Ottawa appoints new management to ‘strengthen’ pandemic surveillance system

Needed given short-sightedness of PHAC-decisions regarding pandemic preparations:

The Public Health Agency of Canada has installed new management to oversee and “strengthen” the country’s pandemic surveillance system, a once-globally renowned unit whose capabilities were curtailed less than a year before the COVID-19 crisis hit.

In a statement provided to The Globe and Mail, the department said Brigitte Diogo, a senior official with 25 years of experience in government, has taken over as the vice-president of the Health Security Infrastructure Branch. The division oversees the government’s pandemic early warning and surveillance unit, known as the Global Public Health Intelligence Network, or GPHIN, among other operations, such as an emergency stockpile of medical supplies.

Sally Thornton, who previously served in that role, left the government last week, the department said. “After a long and distinguished career, Ms. Thornton is retiring from the federal public service,” Public Health spokeswoman Natalie Mohamed said in an e-mailed statement.

Ms. Thornton declined requests for an interview. Ms. Diogo was also not available for comment, the department said.

GPHIN has been at the centre of controversy since a Globe investigation in late July detailed how the intelligence-gathering capabilities of the government’s pandemic early warning system were reduced significantly in late 2018 and early 2019. That effectively shut down much of its surveillance work on international health threats less than eight months before the outbreak in China began to spread, and appears to have impacted Canada’s ability to gauge the risk of the virus.

Throughout January, February and much of March, the government judged the threat from the outbreak as “low” in its official risk assessments, even after the World Health Organization warned in late January that the risk to the world was high.

In her new role, Ms. Diogo’s mandate will include bolstering the surveillance system, although no specifics were provided.

“Ms. Diogo will lead efforts to maintain and strengthen Canada’s public health event-based surveillance system including the Global Public Health Intelligence Network,” department spokesman Eric Morrissette said in a statement.

In late 2018, believing that GPHIN was too internationally focused and could be put to better use on domestic projects, the department reassigned doctors and epidemiologists in the highly specialized unit to projects that didn’t involve pandemic preparedness. A once-prolific alert system operated by GPHIN, designed to track evolving health threats and inject urgency into government responses, was effectively shuttered when a new edict required that Ms. Thornton approve all such alerts.

With no approvals given, the alert system eventually went silent on May 24, 2019, according to 10 years’ worth of PHAC records obtained by The Globe. With it, much of the unit’s surveillance activities – designed to track early signals of an outbreak and inform government risk assessments – effectively shut down as well.

The alert system remained silent for 440 days, and was restarted only last month, less than two weeks after the Globe investigation. During the intervening months, employees inside Public Health say GPHIN’s intelligence-gathering abilities were a fraction of what they once were. Created in the 1990s, GPHIN had garnered international acclaim for its ability to detect and gather continuing intelligence on outbreaks of diseases such as H1N1, Ebola, Zika and others, helping the government formulate a response if needed.

In addition to GPHIN, Ms. Thornton also oversaw the national emergency stockpile of medical supplies, which came under heavy scrutiny this spring after it fell short of supplying the provinces and territories with badly needed personal protective equipment.

In April, Ms. Thornton testified before the House of Commons Health Committee that the stockpile held a “minimum level” of equipment, and wasn’t designed to handle the surge of a pandemic, raising questions about how it was being managed.

The Globe has made several requests since May to interview department officials connected to GPHIN, including Ms. Thornton. All of those requests were declined.

Last week, Health Minister Patty Hajdu ordered an independent federal review of the problems at GPHIN, saying she was troubled that scientists at Public Health told The Globe they were not being listened to within the department. The Auditor-General has also launched an investigation.

Scientists within Public Health told The Globe that over the past decade, the department has suffered from an influx of senior officials from other areas of the government, such as the Treasury Board, Border Services and others, who lacked sufficient grounding in Public Health. Epidemiologist Michael Garner, a former senior science adviser at the agency, said it became difficult for scientists to communicate urgent and complex messages up the chain of command, because those officials often didn’t comprehend the problems.

Ms. Diogo, who moves over from Transport Canada, has no science background, which may add to such concerns. However, Mr. Morrissette said she has extensive experience working on safety and security policy, and on program design and delivery.

“While a newcomer to the agency, Ms. Diogo understands the merit of a well-functioning, event-based surveillance system including the timely dissemination of information such as alerts, to inform decision-making in addressing public health threats,” Mr. Morrissette said.

