Health Committee on Aug. 12th, 2009

[Jan Kasperski, Chief Executive Officer, Ontario College of Family Physicians]

Thank you.

I represent 9,000 family physicians in the province of Ontario. We were at ground zero during SARS. In 2003, following the outbreak of SARS in Toronto, the Ontario College of Family Physicians was asked to present to the Campbell commission in Ontario and to the National Advisory Committee on SARS and Public Health. Our discussion document, entitled “The Mushroom Syndrome: SARS and Family Medicine”, and a second document, written with our community partners, called “SARS and Community Care: Impact and Opportunities”, outlined the struggles we faced in Toronto during the SARS outbreak and the heroism of family doctors, our specialist colleagues, nurses, and other health professionals as we worked tirelessly in a confusing fog related to a lack of surge capacity, a lack of supplies, and a lack of proper communication systems to provide the guidance and advice that we desperately needed during this tragic episode. The recommendations in those two papers focus on the needs of family doctors and our community-based professionals in relation to pandemic planning. But just as importantly, they focus attention on the need to repair our health care system and to better align public health units with family practices and other community-based services.

When news of H1N1 hit the front pages of the national newspapers, controlled panic overtook the health care community in Toronto, especially among those who were providing care in family practices. We relived our experiences with SARS. You see, during SARS, the public was in a panic and so were we. With every sniffle, the public feared that they had SARS. They were worried about going to emergency departments or to SARS clinics. Instead, they headed in droves to their family doctors' offices.

Family doctors not only work in their offices; they work in emergency departments, they deliver babies, they look after people in hospitals and in long-term care facilities, and they look after palliative care patients and home-bound patients in people's homes. When SARS hit, they continued to perform all these tasks. They also manned the SARS clinics and took over the emergency departments and the ICUs when other physicians were deadly ill with SARS. But no one thought about their needs and those of their families. They worried of exposing their loved ones to that deadly disease, and their families worried about them. Most frightening of all, many of our patients in those days were our own colleagues, the ones we worked with day in and day out. We thought health care professionals were invincible and we found out that they weren't.

For the most part, SARS was confined to hospitals in Toronto, but the only physician who died from SARS acquired it in his family practice. Not until that family practice was brought to its knees did the system start to appreciate the role that family doctors were playing during SARS. It took our college and the family doctors themselves to make people take notice of them. Believe me, it was a tiring and stressful process to get noticed.

Post-SARS, a great deal of health planning has occurred. We are very much more prepared than we were then. Family doctors have actually had a place at the planning table in Ontario. We were first invited to the table with dentists, pharmacists, funeral directors, and the like, people who may have a role to play in the outbreak, but not the central role that family doctors play. Unfortunately, health care planners may still believe that the outbreaks are hospital-centric and they forget about the central role that family doctors play in our health care system, particularly through influenza.

During the initial few weeks following the H1N1 outbreak in Mexico and across Canada, communications were swift and concise. But since we don't have one list of all the physicians in the province that can be used to send information, news briefs from the Public Health Agency of Canada, the Ministry of Health, and our agency on health promotion and prevention were sent through a variety of organizations, so the same message was received multiple times. Fortunately the messages were usually concise and usually consistent, but there has to be a better way of getting the right information at the right time to physicians. The information needs to come from someone in a trusted position. Where physicians are concerned, the information needs to come from a physician with the authority to say, “This is what you will do, and you will do it now.”

The system we did use provides some degree of two-way communication. The OCFP regularly communicates with our members, and they're used to e-mailing us back with questions, concerns, and solutions. We received a lot of e-mails during those early days of H1N1, and we passed them on to the ministry. The ministry also set up a hotline to provide information to the public and to health care professionals. Those who answered the phone were confident and very well meaning, but it soon became clear that they were not able to address the clinical questions that family physicians were asking. We assisted the Ministry of Health by recruiting retired family physicians and some of our members who were on maternity leave to be a valuable source of providing that telephone contact. This strategy gave the Ministry of Heath an opportunity to hear from the field, and news briefs were then used to address most of the questions that were coming up the pipe. Hospital departments of family medicine also play a really key role in supporting and informing their members.

