: As we have said, it is complex but we need a system. My province is jealous about their jurisdiction. However, as a former Member of the National Assembly of Québec, I think in a case like emergency preparedness we could ask the federal government to play the role of preparing the national plan. After that, we can all work together. As a great country, I think we can do it.

Alain Normand, Member, Pandemic Preparedness Working Group, Federation of Canadian Municipalities: The question of the system is important. There is a great willingness to address the surge needs. A lot of groups out there are willing to provide support and help. One group with the same kind of idea is the Canadian Blood Services. Possibly, they could be brought in to give vaccinations as well. The system is not there to enable this kind of thing on a national basis. It will work in one jurisdiction and may not work in another. There are a lot of retired nurses, doctors and paramedics that could be called back, but we have no system to communicate with them. The municipalities are not equipped to provide that communication, particularly the smaller municipalities. The larger ones may have a system, but we need something at a national level. We need the guidance and leadership on that aspect.

Ms. Donnelly: I want to paint a picture of the school systems, and to recognize the importance of a real plan if we are to keep our schools open.

Our classes have changed over the last 30 years. I know you are all aware of that, but one in five of our students have some sort of special need. Some of these special needs are high special needs that require medical attention. We have teachers' aides with a number of our students. When they become sick, we do not have the personnel who are qualified to be with these students.

In one board, the communication was out there that the schools were remaining open. Even if the teachers' aides are sick and not replaced, those students will go to school. It was left upon the school personnel to be with that student, and to provide the necessary care for that student. Teachers were uncomfortable with that role because they are not trained to provide that care. It is difficult to obtain a substitute teacher's aide or a substitute teacher to provide that care. Those are some of the things that we need to be aware of as well.

Senator Martin: I was a secondary teacher myself and once was in a situation where I to deal with a high-risk diabetes student. It was an urgent matter, and I had not been fully trained. Fortunately it was okay, but it could have been a dire situation.

I was thinking that schools have a captive audience, including parents who are interested, and schools play the role of disseminating key information. Teachers wear many hats, so thank you for the work you do.

The Chair: One quick question from Senator Callbeck to wrap things up.

Senator Callbeck: I want to come back to this national plan that has been mentioned many times this morning. Many of you have spoken in support of why we need it. It makes a lot of sense to me.

The Federation of Canadian Municipalities wrote to the Minister of Health back in July 2009. Have you had any response to that letter, or have you had a meeting with the minister? Where is the department coming from?

Mr. Dauphin: We discussed that this morning. We had a great response from the minister as well as from Dr. Butler- Jones. We are exchanging regularly with them and it is positive, but at the same time, we are still pleading this morning for a national plan. I do not think they are against that.

Mr. Normand: The problem is on the implementation. There is a willingness to work, and we are sitting at the table and having discussions, but when it comes to the implementation, we saw that the H1N1 did not translate into actual actions. The recommendations we made were not directly followed.

On the communication, some newspapers had advertisements about the pandemic, and the federal government gave general guidelines about who should get the vaccine. There were provincial guidelines about where to get it and who is authorized to give it, and then there were the municipal guidelines that said where to go to get the vaccines. Why could we not get some consortium to work so that we would have one message so the public knows? It was confusing sometimes. That is why we need to sit down and do more than discuss. We need to be ready to implement together.

Ms. Donnelly: That readiness is important. We conducted our poll of our teachers in late October. If we had waited two weeks, we feel that we would have gotten different responses about their comfort level in preparedness for it because a lot happened last fall. Teachers were dying, actually. A number of pregnant teachers across the country died, and there was a real concern there.

When Dr. David Butler-Jones made it to the media and really took over the whole thing, it brought a real comfort level. Every time something came out from his office and under his name, it came to the schools. The boards were getting that information out to the schools, and it brought a calm to the situation, and people felt a lot better about it.

That brings me back to the national plan. Here was this national doctor who was in charge of this whole thing, and people felt comfortable because someone was in charge of that. If there is a national plan, people will feel that we are all in this together; it will give us a much better comfort level. With that comfort level comes confidence in carrying out your plan.

The Chair: On that note, we will bring this part of the meeting to a conclusion. This is our second panel. Thank you all very much for being part of helping to reflect on what happens on the ground in our cities and towns and rural areas right across the country.

We will begin our final panel for today on pandemic preparedness looking at the local level. The last panel dealt with first responders, and now we are dealing with the private sector's involvement in all of this.

