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More than a year after it was silenced by the federal government, Canada’s international pandemic surveillance and alert system has been brought back to life.
Late last week, despite no official pronouncement from the government, the Global Public Health Intelligence Network (GPHIN) began issuing alerts about serious disease outbreaks for the first time since May 24, 2019, when it was effectively shut down.
The change follows a Globe and Mail investigation just more than two weeks ago that reported the GPHIN system, which had been lauded around the world for its ability to detect potentially dangerous outbreaks at their earliest stages – and provide continuing intelligence to decision-makers – had effectively been shelved amid shifting government priorities.
The highly specialized unit, comprised of doctors and epidemiologists who scour global news feeds, online reports of symptoms, official health data and many other sources of intelligence to detect and track outbreak threats as they develop, had been called the cornerstone of Canada’s pandemic response capability. Faced with governments often reluctant to disclose outbreaks, the World Health Organization also relied on GPHIN for 20 per cent of its “epidemiological intelligence,” according to federal documents.
But in late 2018, the analysts were told to focus on projects considered more valuable to the government’s priorities. With no global pandemic threats in recent memory, the government shifted GPHIN toward domestic assignments, such as tracking the health effects of vaping in Canada.
This dramatically curtailed the unit’s international surveillance work, raising questions about whether the system failed when it was needed most. On May 24 last year, GPHIN issued its last alert – about a strange outbreak in Uganda that killed two people – and fell silent. With that, much of its surveillance work – which is the key benefit of the operation – also shut down. As the COVID-19 outbreak began, the government instead relied mostly on official disclosures from the Chinese government, and data from the WHO to determine the size of the threat.
However, on Thursday evening last week, GPHIN issued its first outbreak alert in 440 days, signalling that some of its epidemiological intelligence capacities are now being restored by the government.
The Globe obtained a copy of the alert, which warns of a potentially deadly tick-borne illness in China that is showing signs of human-to-human transmission.
It is a system designed to inject urgency into the public-health system, since the alert prompts continuing independent surveillance of the threat by Canada and 85 other countries that rely on GPHIN. “The primary value of GPHIN alerts is not to ensure that public health professionals simply know that certain events have occurred… but to know which events merit more scrutiny,” Natalie Mohamed, a spokeswoman for PHAC, said in a statement Wednesday.
Before it went silent last year, GPHIN sent out more than 1,500 such warnings around the world over the past decade, which helped spur public-health officials and the WHO into action when necessary.
One Public Health employee, who is not being named because they fear reprisal for speaking out, said staff were relieved when the surveillance and alert system was suddenly restarted.
“I almost cried when the new alert went out. That’s how I felt,” the GPHIN employee said. “None of us treat it just like a job. We’re all so emotionally tied into the work. You do this because you figure somebody’s going to pick it up and it will change behaviour [among decision-makers]. That’s what these alerts do, they’re supposed to change a behaviour so that people are aware of it and can fix a health problem before it grows too much.”
The move to restart the system occurred on the same day The Globe reported that the Auditor-General intends to investigate the government’s handling of GPHIN, which was used in past outbreaks such as H1N1.
Though it’s difficult to know what impact GPHIN might have had on the COVID-19 outbreak in its earliest days, had the system been operating properly, the Public Health employee said the unit is designed to not only sound the alarm as early as possible on a problem, but as it worsens, so that governments can recognize the threat and speed up their response, including stepping up measures at airports, closing borders, physical distancing, the implementation of masks and other steps.
“The cumulative effect of all the alerts from GPHIN during the pandemic might have changed a few countries’ responses,” the PHAC employee said.
The Globe’s investigation detailed how scientists inside PHAC were stripped of their ability to conduct surveillance and issue alerts independently. Starting in late 2018, the department had grown weary of GPHIN’s international mandate, and began requiring all alerts to be approved by senior management. This created delays and, in many cases, stopped the alert altogether. It also choked off much of GPHIN’s international surveillance functions, since there was no longer any impetus to gather intelligence.
Doctors and epidemiologists inside PHAC said they no longer felt their voices were being heard, and grew concerned that some of their most urgent warnings during the early days of the COVID-19 outbreak weren’t being transmitted up the chain of command to top government officials a soon as possible.
The system is not yet running at its previous capacity though. The alert sent out on Thursday, which warned doctors and governments around the world to monitor for signs of human-to-human spread of a novel tick-borne bunya virus, took nearly 20 hours before management gave approval. Before the approval system was implemented, the GPHIN system was created to issue alerts in as little as 15 minutes.
The government has been reluctant to discuss GPHIN publicly, and at times has supplied conflicting information on its status.
When The Globe asked this summer why the government’s pandemic surveillance and alert system had been shut down, a PHAC spokeswoman responded in a statement that, “GPHIN has not ceased issuing alerts.” It was only when The Globe informed the government that it had obtained 10 years of records showing the system had issued more than 1,500 alerts since 2009 then stopped suddenly on May 24 last year, that the government acknowledged the change. The alerts hadn’t stopped, PHAC suggested, they just weren’t being made any more. They now required senior management approval.
This week, PHAC told The Globe in a statement that GPHIN’s capabilities, rather than being cut, as scientists inside the department have raised alarms about, had instead been “enhanced.” The example given was a recent partnership with the National Research Council to upgrade its technology.
However, The Globe obtained an internal government document this week showing that the project with the NRC had been largely deemed a failure inside the department, and that most of its objectives were not met, despite the $2-million price tag.
GPHIN’s work had garnered it praise from other countries. In one case, the Canadian analysts, studying bits of intelligence from afar, alerted West African governments to flare-ups of Ebola that officials in those countries had missed. Despite a budget of $2.8-million, which was relatively small inside PHAC, the operation was under constant threat of cuts, particularly as the government grew weary of GPHIN’s international focus.