We still have a lot of work to do, as we approach the fall, in improving that two-way communication system. We need to address public education and messaging, and soon. While we certainly don't want to alarm the public unduly, it seems as if the public and professionals alike have been lulled into thinking that H1N1 is a non-event. People need to better understand the potential for a severe reaction to the virus, and they need to—

[The Chair, Conservative, Joy Smith]

I hate to interrupt you, Ms. Kasperski, you're two minutes over. I'm wondering if you have much more. I want to give everyone a chance.

[Jan Kasperski]

I'll simply emphasize the fact that we need supplies, we need information, and we need to have the human resources to keep our offices open.

[The Chair, Conservative, Joy Smith]

Thank you very much. There will be time for questions and answers too.

We'll now go to the Federation of Canadian Municipalities and start with Mr. Vrbanovic.

You have 10 minutes. I understand you're sharing your time with Mr. Normand. Is that correct?

[Berry Vrbanovic, Councillor, City of Kitchener; and Second Vice-President, Federation of Canadian Municipalities]

I'll be speaking for all three of us.

[The Chair, Conservative, Joy Smith]

Okay, go right ahead, then. Thank you.

[Berry Vrbanovic]

Merci beaucoup, madame la présidente and members of the committee. It is a privilege to be here today to speak about a pressing challenge facing our country, the H1N1 pandemic.

My name is Berry Vrbanovic, and I'm a vice-president with the Federation of Canadian Municipalities and a councillor in the city of Kitchener, Ontario. I'm joined today by Alain Normand, who is with the City of Brampton's emergency measures and corporate security department; and Joshua Bates, a policy adviser with the Federation of Canadian Municipalities.

The Federation of Canadian Municipalities, or FCM, has been the national voice of municipal government in this country since 1901. With more than 1,800 members, FCM represents the interests of municipalities on policy and program matters that fall within federal jurisdiction. Members include Canada's largest cities, small urban and rural communities, and 18 provincial and territorial municipal associations. Collectively we represent almost 90% of the Canadian population.

The H1N1 influenza virus is a global pandemic that respects neither borders nor jurisdictional boundaries. Already, this deadly strain of influenza has killed more than 60 people in Canada, and health experts warn that a second wave of the virus could result in many more deaths during the coming flu season.

The central question facing all orders of government in this country is, are we as prepared as possible to effectively manage the H1N1 outbreak and protect Canadians?

It is FCM's position that any national pandemic plan is incomplete unless it includes provisions to keep key municipal services operating under the most difficult circumstances. We are therefore asking that the federal government design and implement a national plan, with municipal input, to keep critical front-line workers safe and on the job. This requires planning now to ensure that critical front-line municipal workers, such as police, firefighters, road crews, public transit operators, water and waste water workers, and municipal public health professionals, remain on the job during the worst of a pandemic. Without these workers on the job, the nation's entire pandemic response will be jeopardized, no matter how robust the rest of the plan.

Today there are 270,000 men and women working in these critical service areas for Canada's more than 3,600 municipal governments. Currently there is no national strategy, guidelines, or resources in place to ensure that these workers have timely access to the H1N1 vaccine, sufficient antiviral medications, or personal protective equipment; nor is there funding, resources, and expertise to respond to a pandemic crisis in the event it's needed. Only the federal government can provide the national leadership and coordination to address this gap.

A global pandemic such as H1N1 requires international and national coordination and the engagement of all orders of government. Canada must not limit itself to a patchwork of regional pandemic responses. Cities and communities from St. John's to Whitehorse must be assured that their citizens and the essential services they rely on will be protected by an effective national strategy that meets national guidelines.

Since the spring, FCM has engaged federal health officials, including Minister Aglukkaq, on these issues and concerns. We recognize that the federal government has taken important steps to protect Canadians against a pandemic. A national plan to protect the health sector has strengthened federal-provincial-territorial coordination in this area and provided a framework that can be extended to the municipal sector. Actions to increase a national antiviral stockpile and to secure a vaccine supply are also positive and welcome. However, the H1N1 outbreak has exposed a long-standing gap in the federal government's overall pandemic preparedness strategy, a gap that has been present under successive governments: a national plan to help cities and communities protect their critical front-line staff and to ensure they have the resources and expertise needed to carry out pandemic response roles assigned to them by federal, provincial, and territorial governments. As a country, we must safeguard the health of the men and women who will be on the front lines during a pandemic and responsible for keeping our cities and communities running while protecting the public.