We have four panellists. John Neily is Director of National Security and Public Safety with The Conference Board of Canada. He is a recently retired executive leader with the RCMP with extensive experience in strategic policy development as it relates to national security and public safety.

Suzanne Kiraly is Executive Vice-President of Government Relations for the Canadian Standards Association. She has more than 23 years of in-depth business knowledge combined with extensive management experience across CSA Group's business divisions.

From Ontario Power Generation, OPG, we have Gian Di Giambattista, Director of Emergency Management and Business Continuity. He is responsible for managing OPG's emergency management of business continuity programs and for integrating the various functional elements, such as physical and cyber security, business continuity, environment and corporate affairs. In 2006 he took responsibility for rolling out the pandemic influenza plan at OPG.

From RiskAnalytica, we have Paul Smetanin, President and Chief Executive Officer. Since 2001, RiskAnalytica has been an employee-owned management science firm specializing in independent evaluation and analytical services that support better policy, business and investment decisions.

Welcome to all of you. We will start with Mr. Neily from The Conference Board of Canada. You could take five minutes in your introductory remarks.

John Neily, Director, National Security and Public Safety, The Conference Board of Canada: It is a pleasure to be here on behalf of The Conference Board of Canada and the members of the various networks we have.

Over the last four years, the Conference Board has undertaken two separate executive networks in which we have engaged with Canadians from the public and private sector on issues surrounding pandemic. We started, of course, with H5N1, and after that, once the H1N1 pandemic was declared, we created the Pandemic Response Working Group.

The comments I make to you this morning arise from a recent workshop or set of workshops we have had as we have concluded the work of the Pandemic Response Working Group. I apologize for the fact that we do have a report, but it is being edited as I speak. I will ensure that the clerk of the committee receives sufficient copies when it is completed. This refers to the report, Mr. Chair, but it is not quite yet produced. We will ensure you get it.

The report that I speak of, Learning from H1N1: Maintenance and Momentum, forms the basis of my comments. We asked participants in workshops what they learned, how they can change and what we need to adjust in our plans for the future. It builds on other work we had done in three other reports previous to that.

If I could categorize the challenges as we heard them, the first area was around triggers. That is a fairly common comment when you hear other groups speak about their challenges. Of course the pandemic that occurred was not the pandemic that many organizations had planned for. As a result, from the onset, some assumptions were challenged, and the ability of crisis management teams to be flexible was the marker of success and effective employee engagement, protection and response. Immediately, those organizations that had identified World Health Organization, WHO, triggers within their plans to initiate certain responses were faced with a disparity as it related to regional reality. Many lessons have been taken from that by those participants and Canadians.

The triggers used by WHO related to spread and not severity. The work of many organizations over time focused on the effective means, with partners, to measure severity for true organizational forecasting. Situational awareness was key, and those who monitored as many sources as they could beyond including their own internal systems were soon able to cut through the information confusion to provide effective communications internally and externally.

The issue of severity should be addressed seriously for effective response planning for organizations across the country, both public and private. We applaud the work of the experts in the electrical sector, led by the crisis team at Ontario Power Generation, in their efforts to sensitize the community to severity measurement.

Effective internal communications allowed for organized, confident response of some organizations. Organizations or communities whose communications were built on trusted relationships or that used effective collaborative teams of trusted entities within, and indeed with partners, were more successful than those who did not communicate.

Information for employees and their families, as well as the corporate and public sector executives, was available 24 hours a day outside of the workplace. It was oftentimes contradictory and confusing, especially in those organizations that had workplaces spread across jurisdictions where different bodies of public health experts were managing one province or another's response. Successes such as the broadly applied and highly effective personal hygiene and personal responsibility message were not only effective but can be maintained.

Regional relevance to the messaging is essential for the future. Those organizations that focused on employee confidence and well-being and honest dialogue and that found effective means to include the families and loved ones of employees spoke of their successes. However, they also said that in the future they wish to find a means to measure the success of their communications so they can identify obvious gaps or issues to close for a more effective approach to the dynamic nature of disease spread.

External communications were also critical. Suddenly the concept of supply chain relationships and understanding of the need of preparedness and effective response up and down that supply chain and business chain became evident to many who had no means to address that. This forced dialogue and the exchange of plans, including those who assisted partners in preparing their plans.

Those organizations that spoke of new relationships with regional and local health authorities spoke of the beneficial effects across their organizations from that situational awareness. On the other side of that discussion, regional and public health authorities gained a real-time picture of the impacts on their regions and in their communities, allowing them to check and, if required, adjust their planning and responses.

