Health Committee on Oct. 2nd, 2012

[Dr. John Spika]

We've had a pandemic plan of sorts in place since 1988, but that was after the third pandemic of the 20th century. In effect, this was the first time we actually were able to test the plan and the framework. I think we learned a lot. I definitely see that in the future, unless we have an unlimited supply of a vaccine that's good against all influenza strains, or we can vaccinate everyone and have the health care resources to do that, we're going to have to have a framework to at least identify, based on the epidemiology, who should be targeted first.

[The Chair, Conservative, Joy Smith]

Thank you so much.

Dr. Strang also has to leave at 12 o'clock, so if you have any questions as we continue, be mindful of that.

We'll now go to Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

I want to thank the witnesses for coming to discuss an issue that is of great importance to all of us.

I am very well aware that when you look at a pandemic or an epidemic, you're looking at the causative agent. You have to be mindful of the mode of spread, etc., as you apply public health principles to diminish the spread, or to find the best ways to protect vulnerable populations.

I'm going to ask a series of questions.

Did you learn anything from the way in which the last H1N1 epidemic was handled? Do you feel that you learned some important lessons? Would you do things differently the next time around?

If another pandemic were to occur, and it could be H1N1, a flu, or something else, would you always set a priority list of the people who must be vaccinated or must be protected? I would think that first responders would always fall into that category. It is not only because of the mode of spread. Some first responders may not contact the disease if it's a different mode of spread than one in which they are going to be in touch with the people. However, they must always be ready and on the ball as first responders to go into the community and do what they need to do. Their getting sick is not going to help that.

I would like to know how you feel about putting first responders always on some priority list, if you're facing any kind of epidemic, because of their importance to the community in terms of their need to be in the community to do their work.

Those are the questions I wanted to ask you. Did you learn anything? Do you believe that every time there's an epidemic you should set up a priority list, which would include first responders because of the nature of their work, regardless of the mode of spread, so they will be able to do their jobs in the community?

[The Chair, Conservative, Joy Smith]

Dr. Corriveau, I think I saw you raise your hand. Did you want to respond to that?

[Dr. André Corriveau]

Yes, please.

We have learned a lot. Most jurisdictions, including at the national level, have done a review of what happened during the pandemic of 2009 and 2010, and they have received recommendations from advisory groups. When I was in Alberta, the Health Quality Council of Alberta did the review and provided a list of recommendations that were accepted by the government. There's work being done to improve. I think we all learned how to do things better.

It was the first pandemic, I should point out, where we had a vaccine. For all the previous pandemics in the 20th century, there was no vaccine available at the time. We also had to develop priority lists for the use of antivirals, because in the first wave, the antivirals were all we had available, besides the social-distancing techniques that can be applied in any situation of that sort. We learned from that as well.

The final thing I want to add is that first responders were on a list. They just weren't at the top of the list, because we had identified some groups that were at the highest risk of dying and having severe morbidity. You have to recall that some of the people would end up in an ICU. Instead of spending two or three days each, they would spend weeks, sometimes two or three weeks, in an ICU, and would be mobilizing beds that would not be available for other types of emergencies. That was viewed as our very top priority in terms of immunization.

[The Chair, Conservative, Joy Smith]

Thank you, Dr. Spika.

Did you want Dr. Spika to comment?

[Hedy Fry, Liberal, Vancouver Centre, BC]

Yes, if Dr. Spika has something to say, but I have a couple more questions to ask.

[The Chair, Conservative, Joy Smith]

Go ahead, Dr. Fry.

[Hedy Fry, Liberal, Vancouver Centre, BC]

You had first responders on your list the last time, but the question is, how long did it take between giving it to your top-of-list people and to the first responders? Was it a delay of a day? Was it a delay of two days? How long did it take to get to first responders?

We know that because of global travel and ease of movement, pandemics are not going to be rare any more. Unfortunately, they're going to be the norm. Would you want to identify the causative factor once you have a vaccine, and if you have one? Will you now always build in a first responder piece? Will you order enough vaccine so first responders can be moved up the list, in terms of the people who should get the vaccines? Is that something you feel is more important?

Again, I'm harping on the fact that first responders are essential in the community. They are the people we need to put out fires, for example. They need to be well and healthy to do their work.

What do you think? What was the difference in time between first responders getting the vaccine and the people at the top of the list?

[Dr. John Spika]

It did vary by jurisdiction. Perhaps either Dr. Strang or Dr. Corriveau could comment from their perspective in terms of how long it took. In general, it would appear that it was anywhere from the first responders being identified during the first week that the vaccine was rolled out to maybe the third or fourth week in one jurisdiction.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Did Dr. Strang want to say something?

