Hon. Art Eggleton:

Honourable senators, on June 15, last year, the Honourable Leona Aglukkaq, the Minister of Health, requested that the Standing Senate Committee on Social Affairs, Science and Technology undertake a review of Canada's response to the 2009 H1N1 influenza pandemic. This request was authorized by the Senate on June 28.

The goal of the study was to find the lessons learned from this public health challenge that I am sure we all remember, and to try to improve upon Canada's pandemic preparedness.

Honourable senators, our committee heard from representatives of the federal departments. We heard from medical officers of health of provincial and territorial governments, First Nations and Inuit organizations, health care professionals and the research community. We also heard from first responders and front-line workers — certainly the national associations representing them — that contributed so much to community preparedness during the pandemic.

The result is the report before you, which was adopted unanimously by the committee; senators on both sides supported it. It is a bipartisan effort. It is not controversial. I think it has a number of very useful recommendations, 18 in all, to help in terms of pandemic preparedness.

I want to thank Senator Ogilvie, the deputy chair of the committee, and all of the members of the committee who participated in this study. I see some of them around the room.

Honourable senators, the 2009 H1N1 pandemic was a test that stretched our pandemic response to the limit. It is estimated that roughly 10 per cent of the population — 3.5 million people — were infected with the virus, with 428 confirmed deaths.

Overall, we found that Canada's response was successful and that the planning, which began many years ago and had increased since the SARS outbreak in 2003, proved effective in reducing the impact of the H1N1 influenza pandemic.

All agencies should be congratulated and thanked for their exemplary efforts here at home and for their leadership on the international stage; particularly the Public Health Agency of Canada, by effectively providing assistance to countries that were less well equipped.

However, honourable senators, our committee did find areas that need improvement. Our report offers some 18 practical ways to increase our efforts, because it is not a matter of if there will be another pandemic but when there will be another pandemic, and we need to be prepared.

First, we would like to emphasize the importance of pandemic readiness and the need to maintain a focus on planning. We are recommending that the Government of Canada renew the funding for pandemic preparedness in the 2011 federal budget. It is coming up soon; we need it to be renewed. Honourable senators, $1 billion over five years was put into the budget five years ago, and now is the time to renew it.

We heard considerable testimony expressing concerns and challenges with respect to communications and messaging. Some senators may remember that testimony. We heard complaints that the general public and many health practitioners were receiving mixed messages regarding the diagnosis and how to clinically treat the flu. We also heard that there was a lot of diverse messaging regarding the safety of the vaccine. Was it safe? Had it been tested? What were the long-term effects? Do we really need it? These were the type of questions that many in the public had, and they had trouble finding the answers because of differing messages coming in the mainstream media — and also, I might add, in the social media.

Honourable senators, we are calling for the communications annex to the Canadian Pandemic Influenza Plan to be updated, clarifying the roles and responsibilities of the different levels of government. We are also recommending that the Public Health Agency of Canada consult widely on how best to communicate real-time policy decisions, as well as how to harmonize messaging.

Harmonizing messaging is very important. The Medical Officer of Health for British Columbia said that because of the split jurisdiction between the federal government and the provincial and territorial governments, we have many people speaking but while there are many voices, there needs to be one message. Harmonizing that message is critical.

We must expand our reach into the social media — to Facebook, Twitter, et cetera — because many people, particularly young people, gain their information and determine whether they have confidence in the vaccine or the system by what they see in the social media.

Finally, the committee is calling on the Public Health Agency of Canada to begin public awareness campaigns, using tools like social media, aimed at various aspects of public health such as vaccine safety and effectiveness. We need a little preplanning before we get to that stage so that we build up the confidence and they get used to hearing the messaging from our key health officials like Dr. Butler-Jones, our Chief Medical Officer of Health.

