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/

Health agency reveals race-based data guideline as calls grow for nation-wide collection

Yes!

Will take some time given the coordination required to ensure consistent data across provinces, with Quebec unlikely to play ball unfortunately (CIHI data does not automatically include Quebec data. When I asked the Ministère de la Santé et des Services sociaux for the comparable birth tourism (non-resident) birth statistics, I was met by bureaucratic obfuscation and had to go to major hospitals directly):

In response to calls for better demographic data to understand health inequities and COVID-19, this week the Canadian Institute for Health Information is releasing an interim race data standard that public health agencies can use.

Many advocates, though, are pushing for more than advice, saying the federal government has a leadership role to play to ensure there’s consistent data, regardless of jurisdiction. That gap in information affects the provincial, territorial, and federal response to the pandemic and until the country moves forward with race-based and disaggregated income data, Canada “can’t possibly target resources” and care where they’re most needed, said Dr. Jennifer Rayner, an epidemiologist and director of research at the Alliance for Healthier Communities.

“It’s ignorance and blindness to where there’s gross inequities. Until we know where the discrepancies and inequities in health are, we can never tackle them,” she said, saying communities need action and the work needs to start somewhere. “I hate to keep waiting until we get it all perfect.”

The alliance is part of a national working table headed by Canadian Institute for Health Information (CIHI)—which the institute notes are not formal—that’s considering two things: what data to collect, and how to train health professionals so they’re comfortable asking these questions. While this work has been going on for years, the report on the interim standard noted a “heightened awareness and interest” in collecting such data to better understand COVID-19’s spread.

The lack of data on race in Canada makes it difficult to monitor racial health inequalities and CIHI’s interim standard was created in an effort to “harmonize and facilitate collection of high-quality data,” according to a copy shared with The Hill Times of the standard, “Race-Based Data Collection and Health Reporting,” to be released later this week.

It proposed two questions asking patients to identify their race categories (also giving the option of “prefer not to answer”) and whether they identify as First Nations, Inuit, or Métis.

Though the Public Health Agency of Canada (PHAC) has said it is looking into the possibility of collecting more demographic data related to COVID, most said it’s a matter of political will, under the direction of Health Minister Patty Hajdu (Thunder Bay-Superior North, Ont.) and Indigenous Services Minister Marc Miller (Ville-Marie–Le Sud-Ouest–Île-des-Soeurs, Que.).

When asked, neither of the ministers’ offices, the PHAC, or CIHI offered a position on whether such data should be collected nation wide.

However, Ms. Hajdu’s spokesperson, Cole Davidson, said in an email that “[d]emographic data collection and data sharing between the federal and provincial/territorial governments is crucial to advancing our knowledge of COVID-19 and understanding potential inequalities in our health care system. We’re working with provinces and territories to ensure we’re collecting the data we need to better understand this pandemic.”

And while these conversations are happening, advocates say it’s not leading to the outcome that is becoming more urgent by the day—a commitment and timeframe for nationwide data collection.

“As a national strategy, if you don’t value gathering the data it’s hard to motivate other places to do so,” said Aimée-Angélique Bouka, the College of Family Physicians of Canada vice-chair-elect for residents. “You’ll see disparity across the board if you don’t see proper federal leadership in the project.”

‘It’s all about political will’

Canada has a blind spot regarding its treatment of racialized groups and immigrants, despite the evidence, she said.

COVID-19 was thought to be “the grand equalizer,” but some populations have proved more vulnerable. In the United States, by mid-April nearly one-third of those who died were African American, an Associated Press report revealed, though Black people represent about 14 per cent of the population where they reported. Such disparities exist in Canada, though Dr. Bouka said society is uncomfortable with painful questions that reveal a pattern of neglect.

“COVID is only a snapshot and a clear representation of what happens in our country in a systematic way.”

She said she would add a question about immigrant status, and how long a person has been in Canada as other important markers that influence health, said Dr. Bouka, who wrote about that blind spot for Policy Optionsthis month.

Because we don’t have this self awareness we are slow to accept it, but once the outbreaks became evident, demographics became impossible to ignore, she said.

For more than two decades, Independent Senator Wanda Thomas Bernard has been calling for race-based data collection.

“It’s so frustrating and infuriating,” said Sen. Bernard (East Preston, N.S.), a former social worker and researcher who co-authored a 2010 book, Race and Well-Being, which she said demonstrated racism is an everyday experience for Black Canadians and has an impact on all forms of their health.

