Health committee  I don't believe there is. We're consulting with the Public Health Agency of Canada to coordinate communications. The Japanese student who was incubating measles when she arrived with her tour group became clinically ill and was hospitalized, and the diagnosis of measles was made.

Health committee  Monique, it's up to you.

Health committee  I'm willing to go there, but I want you to talk to this.

Health committee  I would agree with Dr. Douville, and it is the opinion of the public health network and the folk who are working on our Canadian pandemic influenza plan that the Quarantine Act is not going to keep pandemic influenza out of Canada. In all likelihood, the first cases we actually identify are going to be second-, third-, or fourth-generation cases, and by the time we pick it up, it's going to be spread in our communities.

Health committee  I have consulted only with the public health officials in B.C. who have a responsibility in health areas next to or very close to the border and who would be impacted by this.

Health committee  Answering the same questions? My concern would be that if it did stay in the act, it would have to be acted on, and then, I would say, there could be unintended consequences that could weaken our existing system.

Health committee  I'm sorry. If it were left in the act, I would be concerned that it would then need to be acted upon, with the potential downside of the unintended consequences of weakening the public health system and draining away resources to no benefit. As to whether you might need such a tool, I understood from reading the transcripts of your last meeting around this that the potential exists for a regulatory change immediately if one should discover an epidemiological situation in which a disease, whose characteristics I can't imagine at the moment, did make it necessary or desirable that we stop someone or have advance notice of their carrying the disease from a particular place in the United States to a particular destination in Canada.

Health committee  I think all medical officers in provinces and territories have the abilities within their acts and exceptions within their protection of privacy acts to enable them to make the appropriate communications to other public health officials in other provinces and territories or indeed at the federal level.

Health committee  Yes. We're attempting to develop specific and official memoranda of understanding through the public health network, with sign-off by ministers of health at the federal, provincial, and territorial levels so that everybody is very explicitly clear that we have that ability, that we have practised it, that we have particular protocols for respiratory outbreaks or gastrointestinal outbreaks or any other kind of outbreak.

Health committee  Yes. Alaska is included in our meetings.

Health committee  I think, on Dr. Douville-Fradet's proposal, with very specified mechanisms of transportation such as a train, one wouldn't necessarily need to stop it at the border, but then if you had concerns that someone on board that conveyance was ill and needed medical attention, if you hadn't put them off to give them medical attention before they got to the border, then rather than putting them off at the border where there aren't diagnostic or care facilities, it would actually make more sense to arrange for them to be met by an ambulance and transported to a hospital at their closest point of destination.

Health committee  To the first question, official linkages between British Columbia health officials and health officials of governments outside of Canada would be through PHAC. But in fact, our public health officials at the B.C. Centre for Disease Control do have ongoing relationships with other public health officials and scientists in other institutes of infectious disease in China, Hong Kong, Vietnam, Taiwan, and other countries.

Health committee  We would be just as safe without this. I agree with Dr. Douville. As far as erring on the side of caution goes, my concern would be that if we set up a process that had many advance calls to quarantine officers or others, which then required public health professionals to be diverted from what they were currently doing or to get up at 2 o'clock in the morning, the downside risk is that we would take away scarce resources and basically be diverting them for no additional benefit.

Health committee  I'm thinking that if anybody is extremely ill on a bus or a train, they ought to be taken off the train or the bus whenever they go through a city with a health facility before they get to the border; or rather than stopping them at the border, as Dr. Douville-Fradet suggested, make sure they get some care immediately upon arrival at their final destination.

Health committee  Yes.