Canada did not use its pandemic early warning system appropriately during the early months of COVID-19 and underestimated the threat posed by the virus, the Auditor-General says in a scathing assessment of the federal government’s handling of the outbreak.
In a report released Thursday, Auditor-General Karen Hogan said the Public Health Agency of Canada misjudged the outbreak – and was ill-prepared – because it was acting on incomplete information and faulty risk assessments.
“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,” Ms. Hogan said.
“We will never be able to tell Canadians what would have happened if the preparedness issues had been better addressed before the pandemic hit,” the Auditor-General said. “Perhaps the government’s pandemic response would have been different.”
The report’s major findings focused on the government’s use of inaccurate risk assessments and the silencing of Canada’s pandemic early warning system, which contributed to a sluggish response.
A Globe and Mail investigation last year found that Public Health repeatedly rated the threat of the virus as low throughout January, February and into March, in part because the government had downgraded its once-respected early warning system, known as the Global Public Health Intelligence Network, or GPHIN.
The Auditor-General said the system, which is designed to inject urgency into government decision-making, was not used properly, and the government’s internal risk assessments failed to peg the danger of the outbreak as it progressed.
“We found that no alert from the Global Public Health Intelligence Network was issued to provide early warning of the virus,” Ms. Hogan said.
At a press conference, she likened the system to a smoke detector for outbreaks. It is designed to heighten scrutiny and alarm over a potential threat. “I trust that when I’m in my home that [the smoke detector] will go off to give me a warning to go inspect and see what’s going on and then react as needed. That’s the intention of alerts – to alert both domestically and internationally, something of concern, something that was unusual.”
This includes not only at the first sign of a problem, but on a continuing basis as the outbreak worsens, so that escalating response measures can be taken.
“However, no alert was issued when news of an unknown pneumonia was first reported, when the virus spread outside of China, or when domestic cases were first suspected and confirmed,” the report said.
The report criticized the government’s tool for risk assessments, which Ms. Hogan said was only designed to handle domestic outbreaks, and was unable to accurately assess threats from outside the country. So as COVID-19 spread around the world and became progressively worse, Canada considered it a low risk because the tool only assessed threats within its borders.
“The risk-assessment tool was not designed to consider a pandemic,” Ms. Hogan said, calling it a “concerning” oversight. “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.”
Public Health didn’t rate the outbreak a high risk to Canada until March 16, 2020, five days after the World Health Organization had already declared COVID-19 a global pandemic.
“We reviewed the meeting minutes of the agency’s two key pandemic response committees and found little discussion concerning the ongoing low risk rating for COVID-19 before March 12,” the report said.
The Auditor-General said the agency “should strengthen its process to promote credible and timely risk assessments.” In response, Public Health said it would conduct a review of the risk-assessment process.
The Globe’s investigation into the mishandling of GPHIN found that the pandemic early warning system was sidelined inside the department. With seemingly no pandemic threats on the horizon, the agency sought to use its intelligence-gathering capabilities on domestic projects, such as studying the impact of vaping in Canada.
Scientists inside the department have said that in past outbreaks such as SARS and H1N1, analysis provided by GPHIN was used to better inform the government’s risk assessments. Ms. Hogan said there was “a very logical link” between the pandemic early warning system’s intelligence gathering and the risk assessments that underestimated the crisis.
The department began restructuring GPHIN in late 2018 and by May, 2019, the alert system fell silent, taking much of GPHIN’s international focus away from scouring the world for pandemic threats. Analysts lost the ability to independently issue alerts on situations that were worsening and deserved closer attention. “After this change, the number of alerts decreased significantly,” the report said.
The Auditor-General called on Public Health to “appropriately utilize” the system “and provide early warning of potential public-health threats.”
Health Minister Patty Hajdu acknowledged the criticisms. ”We fully accept the Auditor-General’s findings and of course agree with the recommendations that a much stronger focus on public health and pandemic preparedness must be part of Canada’s plans now and into the future,” Ms. Hajdu said.
The Auditor-General’s findings follow an interim report issued last week by an independent panel reviewing the pandemic early warning system. That interim report appeared to adopt the position of Public Health management that even though GPHIN’s alerts were not active, the system distributed information throughout the government and to the provinces via e-mail.
However, the Auditor-General pointed out that such methods are not the same as alerts, which elevate a problem. “The alerts are meant to signal something of significance that’s unusual,” Ms. Hogan said. “I do think that they need to figure out exactly what GPHIN’s supposed to be doing, make it clear and then use it as intended.”
After implementing border-control and quarantine measures, the Auditor-General said Public Health also could not verify whether many incoming travellers who were required to quarantine actually did so.
“The Public Health Agency of Canada did not know whether two-thirds of incoming travellers followed quarantine orders,” the report said. The agency followed up in person with very few of the travellers to verify compliance.
The report also found that Canada had not fully tested its pandemic preparedness plans, which are supposed to be examined every two years. Canada hadn’t conducted such a test since 2016 and was in the process of doing so when COVID-19 struck. This was first reported in a Globe investigation in December, in which scientists inside Public Health said they had warned internally that the agency wasn’t ready for a pandemic.
The Auditor-General said Public Health also lacked the ability to systematically collect and analyze health intelligence and surveillance data from the provinces and territories. In the first half of 2020, only 4 per cent of COVID-19 cases across the country were reported to Public Health within 24 hours of being detected.
Michael Garner, a former senior science adviser at Public Health, who left the agency in 2019, called the slow processing of data a “failure that cannot be overstated.”
Editor’s note: This version corrects the dates on the pandemic assessment by the Public Health Agency of Canada in March, 2020