Report of the Expert Panel for the Review of the Federal Approach to Pandemic Science Advice and Research Coordination: The Time to Act is Now
Organization: Health Canada
Date published: 2024-10-10
Cat.: H22-4/41-2024E-PDF
ISBN: 978-0-660-73380-7
Pub.: 240513
Table of contents
- Forward by the chair
- Panel members
- Recommendations and summary of key findings
- Introduction and context
- Major findings
- National health risk governance
- Science advice mechanisms
- Health research prioritization, funding, and coordination
- Health data availability and use
- Conclusion
- Glossary
- Appendices
- Footnotes
- References
Foreword by the chair
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. 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.
This requires better monitoring, understanding, and communication of the most important infectious diseases and other public health risks that face the country. These risks must be mitigated in order to minimise their impact when they transpire, including addressing factors that result in disproportionate impacts on certain populations including those in poverty, those experiencing homelessness, Black and other racialized groups, and Indigenous communities.
New approaches are needed so that research in Canada as far as possible anticipates, and is able to immediately respond to, public health needs during an emergency. Ever-ready systems must be put in place so that the best scientific evidence is available and can be generated rapidly to inform decision makers and all Canadians as soon as an emergency strikes. Finally, 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.
Canada has the key ingredients needed to be a global leader in health emergency-related science advice and research coordination, including world-class research and public health care systems. The recommendations in this report are aimed at building on these strengths and creating a cohesive approach. Effective implementation of our recommendations will also pay dividends in terms of improved overall health for Canadians.
A central and prime duty of government is to protect the health, wellbeing, and security of its population. While COVID-19 sadly led to significant death, illness, and wellness and society-wide impacts across the globe, a future pandemic or other health emergency could be swifter and more severe, leaving no room for error. Governments that do not adequately prepare for the most important risks put their countries and the rest of the world in grave danger, exposing their citizens to potentially disastrous health, social, and economic consequences.
I want to thank Health Canada, and specifically Deputy Minister Stephen Lucas, for asking an independent expert panel to take stock of lessons learned and provide recommendations for the future of health emergency-related science advice and research coordination in Canada. Thank you to my fellow panel members, whose expertise was invaluable and dedication was unwavering. Thank you also to the secretariat at Health Canada who supported the panel in its work. Finally, many thanks to the many people across the country who spent time to provide their perspectives. Their contributions informed our findings and recommendations aimed at better preparing Canada for the next health emergency.
Sir Mark Walport
Chair, Expert Panel for the Review of the Federal Approach to Pandemic Science Advice and Research Coordination
May 9, 2024
Panel members
Sir Mark Walport: Chair
Sir Mark has extensive experience in the life sciences, government, and national research and innovation organisations, including as Director of the Wellcome Trust, Chief Scientific Advisor to the UK Government, and the founding Chief Executive of UK Research and Innovation. In his recent roles he has provided national and international leadership at the highest level on biomedical research and policy issues. He chairs Imperial College Health Partners and is Foreign Secretary and Vice President of the Royal Society.
Dr. Éric A Cohen
Dr. Cohen is Head of the Human Retrovirology Laboratory at the Institut de recherches cliniques de Montréal and Professor of Virology at the Université de Montréal. Since 2014, he has led the Canadian HIV Cure Enterprise, CanCURE, a multidisciplinary research consortium dedicated to studying HIV reservoirs and developing effective therapeutic strategies for a cure. He is a Fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences.
Dr. Bev Holmes
Dr. Holmes has 20+ years' experience in the funding, production, and use of research evidence to improve health. As President & CEO of British Columbia's health research agency, Michael Smith Health Research BC, she works to strengthen the province's health research system. She is a member of the National Alliance of Provincial Health Research Organizations, an adjunct professor at Simon Fraser University's Faculty of Health Sciences and University of British Columbia's School of Population and Public Health, and a Chartered Director at the Degroote School of Business, McMaster University.
Dr. Thomas Marrie
Dr. Marrie is a retired infectious diseases physician whose research focused on community acquired pneumonia. He was Dean of Medicine at the University of Alberta and Dalhousie University, and served as interim Deputy Minister of Health in Nova Scotia. His internationally renowned work on pneumonia has resulted in the definitive textbook on this infection, altered the way it is handled in hospitals and clinics, and led to evidence-based guidelines for its management and treatment.
Dr. Shannon McDonald
Dr. McDonald is the former Chief Medical Officer at the First Nations Health Authority in British Columbia. She is proudly Métis/Anishinabe with deep roots in the Red River Valley of Manitoba and a trained physician with post-graduate medical training in Community Medicine and Psychiatry. She has worked for more than 20 years in the area of Indigenous health, with broad experience at multiple levels of health care service delivery and health administration in both provincial and federal contexts.
Dr. Allison McGeer
Dr. McGeer is a Professor in the Departments of Laboratory Medicine and Pathobiology and Public Health Sciences at the University of Toronto. In addition to her position as Director of Infection Control at Mount Sinai Hospital, she is an infection control consultant to the Scarborough Hospital and the Baycrest Centre for Geriatric Care. She currently serves on Canada's National Advisory Committee on Immunization and on the infection control subcommittee of the Ontario Provincial Infectious Diseases Advisory Committee.
Dr. Fahad Razak
Dr. Razak is an internist at St Michael's Hospital (Unity Health Toronto), and Canada Research Chair in Healthcare Data and Analytics at the University of Toronto. He co-founded GEMINI, the largest hospital research network in Canada, and one of few such examples globally. He was the Scientific Director of the Ontario COVID-19 Science Advisory Table and co-authored >50 science and policy briefs that shaped the policy, public health, and clinical response to the COVID-19 crisis.
Recommendations and summary of key findings
The COVID-19 pandemic reinforced the critical importance of scientific research and advisory systems to support timely responses to an uncertain and evolving public health emergency. In reaction to the pandemic, Canada's federal government quickly activated existing emergency coordination structures, made research investments to enhance understanding of the virus and its impacts, and sought scientific evidence and advice through a wide range of mechanisms. These actions supported the country's overall response and relatively positive outcomes as compared with other G10 countriesFootnote 1. However, the pandemic had disproportionate impacts on Canadians who have historically experienced systemic barriers to health care access, higher rates of underlying health conditions, and increased adverse social determinants of health that can exacerbate the impact of health emergenciesFootnote 2. The pandemic also highlighted important gaps and inefficiencies in science advisory and research coordination systems. It is important to reflect on what has been learned, to improve readiness well in advance of the next pandemic or other public health emergency.
Mandate and approach
In August 2023, Health Canada asked an independent expert panel to conduct a review of the federal approach to pandemic science advice and research coordination, take stock of the lessons learned, and provide concrete recommendations to strengthen Canada's preparedness in these areas for future health emergencies. The scope of the review was developed in consultation with the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Office of the Chief Science Advisor, and other federal departments and agencies. The panel's work is also relevant to other emergencies and to the management of research and science advice in general. Its mandate did not extend to an evaluation of the impact of research funding, how science advice factored into government decision-making processes, or the outcomes of government policies and actions.
Through interviews and roundtable discussions, the panel consulted with more than 300 individuals across the country, from government departments, public health agencies, academia, and the private sector, and Indigenous knowledge holders and health practitioners. It also reviewed relevant national and international literature on research coordination in emergencies and the provision of scientific advice to government. The panel found a high level of consistency between the views expressed in its consultations and the research it undertook.
Major findings
Four broad, cross-cutting findings emerged from the panel's consultations, research, and deliberations. These underpin its recommendations:
- Canada must act now to be prepared for the next health emergency: A common thread running through the panel's recommendations is the urgent need to improve and sustain readiness in advance of the next emergency. The pandemic exposed and exacerbated the weaker elements of Canada's health research and science advisory systems. It 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. To overcome these challenges, the federal government and other levels of government implemented a wide range of supplemental ad hoc mechanisms. See Appendix A, Appendix B, and Appendix C for a full inventory of bodies and timelines. However, these took time to put in place. The lack of ready infrastructure and processes delayed the generation of evidence and synthesis of knowledge to inform urgent policy decisions. The long-term funding for newly created critical infrastructure and networks is uncertain; 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 to prevent possible disastrous health, social, and economic consequences of a future emergency, which could be faster moving and more severe than the COVID-19 pandemic. Advance preparation for pandemics and other key threats to public health is a more cost-effective approach than waiting for the next emergency to strike before acting. It will also improve the overall health of Canadians during times of stabilityFootnote 3.
- Greater pan-Canadian coordination of research and science advice is required: The response to the COVID-19 pandemic spurred unprecedented collaboration among governments, public health officials, researchers, and other relevant groups and partners across Canada and abroad. Well-established federal-provincial-territorial health, public health, laboratory, and other coordination bodies were quickly activated in early 2020 (see Appendix B for a COVID-19 timeline) and met regularly to support information exchange. However, 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 scaleFootnote 4. 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. More effective pan-Canadian collection and triage of public health research questions are required, along with better coordination of intramural and extramural research, knowledge synthesis, guidance development, and advisory processes. Canada must also harness a broader range of expertise, including from social, economic, behavioural, and applied sciences, and remove barriers to interdisciplinary, transdisciplinary, and cross-sectoral collaboration. These processes must be put in place now and tested and refined through simulations and exercises before the next health emergency.
- 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 disparitiesFootnote 5. This included 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. The social and economic conditions that are well known to influence differences in health status greatly shaped differential exposure and vulnerability to the SARS-CoV-2 virus and access to treatmentFootnote 6. While the importance of these social determinants and underlying structural determinants of health is well understood, a greater focus must be placed on reducing their impacts before the next pandemic strikes. This requires greatly increased research on the effectiveness of public health and other interventions, accompanied by science advice to policy makers. Such prior research is essential to guide equitable preparation for, mitigation of, and responses to future health emergencies, as well as efforts to address the underlying inequities.
- 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 servicesFootnote 7. In addition, the advice of Indigenous health experts and engagement with their communities were not sought early enough in decision-making processes. Before the next health emergency strikes, Indigenous health expertise and considerations for the unique needs of their communities must be integrated in data collection, risk assessment, expert advice, and research funding processes to support their health and wellness and advance reconciliation.
Many previous expert panels dating back decades have called for action in these areas. For example, the 2003 report of the National Advisory Committee on SARS and Public Health chaired by Dr. David Naylor noted the following:
There have been many calls to strengthen public health infrastructure in Canada over the last decade. For example, in late 1993, given the global spread of HIV, Health Canada organized an Expert Working Group on Emerging Infectious Disease Issues. 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", and strengthening "the capacity and flexibility to investigate outbreaks of potential emerging and resurgent infections in Canada". A decade later, very similar recommendations are repeated in our reportFootnote 8.
Considerable progress has been made on these issues, but important gaps remain. Many of the 2003 report's recommendations remain salient and are echoed in the recommendations of this panel.
Recommendations
Building on the major findings, the panel developed 12 recommendations organized into four areas.
- National health risk governance
- Science advisory mechanisms
- Health research prioritization, funding, and coordination
- Health data availability and use
These recommendations aim to build on the wide range of actions taken by the federal government in response to the COVID-19 pandemic. If effectively implemented, they will enable a stronger and more systematic Canadian response to future health emergencies. The panel made two additional recommendations, strongly related to its findings but broader than the remit of its review.
National health risk governance
Following the lessons from HIV, SARS-CoV-1, MERS, and Ebola, the COVID-19 pandemic was a forceful reminder of the critical importance of robust and effective mechanisms for the identification, assessment, mitigation, and management of natural hazards and human threats. Plans need to be prepared in advance to guide rapid and efficient resource allocation, including for research funding, infrastructure, and timely sourcing of scientific evidence to inform urgent policy decisions during an emergency.
National risk registers offer a systematic approach to help countries identify, plan for, and address population-level health risks. A risk register's four main purposes are to 1) prevent risks from transpiring as far as is possible; 2) mitigate the worst effects of risks through advance preparation; 3) handle risks when these transpire; and 4) support recovery. This requires an active process, led centrally within government, working with the relevant government departments for each risk (and recognizing that, in catastrophic emergencies, risks can cascade across the activities and responsibilities of many government departments). Continuous horizon scanning is essential to ensure the continuing salience of a national risk register.
Public Safety Canada is currently leading the development of a National Risk ProfileFootnote 9 (similar to a risk register) that includes considerations relating to pandemics but omits consideration of biological and health hazards and threats in and of themselves. The Public Health Agency of Canada has also invested to bolster its internal capacity and governance relating to risk assessment and response. These are important steps towards a more comprehensive assessment and preparedness plan to address the full range of the most serious health hazards and threats facing the country. Risk analysis needs to be made available to inform research priorities and other preparedness actions by all levels of government and other relevant groups. Canada's emergency management plansFootnote 10, pandemic plansFootnote 11, and federal-provincial-territorial public health emergency response plansFootnote 12 do not currently outline protocols for science advice or research coordination. Other countries–such as the United Kingdom, New Zealand, and the Netherlands–maintain and publish more comprehensive national risk assessments and response plansFootnote 13Footnote 14Footnote 15.
Well-coordinated surveillance systems are critical to inform health risk assessment. The 2003 report of the National Advisory Committee on SARS and Public Health called for the development of an integrated risk assessment capability for public health emergency response, and a comprehensive and national public health surveillance system to collect, analyze, and disseminate laboratory and health care facility data on infectious diseases and non-infectious diseases to relevant groupsFootnote 8. Yet, 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 did not collect demographic information, they did not know which segments of the population were disproportionately impacted.
In response to the pandemic, the federal government funded new surveillance networks, including wastewater monitoring networks that provided critical data on infection. However, the panel heard that the future of some of these networks is uncertain because they have not received long-term funding and that processes for real-time clinical surveillance and data sharing are lacking. Given the federated nature of the Canadian health care system, solutions to these problems require actions by all levels of government and strong intergovernmental collaboration.
Recommendation 1: Put in place a comprehensive national health risk management system
- Develop a national health risk register and preparedness plan including mitigation, response, and recovery elements. This should encompass the health implications of environmental, zoonotic, chemical, biological, radiological, nuclear, and other natural hazards and human threats that could originate domestically or internationally. It should be updated regularly based on horizon scanning, and an external version should be published at least annually. The Health Portfolio should lead this process in coordination with Public Safety Canada and other departments and agencies as required. The plan should be developed in collaboration with provincial/territorial public health agencies and health departments.
- Incorporate the health risk register and preparedness plan within broader national emergency protocols, clearly outlining the roles and responsibilities of relevant departments and agencies. Plans should be rehearsed and refined through regular table-top simulations and exercises.
- Establish a standing health risk assessment and planning advisory body to inform the health risk register and preparedness plan. This should include a dedicated standing expert advisory committee on infectious diseases and pandemic preparedness.
Recommendation 2: Ensure that surveillance systems adequately support real-time assessment and public health security
- Provide sufficient long-term funding for clinical, public health, and laboratory surveillance networks and infrastructure for emerging infectious diseases and risks to public health, accompanied by the underpinning technical infrastructure, in coordination with provincial/territorial governments and First Nations, Inuit, and Métis partners.
- Systematically provide the results of all federally managed and funded public health surveillance efforts to provincial/territorial, local, and Indigenous health agencies and pursue reciprocal sharing agreements.
Science advisory mechanisms
Effective mechanisms for the transmission of scientific advice to senior policy makers are crucial to a government's ability to make informed, timely policy decisions during health and other emergencies. This is especially important when the threat is novel and rapidly emerging, where there is significant uncertainty, and where the full extent of the health, social, and economic impacts is not clearly understood. In response to COVID-19, the federal government went to great lengths to seek science and expert advice through both established structures and newly created ad hoc advisory bodies. See Appendix A, Appendix B, and Appendix C for a full inventory of bodies and timelines.
The effectiveness of federal advisory structures varied depending on many factors including the timing of their establishment, membership, mandate, access to data, how advice was delivered, and whether that advice related to matters within federal jurisdiction or to that of other levels of government. The panel heard that among federal advisory bodies, those relating to vaccines were the most effective. For example, the expert roster, strong secretariat, and clear mandate of the Vaccine Task Force created in June 2020 enabled it to rapidly deliver advice directly to Ministers, which was vital to making critical procurement decisionsFootnote 16. The pre-existing National Advisory Committee on ImmunizationFootnote 17 provided important guidance on vaccine administration and sped up its processes during the pandemic; however, its advice was not consistently timely due to a shortage of surge capacity.
Roundtable participants highlighted the insufficient guidance for diagnostics, therapeutics, non-pharmaceutical interventions, and patient care in Canada. AustraliaFootnote 18, FranceFootnote 19, GermanyFootnote 20, the United KingdomFootnote 21, and the United StatesFootnote 22, 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. Various science advisory tables led by the Health Portfolio, other federal departments and agencies, and the Chief Science Advisor of Canada resulted in multiple streams of advice. Given the rapidly changing knowledge environment, this advice was sometimes conflicting and there was a lack of capacity to coordinate the advice. As a result, additional ad hoc coordination mechanisms were developed for this complex landscape of advisory tables.
Science and expert advisory structures should be established and ready to be activated in advance of an emergency, rather than created in response to one. An emergency is not the time to decide on the nature of the bodies, identify and secure experts, establish terms of reference, put in place organizational support, and establish efficient and effective work patterns. Other countries have systems that are ready to provide advice in response to an emergency, such as the United Kingdom's Scientific Advisory Group for EmergenciesFootnote 23. This system was immediately activated in January 2020 to support COVID-19 decision-making.
The panel's experience, insights collected in consultations, and a literature scan conducted by the Public Health Agency of CanadaFootnote 24 point to four key features of effective science advisory bodies. First, they operate with a high degree of independence, yet have strong ties to government and a clear "customer" in the form of senior government policy makers who are receptive to their advice. Second, they are properly resourced, have access to required data, and are populated with a diversity of perspectives and expertise. This enables the provision of interdisciplinary advice based on the best available evidence at the time. Third, they provide timely advice that observes principles of effective science communicationFootnote 25, with advice publicly released soon after its provision to government. Finally, they are sufficiently connected to government to understand the context in which science information for decision making is needed.
The panel observed considerable duplication of experts across the various federal advisory bodies active during the pandemic. Certain bodies lacked sufficient diversity and breadth of expertise, including in relation to Indigenous health, behavioural sciences, and health equity. In addition, the output of many federal advice bodies was not publicly released in a timely manner. In contrast, the Ontario COVID-19 Science Advisory Table (which operated largely independently while having strong links into government) publicly released more than 70 briefs during its operation from July 2020 to September 2022. However, this ad hoc advisory body also took time to establish and was stood up after the first wave of the pandemic was largely overFootnote 26.
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.
Canada requires a more structured approach to science advice for future emergencies. Independent advice, which benefits from a broad range of interdisciplinary expertise and considers health equity and Indigenous health implications, must be quickly and widely available at any time. A more coordinated, streamlined, and transparent federal advisory process, with advice flowing in real time to other levels of government, and publicly in a timely fashion, will reduce duplication and improve efficiency by providing a foundational resource for provinces and territories, local public health units, and others.
Recommendation 3: Establish a science advisory system for emergencies
- Create a central federal mechanism that is 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. This system should be co-led by the Privy Council Office and the Health Portfolio, in collaboration with the Office of the Chief Science Advisor, Public Safety Canada, and other departments and agencies as required.
- Ensure that this mechanism is ever-ready by establishing a standing interdepartmental government secretariat with sufficient ongoing and surge capacity. The secretariat should have knowledge mobilization and communications expertise, and access to all required intelligence. It should maintain a roster of experts relating to key health risks (as per the proposed health risk register in recommendation 1). Preparedness work should include training the roster of experts, secretariat members, and government decision makers on best practices for providing, receiving and communicating evidence; as well as simulations and exercises.
- Designate the activated expert advisory group as the main federal science advisory body for health emergencies. This group should typically be convened jointly by the Chief Public Health Officer and Chief Science Advisor. Members should be assembled based on the nature of the emergency, drawing from the roster of experts, standing advisory committees, and elsewhere as required. The majority of members should be independent experts, chosen solely for their expertise. Expertise should be diverse with health, social, behavioural, humanities, and applied sciences as required, and cut across sectors, including intramural, extramural, industry, health equity, Indigenous health, and other relevant experts. Other relevant senior government officials should participate as liaisons. Supporting sub-groups and task forces should be formed as required.
- Embed this advisory system in overall government emergency protocols; establish strong links with other domestic health advisory bodies, federal-provincial-territorial health and emergency networks, and international emergency advisory systems; and invite provincial/territorial governments and Indigenous partners to name liaisons.
- Expand this advisory system over time to cover all emergencies, not just health emergencies.
Recommendation 4: Improve external communication of advice from federal advisory bodies
- Stipulate in terms of reference that during an emergency, advisory bodies should publicly release evidence and advice briefs in a timeframe commensurate with the urgency of the situation, typically within days of their provision to government unless there are extenuating circumstances.
- Develop corresponding internal emergency communications protocols that accelerate and streamline release processes to achieve releases in this timeframe.
- Include provisions to protect sensitive and confidential information, and require that the level of uncertainty of evidence and advice is clearly communicated in all outputs.
Recommendation 5: Improve national guidance for the use of diagnostics, non-pharmaceutical interventions, and therapeutics in response to an emergency
- Put in place sufficient emergency capacity and protocols to develop and release timely clinical and community guidance in these areas as reliable evidence emerges, in a similar fashion to the National Advisory Committee on Immunization's role on vaccinesFootnote a.
Health research prioritization, funding, and coordination
In response to the COVID-19 pandemic, the federal government quickly mobilized to make additional research funding available through rapid response funding competitions starting in February 2020. However, the panel heard that research was not sufficiently directed and coordinated to address the most important and urgent knowledge gaps, including how the pandemic was manifesting across Canada; modes of transmission; appropriate use of non-pharmaceutical interventions; development of rapid diagnostic tools, therapeutics, and vaccines; and understanding and addressing issues of misinformation, disinformation, and vaccine hesitancy. 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, including their funding agencies; and the limited ability of the granting councils to coordinate research efforts at a national scale or insist on enhanced sharing of suitably anonymized data.
Expert panels dating back to 1993 have called for a national research agenda for emerging and resurgent infectious diseases. The National Advisory Committee on SARS and Public Health reflected on research coordination issues during the 2002-03 SARS outbreak and recommended that the federal government establish mechanisms with provincial/territorial health agencies to set research priorities for emerging infectious diseases, and clear protocols for the management of future epidemic research responsesFootnote 8. Despite previous warnings, processes in place when COVID-19 emerged in 2020 were unable to quickly identify key research priorities, effectively communicate these to all relevant groups, and direct funding accordingly and promptly. 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.
In response, and in a similar fashion to the establishment of the many ad hoc scientific advisory bodies, the federal government facilitated and supported a broad range of new research coordination, knowledge synthesis, and modelling networks. The panel heard that many of these efforts played important roles during the pandemic. However, their funding and implementation took time (see Appendix A, Appendix B, and Appendix C for a full inventory of bodies and timelines) and researchers struggled to overcome administrative challenges to starting their work expeditiously, including accessing facilities and obtaining the ethics approvals and data sharing agreements required to access biological samples and data. In contrast, pre-existing bodies and networks with federal funding, such as Genome CanadaFootnote 27 and the Canadian Immunization Research NetworkFootnote 28, were able to leverage established expertise, relationships, and agreements, and immediately pivot to pandemic priorities. This demonstrated the importance of maintaining capacity in inter-emergency periods, rather than attempting to establish new mechanisms during an emergency.
In January 2022, the federal government created the Centre for Research on Pandemic Preparedness and Health Emergencies within the Canadian Institutes of Health ResearchFootnote 29, with a mission to grow Canada's capacity to research and mobilize knowledge to prevent, prepare for, respond to, and recover from existing and future pandemics and public health emergencies. However, the panel heard repeatedly that a more robust interdepartmental and intergovernmental undertaking is required to achieve this critical mission.
The research needs of public health practitioners, health care providers, industry, and policy makers in pandemics extend far beyond infectious diseases. They encompass other areas of medical research, including consideration of the mental health and other health consequences; social and behavioural considerations; operational research related to the maintenance of critical national infrastructure; economics; education; and more. Answering many of the questions about these wider consequences requires a transdisciplinary approach. Researchers noted that federal granting council eligibility requirements, including finely delineated subject-matter boundaries between councilsFootnote 30, were not fit for purpose during an emergency. In addition, funding restrictions for researchers affiliated with government agencies presented barriers to collaboration between academia and intramural scientists. The 2023 Advisory Panel on the Federal Research Support SystemFootnote 31 and othersFootnote 32 have provided related observations and recommendations on Canada's research funding processes.
There were also major gaps in the research response to COVID-19. More work needed to be done to determine vaccine efficacy in different population demographics across Canada, which should have been possible using routinely collected clinical data. While the federally funded COVID-19 Immunity Task Force did seroprevalence studiesFootnote 33Footnote 34Footnote 35Footnote 36 and Canada had some major randomized control trialsFootnote 37Footnote 38 and vaccine effectiveness studiesFootnote 39Footnote 40Footnote 41Footnote 42, the federated health system and a lack of coordination and timeliness hampered the effectiveness and impact of this important work. There is a need for continued investment in Canada's clinical trial infrastructure, including streamlining research ethics approval and data and specimen sharing processes for anticipated areas of research, and for the establishment of emergency processes for working with industry. In response to the pandemic, the federal government has invested heavily in medical countermeasure research and development and clinical trial infrastructure via its Biomanufacturing and Life Sciences StrategyFootnote 43. Investments under this strategy should be systematically informed by the panel's proposed new health risk register to maximize the likelihood that they will most effectively prepare Canada for future health emergencies.
To achieve more equitable health outcomes, greater focus and investment is needed to support transdisciplinary research to identify the best ways to implement public health and other interventions to tackle well-documented inequalities. The panel heard that additional research is required before the next health emergency to examine the effectiveness of interventions aimed at reducing the disproportionate risk posed to certain populations such as those experiencing homelessness. The panel also heard that federal research grant funding processes do not adequately value Indigenous knowledge and processes and are not compatible with the realities of Indigenous communities including those in northern Canada. Overall, better prioritization and coordination of research will increase the efficiency of government funding and improve health outcomes for Canadians.
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 it objectively lags behind peer nations)Footnote 44 to ensure that the necessary expertise exists and to fully realize the benefits of these changes for Canadians. 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%, compared with the G7 and OECD averages of 2.6% and 2.7%, respectivelyFootnote 44. Without an adequate foundation of expertise, Canada cannot effectively prepare for and respond to future health and other emergencies. While these issues are outside the remit of this panel, they have been addressed by other expert panels including the Advisory Panel on the Federal Research Support System. Its report emphasized that a modern research enterprise must be equipped to respond to the needs of government in order to provide benefits to Canadians, and increased funding for research and talent must be a top priority to make the Canadian system globally competitiveFootnote 31.
Recommendation 6: Improve pan-Canadian coordination of health emergency-related research
- Establish 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. This mechanism should be led by the Health Portfolio in collaboration with federal research granting councils and other departments and agencies.
- Use the proposed new national health risk register and response plan, including the standing health risk assessment and planning advisory body (in recommendation 1), to inform this research prioritization during periods of stability. In response to an emergency, the activated special scientific advisory group for that emergency (as per recommendation 3) should take the lead advisory role in supporting the prioritization of new research questions as these arise in real time.
- Establish a mechanism (linked to recommendations 6.a and 6.b) for the prioritization of medical countermeasure research and development, working closely with industry and other relevant groups, informed by supply chain intelligence and coordinated with international allies.
Recommendation 7: Enhance the readiness of research and clinical trial networks and infrastructure
- Create and maintain domestic and international research networks during inter-emergency periods. Some of these networks can be maintained in the form of "sleeping protocols", capable of rapid activation in the event of an emergency, while others should operate continuously and be used to address ongoing health priorities. These networks should put in place, as much as possible, the required inter-organizational agreements and ethical and other approvals, considering what may be required in response to potential future health emergencies including those identified in the proposed national health risk register (in recommendation 1).
- Ensure that critical intramural and external health research infrastructure and human capacity are available and can operate during the next health emergency through sufficient and sustained funding. This should include creating an inventory of relevant assets, establishing protocols for the operation of federal facilities during an emergency, and publishing guidance for external labs.
- 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.
Recommendation 8: Strengthen the emergency preparedness of the federal research granting councils
- Put in place processes and protocols so that 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. Funding conditions should include the timely completion of new inter-institutional agreements between collaborating research institutions as required, and the timely release of research data and results where appropriate.
- Facilitate interdisciplinary research by removing subject-matter boundaries currently specified in very fine detail between the granting councils, and through capacity building where necessary.
- Remove barriers to intramural and extramural research collaboration including federal funding eligibility restrictions for provincial and territorial intramural researchers. Operating funding envelopes for federal intramural researchers collaborating with recipients of grants and contributions should also be put in place.
Recommendation 9: Increase investments in research on actions required to better support and prioritize the needs of groups disproportionately impacted by health emergencies
- Provide 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. This research should be developed and conducted in concert with affected communities.
- Establish a standing science advisory body of independent experts on health equity, supported by a secretariat within the Health Portfolio, to inform government policies and public health measures in this area.
Recommendation 10: Increase investments to advance research on actions required to improve Indigenous health outcomes
- Co-develop health priorities with First Nations, Inuit, and Métis health experts and communities and provide sufficient funding for research on actions to address these priorities. This should include increased investments to advance Indigenous-led research and training in areas including epidemiology.
- Cultivate and invest in the development of expertise in the coordination and funding of Indigenous health research, in and among federal departments and agencies.
Health data availability and use
Many previous reports have outlined the deficiencies in the Canadian health data system and the harms that Canadians are experiencing from an inability to properly collect, share, and use health dataFootnote 5Footnote 8Footnote 45Footnote 46Footnote 47. The panel consistently heard about 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. While these issues remain unsolved, all Canadians are vulnerable. The most disadvantaged will remain the most vulnerable to the worst health outcomes; health research and policy advice will be hampered; and Canadian scientific innovation will not reach its full potential.
The most effective health data systems globally operate as data stewards, providing appropriate real-time access to clinicians, researchers, public health officials, and public servants. They protect the privacy of individual citizens as an integral part of promoting public health research. In these systems, research is seen as an intrinsic part of care. Canada is currently operating a health data custodianship model, primarily concerned with data security and privacyFootnote 47. Its fragmented data system means that it is less equipped to make evidence-informed decisions, including during a health emergencyFootnote 47.
Provincial/territorial health data systems vary greatly in their ability to collect data and make them available. During the COVID-19 pandemic, some provinces made detailed anonymized health data available to researchers and advisory bodies, enabling critically important insights. These successes demonstrate that essential data are available in some provinces and can be responsibly accessed by researchers. They also raise further questions as to why real-time, disaggregated data cannot be leveraged inter-emergency to better support the provision of health services and prepare for and mitigate the effects of future health emergencies. The panel heard that some jurisdictions had to collect basic data manually, leading to delays and inconsistency in reporting. One of the most important predictors of infection exposure and outcomes–basic sociodemographic data at the individual level including information on race and ethnicity–was largely absent in almost all jurisdictions.
Some provincial governments are currently winding down the vaccine registries they created during the pandemic despite their potential to capture accurate and precise information on the distribution, uptake, and effectiveness of vaccines. There are compelling reasons for this type of routine data collection. The United Kingdom has recently published work, using routine information collected from approximately 59 million people, to examine the effectiveness of different numbers of vaccine doses in relation to the risk of hospitalization for severe clinical manifestations of COVID-19Footnote 48. The results showed that even missing one recommended vaccine dose was associated with a substantially increased risk of severe infection requiring hospital admission.
In recent years, the federal government has worked with provinces and territories to receive advice from an Expert Advisory GroupFootnote 49. As a condition of their federal funding provided through the 2023 Working Together to Improve Health Care for Canadians PlanFootnote 50, provinces and territories have committed to work with the federal government and other partners to improve the collection, sharing, use, and reporting of health information. Health data priorities are being implemented through a Joint Federal-Provincial-Territorial Action Plan on Digital Health and Health DataFootnote 51 and a Pan-Canadian Health Data CharterFootnote 52. The federal government has also provided funding to the Canadian Institute for Health Information, Canada Health Infoway, and Statistics Canada to support this health data agenda. However, many individuals expressed skepticism to the panel that these measures would be sufficient in the absence of strong and sustained federal, provincial/territorial, and Indigenous political leadership and support.
Given the substantial challenges to data sharing, close monitoring of the impact of these investments on improving the scope, scale, interoperability, and responsiveness of the health data structure, as well as accountability for expected outcomes, is critical.
The federal government must continue to take a leadership role and place an even higher priority on these efforts. For the efforts to effectively support health emergency preparedness and response, Canada needs to be able to generate, and make available to researchers, real-time health and related data from across the country, including sociodemographic and race-based data, de-identified in such a way as to protect individual privacy. This will enable characterization at a national scale of the incidence and prevalence of infection, hospitalizations, deaths, therapeutic interventions, vaccination data and possible adverse effects, and other critical issues at all times. Efforts to do so will provide benefits in crisis periods and in periods of stability, further improving health outcomes and addressing inequalities. Ultimately, sustained political leadership across federal and provincial/territorial governments is essential to overcome the barriers to the collection and use of data that have great potential to provide health benefits to all Canadians.
A critical piece of transforming Canada's health data systems is the co-development of culturally relevant, distinction-based health data systems for First Nations, Inuit, and Métis peoples. An Expert Advisory GroupFootnote 49 on health data stressed that jurisdictions must demonstrate support for First Nations, Inuit, and Métis data sovereignty across geographies. It also highlighted the importance of meaningful Indigenous participation and representation on senior health data committees and governance tables to ensure support for, and alignment with, First Nations, Inuit, and Métis data principles and strategiesFootnote 45. The recently endorsed Pan-Canadian Health Data Charter also commits to support and respect First Nations, Inuit, and Métis data sovereignty and Indigenous-led health data governance frameworksFootnote 52. The federal government must continue efforts to meaningfully engage with Indigenous Peoples to support their respective health data strategies and advance shared digital health and health data priorities.
Recommendation 11: Resolve the longstanding issue of the non-availability and fragmentation of essential public health and clinical data
- Accelerate dedicated efforts with the provinces and territories to establish data standards, interoperable data systems and data sets, and provide access to data that are essential for assessing and managing public health between and during emergencies, reducing the health disparities between sociodemographic groups, and enabling the conduct of innovative and important research. This should include the systematic collection and availability of de-identified routinely collected health data, including vaccination data, across the country.
- Provide sufficient resources 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.
Recommendation 12: Continue efforts to meaningfully engage with Indigenous Peoples and their communities to support their respective health data strategies and advance shared digital health and health data priorities
- Support and collaborate with First Nations, Inuit, and Métis communities and authorities across the country to bring their health data systems in line with the most robust systems in Canada, while preserving Indigenous data sovereignty and ensuring data integration and interoperability with provincial/territorial and federal systems, further to the commitment in the Pan-Canadian Health Data Charter.
Broader recommendations
The panel proposes two additional recommendations that relate to its key findings but are broader than the scope of its remit.
Unlike the role of the Chief Public Health Officer, the position of the 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. In an increasingly complex and interconnected world, scientific information is critical to inform government decision making during and between emergencies. 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.
Broader recommendation A: Pursue legislation to formalize the role of the Chief Science Advisor of Canada
This should include defining the role in preparation for and response to health and other emergencies.
The panel's consultations pointed to insufficient Indigenous health expertise within the Health Portfolio. Discussions also highlighted that efforts to seek this expertise through contractual and advisory roles were inadequate to properly factor health considerations for Indigenous populations into health research prioritization and other processes during the pandemic. A plan to recruit this expertise is needed, and this should include creating a new dedicated senior role in the Public Health Agency of Canada.
Broader recommendation B: Create a new Deputy Chief Public Health Officer position that is fully dedicated to Indigenous health
This role should be held by an Indigenous person and have 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. It should interface with other areas of the Health Portfolio, Indigenous Services Canada, and other departments and agencies as required.
Addendum
The work of the Expert Panel was completed prior to the release of the 2024 federal budget, which included commitments relating to research funding and coordination in general. The panel has not assessed these commitments but notes that the implementation of the envisioned measures will benefit from the findings and recommendations of this report.
Conclusion
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. The panel's recommendations centre around the need for a more sophisticated national risk assessment and preparedness planning process; a more robust science advisory system that is ready to immediately activate in response to an emergency; ongoing research infrastructure that is ready to mobilize; centralized leadership to facilitate the prioritization and coordination of major public research investments; and improved health data systems.
The panel considers its recommendations to be cost effective, especially when compared with the consequences of inadequate preparedness. The actions will also improve the effectiveness and efficiency of a broad range of government investments. To achieve success, these efforts require enhanced interdepartmental and international coordination, and, given the federated nature of Canadian health systems, actions by and collaboration with provincial and territorial governments. Success also requires increases to ongoing public investment in health research. Previous expert panels, dating back at least 30 years, have called repeatedly for action in these areas. The government must take action now to comprehensively address these shortcomings and to prevent or mitigate, as far as possible, the potentially disastrous health, social, and economic consequences of a future health emergency.
Introduction and context
Panel mandate and scope of review
In August 2023, Health Canada asked an independent expert panel to conduct a review of the federal approach to pandemic science advice and research coordination. The scope of this review was developed in consultation with the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Office of the Chief Science Advisor, and other departments and agencies.
The panel's mandate was to take stock of domestic and international learnings and best practices and provide concrete recommendations for better federal preparedness for future pandemics and health emergencies in the areas of science advice and research coordination. Its review included the structures and processes in place to prioritize, fund, and coordinate science advice and research and extended to research across and between all disciplines (e.g., health, natural, engineering, social sciences, the humanities); sectors (intramural and extramural); functions (e.g., data collection, analysis, clinical trials, knowledge synthesis); and the prioritization and coordination of these structures and processes. The panel determined that to comprehensively address its mandate, it needed to take a close look at two inter-related areas of health emergency preparedness: 1) the monitoring and assessment of risks and threats and the plans to address them when they arise, and 2) the health data ecosystem, with a focus on the collection and use of timely and interoperable data.
The review did not include an assessment of the formulation, implementation, or public communication of government policies during the pandemic or the outcomes of them. It also did not extend to an evaluation of the impact of research funding or how science advice factored into government decision-making processes.
While the goal of the review was to provide recommendations to strengthen Canada's preparedness for health emergencies, the panel's work also has implications for improving the health of Canadians overall, and to better prepare for emergencies more broadly. These include the roles of surveillance and risk assessment, research, data, and science advice during and between emergencies.
Approach and consultation
The panel, supported by a secretariat at Health Canada, was convened in August 2023 and had its first meeting that same month. Its work ended in April 2024. The panel's approach comprised four elements:
- Retrospective assessment and evidence synthesis of the overall lessons learned from the Canadian approaches to science advice, research coordination, health risk governance, and health data collection and use at different stages of the COVID-19 pandemic;
- Examination of the current situation and future needs;
- Identification of approaches, best practices, and national and international lessons learned; and
- Development of recommendations for federal departments and agencies.
In addition to the individual and collective expertise and experience of its members, the panel relied on three main evidence streams to conduct its analysis and develop its recommendations:
- National and international reports on the provision of scientific advice to government, research coordination, health risk governance, and health data collection and use, both in preparation for and during emergencies;
- National and international lessons-learned reviews, assessments, studies, and other relevant source materials related to the response to the COVID-19 pandemic specifically; and
- Interviews and roundtables with participants in key federal, provincial, and territorial departments and agencies, Indigenous knowledge holders and health care practitioners, and a wide range of external experts from academia and the private sector involved in pandemic scientific advice and research.
In identifying international comparators, the panel focused on countries where the policy context or governance system was similar to that of Canada, in order to improve the likelihood of effective policy transfer to a Canadian context.
Between August 2023 and February 2024, the panel met about 300 individuals from across the country, virtually or in person. See Appendix E for a complete list of organizations represented in this process. In addition, the panel received and considered 55 written submissions from individuals and groups. This report relies heavily on evidence collected through interviews and roundtable meetings and the first-hand experiences of individuals involved in Canada's COVID-19 pandemic response.