Through coordination and planning, the ability to be flexible during pandemic response was critical to the success of organizations that did fare well in this. Organizations or communities that viewed the pandemic as simply a health emergency were missing the obvious connections to the need to engage the broader strengths of community and organizational partners, whereas the response required effective business continuity, thinking and emergency management engagement.

A lesson forward from this is the need to keep disease outbreak on the agenda of executives of organizations. The seasonal flu provides an opportune time to refresh the planning and the personal hygiene messaging and to continue to build on the confidence of employees, their families and residents. In many Canadian communities, the large employer is the trendsetter and beacon for the messaging. Many understood that and rallied their communities through effective response.

When they were asked what they would do differently, the members of the network and the participants of the workshop provided several observations. These included the following: continue to build relationships with stakeholders, revise the triggers for their organizations that make sense for their realities and the information they have available, ensure there is flexibility in the plans and an appetite to trust that flexibility through exercising, incorporate pandemic preparedness in the risk registry of corporations and governments, incorporate pandemic preparedness into contract requirements between businesses, and find a way for the role of the private sector to enhance the vaccine distribution system.

The large concern expressed by all is keeping the issue of potential pandemics on the radar of those in positions of authority or those in positions that need to resource a moderate but sensible continued presence in planning for potential other disease outbreaks. The large concern was complacency.

Suzanne Kiraly, Executive Vice-President, Government Relations, Canadian Standards Association: On behalf of the Canadian Standards Association, thank you for your invitation today and the opportunity to appear before you to discuss the state of Canada's pandemic preparedness as well as lessons learned from the 2009 H1N1 pandemic.

At the outset, let me say that CSA is actively involved in the health care sector. We have more than 150 standards in the area of health care and more than 700 expert volunteers who work every day in the health care system. We are also involved in emergency management; we introduced our first standard in the 1990s and in 2008 introduced a comprehensive standard entitled Z1600 Emergency Management and Business Continuity Programs.

CSA also has many standards in related areas, including personal protective equipment — chemical, biological, radiological and nuclear protection — and health care facility design optimization.

As committee members may be aware, during the 2009 H1N1 pandemic, CSA hosted a national round table to discuss what worked and what gaps existed in Canada's pandemic preparedness response. We did so in order to utilize this real-life experience to enhance our emergency planning standard content to ensure that we had a pragmatic and effective tool for government and industry.

Through the course of this process, it was decided that the recommendations coming out of this discussion could work to improve the Canadian Pandemic Influenza Plan for the Health Sector, and participants urged us to share them in order to more effectively counter future pandemics that could be of increased severity.

Our report, which was released on June 8, 2010, is entitled Voices from the H1N1 Influenza Pandemic Front Lines: A White Paper About How Canada Could Do Better Next Time.

The report focused specifically on the challenges and opportunities faced by health care and emergency service sector front-line professionals during the pandemic and included viewpoints of such participants as the Canadian Nurses Association, the Canadian Association of Emergency Physicians and the College of Family Physicians of Canada, to name but a few.

All participants in the report's round table agreed that although the current 2006 Canadian Pandemic Influenza Plan for the Health Sector is a step in the right direction for mitigating serious illness and overall deaths during a pandemic, more needs to be done to prepare Canada and Canadians for future, more moderate or severe pandemics.

Among the numerous recommendations made, I want to highlight two in particular and add a third that CSA has been advancing with the federal government.

First, CSA and the expert round table believe that Canada's pandemic plans need a common baseline of preparedness at the grassroots level. That preparedness is needed among health units, front-line health care workers and first responders, for training, readiness, processes and interoperability to ensure a nationwide standard of care and an ability to provide mutual support to each other, regardless of where in Canada the expertise and capabilities are located.

From first responders to emergency room nurses, there was a call for a more consistent approach to education, planning and engagement at all levels of the health care system for an emergency plan to be successful. We believe that this is absolutely crucial to ensure effective response, treatment and management of care during a pandemic or national emergency.

Second, I believe all Canadians can agree that while the federal government deserves a high degree of credit for the communications with the public and stakeholders during the pandemic, there is a need for greater coordination among federal, provincial and territorial governments to decrease the risk of misinformation and confusion getting into the public discourse. Ensuring family physicians, firefighters and government authorities have access to information consistently is crucial to success. Indeed, we can all recall an instance where we turned on our television or logged onto the Internet to discover experts espousing different views on the status of the pandemic and appropriate steps for the public to take.

The reality is that in this age of 24-7 media coverage and technology that enables Canadians to access information with the click of a button, we must be consistent in our approach to messaging and communications in times of national emergencies or pandemic.

