Question Period Note: Current COVID Posture and Prepareness

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• On May 5, 2023, the World Health Organization (WHO) announced that COVID-19 no longer constitutes a Public Health Emergency of International Concern as the data shows that the death rate globally has slowed down, reflecting widespread vaccination, availability of better treatments and a level of population immunity from prior infections.

KEY MESSAGES

• Protecting the health and safety of Canadians remains a top priority for the Government of Canada, and this includes ensuring preparedness for future pandemics and global health events.
• The recent WHO statement reflects the collective progress made to date both in Canada and around the world in responding to the COVID-19 pandemic.
• While the emergency phase is over, WHO has not yet declared an end to this pandemic. We will continue to remain vigilant.
• The COVID-19 pandemic has shown that a proactive, efficient, and organized response is crucial to address public health threats and keep Canadians safe.
• Public health investments made during the pandemic have increased Canada’s ability to plan for and respond to respiratory threats.
• Moving forward, we will continue to work with the WHO, international partners, the provinces and territories, and health care organizations to monitor COVID-19 while building on lessons learned during the COVID-19 pandemic and adjusting Canada’s approach to remain well-positioned and prepared to respond to future global health events.

IF PRESSED ON WORK BEING DONE ON PANDEMIC PREPAREDNESS AND RESPONSE TO LESSONS LEARNED

• The Government will be taking all lessons learned into account to be prepared for potential future pandemics. These efforts will build on significant investments made in response to COVID 19.
• For example, in 2022, we announced the creation of a Centre for Research on Pandemic Preparedness and Health Emergencies at the Canadian Institutes of Health Research, and that Moderna would build a state-of-the-art mRNA vaccine manufacturing facility in Quebec, to strengthen the domestic biomanufacturing sector and pandemic preparedness.
• The Public Health Agency of Canada also established a new Centre for Integrated Risk Assessment in 2021 to bolster the Agency’s public health risk assessment capacity to anticipate, detect, and assess potential public health risks to Canadians.
• Our National Emergency Strategic Stockpile is well stocked. We continue to coordinate closely with our provincial and territorial partners to ensure that medical assets such as personal protective equipment and medical countermeasures are available to help them respond to public health emergencies and disasters.
• PHAC is developing a comprehensive management plan for the NESS, which will focus on key areas such as optimizing life-cycle material management, enhancing infrastructure and systems, and is working closely with provinces and territories and other key partners to better define needs and roles.
• The Public Health Agency of Canada will continue to work with federal, provincial, and territorial partners to improve our collective governance, and on the development of shared priorities, such as the pan-Canadian Health Data Strategy.

IF PRESSED ON EXISTING PREPAREDNESS FRAMEWORKS AND PLANS

• The Auditor General recognized that PHAC had developed plans to guide a response to a pandemic since the global H1N1 pandemic in 2009.
o The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) provides guidance to prepare for and respond to an influenza pandemic. Developed together with PTs, the CPIP outlines how jurisdictions will work together to ensure a coordinated and consistent health-sector approach to pandemic preparedness and response, while providing flexibility for the PTs to adapt their own pandemic influenza plans.
o FPT Public Health Response Plan for Biological Events: The Federal-Provincial-Territorial Public Health Response Plan for Biological Events was developed in 2017 in order to facilitate formal coordination of FPT responses to public health events that are biological in nature and of a severity, scope or significance to require a high level FPT response. This plan acted as a guide for the development of the FPT Public Health Response Plan for the Ongoing Management of COVID-19 and has provided the framework for our FPT governance and concept of operations (e.g., Special Advisory Committee).
o FPT Public Health Response Plan for the Ongoing Management of COVID-19: During COVID-19, the FPT Public Health Response Plan for the Ongoing Management of COVID-19 was developed in collaboration with FPT public health officials via the FPT Special Advisory Committee (SAC) on COVID-19, First Nations, Inuit and Métis partners, and health system partners. It is an evergreen document that provides a Pan-Canadian forward planning approach for ongoing management of COVID-19 in Canada and facilitates awareness and coordination both within and beyond the public health sector.
o The Agency continues to test and adapt its plans and processes informed by lessons learned and from other recent events such as the outbreak of Sudan Virus Disease (Ebola) in West Africa, and the outbreak of Mpox.
o We will continue to work with PTs to reflect shared responsibilities for public health emergencies.

