Public Accounts Committee on April 20th, 2021

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Madam Chair.

I want to welcome our witnesses today.

My first question is for Ms. Hogan.

Welcome back to our committee, Ms. Hogan. It is a pleasure to see you again. We usually see each other about twice a week.

Among all the reports you tabled on March 25, I note that the one we are interested in today is without question the most alarming and probably the most devastating. You have identified major shortcomings within the Public Health Agency of Canada in the distribution and transmission of information intended for Quebec, the various provinces and their partners, as well as in risk analysis. You have raised issues regarding information technology infrastructure.

As you mentioned yourself in your introductory remarks, this lack of preparation has been going on for over 20 years. Beyond these dismal failures, do you think there is an even bigger problem within the federal government in this area? I take as evidence your needs at the Office of the Auditor General as well as the failures of the Phoenix payroll system. Is this negligence or laxity?

We are currently seeing that the federal government is not focusing on prevention when it comes to computer system maintenance and upgrades. They seem to be waiting for the worst to happen, a disaster, before they act.

[Karen Hogan]

Your question touches on a point that certainly concerns me. It sounds as if we've been reacting instead of relying on prevention. Yet, an ounce of prevention is worth a pound of cure; that's the expression that comes to mind here. There is a constant focus on the immediate emergency. Everyone is very good, even within the federal government, at getting by and managing to do their job with the tools in place.

However, we really need to start being better prepared and better supported by our tools. In our office, as well as throughout the federal government, we see decisions being made to support individuals instead of investing in systems. We must remember that the effectiveness of any system relies on well-trained, intelligent individuals, but the system must also be prepared to support them by enabling data analysis.

So I would say that this is a government-wide problem, not just in the Public Health Agency of Canada. That said, this is the report that the committee is considering right now, and there are obviously gaps there as well.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you, Ms. Hogan.

You're taking the words right out of my mouth. You say prevention is better than cure. I would like to add that governing is planning. But we have not foreseen anything in the last 20 years. Before we decide to act, we really wait for a catastrophe to happen and for it to blow up in our faces.

At the same time, you have raised an important alert about the Public Health Agency of Canada's transmission of data to its partners in the Global Outbreak Alert and Response Network, where Canada has played a leading role for decades.

The previous government cut investments in scientific research, literally muzzled government scientists, and eliminated their independent thinking and policy role. In your opinion, is there a causal link between this attitude of the previous government and some of the problems revealed by your report?

[Karen Hogan]

In our report, we did not look at this point. We did not look at the human resources aspect of PHAC.

You mentioned the Global Public Health Information Network. I think the problem with that network is the confusion it causes. The moment when an alert should be issued was not clearly defined. That is why I encourage PHAC to properly establish the objectives of this network and make the guidelines very clear. Employees need to be trained and the network needs to be used properly. There is nothing easier than having clear guidelines and following them. That's what I encourage PHAC to do in terms of the network. It plays an important role internationally as well as nationally. There needs to be accountability for both of these responsibilities.

[Maxime Blanchette-Joncas, Bloc, Rimouski-Neigette—Témiscouata—Les Basques, QC]

Thank you for the clarifications, Ms. Hogan.

And speaking of specific instructions, I have a clear question for Mr. Stewart.

Has the Public Health Agency of Canada submitted recommendations to the government to completely ban non-essential travel abroad?

[Iain Stewart]

The Public Health Agency of Canada has not been the source of a recommendation of that nature, to my knowledge. A lot of advice has been generated on various ways to respond to the border, but we can come back to that issue, if that would be helpful to you.

[The Chair, Conservative, Kelly Block]

Thank you very much, Monsieur Blanchette-Joncas.

We will now move on to Mr. Bachrach for six minutes.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Thank you, Madam Chair.

It's good to see you again, Ms. Hogan, and thank you, Mr. Stewart and Mr. Ossowski, for being with us and answering our questions today.

I must say that reading over your report, Ms. Hogan, I felt a fair degree of alarm that this could have happened under such serious circumstances. I was trying to think of a metaphor or an analogy that could help Canadians understand the main findings of your report, particularly around the risk assessment. It seemed to me that in a way, Canada had installed a fire alarm system and our house was filled with smoke, and yet the fire alarm didn't go off. Then in mid March, the public health officer of Canada had to go in and manually pull the alarm. Is that a fair characterization? I want people, without having to dive into the detail of the report, to be able to understand the key failure that you've characterized.

[Karen Hogan]

I like your analogy. I think I've used it before, that an alert is like a fire alarm. An alert is meant to make you stop what you're doing and go investigate and decide what action is needed. If you're standing outside your home looking at the fire, it doesn't really matter if your smoke detector is going off inside.

I think when it comes to risk assessments, I would look at two things. I would look at the alert system having to trigger a different response or create a sense of heightened awareness. As well, once the daily report identified this that this virus was of concern, the agency had the risk assessment tools it needed to use in order to help predict the impact of the virus. This is where we saw a tool that was not appropriate being used: It wasn't considering the risk of a pandemic. As you can imagine, when there is a virus here, you need to look at risk of its spreading. In a pandemic you also need to look at what the risk of a virus coming to Canada is and then look at what the risk of its spreading. It really needs to have that forward-looking projection. That was not there. Again, it's like your smoke detector, that warning that makes you stop and go to look to see what you need to do.

In this instance, our audit found that the two alert systems did not work as intended.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Thank you, Ms. Hogan.