The need for consistency should outweigh broader concerns about jurisdictional responsibilities. CSA and its expert round table recommend that in addition to the creation of an integrated federal-provincial-territorial communications body comprised of medical officers and disaster management experts, federal, provincial and territorial governments work towards creating a primary care and emergency service communication network to reach those on the front lines working outside of hospital settings during a pandemic. These would include family physicians; those working in walk- in clinics, home care and long-term care settings; and first responders.

From CSA's perspective, we believe there is strong merit in developing national standardized emergency management planning templates and tools for both the health care sector and small to medium-sized enterprises. For the health care sector, it would include the acquisition, distribution and dispensing of vaccine; the use of antivirals; and how to manage mass inoculations, communications and quarantines. For small to medium-sized enterprises, it would involve contingency and business continuity planning as well as protocols for sick days and vaccinations.

Over the course of the summer, CSA held discussions with officials from the Public Health Agency of Canada, Health Canada, Public Safety and the Prime Minister's Office to determine whether there is interest in having CSA facilitate a national discussion with Canada's top emergency planning experts on how best to develop those templates and tools for pandemics and national emergencies. I can advise the committee that officials we have met with have been highly receptive to this offer, and we are exploring ways to make such a national discussion transpire.

Constructing a truly national, integrated approach to emergency management is a challenge in Canada, given federal, provincial and territorial jurisdictions. On that, I think we can all agree. However, in CSA's view, when it comes to public safety and public health, jurisdictional silos of excellence must be dismantled if we are to ensure that the protection of Canadians and their families is put first.

In closing, Mr. Chair, although CSA has sent a copy of our report by our expert round table to the committee members, I wish to table a copy for reference by the committee as you continue this important study. I will be pleased to take your questions.

The Chair: Thank you very much.

Gian Di Giambattista, Director, Emergency Management and Business Continuity, Ontario Power Generation Inc.: Good morning, honourable senators. Thank you for inviting me to share our experience with the planning, which includes our planning response to the H1N1 pandemic, and some recommendations regarding improvement opportunities.

I am sure you are aware that OPG is Ontario-centred, and we produce about 60 per cent of Ontario's electricity. As part of Ontario's critical infrastructure that provides such an essential service, we do not have the option of shutting down during a pandemic, which is a strategy that some businesses use.

We started our planning for the pandemic in 2005, and we completed it in 2008. The plan includes various planning assumptions, a staged response and 11 protocols, such as human resources, communications, cleaning and so forth.

The plan considers mild, moderate and severe scenarios for 20 per cent, 30 per cent, and 40 per cent absenteeism during the peak of the wave. Decisions are based on local threats and on the World Health Organization phases.

Business impact analyses were created to identify risks, processes, staff and systems as well as recovery priorities. Plans for continuity of operations were written for critical functions.

Our preparations included purchasing antivirals for prophylaxis for all staff and cross-training where possible. For our business, that is not always practical, as some staff require years of extensive training, experience and licensing. It also involved conducting a respiratory study and stockpiling respirators, masks, gowns, gloves and hand sanitizers; developing special cleaning procedures; and considering social distancing wherever possible.

We validated our plans through extensive peer and executive reviews. We undertook an external audit, and we did many tabletop exercises that included external stakeholders and regulators.

We managed many of the unknowns and other risks through engaging the executives and communicating with the employees during the planning as well as the response phase. We involved our unions, networked with all levels of government and other critical infrastructure groups, assessed various supply strategies and did additional planning to increase certain critical inventories.

When the H1N1 pandemic started in April 2009, we responded by activating our pandemic response working group and defined decision thresholds for activating parts of a staged response. It was obvious that a number of things were not evolving as we had envisioned because of the H5N1. We provided employees with updates about the threat and what they could do to protect themselves. We selectively activated parts of the continuity plans based on local threats.

We fit-tested designated staff on respirators, and under the direction of our chief physician, we administered the antiviral consent forms. We went through a consent process for the antivirals and administered the vaccine once it became available to us.

Before the H1N1 pandemic, we knew the importance of considering local threats rather than taking direction from a global source such as the World Health Organization. However, the pandemic reinforced the need for flexible and nimble plans. It is important to recognize that no two pandemics will ever be the same. We should not fall into the trap of preparing for the last pandemic.