“I can’t help but ask myself, ‘How many more casualties do we have to see before there’s a true appreciation for why the collection of this data across all provinces and territories [is] essential?’”

Sen. Bernard said she has been asking these questions of Liberal ministers and their aides—she’s not comfortable divulging the details of these conversations—and while she remains hopeful, she said it’s “all the more urgent to make the decision now.”

“We need to be on the same page with this, and let’s cut through the politics,” she said, and look at COVID-19 as a starting point, an “awakening” for the inequities in health that long predated the pandemic.

Unfortunately, it takes more than proof to shift policy, said Dr. Bouka and it becomes about building more evidence and raising enough voices to make inaction impossible.

“It’s mostly us being reminded so politicians can’t ignore it. Ultimately, it’s all about political will. If your weaknesses are shown repeatedly, then you can’t just pretend that you didn’t know,” she said.

Though it’s left up to the individual jurisdictions, Sen. Bernard said it’s important to have data that’s consistent across the country, which requires leadership so that it is collected in the same way.

Alex Maheux, CIHI spokesman said by email it’s up to the provinces and territories to decide how to proceed, but it has expressed willingness to support jurisdictions in that data collection and is currently working with partners to understand race and ethnicity data needs.

Earlier this month, Manitoba became the first province to track the ethnicity of COVID-19 patients while Quebec and Ontario have said they will as well. At a local level, Toronto has also said it tracks demographics.

In mid-July, CIHI said it will also publish a broader discussion document, followed by ongoing engagement with relevant stakeholders to “refine” the standard, if needed.

Public Health Agency of Canada spokesperson Maryse Durette said by email the government is committed to working with the provinces and territories—as well as other partners—to improve data completeness and access, including demographic information.

“These indicators will help to further our understanding of COVID-19 among different population subgroups and to monitor trends going forward,” she said, and it plays “a critical role” in helping to understand disease severity and risk factors, to monitor trends over time, and to ensure that public health measures can be effectively designed and delivered where needed.”

Data collection on Indigenous people ‘distinct’

CIHI’s standard notes that though Indigenous groups are often considered alongside racial and ethnic categories, First Nations, Inuit, and Métis have “inherent and collective rights to self-determination,” including ownership and governance of their data. That warrants “distinct consideration” and must include engagement with Indigenous communities and data governance agreements.

Canada tracks on-reserve cases of the coronavirus, but with nearly half of First Nations living off-reserve, the picture is incomplete. Yellowhead Institute independently researched, and on May 12 published findings revealing more than triple the cases reported by Indigenous Services Canada. Mr. Miller has acknowledged the department’s data is insufficientand on May 9 announced $250,000 towards improving data collection—not enough, according to Yellowhead researcher Courtney Skye.

“If we’re going to recognize First Nations, Indigenous, and Inuit are more impacted and more at risk for poor outcomes because of COVID-19, there needs to be a multi-jurisdictional prioritization of getting proper information available to communities to make informed decisions,” she said.

“Communities have a right to that information and the federal government has a fiduciary responsibility to make sure this work is adequately funded.”

Rose LeMay, CEO of the Indigenous Reconciliation Group and regular Hill Timescolumnist, penned a plea in April for COVID-19 data that notes background and Indigeneity. A month later, she said she remains baffled there’s been limited movement to close the data gap.

“This is a once-in-a-lifetime data dump, if we were to access it, because this shows the inequities of the system”, she said, noting Canada has “substantial work” to build trust given its problematic history collecting information on Indigenous people, and declaring who is and isn’t status.

That could be addressed by involving organizations perceived as objective to lead the way alongside Indigenous groups, and would likely require building new partnerships to do it well.

The lack of trust shouldn’t stop this work from happening, she said, adding the “how” is a “purely technical exercise” that she said she thinks Canada’s health-care system is capable of managing.

Ms. Skye said the patchwork approach isn’t working and it needs to be led by Indigenous people and be properly resourced. She added that this is another indication that the Liberal government’s approach to reconciliation is more for “show” than addressing “tangible barriers,” like health, that impact the daily lives of Indigenous people.

“These realities are known, are well-documented, and have existed for a long time, and there hasn’t been enough of the practical work done on behalf of the federal government and provinces,” she said. “It does come down to the will of the government.”

