Evidence of meeting #9 for Public Accounts in the 40th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was things.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Neil Maxwell  Assistant Auditor General, Office of the Auditor General of Canada
  • David Butler-Jones  Chief Public Health Officer, Public Health Agency of Canada
  • Gregory Taylor  Director General, Office of Public Health Practice, Public Health Agency of Canada

3:30 p.m.

Liberal

The Chair Shawn Murphy

I'd like at this point in time to call the meeting to order. On behalf of the committee, I want to extend a warm welcome to everyone here. Bienvenue à tous.

Ladies and gentlemen, this meeting of the public accounts committee has been called pursuant to the Standing Orders to deal with chapter 5, “Surveillance of Infectious Diseases—Public Health Agency of Canada”, of the May 2008 report of the Auditor General of Canada.

The committee's very pleased to have with us today, from the Office of the Auditor General, the assistant auditor, Mr. Neil Maxwell, and he's accompanied by Madame Louise Dubé, the principal.

From the Public Health Agency we have Dr. David Butler-Jones, who is the accounting officer and the Chief Public Health Officer of Canada. He's accompanied by Dr. Gregory Taylor, director general, Office of Public Health Practice; and Dr. Danielle Grondin, acting assistant deputy minister, Infectious Disease and Emergency Preparedness Branch.

Again, I want to extend to everyone a warm welcome and thank you for being here.

We are going to hear from Mr. Maxwell.

Mr. Maxwell, your opening remarks.

3:30 p.m.

Neil Maxwell Assistant Auditor General, Office of the Auditor General of Canada

Mr. Chairman, thank you for this opportunity to present the results of our audit on surveillance of infectious diseases at the Public Health Agency of Canada, published in our May 2008 report.

With me today, as you've noted, is Louise Dubé, principal responsible for audits of the Public Health Agency of Canada.

Important to note is that the work on this audit was completed in October 2007, and we have not audited actions taken by the agency since then.

Public health officials need to know when and where infectious disease outbreaks occur so that they can reduce the health impacts on Canadians. The Public Health Agency of Canada, created in 2004, is the federal organization responsible for the surveillance of infectious diseases. The agency works in concert with other federal departments and agencies and other levels of government, as well as health professionals, hospitals, and laboratories across the country.

One of the things we examined was whether the agency, in collaboration with its partners, had obtained, analyzed, and disseminated the information needed by public health officials in Canada and internationally to help anticipate, prevent, and respond to threats of infectious disease.

We also followed up on some serious concerns raised by our audits in 1999 and 2002, when surveillance of infectious diseases was the responsibility of Health Canada.

We found that the fundamental weaknesses noted in our 1999 and 2002 reports remained. Although some important steps had been taken, our concerns related to strategic direction, data quality, results measurement and information sharing had not been satisfactorily addressed.

We also found that to obtain routine surveillance information, the agency relied on the goodwill of the provinces and territories to send useful and complete data, but this was not always done and the flow of information was interrupted at times. After two years of negotiations, the agency signed in September 2007 a comprehensive information-sharing agreement with one province, Ontario.

We were concerned that a nationally standardized approach to disease reporting remained years away.

Good information-sharing is especially critical in the event of a public health emergency. Local or provincial public health officials will almost certainly be the first to detect a public health emergency. As a national focal point, the agency needs the information about such events because, according to the revised International Health Regulations of 2005, the agency has 48 hours to assess all reports of urgent events to determine whether a potential public health emergency of international concern exists. The agency then has 24 hours to notify the World Health Organization of the results of the assessment.

Although the agency has laid the groundwork for sharing essential information in emergency situations, we found that critical arrangements still needed to be sorted out. For example, public health officials at all levels need to know the procedures for notifying other parties and what personal health information they can and should share so they can respond appropriately to the outbreak and ultimately save lives.

Therefore, faced with a public health threat that could affect other countries, and without information-sharing agreements in place, the agency may be unable to notify the World Health Organization within the times specified in the revised International Health Regulations (2005) and to keep it informed of subsequent events.

