Evidence of meeting #35 for Health in the 43rd Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was pandemic.
A recording is available from Parliament.
NDP
Don Davies NDP Vancouver Kingsway, BC
I have a related question. Does it meet the definition of a public welfare emergency under the Emergencies Act?
Associate Professor, Faculty of Law and Cumming School of Medicine, University of Calgary, As an Individual
Absolutely. I think it satisfies the definition of a public welfare emergency.
NDP
Don Davies NDP Vancouver Kingsway, BC
I know that you're from Alberta, so maybe you can think of Alberta, but also other provinces. In your view, has the third wave of COVID-19 exceeded any provincial government's capacity to respond effectively?
Associate Professor, Faculty of Law and Cumming School of Medicine, University of Calgary, As an Individual
I think that's exactly what we're seeing right now with the vast disparity between different provincial rates, the spread of the variant and the seeming inability they have to keep people out of their province—apart from the Maritimes. All those things point to an inability to manage this at the provincial level.
NDP
Don Davies NDP Vancouver Kingsway, BC
Finally, I'm going to switch gears a bit.
You have written about the issue of medical officers of health. Basically, you've said that in Canada, the law gives public health and safety officials the power—indeed the duty—to act. You point out that this is not subject to politicians approving it, but rather it's the other way around. In fact, you've said, “Canada’s medical officers of health must find the morality and courage to stare down the politicians making dangerous errors. That is why our society entrusts them with sweeping legal powers.”
Can you give us a little testimony about what their powers are and whether you think they're being exercised properly?
Associate Professor, Faculty of Law and Cumming School of Medicine, University of Calgary, As an Individual
In the provinces, the chief medical officers of health, for the most part—I'll speak broadly, but there's interprovincial variation—have the sweeping power to do almost anything necessary to contain a communicable disease. In the law, they're very powerful.
Where it gets complicated is the politics. For example, even though many chief medical advisors of health have broad legal authorities and the public health orders are in their names, at the same time, politically, they have been put in more of an advisory role. I think the provinces need to go one way or the other. Either they're independent people with legal authority who can speak out or act independently, or they are made subordinate to the government and their orders are subject to ministerial approval.
We can't have it both ways. We can't have these people be in charge when it's convenient for the provinces to have them be in charge or subordinate when it's convenient for the provinces. That's a—
NDP
Associate Professor, Faculty of Law and Cumming School of Medicine, University of Calgary, As an Individual
No. That's a different role from in the provinces. The provinces have more power because they're doing this as day-to-day operations of public health.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Mr. Davies.
That wraps up our questioning for this panel. I would like to thank the witnesses for sharing their time with us today and for their enormous expertise and great advice. Thank you for helping us with our studies.
With that, we will suspend and bring in the next panel.
Liberal
The Chair Liberal Ron McKinnon
Welcome, everyone.
We are resuming meeting 35 of the House of Commons Standing Committee on Health. The committee is meeting today to study the emergency situation facing Canadians in light of the COVID-19 pandemic. Specifically, today we are examining Canada's national emergency response landscape.
I would like to welcome the witnesses. We have appearing today, as an individual, Dr. Lisa Barrett, assistant professor. Also as an individual, we have Reverend Michael Garner, Anglican priest.
I will invite the witnesses to go forth with their statements. I will start with Dr. Barrett.
I also advise the witnesses that I will be using these cards to indicate when your time is almost up. I will display this when there's roughly a minute remaining—but that's approximate—and this when your time is officially up. If you see the red card, you don't have to stop instantly, but try to wrap up.
Thank you.
With that, we'll go to Dr. Barrett.
Go ahead for six minutes, please.
Dr. Lisa Barrett Assistant Professor, Dalhousie University, As an Individual
Thank you so much.
The invitation to bear witness here this afternoon is very much appreciated. Thank you to the committee for inviting me.
I'm an infectious disease physician and clinician, scientist and researcher at Dalhousie University, and I speak from that perspective today. Although I work with and collaboratively around both the Nova Scotia Health Authority and the public health department at the government of Nova Scotia, I speak as an individual here today.
I want to provide a bit of context perhaps of somewhat of a microcosm of the pandemic response from Atlantic Canada, specifically in terms of Nova Scotia and our response. As an infectious disease person, I think the things that have made our response arguably very successful.... We have, even with our current wave, 346 per 100,000 people who have had COVID-19 infections. To put that into context, other provinces include Ontario at 3,200 per 100,000 and Saskatchewan at 3,800 per 100,000. Again, as I said, there were 346 per 100,000 here in Nova Scotia.
We have arguably had a successful response and, as an infectious disease person, I would say there are several components to the response that are rather important.