Source: Health agency reveals race-based data guideline as calls grow for nation-wide collection 

Canadian doctor once posted to Beijing ignored by Ottawa after offering help with COVID-19 response

Does seem to be an oversight. The more serious one is why was he not replaced (likely due to budget pressures and the high cost, and changing priorities):

For seven years, Felix Li served on the distant front lines of Canadian public health, in China. As a doctor posted to Beijing, he fostered ties with health authorities that let him peer beneath the official rhetoric of a country that has been the source of multiple viral epidemics in recent decades.

When Dr. Li returned to Canada in 2015 and retired from the Public Health Agency of Canada (PHAC) after 23 years, he was not replaced.

But he retained his contacts inside the Chinese public health system and was keen to help when another outbreak began to emerge.

So, a few days after the Jan. 23 lockdown of Wuhan, he sent an e-mail to the PHAC, including Chief Public Health Officer Theresa Tam, offering his expertise.

“I offered to go back to Ottawa to work with them on this. I needed to help, to save lives,” Dr. Li said in an interview.

In the e-mail, he described his knowledge of the Chinese system and the contacts he maintains there.

“I got an e-mail back saying, ‘We’ll talk about it and let you know.’ But I never had any response after that.”

Instead, the PHAC has relied heavily on the World Health Organization for information and guidance in its response to the rapid spread of the deadly new virus.

But critics have questioned the relationship between the WHO and China, whose response the WHO has praised effusively. The health organization has raised few public concerns about the reliability of information provided by Beijing, despite evidence suggesting Chinese authorities have significantly underreported the death toll from the outbreak.

Dr. Li said that, during his time in China, there was a difference in “the quality of the information” he was able to obtain by communicating directly with people at China’s Ministry of Health and the Chinese Centre for Disease Control and Prevention. During the 2013 H7N9 avian influenza outbreak, for example, he received updates directly from Chinese officials.

Were he working now, he’d “probably get a lot more timely and accurate information on things,” he said.

There is good reason to seek more sources of information, public health experts say.

“In any acute emergency, there is always benefit of ‘on the ground’ expertise and contacts in getting access to data and understanding the nuances of actual context. There is also always value in having multiple sources of data, information or intelligence, and it would be wise to have as many sources as possible,” said James Orbinski, director of York University’s Dahdaleh Institute for Global Health Research.

“Relying on one source of information for critical decision making leaves you open to all of its biases and limitations, and every source – even ‘official’ ones, like the WHO, the government of China, the CIA, the government of the United States, the government of Canada – has biases and limitations.”

The PHAC says it has full confidence in its methods – and in the WHO. “With the situation related to COVID-19 continuing to evolve rapidly around the world, Canada will continue to work closely with its international partners, including the WHO and China, as well as with provincial and territorial counterparts to reduce risks to Canadians and the global community,” spokesperson Anna Maddison said in an e-mailed statement.

The agency can rely on Canada’s foreign service “to share and gather information related to health and public health matters,” Ms. Maddison said.

Canada’s embassies and consulates in China, however, have been working with low staffing levels after non-essential staff – including provincial representatives – were sent home.

Unlike the U.S., Canada does not have a wide-reaching global public health service, which makes it reliant upon the WHO. That’s not a bad thing, said Srinivas Murthy, an infectious disease specialist at the University of British Columbia who has worked with the WHO.

“The WHO is a very reputable, very strong organization which has that capacity,” Dr. Murthy said. “I don’t think Canada specifically needs a foreign public health agency.”

But there are also risks in relying on an agency that itself relies on information from China, a country where statistics are often bent to political imperatives. The U.S. Centers for Disease Control and Prevention has itself been criticized for cutting its staff in China by two-thirds before the COVID-19 outbreak.

In Canada, meanwhile, it appears health leaders are not receiving sufficient advice on the potential weaknesses of Chinese data being transmitted by the WHO, said Charles Burton, a senior fellow at the Macdonald-Laurier Institute who has twice worked out of the Canadian embassy in Beijing.

The result is that China’s “politically motivated misinformation tragically leads to unnecessary Canadian deaths,” he said.

Dr. Li began his public health work in Beijing in 2008 with the belief that “Canada should not be responding to epidemics or pandemics when they reach the shores of Canada. We should be proactively working with China.”

He declined to offer his views on how China and Canada have responded to COVID-19, for fear of damaging his relationships with public health officials he still hopes to work alongside.

“As a medical doctor and a public health doctor, our task is to save lives. If I were called upon, I’d jump on the next plane to Ottawa,” he said.

Source: Canadian doctor once posted to Beijing ignored by Ottawa after offering help with COVID-19 response