1994 Warning of New Diseases 'Sat on Shelf'

Farsighted recommendations about health threats were ignored; First health worker dies from SARS

June 30, 2003 
Mark Kennedy, The Ottawa Citizen

A federally commissioned report nearly a decade ago warned the Chrétien government it must show stronger national "leadership" in the face of new and emerging public health threats, the Citizen has learned.

But the 1994 report, produced for Health Canada by a group of public health experts, was largely ignored -- leaving the country vulnerable to a wide range of emergencies such as episodes of tainted drinking water and the recent SARS outbreak that almost paralysed Ontario's health system.

Now, with the federal government promising to learn the lessons from SARS, critics are demanding that it act on the advice of another expert panel review it has recently appointed.

The news of the report's existence comes as Ontario recorded its 39th SARS death yesterday. The 51-year-old was a nurse, and is the first health care worker to die from the disease.

Canadian Medical Association president Dr. Dana Hanson said the decade-old report was remarkably prescient.

He said the problem is that in the mid-1990s, all governments were slashing budgets to reduce their deficits and there were not yet any "sharp, crisp examples" of the looming infectious diseases that could harm and kill Canadians. And so, he said, the advisory report "sat on the shelf gathering dust."

"This excellent, forward-looking work wasn't acted upon because of complacency," said Dr. Hanson.

The 1994 warnings are contained in a little-known document dubbed the "Lac Tremblant Declaration." It emanated from a U.S. government report in 1992 that examined new infections and microbial threats to health in that country.

In response, the Laboratory Centre for Disease Control (LCDC) at Health Canada convened a three-day meeting in December 1993 at Lac Tremblant, north of Montreal, where about 40 Canadian scientists, who formed an "expert working group," examined the issue.

The proceedings and recommendations of their meeting now stand as an ominous foreshadowing of subsequent public health emergencies -- such as the tainted-water scandal in Walkerton, the arrival in North America of the West Nile virus, and the SARS outbreak.

"The world is rapidly becoming a global community," said the report. "Global interdependence, massive internal and external population movements, rapid transportation, increasing trade, and changing social and cultural patterns expose large populations to new and different pathogens and pose new threats to their health and well-being. National boundaries no longer offer isolation or protection from infectious diseases, toxic chemicals and hazardous products."

The report warned that in coming years, "evolutionary changes in existing organisms may result in the appearance of new diseases."

"The development of antibiotic resistance in known infectious organisms coupled with failure to invest in public health measures for previously controlled infectious diseases may lead to the re-emergence of conditions that will challenge the health of all Canadians."

The report concluded that Health Canada "must take a leadership role" in ensuring that provinces, municipal health authorities, and front-line medical workers are prepared for future health threats with a co-ordinated response.

Among the recommendations:

- Set priorities on how to prepare for new threats;

- Form "partnerships" so that governments and public health agencies work together more cohesively and share information;

- Improve disease surveillance systems to quickly spot when "anomalies" suggest a new threat is at hand;

- Develop a national computer database to keep track of emerging threats;

- Strengthen the links between hospitals and local public health units;

- Speed up the transfer of information between provinces and the federal government;

- Improve public communications and an "alarm response" in the event of crises;

- Develop "healthy levels of suspicion among clinical practitioners" so they keep an eye out for emerging infectious diseases and recognize "what they are dealing with" if one does occur;

- Improve the way hospitals and health care institutions communicate with each other.

- Deal with "biosecurity issues of food and water control."

Dr. Allan Ronald, professor emeritus at the University of Manitoba, was a member of the group and individually wrote a prescient chapter of the report.

He advised the government that although all provinces would have to make strides in public health, it was federal leadership that was most needed.

In an interview, Dr. Ronald said he was not surprised the federal government did not act on the Lac Tremblant Declaration because it has tended to worry too much about provincial complaints that it is intruding on their turf.

"Whether it was Walkerton, West Nile, SARS or HIV, the federal government has always been tip-toeing around and not demonstrating leadership."

But he expressed confidence the SARS outbreak may have shaken off that "lethargy" and convinced the government it's time to be more proactive.

In May, federal Health Minister Anne McLellan appointed an advisory group, headed by University of Toronto dean of medicine Dr. David Naylor, to examine Canada's public health infrastructure. It will issue its report in August.

Ms. McLellan has also suggested it may be time for Canada to create a national authority, similar to the U.S. Centers for Disease Control -- an idea she's expected to broach with her provincial counterparts at their annual meeting in September.

Better preparation: WHO didn't learn from the flu, A13

http://canada.com/national/story.asp?id=BEEAA8BA-F11C-4B29-A4DE-6B501A1397B9