A serious disruption in critical services such as policing, waste management, or public health would put Canada's pandemic response plan on life support and bring our cities and communities to a grinding halt. For example, without enough transit operators on the job, bus and light rail service would suffer and traffic gridlock would worsen. Doctors, nurses, and public health workers would struggle to get to hospitals, clinics, and temporary flu centres.

Establishing a strategy to protect and equip critical workers is a long-standing priority of municipalities. Well before the emergence of the H1N1 virus, many municipalities adopted comprehensive plans to minimize health and economic impacts of a pandemic.

More recently, municipalities have stepped up their preparations by training staff, preparing local flu treatment centres, implementing communication strategies to quickly share information with employees and citizens, and fast-tracking procurement of personal protective equipment to add to existing stockpiles. FCM's pandemic preparedness working group, established in April 2008, includes public health workers, emergency managers, and front-line emergency service providers from across the country.

We are fortunate to have Alain Normand, an emergency manager from the City of Brampton and a member of that working group, here with us today. The working group shares information about recent developments and best practices and relays information to the federal government about issues playing out on the ground, but local governments cannot go it alone. To keep cities and communities functioning during a pandemic, front-line municipal workers need access to a national vaccine, antiviral and personal protective equipment stockpiles, as well as resources and expertise.

I would point out that in 2008 a task force of the Public Health Agency of Canada recommended that the agency work with all orders of government to identify critical infrastructure workers and ensure they have access to rapid assessment and early treatment. More recently, federal officials have publicly stated that critical workers should receive priority access to an H1N1 vaccine.

Municipal leaders have been encouraged by recent public statements suggesting that the federal government understands the importance of protecting critical front-line staff, but we must implement a national standard or strategy to equip and protect these workers, and municipalities should be consulted by the federal government to help develop such a plan.

The challenge now is to put these words into action and to do so quickly. Cities and communities across this country are ready to help federal, provincial, and territorial governments identify and protect front-line municipal staff. With the flu season approaching, there's still time to fix this problem, but there is no time to waste.

Given the urgency of the current situation, we would ask that the Government of Canada implement the following four recommendations: one, design and implement a national plan with municipal input to keep critical front-line workers safe and on the job; two, implement the task group on antivirals for prophylaxis recommendation to engage all orders of government to ensure that critical infrastructure workers have access to rapid assessment and early treatment; three, ensure that critical infrastructure workers have prioritized access to the H1N1 vaccine; and four, ensure that municipalities have the expertise and resources required to fulfill pandemic response roles mandated by federal, provincial, and territorial governments.

Thank you, ladies and gentlemen. My colleagues and I will be pleased to answer any of your questions.

[The Chair, Conservative, Joy Smith]

Thank you very much for that presentation.

We will now go into a seven-minute round with questions and answers, and we'll begin with Ms. Neville.

[A voice]

Were you going to mention Dr. Kendall?

[The Chair, Conservative, Joy Smith]

I should mention that. Thank you.

Dr. Kendall is going to be presenting at 4:30 via video conference, so we have to keep that in mind. I'm trying to move this along quite quickly so we stick to timelines.

Ms. Neville.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Thank you, Madam Chair.

Let me begin by thanking each of you for coming here today, particularly on somewhat short notice, I think. Thank you for your presentations.

You raised a number of important issues. If you will allow me, Madam Chair, one of you spoke about the patchwork of responses across the country, and I want to go on record right now, Madam Chair, of identifying what I believe was misinformation of the previous panel, particularly as it related to first nations communities and the preparedness in first nations communities.

I had the opportunity on Monday to meet with Treaty 3 first nations leadership on health issues, and quite clearly, a third of those communities do not have plans. As well, many of the other plans that are in place are not current and need revision. So I think that is a kind of misinformation or patchwork of responses. I'm well familiar with what's happening or not happening in the province of Manitoba, and again, it gives me concerns about the patchwork of responses that we're seeing in first nations communities and that we may well, indeed, be seeing across the country.

I want to thank you very much, because what both organizations have done in different manners is to identify the gaps, as you have seen them, in the plans. Each group spoke about the recommendations made following SARS, and I wonder if both groups would again elaborate on those gaps, as you see them, and what kind of input and consultation your respective organizations would like to see to address those gaps.