IF PRESSED ON ADDRESSING OFFICE OF THE AUDITOR GENERAL (OAG) RECOMMENDATIONS

• The Public Health Agency of Canada accepts the recommendations from the four Auditor General reports related to the COVID-19 pandemic.
• Recommendations focused on:
o Pandemic planning, health surveillance information, early warning of public health threats, and border measures (OAG Audit Report #8 – Pandemic Preparedness, Surveillance and Border Control Measures);
o Assessing needs of and managing the National Emergency Stockpile (OAG Audit Report #10 – Securing PPE and Medical Devices);
o Improvement of enforcement of emergency orders imposed to limit the spread of COVID-19 and improving the use of information on the outcomes of its referrals for follow-up (OAG Audit Report #15 – Enforcement of Quarantine and COVID-19 Testing Orders); and
o Procurement support to secure COVID-19 vaccines, vaccine access and surveillance (OAG Audit Report #9 – COVID-19 Vaccines).
• Work is underway to address these recommendations including improved surveillance systems and reducing barriers to vaccine surveillance, and planning for the management of the National Emergency Strategic Stockpile as examples.
• The Public Health Agency of Canada will continue to consider these findings, along with other audits, evaluations, and further lessons learned from the response to COVID-19, to inform future planning and to position Canada well to respond to future global health events.

IF PRESSED ON WASTEWATER SURVEILLANCE

• The Public Health Agency of Canada worked in collaboration with other federal departments, provincial, territorial, and municipal governments to establish a pan-Canadian wastewater surveillance network for timely detection and monitoring of emerging COVID-19 variants of interest and concern across the country.
• Wastewater surveillance data have already been used for early detection of COVID-19 in many regions, which have been critical to informing public health responses.
• The Agency continues to track and compare COVID-19 levels in some major communities across Canada.
• The Agency and its partners have also established a pilot project to monitor wastewater from airports and a short-term aircraft wastewater testing program to assess the COVID-19 variants coming into Canada from various regions of the world.

IF PRESSED ON FALL 2023 VACCINATION CAMPAIGN

• The Public Health Agency of Canada will have ample supply of vaccines, treatments, tests, and personal protective equipment in the case of a fall 2023 COVID-19 resurgence.
• The advice from the National Advisory Committee on Immunization (NACI) will continue to inform Canada’s COVID-19 vaccination strategy, including planning for vaccination in fall 2023.
• Storage and distribution of COVID-19 vaccines are underway to support vaccine boosting campaigns for fall 2023 and into spring of next year.
• Canada continues to improve the VaccineConnect digital platform to support planning and reporting on national vaccine supply and inventory management.
• PHAC continues to support and improve vaccine information data sharing among provincial and territorial health authorities and Indigenous partners, healthcare professionals, and vaccine manufacturers.

IF PRESSED ON PANDEMIC INSTRUMENT

• In December 2021, the 194 World Health Organization (WHO) Member States, including Canada, agreed to launch a process to develop a pandemic instrument.
• The new pandemic instrument will be one tool among others, including the International Health Regulations (2005), to improve how the world prevents, prepares for, and responds to future international health emergencies.
• Building on lessons learned from the pandemic, it is expected to integrate whole-of-government and whole-of-society approaches, promote health equity and gender equality, bolster activities related to pathogen spillover between humans and animals, and strengthen capacities to detect, understand and act on public health emergencies.
• The Health Portfolio continues to work to engage relevant federal government departments, provincial and territorial governments, National Indigenous Organizations, and other partners and stakeholders to inform Canada’s approach to the negotiations of the pandemic instrument.

IF PRESSED ON PMB C-293: AN ACT RESPECTING PANDEMIC PREVENTION AND PREPAREDNESS

• We’ve had the chance to study and consider Bill C-293. The proposals suggested in the Bill will build upon a solid foundation of work we already do in this domain.
o It is noted that the proposed Bill would establish three requirements for the Minister of Health: establish an advisory committee to review the response to the COVID-19 pandemic in Canada
o establish a pandemic prevention and preparedness plan
o appoint a national pandemic prevention and preparedness coordinator
• As the COVID-19 pandemic highlighted, the impact of public health events on both society and the economy are immense.
• While PHAC was able to respond quickly and effectively to the evolving COVID-19 situation, we are committed to further strengthening pandemic preparedness in Canada by building on the lessons learned.
• We look forward to building on work currently under way, in collaboration with international and domestic partners alike, to help ensure a strong posture in preparedness and response.

