Public Accounts Committee on March 10th, 2009

[The Chair, Liberal, Shawn Murphy]

Doctor, I'm going to have to interrupt you, sir. The DPR is what I'm talking about.

[Dr. David Butler-Jones]

It's the context for that.

[The Chair, Liberal, Shawn Murphy]

Please identify the DPRs.

[Dr. David Butler-Jones]

Yes.

The development of the DPRs—and again, maybe it's a broader discussion across government, as you say, sort of something that you hear across government, and maybe it's an issue of how they're formatted, what goes into them, how they're articulated, and the kinds of conversations that follow. We've been following what we understood to be what we do. It's fair comment, and I'll take that back.

Thank you.

[The Chair, Liberal, Shawn Murphy]

Thanks.

I don't want to belabour the point, but there's no mention of your lack of legislative framework, there's no mention of the lack of memoranda of understanding with the provinces, no mention of the privacy issue, no mention that you're not in compliance with the 2009 and 2002 recommendations. There's the whole issue of the World Health Organization, that you have to be assessed this year and you have to be compliant by 2012, which is a major issue. These aren't easy challenges that you face, and I would have thought there'd be something. But you went on for how many pages here?

[Dr. David Butler-Jones]

If I may, Chair—

[The Chair, Liberal, Shawn Murphy]

You went on for something like 40 pages, and it just couldn't be better, according to this document.

[Dr. David Butler-Jones]

Well, if I may, again, I'm speaking from a public health perspective, in terms of having managed outbreaks for 25-plus years, of having worked across jurisdictions for that amount of time. These are important issues that we are addressing, but they are process issues. I can have legislation that compels provinces to give me information. If they don't give me information, I still don't have it.

Because the legal wording, etc., is really important and the provinces care a lot about that, we've focused on making sure that they're comfortable with any agreements. Those take time. But in the meantime, we've built the relationships so that chief medical officers phone me up and say, “I'm worried about this”. We have systems in place; we monitor things all the time. So from a public health standpoint, they're important to do, but they're not the most essential things to do. It is not make or break for the ability of the people—

[The Chair, Liberal, Shawn Murphy]

Okay.

Before we go to Ms. Crombie, I urge everyone who hasn't read it to read the departmental performance report, and you'll be surprised what you read.

Ms. Crombie, you have five minutes.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Welcome to the public accounts committee.

Mr. Butler-Jones, I would challenge you that these issues aren't process issues. They're accountability issues, accountability to the Canadian people. In your last comment you said this is a process issue, and I feel it's an accountability issue.

[Dr. David Butler-Jones]

Fair enough, fair comment. That's why we're doing them, because they're important to do. We do them, but they do take time.

But from a public health standpoint—the public can agree with me or not—the point is to find the disease, figure out what's going on, and stop it, and whatever the paperwork is, that follows behind.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Okay, let's continue.

Mr. Saxton was very glowing in his comments. I just want to ask you about this action plan, which I received about 30 minutes before this meeting. It is helpful, but it's not useful if it's not implemented, and it's not helpful to us if we don't receive it with some advance warning.

Is there any reason that we didn't have this document with due course?

[Dr. David Butler-Jones]

I'm sorry, I'm not sure about the timing, but we will be implementing.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Okay.

Let's go to our commitment to the WHO. In 2006, which I think is your era, we committed to implementing parts of the regulation. The audit has found we have not taken the steps to meet our commitments and we may not be able to obtain the information needed to do the assessments within 48 hours or notify the WHO within 24 hours or keep the WHO informed. The results are inadequate with respect to information-sharing agreements with provinces and territories.

How many provinces have entered into the MOUs to date, and when do you anticipate securing agreements with other provinces? And what are the reasons for the delays?

[Dr. David Butler-Jones]

In terms of the information sharing for that purpose, all.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Point of order, Mr. Chair.

Mrs. Crombie, can you say where you're reading from, because I'm interested in that area as well.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

These are my notes, Mr. Weston. Yes, it's all there.

[John Weston, Conservative, West Vancouver—Sunshine Coast—Sea to Sky Country, BC]

Which part of the report? No?

[The Chair, Liberal, Shawn Murphy]

What's the problem?

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

I have to go back and look at this. The witness doesn't have it.

[The Chair, Liberal, Shawn Murphy]

Okay, one speaker at a time. What's the problem here?

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

We're not sure.

Dr. Butler-Jones?

[Dr. David Butler-Jones]

There are two things. One is the international health regulations and our ability as a country to respond to them. All jurisdictions have committed to that in Canada and we're working on implementation of that. We have a memorandum with all jurisdictions in Canada, all the provinces and territories, around information sharing and public health emergencies. That is in place. We are supplementing that with routine information sharing with the provinces, as we now have with Ontario, and that will be implemented as soon as we can get those agreements in place. But in emergencies, the kinds of things that are critical, that's in place.

[Bonnie Crombie, Liberal, Mississauga—Streetsville, ON]

Okay. On a slightly different tack, if I have time, what role does the Public Health Agency have in response and alerting the public of possible epidemics and public health emergencies? For instance, what role do you have in preparing or preventing outbreaks such as SARS and avian flu and hoof and mouth, for that matter? Do you have a role in making the scientific and pharmaceutical biotech industries aware of potential outbreaks and allowing them to prepare? I have the pharmaceutical company Hoffman-La Roche in my riding, and they are the creators of Cipro, as you know. Do you play a role in emergencies in letting them know what minimum target levels of antibiotics they need to keep on hand and who is responsible for setting those?

[Dr. David Butler-Jones]

It's a shared responsibility, because health care is largely provincial and territorial, and public health is local. It may happen in a thousand localities at the same time, but it's still a local event. And that's why you have local structures for public health medical officers, inspectors, nurses, and others, linked in to the hospital sector, etc.

Most of the legislation is provincial. It supports the local public health officers, and then we support the provinces and local public health officers, sometimes based on a request but obviously it's multiple jurisdictions. We also are the keeper of the pen, for lack of a better term, on the national pandemic plan and other plans, best practices, guidelines, etc. We work through the various expert committees and with the provinces and territories in terms of what that is. We also maintain stockpiles. We have the national emergency stockpile. We also have a joint stockpile of antivirals with the provinces for dealing with the pandemic of influenza and in our national emergency stockpile we have a range of equipment, drugs, etc., to support that. The planning in terms of what is needed happens at two levels. One is locally, what is needed; and then provincially, they make their decisions, and then we're part of the overall coordination of those activities.

In terms of the sharing of information, again it depends on its level. If it's a local outbreak in a nursing home, generally it's the local medical officer, etc., who will deal with it. If it's multi-jurisdictional or they need help, that's where we send in field epidemiologists and others to assist them with the investigation. We also have the reference lab, and we do the more sophisticated testing for strange bugs.