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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
Outline
• Canadian Context
• Summary of the Canadian plan
• Challenges
• Next steps
Context
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Canada is a vast country with:
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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
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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)
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
Pandemic Influenza
Committee
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Began with a Working Agreement in 2001
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Federal and Provincial Co-chairs
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between Provincial and Federal Deputy Ministers of
Health
Reports to Deputy Ministers of Health
Funded by the Federal Minister of Health
Working Groups
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Good mix of infectious disease and public health
expertise
Canadian Pandemic
Influenza Plan
• Released January 2004
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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
Overall Goal
First, to minimize serious illness
and death, and
second to minimize societal
disruption.
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
Key Components
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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)
Infection Control
• National level steering committee
guidelines
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Management of pandemic influenza in
various “traditional” and “non-traditional”
settings
Addresses mask use
Emphasizes hand hygiene
Discusses self-care
Provides educational tools
Clinical Care
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Describes common clinical presentations and
complications
Offers best practices for triage and initial
assessment
Describes patient management in:
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Hospital departments, LTCF, Non-traditional sites,
Isolated communities, Correctional Institutions,
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Antiviral and antibiotic use
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Telephone advice
Mass Fatalities
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Planning checklists for funeral homes
Plans for temporary morgues
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Other technical considerations
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Death registration
Infection control
Transportation
Supply management
Identifies social/religious considerations
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First Nations, Inuit, Jews, Hindus, Muslims all
have special directives…
Resource Management
• Reviews emergency preparedness
legislation
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Ability to requisition property
Identifies triggers for intervention
• Offers plans/checklists for:
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increasing bed capacity
patient prioritization
critical equipment and supplies
Non-traditional Sites and
Workers
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Addresses how to assess sites for health care
delivery during a pandemic
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Potential roles
Administrative options/Insurance issues
Identifies how to create surge capacity with
other HCW, students, retirees, volunteers
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Recruitment and Training
Potential roles
Administrative issues (compensation,
management)
Insurance/licensing issues
Effects of national plan
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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
Challenges
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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
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Emphasis on early treatment
Prophylaxis under debate
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Lack of meaningful involvement to date
Concerns about lack of training/support,
insurance
Family physicians are sceptical…
Next steps
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Joint PHAC/Public Safety and Emergency
Preparedness Canada Committee
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Involves > 20 federal departments
Preparing a Federal Pandemic Plan
All Departments developing business continuity
plans
Other initiatives underway in other departments
Increase surveillance capacity
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Strengthen our “FluWatch” program (use of
sentinel physicians with lab or ILI reports)
Educate physicians on SRI reporting
Next steps
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AI/PI coordination
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Finalize antiviral strategy
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Develop a joint response plan for:
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LPAI outbreak
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HPAI outbreak
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H5N1 outbreak in birds with human cases
Conducting national consultations of both general
public and stakeholders.
Engage family physicians
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Funding national initiative through College of
Family Physicians of Canada and Canadian Public
Health Association to come up with
recommendations and best practices.
Closing quote:
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“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
Acknowledgements
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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
Gracias!