IF PRESSED ON COVID-19 ACTIVITY IN CHINA

• From the beginning, COVID-19 activity has varied from country-to-country. The global risk remains high unless and until all countries have sufficient capacity to prevent, test and treat this disease.
• While the WHO announced the end of the emergency phase of the COVID-19 outbreak, COVID-19 is still a global threat – case surges are likely and new variants could still emerge.
• The Public Health Agency of Canada continues to monitor potential COVID-19 resurgence in Canada and internationally, including in China, and routinely assesses the potential impacts of new variants of concern on public health in Canada using available epidemiological data and scientific evidence.
• The Government of Canada will consider additional protective measures for the health and safety of people in Canada, based on risk analysis, should it be necessary.

COVID-19 Preparedness Posture Globally
• Globally, the COVID-19 death rate has slowed from a peak of more than 100,000 people per week in January 2021 to just under 2,000 in the week of May 15, 2023, according to WHO data. These numbers reflect global efforts of widespread vaccination and treatments available, along with population immunity from prior infections.

• On May 5, 2023, the WHO announced that COVID-19 no longer constitutes a Public Health Emergency of International Concern and is now an established and ongoing health issue.
• In September 2022, U.S. President Joe Biden declared the pandemic over. Like several other countries, the U.S. has since been de-escalating its domestic state of emergency for COVID-19, which officially ended on May 11. The U.S. government has stopped paying for vaccines, treatments, and testing.
• In April 2022, the European Union said the emergency phase of the pandemic was over, and other regions have taken similar steps.

• While the world continues to learn and apply lessons learned for the management of COVID-19, countries are working to maintain the significant gains that have been made during the past 3 years.

De-Escalation of COVID-19 Operations within Canada
• As COVID-19 cases approach a steady state, all provinces and territories (PTs) have shifted public health priorities to focus on a more sustainable response for the long-term management of COVID-19.

• All PTs have already or are moving towards de-escalating many COVID-19 public health measures and reducing surveillance and laboratory testing capacities.

Activity on PMB C-293: An Act Respecting Pandemic Prevention and Preparedness

• Bill C-293, “An Act Respecting Pandemic Prevention and Preparedness” was introduced in the House of Commons on June 17, 2022, and was referred to the House of Commons Standing Committee on Health for study on February 8, 2023. The Bill proposes to establish an advisory committee to review Canada’s response to the COVID-19 pandemic, form a pandemic prevention and preparedness plan, and delegate a coordinator of these activities, with the intention of reducing risks associated with future pandemics.

• The Bill’s Sponsor, MP Nathaniel Erskine-Smith, appeared virtually on April 20, 2023, to respond to the committee’s questions in consideration of the Bill. Overall, members were generally supportive of the Government being required to table a pandemic preparedness and prevention plan. However, the section of the Bill that prescribes a review of the Government’s response to the COVID-19 Pandemic was deemed problematic by opposition members.

• Members are now looking to invite witnesses to appear on June 13 and 15, 2023, starting with government officials including from PHAC, CFIA, as well as Health Canada.

• During the proposed June 13 and 15 meetings, members would like to receive the officials’ perspectives on the bill and current actions to support pandemic preparedness. There could be questions on the specific proposals in the legislation.

• Possible areas of interest with respect to Canada’s pandemic response include: One Health concept, independent review of the response to COVID-19, preparedness/accountability, pandemic instrument, PPE/National Emergency Strategic Stockpile, access to data/surveillance, vulnerable populations and the mental health of children.

Canada’s continued efforts to address the effects of COVID-19
• Canada plans to continue collecting, analyzing, and interpreting COVID-19 surveillance and epidemiological data to inform public health decision-making. These surveillance activities include wastewater surveillance and National COVID-19 surveillance.

• Canada continues to store and distribute COVID-19 vaccines to support booster campaigns for fall 2023 and spring 2024.

• The National Emergency Strategic Stockpile continues to hold inventories of medical supplies and biomedical equipment procured to support the response to the COVID-19 pandemic. There is surge capacity available for other public health events that could arise in Canada.

• In addition, Canada continues to support global efforts to mitigate COVID-19 and has invested in COVAX to provide COVID-19 doses around the world. Through COVAX and bilateral donations, Canada has donated and delivered 28.8 million doses to 36 recipient countries.

