Ottawa was told about potential problems at Public Health Agency, top doctors say

This is a much bigger scandal than WE in terms of governance and expertise, reflecting in part the previous Conservative government’s disregard for science and expertise:

The federal government was warned years ago that the Public Health Agency of Canada was destined for serious problems unless changes were made to its oversight, but those concerns were ignored, two of Canada’s top doctors say.

A steady erosion of scientific capacity and a chronic shortage of resources over the past decade have left the agency unable to do its job properly, public-health experts Perry Kendall and Paul Gully told The Globe and Mail.

Recent problems, including the mishandling of the country’s pandemic early warning system, emergency stockpile shortages and allegations that scientists were forced to “dumb down” reports for senior government officials, are all symptoms of a larger ailment afflicting the agency, the doctors said.

“We are of the view that long-term deficiencies of expertise and funding prevent the Public Health Agency of Canada from fully carrying out its intended and necessary role,” Dr. Kendall said.

“A lot of the tools that the Public Health Agency had for influencing policy and programs were removed and budgets were cut.”

They are harsh words from two of Canada’s most respected public-health figures. Dr. Kendall preceded Bonnie Henry as B.C.’s provincial health officer from 1999 to 2018, and has been a leading voice in public-health policy. Dr. Gully spent 14 years in senior roles at Health Canada, and was also the country’s deputy chief public health officer from 2004 to 2006. He later worked on pandemic preparedness for the World Health Organization.

Both Dr. Kendall and Dr. Gully say many of today’s problems can be traced back to serious funding constraints that began in 2011, and a controversial 2015 decision to restructure the management hierarchy.

After the 2003 SARS crisis, the agency was created to act as an independent voice within government. But a move by the Harper government to install a president to run Public Health effectively reduced the Chief Public Health Officer (CPHO) to the role of an adviser, and left the department exposed to competing priorities and political influence.

Dr. Kendall warned during federal hearings five years ago that the change would weaken the agency in ways that were not readily apparent.

By taking oversight of programs and budgets away from the CPHO, whose job was to plan for a pandemic even in times of relative safety, and placing them in the hands of government appointees instead, the agency would be subject to inadequate planning, he warned in 2015. This was particularly risky during the years in between a crisis, Dr. Kendall argued, when resources could be reallocated without thought to the consequences.

That erosion is now on display during the COVID-19 crisis, Dr. Gully and Dr. Kendall said. They argue that current CPHO Dr. Theresa Tam and other public-health doctors have performed their roles well in the face of these constraints, but the agency itself was never intended to operate this way.

Public Health has been beset by numerous problems, including the silencing of the country’s once highly respected pandemic early warning system, known as the Global Public Health Intelligence Network. GPHIN was the focus of a Globe and Mail investigation in late July, which prompted the Auditor-General and the Health Minister to launch separate probes into the the matter.

Doctors and epidemiologists at Public Health told The Globe that the agency experienced an influx of senior government officials in recent years who lacked a sufficient understanding of science. That made it difficult to convey urgent and crucial information up the chain of command, and complex reports had to be oversimplified or “dumbed down.”

Soon after those concerns came to light, management at the agency was shuffled. Public Health president Tina Namiesniowski, who came to the job with no background in science, resigned suddenly last month and was replaced by the former head of the National Research Council, Iain Stewart.

“Certainly, my sense is that there’s been a loss of that scientific capacity,” Dr. Gully said, which impacts how Canada responds to a crisis such as COVID-19.

“If the scientific capacity of PHAC was such that the agency could rapidly analyze and give advice, in real time, on the numerous issues that require policy and political decisions, then the federal role would have been more effective,” Dr. Gully said.

The silencing of GPHIN, which was renowned for its ability to gather intelligence on past outbreaks to help speed government decision-making, is an example of the kinds of breakdowns Dr. Kendall warned could happen in his testimony five years ago. With no threat of a deadly outbreak in years, the department officials believed in 2019 that GPHIN’s analysts and resources could be put to better use on domestic projects that did not involve pandemic preparedness.

Dr. Kendall called that decision “short-sighted,” adding that the warning and surveillance system had once worked effectively. “In the past, as a prime source of intelligence, GPHIN would have been able to provide a more timely alert and analysis.”

However, the concerns are not limited to GPHIN, he said.

“Obviously, rebuilding the Global Public Health Intelligence Network capacity is important, and big data is on everybody’s lips, so maybe there’s some way of using big data to enhance [GPHIN],” he said.

Both Dr. Kendall and Dr. Gully believe the government should now revisit the structure of the Public Health Agency, including how it is funded.