Relationships and networks that were developed during SARS and the blackout and through public- and private- sector working groups were invaluable during the pandemic response. Balancing internal communications with media information was tricky. Informing and reassuring employees was a priority with conflicting news regarding severity versus spread, the impact on specific target groups and the challenge of dealing with the adjuvanted vaccines.

For OPG, overall absenteeism was not significantly different from a typical influenza. However, we also confirmed that not all sick individuals will stay home, and some individuals will stay home for other reasons, such as being worried or looking after family. Some job functions experience significantly higher absenteeism rates, which, from a licensing requirement, makes cross-training or hiring temporary staff impractical. That reinforces for us the need to prioritize antivirals and vaccines for critical infrastructure staff.

Sourcing health-related supplies, such as hand sanitizers, was nearly impossible during the pandemic. Maintaining the stockpile was important. This reinforces the issues of supply chain.

During the H1N1 pandemic, it became evident to us that the response to a pandemic should be based on severity rather than on spread only, which had been the case. I was involved with a number of my peers in the electricity sector. We developed a severity response matrix concept, which is currently part of the sector pandemic guidelines.

The matrix factors in case fatality, the illness attack rate and staff absenteeism, allowing companies to tailor their responses. Further research and analysis must be conducted on this severity response matrix to validate this concept. I can provide more details on the matrix if you wish to receive those.

In conclusion, from our perspective, it is critical that health authorities consider critical infrastructure as a priority during health emergencies, particularly for antivirals and vaccines. During a severe pandemic, the health sector will be impacted if critical infrastructure cannot maintain continuity of operations. Further research and analysis are needed and should be carried out by health agencies to develop a more robust severity response matrix.

H1N1 provided an excellent opportunity to test our pandemic plans and many of the provincial, municipal and federal plans. We will continue to work with health authorities and other critical infrastructure to improve our collective preparedness and the resiliency of Canadian society.

Paul Smetanin, President and Chief Executive Officer, RiskAnalytica: Thank you, Mr. Chair, for the opportunity to address the committee this morning. As Canada emerges from the recent H1N1 pandemic, it is important to examine and evaluate the outcomes of the country's response. Given the complexity of a pandemic, it is difficult to measure and manage with certainty during an outbreak. Most of what we learned is gained in hindsight. To that end, I commend the committee for undertaking these hearings, and I am hopeful that RiskAnalytica's research and knowledge will assist the committee in its deliberations.

RiskAnalytica is a group of interdisciplinary researchers who examine population health issues through the lens of mathematical analysis. Based upon government surveillance data, we conduct our pandemic research under the direction and oversight of leading Canadian and international infectious disease experts. Our independent pandemic research has been made available and possible through funding from the Public Health Agency of Canada and from an unrestricted grant from Hoffmann-La Roche.

Since the onset of the 2009 pandemic, RiskAnalytica has been extensively researching the life and economic impacts of the pandemic across Canada. In particular, we have been conducting post-pandemic analysis to inform the debate around the severity of the pandemic and the effectiveness of Canada's vaccine and antiviral intervention, as well as looking at what could have happened if the pandemic had been more severe.

While we do not wish to minimize the hospitalizations and deaths that occurred last year, the sobering reflection is that the severity of the H1N1 pandemic was generally mild. Despite this, many issues emerged throughout the pandemic, fuelling debate regarding communication, capacity, level of intervention and priorities. Due to the relative mildness of the pandemic, it is important not to base future pandemic strategies solely upon last year's experiences.

RiskAnalytica's research into the life and economic impact of pandemic in Canada and the possible impacts of its timing and severity, if its severity were changed, shows that without the reported use of antivirals and vaccine in 2009, the pandemic could have resulted in twice the hospitalizations and employee absenteeism that were seen last year, almost three times the health care costs and almost four times the number of deaths.

An important caveat is that these results are based upon high-level estimates of Canadian vaccination rates and timing. While pinning down the actual vaccination details is an ongoing challenge, we generally conclude that antiviral and vaccine interventions in 2009 were cost-effective when considered in accordance with the World Health Organization guidelines.

Notwithstanding our conclusion as to the general cost-effectiveness of the antivirals and vaccine used last year, as researchers familiar with plausible pandemic scenarios and as members of the Canadian community, we have three recommendations that we wish to raise.

The first recommendation is to avoid basing future pandemic plans solely on the experience from last year. While many useful lessons were learned about vaccine distribution, communication policies and health authority coordination, it is important to avoid underestimating future pandemics. Since last year's outbreak, the notion of a pandemic is not as abstract as it was. Given that the pandemic was mild in population terms, any communication, distribution and coordination issues that were revealed last year would be significantly amplified if we had a more severe pandemic. Our concern is that people will normalize their assessments of the risks of a pandemic against their own recent experience and that pandemic debates may not reflect that last year's pandemic could have been a lot worse.

