Photo by Henry Romero/Reuters

April 3, 2012 – Globe and Mail

ANNA MEHLER PAPERNY

There are still serious shortcomings in the way public-health bodies communicate with physicians, nurses and pharmacists on the front lines of a pandemic, says the Public Health Agency of Canada.

And almost three years after a flu pandemic put the country on high alert, the federal agency has put out a call for a new strategy to improve communication with clinicians during pandemic response.

There are “specific gaps and challenges” when it comes to Canada’s current process of giving the health-care community guidance for dealing with a pandemic, the public-health agency said in a request for proposals it put out last week.

Those gaps include everything from the way researchers study hospital admissions – is there a spike in flu or pneumonia in a certain area? – to the way public-health agencies tell physicians who should get a vaccine, and where and when they should get it.

The request comes as a group of health professionals convened by the agency embarks on a year-long project to rewrite Canada’s six-year-old pandemic response strategy. At the same time, Canada is pledging increased international co-operation in dealing with the threats of infectious disease in an increasingly globalized environment.

During their meeting in Washington Monday, Prime Minister Stephen Harper, U.S. President Barack Obama and Mexican President Felipe Calderon announced the North American Plan for Animal and Pandemic Influenza. The strategy is meant to co-ordinate preparation and response to diseases with no respect to borders or trade agreements.

It’s fitting, notes Bonnie Henry, director of Public Health Emergency Management with the British Columbia Centre for Disease Control: The swine flu that sparked a global pandemic in 2009 originated in Mexico, and not even its closest neighbours saw it coming. Dr. Henry is a member of the committee crafting a new pandemic response plan.

The crucial thing about this latest public offering, she notes, is that it goes to one of the most basic elements of pandemic preparation and response: Get public-health officials talking to the people dealing directly with patients – and vice versa.

It may sound like a no-brainer to neophytes, but facilitating communication among 13 divergent provincial and territorial health-care systems, a federal organization and myriad local and regional health authorities is not so simple.

“It was an area that we hadn’t really fully developed: People were unclear where to go to get the information they needed, who to get it from and who’s calling the shots along the way,” Dr. Henry said. “We learned a lot. … [But] there are still gaps there.”

These basic gaps are at the core of some of the most commonly identified problems with Canada’s response to the H1N1 pandemic. And if communication breakdowns stymied front-line physicians, the public was confused completely.

The Public Health Agency of Canada wants a new process to develop, disseminate and evaluate pandemic guidelines for all types of health-care professionals in areas both metropolitan and remote. The agency wouldn’t comment on the scope, timeline or estimated cost of the project Monday.

This request for proposals comes just as a five-year, multimillion-dollar research project in comprehensive pandemic planning and research winds down. The Pandemic Preparedness Strategic Research Initiative was created to tackle pandemic threats from all perspectives, including vaccines, virology, prevention and the ethics involved in managing a large-scale medical emergency.

Outlasting it is a more specific research project, a joint effort between the Public Health Agency and the Canadian Institutes of Health Research, focused on creating, testing and distributing vaccines as quickly as possible.

Its emphasis on speed, says Marc Ouellette, scientific director of CIHR’s Institute of Infection and Immunity, is in response to one of the key lessons from the previous pandemic – the ability to swiftly pivot in response to threats that didn’t exist a week ago.

“We need to be more nimble,” Dr. Ouellette said. “It’s not easy: You don’t know where the enemy is coming from.”

A review of Canada’s response to the H1N1 pandemic noted flaws public-health agencies are still grappling with:

Who’s on first?

Information-sharing is vitally important to combatting a widespread, ever-changing disease. It’s also extremely difficult, given Canada’s myriad, often isolated levels of health care and governance. Provinces and territories need to know what the federal government is doing, and vice versa; front-line physicians need to pass infection information to public-health officials, who need to ensure those on the front lines know what’s going on.

Get a (highly flexible) grip on reality

It’s one thing to spend years planning a pandemic response, down to numbering each anticipated phase of the virus’s spread; it’s quite another to react to that outbreak on the ground, says the B.C. Centre for Disease Control’s Bonnie Henry. Those phases don’t always pan out as planned.

Public-health agencies sought to prioritize the most vulnerable populations for the first round of vaccines. But they didn’t plan a vaccine rollout for remote and often woefully under-resourced first nations communities. The result was, in many cases, a delayed, unco-ordinated or inadequate response. This was made most evident by a highly publicized delay of hand-sanitizer shipments because of concerns over their alcohol content.