[Jan Kasperski]

In Ontario, at the family medicine level, it's really important for the committee to understand that H1N1 and seasonal flu are community infections. SARS affected the hospital environment; it was a very severe disorder, and people needed to be in hospital.

What we're dealing with is outbreaks that affect the communities and the people who live and work in the communities. I don't think there has been as much emphasis on supplying the equipment, the human resources, and the information that the front-line family doctors and public health nurses need in order to really get ready for both seasonal flu and H1N1 flu.

We need, in each and every season, to get as many people as possible vaccinated for the seasonal flu. That taxes both public health and family practices. We will now be dealing with a vaccine for two different strains almost simultaneously, by the time we get seasonal flu into people and start doing H1N1, at the same time as we're trying to deal with very sick patients in the community. We're very worried about our abilities to cope with the workload.

We haven't been given the supplies that we require, both from—

[Anita Neville, Liberal, Winnipeg South Centre, MB]

Can I interrupt you for a minute? What I'm interested in as well is what input you had into federal planning in the preparation.

[Jan Kasperski]

I can speak to the Ontario scene. One family physician has been working with the Agency for Health Protection and Promotion, and another has been working with the ministry. The ministry consults with us from time to time, but I wouldn't say we've had an extremely strong voice during the planning. I think we're at a stage now where we really need to have that happen.

[Anita Neville, Liberal, Winnipeg South Centre, MB]

My time is limited, because I have only seven minutes. I want to hear from the municipalities too.

What I'm really quite concerned about are the concrete measures that are available to your organizations. Mothers are sending their children off to school, whether it's day care, elementary, or post-secondary education. We need to know at every level that there are plans in place to address this and that the host organizations or those most close to the ground have the input into the communication.

[Berry Vrbanovic]

Thank you.

Ms. Neville, very simply, I think what we're looking for is the federal government to design and implement a national plan, with municipal input, that will keep critical front-line workers safe and on the job during a pandemic. Specifically with respect to your question about the dialogue that has occurred, we've had a long-standing dialogue with the federal government about the need for this. In light of the H1N1 outbreak, we raised the issue again in a letter from our president to the Minister of Health in early May. Since then, our staff has had dialogue with federal officials, including the public officer for health, and we've been encouraged by recent statements suggesting that they understand the importance of critical front-line workers having their needs addressed, but so far we are yet unaware of a national plan that will actually do that.

My colleague Mr. Normand might want to add something as well from a staff perspective.

[Alain Normand, Manager, Emergency Measures and Corporate Security, City of Brampton, Federation of Canadian Municipalities]

Yes, Madam Chair. We were involved during SARS ourselves and we had to respond. We had a number of situations that were totally under the radar because all the attention was on the health aspect and on hospitals. Meanwhile, for example, our bus operators threatened to walk off the job completely, en masse, because they felt that they had inadequate protection during SARS. We know they didn't really need any special equipment; however, there was not enough information flowing to the front-line workers to enable them to make those judgment calls. So we had to step in and scramble to get all sorts of information in order to help our front-line workers.

That's just one example. The focus was really all about hospitals, whereas the background, the infrastructure needed to make sure those hospitals actually continue to function, was totally ignored. We would like to see a lot more municipal involvement in the development of plans in order to make sure that when the H1N1 comes around again we have the capacity to respond in a better way than we did during SARS.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to Mr. Malo.

[Carolyn Bennett, Liberal, St. Paul's, ON]

I think Mr. Maxted had something to say.

[The Chair, Conservative, Joy Smith]

Well, Mr. Malo, we're two minutes over. Perhaps you can continue with Dr. Maxted, if you choose. Mr. Malo, it is your choice. Please go ahead.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Madam Chair, I would like to make a special request. Since there is one witness we have yet to hear from, would it be possible to take only half of my time and use the other half following the next witness' presentation?

[The Chair, Conservative, Joy Smith]

I'm sorry, I was consulting with the clerk on something. Go ahead, Mr. Malo.

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

Madam Chair, since we have yet to year from one witness, would you allow me to use half of my time now and use the other half once I have heard the last witness' testimony, so that we can have a complete round?

[The Chair, Conservative, Joy Smith]

Well, I'm trying to stay within the timelines. We have another person who does want to ask the question, so would that be using your own time then, Mr. Malo?

[Luc Malo, Bloc, Verchères—Les Patriotes, QC]

I will take three and a half minutes now and three and a half minutes later.