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Federal Report: Learning from SARS
Renewal of Public Health in Canada

Cheryl Krawchuk, CBC News Online | Oct. 7, 2003

Canada needs to create a national face for public health care that will play a lead role in any future health crises.

Dr. David Naylor
This is the key lesson of SARS, says Dr. Andrew Naylor, who released his 234-page report into the outbreak of severe acute respiratory syndrome in Canada on October 7, 2003. Naylor, dean of medicine at the University of Toronto, was appointed by Health Canada to head the federally sponsored National Advisory Committee on SARS and Public Health.

Forty-three Canadians died from SARS since the first known case was reported in Toronto on February 23, 2002. While most of the country's 251 probable or suspected cases were in Ontario, there was also a small outbreak in British Columbia.

Naylor, who earlier called Canada's handling of the outbreak an "international embarrassment," blamed it on a lack of leadership, poor collaboration between provincial and federal health organizations and longstanding funding and workforce shortages in the field of public health care.

Canada has to learn from the hard lessons of SARS and look at the outbreak as a "reminder, warning and opportunity" to renew the public health system. Disease prevention around the world is only as strong as its weakest link – Canada must provide a strong link, said Naylor.

Highlights from Naylor's 75 recommendations include:

  • Create a national organization to monitor public health. Similar to the Atlanta-based Centers for Disease Control, the Canadian Agency for Public Health or "CDC North" would act as an umbrella organization for health agencies across the country to help share and promote information;

  • Appoint a chief public health officer similar to the surgeon general in the United States. This person would lead the Canadian Agency for Public Health and report directly to the federal minister of health;

  • New agency will form knowledge-sharing partnerships with government and academic research institutions;

  • Ottawa should increase spending on public health care by $700 million per year by the year 2007;

  • Federal, provincial and territorial governments should work together to create a strategy to address the shortage of public health care workers, including nurses, doctors, microbiologists and infection control experts;

  • Bolster a national laboratory surveillance system to identify and anticipate future outbreaks;

  • Boost the national immunization strategy by $100 million and place it under control of the new national agency;

  • Canada, in conjunction with the World Health Organization, should take a lead role and push for international standards regarding when to issue travel advisories and warnings.

Lack of government co-operation

Naylor identifies specific examples of "multiple, serious inadequacies" in the handling of SARS. While praising the work of frontline health care workers despite a lack of funding and skilled workers, the committee says they were hampered by the conflicting responses of all government levels:

  • The Ontario Health Ministry didn't share data with infectious disease experts from the National Microbiology Laboratory in Winnipeg, saying the information could breach patient confidentiality;

  • There was tension between the offices of Dr. Colin D'Cunha, commissioner of public health, and Dr. James Young, Ontario's commissioner of public safety, as to who was in charge. "In separate interviews, both Drs. Young and D'Cunha acknowledged that the dual leadership structure was less than ideal and one person should have been in charge," the report said;

  • Airport screening for SARS, ordered by the World Health Organization, was likely ineffective.

Health Canada 'invisible'

Saying the health of Canadians was undermined by a lack of co-operation between governments, Naylor was especially critical of Health Canada, calling the federal department "largely invisible" on the front lines of the outbreak.

But he was most agitated when discussing government inaction. In the report, the committee echoes recommendations made in 1993 in another study commissioned by Health Canada, Naylor said. "The National Advisory Committee on SARS and Public Health has found that there was much to learn from the outbreak of SARS in Canada – in large part because too many earlier lessons were ignored," said the report.

Arms-length agency needed

An arms-length national agency setting the public health agenda will ensure the priorities are scientific, rather than political, says Naylor.

The agency, which will report directly to the health minister, will follow a "hub and spoke model" with links to existing and new regional public health centres, instead of being located in one area. Winnipeg, home to Canada's National Microbiology Laboratory and Ottawa, home to the Centre for Infectious Disease Prevention and Control, have already lobbied to become the home of the new agency.

Report reaction: quick quotes

"This report reflects much of what we said last spring…The federal government failed to show effective leadership in co-ordinating a national response and was virtually invisible during the outbreak."
—Canadian Alliance health critic Rob Merrifield.

"Dr. Naylor's recommendations appear to be very good."
—Linda Silas, President of the Canadian Federation of Nurses Unions.

"I would like to move quite quickly…It's not possible to say the timeframe here. But I am very much committed to ensuring it is reviewed quickly and acted upon."
—Federal Health Minister Anne McLellan says she supports the report's recommendation to create a national public health agency.

"If we don't listen to those that are day-in and day-out working with patients, no system and no co-ordinated national approach will decrease the number of (disease) transmissions."
—Doris Grinspun, executive director of the Registered Nurses Association of Ontario, says a national agency isn't the only solution to improve public health.

"We have to move away from pencil, paper and flip charts."
—Toronto Public Health Medical Officer of Health Sheila Basrur says public health needs a financial investment in new technology and resources.



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The SARS (Campbell) Commission

New England Journal of Medicine

Canadian Medical Association

Ontario Ministry of Health Update on SARS

Vancouver SARS page

Hong Kong SARS page

WHO: SARS Outbreak News

World Health Organization travel advisory

Health Canada SARS site

Toronto Public Health's SARS site

Health Canada travel advisory

Severe Acute Respiratory Syndrome (SARS), Centers for Disease Control and Prevention

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