Number one, we understood speed of response fairly quickly, as in infectious disease, speed is always important. Number two, that speed has added distance between human beings which, with a respiratory infection, is an incredibly important thing to do. Number three, in addition, there has been awareness of the infection and where it is through the use, primarily, of an exceptional amount of testing, both in people who are symptomatic and those who are asymptomatic, throughout the pandemic. The fourth, less quantitative and I think exceptionably important thing that we have managed to do as part of our pandemic response is to engage the community, not just as passive members of the pandemic response but as active members in being tested, getting tested, being the testers and being actively engaged throughout. I'll speak briefly to each of those components.
On the first part, speed, I'll use our most recent wave as an example. We went from zero to six cases per day from about last June until November, when we had a small number of increased cases up into the low double digits. Until then, we had gone back down to zero to six cases, again per day, with almost zero unlinked epidemiologic cases. For those who don't spend their lives looking at microbes and infectious diseases, that would imply that community spread was limited, which is very important. We knew where the cases were coming from and how. That changed in April. Between April 15 and April 21, we started to go into double digits of new cases per day, and there was the beginning of a signal by April 27 that we had community spread when we hit 97 cases per day. At that point, our restrictions went from being fairly open to being very closed.
In the intercurrent period between our waves, the Atlantic bubble still existed, and I'll speak to that in the distance part of things, when people coming into the region were required to quarantine. Anyone coming in from outside the Atlantic bubble.... In fact, our bubble burst a couple of months ago when our cases started to go up a little, and even people coming from within the Atlantic provinces were required to quarantine for 14 days.
The reason that's important is that we were able to keep track of where the cases were and how they were. At 97 cases, our government closed down public places where you would be unmasked and indoors, both retail and restaurants, etc., which had been open in between waves. Gyms were closed down very quickly, and people were asked to be at home. Then the cases went up even higher, into the hundred range, and the whole province was shut down. That's the speed part of things.
Seeing cases go up and community spread go up met the criteria that we have in place here that are quantitative: high numbers of unlinked cases, high reproductive numbers of the virus and case numbers going up in the community per hundred thousand. That was done very quickly, and distance was added. Inside, and in places where people can't mask, they were asked to do so quite a bit.
Then there was awareness. We always maintained asymptomatic testing between waves, so we knew when there was asymptomatic virus in the community. We also ramped that testing up to between 1.5% of the population per day when we went into this wave of the last week and a half ago and 5% of the population per day in our hot spots. In addition to that, awareness through our symptomatic testing was maintained.
On the engagement part, which I will be happy to give testimony on later, is the fact that we ran much of this testing outside our labs. Community-based volunteers were doing this work. There were taught to test, swab and provide an exceptional resource to people at the time, so we had a warning detection system for virus in the community.
I think, together, this has been an example of how we may be able to do things better in Canada and in different parts of the world as we go forward in this pandemic. The effects of speed of response, distance of people, awareness through diagnosis, and engagement of the community cannot be underestimated. I'd love to take questions on that afterwards.
Thank you for allowing me to speak.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Doctor.
We'll go now to Reverend Garner.
Please go ahead, sir. You have six minutes.
Reverend Michael Garner Anglican Priest, As an Individual
Good afternoon, Mr. Chair and honourable members of the committee. Thank you for inviting me here today to speak with you.
My name is Michael Garner. I am an Anglican priest and an infectious disease epidemiologist. I worked at the Public Health Agency of Canada from 2006 to 2019. I was invited here today to expand on my comments in the July 25 edition of The Globe and Mail.
When the Public Health Agency of Canada was created in the aftermath of SARS in 2004, the government of the time decided that the chief public health officer should be the deputy head of the agency because then the authority and responsibility for public health in Canada would reside in one person who would be an expert responsible for the public health resources of the federal government. This leadership structure echoed most other national public health institutes around the world.
I trust you have all read the recent Auditor General's report on the performance of PHAC in the pandemic. The Auditor General's conclusion confirmed the reality of what all Canadians have been living. It said, “The agency was not adequately prepared to respond to the pandemic, and it underestimated the potential impact of the virus at the onset of the pandemic.”
Despite identifying a myriad of issues at PHAC, the Auditor General failed to identify the root of the problem. At no point did she ask why the systems were allowed to go untested. Why didn't the risk assessments from January to March of 2020 look adequately at the potential for COVID-19 to become a global pandemic?
Plainly, we have a national public health institute that is run by non-experts.
Six and a half years ago, the Harper government moved the leadership of PHAC from the CPHO, who is a public health doctor, to a president who is a career bureaucrat. This decision set PHAC on a course that has gravely influenced its ability to put into place the foundational elements required to proactively prepare for and effectively respond to the coronavirus pandemic. It also created a cascade where public health experts are no longer present at the senior levels of the agency. They have been largely forced out and replaced over time by generic bureaucrats with no experience in or understanding of the very basic principles of public health science.
