Public Safety and Health Cooperation from the Canadian Perspective

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2 2 Public Safety and Health Cooperation from the Canadian Perspective Presentation by: Dr. Rainer Engelhardt Assistant Deputy Minister Infectious Disease Prevention and Control Public Health Agency of Canada Friday, March 12, 2009

3 3 Overview Public Health Agency of Canada structure and function Key components of surveillance, preparedness and response International cooperation Canada-US-Mexico cooperation Challenges and benefits

4 4 Public Health Agency of Canada Functional Organization A Government of Canada Agency Headed by Canada s Minister of Health and led by Chief Public Health Officer Branches: Infectious Disease Prevention and Control Health Promotion and Chronic Disease Prevention Corporate services, including Centre for Emergency Preparedness and Response Supporting directorates Strategic Policy and International Affairs Communications Corporate Secretariat

5 5 Public Health Agency of Canada - Legislative Authorities Quarantine Act (2005) Public Health Agency of Canada Act (2006) Human Pathogens and Toxics Act (2009)

6 6 Public Health & Security A robust public health system is a critical line of defence against current and emerging threats Securing an Open Society: Canada s National Security Policy, April 2004 Post 9/11, anthrax attack and SARS events, public health & national security agendas in Canada have become integrated in the areas of: Public health emergencies Chemical, biological, radiological and nuclear (CBRN) threats Incl. bioterrorism and use of biological weapons

7 Federal Public Safety Governance Stakeholders 7 Federal Departments and Agencies Privy Council National Defence Public Health Agency of Canada Health Canada Canadian Food Inspection Agency Citizenship and Immigration Canada Transport Canada Foreign Affairs Canada Border Services Agency Canadian Coast Guard Environment Canada RCMP Etc. Lead Department PUBLIC SAFETY CANADA Academia Private research facilities Private sector NGOs Provinces and Territories Regional authorities First-line responders International partners International organisations (eg. WHO) Countries (eg. US, Mexico)

8 Federal Emergency Management Framework 8 National Microbiology Laboratory EOC Canadian Food Inspection Agency Other Departments PHAC CEPR Health Canada HP EOC Foodborne Zoonoses EOC Environment Canada Department of National Defence Public Safety Canada Transport Canada GoC Department of Foreign Affairs and International Trade In a complex public health emergency, coordination reverts broadly to Public Safety Canada while the Public Health Agency of Canada (PHAC), responds to public health issues.

9 9 Public Health Surveillance, Preparedness and Response Canada s National Security Policy (2004): Strong national security interest in developing and maintaining strong public health system Integrated National Security System includes: Public Health System includes: Threat assessment Protection and prevention Consequence management Evaluation and oversight Risk assessment Surveillance and preparedness Response and recovery Evaluation

10 Public Health Surveillance, Preparedness and Response PHAC Mechanisms (1) 10 Preparedness Applied and discovery research R&D on medical countermeasures Contracts with vaccine manufacturers for domestic supply Canadian Pandemic Influenza Plan for the Health Sector Surveillance and epidemiology capacity The Canadian Integrated Public Health System (CIPHS) The Canadian Network for Public Health Intelligence (CNPHI) The Global Public Health Information Network (GPHIN) C-EnterNet Canadian Integrated Program for Antimicrobial Resistance Surveillance

11 Public Health Surveillance, Preparedness and Response PHAC Mechanisms (2) 11 Laboratory service capacity PHAC s CL2, CL3 and CL4 laboratories (level 5 in planning) Canadian Public Health Laboratory Network PulseNet Canada (member of PulseNet International) National Reference Laboratory for number of viral diseases Canada s provincial public health laboratories A Canadian Laboratory Response Network, based on the US Laboratory Response Network for Bioterrorism is currently being established Response capacity $300 million National Emergency Stockpile System (NESS) The National Office of Health Emergency Response Teams (NOHERT) Two emergency operations centres (EOC) Mobile laboratory units and Microbiological Emergency Response Team (MERT) Nation wide laboratory response strategy for respiratory disease outbreak management