According to information from the department, Ms. Diogo was director-general of rail safety at Transport Canada from 2015-20, and director of operations at the Security and Intelligence Secretariat in the Privy Council Office, where she oversaw matters related to national security from 2011-14. She also has a background in risk mitigation while at Immigration, Refugees and Citizenship Canada, the department said.

Source: Ottawa appoints new management to ‘strengthen’ pandemic surveillance system

Health Minister orders review of pandemic warning system, concerns raised by scientists

Really hope the review will be truly independent, review all appropriate documentation, analysis and memos and identify what level and persons were responsible for the decision (i.e., was the decision made at the bureaucratic or political level):

Canada’s Health Minister has ordered an independent review of the country’s pandemic early warning system, after The Globe and Mail reported that the respected surveillance and research unit was silenced last year, several months before the COVID-19 outbreak hit.

Health Minister Patty Hajdu said the federal review will probe the shutdown of the system, as well as allegations from scientists inside the Public Health Agency of Canada that their voices were marginalized within the department, preventing key messages from making it up the chain of command.

“My hope is that we can get the review off the ground as soon as possible,” Ms. Hajdu said in an interview. “The independence of this review is critically important.”

A Globe investigation in late July detailed how the unit, known as the Global Public Health Intelligence Network, or GPHIN, was effectively silenced in May, 2019. The team of analysts – including doctors and epidemiologists specially trained to scour the world for health threats – were reassigned to other tasks within the government amid shifting department priorities.

Though GPHIN had garnered a stellar reputation internationally, and was dubbed a “cornerstone” of global pandemic preparedness by the World Health Organization, officials within Public Health decided in late 2018 and early 2019 that the operation was too internationally focused and could be put to better use working on domestic projects. The new work did not involve pandemic preparedness.

Those changes led to the shutdown of a special surveillance and alert system that helped Canada and the WHO gather intelligence on potentially threatening outbreaks, particularly in situations where foreign governments were trying to hide or play down the event.

Current and former scientists and doctors at Public Health also said they began to fear that their messages were not being heard, or understood, by layers of department officials who lacked a sufficient background in science. That made it difficult to convey urgent and complex information up the chain of command.

Responding to those concerns, Ms. Hajdu said her office has spent the past month looking into the problems at the departmental level, which led her to order the review.

“I’m concerned when there is an accusation that scientists are not being fully empowered, or in some way feel their voices are being blunted or muted,” Ms. Hajdu said in an interview.

“I can listen to those kinds of worries and do the kinds of things that I’m prepared to do, which is to order a review of the program and to determine whether or not the changes are actually resulting in the kind of information that Canada needs.”

Ms. Hajdu said she has asked that the review be done expeditiously, so that fixes can be identified and the recommendations implemented as soon as possible. She said that could mean having the recommendations back in six months.

“We’re working on [appointing] some professionals that would have the experience and the expertise to be able to do this review thoroughly, but also expeditiously … I don’t want this to be a two-year review,” the Health Minister said. The people leading the review are expected to be named in the coming weeks and will be independent of Public Health Canada.

Created as an experiment in the 1990s, GPHIN became a key part of Canada’s pandemic preparedness capacity after the deadly 2003 SARS outbreak, and was seen as a way to collect intelligence on global outbreaks. The point was not merely to identify the threat early, but also to monitor crucial developments and clues about the spread, often before official announcements were made by foreign governments, to speed up government decision-making.

With a team of roughly a dozen highly specialized analysts working in multiple languages, GPHIN was globally renowned for its ability to collect and disseminate credible information. It scoured more than 7,000 data points a day, including medical data, news reports, scraps of information on social media, and details on internet blogs to gather intelligence on outbreaks.

GPHIN had been credited with detecting some of the most important signals from the 2009 H1N1 outbreak in Mexico, outbreaks of Zika in West Africa, and a potentially catastrophic 2005 bird flu outbreak that the Iranian government tried to hide. As recently as two years ago, the WHO credited the Canadian unit for supplying 20 per cent of its “epidemiological intelligence.”

However, department changes effectively shuttered the operation, and limited the power of scientists inside the agency. The Globe obtained 10 years of internal GPHIN records which showed the system, which had issued more than 1,500 intelligence alerts about potential health threats over that time, went silent on May 24 last year. That coincided with a department edict that all such alerts had to be approved by senior managers inside Public Health. GPHIN analysts were shifted to domestic projects, such as tracking the effects of vaping in Canada, which effectively curtailed Canada’s surveillance of international health threats.