Guiding principles for recommendations
The following key principles guided the panel's deliberations and formulation of recommendations:
- Build on successes: The panel's work acknowledges the processes, organizations, and elements of Canada's scientific advice and research coordination system that worked well during the COVID-19 pandemic. Its recommendations seek to build on these successes by addressing the gaps and weaknesses in the approach.
- Be practical: The panel's focus is how to improve Canada's preparedness for the next health emergency. While noting the jurisdictional responsibilities of the federal and provincial/territorial governments in health emergencies, the panel encourages creative yet practical approaches to further collaboration and coordination. The panel proposes solutions that can be realistically implemented and achievable within Canada's federated system.
- Reinforce findings and recommendations of previous expert panels: The panel acknowledges the many reports of previous expert panels and committees, whose valuable work–on strengthening both Canada's health emergency response and health research system generally–is relevant to this reviewFootnote 45Footnote 46Footnote 47Footnote 53Footnote 54Footnote 55. This report does not seek to duplicate their efforts; rather it aims to reinforce relevant findings and recommendations.
- Focus on the functions and roles required: While some of the panel's recommendations name specific federal departments and agencies that are seen to be instrumental, the focus is to identify the roles, functions, and mechanisms that must be set up and ready, within a coherent science advice and research coordination system, for the next health emergency.
- Foster greater inclusivity and diversity: The panel acknowledges the critical importance of incorporating a diverse range of perspectives in advisory and coordination structures and mechanisms. To inform its recommendations, the panel met with a broad range of experts, including in the areas of health equity and Indigenous health.
Report structure
The Major findings section presents four major findings that emerged from the panel's analysis and deliberations on the evidence. These findings underpin the panel's detailed recommendations.
Building on the major findings, the next four sections present the panel's analysis supporting its 12 recommendations on how Canada can be better prepared for future health emergencies across four key areas:
- National health risk governance
- Science advice mechanisms
- Health research prioritization, funding, and coordination
- Health data availability and use
For each recommendation, the panel offers its rationale, highlighting key evidence from its consultations and literature review. Best practices and lessons learned from domestic and international bodies are also highlighted.
The last section provides a brief conclusion. Various appendices contain inventories, timelines, and other contextual information.
Major findings
This section summarizes four cross-cutting findings that emerged from the panel's consultations, research, and deliberations. They underpin and inform the panel's analysis and recommendations in the areas explored in sections on National health risk governance through to Health data availability and use.
Canada must act now to be prepared for the next health emergency.
A common thread running through the panel's recommendations is the urgent need to build on and refine the extensive actions taken during the COVID-19 pandemic to coordinate research and effectively provide and use science advice. This is required to improve and sustain readiness in advance of the next emergency. The pandemic exposed and exacerbated the weaker elements of Canada's health research and science advisory systems, requiring federal departments to implement a wide range of supplemental ad hoc mechanisms. See Appendix A, Appendix B, and Appendix C for a full inventory of bodies and timelines. However, these took time to put in place and the lack of ready infrastructure and processes delayed the generation of evidence and synthesis of knowledge to inform decisions.
The pandemic also highlighted the shortcomings of Canada's health data systems, particularly the well-documented structural barriers to sharing surveillance data and an inability to conduct timely and adequate observational studies and clinical trials for medical countermeasures, such as vaccines and therapeutics. To trial critical vaccines and therapeutics, global life sciences companies chose countries with well-prepared clinical trial and emergency regulatory infrastructure and processes, resulting in lost opportunities for Canadians.
Many of the networks created during the pandemic have not received long-term funding and their future remains uncertain. This situation may return Canada to a pre-2020 state of readiness and puts Canada's preparedness for future emergencies at risk. It also results in a host of missed opportunities to leverage these networks during inter-pandemic periods of stability to address other public health issues. The panel's recommendations in the sections that follow call for immediate and sustained actions to address these issues to prevent possible disastrous health, social, and economic consequences of a future emergency that could be faster moving and more severe than the COVID-19 pandemic. Advance preparation for pandemics and other key threats to public health is a more cost-effective approach than waiting for the next emergency to strike before actingFootnote 3. It can also improve the health of Canadians in periods of stability.
Greater pan-Canadian coordination of research and science advice is required.
The response to the COVID-19 pandemic spurred unprecedented collaboration among government policy makers, public health officials, researchers, and other relevant groups and partners across Canada and abroad. Well-established federal-provincial-territorial public health bodies, such as the Pan-Canadian Public Health Network, were quickly activated in early 2020 and met regularly to support information exchange. However, there was a lack of sufficiently robust and tried systems for specifically coordinating health research and science advice across the country in response to a nationwide emergency of such scaleFootnote 4. This made it even more challenging to coordinate the many new permanent and ad hoc bodies created during the pandemic, and the information flowing to and from themFootnote 4.
Inadequate national coordination of science advice and research efforts, across sectors and geographies, as the pandemic evolved led to duplication of efforts in many areas of research and knowledge synthesis, as well as challenges in identifying, communicating, and funding COVID-19 research priorities. Duplication of knowledge synthesis and modelling activities to inform science advice, with different advice coming from different sources, also occurred within some jurisdictions. While some level of duplication and redundancy was to be expected and could potentially improve thoroughness and contextualization, the right balance was not achieved between larger national efforts on key priorities and smaller-scale projects. Provinces and territories had varying internal capacity to review and assess the emerging literature and to build models that could project possible outcomes under different scenarios. Those with limited capacity relied heavily on federal advice as well as advice from provinces with more advanced synthesis, modelling, and advisory resources.
The panel's recommendations urge greater pan-Canadian coordination in a number of areas to prepare for and respond to the next health emergency more effectively. For example, new federal mechanisms are required to bring together national efforts on key issues and coordination internationally, as well as more effective pan-Canadian collection and triage of public health research questions across jurisdictions with more direct targeted funding to answer those questions and share the resulting outputs. Intramural and extramural research, knowledge synthesis, and science advisory processes must be better coordinated. The government must place an even higher priority on its recent efforts with provincial/territorial governments to advance the use of health data and digital tools and require health data sharing as part of bilateral health funding transfer agreements. Finally, Canada must harness and embed a broader range of expertise, including from social, economic, behavioural, and applied sciences, into advisory bodies, and remove barriers to interdisciplinary, transdisciplinary, and cross-sectoral collaboration.
These processes must be put in place now and tested and refined through simulations and exercises before the next health emergency.
A greater focus needs to be placed on equity and addressing social and structural determinants of health.
COVID-19 disproportionately negatively impacted communities in Canada already experiencing inequities and health disparitiesFootnote 2Footnote 5. This included 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. The social and economic conditions that contribute to differences in health status, such as income, employment, education, food insecurity, and housing, greatly influenced differential exposure and vulnerability to the SARS-CoV-2 virus and access to treatment.
The pandemic exposed many of the structural and systemic factors that contribute to inequities. Research on the effectiveness of public health interventions to address health inequities and the social and structural determinants of health was generally not well funded, prioritized, or coordinated in advance of or during the pandemic. In some cases, advisory bodies themselves were not sufficiently diverse or their members did not have enough expertise in these areas to identify recommendations that would improve health equity outcomes.
Before COVID-19, there was insufficient collection and sharing of disaggregated data on the determinants of health. As the virus spread, municipal public health units across the country began to collect relevant data to better understand the needs of populations that were heavily or more severely affected by the virus and the wider consequences of public health measures. In many cases, this work came too late in the pandemic. The National Advisory Committee on Immunization's use of a framework and a validated equity tool to identify priority populations for vaccination is an example of effective use of health equity principles, with the subsequent wide adoption of its guidelines by provinces and territoriesFootnote 56Footnote 57Footnote 58.
The importance of social and structural determinants of health is well documented and understood in Canada. However, efforts to lessen their impacts have been insufficient to date, as has systematic measurement of these factors to allow for targeted policy action in a timely manner. A greater focus must be placed on reducing these impacts before the next pandemic or other health emergency strikes. This requires embedding an equity lens into scientific advisory processes and health emergency research, including comprehensive adoption of broader collection and sharing of disaggregated sociodemographic and race-based data. Further research on interventions, in addition to activities that build trust with communities, is essential to guide equitable preparation for, mitigation of, and responses to future health emergencies, as well as efforts to address the underlying inequities. Many of the panel's recommendations reflect the urgent need to improve Canada's performance in these areas.
Indigenous health expertise must be embedded in research coordination and science advice processes.
Indigenous populations were disproportionately impacted by the COVID-19 pandemic due to longstanding and well-documented health inequities linked to social and structural determinants of health such as differential access to health services, proper housing, and clean water, among othersFootnote 6. Indigenous health considerations and expertise were also not adequately integrated into science advice and research coordination structures and processes, despite the government's efforts to quickly leverage pre-existing structures relating to Indigenous health. These included the Canadian Institutes of Health Research Institute of Indigenous Peoples' Health and the National Collaborating Centre for Indigenous Health. There is a need for broader Indigenous inclusion at many science advisory and research tables convened by Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, and other federal government departments, both during and between emergencies.
The view of Indigenous health leaders is that the health of the communities they serve is treated as an add-on responsibility for federal advisory bodies, rather than as an overall priority that incorporates Indigenous methodologies, perspectives, and priorities from the outset. In addition, federal research grant funding processes do not adequately value Indigenous knowledge and ways of knowing, being, and working, and are not compatible with the realities of Indigenous communities including those that are remote and isolated. Leadership issues and changes, particularly at the Canadian Institutes of Health Research Institute of Indigenous Peoples' Health, also exacerbated mistrust and coordination challenges that were already present due to the history of health-related abuses of Indigenous people in CanadaFootnote 59.
Many of the panel's recommendations reflect the urgent need for the federal government to integrate and embed Indigenous health expertise and considerations in surveillance, data collection, risk assessment, expert advice, and research funding processes. First Nations, Métis, and Inuit communities each need to be integrated into the broader systems in their own right using a "distinctions-based"Footnote bFootnote 60 approach, rather than as part of a pan-Indigenous approach. This integration of knowledge and decision making is critical to advance reconciliation with Indigenous Peoples, build meaningful relationships, and overcome mistrust related to historical data collection and misuse by governments. Research coordination and data use must reinforce the right to self-determination and principles of data sovereigntyFootnote 8.
National health risk governance
Past public health emergencies, such as HIV, SARS-CoV-1, MERS, and Ebola, have demonstrated the vital importance of emergency preparedness and response structures to the effectiveness of the overall response. The COVID-19 pandemic reinforced the need for surveillance, monitoring, and risk assessment to populate data ecosystems and support science advice and research coordination.
Canada has made strides in the development of a risk governance system, but still has challenges to overcome. It does not yet have a comprehensive, centralized system that assesses the most pressing health and public health risks, let alone one that is integrated with other types of threats and hazardsFootnote c. Efforts to enhance Canada's science advisory and research coordination structures must also consider how risk governance structures and their functions, including surveillance, monitoring, and risk assessment, can support experts and decision makers. Together, these elements can form a comprehensive national health risk management system.
This section explores the need for Canada to develop more robust governance mechanisms for the identification, assessment, mitigation, and management of natural hazards and human threats. Drawing on best practices in countries such as the United Kingdom (UK), the Netherlands, and New Zealand, the panel's recommendations focus on strengthening the risk governance system and integrating it with science advisory and research coordination mechanisms.
Perspectives on national risk registers
Federal government departments are mandated to develop emergency management plans in their respective subject areas, which must align with the government-wide Federal Emergency Response PlanFootnote 61. The panel heard that federal emergency management protocols are siloed and disjointed across departments, and lack provisions for science advice and research coordination. See Appendix D for more information on the Federal Emergency Response Plan and associated Health Portfolio emergency plans.
This section outlines ongoing work across the federal government to address gaps in risk governance and suggests how the distinct areas of expertise in departments and agencies can be integrated to develop a more robust approach. It also discusses the elements or lenses necessary to conduct effective risk assessments and produce a comprehensive health risk register for Canada.
Canada's current approaches to risk assessment
In 2019, Public Safety Canada (PSC) released an Emergency Management Strategy for Canada: Toward a Resilient 2030Footnote 62. The strategy builds on the foundational principles articulated in previous emergency management frameworks and emphasizes the need to consider different vulnerabilities, resilience factors, and the culture of risk assessment and response in Canada
In accordance with the strategy, PSC began work in 2021 to lead the development of a National Risk Profile, which is similar to what other jurisdictions call a risk register (UK) or risk assessment (Netherlands). Intended to fill a gap in Canada's risk governance structures, the National Risk Profile uses an all-hazards risk assessment methodology to consider the impacts of risks in five areas:
- People (fatalities, injuries, and psychological illnesses);
- Economy (direct and indirect economic losses);
- Environment (all forms of environmental damage);
- Government (damage to influence or ability to govern); and,
- Social function (disruptions to societal functions).
The methodology assesses the impact and likelihood of a risk and uses cost estimates to develop realistic scenarios and standardized comparisons of all scenarios (with the expected loss caused by the hazard, per year, and averaged over a set period). This allows PSC to compare risks across sectors in a standardized way and determine where to focus emergency management system changesFootnote 63.
PSC's report from its first round of research, released in May 2023, focused on the three most costly natural hazards: earthquakes, wildland fires, and floods. The report includes a section that takes a "pandemic lens", and considers the impacts a pandemic (as a broad, society-wide emergency) can have on emergency responses to the three natural hazards. The second round, currently underway, focuses on heat events, hurricanes, and space weather due to their significant impacts on public health, critical infrastructure, the economy, and ecosystemsFootnote 9.
The development of the National Risk Profile is an important step towards a more comprehensive assessment and preparedness plan for Canada. However, the panel has identified a gap in the type of risks assessed. The analysis considers the health impacts of emergencies on a population, but does not recognize and assess biological threats in and of themselves. This omission indicates a potential lack of risk assessment that considers health security, or how pathogens, pandemics, and other illnesses can harm the population of Canada, as the National Risk Profile may not address biological or health-related emergencies among the most important risks facing Canadian populations until future rounds, if at all.
The UK's National Risk Register demonstrates how a national risk register can be effectively used in risk assessment and analysis. First published in 2008, the publicly available National Risk Register includes an assessment of 89 risks across nine themesFootnote dFootnote 13. These risks include natural disasters, pandemics, cyber threats, and other emergencies that could impact the wellbeing of the population. This all-hazards approach acknowledges that all risks, including biological and health-related hazards and threats, can result in similar direct effects and pathways of cascading consequences on a population. This is why it is critical for Canada's National Risk Profile to take a common approach to assessing all major risks that may transpire at a national level, regardless of which federal portfolio would be implicated in a response.
At present, the Public Health Agency of Canada (PHAC) and the Canadian Food Inspection Agency (CFIA) prepare assessments of risks related to their individual mandates. However, there is no publicly available comprehensive register of health-related risks. The panel considers the Health Portfolio as best placed to conduct the analysis of health-related risks and to produce a comprehensive health risk assessment. There is an opportunity within the Health Portfolio to leverage the work of PHAC, CFIA, and other departments and agencies such as Environment and Climate Change Canada to integrate a One Health approach in risk assessment processes, and track pathogens and zoonoses, whether they originate from humans, plants, or animals. In doing so, PHAC would expand its current approach to risk analysis from the traditional public health approach (considerations of long-term public health and prevention of chronic disease) to adopt a health security focus that monitors all biological and health threats. This approach would address the previously mentioned gap in the PSC National Risk Profile.
One Health
A One Health approach acknowledges that the health of humans, animals, and ecosystems are interlinked. This includes pathogens and zoonoses and the analysis of other areas of the human-ecosystem interface, including urbanization, international travel and trade, and food production–all of which can contribute to the emergence of new diseasesFootnote 65. In the Canadian context, the widespread wildfires in summer 2023 demonstrated the benefits and necessity of a One Health approach, as both ecological and human health concerns were critical in the response. The 2024 H5N1 influenza outbreaks in dairy cattle also underscore the need for a fully coordinated approach to risk assessment and surveillance.
Federal-provincial-territorial coordination
The panel observed a lack of coordination and alignment between federal and provincial/territorial risk assessment and emergency response plans and activities. Infectious agents do not recognize political boundaries. Therefore, a lack of coordinated responses across borders increases both health risks and other adverse consequences of outbreaks and pandemics. Since all jurisdictions and levels of government are implicated in many major health emergencies, a common understanding of and consistent approach to coordination for emergency response protocols will greatly enhance emergency response across Canada. Early in the pandemic, the Federal-Provincial-Territorial Public Health Response Plan for Biological EventsFootnote 12 guided action to activate a Special Advisory Committee and associated Technical and Logistics Advisory Committees under the Pan-Canadian Public Health Network. However, the panel heard that current guidance and structures were not robust enough to coordinate a response to an emergency of such scale and multi-sectoral scope, and did not include sufficient provisions for science advisory and research coordination processes.
The UK National Risk Register provides an example of how Canada can integrate provincial and territorial partners into this work. The register highlights the processes and risks that the UK government considers most pressing, enabling local and regional governments to prioritize their own risk assessment and mitigation plans. Moreover, the associated Civil Contingencies Secretariat produces guidance for local administrations on how to interpret the National Risk Register at their levelFootnote 66. This approach can also be adapted to account for jurisdictional boundaries.
The proposed Canadian health risk management system must be linked to emergency protocols at all levels of government. Isolating risk assessment and response processes at different levels of government (federal, provincial/territorial, regional, or municipal) may create unnecessary gaps in assessment and response. Reducing gaps and maintaining readiness across all levels of government also requires regular table-top exercises where participants can test protocols, complemented by ongoing updates and revisions to plans based on emerging threats and ongoing governance changes. Practice simulations also ensure that participants are familiar with the process and working with one another. This idea is explored further in the Science advice mechanisms section.
The Netherlands' National Risk Assessment demonstrates how Canada can integrate expertise from outside of government into its risk governance mechanisms. The panel heard that expertise in some scientific and technical fields in Canada is primarily concentrated in the private or academic sectors with limited expertise found within the federal government. The Netherlands addressed a similar challenge through its National Steering Committee for National Safety and Security, which features representatives from 16 national ministries and determines which risks to prioritize and address. Notably, the Steering Committee also includes representatives from the private sector and industry, acknowledging that public-private partnerships are necessary to safeguard national securityFootnote 67. The Network of Analysts for National Safety and Security, a knowledge network composed of experts and representatives from outside government, develops scenarios based on the identified risksFootnote 67. This approach also ensures that the development of the National Risk Assessment is a collaborative exercise between government representatives and external experts, and that scientific and governance expertise drives the risk analysis process.
Application of an equity lens to risk assessment
The panel frequently heard that the impacts of emergency events are not evenly distributed across populations in Canada, and that social and economic status results in differential risk and capacity to respond. Incorporating an equity lens into risk assessment functions across the Government of Canada is essential for a risk management system to be able to support analysis of the most pressing risks for diverse populations. This idea was also introduced in the Chief Public Health Officer's 2023 reportFootnote 68. An equity lens would also ensure that disproportionally impacted groups are involved earlier in the planning process and are familiar with the response protocols.
New Zealand provides an example of how Canada's Health Portfolio can integrate Indigenous perspectives into a new health risk register. New Zealand's National Intelligence and Risk CoordinationFootnote 69 uses a National Risk ApproachFootnote 70 to proactively and comprehensively manage the most significant risks to national security in the form of a National Risk RegisterFootnote 14. The National Risk Register supports government departments in risk assessments and encompasses a wide array of hazards and threats spanning various domains, including natural, biological, and technological hazards; malicious threats; and economic crises. The Manual for Communicable DiseasesFootnote 71, for which the Ministry of Health is responsible, outlines the need for a strong focus on Māori health and the health of other Pacific peoples, refugees, and asylum seekers. It recognizes the higher rates of infectious disease and increased risk of severe communicable disease among those populationsFootnote 72. The principles for guiding this work originate from a broader treaty articulating the responsibilities of the New Zealand government in relation to Māori peoples, and includes Māori representatives and those with expertise in Māori ways of knowing early in the planning and response processes, and works in partnership with kaumātua (Elders) and communities throughout the processFootnote 73. In the Canadian context, it is critical for Indigenous Services Canada and Indigenous peoples and communities to be included in health risk assessments and planning. This includes considerations for how First Nations, Inuit, and Métis expertise and cultural contexts can be embedded in emergency planning, and not only for Indigenous communities.
A comprehensive national health risk management system for Canada
The current approach to national risk assessment is fragmented. It isolates the assessment of health risks within the Health Portfolio, with other risks assessed separately, including through the National Risk Profile process. It also does not provide a comprehensive basis for developing the collective, interdepartmental understanding of all risks that is required to respond to an emergency that spans departmental mandates. It is crucial to acknowledge that multiple types of threats and hazards can (and do) occur in complex systems, and to address the gaps in Canada's current approach, which silos the assessment of certain risks within individual portfolios. A shared approach to risk assessment activities across government will create a shared foundation for interdepartmental collaboration and integration of disparate risk assessment products and preparedness plans moving forward.
Recommendation 1: Put in place a comprehensive national health risk management system
- Develop a national health risk register and preparedness plan including mitigation, response, and recovery elements. This should encompass the health implications of environmental, zoonotic, chemical, biological, radiological, nuclear, and other natural hazards and human threats that could originate domestically or internationally. It should be updated regularly based on horizon scanning, and an external version should be published at least annually. The Health Portfolio should lead this process in coordination with Public Safety Canada and other departments and agencies as required. The plan should be developed in collaboration with provincial/territorial public health agencies and health departments.
- Incorporate the health risk register and preparedness plan within broader national emergency protocols, clearly outlining the roles and responsibilities of relevant departments and agencies. Plans should be rehearsed and refined through regular table-top simulations and exercises.
- Establish a standing health risk assessment and planning advisory body to inform the health risk register and preparedness plan. This should include a dedicated standing expert advisory committee on infectious diseases and pandemic preparedness.
Developing a health risk register–and integrating it with other aspects of emergency response–would give federal, provincial, territorial, and Indigenous partners a common understanding of which risks are most critical, facilitating collaboration and coordination in the areas of science advice and research coordination, among others. In this context, the risk register should also be used to inform research priorities, developed by a central research coordination mechanism (discussed further in the Health research prioritization, funding, and coordination section).
The panel considers the formation of three new standing advisory structures instrumental to integrating external expertise into Canada's health risk management system during inter-emergency periods: a health risk assessment and planning advisory committee, a specialized infectious diseases and pandemic preparedness advisory body, and a health equity advisory body (discussed further in the Health research prioritization, funding, and coordination section). The Health Portfolio is best positioned to lead the processes for these new bodies. PSC, the Office of the Chief Science Advisor, Indigenous Services Canada, and other departments and agencies (as required) should be involved to ensure strong interdepartmental, intergovernmental, and broader coordination. Representatives from provincial and territorial governments and First Nations, Inuit, and Métis partners should be invited to name liaisons to attend sessions, provide important context to members, and report back to their organizations.
The health risk assessment and planning advisory body should be composed of intramural and extramural experts on health risks, and on their potential outcomes, consequences, and challenges, who can guide the development and maintenance of a national risk register. Membership should be based exclusively on individual areas of expertise and include experts who can speak to health equity and community health in the context of risk assessments and prioritization. This ensures that the risk register meaningfully considers groups who are most likely to be disproportionately impacted by an emergency in its preparedness, mitigation, response, and recovery strategies.
The standing expert advisory committee on infectious diseases and pandemic preparedness should be composed of federal and provincial/territorial intramural and extramural researchers who advise Health Portfolio leaders and decision makers on the emerging threats, trends, and research. Representatives from federal research organizations such as the National Research Council and granting councils should attend committee meetings to ensure awareness of research priorities and trends. The support of secretariats is critical to ensure tangible progress in inter-emergency periods and readiness for emergencies.
Linking the health risk register and broader risk profile beyond health-related risks should be a next step in strengthening Canada's emergency preparedness and risk governance structures. The integration of the work of the Health Portfolio and other science-based departments and agencies with PSC's in-progress National Risk Profile would facilitate additional cross-governmental collaboration, streamlined processes, and clear reporting structures in a future crisis.
Surveillance infrastructure
During the COVID-19 pandemic, the federal government funded new surveillance networks, including wastewater monitoring, which provided crucial data on infection rates. Well-coordinated surveillance systems are critical to inform health risk assessment and science advice and direct future areas of research. The panel heard, however, that processes for real-time clinical surveillance and data sharing were lacking and impeded timely coordination among federal, provincial, and territorial governments.
The 2003 National Advisory Committee on SARS and Public Health raised similar issues, calling for the development of a comprehensive national public health surveillance system that leveraged capacity from all levels of government and different sectors. It envisioned a system that:
…would begin by collecting data on communicable diseases, and extend its ambit to non-communicable diseases as well as relevant population health factors. The surveillance system must be relevant at the local level, with timely reporting and analysis, and flexible enough to adapt to changing needs and different local and institutional circumstances. Such a system must be built so that databases can communicate with one another, and be sufficiently 'low tech' to maximize uptake in hospitals (not least hospital emergency rooms where renewal and upgrading of information systems is urgently needed), clinics and public health unitsFootnote 8.
The development of such a system that feeds into the risk governance system more broadly requires the ongoing efforts of many surveillance programs and networks established during the COVID-19 pandemic.
Surveillance using routinely collected health care data and public health data
At the federal level, health surveillance is a PHAC responsibility; however, the jurisdictional realities of collecting public health data and combining and sharing routinely collected health care data in Canada present challenges for integrating these data into national health surveillance functions. Many public health data are generated locally and routinely collected from individual care settings (e.g., hospitals, laboratories, clinics, pharmacies). Critically important data related to infectious diseases are collected by public health units across the country, both for surveillance and case and contact/outbreak management. Integrating data from many sources is critical to the development of a robust and effective surveillance structure in Canada.
The panel heard that the separation of public health and clinical care may be impeding Canada's ability to harness routinely collected clinical data to feed into broader surveillance efforts. At a local level, partnerships of public health with primary care teams, hospital laboratories, school nurses, environmental health officers, and others directly involved in health services delivery are common and are recognized to improve response to outbreaksFootnote 24. At a federal level, PHAC supports some longstanding and effective surveillance networks that take advantage of data from health care delivery, such as IMPACT (Canada's Immunization Monitoring Program ACTive)Footnote 74 and the Canadian Nosocomial Infection Surveillance ProgramFootnote 75, and incorporates routinely collected data into other systems (e.g., the Respiratory Viral Detection component of FluWatch)Footnote 76. Further work is needed for the federal government to take best advantage of routinely collected health data in its national surveillance structures. The current rapid advances in the ability to automate the aggregation of routinely collected data mean that major advances in this area of surveillance will be possible over the next few years, if data sharing challenges can be overcome.
Effective use of routinely collected health data for surveillance at a national level requires that data collected locally and provincially be standardized to permit national aggregation, and shared across jurisdictions. Currently, barriers to interprovincial data sharing are a major limiting factor, as discussed in the Health data availability and use section. Routinely collected health data also have other limitations. Many such data that are important for infectious disease surveillance are not currently available: for instance, results of some microbiology laboratory testing have only become available in Ontario provincial databases in the last five years. Routinely collected health care data also provide little to no insight into cases of low severity occurring in the community for which medical care is not sought.
The systems used for routinely collected health data are complex and aggregate data from many sources (e.g., individual hospitals) that may require manual coding and entry; for these reasons, data quality and reproducibility challenges exist. These complexities result in additional challenges for real-time data collection. For example, in April 2020, the Canadian Institute for Health Information (CIHI) started collecting hospital occupancy and capacity data from provinces and territories to support the COVID-19 response, which it then provided to Health Canada and PHAC in its COVID-19 Hospital report. This provided federal departments with near real-time indicators of COVID-19 hospital occupancy and hospital capacity to assess health system impact. However, the challenge associated with providing real-time data in current systems is often that data are incomplete in initial reports. Real-time data for more complex information, such as hospital discharge data, are much more challenging to provide in close to real time, and repeated downloads with varying degrees of incompleteness and data quality make analysis more difficult and complex.
The panel heard that public health surveillance and data management capacity differs greatly across provinces and territories. Some jurisdictions noted that much of the case reporting was done manually in hospitals during the early days of the pandemic, and in northern, remote, and isolated communities throughout the pandemic. The panel also heard that the complete absence of surveillance and data infrastructure in some regions meant that confirmed case counts were often only available by calling frontline health care workers. Federal funding under the Safe Restart Agreement was used to improve provincial and territorial data systems, including enhancing clinical information systems and supporting integration of primary care and public health functionsFootnote 77, but the panel observes that there is much more work required in this area.
Wastewater and other surveillance
The use of wastewater surveillance for infectious disease risks other than polio was very limited prior to the pandemic. However, it has proved to be a valuable component of COVID-19 surveillance programs. In Canada wastewater monitoring had important benefits for northern, remote, and isolated communities because it enabled early detection of local COVID-19 activity, permitting more effective implementation of interventions to limit the spread. For example, Nunavut's Chief Public Health Office reported the first positive COVID-19 wastewater signal in Ranken Inlet on August 27, 2021 before any cases were identified, indicating that unrecognized infections were occurring.
The initial challenge in northern communities was delayed reporting, as samples had to be sent to the National Microbiology Laboratory (NML) in Winnipeg for testing. Further innovations by NML and regional partners allowed field-deployable point-of-care devices to be adapted for local use, without requiring new infrastructureFootnote 78. Point-of-care devices were deployed to multiple locations, including First Nations communities, and a federal correctional site. For example, the Taiga Environmental Laboratory in Northwest Territories could run up to five samples within two hoursFootnote 79.
The panel also learned that a pilot program conducting wastewater surveillance at airports was instrumental in identifying some of the new variants of concern one to four weeks prior to clinical cases being identified. Established by NML in January 2022, in partnership with the Greater Toronto Airport Authority, the Universities of Waterloo and Guelph, and the Ontario Ministry of Environment, Conservation, and Parks, the program collected samples from airport terminals and a waste management building for airplane sewage. Despite the success of detecting variants from airport wastewater testing and the cost-saving advantages (one sample of wastewater is more cost and labour effective than testing individual travellers or community members), the panel heard that local public health and industry partners did not have access to the data and the results were not published.
Narrowly focusing emergency preparedness efforts and associated research on the subject of the most recent emergency was a concern following the 2003 SARS outbreak and continues to apply more than 20 years later in the wake of COVID-19. As described by the National Advisory Committee on SARS and Public Health, "Focusing on smallpox, SARS or pandemic influenza raises the risk of over-investing limited resources in managing a restricted range of public health emergencies rather than engineering a system that can be flexible and responsive as well as sustainable"Footnote 8. The panel heard that flexibility and adaptability are core components of successful risk governance structures. Wastewater has also proven its value in monitoring Mpox activityFootnote 80, and is being investigated for potential wider use for monitoring of influenza A(H5N1), a highly pathogenic avian influenza. Ongoing research is needed to realize the value of wastewater surveillance and how to best integrate it into an overall surveillance strategy for Canada. Despite this, the panel heard that long-term funding for some wastewater networks is not yet confirmed, including those funded through the Health Portfolio and other federal initiatives during the pandemic. The pandemic demonstrated that developing physical and governance infrastructure in the middle of an emergency situation is costly and delays response. Maintaining and improving surveillance infrastructure would help ensure both Canada's preparedness for a future health emergency and effective public health surveillance in inter-emergency periods.
Many other data sources (e.g., microbiology laboratory networks, vital statistics databases, volunteer population cohorts), which are included in provincial and federal surveillance programs in Canada as well as programs in other countries in specific areas, were used during the pandemic. These sources have different advantages, but many of them also faced challenges with timely reporting during the pandemic. For example, despite substantial efforts to shorten the timeline for mortality reporting, significant time lags persisted because of the time required to centralize data, verify records, and categorize causes of death. The pandemic also resulted in other novel approaches to surveillance. For instance, Canadian researchers validated the use of cremation data as a more timely surveillance tool for all-cause mortality during a public health emergency than vital statistics dataFootnote 81. Encouraging and supporting the creation and validation of new approaches to surveillance is another important requirement for the development of Canada's overall surveillance strategy. The panel did not hear evidence for surveillance, other than for human infections, but a One Health approach is necessary to guide Canada's infectious disease surveillance strategy. The current H5N1 avian influenza outbreak emphasizes the need to build and maintain strong linkages between animal and human health surveillance systems.
Sharing surveillance data among federal, provincial, and territorial partners
Challenges and barriers related to data sharing (explored in greater detail in the Health data availability and use section) continue to impede effective and coordinated surveillance efforts in Canada. While some provincial roundtable participants expressed their desire to have conducted more surveillance during the pandemic, the panel heard that some provinces and territories do not have the capacity or training to carry out public health surveillance functions. The same is true for other jurisdictions and organizations: municipal public health offices and Indigenous or regional governments do not consistently possess the resources to conduct independent surveillance or analysis of clinical case reporting. In addition, synthesized information shared by federal departments, such as PHAC and CFIA, is critical to supplement provincial and territorial capacity to conduct public health analysis.
The panel heard that existing federal government open data and open science policies and processesFootnote 82Footnote 83, with surveillance data sets and analyses reported regularly, do not allow for real-time assessment, coordination, or action during an emergency. Federal government employees expressed concern about sourcing information from provincial and territorial governments, while some individuals from provincial and territorial governments described federal data collection as a one-way valve: provinces and territories gave information to the federal government but could not always access federal surveillance data sets in return.
The challenges in sharing surveillance data stem from, at least in part, the gaps in agreements between PHAC and provincial/territorial governments. The 2003 report of the National Advisory Committee on SARS and Public Health raised the same issues for the SARS outbreak, describing challenges in communicating case information through provincial/territorial governments to the federal levelFootnote 8. The Multilateral Information Sharing Agreement, for example, is intended to define why, how, what, and when information and biological substances can be shared between health authorities in CanadaFootnote 84. The panel heard that this agreement (established in 2016 and not adapted since) is not robust or comprehensive enough to guide surveillance data sharing, especially during a public health emergency. The agreement requires PHAC to give 30 days' notice to a province or territory before publishing any data or analysisFootnote 85. This requirement limits PHAC's ability to publish real-time and current epidemiological analysis, which is an essential source of information during a quickly evolving public health emergency. This limitation was demonstrated during the pandemic with PHAC's inability to share real-time provincial/territorial vaccine adverse effects surveillance data with Health Canada, biomanufacturing industry partners, and the World Health OrganizationFootnote 86.
The challenges with vaccine surveillance data sharing also extended to the type of data shared. Although PHAC's COVID-19 Vaccination Coverage Surveillance System compiled the data that provinces and territories voluntarily supplied, these did not include population or demographic data (such as race or Indigenous status), which are not always collected or shared. (The Health data availability and use section further explores the gaps in data systems and the limited availability of disaggregated sociodemographic and race-based data.)
Effective surveillance systems and timely surveillance data sharing
Strengthening Canada's preparedness for future health emergencies requires maintaining and leveraging the surveillance expertise and data sharing mechanisms developed during the pandemic. Successful development and long-term use of surveillance infrastructure requires jurisdictions to create a culture that prioritizes public health surveillance as a tool for use during a public health emergency and to track chronic health issues at the population level. Moreover, it requires all levels of government to shift away from the prevalent "culture of caution" and data protectionism to one where data are appropriately handled to protect individual privacy and security while enabling the seamless sharing of surveillance data. (This is explored further in the Health data availability and use section.)
Recommendation 2: Ensure that surveillance systems adequately support real-time assessment and public health security
- Provide sufficient long-term funding for clinical, public health, and laboratory surveillance networks and infrastructure for emerging infectious diseases and risks to public health, accompanied by the underpinning technical infrastructure, in coordination with provincial/territorial governments and First Nations, Inuit, and Métis partners.
- Systematically provide the results of all federally managed and funded public health surveillance efforts to provincial/territorial, local, and Indigenous health agencies and pursue reciprocal sharing agreements.
Science advice mechanisms
Effective mechanisms for the transmission of scientific advice to senior policy makers are crucial to a government's ability to make informed, timely decisions during health and other emergencies. This is especially important when the threat is novel or rapidly emerging, where there is significant uncertainty, and where the full extent of the health, social, and economic impacts are not clearly understood. In response to COVID-19, the federal government went to great lengths to seek science and expert advice through both established structures and newly created, ad hoc advisory bodies. See Appendix A, Appendix B, and Appendix C for a full inventory of bodies and timelines.
The process of providing science advice includes collecting and analyzing data and other information, evaluating the information for significance and relevance, synthesizing multiple types of scientific evidence, applying context to the evidence, and communicating the result–advice–to policy makers to inform the government's decisionsFootnote 25. Specific types of scientific information, and their synthesis, were critical to formulating science advice throughout the COVID-19 pandemic due to the scale and rapid pace of the virus' evolution. The need to draw from different disciplines evolved over time and while biomedical publications dominated the early COVID-19 literature, the number of social and behavioural science articles published subsequently increasedFootnote 87. Knowledge synthesis of emerging research findings, health surveillance, and predictive epidemiological modelling imparted foundational information.
This section focuses on the urgent need to create a new science advisory system for emergencies, including the required structure and components, diversity of expertise and perspectives, and support from effective secretariats. The panel also reflects on effective science communication and the types of science advice that may be required in future health emergencies.
Features of effective science advisory bodies
Canada's emergency management plansFootnote 10, pandemic plansFootnote 11, and federal-provincial-territorial public health emergency response plansFootnote 12 do not currently outline protocols for science advice. The federal government has an opportunity to establish a science advice mechanism for future pandemics and emergencies that leverages the lessons learned domestically and internationally from the COVID-19 pandemic and previous health emergencies.
The effectiveness of science advisory structures that operated during the pandemic varied depending on multiple factors including the timing of their establishment, mandate, membership, access to data, how advice was delivered, and whether that advice was to be acted upon within a federal jurisdiction or at other levels of government.
The panel's experience, consultations, and a literature scan conducted by the Public Health Agency of Canada (PHAC)Footnote 24 point to four key features of effective science advisory bodies. First, they operate with a high degree of independence, yet have strong ties to government and a clear "customer" in the form of senior government policy makers who are receptive to their advice. For example, the COVID-19 Vaccine Task Force, an ad hoc group stood up by Innovation, Science and Economic Development Canada and Health Canada in June 2020, operated with a high degree of independence, yet had clear customers in the Minister of Innovation, Science and Industry, the Minister of Health, and other MinistersFootnote 16. These features, along with its expert roster, strong secretariat, and clear mandate enabled the rapid delivery of vital advice to inform critical procurement decisions. The Ontario COVID-19 Science Advisory Table was established in July 2020 as an independent advisory science body supported by the Dalla Lana School of Public Health at the University of Toronto, with strong links into government. For both bodies, mechanisms were put in place to safeguard their autonomy–allowing them to meet privately and work independently–while providing advice directly to the government as and when requiredFootnote 24. Both of these bodies were formed when the first wave of the pandemic was largely over.
Second, effective science advisory bodies are properly resourced, have access to required data, and are populated with a diversity of perspectives and expertise. They provide interdisciplinary advice based on the best available evidence at the time. The concepts of diversity of perspective and expertise are discussed in greater detail in the sections on Diversity of expertise and perspectives through Equity considerations in science advice.
Third, effective science advisory bodies provide timely advice that observes principles of effective science communication (see Effective communication of scientific advice section), with advice publicly released soon after its provision to government. Many countries–such as the UK and Norway–activated science advisory bodies more quickly than Canada. The UK's Scientific Advisory Group for Emergencies (SAGE), notable for its readinessFootnote 88, offers an example of a standing mechanism that can be quickly activated in response to a health emergency. Before the COVID-19 pandemic, the UK had already activated SAGE nine times between 2009 and 2019 to advise on infectious disease outbreaks, natural disasters, nuclear incidents, and other mattersFootnote 23. Due to existing structures, the UK government was able to rapidly operationalize SAGE in January 2020 to respond to COVID-19. SAGE briefs were publicly released with increasing speed, following their provision to government. The Norwegian Institutes of Public Health began developing rapid COVID-19 reviews for decision making on March 20, 2020, and by April 10, had published eight rapid reviews on its websiteFootnote 89.
