What happened with Canada’s pandemic alert system? The GPHIN controversy explained

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What is the controversy?

The controversy that has engulfed the Public Health Agency of Canada and its pandemic early warning system, known as the Global Public Health Intelligence Network, or GPHIN, is twofold.

First, as a Globe and Mail investigation revealed on July 25, 2020, the federal government silenced GPHIN’s highly regarded international alert system for outbreaks in May, 2019, and curtailed much of its pandemic surveillance activity – less than a year before the COVID-19 pandemic began.

Second, past and present doctors and epidemiologists at Public Health have spoken out to The Globe, saying they were increasingly marginalized within the department, and struggled to get important messages up the chain of command because of senior officials who lacked a sufficient understanding of science.

A former senior science adviser said crucial information about outbreaks often had to be “dumbed down” and that science has become “devalued” within the department over the past several years, which led to problems when the pandemic hit. A Dec. 26 Globe investigation detailed how scientists became frustrated in the early days of the outbreak over the agency’s slow response and lack of scrutiny into the severity of the situation in China.

What is GPHIN?

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GPHIN (pronounced Gee-Fin) was created in the mid-1990s after Canada was caught off guard when a sudden outbreak of pneumonic plague in India sparked panic over air travel from that country, including among staff at Toronto’s Pearson International airport. Health officials wanted to devise a system that could provide early warning of problems, so that Canada could better prepare, since even a few days or a week can mean a dramatic difference in containing outbreaks and preventing deaths.

GPHIN began as an international news monitoring system in the early days of the internet, but eventually grew in sophistication. Bolstered after the 2003 SARS crisis, the unit expanded to employ highly specialized doctors and epidemiologists, working in multiple languages, whose job was to detect the earliest signals of outbreaks. It became a combination of machine learning and human analysis.

GPHIN developed algorithms to comb through news reports from around the world, while analysts scrutinized clues on social media, internet blogs, hospital data, financial reports, and by talking to medical sources on the ground. For example, an unusual fluctuation in hog futures in one country might suggest a hidden outbreak of swine flu. GPHIN once successfully detected an undisclosed problem in China by scrutinizing the financial reports of a company that made antivirals, noticing surging sales in one particular region.

The goal was to gather unofficial intelligence in cases where certain countries were inclined to hide outbreaks from the world. Its job was not merely to detect an outbreak, but also to provide continuing surveillance so that Canada and other countries could act faster as a problem grew. The World Health Organization relied on GPHIN for 20 per cent of its epidemiological intelligence.

What happened to GPHIN?

Over the years, with no major threats materializing, the government grew weary of GPHIN, and sought to use its resources for other purposes. Officials inside Public Health questioned GPHIN’s international focus, and whether it needed to be combing the world for hints of problems. In an effort to curtail those operations, a department edict in late 2018 required that GPHIN analysts could no longer issue outbreak alerts without senior management approval. This effectively shut down the warning system. The Globe obtained 10 years of Public Health records that showed how quickly this happened. With no management approvals, GPHIN issued its final warning on May 24, 2019, about a strange deadly outbreak in Uganda, then went silent.

Halting the alerts had a cascading effect. Pandemic surveillance was soon curtailed and much of GPHIN’s intelligence capacity dwindled. Analysts were reassigned to domestic projects that the government considered more valuable, such as studying the impact of vaping in Canada. By the time the COVID-19 outbreak took hold in China, GPHIN was a shadow of its former self. The earliest signs of trouble, which would have been detectable before the first reports of the novel coronavirus began emanating from China, were missed, analysts said.

What were the implications of GPHIN being cut back?

As an intelligence unit, one of GPHIN’s key functions was to help inform Canada’s risk assessments for an outbreak, which helps the government decide how quickly to respond and what measures are needed. However, with GPHIN’s role dramatically reduced, the government has faced criticism over the accuracy of its official risk assessments. For much of January, February and March, Ottawa maintained that the virus posed a “low” threat to Canada, even as COVID-19 was spreading aggressively around the world, with mounting evidence of human-to-human transmission. Even when the WHO changed its rating to “high” at the end of January, and warned countries to prepare, Canada maintained its low-risk rating for another seven weeks, until mid-March, when it began urging Canadians to physically distance.

Scientists inside Public Health and GPHIN have said the government placed a higher priority on official information from China and the WHO than on the unofficial intelligence gathered by the analysts. Such unofficial intelligence would have indicated that the problem was more urgent than Beijing was letting on. Early on, GPHIN analysts learned that some of their early warnings weren’t making it up the chain of command to top officials.

