Canada's Pandemic Influenza Plans

UNCLAS SECTION 01 OF 04 OTTAWA 003482

SIPDIS

STATE FOR OES/IHA (CRODDY, FOSTER, SINGER, DALEY),
WHA/CAN (NELSON),M/MED/DASHO (TRIPLETT)

DHHS FOR KAREN BECKER

DHHS FOR BILL STEIGER AND ROSE BROWNRIDGE, OFFICE OF
GLOBAL HEALTH

CDC FOR ROBERT BALDWIN, OFFICE OF GLOBAL HEALTH

USDA FOR APHIS

E.O. 12958: N/A
TAGS: TBIO KSCA SOCI CA WHO KSTH
SUBJECT: Canada's Pandemic Influenza Plans

Ref. (A) State 209622
(B) Ottawa 2827 (Public Health Governance)
(C) Ottawa 3448 (Avian Influenza Report 1)


1. Summary: Canada has a national pandemic flu plan
dating from early 2004; an updated version is expected
in December 2005. Preparing for an influenza pandemic
is a top priority for the government of Canada. Canada
is working with many partners, including the United
States, to enhance global capacity to respond to a
pandemic. Canada's experience with SARS in 2003 and
with outbreaks of Avian Influenza in domesticated fowl
in 2004 and 2005 have given public health officials
recent experience in detecting and managing significant
infectious disease outbreaks. We think that Canada's
medical science and public health infrastructure is
capable of timely and effective disease detection and
outbreak response. End summary.

A) Preparedness and Communication


2. Canada has a strategy that addresses Pandemic
Influenza. The Public Health Agency of Canada (PHAC),
in conjunction with Health Canada (HC) and the Canadian
Food Inspection Agency (CFIA) maintains the Canadian
Pandemic Influenza Plan. The Canadian Pandemic
Influenza Plan is designed for: federal, provincial and
territorial departments of health; emergency workers;
public health officials; and health care workers. The
plan includes guidelines and checklists that these
groups can use in emergency response planning and
creates a framework that guides the actions of all
levels of government in the event of influenza
pandemic. The plan describes the different phases of a
pandemic and the roles and responsibilities for each
level of government at each phase. The phases described
in Canada's plan are based on the World Health
Organization's model. The plan covers three activities:

-- Prevention activities such as surveillance
programs and the establishment of an
infrastructure for manufacturing sufficient
vaccines to protect all Canadians at the time of a
pandemic.

-- Preparedness activities include the preparation
of actual plans for a pandemic. The preparedness
section addresses key activities, such as vaccine
programs, surveillance and public health measures
in terms of their current status and future
requirements.


-- Response/Implementation activities for
controlling the pandemic, minimizing deaths and
any social disruption it causes, including
communication activities. Implementation also
involves documenting the current activities and
outcomes to determine if any changes need to be
made to the response.

-- The plan was drafted in 2004 and PHAC continues to
modify the plan based on new information that comes
available; we expect an updated plan to be released in
December 2005. The plan also provides a model for
responding to other infectious disease outbreaks.
British Columbia, Alberta, Ontario and Manitoba have
their own pandemic plans, which build on the national
model. We think that Canada is fully capable of
mounting an effective, internationally coordinated,
plan to address an avian influenza pandemic.

-- The Canadian Pandemic Influenza Plan is available
at:
http://www.phac-aspc.gc.ca/cpip-pclcpi/index. html



3. We think that the Government of Canada will be fully
truthful in the reporting of disease outbreaks in both
animal and human populations. Already the Government of
Canada has been forthright with the Canadian public
about cases of low pathogenic avian influenza found in
wild and domestic fowl (Ref C). Officials in the
Canadian and United States human public health and
animal health communities are in frequent and frank
communication about this and other infectious disease
issues, which further ensures transparency.