“I would strongly support revisiting and reopening the Act and creating the Chief Public Health Officer as the head of the agency. And then having the necessary administrative and political support underneath,” Dr. Kendall said.

Their comments echo those of another respected public-health doctor, David Butler-Jones, the country’s first CPHO, who warned in February that Canada had, over the years, “replaced public-health managers and analysts with generic public servants.” He added: “Resources, expertise and capacity have been reduced, and expertise positioned further away from where organizational decisions are made.”

In creating the president’s role in early 2015, the government said it wanted to ease the CPHO’s administrative workload. However, the doctors don’t buy that argument, saying the change allowed for greater control over Public Health’s decisions and hindered its ability to handle a crisis.

“We sincerely hope that there is a comprehensive examination of federal public-health capacity,” Dr. Gully said. “And that Public Health will be adequately resourced and empowered to return to its former pre-eminence as a trusted source of independent advice, scientific knowledge, and national and global leadership.”

“That’s why we’re coming forward now – because it’s obvious now,” he said.

Source: https://www.theglobeandmail.com/canada/article-ottawa-was-told-about-potential-problems-at-public-health-agency-top/

Ending Canada’s pandemic alert system was a mistake, internal government e-mails show

More details regarding this fail continue to emerge:

Internal government e-mails show at least one senior manager at the Public Health Agency of Canada believed the decision that caused the country’s pandemic early warning system to go silent last year was a mistake. In an e-mail sent to staff July 27 – two days after The Globe and Mail published an investigation into the Global Public Health Intelligence Network, or GPHIN – a senior department official acknowledged the shutdown shouldn’t have happened.

The investigation detailed how Canada’s globally respected pandemic alert system went silent in early 2019, after the department issued an edict requiring GPHIN’s doctors and epidemiologists to obtain “senior management” approval before they could warn of potentially deadly outbreaks.

That edict, which came as the department sought to reallocate GPHIN’s resources to other projects, effectively shut down one of its most critical functions. With no management approvals, the alert system went silent. And with it, much of the unit’s advance warning and intelligence gathering soon dried up – less than a year before the COVID-19 outbreak hit.

“I believe I can make the assumption that you’ve all noticed that The Globe did an article on GPHIN,” Christopher Burt, a senior manager at Public Health, told colleagues in the e-mail, which was obtained under Access to Information laws.

“You and I know the right answer was always to let the analysts issue alerts where they see fit.”

It is a surprising admission, providing a glimpse into the mindset of a department that has largely kept quiet about the GPHIN problems. It suggests that different layers of managers disagreed over the decisions that would ultimately hinder Canada’s pandemic warning and intelligence gathering.

In a statement this summer, the government initially denied the system had stopped working. However, The Globe obtained 10 years of internal GPHIN records that showed the alert system suddenly ceased operating on May 24, 2019, as a result of the decision.

After the edict was made, some of the analysts inside the highly specialized unit – whose job was to detect and monitor dangerous outbreaks around the world and issue warnings of potential threats – were reassigned to other work that didn’t involve pandemic preparedness. With no threats of a pandemic for years, the analysts were moved to domestic projects deemed more valuable to the government, such as studying the effects of vaping in Canada.

However, GPHIN’s role in pandemic preparedness is now being reassessed. Canada’s Auditor-General is investigating the matter and, last month, Health Minister Patty Hajdu ordered an independent federal review into the department’s oversight of GPHIN.

“The conversation around alerts is still a schmozzle,” Mr. Burt told staff in the July 27 e-mail. “That this conversation is even occurring is further proof that GPHIN remains an important and valuable tool – respected in Canada and around the world.”

Referencing The Globe’s investigation, Mr. Burt said, “It’s clear the reporter had a number of sources, all of whom seem to have painted a rather stark picture. Democracy is messy sometimes.”

He added. “From a policy effectiveness standpoint, all news is good news. Although the tone of the article is negative, I believe that the effect for GPHIN will ultimately be a positive one.”

Created in the mid-1990s when Canada realized it needed better advance warning of potentially dangerous global outbreaks, GPHIN’s role was to act as a sort of smoke detector inside the government, sounding alarms early and often – not merely when problems were initially detected, but also as they worsened. The idea was to inject urgency into government decisions by gathering intelligence on situations, so that officials could assess the threat early and take quick action to protect the country.

As an intelligence unit, GPHIN was also intended to help inform Canada’s risk assessments on a potential crisis.

The government has faced criticism over the accuracy of its official risk assessments. For much of January, February and March, Canada’s official position on the outbreak was that the novel coronavirus posed a “low” threat to the country, despite evidence the virus was spreading aggressively and that human-to-human transmission was a reality. Even after the World Health Organization changed its rating to “high” at the end of January, and warned countries to begin preparing, Canada maintained that low rating for another seven weeks.