For example, if the severity of the pandemic were increased to resemble a moderate pandemic, such as the 1957-58 Asian flu pandemic, and the pandemic response remained the same as it was last year, a best-case scenario estimates that there would have been over a 20 per cent increase in employee absenteeism, at least 4 times the hospitalization and 13 times the mortality compared to what was experienced last year. We recommend extensive scenario analysis be included in any pandemic planning process so that appropriate pandemic plan responses that can scale to a wide range of potential pandemics are developed.

The second recommendation relates to the timing of vaccine. Last year, Canada was presented with a two-wave pandemic, with the first wave resulting from the interruption of the pandemic process. The slow spread of the pandemic during the summer months provided health authorities with much needed time for vaccine production, approval and distribution. Nonetheless, it appears that vaccine in Canada had generally arrived just in time to prevent the full impact of the second wave. Our analysis shows that had the pandemic in Canada been a full single wave, possibly due to its arrival in Canada in the fall instead of the spring, a vaccine would not have arrived in time.

Current vaccine manufacturing processes and the resultant distribution timelines appear to be insufficient to protect Canadians against the hospitalizations, mortalities and economic disturbances that could accrue from a pandemic with a significant first wave. For example, if Canada were presented with a single moderate pandemic and the pandemic response remained the same as last year, a best-case scenario estimates that there would be over twice the absenteeism within the labour force, 10 times the hospitalization and health care costs, and 31 times the mortality of what was experienced last year.

In the absence of widely available vaccine, the emphasis would be upon other mitigating strategies, such as the release of the federal and provincial stockpile of antivirals, which could reduce the impact of a moderate pandemic to similar magnitudes of what was experienced last year, assuming that the pandemic is susceptible to antiviral use. Yet the preparedness around the large-scale distribution and use of antivirals was not generally tested last year, or in any other year, for that matter. We therefore recommend that techniques for improving the processes surrounding pandemic vaccines be intensively examined and that the practical details to deploy alternative interventions, such as the distribution of the federal and provincial stockpiles of antivirals, be thoroughly tested.

Our final recommendation relates to the current antiviral stockpiling policies in Canada. If a moderate single-wave pandemic were to occur in Canada in which vaccine is expected not to arrive and widespread antiviral use is implemented, our research indicates that Canada could be at risk of running out of its federal and provincial stockpiles of antivirals before the end of a significant first wave.

Our widespread-use policy assumes that 50 per cent of those who become ill will seek treatment, and 5 per cent of the Canadian population seeks antivirals for post-exposure prophylaxis. The benefits of widespread antiviral use are significant in the absence of vaccine. For example, in a single-wave pandemic, moving to widespread antiviral use instead of the limited treatment policy that was used last year could reduce employee absenteeism, hospitalizations and deaths by more than 30 per cent. However, such a policy requires over 80 million doses of antivirals to be distributed across Canada, which comes extremely close to the total stockpiles held by various Canadian governments. Any increase in demand, wastage or distribution losses could result in a shortage of antivirals. We recommend that any post-pandemic debates should investigate further the role of antivirals and the size and distribution of the Canadian stockpile.

Once again, I commend the work of the committee, and I look forward to the committee's report. I would be happy to take any questions.

The Chair: Thank you all very much for your initial presentations.

Someone mentioned a working group established by the federal government called the Private Sector Working Group on Pandemic Influenza Planning. Mr. Neily mentioned a working group at the Conference Board. The CSA did work with its round table and the report that it subsequently produced.

Are these different groups exchanging information? The private sector is very diverse, and it seems to me there has to be a fair bit of cooperation and communication between the different groups. Could you talk about that briefly, and also about what you see as the federal government's role in pulling that diverse community together?

Mr. Neily: The working group that we convened at the Conference Board was made up of a fairly broad constituency of private and public sector people. It was focused on human resources and organizational excellence issues as well as emergency planning and so on.

I started with the board only a year ago. My predecessor sat on the federal working group, and I had a chair on it as well. We were aware of some of the work that our colleagues in the CSA did because some of the people who sat on our working group were also part of the panel of experts that they regularly interface with as they are doing their emergency management planning around Z1600 and so on.

As to the value of that type of committee by the federal government, there is a critical need to maintain that. If that goes away, I fear the complacency that we spoke of. We need to be able to keep this on an agenda. We need a common place to meet and talk and share best ideas.

