I'll start off with some general comments and my introductory part.
Good afternoon, and thank you for the opportunity to address this committee on the management of the 2008 listeriosis outbreak in Ontario.
Today l'd like to talk about my report on the outbreak, released publicly on April 17, 2009, basically on what we did right, on what we could do better, and the lessons learned for the future. Copies of the report, in both official languages, I have heard, have been provided to the members.
As you know, the outbreak that began last summer was first detected in Ontario and eventually spread to seven provinces across Canada. By the time the outbreak was declared over, 57 confirmed cases were reported across Canada and 22 people died. Ontario suffered the brunt of the outbreak. Sixteen people died, most of them elderly and either living in a long-term care home or hospitalized. Ultimately, our goal is to strengthen the public health system to protect Ontarians from food-borne illnesses that cause such suffering.
Any time there's an outbreak affecting so many people in so many communities, it's important to engage in a thoughtful analysis of the way we respond to and manage these situations. That's why I established a provincial listeriosis outbreak review committee. The report I released in April, of which you have copies, outlined the committee's key findings and my recommendations to help us improve how we respond in future.
Ontario's priority has been to build on existing resources to create a more coordinated, better-resourced, and more responsive food-borne outbreak surveillance and response system. Since this outbreak affected so many Canadians, I shared the report's recommendations with our federal, provincial, and territorial partners so that others might benefit from Ontario's analysis.
Let me now turn to my report's findings and recommendations.
First of all, detecting the outbreak.... The Integrated Public Health Information System, or iPHIS, as some people say, is a web-based system into which all public health units enter case information on all reportable diseases. It was put in place after SARS and it continues to prove its worth. Ministry staff analyze data from iPHIS every day with the help of another system called EARS, the early aberration reporting system. EARS detects and raises flags when there are statistically significant increases in the number of cases above a given norm. Thanks to iPHIS and EARS, the small number of listeriosis cases at the outset were linked together and allowed us to detect the outbreak before many people fell ill.
Although the iPHIS system works well, there is sometimes a lag between when a public health unit is aware of a case and when the data on the case is entered into the system. My report therefore recommends that public health units be vigilant about providing timely, comprehensive data to ensure the full effectiveness of the surveillance system. At the time, we need to make sure that local health units as well as the ministry have the necessary skilled staff and resources to investigate and respond to signs of possible outbreaks.
Confirming the outbreak. The symptoms of listeriosis are not specific. Vomiting, nausea, severe headaches, and fever can be symptoms of many other illnesses. Also, historically, only a relatively small number of people fall ill with listeriosis. That's why lab testing is essential to help identify and confirm an outbreak. For the 2008 outbreak, molecular typing, or what is often referred to as fingerprinting, was conducted through a complex test called the pulsed-field gel electrophoresis, or PFGE, for short, for this presentation. It was PFGE testing that confirmed that the listeriosis cases across the country were in fact linked, and that the source of the contamination was packaged luncheon meat from the Maple Leaf Foods plant in Toronto. This molecular typing was done in federal laboratories, at the National Microbiology Laboratory in Winnipeg, and at the Listeria Reference Laboratory in Ottawa.
The federal government should consider the need for greater regional capacity for this testing as molecular typing moves from being a research tool into a more standardized use. I also recommend in my report that the Ontario Agency for Health Protection and Promotion develop a plan to increase the Ontario Public Health Laboratories' capacity to conduct a wider range of tests, to monitor strains of bacteria and other organisms that pose a threat to public health, and to educate public health units about optimal and quality sampling techniques. Because time is crucial during an outbreak, the Ontario Agency for Health Protection and Promotion should also assess the potential to improve testing timelines.
Managing the outbreak. Today, foods are processed and packaged in a few large plants, then shipped across the country, and even abroad, either to be sold as a packaged product or made into other products. For example, the two lines that were contaminated at the Maple Leaf Foods plant made products that were shipped across Canada and marketed under more than 200 different brand names or labels, and that's not unusual in the industry.
In that light, when food-borne outbreaks occur, more and more of them will be cross-jurisdictional, with a national or even international perspective. To ensure a better response to such outbreaks, roles and responsibilities need to be clarified among local, provincial, and federal agencies.
In a provincial outbreak, I recommend that the chief medical officer of health should establish an outbreak coordinating committee to provide information and advice in managing the outbreak. The committee should include all lead provincial and federal food inspection, regulation, and public health agencies, including labs. Despite the differing mandates of these agencies, the committee's overarching priority needs to be to protect the public's health.
In the case of a national or international outbreak, I recommend that the federal chief public health officer establish a similar committee on the national level with participation by the chief medical officers of health of the provinces and territories. The role of the federal chief public health officer would allow for the integration of information so as to inform decision-making by the provincial and territorial chief medical officers of health.
Communications. There is no doubt that effective, timely communication is essential in managing an outbreak and in maintaining public confidence. Effective communications in a cross-jurisdictional outbreak can be challenging. Frankly, during the listeria outbreak, there was a lack of effective communications among some of the partner agencies, and this created a sense of lack of coordination.
Communications to the public were not well coordinated. Each level of government provided communication within their own jurisdictions. There was no clear public spokesperson for the outbreak or food recall. Once Maple Leaf Foods announced a voluntary recall of its products, the media turned to the company for information. In my view, it would have been more appropriate to have a government spokesperson take the lead to ensure that appropriate public health messages were communicated to the public.
This was a national outbreak, but it was not clear whether the federal chief public health officer had a mandate for leadership at the federal level in this cross-jurisdictional outbreak. I therefore recommend that in a province-wide outbreak, the provincial chief medical officer of health should be the official media spokesperson. In a national outbreak, on the other hand, the spokesperson should be the federal chief public health officer.
My report also recommends that all agencies involved in managing the outbreak should adopt the 24-hour information cycle that is an integral part of our emergency response plans. This would encourage a coordinated sharing of information among partner agencies and clear, more timely communication to the public.
Overall, I was pleased that the public health system in Ontario worked well during this outbreak, but there are indeed ways we could improve in the future. I want to emphasize that this review was not merely an academic exercise. Our mandate is protecting people's lives, and we take that responsibility very seriously. We recognize that we must continue to do our utmost to strengthen and enhance Ontario's public health system.
Thank you. I'm prepared to answer your questions.