Several Public Health employees, who The Globe is not naming because they are not authorized to speak publicly, have said the government preferred to rely on “official” information provided by the Chinese government and the WHO, and dismissed intelligence gathering as “rumours.”

Intelligence experts say this was a critical mistake, particularly since countries have been known to hide or play down outbreaks in the past.

“It’s invaluable to have a separate monitoring source so that you can know everything that’s possible to know about the course of the disease and what the country of origin, or city, knows about it,” said Greg Fyffe, the former executive director of the government’s Intelligence Assessment Secretariat from 2000 to 2008.

When word of the coronavirus outbreak leaked out of China through social media on Dec. 30 last year, GPHIN’s intelligence gathering and surveillance capabilities had been significantly diminished. In his e-mail to GPHIN’s analysts, however, Mr. Burt expressed doubts that Canada’s response was slowed by the changes to the alert system.

However, that opinion puts Mr. Burt at odds with several of the scientists he oversees. One GPHIN employee said senior officials lacking a background in public health struggled to understand the purpose of the alert system.

Other internal department e-mails obtained by The Globe show Sally Thornton, vice-president of the Health Security Infrastructure Branch, and Jim Harris, director-general of the Centre for Emergency Preparedness and Response, oversaw the decision that curtailed alerts. An e-mail from late 2019 explaining the changes to staff summarizes the instructions given by “Jim and Sally.”

Rebuilding the pandemic warning and surveillance system will fall to a new set of managers.

Mr. Harris has since left the department, while the government said in a statement last month that Ms. Thornton retired. She departed about a week before the government announced the sudden resignation of Public Health president Tina Namiesniowski. The government has declined numerous requests by The Globe to speak to department officials.

Source: Ending Canada’s pandemic alert system was a mistake, internal government e-mails show

Lapse in early pandemic warning system ‘a colossal failure,’ says former federal Liberal health minister Dosanjh

Appears, if Minister’s spokesperson correct, decision was taken at the official not political level:

Following the abrupt resignation of the Public Health Agency of Canada’s (PHAC) president Tina Namiesniowski on Sept. 18, a former Liberal federal health minister says the lapse in the Global Public Health Intelligence Network (GPHIN)’s role under this government’s watch was “a colossal failure,” with the Bloc Québécois’ health critic saying the new president of PHAC will have to work hard to rebuild the agency “so that it can be more efficient in carrying out its duties [of] prevention, detection and management of public health crises.”

Former health minister Ujjal Dosanjh, who was in the role from 2004 to 2006 under then-prime minister Paul Martin, told The Hill Times that “the Public Health Agency isn’t an agency that’s supposed to sleep, ever. Its job is to continuously surveil, nationally, and internationally.”

“I think there is something the matter. If you are an activist minister, and you’re not just a politician who got elected, but you’re there to change the world even in the [most minute possible way], you would ask questions as to why GPHIN was folded. You would ask questions [about] when the information was coming from China,” Mr. Dosanjh said in a phone interview.

Canada was a leader in pandemic preparedness during his tenure, according to Mr. Dosanjh.

“I think it was a colossal failure on the part of government, and unfortunately no one is looking at these things because we are so wrapped up—and rightly so—dealing with the here and now, and we’re prepared to forgive the errors that have been made.”

“Whoever is responsible for it, it’s been a near fatal mistake in the pre-pandemic era which has come back to bite us in the pandemic era,” said Mr. Dosanjh, who also served as premier of British Columbia from 2000 to 2001.

“We would have been far better prepared, we would have had far more robust tools at our disposal, had we not put GPHIN to sleep,” said Mr. Dosanjh, who also noted that GPHIN was initially established following the SARS epidemic in the early 2000s.

“The infrastructure had been put in place before I got there, it was only completed when I got there, so I can’t take responsibly for it, but I’m somewhat saddened (which is not the best word), but knowing what I know, I’m angry,” said Mr. Dosanjh. “I’m actually sad at the kind of conflicting and unclear information that’s emanated from all of the responsible sources as COVID-19 started.”

Protecting the health and safety of Canadians ‘top priority’ 

According to Cole Davidson, spokesperson for Minister Hajdu, “protecting the health and safety of Canadians is our top priority.”

“Public health intelligence is vital to that goal,” said Mr. Davidson. “The minister was concerned to learn about the changes made to the Global Public Health Intelligence Network (GPHIN), and has ordered an independent review to look into these changes. The minister is expecting recommendations from this review in the next six months.”