[Dr. Robert Strang]

I can add to that with some specifics.

In Nova Scotia, we first rolled out vaccine on October 30 and then by November 20, we had made vaccine available to all Nova Scotians. I clearly recall that we were making decisions with our emergency responders well in mind, but we did not include police or firefighters in our previous allotments as we added people to the prioritization list. It was not because they weren't important but, as Dr. Corriveau referred to, our overall priorities were to protect those who were at the greatest risk of getting ill. We needed to preserve the health care system, but we also acknowledged that we were looking to include police and firefighters to protect the community infrastructure as soon as we had sufficient vaccine available.

I do know that if we hadn't obtained enough vaccine to open up immunization to all Nova Scotians by November 20, our next move would have been to add further subgroups, which would have included police and firefighters.

[The Chair, Conservative, Joy Smith]

Thank you very much. If you could just wind up. We're quite a bit over the time.

[Hedy Fry, Liberal, Vancouver Centre, BC]

Okay, thank you.

[The Chair, Conservative, Joy Smith]

We'll now go to Ms. Block.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

I would like to join my colleagues in welcoming all our guests who have been able to join us today.

Dr. Corriveau, I thought I heard you say in your introductory remarks, given that pandemic planning is an evidence-based epidemiologically driven process, that is something that drives your decision-making. Would jurisdictions have several plans in place to address that fact?

[Dr. André Corriveau]

The plan is developed more generically. I think Dr. Spika highlighted that it provides the framework to make the decision on prioritization, but it doesn't spell out which groups will be first, second, and third. You have to wait until you see it unfold and gather the evidence. Most of us who have access to a public health lab had the results in the morning from the testing that was being done the day before. We were able to keep a rolling tally. We were sharing that information across the country. People in Nova Scotia knew what was going on in Alberta, and vice versa, on an almost real-time basis. That was quite a feat and can only get better as we improve our information systems. Then the decisions are made.

If we had found out, for example, that as in 1918-19 the greatest mortality was in young adults, people 20 to 35 years old, the prioritization would have been quite different from what we ended up doing. We saw that pregnant women were getting very seriously ill, very young children were ending up in the ICU, and first nations people were being affected disproportionately, as we saw in the news. The final list was prepared using the framework, but with an outcome that might have been different had it been a different virus or a different pattern of illness.

[The Chair, Conservative, Joy Smith]

Dr. Plummer, I think you raised your hand.

[Dr. Frank Plummer]

No, I didn't.

[The Chair, Conservative, Joy Smith]

Okay, thank you. You can't scratch your ear around here.

Dr. Spika.

[Dr. John Spika]

To me, that's one of the key lessons learned from the last pandemic. That came out loud and clear in the Senate report. Our plan was inflexible and not scalable.

We're working to adapt to that. Instead of having one scenario, we're looking at four scenarios, based on the overall impact they may have, from low to high, so that jurisdictions are in a position to better plan for these differences.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

Thank you very much. That's a great segue into the other question I want to ask this morning.

In your opening remarks you gave us some of the history on the different pandemics we have faced. In 1968, it was the Hong Kong flu. It was 20 years later that CPIP was created. I would like to know what transpired in that 20 years to cause the federal government to decide to create CPIP.

Then in 2009, H1N1 hit. It was the first major public health event to test CPIP. Given that you've identified one lesson learned, are there others you can share with us today, before the report is released, from the H1N1 pandemic?

[Dr. John Spika]

It's an interesting question.

Canada was one of the leaders in pandemic planning. It wasn't as though everyone else was out in front of us in 1988. We, and maybe the folks in the U.K., were working on it. We were the leaders. It's just that people hadn't really thought about how to approach it.

In terms of the overall lessons learned, one of the key things is that following the Senate committee review, both Health Canada and we have developed a management response and action plan. On the basis of that, we've identified a number of areas where we need to work.

To highlight some of them, it's to strengthen federal-provincial-territorial capacity. We are working in those areas, both in the way we engage the stakeholders and the way we're working with jurisdictions in the development of the new pandemic plan.

Another one is in the area of information exchange. We are working with other jurisdictions, the provinces and territories, to develop agreements on how information can be shared, particularly at the time of an emergency, but in general as well, because that's when it's probably needed the most. We are continuing to communicate and test our federal emergency management roles and responsibilities.

Another one of the issues that came out of that review was our ability to communicate complicated information to the public in an understandable way. That's another area of focus that we've been working on.

[The Chair, Conservative, Joy Smith]

Thank you very much. You have about 30 more seconds.

[Kelly Block, Conservative, Saskatoon—Rosetown—Biggar, SK]

That's fine.