Question Period Note: GLOBAL PUBLIC HEALTH INTELLIGENCE NETWORK (GPHIN)

• What is the Government of Canada doing to respond to concerns about Canada’s Global Public Health Intelligence Network?

KEY MESSAGES
• The Government of Canada is committed to scientific excellence, and I am committed to improving Canada’s early warning system for potential emergencies – including pandemics.
• That is why, last year, I announced that the External Review Panel would undertake a review of the Global Public Health Intelligence Network (GPHIN) at my request.
• The Panel’s final report was provided to me on May 28, 2021.
• The report is now undergoing final technical editing and formatting in order to be published online.
• I am committed to addressing the recommendations in the report, as well as the recommendations of the Auditor General, to further improve Canada’s early warning system that informs public health action.
• Recommendations from both of these reports will help inform decisions and further improvements to the Government of Canada’s public health intelligence and surveillance so that Canada is well-positioned to detect and respond to future public health events.

IF PRESSED FOR DETAILS ON THE FINAL REPORT
• The final report provides recommendations that will be used to determine how this global public health surveillance system can best serve Canadians and the international community.
• The External Panel has confirmed that GPHIN was not shut down. GPHIN provided early warning of COVID-19 to Canadian public health professionals, and continues to operate as Canada’s event-based public health surveillance system.
• The Public Health Agency of Canada fully supported the work of the External Review Panel by connecting them with program staff and officials, and providing documents and information requested by this Panel to complete their review and the final report.

IF PRESSED ON THE ISSUANCE OF ALERTS
• At the onset of the pandemic, GPHIN performed its key function of providing early warning within Canada.
• The Public Health Agency of Canada will continue to use GPHIN as Canada’s global event-based surveillance system, relying on the full scope of its capabilities to provide early detection and warning of potential public health threats.

BACKGROUND
The Public Health Agency of Canada’s (PHAC) Global Public Health Intelligence Network (GPHIN) is an open source early-warning and situational awareness system for potential chemical, biological, radiological and nuclear public health threats worldwide, including outbreaks of infectious disease. GPHIN users include non-governmental public health agencies and organizations, as well as government authorities who conduct public health surveillance. GPHIN requires a free subscription from eligible users. GPHIN is an important contributor to the World Health Organization’s (WHO) Epidemic Intelligence from Open Sources.

GPHIN consists of two critical components:
• a professional multidisciplinary team of life science analysts conducting rapid risk assessments to detect public health threats; and
• an Information Management Tool that uses machine learning and natural language processing to facilitate the work of the analysts.

Every day, GPHIN analysts conduct their daily review of, on average, 7,000 articles in nine languages (Arabic, Farsi, English, French, Portuguese, Russian, Spanish, and simplified and traditional Chinese) sourced from open event-based surveillance to validate and assess the data for inclusion in reports, including the GPHIN Daily Report published each morning. This report goes directly from GPHIN to Canadian public health practitioners at the federal, provincial and territorial levels, including senior management at PHAC and other government departments.

Independent Review of GPHIN
In August 2020, the Minister of Health requested an external review of the global public health surveillance system. This review was established to consider:
• the capabilities and effectiveness of the existing system;
• the system’s role in detecting and informing the Public Health Agency of Canada’s response to COVID-19 and in global and domestic public health surveillance;
• opportunities to improve the system; and
• the future of Canada’s global health surveillance system, including advice on the next generation of intelligence systems and lessons learned from COVID-19, so that the Government of Canada is well positioned to respond to future public health events.

Panel members, Margaret Bloodworth, Dr. Paul Gully, and Dr. Mylaine Breton, were selected based on their expertise in public health, governance, health security, and intelligence.

On March 20, 2021, the External Review Panel’s interim report was made publicly accessible on the Canada.ca website.