Honourable senators, we also heard many other issues about the vaccine. Witnesses said that although the vaccine was generally provided on time, if any production delays had occurred there was no backup supplier to fill the void. Hence, the committee recommends that the 10-year vaccine contract, which will be established this year, should include a backup supplier. In fact, the bidding has gone out and is asking for backup suppliers. We are delighted with that because we need to ensure that Canada and Canadians have a safe and sufficient supply of pandemic vaccine.

We also heard that the packaging chosen for the vaccine, that is, the number of doses per vial, was 500 doses. The average small-town doctors, and even some of the big-city doctors, were not able to cope with that kind of dosage, particularly since it had timelines associated with its use. This packaging led to some vaccine being wasted because many doctors' offices did not have the capacity to deal with that quantity. Some of them did not even open the package — my own doctor did not.

As a result, we recommend that the manufacturer consult the health agency prior to determining the packaging to better meet the needs of the end user.

We were also concerned that the logistics of implementing the vaccination program was not fully appreciated, as the vaccination rollout and rates differed from province to province. As such, we recommend that mass vaccination programs be more thoroughly investigated and tested.

When there was rollout, there were feelings that some people were jumping the line, and prioritization issues came up at the same time. These issues need to be worked out further between the federal and provincial officials.

Honourable senators, in terms of capacity for public health service delivery we are calling on the Public Health Agency of Canada to monitor the scope of practice of paramedics and pharmacists across Canada, to include them, wherever possible, as a valuable resource during public health emergencies. They have skills that could be beneficial, particularly if we have a larger scale pandemic than what this one turned out to be.

In addition, we want the agency to work with the provinces and territories to encourage greater interconnectivity between the different health care infrastructures, namely acute care, primary care, clinical care and public health care. The hospitals, of course, are key in all of that interconnectivity. These measures can contribute to increased surge capacity in hospitals and in individual communities.

We also heard concerns regarding a lack of collaboration and consultation outside of the government sphere. We are calling therefore for broader inclusion of health professionals — the Canadian Medical Association was in to see us and made this point — during future planning processes.

Also, we recommend that the health agency establish formal collaborative arrangements with provincial public health agencies. Only three provinces have them at this point — British Columbia, Ontario and Quebec — but here are further resources and expertise that should be useful. There should be further collaboration there.

Honourable senators, we also note specific circumstances faced by First Nations and Inuit populations. We commend the efforts made by health practitioners to ensure that remote communities and on-reserve First Nations received necessary care, such as antivirals and vaccines, noting that the vaccination rates were high in these communities — as high in the North as in some of our provinces. With people in the First Nations and Inuit communities it went as high as 80 per cent. In fact, the average overall in those communities was 60 per cent, whereas the average for the rest of the population was about 40 per cent.

However, we are concerned about unhealthy conditions that exist in these areas. Unhealthy conditions, such as poor access to clean water and overcrowding in housing accommodation, increased their vulnerability to communicable disease, and this issue must be tackled. This is a key point that came out of all of our findings. We also recommend that the federal government begin discussions with First Nations and Inuit organizations and communities to clarify its role in a public health emergency.

The final area of concern identified during this study was that of research. We recommend that research be included in the ongoing focus on pandemic preparedness by maintaining the influenza research infrastructure with dedicated and sustained funding.

We have good researchers in this country that can be helpful to us, but if we do not maintain their funding, we will lose them to somewhere else. Let us be sure, when the budget comes up, that we also consider this aspect as well.

In conclusion, honourable senators, the 2009 H1N1 pandemic was difficult. It stretched our capacity to the limit. Nevertheless, we performed well, and we owe a debt of gratitude to the many men and women across the country who served Canadians so well in that time period. We cannot sit on our laurels, however. Although this pandemic was not as big as some had feared it might be, we need to make sure that we are ready for the next one, and perhaps it will be even greater. We have asked that we look at the mild, moderate and severe possibilities. Those possibilities need to be part of the planning as well, because the next one might be more severe. Again, honourable senators, it is not a matter of "if;" it is a matter of "when."

Thank you.

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