Public Accounts Committee on March 10th, 2009

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

If there were SARS that were to come out now, what has changed? I read in the report that there have been significant changes that have happened since 2003. If that were the case, what are the main changes that have happened that would give Canadians the security that it has improved a lot since 2003 on a major outbreak like SARS?

[Dr. David Butler-Jones]

I've given you a few examples. There are lots of other examples of where we've actually done this.

Basically, there are a number of things in place—the Public Health Network, for example. We now have a coordinated connection of public health across the country in all jurisdictions and a mechanism by which decisions can be made rapidly, people can be consulted. Our communication systems are much better. The surveillance systems at the provincial level, territorial level, and our own are improving. The cooperation is different. We've sorted through a lot of the legal issues around information sharing, etc., and that takes time. We should not be in a situation again where information was not being shared as during SARS. We have a greater capacity, too, to actually respond to things.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I'm sorry...?

[Dr. David Butler-Jones]

We have greater capacity to actually respond. We have more people in the agency. We have more people working in public health. We have better connections. It really is about getting the most appropriate expertise to the right place at the right time.

[The Chair, Liberal, Shawn Murphy]

One more question.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

I have one follow-up question, for my understanding and maybe some others.

With respect to vaccines and pharmaceuticals, in the global perspective, if there were an outbreak, how would that work when you may have something you're not familiar with from another country and having the vaccines that would be needed to treat that disease?

[Dr. David Butler-Jones]

It really depends on the disease. The most worrisome is a pandemic of influenza, because of its large scale. The interesting thing, though, is that more people die from influenza between pandemics than during pandemics--from regular every-year flu. We lose about 4,000 people a year from influenza, which is much greater than the worst predictions we can think of, for even one as bad as 1918-19. So prevention immunization on an annual basis is important.

As I mentioned earlier, we operate the national emergency stockpile. Provinces have their stockpiles. When it comes to influenza, which is the one we're most concerned about, we have a joint stockpile, plus what we've supplemented federally. We think we would have enough, assuming it is effective, for whatever the pandemic strain would be.

We could treat in the meantime, while we get vaccines into people's arms. We have a domestic-based manufacturer that can produce enough vaccine for the whole country. We're the only country in the world that has developed that capacity.

[The Chair, Liberal, Shawn Murphy]

Thank you, Mr. Shipley.

Ms. Ratansi, five minutes.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Thank you.

I have some brief questions.

The audit found that the national surveillance remained weak, that you lacked timely, accurate, and complete information on infectious disease, and that in 2004, since the Public Health Agency has been established, the agency has only signed one agreement--in 2007, with Ontario--to a nationally standardized approach to disease reporting.

You gave an example of what happened in northern Ontario and how you were able to capture the problem, a person. Could you tell me if this was goodwill, luck, or were there systems in place? Basically the audit did mention that you relied on the provincial information you were gathering, which was based on good will.

How much of a national strategy do we have? What systems are actually in place? I guess everybody is playing with that notion, but we do not seem to see something tangible. You've been able to address issues, but after SARS we still do not have a national strategy or standardized approach to collecting and disseminating information, trying to get immediate information to every player of what the problem might be.

[Dr. David Butler-Jones]

We actually do. We have several protocols in place. That's how we operate. The question is, do we have--

[Yasmin Ratansi, Liberal, Don Valley East, ON]

You have protocols in place?

[Dr. David Butler-Jones]

We have protocols with the provinces on a range of issues. What is the overarching memorandum that says, as government to government, we will do this? We do that. I mean, it's the nature of what we do. And we have the relationships, the protocols. We have things about what goes to whom, who makes decisions, all of those kinds of things. That's all in place.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

How solid are those protocols, Mr. Maxwell?

[Neil Maxwell]

Thank you. I was starting to feel a little unloved here.

[Some hon. members]

Oh, oh!

[Neil Maxwell]

Thank you for that question.

There have been several questions, I think, that really get to this question: how important are all these agreements? We said in the report they're essential, and they are essential. I think what's really important on this subject is all of the direct contacts and all the relationships and the networks that have been built. There really are important networks in place, and that was a major accomplishment for the agency, but it's not an either/or. That's important. Equally, those agreements are important as well.

What we were concerned about in the audit--and thank you for referencing that particular case--is that on the side of the routine collection of surveillance information, outside the situation of an emergency like SARS, the only agreement in place is the one with Ontario. That came after a very difficult period of about two years, in which the Province of Ontario was quite concerned about the ability of the agency to protect privacy, to protect personal information. Because of those concerns, the Province of Ontario no longer provided the same level of detail in information that they had previously, so there have been interruptions.