Past and present employees told The Globe that the system was designed to provide information to speed up Canada’s response to a dangerous outbreak such as COVID-19, including measures such as shutting down the border, quarantining travellers, enforcing physical distancing, and locking down long-term care homes.

“A lot of the work that we’ve done [over the past month] is to try to dig a little bit deeper into how this is working and why were these changes made,” Ms. Hajdu said.

GPHIN “has the potential to be a very valuable asset for Canada. It can’t be wasted,” the Health Minister said.

“The intent when there is an emerging pathogen is to close it off, to try and contain it as best as possible – at its source. So that you don’t end up in a pandemic like this again.”

The independent review follows a pair of other developments in recent weeks. Last month, the Auditor-General of Canada launched an investigation into the shutdown of the pandemic surveillance unit. And Public Health officials have restarted the GPHIN alert system.

COVID-19 has been a reckoning for governments around the world, exposing weaknesses in pandemic readiness and responsiveness. Ms. Hajdu said countries must now take stock of what needs to be done to implement stronger measures, including early warning and surveillance capacity, that will remain effective and not be eroded over time, when the memories of the crisis fade.

The federal review will look at “governance and what works best” for GPHIN, Ms. Hajdu said, adding that the messages raised by scientists inside Public Health, who took risks by speaking out publicly, resonated with her.

“In [The Globe’s] reporting, the plea from the scientists and the researchers that work in that team were particularly profound,” Ms. Hajdu said.

“There is still enough there to save, and to boost, and I think this independent review is going to be very helpful,” she said. “Obviously there is a lot of work to do.”

Source: Health Minister orders review of pandemic warning system, concerns raised by scientists

Auditor-General to probe lapse in Canada’s pandemic warning system

Needed:

Canada’s Auditor-General is planning to investigate what went wrong with the country’s once-vaunted early warning system for pandemics after the unit curtailed its surveillance work and ceased issuing alerts more than a year ago, raising questions about whether it failed when it was needed most.

Sources close to the matter said the Auditor-General is planning to probe the government’s handling of the Global Public Health Intelligence Network, or GPHIN, which was a central part of the country’s advance surveillance, early detection and risk-assessment capacity for outbreaks.

The Globe and Mail reported on Saturday that a key part of GPHIN’s function was effectively shut down last spring, amid changing government priorities that shifted analysts to other work. According to 10 years of documents obtained by The Globe, the system went silent on May 24 last year, after issuing more than 1,500 alerts over the past decade about potential outbreaks including MERS, H1N1, avian flu and Ebola.

GPHIN was part of Canada’s contribution to the World Health Organization. Those alerts often helped Canada, the WHO and other countries assess outbreaks at their earliest stages to determine the urgency of the situation. It was responsible for alerting the WHO to the first signs of several potentially catastrophic events, including a 2009 outbreak of H1N1 in Mexico, a 2005 flare-up of bird flu in Iran that the government there tried to hide, and the 1998 emergence of SARS in China.

According to federal documents, “approximately 20 per cent of the WHO’s epidemiological intelligence” came from GPHIN. But sources from inside the Public Health Agency of Canada (PHAC) said the analysts were stripped of their ability to independently issue alerts in late 2018. Those alerts, which had garnered GPHIN a global reputation as a leader in pandemic intelligence, had to be approved by senior management, a move that ultimately silenced the system.

Several past and present employees told The Globe that the government had grown wary of GPHIN’s mandate in recent years, believing it was too internationally focused, given that pandemic events were rare. Analysts were given domestic projects to focus on that didn’t involve global surveillance, and the operation’s early-warning capacity soon suffered. Over the past decade, doctors inside Public Health also began to fear their messages weren’t being heard, or understood, on important topics, the employees said, which affected Canada’s readiness for the COVID-19 pandemic.

The Auditor-General is also planning to look at Canada’s risk assessments during the pandemic, which may have affected the speed and urgency of mitigation measures, such as border closings, airport shutdowns and the use of protective masks. Throughout January, February and into March, the government maintained the risk the virus posed to Canada was “Low,” even as evidence of human-to-human spread became increasingly evident around the world. Canada didn’t elevate its risk rating to “High” until March 16, nearly seven weeks after the WHO declared the global risk was high and urged countries to start preparing.

