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Source: http://www.canada.com/health/Ottawa+provinces+lack+deal+share+pandemic+data/1830800/story.html
Ottawa, provinces lack deal to share pandemic data
By Andrew Mayeda, Canwest News ServiceJuly 26, 2009 12:01 PM
OTTAWA -- Canadian public-health officials have warned that the second wave of the swine-flu outbreak, expected to hit in the fall and winter months, could be far more severe than the first.
But six years after the SARS outbreak exposed gaping holes in Canada's response to infectious diseases, the federal government still doesn't have a formal agreement with the provinces for how information should be shared.
Public-health policy experts say the lack of such an agreement is not just an academic issue. When Canadians need updates on how to protect themselves against swine flu, they often look to the Public Health Agency of Canada, which in turn relies on provinces and municipalities to provide clinical data and laboratory results.
"In times of epidemic emergencies, time equals lives. That's especially true when you're dealing with an epidemic that's growing exponentially," said Amir Attaran, a University of Ottawa law professor who is an expert on pandemic preparedness.
"If you lose even a day in that kind of exponential-growth scenario, you could easily be killing people avoidably. And there will be no time in such a scenario for negotiating the niceties of sharing information."
Then there are the potential financial costs of not reporting information quickly enough to the World Health Organization, which has significant powers to oversee national pandemic plans under international health regulations.
In the spring of 2003, the World Health Organization imposed a travel advisory against any non-essential travel to Toronto, one of the cities hit hardest by the outbreak of severe acute respiratory syndrome (SARS).
A provincial inquiry led by the late Justice Archie Campbell concluded that the failure of Ontario health authorities to provide complete data to Ottawa contributed to the WHO's perception that the advisory, which cost the Toronto economy nearly $1 billion and angered Canadian authorities, was necessary.
"That's the big wake-up call that's been missed," said Attaran. "Because (the Ontario and federal governments) couldn't agree on an answer, WHO assumed the worst."
In response to questions from Canwest News Service, PHAC said in an e-mailed statement that a memorandum of understanding on information sharing during a health emergency was "approved in principle" by the federal, provincial and territorial health ministers last September. But not all provinces and territories have signed the agreement, which in any case would not compel them to send information to Ottawa.
PHAC declined to provide a copy of the agreement, saying that would require the approval of all provinces and territories. It also would not say which provinces have signed the deal. Ontario is one of the few, if not the only, province to have a formal agreement with Ottawa.
The Campbell inquiry recommended that the federal government work out formal information-sharing "machinery" with the provinces and territories. But the gaps in the federal-provincial communications system were revealed by Canada's auditor general as far back as 1999.
In a report that year, the auditor general noted that Health Canada drafted a memorandum of understanding roughly 10 years earlier that would have governed how information is shared with the provinces, but the agreement was never finalized.
The auditor general urged Ottawa to reach a data-sharing deal with the provinces. But after limited progress, the auditor general essentially issued the same recommendation in 2002 and 2008.
In a May 2008 report, Auditor General Sheila Fraser concluded that PHAC, which took over responsibility for responding to pandemics from Health Canada after the SARS outbreak, relies on the "goodwill" of the provinces and territories for routine surveillance information. In the end, the agency "is not assured of receiving timely, accurate and complete information," she said.
Certainly, it is no easy task to co-ordinate the responses of 13 different provinces and territories, each with their own health care systems. Ontario's chief medical officer during the SARS outbreak said he was reluctant to release data to the federal government in case the disclosure were to violate patient confidentiality, which is protected under Ontario's health laws.
But Attaran says there is no excuse for an advanced country such as Canada not to have a national agreement for how information should flow in a public-health emergency.
"If we have failed to protect our citizens because we cannot come to an agreement about sharing information when there is a threat to our citizens' lives, then we are not a serious country," he said.
Ottawa, provinces lack deal to share pandemic data
By Andrew Mayeda, Canwest News ServiceJuly 26, 2009 12:01 PM
OTTAWA -- Canadian public-health officials have warned that the second wave of the swine-flu outbreak, expected to hit in the fall and winter months, could be far more severe than the first.
But six years after the SARS outbreak exposed gaping holes in Canada's response to infectious diseases, the federal government still doesn't have a formal agreement with the provinces for how information should be shared.
Public-health policy experts say the lack of such an agreement is not just an academic issue. When Canadians need updates on how to protect themselves against swine flu, they often look to the Public Health Agency of Canada, which in turn relies on provinces and municipalities to provide clinical data and laboratory results.
"In times of epidemic emergencies, time equals lives. That's especially true when you're dealing with an epidemic that's growing exponentially," said Amir Attaran, a University of Ottawa law professor who is an expert on pandemic preparedness.
"If you lose even a day in that kind of exponential-growth scenario, you could easily be killing people avoidably. And there will be no time in such a scenario for negotiating the niceties of sharing information."
Then there are the potential financial costs of not reporting information quickly enough to the World Health Organization, which has significant powers to oversee national pandemic plans under international health regulations.
In the spring of 2003, the World Health Organization imposed a travel advisory against any non-essential travel to Toronto, one of the cities hit hardest by the outbreak of severe acute respiratory syndrome (SARS).
A provincial inquiry led by the late Justice Archie Campbell concluded that the failure of Ontario health authorities to provide complete data to Ottawa contributed to the WHO's perception that the advisory, which cost the Toronto economy nearly $1 billion and angered Canadian authorities, was necessary.
"That's the big wake-up call that's been missed," said Attaran. "Because (the Ontario and federal governments) couldn't agree on an answer, WHO assumed the worst."
In response to questions from Canwest News Service, PHAC said in an e-mailed statement that a memorandum of understanding on information sharing during a health emergency was "approved in principle" by the federal, provincial and territorial health ministers last September. But not all provinces and territories have signed the agreement, which in any case would not compel them to send information to Ottawa.
PHAC declined to provide a copy of the agreement, saying that would require the approval of all provinces and territories. It also would not say which provinces have signed the deal. Ontario is one of the few, if not the only, province to have a formal agreement with Ottawa.
The Campbell inquiry recommended that the federal government work out formal information-sharing "machinery" with the provinces and territories. But the gaps in the federal-provincial communications system were revealed by Canada's auditor general as far back as 1999.
In a report that year, the auditor general noted that Health Canada drafted a memorandum of understanding roughly 10 years earlier that would have governed how information is shared with the provinces, but the agreement was never finalized.
The auditor general urged Ottawa to reach a data-sharing deal with the provinces. But after limited progress, the auditor general essentially issued the same recommendation in 2002 and 2008.
In a May 2008 report, Auditor General Sheila Fraser concluded that PHAC, which took over responsibility for responding to pandemics from Health Canada after the SARS outbreak, relies on the "goodwill" of the provinces and territories for routine surveillance information. In the end, the agency "is not assured of receiving timely, accurate and complete information," she said.
Certainly, it is no easy task to co-ordinate the responses of 13 different provinces and territories, each with their own health care systems. Ontario's chief medical officer during the SARS outbreak said he was reluctant to release data to the federal government in case the disclosure were to violate patient confidentiality, which is protected under Ontario's health laws.
But Attaran says there is no excuse for an advanced country such as Canada not to have a national agreement for how information should flow in a public-health emergency.
"If we have failed to protect our citizens because we cannot come to an agreement about sharing information when there is a threat to our citizens' lives, then we are not a serious country," he said.