Pandemic Influenza Preparedness in Canada

Health SantéCanada Canada

Meeting of the National Vaccine Advisory CommitteeWashington DC, June 1-2, 2004

Pandemic Influenza Preparedness in Canada

Arlene King, MD, MHSc, FRCPCDirector, Immunization and Respiratory Infections Division,

Federal Chair, Pandemic Influenza Committee



Outline

• Evolution of Canadian Pandemic Influenza Plan

• How the Plan was used during the H5N1 (2003) and SARS responses

• How the Plan has been modified– Key challenges, successes and general lessons

learned from SARS• Current status of the Plan and next steps



Pandemic Planning in Canada• 1988: First draft plan (planning began in 1983)

• 1996: Second draft plan

• 1997: Lessons from Hong Kong “bird flu” incident• 1998-2000: Federal-provincial-territorial (F/P/T) planning process

began

• 2000/2001: Two national planning meetings and working groups established

• 2001: F/P/T Working Agreement acceptedby all provinces and territories



Pandemic Planning in Canada - II• 2001: Multiyear vaccine contracts and pandemic

contract signed• 2002: Pandemic Influenza Committee (PIC)

established• 07/2003-01/2004: Lessons from SARS incorporated• 2003 Dec 12: Canadian Pandemic Influenza Plan

approved by Deputy Ministers of Health• 2004 Feb 12: Public release of the Plan

www.hc-sc.gc.ca/pphb-dgspsp/cpip-pclcpi/www.hc-sc.gc.ca/pphb-dgspsp/cpip-pclcpi/



Pandemic Influenza Committee (PIC)

• Established under F/P/T working agreement• Federal and provincial co-chairs• 18 voting members, including all

provinces/territories• Provides technical advice for annual and

pandemic influenza prevention and control• Provides overall guidance on the Plan



PIC - II

• First meeting, March 2002, followed by regular teleconferences and face-to-face meetings in Nov 2002 and Sept 2003

• November 2002 PIC Meeting– Discussion/reformulation of goal and objectives– Review of Preparedness Section and Annexes– Review of draft Response Section



PIC - III

• January/February 2003– Preparedness Section and Annexes updated

based on meeting and consultation feedback– Plan re-structured to include:

• Introduction• Background• Preparedness Section• Response Section

– Plan posted on password protected website …



March to July 2003…



PIC “F/P/T SARS”• “F/P/T SARS:” PIC, Council of Chief Medical

Officers of Health, Canadian Medical Association, Canadian Public Health Laboratory Network

• Working Groups– Surveillance– Laboratory Issues– Clinical Issues– Infection Control– Public Health Measures

• F/P/T Communications Network



www.sars.gc.ca

• Single reference for information, tools and guidelines – for health

professionals– for public and media



Key Challenges• Public health infrastructure: Human resources,

data management capacity, policies, procedures and legislation to support public health action at all levels

• Information generation (real time epidemiology and rapid implementation of applied research)

• Information sharing (competing priorities, academic versus public health)

• Evidence-based decision making



Key Successes• Pandemic influenza structures and

processes as template for the SARS response– Early phases of the national pandemic influenza

response have been tested and applied to another emerging infectious disease

– Lessons learned incorporated into the Plan• Disease control measures, despite

uncertainties, were effective



Key Successes - II

• F/P/T communications network• International and national laboratory

networks (etiologic and genomic work and diagnostic test development)

• Other permanent partnerships in disease control, both nationally and internationally



Lessons Learned: General

• Team work is essential– Plan for dedicated leadership that will not be

pulled away to deal with other issues– Plan staffing to allow time off but for

continuity of response activities (eg, rotating shifts)

– Plan to support your staff/responders (provide meals, off hours transportation, child care, etc)



Lessons Learned: General - II

• Develop generic communicable disease emergency plans

• Need a “think tank” team that is not directly involved in the response

• Response team components should include:– Coordination and operations (with int’l liaison);

Technical (surv, epi, etc); Logistics; Communications; Think Tank



Additional Lessons Learned from Human and Avian Influenza

• Every new emergency provides an opportunity to strengthen pandemic influenza (and emerging infectious disease preparedness) … eg, Fujian (H3N2), Avian influenza (H5N1), Asia … and now, Avian influenza (H7N3), Canada … – Strengthen real time surveillance of morbidity and

mortality due to influenza– Develop capacity to do vaccine effectiveness studies



Additional Lessons Learned from Human and Avian Influenza - II

• Zoonotic diseases can and will cross the species barrier and cause illness in humans– Forge ties with those responsible for non-

human animal disease surveillance and response

• Those managing epizootics may be the index cases of the next emerging infectious disease

– Occupational health and safety personnel are allies in your public health response



Canadian Pandemic Influenza Plan

• Based on nationally agreed upon goal• Organized into components (framework for

national working group activities)• Uses WHO Pandemic Phases• National plan, outlines roles and responsibilities

of all levels of government• Model for national emergency response plans• Contains checklists and technical annexes• Dynamic or “evergreen” document



Goal of Influenza Pandemic Planning and Response

First, to minimize serious illness and overall deaths, and second to minimize societal disruption among Canadians as a result of an influenza pandemic



