Canada should implement a comprehensive national health risk management system and ensure that surveillance systems adequately support real-time assessment and public health security, says a report by a federal advisory group.

The country also needs to establish a science advisory system for emergencies, improve pan-Canadian coordination of health emergency-related research, and enhance the readiness of research and clinical trial networks and infrastructure, according to the report.

The report, The Time to Act is Now, is by the Expert Panel for the Review of the Federal Approach to Pandemic Science Advice and Research Coordination.

“The key message of this report is that Canada needs to take further action now if it is to be adequately prepared for future health emergencies,” Sir Mark Walport (photo at right), a U.K. health administrator and chief executive of UK Research and Innovation, who chaired the seven-member expert panel, said in the report.

“Now is the time to build on the unprecedented collaboration and actions taken during the COVID-19 pandemic and to act on the important lessons learned from this crisis and previous outbreaks of infectious diseases.”

Strong action by and collaboration between all levels of government is required to address Canada's longstanding and increasingly urgent need to put in place health data systems that are capable of alerting the country to an emerging threat, and enabling the most effective response to it, Walport said.

Through interviews and roundtable discussions, the expert panel consulted with more than 300 individuals across the country, including government departments, public health agencies, academia, the private sector, and Indigenous knowledge holders and health practitioners.

The panel also reviewed relevant national and international literature on research coordination in emergencies and the provision of scientific advice to government. 

The panel made four broad, cross-cutting findings:

• Canada must act now to prepare for the next health emergency.

The COVID-19 pandemic exposed and exacerbated the weaker elements of Canada's health research and science advisory systems, the report says. The pandemic also highlighted severe shortcomings of health data systems and an inability to conduct timely and adequate observational studies, including infectious disease surveillance, and clinical trials.

“The lack of ready infrastructure and processes delayed the generation of evidence and synthesis of knowledge to inform urgent policy decisions.”

• Greater pan-Canadian coordination of research and science advice is required.

During the COVID-19 pandemic, there was a lack of sufficiently robust systems for specifically coordinating research and science advice across the country in response to a nationwide emergency of such scale, according to the report.

This led to duplication of efforts and challenges in areas including identifying, communicating and funding research priorities.

“New mechanisms are needed to bring together national efforts on key issues, and coordinate internationally, both in preparation for and in response to future national and global emergencies.”

• A greater focus needs to be placed on equity and addressing social and structural determinants of health.

COVID-19 disproportionately negatively impacted communities already experiencing inequities and health disparities, including lower-income Canadians, homeless and under-housed populations, Black and other racialized populations, and individuals living in vulnerable conditions. People living in congregate living settings, such as long-term care homes, were also heavily impacted.

• Indigenous health expertise must be embedded in research coordination and science advice processes.

Indigenous populations were disproportionately negatively impacted by the COVID-19 pandemic due to longstanding health inequities with well-documented differential access to health and social services. In addition, the advice of Indigenous health experts and engagement with their communities were not sought early enough in decision-making processes. 

Many calls over last decade to strengthen Canada’s public health infrastructure

There have been many calls to strengthen public health infrastructure in Canada over the last decade, the panel pointed out in its report.

For example, in late 1993, given the global spread of HIV, Health Canada organized an Expert Working Group on Emerging Infectious Disease Issues. In a 2003 report, this “Lac Tremblant” group called for:

• "a national strategy for surveillance and control of emerging and resurgent infections."
• support and enhancement of "the public health infrastructure necessary for surveillance, rapid laboratory diagnosis and timely interventions for emerging and resurgent infections."
• coordination and collaboration in "setting a national research agenda for emerging and resurgent infections."
• "a national vaccine strategy."
• "a centralized electronic laboratory reporting system to monitor human and non-human infections."
• strengthening "the capacity and flexibility to investigate outbreaks of potential emerging and resurgent infections in Canada.”

Two decades later, Walport’s expert panel is making very similar recommendations in its report across four areas: national health risk governance; science advisory mechanisms; health research prioritization, funding and coordination; and health data availability and use.

The panel heard that during the COVID-19 pandemic, surveillance data were incomplete and not consistently available to the public health officials, researchers and relevant groups who required them. Since many jurisdictions didn’t collect demographic information, they didn’t know which segments of the population were disproportionately impacted.

The panel recommended developing a national health risk register and preparedness plan including mitigation, response and recovery elements.

This should include establishing a standing health risk assessment and planning advisory body to inform the health risk register and preparedness plan. This body should include a dedicated standing expert advisory committee on infectious diseases and pandemic preparedness.

Roundtable participants highlighted for the panel the insufficient guidance for diagnostics, therapeutics, non-pharmaceutical interventions and patient care in Canada.

The panel found that Australia^, France, Germany, the United Kingdom and the United States, for example, had more robust processes for providing national clinical guidance, informed by the best available clinical trial results and international studies.

“Overall, the absence of pre-existing emergency protocols for science advice in Canada caused significant delays, with time being of the essence in an emergency, as well as coordination issues within and across all levels of government.”

The panel recommended creating a central federal mechanism designed to immediately activate a specialized expert advisory group in response to a health emergency to provide the best independent scientific advice directly to Cabinet, and designate this group as the main federal science advisory body for health emergencies.

The panel heard that during the COVID-19 pandemic, research was not sufficiently directed and coordinated to address the most important and urgent knowledge gaps.

Concerns included the lack of a central voice for research prioritization across the federal government, the need for better coordination among federal, provincial and territorial governments, and the limited ability of the federal granting councils to coordinate research efforts at a national scale or insist on enhanced sharing of suitably anonymized data.

“No federal body was able to set out a clear overall research agenda for many months to support the varying needs of public health practitioners, health care providers, industry and policy makers.”

