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

In the fall of 2020, the Minister of Health announced an independent review of the Public Health Agency of Canada’s (PHAC’s) Global Public Health Intelligence Network (GPHIN). PHAC has planned its response to the Final Report of the Global Public Health Intelligence Network (GPHIN) Independent Review and the Auditor General’s Report 8—Pandemic Preparedness, Surveillance, and Border Control Measures. There has been significant media and parliamentary interest in GPHIN since early 2020.

• The Government of Canada’s top priority is the health and safety of Canadians, and we are taking action to improve and strengthen Canada’s early warning system for potential emergencies, including pandemics.
• These actions are focused on having the right systems, people, and partnerships in place to detect and share information about potential public health threats.

If pressed for details on the final report
• The final report provides recommendations on the role and purpose of GPHIN, its organization and flow of information, and technology considerations going forward.
• The recommendations relate to a range of topics, from international and domestic partnerships to advice on the next generation of public health intelligence systems, and the future of surveillance tools.
• The Independent Panel confirmed that GPHIN was never 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.

Budget 2022 key messages
• Budget 2022 proposes to provide $436.2 million over five years, starting in 2022-23, with $15.5 million in remaining amortization, to the Public Health Agency of Canada, to strengthen key surveillance and risk assessment capacities within the Agency, including the GPHIN.
• This funding supports the real-time tracking of the evolution of viruses, the monitoring of the longer-term health impacts of COVID-19, and will expand risk assessment capacity and research networks for new strains of flu, emerging respiratory infections, and vaccine safety and effectiveness.

About GPHIN

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’s products and services are freely available to 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:
• an Information Management Tool that uses machine learning and natural language processing to automatically collect and filter data from multiple open sources; and
• a professional multidisciplinary team of analysts that reviews and refines the filtered data, and also monitors additional open sources to scan for signals of potential public health threats.

Every day, the GPHIN system automatically collects about 7,000 articles, half of which are filtered out before the GPHIN analysts conduct their daily review of the remaining 3,500 articles in nine languages (Arabic, Farsi, English, French, Portuguese, Russian, Spanish, and simplified and traditional Chinese). Articles are collected from open sources and are validated and assessed for inclusion in reports, including the GPHIN Daily Report. This report goes directly from GPHIN to Canadian public health practitioners at the federal, provincial, territorial and regional levels, including senior management at PHAC and other government departments.

In addition to the GPHIN Daily Report, if an article meets specific criteria related to a potential public health threat, the GPHIN team issues what is known as an “Alert” – an email with a highlighted article about a health event of potential interest that is sent to international and domestic subscribers. Such Alerts do not include a risk assessment or recommendations for specific actions or responses.

Independent Review of GPHIN

In the fall of 2020, the Minister of Health requested an independent review of GPHIN. This review considered:
• the capabilities of the existing system;
• its role in detecting and informing PHAC’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.

The Review also looked beyond GPHIN and examined opportunities to improve how the Agency synthesizes, shares, and leverages all of its key information sources for early detection of potential public health threats.

The External Review Panel consisted of Margaret Bloodworth, Dr. Mylaine Breton, and Dr. Paul Gully, who were selected based on their expertise in public health, governance, health security, and intelligence. The panel interviewed more than 55 individuals, including former and current program staff, provincial officials, international partners, and technical experts from the public and private sector.

The final report was published online on July 12, 2021, and the 36 recommendations therein relate to:
• the role and purpose of GPHIN, including better articulating its role and functions as part of PHAC, the Government of Canada and the international community’s public health surveillance activities;
• extending its partnerships and subscriber outreach and regularly evaluating its processes and products;
• enhancing development, training, and recruitment of GPHIN staff;
• modernizing technology, such as additional social media and other new sources of data, platform improvements, and advice on the next generation of public health intelligence systems;
• improving the flow of information from all relevant surveillance systems across PHAC; and
• establishing a central risk assessment hub at PHAC.

To date, the Agency has undertaken the following actions to address the Panel’s recommendations:
• Improved decision-making process around Alerts and other communication products;
• Made significant improvements to the GPHIN online platform, including hiring a technical advisor to oversee continued improvements;
• Increased staffing levels and provided improved professional training to GPHIN analysts and epidemiologists; and
• Established a new Centre for Integrated Risk Assessment to lead integrated public health risk assessments, working in partnership with surveillance and risk assessment experts Agency-wide.

Auditor General Report on Pandemic Preparedness, Surveillance, and Border Control Measures

The Office of the Auditor General of Canada (OAG) tabled a report in Parliament on March 25, 2021 titled COVID-19 Pandemic: Report 8 – Pandemic Preparedness, Surveillance, and Border Control Measures. This included an audit of PHAC’s and the Canada Border Services 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. GPHIN did include a signal about a “mystery pneumonia outbreak” in the Daily GPHIN report, published before 8 am on December 31, 2019, and sent to Canadian partners including federal, provincial, and territorial public health officials. GPHIN thus performed its key function of providing early warning within Canada. By the evening of December 31, 2019, the significance of this event was clear in the public health surveillance community. Because the information was being disseminated widely through a number of other mechanisms, and Canadian officials and international and domestic partners were already aware (including through the GPHIN Daily Report), it was unnecessary to issue an alert to further flag this event.

While the audit concluded it was problematic that PHAC did not issue an alert, it is clear that the lack of issuing alert in no way impeded the actions and response of PHAC. The Interim report noted “documents received by the Panel show that both PHAC’s former President and Chief Public Health Officer (CPHO), took action upon receipt of the January 1 Special Report from GPHIN’s management shortly after 9:00 am that day. The President shared information with the Minister of Health’s office, as well as counterparts at the Privy Council Office (PCO), Global Affairs Canada (GAC) and Public Safety Canada (PSC). The following day (January 2), the CPHO notified the Council of Chief Medical Officers of Health (CCMOH), and PHAC alerted the federal/provincial/territorial (F/P/T) Public Health Network Communications Group and the Canadian Public Health Laboratory Network (CPHLN). The first meeting of CCMOH related to this viral pneumonia outbreak took place on January 14.”

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.

PHAC has, and will continue to take actions to improve GPHIN policies, procedures, and operations in response to the Auditor General’s recommendation and the recommendations from the GPHIN Independent Review.

Key Facts
• GPHIN is an event-based surveillance system that relies on publicly available information and provides early-warning for potential health threats worldwide.
• GPHIN analysts conduct a daily review of more than 3,500 articles in nine languages (Arabic, Farsi, English, French, Portuguese, Russian, Spanish, and simplified and traditional Chinese) and produce a daily report.
• In addition to the GPHIN Daily Report, if an article meets specific criteria related to a potential public health threat, GPHIN issues what is known as an “Alert” – an email with a highlighted article about a health event of potential interest that is sent to international and domestic subscribers.
• GPHIN Alerts do not include a risk assessment or recommendations for specific actions or responses.
• The 2021 Final Report of the GPHIN Independent Review proposed recommendations to improve GPHIN, and to better integrate PHAC’s surveillance and risk assessment programs.
• In response to the Independent Review, PHAC is taking a number of actions to enhance the systems, technical aspects and decision-making processes for GPHIN.