The Office of the Auditor-General has previously signalled that it would be taking a critical look at the federal government’s response to COVID-19, but the probe of GPHIN is now among its top priorities, according to sources familiar with the matter. The sources were not authorized to speak publicly and the Auditor-General, as a matter of course, does not comment publicly on its investigations. The work is to be completed late this year or early next year.

“It’s still early in the process,” said Vincent Frigon, spokesman for the Office of the Auditor-General. “We don’t comment on ongoing audits, however when we do have a better idea of what’s the scope of the audit we should be able to release the information. … We should have a more specific timeline later this year.”

A PHAC spokesman said the agency would assist in the audit. “The Auditor-General plays an important role in Canada’s democracy as a key Officer of Parliament,” PHAC said in an e-mailed statement. “The Public Health Agency of Canada is fully prepared to assist the Office of the Auditor-General as they work on their audit of the Government’s pandemic preparedness and response.”

Few outside GPHIN knew the operation had curtailed its outbreak surveillance work to the extent it had. When a senior public health official addressed the WHO in November, the government described the system as still active. In a 2018 assessment of Canada’s pandemic preparedness capabilities, the WHO referred to GPHIN as the “cornerstone” of Canada’s pandemic response capability, and “the foundation” of global early warning, where signals are “rapidly acted upon” and “trigger a cascade of actions” by governments.

The unit, which involves roughly a dozen highly trained epidemiologists and doctors fluent in multiple languages, began as an experiment in the 1990s during the advent of the internet, but was elevated after the 2003 SARS crisis, when Canada realized it needed to be better prepared for serious outbreaks.

When fully operational, it was a combination of machine learning and human analysis, with GPHIN’s algorithms sifting through more than 7,000 data points from around the world each day, from local news reports and online discussions to arcane medical data, searching for unusual patterns. Those were then narrowed down for closer analysis by medical experts.

Source: https://www.theglobeandmail.com/canada/investigations/article-auditor-general-to-probe-oversight-of-countrys-pandemic-warning/

‘Without early warning you can’t have early response’: How Canada’s world-class pandemic alert system failed

This has to be considered a significant fail: disbanding the PHAC Global Public Health Intelligence Network, or GPHIN a few years before COVID-19.

Kudos to the Globe for good investigative reporting and analysis.

Given that resource reductions and reallocations are normally executed at the bureaucratic level (with political sign-off), one would hope that PHAC is revisiting this decision and the relative importance within PHAC of senior bureaucratic decision-makers vs scientific advice and expertise. Savoie’s comments on senior public servants as courtiers comes to mind when reading about these differences so well captured in the Globe report.

Some form of enquiry (preferably external) is needed  to assess how this short-sighted decision took place and the related accountabilities.

While there is no excuse for the ethical violations of the PM and Finance Minister regarding WE, it would be a far better use of Parliament to investigate this decision and its impact, given that it contributed to Canada’s missing the opportunity for an early and thus likely more effective response, with fewer deaths of Canadians:

On the morning of Dec. 31, as word of a troubling new outbreak in China began to reverberate around the world, in news reports and on social media, a group of analysts inside the federal government and their bosses were caught completely off guard.

The virus had been festering in China for weeks, possibly months, but the Public Health Agency of Canada appeared to know nothing about it – which was unusual because the government had a team of highly specialized doctors and epidemiologists whose job was to scour the world for advance warning of major health threats. And their track record was impressive.

Some of the earliest signs of past international outbreaks, including H1N1, MERS and Ebola, were detected by this Canadian early warning system, which helped countries around the world prepare.

Known as the Global Public Health Intelligence Network, or GPHIN, the unit was among Canada’s contributions to the World Health Organization, and it operated as a kind of medical Amber Alert system. Its job was to gather intelligence and spot pandemics early, before they began, giving the government and other countries a head start to respond and – hopefully – prevent a catastrophe. And the results often spoke for themselves.

Russia once accused Canada of spying, after GPHIN analysts determined that a rash of strange illnesses in Chechnya were the result of a chemical release the Kremlin tried to keep quiet. Impressed by GPHIN’s data-mining capabilities, Google offered to buy it from the federal government in 2008. And two years ago, the WHO praised the operation as “the foundation” of a global pandemic early warning system.