We are pleased that the Public Health Agency of Canada has agreed with our recommendations and that it has published an action plan and a timetable for its implementation on its website. Many of the actions identified in the action plan are time-sensitive. For example, in order for the agency to meet its obligations under the International Health Regulations (2005), an assessment of the surveillance capacity at the local, provincial, and national levels needs to be carried out by 15 June 2009, and mechanisms to ensure a complete and timely flow of information between the agency and the provinces and territories on public health emergencies need to be in place by June 2012.

Mr. Chairman, because this area is so critically important to Canadians, your committee may wish to ask the agency's officials what concrete results they have achieved since the tabling of our report in May 2008. Because many of the recommendations in the report date back to 1999 and 2002, the committee may also wish to obtain a commitment from the Public Health Agency to implement our recommendations and to provide the committee with regular progress reports.

Mr. Chairman, that concludes my opening statement and we would be pleased to answer your committee's questions.

3:35 p.m.

Liberal

The Chair Shawn Murphy

Thank you very much, Mr. Maxwell.

We're now going to hear from Dr. David Butler-Jones, the Chief Public Health Officer of Canada and the accounting officer of this agency.

3:35 p.m.

Dr. David Butler-Jones Chief Public Health Officer, Public Health Agency of Canada

Mr. Chair, members of the committee, I'd like to thank the public accounts committee for this opportunity to appear before you today.

I listened with interest to the remarks of Neil Maxwell from the Office of the Auditor General.

In 2003, our country witnessed firsthand the impact of an unknown infectious disease: severe acute respiratory syndrome, better known as SARS. The outbreak impacted both our people, claiming 44 lives, and our economy, costing billions of dollars. The outbreak led to the tabling of Dr. David Naylor's report, “Learning from SARS: Renewal of Public Health in Canada”. One of its key recommendations was to establish a public health agency at the federal level, to provide national leadership and coordination on public health issues, and the position I have the privilege to hold.

In 2004, the Government of Canada created the Public Health Agency of Canada with a mission to “promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.”

The 2008 Auditor General's report identified key areas for improvement and continued improvement in the agency's surveillance activities, particularly with respect to infectious diseases. It takes us further down the path we started along four years ago. I welcome their assistance with our ongoing strengthening of surveillance.

Surveillance is simply the systematic collection and use of health data to track and forecast health trends and health events. As a result of our surveillance activities, the agency is able to guide and promote health policies and actions across Canada. As such, we have developed a surveillance strategic plan, a five-year plan that outlines the agency's surveillance priorities, goals, and objectives, which was finalized in 2007.

We have appointed a senior surveillance advisor, Dr. Gregory Taylor, who is providing me with updates and advises me on the status of surveillance activities throughout the agency including progress on implementing the Auditor General's recommendations.

I'd specifically like to address the issue of information sharing, particularly with provinces and territories. In ensuring we have a robust surveillance system, we must take into consideration the very nature of our health care system. The provinces and territories deliver health services and they own the resulting data. Furthermore, as a federal government, we encounter both legal and privacy constraints when we try to gather the most effective data in the shortest time period.

All our partners are well aware of the need for accurate and timely data to help maintain an understanding of infectious diseases in Canada, including in the event of a public health emergency. To this end, the memorandum of understanding for information sharing during a public health emergency was approved by federal, provincial, and territorial ministers of health in September 2008. The Pan-Canadian Public Health Network created an FPT task group, in which the agency is a lead member. It has begun work with the provinces and territories on the development of information sharing agreements. We are confident this will create a new path forward in federal, provincial, and territorial relations in the arena of public health surveillance and information sharing.

Also, as we get into questions, to some extent the proof is in the pudding in terms of the events we've dealt with over the last four years and the stark contrast between what occurred during SARS and our abilities as a nation to respond quickly and effectively.

I'm committed to implementing the recommendations put forth by the Auditor General, and we have made progress in many areas. I also recognize that more work needs to be done and that protecting the health and well-being of Canadians requires effective and timely surveillance as one of the actions.