The UK's Scientific Advisory Group for Emergencies (SAGE)
The SAGEFootnote 23 system allows for the immediate convening of multidisciplinary experts in response to an emergency to provide science and technical advice to Cabinet. SAGE does not have a standing membership; rather, it maintains a roster of experts with relevant expertise to be called forward depending on the nature of the emergency. The Cabinet Office Briefing Rooms activate SAGE in response to a national emergency. The system provides critical advice on risk assessment, strategy development, data analysis and modelling, resource allocation, and communication.
Fourth, science advisory bodies must be sufficiently connected to government so that members understand the context in which science information for decision making is needed and the role and limitations of science advice in decision-making processes, and so that government officials receiving technical advice can properly interpret it. For example, the Federal Pandemic Science Coordination and Action Group was co-chaired by the Deputy Minister of Health and the Executive Vice President Science and Research of the University Health Network; its members had previously or were concurrently working together on other COVID-19 and health initiatives. This integration of governance and technical expertise in a single advisory body allowed it to identify key response areas that could benefit from enhanced coordination and targeted research efforts.
National Advisory Committee on Immunization (NACI)
NACIFootnote 17, established in 1964, provided essential advice for immunization program planning, prioritization, and administration during the pandemic. It used its well-established processes to monitor evolving evidence on COVID-19 vaccines and to issue new or updated vaccination recommendations. It was often able to issue vaccine advice concurrently with or within days of Health Canada regulatory vaccine authorizations due to its confidential direct access to vaccine regulatory submission data throughout the pandemicFootnote 90. However the panel also heard that NACI lacked surge capacity to keep pace for the duration of the pandemic.
Canada can look to Australia as a strong international example of this feature. During the pandemic, the National COVID-19 Health and Research Advisory Committee, which included community leaders, parliamentarians, clinicians, researchers, and representatives of priority populations, provided advice to the Commonwealth Chief Medical OfficerFootnote 91. The National Health and Medical Research Council provided the Committee with secretariat support. The Australian Committee is notable for its breadth of interdisciplinary experience and expertise.
This understanding between policy and science can also be built when advisory bodies work together regularly, refining their processes and building relationships and trust. Based on the panel's experiences, this is critical in an emergency that requires rapid development and delivery of science advice.
Diversity of expertise and perspectives
Many of the science advisory bodies created during the pandemic to support one or more aspects of the response were created quickly. The urgency of the emergency limited the time available to consider the full breadth and depth of expertise required and to ensure diversity. The panel heard a great deal about the need for more diverse advisory bodies and the types of diversity and expertise that should be considered. This section explores the various types of diversity that should be considered well in advance of an emergency. The First Nations, Inuit, and Métis expertise section focuses on the need for more First Nations, Inuit, and Métis representation on advisory bodies.
The panel heard that relevant individuals with expertise in infectious diseases or biomedicine were asked to serve on multiple federal science advisory bodies with overlapping mandates during the pandemic. This drew heavily on the time of individuals with other professional responsibilities (including to provincial or territorial advisory bodies). For example, expert advisory groups on modelling were established by both PHAC and the Office of the Chief Science Advisor, less than one month apart (February and March 2020, respectively), with significant overlap in membership: 9 out of 10 members of the latter were also members of the former. Overall, according to the panel's analysis, 23% of federal COVID-19 advisory body members served on more than one federal body, with some participating in up to 10 bodies. Some membership overlap between groups was a strategic choice, and by design to improve governance and coordination. While multiple memberships potentially enriched the scope of information to which an individual was exposed, the panel heard concerns about a lack of diversity and broad perspectives on these advisory bodies and concerns about leaning too heavily on certain types of evidence as well as incidences of "groupthink."
The panel also heard that having mainly clinical experts on advisory bodies, and not enough individuals with broader expertise from areas such as behavioural science, engineering, economics, and the social sciences, affected how problems were defined and which solutions were deemed acceptable. Transdisciplinary perspectives help inform science advice that considers the biological, psychological, social, and behavioural mechanisms underlying health emergencies, in addition to structural factors that influence health inequities, and benefit from the experiences of community leadership and lived experiencesFootnote 24. There was a clear need for more expertise in knowledge mobilization and translation, as well as in the natural sciences and engineering (e.g., ventilation and aerosols).
A diversity lens must be applied to existing and future bodies to ensure they contain a breadth of expertise and perspectives. For example, the panel heard that scientific advice structures across the country lost months during the pandemic as the evidence on the benefit of masking unfolded because the dominant clinical and public health perspectives were that masks in public settings did not work for COVID-19. Advance preparation of a database of experts, who can be called upon during an emergency, would help ensure that a broader and more diverse group of individuals are invited to participate. Supports such as honorariums and teaching release reimbursements should also be put in place, in recognition of the need to reduce barriers to participation. Provisions should be made to rotate experts, to avoid burn out and recognize the many demands placed on these individuals in times of crisis.
Science advice in Canada must be customized and adapted to the local context, with membership of national science advisory tables reflecting the country's geographic diversity. Doing so will help bring local perspectives into national advisory processes and enable members to bring back the advice to their regions to adapt as needed.
First Nations, Inuit, and Métis expertise
Various reports have called for greater representation of Indigenous perspectives in science advice bodies to widen the scientific evidence base to include other ways of knowing and varied methodological approachesFootnote 5Footnote 87Footnote 92. The panel's analysis of the leadership and membership of 14 federal COVID-19 science advisory bodiesFootnote e (N=204) highlighted the severe underrepresentation of First Nations, Inuit, and Métis experts. Only 14% of these bodies (2 out of 14) had First Nations, Inuit, and Métis representation within their membership. First Nations, Inuit, and Métis peoples represent 5% of the total Canadian population (2021), yet made up only 1.4% of the total membership of these federal advisory bodies. The analysis is limited, however, as it only captures individuals who have publicly self-identified as First Nation, Inuit, or Métis.
There was also general agreement among the Indigenous health experts and knowledge holders who met with the panel that science advisory structures and research processes do not always work for Indigenous Peoples. Many noted that existing equity, diversity, inclusion, and anti-racism frameworks do not accurately represent their needs and priorities. These frameworks fail to reflect their histories in Canada, knowledge systems and ways of being, and lived experiences, including the socioeconomic challenges and structural barriers they often face.
The panel's discussions with Indigenous health experts revealed a systems-level disconnect between the health priorities of their communities and those that science advisory bodies identified during the pandemic. This disconnect extends more broadly than science advice. During the pandemic, the mandates of advisory bodies were often predetermined prior to the request for Indigenous participation. They did not allow for the level of nuance required to explore the relevant subjects in the context of the history and ongoing realities of Indigenous Peoples. Indigenous knowledge holders and health care practitioners noted a history of academic tokenism in the processes for selecting scientific advisory body members, both before and during the pandemic. The limited number of qualified First Nations, Inuit, and Métis health practitioners and researchers in Canada imposes a burden on those individuals repeatedly asked to participate in engagement activities. Many of them highlighted a repetitive cycle of discussion followed by minimal concrete action, which offers them little reward or benefit for taking on this additional and often unpaid or underpaid work. In addition, First Nations, Inuit, and Métis populations must be recognized as diverse; one person cannot be expected to represent the health priorities of all Indigenous Peoples.
Indigenous knowledge holders and health practitioners communicated their concern to the panel about how PHAC and other government departments and agencies sought Indigenous health expertise during the pandemic. Due to the low number of full-time Indigenous staff within the federal Health Portfolio, Indigenous health leaders were often asked to attend meetings and engagements on short notice on topics of critical importance. The inadequate in-house expertise and foundational work before engagement with Indigenous representatives on committees was perceived as a lack of government effort and respect. First Nations, Inuit, and Métis knowledge holders and health care practitioners stated that it was unacceptable to ask them to work to amend the public health care system and incorporate Indigenous perspectives and practices on their own in a piecemeal fashion without adequate supports and resources. The perception was that they were asked to simply "Indigenize" policies and programs after the fact and their efforts would be sufficient to satisfy the need to fully engage and provide fully informed and prior consent of First Nations, Inuit, and Métis peoples to the plans, policies, and programs that were being acted upon.
To mitigate these challenges, Indigenous knowledge holders and health care practitioners called for the integration of First Nations, Inuit, and Métis health perspectives into science advice functions. The objective should be to incorporate their priorities in the early stages of identifying scientific priorities, to avoid creating the necessary structures and capacity anew in an emergency context. They also expressed strong support for increasing Indigenous representation in public health offices, at both the leadership and working levels. The integration of First Nations, Inuit, and Métis health priorities would also more effectively engage their communities in guiding and pursuing research and emergency planning on their own public health priorities, while respecting concerns around data sovereignty and collecting biosamplesFootnote 7Footnote 92.
As the Government of Canada pursues reconciliation with Indigenous Peoples, the United Nations Declaration on the Rights of Indigenous PeopleFootnote 93, the United Nations Declaration on the Rights of Indigenous Peoples ActFootnote 94, and the United Nations Declaration on the Rights of Indigenous Peoples Act Action PlanFootnote 95 present important implications for the design and implementation of science advisory mechanisms and research.
United Nations Declaration on the Rights of Indigenous Peoples Action Plan
This Action Plan, published by the Government of Canada in 2023, outlines specific roles and responsibilities for all federal departments and agenciesFootnote 95. The responsibilities assigned to Health Canada and PHAC include improving bilateral mechanisms with Indigenous partners and linkages across public health and health care systems, and better aligning strategic direction among these partners.
They do not include, however, any actions related to advisory committees. As such, the Health Portfolio should consider collaborating with other government departments with action items related to advisory committees, to learn from those processes and ensure any future design and implementation of federal science advisory bodies adheres to principles embedded in the United Nations Declaration on the Rights of Indigenous Peoples. These include Indigenous Peoples' right to self-determination (article 3) and the right to determine and develop priorities (article 23). Specifically, article 23 states that "Indigenous peoples have the right to determine and develop priorities and strategies for exercising their right to development. Indigenous peoples have the right to be actively involved in developing and determining health, housing, and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions"Footnote 93.
Equity considerations in science advice
The panel acknowledges the unique challenges and disparities faced by Black and other racialized communities in relation to pandemic preparedness and response. As highlighted in the Major findings section, these communities were, among others, disproportionately negatively impacted by the COVID-19 pandemic. They also have historically experienced systemic barriers to health care access, higher rates of underlying health conditions, and increased adverse social determinants of health that exacerbate the impact of health emergencies.
Intersectional analysis, which includes a multitude of factors and characteristics, including overlapping social, economic, and biological characteristics, can help identify groups who may be negatively affected by a viral outbreak or other health emergency. For example, older adults were at greater risk of negative outcomes following COVID-19 infection due to their biological status. Among this group, individuals who also lived in congregate or crowded settings such as long-term care homes were further impacted due to increased potential exposure to the virus. Some intersectional considerations are specific to the novel nature of an emerging health emergency and science can be used to gather information that can inform subsequent analyses.
Health equity should be emphasized across all stages of the research and science advice continuum, including by embedding equity analyses in science advice development to identify the groups most likely to be impacted by an emergency and who should be prioritized for early interventions. For example, NACI used a framework and validated equity tool to guide prioritization for COVID-19 vaccination and identify the groups most at risk of adverse outcomes from the virusFootnote 56Footnote 57Footnote 58. Provinces and territories widely adopted its advice on prioritization. While identifying priority groups for early vaccination is positive, the panel heard that NACI should have tailored preliminary guidanceFootnote 96 to specifically include new and low-income Canadians. These groups were often disproportionately exposed to the virus through their living and working conditions.
Literature emphasizes the need for science advice provided during an emergency to account for inequitiesFootnote 24. It is also important to learn from the lived experience of communities to ensure that the science used to develop the advice does not harm community members. Language guides, such as the British Columbia Centre for Disease Control COVID-19 Language GuideFootnote 97 and the Glossary of Essential Health Equity TermsFootnote 98, can help ensure that communications are non-stigmatizing and there is an appropriate focus on the structural and social determinants of health that underlie inequities. A 2023 report from Canada's Chief Public Health Officer recommended centring "equity in emergency science, evidence, and technology"Footnote 68. Focusing on equity during a health emergency can help decision makers understand how different communities may be affected. Equity-informed advice can be supported by community knowledge, disaggregated data, and research on the wider impacts of emergencies on health and health determinants. Equity tools and frameworks can also help identify the possible wider impacts of policies intended to mitigate health emergenciesFootnote 68.
A ready and robust science advisory mechanism
The panel proposes the creation of a comprehensive science advisory system in Canada that is ready to mobilize quickly and operate effectively and efficiently when a health emergency strikes.
Recommendation 3: Establish a science advisory system for emergencies
- Create a central federal mechanism that is 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. This system should be co-led by the Privy Council Office and the Health Portfolio, in collaboration with the Office of the Chief Science Advisor, Public Safety Canada, and other departments and agencies as required.
- Ensure that this mechanism is ever-ready by establishing a standing interdepartmental government secretariat with sufficient ongoing and surge capacity. The secretariat should have knowledge mobilization and communications expertise, and access to all required intelligence. It should maintain a roster of experts relating to key health risks (as per the proposed health risk register in recommendation 1). Preparedness work should include training the roster of experts, secretariat members, and government decision makers on best practices for providing, receiving and communicating evidence; as well as simulations and exercises.
- Designate the activated expert advisory group as the main federal science advisory body for health emergencies. This group should typically be convened jointly by the Chief Public Health Officer and Chief Science Advisor. Members should be assembled based on the nature of the emergency, drawing from the roster of experts, standing advisory committees, and elsewhere as required. The majority of members should be independent experts, chosen solely for their expertise. Expertise should be diverse with health, social, behavioural, humanities, and applied sciences as required, and cut across sectors, including intramural, extramural, industry, health equity, Indigenous health, and other relevant experts. Other relevant senior government officials should participate as liaisons. Supporting sub-groups and task forces should be formed as required.
- Embed this advisory system in overall government emergency protocols; establish strong links with other domestic health advisory bodies, federal-provincial-territorial health and emergency networks, and international emergency advisory systems; and invite provincial/territorial governments and Indigenous partners to name liaisons.
- Expand this advisory system over time to cover all emergencies, not just health emergencies.
Figures 1 and 2 (see Recommendations and summary of key findings) illustrate the proposed structure for science advice to prepare for and respond to future emergencies. The panel proposes the creation of three standing advisory bodies to address gaps in the current science advice system (discussed in the National health risk governance and Health data availability and use sections), and a standing mechanism that can quickly activate a specialized, interdisciplinary, expert advisory group to provide independent science advice to Cabinet in the case of a health emergency.
The Privy Council Office's co-leadership of the scientific advisory group for emergencies mechanism, and its secretariat in inter-emergency periods and during an emergency, is critical because of its responsibility for managing the delivery of information to Cabinet and the Prime Minister. This would be paramount during an activation of the advisory group to ensure timely information flow. The Privy Council Office's central coordination role is also essential given that a health emergency may lead to much broader implications, including for the movement of people and goods and national security. Its leadership also allows the scientific advisory group for emergencies to extend to all emergencies, not just health emergencies.
During a health emergency, relevant Deputy Heads should be invited to meetings of the scientific advisory group for emergencies to provide internal policy and public health decision-making context. The embedding of this mechanism into emergency protocols and creation of strong linkages with international and domestic advisory bodies would help ensure its quick activation and the effectiveness of its work to support and enhance Canada's science advisory capacity. Inviting liaisons from provinces, territories, and Indigenous partners would improve timely and transparent sharing of evidence and advice.
An interdepartmental standing secretariat is essential to ensure that the advisory group can be rapidly convened. The expertise required may vary depending on the health emergency. To enhance preparedness, the secretariat should maintain an active roster of experts who can be called upon in response to a health emergency, as well as an expedited process to recruit additional experts who may be required given the bespoke nature of an emergency. It should also maintain standing protocols, oversee emergency simulations, and coordinate training exercises for expert advisors on communications and other pertinent interdisciplinary science topics. Canada's two top public health and science advisors, the Chief Public Health Officer and the Chief Science Advisor, should jointly convene the advisory group in response to a public health emergency. For non-health-related emergencies, the Chief Science Advisor is best placed to chair the group.
The secretariat staff must have the right technical skills and expertise to support both the preparedness of the advisory structure and the work of experts during an emergency. This includes the capacity for knowledge mobilization and conducting regular preparedness exercises and workshops for researchers and policy makers on how to provide and receive scientific evidence. Expertise in risk communications, with an emphasis on proactively addressing misinformation and disinformation, is also important.
Close connectivity with the Office of the Chief Science Advisor and the Departmental Science Advisors will facilitate secretariat access to intramural evidence syntheses. The panel heard that the capacity of civil servants to support the provision of science advice was affected by policies that led to a loss of permanent technical content expertise in favour of rotating public servants. In the future, organizations should adapt hiring and training to ensure that additional technical expertise is ready to provide support during an emergency.
The expected outcome of the science advisory system for emergencies is a ready and more structured approach to science advice for future emergencies. Independent advice that benefits from a broad range of interdisciplinary expertise, and that considers health equity and Indigenous implications, must be quickly and widely available at any time.
Effective communication of scientific advice
Health emergencies, especially those with rapidly evolving evidence, require skilled nuanced communication of the latest information upon which updated advice is based. Communication must also reinforce that science advice is only one factor of many that feed into decision making. As evidenced during the COVID-19 pandemic, governments often have to make difficult choices while considering trade-offs between issues such as health, economic, and social considerations, and individual liberty.
In Canada, many reports have stressed the importance of communication in creating public trust in scientific evidence. For example, a 2023 Council of Canadian Academies report emphasized the importance of trust in knowledge institutions and health experts in combatting misinformation, and that communicating research accurately can help build trustFootnote 99. In addition, 20 years prior, the National Advisory Committee on SARS and Public Health recommended that Canada create real-time alert systems for SARS and other respiratory illnesses that included mechanisms to inform Canadians rapidly of developments in other jurisdictions and of the evolving domestic and international scientific dataFootnote 8.
Some federal science advisory bodies publicly released evidence briefs on COVID-19, but they were often delayed for a variety of reasons including the use of standard federal government communication approval protocols. The panel heard that inconsistent approaches to the public communication of scientific evidence and related uncertainties contributed to public confusion and reduced confidence and trust in governments and their decision making. The evidence and methodologies used to develop science advice that informs decision making need to be more transparent. As well as helping to foster public trust, increased transparency would also facilitate discussions on evolving evidence and diverging analytical assessments.
Ontario COVID-19 Science Advisory Table
The table produced more than 70 evidence briefs between July 2020 and September 2022 on a wide variety of topics including epidemiology, public health and implementation, health equity and social determinants of health, infectious diseases and clinical care, and public policy and economic impact. Only NACI issued more publications during this periodFootnote 26. The panel heard about the value and benefits that Canadians derived from the evidence briefs, which were publicly released shortly after Ontario decision makers received them. Public health officials across Canada used the briefs to support work in their respective jurisdictions. The table also produced modelling forecasts and clinical guidelines and its COVID-19 Dashboard was accessed more than three million times.
As noted in the Features of effective science advisory bodies section, the communication of advice should be 1) understandable to a non-specialist audienceFootnote f; and 2) observe the key principles of effective science communication: honesty, accuracy, transparency, and addressing of uncertainties in the evidenceFootnote 100, which includes clearly outlining what is known and not known. There is emerging evidence that although communication of uncertainty can result in lower uptake and action on scientific advice in the short term, it can enhance trust and its durability over the long term. This is critical in maintaining the ability to galvanize and guide the public on crises that unfold over many months or years (such as the COVID-19 pandemic)Footnote 101.
The advice must be publicly communicated with two caveats: 1) advisory bodies may be privy to sensitive government data that are not appropriate to reveal externally; and 2) when communicating advice in a fast-moving emergency, policy makers need time to consider the advice before it is released publicly. During an emergency, the time interval between the communication of scientific advice to policy makers and its public release should be as short as possible, in line with the principle of open by default. This supports the public release of government information with information being withheld only due to privacy, confidentiality, or security considerationsFootnote 102.
Scientific advice must be accessible to the public to maintain trust in the policy-making process and to combat misinformation and disinformation. A more coordinated, streamlined, and transparent federal advisory process, with timely advice flowing in real time to other levels of government and all relevant groups, is needed to provide a foundational resource for provinces and territories, local public health units, and others.
Recommendation 4: Improve external communication of advice from federal advisory bodies
- Stipulate in terms of reference that during an emergency, advisory bodies should publicly release evidence and advice briefs in a timeframe commensurate with the urgency of the situation, typically within days of their provision to government unless there are extenuating circumstances.
- Develop corresponding internal emergency communications protocols that accelerate and streamline release processes to achieve releases in this timeframe.
- Include provisions to protect sensitive and confidential information, and require that the level of uncertainty of evidence and advice is clearly communicated in all outputs.
The panel considers the timely communication of science advice across all jurisdictions to be essential in an emergency to reduce duplication. The overall expected outcomes of more timely and clear communication of scientific evidence and science advice are improved pan-Canadian coordination and enhanced transparency to build public trust.
National clinical guidelines and public health guidance
The panel heard that there was a shortage of guidance relating to diagnostics, therapeutics, patient care, and non-pharmaceutical interventions during the COVID-19 pandemic. Canada does not have a mechanism to frequently update clinical management guidelines at the national levelFootnote 5. As a result, no national clinical guidelines were issued for the treatment of COVID-19 and much of the available guidance was developed on an ad hoc basis. Physicians themselves had to search for guidance on appropriate treatments and alternative options when, for example, there were shortages of particular medications.
Some organizations developed their own guidance. In Quebec, for example, the Institut national d'excellence en santé et en services sociaux, an independent government agency that assesses the clinical advantages and costs of medications, health technologies, and interventions in social services and health care, developed clinical practice recommendations and guidelines. It played a critical role during the pandemic in disseminating scientific publications to health and social service workers.
Similarly, pre-existing intramural networks such as the Canadian Public Health Laboratory Network used existing infrastructure to establish consistent national practices for clinical testing. This network, which is a forum where federal, provincial, and territorial stakeholders address issues of concern for public health laboratories, published materials on best practices for COVID-19 detection.
Some roundtable participants identified the need for a body (similar to NACI) to provide national guidance on therapeutics. They noted that the Canadian Agency for Drugs and Technologies in Health (CADTH), the national health technology assessment agency, lacked the resources, emergency protocols, and capacity to provide such guidance on a sufficiently broad range of topics, and to release the advice in a timely fashion. The panel also heard that if COVID-19 vaccines had been less effective, therapeutics would have had heightened importance. In this case, the national response would have been further challenged by the limited capacity available to provide rapid advice on treatments. The federal government has developed the new Canada's Drug AgencyFootnote 103 which will incorporate and expand on CADTH's expertise, with several new workstreams including "improving the appropriate prescribing and use of medications"Footnote 104. The panel recognizes the need for national guidance on therapeutics but does not have particular views on where the responsibility for the provision of timely and comprehensive guidance relating to diagnostics, therapeutics, non-pharmaceutical interventions, and patient care should lie.
In countries such as AustraliaFootnote 18, the UKFootnote 21, the USFootnote 22, GermanyFootnote 20, and FranceFootnote 19, national clinical guidelines for COVID-19 treatment were developed by various entities and reflect a diversity of approaches and partnerships. Taken together, they highlight the internationally recognized value of developing such guidelines during a health emergency.
In Australia, the National Clinical Evidence Taskforce, a multidisciplinary collaboration of medical colleges and membership and health organizations, worked to continuously update clinical guidelines for COVID-19 throughout the pandemicFootnote 18. In the UK, the national health technology assessment agency, the National Institute for Health and Care Excellence, provided independent assessments of new health technologies and rapid guidelines for managing COVID-19, including information on therapeuticsFootnote 21. The National Institutes of Health in the US developed COVID-19 treatment guidelines with the support of a COVID-19 Treatment Guidelines PanelFootnote 22 and the national health technology assessment agency, the Institute for Clinical and Economic Review, conducted special assessments for COVID-19 treatments as part of its role in assessing the clinical benefit and cost effectiveness of treatmentsFootnote 105.
In Germany, the Robert Koch Institute played a key role in developing and updating national guidance for COVID-19 diagnostics and non-pharmaceutical interventions. Specifically, it provided evidence-based recommendations on testing strategies, diagnostic methods, infection control methods, and public health interventions. It also collaborated with the Association of Scientific Medical Societies and other medical experts to develop clinical practice guidelinesFootnote 20. The French National Authority for Health, responsible for issuing rapid guidelines during the COVID-19 pandemic, surveyed 800 health care professionals on the effectiveness and impact of its guidelinesFootnote 19. Most respondents saw the rapid responses as helpful (84%), were aware of the guidelines in their field of study (94%), and believed that they respected scientific integrity (90%)Footnote 19.
Canada needs a mechanism with appropriate expertise on non-pharmaceutical interventions. During public health emergencies, these interventions are frequently implemented to reduce infection, with guidance required for various settings such as businesses and communities. Formally, the federal government does not develop national guidelines for these public health measures, beyond infection prevention and control guidance for health care settings. PHAC led the development of non-pharmaceutical intervention guidance documents for COVID-19 public health measures in collaboration with representatives from some provinces and territories. These documents were designed to be considered alongside jurisdiction specific considerations. The panel notes that emergency preparedness could be enhanced by putting processes in place for the federal government to quickly develop guidance for non-pharmaceutical interventions during a health crisis and to rapidly publish supporting evidence briefs.
Recommendation 5: Improve national guidance for the use of diagnostics, non-pharmaceutical interventions, and therapeutics in response to an emergency
Put in place sufficient emergency capacity and protocols to develop and release timely clinical and community guidance in these areas as reliable evidence emerges, in a similar fashion to the National Advisory Committee on Immunization's role on vaccinesFootnote a.
The panel considers expert advisory protocols, for developing national clinical and public health guidance on the use of diagnostics, non-pharmaceutical interventions, and therapeutics, to be an essential element of emergency preparedness. Once an emergency is declared, swiftly activated capacity and protocols can support clinicians and public health professionals by quickly generating guidance that they can use to treat patients and protect their communities and institutions. Provisions should also be made to allow for real-time updates during emergencies, as required.
The role of the Chief Science Advisor of Canada
The panel offers an additional recommendation related to its analysis and findings but broader than its remit. Since 1964, Canada has experimented with various models for providing science advice to the Prime Minister, Cabinet, and Members of Parliament. At times, such a mechanism has been absent. As the panel reflected on the existing and necessary mechanisms for science advice in health emergencies, it often heard about the broader federal landscape of science advice, and specifically about the role of the Chief Science Advisor.
The current Chief Science Advisor role was established in 2017 through a Governor in Council appointment, with a mandate to provide advice to the Prime Minister and Minister of Science and "serve primarily in an advisory and coordinating capacity"Footnote 106. Budget 2017 stated that the "Chief Science Advisor will provide advice on how to ensure that government science is open to the public, that federal scientists are able to speak freely about their work, and that science is effectively communicated across government"Footnote 106. Subsequent text from 2018 indicates that the Chief Science Advisor will "provide and coordinate expert advice to the Minister of Science and members of Cabinet, as appropriate and requested"Footnote 107. The Chief Science Advisor chairs a network of science advisors from government departments and agenciesFootnote 108. The network meets monthly to support the coordinated provision of science advice to government as well as other science initiatives.
The role of the Chief Science Advisor, however, has no formal responsibility to proactively raise issues or documented responsibilities in response to an emergency. Despite this, during the COVID-19 pandemic, the Chief Science Advisor proactively created a number of science advisory bodies, resulting in a lack of clarity about the relative responsibilities of the Chief Science Advisor and the Chief Public Health Officer (whose role is documented in legislation and has authority to raise issues of relevance and concern). There have been calls to clarify and formalize the role of the Chief Science Advisor in legislationFootnote 109Footnote 110Footnote 111Footnote 112.
Broader recommendation A: Pursue legislation to formalize the role of the Chief Science Advisor of Canada
This should include defining the role in preparation for and response to health and other emergencies.
Health research prioritization, funding, and coordination
Expert panels dating back to 1993 have called for a national research agenda for emerging and resurgent infections. The National Advisory Committee on SARS and Public Health, in its reflections on research coordination during the 2002-03 SARS outbreak, recommended that the federal government establish mechanisms with provincial and territorial health agencies to set research priorities for emerging infectious diseases, and clear protocols for leadership and coordination of future epidemic research responsesFootnote 8. Despite this and other warnings, the processes in place when COVID-19 emerged were unable to quickly identify research priorities, effectively communicate them to all relevant groups, and direct funding accordingly and promptly. 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.
Recent reports and studies have identified how the pandemic exposed the research system's gaps, inefficiencies, and inequalities, and made recommendations to address them in the areas of governance, financing, capacity building, and research production and useFootnote 113. The Report of the Advisory Panel on the Federal Research Support SystemFootnote 31 made recommendations to modernize the federal system that supports academic research. While these and other reports have informed this review, the panel's work focused specifically on research prioritization, funding, and coordination in the context of health emergency preparedness and response.
This section identifies and assesses the critical challenges and gaps in the areas of research funding, prioritization, and coordination. See Appendix D for an overview of health research governance in Canada. It also presents the panel's recommended actions to better prepare Canada for the next health emergency.
Health research coordination
In response to the COVID-19 pandemic, the federal government quickly made additional research funding available, including through rapid response funding competitions starting in February 2020. Despite these efforts, the panel heard that research was not sufficiently directed and coordinated to address the most important and urgent knowledge gaps, including how the pandemic was manifesting across Canada; modes of transmission; appropriate use of non-pharmaceutical interventions; development of rapid diagnostic tools, therapeutics, and vaccines; and understanding and addressing issues of misinformation, disinformation, and vaccine hesitancy. Roundtable participants expressed concerns about the lack of a central mechanism for research prioritization across the federal government, including the granting councils; the federal capacity to lead a cohesive and targeted national research agenda in response to the crisis; and the need for better coordination among federal, provincial, and territorial governments including their funding agencies. Government officials and Indigenous experts specifically noted the longstanding absence of a dedicated federal-provincial-territorial-Indigenous coordination body for health research investments.
The Advisory Panel on the Federal Research Support System found that the fragmentation of the federal research funding system (with a focus on the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council) has resulted in a lack of clarity about roles and responsibilities, and gaps in interdisciplinary and transdisciplinary research supportFootnote 31. Its report suggested that although the Canada Research Coordinating Committee (created in 2017) had contributed to a better understanding of the needs and constraints of the granting councils, it was implemented within a system that was not designed to drive coordination and broaden strategic perspectives or address urgent issuesFootnote 31. While internal government participants told the panel that the Canada Research Coordinating Committee was active during the pandemic, the results of those coordination efforts were not evident to the research community.
Federal-Provincial-Territorial coordination
The shared federal-provincial-territorial responsibility for health in Canada poses challenges to pan-Canadian health research coordination, efficiency, and action during an emergency. Provincial and territorial roundtable participants emphasized the need for more coordination between the federal government and provinces/territories. Efforts during the pandemic did not support sufficient coordination among health research funders or allow members of science advisory groups to contribute to identifying research priorities to inform the broader research agenda.
Coordination between CIHR and the provincial research funding bodies—both bilaterally and collectively, as the National Alliance of Provincial Health Research Organizations—was improving before the pandemic due to a dedicated effort, but the challenges posed by COVID-19 made partnership difficult. Provincial funders expressed appreciation for coordination efforts, but no structures or mechanisms existed to enable input into the design of federal research funding calls and consideration of provincial priorities. Others reported that the rapid response structures made it difficult for provinces to mobilize and engage with federal funding initiatives.
CIHR used World Health Organization frameworks to guide various mechanisms and competition formats, such as strategic investments based on focused needs and funding calls for investigator-driven projects. Many provincial funders indicated they were unaware of CIHR's efforts to align its investments with the Global Research Collaboration for Infectious Disease Preparedness (GLOPID-R)Footnote 114. The focus on international priorities and lack of domestic coordination led to major gaps in the domestic research response. This posed challenges in Canada as global priorities did not correspond to the social and structural determinants of health, rural and remote communities, and misinformation and disinformation in the Canadian context.
The 2017 Federal/Provincial/Territorial Public Health Response Plan for Biological Events, which is intended to guide a coordinated response to public health emergencies, states that during a national-level public health response, the federal, provincial, and territorial governments' responsibilities should include "identifying and addressing rapid research response priorities and leveraging existing research undertakings"Footnote 12. However this plan does not assign direct responsibility to any party or contain specific provisions or protocols for research coordination or prioritization. It also does not envision a rapidly evolving emergency of the scale of COVID-19. Provincial roundtable participants noted that during the pandemic, in the absence of another forum for identifying and prioritizing new areas of research, public health officials in smaller jurisdictions and provinces brought their questions forward to the Pan-Canadian Public Health Network's Special Advisory Committee and Technical Advisory Committee, which were created to coordinate public health policy and technical information respectively, but not designed to coordinate a national research response. This further demonstrates the need for a dedicated, centralized mechanism to prioritize research.
In January 2022, the federal government created the Centre for Research on Pandemic Preparedness and Health Emergencies within CIHRFootnote 29 to grow Canada's capacity to research and mobilize knowledge to prevent, prepare for, respond to, and recover from existing and future pandemics and public health emergencies. While this effort is nascent, the panel is of the view that a more robust interdepartmental and intergovernmental undertaking with appropriate resourcing is required to achieve the critical mission currently assigned to this centre.
Coordination of medical countermeasures research and development
The panel heard that there is a need for central coordination of Canada's investments in medical countermeasure research and development. In 2021, in response to the pandemic, the federal government invested heavily in medical countermeasure research and development and clinical trial infrastructure via its Biomanufacturing and Life Sciences StrategyFootnote 43. To advance the strategy, Budget 2021 announced $2.2 billion in funding, including $500 million over four years to support the bioscience infrastructure needs of post-secondary institutions and research hospitals; and $250 million over four years, starting in 2021-22, for the federal granting councils to create a new Tri-Agency Biomedical Research Fund.
Investments under this strategy should be systematically informed by the panel's proposed new health risk register (outlined in recommendation 1) to maximize the likelihood that they will most effectively prepare Canada for future health emergencies. This work in medical countermeasures can be further strengthened through increased collaboration and coordination with international counterparts.
Improved health research coordination and prioritization
In the panel's view, the concerns outlined in the Health research prioritization, funding, and coordination section stem from Canada's need for a preparedness research plan for emergency response that includes components for identifying research priorities, rapidly funding necessary research areas, and implementing clinical trials in an emergency.
Recommendation 6: Improve pan-Canadian coordination of health emergency-related research
- Establish 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. This mechanism should be led by the Health Portfolio in collaboration with federal research granting councils and other departments and agencies.
- Use the proposed new national health risk register and response plan, including the standing health risk assessment and planning advisory body (in recommendation 1), to inform this research prioritization during periods of stability. In response to an emergency, the activated special scientific advisory group for that emergency (as per recommendation 3) should take the lead advisory role in supporting the prioritization of new research questions as these arise in real time.
- Establish a mechanism (linked to recommendations 6.a and 6.b) for the prioritization of medical countermeasure research and development, working closely with industry and other relevant groups, informed by supply chain intelligence and coordinated with international allies.
The panel recommends that the proposed mechanism (see Figure 3 in Recommendations and summary of key findings) be led by the Health Portfolio in coordination with Innovation, Science and Economic Development Canada and the federal research granting councils. The body would work with experts across all relevant fields, from the social and natural sciences to mathematics, bioengineering, technology, life sciences, and health, to determine how best to leverage collective resources to address identified research priorities. The inclusion of industry representatives ensures that priorities are aligned with innovation and economic considerations. Representation from non-profit organizations and advocacy groups ensures that priorities reflect the diverse needs of communities already experiencing inequities and health disparities and that attention to inequalities is maintained during an emergency.
The expected outcome is an inclusive approach to identifying research priorities as well as the publication of these priorities in a consensus manner. The creation of such a mechanism is not a recommendation to deprioritize discovery research, investigator-driven projects, and broader federal research granting processes. Rather, it is an argument to sharpen the country's ability to identify and direct resources to specific areas of research that are required to adequately prepare for and respond to the most likely health emergencies.
Research networks, infrastructure, and investments
In response to the pandemic, the federal government directed funding to support a broad range of new and existing research networks. See Appendix A, Appendix B, and Appendix C for a full inventory of bodies and timelines. The panel heard that while many of these networks played important roles in the pandemic response, there are still lessons to be learned. And, even with this additional funding, Canada continues to fall behind in overall research funding levels compared to its global counterparts (see Investments in Canada's research ecosystem section). This section delves into these investments made in research and clinical trial networks and infrastructure, highlighting both strengths and areas for improvement.
Pan-Canadian research networks
Many of the most effective pan-Canadian networks were in place prior to the pandemic, or came together quickly as a result of strong, pre-established relationships. This section explores four such examples: the Canadian COVID-19 Genomics Network (CanCOGeN), Canadian Immunization Research Network (CIRN), Mathematical Modelling of COVID-19 Task Force, and National Collaborating Centres for Public Health pre-date the pandemic or were born quickly from pre-existing relationships.
Genome Canada's expertise and relationships enabled it to receive and deploy surge funding to create CanCOGeN, which has since strengthened genomic sequencing capacity, skills, data sharing, and collaboration across the country, bolstering capacity to tackle other major public health challenges and future pandemics. CanCOGeN has increased public health sequencing capacity by training more people and producing soft infrastructure to conduct genomic surveillance. This has led to nine provinces sequencing in-province compared with four at the onset of COVID-19. The new capacity helped provinces better respond to local outbreaks of COVID-19 and positions them to quickly address future pathogen outbreaks with local public health solutions.
CIRNFootnote 28 drew on its pre-existing infrastructure, expertise, and partnerships to quickly pivot to tackle pandemic research priorities. CIRN comprises public health experts, epidemiologists, clinicians, researchers, and community groups from across Canada. During the pandemic, CIRN contributed to immunization research, clinical trials, vaccine acceptance and uptake, monitoring of vaccine effectiveness, and vaccine safety evaluation. CIRN research also informed public health decision making. It shared data and resources with PHAC and collaborated with other groups and organizations, such as the National Advisory Committee on Immunization to provide recommendations for vaccine prioritization and administration; and the COVID-19 Immunity Task Force (CITF) to study population immunity and vaccine effectiveness and conduct serological studiesFootnote 115Footnote 116.
Investments in the internal modelling capacity of the Public Health Agency of Canada (PHAC) during the pandemic enabled it to conduct short-range and long-range projections for outbreak trajectories, assess transmission risk, evaluate the effectiveness of medical countermeasures and conduct scenario-based modelling, and strengthen internal modelling capacity overall. The extramural Mathematical Modelling of COVID-19 Task Force was created as a partnership between the four members of the Canadian Network of Mathematics Institutes (The Fields InstituteFootnote 117, Atlantic Association for Research in the Mathematical SciencesFootnote 118, Centre de Recherches MathématiquesFootnote 119, and Pacific Institute for the Mathematical SciencesFootnote 120); PHAC; the National Research Council; and Vaccine and Infectious Disease Organization (VIDO-Intervac)Footnote 121. The task force acted as a review function for PHAC's internal modelling capacity and supported other Canadian jurisdictions with limited modelling capacity. A 2023 report that highlighted the gaps in the pandemic response underscored a need for investing in lasting research capacity and recommended the creation of an independent institute of emerging infectious disease modellers and policy experts to ensure continued capacityFootnote 122.
The National Collaborating Centres for Public Health identified knowledge gaps and fostered collaborative relationships and knowledge mobilization throughout the pandemic. They have ongoing funding and focus on Indigenous Health, Determinants of Health, Healthy Public Policy, Environmental Health, Infectious Diseases, and Methods and Tools. While the panel heard that the Centres' priorities diverged from federal health agencies at times during the pandemic, they facilitated networks and provided the public health system with evidence-based resources and knowledge mobilization services.