What difference could GPHIN have made?

It is impossible to know after the fact precisely what impact a fully functioning GPHIN would have had on Canada’s COVID-19 response. However, it is possible to look back at past threats when the unit’s analysis played a key role in identifying and tracking those outbreaks, allowing Canada and other countries to respond and adjust their strategy quickly as those situations evolved. GPHIN earned a stellar international reputation for its work on the emergence of H1N1 in 2009, for example, and was praised for allowing governments around the world to respond quickly. It was also praised for its early detection and surveillance of Ebola outbreaks in West Africa.

Dr. David Heymann, a renowned epidemiologist who was part of the WHO team that detected the first Ebola outbreak in 1976, said GPHIN was instrumental during the 2003 SARS crisis, when China was not forthcoming with crucial data about the outbreak, and governments were scrambling for reliable information. He argues that GPHIN should have played a similar role in the COVID-19 crisis.

The goal is to inject urgency into government decisions. As the WHO has said in the past, GPHIN’s intelligence could be “rapidly acted upon” and “trigger a cascade of actions.” This includes decisions such as when to stockpile personal protective equipment, when to shore up hospitals and long-term care facilities in advance, and when to implement stricter measures such as border closings, physical distancing and mask-wearing so that they have a larger impact.

Ultimately, GPHIN wasn’t watching as closely as it once did, so the government has no way of telling what it would have known had GPHIN been operating at full capacity.

Prime Minister Justin Trudeau has said he is unsure what role added intelligence would have played in the government’s response, although he regrets not bolstering Canada’s critical supplies of personal protective equipment sooner. But providing the intelligence to make those decisions early, and faster, is exactly what GPHIN was created to do – and did in previous outbreaks.

As Margaret Bloodworth, a former national security adviser, said: “You never know what you don’t know.” When it came to GPHIN, “There clearly were problems, particularly earlier in 2019,” said Ms. Bloodworth, who led an independent review of the system following The Globe’s investigation.

What has the fallout been?

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Two investigations were launched into the problems at GPHIN and the complaints from scientists within Public Health. Canada’s Auditor-General conducted a probe and Health Minister Patty Hajdu ordered an independent federal review.

Top management has also been shuffled amid the controversy. The government announced in September that Public Health president Tina Namiesniowski was stepping down and would be replaced by former National Research Council head Iain Stewart.

As president of the agency, Ms. Namiesniowski not only oversaw GPHIN but also the national emergency stockpile, which was also beset by problems early in the pandemic. The government also announced that Sally Thornton, the vice-president of the Health Security Infrastructure Branch who oversaw the approvals for GPHIN alerts, had retired.

Intelligence experts have criticized the government for not understanding the significance of pandemic surveillance, and its role in national security.

In early August, the GPHIN alert system was suddenly restarted after 440 days of silence.

What did the federal investigations find?

In March, Auditor-General Karen Hogan released her report into the problems and found Canada failed to use its pandemic early-warning system appropriately during the early months of COVID-19, and repeatedly underestimated the threat posed by the outbreak. The report was a scathing assessment of the Public Health Agency’s mishandling of GPHIN, stating that “The agency was not adequately prepared to respond to a pandemic, and it did not address long-standing health surveillance information issues prior to the pandemic to support its readiness.”

“We will never be able to tell Canadians what would have happened if the preparedness issues had been better addressed before the pandemic hit,” Ms. Hogan said. “Perhaps the government’s pandemic response would have been different.”

When it came to GPHIN’s alerts, the report said: “We found that no alert from the Global Public Health Intelligence Network was issued to provide early warning of the virus,” which corroborated the findings of The Globe’s investigation. Nor were any alerts issued as the outbreak worsened internationally in early 2020, which led to a lack of urgency within the Canadian government.

The Auditor-General’s report also found that Ottawa’s risk assessments on the outbreak – which repeatedly stated the virus was a “low” threat to Canadians during the first several months of 2020 – were faulty and incapable of properly verifying the threat. “The risk-assessment tool was not designed to consider a pandemic,” Ms. Hogan said, calling it a concerning lapse. “Because these assessments did not consider forward-looking pandemic risk, the agency assessed that COVID-19 would have a minimal impact if an outbreak were to occur in Canada.”