12 12 International Relations (1) World Health Organization (WHO) H1N1 outbreak first public health emergency of international concern reported under the International Health Regulations (IHRs) WHO s Global Outbreak Alert and Response Network (GOARN) WHO Global Food Infection Network WHO Global Influenza Network Dangerous Pathogens Laboratory Network for Outbreak Response and Readiness Plan for the WHO Global Laboratory Directory (GLaD) Pan-American Health Organization (PAHO) PAHO Latin American Network for Antimicrobial Resistance Surveillance Caribbean Public Health Agency Haiti response in 2010 Technical assistance to help assess Guyana s core capacities for surveillance and response under IHR Expertise to support States of the Caribbean sub-region with legislative issues and challenges arising from IHR implementation, and the potential adaptation of national legislation

13 13 International Relations (2) Global Health Security Initiative (GHSI) Global Health Security Action Group (GHSAG) Forum of like minded countries Undertaking joint activities Aimed at enhancing global health security Instrumental initiative for: Information sharing Policy-based decision making Ongoing risk assessment of new threats Key topics: Laboratory Network Medical Countermeasures Pandemic influenza Emergency Communications and Exercise International Health Regulations International Gatherings of High Consequence (Mass Gatherings) Example - Important information sharing, technical assistance and policy making forum for H1N1

14 14 Canada-US-Mexico Cooperation (1) Health and Security: one of the 3 priorities at the 2009 North American Leaders Summit Bi- and Trilateral cooperation: Promotes a North American approach to security and public health threats Strengthens cross-border coordination and cooperation, Fosters greater understanding of national security priorities Strengthens multilateral relationships on security issues derived from public health threat, including bioterrorism

15 15 Canada-US-Mexico Cooperation (2) Implementation agreements: Declaration of Mutual Aid Assistance during a public health emergency (Canada, US, Mexico) Agreement between PulseNet Canada and PulseNet USA Agreement between Canada and Mexico MOH on Network of Public Health Intelligence Case examples: Canada-US collaboration for the 2010 Winter Olympics Exchange of public health liaison officer Deployment of supplies and equipment from NESS in the aftermath of Hurricane Katrina Diagnostic and training support to Mexico Share information for faster outbreak mitigation CNPHI is working to deliver CNPHI-like technology in Mexico in a Spanish language platform. Other cooperation activities: International Circumpolar Surveillance (ICS); Canada-US cross-border health alliances; Memoranda of Understanding between CPHLN and the US Association for Public Health Laboratories; Surveillance and outbreak investigation in food-borne, environmental and zoonotic diseases; Joint testing and exercises; Plan to link CNPHI Public Health Alerting to EpiX Alerting tool in the US; Plan to develop an early warning infectious disease surveillance system in Mexico.

16 16 Canada-US-Mexico Cooperation H1N1 example «North America s coordinated response to the initial outbreak of the H1N1 flu virus has proven to be a global example of cooperation. We set an example of a joint, responsible, and transparent response, enabling other regions to react quickly to protect their populations. Through planning and foresight, we were quickly able to put effective health measures in place.» Joint Statement By North American Leaders, Guadalajara, August 2009 North American Plan on Avian and Pandemic Influenza A regional Canada-US-Mexico coordinated plan which allowed: Regular teleconferences, early detection of outbreak, early genotyping and sequencing of virus Early notification to WHO and PAHO under IHR requirements Information sharing on epidemiological data, vaccines, adverse reactions, laboratory results, communications messaging Sample sharing and analysis; laboratory support to Mexico Deployment of PHAC personnel in Mexico Bridging 5 M doses of vaccines to Mexico

17 Conclusion Challenges and Benefits 17 Challenges for trilateral cooperation: Balance between sovereignty and interdependency From national security to continental security Need to overcome differences in governance, legislation and regulations through: Common principles and best practices, Network of networks, Sharing of expertise and experiences, Understanding of respective health emergency and public safety structure. Benefits of trilateral cooperation: Increase preparedness and response capacity in each country and on the North American continent Promote partnership, strategic alliance and intelligence sharing Provide a North American perspective at key global health security fora Influence global policies and best practices

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