Reports call Canada's pandemic response effective, cite gaps

Dec 30, 2010 (CIDRAP News) – In two new reports, the Canadian government gives itself a generally good grade for its response to the H1N1 pandemic but also lists many areas for improvement.

"Overall, the response of [health authorities] to the H1N1 pandemic is considered to have been effective," says the Public Health Agency of Canada's (PHAC's) report, released yesterday. The report covers the actions of that agency and of Health Canada.

Referring to the second report, from the Standing Senate Committee on Social Affairs, Science and Technology, Ontario Sen. Art Eggleton said in a news release, "The 2009 H1N1 pandemic was a major test that stretched our pandemic response to the limit." Eggleton is chair of the committee, whose report was also released yesterday.

"Our report offers practical ways to increase our efforts," he added, "because it is not a matter of if there will be another pandemic but when. We must be prepared."

PHAC report: Successes and action plan
The 100-page PHAC document lists 32 specific activities in nine categories that worked well. At the same time, it lists 34 "areas for action," meaning possible improvements, in the same categories. It groups these action items into three overarching approaches:

  • Strengthen the federal, provincial, and territorial preparedness and response to pandemic influenza.
  • Continue to clarify, communicate, and test federal emergency management roles.
  • Improve public health's ability to communicate science to various audiences.

The report is based on a review of internal documents, an analysis of reviews by other organizations, written feedback sought by PHAC during the pandemic, and interviews with key senior managers.

In the science and surveillance category, the report says existing systems and tools for exchanging information worked well, PHAC helped identify and understand the virus, and Health Canada's review of the vaccine was conducted promptly. However, it also says the government needs to finish agreements on sharing surveillance information across jurisdictions and consider ways to ensure there are proper mechanisms for facilitating rapid research.

Concerning the vaccine, the report says advance planning ensured timely availability of a safe and effective shot, and Canada's immunization rate was one of the world's highest. In October, Statistics Canada estimated overall uptake during the 2009-10 flu season at 41%, according to earlier reports.

But Canada could improve its pandemic vaccination efforts by establishing "an integrated surveillance system for immunization, including managing inventories, tracking vaccine uptake, and monitoring adverse events," the report states. It also calls for a review of the procedures for federal delivery of vaccines to provinces and territories.

The document says the various levels of government in Canada generally collaborated well during the pandemic. However, it noted that the federal government needs to clarify and communicate the roles of the various advisory groups involved in pandemic response and clarify decision-making processes.

On the communications front, the report cites several achievements: Planning ensured that key products and activities were quickly launched, "social marketing efforts helped to change infection prevention behaviours," and the different levels of government coordinated their communications effectively.

However, the information given to Canadians in different jurisdictions could have been more consistent, the authors found. To build public trust, they also recommend reviewing strategies for communicating uncertainty, risk, and changes in scientific knowledge.

Further, the report calls for developing "plain-language approaches to convey complex scientific findings, processes, uncertainties, risks and shifts" to a range of different audiences, from decision makers to the media and the public.

As for Canada's response in First Nation (indigenous) communities, the report notes that "many" communities had pandemic plans in place, vaccination clinics were "generally successful," antiviral drugs were in place for the second wave, personal protective equipment was bought, and there was good cooperation between federal agencies and First Nation leadership.

The report, however, says that guidance needs to be developed on the "logistical aspects" of implementing plans, public health guidance needs to be made available quickly to First Nation communities, regional spokespeople need to respond to local issues, and barriers to the movement of health professionals need to be addressed.

First Nation populations were hit especially hard by the pandemic.

Senate report: Further steps needed
In response to a request from Canada's Minister of Health, Leona Aglukkaq, the Standing Senate Committee on Social Affairs, Science and Technology also assessed the country's pandemic response and made recommendations for improvement.

"Canada managed very well compared with other countries," said Sen. Kelvin Ogilvie, deputy chair of the committee, in the news release. "We had a remarkable degree of cooperation across national, provincial, and municipal jurisdictions."

Key recommendations in the Senate report, many geared toward PHAC, include:

  • Pursue establishing a backup supplier for the country's vaccine.
  • Renew funding in the 2011 budget for pandemic preparedness planning.
  • Harmonize local, provincial, and federal roles in making expedient policy decisions and communications across media, including social media.
  • Make the Canadian Pandemic Influenza Plan for the Health Sector scalable to mild, moderate, and severe pandemics and implement regular testing of the plan.
  • Explore ways pharmacists and paramedics can contribute to front-line response.
  • Ensure that Health Canada's First Nations and Inuit Health Branch continue to work with Indian and Northern Affairs Canada and PHAC to address First Nation communities' unique concerns.

CIDRAP Editorial Director Jim Wappes contributed to this article.

See also:

PHAC report landing page

Dec 29 Senate committee news release

Nov 24 CIDRAP News story "Pandemic had significant impact on Canada's hospitals"

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