Ms. Kiraly: The CSA develops its standards using experts from industry, government, consumers and other users. When we introduced the standard in 2008, we did a wide publicity event. Our standard is made up of electrical utilities, private sector organizations like oil companies, and other experts such as the Greater Toronto Airports Authority, so it is a broad, emergency-based standard.

The round table we launched was specifically for front-line health care, and that was in response to our stakeholders from the health care industry. The report that we produced is publicly available. We continue to train the health care sector as well as other industry groups on emergency planning principles and how to implement emergency plans, and we continue to have dialogues at both the federal and the provincial levels about their needs for emergency plans, so there is continual information.

When we put a standard out, there is a process of publishing it as well as gathering information to determine how effective it is. We then revise it and bring it back out to support industry and government needs.

The Chair: Specifically with regard to OPG, as you said, communications was a vital part of the work you were doing. From where did you get your communications around health advice? Were you getting information primarily from the Public Health Agency of Canada, the province or the municipalities? If you were getting conflicting advice, as some people suggested they were, how did you sort that out?

Mr. Di Giambattista: I spoke specifically about the collaboration that took place leading up to the pandemic through planning and so forth. Our strategy was to deal with the Ontario Ministry of Health and Long-term Care specifically for aligning how we would respond. We are mainly based in Ontario. We were aware of what was happening. I was a member of the public-private sector working group at the federal level, so we were aware of the different positions and responses, but we had direct discussions with the Ministry of Health and Long-Term Care at the provincial level before finalizing our communications.

The Chair: There was dialogue.

Mr. Di Giambattista: Yes.

Senator Ogilvie: Thank you all for outlining the various aspects in the private sector very clearly and understandably.

Mr. Smetanin, in your report you outline very clear numbers of estimates of the antiviral and vaccine saved. Did you break that down between antiviral and vaccine?

Mr. Smetanin: We did. It is a very difficult exercise, but we were able to break it down to the extent possible. We found that the use of antivirals and vaccines had a synergistic effect. That is part of the problem of doing a breakdown between the two. Antivirals on their own could have reduced deaths by about 40 per cent.

Vaccines have a much greater propensity to reduce the number of deaths, but of course vaccine is highly dependent upon when it shows up. In this case, it was approximately 58 per cent. It varied from province to province, however. We can send the committee material showing how the experience differed from province to province due to both antivirals and vaccine.

Senator Ogilvie: The synergistic effect often occurs. How were you able to determine that that occurred during a pandemic? It is often only under sustained clinical trial that you can actually demonstrate a synergistic effect. Are you speaking from your instinct, or did you have an actual clear control that gave you that answer?

Mr. Smetanin: The analysis that I am speaking to today is based upon evidence that was collected throughout the pandemic. As I mentioned earlier, it is very difficult to say during a pandemic what is and what is not. It is a highly complex and uncertain event.

Each week last year we ran the same model for the Public Health Agency of Canada that we have used as part of this research in order to begin to understand where the pandemic was going and how it could quickly change shape and size. We can quite happily say that in early June the numbers that the model was producing were quite close to what the experience was in August, September and October prior to the rollout of the vaccine. Having said that, there is no particular feature about the model that we used that is promising and better than anything else.

Last year's pandemic was quite a deterministic event as far as pandemics go. In the research that we are looking at now, we tend to understand pandemics after the fact and hence have these post-pandemic debates.

We have taken data sets of antiviral use across the country by province and by months, and we have taken the vaccine usage. We looked at what happened in terms of hospitalizations, intensive care unit admissions, and deaths, and we were able to calibrate a model with a lot of the underlying structure using infectious disease experts to come up with a re-emulation of what the pandemic looked like. From there we can take out the timing of vaccines and the efficacy aspects of the vaccines, and then we can take out antivirals.

At that point we start to arrive at conclusions about what would have happened if the antivirals had not been used. Last year they were used in a small proportion; one twenty-seventh of the Canadian stockpile is the number of antivirals that were used last year. However, when we take them out and when we take out vaccine, we can draw conclusions as to how the experience could have been different with and without them.

Senator Ogilvie: The reason for my question, and I am pleased with your answer, is that in the pre-pandemic information available on Tamiflu there is a considerable range of opinion as to its efficacy. Some of the documents suggest it is actually in the range of a placebo effect overall. That is the reason for my question. I was curious as to how during a pandemic you could come up with such significant issues and why I asked if you could separate it out.

I appreciate your answer very much. Thank you.