The panel heard from roundtable participants across the country that a greater focus should have been placed on building on the momentum of longstanding networks and on large, coordinated research projects during the pandemic. An internal synthesis prepared by PHAC's Office of the Chief Science Officer reinforced this finding and highlighted the need for longstanding networks to be in place before an emergency strikes. Strong relationships allow for an adaptive, capable, and robust health research ecosystem. The focus during the inter-emergency periods should be on building relationships, investing in people, and increasing capacityFootnote 24.
Investments in Canada's research ecosystem
In general, the panel observes that Canada is falling behind on overall research funding levels. Organisation for Economic Cooperation and Development (OECD) dataFootnote 44 indicates that Canada's overall spending on research and development as a percentage of gross domestic spending is the second lowest of the G7 countries and has been steadily declining over the 20 years of data (Figure 5), with the gap between Canada's overall spending and the OECD average expanding over the same period. Canada's public investment in research and development as a percentage of gross domestic spending currently sits at 1.55% compared with G7 and OECD averages of 2.6% and 2.7%, respectively. The panel heard that the overall Canadian research ecosystem needs more support to ensure it has the capacity to meet future needs. Through increased investments in research and development, Canada will become more competitive in attracting and retaining research talent, thus fostering a more vibrant and diverse research community.
Figure 5. Percentage of gross domestic spending on research and development, G7 countries (2001-21)
Source: OECD (2024), Gross domestic spending on R&D (indicator). Doi: 10.1787/d8b068b4-en (Accessed on 05 April 2024)
Figure 5: Text description
G7 Country (by percentage of gross domestic spending on research and development) | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Canada | 2.02 | 1.97 | 1.97 | 2.00 | 1.97 | 1.94 | 1.90 | 1.86 | 1.92 | 1.83 | 1.79 | 1.77 | 1.71 | 1.71 | 1.69 | 1.73 | 1.69 | 1.74 | 1.76 | 1.89 | 1.70 |
France | 2.14 | 2.17 | 2.12 | 2.09 | 2.05 | 2.05 | 2.02 | 2.06 | 2.21 | 2.18 | 2.19 | 2.23 | 2.24 | 2.28 | 2.23 | 2.22 | 2.20 | 2.20 | 2.19 | 2.28 | 2.22 |
Germany | 2.40 | 2.44 | 2.47 | 2.44 | 2.44 | 2.47 | 2.46 | 2.62 | 2.74 | 2.73 | 2.81 | 2.88 | 2.84 | 2.88 | 2.93 | 2.94 | 3.05 | 3.11 | 3.17 | 3.13 | 3.13 |
Italy | 1.04 | 1.08 | 1.06 | 1.05 | 1.04 | 1.08 | 1.13 | 1.16 | 1.22 | 1.22 | 1.20 | 1.26 | 1.30 | 1.34 | 1.34 | 1.37 | 1.37 | 1.42 | 1.46 | 1.51 | 1.45 |
Japan | 2.92 | 2.97 | 2.99 | 2.98 | 3.13 | 3.23 | 3.29 | 3.29 | 3.20 | 3.10 | 3.21 | 3.17 | 3.28 | 3.37 | 3.24 | 3.11 | 3.17 | 3.22 | 3.22 | 3.27 | 3.30 |
United Kingdom | 1.60 | 1.61 | 1.58 | 1.53 | 1.55 | 1.58 | 1.62 | 1.61 | 1.67 | 1.63 | 1.65 | 1.58 | 1.62 | 2.26 | 2.27 | 2.31 | 2.32 | 2.70 | 2.67 | 2.93 | 2.91 |
United States | 2.64 | 2.55 | 2.55 | 2.49 | 2.50 | 2.55 | 2.62 | 2.74 | 2.79 | 2.71 | 2.74 | 2.67 | 2.70 | 2.72 | 2.79 | 2.85 | 2.90 | 3.01 | 3.17 | 3.47 | 3.46 |
European Union – 27 countries (from 01/02/2020) | 1.70 | 1.71 | 1.70 | 1.68 | 1.68 | 1.70 | 1.70 | 1.78 | 1.86 | 1.86 | 1.91 | 1.96 | 1.98 | 2.00 | 2.00 | 1.99 | 2.03 | 2.07 | 2.11 | 2.18 | 2.16 |
OECD - Total | 2.16 | 2.14 | 2.14 | 2.11 | 2.14 | 2.17 | 2.21 | 2.28 | 2.33 | 2.29 | 2.31 | 2.31 | 2.34 | 2.36 | 2.38 | 2.38 | 2.42 | 2.50 | 2.57 | 2.74 | 2.72 |
Source: OECD (2024), Gross domestic spending on R&D (indicator). Doi: 10.1787/d8b068b4-en (Accessed on 05 April 2024) |
Clinical trial infrastructure
As a signatory to the 2021 G7 Therapeutics and Vaccines Clinical Trials CharterFootnote 123, the Government of Canada committed to supporting international efforts for improved clinical trial collaboration and cooperation to respond to future health emergencies. Canada is a leader in clinical trial productivity (number of trials per capita), capturing 4% of global clinical trialsFootnote 124. It also boasts various clinical trial networks spanning different disease areas and offering access to specialized research expertise. A 2020 global mapping exercise of articles related to randomized trials published in high-impact-factor medical journals ranked Canada third for global productivity (n=4548 articles), following the US (n=18,393) and UK (n=8028), despite only ranking 38th in population sizeFootnote 125. This ranking was primarily due to the strength of Canada's clinical trialists. Despite this strength, when the COVID-19 pandemic struck, it became clear that Canada's capacity for the rapid implementation of clinical trials, especially through mechanisms such as harnessing health system data and centralized coordination and prioritization of research questions, did not match that of global leaders such as the UK.
In the fall of 2022, CIHR conducted an online consultation with the research community and stakeholders involved in clinical trials (140 individuals representing more than 100 organizations) to gather insights for the development of a long-term strategy to support Canada's clinical trials ecosystemFootnote 126. Participants made several recommendations about improving funding for clinical trials, including creating a pan-Canadian structure that coordinates efforts and leverages existing infrastructure. They also recommended the expansion of clinical trial priorities in Canada's Biomanufacturing and Life Sciences StrategyFootnote 43 to include pre-clinical and translational research and funding of early (pilot, phase I, phase II) trials to build Canada's drug development and biomanufacturing sector.
Canada must continue investing in, maintaining, and enhancing its clinical trial capacity and infrastructure to be better prepared for the next pandemic or health emergency. This includes streamlining research ethics approvals and data and specimen sharing processes for anticipated areas of research, and the establishment of emergency processes for working with industry, as well as investing in processes that can be leveraged for other health emergencies.
In 2022, CIHR created the Clinical Trials Fund as a part of the Biomanufacturing and Life Sciences Strategy to support the full spectrum of clinical trials, including the development and testing of new drugs, treatments, and public health interventions related to various diseases or medical conditions. It subsequently launched three funding streamsFootnote 127. The Clinical Trial Fund's funding envelope has already been allocated towards building infrastructure for clinical trials in Canada, with no further budget yet identified to maintain or build on these investments following the expiry of funding agreements.
Industry representatives communicated to the panel that while Canada's size (population and geography) is a challenge, smaller nations (such as Israel) successfully attracted important mandates for medical countermeasure development through strong coordination structures that partner with industry to provide access to ready trial infrastructure and facilitate communication with regulators.
Roundtable participants called for a national strategy to better coordinate and guide investments in clinical trials to ensure Canada's readiness to contribute domestically and internationally. They highlighted some examples of international collaboration and adaptive trial designs that facilitated the rapid evaluation of therapeutics for COVID-19 and led to evidence-based treatment recommendations and improved patient outcomes: the Randomised Evaluation of COVID-19 Therapy trial (RECOVERY)Footnote 128 in the UK; the Solidarity TrialFootnote 129 coordinated by the World Health Organization (the Canadian branch of which was one of the largest COVID-19 studies in Canada); and the Randomized Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia (REMAP-CAP) COVID-19 trial in 25 countries including CanadaFootnote 130.
A 2021 articleFootnote 131 recommended the creation of a Canadian clinical research network modelled on the UK's National Institute for Health and Care ResearchFootnote 132. The Institute's Clinical Research Network infrastructure enabled rapid research production and knowledge dissemination during the pandemic. Its streamlined ethics and governance processes also significantly reduced barriers.
The UK Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial
The RECOVERY clinical trial, developed in March 2020, is the world's largest study of COVID-19 treatments and has redefined how clinical research is undertakenFootnote 128. It aimed to quickly compare potentially beneficial treatments for patients hospitalized with COVID-19 and/or influenza pneumonia.
The UK government approved funding for the RECOVERY trial in nine days, allowing frontline medical professionals to be trained and ready to recruit patients before COVID-19 patients overwhelmed hospitals. The fastest-recruiting trial in medical history, it recruited more than 10,000 patients within a two-month periodFootnote 133. The team developed easy-to-use forms for participants, a select number of key outcomes, and streamlined data collection processes to enable researchers to investigate the long-term effects of severe COVID-19. The trial focused on affordable and readily available drugs with well-established safety.
One of its most important discoveries has been the effectiveness of dexamethasone, a widely available corticosteroid. In June 2020, the trial reported that dexamethasone reduced the risk of death among COVID-19 patients on mechanical ventilation by 35%, and by 20% for those receiving oxygen only. There was no benefit for patients who did not require respiratory support. Dexamethasone rapidly became part of the global standard-of-care for hospitalized COVID-19 patients.
Canada can learn from Israel's effective use of its health system data infrastructure, medical research capabilities, researchers, scientists, and clinicians. The Israeli government has fostered an environment conducive to evaluating novel treatments and therapies. Its ability to harness health system data to do rapid observational studies of vaccine effectiveness led to its country-level partnership with Pfizer and resulted in critical vaccine effectiveness studies conducted during the pandemic. In addition, the focus on streamlining the regulatory process and bureaucratic hurdles enabled researchers to initiate clinical trials expeditiouslyFootnote 134.
Ready research networks and infrastructure
The panel considers that dedicated and ongoing funding and investments in research networks, human capacity, and other necessary clinical trial infrastructure are critical to enable rapid and robust clinical trials that can yield reliable results. Continuous funding allows for the maintenance and development of physical infrastructure such as specialized laboratories and medical equipment. It also supports the development and enhancement of non-physical infrastructure such as networks and collaborations to promote overall preparedness.
Recommendation 7: Enhance the readiness of research and clinical trial networks and infrastructure
- Create and maintain domestic and international research networks during inter-emergency periods. Some of these networks can be maintained in the form of "sleeping protocols", capable of rapid activation in the event of an emergency, while others should operate continuously and be used to address ongoing health priorities. These networks should put in place, as much as possible, the required inter-organizational agreements and ethical and other approvals, considering what may be required in response to potential future health emergencies including those identified in the proposed national health risk register (in recommendation 1).
- Ensure that critical intramural and external health research infrastructure and human capacity are available and can operate during the next health emergency through sufficient and sustained funding. This should include creating an inventory of relevant assets, establishing protocols for the operation of federal facilities during an emergency, and publishing guidance for external labs.
- 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.
Emergency preparedness and the federal research granting councils
Many roundtable participants observed that the federal granting councils were simply not designed or prepared to respond rapidly to a crisis of the scale of COVID-19. At the very outset of the pandemic, the three granting councils worked quickly to fund pandemic-related research. CIHR, for example, swiftly activated the Emerging Health Threats Fund and went into Business Continuity Mode, shifting its focus to pandemic program delivery and adjusting its rapid research funding to meet the needs of the research community such as expedited funding competitions. However, in June 2021, CIHR shifted out of Business Continuity Mode to deliver both regular competitions and COVID-19 focused funding, which posed challenges to overall operations. The panel heard that the Business Continuity protocols were insufficient to effectively guide how the granting councils should operate differently–and in a unified fashion–during a crisis. The protocols lacked the flexibility to direct funding to specific communities or areas of expertise and to promote interdisciplinary and transdisciplinary collaboration to address complex challenges.
Roundtable participants cited many standard aspects of research funding and coordination processes–such as grant competitions, peer review processes, and research ethics approvals–that are necessarily rigorous, but need to be adjusted to reflect the urgency of an emergency. They also noted that federal granting councils have traditionally focused on funding investigator-driven research, which could not fully meet the country's pandemic needs.
The National Advisory Committee on SARS and Public Health highlighted these same challenges in 2003 and called for a balance of mission-oriented and open funding competitions:
Canada has generally produced research on emerging infectious diseases through the academic model…These normal processes for planning, approving, funding, conducting, analyzing, and communicating research are ill-suited to meet the early research needs of an epidemic response. Changes must be made during an epidemic investigation, just as changes in the health system's hierarchical structures must be made for effective outbreak managementFootnote 8.
The panel heard that the granting councils should have the authority to exercise greater control over the research they fund, particularly during an emergency. Many roundtable participants highlighted the benefits of the approach taken by the federally funded COVID-19 Immunity Task Force (CITF)Footnote 33. The CITF sought to facilitate a national approach in various areas (including serology) that addressed changing priorities as the pandemic evolved. Roundtable participants also noted that, although CITF was established in April 2020, it took time to put this external body in place and to overcome challenges in establishing governance and operational procedures, during a rapidly escalating pandemic. The task force's research outputs therefore ultimately came later in the pandemic. Overall, the panel heard that it should have been possible for CIHR to execute such health research coordination, rather than it needing to be outsourced.
COVID-19 Immunity Task Force (CITF)
In April 2020, the Government of Canada supported the establishment of CITFFootnote 33 and provided it with $300 million in fundingFootnote 135. CITF mobilized 120 serological and vaccine surveillance studies to determine the extent of SARS-CoV-2 infection and immune response in the Canadian population and in specific priority groups. It supported research about the impact of the pandemic on Canadians including providing the only nationally representative picture of seroprevalence. Its insights also improved understanding of the safety and effectiveness of vaccines across different subpopulations, and the degree and duration of immune protection arising from infection and/or vaccination. The task force completed its mandate on March 31, 2024.
A 2022 review of health research systems in seven countries (Australia, Brazil, Canada, Germany, New Zealand, the UK, and the US) during the COVID-19 pandemic found that existing or rapidly established research coordination was necessary for effective responses and reduced risk of wasted resources. The study delineated three categories of research coordination: 1) pre-pandemic efforts aimed at bolstering research preparedness and response readiness; 2) endeavours during the pandemic to establish mechanisms for enhanced coordination in research efforts; and 3) mobilization of existing coordination mechanisms within health research systems, aligned with established health research strategiesFootnote 136. Coordinating with partners in these areas can help reduce duplication of efforts on a global scale.
Intramural and extramural research collaboration
Intramural and extramural researchers need to be able to work together as seamlessly as possible. It is important that this collaboration be in place at all times to prepare for and respond effectively to emergencies. Coordination between extramural academic and industry researchers and intramural researchers within provincial and federal governments is important to achieve synergies. These researchers often have access to different data sets and research infrastructure, and they are funded through different mechanisms. Roundtable participants highlighted the lack of protocols to facilitate collaboration between intramural and extramural researchers. The National Advisory Committee on SARS and Public Health emphasized the need to improve linkages between infectious disease research in government and in academic institutionsFootnote 8. In 2003, it proposed enabling the combination of enhanced intramural research and development capacity with intramural funds to allow for contracting out of research and development functions through partners such as CIHR. Federal/provincial/territorial intramural research and development activities should be linked to academic health institutions and major municipal health units through co-location, joint venture research institutes, cross-appointments, joint recruitment, and interchanges, as well as networks and other collaborative research activities.
Longstanding barriers to research collaboration between government, academic, and industry researchers include 1) the federal research granting councils' practice of restricting the eligibility of researchers employed by or affiliated with a provincial/territorial government department or agency, and 2) federal government financial rules that prevent grant and contribution funding from flowing to federal intramural scientists.
The panel also learned that the perception of some intramural research organizations within federal departments and agencies was that they could not collaborate with extramural researchers who had received grants or contributions from their department or agency. This is not consistent with the Treasury Board of Canada Secretariat's Guide to Departmental Collaboration with Recipients of Grants and Contributions, which clearly outlines that such collaboration is permitted in many situations. This guide notes that collaboration provides opportunities to leverage capacity across sectors, transfer knowledge, and further shared objectivesFootnote 137. These goals are important at all times, but even more critical during an emergency.
Federal Transfer Payment Policy rules restrict the use of funding that has been earmarked for grants and contributions for external recipients. However, programs can be designed to also include operating funding for internal researchers and thus promote intramural-extramural collaboration. The National Research Council of Canada's Collaborative Research Program structure is an example of such a designFootnote 138.
National Research Council's Collaborative Research Programs
The programs explicitly seek proposals for collaborative research projects that involve extramural collaboration with federal researchers and include separate funding envelopes–both internal operating funding for intramural researchers and grant and contribution funding for external researchers. An independent National Program Office within the National Research Council administers the funding envelopes to keep funding processes separate from those implementing the research, thus respecting Treasury Board policy and guidanceFootnote 138.
In addition to the underfunding of extramural research noted in the Investments in Canada's research ecosystem section, there is a deficit in Canada of intramural researchers working on public health, including infectious diseases work. This was a particular issue in the case of both PHAC and some provincial/territorial and Indigenous public health agencies and authorities. For example, the panel heard that the overall COVID-19 response in Ontario was hampered by a lack of intramural capacity because of budget cuts to Public Health Ontario over the years leading up to the pandemic. In contrast, investments in intramural research capacity at the British Columbia Centre for Disease Control strengthened the overall provincial response.
An emergency preparedness plan for thefederal research granting councils
The panel recommends the development of an emergency preparedness plan for the granting councils that considers all researchers across Canada. The granting councils must also operate as a unified whole in an emergency, prioritizing streamlined review processes, rapid decision making, and larger-scale national research projects as appropriate, and ensuring the timely sharing of research results.
Recommendation 8: Strengthen the emergency preparedness of the federal research granting councils
- Put in place processes and protocols so that 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. Funding conditions should include the timely completion of new inter-institutional agreements between collaborating research institutions as required, and the timely release of research data and results where appropriate.
- Facilitate interdisciplinary research by removing subject-matter boundaries currently specified in very fine detail between the granting councils, and through capacity building where necessary.
- Remove barriers to intramural and extramural research collaboration including federal funding eligibility restrictions for provincial and territorial intramural researchers. Operating funding envelopes for federal intramural researchers collaborating with recipients of grants and contributions should also be put in place.
Health equity
As highlighted in the Major findings section, COVID-19 disproportionately negatively impacted communities already experiencing inequities and health disparitiesFootnote 5. This included lower-income Canadians, homeless and under-housed populations, Black and racialized populations, and individuals living in vulnerable conditions or in long-term care homes or other congregate living settings. The panel heard that a greater pre-pandemic focus on domestic research relating to populations already experiencing health inequities could have provided for a more effective COVID-19 response. The lack of pre-pandemic progress in this area can be attributed, in part, to limits on available data (discussed in the Health data availability and use section).
Recent reports by Canada's Chief Public Health Officer and the Royal Society of Canada have called for more research and action on the social and structural determinants of health to improve community wellbeing before, during, and after emergencies, and to understand the long-term impacts of public health crisesFootnote 68Footnote 139. This would increase graduate and postdoctoral training capacity and enhance the knowledge base across all health-related disciplinesFootnote 139. However, a greater focus on the structural and social determinants of health is only part of the challenge. Populations that were most negatively impacted during the pandemic also, historically, have experienced the greatest barriers to health care, and may have lower than average trust in Canadian institutions and research processes due to differences in history and experiences. According to experts who presented to the panel, a concerted effort on the social and structural determinants of health must also include building trust with these communities.
The pandemic also disproportionately impacted the older adult population in Canada where the intersection of many vulnerabilities (biological and social) resulted in a significant number of deaths in retirement and long-term care homes. Future work must consider the intersection of such impacts; although they are not predetermined social impacts in nature, they demonstrate that disproportionate impacts can be generated by other factors that still require research to inform targeted interventions.
Recommendation 9: Increase investments in research on actions required to better support and prioritize the needs of groups disproportionately impacted by health emergencies
- Provide 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. This research should be developed and conducted in concert with affected communities.
- Establish a standing science advisory body of independent experts on health equity, supported by a secretariat within the Health Portfolio, to inform government policies and public health measures in this area.
In the panel's view, the implementation of these recommendations is essential to understand, address, and eventually alleviate the impacts of health emergencies on communities and populations already experiencing inequities and health disparities, and improve their long-term health outcomes.
The panel considers the creation of a multidisciplinary body with expertise in the social and structural determinants of health research, including representatives from government agencies, Indigenous communities and leadership, academia, and nongovernmental organizations, essential to guide the work of the Health Portfolio in this area. This science advisory body should develop a comprehensive research agenda, prioritize research on the structural and social determinants, identify research gaps, facilitate collaboration, provide evidence-based recommendations to policy makers on strategies to address health inequities, and engage with communities.
Research to improve Indigenous health outcomes
As reported earlier, the panel's discussions with Indigenous health experts and knowledge holders revealed a systems-level disconnect between the health priorities of their communities and those identified by science advisory bodies. This disconnect extends to how research is funded and conducted with Indigenous communities, and the data that inform research and science advice (discussed in the Health data availability and use section).
The panel's analysis of the leadership and membership of 22 COVID-19 research and governance bodies in CanadaFootnote g (with a total of 286 members) highlights the severe underrepresentation of First Nations, Inuit, and Métis knowledge holders and health practitioners. Only 18% of these bodies had Indigenous representation in their membership. In 2021, First Nations, Inuit, and Métis peoples represented approximately 5% of the total Canadian populationFootnote 140, but made up less than 1.5% of the total membership of research advisory bodies during the pandemic (2020-23)Footnote h. The underrepresentation of Indigenous knowledge holders and health practitioners in research coordinating bodies contributed to the challenges faced by many Indigenous scholars in adapting pandemic initiatives to the needs of their communities. Applying a one-size-fits-all approach does not accurately capture the impact on First Nations, Inuit, and Métis populations.
The panel heard that research capacity and knowledge dissemination were unevenly distributed across the country during the pandemic and that, in general, research processes do not recognize or value Indigenous ways of knowing or research methods, or accommodate the realities of Indigenous communities, especially those in northern Canada. For example, the lack of universities and research ethics boards in the territories limited the ability of their governments to encourage and facilitate research during the pandemic. Similarly, interprovincial/territorial pandemic travel restrictions prevented researchers from travelling to the territories. The lack of northern institutional capacity means that territorial governments cannot effectively participate in the traditional research funding system, which often prioritizes clinical medicine and research.
Indigenous knowledge holders and health practitioners who met with the panel reaffirmed the need for self-determination through research, as articulated in the United Nations Declaration on the Rights of Indigenous PeopleFootnote 93, the Government of Canada's Action PlanFootnote 95 to respond to the Declaration (discussed in the Science advice mechanisms section), and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans TCPS2Footnote iFootnote 141. Indigenous scholars noted that continued long-term support and strong leadership for the CIHR Institute of Indigenous Peoples' Health is necessary to ensure that First Nations, Inuit, and Métis issues are a priority, and that the institute participates meaningfully during health crises.
Recommendation 10: Increase investments to advance research on actions required to improve Indigenous health outcomes
- Co-develop health priorities with First Nations, Inuit, and Métis health experts and communities and provide sufficient funding for research on actions to address these priorities. This should include increased investments to advance Indigenous-led research and training in areas including epidemiology.
- Cultivate and invest in the development of expertise in the coordination and funding of Indigenous health research, in and among federal departments and agencies.
This research should be co-designed and implemented in a culturally appropriate manner for each community and build capacity and understanding for future generations to enable local retention of new knowledge. The government should also develop expertise in the coordination and funding of Indigenous health research, within and across federal departments and agencies, including Indigenous-led research and supports for trainees.
Indigenous health expertise in the Health Portfolio
The panel offers an additional recommendation related to its analysis and findings but broader than its remit. Its consultations pointed to insufficient Indigenous health expertise within the Health Portfolio. Discussions with Indigenous knowledge holders and health care practitioners also highlighted the inadequacy of efforts to seek this expertise though contractual and advisory roles. As a result, health considerations for Indigenous populations were not properly factored into health research prioritization and other processes during the pandemic. A plan to recruit this expertise is needed, and this should include creating a new dedicated senior role in the Public Health Agency of Canada.
Broader recommendation B: Create a new Deputy Chief Public Health Officer position that is fully dedicated to Indigenous health
This role should be held by an Indigenous person and have 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. It should interface with other areas of the Health Portfolio, Indigenous Services Canada, and other departments and agencies as required.
This role would need support from an adequate number of Indigenous staff with experience across nations and geographies. It would also require diverse public health expertise and sustained funding, to allow for ongoing engagement and relationship building.
Health data availability and use
During a health emergency, researchers, science advisors, and public health and government officials all require comprehensive health data to understand the scope of a crisis, guide decision making to provide better care for patients, and improve the overall efficiency of health systems. Researchers–in universities, teaching hospitals, and government labs–rely on available data sets to rapidly perform analysis and answer pertinent questions that ultimately allow health care providers to implement effective treatments and practices, or halt ineffective or harmful ones. Science advisors use these data, combined with evidence syntheses, to provide relevant and contextually appropriate advice. Data are also critical during times of stability, to help prepare for health emergencies, and can be used to identify vulnerabilities, health risks, and opportunities to build community resilience.
Public health data and routinely collected health care data are often distinct sources of information that support an effective emergency response. Public health data include data about vaccines, outbreaks, and contact tracing that are held by provincial and territorial public health units. Health care data are collected in clinical settings such as hospital and doctor visits, and through outpatient prescriptions, laboratory results, and vital statistics. Public health surveillance data build a national picture of the emergency and its impact on different geographic areas and segments of the population.
This section explores various aspects of Canada's health data challenges and complexities and offers recommendations for a more efficient and equitable path forward. The focus is on both improvements to data systems and adaptations to ensure that the right types of data are available during an emergency. These improvements and adaptations include accelerating federal government efforts with the provinces and territories to establish data standards and interoperable data sets, providing access to data that are essential for assessing and managing public health, and meaningfully engaging with Indigenous Peoples and their communities to support their dedicated distinctions-based health data strategies.
Data limitations and advancements during the pandemic
Canada's federated structure leads to significant complexities in how, when, and whether health data are collected, stored, shared, and used, as well as how they are protected by statutes and legislation. Many reports, such as the first report from the Expert Advisory Group for the Pan-Canadian Health Data StrategyFootnote 45, have outlined the deficiencies in the health data system and the resulting harms to CanadiansFootnote 54Footnote 55. A recent report from the Chief Public Health Officer of Canada highlighted the resulting challenges of collecting and sharing health data and information during the COVID-19 pandemicFootnote 5. The panel consistently heard about challenges in accessing health data essential for important research, scientific advice, and health delivery. The timely collection and sharing of data between health care systems, levels of government, and research institutions was a barrier to a well-coordinated and consistent national response to the pandemic. The panel heard that capacity for surveillance data collection varied greatly among subnational jurisdictions. The lack of data in some regions prevented public health officials from analyzing the full impact of the pandemic on various segments of the population. For example, several provinces noted challenges in reporting real-time mortality data given that death certificates took months to prepare and were often first developed as paper copies for subsequent entry into digital systems.
Throughout the pandemic, organizations across the country mobilized to build better processes and structures to promote better access to health information. For example, in Quebec, the Fonds de recherche du Québec-Santé and Génome Québec funded the development of Biobanque Quebecoise de la COVID-19Footnote 142 to improve researchers' access to samples and data related to COVID-19 to support research on SARS-CoV2 infection. Despite these efforts, data systems across the country continue to be fragmented. The panel also heard sobering recounts from clinical settings about the repercussions of poor or no data to inform patient care. While this issue remains unsolved, all Canadians are vulnerable. The most disadvantaged will remain vulnerable to the worst health outcomes; health research and policy advice will be hampered; and Canadian scientific innovation will not reach its full potential.
In recent years, Canadian health systems have undergone significant transformation through digitization of health information, accelerated by the adoption of virtual tools during the pandemic. However, considerable amounts of information continue to be siloed and are not readily accessible or exchangeable. Public health data and health care data are typically kept in different systems that often do not intersect. For example, medical hospitalization records are collected by provinces and territories and held by the Canadian Institute for Health Information (CIHI), while vaccination information is held by public health units and shared with the Public Health Agency of Canada (PHAC). As noted in the National health risk governance section, during the pandemic, CIHI began collecting and providing hospital occupancy and capacity data to Health Canada and PHAC.
The third report of the Expert Advisory Group for the Pan-Canadian Health Data Strategy recommended that information from health care and public health must be linked, and suggested that this requires a common planFootnote 45. There are multiple examples of the benefits of linking these types of data. For example, health care data can help determine the level of strain on the health care system during a health emergency and the associated analysis can help inform a public health emergency responseFootnote 143. Public health data on infection rates may also be used for planning purposes to help anticipate the number of individuals who may need health care services.
Health data systems: Cultural challenges
Canada lags its international comparators on health data infrastructureFootnote 144. According to the Health Data Interoperability Working Group of the Alberta Virtual Care Coordinating Body, "[Canada's] ineffectual approach to health data interoperability is an obstacle to everything from individual patient care to the advancement of our understanding of the complex relationship between health, wellbeing, and the social determinants of health." The same report emphasized that "maintaining the status quo is NOT an option"Footnote 46.
Singular electronic patient records, which follow a patient for all care, have not been implemented in all provinces and territories. Data inadequacies impact patients directly. Information scattered across different health providers can lead to delayed diagnoses and treatment, and to poor health outcomes. Provinces and territories do not use consistent formats for data sets and the ability of their health data systems to collect and make data available varies greatly. Clear plans and protocols that guide data identification and collection could improve the interoperability of data between systems as well as the ability to reuse them to further research inquiries. FAIR (Findable, Accessible, Interoperable, and Reusable) data principles have been developed and adopted internationally to support data reuse and feature prominently in the US National Institutes of Health strategic plan for data scienceFootnote 145Footnote 146.
The panel heard that the absence of an effective public health information system in the territories is one of the biggest hindrances to effective data management. During the pandemic, some territorial governments relied on antiquated methods and systems, including calling individual contacts on the front line and manually reconciling information from disparate sources. While real-time data may exist in larger provinces, the panel heard that the Government of Nunavut, for example, does not have data on childhood vaccination rates, let alone have access to real-time, emerging data during a pandemic. Efforts are currently underway to enhance these health information systems, but the panel heard that territorial governments are severely under-resourced for this work. They are not always included in national reporting due to insufficient data systems.
During the panel's consultations, many individuals classified data sharing challenges in Canada as largely cultural and political. Many attributed them to the disproportionate power of the legal "middle management", often referred to as data custodians, in identifying, assessing, and balancing risks. The Expert Panel on Health Data Sharing convened by the Council of Canadian Academies found that unclear guidance in privacy laws has generated a "culture of caution" that impels data custodians to approach data management more conservatively than may be necessary by lawFootnote 47. This culture can perpetuate harms at the levels of the individual, population, and health systemFootnote 46. The panel heard that the resulting lack of health care data has serious implications for patient care and therefore the health and wellbeing of Canadians. Clinicians expressed their frustration and fear of making mistakes based on incomplete information.
The panel heard a clear need for national coordination to establish a standard structure that harmonizes health data systems, increases transparency in data sharing, and creates a culture of collaboration.
Moving from a custodianship to a stewardship model
Canadian health data legislation and governance is currently based on a custodianship model, emphasizing privacy rights and limiting the ability to link individual health data with sociodemographic information and associated analysis to inform population-level priorities. Custodian-centric privacy laws provide rules for organizations that collect, use, and disclose public health informationFootnote 147. The panel heard that Canada needs to shift to a patient-centric "data stewardship" approach that balances privacy and security considerations with enabling access to data. Adopting this model would help build trust with the expectation of using data to improve clinical care. The 2023 Expert Panel on Health Data Sharing report also pointed to the benefits of a stewardship model and identified that the transition to this governance model requires national leadership to establish a structure "that harmonizes health data systems and facilitates cross-jurisdictional data sharing"Footnote 47.
Canada can learn from the health data systems of countries such as Australia and Germany that operate as data stewards, and from the US, which has adopted a legislative approach to compel data sharing. In the Australian and German systems, data are available to help inform policy decisions, and government institutions make comprehensive health data sets available to researchers while maintaining privacy protections. The Australian Institute of Health and Welfare manages more than 150 data sets covering a diverse range of fields including hospital activity, disease, disability, drugs, perinatal health, mental health, homelessness, and the needs of Aboriginal and Torres Strait Islander peopleFootnote 148. The Australian Institute of Health and Welfare publishes more than 250 statistical products and provides data to government agencies, researchers, and the community while maintaining data privacy and confidentiality. Accredited users from Australian state and territory governments and universities can obtain government data (that are not publicly available) from the Australian Institute of Health and Welfare under the Data Availability and Transparency SchemeFootnote 149 established under the Data Availability and Transparency Act 2022Footnote 150. Data are treated to minimize potentially identifying information and can be shared with authorized individuals to 1) deliver government services, 2) inform government policies or programs, and 3) conduct research and development.
The Australian Institute of Health and Welfare also manages and provides access to three linked data assets that bring together data from multiple sources, including across states and territories: 1) National Integrated Health Services Information, 2) National Disability Data Asset, and 3) COVID-19 Register and Linked Data Set. These assets make it easier for researchers to conduct complex cross-sector and cross-jurisdictional researchFootnote 151.
The Robert Koch Institute, the national public health institute within the German Federal Ministry of Health portfolio, uses research to generate data for decision making and the provision of independent advice to public health officials and policy makers. During the pandemic, the coordinated and strategic integration of public health research, science advice, and surveillance in a single institution provided Germany with a centralized source of emerging information, while ensuring science advice and research were continually informed by surveillance efforts and risk assessments.
Robert Koch Institute (RKI)
In Germany, RKI regularly conducts studies that provide reliable and extensive data on 1) the current health situation, 2) health promoting and risk behaviour, 3) health care and prevention, and 4) the environment and living conditions of different population groups. RKI uses the data in its federal health reporting and epidemiological research and provides them to researchers through public use files. It also maintains the SurvStat Disease Database, which tracks cases of notifiable diseases and pathogens reported under the Act on the Prevention and Control of Infectious Diseases in HumansFootnote 152. Local and state health departments report most of these cases to RKI. The SurvStat allows researchers to retrieve aggregated data directly from a limited version of the German notification system databaseFootnote 153.
RKI developed daily surveillance reports on COVID-19, beginning in January 2020, and risk assessments and technical guidelines for testing, contact tracing, and disease management. It also developed one of the first diagnostic tests in the world, allowing Germany to start increasing its testing capacity. Laboratories already had the expertise, accreditation, and equipment to conduct polymerase chain reaction (PCR) assays and quickly deliver diagnoses.
The US has pursued a defined legislative approach to health data interoperability with the US Trusted Exchange Framework and Common Agreement establishing common governance, policy, and technical standardsFootnote 154. This is in stark contrast to Canada, where interoperability has largely been attempted on an optional, regional, and sectoral basis, without being grounded in a vision for, or accountability to, person-centric health dataFootnote 46.
In recent years, the federal government has worked with provinces and territories to receive advice from an Expert Advisory GroupFootnote 49. As a condition of their federal funding provided through the 2023 Working Together to Improve Health Care for Canadians PlanFootnote 50, provinces and territories have committed to work with the federal government and other partners to improve the collection, sharing, use, and reporting of health information. Health data priorities are being implemented through a Joint Federal, Provincial and Territorial Action Plan on Digital Health and Health DataFootnote 51, and a Pan-Canadian Health Data CharterFootnote 52, which highlights principles for person-centric health information, equity, public engagement, trust, and Indigenous data sovereignty and Indigenous-led health data governance (see the Dedicated Indigenous Peoples health data strategies section). The federal government has also provided funding to CIHI, Canada Health Infoway, and Statistics Canada to support this health data agenda. A Pan-Canadian Interoperability RoadmapFootnote 155, endorsed by federal, provincial, and territorial governments (except Quebec), outlines the path forward for connected care where health information can flow easily between different parts of the health care system, allowing patients to access their health information and improving care coordination between providers. Through the implementation of the Roadmap, Infoway is collaborating with federal-provincial-territorial governments and other partners to establish common standards that will enable digital systems to connect, so that health information can be shared effectively with those who need it, in an easy to use format.
The panel proposes that the federal government maintain its leadership role and place greater priority on health data initiatives. While recent efforts to move towards a data stewardship model are positive, this work is nascent. Sustained long-term efforts are needed to bring systems and processes to a level where health data can be quickly used in an emergency to inform research and science advice. Monitoring of the impact of these investments on improving the scope, scale, interconnectivity, and responsiveness of Canada's health data structure, as well as accountability for expected outcomes, is critical.
Sociodemographic, race and ethnicity data to inform science advice
The panel heard that one of the most important predictors of infection exposure and outcomes was largely unavailable at the national level during the pandemic: disaggregated data, including basic sociodemographic information on race and ethnicity. The absence of these data reduced the contextual information available to decision makers to identify the groups disproportionately impacted by COVID-19 and the wider consequences of the pandemic response.
In certain cases, advisory bodies such as the Ontario COVID-19 Science Advisory Table were able to access critical real-time, anonymized, provincial health data. Several municipal public health departments in Ontario, including Toronto Public Health, began collecting and publishing disaggregated COVID-19 data. The level of detail in the disaggregated data available through the Manitoba Population Research Data Repository at the Manitoba Centre for Health Policy played a significant role in the provision of science advice. This comprehensive and linked health data set collection, for use by Manitoba Health and researchers, holds de-identified, individual-level data from multiple provincial government departments (health, social services, education) and links them further to provincial registries and population databases. The panel heard that access to real-time data allowed provincial public health officials to gauge the effectiveness of various measures.
The Nova Scotia Fair Care Project
Launched in 2022, the project is an example of an effective provincial initiative for collecting race-based and linguistic identity data in health care. Individuals can opt-in to share their information when they renew their provincial health card, or online at any time. The project, which aims to improve equity in health care, will help decision makers understand which communities require better health care support. A community-based working group, with members from racialized communities, helped lead consultations and provided feedback throughout the development processFootnote 156.
These provincial and municipal examples demonstrate that essential data are available in some provinces and can be responsibly accessed by researchers to inform better decision making and improve patient care. They also raise further questions as to why real-time, disaggregated data cannot be leveraged more broadly during inter-emergency periods to better support the provision of health services and prepare for and mitigate the effects of future health emergencies.
The collection of race and ethnicity data is a standard global practice, commonly used in the US and the UK. It has been suggested that the federal government should work with provinces and territories to ensure the availability of high-quality sociodemographic data, including race and ethnicity data, to support their health systemsFootnote 157. During the pandemic, the same expert proposed legislation specifying that "COVID-19 socio-demographic and race and ethnicity data should be collected at all levels of government. Data collection, data analysis and subsequent actions should be undertaken in partnership with impacted communities"Footnote 157. Decisions about the use of these data must be made in an inclusive way, so that work is done with an identifiable group, rather than about them.
Health data standards and interoperable data sets
The panel highlights the critical need to strengthen health data sharing standards, platforms and protocols, surveillance networks, and data sharing agreements to enhance Canada's preparedness for the next emergency. Canada must be able to generate and make health and related data from across the country available to researchers in real time and de-identified in such a way as to protect individual privacy. This would enable characterization at a national scale of the incidence and prevalence of infection, hospitalizations, deaths, therapeutic interventions, vaccination rates and possible adverse effects, and other critical issues at all times. Efforts to do so would improve research, scientific advice, overall response during crisis periods, and generate important benefits in inter-emergency periods, further improving health outcomes by helping to address the many inequalities.
