Invest in Health, Build a Safer Future Dr. David Butler-Jones, Chief Public Health Officer of Canada April 2, 2007

2. Invest in Health, Build a Safer Future Dr. David Butler-Jones, Chief Public Health Officer of Canada April 2, 2007

3. The Lessons of SARS: Canada’s Experience

4. Infections and History: A Sampler • 1/3 of Europe killed by Plague (Middle Ages) • 90-95% pop of Americas lost post contact • Napoleon and Typhus in Russia • 40,000 child deaths/ day-inf. and malnutrition • HIV and Poverty in Africa • 1 million deaths from Malaria/year etc. etc.

5. Probable Cases SARS, Canada • November 2002 to July 2003: • World:8,100 probable SARS cases in 29 countries -- 774 deaths • Canada:438 probable and suspect cases--43 deaths (1 suspected) Canadian Epidemic Curve

6. SARS in Retrospect Some things went right: • Heroic health professionals • National and international cooperation • Rapid collaborative work to identify • Broad public cooperation (though not perfect) • Fortunately not as infectious as others Others didn’t: • Outbreak highlighted health system’s weaknesses. • Public health capacity/ response different across country • Surge capacity was limited • Public health leadership wasn’t always there • Decision lines weren’t always clear.

7. SARS – Some Lessons • Nature is inventive and unpredictable • Next crisis a plane ride away • Hospitals = Magnifiers of risk • Economic Impacts - (contagion fear) exceed and last beyond other disasters • Role of Media- hinder and help? • Communications - public and players • Underlying Chronic Disease=Mortality • Leadership, coordination, communication vital in public health emergencies • Strong infrastructure, expertise and surge capacity is essential A Public Health Agency?

8. “The health of the public is the foundation upon which rests the happiness of the people and the welfare of the state.” Disraeli

9. Applying the Lessons Investing in Public Health, Strengthening the foundations

10. The Public Health Agency • Agency and Chief Public Health Officer created in 2004: • National public health leadership and coordination • Strengthen Canada’s ability to protect the health and safety of Canadians • Develop, implement and assess policies and programs that enable Canadians to live a healthier life. • Public Health Functions: • Population Health Assessment • Surveillance • Health Promotion • Prevention of Disease and Injury • Health Protection • Emergency Preparedness and Response

11. Peace and Stable Ecosystem Food and Shelter Education Sustainable Resources Social Support Network Child Development Working Conditions Choices and Coping Income and Social Status Health Services The Health of the Population

12. Health & Global Change • Urbanization • Climate Change • Globalization • Economic Gaps • Technology • Social Change The Basics Still Matter

13. Partner Who can we work with, to do it better together? Enable What we do directly to change the determinants Cheerlead Encouraging and not getting in the way Addressing the Determinants Mitigate Picking up some of the pieces, so it isn’t worse Advocate What should be done at policy, legislative level?

14. Building Resiliency • A disaster occurs when the impact on the community exceeds its normal coping resources. • Community’s vulnerabilities, ability to respond to / recover from disasters • Tsunamis, hurricanes, infectious outbreaks, etc • Those who are most vulnerable will be most affected • Hardest hit communities usually poorest and most vulnerable • Pro-actively build resiliency: Focus on finding ways to address underlying health of populations

15. New and re-emerging epidemicsPrinciples • Cannot completely prevent, but can reduce by addressing underlying determinants • All emergencies are messy, but the mess should be as short as possible • Basic capacity for outbreaks is the same as for prevention of chronic disease and infection • Organization and Flexibility - rapid research and analysis, control and prevention • Those who die are largely those with chronic disease, poor health or poverty

16. Pandemic Planning in Canada

17. Pandemic in Canada -- 1918-19 By today’s population: 150-160,000 deaths…but • General better health and nutrition • Antibiotics for secondary infections • Vaccines and anti-virals • Not post WWI – Magnified in trenches & mass population movements • Not multiple underlying infections • Good health care and better understanding • However, many developing countries similar

18. The next pandemic – Impact in Canada Estimates of Health impacts in Canada: • 11,000 to 58,000 deaths (Most due to secondary infections) • 34,000 to 138,000 hospitalizations • 2 to 5 million outpatients Economic costs: • health care: $330M to $1.4B • societal (lost productivity): $5- $38B Impact depends on: • Virulence, severity, age groups most affected, adverse effects/complications, • Effectiveness of the response, availability of vaccines and antivirals

19. Canada’s Pandemic Influenza Plan Objectives: • To minimize serious illness and overall deaths • To minimize societal disruption among Canadians as a result of an influenza pandemic • Whole of Government Approach • Constant updates • Domestic contract for vaccine manufacturing • Antiviral stockpile • Guides planning, surveillance, public health measures, infection control, and health care during a pandemic

20. Key Strategies • PREPARE: • Plan for rapid detection, monitoring spread, assessing impact, and risk communications • Plan extends throughout all jurisdictions to include Personal and Community Measures • Test the Plan; revise the plan; test again. • RESPOND: • Reduce spread and impact through public health measures & infection control • Vaccines and Antivirals • Maintain health emergency & social services • Business continuity and critical infrastructure • Risk communication • RECOVERY: • On-going social service support.

21. What do we have in place: Public Health Network Pandemic Preparedness Secretariat Public Health Agency of Canada Centre for Emergency Prep. and Response National Emergency Stockpile System National Office of Health Emergency Response Teams Canadian Integrated Outbreak Surveillance Centre Alerts PHAC Influenza Science and Research New CIHR Research Measures & Programs Partners & Planning Engagement

22. WHO,PAHO, UN, G8, APEC, etc. Chair of GHSAG and APEC Health task force Founding member of GOARN Support regional development of national pandemic plans Contribute to WHO Global Action Plan on Pandemic Vaccines Work with US/Mexico on continental preparedness Funding, expertise to affected regions 2007 - Cricket World Cup: Contributing to PAHO’s Enhanced Disease Surveillance project ; epi support in 5 countries Promoting Global Coordination and Strengthening Regional Capacity

23. Planning • Know partners before the crisis • Consistent, Clear, Helpful communication • Plan, Act, Reflect, Adjust • Beware -- so busy addressing the crisis, that otherwise routine becomes crisis • Don’t lose focus on Health of Population

24. Still to Do? • Continue practicing and revising plans • Continue filling in gaps, making connections • Business continuity planning • Improve local planning across sectors • More Research: Better Vaccines, Antivirals • Continue public awareness, planning and preparation • “Don’t Let the Best be the Enemy of the Good”