On the side of emergency, again, as Dr. Butler-Jones has said, I think the achievement of getting an MOU with all the levels of government in support of the international health regulations is a major achievement. Our concern in the audit was very much that that it's good as a first step, you know, but the devil's always in the details. Getting the protocols in place that would actually dictate how that would work in an emergency situation is important.

Lastly, I might just note again in regard to the importance of agreements that I recall David Naylor's report in the aftermath of SARS. One of the things that Naylor concluded was that those agreements were very important and that many of the problems of SARS were in fact due to the absence of protocols and agreements and too much reliance on goodwill.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

If I'm reading your report or your analysis correctly, there are procedures in place so if there is a SARS outbreak in China and a traveller is coming from China to Canada, we have all the protocols in place to catch the disease and notify public health and safety officials of the problem, isolate it, and ensure it doesn't spread.

[Dr. David Butler-Jones]

To the extent that it's recognized, yes. No surveillance system will deal with that issue. As a for instance, the difference between Vancouver and Toronto with SARS was that a woman arrived from Asia, came to Toronto, and died at home, and nobody knew what was going on. Her children then took it to hospital. They had no travel history, whereas in Vancouver there was a clear travel history.

We absolutely agree--and again, I wanted to make this very clear--with the importance of these. That's why we're working very hard to make sure we get them in place, but in the meantime, in terms of the question of whether it's the paper that reassures Canadians or the experience, the commitment, and the collaboration, I think it is both. We need both and we've been addressing both, but in terms of many of those issues, we're much better off. We will still get surprises. The sooner we find them, the better.

[David Christopherson, NDP, Hamilton Centre, ON]

Why can't you--

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Wait, David, it's my turn.

The AG was looking for some key indicators. Do you have those key indicators in place?

Also, I will just throw something in. I went to an APEC conference with the health minister. What do you do when countries do not share information with you? For example, Indonesia or Vietnam might have a pandemic outbreak. If they don't share what they have found, what do you do?

If you could, address my first issue on key indicators that are available so that the AG can be satisfied with that, and also the second one on an international scale.

[Dr. David Butler-Jones]

On the indicators of performance, I'll come back to that.

First is the interconnection. It's the WHO. When we get information on a country, we give it to the WHO, and they work with the country.

In addition, one other advantage since SARS is the development of the International Association of National Public Health Institutes, the CDCs of the world, the agencies of the world, and developing and developed countries. Most of these countries are now part of that.

The Gates Foundation provides funding to ensure that developing countries have access. It's about building capacity for public health and building expertise in public health, but it's also about sharing. I have counterparts around the world who I now know and can phone up, rather than going government to government, and ask, “What's really going on?” That helps. It doesn't guarantee, I know, but it's certainly one more piece of information.

In terms of the performance indicators, they will be done this year.

[Yasmin Ratansi, Liberal, Don Valley East, ON]

Thank you.

[The Chair, Liberal, Shawn Murphy]

Thank you very much, Ms. Ratansi.

Mr. Young, five minutes.

[Terence Young, Conservative, Oakville, ON]

Thank you, Chair.

Dr. Butler-Jones, I've been listening very carefully to what you say, and I've read your reports, and I think the concern of some of my colleagues on this committee is that the reports are all about process, and the remarks are all about process, and in fact most of what you do is communications. And of course what we have to be concerned about, what the public's concerned about, is where processes produce results, where the rubber hits the road.

I'm going to go over some territory my colleagues covered in part, and if you could give me a detailed answer, it would be very helpful.

There was one thing you said that was really impressive to me. You said, “The proof is in the pudding—can you respond effectively at the time?” And then, and I wish this was in the report—I think that if it was in the report we all would have felt better about the report—you said, "Chief medical officers phone me up and say they have a problem”.

I've done a lot of research into prescription drug safety, and I know that when somebody is injured or dies after taking a prescription drug, no one calls anyone. So I know it's really important when the chief medical officer calls you, but I wonder if you could tell me what happens next. I understand your role is primarily communication, but what would happen next? Like the previous SARS epidemic, what would you do and what would happen step by step after a chief medical officer calls you? And then I'd like to know what the result would be this time. Forty-four people died last time. Forty-four families lost a loved one. Can you say there would be far fewer deaths? What would be the result with a similar situation this time? That would give us an idea of how far you've come along.

[Dr. David Butler-Jones]

Again, given the vagaries of nature and how infectious—fortunately SARS was not more infectious than it was. It was obviously a great tragedy in and of itself and a big wake-up call for the system. I'll walk you through a little more details in terms of.... We get a call. We have people on 24 hours. They're monitoring the system. They're looking around the world and in Canada for potential outbreaks for other things. So we get a call.