The goals of influenza pandemic preparedness and response are:
First, to minimize serious illness and overall deaths, and second to minimize societal disruption among Canadians as a result of an influenza pandemic.
These goals will be realized only through the coordinated efforts of all levels of government in planning and preparation.
The objectives of the Canadian Pandemic Influenza Plan for the Health Sector are:
To assist and facilitate appropriate planning and response at all levels of government by
To provide a Plan that is reviewed on an annual basis to ensure the incorporation of new developments and to ensure consistencies with best practices.
To provide an evaluated Plan that is sufficiently clear and comprehensive to ensure operational viability.
Pandemic contingency planning activities in Canada began in 1983. The first detailed draft of a plan, then referred to as the Canadian Contingency Plan for Pandemic Influenza, was completed in 1988; there have been several drafts since then. The latest plan, first published in February 2004, now referred to as the Canadian Pandemic Influenza Plan for the Health Sector (the Plan), targets a wide range of people in the health sector who will be involved in planning and responding to an influenza pandemic; these include health emergency responders, health planners, health care workers, public health laboratories, as well as those involved in the manufacture, registration and supply of pharmaceuticals. However, the primary audiences are the P/T Ministries of Health because the provision of health care and essential services is the jurisdiction of the provinces and territories.
Given that an influenza pandemic is the public health event that is the most likely to have a major national impact, a specific plan to address this national public health emergency is needed. The Canadian Pandemic Influenza Plan for the Health Sector is one of several national emergency response plans. The Plan is however focused on the health sector response and therefore is not designed to address other important issues such as business continuity during a pandemic. As a national plan this document is intended to provide guidance and support planning at the P/T, regional, local and facility level. Each level of government and each health care institution should develop their own pandemic plans that use the overall approach in the Plan but contain more operational details relevant to the specific site or jurisdiction.
The Plan consists of a Preface, the core sections and the annexes. The Introduction Section and the Background Section are followed by the Preparedness Section and the Response Section; a Recovery Section is being developed for a later edition of the Plan. The Introduction and the Background Sections provide the conceptual and historical basis for the Plan and highlight overarching principles, such as roles and responsibilities. The Preparedness and Response Sections and pending Recovery Section reflect the general principals of emergency response of the Plan. Under this framework, the types of preparedness and response activities needed for comprehensive pandemic planning can be summarized as follows:
Prevention activities include planning actions to ensure that all existing or known or unavoidable risks are contained. In conjunction with infection control recommendations (e.g. hand hygiene, respiratory etiquette), immunization with vaccines is the primary means of prevention (e.g., pneumococcal vaccine in the Interpandemic Period and pandemic vaccine once it becomes available); it forms the basis of the pandemic response in Canada and many other countries. The annual vaccine infrastructure is the building block used to develop the pandemic vaccine response.
Preparedness activities include preparing the actual plans, training and simulation exercises to pretest the plans, communications and other interfaces to inform the public and other stakeholders.
Mitigation/Response activities are directed at controlling the pandemic and repressing direct outcomes (mortality and morbidity due to influenza) and indirect associated effects (social disruption). Implementation of these activities would involve a series of escalating and potentially varying (but harmonized) responses as the pandemic unfolds across the country. Implementation also involves documenting activities and outcomes to determine if a more extensive response is required or if adjustments to the planned response are necessary.
Recovery activities may start at different times across the country as the pandemic waves move through the various jurisdictions. These activities involve the organization of post-event activities to ensure restoration of “normal” Interpandemic services and service levels. Dismantling alternative care sites, phasing out alternate care workers, and commencing new services that may be required to address the impacts are examples of these types of activities. Activities would continue until the declaration of the end of the pandemic in Canada and the Interpandemic status is restored.
The content of this comprehensive pandemic influenza plan for the health sector has been organized into components. These components which include; surveillance, vaccine programs, the use of antivirals, health services, public health measures and communications, are first identified in the Preparedness Section. In that section, each component is addressed in terms of current status as well as planning principles and assumptions. Checklists of potential planning activities are also included as an annex (Annex A, Planning Checklists).
The Preparedness Section addresses prevention and preparedness activities during the Interpandemic Period. This section is the result of work that began after the first national meeting on F/P/T and local planning, which was held in January 2000; it is based on the deliberations of a number of pandemic influenza working groups, as well as the input of other stakeholder groups and organizations. The purpose of this section is to provide information and guidelines that can be used in the development of plans for F/P/T and local management of an influenza pandemic.
The Response Section addresses high-level operational activities for an effective national health sector response, including essential F/P/T coordination. (See Annex L, for details on the National Emergency Response System.) The Recovery Section, which is anticipated for the next edition of the Plan, will provide guidance on the coordinated post-pandemic activities for the health and emergency response sectors.
The national working groups and subcommittees addressed specific issues in the Plan and developed the guidelines and reference documents annexed in the Plan. The original working groups included: Surveillance, Vaccines, Antiviral Drugs, Public Health Measures, Communications and Health Services, with the latter divided into Infection Control, Clinical Care, Non-traditional Sites and Workers, and Resource Management. Each annex was created to address specific issues related to the overall goals of pandemic planning: firstly to minimize serious illness and overall deaths and secondly to minimize societal disruption among Canadians. The annexes published with the 2004 edition of the Plan were written based on the data available and prevailing beliefs and approaches to pandemic planning at that time. The annexes have been or are in the process of being updated to reflect current thinking and advancements in science and planning activities, and some new annexes have also been added to this edition to make the Plan more comprehensive.
A coordinated response to pandemic influenza requires collective infrastructures, response capacities and coordinated activities that will permit the F/P/T Ministers of Health and their representatives to anticipate problems, monitor for adverse outcomes and respond to minimize the impact of pandemic influenza within their jurisdictions.
The roles and responsibilities of the Pandemic Influenza Committee (PIC) and the F/P/T Ministers of Health were detailed in a Working Agreement between Deputy Ministers of Health in March, 2001.The Working Agreement is an iterative document that allows for roles and responsibility components to be adapted or added as they are developed. This agreement was drafted prior to the creation of PHAC in September 2004. Currently PHAC and Health Canada, which together now comprise the federal health portfolio, will cover the federal responsibilities.
The F/P/T roles and responsibilities, including joint responsibilities as outlined in the Working Agreement 2001, are captured in the current Plan.
In general, the roles and responsibilities of the respective jurisdictions are as follows:
The PIC is a F/P/T committee that first met by teleconference in March 2002. It is co-chaired by two public health experts who represent the federal and P/T governments. The PIC is supported by the CIDPC, PHAC. With the establishment of the Pan-Canadian Public Health Network, PIC now reports to the Communicable Disease Control Expert Group, the terms of reference for PIC are being updated.
The mandate of PIC includes providing advice, expertise, recommendations, liaison and other activities associated with the Interpandemic, Pandemic Alert, Pandemic and Post-Pandemic Periods to support the health and safety mandates of all levels of government. The PIC will also provide advice, assistance and expertise concerning the development, maintenance, testing and evaluation of the Canadian Pandemic Influenza Plan, and when requested to do so, any P/T contingency plan.