Pandemic Preparedness in the Health Care System in Canada

1
Pandemic Preparedness in the Health Care System
in Canada
Patricia Huston MD, MPH Chief, Emerging
Infectious Diseases Immunization and Respiratory
Infections Division Centre for Infectious Disease
Prevention and Control PUBLIC HEALTH AGENCY OF
CANADA
Pan-American Health Organization Workshop April
20, 2006
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Outline

• Canadian Context
• Summary of the Canadian plan
• Challenges
• Next steps

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Context

• Canada is a vast country with
• Approx 30 million people
• English and French 2 official languages
• First Nations people
• 20 multicultural (Asia/Africa)
• It has a publicly funded health care system
• Covers all hospital and physician-based care
• Managed by provinces/territories
• Most physicians paid on a fee-for-service basis
  (essentially work as an independent business)

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Why has planning worked in Canada?

• SARS was a major wake-up call (people
  motivated)
• Process broad-based buy-in from the start
• Structure high level support

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Pandemic Influenza Committee

• Began with a Working Agreement in 2001
• between Provincial and Federal Deputy Ministers
  of Health
• Federal and Provincial Co-chairs
• Reports to Deputy Ministers of Health
• Funded by the Federal Minister of Health
• Working Groups
• Good mix of infectious disease and public health
  expertise

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Canadian Pandemic Influenza Plan

• Released January 2004
• Identified federal, provincial and local
  responsibilities
• Included prevention, preparedness, response and
  recovery activities
• Followed the WHO phases
• Focused largely on the Health Sector response
• P/T and local authorities have used this plan to
  develop their own

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Overall Goal

• First, to minimize serious illness
• and death, and
• second to minimize societal
• disruption.

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Key Strategies

• Clarify roles and responsibilities
• Promote rapid detection/surveillance
• Reduce spread and impact
• Maintain public awareness and facilitate
  acceptance of response strategy
• Conduct research to support response

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Key Components

• Surveillance and Laboratory Testing
• Vaccine Programs
• Antivirals
• Health Services Emergency Planning
• Infection Control, Clinical Care, Resource
  Management, Mass Fatalities, Non-Traditional
  Sites and Workers
• Public Health Measures
• Communications
• Currently being updated (release 2006)

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Infection Control

• National level steering committee guidelines
• Management of pandemic influenza in various
  traditional and non-traditional settings
• Addresses mask use
• Emphasizes hand hygiene
• Discusses self-care
• Provides educational tools

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Clinical Care

• Describes common clinical presentations and
  complications
• Offers best practices for triage and initial
  assessment
• Describes patient management in
• Hospital departments, LTCF, Non-traditional
  sites, Isolated communities, Correctional
  Institutions,
• Antiviral and antibiotic use
• Telephone advice

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Mass Fatalities

• Planning checklists for funeral homes
• Plans for temporary morgues
• Other technical considerations
• Death registration
• Infection control
• Transportation
• Supply management
• Identifies social/religious considerations
• First Nations, Inuit, Jews, Hindus, Muslims all
  have special directives

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Resource Management

• Reviews emergency preparedness legislation
• Ability to requisition property
• Identifies triggers for intervention
• Offers plans/checklists for
• increasing bed capacity
• patient prioritization
• critical equipment and supplies

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Non-traditional Sites and Workers

• Addresses how to assess sites for health care
  delivery during a pandemic
• Potential roles
• Administrative options/Insurance issues
• Identifies how to create surge capacity with
  other HCW, students, retirees, volunteers
• Recruitment and Training
• Potential roles
• Administrative issues (compensation, management)
• Insurance/licensing issues

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Effects of national plan

• Most provinces, and many local jurisdictions have
  a pandemic plan consistent with the national plan
• Hospital planning is well-advanced (esp. in
  province that had SARS)
• Annual influenza vaccine coverage is high
• Public awareness is good
• We have vaccine production capacity
• We have an antiviral stockpile

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Challenges

• Focus has been on health sector now need to
  focus on strategies to minimize societal
  disruption
• Surveillance is still a weak link
• Need to combine AI and PI initiatives
• Need to arrive at consensus on priority groups
  for antivirals
• Emphasis on early treatment
• Prophylaxis under debate
• Family physicians are sceptical
• Lack of meaningful involvement to date
• Concerns about lack of training/support, insurance

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Next steps

• Joint PHAC/Public Safety and Emergency
  Preparedness Canada Committee
• Involves gt 20 federal departments
• Preparing a Federal Pandemic Plan
• All Departments developing business continuity
  plans
• Other initiatives underway in other departments
• Increase surveillance capacity
• Strengthen our FluWatch program (use of
  sentinel physicians with lab or ILI reports)
• Educate physicians on SRI reporting

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Next steps

• AI/PI coordination
• Develop a joint response plan for
• LPAI outbreak
• HPAI outbreak
• H5N1 outbreak in birds with human cases
• Finalize antiviral strategy
• Conducting national consultations of both general
  public and stakeholders.
• Engage family physicians
• Funding national initiative through College of
  Family Physicians of Canada and Canadian Public
  Health Association to come up with
  recommendations and best practices.

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Closing quote

• Let no one be discouraged by the belief there is
  nothing one man or one woman can do against the
  enormous array of the worlds ills each of us
  can work to change a small portion of events, and
  in the total of all those acts human history is
  shaped.
• Robert Kennedy

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Acknowledgements

• Drs. Arlene King and Theresa Tam the
  masterminds of pandemic preparedness in Canada
  and Jill Sciberrras, Sr. Epidemiologist
• The members of the Pandemic Influenza Committee
  and its Working Groups
• Efforts of many others in health care and at all
  levels of government who have helped to make
  pandemic preparedness in Canada what it is today

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Gracias!