Overview of the PlanExecutive SummaryOverview List of Annexes I. INTRODUCTION

Goal of Influenza Pandemic Preparedness and ResponseOverview of the Canadian Pandemic Influenza Plan Roles and ResponsibilitiesThe Pandemic Influenza CommitteeThe Pre-Pandemic PeriodThe Pandemic PeriodThe Post-Pandemic Period

II. BACKGROUNDEpidemiology of Pandemic InfluenzaEstimated Impact of an Influenza Pandemic on CanadiansTerminologyPandemic Phases List of AbbreviationsLegal IssuesEthical Issues

III. PREPAREDNESS SECTIONIntroduction (to Preparedness Section)Components of the Preparedness SectionSurveillanceVaccine ProgramsAntiviralsHealth Services Emergency PlanningEmergency ServicesPublic Health MeasuresCommunicationsPlanning Activities by ComponentsPandemic Planning Checklists

IV. RESPONSE SECTIONIntroduction (to Response Section)Phased Approach Experience to DateKey Response Activities by Pandemic Phase

V. RECOVERY SECTIONCurrently in development

ANNEXESSee “List of Annexes”

•Each section for FPT audience•Consistent terminology/approach throughout•Tools: checklists, technical annexes

Released February 12, 2004




II. BACKGROUNDEpidemiology of Pandemic InfluenzaEstimated Impact of an Influenza Pandemic on CanadiansTerminology

Pandemic Phases List of Abbreviations

Legal IssuesEthical Issues

NEW!

NEW!

Refer to consultant’s documents



III. PREPAREDNESS SECTIONIntroduction (to Preparedness Section)Components of the Preparedness Section

SurveillanceVaccine ProgramsAntiviralsHealth Services Emergency PlanningEmergency ServicesPublic Health MeasuresCommunications

Planning Activities by ComponentsPandemic Planning Checklists

NEW!

Includes:• Description•Objectives•Current Status•Outstanding issues•Planning principles & assumptions



IV. RESPONSE SECTIONIntroduction (to Response Section)Phased Approach Experience to DateKey Response Activities by Pandemic Phase

NEW!

Includes:• series of tables (one table per Pandemic Phase/Level)• “Focus”, “Actions”, “Response Level” for each component

Including SARS



The Plan: Current Activities

• Using pandemic influenza structures and processes to define Canada’s response to Avian Influenza (Phase 0.2)

• “Management of Human Health Issues related to Domestic Avian Influenza Outbreaks”



The Plan: Current Activities - II• Finalize and post new Annexes (2004)

– First Nations– Public Health Measures– Surveillance

• Completion of antiviral drug strategy (2004)• Testing domestic vaccine production infrastructure,

regulatory processes and clinical trial protocols (2004-2005)

• Influenza research agenda (2004)• Further “exercising” of the Plan• Completing the Recovery Section



“The only thing more difficult than planning for an emergency is having to explain why you didn’t.”



Feuille d’érable et globe

Cette feuille d’érable stylisée nous rappelle qu’il s’agit d’une initiative nationale du Canada. La forme de la feuille fait penser à l’art autochtone — un rappelle de l’impact de la maladie sur le monde autochtone.

Le mouvement de balayage vers l’avant suggère l’élan donné au projet. Le globe au centre du design place l’initiative dans un contexte international la pandémie ne connaît pas de frontières. Les trois bandes encerclant le globe représentent les trois étapes de l’initiative : avant, pendant et après la pandémie.

Maple leaf and globe

The stylized maple leaf reminds us that this is a national Canadian initiative. The shape of the leaf is reminiscent of aboriginal art—a reminder of the impact of the disease on native peoples.

The forward, sweeping motion of the leaf suggests the momentum of the project. The globe in the center of the design places the initiative in an international context—pandemics have no boundaries. The three bands on the globe represent the three stages of the initiative: pre-, during, and post-pandemic.



Vaccine Strategy

• Goal: to provide sufficient infrastructure and capacity to produce 100% of domestic supply needs in the event of a pandemic (enough vaccine for all Canadians)– 32 million doses in 16 weeks

• Current capacity 6 million doses per month– Sufficient egg supply to maintain constant

pandemic readiness



Use of Vaccines in Short Supply1. Health care workers, including paramedics and public health2. Essential service providers / government leaders3. Persons at high risk of severe or fatal outcomes

a) persons in nursing homes and long-term carefacilities b) persons with high-risk medical conditions c) persons >65 yearsd) children 6 to 23 months of agee) pregnant women

4. Healthy adults5. Children 24 months to 18 years old



Antiviral Strategy• Options for use and stockpiling

– All available drugs in an emergency– Neuraminidase inhibitors for stockpile

• Guidelines on use of antivirals in short supply• Strategies for delivery, administration• Monitoring of distribution, uptake, wastage • Monitoring for adverse events and resistance • Clinical use guidelines



Planning Guidance forUse of Antivirals in Short Supply

1. Treatment of persons hospitalized for influenza2. Treatment of ill health care and emergency services workers3. Treatment of ill high-risk persons in the community4. Prophylaxis of health care workers 5. Control outbreaks in high-risk residents of institutions (nursing

homes and other chronic care facilities) 6. Prophylaxis of essential service workers7. Prophylaxis of high-risk persons hospitalized for illnesses other

than influenza8. Prophylaxis of high-risk persons in the community

Pandemic Influenza Preparedness in Canada

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