Thank you.
I sent around my presentation beforehand. I hope everybody has a copy; largely, I'm going to read from it. My presentation will centre around two main points.
I've been studying public health in Canada for about ten years now as a Canada research chair in public health policy. I've studied problems with surveillance, disease outbreaks, and blood safety.
I'm going to focus on two issues related to listeria that also relate to those previous emergencies we've dealt with: the coordination of activities in health protection between federal and provincial governments and the effectiveness of the current governance system of the Public Health Agency and its chief public health officer in protecting the health of Canadians.
With respect to the first point, the issue of coordination of activities between federal and provincial governments has been an ongoing problem in Canada and the subject of multiple reports. Specifically, three Auditor General's reports have identified this as a shortcoming, the latest of which was in 2008. Also, following the SARS outbreak, this was a major finding of the reports that followed.
One of the issues that continues to recur is the problem of sharing data between federal-provincial-territorial partners. There have been efforts at developing data sharing agreements for I think 10 to 15 years now in Canada, and we've had very little success in developing comprehensive agreements. Again, three Auditor General's reports have highlighted this as a problem.
During SARS, this was a major issue, as identified in particular by the Campbell report. In fact, if we had had adequate ground-level surveillance and proper data sharing in place, we likely could have avoided the travel advisory, because the epidemiological evidence at the time suggested only in-hospital transmission.
More significantly now, we have approved the international health regulations, so it's now binding international law that we have these agreements in place. This does not mean simple letters of intent, but clear protocols on how data needs to be shared between provincial and territorial governments and the federal government.
We have looked at this in detail and specifically at how Canada is doing compared to other countries, including India, the U.S., and Australia. At least from what we've seen on paper, we're one of the least prepared, particularly to comply with the international health regulations. Australia, a parallel federal country, is in a much better position to administer this agreement and respond to public health emergencies. The practical situation may be different, though it is worrisome that little legislative, funding, or intergovernmental agreement progress has been made, given the multitude of reports we've had on this topic.
Again, during listeria--and I found this concerning--we saw the same problems recur. What was particularly peculiar with listeria, though, was that usually the information sharing issues had been between the province and the federal government, but, at least according to the Ontario report, the problem as they viewed it was that Ottawa didn't share information with the province.
I have a quote from the Ontario report. Specifically, it states, “Although the Ministry of Health and Long-Term Care asked the CFIA for comprehensive information on the distribution of the products implicated in the outbreak, this information was never received.” It later goes on to say, “If public health authorities had had timely access to this information, they might have been able to take additional targeted steps to reduce possible exposure among the general public.” These information sharing issues have real health consequences.
Again, it's unfortunate that it has to be said yet again that this issue has to be immediately addressed or else we're going to have yet another public health emergency that could have avoidable aspects to it. What may be different this time is that these agreements need to be bidirectional: not only do there need to be commitments from the provinces to share information with the federal government, but the federal government has to make an equal commitment to share information with the provinces and territories. If these agreements cannot be arrived at, I think legislation is the only other alternative. I'll leave it to Professor Attaran to discuss the constitutionality of that.
My second and perhaps more substantive issue that I would to discuss is that the Public Health Agency as it's currently structured is not designed to maximally protect the health of Canadians. I'd argue that listeria was the first major test for the agency since its creation, even more so than HINI, because it was an unusual, unexpected outbreak and we have had multiple protocols for things such as influenza outbreaks.
I remain uncertain about the ability of the Public Health Agency, particularly the chief public health officer, to act independently to address these types of emergencies independent of political and economic pressures in particular. I will make the caveat that this is not a simple question. Public health is interlinked with the mandates of numerous other federal agencies, and complete independence of the agency and the chief public health officer may not be desirable because public health officials have to work within government. But my conclusions are that the existing sets of arrangement are not satisfactory.
It's certain that the contamination of foods by listeria is a matter that falls under the jurisdiction of CFIA. However, once individuals start to fall ill from these foods and die from these foods, at that point, this is not a food inspection emergency. I would argue that it's a primarily a public health emergency.
In the listeria outbreak, the Public Health Agency of Canada, however, was not the public face of the response. The primary communication of the outbreak was conducted by CFIA and the Minister of Agriculture. I must say that I found it odd that the chief public health officer was not the chief spokesperson during the listeria outbreak.
As stated in the SARS report, the purpose of the chief public health officer is to “be a leading national voice for public health, particularly in outbreaks and other health emergencies, and a highly visible symbol of a federal commitment to protecting and improving Canadians' health”. This was clearly not the case during the listeria crisis, and my observations were echoed in Ontario's report as well.
I believe some of the explanation for what may have transpired lies in the Public Health Agency's less than arm's-length status from the government. Listeria was a prototypical example of why an arm's-length public health agency is needed. The outbreak crossed over two areas, food safety and public health, had political repercussions, given the presence of a federal election, and, as well, the outbreak had important economic consequences. Therefore, there may have been many opportunities to subordinate the role of the Public Health Agency and consequently public health concerns during the management of the outbreak.
The structure of the Public Health Agency was discussed in detail in the SARS report. I had the opportunity and the privilege to present to the head of the investigation. At that time, I argued that, to an extent, a Canadian Blood Services model may have been preferable to provide more autonomy for the decision-making with regard to public health safety. Our Canadian blood system is a textbook case of how to recover from a public health tragedy, one of much larger scope than both SARS and listeria. Currently, our Canadian blood system is viewed as an international leader. An important reason for that is its independence and autonomy, and it has the ability to attract highly qualified scientists and blood safety experts.
So I'd argue that the Public Health Agency, or at least a component of it, needs to have more autonomy. One mechanism is to create a separate health protection agency specifically designed to prepare for and manage public health security threats, such as foodborne illnesses, pandemics, etc. This can be staffed with high-expertise scientists, some of whom would be shared with provincial agencies.
Along with that, we would have to develop an independent chief public health officer. The chief public health officer at present is not truly independent. They hold the position of deputy minister and serve at the pleasure of the minister. As long as this is the case, we cannot be assured that a chief public health officer is speaking independently.
At the minimum, I believe that a chief public health officer should be provided with protection against dismissal without cause and should be provided with unambiguous authority to communicate directly with the legislature. Also, the Public Health Agency should have a protected budget.
Thank you very much.