Without a new federal centre for disease control and $700-million in funding to manage the next public-health crisis, Canada will fall prey to the same chaos that erupted during last spring's SARS outbreak, a blue-ribbon panel warned yesterday.
A Canadian Agency for Public Health, led by a chief public health officer, must be established to prepare immediately for the next foreign invader, which could be pandemic flu, the experts said.
"The lack of collaboration between the federal and provincial governments [during the SARS outbreak]was an international embarrassment," David Naylor, the University of Toronto's dean of medicine and head of the panel, told reporters yesterday. "People are chastened. We don't want to see this happen again."
Mary Ferguson-Pare, a panel member and vice-president of the University Health Network, said the flu season "is the next test and we are not ready."
Federal Health Minister Anne McLellan said yesterday she supports an agency for disease control that probably won't cost a lot of money "in terms of bricks and mortar." She promised to move as quickly as possible to obtain funding for Dr. Naylor's recommendations, and to use the 224-page report as a framework to "renew public health infrastructure."
"For over 10 years, signals have been sent to all levels of government to ensure we have the right public-health infrastructure in place," she said in Ottawa. "Now it's time to act . . . I will go to cabinet committee fairly soon to ensure my colleagues understand the nature of the recommendations."
The outbreak of severe acute respiratory syndrome claimed the lives of 44 people in the Toronto area. Thousands more were forced into quarantine as the health-care system struggled to contain the virus, which was spread by droplets and transmitted largely in hospitals.
Dr. Naylor, whom Ms. McLellan appointed to lead the National Advisory Committee on SARS and Public Health, said efforts to control the outbreak were hampered by squabbling among jurisdictions, dysfunctional relationships among public-health officials from the three levels of government, an inability to collect and share epidemiological data, and ineffective leadership.
He said the health of Canadians was held hostage to these problems.
While the role of Health Canada was almost "invisible," Ontario also refused to appoint a SARS czar to lead efforts to contain the outbreak. Instead, James Young, the province's public security commissioner, and Colin D'Cunha, public health commissioner, were jointly in charge.
"In separate interviews, both Drs. Young and D'Cuhna acknowledged that the dual leadership structure was less than ideal and one person should have been in charge," the report said.
While Singapore, which was also hit hard by SARS, held daily news conferences with a single spokesman, in Toronto there was "no coherent communications strategy aimed at dispelling the sense of deepening crisis."
Data that officials needed to contain the disease were not made available to experts or Health Canada officials, who in turn couldn't pass the information along to the World Health Organization, the report said. Experts collating data on the disease had to use antiquated computer software.
Yesterday, Dr. Young acknowledged that Ontario "clearly had limited tools" to manage SARS. "Public-health units around the country need protocols for the exchange of information so that we can respect confidentiality but at the same time move information," he said.
Sheela Basrur, Toronto's medical officer of health and a member of the panel, said a computerized data base was set up to monitor only the 224 actual SARS cases; paper files had to be created for 23,000 "contacts," people who might have been infected.
"I witnessed thousands of staff hours wasted in the inefficient pursuit of manual transmission of information," she said.
Dr. Basrur said she is worried Ontario will not be prepared for the next pandemic, noting the SARS crisis was really just a "moment in the history of political memory."
Hospitals do not have the capacity to introduce the infection-control measures required, said Dr. Basrur, who wants a national immunization strategy put in place immediately to contain influenza outbreaks.
The U.S. Centers for Disease Control and Prevention is a model for the Canadian Agency for Public Health.
The proposed centre would both manage public-health emergencies and create a federal public-health strategy.
Other recommendations in the report include:
Creating a new network of communicable disease control that could assist local efforts to contain disease outbreaks;
Improving Canada's lab systems for better detection of infectious disease threats;
Hiring more public health officials;
Devising a national immunization strategy.
Marina Jimenez