4. We are of the opinion that preparing for an avian
flu pandemic is among the top priorities of the
Canadian government. Prime Minister Martin raised the
issue in June 2005 during his first meeting with
Ambassador Wilkins and identified it as one of the most
important issues that Canada and the United States, and
the global community, must address. Minister of Health
Ujjal Dosanjh hosted the "Global Pandemic Influenza
Readiness" meeting of international Health Ministers in
Ottawa in late October 2005, further emphasizing the
significance that Canada places on pandemic
preparation. Both the Prime Minister and the Minister
of Health would be appropriate officials to engage.


5. According to Foreign Affairs Canada (the foreign
ministry),Canada has fully accepted the International
Health Regulations and a recent review of Canadian law
indicates that they comply with the IHRs. In our
estimation Canada's national laws do not pose any
barriers to avian influenza detection, reporting,
containment or response. The Canadian provinces play
the most significant role in monitoring public health
and administering public health responses (ref B); most
of Canada's ten provinces have updated their public
health and quarantine laws in the wake of the SARS
crisis of 2003 to make them more flexible and
effective.


6. Canada is collaborating with the WHO, other
international organizations and other countries to
improve global pandemic preparedness, for example, via
the Global Pandemic Influenza Readiness meeting of
Ministers of Health in October 2005 in Ottawa. As
well, Canada is a member of the Global Health Security
Initiative (GHSI) of the G7 plus Mexico and within that
forum is co-leading with the United Kingdom discussions
related to the supply and use of antiviral medications.
Also under the aegis of the GHSI, Canada leads the
Global Health Security Laboratory Network. Under the
Security and Prosperity Partnership (SPP) Canada, the
United States and Mexico have agreed to develop a
continental "North American plan" for pandemic
influenza by 2006. Canada is a core member of the
United States led International Partnership on Avian
and Pandemic Influenza.


7. Annual flu shots are administered in Canada. Over
the past few years Canada has typically had 10 to 11
million doses of the flu vaccine available annually for
publicly funded programs. The Canadian supply comes
from manufacturing facilities in Quebec (ID Biomedical
produces about 75% of the supply) and France (Aventis
which produces about 25% of the supply). ID Biomedical
received a ten-year mandate from the Government of
Canada in 2001 to assure a state of readiness in the
event of an influenza pandemic and provide sufficient
influenza vaccine for all Canadians (approximately 60
million doses) in such an event. ID Biomedical is
currently in the process of expanding and upgrading its
Canadian manufacturing facilities, which are expected,
beginning in 2007, to produce around 75 million doses
per year of their "Fluviral" brand trivalent,
inactivated split-viron egg based influenza vaccine.
Although the specific avian influenza vaccine itself
cannot be produced until the new pandemic strain
emerges, the contract with ID Biomedical allows Canada
to build the infrastructure and systems to produce
sufficient pandemic vaccine for all Canadians. In
addition, in its March 2005 Budget, the federal
government provided C$34 million (approximately US$29
million) over five years to assist in the development
and testing of a prototype pandemic influenza vaccine.
According to Foreign Affairs Canada there is currently
no liability shield for foreign makers or donors of
vaccines. The question of how to facilitate
development, production, access and distribution of
vaccines and antiviral drugs is, however, a subject of
on-going discussions as seen, for example, at the
recent Pandemic Flu Ministerial in Ottawa.

-- Canada does not produce an influenza vaccine for
poultry.


8. The Canadian population is well informed of the
avian influenza threat and of global developments in
the progress of the disease and response. Mass media
including television, radio and newspapers are
reporting on the influenza phenomenon. Government of
Canada websites present comprehensive information on
the Avian Influenza threat, as well as provide
practical guidelines to poultry farmers and the general
public regarding poultry management, Biosecurity and
food handling to minimize the risk of infection. We
fully expect Canadian efforts to inform the public to
be as effective as similar measures in the United
States.

B) Surveillance/Detection


9. We have observed the recent Canadian experience of
detection of avian influenza in wild birds and domestic
fowl (ref C). We understand that the medical and
agricultural sectors are fully capable of detecting a
new strain of influenza among people or animals in a
timely fashion. Canada possesses a Biosafety level 4
facility in Winnipeg, Manitoba capable of sub-typing
influenza viruses. This facility, the Public Health
Agency's National Microbiology Laboratory (www.nml.ca)
is co-located with the CFIA's National Centre for
Foreign Animal Diseases at the Canadian Science Centre
for Human and Animal Health. Foreign Affairs Canada
has indicated to us that the international community is
considering the Canadian facility for inclusion as a
WHO Reference laboratory.