Turning to the Global Public Health Intelligence Network, in your report, paragraph 8.76, reads:

We found that no alert from...GPHIN...was issued to provide early warning of the virus. According to the agency's criteria, an alert is to be issued for an unusual event that has the potential for serious impact or spread. However, no alert was issued when news of an unknown pneumonia was first reported, when the virus had spread outside of China, or when domestic cases were first suspected and confirmed. Public Health Agency of Canada officials confirmed that by the end of December 2019, other international sources had already shared news of the virus and therefore it was unnecessary to issue an alert.

Perhaps I'll ask this of Mr. Stewart. How did your agency determine that COVID-19 didn't warrant an alert?

[Iain Stewart]

On December 30, an event was reported through the GPHIN system, as we're talking about here. The GPHIN system succeeded in identifying the event and then it was communicated out. As the Auditor General mentioned in her comments, the notification of an event goes out through two pathways. It goes out through a daily report, which goes to the Public Health Agency of Canada and domestic parties, and then there's an alert, which goes to a broader international audience. The daily report went out and notified people about this event of concern. As has been noted here, the chief public health officer acted upon that and spoke to provincial public health officers, for instance, as a result. The international alert, as the Auditor General mentioned, did not get issued.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Mr. Stewart, would an alert have prompted a different response if it had been issued?

[Iain Stewart]

No, not within the Public Health Agency of Canada, nor within the Government of Canada per se, because the daily alert resulted in action from the chief public health officer.

[Taylor Bachrach, NDP, Skeena—Bulkley Valley, BC]

Ms. Hogan, if I understand Mr. Stewart correctly, he's saying that in our domestic response, there was no need for an alert because the daily report was adequate to trigger the domestic response. Is that consistent with your findings?

[Karen Hogan]

What I would highlight is that alerts are also meant to alert our international counterparts. If we had done that, maybe we would have changed the response internationally, which may have changed the response, or the need to respond, in Canada.

I agree that the chief public health officer, in following the daily report issued at the end of December and with her knowledge of what was going on around the world, alerted her provincial counterparts, and this did trigger some response in Canada. However, I think no one will really know whether an alert would have caused a global change in the response.

We have a system in place that has issued alerts in the past for H1N1 and SARS, and we saw alerts being issued for other events during the COVID pandemic. What therefore really needs to be clarified is when an alert should be issued, why and what the expected response is once it has been issued.

[The Chair, Conservative, Kelly Block]

Thank you very much, Ms. Hogan.

We will now go to our second round of questioning of five minutes, starting with Mr. Berthold.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Thank you very much, Madam Chair.

Ms. Hogan, word choice is always important in your reports. What prompted you to write that you were discouraged? You knew that word would have a lot of impact and send a very strong message. How discouraged were you that you felt compelled to phrase it in that way?

[Karen Hogan]

I personally made the decision to use the word “discouraged” to describe my perception of the situation. I am discouraged that long-standing deficiencies have not been addressed. The Public Health Agency of Canada was not made aware of these problems only once; they were made aware of them repeatedly by our office, in addition to the lessons they themselves have learned from other health crises.

It is disheartening that we wait for an emergency to respond. So I chose this word in the hope that it would provoke a change in the approach to preparing for another health crisis in this country.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Thank you, Ms. Hogan.

Mr. Stewart, how did you react to the Auditor General's use of the word “discouraged”? I think you just got a big rap on the knuckles.

[Iain Stewart]

I received it as a call to service and a call to action. I think the work of the Auditor General is invaluable in identifying areas where we could make improvements. Her report is actually very helpful in that regard in a number of areas where, I agree, that we need to do more.

If I talk about words that I use personally, I used the phrase, “a call to duty”. I was doing a different job and was asked to do this job. I came to it because of the pandemic. It was a call to action, and I'm pleased and honoured to be here.

Like the Auditor General, I believe we can do more and we will do more.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Mr. Stewart, how can you explain the failure of the alert issuance system?

Earlier, you mentioned the Chief Public Health Officer of Canada. What is the relationship between politicians, the Chief Public Health Officer and the Public Health Agency of Canada? Who is to blame?

[Iain Stewart]

The distinction I'm trying to introduce, which I think the Auditor General did first in her comments, is that there is an internal system that says “something's happening”. That's the daily report. I get it myself every day, as does every other public health official and our related agencies in the government. They tell us “something's happening, pay attention to this”.

We have them every day occurring in different places in the world, with Ebola right now in Africa and so on.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

Who is responsible to read it and interpret it, and to call for action after that? I ask because that is the main problem we have.

[Iain Stewart]

That's right. With us here today is Cindy Evans, the vice-president of emergency management. We set up a health portfolio operation centre; we set up a team around the response. As our chief public health officer, Theresa plays a big role in leading us on that guidance, and she has mentioned in an analysis of GPHIN that she herself reached out to the provincial chief public health officers.

There is an integrated system through which notifications get triggered, and which organizes a response. The emergency management group under Cindy looks after organizing that response.

[Luc Berthold, Conservative, Mégantic—L'Érable, QC]

I know that everyone in your agency has the well-being of every Canadian at heart . I don't doubt that, but we must have a better system to prepare for the next time.

Mr. Ronald St. John, who was responsible for the public health agency before, said:

I am left wondering what kind of event would merit a Level 4 activation. I can’t believe that a global pandemic with millions of deaths, variants...and on and on, would not merit continuous Level 4.... I mean, what would be a Level 4 event, the extinction of humanity?

I think he is talking about a level of security. What does it take to elevate the level and to be prepared? We don't perceive it right now.