Public health agency was unprepared, led to lacking early pandemic response: AG
OTTAWA -- The Public Health Agency of Canada (PHAC) “underestimated” the potential impact of COVID-19, and was not adequately prepared to respond in the early days of the pandemic after failing to heed decades-long recommendations for changes, according to new findings from the auditor general.
Further, shortcomings with the pandemic early-warning system, and how the Canada Border Services Agency (CBSA) and PHAC applied and followed up on border restrictions impacted the federal government’s overall efforts to control the virus’ spread.
In a report card that was tabled in the House of Commons on Thursday and assessed the federal government's pandemic preparedness, surveillance, and border-control measures, auditor general Karen Hogan noted some of the key weak points in the first six months of COVID-19 hitting this country.
“We will never be able to tell Canadians what would have happened if the preparedness issues had been better addressed before the pandemic hit and if all plans had been updated and tested as they needed to be. Perhaps the government’s pandemic response would have been different,” Hogan said in a statement accompanying her latest reports.
The audit covered the agencies’ response from Jan. 1, 2020 to June 30, 2020, and involved interviews with departmental and federal officials, review of relevant documents such as meeting minutes, explanations of the internal processes, and analysis of available data.
Among the shortcomings exposed in this performance audit:
- Prior to this pandemic, PHAC failed to heed recommendations to improve its information-sharing, and while it had developed plans to guide a national health response to a pandemic, they were not regularly updated and never tested;
- PHAC relied on a risk assessment tool that was not designed to consider pandemic risk, and as a result continued to state the risk to Canadians was low, even as cases began to grow exponentially;
- The Global Public Health Intelligence Network (GPHIN), Canada’s so-called pandemic early warning system, did not issue an alert about the emerging novel coronavirus that would have informed decisionmakers on the public health measures needed to control spread;
- The Canada Border Services Agency quickly implemented restrictions at the border and quarantine measures, however the agency didn’t verify its officers were properly applying exemptions to travel restrictions for essential workers; and
- Lacking a pre-existing national plan for mandatory quarantine, PHAC attempted to follow-up with 60 per cent of incoming travellers, but could only confirm compliance for one-third of them. Even when people were flagged for being a risk for breaking the rules, they weren’t always followed up with.
In terms of lacking pre-planning, among the most damning findings was that while PHAC is responsible for leading the updating of pan-Canadian preparedness plans, the two main plans were several years outdated by the time COVID-19 hit.
Specifically, the “Health Portfolio Strategic Emergency Management Plan” is supposed to be reviewed every two years at a minimum, but it had not been updated since 2016.
Worse, the “Health Portfolio Emergency Response Plan” was to be regularly updated to reflect any changes to policy or lessons learned, but the auditor general found the last time it was assessed was in 2013, “despite an agency evaluation on pandemic preparedness and response done in 2018 that identified the need to review and update the plan by March 2020.”
When reports began emerging of a cluster of cases of a new coronavirus in Wuhan, China back in December 2019, PHAC still had outstanding health surveillance and information technology (IT) infrastructure issues identified in the aftermath of both the 2009 H1N1 pandemic and 2003 SARS epidemic.
Around this time, Health Minister Patty Hajdu told reporters asking about this mysterious new illness that Canada had learned lessons from these past health crises and was ready to respond.
Reacting to the auditor general’s findings, Hajdu said that despite the shortcomings noted in the report, the agency was making preparations.
“Every country… is going to be reviewing lessons learned, and there will be a full review of the Public Health Agency of Canada and the government's response as a whole, but I can confidently tell you that Dr. Tam and the entire Public Health Agency of Canada, knew that this was a health threat to Canadians and knew that we needed to begin our preparations… and that is exactly what happened,” she said, noting that in the last year more than 1,000 additional employees have been hired to assist the agency.
“Identifying, tracking, and forecasting the spread of viruses helps governments and public health officials quickly respond and deploy resources,” writes Hogan in her report.
“We found that the Public Health Agency of Canada had not made satisfactory progress on selected recommendations made in our previous audit reports on health surveillance information.” Some of these recommendations not taken date back to 1999.
“I am discouraged that the public health agency did not address long-standing issues, some of which were raised repeatedly for more than two decades. These issues negatively affected the sharing of surveillance information between the agency and the provinces and territories, during the pandemic,” said Hogan during a press conference at the unveiling of her report.
Hajdu said that in October 2020, a new national public health data portal was set up to assist with information-sharing.
EARLY WARNING NOT SENT
In early 2020, PHAC continued to assess the risk of the virus to Canadians being low and rather than issuing an early warning, the GPHIN sent daily email reports with links to news articles.
In contrast, while an alert for the unknown pneumonia later called COVID-19 was not proposed by GPHIN analysts even after suspected cases reached Canada, the network’s mandate is to alert “an unusual event that has the potential for serious impact or spread,” and had alerted to an Ebola-like illness detected in Uganda in 2019.
Part of the scramble when it came to the early alert was that the mechanisms to assess the risk of the pandemic that were not working as intended. For example, an artificial intelligence tool continued to generate a low risk rating.