As one example, vaccine registries are valuable for their potential to capture accurate and precise information on the distribution, uptake, and effectiveness of vaccines at both the individual and population level. For example, the Manitoba government was able to prioritize vaccination by postal code area during the pandemic. Researchers also articulated a desire for greater access to expanded government vaccination registry data to conduct effectiveness and safety studies using real-time linked cohort analysis.
A recent UK study demonstrated the power of the effective use of routinely collected data at a population level. It used routine information collected from approximately 59 million people to examine the effectiveness of different numbers of vaccine doses in relation to the risk of hospitalization for severe clinical manifestations of COVID-19Footnote 48. The results showed that even missing one recommended vaccine dose was associated with a substantially increased risk of severe infection requiring hospital admission.
The panel heard a strong consensus among researchers and health experts that comprehensive de-identified vaccination information should be regularly collected and reported across Canada. This would allow for the identification of populations and geographic areas with low vaccination rates for re-emerging infectious diseases (e.g., measles) and enable public health and health care to better prepare for future outbreaks.
The panel recognizes the leadership role of the federal government in advancing pan-Canadian data infrastructure, data sharing, and interoperability. It encourages the federal, provincial, and territorial governments to continue to work together to realize the objectives of the Pan-Canadian Health Data Charter and the Shared Pan-Canadian Interoperability RoadmapFootnote 155. Advancements to improve access to data requires political will and collaboration.
Canada must realize the Chief Public Health Officer's vision for a Pan-Canadian data ecosystem that is interoperable and equitableFootnote 5. To achieve this vision, all levels of government need to use every available lever to encourage standardized approaches to collecting and sharing data.
- Accelerate dedicated efforts with the provinces and territories to establish data standards, interoperable data systems and data sets, and provide access to data that are essential for assessing and managing public health between and during emergencies, reducing the health disparities between sociodemographic groups, and enabling the conduct of innovative and important research. This should include the systematic collection and availability of de-identified routinely collected health data, including vaccination data, across the country.
- Provide sufficient resources 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 panel considers the creation of an interoperable data system that provides real-time access to data an essential component of an efficient and effective health care system. Researchers, science advisors, and public health and government officials all depend on data: to indicate promising areas of research, inform future decisions, evaluate promising treatments, and cease ineffective treatments. The realization of many recommendations in this report is contingent on the ability to collect good data and store it in a robust, interoperable data system.
The expected overall outcomes of an interoperable data system and data sets are to provide better and more timely information to guide public health and public policy decisions, and to improve health care during health emergencies as well as inter-emergency periods.
Dedicated Indigenous Peoples health data strategies
Health data from Indigenous people are essential to support Indigenous communities and all levels of government in Canada, to inform action during a health emergency, and to support health and wellbeing between emergency periods. According to the National Collaborating Centre for Indigenous Health, "Achieving our shared goal of healthy, vibrant Indigenous peoples requires robust Indigenous health data that makes it visible where we are and where we need to go"Footnote 92.
Specific First Nations, Inuit, and Métis data governance principles govern Indigenous population health data control and emphasize self-determination and self-governance. Principles guiding the use of data must ensure that data remain in the care of Indigenous communities and advance the rights, jurisdictions, and interests of distinct Indigenous populationsFootnote 92Footnote 93Footnote 94. Canada's United Nations Declaration on the Rights of Indigenous Peoples Act Action Plan "provides a roadmap of actions Canada needs to take in partnership with Indigenous peoples to implement the principles and rights set out in the Declaration and to further advance reconciliation in a tangible way"Footnote 95.
Indigenous health experts consistently raised concerns about data collection, use, and sharing, including the processes through which data are analyzed. They stressed the importance of data sovereignty and custodianship related to both population- and individual-level health data. Historical harms, particularly through biological/medical sampling, have contributed to a lack of trust in the federal government in this area.
Although Indigenous knowledge holders and health care practitioners emphasized to the panel that Indigenous data sovereignty must be upheld, they also noted that this has sometimes led to silos between independent Indigenous communities and health authorities. They recommended the creation of mechanisms to build linkages in public health systems that can safely and effectively link data possessed by Indigenous communities. They also expressed significant interest in exploring how federal and provincial/territorial governments can increase interoperability and collaborate with communities to provide them with the data needed in ways that they can functionally use. There was general acknowledgement that work to develop dedicated health data strategies requires trust building and reconciliation of data principles more broadly.
Indigenous knowledge holders and health care practitioners also noted the inherent differences between what governments and Indigenous communities consider as important data; the divide extends to the frameworks and principles themselves. For example, metrics used in institutional public health do not necessarily align with the values or priorities of Indigenous practitioners and communities. As discussed in the First Nations, Inuit, and Métis expertise section, equity, diversity, inclusion, and anti-racism frameworks that may work for other equity-deserving populations do not necessarily reflect the needs and priorities of Indigenous Peoples. This extends to designing data processes and systems which must be Indigenous led and respect Indigenous sovereignty. The panel also heard about the need for Indigenous-specific public health and epidemiological training models and data systems.
Indigenous data infrastructure suffers from uneven geographic coverage and capacity and a lack of distinctions-based disaggregated data. The panel heard that it is often restricted to provincial governments and organizations and in some provinces, only encompasses First Nations people living on-reserve. The exclusion of urban Indigenous populations has resulted in flawed public health data and statistics. For example, the frequently cited federal statistics of high vaccination rates of First Nations people do not include data from Indigenous populations in urban areas who have significantly lower uptake of vaccines compared with the general populationFootnote 158.
The pandemic, however, did spur some jurisdictions to collect and share distinctions-based Indigenous health data. For example, the Manitoba government began collecting First Nations, Métis, and Inuit identifiers in April 2020Footnote 159. Individuals who tested positive for COVID-19 were asked to volunteer information about their Indigenous status. This data collection stemmed from the establishment of a data sharing agreement between Manitoba Health and the Assembly of Manitoba Chiefs, which recognized and abided by the principles of First Nations self-governance and data sovereignty (ownership, control, access, and possession). The agreement also specified how First Nations COVID-19 data are accessed, how reports are generated, and how information is shared. The Manitoba Keewatinowi Okimakanak emphasized the importance of this agreement in capturing COVID-19 data on community members who would have been excluded from previous data collection efforts, including non-status First NationsFootnote 160.
Manitoba researchers observed that the use of Inuit health identifiers, particularly in the health administrative data system, would positively benefit Indigenous health reporting and planning activities in the provinceFootnote 161. Manitoba Health also established and published data sets on vaccination rates in the First Nations population, broken down by tribal council region and health authority. This included data on community members who had received vaccinations both on- and off-reserve, a key gap identified in this section.
The panel strongly agrees with the multiple reports that have emphasized a need to take action that supports and aligns with Indigenous data principles and strategiesFootnote 92Footnote 162Footnote 163. An Expert Advisory GroupFootnote 49 on health data stressed that jurisdictions must demonstrate support for First Nations, Inuit, and Métis data sovereignty across geographies and highlighted the importance of meaningful Indigenous participation and representation on senior health data committees and governance tables to ensure support for, and alignment with, First Nations, Inuit, and Métis data principles and strategiesFootnote 54. The Pan-Canadian Health Data Charter, which was recently endorsed by federal, provincial, and territorial Ministers of Health (except Québec), also commits to support and respect First Nations, Inuit, and Métis data sovereignty and Indigenous-led health data governance frameworksFootnote 52. The panel urges the government to continue to strengthen existing efforts to support dedicated and robust distinctions-based Indigenous Peoples health data strategies.
Recommendation 12: Continue efforts to meaningfully engage with Indigenous Peoples and their communities to support their respective health data strategies and advance shared digital health and health data priorities
- Support and collaborate with First Nations, Inuit, and Métis communities and authorities across the country to bring their health data systems in line with the most robust systems in Canada, while preserving Indigenous data sovereignty and ensuring data integration and interoperability with provincial/territorial and federal systems, further to the commitment in the Pan-Canadian Health Data Charter.
The expected overall outcome is culturally distinct and relevant health data systems that advance the digital health and data priorities of Indigenous Peoples and contribute to improved health for all Indigenous people across Canada.
Conclusion
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. The panel's recommendations centre around the need for a more sophisticated national risk assessment and preparedness planning process; a more robust science advisory system that is ready to immediately activate in response to an emergency; ongoing research infrastructure that is ready to mobilize; centralized leadership to facilitate the prioritization and coordination of major public research investments; and improved health data systems.
The panel considers its recommendations to be cost effective, especially when compared with the consequences of inadequate preparedness. The actions will also improve the effectiveness and efficiency of a broad range of government investments. To achieve success, these efforts require enhanced interdepartmental and international coordination, and, given the federated nature of Canadian health systems, actions by and collaboration with provincial and territorial governments. Success also requires increases to ongoing public investment in health research. Previous expert panels, dating back at least 30 years, have called repeatedly for action in these areas. The government must take action now to comprehensively address these shortcomings and to prevent or mitigate, as far as possible, the potentially disastrous health, social, and economic consequences of a future health emergency.
Glossary
A list of jargon and often used terms, accompanied by brief definitions. In most cases, definitions have been adopted and adapted from other sources and not unique to this report.
- All-hazards:
- "Referring to the entire spectrum of hazards, whether they are natural or human-induced"Footnote 164.
- Biomanufacturing:
- "Biomanufacturing is a type of manufacturing that utilizes biological systems (e.g., living microorganisms, resting cells, animal cells, plant cells, tissues, enzymes, or in vitro synthetic (enzymatic) systems) to produce commercially important biomolecules for use in the agricultural, food, material, energy, and pharmaceutical industries"Footnote 165.
- Clinical guidelines:
- "Clinical guidelines are recommendations on how to diagnose and treat a medical condition. Guidelines summarize the current medical knowledge, weigh the benefits and harms of diagnostic procedures and treatments, and give specific recommendations based on this information"Footnote 166.
- Clinical trial:
- "A clinical trial is a research study involving human participants that evaluates the safety and/or effects of one or more interventions on health outcomes"Footnote 167.
- Data custodian:
- "As defined in Canadian health legislation, an individual or organization responsible for the secure collection and/or storage of health data and the curation of health data use, disclosure, retention and disposal. Primarily concerned with security and privacy of health data"Footnote 45.
- Data steward:
- "An entity or senior government role responsible for assuring the quality, integrity and access arrangements of data and metadata in a manner that is consistent with applicable law, institutional policy and individual permissions. Includes entities and positions that deal primarily with personal health information, and those that deal with other health information"Footnote 45.
- Disaggregated data:
- Data "that has been extrapolated (taken) from aggregated data and divided and broken down into smaller information units.... Disaggregating data involves delving more deeply into a set of results to highlight issues that pertain to individual subsets of results and/or outcomes of aggregated data. Collective or aggregate data can be broken down or disaggregated, for instance, by: gender, urban/ rural location, income, socio-cultural or ethnic background, language, geographical location, political/ administrative units, or age groups"Footnote 168.
- Distinctions-based:
- "An approach that aims to avoid conflating the Indigenous Peoples within Canada, and instead recognizes First Nations, Inuit and Métis as separate groups, each with their own diverse cultures, traditions, communities and histories. A distinctions-based approach ensures that the unique rights, interests and circumstances of each of these groups are acknowledged, affirmed and implemented"Footnote 60.
- Expert:
- An individual "having, involving, or displaying special skill or knowledge derived from training or experience"Footnote 169. Expertise includes both codified and tacit knowledge.
- FAIR data principles:
- Guidelines to support scientific data management and stewardship. FAIR Data are Findable, Accessible, Interoperable and ReusableFootnote 146.
- Health care data:
- Data or information collected during and related to the health care provided to an individual person. It is distinguished from public health data (see definition), although there may be some overlap (e.g., vaccination data).
- Health data system:
- A health data or information system refers to a system designed to manage health care data. This includes primarily systems that collect, store, manage and transmit patients' electronic medical records related to any care within a health system.
- Health equity:
- "Means that all people (individuals, groups and communities) have fair access to, and can act on, opportunities to reach their full health potential and are not disadvantaged by social, economic and environmental conditions, including socially constructed factors such as race, gender, sexuality, religion and social status. Achieving health equity requires acknowledging that some people have unequal starting places, and different strategies and resources are needed to correct the imbalance and make health possible. Health equity is achieved when disparities in health status between groups due to social and structural factors are reduced or eliminated"Footnote 98.
- Health data:
- "Observations, facts or measurements–captured for possible further analysis, calculation or reasoning–which relate to the physical or mental health status of individuals, health system performance and socio-economic, community and health system characteristics"Footnote 45.
- Health data interoperability:
- Refers to "the ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner to optimize the health of individuals and populations"Footnote 46.
- Health outcome:
- "Health outcomes are defined as those events occurring as a result of an intervention. These may be measured clinically (physical examination, laboratory testing, imaging), self-reported, or observed (such as gait or movement fluctuations seen by a health care provider or caregiver)"Footnote 170.
- Health portfolio:
- A group of federal government departments that support the Minister of Health, namely Health Canada, Public Health Agency of Canada, Canadian Institutes of Health Research, Patented Medicine Prices Review Board and Canadian Food Inspection AgencyFootnote 171.
- Health research system:
- "The people, institutions, and activities whose primary purpose in relation to research is to generate high-quality knowledge that can be used to promote, restore, and/or maintain the health status of populations; it should include the mechanisms adopted to encourage the utilization of research"Footnote 172.
- Indigenous and First Nations data sovereignty:
- "The concept of First Nations authority, right, power to govern as sovereign Nations and make decisions or laws on the ownership, control, collection, access, analysis, application, possession and use of their own data"Footnote 162.
- Interdisciplinary:
- An interdisciplinary research approach involves the interplay and reconciling of methodologies, theories, and knowledges from distinct disciplines in the pursuit of addressing new scientific questions or societal challengesFootnote 173.
- Knowledge mobilization:
- Knowledge mobilization encompasses "a wide range of activities relating to the production and use of research results, including knowledge synthesis, dissemination, transfer, exchange, and co-creation or co-production by researchers and knowledge users"Footnote 174.
- Learning health system:
- Drives better outcomes for individuals with their own health data and personalized insights while improving overall system quality, population health, evaluation, planning, and public health, aligned with data user needs and supporting equitable healthFootnote 45.
- Medical countermeasure:
- "Medical countermeasures are medicines and medical supplies that can be used to diagnose, prevent, or treat diseases related to chemical, biological, radiological, or nuclear threats"Footnote 175.
- Multidisciplinary:
- Multidisciplinary approaches draw "on knowledge from different disciplines but stays within their boundaries"Footnote 176.
- Non-pharmaceutical intervention:
- "Non-pharmaceutical Interventions (NPIs) are actions, apart from getting vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like pandemic influenza (flu)"Footnote 177. NPIs are also referred to as public health measures.
- One Health Approach:
- The approach mobilizes multiple sectors, disciplines, and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for healthy food, water, energy, and air, taking action on climate change and contributing to sustainable development"Footnote 178.
- Person-centric health data:
- "Data follows the individual across points of care to support individual, clinical, and analytical access and use while respecting individual privacy with regard to the handling of their information under existing privacy legislation"Footnote 52.
- Personal health information:
- "Health data or information that is specific to a unique and identified individual"Footnote 45.
- Public health data:
- Public health data are data collected by local, provincial/territorial or federal public health departments/professionals in exercising their mandate to help protect and improve people's health. These data include data about individuals (collected, for instance by surveillance or surveys or contact tracing), as well as other information (e.g., wastewater surveillance data).
- Research:
- "Research is defined as an undertaking intended to extend knowledge through a disciplined inquiry and/or systematic investigation"Footnote 141. Research may be led by practitioners, communities or researchers and is inclusive of a wide variety of theoretical and methodological approaches, including but not limited to Indigenous research methods, clinical research practices and epidemiological investigationsFootnote 141.
- Risk governance:
- The system developed to manage the identification, assessment, and plan to address various risks when they arise. This includes taking measures to prevent their occurrence or to minimize their impactsFootnote 179.
- Risk register:
- "A register that contains a list of identified risks and related information used to facilitate the monitoring and management of risks. Note: The risk register is generally in the form of a table, spreadsheet or database and may contain the following information: statement or description of the risk, source of risk, areas of impact, cause of the risk, status or action of sector network, existing controls, risk assessment information and any other relevant information"Footnote 164.
- Science advice:
- "The provision of advice from scientific experts to key stakeholders such as policy makers, crisis managers and the public, based on their scientific evidence and expertise. The process can include collecting and analysing evidence, providing advice, and communicating with key stakeholders in appropriate and timely manners"Footnote 25.
- Seroprevalence:
- "Seroprevalence is a type of health information surveillance that indicates infection history in a population, based on a measure of blood proteins (known as antibodies)"Footnote 180.
- Social determinants of health:
- "The non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems"Footnote 181.
- Structural determinants of health:
- "Structural determinants of health are processes that create inequities in money, power and resources. They include political, cultural, economic and social structures; natural environment, land and climate change; and history and legacy, ongoing colonialism and systemic racism. Structural determinants, also known as structural drivers, shape the conditions of daily life (social determinants of health) including education, work, aging, income, social protections, housing, environment and health systems"Footnote 98.
- Surveillance:
- "Tracking health events and determinants through the collection, analysis and reporting of data"Footnote 182.
- Table-top simulation:
- Teaching and training exercise based on fictious scenariosFootnote 183.
- Therapeutics:
- "Therapeutics are treatments used to alleviate or prevent a particular disease. Examples of therapeutics include drug therapy, medical devices, nutrition therapy and stem-cell therapies. Therapeutics can be used in patients with active disease–to treat the disease itself or its signs and symptoms–in preventive medicine, or as palliative care"Footnote 184.
- Transdisciplinary:
- "Transdisciplinary research, which is necessarily interdisciplinary, goes further; it integrates knowledges from different disciplines as well as knowledge and perspectives which may be viewed as 'non-scientific', such as local and traditional knowledge, cultural norms, and social values"Footnote 173.
- Variant of interest:
- "A SARS-CoV-2 variant with changes that are known to affect how the virus behaves or its potential impact on human health. This can include, for example, its ability to spread, its ability to cause serious disease, or how easily it may be detected or treated"Footnote 185.
- Variant of concern:
- "A SARS-CoV-2 variant that meets the definition of a [Variant of Interest], but also meets at least one of the following criteria when compared with other variants: it can cause a detrimental change in disease severity; it can have a substantial impact on the ability of health systems to provide care to patients with COVID-19 or other illnesses and therefore require major public health interventions; or there is a significant decrease in the effectiveness of available vaccines in protecting against severe disease"Footnote 185.
Appendices
Appendix A: List of permanent and ad hoc federal research coordination and science advisory groups that supported the COVID-19 pandemic response
Governance
- Canada Research Coordinating Committee
- Coordination Forum on Major COVID-19 Initiatives
- Deputy Minister Committee on Medical Countermeasures and Research Initiatives
- Federal Pandemic Science Coordination and Action Group
- Special Advisory Committee on COVID-19
- Technical Advisory Committee on COVID-19
- Variants of Concern Leadership Group
- Variants of Concern Scientific Advisory Council
Expert advice
- Ad-hoc COVID-19 Clinical Pharmacology Task Group
- Chief Science Advisor COVID-19 Expert Panel
- Chief Science Advisor Expert Groups and Task Forces
- Council of Expert Advisors
- COVID-19 Exposure Notification App Advisory Council
- COVID-19 Testing and Screening Expert Advisory Panel
- COVID-19 Therapeutics Task Force
- COVID-19 Vaccine Task Force
- Expert Advisory Group on the Pan-Canadian Health Data Strategy
- Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management
- National Advisory Committee on Immunization (NACI)
- National Collaborating Centres for Public Health
- Public Health Ethics Consultative Group
Mission-focused networks
- Canadian Public Health Laboratory Network
- Wastewater working groups
Research funding
- Canadian COVID-19 Genomics Network (CanCOGeN)
- Canadian Institutes of Health Research (CIHR) COVID-related initiatives:
- Rapid Response Research
- Emerging COVID-19 Research Gaps and Priorities
- Centre for Research on Pandemic Preparedness and Health Emergencies
- Canadian Network of COVID-19 Clinical Trials Networks
- Canadian Post COVID-19 Condition Research Network
- Coronavirus Variants Rapid Response Network (CoVaRR-Net)
- COVID-19 Immunity Task Force (CITF)
- Natural Sciences and Engineering Research Council of Canada (NSERC) COVID-related initiatives
- Alliance COVID-19 Grants Initiative
- Emerging Infectious Diseases Modelling Network (with the Public Health Agency of Canada)
- Social Sciences and Humanities Research Council (SSHRC) COVID-related initiatives
- Partnership Engage Grants COVID-19 Special Initiative
Knowledge synthesis
- CanCOVID
- COVID-19 Evidence Network to support Decision-making (COVID-END)
Appendix B: COVID-19 timeline
Figure 6. Timeline of science advisory and coordination bodies in response to COVID-19
Source: Graph and data from World Health Organization (weekly).
Concept adapted from: Bhatia, D., Allin, S. & Di Ruggiero, E. Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response. Humanities and Social Sciences Communications 10, 19 (2023).
Figure 6: Text description
This diagram shows when science advisory and coordination groups were activated in response to COVID-19 as a sequence of coloured boxes moving from left to right. A timeline in the background depicts the confirmed cases per week using grey bars.
January 2020: COVID-19 FPT Conference of Ministers of Health and FPT Conference of Deputy Ministers; and the Special Advisory Committee and Technical Advisory Committee, led by the Health Portfolio.
February 2020: External COVID-19 Expert Modelling Group led by the Health Portfolio.
March 2020: DM Committee for COVID Management Medical Countermeasures and Research Initiatives, led by Health Canada and Innovation, Science, and Economic Development Canada and chaired/co-chaired by the Deputy Minister of Health.
March 2020: COVID-19 Expert Panel, led by the Chief Science Advisor of Canada.
March 2020: Expert Group on Modelling Approaches and the Expert Group on Health Systems, led by the Chief Science Advisor of Canada and chaired/co-chaired by the Deputy Minister of Health.
April 2020: COVID-19 Immunity Task Force, led by the Health Portfolio.
May 2020: Industry Strategy Council, led by Innovation, Science and Economic Development Canada.
June 2020: Minister's COVID-19 Expert Group and the COVID-19 Clinical Pharmacology Task Group, led by the Health Portfolio.
June 2020: COVID-19 Vaccine Task Force, led Health Canada by Innovation, Science and Economic Development Canada.
July 2020: DM Committee on advance purchase agreements and DM Committee on Vaccine Roll-out (amalgamated Oct/20) led by Health Canada and Innovation, Science and Economic Development Canada and chaired/co-chaired by the Deputy Minister of Health.
July 2020: Coordination Forum on Major COVID-19 Initiatives, led by Health Canada and Innovation, Science and Economic Development Canada and chaired/co-chaired by the Deputy Minister of Health.
July 2020: COVID-19 Therapeutics Task Force, led by Health Canada and Innovation, Science and Economic Development Canada.
September 2020: COVID-19 Exposure Notification App Advisory Council, led by Health Canada and Innovation, Science and Economic Development Canada.
October 2020: Industry Advisory Roundtable on COVID-19 Testing, Screening and Data Management, led by the Health Portfolio.
November 2020: COVID-19 Testing and Screening Expert Advisory Panel, led by the Health Portfolio.
December 2020: Vaccine Surveillance Reference Group and the Expert Advisory Group on the Pan Canadian Health Data Strategy, led by the Health Portfolio.
February 2021: Variants of Concern Leadership Group, led by the Health Portfolio and chaired/co-chaired by the Deputy Minister of Health.
February 2021: Variants of Concern Scientific Advisory Committee, led by the Health Portfolio.
January 2022: Federal Pandemic Science Coordination and Action Group, led by the Health Portfolio and chaired/co-chaired by the Deputy Minister of Health.
January 2022: Centre for Research on Pandemic Preparedness and Health Emergencies, led by the Health Portfolio.
May 2023: Council of Expert Advisors.
Date | Number of COVID-19 cases |
---|---|
1/5/2020 | 0 |
1/12/2020 | 0 |
1/19/2020 | 0 |
1/26/2020 | 1 |
2/2/2020 | 3 |
2/9/2020 | 3 |
2/16/2020 | - |
2/23/2020 | 2 |
3/1/2020 | 6 |
3/8/2020 | 36 |
3/15/2020 | 125 |
3/22/2020 | 795 |
3/29/2020 | 3704 |
4/5/2020 | 7844 |
4/12/2020 | 9614 |
4/19/2020 | 9739 |
4/26/2020 | 12005 |
5/3/2020 | 11173 |
5/10/2020 | 11372 |
5/17/2020 | 8180 |
5/24/2020 | 7867 |
5/31/2020 | 6938 |
6/7/2020 | 4917 |
6/14/2020 | 3608 |
6/21/2020 | 2686 |
6/28/2020 | 2165 |
7/5/2020 | 2296 |
7/12/2020 | 2035 |
7/19/2020 | 2544 |
7/26/2020 | 3535 |
8/2/2020 | 3105 |
8/9/2020 | 2672 |
8/16/2020 | 2682 |
8/23/2020 | 2720 |
8/30/2020 | 2938 |
9/6/2020 | 3814 |
9/13/2020 | 4502 |
9/20/2020 | 6285 |
9/27/2020 | 8545 |
10/4/2020 | 12203 |
10/11/2020 | 15458 |
10/18/2020 | 15989 |
10/25/2020 | 17626 |
11/1/2020 | 20267 |
11/8/2020 | 23810 |
11/15/2020 | 31509 |
11/22/2020 | 33401 |
11/29/2020 | 38345 |
12/6/2020 | 43504 |
12/13/2020 | 46271 |
12/20/2020 | 46504 |
12/27/2020 | 43898 |
1/3/2021 | 49698 |
1/10/2021 | 55410 |
1/17/2021 | 51355 |
1/24/2021 | 41703 |
1/31/2021 | 33386 |
2/7/2021 | 26963 |
2/14/2021 | 22550 |
2/21/2021 | 20280 |
2/28/2021 | 20961 |
3/7/2021 | 20207 |
3/14/2021 | 21462 |
3/21/2021 | 23846 |
3/28/2021 | 29593 |
4/4/2021 | 38181 |
4/11/2021 | 50441 |
4/18/2021 | 60788 |
4/25/2021 | 58515 |
5/2/2021 | 54838 |
5/9/2021 | 53748 |
5/16/2021 | 45246 |
5/23/2021 | 33709 |
5/30/2021 | 22152 |
6/6/2021 | 15229 |
6/13/2021 | 10215 |
6/20/2021 | 7541 |
6/27/2021 | 5043 |
7/4/2021 | 4015 |
7/11/2021 | 3648 |
7/18/2021 | 2677 |
7/25/2021 | 3070 |
8/1/2021 | 4772 |
8/8/2021 | 7218 |
8/15/2021 | 12150 |
8/22/2021 | 16015 |
8/29/2021 | 20570 |
9/5/2021 | 24776 |
9/12/2021 | 26881 |
9/19/2021 | 31093 |
9/26/2021 | 29621 |
10/3/2021 | 30335 |
10/10/2021 | 26222 |
10/17/2021 | 21482 |
10/24/2021 | 19068 |
10/31/2021 | 16214 |
11/7/2021 | 15555 |
11/14/2021 | 17666 |
11/21/2021 | 17085 |
11/28/2021 | 19737 |
12/5/2021 | 20188 |
12/12/2021 | 25396 |
12/19/2021 | 39945 |
12/26/2021 | 94023 |
1/2/2022 | 226586 |
1/9/2022 | 293833 |
1/16/2022 | 238269 |
1/23/2022 | 171610 |
1/30/2022 | 124003 |
Figure 7. Timeline of research coordination initiatives in response to COVID-19
Source: Graph and data from World Health Organization (weekly).
Concept adapted from: Bhatia, D., Allin, S. & Di Ruggiero, E. Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response. Humanities and Social Sciences Communications 10, 19 (2023).
Figure 7: Text description
This diagram shows when research coordination initiatives were activated in response to COVID-19 as a sequence of coloured boxes moving from left to right. A timeline in the background depicts the confirmed cases per week using grey bars.
February 2020 research funding: COVID-19 Rapid Research funding competition (Round 1).
April 2020 research networks: COVID-19 Immunity Task Force, CanCOVID, and Canadian COVID Genomics Network (CanCOGeN).
April 2020 research funding: COVID-19 Rapid Research funding competition (Round 2) and Canadian Treatments for COVID-19 trial (CATCO).
August 2020 research network: Canadian Immunization Research Network (vaccine readiness).
September 2020 research funding: Indigenous COVID-19 Rapid Research grants.
October 2020 research network: Knowledge Synthesis Network.
October 2020 research network: Emerging Infectious Diseases Modelling Initiative.
November 2020 research network: Canadian Network of COVID-19 Clinical Trials.
January 2021 research network: COVID-19 Evidence Network to support Decision-making (COVID-END).
February 2021 research network: Coronavirus Variants Rapid Response Network (CoVaRR-Net).
March 2021 research funding: Emerging COVID-19 research gaps and priorities funding (Round 2).
July 2021 other: Canada's Biomanufacturing and Life Sciences Strategy.
July 2021 research funding: Emerging COVID-19 research gaps and priorities funding (Round 3).
October 2021 research network: Evidence Network to support Decision-making (COVID-END) extension.
April 2022 research network: Canadian Network of COVID-19 Clinical Trials Extension.
July 2022 research funding: CIHR Clinical Trials Fund – Accelerating Clinical Trials (ACT) Consortium, CIHR Clinical Trials Fund – Clinical Trials Training Grants, CIHR Clinical Trials Fund – Clinical Trials Projects, and Canadian ADAptive Platform Trial of COVID-19Therapeutics in Community Settings.
March 2023 research network: Canadian Post-COVID-18 Condition Research Network.
March 2023 other: Biomanufacturing Research Hubs.
August 2023 research funding: CIHR Clinical Trials Fund Extension.
Date | Number of COVID-19 cases |
---|---|
1/5/2020 | 0 |
1/12/2020 | 0 |
1/19/2020 | 0 |
1/26/2020 | 1 |
2/2/2020 | 3 |
2/9/2020 | 3 |
2/16/2020 | - |
2/23/2020 | 2 |
3/1/2020 | 6 |
3/8/2020 | 36 |
3/15/2020 | 125 |
3/22/2020 | 795 |
3/29/2020 | 3704 |
4/5/2020 | 7844 |
4/12/2020 | 9614 |
4/19/2020 | 9739 |
4/26/2020 | 12005 |
5/3/2020 | 11173 |
5/10/2020 | 11372 |
5/17/2020 | 8180 |
5/24/2020 | 7867 |
5/31/2020 | 6938 |
6/7/2020 | 4917 |
6/14/2020 | 3608 |
6/21/2020 | 2686 |
6/28/2020 | 2165 |
7/5/2020 | 2296 |
7/12/2020 | 2035 |
7/19/2020 | 2544 |
7/26/2020 | 3535 |
8/2/2020 | 3105 |
8/9/2020 | 2672 |
8/16/2020 | 2682 |
8/23/2020 | 2720 |
8/30/2020 | 2938 |
9/6/2020 | 3814 |
9/13/2020 | 4502 |
9/20/2020 | 6285 |
9/27/2020 | 8545 |
10/4/2020 | 12203 |
10/11/2020 | 15458 |
10/18/2020 | 15989 |
10/25/2020 | 17626 |
11/1/2020 | 20267 |
11/8/2020 | 23810 |
11/15/2020 | 31509 |
11/22/2020 | 33401 |
11/29/2020 | 38345 |
12/6/2020 | 43504 |
12/13/2020 | 46271 |
12/20/2020 | 46504 |
12/27/2020 | 43898 |
1/3/2021 | 49698 |
1/10/2021 | 55410 |
1/17/2021 | 51355 |
1/24/2021 | 41703 |
1/31/2021 | 33386 |
2/7/2021 | 26963 |
2/14/2021 | 22550 |
2/21/2021 | 20280 |
2/28/2021 | 20961 |
3/7/2021 | 20207 |
3/14/2021 | 21462 |
3/21/2021 | 23846 |
3/28/2021 | 29593 |
4/4/2021 | 38181 |
4/11/2021 | 50441 |
4/18/2021 | 60788 |
4/25/2021 | 58515 |
5/2/2021 | 54838 |
5/9/2021 | 53748 |
5/16/2021 | 45246 |
5/23/2021 | 33709 |
5/30/2021 | 22152 |
6/6/2021 | 15229 |
6/13/2021 | 10215 |
6/20/2021 | 7541 |
6/27/2021 | 5043 |
7/4/2021 | 4015 |
7/11/2021 | 3648 |
7/18/2021 | 2677 |
7/25/2021 | 3070 |
8/1/2021 | 4772 |
8/8/2021 | 7218 |
8/15/2021 | 12150 |
8/22/2021 | 16015 |
8/29/2021 | 20570 |
9/5/2021 | 24776 |
9/12/2021 | 26881 |
9/19/2021 | 31093 |
9/26/2021 | 29621 |
10/3/2021 | 30335 |
10/10/2021 | 26222 |
10/17/2021 | 21482 |
10/24/2021 | 19068 |
10/31/2021 | 16214 |
11/7/2021 | 15555 |
11/14/2021 | 17666 |
11/21/2021 | 17085 |
11/28/2021 | 19737 |
12/5/2021 | 20188 |
12/12/2021 | 25396 |
12/19/2021 | 39945 |
12/26/2021 | 94023 |
1/2/2022 | 226586 |
1/9/2022 | 293833 |
1/16/2022 | 238269 |
1/23/2022 | 171610 |
1/30/2022 | 124003 |
Appendix C: Permanent and ad hoc federal research coordination and science advisory groups that supported the COVID-19 pandemic response
Canada's pre-COVID-19 health research and science advice ecosystem that supported the government of Canada's pandemic response
Prior to the COVID-19 pandemic, there were established institutions and processes in place to manage national emergencies. Canada's ecosystem for health research and science advice proved crucial in aiding decision makers during the initial stages of the pandemic, prior to the implementation of more comprehensive procedures. Further information about this ecosystem is outlined in this section.
- Health CanadaFootnote 186 plays a leadership role in managing health crises by promoting research collaboration, providing funding support, overseeing ethical considerations, and facilitating knowledge mobilization to advance public health in Canada. The department:
- Works with various groups, including federal, provincial and territorial (FPT) partners, academic institutions, and international organizations, to foster research collaborations and support science innovation that helps mitigate emerging health threats.
- Supports and funds research related to health crises, including epidemiological studies, clinical trials, and health system evaluations.
- Works with other federal departments and agencies to ensure the availability of high-quality data for research purposes that allows for a cohesive and effective response.
- Oversees regulatory guidelines and approves drugs, vaccines, medical devices, and other health products.
- Manages specific regulatory guidelines for the use of new drugs for emergency treatments, allowing for drugs not authorized in Canada to be used for health emergencies, including facilitating stockpiling of new drugs by the Government of Canada during a public health emergency.
- The Public Health Agency of Canada (PHAC)Footnote 187 is responsible for governing public health functions including emergency preparedness and response and has laboratory science capacity at its National Microbiology Laboratory in Winnipeg, as well as surveillance and epidemiological expertise across branches. PHAC also funds the National Collaborating Centres for public health and manages Canada's public health through an intergovernmental FPT collaboration via the Pan-Canadian Public Health Network. The National Advisory Committee on Immunization is a permanent external advisory committee to PHAC.
- The Chief Public Health Officer (CPHO) of CanadaFootnote 188 position was created in 2004 to improve public health in Canada and strengthen the country's ability to respond to the public health threats, outbreaks and emergencies. The CPHO provides advice to the Minster of Health and the President of PHAC on health issues, works with other governments, jurisdictions, agencies, organisations, and countries on health matters, and speaks to Canadians, health professionals, relevant groups and the public about issues affecting the population's health.
- As Canada's health research granting council, the Canadian Institutes of Health Research (CIHR)Footnote 189 funds the research and knowledge mobilization needed to inform the evolution of Canadian health policy and regulation. This is achieved by funding strategic research priorities–such as population and public health, and infection and immunity–through its 13 virtual institutes. CIHR's Institutes form national research networks linking researchers, funders, and knowledge users across Canada in order to work collaboratively on priority research areas. CIHR also works with many partners domestically and internationally for research coordination.
- The Pan-Canadian Public Health Network (PHN)Footnote 190 is the formal governance for federal-provincial-territorial governments across Canada. The PHN is composed of the PHN Council, the Council of Chief Medical Officers of Health, the PHN Secretariat, and 3 steering committees. The PHN Council is accountable and reports to the Conference of Federal-Provincial-Territorial Deputy Ministers of Health, which is, in turn, accountable to Federal-Provincial-Territorial Ministers of Health. The Network supports horizontal linkages across public health science, policy, and program priorities through collaboration with federal, provincial, and territorial Chief Medical Officers of Health/Chief Public Health Officers, senior government officials, and other key groups across the Federal-Provincial-Territorial public health system. The PHN works to strengthen the public health policy and practice in Canada, anticipate, prepare for, and respond to public health events, and enable federal, provincial, and territorial governments to work together to address public health priorities. A key function of the PHN is to activate time-limited Special Advisory Committee that is activated in response to a public health emergency and includes PHN members and the Council of Chief Medical Officers of Health. The PHN structure and governance also includes permanent steering committees (e.g., Healthy People and Communities, Communicable and Infectious Disease, etc.).
- The Canadian Public Health Laboratory Network (CPHLN)Footnote 191 is a forum where representatives from federal, provincial, and territorial public health laboratories address issues of common concern, including public health infrastructure, surveillance capabilities, and emergency preparedness. The Network is supported by PHAC's National Microbiology Laboratory (NML). During the COVID-19 pandemic, The Canadian Public Health Laboratory Network published materials on best practices for the detection of the virus; including for specimen collection, transportation, testing, and biosafety to ensure a consistent national approach.
- The Canadian Immunization Committee (CIC)Footnote 192, which consists of federal, provincial, and territorial government representatives, provides strategic, operational, and technical advice on immunization program planning to the PHN. The CIC is supported by technical governance bodies including the Canadian Immunization Registries and Coverage Networkand the Vaccine Vigilance Working Group. The Vaccine Vigilance Working Group works to implement post-market vaccine safety surveillance in Canada.
- The National Advisory Committee on Immunization (NACI)Footnote 17 provides ongoing scientific, medical, and public health advice for routine and urgent programs related to Canada's use of vaccines. The Committee is composed of experts in varied fields (e.g., infectious diseases, immunology, social science, pharmaeconomics, nursing, etc.) and reports to PHAC, Vice President of the Infectious Disease and Vaccinations Programs Branch. NACI's knowledge syntheses, analyses and recommendations on vaccine use in Canada are included in published literature reviews, statements, and updates. NACI recommendations are also published in the Canadian Immunization GuideFootnote 193. NACI played a significant role during the COVID-19 pandemic as a publisher of recommendations surrounding the distribution, prioritization, and use of vaccines. This includes guidance on dose scheduling amidst vaccine shortages and limited availability, preference of mRNA vaccines as opposed to viral vector vaccines, and mixed vaccine schedules.
- Canada's Drug and Health Technology Agency (CADTH)Footnote 194 was established jointly by Canada's federal, provincial, and territorial governments as a trusted source of independent information and advice for the country's publicly funded health care systems. During the COVID-19 pandemic, CADTH provided advice to health administrators and policy experts on drugs, devices, and services used to prevent, diagnose, and treat medical conditions. In May 2024, CADTH became Canada's Drug AgencyFootnote 103.
- The National Advisory Committee on Infection Prevention and Control (NAP-IPC)Footnote 195 is a longstanding external advisory body that provides subject matter expertise and advice to PHAC on the prevention and control of infectious diseases in Canadian healthcare settings. The NAP-IPC provides advice to inform the development of comprehensive or concise guidelines, quick reference guides and interim guidelines (usually for emerging pathogens), working closely with PHAC's national Healthcare-Associated Infections surveillance programs for Canadian healthcare facilities.