Merci beaucoup.

3:40 p.m.

Liberal

The Chair Shawn Murphy

Thank you very much, Dr. Butler-Jones.

I'm going to go now to the first round, seven minutes each.

Ms. Ratansi, you have seven minutes.

3:40 p.m.

Liberal

Yasmin Ratansi Don Valley East, ON

Thank you, everyone, for being here.

My question is going to go back and forth between the action plan you've given and the notes the Auditor General has. In May 2008, the Auditor General examined whether the Public Health Agency had obtained, analyzed, and disseminated the information needed to respond to the threats. The audit specifically observed that there were no clear roles and responsibilities defined. The Auditor General's office just now said these are weaknesses since 1999. I can appreciate that this was Health Canada and then the agency was created.

Why is this action plan not robust enough, in terms of how it is really not addressing some of the issues the Auditor General has raised? For example, you said you had a senior surveillance adviser. How does that manage the risk the Auditor General is talking about? For example, how does that surveillance officer obtain information, from where will he or she obtain information, how will they analyze it, how will they disseminate it, how will they work with the provincial, territorial, and municipal partners? Where are the roles and responsibilities?

I know I have a lot of questions in there, but the question is addressed to the Public Health Agency. If the Auditor General's office could, in the response they give, tell me that's robust enough, then I'll go with that.

Thanks.

3:40 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

Thanks very much for the questions.

There are a number of interrelated activities. Having the senior surveillance adviser is simply to make sure there's a clear focal point for responsibility. It is not to actually do the surveillance, etc., but to make sure we have the systems in place. Across the agency, we've been reviewing all our surveillance systems, not just in infectious disease. Also, within the public health network, which is again the joint governance of the system between the provinces, territories, and us, we have expert committees and others that report to the conference of deputy ministers, where I sit, and on to the conference of ministers, to actually do the kind of joint planning we need to do.

In addition, in terms of roles, we've worked through memoranda and letters of agreement. For example, with CFIA we have the MOU with the provinces in terms of roles. We have plans in terms of who does what when, related to our relationships with the provinces, not just on surveillance but also in response to it and who deals with issues as they arise.

Secondly, every day we do scan. We operate GPHIN, the Global Public Health Intelligence Network, and at this moment WHO tells us that between 40% and 60% of all outbreaks in the whole world are first notified to them by us, not by the country affected. We run that system for the world. Each day that's reviewed. In the morning there's a meeting of officials in the agency with other relevant people, to look at the risks that are occurring around the world. That then comes to a meeting with me, usually at 9:00 or 9:30, and decisions are made as to how we go forward, what we need to do, and what else needs to happen. If it's something that requires engagement with the provinces, we will have a conference call with the chief medical officers across the country that very same day. And that's how we've been practising.

Those are just some of the systems we have in place. We monitor that on a daily basis, 24 hours a day.

3:40 p.m.

Liberal

Yasmin Ratansi Don Valley East, ON

On these systems that you've put in place, did they come into place after the audit or were they there as the audit was being conducted?

3:40 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

They were in place as the audit was being conducted, but one of the questions from the Auditor General's office really was, okay, can you put more structure to these? So, for example, do you have minutes for those morning meetings that were occurring daily? Now we do. There's an ability to track that.

We make the decisions, we act on the decisions, and we write them down, but now we have more detailed minutes of the items so that someone who wants to go back in 10 years can do that. It is the same with the development of chronologies of events.

3:45 p.m.

Liberal

Yasmin Ratansi Don Valley East, ON

To the Auditor General, is that what you meant? I'm an accountant, so I need tangible things. When somebody tells me that I've achieved by putting in a senior surveillance adviser to the Chief Public Health Officer, I do not consider that to be managing risk.

Perhaps you can tell me from your audit whether you felt that the information and the processes that are in place, the processes they have, which probably in the auditor's mind were not so streamlined so that the information was not being gathered the way it should be gathered, posed any risks to the public.