Perhaps even more troubling was that in the midst of the pandemic, when faced with the need to install a new deputy head of PHAC in September of 2020 and with the failures of responding to the crisis evident to all Canadians, the Prime Minister, rather than installing a doctor with expertise and experience in public health and pandemic response, picked another career bureaucrat with no credentials in public health, who would have to learn on the job in the midst of the biggest health crisis of the last century.
Interestingly, the United States' CDC faced a similar situation of needing a new director. It replaced the outgoing director—a physician and virologist—with a physician and public health expert.
In the midst of the catastrophe of the federal response to the pandemic, the government has continued its long practice of devaluing expertise and subject matter competency in favour of bureaucrats. However, I would suggest to you that the failures in the PHAC response to the pandemic should not be pinned solely on the bureaucratic leadership of PHAC. If I was put into a cockpit of an airplane and the lights began to flash, I wouldn't understand what to do because I wasn't trained to be a pilot. It is unfair to expect Mr. Stewart or any of the other non-experts running PHAC to adequately manage the Canadian response to the pandemic. They don't have the training or experience required.
As we emerge from the pandemic—as we surely will—I hope this committee and others will initiate a re-examination of where public health experts are needed in the federal government. I hope the Public Health Agency of Canada Act will be restored to its original form, with the position of president of the Public Health Agency removed and that power restored to the CPHO role.
Ideally, this will initiate a new cascade, where public health training and expertise is valued over the ability to work the bureaucracy for personal gain. It is the decisions of the Harper and Trudeau governments over almost a decade that have led us to the depths of this crisis. The decisions of Mr. Harper and Mr. Trudeau have had a cost—a cost that has been paid for with the lives of Canadians who have needlessly died from COVID-19.
Thank you. I look forward to our discussion.
Liberal
The Chair Liberal Ron McKinnon
Thank you, Reverend.
We'll start our questioning right now.
We will go once again to Ms. Rempel Garner, for six minutes, please.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
It will be the Garner and Garner show here, I think.
I really appreciate your comments, Reverend Garner. The question is how we move forward.
I almost wonder if PHAC is the right organizational model, writ large, to deal with a public health challenge or a pandemic. In the previous panel, there were comments about four silos of work. There's the need to be able to gather intelligence on emerging pathogenic threats, to be able to meld that into some sort of a consistent warning system that is associated with clear action, and then to have some sort of monitoring for efficacy framework.
Do you think this is even possible with the current model of PHAC?
Michael Garner
The Public Health Agency, as originally constituted, was set up to manage the pandemic. You need to remember that the Public Health Agency of Canada was set up because of a coronavirus outbreak. It's the changes that have come, with the diminishment of science and the diminishment of public health expertise in the agency at the most senior of levels, that mean we're unable to act and understand the evidence and the signals that are coming.
I was listening to Dr. Wark's commentary, which was very interesting. He's right that we need a process of risk assessment, but ultimately if the risk assessment is going to someone who has no training to interpret and act on that risk assessment, we could have the best risk assessment in the world and we'd not be able to go forward.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
In a minute or so, could you give us an illustrative example of where that lack of expertise impacted this particular pandemic?
Michael Garner
As someone who's not on the inside, it's hard to give a specific example of that, but I can suggest that GPHIN provides a nice example. You have a group of people who are in charge of GPHIN but don't understand that you have to keep looking for the pandemic, and the fact that you haven't found one yet doesn't mean you can stop looking.
If we look at the mandate letters of recent ministers of health, you'll notice that at some point “pandemic” falls off the mandate letter. I would suggest that “pandemic” should always be part of the Minister of Health's mandate letter.
Continuing to invest, despite the absence of this event that we're seeing, is part of the issue at hand.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
Something else has struck me.
Absolutely, we need medical advice and that needs to be driving this. I can't even imagine the frustration you must feel.
This week we've seen, for example, a lack of clarity of communication on vaccines. How can we fix that? To me, that's something that needs to happen in the very short term. I think there's this fallacy that somehow the public doesn't perceive all the different moving parts that the government does in relation to, let's say, vaccine advice.
How can we fix that in the short term?
Michael Garner
You need bureaucrats. You need communications experts to help the public health professionals. Regarding that group at NACI, what they're saying needed to be run through with some communications people and tested and thought through. I know where they're coming from, but they're not thinking through all the various impacts. I think that's the thing.
In my comments, I'm not saying we don't need a bureaucracy. We do, but we need the public health expertise actually making the decisions, with the support of comms and bureaucrats and all the rest.
Conservative
Michelle Rempel Conservative Calgary Nose Hill, AB
That is where I was hoping you were going to go with regard to a recommendation.
Tell me if I'm getting this wrong, but public health expertise has to be driving the advice, and then you need the suite of support experts—comms, even finance, looking at the corollary impacts or opportunity cost to public health—coming together in some sort of system to communicate to the public and then monitor the efficacy of that advice.
Is that what you're getting at? If so, is there any low-hanging fruit that the government could be implementing now to get to that point?