Senator Callbeck: Mr. Neily, the chair mentioned the two groups that have been set up, one by the Conference Board and one by the federal government. What is the difference in the roles of those two committees?

Mr. Neily: The Conference Board of Canada operates a series of executive networks designed for peer-to-peer learning, and in our case, the groups that I manage are also for public policy debate influence and so on around national security and public safety. We work with our members to provide dialogue that is designed to bring the best effect, the best lessons forward, either on live issues or emerging issues.

As I understand it, the federal government's network was largely for communications, for allowing policy-makers to have access to private sector concerns and experts. Although it existed, I do not believe that committee met that frequently.

Our group though was very active. We met on a regular basis by a variety of means, such as monthly teleconferences plus face-to-face meetings. The members designed and demanded that they be on the edge of what is going on for best practice exchange and so on. Ours is designed to be a long-running, peer-to-peer learning type of experience and a true network. The Pandemic Response Working Group has actually been terminated. Some of the members and the topic itself have moved into another network called the Council on Emergency Management.

Senator Callbeck: Yes, I believe I read somewhere that your group is going on until the summer of 2011.

Mr. Neily: We hope to bring the group back together. They have demanded to be brought together a year out after the last workshop to see what has changed in that year, such as the successes that others have had in maintaining their battle against complacency, keeping the issue alive and the progress, so we will be bringing them back together. However, the topic itself is discussed regularly at other meetings of the Council on Emergency Management.

Senator Callbeck: In your brief you say that a lesson forward from this is the need to keep disease outbreak on the agenda of the executives of organizations and government. Do you have recommendations on that?

Mr. Neily: The report does cover more specific recommendations, yes. I have not referred to them in the summary, but the recommendations are largely to address the issue of complacency and educate executives to be conscious of the fact that there were tremendous successes in the movement of and the progress on personal hygiene programs within organizations. Those actually had a positive effect, among many other things, in keeping the pandemic to the level that it was. That should not stop, and that is really the message. There are derivative benefits of the work done during the pandemic that can keep the message alive, short of panic. We are not talking about trying to build a false image or false messaging, but it is taking the lessons that have been learned and actually operationalizing them.

Senator Callbeck: What role do you see the federal government playing in this?

Mr. Neily: The federal government could assist by providing standards. For standard communication, they could provide best lessons on tools that were used effectively. They could farm that information with a variety of constituents. I believe that standardization in approach would be one of the best methodologies for the future for planning that would provide for a base of knowledge for others to then become more adept and dynamic to deal with their own situations. They have a significant role.

The Chair: Does anyone else want to pick up on that?

Ms. Kiraly: As a standards organization, we develop standards for Canadians, and our standards are voluntary until some agency, government or industry sector actually references them. When CSA developed this standard, we were working in conjunction with Public Safety Canada but also with the U.S. Department of Homeland Security to take a look at Canada's approach to emergency planning as well as to look at how we stack up internationally. The idea is to provide a framework that can be used by government, by small business, by large businesses, to have a plan not only to prepare for the event but also to ensure business continuity afterwards. Unless the standard is referenced and utilized by various levels of government or industry, it will not make a difference. That is one of the reasons we are here today.

Senator Braley: Standards I understand, when you manufacture things and you are dealing with provincial standards for electricity versus other provinces, versus the U.S. and so on.

Have you thought about the solution? Everyone is telling us the same thing about the communications, cooperation and coordination, and other people are saying things. Do you have any standards on communication?

Ms. Kiraly: As a matter of fact we do.

Senator Braley: I ask that because people were confused.

Ms. Kiraly: One of the recommendations is specifically to provide a network and to get the people who have the expertise to provide the information in a consistent fashion. What we would do and have proposed is to put together communication templates that would identify how to get to the front lines and to the various groups and identify in advance the consistent approach and the frequency and how to mitigate changing circumstances. Yes, we do have a proposal.

Senator Braley: That might be useful.

Senator Dickson: How do we stack up against the U.S.?

Ms. Kiraly: The CSA Z1600 emergency management planning standard is based on a U.S. standard of the National Fire Protection Association. Interestingly enough, the Canadian committee looked at the U.S. version and said that is really good but we can do better. Therefore, we have made some improvements, and those improvements are actually now being considered by the U.S. committee so that we have a harmonized approach in Canada and the U.S. We have a consistent approach.

The Chair: Thank you very much for your input. You have given us valued information in all cases. Thank you for participating. This brings to a close our meeting for today.

(The committee adjourned.)