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

Public Health Agency head should have a science background, advisor says

Good summary of some of the issues regarding whether the head of PHAC should be a general administrator or one who also has a scientific or medical background (government announced the appointment of the president of the National Research Council, Iain Stewart, who also has extensive government experience):

With the government expected to name a new president of the Public Health Agency of Canada this week, a former top adviser says the COVID-19 pandemic has shown that the department needs a person with a science background at the helm, not an administrator.

After the sudden departure of president Tina Namiesniowski on Friday, the naming of a new leader is under heightened scrutiny. The resignation followed a string of problems associated with Canada’s pandemic preparedness and response over the past several months that were recently made public.

The government has signalled it will name a replacement as early as this week, but Michael Garner, a former senior science adviser and epidemiologist at the federal department, said the lessons of the pandemic are that a background in public health should be a primary requirement for the job.

“We can have all the expertise in the world working at PHAC, but if the leaders don’t understand public-health science, our pandemic response will continue to suffer,” Mr. Garner said. “It’s someone who can ask the right questions of the scientists. They have to be able to rapidly adjust as they get new information.”

Mr. Garner, who left Public Health last fall, is speaking out to The Globe and Mail on behalf of some of his former colleagues, including doctors and epidemiologists who still work at the department and are not authorized to speak publicly.

Several Public Health employees, who can’t be named owing to fears they could face reprisals, have told The Globe that they often struggled to communicate urgent and complex messages up the chain of command inside Public Health. Because senior officials within the department lacked an understanding of the science, key messages often had to be “dumbed down” one scientist told The Globe this summer.

Ms. Namiesniowski, who previously worked at the Border Services Agency, after roles with Agriculture and Public Safety, came to the agency with a political-science background. Vice-president Sally Thornton, who also left recently, had a background in law, and served in the Treasury Board and Privy Council before being appointed to a senior Public Health role.

Both oversaw critical aspects of the country’s pandemic preparedness and response systems. That included the handling of Canada’s early warning and surveillance unit, the Global Public Health Intelligence Network or GPHIN, which had its operations cut back last year, and the national emergency stockpile, which came up short in supplying personal protective equipment.

In an e-mail sent to staff, Ms. Namiesniowski said she needed a break, and was stepping aside to spend time with family. The e-mail indicated a new president for Public Health would be named early this week, suggesting the government already had a replacement for Ms. Namiesniowski in mind when her resignation was announced.

The selection of a new president has taken on increased importance with Canada seeing a spike in COVID-19 cases, and signs of a second wave of the outbreak emerging.

Canada’s pandemic response has been criticized for delaying critical decisions, and for underestimating the threat of the virus, particularly as the country curtailed much of its intelligence-gathering capacity by early 2019. That led to the government’s official risk assessments of the outbreak repeatedly labelling the virus a “low” risk to the country, even as it began to spread aggressively around the world in February and mid-March, and new evidence emerged about human-to-human transmission.

A Globe investigation in July detailed the problems inside Public Health, including the concerns from staff who said that science had been “devalued” within the department. Health Minister Patty Hajdu told The Globe those revelations were troubling.

“The pleas from the scientists and the researchers [inside Public Health] were particularly profound,” Ms. Hajdu said two weeks ago, as she ordered a federal review into the department’s handling of the pandemic early warning and surveillance unit, which was cut back against the protests of the scientists inside the department.

“The review, hopefully, will get at why are these processes in place, and are there better ways to manage?”

The Auditor-General has also launched an investigation of its own into the oversight of GPHIN and the decisions surrounding the intelligence-gathering unit.

Mr. Garner and several employees working inside Public Health say the department underwent a crucial shift in 2014, when the Conservative government revised the Public Health Act. That decision moved the leadership of PHAC from the Chief Public Health Officer, which is a public-health doctor, to the role of President, which became a government appointee.

While the Chief Public Health Officer is the face of the agency, and speaks directly to Canadians, the structural decisions for the department, which have the greatest influence over how the various programs operate, are made by the president.

Though the Liberals opposed the move when it was made, the structure remained in place when the government changed.

“This decision set PHAC on a course that has gravely influenced its ability to put into place the foundational elements required to proactively prepare for and effectively respond to the coronavirus pandemic,” Mr. Garner said.

Ms. Thornton has been replaced as vice-president by Brigitte Diogo, who recently worked in rail safety for the federal government. A spokesman for Public Health told The Globe that Ms. Diogo has experience in safety and security policy at Transport Canada and the Privy Council, and risk mitigation while at Immigration Canada.

Source: https://www.theglobeandmail.com/canada/article-public-health-agency-head-should-have-a-science-background-advisor/

 

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/

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