Peter Phillips is Clinical Professor of Medicine in the Division of Infectious Diseases at the University of British Columbia.
During the past year, findings related to the gradual dismantling of Canada’s Global Public Health Intelligence Network (GPHIN) prompted an independent review of the Public Health Agency of Canada (PHAC). The GPHIN had been created in the 1990s and served as an early warning system for international health threats using global open-source data. It was highly regarded internationally and had been an asset to the WHO. However, it stopped issuing international alerts in May of 2019. Last month the Auditor General, Karen Hogan, released the review and stated that “the agency [PHAC] was not adequately prepared to respond to the pandemic and it underestimated the potential impact of the virus.” There are now reports of a proposal to relocate the GPHIN to the University of Ottawa’s Bruyere Research Institute so that it can work independently from government.
Access to data on potential health threats, weeks or even days earlier than by way of conventional sources may be critical in changing the course of an epidemic. Well after early warning systems generate alerts, information on health threats are reported by public health departments or the WHO, in the media, as non-peer-reviewed papers on pre-print servers (e.g., medRxiv) and later in peer-reviewed scientific journals. However, timely information is only of value if decision-makers utilize it effectively with prompt measures to counter the threat.
If the GPHIN had been fully functional, important data regarding COVID-19 would likely have been available to PHAC and Canada’s governments in December 2019. It wasn’t. However, before the end of January 2020, publications in reputable peer-reviewed journals had already warned of a possible COVID-19 pandemic and documented the following disturbing findings: 1) a crude mortality rate of 2.9% (vs ~ 0.1% for seasonal influenza, but similar to the 1918 Spanish influenza at <5%); 2) human to human transmission of the pathogen; 3) evidence of transmission from individuals without symptoms; 4) far greater contagious risk than SARS in 2002; and 5) epidemic spread to 32 other provinces in China, 5 other countries, and 3 jurisdictions (Singapore, Hong Kong, Taiwan). In addition, there was the alarming spectacle of the first of 2 one thousand-bed hospitals being built in Wuhan in 10 days (January 23-February 2), reminiscent of the temporary US military hospitals utilized during the Spanish influenza.
By the end of January 2020, it should have been clear that COVID-19 had the potential to be a greater respiratory virus pandemic threat than anything experienced in the past 100 years.
Yet, despite these warnings by late January 2020, the federal government and PHAC delayed implementation of both the Quarantine Act and mandatory border restrictions until 2 months later on March 25th. During that time, Canada continued to follow the advice of China and the WHO, which included the recommendation not to implement border restrictions with quarantine. The COVID-19 epidemic was underestimated and Canada’s political agenda prevailed, including foreign relations interests with China and overestimated concerns related to the economic impact of travel restrictions and societal acceptance of such measures. For the most part, the Western Pacific jurisdictions that successfully controlled COVID-19 did not follow such recommendations. For the most part, the Western Pacific jurisdictions that successfully controlled COVID-19 did not follow suit.
Some Canadians could see what was needed and implemented their own precautions well before government decision-makers realized they were necessary. For example, by February 2020 the Canadian Chinese community in Richmond, BC had reduced communal gatherings, increased mask usage and, along with several WeChat groups across the country, facilitated self-imposed quarantine for their friends and relatives returning from various regions where there was ongoing transmission.
The tainted blood tragedy of the 1980s involving the transmission of both HIV and hepatitis C gave way to the Krever Commission in 1997. The SARS epidemic in 2002-2003 resulted in the SARS Commission report in 2007. Major recommendations which emerged from both of these reviews included the need for decision-makers to follow the “precautionary principle”, which states that action to reduce a health risk should not await scientific certainty. However, the application of this principle in public health should be guided by an assessment of the level of certainty and severity of the health risk, and the acceptability and societal consequences of both action and inaction.
The delay in Canada’s early response to COVID-19 related to the dismantling of the GPHIN appears to have been overshadowed by the delay related to the failure to apply the precautionary principle in late January, by which time there was considerable published evidence of a major pandemic threat. Unfortunately, lack of attention to the precautionary principle continues to be a major shortcoming of Canada’s response to health-related threats, despite attempts of previous commissions to draw attention to this recurring problem. The upgrading of the GPHIN needs to be accompanied by full adherence to this principle.