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.
The Chair: Welcome to the Standing Senate Committee on Social Affairs,
Science and Technology.
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
Each organization has five minutes to make a presentation. I am sorry; I wish
it were more, but we are a bit rushed.
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.
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
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
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
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.
The CMA has been warning of the lack of surge capacity in our health system
for over a decade.
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
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
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
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
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
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
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
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
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
Innovative approaches to explore how federal investments in public health can
reap ever better returns directly at local points of service are especially
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
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.
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.
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
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
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
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
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
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
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
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
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
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
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
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
Dr. Turnbull, you talked about the sequence of patients. I assume you mean
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
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
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
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
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
CAFC agrees with that observation as far as it goes but recommends following
the words ``shared responsibilities'' with the words ``under federal
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
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
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
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
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
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
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
The Chair: Thank you very much. We will now hear from the Federation
of Canadian Municipalities.
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.
About 270,000 front-line workers need safety and security, and more than
3,600 municipalities are involved.
I realize I do not have much time left, but I must emphasize that
municipalities, territories, provinces and the federal government must all work
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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,
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
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
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
Senator Callbeck: What role do you see the federal government playing
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
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.