- The National Collaborating Centres (NCCs) for Public HealthFootnote 196 are funded through PHAC and work together to promote the use of scientific research to strengthen public health practices, programs, and policies in Canada. The NCCs for Public Health identify knowledge gaps, foster networks, and provide the public health system with evidence-based resources and knowledge mobilization services. The NCCs for Public Health are focused on: Indigenous Health, Determinants of Health, Healthy Public Policy, Environmental Health, Infectious Diseases, and Methods and Tools.
- PHAC's Public Health Ethics Consultative GroupFootnote 197 is composed of academic and health care professionals with experience in ethical theory, and public health or research ethics. They support PHAC decision-making, service delivery, and response to public health emergencies as they relate to ethical considerations. The Public Health Ethics Consultative Group established the Framework for Ethical Deliberation and Decision-Making in Public Health: A Tool for Public Health Practitioners, Policy Makers and Decision-MakersFootnote 198 and issued further COVID-19 specific guidance.
- The Canadian Task Force on Preventive Health CareFootnote 199 is an arms-length group funded by PHAC to develop and publish evidence-based primary care guidelines. The group was leveraged by PHAC early in the pandemic for guidance on personal protective equipment.
- The Canadian Immunization Research NetworkFootnote 200 was established in 2009 through a PHAC and CIHR partnership to be a national network of key vaccine researchers who develop and test methodologies related to the evaluation of vaccines as they pertain to safety, effectiveness, and program implementation and evaluation. The Canadian Vaccine Safety Network, which is a research sub-network of the Canadian Immunization Research Network, was established in 2009 and provides active surveillance capacity by quickly identifying any safety signal or adverse events following immunization.
- The role of the Chief Science Advisor of CanadaFootnote 201 was created in 2017 with the mandate to support the Government of Canada's science function and improve the flow of scientific advice to decision makers. The Chief Science Advisor's key functions are to provide advice on the development and implementation of guidelines to ensure that government science is fully available to the public and that federal scientists are able to speak freely about their work; provide advice on creating and implementing processes to ensure that scientific analyses are considered when the Government makes decisions; assess and recommend ways to improve the existing science advisory function within the federal government; and assess and recommend ways for the Government to better support quality scientific research within the federal system.
- In 2018, the Chief Science Advisor established the Departmental Science Advisors (DSA) NetworkFootnote 108—a network of lead science officials and subject matter experts within each of the government's science-based department and agencies. The DSA network promotes a community of practice by sharing information and best practices, developing cross-departmental partnerships, and promotes a coordinated approach to providing science advice to government. The network recommends approaches that enable high standards of research, champion departmental science portfolios, and support a culture of scientific excellence and collaboration. Finally, the DSA network serves as a major conduit in timely development and provision of science advice to senior departmental decision makers and to the Chief Science Advisor. In the Health Portfolio, both Health Canada and PHAC have Departmental Science Advisors that advise the Deputy Minister of Health and President of PHAC, respectively.
- The Presidents of the granting councils, CIHR, the Natural Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research Council, form the Tri-Council. The table promotes high-quality research in a wide variety of disciplines at post-secondary institutions in Canada.
- The Canada Research Coordinating CommitteeFootnote 202 advances federal research priorities and the coordination of policies and programs of Canada's federal research granting councils and the Canada Foundation for Innovation. It provides a strategic forum for sharing information, building consensus, and making decisions on forward-looking initiatives that strengthen Canada's research enterprise, foster world-leading research, and advance Canadians social and economic well-being. This includes focusing on key priority areas such as enhancing equity and diversity in research, increasing the capacity of First Nations, Inuit, and Métis communities to conduct research and partner with the broader research community, and improving support for the next generation of researchers. The Committee consists of the Presidents of the federal granting councils, the Chief Science Advisor, Presidents of the Canada Foundation for Innovation and the National Research Council (NRC) of Canada, and Deputy Ministers of Health Canada and Innovation, Science and Economic Development Canada (ISED).
- The National Alliance of Provincial Health Research Organizations'Footnote 203 primary role is to facilitate coordination, communication, strategic alignment, convergence, and quality leadership through inter-provincial and national efforts. The Health Charities Coalition of CanadaFootnote 204 supports member organizations working together on common issues related to health research and health policy to achieve better health outcomes for Canadians. CIHR also plays an advisory role on research and innovation issues through an extensive and growing set of linkages with Health Canada and PHAC, providing decision makers with access to high-quality and timely health research outcomes and results.
Health research and science advice ecosystem established during various stages of the COVID-19 pandemic (2020-2023)
As part of Canada's evolving pandemic response, significant research investments were made through multiple federal departments and agencies including Health Canada, PHAC, ISED, the NRC, and CIHR to improve the understanding of, and ability to respond to, COVID-19. Various initiatives were funded to enhance the understanding of the virus and scientific evidence was collected and analysed in real-time to support evidence-based decisions.
In addition to governance bodies that were activated as part of existing pandemic response protocols, it was quickly determined that a more comprehensive response to the Government of Canada's approach to collecting and facilitating science advice and research coordination was required. Health Canada played a central role in this regard, collaborating with other federal departments and agencies to ensure that Canada's scientific ecosystem adequately supported the creation of knowledge and advancement of technology. Various governance and coordination bodies were established across disciplines at various stages of the pandemic. The Deputy Minister of Health played a leadership role in this regard, defining needs, designing structures, and supporting the evolution of governance. The actions taken are summarised in this appendix.
The Deputy Minister of Health had a chairing or similarly critical role on many different committees and had direct or indirect visibility into all others. As Portfolio Head, the Deputy Minister of Health also engaged in continuous coordination with the Presidents of PHAC and CIHR, in addition to other Deputy Heads and the Chief Science Advisor of Canada; and formed numerous Deputy Minister-level committees to coordinate the receipt of scientific advice and the translation of guidance to inform policy and decisions, including recommendations to Cabinet.
Health research and science advice ecosystem established during the early COVID-19 pandemic period (2020)
Governance bodies
Existing Federal-Provincial-Territorial governance committees such as the Conference of Federal-Provincial-Territorial Ministers of Health and Conference of Federal-Provincial-Territorial Deputy Ministers of Health played a critical role in the Canadian pandemic response, also met frequently and served as a focal point to coordinate the federal-provincial-territorial response to the pandemic.
- PHN's Special, Technical, and Logistics Advisory CommitteesFootnote 4: In response to the first case of COVID-19 in Canada, PHAC initiated its Incident Management System in mid-January 2020. As part of the emergency response, an ad hoc COVID-19 Special Advisory Committee, Technical Advisory Committee, and Logistics Advisory Committee were stood up under the Pan-Canadian PHN framework to provide an active forum for discussion on various shared jurisdiction public health issues. The Special Advisory Committee met regularly to discuss the evolution of COVID-19 in Canada and public health measures being undertaken to manage the pandemic. The Special Advisory Committee also developed the Federal/Provincial/Territorial Public Health Response Plan for Ongoing Management of COVID-19Footnote 205, in 2020, in collaboration with First Nations, Inuit, and Métis governments, and other health partners. Subsequent updates have focused on the transition from the acute waves of COVID-19 activity towards a more sustainable long-term response.
- Deputy Minister Committee for Medical Countermeasures and Research Initiatives (Health Canada and ISED led, May 2020): The Deputy Minister and Assistant Deputy Minister Committees for Medical Countermeasures aimed to provide strategic oversight and decision making based on scientific advice related to diagnostics, treatments, therapies, and vaccines required for the Canadian health care system and national health security. This included advising Ministers on large-scale investments and coordinating direction of procurements and other investments to ensure supply.
- The Coordination Forum on Major COVID-19 Initiatives (Health Canada led), established by the Deputy Minister of Health to coordinate efforts, exchange information, maximise COVID-19 intelligence to support research and experimentation efforts, identify options and opportunities to enhance the effectiveness of COVID-19 efforts across the country, and avoid duplication between the major governance, research and manufacturing initiatives, focused on medical countermeasures and immunity. Co-chaired by the Deputy Ministers of Health and ISED, the forum membership included a wide range of experts including the chairs of other expert panels and task forces.
Establishment of expert advisory committees
- COVID-19 Expert PanelFootnote 206 (Office of the Chief Science Advisor-led, established March 2020): The Chief Science Advisor led the creation of multidisciplinary science panel to provide the government with advice on the latest scientific developments relevant to COVID-19. The Expert Panel met 40 times in its first year; participants included federal Ministers and Deputy Ministers, as well experts from across Canada's scientific community to provide evidence-based advice on issues such as disease modelling, risk management, diagnostics, and clinical research. Subgroups of experts co-chaired with the Deputy Minister of Health were further formed to provide advice, such as Health Systems and Modelling Approaches. Subject-specific task forces and special meetings of experts were also convened on a variety of timely topics. These task forces allowed the Expert Panel to benefit from additional, focused expertise in gathering practical and scientific information and formulating advice. Six public reports have been published by the Expert Panel on emerging COVID-19 issues, including COVID-19 in children, bioaerosols and indoor ventilation, COVID-19 vaccination certificates, and long COVID, amongst others.
- COVID-19 Vaccine Task ForceFootnote 16 (Health Canada and ISED led, June 2020-March 2023): The Vaccine Task Force was established in June 2020 to provide advice on COVID-19 vaccine development, commercialization, and manufacturing. The Task Force was made up of key external experts, and ex officio members (e.g., the Deputy Ministers of ISED and Health Canada, the President of PHAC and the Chief Science Advisor). The Task Force ultimately advised decision makers on promising domestic vaccine development candidates, priority international vaccines for procurement and supply chain coordination, recommended investments to expand domestic biomanufacturing capacity, and other related public health priorities. The Task Force provided over 50 letters of advice to Ministers. The Deputy Minister Committees on Vaccine and Therapeutics Procurement integrated advice from different sources and coordinated recommendations.
- COVID-19 Therapeutics Task ForceFootnote 207 (Health Canada and ISED led, July 2020-February 2021): The task force was created by ISED to provide expert advice to decision makers on developing and/or producing treatments for COVID-19 and bring new therapies into the Canadian market. The Task Force worked to assess and prioritize COVID-19 therapeutic projects seeking government support and drew from their expertise as industry leaders and researchers in drug research, development, and commercialization. The task force provided advice to the Ministers of Health Canada and Innovation, Science and Industry, with Deputy Ministers of ISED and Health Canada, the President of PHAC, and the Chief Science Advisor as ex officio members.
- The Joint Bio-Manufacturing Sub-CommitteeFootnote 208 was convened in June 2020, comprising members of the Therapeutics Task Force and Vaccine Task Force, with a mandate to provide Ministers of Innovation, Science, and Industry and Health Canada with recommendations on bio-manufacturing investments. This included assessing bio-manufacturing projects proposed to the government under the Strategic Innovation Fund, developing an overall strategy to increase domestic bio-manufacturing capacity, and advising the government on efforts to attract international vaccine candidates to manufacture vaccines in Canada.
- Industry Strategy CouncilFootnote 209 (ISED led, May 2020): The Minister of ISED established the Industry Strategy Council to evaluate the effect of COVID-19 on Canada's economy. The Council's purpose was to identify the extent of pandemic impact on the industry, communicate sector-specific challenges to the government, and gather input from the industry. The council held multiple meetings and presented detailed suggestions to the Minister on restarting, recovering, and reimagining Canadian businesses in the aftermath of the pandemic.
- COVID-19 Testing and Screening Expert Advisory PanelFootnote 210 (Health Canada led, established October 2020): Recognizing the need to stay on top of the latest science developments, Health Canada established a Testing and Screening Expert Advisory Panel to provide evidence-informed advice to the federal government and provincial and territorial partners on science and policy related to innovative approaches to testing and screening for COVID-19. The Panel comprised 13 individuals with expertise in epidemiology, virology, advanced data analytics, pediatrics, health care provision, and technology assessment, both internationally and in Canada, and included the Deputy Minister of Health Canada and other senior leadership from across the Health Portfolio as ex officio members. The Panel released five reports in 2021—the first focused on broad strategies to optimize self-testing in Canada, while others focused on discreet issues, such as testing and screening, long-term care, educational institutions, and border management with timely and relevant guidance to the Minister based on the best available science, data, and experiences. Based on the advice from the panel and roundtable, the Health Canada Testing Secretariat looked to expand the distribution of rapid tests across Canada to support workplace and individual screening in addition to provincial and territorial efforts to help limit the spread of the virus and workplace/community outbreaks. Health Canada and the NML worked on developing guidelines and workflows related to testing in support of Safe Restart and broader re-opening efforts.
- Industry Roundtable on COVID-19 Testing, Screening, Tracing and Data ManagementFootnote 211 (Health Canada led, November 2020): As it became apparent that Health Canada needed a better understanding of industry and civil society needs on testing, the Department launched the Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management, which provided recommendations on testing and screening and its role in the resumption of the economy. The Roundtable was launched in consultation with the Industry Strategy Council and allowed the federal government to hear directly from and collaborate with leaders from across Canadian industry sectors. The expert panel published reports to recommending the implementation of screening protocols using rapid antigen tests at scale in Canada and providing free support to organizations to implement workplace screening programs and navigate procurement of tests through various available channels.
- COVID-19 Exposure Notification App Advisory CouncilFootnote 212 (Health Canada and ISED led, August 2020-July 2021): The COVID-19 Exposure Notification App Advisory Council was established in August 2020 by ISED and Health Canada to support the effective roll-out and operations of Canada's national exposure app (COVID Alert), with the aim of building public trust in the initiative and ensuring provincial and territorial governments benefit from related expert advice and guidance. The Advisory Council consisted of experts with technological and/or health governance expertise and oversaw the technical development of the app including providing design methodology and behavioural science to maximize public uptake, roll-out and necessary guidance, and wind-down. The Council provided reports to the Deputy Ministers of Health Canada, ISED, and Intergovernmental Affairs, as well as the Secretary of the Treasury Board of Canada and relevant provincial and territorial Deputy Ministers; and published three reports outlining the social and economic determinants of the app, and the use of COVID Alert as a government service and as a public health tool.
- Ad hoc COVID-19 Clinical Pharmacology Task group (CPTG)Footnote 213 (PHAC led, summer 2020-March 2021): Composed of volunteers from various Canadian medical associations, the CPTG was convened by PHAC in mid-2020 to inform decision makers and health care professionals on the use of pharmaceuticals for the treatment or chemoprophylaxis of COVID-19, including the determination of appropriate allocation of limited supplies to provinces and territories.
- Minister of Health's COVID-19 Expert Group (June 2020-2021): This was an informal mechanism created with an inter disciplinary group of experts for the purpose of open, informal discussion with the Minister of Health, Deputy Minister of Health, and senior Health Portfolio officials on a wide range of strategic issues related to COVID-19 (e.g., second wave preparations, epidemiology, behavioural science, risk communications, etc.).
Mission-focused networks
- In October 2020, the Natural Sciences and Engineering Research Council of Canada launched the Emerging Infectious Disease ModellingFootnote 214 initiative to establish multi-disciplinary networks of specialists in modelling infectious diseases to be applied to public needs associated with emerging infectious diseases and pandemics such as COVID-19. Jointly delivered with PHAC, this initiative provided $10M in funding to five research networks.
- COVID-19 Immunity Task Force (CITF)Footnote 33 (Health Canada and PHAC led, established April 2020): The CITF was created with the goal of catalyzing, supporting, funding, and harmonizing research into COVID-19 immunity to inform evidence-based decisions. The CITF made recommendations to Health Canada and PHAC through its Executive Committee (dissolved in December 2022) regarding research projects to be funded, and supported a series of serological, immunity, and vaccine surveillance studies aimed at the Canadian population and priority sub-groups. The CITF membership consists of expert researchers/academics in relevant fields and senior government representatives (Chief Science Advisor of Canada, Health Canada, PHAC's Chief Science Officer). The Vaccine Surveillance Reference Group, a subcommittee of CITF, identified specific issues in vaccine surveillance, based on inventories of existing resources and networks, and helped develop and support additional surveillance initiatives to address these gaps in coordination with the provinces and territories.
- Canadian COVID-19 Genomics Network (CanCOGeN)Footnote 215: In April 2020, Genome Canada launched CanCOGeN to establish a coordinated pan-Canadian, cross-agency network for large-scale SARS-CoV-2 and human host sequencing to track viral origin, spread and evolution, characterize the role of human genetics in COVID-19 disease, and to inform time-sensitive critical decision making relevant to health authorities across Canada during the pandemic. CanCOGeN is a Genome Canada-led consortium of Canadian federal, provincial and regional public health authorities and their health care partners, academia, industry, hospitals, research institutes and large-scale sequencing centres. The network contributed to building national capacity to address future outbreaks and pandemics.
- Coronavirus Variants Rapid Response Network (CoVaRR-Net)Footnote 216: CoVaRR-Net was established in March 2021 at the request of the Deputy Minister of Health Canada with funding from CIHR to help address growing concerns around emerging COVID-19 variants. CoVaRR-Net is a network of interdisciplinary researchers that work with the PHAC NML, CanCOGeN, and provincial, territorial, and international institutions to understand the impact of COVID-19 variants on the immune response to the virus and the potential for vaccine escape. In addition to research on variants of concern, CoVaRR-Net also developed resource and data sharing platforms (e.g., BioBank and data platforms and laboratory safety guidance (Canadian Consortium of Academic Biosafety Level 3 Laboratories)). CoVaRR-Net's work also includes the Computational Analysis, Modelling and Evolutionary Outcomes (CAMEO) group; composed of academic researchers and members of PHAC, CAMEO uses computer modelling to evaluate the genetic evolution of COVID-19 variants.
- Wastewater surveillanceFootnote 217 (Health Canada and PHAC led, 2020): Using early funding from Health Canada's Safe Restart Agreement, PHAC established a pan-Canadian wastewater surveillance network to detect COVID-19 levels in communities; the four Working Groups provided a forum to discuss sampling, laboratory methods, data models, modelling, and public health action and response. These included 1) SARS-CoV-2 Variants of Concern in Wastewater; 2) Wastewater Laboratory Detection of SARS-CoV-2 Working Group; 3) Wastewater SARS-CoV-2 Surveillance Updates; and 4) Data Modelling and Epidemiological Interpretation Working Group.
- COVID-19 PHAC Modelling Expert GroupFootnote 218 (PHAC led, 2020): PHAC's senior officials and the PHN's Technical Advisory Committee requested the establishment of a COVID-19 PHAC Modelling Expert Group to include members from the wider modelling community. This group established linkages between experts in federal, provincial, and territorial government public health organisations and academic experts across Canada, allowing further collaboration and benchmarking of modelling activities. The working group contributed knowledge, advice and expertise to inform the public health response to the COVID-19 outbreak through the analysis of information available internationally and nationally.
Knowledge synthesis and evidence gathering bodies
During the pandemic, a significant amount of scientific information was generated to advance basic and applied knowledge related to COVID-19 within various academic, industry, and governmental institutions, nationally and internationally. Initiatives were funded to provide regular updates on best emerging evidence pertaining to public health measures, clinical management, and socio-economic impacts, as well as undertaking horizon scans on emerging new technologies (therapeutic and diagnostic) and approaches/challenges other jurisdictions have identified to support decision-making.
- CanCOVIDFootnote 219 (April 2020-March 2023): CanCOVID, a transdisciplinary, open science initiative, committed to giving a line of sight on existing and emerging COVID-19 science and research, was launched with funding from ISED and support from the Chief Science Advisor. The initiative helped expedite communication and collaboration between the scientific, health care, and policy communities during the COVID-19 crisis. The network's activities include: a weekly virtual speaker series on topics related to COVID-19 science, a searchable digital library of reports and other research products from trusted sources, misinformation tools, and resources to help people identify trustworthy information on COVID-19. In addition, CanCOVID made its expertise available to the Chief Science Advisor, Health Canada, and PHAC upon request, providing analysis, advice, and support to policy makers. CanCOVID's theme lead advisors, a team of experts in the fields of public health, clinical research, behavioural science and health policy, worked with their respective networks to mobilize scientific knowledge for government and public policy responses.
- COVID-19 Evidence Network to Support Decision-making (COVID-END)Footnote 220 (PHAC and CIHR-led, 2020-March 2023): COVID-END was a time-limited network created in April 2020 that brought together more than 50 of the world's leading evidence-synthesis, technology-assessment, and guideline-development groups. It covered the full spectrum of the pandemic response, from public-health measures and clinical management to health system arrangements and economic and social responses. Sharing of this information on an open platform reduced duplication of research efforts and provided opportunities for scientific collaboration and coordination.
- CIHR led a series of Virtual Investigator Meetings to provide a platform for funded researchers to discuss barriers or accelerators to their research with relevant Government of Canada departments. CIHR developed an evergreen compilation of COVID-19 Resource Briefs, in collaboration with government departments and other key groups, containing regulatory and policy levers to further facilitate and accelerate Canada's health research response to COVID-19. CIHR was also able to support federal researchers in accessing the best available evidence related to specific aspects of the COVID-19 pandemic response through its Best Brains Exchanges program, which was adapted to be delivered virtually. For example, CIHR hosted a Best Brains Exchange with the Office of the CPHO to inform the State of Public Health in Canada 2020 report.
Intramural research and surveillance initiatives
In addition to external science advice and research coordination activities, federal departments and agencies were involved in science advice, technical expertise provision and access to capacity. Examples include the NRC's work with partners to advance research and technology development for COVID-19 therapies and vaccines, its construction of a Biomanufacturing Centre and Clinical Trial Material Facility, the testing of new-to-market critical personal protective equipment for front-line health care workers, and NRC researchers working with Canadian and international researchers to fast-track R&D aimed at pressing gaps and challenges; the many roles that the PHAC NML played in vaccine development, diagnostic testing and supporting wastewater surveillance; the PHAC Behavioural Science Office, which worked with the Privy Council Office to embed behavioural science fellows across the PHAC to address emerging needs, scientific capacity within the PHAC Vaccine Rollout Task Force branch engaged external experts and integrated surveillance and science activities to address key issues related to coverage, safety, effectiveness, vaccine confidence/hesitancy, and guidance for Canadians.
This work often involved creation of highly-focused technical groups to bring intramural scientists and experts from across PHAC branches, federal departments, Federal-Provincial-Territorial public health systems, and/or academia together. This included technical groups on modelling, vaccine confidence, and ventilation, for example, and Health Canada's regulatory review of proposed therapies and vaccines and post-market safety data collection, analysis, and risk management activities. Interdepartmental groups and committees were assembled to leverage and share expertise across the federal system.
In May 2020, Health Canada launched regular engagement sessions with CIHR and the Canadian Association of Research Ethics Boards. The forum brought relevant organizations together and provided support for provincial and territorial Research Ethics Boards through enabling discussions on issues related to COVID-19 clinical trial oversight and ethics reviews, including lessons learned, best practices, challenges, and novel trial platforms or approaches.
Data sharing
There are systemic challenges to effective health data collection, access, sharing, and use in Canada, and the COVID-19 pandemic highlighted the critical importance of timely access to clinical, surveillance, administrative, and research data. To support data sharing for large-scale and near real-time analyses, the deployment of existing and new health data technologies and data infrastructure increased substantially, to varying degrees of success.
- The Expert Advisory Group on the Pan-Canadian Health Data StrategyFootnote 221 published three reports between June 2021 and May 2022 that reflected on barriers, advised that substantial coordinated investment in governance, policy, interoperability, data literacy and public trust was needed to strengthen the health data foundation, and provided recommendations for the path forward.
- To inform the work of a Federal-Provincial-Territorial Virtual Care/Digital Table, a Virtual Care Expert Working GroupFootnote 222, which included both relevant group and government official experts, was struck to provide advice and guidance on issues related to the deployment of virtual care in Canadian health systems. A virtual care summit was held in June 2021 to discuss the policy enablers underpinning virtual care and to identify key considerations for a national action plan to maintain the unprecedented momentum spurred by the pandemic in the delivery of virtual care services. Nearly 80 participants from federal, provincial, and territorial governments, pan-Canadian health organizations, First Nations, Inuit, and Métis representatives, rural and remote community representatives, provincial and territorial medical associations, health profession regulatory bodies, patient representatives, and other relevant groups, participated in the summit. The summit was grounded on the findings of Will Falk's DiagnostiqueFootnote 223, and a report developed by the Task Team on Equitable Access to Virtual Care.
- How the federal approach facilitates the timely dissemination of research results to inform scientific advice and improve research coordination has been the subject of granting council efforts including the Tri-Agency Research Data Management PolicyFootnote 224, and is also being examined as part of CIHR's lessons learned assessment.
Health research and science advice ecosystem established during later stages of the COVID-19 pandemic (2021-2022)
- The Variants of Concern Leadership Group (VOC LG) and associated Scientific Advisory Council (VOC SAC) were established by Health Canada in February 2021 to support the Government of Canada's variants of concern strategy and rapidly scale up surveillance, sequencing, and research efforts of new and emerging variants. The Leadership Group was co-chaired by the Deputy Minister of Health and the Executive Vice President Science and Research of the University Health Network. The groups met frequently to drive the Variants of Concern Strategy forward and inform public health responses to variants of concern as well as research to further understand the shifting implications. Membership consisted of researchers and Government of Canada officials; and advanced new scientific techniques, and received updates from relevant research networks (e.g., CoVaRR-Net). The VOC SAC advised on the scientific work of the Variants of Concern Strategy and integration of public health, sequencing, and research across a range of disciplines to ensure rapid identification, characterization, and responsive action to emerging variants of concern.
- In July 2021, the Government of Canada launched Canada's Biomanufacturing and Life Sciences Strategy (BLSS)Footnote 43, with a $2.2 billion investment from Budget 2021. The Strategy, co-led by the Ministers of Health and Innovation, Science and Industry, stemmed from the work of the Vaccine Task Force, Therapeutics Task Force, and Joint Biomanufacturing Sub-Committee, and was informed by public consultations in winter 2021. The Strategy focuses growing a strong, competitive domestic life sciences sector with cutting edge biomanufacturing capabilities and ensuring preparedness for pandemics or other health emergencies. To guide this work, a dedicated and coordinated governance structure which includes a Deputy Head Steering Committee and Assistant Deputy Minister Oversight Committee, was established to enable aligned priority-setting, linked through strategic planning, decision making, performance monitoring, and risk management, and is directly shaped by internal and external experts from academia, industry, and public health.
- The BLSS included a new Biosciences Research Infrastructure Fund (BRIF) delivered by the Canada Foundation for Innovation, to support the bioscience capital and infrastructure needs of post-secondary institutions and research hospitals. The Strategy also included the Canada Biomedical Research Fund (CBRF), created in October 2021 and delivered by the federal research granting councils. The CBRF supports translational and applied research, training and talent development, and develop the pipeline that drives downstream manufacturing capacity.
- As part of Budget 2021, CIHR was allocated $250 million to establish the Clinical Trials FundFootnote 225. Through this fund intended to strengthen the clinical trials ecosystem, CIHR has funded a pan-Canadian clinical trials consortium to improve coordination, training platforms to build clinical trials capacity, and a number of trials to support pandemic preparedness and response and new vaccine and treatment developmentFootnote 127. CIHR also continues to fund research networks on COVID-19 Clinical Trials and Post COVID-19 Condition and develop a long-term clinical trials strategy for Canada.
- In January 2022, the Federal Pandemic Science Coordination and Action Group (FPSCAG) was launched to enhance coordination, collaboration and foster collective action to address and advance Canada's COVID-19 pandemic science plan and actions. This committee, co-chaired by the Deputy Minister of Health and the Executive Vice President Science and Research of the University Health Network, met frequently to identify and advance key areas for the pandemic response, such as wastewater surveillance, long COVID, and vaccine strategies, which could benefit from enhanced coordination and targeted research efforts.
- In January 2022, the Minister of Health formally announced the creation of the Centre for Research on Pandemic Preparedness and Health Emergencies (CRPPHE)Footnote 29. Since its launch, the CRPPHE has enabled CIHR to implement more than $65 million in investments to support a diverse array of research on pandemic and health emergencies, such as projects related to COVID-19, post COVID-19 condition, monkeypox, Ebola, behavioural sciences to address misinformation and improve vaccine confidence, building multidisciplinary teams that work across the human, animal and environmental health pillars (e.g., building capacity in One Health), and health human resource planning in preparation for the next emergency.
- In July 2022, CIHR invested $10 million in the Canadian ADAptive Platform Trial of COVID-19 Therapeutics in Community Settings (Can-ADAPT COVID)Footnote 226 initiative intended to enhance research on novel COVID-19 treatments for non-hospitalized patients, including nirmatrelvir/ritonavir (PaxlovidTM). The focus was on determining the effectiveness and addressing clinical challenges associated with these treatments.
Current health research coordination and science advice ecosystem (March 2023 onwards)
- In March 2023, PHAC deactivated the COVID-19 Incident Management System due to a significant decrease in new COVID-19 positive cases, which were being managed with the current provincial and territorial healthcare systems. The Health Portfolio Operations Centre's functions have become integrated into various branches of Health Canada and PHAC as part of regular programming. Furthermore, various advisory committees, task groups and expert panels have sunset as they completed their mandates.
- The CITFFootnote 33 was later overseen by the PHAC Program Oversight Committee who, in collaboration with the CITF Secretariat, provided ongoing support to research studies currently in progress, the transitioning of CITF research and platforms to appropriate agencies where possible, and the securing ongoing arrangements for the CITF Databank. This includes two reviews of the initiative, led by PHAC and the CITF Secretariat respectively. All activities were completed by March 2024.
- In March 2023, the Government of Canada announced the creation of five new research hubsFootnote 227 across the country to accelerate Canada's vaccine and therapeutics research and development. Research hubs will have access to up to $570 million in available funding, through the CBRF and BRIF, for proposals aimed at cutting-edge research, talent development and research infrastructure projects. Funding decisions were made in March 2024. Funding through these programs is approximately five years in duration.
- The Centre for Research on Pandemic Preparedness and Health Emergencies (CRPPHE)Footnote 29 has ongoing funding of $18.5 million per year to protect the health of people living in Canada by funding and mobilizing health research for pandemic and health emergency preparedness, prevention, response, and recovery that contributes meaningfully to timely, equitable, and effective responses and recovery. The CRPPHE is seeking to coordinate research responses to pandemics and health emergencies by collaborating with other federal departments and agencies, as well as relevant groups domestically and internationally.
- The Chief Science Advisor COVID-19 Expert PanelFootnote 228 had a final meeting in July 2023 and discussed emergency preparedness for the future, in the context of the scientific deliberations during the COVID-19 pandemic. All expert meeting summaries and are available onlineFootnote 228. Subject-specific task forces and expert groups reporting to the Chief Science Advisor's COVID-19 Expert Panel have also concluded.
- The Council of Expert AdvisorsFootnote 229 was established in 2023 by ISED and Health Canada; and acts as the foremost advisory body on enhancing Canada's biomanufacturing, biopharmaceuticals, and life sciences sectors. Its primary role is to provide expert guidance on the implementation of Canada's BLSS. The Council of Expert Advisors is composed of scientific researchers and leaders in the biomanufacturing/biopharmaceutical industry and builds upon the work of the Vaccine Task Force.
Appendix D: Canada's health research and science advice ecosystem: Roles and responsibilities in a federated context
This section briefly describes the roles and responsibilities of various federal departments and agencies and levels of government charged with the delivery of health care and public health. Please see Appendix C for additional background on organizations mentioned within this appendix. It is intended as context for the panel's analysis and recommendations. As such, it does not assess the performance and effectiveness of individual organizations. (For more detailed information about the many task forces and advisory bodies activated or created to address elements of science advice and research coordination components of Canada's COVID-19 response, please see Appendix A and Appendix C.)
Governance of health care and public health
The delivery of health care in Canada is a shared responsibility between the federal government, provincial and territorial governments, and some First Nations organizations that have taken on a health care mandate from the federal government.
The federal government's health care responsibilities are spread across Health Canada, Public Health Agency of Canada (PHAC), and Indigenous Services Canada (ISC). The federal government funds health care, fosters innovation and health research, and sets national principles to ensure quality.
Health Canada is responsible for policy priorities, and promotes and helps protect the health and safety of Canadians by overseeing and regulating products such as drugs, vaccines, diagnostics, medical devices, consumer products, and food. It also supports universally accessible, publicly-funded health care for Canadians through stewardship of the Canada Health Act, leadership on emerging issues (such as legalizing cannabis and medical assistance in dying), and collaboration with provinces, territories and First Nations, Inuit, and Métis-led organizations on the health systemFootnote 230.
PHAC promotes health through the surveillance, prevention, and control of chronic and infectious diseases; prepares for and responds to public health emergencies; strengthens intergovernmental collaboration on public health; and facilitates national approaches to public health policy and planning. PHAC provides guidance on health promotion and health security, and builds partnerships with community-based organizations and equity-deserving groups.
Health Canada and PHAC collaborate with ISC and provinces and territories to improve access to health services for Indigenous Peoples. There is an ongoing process to enable communities to have greater control and decision-making power over the design, management, and administration of health services. There are various funding and governance models through which this progress toward cultural safety and self-determination in health care services for First Nations, Inuit, and Métis peoples is being accomplished, guided by The United Nations Declaration on the Rights of Indigenous PeoplesFootnote 93. Co-funding arrangements by federal and provincial governments support organizations such as the Athabasca Health Authority and Northern Inter-Tribal Health Authority in Saskatchewan. The British Columbia First Nations Health Authority works to design and deliver health programs and services for First Nation communities through a governance structure that addresses health and other inequities. Other health transformation projects are underway across Canada to support First Nations-led institutions and organizations to improve health outcomes and access to services depending on the communities' unique needs and prioritiesFootnote 231.
Provincial and territorial governments have the mandate to organize, manage, and deliver health services to their residentsFootnote 232. This includes administering health insurance plans; planning and funding of care in medical facilities; governing services provided by doctors and other health professionals; and implementing public health initiatives within their jurisdiction. Although the basics of health care are identical across Canada, specific services, administration, and funding vary by jurisdiction. These differences can be attributed to variable geography, finances, and labour forces.
Governance of public health emergencies
In a public health emergency, the federal Health Portfolio, overseen by the Minister of Health, provides national leadership as follows:
Under the Federal Emergency Response Plan, the Health Portfolio leads the response to the health consequences of natural and human-caused emergencies, including situations where the emergency itself is health-related or biologicalFootnote 61.
Within Health Canada, emergency preparedness and planning functions are largely divided by program area expertise, with individual program areas developing and managing preparedness plans for specific emergencies within the broader federal emergency management framework. For example, the Healthy Environments and Consumer Safety Branch at Health Canada consists of independent teams with specific expertise (e.g., nuclear, air and water, chemical) that maintain emergency plans for their subject areas that are annexes to the broader Health Portfolio Emergency Response PlanFootnote 233.
PHAC, formed in 2004, governs public health emergency preparedness and response. It has laboratory science capacity at its National Microbiology Laboratory, as well as surveillance and epidemiological expertise across branches. These functions, along with the mandate to promote collaboration with provincial and territorial partners as it relates to public health, are outlined in the Public Health Agency of Canada Act. PHAC also funds the National Collaborating Centres (NCCs) for Public HealthFootnote j and manages intergovernmental federal-provincial-territorial collaboration in anticipation of, preparation for, and response to public health events via the Pan-Canadian Public Health Network (PHN)Footnote 234. The network's governance structure includes steering committees, working groups, and time-limited Special Advisory Committees that are activated in times of crisis (e.g., the Special Advisory Committee on COVID-19). The PHN is governed by a Council, which reports to the Federal-Provincial-Territorial Conference of Deputy Ministers of Health.
PHAC's Chief Public Health Officer (CPHO), a position created specifically to strengthen Canada's ability to respond to public health threats and emergencies, provides "the Minister [of Health] and the President [of PHAC] with public health advice that is developed on a scientific basis"Footnote 235. The role is accountable or has delegated responsibilities for related provisions of federal health legislation, including the Public Health Agency of Canada Act, Quarantine Act, Human Pathogens and Toxins Act, and Department of Health ActFootnote 235Footnote 236Footnote 237Footnote 238. The CPHO works with other governments, jurisdictions, agencies, organizations, and countries on health matters, and speaks to Canadians, health professionals, relevant groups, and the public about issues affecting the population's health.
The federal government's various emergency plans drive the public health emergency response. PHAC is responsible for the development and maintenance of emergency management plans within the Health Portfolio, including the Health Portfolio Strategic Emergency Management Plan and a subset of it, the Health Portfolio Emergency Response Plan, created in 2013 to provide a policy-governance framework to guide emergency management activitiesFootnote 233. The Health Portfolio Strategic Emergency Management Plan outlines the approach to responding to single, dual, or multiple emergencies. It provides guidance on when the scope and intensity go beyond program-level normal operations and therefore require a coordinated Health Portfolio response. It also informs response coordination and contains the operational guidance and procedural tools applicable to an all-hazard response. As needed, it is supplemented by a hazard-specific plan. The plan itself specifies that it should be reviewed every two years. In 2019, the year before the pandemic struck, PHAC identified the need to review and update the plan. However, in 2021 the Office of the Auditor General found that PHAC had not reviewed it since 2016. Similarly, PHAC had not updated the Health Portfolio Emergency Response Plan, despite the stipulation that it should be reviewed and updated regularlyFootnote 239. PHAC subsequently updated the plan in 2023.
The federal government also maintains joint plans with provinces and territories, such as the Federal-Provincial-Territorial Public Health Response Plan for Biological Events (last updated October 2017) and the Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (last updated August 2018)Footnote 12Footnote 240. The Canadian Pandemic Influenza Preparedness guidance document outlines how jurisdictions will work together to ensure a consistent health-sector approach to pandemic preparedness and response.
The Federal-Provincial-Territorial Public Health Response Plan for Biological Events stipulates that PHAC is responsible for conducting an initial risk assessment (rapid risk assessment and situational analysis) upon receiving notifications of public health events through monitoring or surveillance networks. While the plan is robust in its procedures for pathogen-related and epidemic public health events, its scope is based on the accountabilities of the responsible departments/agencies. It is "intended for the situations where the principal issue is human health and includes biological agents found in the environment, or diagnosed in animals, that have the potential for transmission to humans (zoonoses)"Footnote 12. The plan does not include other biological or public health emergencies that may arise from natural or environmental hazards, such as wildfires and respiratory consequences for population health. However, its stated intention is to be a model for an all-hazard federal-provincial-territorial framework, especially for the health sector, related to natural disasters or chemical, biological, radiological/nuclear, and explosive events.
Evolution of the ecosystem during COVID-19
When the first COVID-19 cases were confirmed in Canada in January 2020, followed by the World Health Organization declaration of a pandemic in March, the Health Portfolio activated its existing pandemic response controls to target the emerging threat.
The PHN immediately activated the time-limited Federal/Provincial/Territorial Special Advisory Committee on COVID-19 governance structure, including the Technical and Logistical Advisory Committees, the Public Health Network Communications Group and the Working Group on Remove and Isolated Communities, to provide a regular federal-provincial-territorial forum for discussion. The Special Advisory Committee on COVID-19 developed and updated the Federal/Provincial/Territorial Public Health Response Plan for Ongoing Management of COVID-19 in collaboration with provincial/territorial and First Nations, Inuit, and Métis governments and other health partnersFootnote 205. It included an appendix outlining the response planning efforts and plans with First Nations, Inuit, and Métis communities.
The Chief Science Advisor and the CPHO, along with permanent external advisory groups such as the National Advisory Committee on Immunization, the Public Health Ethics Consultative Group, Infection Prevention and Control, and networks such as the Canadian Public Health Laboratory Network and the NCCs for Public Health began developing and sharing science-based advice on various aspects of pandemic response. The Canadian Institutes of Health Research (CIHR) participated in Canada's delegation to the World Health Organization/GloPID-R COVID-19 Research & Development Blueprint, and in February 2020, was among the first globally to issue an open call for COVID-19 rapid response research funding in response to those globally set research priorities, distributing $55.3 million. Another call followed in April with $123.5 million; various federal research granting council funding initiatives were launched soon after, informed by coordinated research priority-setting processes led by CIHR which PHAC and others provided input to in order to address gaps in platform funding for knowledge syntheses, Canada's participation in the World Health Organization Solidarity Trial, variants of concern, and other areas. A series of new research funding groups and initiatives were also formed by hospital foundations, universities and provincial/territorial governments–adding to response efforts, but further complicating the coordination of evidence generation.