In July, the independent federal review appointed by Ms. Hajdu published its report on GPHIN. The review panel called for a “critical rethink” of the pandemic early-warning system, and recommended the federal government overhaul risk assessments on outbreaks.

The review found GPHIN had become isolated within the government and called for it to be better used, particularly in feeding information into Ottawa’s risk assessment processes. “The panel has observed that GPHIN is not well connected to the essential function of risk assessment, a critical step in early warning and response,” the report said. “If GPHIN’s early signals are not being fully incorporated into the risk-assessment [process], then its intelligence is not being fully leveraged.”

The review was led by Ms. Bloodworth, a national security expert, as well as Paul Gully, a public-health doctor and former deputy chief public-health officer, and Mylaine Breton, a professor at the Université de Sherbrooke who specializes in health care governance.

On the concerns detailed in The Globe’s investigation about PHAC managers lacking proper training in public health, the independent review concluded: “There might not always have been a sufficiently high ratio of public health expertise in [PHAC] management roles.” And on the concerns raised by The Globe’s investigation that scientists at the agency struggled to get important messages up the chain of command, the panel found: “It is also clear that there is a feeling that [analysts] have not been heard or recognized... and that their autonomy and needs have been compromised.”

The independent review also found problems with the government’s approach to risk assessments, recommending that the Public Health Agency establish an office of risk assessment that would be more accountable for these decisions. This new office would work closely with GPHIN so that the government can more effectively process rapidly developing information to better gauge the threat of outbreaks, allowing decision makers to act faster in a crisis.

Both the Auditor-General’s report and the independent federal review have made a number of recommendations for how to rebuild GPHIN, strengthen Canada’s risk assessment capabilities and bolster the country’s pandemic early-warning and response capacity. The federal government said it accepts the recommendations and will work on implementing them in the months ahead. However, it remains to be seen to what extent the recommendations from both reports will be adopted, and how quickly.

The story behind The Globe and Mail’s GPHIN investigation

The GPHIN investigation spans more than 30 articles, but it began with a single question about Canada’s COVID-19 response, examining the very root of the problems the country has experienced during the pandemic.

During the first several months of the global outbreak, as the situation was worsening by the day, why did the federal government’s official risk assessments repeatedly state that the threat COVID-19 posed to Canada was low? Why did these risk assessments not change, even in the face of mounting evidence that the virus was dangerous and the impact on countries would be serious?

It was a crucial miscalculation. Those official risk assessments, as federal documents show, were used to inform some of the most important decisions Ottawa made on when to act and how to confront the outbreak. Starting with that question, The Globe then talked to insiders at the Public Health Agency, who chose to speak out despite fears of punishment and risk to their careers because they believed it was a critical matter for the country. These people included doctors, epidemiologists, directors and other key personnel who were both current and past employees at the agency.

Many of them raised alarms about a crucial issue they said had hurt the agency for years, but had gone unnoticed outside government: Public Health had lost much of its scientific capacity, and it was impacting the country’s ability to respond to the COVID-19 outbreak. They detailed how an influx of senior civil servants from other government departments, who had no background or sufficient training in public health, limited the agency’s ability to react properly, and quickly. Scientists told stories of having to oversimplify information before it was moved up the chain of command, how there were signs that urgent data had been removed from internal department reports, and that crucial decisions were being made without public health and pandemic preparedness being the focus.

The Globe then began looking for evidence of how this situation may have impacted Canada’s response to COVID-19. One of the most troubling examples given was the story of GPHIN. Though few people outside government knew that Canada had a pandemic early warning system, the curtailing of its operations before the pandemic hit was a glaring example of what employees described as the erosion of scientific knowledge within the agency. However, the government originally denied that GPHIN’s early warning alert system had been silenced in early 2019. It wasn’t until The Globe obtained 10 years of internal government data showing what had really happened, that the shift was acknowledged, and the problem was revealed.

More reading

Grant Robertson on the GPHIN controversy

‘We are not prepared’: The flaws inside Public Health that hurt Canada’s readiness for COVID-19

‘Without early warning you can’t have early response’: How Canada’s world-class pandemic alert system failed

Auditor-General to probe lapse in Canada’s pandemic warning system

How COVID-19 caught us off guard

Ottawa had a playbook for a coronavirus-like pandemic 14 years ago. What went wrong?

Federal emergency stockpile of PPE was ill-prepared for pandemic

How systemic flaws led to tragedy at a Bobcaygeon nursing home

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