The interim report provides a comprehensive overview of GPHIN and clearly states that, while areas for further improvement exist, GPHIN’s actions did not hinder Canada’s knowledge of or subsequent action in response to COVID-19. The report highlights the Panel’s approach and work on this review, which includes a look at the past and present state of GPHIN, from its creation in the 1990s to its current operations. The report provides an overview of GPHIN’s structure and functions, and GPHIN’s initial detection of what would become the COVID-19 pandemic.

The final report was provided to the Minister on May 28, 2021. The External Review Panel found that:
• GPHIN identified the outbreak in Wuhan on December 30, 2019, and included this report in the December 31, 2019 Daily Report and in a stand-alone Special Report shared internally on January 1, 2020.
o GPHIN performed its key function of providing early warning within Canada through the Daily Report. Daily Reports are sent to domestic subscribers, such as PHAC and other federal departments, provincial and territorial officials, and others.
• Canada’s response was swift and effectively began on the first day of 2020, in part due to event identification and notification of the initial signal by GPHIN.
o PHAC’s leadership took immediate action on becoming aware of this emerging public health threat, including enhanced surveillance and reporting, and notification of officials across government, followed by notification of public health officials across Canada on January 2, 2020.
• Issuing a GPHIN Alert would not have made Canada’s response to COVID-19 faster or more effective.
o An Alert is issued to flag signals for domestic and international subscribers, however, international partners were already aware of this signal, as it was being disseminated widely through a number of other mechanisms at the time.
o By the evening of December 31, 2019, the significance of this event was clear in the public health surveillance community. The WHO stood up its Incident Management Support Team on January 1, 2020.
• The Panel saw no evidence suggesting earlier identification by GPHIN of the outbreak was possible, though other systems, such as BlueDot and ProMed, did identify the outbreak on the same day.
• Event-based surveillance provided the earliest global detection of the outbreak of pneumonia in Wuhan, by GPHIN and other systems, which all signalled the outbreak of pneumonia in Wuhan within a similar timeframe.
The recommendations in the final report are focused on:
• The operational context, role and mandate of GPHIN;
• Governance structures that support GPHIN;
• Partnerships and flows of information between GPHIN and stakeholders, domestically and globally;
• Lessons learned from COVID 19 and opportunities to further improve the system; and
• Advice on the next generation of public health intelligence systems and the future of surveillance tools.

The final report will be made publicly available by the end of June 2021.

GPHIN in the Auditor General’s Report on Pandemic Preparedness
The Office of the Auditor General of Canada (OAG) tabled a report in Parliament on March 25, 2021 entitled Covid-19 Pandemic: Pandemic Preparedness, Surveillance and Border Control Measures. This included an audit of PHAC’s and Canada Border Service Agency’s pandemic response. The report notes that GPHIN Alerts play a key role in early warning, and that overall, PHAC quickly mobilized and adapted its response as the pandemic progressed.
With regard to GPHIN, the following recommendation was made: “The Public Health Agency of Canada should appropriately utilize its Global Public Health Intelligence Network monitoring capabilities to detect and provide early warning of potential public health threats and, in particular, clarify decision making for issuing alerts.”
The OAG audit found that no alert was issued when news of an unknown pneumonia was first reported, when the virus had spread outside of China, or when domestic cases were first suspected and confirmed.
• PHAC officials confirmed that by the end of December 2019, other international sources had already shared news of the virus and therefore it was unnecessary for GPHIN to issue an alert.
• GPHIN did issue daily reports about the new virus to Canadian partners (including federal, provincial, and territorial public health officials) starting on December 31, 2019, and thus performed its key function of providing early warning within Canada.
The OAG report also notes that the approval process for issuing alerts changed in 2018, after which the number of alerts decreased significantly.
• PHAC officials confirmed this change was to ensure appropriate awareness of and response to emerging issues, but GPHIN subscribers were not informed of this operational change in alert reporting.
• In recognition of the need for clear decision-making processes, a standard operating procedure was put in place in fall 2020 regarding the issuance of GPHIN alerts.

In response to the Auditor General’s recommendation, and the recommendations from the GPHIN External Review Panel, PHAC will make further improvements to GPHIN including the alert process.

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