The speed at which the virus spread and its widespread health, social, and economic impacts, overwhelmed existing public health emergency response plans and systems. The federal government had to quickly adapt existing strategies and structures and put new ones in place to augment and coordinate the evolving understanding of and response to COVID-19. This led to new and sharpened mandates for existing permanent bodies and groups, along with the rapid creation of 38 new and ad hoc groups, many of them issue-specific and time-limited, by various departments and decision makers. These included various governance bodies, expert advisory committees, mission-focused networks, research initiatives, knowledge synthesis/evidence-gathering bodies, intramural research groups, surveillance initiatives, and data-sharing mechanisms. (A full list of these groups and their mandates are included in Appendix A and Appendix C).
These new groups had to be rapidly integrated into the existing, and changing, advice-giving and information flow system. The government also had to create or modify secretariats to manage the interface between specialized technical discussions within scientific forums and the non-technical language of advice to decision makers. Health Canada and PHAC also increased the number of federal employees engaged in science and technological activities during the pandemic. In addition, provincial and territorial governments established their own advisory bodies and structures to focus on the scientific issues and evidence most relevant to their regions at specific points in the pandemic.
As hospitalization and death rates climbed in 2020, the development and production of targeted COVID-19 vaccines and therapies, and Canada's biomanufacturing capacity, was a top priority. In response, the government created three new expert advisory groups (made up of external experts and ex officio members) in June and July: the Vaccine Task Force, Therapeutics Task Force, and Joint Biomanufacturing SubcommitteeFootnote 207Footnote 241. Many other subject-specific expert groups, both formal and informal, were struck by various individuals and departments on timely topics as needed, e.g., COVID-19 Testing and Screening Expert Advisory Panel in October 2020. (See Appendix B for a timeline of the creation of new bodies and groups.)
The need for more targeted research and greater research collaboration and harmonization in efforts to track the virus's origin, spread, and evolution was identified early in 2020. As a result, the government established two mission-focused networks: the COVID-19 Immunity Task Force and the Canadian COVID-19 Genomics Network (CanCoGeN). The former was given a budget to directly fund targeted research on immunity within the Canadian population and priority subgroups. Additional networks followed over time, focusing on, for example, modelling, wastewater surveillance, and tracking and responding to emerging variants of concern. CoVaRR-Net, a network focused on variants of concern, was created in March 2021 with funding from CIHR, and received renewal funding as part of the Government of Canada's Variants of Concern Strategy. Canada's $2.2 billion Biomanufacturing and Life Sciences Strategy was launched in July 2021 to establish coordinated governance structures to enable timely decision making informed by experts and to build public capacity to produce vaccine or other biologicsFootnote 43.
The need for a robust rapid knowledge synthesis function also became clear in the first few months of the pandemic with the rapid generation, both nationally and internationally, of a significant amount of scientific information related to COVID-19. The NCCs for Public Health program was designed for this purpose and a recent evaluation showed that they met this purpose and served the needs of different levels of the public health system. However, their baseline capacity was exceeded by demand. In response to the need for increased capacity, the government created two important bodies in April 2020: CanCOVID (an open information-sharing platform) and the COVID-19 Evidence Network to Support Decision-making (COVID-END). The aim was to facilitate scientific information dissemination; promote collaboration between the scientific, health care, and policy communities; reduce duplication of efforts; and mobilize scientific knowledge for public policy responses. The time-limited COVID-END shut down in March 2023, however, has maintained an online repository of work. CanCOVID remains active. A timeline denoting the activation of permanent bodies and creation of new ad hoc bodies is found in Appendix B.
In addition to CIHR's ongoing open research funding calls throughout the pandemic, the federal government set up a range of new research initiatives to fill gaps in Canada's COVID-19 response with dedicated long-term funding for some projects. For example, Budget 2021 allocated $250 million to CIHR to establish the Clinical Trials Fund, a pan-Canadian clinical trials consortium to improve coordination and training platforms to build clinical trials capacity to support current and future pandemic preparedness and response. While this funding ends in 2027, Budget 2021 also allocated $65 million to CIHR to create a permanent, dedicated interdisciplinary Centre for Research on Pandemic Preparedness and Health Emergencies in January 2022.
The use of existing and new health data technologies and data infrastructure increased substantially during the pandemic with the growing need for critical data sharing for large-scale and near real-time analyses. To better support the effective creation, exchange, and use of critical health data for the benefit of Canadians, the government created the Expert Advisory Group on the Pan-Canadian Health Data Strategy in Fall 2020. Its three reports, published between June 2021 and May 2022, made recommendations on the need for more substantial coordinated investment in governance, policy, interoperability, data literacy, and public trust to strengthen the health data foundationFootnote 45Footnote 54Footnote 55.
Science advice in a federated context
The federal, provincial, and territorial governments share the responsibility to develop and communicate public health guidance to respond to a pandemicFootnote 239. Provinces and territories are responsible for communicating messages within their jurisdictions while the federal government helps develop technical guidance, as well as technical and policy recommendations, to facilitate the multi-jurisdictional response.
During a pandemic, the federal government is responsible for preparing risk assessments and coordinating the overall federal-provincial-territorial response. Within this context, the development and provision of science advice to inform pandemic public health guidance can be considered a shared federal-provincial-territorial responsibility. However, joint emergency plans, such as the Federal/Provincial/Territorial Public Health Response Plan for Biological Events and the Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector, do not articulate roles and responsibilities for science advice provision during an emergencyFootnote 12Footnote 240. First Nations, Inuit, and Métis, municipal, or regional public health departments may also have responsibilities for public health guidance; the division of municipal powers, authorities, and resources varies by province.
The mandate of the Chief Science Advisor is to support the federal science function and improve the flow of scientific advice to decision makers. The Chief Science Advisor ensures that government decision making considers scientific analyses and federal science is fully available to the public; recommends how the government can better support quality research within the federal scientific system; promotes a positive and productive dialogue between federal scientists and academia in Canada and abroad; and raises public awareness of scientific issues. The mandate of the Chief Science Advisor does not have a formal role in an emergency.
Research coordination in a federated context
Canada's complex research landscape features multiple funders and producers of research. The federal and provincial governments fund research directly or through arms-length agencies (known as extramural research). At the federal level, all science-based departments and agencies fund and perform research (intramural research). These departments and agencies, including Innovation, Science and Economic Development Canada and the National Research Council Canada (NRC), help build capacity in research, talent, infrastructure, and biomanufacturing, and support innovative companies and technologies to bring health products to market during a crisis. The Department of National Defence and Defence Research and Development Canada also fund research initiatives in emergency situations.
Extramural research
The federal government funds research at universities and colleges through four at-arms-length granting agencies—CIHR, the International Development Research Centre, the Natural Sciences and Engineering Research Council, and the Social Sciences and Humanities Research Council—and various nongovernmental organizations such as the Canada Foundation for Innovation and Genome Canada.
CIHR, the federal health research investment agency, works to advance both priority-driven and investigator-initiated research across all four pillars of health research: biomedical, clinical, health systems services, and population health. It aims to strengthen Canadian health research capacity; accelerate the self-determination of First Nations, Inuit, and Métis Peoples in health research; pursue health equity through research; and integrate evidence in health.
CIHR funds and coordinates the knowledge mobilization needed to inform the evolution of health policy and regulation during a crisis. This is achieved by funding strategic research priorities, such as population and public health, and infection and immunity, through its 13 virtual institutes. The institutes form national research networks that enable researchers, funders, and knowledge users to collaborate on these priorities. CIHR also advises on research and innovation issues through linkages with Health Canada and PHAC, providing decision makers with access to high-quality and timely health research outcomes and results during a crisis.
The Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council also fund research related to health emergencies. The presidents of the three granting agencies, as well as the presidents of the Canada Foundation for Innovation and the NRC, Deputy Ministers of Health Canada and Innovation, Science and Economic Development Canada, and the Chief Science Advisor constitute the Canada Research Coordinating Committee. As the pandemic progressed, the Government of Canada formed additional research bodies and networks to respond to the need for more directed research to answer critical questions.
Seven provinces–British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador–have health research funding organizations. Collectively, they make up the National Alliance of Provincial Health Research Organizations, which facilitates and coordinates funding across the country, with a yearly investment of $500 million. Its membership enables national and inter-provincial collaborations, which inform strategic research funding, and the sharing of best practicesFootnote 203.
Intramural research
Intramural research generally refers to the portion of the federal government employed as performers of research. The Government of Canada employs around 40,000 personnelFootnote 242 across a range of science-based departments and agencies on science and technology activities including research and development and data collection.
These activities may be undertaken in partnership with other federal departments, provinces and territories, universities, nongovernmental organizations, the private sector, or international partners.
The science and technology activities are generally associated with five responsibilities: informing regulatory and policy decisions and standards, producing public good products and services, maintaining expertise in areas supporting public security and welfare, ensuring capacity to anticipate and respond quickly to adverse events, and supporting innovation to improve the economic well-being of Canadians. Intramural research capacity within PHAC, Health Canada, and the NRC expanded by around 16% to meet capacity needs during the pandemic, from 8,834 full time employees in fiscal year 2018/19 dedicated to science and technology activities, to 10,222 in fiscal year 2021/22Footnote kFootnote 242. At 52%, PHAC had the greatest growth rate over that periodFootnote 242.
Health data governance
Various federal, provincial, territorial, and nonprofit organizations collect national, provincial, and territorial health and administrative data. The lack of interoperability of these systems and organizations, however, contributes to barriers in accessing this data. Obtaining consistent, timely, interoperable data and comprehensive national health information has consistently been a challenge given that provincial and territorial jurisdictions do not always collect or report information in the same way. Additionally, public health surveillance data is primarily collected under the jurisdictional responsibilities of provinces and territories and is shared with the federal government through data sharing agreements.
Health care data is collected by health care organizations and similar to mortality data, it is held at the provincial or territorial level. Health care data is sent to the Canadian Institute of Health Information, as well as provincial organizations such as ICES (formerly known as the Institute for Clinical Evaluative Sciences). Researchers can access de-identified data from these and other organizations, despite a long time lag before information is available to researchers.
Privacy and data protection in Canada are subject to federal and provincial/territorial legislation. No single law governs personal health information across Canada; instead, unique provincial and territorial laws offer similar but varying levels of privacy protection. These laws vary even on, for example, permitted uses and specified disclosures, making it impossible to achieve a consistent national picture of health data. Health privacy protection supports patient confidentiality, a fundamental pillar of patient care. Many health privacy laws also account for secondary uses of personal health information to support health system planning, evaluation, and research. However, it is difficult to pinpoint the exact differences between each jurisdiction's specific legislation. As a result, researchers, research institutions, and organizations conducting national research or collecting national data must address the differences directly or invest resources in detailed jurisdictional scans to prepare data requests and data collection practices that comply with all laws and approval processes across Canada. As the protections imposed by each law can vary, those compiling national data are also tasked with upholding each law, potentially placing highly sensitive information at risk for non-compliance due to the challenging nature of sorting the various requirements.
Appendix E: Experts who contributed to the Review of the Federal Approach to Pandemic Science Advice and Research Coordination
Between August 2023 and February 2024, the panel met with about 300 individuals from across Canada, virtually or in person. In addition, the panel received and considered 55 written submissions from individuals and groups. While the panel's consultations were extensive, the process necessarily represented a small tranche of Canadians.
This is a list of all organizations and institutes represented in these engagement sessions, as well as written submissions. There are also a number of individuals unaffiliated with a group or institution that participated in these consultations. The panel would like to thank all participants for their time and contributions to this process.
- Acuitas Therapeutics
- Alberta Innovates
- Amplitude Ventures
- Atlantic Veterinary College
- Baycrest Centre, Centre for Aging + Brain Health Innovation
- Biologics Manufacturing Centre Inc.
- British Columbia Cancer Research Institute, Genomic Sciences Centre
- British Columbia Children's Hospital Research Institute
- British Columbia Network Environment for Indigenous Health Research
- Canada Foundation for Innovation
- Canadian Academy of Health Sciences
- Canadian College of Health Information Management
- Canadian Food Inspection Agency
- Canadian Health Information Management Association
- Canadian Indigenous Nurses Association
- Canadian Institute for Advanced Research
- Canadian Institutes of Health Research
- Canadian Institutes of Health Research, Centre for Research on Pandemic Preparedness and Health Emergencies
- Canadian Institutes of Health Research, Institute of Indigenous Peoples' Health
- Canadian Institutes of Health Research, Institute of Infection and Immunity
- Canadian Institutes of Health Research, Institute of Population and Public Health
- Canadian Medical Association
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research
- Centre Hospitalier Universitaire de Sherbrooke
- Centre intégré de santé et de services sociaux de Laval
- City of Ottawa, Ottawa Public Health
- City of Toronto, Toronto Public Health
- College of Physicians and Surgeons of Alberta
- Concordia University
- Council of Canadian Academies
- Dalhousie University
- Dalhousie University, Faculty of Medicine
- Dalhousie University, Faculty of Medicine, College of Pharmacy
- Dalhousie University, Faculty of Medicine, Department of Community Health and Epidemiology
- Dalhousie University, Faculty of Medicine, Department of Medicine
- Dalhousie University, Faculty of Medicine, Department of Microbiology and Immunology
- Dalhousie University, Faculty of Medicine, Department of Pathology and Laboratory Medicine
- Dalhousie University, Faculty of Medicine, Department of Pediatrics
- Defence Research and Development Canada
- DIGITAL Supercluster
- Environment and Climate Change Canada
- Fields Institute for Research in Mathematical Sciences
- First Nations Health Authority
- Fonds de recherche du Québec–Santé
- Fraser Health Authority
- Fusion Genomics
- Genome Canada
- Gouvernement du Québec, Institut National de santé publique du Québec
- Gouvernement du Québec, Ministère de la Santé et des Services sociaux
- Gouvernement du Québec, Ministère de l'Économie, de la Science et de l'Innovation
- Government of Alberta
- Government of Alberta, Alberta Health
- Government of Alberta, Alberta Health Services
- Government of Alberta, Alberta Health Services, Provincial Public Health Laboratory
- Government of Alberta, Alberta Health, Health Protection
- Government of Alberta, Alberta Health, Health Standards, Quality, and Performance
- Government of British Columbia, British Columbia Centre for Disease Control
- Government of British Columbia, Ministry of Health
- Government of British Columbia, Provincial Health Services Authority
- Government of Manitoba, Manitoba Health
- Government of Manitoba, Shared Health Manitoba
- Government of New Brunswick, Department of Health
- Government of Newfoundland and Labrador, Department of Health and Community Services
- Government of Northwest Territories, Department of Health and Social Services
- Government of Nova Scotia, Department of Health and Wellness
- Government of Nova Scotia, Nova Scotia Health
- Government of Nunavut, Department of Health
- Government of Ontario, Ministry of Health
- Government of Ontario, Public Health Ontario
- Government of Prince Edward Island, Department of Health and Wellness
- Government of Prince Edward Island, Health PEI
- Government of Saskatchewan, Ministry of Health
- Government of Saskatchewan, Saskatchewan Health Authority
- Government of Yukon, Department of Health and Social Services
- Hamilton Health Sciences
- Health Canada
- Health Data Research Network Canada
- HealthCareCAN
- Hôpital Montfort, Institut du Savoir Montfort
- Immune Biosolutions
- Indigenous Physicians Association of Canada
- Indigenous Services Canada
- Innovation, Science and Economic Development Canada
- Island Health
- IWK Health
- JML Advisory Services
- Lakehead University, Faculty of Health and Behavioural Sciences, Department of Psychology
- Laurent Pharma
- Lawson Health Research Institute
- Life Sciences BC
- London Health Sciences Centre
- McGill University
- McGill University, Faculty of Medicine and Health Sciences, Department of Global and Public Health
- McGill University, Faculty of Medicine and Health Sciences, Department of Biomedical Engineering
- McGill University, Faculty of Medicine and Health Sciences, School of Biomedical Sciences
- McGill University, McGill International TB Centre
- McGill University, McGill University Health Centre Research Institute
- McMaster University, Faculty of Health Sciences, McMaster Immunology Research Centre
- McMaster University, Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact
- McMaster University, Faculty of Health Sciences, McMaster Centre for Transfusion Research
- McMaster University, Faculty of Health Sciences, Michael G. DeGroote Institute for Infectious Disease Research
- McMaster University, Faculty of Medicine, Department of Medicine
- McMaster University, Faculty of Social Sciences, Department of Anthropology
- McMaster University, McMaster Health Forum
- Memorial University, Faculty of Medicine, Division of Population Health and Applied Health Sciences
- Memorial University, Faculty of Nursing
- Memorial University, School of Pharmacy
- Memorial University, Newfoundland and Labrador Centre for Applied Health Research
- Métis National Council
- Mi'kmaq Confederacy of Prince Edward Island
- Michael Smith Health Research BC
- Middlesex-London Health Unit
- Moderna Canada
- Montreal Heart Institute
- Mount Allison University, Faculty of Science, Department of Mathematics and Computer Science
- Mount Saint Vincent University, Faculty of Arts, Department of Family Studies and Gerontology
- Mount Sinai Hospital
- National Collaborating Centre for Environmental Health
- National Collaborating Centre for Healthy Public Policy
- National Collaborating Centre for Indigenous Health
- National Collaborating Centre for Infectious Diseases
- National Research Council Canada
- Natural Resources Canada
- Natural Sciences and Engineering Research Council
- New Brunswick Health Research Foundation
- Nimbus Synergies
- Northern Ontario School of Medicine University, Division of Human Sciences
- Novavax
- Office of the Chief Science Advisor of Canada
- Ontario Hospital Association
- Ottawa Hospital Research Institute
- Pfizer Canada
- Privy Council Office
- Providence Health Care Research Institute
- Public Health Agency of Canada
- Public Health Network
- Public Safety Canada
- Public Services and Procurement Canada
- Queen's University
- Research Manitoba
- Research New Brunswick
- Research Nova Scotia
- Research Universities' Council of British Columbia
- Roche Diagnostics
- Saskatchewan Cancer Agency
- Saskatchewan Health Research Foundation
- Sick Kids Hospital
- Simon Fraser University, Faculty of Health Sciences
- Simon Fraser University, Faculty of Health Sciences, Centre for Collaborative Action on Indigenous Health Governance
- Sinai Health, Lunenfield-Tanenbaum Research Institute
- Sinai Health, Mount Sinai Hospital, Department of Medicine
- Social Sciences and Humanities Research Council
- St. Paul's Hospital, Center for Advancing Health Outcomes
- STEMCELL Technologies
- Sunnybrook Hospital
- Teralys Capital
- The Hospital for Sick Children, Division of Infectious Diseases
- The Ottawa Hospital
- The Royal, Institute for Mental Health Research
- Thompson Rivers University, Faculty of Education and Social Work, All My Relations Research Institute
- Thunder Bay Regional Health Sciences Centre
- Toronto General Hospital Research Institute
- Unity Health Toronto
- Unity Health, St. Michael's Hospital
- Unity Health, St. Michael's Hospital, Li Ka Shing Knowledge Institute
- Université de Montréal
- Université de Montréal, École de santé publique, Département de médecine sociale et préventive
- Université de Montréal, Faculté de médecine, Département de microbiologie, infectologie, et immunologie
- Université de Montréal, Faculté des Arts et des Sciences, Département de psychologie
- Université de Montréal, Institut de recherche Robert-Sauvé en santé et en sécurité du travail
- Université Laval
- University Health Network
- University Health Network, Science and Research
- University Health Network, Toronto General Hospital Research Institute
- University of Alberta
- University of Alberta, Faculty of Medicine and Dentistry
- University of Alberta, Faculty of Medicine and Dentistry, Department of Psychiatry
- University of Alberta, Faculty of Medicine and Dentistry, Department of Biochemistry
- University of Alberta, Faculty of Medicine and Dentistry, Department of Laboratory Medicine and Pathology
- University of Alberta, Faculty of Medicine and Dentistry, Department of Family Medicine
- University of Alberta, Faculty of Medicine and Dentistry, Department of Medicine
- University of Alberta, Faculty of Medicine and Dentistry, Li Ka Shing Institute of Virology
- University of Alberta, Faculty of Nursing
- University of Alberta, School of Public Health
- University of British Columbia
- University of British Columbia, Faculty of Medicine, Department of Medical Genetics
- University of British Columbia, Faculty of Medicine, Department of Psychiatry
- University of British Columbia, Faculty of Medicine, Department of Pathology and Laboratory Medicine
- University of British Columbia, Faculty of Medicine, Department of Obstetrics & Gynaecology
- University of British Columbia, Faculty of Medicine, Department of Medicine
- University of British Columbia, Faculty of Medicine, School of Population and Public Health
- University of British Columbia, School of Population and Public Health, Centre for Health Services and Policy Research
- University of Calgary
- University of Calgary, Cumming School of Medicine, Department of Medicine
- University of Calgary, Cumming School of Medicine, Department of Pathology and Laboratory Medicine
- University of Calgary, Cumming School of Medicine, Department of Community Health Sciences
- University of Calgary, Faculty of Arts, Department of Anthropology and Archaeology
- University of Calgary, Faculty of Science, Geomicrobiology, Enviromics, and Microbial Markets
- University of Calgary, Schulich School of Engineering, Department of Biomedical Engineering
- University of Calgary, Schulich School of Engineering, Department of Mechanical and Manufacturing Engineering
- University of Manitoba
- University of New Brunswick
- University of New Brunswick, Institute for Research, Data and Training
- University of New Brunswick, New Brunswick Institute for Research, Data and Training
- University of Northern British Columbia, Faculty of Human and Health Sciences, Northern Medical Program
- University of Northern British Columbia, Faculty of Indigenous Studies, Social Sciences and Humanities
- University of Northern British Columbia, Faculty of Medicine
- University of Ottawa
- University of Ottawa, Faculty of Medicine, Department of Biochemistry, Microbiology, Immunology
- University of Ottawa, Faculty of Medicine, Department of Family Medicine
- University of Ottawa, Ottawa Health and Life Sciences Innovation Hub
- University of Oxford, Medical Sciences Division, Nuffield Department of Population Health
- University of Prince Edward Island
- University of Prince Edward Island, Atlantic Veterinary College, Department of Health Management
- University of Regina
- University of Regina, Faculty of Arts, Psychology
- University of Regina, Faculty of Education, Educational Psychology and Counselling
- University of Regina, Faculty of Science, Institute for Microbial Systems and Society
- University of Regina, Johnson Shoyama Graduate School of Public Policy
- University of Regina, Saskatchewan Population Health and Evaluation Research Unit
- University of Saskatchewan
- University of Saskatchewan, College of Arts and Science, Department of Anthropology
- University of Saskatchewan, College of Medicine, Community Health and Epidemiology
- University of Saskatchewan, College of Medicine, Northern Medical Services
- University of the Fraser Valley, Faculty of Health Sciences
- University of Toronto
- University of Toronto, Dalla Lana School of Public Health
- University of Toronto, Dalla Lana School of Public Health, Centre for Global Health
- University of Toronto, Faculty of Arts and Science, Department of Statistical Sciences
- University of Toronto, Institute of Health Policy, Management & Evaluation
- University of Toronto, Temerty Faculty of Medicine, Department of Medicine
- University of Victoria, Faculty of Science, Department of Mathematics and Statistics
- University of Victoria, Institute on Aging and Lifelong Health
- University of Waterloo
- University of Western Ontario
- Urban Public Health Network
- Vaccine and Infectious Disease Organization
- Vancouver Coastal Health Research Institute
- Wellesley Institute
- York University, Faculty of Science, Department of Mathematics and Statistics
Footnotes
- Footnote a
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However, as noted, NACI did not have sufficient surge capacity during the COVID-19 pandemic.
- Footnote b
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Distinctions-based is defined as "an approach that aims to avoid conflating the Indigenous Peoples within Canada, and instead recognizes First Nations, Inuit and Métis as separate groups, each with their own diverse cultures, traditions, communities and histories. A distinctions-based approach ensures that the unique rights, interests and circumstances of each of these groups are acknowledged, affirmed and implemented."
- Footnote c
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In the context of this report, hazards refer to events that occur in the natural world, such as volcanic eruptions and forest fires. Threats generally refer to human activities, such as an attack. The term risk is used to encompass hazards and threats; and risk analysis is the study of the probability and severity of these occurrences.
- Footnote d
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Accidents and system failures; Conflict and instability; Cyber; Geographic and diplomatic; Human, animal, and plant health; Natural and environmental hazards; Societal; State threats; and Terrorism.
- Footnote e
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Ad-hoc COVID-19 Clinical Pharmacology Task Group; Council of Expert Advisors; COVID-19 Exposure Notification App Advisory Council; COVID-19 Therapeutics Task Force; COVID-19 Vaccine Task Force; Expert Advisory Group on the Pan-Canadian Health Data Strategy; Expert Group on Health Systems; Expert Group on Modelling Approaches; Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management; Minister’s COVID-19 Expert Group; National Advisory Committee on Immunization; Chief Science Advisor COVID-19 Expert Panel; Public Health Ethics Consultative Group; Testing and Screening Expert Advisory Panel
- Footnote f
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Recognizing that many decision makers and members of the public do not have formal training in areas of health or science.
- Footnote g
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Canada Research Coordinating Committee; Canadian COVID-19 Genomics Network (CanCOGeN); CanCOVID; Centre for Research on Pandemic Preparedness and Health Emergencies Steering Committee; Coordination Forum on Major COVID-19 Initiatives; Coronavirus Variants Rapid Response Network (CoVaRR-Net); COVID-19 Immunity Task Force; Deputy Minister Committee on Medical Countermeasures and Research Initiatives; Federal Pandemic Science Coordination and Action Group; Special Advisory Committee on COVID-19; Technical Advisory Committee on COVID-19; Variants of Concern Leadership Group; Wastewater working groups; and the Office of the Chief Science Advisor's Task Force on Long-Term Care; Task Force on Optimal Use of Health System Capacity; Task Force on Long-Term Care Systemic Issues; Task Force on Data Analytics; Task Force on Post-COVID-19 Condition; Task Force on COVID-19 in Children; Task Force on Ventilators; Task Force on Reprocessing of Respirators/N95 Masks; and Task Force on Virtual Care.
- Footnote h
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The analysis is limited to individuals who publicly identify as First Nation, Inuit, or Métis.
- Footnote i
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See "Chapter 9: Research Involving First Nations, Inuit, and Métis Peoples of Canada" of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans TCPS2.
- Footnote j
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National Collaborating Centres have specific areas of expertise, including Indigenous Health, Determinants of Health, Environmental Health, Infectious Diseases, Healthy Public Policy, and Methods and Tools.
- Footnote k
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This was the last year that complete data was reported to Statistics Canada, year 2022/23 represents preliminary estimates and intentions.
References
- Footnote 1
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Razak F, Shin S, Naylor CD, Slutsky AS. Canada's response to the initial 2 years of the COVID-19 pandemic: a comparison with peer countries. CMAJ 2022 Jun 27;194(25):E870-E877.
- Footnote 2
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Gupta S, Aitken N. COVID-19 mortality among racialized populations in Canada and its association with income. 2022. [Cited Mar 22, 2024]. Available from: https://www150.statcan.gc.ca/n1/pub/45-28-0001/2022001/article/00010-eng.htm
- Footnote 3
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G20 High Level Independent Panel. A Global Deal for our Pandemic Age. 2021. [Cited Mar 13, 2024]. Available from: https://pandemic-financing.org/report/foreword/
- Footnote 4
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Pan-Canadian Public Health Network. Special Advisory Committee on COVID-19. 2023. [Cited Mar 20, 2024]. Available from: https://www.phn-rsp.ca/en/about/covid-19-response.html
- Footnote 5
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Chief Public Health Officer of Canada. A Vision to Transform Canada's Public Health System. 2021. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2021/report.html
- Footnote 6
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Chief Public Health Officer of Canada. From risk to resilience: An equity approach to COVID-19: Chief Public Health Officer of Canada's Report on the State of Public Health in Canada 2020. 2020. [Cited Mar 21, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19.html
- Footnote 7
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Mashford-Pringle A, Skura C, Stutz S, Yohathasan T. What we heard: Indigenous Peoples and COVID-19. 2021. [Cited Mar 18, 2024]. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19/indigenous-peoples-covid-19-report/cpho-wwh-report-en.pdf
- Footnote 8
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National Advisory Committee on SARS and Public Health. Learning from SARS Renewal of Public Health in Canada. 2003. [Cited Mar 7, 2024]. Available from: https://www.phac-aspc.gc.ca/publicat/sars-sras/pdf/sars-e.pdf
- Footnote 9
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Public Safety Canada. The First Public Report of the National Risk Profile. 2023. [Cited Mar 11, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/2023-nrp-pnr/index-en.aspx
- Footnote 10
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Public Safety Canada. Emergency Management. 2022. [Cited Mar 20, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/index-en.aspx
- Footnote 11
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Public Health Agency of Canada. Pandemic Plans. 2022. [Cited Mar 20, 2024]. Available from: https://www.canada.ca/en/public-health/services/flu-influenza/pandemic-plans.html
- Footnote 12
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Public Health Agency of Canada. Federal/Provincial/Territorial Public Health Response Plan for Biological Events. 2017. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/services/emergency-preparedness/public-health-response-plan-biological-events.html
- Footnote 13
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HM Government. National Risk Register 2023 Edition. 2023. [Cited Mar 11, 2024]. Available from: https://assets.publishing.service.gov.uk/media/64ca1dfe19f5622669f3c1b1/2023_NATIONAL_RISK_REGISTER_NRR.pdf
- Footnote 14
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New Zealand Department of the Prime Minister and Cabinet. New Zealand's Nationally Significant Risks. 2022. [Cited Mar 8, 2024]. Available from: https://www.dpmc.govt.nz/our-programmes/national-security/national-risk-approach/new-zealands-nationally-significant-risks
- Footnote 15
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Danish Emergency Management Agency. National Risk Profile 2022. 2022. [Cited Mar 8, 2024]. Available from: https://www.brs.dk/globalassets/brs---beredskabsstyrelsen/dokumenter/krisestyring-og-beredskabsplanlagning/2022/-national-risk-profile-2022-.pdf
- Footnote 16
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Innovation, Science and Economic Development Canada. COVID-19 Vaccine Task Force. 2022. [Cited Mar 11, 2024]. Available from: https://ised-isde.canada.ca/site/biomanufacturing/en/covid-19-vaccine-task-force
- Footnote 17
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Public Health Agency of Canada. National Advisory Committee on Immunization (NACI): Membership and representation. 2024. [Cited Mar 20, 2024]. Available from: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/naci-membership-representation.html
- Footnote 18
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National Clinical Evidence Taskforce. About the taskforce. 2024. [Cited Mar 13, 2024]. Available from: https://clinicalevidence.net.au/about-the-taskforce/
- Footnote 19
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Blanchard-Musset S, Le Goaster L, Ertel-Pau V, Menanteau-Bendavid L, Gabach P. Rapid guidelines in the context COVID-19: what is the perception of their quality and value by French healthcare professionals. 2022. [Cited Mar 13, 2024]. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2022-09/gin_poster_retex_specialist_v1-310822_003.pdf
- Footnote 20
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Napierala H, Schuster A, Gehrke-Beck S, Heintze C. Transparency of clinical practice guideline funding: a cross-sectional analysis of the German AWMF registry. BMC Medical Ethics 2023 May 19;24(1):32.
- Footnote 21
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National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing COVID-19. 2024. [Cited Mar 13, 2024]. Available from: https://www.nice.org.uk/guidance/ng191/chapter/4-Therapeutics-for-COVID-19
- Footnote 22
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COVID-19 Treatment Guidelines Panel. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. 2024. [Cited Mar 13, 2024]. Available from: https://www.covid19treatmentguidelines.nih.gov/
- Footnote 23
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Scientific Advisory Group for Emergencies. About Us. 2022. [Cited Mar 12, 2024]. Available from: https://www.gov.uk/government/organisations/scientific-advisory-group-for-emergencies/about#sage-activations
- Footnote 24
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Public Health Agency of Canada. COVID-19 Lessons Learned in Science Advice: Living Scan (Internal Document). Ottawa, ON; 2024
- Footnote 25
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OECD. Scientific Advice During Crises: Facilitating Transnational Co-operation and Exchange of Information. Paris: OECD Publishing; 2018
- Footnote 26
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Ontario COVID-19 Science Advisory Table. Science in Service: Informing Ontario's response to COVID-19. 2022. [Cited Mar 13, 2024]. Available from: https://covid19-sciencetable.ca/
- Footnote 27
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Genome Canada. About. 2022. [Cited Mar 20, 2024]. Available from: https://genomecanada.ca/about/
- Footnote 28
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Canadian Immunization Research Network. Canadian National Vaccine Safety Network (CANVAS). 2024. [Cited Mar 20, 2024]. Available from: https://cirnetwork.ca/network/national-ambulatory-network/
- Footnote 29
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Canadian Institutes of Health Research. Centre for Research on Pandemic Preparedness and Health Emergencies. 2024. [Cited Mar 20, 2024]. Available from: https://cihr-irsc.gc.ca/e/52397.html
- Footnote 30
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Natural Sciences and Engineering Research Council of Canada. Addendum to the guidelines for the eligibility of applications related to health. 2022. [Cited Mar 15, 2024]. Available from: https://www.nserc-crsng.gc.ca/nserc-crsng/policies-politiques/addendum-addenda_eng.asp
- Footnote 31
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Innovation, Science and Economic Development Canada. Report of the Advisory Panel on the Federal Research Support System. 2023. [Cited Mar 18, 2024]. Available from: https://ised-isde.canada.ca/site/panel-federal-research-support/en/report-advisory-panel-federal-research-support-system
- Footnote 32
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Tsang JLY, Fowler R, Cook DJ, Ma H, Binnie A. How can we increase participation in pandemic research in Canada? Can J Anaesth 2022 Mar;69(3):293-297.
- Footnote 33
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COVID-19 Immunity Task Force. The COVID-19 Immunity Task Force. 2023. [Cited Mar 18, 2024]. Available from: https://www.covid19immunitytaskforce.ca/
- Footnote 34
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COVID-19 Immunity Task Force. Seroprevalence in Canada. 2023. [Cited Mar 18, 2024]. Available from: https://www.covid19immunitytaskforce.ca/seroprevalence-in-canada/
- Footnote 35
-
Tang X, Sharma A, Pasic M, Brown P, Colwill K, Gelband H, et al. Assessment of SARS-CoV-2 Seropositivity During the First and Second Viral Waves in 2020 and 2021 Among Canadian Adults. JAMA Netw Open 2022 Feb 1;5(2):e2146798.
- Footnote 36
-
Murphy TJ, Swail H, Jain J, Anderson M, Awadalla P, Behl L, et al. The evolution of SARS-CoV-2 seroprevalence in Canada: a time-series study, 2020-2023. CMAJ 2023 Aug 14;195(31):E1030-E1037.
- Footnote 37
-
Reis G, Moreira Silva EAS, Medeiros Silva DC, Thabane L, Campos VHS, Ferreira TS, et al. Early Treatment with Pegylated Interferon Lambda for Covid-19. N Engl J Med 2023 Feb 9;388(6):518-528.
- Footnote 38
-
The ATTACC, ACTIV-4a, and REMAP-CAP Investigators. Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. N Engl J Med 2021 Aug 26;385(9):790-802.
- Footnote 39
-
Brown PE, Fu SH, Bansal A, Newcombe L, Colwill K, Mailhot G, et al. Omicron BA.1/1.1 SARS-CoV-2 Infection among Vaccinated Canadian Adults. N Engl J Med 2022 Jun 16;386(24):2337-2339.
- Footnote 40
-
Jorgensen SCJ, Hernandez A, Fell DB, Austin PC, D'Souza R, Guttmann A, et al. Maternal mRNA covid-19 vaccination during pregnancy and delta or omicron infection or hospital admission in infants: test negative design study. BMJ 2023 Feb 8;380:e074035-074035.
- Footnote 41
-
Naylor KL, Knoll GA, Smith G, McArthur E, Kwong JC, Dixon SN, et al. Effectiveness of a Fourth COVID-19 mRNA Vaccine Dose Against the Omicron Variant in Solid Organ Transplant Recipients. Transplantation 2024 Jan 1;108(1):294-302.
- Footnote 42
-
Nasreen S, Chung H, He S, Brown KA, Gubbay JB, Buchan SA, et al. Effectiveness of COVID-19 vaccines against symptomatic SARS-CoV-2 infection and severe outcomes with variants of concern in Ontario. Nat Microbiol 2022 Mar;7(3):379-385.
- Footnote 43
-
Innovation, Science and Economic Development Canada. Canada's Biomanufacturing and Life Sciences Strategy. 2021. [Cited Mar 7, 2024]. Available from: https://ised-isde.canada.ca/site/biomanufacturing/sites/default/files/attachments/1098_01_21_Biomanufacturing_Strategy_EN_WEB.pdf
- Footnote 44
-
OECD. Gross domestic spending on R&D. 2024. [Cited May 3, 2024]. Available from: https://www.oecd-ilibrary.org/content/data/d8b068b4-en
- Footnote 45
-
The Pan-Canadian Health Data Strategy Expert Advisory Group. Expert Advisory Group Report 3: Toward a world-class health data system. 2022. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-reports-summaries/expert-advisory-group-report-03-toward-world-class-health-data-system.html
- Footnote 46
-
Affleck E, Murphy T, Williamson T, Price R, Wolfaardt U, Price T, et al. Interoperability Saves Lives. 2023. [Cited Mar 18, 2024]. Available from: https://cpsa.ca/wp-content/uploads/2023/11/Interoperability-Saves-Lives-Final.pdf
- Footnote 47
-
Council of Canadian Academies. Connecting the Dots: Expert Panel on Health Data Sharing. 2023. [Cited Mar 18, 2024]. Available from: https://cca-reports.ca/wp-content/uploads/2023/10/Connecting-the-Dots_ENdigital_FINAL.pdf
- Footnote 48
-
Kerr S, Bedston S, Cezard G, Sampri A, Murphy S, Bradley DT, et al. Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales. The Lancet 2024 Jan 15;403(10426):554-566.
- Footnote 49
-
Public Health Agency of Canada. The pan-Canadian Health Data Strategy: Expert Advisory Group Overview. 2022. [Cited Mar 18, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-overview.html
- Footnote 50
-
Health Canada. Working together to improve health care in Canada: Overview. 2024. [Cited Mar 20, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/transparency/health-agreements/shared-health-priorities.html
- Footnote 51
-
Health Canada. FPT Communique: Federal, Provincial, Territorial Health Ministers' and Ministers Responsible for Mental Health and Addiction. 2023. [Cited Mar 20, 2024]. Available from: https://www.canada.ca/en/health-canada/news/2023/10/fpt-communique-federal-provincial-territorial-health-ministers-and-ministers-responsible-for-mental-health-and-substance-use.html
- Footnote 52
-
Health Canada. Pan-Canadian Health Data Charter. 2023. [Cited Mar 18, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/transparency/health-agreements/shared-health-priorities/working-together-bilateral-agreements/pan-canadian-data-charter.html
- Footnote 53
-
Office of the Chief Science Advisor. Meeting #48 of the CSA COVID-19 Expert Panel. Ottawa, ON; 2023.
- Footnote 54
-
The Pan-Canadian Health Data Strategy Expert Advisory Group. Expert Advisory Group Report 1: Charting a Path toward Ambition. 2021. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-reports-summaries/expert-advisory-group-report-01-charting-path-toward-ambition.html
- Footnote 55
-
The Pan-Canadian Health Data Strategy Expert Advisory Group. Expert Advisory Group Report 2: Building Canada's Health Data Foundation. 2021. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-reports-summaries/expert-advisory-group-report-02-building-canada-health-data-foundation.html
- Footnote 56
-
Ismail SJ, Hardy K, Tunis MC, Young K, Sicard N, Quach C. A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations. Vaccine 2020;38(36):5861-5876.
