- © 2007 Canadian Medical Association or its licensors
The federal government has taken a tentative step toward bolstering national capacity to handle global health threats by enhancing its authority to deal with suspected cases of communicable diseases at international entry points like airports.
But the revamped Quarantine Act neither applies to domestic travel nor compels provinces to share information about disease outbreaks within their borders. Nor does it give Ottawa the authority to declare or manage a public health emergency within a province. Given these limitations, critics fear the Act falls well short of oversight measures recommended in the aftermath of the SARS outbreak.
The Act does enable officials to take action at ports by denying entry or compelling passengers to debark for transfer to quarantine centers (essentially any facility, including hotels, which the government designates and commandeers for the purpose of isolating, examining and treating infected passengers or those who may have been exposed to a communicable disease.
The new law also allows officials to divert a plane or vessel to another location. And it requires the airline and shipping industries to report an illness or death of a passenger before arrival or departure. Failure to do so, or other willful or reckless contravention of the regulations, causing risk of imminent death is punishable by stiff penalties ranging from a fine of $1 million to 3 years in prison.
Quarantine officers will also be authorized to obligate travelers to report to local public health authorities, detain people who refuse medical examination and prevent Canadians from traveling abroad while infectious. They can also order the decontamination, or even the destruction, of conveyances like airplanes and cargo ships.
But Acting Director General of the Centre for Emergency Preparedness and Response within the Public Health Agency of Canada Dr. Howard Njoo says the Act doesn't address issues such as provincial surveillance and reporting requirements, information exchange or interprovincial travel limitations in the event of a flu pandemic or a disease outbreak, as recommended in the final report of the National Advisory Committee on SARS and Public Health (CMAJ 2003;169:824).
“We are very cognizant of that recommendation but we sort of have to do it in a step-wise fashion,” Njoo said, adding that such jurisdictional issues remain the subject of intergovernmental negotiations towards a Memorandum of Understanding (MOU) about public health emergency protocols and surveillance requirements.
In the absence of an MOU, the Act falls short of meeting Canadian obligations under the WHO's International Health Regulations, argues Dr. Kumanan Wilson, University of Toronto professor of medicine and health policy, management and evaluation.
Reviews of the SARS outbreak indicate information exchange from local to national levels is critical in the management of outbreaks, Wilson says.
The second issue centred on defining the federal government's legislative authority when a public health emergency is confined to a single province. Wilson says provincial officials may be reluctant to declare a public health emergency, or share information for fear of the economic consequences. “We sort of experienced that to a certain extent with SARS, when it was clear the federal government didn't get all the information that it was hoping to get. It's disconcerting.”
Wilson argues the revamped Act should be embedded within a broader legislative framework that clearly states federal authority and protocols for managing outbreaks.
Wilson is also skeptical about the likelihood of an imminent intergovernmental MOU. Such an agreement has been under negotiation since 1995 and the Auditor-General has twice expressed concern. Wilson says conditional funding is needed because of the expense of surveillance and public health infrastructure. “The provinces say, ‚We will perhaps agree to do all of this in exchange for you helping us develop the capacity to do all of this.' And then there's an argument over how much and what responsibilities the provinces have and that inevitably is where it runs into problems.”
However, Njoo argues that an MOU is within reach. “In principle, the provinces are certainly on board. In terms of the final product, obviously, there's a little bit of a ways to go.”
Moreover, a broader legislative framework articulating federal authority to oversee disease outbreaks is unnecessary, he says. In the event of an emergency, existing national security laws or “other acts of last resort” would provide Ottawa with the requisite authority, Njoo says. “I don't think we need to ever get to that type of situation” as there's a “good history of collaboration” between levels of government.