Researchers told the panel that federal granting council eligibility requirements, including finely delineated subject-matter boundaries between councils, were not fit for purpose during an emergency, the report notes.

In addition, funding restrictions for researchers affiliated with government agencies presented barriers to collaboration between academia and intramural scientists. “There were also major gaps in the research response to COVID-19.”

The panel recommended establishing a central interdepartmental mechanism within the federal government to work with other levels of government, academia, industry, First Nations, Inuit and Métis health experts, and international partners to identify research priorities relating to the preparation for, and response to, health emergencies, and coordinate with provincial health research funders. 

Increased investment needed in scientific research and support

While optimization of research coordination structures will pay significant dividends, Canada needs to substantially increase its overall investment in scientific research and support of trainees (an area where Canada objectively lags behind peer nations) to ensure that the necessary expertise exists and to fully realize the benefits for Canadians, the report says.

The panel pointed out that over the last 20 years, Canada's public investment in research and development as a percentage of gross domestic spending has steadily declined. It currently sits at 1.55 percent, compared with the G7 and OECD averages of 2.6 percent and 2.7 percent, respectively.

“Without an adequate foundation of expertise, Canada cannot effectively prepare for and respond to future health and other emergencies,” the report warns.

Another of the panel’s recommendations is to continue to increase the speed, scale and inclusiveness of clinical trial infrastructure and processes by ensuring sufficient funding for the human capacity and necessary infrastructure required across the country.

The panel also recommended putting in place processes and protocols so that research granting councils operate collectively in an emergency, with rapid decision making, streamlined review processes, and processes to facilitate collaboration on projects that are of sufficient scale to address national priorities.

Other recommendations include providing sufficient funding for research on the implementation of public health, government policy and other interventions to mitigate inequities and address the underlying health needs of priority groups, including those in poverty or experiencing homelessness, Black and other racialized communities, and residents and employees of long-term care facilities. 

Also, investments should be increased to advance research on actions required to improve Indigenous health outcomes. This should include co-developing health priorities with First Nations, Inuit, and Métis health experts and communities and providing sufficient funding for research on actions to address these priorities. 

Canada’s “fragmented” data system urgently needs fixing

The panel consistently heard about Canada’s “fragmented data system,” including challenges in collecting and accessing both public health and health care data, which are essential for important research, scientific advice and health delivery.

“The timely collection of key data, and the sharing of these data between health care systems, levels of government and research institutions, was a key barrier to a well-coordinated and consistent national response to the pandemic,” the report says.

The panel recommended accelerating dedicated efforts with the provinces and territories to establish data standards, interoperable data systems and data sets, and to provide access to data that are essential for assessing and managing public health between and during emergencies.

Such data is required to reduce the health disparities between sociodemographic groups, and enable the conduct of innovative and important research. 

Sufficient resources should be provided to the Public Health Agency of Canada, the Canadian Food Inspection Agency, other relevant departments and agencies, and federally funded health data research networks to build and maintain interoperable data systems and data sets and make these available to provinces and territories, Indigenous health authorities, and researchers, the report says.

The panel also pointed out the position of Chief Science Advisor of Canada is not enshrined in legislation, and its mandate does not have a formal role in the event of an emergency. “To support science advisory processes at all times, it is imperative that the role of the Chief Science Advisor be clarified and set in legislation.”

In addition, the panel recommended creating a new deputy chief public health officer position, held by an Indigenous person, that is fully dedicated to Indigenous health and has the mandate to ensure that First Nations, Inuit, and Métis health issues are integrated into the priorities and processes of the Public Health Agency of Canada.

Concludes the panel’s report: “To be prepared for the next health emergency, and improve overall health outcomes for Canadians, there is an urgent need for the federal government to act now to build on previous efforts and make significant improvements to the approach to science advice and research coordination.”

Ottawa released the report, with no response, after five months

Even though the title of the Walport panel’s report is The Time to Act is Now, journalist Paul Wells (photo at right), writing in his substack, pointed out that the federal government actually received the report in May.

Wells, who has been pressing the government to release the report, said it finally did so at the end of the workday, at the beginning of a Thanksgiving holiday weekend, and accompanied by no news release or news conference.

Given the five-month delay in releasing the report, Wells quoted the Walport report as saying: “It is critical that scientific advice, including clarity on the level of certainty of the underlying evidence, be publicly communicated (except for information that is confidential in nature or could jeopardize security). During an emergency, the time interval between the delivery of the advice to policy makers and its public release should be as short as possible.”

“The information benefits all levels of government, provincial/territorial and local public health officials, public and private organizations, other relevant groups, and citizens. Its accessibility is important for maintaining trust in the policy-making process and combatting misinformation and disinformation,” the Walport report says.

Wells sent a copy of the Walport report to Dr. David Naylor, a medical researcher, physician and former president of the University of Toronto, who wrote the federal report on the 2003 SARS outbreak, which led to the creation of the Public Health Association of Canada. Naylor also chaired the expert panel report on Canada’s Fundamental Science Review.

Naylor called the Walport expert panel’s document “a superb report” that “is direct in pinpointing opportunities for improvement and calls out a depressing number of instances in which past advice has been ignored.”

“In the circumstances, I am baffled that the review was released with no fanfare, just posted on a website,” Naylor wrote, adding he’s at a loss to explain why it wasn’t released earlier.

“This isn’t an isolated instance. Canada’s federal and provincial governments have fallen into a pattern of commissioning and then largely ignoring the output of expert reviews and reports,” Naylor said.

Wells again quoted the Walport report: “A lack of continued investment could return Canada to a pre-2020 state of readiness. Immediate and sustained actions are required to address these issues.”

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