• The Pan-Canadian Health Data Strategy aims to improve timely access to health data. On February 7, 2023, the Government of Canada announced FPTs will be working collaboratively to modernize the health care system with standardized health data and digital tools. To access their share of the federal funding, PTs will commit to improving how health information is collected, shared, used, and reported. Co-development of the Pan-Canadian Health Data Strategy with FPTs has been a key enabler to these funding agreements.

OAG Report Recommendations on Preparedness Areas:

• OAG Audit Report #8 (Pandemic Preparedness, Surveillance, and Border Control Measures)
• Pandemic Planning: The Public Health Agency of Canada should work with its partners to evaluate all plans to assess whether emergency response activities during the COVID-19 pandemic were carried out as intended and met objectives. This evaluation and other lessons learned from the pandemic should inform updates to plans. The agency should further test its readiness for a future pandemic or other public health event.
• Health Surveillance Information: The Public Health Agency of Canada should, in collaboration with its provincial and territorial partners, finalize the annexes to the multi-lateral agreement to help ensure that it receives timely, complete, and accurate surveillance information from its partners. In addition, in collaboration with provinces and territories, the agency should set timelines for completing this agreement. This exercise should be informed by lessons learned from data sharing between the agency and its partners during the COVID-19 pandemic. The Public Health Agency of Canada should finalize the improvements to its information technology infrastructure to facilitate the collection of timely, accurate, and complete surveillance information from provinces and territories, both during and after the COVID-19 pandemic. The agency should establish timelines for the completion of these improvements.
• Early Warning of Public Health Threats: 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 Public Health Agency of Canada should strengthen its process to promote credible and timely risk assessments to guide public health responses to limit the spread of infectious diseases that can cause a pandemic, as set out in its pandemic response plans and guidance
• Border Measures: The Public Health Agency of Canada should improve its systems and processes for administering the nationwide mandatory quarantine during the COVID-19 pandemic, including the collection of contact information and follow-up to verify compliance. Lessons learned should be used to develop emergency plans for administering mandatory quarantine orders for future disease outbreak.

• OAG Audit Report #10 (Securing PPE and Medical Devices)
• Assessing Needs and managing the Federal Stockpile: The Public Health Agency of Canada should develop and implement a comprehensive National Emergency Strategic Stockpile management plan with clear timelines that responds to relevant federal stockpile recommendations made in previous internal audits and lessons learned from the COVID-19 pandemic. The Public Health Agency of Canada should enforce, as appropriate, the terms and conditions in its contracts with third-party warehousing and logistics service providers—including the long term contract signed in September 2020—for the provision of timely, accurate, and complete data to help control inventory of personal protective equipment and medical devices.

• OAG Audit Report #15 (Enforcement of Quarantine and COVID-19 Testing Orders)
• The Public Health Agency of Canada should improve its enforcement of emergency orders imposed to limit the spread of the virus that causes COVID 19 by
 improving its automated tracking and data quality so it can better follow up with travelers who are subject to border measures;
 implementing gender-based analysis plus considerations to mitigate any potential adverse effects of existing and future programs on diverse and vulnerable groups.
• The Public Health Agency of Canada should better use information on the outcomes of its referrals for follow-up to assess whether its enforcement approach is working to limit the importation of the virus that causes COVID-19 and its variants. The agency should also improve its capability to achieve a consistent enforcement approach to border measures nationwide, including exploring other tools that could be used in all Canadian jurisdictions.

• OAG Audit Report #9 (COVID-19 Vaccines)
• To minimize further wastage, the Public Health Agency of Canada should draw on the lessons learned from its management of the COVID-19 vaccine supply and work with other implicated federal organizations and stakeholders to adjust its management of COVID-19 vaccine surpluses.
• The Public Health Agency of Canada should complete implementing VaccineConnect. This should include data quality procedures.
• Given the urgency and importance of improving timely access to quality data among health partners, the Public Health Agency of Canada and Health Canada should expedite their work with provinces and territories to implement the Pan-Canadian Health Data Strategy.
• The Public Health Agency of Canada, in collaboration with Health Canada and the provinces and territories, should resolve barriers to better share vaccine surveillance information among themselves, provide access to the Canadian Adverse Events Following Immunization Surveillance System to Health Canada, provide surveillance data, including case-level details as needed, to the World Health Organization and vaccine companies in a timely manner.

• The Public Health Agency of Canada continues to work in collaboration with the WHO, international partners, provinces and territories, and health care organizations to transition critical emergency response activities to longer-term sustained COVID-19 disease prevention, control, and management.