Inside Canada's frayed pandemic early warning system and its COVID-19 response
The Global Public Health Intelligence Network was getting an overdue tech upgrade when COVID-19 hit
As COVID-19 quietly incubated in Wuhan, China, last fall, public health officials in Canada were looking for gaps that needed to be closed in their long effort to upgrade this country's online pandemic early warning system.
Few people outside of a tight circle of highly-specialized epidemiologists and federal bureaucrats had ever heard of the Global Public Health Intelligence Network (GPHIN) before the novel coronavirus became a global pandemic.
That's probably going to change now.
The online, multilingual monitoring and analysis unit, which scours the internet for media reports of infectious diseases, has been a crucial pandemic tripwire for both Canada and the World Health Organization (WHO).
The network delivered its first report about COVID-19 on Dec. 31, 2019 — one day after a similar online monitoring network known as ProMED issued its notification.
CBC News has obtained a series of internal public health agency documents and slide-presentation decks — including one given by a senior epidemiologist from the Public Health Agency of Canada (PHAC) last November on the eve of a pandemic that has since killed tens of thousands and crippled the world economy.
Network needed a tech upgrade
The documents bring into sharper focus the kind of information key decision-makers had at their fingertips as the outbreak started in China and raise questions about how seriously global pandemic preparedness was being taken within the federal government.
The records show GPHIN was in the middle of a long-overdue technology upgrade as the virus was spreading.
Despite almost four years of work with the National Research Council of Canada, the early warning system was — as of last fall — still in need of "improvement in the geographical and time tagging algorithm," according to a Nov 12, 2019 presentation to a WHO conference in Seoul, South Korea by senior epidemiologist Florence Tanguay.
That algorithm is crucial to the system's ability to sort through as many as 7,000 online articles per day to spot disease outbreaks around the globe.
The network also was awaiting an "expansion to new data sources," such as social media feeds. From its inception in the late 1990s, GPHIN had relied on news wire services and later local media articles posted online.
Network's first alert came from a media report
At the time when GPHIN and ProMED issued their COVID-19 notices, little was known about how deadly or contagious the outbreak might be — but the early signs were ominous.
The International Society for Infectious Diseases, which runs ProMED, cited multiple urgent notices from official Chinese sources. One came from the Wuhan Municipal Health Committee, which warned that "multiple patients had been isolated" and medical institutions in China should be on the lookout for respiratory infections "and improve emergency plans for medical treatment."
But the GPHIN's initial notice to its 800 subscribers, which include the WHO as well as the health ministries in Canada's provinces and in 85 countries around the world, cited an Agence France-Presse report.
Chief Public Health Officer Dr. Theresa Tam said last week GPHIN was one of the intelligence sources she relied on, crediting it with detecting the outbreak in Wuhan "right at the end of December."
It wrote daily reports on the progress of the virus, she said.
The Canadian government most likely would have been aware of the ProMED reports and has, according to senior health officials, also had personal contact with agencies in other countries, notably the U.S. Centers for Disease Control.
Earlier this month, the military's health intelligence unit acknowledged it also had been writing regular briefings on the novel coronavirus since early January.
'Critical warning task'
Another major source of intelligence for the Canadian government, naturally, was the World Health Organization — although the documents show up to 20 per cent of that institution's open-source intelligence comes from GPHIN.
It is difficult to understate the importance of the Canadian network, said one of the country's leading intelligence experts.
"The Global Public Health Intelligence Network was meant to perform a critical warning task with regard to the COVID-19 ... outbreak. This was its job," said Wesley Wark, a University of Ottawa professor.
"It should have been at the heart of a Canadian and indeed a global early warning system."
Created in 1997, GPHIN is credited with helping spot the SARS and H1N1 outbreaks.
Did world governments get GPHIN's warnings?
During those previous outbreaks, the network issued rolling email alerts to those governments and the WHO as the viruses it was tracking appeared in new countries.
The documents obtained by CBC News raise questions about whether that practice of issuing specific alerts was followed in the case of COVID-19. The decision to issue those warnings would have been up to the Public Health Agency of Canada.
Wark said those warnings and alerts would have been crucial to other governments — and likely would have been taken more seriously than others because they'd be coming from GPHIN, a trusted source.
"It was the institution that was meant to have the technical tools, meant to have the expertise that governments and health experts around the world would look to as the most reliable source of open-source medical intelligence during an outbreak," said Wark.
But to date, he said, he's seen no indication of how GPHIN daily reports were used, or if they even made their way into government risk assessments.
"The dismaying reality about the Canadian threat assessment of COVID-19 is — from the record we have available — it appears that for some reason or another, Health Canada, the Public Health Agency of Canada, was not able to generate ... consistent, daily reporting from its key sources of information, like the Global Public Health Intelligence Network," said Wark, who pointed to the absence of the reports in documents tabled before the House of Commons health committee.
"The risk assessments referred to in some of the documents made available to the House committee suggest there were only periodic assessments that were done."
The creator of the Global Public Health Intelligence Network says that, despite the network's accomplishments in flagging SARS and H1N1 before they took off, successive Canadian governments have had to be convinced of the need to invest in a global disease early warning system in the age of globalization.
"Governments, [in] Canada and elsewhere, do not invest in preparedness," said Ron St. John, a former director general at the Public Health Agency of Canada who once served as the country's quarantine officer.
"GPHIN, although it had proved itself, was never fully financed."
The network was conceived in 1997. Throughout St. John's time in government, he said, GPHIN was on budgetary life support. He said the Centre for Emergency Preparedness and Response routinely had to use a portion of its budget to keep the network "alive" because it never received enough federal money.
A spokesperson for the Public Health Agency of Canada insisted the network produced quality information for the health agency and the government as a whole.
"From the start of the COVID-19 outbreak, GPHIN was, and continues to be, an important source of public health intelligence for PHAC," said Natalie Mohamed in an email.
Aside from funding, one of the recurring challenges faced by GPHIN has been the speed of technological change and the importance of keeping the network modern, said St. John.
In the presentation Tanguay gave to the WHO last fall, she told delegates the network had undergone a reboot in "collaboration with the National Research Council of Canada" (NRC) which led to the development of a "new, enhanced web-based platform using emerging technologies" powered by more automation.
She was referring to artificial intelligence systems.
Built on late-1990s technology that had been only partially refreshed, the aging network was by 2016 in need of a major overhaul.
The federal government had known for a long time about GPHIN's antiquated system. A 2013 evaluation of epidemic intelligence systems red-flagged trouble that the Global Health Security Initiative — an Ottawa-based partnership between countries that works to strengthen national defences against large-scale health threats — experienced in sourcing information for an ongoing evaluation.
The GPHIN "system design did not allow the extraction or collection of data in a format compatible" with the security initiative analysis, the report read.
In a report posted online early this month, NRC suggested the project was a success.
Even so, the federal government recently put out a request for help from industry to address certain functional aspects of the GPHIN system, including search and location extraction.
In addition, the public health agency has formed a partnership with the University of Toronto's Brain Alliance big data research centre to improve aspects of the network.
Mohamed said the renewal project is in its final stages and has met key objectives.