- © 2008 Canadian Medical Association or its licensors
[CMAJ responds:]
We thank Dr. Butler-Jones for his letter. As noted in our editorial,1 our concern is that of 13 provinces and territories, only 1 (Ontario, as Dr. Butler-Jones cites) has entered a formal agreement with PHAC to share epidemiologic information — an appalling result, reached after 9 years of intergovernmental negotiations. Dr. Butler-Jones writes that PHAC will work “to establish more formal information-sharing agreements.” He believes PHAC's tenth year of effort will pay off.
We believe it is more realistic to conclude that negotiations have reached an impasse. Thus, Ottawa must legislate to oblige all levels of government to share epidemiologic information before another epidemic hits, possibly killing thousands. At present, information exchange depends not on any rules or law, but solely on “good working relationships,” as Dr. Butler-Jones calls them.
But good working relationships come and go, especially in high-pressure crisis situations. What if a nervous mayor convinced the local public health officer to withhold information for a few days or weeks until suspected cases were confirmed? PHAC has no powers to overcome that kind of situation — although it should.
Dr. Butler-Jones cites the readiness of influenza vaccines and antiviral medicines as instances where Canada has achieved isolated successes in epidemic preparedness. We agree, but believe that PHAC's failure to establish rules — clear, firm legal obligations — that compel federal, provincial and territorial governments to share epidemiologic information during outbreaks is a larger, overriding systematic failure.
Dr. Butler-Jones should put PHAC on that job, urgently.
Footnotes
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Competing interests: See www.cmaj.ca/misc/edboard.shtml.
REFERENCE
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