The advisory group appointed to assess lessons learned from Canada's recent SARS epidemic has handed federal Health Minister Anne McLellan a seemingly infinite list of problems.
In its report, the National Advisory Group on SARS and Public Health concludes that Canada was ill prepared for the outbreak and lacked both the resources and the chain of command needed to combat the virus. The group's final report says public health efforts were also dogged by poor communication and missed opportunities to contribute to SARS research.
“We were fortunate that the SARS virus is biologically handicapped,” the report says. “At least in the vast majority of cases, it requires prolonged, close contact to make the short jump from one human being to another.
“Without effective public health measures, SARS would have eventually sickened virtually all 6 billion people on this shrinking planet.”
The report also argues that while the credibility of the Centers for Disease Control and Prevention (CDC) mitigates jurisdictional tensions in the US, the same cannot be said for the Population and Public Health Branch of Health Canada. As a result, the advisory group calls for the creation of a new Canadian agency that would take responsibility for public health.
Committee Chair David Naylor told CMAJ that the new organization won't be “buried inside a large bureaucracy with a political focus.” He says it will be headed by a chief public health officer who reports directly to the health minister, and this will encourage a type of culture change that will promote cooperation among different jurisdictions.
“Who curbed the SARS outbreak?” asks Naylor, dean of medicine at the University of Toronto. “It was Toronto Public Health. It wasn't the province, and it certainly wasn't Health Canada.”
Despite his many concerns about the way the SARS crisis was handled, Naylor is quick to acknowledge the efforts of individual health care workers. “These extraordinary people contained SARS for the rest of Canada,” he says. “Thousands rose to the occasion despite deficient systems.”
Naylor says changes being recommended are needed urgently because the current public health system is a “flimsy patchwork.” With spending varying widely from province to province, the result is a system that is “all over the map.”
Dr. Robert Brunham, director of the University of British Columbia Centre for Disease Control and a member of the advisory committee, says his organization has a lot to offer as a potential nationwide model.
“We can mitigate outbreaks like SARS, but not everywhere in Canada are those structures in place or those programs found.”
To make the required changes, the committee recommends new federal spending that would reach $700 million annually by 2007.
This would include funding for the new CDC-type organization and its activities, as well as $100 million annually to support the purchase of costly new vaccines.
Dr. Richard Schabas, chief of staff at Toronto's York Central Hospital and former medical officer of health for Ontario, agrees that Canada needs a new infrastructure that is at sufficient arm's length from government. However, he worries about the advisory group's objectivity. “A number of [members] were very much in leadership roles during the outbreak, and I wonder how critical they could really be.” — Allison Gandey, CMAJ