Thank you, Mr. Chair. I want to thank the committee for the opportunity to speak here and to acknowledge this very important examination into the listeriosis outbreak of the summer of 2008.
Here with me today are Dr. Frank Plummer, the Public Health Agency's chief science adviser and head of the National Microbiology Laboratory in Winnipeg, and Dr. Mark Raizenne, director general of our Centre for Foodborne, Environmental and Zoonotic Infectious Diseases.
The work of this subcommittee is an important step towards improving our ability to protect the food supply and the health of our population. While we did much right, there are lessons to be learned as we continue to improve the way we respond to such human health events.
The listeriosis outbreak was, without a doubt, a tragic event: 22 people died, and at least 57 more fell ill. Any--any--preventable illness or premature death is a concern for us at the Public Health Agency.
Speaking as Canada's chief public health officer, I can say that it is never easy, either personally or professionally, to deal with events such as this one. As a physician, I've spent countless hours with patients and their families. I understand the feelings of pain, fear, and concern that accompany the many illnesses and injuries a body can endure.
I know as well that those who were affected by this outbreak and the officials who managed it all want a better understanding of the circumstances around it. What we can do is ensure that we learn from these events and apply those lessons--using the right information, shared with the right people, at the right time.
Let me turn briefly, Mr. Chair, to how the Public Health Agency goes about responding to an outbreak.
Broadly, the Public Health Agency of Canada is mandated to promote and protect the health of Canadians and to build public health capacity across the country. This of course includes preparing for and responding to any outbreaks that threaten human health.
Public health is, at its heart, a local activity. Events happen in communities and, by and large, are managed locally. As you know, this particular outbreak was first identified in Ontario and was first managed by the Ontario public health authorities, as was appropriate.
When an outbreak spreads beyond a jurisdiction or exceeds its capacity, the Public Health Agency takes the national lead on the human health side. So when the National Microbiology Laboratory linked listeriosis cases in other provinces to the Ontario outbreak, the agency took the lead in coordinating the national investigation and response.
I'd like to speak for a moment about the role of the chief public health officer in an outbreak.
From the very beginning, I was actively managing the agency's response. As both deputy of the Public Health Agency and Canada's chief public health officer, I have a dual role to play during an outbreak.
As such, I directed our staff, including our medical professionals, our scientists, and our epidemiologists, as they conducted their emergency response activities. I also advised the ministers of health and agriculture on the outbreak itself. Finally, I spoke directly to Canadians, stakeholders, and public health partners about issues affecting their health.
We communicated frequently and in a number of ways to the general public and to those groups most at risk. But you can never communicate too much. For all our actions and preparations, there are always challenges inherent in any public health crisis. We anticipate and overcome those challenges as best we can.
Mr. Chair, I'd like to talk a bit about the challenges faced in investigating and responding to outbreaks.
When public health as a system is dealing with food-borne illnesses, the identification of a source is a particularly complex process. We might be sifting through evidence of cases in towns or cities separated by thousands of kilometres. We need to find the people with the symptoms and have cultures taken so that we can then fingerprint the bacteria to find out whether or not they may have come from the same source. We ask people to identify everything that was eaten over the previous weeks to find, hopefully, a common source. Then those sources need to be investigated to see if they can be connected back to the illness. In this case, we were dealing with an illness where the cause was food that was eaten a month or more earlier.
We were able to do this in this listeriosis outbreak thanks to recent enhancements to our tracking and surveillance systems and to the collaboration with our federal and provincial partners. If this had happened five years ago, we probably would not have found it--if at all--until there were many more cases and deaths.
The technological advances we've made, the systems put in place, and the collaborations we've established since the agency was created have made huge differences in our ability to share and compare data and to plan our responses.
One of the constant challenges with food-borne outbreaks is that authorities are only notified once people have already started getting sick. We usually know we're dealing with a severe outbreak only after there are reports of illnesses of much higher than normal numbers. By that time, it is already too late to prevent cases in those already exposed.
The listeriosis outbreak was more of a challenge than usual, because affected food was being consumed in large numbers by those people who were most vulnerable to infection, including seniors in long-term care facilities and hospitals. Unlike most causes of food-borne outbreaks, with listeria only a tiny percentage of those overall who ate the food actually became ill. It was through our ability to connect the dots across many institutions and provinces that the pattern suggestive of a common problem emerged.
The food supply chain is an intricate web that links many parts of food processes and chains together. From the time food is harvested, through processing, production, delivery, purchase, storage, and preparation, up until we put it into our mouths, there are many possibilities for contaminants. Fortunately, there are many people and organizations involved in our safety and health, from government departments and agencies to industry and individuals. We're all partners in food safety.
While we did find the source, and relatively quickly, much of the criticism has centred around the public's need to be informed even more quickly. Clearly, there are lessons to be learned and applied for each part of the system.
One point I would like to emphasize, however, is the importance of getting it right. Speculation on possible causes during an investigation has the potential to do more harm than good. Take the example of the salmonella outbreak in the U.S. that led to hundreds of people in many states, including some in Canada, getting sick. In the U.S., it was publicly communicated that the cause was thought to be tomatoes. These were removed from the market and people stopped eating tomatoes, thinking the problem was solved, only to find out later that the outbreak was actually caused by jalapeño peppers.
Ultimately, we all have to take stock after an event, especially one such as this. There are always lessons to be learned when we look at what went wrong, what went right, what can be improved, and what can be applied going forward. That's why following the outbreak I asked for the agency to develop a lessons learned report, a process that both Health Canada and the CFIA have also undertaken.
The report noted that we did many things right. For example, our outbreak and emergency management staff expertly managed the human health component of the outbreak. The partnerships between departments, agencies, and the levels of government were strong. Our public communications were important. But it's clear that much needs to be improved. It was found that the agency should approve its advance planning and formalize its outbreak policies and practices as well as its communication protocols. We must also work on clarifying our roles and responsibilities in outbreaks, for the public as well as our partners. We also need to strengthen capacity, for both day-to-day operations and surge capacity during outbreaks.
Going forward, I take each and every one of these recommendations very seriously. I've tasked the agency with the implementation of an action plan and response. We're reviewing our disease surveillance systems, updating our response protocols, strengthening capacity for epidemiological analysis and lab testing, and updating our communications protocols. We're also strengthening our capacity at the national lab, and we've been working with the Council of Chief Medical Officers of Health on a listeriosis working group to maintain public health messaging on listeriosis and food safety. Each lesson learned will be applied.
A coordinated approach is key. We will further engage all agencies and levels of government. A federal-provincial-territorial engagement strategy is planned. This will ensure that we get everybody's input in designing a strengthened system that is more effective and efficient for everyone to use.
In conclusion, let me say that I await with interest the recommendations of this committee and those of the investigator.
Independent investigation and analysis is tremendously important to us—as a complement to our own reviews and work.
Canadians expect that we will constantly improve our abilities and that we will learn from the past, anticipate the future, and respond to the unexpected. This is our work.
Thank you. Merci.