Pandemic Preparedness in the Health Care System in Canada

1. Pandemic Preparedness in the Health Care System in Canada Patricia Huston MD, MPH Chief, Emerging Infectious Diseases Immunization and Respiratory Infections Division Centre for Infectious Disease Prevention and Control PUBLIC HEALTH AGENCY OF CANADA Pan-American Health Organization Workshop April 20, 2006

2. Outline • Canadian Context • Summary of the Canadian plan • Challenges • Next steps

3. Context • Canada is a vast country with: • Approx 30 million people • English and French 2 official languages • First Nations people • 20% multicultural (Asia/Africa) • It has a publicly funded health care system • Covers all hospital and physician-based care • Managed by provinces/territories • Most physicians paid on a fee-for-service basis (essentially work as an independent business)

4. Why has planning worked in Canada? • SARS was a major “wake-up call” (people motivated) • Process: broad-based buy-in from the start • Structure: high level support

5. Pandemic Influenza Committee • Began with a Working Agreement in 2001 • between Provincial and Federal Deputy Ministers of Health • Federal and Provincial Co-chairs • Reports to Deputy Ministers of Health • Funded by the Federal Minister of Health • Working Groups • Good mix of infectious disease and public health expertise

6. Canadian Pandemic Influenza Plan • Released January 2004 • Identified federal, provincial and local responsibilities • Included prevention, preparedness, response and recovery activities • Followed the WHO phases • Focused largely on the Health Sector response • P/T and local authorities have used this plan to develop their own

7. Overall Goal First, to minimize serious illness and death, and second to minimize societal disruption.

8. Key Strategies • Clarify roles and responsibilities • Promote rapid detection/surveillance • Reduce spread and impact • Maintain public awareness and facilitate acceptance of response strategy • Conduct research to support response

9. Key Components • Surveillance and Laboratory Testing • Vaccine Programs • Antivirals • Health Services Emergency Planning • Infection Control, Clinical Care, Resource Management, Mass Fatalities, Non-Traditional Sites and Workers • Public Health Measures • Communications • Currently being updated (release 2006)

10. Infection Control • National level steering committee guidelines • Management of pandemic influenza in various “traditional” and “non-traditional” settings • Addresses mask use • Emphasizes hand hygiene • Discusses self-care • Provides educational tools

11. Clinical Care • Describes common clinical presentations and complications • Offers best practices for triage and initial assessment • Describes patient management in: • Hospital departments, LTCF, Non-traditional sites, Isolated communities, Correctional Institutions, • Antiviral and antibiotic use • Telephone advice

12. Mass Fatalities • Planning checklists for funeral homes • Plans for temporary morgues • Other technical considerations • Death registration • Infection control • Transportation • Supply management • Identifies social/religious considerations • First Nations, Inuit, Jews, Hindus, Muslims all have special directives…

13. Resource Management • Reviews emergency preparedness legislation • Ability to requisition property • Identifies triggers for intervention • Offers plans/checklists for: • increasing bed capacity • patient prioritization • critical equipment and supplies

14. Non-traditional Sites and Workers • Addresses how to assess sites for health care delivery during a pandemic • Potential roles • Administrative options/Insurance issues • Identifies how to create surge capacity with other HCW, students, retirees, volunteers • Recruitment and Training • Potential roles • Administrative issues (compensation, management) • Insurance/licensing issues

15. Effects of national plan • Most provinces, and many local jurisdictions have a pandemic plan consistent with the national plan • Hospital planning is well-advanced (esp. in province that had SARS) • Annual influenza vaccine coverage is high • Public awareness is good • We have vaccine production capacity • We have an antiviral stockpile

16. Challenges • Focus has been on health sector; now need to focus on strategies to minimize societal disruption • Surveillance is still a weak link • Need to combine AI and PI initiatives • Need to arrive at consensus on priority groups for antivirals • Emphasis on early treatment • Prophylaxis under debate • Family physicians are sceptical… • Lack of meaningful involvement to date • Concerns about lack of training/support, insurance

17. Next steps • Joint PHAC/Public Safety and Emergency Preparedness Canada Committee • Involves > 20 federal departments • Preparing a Federal Pandemic Plan • All Departments developing business continuity plans • Other initiatives underway in other departments • Increase surveillance capacity • Strengthen our “FluWatch” program (use of sentinel physicians with lab or ILI reports) • Educate physicians on SRI reporting

18. Next steps • AI/PI coordination • Develop a joint response plan for: • LPAI outbreak • HPAI outbreak • H5N1 outbreak in birds with human cases • Finalize antiviral strategy • Conducting national consultations of both general public and stakeholders. • Engage family physicians • Funding national initiative through College of Family Physicians of Canada and Canadian Public Health Association to come up with recommendations and best practices.

19. Closing quote: • “Let no one be discouraged by the belief there is nothing one man or one woman can do against the enormous array of the world’s ills… each of us can work to change a small portion of events, and in the total of all those acts… human history is shaped.” • Robert Kennedy

20. Acknowledgements • Drs. Arlene King and Theresa Tam – the “masterminds” of pandemic preparedness in Canada and Jill Sciberrras, Sr. Epidemiologist • The members of the Pandemic Influenza Committee and its Working Groups • Efforts of many others in health care and at all levels of government who have helped to make pandemic preparedness in Canada what it is today

21. Gracias!