10. The Science Section of the Immunization and
Respiratory Infections Division, Centre for Infectious
Disease Prevention and Control (CIDPC) of PHAC produces
weekly (October thru May) or biweekly (June thru
September) FluWatch reports, summarizing influenza
surveillance activities in Canada. Influenza
surveillance is a collaborative effort between
provincial and territorial ministries of health,
participating laboratories, the College of Family
Physicians of Canada, sentinel practitioners, and
CIDPC. For the 2005-2006 season, the FluWatch website
includes graphical representation of the data collected
through the three main components of the influenza
surveillance system: 1) laboratory-based influenza
virus identification, 2) influenza-like illness
reporting by sentinel physicians across the country and
3) reporting of influenza activity by provincial and
territorial epidemiologists. Influenza activity level
maps enable the user to select single or dual map
views, zoom in to look at the activity levels for a
specific province/territory and to view a dynamic map
depicting changes in activity levels for user-defined
time periods

-- The FluWatch website is at:
http://www.phac-aspc.gc.ca/fluwatch/index.htm l


11. We think that Canada's medical science and public
health infrastructure is capable of timely and
effective disease detection and outbreak response. We
do not think there is any critical gap at this time
that need be filled by U.S. or international
organizations.

C) Response/Containment


12. Canada has a national antiviral stockpile; in
February 2005 the Minister of Health announced a
federal contribution of C$24 million (approximately
US$20 million) towards the creation a national
antiviral stockpile of oseltamivir. As of November 1,
2005 federal, provincial and territorial governments
together currently own 35 million capsules (75
milligrams each) of oseltamivir (Tamiflu),with another
five million on order. The national antiviral
stockpile will be used to treat identified priority
groups agreed upon by a national expert advisory
committee on pandemic influenza. The priority groups
include, for example, those hospitalized for influenza.


13. The National Emergency Stockpile System (NESS)
contains everything that one would expect to find in a
hospital: beds, blankets, personal protective gear such
as masks and gowns, surgical and medical devices and a
supply of pharmaceuticals. This includes a stockpile of
antiviral medication.


14. We believe that the rapid response capacity for
animal and human outbreaks is comparable to that in the
United States. Federal and provincial guidelines are in
place for preventing the spread of avian influenza on
farm premises and for implementing on-farm Biosecurity
precautions. The CFIA implemented preventative and
precautionary control measures in response to the
discovery of avian influenza in a domestic duck in
British Columbia (Ref C) to limit and prevent the
spread of the virus to other commercial premises -
including quarantine, culling and disinfection. The
CFIA actions are consistent with the recommendations
agreed to by governments and industry following the
2004 Abbotsford British Columbia outbreak of Avian
Influenza and reflect the guidelines of the World
Organization for Animal Health.


15. Canada's National Pandemic Influenza Plan
explicitly describes actions authorities would take,
such as quarantine and social distancing measures,
including closing schools and restricting public
gatherings to address a pandemic. Canadian authorities
are willing and capable of imposing these measures.
The National Pandemic Influenza Plan provides for
military assistance in preparing "alternate care sites"
(auxiliary hospitals) for infected individuals. The
GoC, however, has not made any explicit mention of
using its armed forces to enforce quarantine;
nevertheless this option exists as the Canadian federal
system allows for the military to provide "aid to the
civil power". Typically "aid to the civil power" would
involve a province asking the Chief of Defence Staff
for military assistance during natural disasters (the
Great Ice Storm of 1998) or civil unrest (Quebec
Separatist FLQ crisis of 1970). The federal government
could also deploy the military in areas where it has
sole jurisdiction such as at ports of entry, including
airports and seaports or along the frontier to maintain
a cordon sanitaire.

Wilkins