Key fixes needed to Canada's early-warning system before next pandemic: review

OTTAWA -

Canada’s so-called pandemic early warning system needs a series of reforms in order to be better prepared to respond to future emerging health threats, according to a new report issued Monday, stemming from a federal independent review.

The Global Public Health Intelligence Network (GPHIN) is based out of the Public Health Agency of Canada (PHAC). It is the intelligence network that informs Canada’s response to disease outbreaks, and was designed to assist with early alerts of emerging threats and to inform the decision-making of top public health officials.

However, as has now been well documented in this and previous reports, the system fell short and left officials scrambling to prepare domestically when China first began seeing a suspicious cluster of pneumonia cases in December 2019. These infections quickly spread, and developing into the global COVID-19 pandemic that has killed millions, including more than 26,400 Canadians.

In its final report issued Monday and called “Signals,” the federal government-struck independent review panel has issued 36 recommendations for how the system needs to recalibrate and evolve to keep up with the evolving technological landscape and to better monitor and analyze the massive amounts of information available to better inform its work.

“The system is not operating as clearly or smoothly as it should,” reads the report. “A recalibrated GPHIN will help PHAC continue to serve and protect all Canadians, while also meeting Canada’s international obligations as a trusted ally in the global public health surveillance community. It is our hope that the recommendations in this report serve as a roadmap to that future.”

PHAC also needs to boost GPHIN’s risk assessment functions so it can send early warning alerts as soon as serious and legitimate new threats emerge, and conduct an overall review of the system’s management including who receives information and when, the report found.

“GPHIN’s success is not about returning to the past state but returning to the vision that inspired its creation. GPHIN… has the potential to contribute to surveillance capacity that leads to proactive responses,” read the report’s conclusion. “In the future, the complexity and scale of the challenges of global public health surveillance will demand systems that can work together seamlessly in order to form the connective web that can filter and catch potential events before one becomes the next global crisis.”

HAJDU: LESSONS WILL BE LEARNED

In a statement issued Monday, Health Minister Patty Hajdu said that the recommendations made will inform work already happening to improve Canada’s public health warning process and to fix the broken alert system before the next major health emergency.

While she was not specific about what new work will be undertaken based on the report’s recommendations, she thanked the panel for their insight.

“It is critical that the lessons learned from our response to the pandemic help improve the tools in place to protect Canadians,” said the minister.

Hajdu announced the independent review in late 2020, following reports of employees feeling constrained in their work and concerns raised that the system was slow to alert officials early on of the threat of the coronavirus.

In a statement, Conservative MP and health critic Michelle Rempel Garner said the report showed “once again the Liberal government was unprepared for the COVID-19 pandemic.”

“These failures lead to lost lives and the countless consequences of the pandemic,” she said, noting that if elected the Conservatives have vowed to roll out a new emergency preparedness plan for future pandemics.

Former national security adviser Margaret Bloodworth led the three-member review panel alongside Universite de Sherbrooke expert in front-line health organization Mylaine Breton and former deputy public health officer Dr. Paul Gully. 

The panel reviewed documents and conducted six months of interviews with more than 55 individuals, including: GPHIN analysts; current and past PHAC employees; provincial officials; international counterparts; as well as public and private technical experts. It also assessed the current state of the system’s capabilities and management.

In Monday’s statement accompanying the release of the final report, Hajdu noted that the federal government set aside $680 million in the fall for PHAC to spend to boost its pandemic response efforts over the next two years.

However, as the report states, GPHIN received just $830,000 of that funding. It is being used to “support research, ongoing platform support, additional staff,” and includes funding earmarked for international grants.

These findings and recommendations build off calls for change that were recently documented by federal Auditor General Karen Hogan, in a special report.

AG REPORT FOUND ALERT NOT SENT

Hogan’s study found that PHAC underestimated the potential impact of COVID-19 and was unprepared at the outset of the global health crisis. As a result, Canada was left scrambling to catch up with its early pandemic response.

One of the key points in the auditor general’s report was that GPHIN did not issue an alert about the emerging novel coronavirus that would have informed decision makers on the public health measures needed to control spread.

In early 2020, PHAC continued to assess the risk of the virus to Canadians being low and rather than issuing an early warning, the GPHIN sent daily email reports with links to news articles.

It was in one of these daily reports that the COVID-19 threat was first noted, on Dec. 31, 2019. This information was then shared with senior officials, including the health minister on Jan. 1.

While an alert for the unknown pneumonia later called COVID-19 was not proposed by GPHIN analysts even after suspected cases reached Canada, the network’s mandate is to alert “an unusual event that has the potential for serious impact or spread.”

Part of the scramble when it came to the early alert was that the mechanisms to assess the risk of the pandemic that were not working as intended.

For example, an artificial intelligence tool continued to generate a low risk rating. Hogan’s report found that it was Chief Public Health Officer Dr. Theresa Tam who assessed the GPHIN data surrounding the Wuhan cluster of causes as a more serious risk and then informed her provincial counterparts.

Among Hogan’s recommendations was to re-evaluate how GPHIN is utilized, something PHAC has defended in response to this report, stating in the agency’s eyes it “performed its key function of providing early warning within Canada.”

Echoing PHAC’s perspective, the independent report noted that in its view, Tam’s alert was sufficient to kick-start early pandemic preparations and that the timing was similar with other worldwide systems.

“We saw no evidence that earlier detection by GPHIN would have been possible,” read the report issued Monday.

HISTORY OF EARLY WARNING SYSTEM

The GPHIN was formed in the late 1990s in collaboration with the World Health Organization to "rapidly detect, identify, assess, prevent and mitigate threats to human health." It is made up of international researchers and analysts and managed by PHAC’s Centre for Emergency Preparedness and Response, and described as once “groundbreaking” in Monday’s report.

It consists of two main components: data processing and risk assessment. The former involves a tool that scans and captures about 7,000 articles in nine languages every day. The latter involves a team of professionals that process and assess the data for a daily "Situational Awareness" report released each morning to members, including senior management at PHAC and government departments.

It played a role in putting the SARS pandemic on officials’ radar in 2003, alerting to the H1N1 flu outbreak in 2009, and more recently noting the spread of Ebola in West Africa in 2014.

However, in the fall of 2018, jurisdiction over the alerts approval process was transferred from GPHIN analysts to senior management, according to a spokesperson within the ministry. After this organizational change, the number of alerts decreased and then eventually stopped.

With files from CTV News’ Sarah Turnbull.