Hogan equated the alert to a household smoke detector in that when it goes off, you know to go and inspect what’s going on and react as needed.
“It's unclear why an alert was not issued, and here again is where the chief public health officer [Dr. Theresa Tam] was key in the response in the country, in that she was able to provide an alert to her provincial counterparts… but the fact still remains is that GPHIN did not issue an alert as we believe it should have,” Hogan told reporters.
On Thursday, Hajdu defended her early comments that that the health threat was low, saying that there is a difference between the health threat to individuals and the threat to a country as a whole.
“Certainly in the early months when we had little to no disease activity, COVID disease activity here in Canada, the threat was indeed low to Canadians, individual Canadians here in Canada, but of course as we started to see cases rise… and when Dr. Tam made the assessment that indeed the threat risk to Canadians of contracting COVID-19 was rising, those threat risks were changed accordingly,” she said.
Hajdu noted Thursday that an external review is currently underway of the pandemic early warning system, with a report and further recommendations expected this spring.
BORDER ENFORCEMENT ISSUES
Within a week of the World Health Organization declaring COVID-19 a global pandemic on March 11, 2020, Canada had 400 confirmed cases and PHAC acknowledged that the virus posed a serious health risk to Canadians.
It then took 10 days for Canada’s international borders to begin closing, and another few days before the emergency order imposing a mandatory 14-day quarantine for incoming travellers came into effect.
Once the border measures were in place—which the auditor general found to be quickly enforced—the CBSA failed to review whether all officers at all border checkpoints were consistently applying the essential worker exemption.
Further, while the CBSA worked closely with PHAC on the planning for and execution of the restrictions under the Quarantine Act, public health officials conducting quarantine check-ins did not consistently verify the mandatory isolation orders were being abided by.
As well, PHAC had challenges in contact tracing, and as a result wasn’t able to identify whether new COVID-19 cases were the result of close contact with a traveller who broke their quarantine.
“Of the individuals considered to be at risk of non-compliance, the agency referred only 40 per cent to law enforcement and did not know whether law enforcement actually contacted them. The agency had not contemplated or planned for mandatory quarantine on a nationwide scale and, as a result, had to increase capacity to verify compliance,” the report reads.
Reacting to the report, Public Safety Minister Bill Blair said he was pleased that the auditor general noted border officers’ quick enforcement of the travel measures once they were implemented.
“CBSA had a pandemic plan, which was further developed as the pandemic evolved,” Blair said, adding that work is being done to brief all officers on the implementation of any new border provisions.
Over time, the federal health agency did manage to course-correct and has been working “persistently” to support Canada through the unprecedented health crisis and improve its data collection and surveillance, Hogan notes in the report. However, there remain issues that need to be rectified to avoid history repeating itself the next time Canada finds itself facing down a global pandemic.
One example of the outstanding gaps in provincial-federal communication is that according to the auditor general, between February and June 2020, just four per cent of COVID-19 cases in Canada were reported to PHAC within 24 hours of detection.
“The lack of complete and timely surveillance data made it difficult for the agency to meet its two main public health surveillance goals during the COVID-19 pandemic: detecting and containing the virus early [and] characterizing the clinical features (such as symptoms) and epidemiologic features (such as close contacts or travel history) of COVID-19 cases to better inform prevention and control efforts,” reads the report.
Among the recommendations, which have largely been agreed to by PHAC and CBSA:
- Have the public health agency conduct an autopsy on the COVID-19 response and make changes including IT upgrades promptly, based on the lessons learned and gaps exposed in their data sharing, virus surveillance, and general pandemic readiness;
- Re-evaluate how the Global Public Health Intelligence Network is utilized, something PHAC has defended in response to this report, stating in the agency’s eyes it “performed its key function of providing early warning within Canada”; and
- Ensure the CBSA border officers and PHAC quarantine compliance officials have the tools they need to enforce the travel restrictions and border control measures, including improving the collection of contact information needed to trace cases and conduct more follow-up.
Pre-emptively responding to the findings before the report was tabled, Deputy Chief Public Health Officer Dr. Howard Njoo said Thursday that while the audit focused on the first half of 2020, “lots has happened even since then in terms of measures and steps that the agency has taken to address… some of the issues, concerns raised in the report.”
“There's always things that we can learn from as we look forward, things we could do in the future differently or better,” Njoo said.
In a joint statement, Hajdu and Blair said that $690.7 million was allocated to PHAC in the fall economic statement to “allow CBSA and the Public Health Agency to keep adjusting their approach, informed by the latest available scientific evidence and epidemiology– with the objective of always keeping Canadians safe."
Responding to the findings, the Conservative Party issued a statement from a series of MPs with relevant critic portfolios saying that the auditor general’s report “confirms what we already knew.”
“The Liberal government was slow to react to reports of the COVID-19 pandemic. When they called over a million Canadians home last year, they had not implemented the necessary tools to monitor returning travellers, and they didn’t have the ability to enforce quarantine…. They underestimated the threat of the virus and downplayed the risk of the pandemic, putting Canadians' health and well-being, the economy, and our prosperity in jeopardy,” read the statement. “We must never again be caught as unprepared as we were when COVID hit last year.”