“As the minister has said, these changes were made within the Public Health of Agency of Canada, not at the political level. These are serious and disturbing allegations—ones that we take seriously,” wrote Mr. Davidson. “When the minister became aware of these changes, she requested an independent review to investigate the questions that she had. GPHIN is an important tool for the government of Canada, and the analysts that serve this country must be empowered to do their work.”

PHAC’s president Tina Namiesniowski announced she was stepping down from the organization on Sept. 18, saying she was “now at a point where I need to take a break” and that she felt she “must step aside so someone else can step up” in a message to staff that day, according to multiple media reports.

Ms. Namiesniowski worked as a bureaucrat within the federal public service for decades, including stints as executive vice-president with the Canada Border Services Agency, as an assistant deputy minister at the Department of Agriculture, and as assistant secretary to cabinet, operations secretariat, with the Privy Council Office. She was appointed as president of the PHAC in May 2019.

‘There should be a strong public health capacity at different levels of government’

Dr. Paul Gully, a senior public health physician who was director of Health Canada’s population and public health branch and the department’s main spokesperson during the 2003 SARS outbreak, said he believes the Public Health Agency of Canada has responded well and continues to respond well to COVID-19.

“But I think lack of increased funding over the last few years, which probably goes back to the creation of the agency in 2014, is that it hasn’t been able to do a number of things,” said Dr. Gully. “One is to enhance its scientific capacity, while at the same time losing scientific capacity. It also hasn’t been able to deal with issues which have been well-known, such as the national emergency stockpile, for example.”

“There should be a strong public health capacity at different levels of government, that could then advise government and ensure that fiscal policies and all of the other policies are scientifically-based,” said Mr. Gully.

Government ‘asleep at the switch’ in ensuring strong PPE stockpile, says NDP’s Don Davies 

“I think the rapid removal of Ms. Namiesniowski and her rapid replacement is a clear acknowledgment that PHAC has been mismanaged for a long time now,” said NDP MP Don Davies (Vancouver Kingsway, B.C.), his party’s health critic. “The speed at which they replaced Ms. Namiesniowski, I think is also concerning.”

“Without casting any personal aspersions at the current appointment, the process makes me concerned,” said Mr. Davies.

“The Public Health Agency was slow to understand and acknowledge the risk level of COVID-19, they were slow to acknowledge community transmission, they were slow to acknowledge asymptomatic transmission,” said Mr. Davies. “They were also slow to acknowledge the efficacy of closing borders, and perhaps most egregious, they were completely asleep at the switch in making sure that we even had a good PPE stockpile.”

Bloc Québécois MP Luc Thériault (Montcalm, Que.), his party’s health critic, told The Hill Times that the “hasty and unexpected departure” of Ms. Namiesniowski will “definitely complicate the management of the current crisis.”

“But as the resignation of Mrs. Namiesniowski seems to be linked to personal burnout, it is difficult to blame her for this decision,” wrote Mr. Thériault in an emailed message to The Hill Times.“As for Mr. Iain Stewart, who has, it seems, a solid scientific profile, he will have to work hard to rebuild the Health Agency of Canada so that it can be more efficient in carrying out its duties [of] prevention, detection and management of public health crises. Especially since scientists warn us that such crises may be more common in the future because of increasing interference between human activities and nature, and accelerating climate change.”

Mr. Thériault also said that PHAC has shown “several shortcomings” in its handling of the COVID-19 crisis, and that the pandemic has shown that the agency isn’t adequately prepared to face such a crisis.

The government’s stock of masks and PPE was “clearly insufficient,” and PHAC erred by failing to heed warning from GPHIN about the pandemic, said Mr. Theriault.

“In addition, it was only two weeks after the onset of active community transmission and the rise in infections and deaths that the agency recommended social and economic restrictions, due to ineffective data collection,” he said.

“In short, PHAC must redefine its methods of preventing and preparing for future health crises, and it must make its responses to a public health crisis more rapid and effective. With the arrival of the new wave of COVID-19, it will have no room for error, as this wave had been expected for several months. We will be closely monitoring her actions in the face of this second wave.”

Mr. Thériault also said Quebec and the provinces were too much at the mercy of the ineffectiveness of PHAC.

“Indeed, they themselves suffer from systemic underfunding of their health system. That is why the Bloc Québécois, like Quebec and the provinces, is calling for an immediate [provision] of $28-billion in health transfers, an annual indexation of six per cent, and a federal contribution of 35 per cent,” said Mr. Thériault. “As health is a provincial responsibility, this will be the best way to prevent the different health systems from suffering once again from PHAC’s poor preparation for a future health crisis.”

Source: Lapse in early pandemic warning system ‘a colossal failure,’ says former federal Liberal health minister Dosanjh