Experience in Quebec. 20 organizational issues

Transcription

1 Lessons learned by the MSSS following the A (H1N1) pandemic Experience in Quebec 20 organizational issues Dr Michel Savard Medical Consultant, MSSS/ DGSP September 14,

2 Background Organizational issues related to the campaign to combat the A(H1N1) virus Various Debriefings at Various Levels 22

3 1st organizational issue Management in a context of... Management model: Public health? Management model: Health Mission? Management model: Civil Protection? 3

4 Organization of the plan to combat the pandemic in Quebec Civil Protection Model (OSCQ ) Top down approach? Why??? 44

5 Once upon a time, in April 2009, in Mexico.... Conference calls on Wednesday, April 22 a severe respiratory illness with pneumonia transmissible from person to person associated with an unknown agent... but a virus is suspected...! 10% of those who fall ill die! Call for international assistance ( laboratory tests: Winnipeg ) International Health Regulations: monitoring initiated

6 Three, four days later, on Saturday, April 25 and Sunday, April 26 New Influenza A (H1N1) Virus with Pandemic Potential Other cases elsewhere in North America, the United States, Canada The cases are not as severe as in Mexico, Too early to reach any conclusions...! Monitoring: Alert everyone... See a medical specialist if...!

7 New potentially pandemic H1N1 flu virus 2009 Genetic Reassortment PB2 PB1 PA HA NP NA MP NS North American H1N1 (swine/avian/human) Asian swine H1N1 PB2 PB1 PA HA NP NA MP NS Classic swine flu, North American strain Avian flu, North American strain Human, seasonal H3N2 flu Asian swine strain PB2 PB1 PA HA NP NA MP NS Pandemic (H1N1) 2009, combining viral components of swine, avian and human influenza viruses

8 Criteria for a Pandemic e.g. A(H1N1) April 2009 New virus capable of infecting humans???? High morbidity, mortality rates Spreads throughout the world Transmissible from person to person 8

9 Question: Management Context... Management model: Public health? Management model: Health Mission? Management model: Civil Protection? Thursday, April 23 Switch to Health Mission Mode 9

10 Transmission of the virus from person to person out of control incredibly quickly (Phase 4 April 27) (Phase 5 April 29) 10

11 Influenza Pandemic Epidemic: On a number of continents at once.... Phase 6 WHO declares a pandemic on June 11,

12 2. Issue: The notion of severity Proportion of sick people who die 1918 Spanish flu Around 20 / Asian flu Hong Kong flu Around 2 / 1000 Around 2 / 1000 Source: WHO 12 12

13 Flu Virus Scale of Severity of 1 to 5 ( Deaths / numbers sick ) Seasonal flu Our plan Spanish flu A (H1N1) 1917 Mexico 10% or 100 / 1,000 Virus??? A (H5N1) Avian flu aviaire 1 / 1,000 and Category 1 3 / 1,000 Category 2 20 / 1,000 Category / 1,000 and + Category??? 13 13

14 3rd Organizational Issue Lines of Communication OSCQ - MSSS ASSS CSSS - FN OSCQ management model / Health Mission Tailored communications versus Public health management model Normal Communications... 14

15 4th issue: Fully integrate the notion of a... Planning scenario: Yes Predictive scenario: No Deaths 8,500 Hospitalizations 34,000 Out-patient treatment (50% of those who are sick) Percentage sick (35%) General population 1,400,000 2, ,500,000 Plausible scenario in the absence of vaccines and antivirals 15

16 5th issue: Start producting H1N1 vaccines...? Numerous challenges... Number of cases of type A influenza in Quebec confirmed by laboratory tests The possibility of a second and a third wave is announced How Si oui many : doses «Résultats in total 14,» 11, dans 7, 5 3 million à 6 mois... How many doses per person / Effectiveness / Safety? What should be done about the seasonal flu vaccine? Source: SIVSI, updated on October 13,

17 Crucial last-minute decisions Waiting is difficult for organizations to support and it is difficult to backtrack!!! 17

18 6th issue Notion of Canada s self-sufficiency respecting access to vaccines (to be kept...) 18

19 Aggregate epidemiological data 7th issue: Second foreseeable wave Number of cases of type A influenza in Quebec confirmed by laboratory tests? Source SIVSI, updated on October

20 Arrival of the first doses of vaccines in Quebec ( mid-october 2010 ) Difficult conditions, under pressure, shortage,... 20