3:45 p.m.

Assistant Auditor General, Office of the Auditor General of Canada

Neil Maxwell

Thank you. Chair.

There are several elements in that.

Perhaps first to your question of whether it is robust enough, I'd make several points. One is that we have not audited the action plan. Just to put the caveat right up front, we haven't had a chance to sort of look behind the kind of progress that the agency is claiming in order to see what's actually been done.

The second thing I would say is that it is a very complicated business. When I see the action plan, what I see is some action on many different fronts, some of which is behind the scenes. Advisers on surveillance probably play quite an important role in terms of the governance and making sure that information is provided. I wouldn't discount the importance of the individual elements, but I would return to something I said in my opening statement. I think much of the real test of an action plan is its ability and the agency's ability to show concrete results.

I see as I review the action plan that they've made a number of improvements on the systems. I think ultimately the question, then, is that perhaps it is only reasonable to be looking for concrete results through a number of years. You don't expect a great deal of results in the very short term, but I think those are really where the key questions lie.

3:45 p.m.

Liberal

Yasmin Ratansi Don Valley East, ON

Fair enough.

My question, then, goes back to Mr. Butler-Jones. How long have you been in that position? Since 2006?

3:45 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

The agency and my position started at the same time: in September 2004.

3:45 p.m.

Liberal

Yasmin Ratansi Don Valley East, ON

So from 2004 on, could you tell me what concrete actions there are? For example, if there were an Ebola outbreak in Congo, and because of the international travel, etc., what are some of the checks and balances you would have in place that would prevent it from coming here? We did not know SARS. We couldn't prevent it. It came. It cost us $20 billion in economic losses. What checks and balances do you have in place?

3:45 p.m.

Chief Public Health Officer, Public Health Agency of Canada

Dr. David Butler-Jones

There are a number of things. I mentioned GEF and the global intelligence network we operate. In retrospect, an early version of that before it was really operational picked up SARS in November, months before it broke out of China. Now we notify WHO and the affected country, and they can then deal with an issue earlier on. Plus, the addition of the international health regulations that put the onus on countries in terms of containing issues within their borders would allow things to be dealt with in the tens and hundreds, rather than in the thousands and tens of thousands.

Secondly, we have capacity, for example, for Ebola in Congo. We have a portable laboratory capacity that nobody else in the world has, and we've sent it to Vietnam, to Congo; it was at the Olympics in Beijing and it will be at the Olympics in Canada, with the ability to diagnose in the field some of the worst and most difficult nasty diseases so you know what you're dealing with. We have teams we send to those parts of the world to support the WHO and others in that work.

Also, there is the development of the public health network. Before there were many advisory committees across multiple FPT4, etc. Now that all comes to one place, where work plans, planning, etc., is jointly done with the provinces and territories. We review where the gaps are. We can do the kind of planning that's needed. If there are policy issues that need to come up to the deputies or on to ministers, we have a means to do that. Everything then is connected, and there are roles and responsibilities in the response to outbreaks, the chief medical officer's role, the minister's role. We do scenario planning and we also do testing of these things, for example, around a pandemic.

Canada was the first country to have a national pandemic plan for the health sector. Other countries have copied that and built on it. We have other things, like vaccine contracts, anti-virals, etc., to mitigate that. But it's an all-hazards approach, because the work we do is not simply looking at any one disease, like a pandemic of influenza. What if there were another SARS? There are many examples, but I'll give you one from last May.

We got notice on a Friday morning that there was a train in northern Ontario with a number of Asian tourists on it who were sick. One had died and one was airlifted. Within minutes we had our operation centre operating, but within hours, with the province, the local public health office, fire, and others, with VIA Rail, other departments of the federal government, we were able to figure out exactly what was going on. Fortunately, it was a series of unhappy coincidences: they were Australian tourists, they had colds, and the woman died of a pulmonary embolism. It was not the next SARS. But if it had been the next SARS, everything happened exactly the way I would hope it would happen.