So, when it came to the outbreak in Wuhan, the Canadian government had a team of experts capable of spotting the hidden signs of a problem, even at its most nascent stages.

But last year, a key part of that function was effectively switched off.

In May, 2019, less than seven months before COVID-19 would begin wreaking havoc on the world, Canada’s pandemic alert system effectively went dark.

Amid shifting priorities inside Public Health, GPHIN’s analysts were assigned other tasks within the department, which pulled them away from their international surveillance duties.

With no pandemic scares in recent memory, the government felt GPHIN was too internationally focused, and therefore not a good use of funding. The doctors and epidemiologists were told to focus on domestic matters that were deemed a higher priority.

The analysts’ capacity to issue alerts about international health threats was halted. All such warnings now required approval from senior government officials. Soon, with no green light to sound an alarm, those alerts stopped altogether.

So, on May 24 last year, after issuing an international warning of an unexplained outbreak in Uganda that left two people dead, the system went silent.

And in the months leading up to the emergence of COVID-19, as one of the biggest pandemics in a century lurked, Canada’s early warning system was no longer watching closely.

When the novel coronavirus finally emerged on the international radar, amid evidence the Chinese government had been withholding information about the severity of the outbreak, Canada was conspicuously unaware and ultimately ill-prepared.

But according to current and former staff, it was just one of several problems brewing inside Public Health when the virus struck. Experienced scientists say their voices were no longer being heard within the bureaucracy as department priorities changed, while critical information gathered in the first few weeks of the outbreak never made it up the chain of command in Ottawa.

‘WE NEED EARLY DETECTION’

The Globe and Mail obtained 10 years of internal GPHIN records showing how abruptly Canada’s pandemic alert system went silent last spring.

Between 2009 and 2019, the team of roughly 12 doctors and epidemiologists, fluent in multiple languages, were a prolific operation. During that span, GPHIN issued 1,587 international alerts about potential outbreak threats around the world, from South America to Siberia.

Those alerts were sent to top officials in the Canadian government and throughout the international medical community, including the WHO. Countries across Europe, Latin America, Asia and Africa also relied on the system.

On average, GPHIN issued more than a dozen international alerts a month, according to the records. But its purpose wasn’t to cry wolf. Only special situations that required monitoring, closer inspection or frank discussions with a foreign government were flagged.

GPHIN’s role was reconnaissance – detect an outbreak early so that the government could prepare. Could the virus be contained before it got to Canada? Should hospitals brace for a crisis? Was there enough personal protective equipment on hand? Should surveillance at airports be increased, flights stopped, or borders closed?

This need for early detection sprang from a climate of distrust in the 1990s, when it was believed some countries were increasingly reluctant to disclose major health problems, fearing economic or reputational damage. This left everyone at a disadvantage.

For Canada, the wake-up call came in 1994 when a sudden outbreak of pneumonic plague in Surat, India, sparked panic. Official information was sparse, but rumours promulgated faster. As citizens fled the city of millions, many on foot, others boarded planes.

Public Health officials in Ottawa were soon alerted to an urgent problem: Staff at Toronto’s Pearson International Airport, fearing exposure to the plague, threatened to walk off the job if a plane arriving from India was allowed to land. The government scrambled to put quarantine measures in place.

“We were caught flat-footed,” said Ronald St. John, who headed up the federal Centre for Emergency Preparedness at the time. The panic demonstrated the need for advance warning and better planning.

“We said, we’ve got to have early alerts. So how do we get early alerts?”

Waiting for official word from governments was often slow – and unreliable. Dr. St. John and his team of epidemiologists didn’t want to wait. They began building computer systems that could scan the internet – still in its infancy back then – at lightning speed, aggregating local news, health data, discussion boards, independent blogs and whatever else they could find. They looked for anything unusual, which would then be investigated by trained doctors who were experts in spotting diseases.

It was a mix of science and detective work. A report of dead birds in one country, or a sudden outbreak of flu symptoms at the wrong time of year in another, could be clues to something worse – what the analysts call indirect signals.

Find those signals early enough, and you can contain the outbreak before it becomes a global pandemic.

“We wanted to detect an event, we didn’t want a full epidemiological analysis,” Dr. St. John said. “We just wanted to know if there was an outbreak.” …

Source for remainder: https://www.theglobeandmail.com/canada/article-without-early-warning-you-cant-have-early-response-how-canadas/