21 Aggregate epidemiological data 8th issue Accumulation of real-time information Source: SIVSI, updated on October 13,

22 Flu Virus Scale of severity from 1 to 5 Grippe saisonnière Our plan Spanish flu A (H1N1) 1917 Mexico 10% Virus??? A (H5N1) Avian flu A (H1N1) % and Category 1 0.3% Category 2 2% Category 5 60% Category??? 2 22

23 9th issue: Integrated plan? Organizational issues 23 23

24 Integration of Plans International issue: Need for coherence 24

25 10th issue: Win the confidence of partners and of the powers that be April

26 11th issue: scope of recommendations Fine tuning 26 26

27 Consolidate ability to adjust in real time 27

28 12th issue: Mass vaccination sites 314 mass vaccination sites Some able to serve over 320 people per hour. Quite a feat for the 95 CSSSs 28 28

29 13th issue: Vaccine coverage objectives The vaccination campaign Offer the vaccine to the entire population of Quebec As quickly as possible (insofar as possible before the second wave....) 29 29

30 Arrival of first doses in Quebec ( mid-october 2010 ) Uncertainties surrounding the available doses up until the last minute 30

31 14th issue: Files with real-time data input 31

32 Number of doses administered 32

33 Number of side effects Table 1. Personnes vaccinées au Québec MCI MCI sérieuses* MCI MCI sérieuses* Province de Québec ,3 2,2 Groupe d'âge 0 à 5 mois ,0-6 mois à 35 mois ,3 6,1 36 mois à 9 ans ,5 1,0 10 à 29 ans ,3 2,4 30 à 39 ans ,7 1,4 40 à 49 ans ,7 2,8 50 à 59 ans ,6 1,1 60 à 64 ans ,5 2,2 65 ans ou plus ,4 2,7 Inconnu ,0 - Groupe cible Number and aggregate of adverse events following the vaccination against type A (H1N1) influenza in Quebec, April 7, 2010 Nombre Taux pour vaccinés Femmes enceintes ,3 4,9 Travailleurs de la santé ,1 3,2 Malade chronique ,6 4,3 33

34 15th issue: Reach 70 80% of the most vulnerable target groups Couverture vaccinale (%) contre la grippe A(H1N1) chez divers segments de la population québécoise (données en date du 13 janvier 2010, 03h00) Tout âge ( 6 mois) Hommes Femmes Femmes enceintes Population éloignée (RSS 17+18) Malades chroniques ans ans ans ans 5-11 ans 6-59 mois Source : MSSS, Fichier de vaccination A(H1N1). Produit par l'équipe MSSS-INSPQ, Surveillance couverture vaccinale

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36 11 out of 28 First Nations communities received their vaccines before other communities Obeijiwan (region Sag -2) Wemotaci (region Mau -4) Lac Rapide (region Out -7) Lac Simon (region Abi -8) Kitcisakik (region Abi -8) Winneway (region Abi -8) Pakuashipi (region Cot -9) La Romaine (region Cot -9) Natashquan (region Cot -9) Matimekosh (region Cot -9) Manawan (region Lan -14) 36

37 According to the survey, the professionals most respected by Canadians are: nurses (97%) farmers (95%) physicians and scientists (94%) veterinarians (91%). 16th issue: Nurse s credibility Only nurses ranked higher than physicians (97% in Canada, 96% in the United States and 95% in the United Kingdom ). Leadership regarding competence partly based on scientific knowledge 37

38 17th issue: Vaccination outside target groups Flexibility versus Coherence Incoherence versus Rigidity 38

39 Ethics... A question of common sense 39

40 18th issue: Dealing with the media 40

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42 41% have doubts abour the safety of the vaccine and are worried about harmful side effects 42

43 6% are against vaccines in general, out of principle Beliefs: need to be respected.... Reconcile ourseleves with the run-of-the-mill presence of anti-vaccination groups but Conspiracy theory 43

44 Information capsules about the vaccination First information capsule about vaccines in question and answer format, which is useful for you and your patients. http: // php?f=0f6124d939266b091db4541d9531df0f 44

45 19th issue: Maintaining stocks...? 7,757,000 doses of A (H1N1) vaccines 1,443,280 remaining at the provincial and regional levels 15,280,000 doses of antivirals in stock 11 million N-95 respirators (masks) in stock 28 million procedural masks in stock Respirators for the 1,122 available intensive care beds Etcetera...!!! (Syringes, medication, oxygen concentrators....) 45 45

46 ? 46

47 Your house is insured, but it did not burn down this year.... The insurance policy expired on May 1? Someone says: That was a waste of money Will you renew the policy? 47

48 20th issue: Final issues Not to sit back and do nothing Chance for a comprehensive approach addressing all risks not only infections, but also

49 It may be just a film, but...! 49