Invest in Health,

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• Invest in Health,
• Build a Safer Future
• Dr. David Butler-Jones,
• Chief Public Health Officer of Canada
• April 2, 2007

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• The Lessons of SARS
• Canadas Experience

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Infections and History A Sampler

• 1/3 of Europe killed by Plague (Middle Ages)
• 90-95 pop of Americas lost post contact
• Napoleon and Typhus in Russia
• 40,000 child deaths/ day-inf. and malnutrition
• HIV and Poverty in Africa
• 1 million deaths from Malaria/year etc. etc.

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Probable Cases SARS, Canada

• November 2002 to July 2003
• World 8,100 probable SARS cases in 29 countries
  -- 774 deaths
• Canada 438 probable and suspect cases--43
  deaths (1 suspected)

Canadian Epidemic Curve
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SARS in Retrospect

• Some things went right
• Heroic health professionals
• National and international cooperation
• Rapid collaborative work to identify
• Broad public cooperation (though not perfect)
• Fortunately not as infectious as others
• Others didnt
• Outbreak highlighted health systems weaknesses.
• Public health capacity/ response different across
  country
• Surge capacity was limited
• Public health leadership wasnt always there
• Decision lines werent always clear.

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SARS Some Lessons

• Nature is inventive and unpredictable
• Next crisis a plane ride away
• Hospitals Magnifiers of risk
• Economic Impacts - (contagion fear) exceed and
  last beyond other disasters
• Role of Media- hinder and help?
• Communications - public and players
• Underlying Chronic DiseaseMortality
• Leadership, coordination, communication vital in
  public health emergencies
• Strong infrastructure, expertise and surge
  capacity is essential
• A Public Health Agency?

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The health of the public is the foundation upon
which rests the happiness of the people and the
welfare of the state. Disraeli


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• Applying the Lessons
• Investing in Public Health, Strengthening the
  foundations

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The Public Health Agency

• Agency and Chief Public Health Officer created in
  2004
• National public health leadership and
  coordination
• Strengthen Canadas ability to protect the health
  and safety of Canadians
• Develop, implement and assess policies and
  programs that enable Canadians to live a
  healthier life.
• Public Health Functions
• Population Health Assessment
• Surveillance
• Health Promotion
• Prevention of Disease and Injury
• Health Protection
• Emergency Preparedness and Response

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The Health of the Population

• Peace and Stable Ecosystem
• Food and Shelter
• Education
• Sustainable Resources
• Social Support Network

• Child Development
• Working Conditions
• Choices and Coping
• Income and Social Status
• Health Services

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Health Global Change

• Urbanization
• Climate Change
• Globalization
• Economic Gaps
• Technology
• Social Change

The Basics Still Matter
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Partner Who can we work with, to do it better
together?
Enable What we do directly to change the
determinants
Cheerlead Encouraging and not getting in the
way
Addressing the Determinants
Mitigate Picking up some of the pieces, so it
isnt worse
Advocate What should be done at policy,
legislative level?
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Building Resiliency

• A disaster occurs when the impact on the
  community exceeds its normal coping resources.
• Communitys vulnerabilities, ability to respond
  to / recover from disasters
• Tsunamis, hurricanes, infectious outbreaks, etc
• Those who are most vulnerable will be most
  affected
• Hardest hit communities usually poorest and most
  vulnerable
• Pro-actively build resiliency Focus on finding
  ways to address underlying health of populations

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New and re-emerging epidemicsPrinciples

• Cannot completely prevent, but can reduce by
  addressing underlying determinants
• All emergencies are messy, but the mess should be
  as short as possible
• Basic capacity for outbreaks is the same as for
  prevention of chronic disease and infection
• Organization and Flexibility - rapid research and
  analysis, control and prevention
• Those who die are largely those with chronic
  disease, poor health or poverty

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• Pandemic Planning in Canada

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Pandemic in Canada -- 1918-19

• By todays population 150-160,000 deathsbut
• General better health and nutrition
• Antibiotics for secondary infections
• Vaccines and anti-virals
• Not post WWI Magnified in trenches mass
  population movements
• Not multiple underlying infections
• Good health care and better understanding
• However, many developing countries similar

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The next pandemic Impact in Canada

• Estimates of Health impacts in Canada
• 11,000 to 58,000 deaths (Most due to secondary
  infections)
• 34,000 to 138,000 hospitalizations
• 2 to 5 million outpatients
• Economic costs
• health care 330M to 1.4B
• societal (lost productivity) 5- 38B
• Impact depends on
• Virulence, severity, age groups most affected,
  adverse effects/complications,
• Effectiveness of the response, availability of
  vaccines and antivirals

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Canadas Pandemic Influenza Plan

• Objectives
• To minimize serious illness and overall deaths
• To minimize societal disruption among Canadians
  as a result of an influenza pandemic
• Whole of Government Approach
• Constant updates
• Domestic contract for vaccine manufacturing
• Antiviral stockpile
• Guides planning, surveillance, public health
  measures, infection control, and health care
  during a pandemic

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Key Strategies

• PREPARE
• Plan for rapid detection, monitoring spread,
  assessing impact, and risk communications
• Plan extends throughout all jurisdictions to
  include Personal and Community Measures
• Test the Plan revise the plan test again.
• RESPOND
• Reduce spread and impact through public health
  measures infection control
• Vaccines and Antivirals
• Maintain health emergency social services
• Business continuity and critical infrastructure
• Risk communication
• RECOVERY
• On-going social service support.

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What do we have in place
Public Health Network
Pandemic Preparedness Secretariat
Centre for Emergency Prep. and Response
National Emergency Stockpile System
National Office of Health Emergency Response Teams

• Public Health Agency of Canada

Canadian Integrated Outbreak Surveillance Centre
Alerts
PHAC Influenza Science and Research
New CIHR Research
Measures Programs
Partners Planning
Engagement
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Promoting Global Coordination and Strengthening
Regional Capacity

• WHO,PAHO, UN, G8, APEC, etc.
• Chair of GHSAG and APEC Health task force
• Founding member of GOARN
• Support regional development of national pandemic
  plans
• Contribute to WHO Global Action Plan on Pandemic
  Vaccines
• Work with US/Mexico on continental preparedness
• Funding, expertise to affected regions
• 2007 - Cricket World Cup
• Contributing to PAHOs Enhanced Disease
  Surveillance project epi support in 5 countries

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Planning

• Know partners before the crisis
• Consistent, Clear, Helpful communication

• Plan, Act, Reflect, Adjust
• Beware -- so busy addressing the crisis, that
  otherwise routine becomes crisis
• Dont lose focus on Health of Population

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Still to Do?

• Continue practicing and revising plans
• Continue filling in gaps, making connections
• Business continuity planning
• Improve local planning across sectors
• More Research Better Vaccines, Antivirals
• Continue public awareness, planning and
  preparation
• Dont Let the Best be the Enemy of the Good