- Footnote 57
-
Ismail SJ, Zhao L, Tunis MC, Deeks SL, Quach C. Key populations for early COVID-19 immunization: preliminary guidance for policy. CMAJ 2020;192(48):E1620-E1632.
- Footnote 58
-
Ismail SJ, Tunis MC, Zhao L, Quach C. Navigating inequities: a roadmap out of the pandemic. BMJ Global Health 2021;6(1):e004087.
- Footnote 59
-
Henry R, Tait C. Indigenous Identity Fraud: An Interview with Caroline Tait. Aboriginal Policy Studies 2023;10(2):84-92.
- Footnote 60
-
Canadian Institute for Health Information. Race-Based and Indigenous Identity Data Collection and Health Reporting in Canada: Supplementary Report. 2022. [Cited Apr 5, 2024]. Available from: https://www.cihi.ca/sites/default/files/document/race-based-and-indigenous-identity-data-supplementary-report-en.pdf
- Footnote 61
-
Public Safety Canada. Federal Emergency Response Plan. 2011. [Cited Mar 7, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/mrgnc-rspns-pln/index-en.aspx
- Footnote 62
-
Public Safety Canada. Emergency Management Strategy for Canada: Toward a Resilient 2030. 2019. [Cited Apr 16, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/mrgncy-mngmnt-strtgy/mrgncy-mngmnt-strtgy-en.pdf
- Footnote 63
-
Public Safety Canada. National Risk Profile Methodology. 2024. [Cited Mar 7, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/ntnl-rsk-prfl/bckgrndr-mthdlgy-en.aspx
- Footnote 64
-
Public Safety Canada. Backgrounder: Future of the National Risk Profile. 2024. [Cited Apr 16, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/mrgnc-mngmnt/ntnl-rsk-prfl/bckgrndr-ftr-nrp-en.aspx
- Footnote 65
-
World Health Organization. One Health. 2017. [Cited Mar 7, 2024]. Available from: https://www.who.int/news-room/questions-and-answers/item/one-health
- Footnote 66
-
OECD. National Risk Assessments. Paris: OECD Publishing; 2018.
- Footnote 67
-
Ministerie van Binnenlandse Zaken en Koninkrijksrelaties. Instellingsbesluit Stuurgroep Nationale Veiligheid. 2010. [Cited Apr 29, 2024]. Available from: https://wetten.overheid.nl/BWBR0027277/2010-02-23
- Footnote 68
-
Chief Public Health Officer of Canada. Creating the Conditions for Resilient Communities: A Public Health Approach to Emergencies. 2023. [Cited Mar 11, 2024]. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/state-public-health-canada-2023/report/report.pdf
- Footnote 69
-
New Zealand Department of the Prime Minister and Cabinet. National Risk Directorate. 2024. [Cited Mar 20, 2024]. Available from: https://www.dpmc.govt.nz/our-business-units/national-security-group/national-intelligence-and-risk-coordination
- Footnote 70
-
New Zealand Department of the Prime Minister and Cabinet. National Risk Approach. 2021. [Cited Mar 8, 2024]. Available from: https://www.dpmc.govt.nz/our-programmes/risk-and-resilience/national-risk-framework
- Footnote 71
-
Health New Zealand. Communicable Disease Control Manual. 2024. [Cited May 4, 2024]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/communicable-disease-control-manual/updates-to-the-communicable-disease-control-manual/
- Footnote 72
-
Health New Zealand. Māori health – a commitment to Te Tiriti o Waitangi. In: General consideration for the control of communicable diseases in Aotearoa New Zealand: Part of the Communicable Disease Control Manual. 2023. [Cited May 4, 2024]. Available from: https://www.tewhatuora.govt.nz/for-health-professionals/clinical-guidance/communicable-disease-control-manual/general-consideration/#maori-health-a-commitment-to-te-tiriti-o-waitangi
- Footnote 73
-
Health New Zealand. General consideration for the control of communicable diseases in Aotearoa New Zealand: Part of the Communicable Disease Control Manual. 2023. [Cited Mar 20, 2024]. Available from: https://www.tewhatuora.govt.nz/for-the-health-sector/health-sector-guidance/communicable-disease-control-manual/general-consideration/
- Footnote 74
-
Canadian Paediatric Society. Surveillance. 2024. [Cited May 4, 2024]. Available from: https://cps.ca/en/impact
- Footnote 75
-
Public Health Agency of Canada. Canadian Nosocomial Infection Surveillance Program (CNISP). 2022. [Cited Apr 9, 2024]. Available from: https://www.canada.ca/en/public-health/programs/canadian-nosocomial-infection-surveillance-program.html
- Footnote 76
-
Public Health Agency of Canada. Respiratory virus detections in Canada. 2024. [Cited May 4, 2024]. Available from: https://www.canada.ca/en/public-health/services/surveillance/respiratory-virus-detections-canada.html
- Footnote 77
-
Intergovernmental Affairs. The Safe Restart Agreement. 2020. [Cited Mar 27, 2024]. Available from: https://www.canada.ca/en/intergovernmental-affairs/services/safe-restart-agreement.html
- Footnote 78
-
Innovation, Science and Economic Development Canada. Community-led wastewater testing in northern, remote and isolated communities. 2023. [Cited Mar 8, 2024]. Available from: https://science.gc.ca/site/science/en/blogs/science-health/community-led-wastewater-testing-northern-remote-and-isolated-communities
- Footnote 79
-
National Collaborating Centre for Infectious Diseases. Testing and Screening Knowledge Exchange Session: Wastewater Surveillance. 2021. [Cited Mar 8, 2024]. Available from: https://nccid.ca/wp-content/uploads/sites/2/2022/04/HealthCanadaReport.pdf
- Footnote 80
-
Sachdeva H, Shahin R, Ota S, Isabel S, Mangat CS, Stuart R, et al. Preparing for Mpox Resurgence: Surveillance Lessons From Outbreaks in Toronto, Canada. J Infect Dis 2024 -03-26;229(Supplement_2):S305-S312.
- Footnote 81
-
Postill G, Murray R, Wilton AS, Wells RA, Sirbu R, Daley MJ, et al. The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study. JMIR Public Health Surveill 2022 -2-21;8(2):e32426.
- Footnote 82
-
Office of the Chief Science Advisor of Canada. Roadmap for Open Science. 2020. [Cited Apr 9, 2024]. Available from: https://science.gc.ca/site/science/en/office-chief-science-advisor/open-science/roadmap-open-science
- Footnote 83
-
Government of Canada. National Action Plan on Open Government. 2023. [Cited Apr 9, 2024]. Available from: https://open.canada.ca/en/content/national-action-plan-open-government
- Footnote 84
-
Public Health Agency of Canada. ARCHIVED - Multi-lateral information sharing agreement (MLISA). 2022. [Cited Apr 9, 2024]. Available from: https://www.canada.ca/en/public-health/services/public-health-practice/multi-lateral-information-sharing-agreement-mlisa.html
- Footnote 85
-
Pan-Canadian Public Health Network. Multi-lateral Information Sharing Agreement. 2016. [Cited Apr 9, 2024]. Available from: https://www.phn-rsp.ca/en/reports-publications/multi-lateral-information-sharing-agreement.html
- Footnote 86
-
Office of the Auditor General of Canada. Report 9—COVID-19 Vaccines. 2022. [Cited Apr 9, 2024]. Available from: https://www.oag-bvg.gc.ca/internet/English/att__e_44177.html#hd5i
- Footnote 87
-
Waltman L, Pinfield S, Rzayeva N, Oliveira Henriques S, Fang Z, Brumberg J, et al. Scholarly communication in times of crisis: The response of the scholarly communication system to the COVID-19 pandemic. Research on Research Institute; 2021. Figures 2.1, 2.3 and 2.4; p.22-24. [cited May 1, 2024]. Available from: https://rori.figshare.com/articles/report/Scholarly_communication_in_times_of_crisis_The_response_of_the_scholarly_communication_system_to_the_COVID-19_pandemic/17125394/1
- Footnote 88
-
Tuohy CH, Bevan G, Brown AD. Institutional boundaries and the challenges of aligning science advice and policy dynamics: the UK and Canada in the time of COVID-19. Health Econ Policy Law 2023 Oct;18(4):377-394.
- Footnote 89
-
Fretheim A, Brurberg KG, Forland F. Rapid reviews for rapid decision-making during the coronavirus disease (COVID-19) pandemic, Norway, 2020. Eurosurveillance 2020 May 14;25(19):2000687.
- Footnote 90
-
Tunis M, Deeks S, Harrison R, Quach C, Ismail S, Salvadori M, et al. Canada's National Advisory Committee on immunization: Adaptations and challenges during the COVID-19 pandemic. Vaccine 2023 Oct 20;41(44):6538-6547
- Footnote 91
-
National Health and Medical Research Council. National COVID-19 Health and Research Advisory Committee. 2022. [Cited Mar 13, 2024]. Available from: https://www.nhmrc.gov.au/about-us/leadership-and-governance/committees/national-covid-19-health-and-research-advisory-committee
- Footnote 92
-
National Collaborating Centre for Indigenous Health. Visioning the Future: First Nations, Inuit, & Métis Population and Public Health. 2021. [Cited Mar 18, 2024]. Available from: https://www.nccih.ca/495/Visioning_the_Future__First_Nations,_Inuit,___M%C3%A9tis_Population_and_Public_Health_.nccih?id=10351
- Footnote 93
-
United Nations General Assembly. United Nations Declaration on the Rights of Indigenous Peoples. 2007. [Cited Mar 12, 2024]. Available from: https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf
- Footnote 94
-
United Nations Declaration on the Rights of Indigenous Peoples Act. S.C. 2021, c. 14. [Cited Apr 5, 2024]. Available from: https://laws-lois.justice.gc.ca/eng/acts/U-2.2/
- Footnote 95
-
Department of Justice Canada. The United Nations Declaration on the Rights of Indigenous Peoples Act Action Plan. 2023. [Cited Apr 5, 2024]. Available from: https://www.justice.gc.ca/eng/declaration/ap-pa/index.html
- Footnote 96
-
National Advisory Committee on Immunization. Archived: Preliminary guidance on key populations for early COVID-19 immunization [2020-11-03]. 2020. [Cited Mar 27, 2024]. Available from: https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/guidance-key-populations-early-covid-19-immunization.html
- Footnote 97
-
BC Centre for Disease Control. BCCDC COVID-19 Language Guide. 2020. [Cited Apr 16, 2024]. Available from: http://www.bccdc.ca/Health-Info-Site/Documents/Language-guide.pdf
- Footnote 98
-
National Collaborating Centre for Determinants of Health. Glossary of Essential Health Equity Terms. 2022. [Cited Apr 5, 2024]. Available from: https://nccdh.ca/learn/glossary
- Footnote 99
-
Council of Canadian Academies. Fault Lines. Ottawa, ON: Expert Panel on the Socioeconomic Impacts of Science and Health Misinformation, CCA; 2023.
- Footnote 100
-
Keohane RO, Lane M, Oppenheimer M. The ethics of scientific communication under uncertainty. Politics, Philosophy & Economics 2014 June 27;13(4):343-368.
- Footnote 101
-
Petersen MB, Bor A, Jørgensen F, Lindholt MF. Transparent communication about negative features of COVID-19 vaccines decreases acceptance but increases trust. Proceedings of the National Academy of Sciences 2021;118(29):e2024597118.
- Footnote 102
-
Government of Canada. Open by default and modern, easy to use formats. 2019. [Cited Apr 17, 2024]. Available from: https://open.canada.ca/en/content/open-default-and-modern-easy-use-formats
- Footnote 103
-
Canada's Drug Agency. CADTH Is Now Canada's Drug Agency. 2024. [Cited May 7, 2024]. Available from: https://www.cadth.ca/news/cadth-now-canadas-drug-agency
- Footnote 104
-
Health Canada. Canadian Drug Agency Transition Office. 2023. [Cited Mar 13, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/about-health-canada/activities-responsibilities/canadian-drug-agency-transition-office.html
- Footnote 105
-
Institute for Clinical and Economic Review. COVID-19: Special Assessment of Outpatient Treatments for COVID-19. 2022. [Cited Mar 13, 2024]. Available from: https://icer.org/assessment/covid-19-2022/
- Footnote 106
-
Finance Canada. Building a Strong Middle Class: #Budget 2017. 2017. [Cited Apr 8, 2024]. Available from: https://www.budget.canada.ca/2017/docs/plan/budget-2017-en.pdf
- Footnote 107
-
Innovation, Science and Economic Development Canada. Mandate. 2018. [Cited Apr 8, 2024]. Available from: https://science.gc.ca/site/science/en/office-chief-science-advisor/mandate
- Footnote 108
-
Innovation, Science and Economic Development Canada. Departmental Science Advisors Network. 2023. [Cited Apr 5, 2024]. Available from: https://science.gc.ca/site/science/en/office-chief-science-advisor/science-advisory-team/departmental-science-advisors-network
- Footnote 109
-
House of Commons. Petitions e-415 (Chief Science Officer). 2017. [Cited Apr 17, 2024]. Available from: https://www.ourcommons.ca/petitions/en/Petition/Details?Petition=e-415
- Footnote 110
-
House of Commons. Response to Petition No. 421-01115. 2017. [Cited Apr 17, 2024]. Available from: https://www.ourcommons.ca/Content/ePetitions/Responses/421/e-415/421-01115_ISED_E.pdf
- Footnote 111
-
Evidence for Democracy. Safeguarding Science Advice in Canada. 2023. [Cited Apr 17, 2024]. Available from: https://evidencefordemocracy.ca/campaign/safeguarding-science-advice-in-canada/
- Footnote 112
-
Royal Society of Canada. The Next Steps for Sustainable Science Advice in Canada. 2018. [Cited Apr 17, 2024]. Available from: https://rsc-src.ca/sites/default/files/RSC%20Position%20Paper_2018_FINAL_EN.pdf
- Footnote 113
-
Royal Society of Canada. Health Research System Recovery: Strengthening Canada's Health Research System after the COVID-19 Pandemic. 2024. [Cited Apr 17, 2024]. Available from: https://rsc-src.ca/sites/default/files/RS%20PB_EN.pdf
- Footnote 114
-
GloPID-R. About us. 2024. [Cited May 4, 2024]. Available from: https://www.glopid-r.org/about-us/
- Footnote 115
-
COVID-19 Immunity Task Force. Vaccine Surveillance. 2021. [Cited Mar 21, 2024]. Available from: https://www.covid19immunitytaskforce.ca/task-force-research/vaccine-surveillance/
- Footnote 116
-
Canadian Immunization Research Network. MOSAIC. 2024. [Cited Mar 21, 2024]. Available from: https://cirnetwork.ca/mosaic/
- Footnote 117
-
The Fields Institute for Research in Mathematical Sciences. About The Fields Institute. 2014. [Cited Mar 14, 2024]. Available from: https://www.fields.utoronto.ca/about
- Footnote 118
-
Atlantic Association for Research in the Mathematical Sciences. About. 2024. [Cited Mar 14, 2024]. Available from: https://aarms.math.ca/about/
- Footnote 119
-
Centre de Recherches Mathématiques. About the CRM. 2021. [Cited Mar 14, 2024]. Available from: https://www.crmath.ca/en/about-the-crm-2/overview-2/
- Footnote 120
-
Pacific Institute for the Mathematical Sciences. About. [Cited Mar 27, 2024]. Available from: https://www.pims.math.ca/about
- Footnote 121
-
Vaccine and Infectious Disease Organization. About Us. 2024. [Cited Mar 14, 2024]. Available from: https://www.vido.org/about/
- Footnote 122
-
Lewis MA, Brown P, Colijn C, Cowen L, Cotton C, Day T, et al. Charting a future for emerging infectious disease modelling in Canada. White Paper 2023 April 26. Available from: http://hdl.handle.net/1828/15042
- Footnote 123
-
Department of Health & Social Care. G7 Therapeutics and Vaccines Clinical Trials Charter. 2021. [Cited Mar 14, 2024]. Available from: https://www.gov.uk/government/publications/g7-health-ministers-meeting-june-2021-communique/g7-therapeutics-and-vaccines-clinical-trials-charter
- Footnote 124
-
Innovation, Science and Economic Development Canada. Clinical trials environment in Canada. 2022. [Cited Apr 5, 2024]. Available from: https://ised-isde.canada.ca/site/canadian-life-science-industries/en/biopharmaceuticals-and-pharmaceuticals/clinical-trials-environment-canada
- Footnote 125
-
Catalá-López F, Aleixandre-Benavent R, Caulley L, Hutton B, Tabarés-Seisdedos R, Moher D, et al. Global mapping of randomised trials related articles published in high-impact-factor medical journals: a cross-sectional analysis. Trials 2020 Jan 7;21(1):34-9.
- Footnote 126
-
Canadian Institutes of Health Research. What We Heard on the Future of Clinical Trials. 2023. [Cited Apr 29, 2024]. Available from: https://cihr-irsc.gc.ca/e/documents/wwh_clinical_trials_en.pdf
- Footnote 127
-
Canadian Institutes of Health Research. Reinforcing Canada's clinical trials infrastructure, training, and research. 2023. [Cited Mar 21, 2024]. Available from: https://www.canada.ca/en/institutes-health-research/news/2023/01/reinforcing-canadas-clinical-trials-infrastructure-training-and-research.html
- Footnote 128
-
University of Oxford. RECOVERY. 2024. [Cited Mar 15, 2024]. Available from: https://www.recoverytrial.net/front-page
- Footnote 129
-
World Health Organization. WHO COVID-19 Solidarity Therapeutics Trial. 2024. [Cited Mar 15, 2024]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments
- Footnote 130
-
REMAP-CAP. Participating sites. [Cited Apr 5, 2024]. Available from: https://www.remapcap.org/participating-sites
- Footnote 131
-
Lamontagne F, Rowan KM, Guyatt G. Integrating research into clinical practice: challenges and solutions for Canada. CMAJ 2021 Jan 25;193(4):E127-E131.
- Footnote 132
-
National Institute for Health and Care Research. Who we are. 2024. [Cited Mar 14, 2024]. Available from: https://www.nihr.ac.uk/about-us/who-we-are/
- Footnote 133
-
United Nations. Learning From the World's Largest COVID-19 Treatment Trial: University of Oxford Leads RECOVERY. 2022. [Cited May 8, 2024]. Available from: https://www.un.org/en/academic-impact/learning-world%E2%80%99s-largest-covid-19-treatment-trial-university-oxford-leads-recovery
- Footnote 134
-
State of Israel Ministry of Health. Promoting Smart and Innovative Regulation for Clinical Trials and Genetic Research. 2024. [Cited Mar 15, 2024]. Available from: https://www.health.gov.il/English/MinistryUnits/HealthDivision/MedicalTechnologies/Drugs/ClinicalTrials/Pages/Clinical_Trial_Project.aspx
- Footnote 135
-
COVID-19 Immunity Task Force. Studies being launched to support vaccine effectiveness and safety monitoring across Canada. 2021. [Cited May 8, 2024]. Available from: https://www.covid19immunitytaskforce.ca/studies-being-launched-to-support-vaccine-effectiveness-and-safety-monitoring-across-canada/
- Footnote 136
-
Hanney SR, Straus SE, Holmes BJ. Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges. Health Research Policy and Systems 2022 Sep 10;20(1):99.
- Footnote 137
-
Treasury Board of Canada Secretariat. Guide to Departmental Collaboration with Recipients of Grants and Contributions. 2021. [Cited Mar 27, 2024]. Available from: https://www.tbs-sct.canada.ca/pol/doc-eng.aspx?id=32616
- Footnote 138
-
National Research Council Canada. Funded collaborative R&D programs and initiatives. 2024. [Cited Apr 17, 2024]. Available from: https://nrc.canada.ca/en/research-development/research-collaboration/programs/funded-collaborative-rd-programs-initiatives
- Footnote 139
-
Royal Society of Canada. The Humanities and Health Policy. 2023. [Cited Mar 18, 2024]. Available from: https://rsc-src.ca/sites/default/files/PB%20Humanities_EN.pdf
- Footnote 140
-
Statistics Canada. Canada's Indigenous Population. 2023. [Cited Mar 18, 2024]. Available from: https://www.statcan.gc.ca/o1/en/plus/3920-canadas-indigenous-population
- Footnote 141
-
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2022. [Cited Mar 18, 2024]. Available from: https://ethics.gc.ca/eng/policy-politique_tcps2-eptc2_2022.html
- Footnote 142
-
Biobanque québécoise de la COVID-19. About BQC19. 2022. [Cited Mar 28, 2024]. Available from: https://en.quebeccovidbiobank.ca
- Footnote 143
-
Canadian Institute for Health Information. Overview: COVID-19's impact on health care systems. 2021. [Cited Apr 24, 2024]. Available from: https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture
- Footnote 144
-
Frangou C. Unlocking Health Care: How to free the flow of life-saving health data in Canada. 2024. [Cited Mar 18, 2024]. Available from: https://ppforum.ca/wp-content/uploads/2024/01/UnlockingHealthcare-LifeSavingDataInCanada-PPF-Jan2024-EN-2.pdf
- Footnote 145
-
National Institutes of Health. NIH Strategic Plan for Data Science. 2018. [Cited Mar 18, 2024]. Available from: https://datascience.nih.gov/sites/default/files/NIH_Strategic_Plan_for_Data_Science_Final_508.pdf
- Footnote 146
-
Wilkinson MD, Dumontier M, Aalbersberg IJJ, Appleton G, Axton M, Baak A, et al. The FAIR Guiding Principles for scientific data management and stewardship. Scientific Data 2016 Mar 15;3(1):160018.
- Footnote 147
-
Canada Health Infoway. A Path Forward for Data Sharing in Canada: A White Paper. 2023. [Cited Mar 18, 2024]. Available from: https://www.infoway-inforoute.ca/en/component/edocman/resources/reports/privacy/6428-a-path-forward-for-data-sharing-in-canada-a-white-paper
- Footnote 148
-
Australian Institute of Health and Welfare. Our Data Collections. 2024. [Cited Mar 18, 2024]. Available from: https://www.aihw.gov.au/about-our-data/our-data-collections
- Footnote 149
-
Office of the National Data Commissioner. Introducing the DATA Scheme. 2024. [Cited Mar 18, 2024]. Available from: https://www.datacommissioner.gov.au/the-data-scheme
- Footnote 150
-
Data Availability and Transparency Act 2022 (Cth). [Cited Mar 18, 2024]. Available from: https://www.legislation.gov.au/C2022A00011/latest/text
- Footnote 151
-
Australian Institute of Health and Welfare. AIHW Linked Data Assets. 2023. [Cited Mar 18, 2024]. Available from: https://www.aihw.gov.au/about-our-data/linked-data-assets
- Footnote 152
-
Act on the Prevention and Control of Infectious Diseases in Humans (Infection Protection Act, as amended up to Act of March 27, 2020), Germany. [Cited Mar 18, 2024]. Available from: https://www.wipo.int/wipolex/en/legislation/details/19753
- Footnote 153
-
Robert Koch Institute. SurvStat@RKI 2.0. 2022. [Cited Mar 18, 2024]. Available from: https://www.rki.de/EN/Content/infections/epidemiology/SurvStat/survstat_node.html
- Footnote 154
-
Office of the National Coordinator for Health Information Technology. Trusted Exchange Framework and Common Agreement (TEFCA). 2024. [Cited Mar 18, 2024]. Available from: https://www.healthit.gov/topic/interoperability/policy/trusted-exchange-framework-and-common-agreement-tefca
- Footnote 155
-
Canada Health Infoway. Shared Pan-Canadian Interoperability Roadmap. 2023. [Cited July 7, 2024]. Available from: https://www.infoway-inforoute.ca/en/component/edocman/6444-connecting-you-to-modern-health-care-shared-pan-canadian-interoperability-roadmap/view-document
- Footnote 156
-
Nova Scotia Department of Health and Wellness. Race-based and linguistic identity data in healthcare: Fair Care Project. 2021. [Cited Mar 18, 2024]. Available from: https://novascotia.ca/race-based-health-data/
- Footnote 157
-
McKenzie K. Race and ethnicity data collection during COVID-19 in Canada: if you are not counted you cannot count on the pandemic response. 2020. [Cited Mar 18, 2024]. Available from: https://rsc-src.ca/en/race-and-ethnicity-data-collection-during-covid-19-in-canada-if-you-are-not-counted-you-cannot-count
- Footnote 158
-
Smylie J, McConkey S, Rachlis B, Avery L, Mecredy G, Brar R, et al. Uncovering SARS-COV-2 vaccine uptake and COVID-19 impacts among First Nations, Inuit and Métis Peoples living in Toronto and London, Ontario. CMAJ 2022 Aug 2;194(29):E1018-E1026.
- Footnote 159
-
Shared Health Manitoba. Racial/Ethnic/Indigenous Identity: Collection of Identifiers. 2020. [Cited Mar 18, 2024]. Available from: https://sharedhealthmb.ca/files/covid-19-rei-script.pdf
- Footnote 160
-
Manitoba Keewatinowi Okimakanak. Manitoba First Nations Information Sharing Agreement with the Province of Manitoba during COVID-19: Backgrounder. 2020. [Cited Apr 9, 2024]. Available from: https://mkonation.com/mko/wp-content/uploads/2020/05/2-PRCT_INFORMATION_SHARING_AGREEMENT_BACKGROUNDER_FINAL.pdf
- Footnote 161
-
Clark W, Lavoie JG, Nickel N, Dutton R. Manitoba Inuit Association's Rapid Response to Include an Inuit Identifier within Manitoba COVID-19 Diagnostic Tests. American Indian Culture and Research Journal 2020 June 1;44(3).
- Footnote 162
-
First Nations Information Governance Centre. A First Nations Data Governance Strategy. 2020. [Cited Mar 18, 2024]. Available from: https://fnigc.ca/wp-content/uploads/2020/09/FNIGC_FNDGS_report_EN_FINAL.pdf
- Footnote 163
-
Health Canada. Unleashing Innovation: Excellent Healthcare for Canada: Report of the Advisory Panel on Healthcare Innovation. 2015. [Cited Mar 18, 2024]. Available from: https://www.canada.ca/en/health-canada/services/publications/health-system-services/report-advisory-panel-healthcare-innovation.html
- Footnote 164
-
Public Safety Canada. ARCHIVE - Hazards Risk Assessment Methodology Guidelines 2012-2013. 2022. [Cited Apr 5, 2024]. Available from: https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/archive-ll-hzrds-ssssmnt/index-en.aspx#annex_7
- Footnote 165
-
Zhang YP, Sun J, Ma Y. Biomanufacturing: history and perspective. J Ind Microbiol Biotechnol 2017 May;44(4-5):773-784.
- Footnote 166
-
InformedHealth.org. What are clinical practice guidelines?. 2016. [Cited Aug 9, 2024]. Available from: https://www.informedhealth.org/what-are-clinical-practice-guidelines.html
- Footnote 167
-
Canadian Institutes of Health Research. Glossary of Funding-Related Terms - CIHR. 2024. [Cited Apr 5, 2024]. Available from: https://cihr-irsc.gc.ca/e/34190.html#c
- Footnote 168
-
National Collaborating Centre for Aboriginal Health. The Importance of Disaggregated Data. 2009. [Cited Apr 5, 2024]. Available from: https://nccah-ccnsa.ca/docs/fact%20sheets/child%20and%20youth/NCCAH_fs_disaggregated_EN.pdf
- Footnote 169
-
Merriam-Webster. Expert. 2024. [Cited Apr 8, 2024]. Available from: https://www.merriam-webster.com/dictionary/expert
- Footnote 170
-
Oleske DM, Islam SS. Chapter 5 - Role of Epidemiology in the Biopharmaceutical Industry. In: Doan T, Renz C, Bhattacharya M, Lievano F, Scarazzini L, editors. Pharmacovigilance: A Practical Approach: Elsevier; 2019. p. 69-87
- Footnote 171
-
Health Canada. Health Portfolio. 2024. [Cited Mar 20, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/health-portfolio.html
- Footnote 172
-
Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. Knowledge for better health: a conceptual framework and foundation for health research systems. Bull World Health Organ 2003;81(11):815-820.
- Footnote 173
-
OECD. Addressing societal challenges using transdisciplinary research OECD Science, Technology and Industry Policy Papers, No. 88. Paris: OECD Publishing; 2020.
- Footnote 174
-
Social Sciences and Humanities Research Council. Guidelines for Effective Knowledge Mobilization. 2023. [Cited Apr 8, 2024]. Available from: https://www.sshrc-crsh.gc.ca/funding-financement/policies-politiques/knowledge_mobilisation-mobilisation_des_connaissances-eng.aspx#a1
- Footnote 175
-
Centers for Diseases Control and Prevention. Medical Countermeasures. 2020. [Cited Apr 8, 2024]. Available from: https://www.cdc.gov/orr/readiness/mcm2-508.html
- Footnote 176
-
Choi BCK, Pak AWP. Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clin Invest Med 2006 Dec;29(6):351-364.
- Footnote 177
-
Centers for Disease Control and Prevention. Nonpharmaceutical Interventions (NPIs). 2022. [Cited Apr 10, 2024]. Available from: https://www.cdc.gov/nonpharmaceutical-interventions/index.html
- Footnote 178
-
One Health High-Level Expert Panel , Adisasmito WB, Almuhairi S, Behravesh CB, Bilivogui P, Bukachi SA, et al. One Health: A new definition for a sustainable and healthy future. PLoS Pathog 2022 Jun;18(6): e1010537.
- Footnote 179
-
International Risk Governance Council. What do we mean by 'Risk Governance'? 2019. [Cited Mar 7, 2024]. Available from: https://irgc.org/risk-governance/what-is-risk-governance/
- Footnote 180
-
Wolfe, A. Seroprevelance: How lifesaving blood donations can also help provide valuable public health insights during a pandemic. 2023. [Cited Apr 10, 2024]. Available from: https://www.blood.ca/en/research/our-research-stories/research-education-discovery/seroprevalence-how-lifesaving-blood
- Footnote 181
-
World Health Organization. Social Determinants of Health. 2024. [Cited Apr 10, 2024]. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
- Footnote 182
-
Public Health Agency of Canada. Surveillance. 2024. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/public-health/services/public-health-practice/surveillance.html
- Footnote 183
-
Johns Hopkins Center for Health Security. Tabletop Exercises. 2022. [Cited Apr 10, 2024]. Available from: https://centerforhealthsecurity.org/our-work/tabletop-exercises
- Footnote 184
-
Nature. Therapeutics articles from across Nature Portfolio. 2024. [Cited Apr 10, 2024]. Available from: https://www.nature.com/subjects/therapeutics
- Footnote 185
-
World Health Organization. WHO COVID-19 dashboard. 2024. [Cited Apr 10, 2024]. Available from: https://data.who.int/dashboards/covid19/variants
- Footnote 186
-
Health Canada. About Health Canada. 2014. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/about-health-canada.html
- Footnote 187
-
Public Health Agency of Canada. Public Health Agency of Canada. 2024. [Cited Jul 24, 2024]. Available from: https://www.canada.ca/en/public-health.html
- Footnote 188
-
Public Health Agency of Canada. Canada's Chief Public Health Officer (CPHO). 2024. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/organizational-structure/canada-chief-public-health-officer.html
- Footnote 189
-
Canadian Institutes of Health Research. About us. 2024. [Cited Apr 10, 2024]. Available from: https://cihr-irsc.gc.ca/e/37792.html
- Footnote 190
-
Pan-Canadian Public Health Network. Pan-Canadian Public Health Network. 2024. [Cited Apr 10, 2024]. Available from: https://www.phn-rsp.ca/en/index.html
- Footnote 191
-
National Collaborating Centre for Infectious Diseases. The Canadian Public Health Laboratory Network. 2021. [Cited Mar 20, 2024]. Available from: https://nccid.ca/cphln/
- Footnote 192
-
Public Health Agency of Canada. Immunization in Canada: Canadian Immunization Guide. 2021. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-1-key-immunization-information/page-2-immunization-in-canada.html
- Footnote 193
-
Public Health Agency of Canada. Canadian Immunization Guide. 2023. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/public-health/services/canadian-immunization-guide.html
- Footnote 194
-
Canada's Drug and Health Technology Agency. About CADTH. 2024. [Cited Apr 10, 2024]. Available from: https://www.cadth.ca/about-cadth
- Footnote 195
-
Ogunremi T, Dunn K, Johnston L, Embree J on behalf of the National Advisory Committee on Infection Prevention and Control. The National Advisory Committee on Infection Prevention and Control (NAC-IPC). Can Commun Dis Rep 2018;44(11):283-9.
- Footnote 196
-
National Collaborating Centres for Public Health. What is The National Collaborating Centres for Public Health. 2020. [Cited Apr 10, 2024]. Available from: https://nccph.ca/
- Footnote 197
-
Public Health Agency of Canada. Public Health Ethics Consultative Group (PHECG). 2021. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/public-health-ethics-consultative-group.html
- Footnote 198
-
Public Health Agency of Canada. Framework for Ethical Deliberation and Decision-making in Public health: A Tool for Public Health Practitioners, Policy Makers and Decision-makers. 2017. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/corporate/transparency/corporate-management-reporting/internal-audits/audit-reports/framework-ethical-deliberation-decision-making/pub-eng.pdf
- Footnote 199
-
Canadian Task Force on Preventive Health Care. About Us. 2023. [Cited Apr 10, 2024]. Available from: https://canadiantaskforce.ca/about/
- Footnote 200
-
Canadian Immunization Research Network. About Us. 2024. [Cited Apr 10, 2024]. Available from: https://cirnetwork.ca/about-us/
- Footnote 201
-
Office of the Chief Science Advisor. Office of the Chief Science Advisor. 2024. [Cited Apr 10, 2024]. Available from: https://science.gc.ca/site/science/en/office-chief-science-advisor
- Footnote 202
-
Canada Research Coordinating Committee. Canada Research Coordinating Committee. 2024. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/research-coordinating-committee.html
- Footnote 203
-
The National Alliance of Provincial Health Research Organizations. About NAPHRO. [Cited Apr 3, 2024]. Available from: https://www.naphro.ca/about
- Footnote 204
-
Health Charities Coalition of Canada. HCCC Vision and Values. [Cited Apr 10, 2024]. Available from: http://healthcharities.ca/about/vision-and-values.aspx
- Footnote 205
-
Public Health Agency of Canada. Federal, Provincial, Territorial Public Health Response Plan for Ongoing Management of COVID-19. 2022. [Cited Mar 8, 2024]. Available from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/guidance-documents/federal-provincial-territorial-public-health-response-plan-ongoing-management-covid-19.html
- Footnote 206
-
Office of the Chief Science Advisor. COVID-19 Expert Panel. 2022. [Cited Apr 10, 2024]. Available from: https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/covid-19-expert-panel
- Footnote 207
-
Innovation, Science and Economic Development Canada. COVID-19 Therapeutics Task Force. 2022. [Cited Mar 20, 2024]. Available from: https://ised-isde.canada.ca/site/canadian-life-science-industries/en/covid-19-therapeutics-task-force
- Footnote 208
-
Innovation, Science and Economic Development Canada. Overview of Canada's Biomanufacturing and Life Sciences Strategy. 2023. [Cited Mar 20, 2024]. Available from: https://ised-isde.canada.ca/site/biomanufacturing/en/overview-canadas-biomanufacturing-and-life-sciences-strategy
- Footnote 209
-
Innovation, Science and Economic Development Canada. Industry Strategy Council. 2021. [Cited Apr 10, 2024]. Available from: https://ised-isde.canada.ca/site/innovation-better-canada/en/industry-strategy-council
- Footnote 210
-
Health Canada. COVID-19 Testing and Screening Expert Advisory Panel. 2022. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/testing-screening-advisory-panel.html
- Footnote 211
-
Health Canada. Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management. 2022. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/medical-devices/testing-outreach-collaboration/industry-advisory-roundtable.html
- Footnote 212
-
Innovation, Science and Economic Development Canada. COVID-19 Exposure Notification App Advisory Council. 2022. [Cited Apr 10, 2024]. Available from: https://ised-isde.canada.ca/site/ised/en/advisory-council
- Footnote 213
-
Public Health Agency of Canada. Ad-hoc COVID-19 Clinical Pharmacology Task Group. 2021. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/covid-19-clinical-pharmacology-task-group.html
- Footnote 214
-
Natural Sciences and Engineering Research Council of Canada. Emerging Infectious Diseases Modelling Initiative. 2021. [Cited Apr 10, 2024]. Available from: https://www.nserc-crsng.gc.ca/NSERC-CRSNG/FundingDecisions-DecisionsFinancement/2021/EIDM-MMIE_eng.asp
- Footnote 215
-
Genome Canada. CanCOGeN. 2021. [Cited Apr 11, 2024]. Available from: https://genomecanada.ca/challenge-areas/cancogen/
- Footnote 216
-
CoVaRR-Net. CoVaRR-Net's Mandate. 2021. [Cited Apr 11, 2024]. Available from: https://covarrnet.ca/
- Footnote 217
-
Public Health Agency of Canada. Statement from the Chief Public Health Officer of Canada on June 7, 2021. 2021. [Cited Apr 11, 2024]. Available from: https://www.canada.ca/en/public-health/news/2021/06/statement-from-the-chief-public-health-officer-of-canada-on-june-7-2021.html
- Footnote 218
-
National Collaborating Centre for Infectious Diseases. The COVID-19 Public Health Agency of Canada (PHAC) Modelling Group. 2022. [Cited Apr 11, 2024]. Available from: https://nccid.ca/covid-19-phac-modelling-group/
- Footnote 219
-
Office of the Chief Science Advisor. CanCOVID Network. 2020. [Cited Apr 11, 2024]. Available from: https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/cancovid-network
- Footnote 220
-
McMaster Health Forum. COVID-END COVID-19 Evidence Network to support Decision-making. 2021. [Cited Apr 11, 2024]. Available from: https://www.mcmasterforum.org/networks/covid-end
- Footnote 221
-
Public Health Agency of Canada. Overview of the former expert advisory group for the Pan-Canadian Health Data Strategy. 2024. [Cited Apr 11, 2024]. Available from: https://www.canada.ca/en/public-health/corporate/mandate/about-agency/external-advisory-bodies/list/pan-canadian-health-data-strategy-overview.html
- Footnote 222
-
Health Canada. Summary report of the Federal-Provincial-Territorial Virtual Care Summit. 2021. [Cited Apr 11, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/transparency/health-agreements/bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19/summary-report-federal-provincial-territorial-summit.html
- Footnote 223
-
Falk, W. The State of Virtual Care in Canada as of Wave Three of the COVID-19 Pandemic: An Early Diagnostique and Policy Recommendations. 2021. [Cited Jul 17, 2024]. Available from: https://www.canada.ca/en/health-canada/corporate/transparency/health-agreements/bilateral-agreement-pan-canadian-virtual-care-priorities-covid-19/wave-three-early-diagnostic-policy-recommendations.html
- Footnote 224
-
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Social Sciences and Humanities Research Council of Canada. Tri-Agency Research Data Management Policy. 2021. [Cited Apr 11, 2024]. Available from: https://science.gc.ca/site/science/en/interagency-research-funding/policies-and-guidelines/research-data-management/tri-agency-research-data-management-policy
- Footnote 225
-
Canadian Institutes of Health Research. Clinical Trials Fund. 2023. [Cited Apr 11, 2024]. Available from: https://cihr-irsc.gc.ca/e/52987.html
- Footnote 226
-
Canadian Institutes of Health Research. Government of Canada invests $10 million in research on outpatient medications for COVID-19. 2022. [Cited Apr 11, 2024]. Available from: https://www.canada.ca/en/institutes-health-research/news/2022/07/government-of-canada-invests-10-million-in-research-on-outpatient-medications-for-covid-19.html
- Footnote 227
-
Tri-agency Institutional Programs Secretariat. Government of Canada establishes new research hubs to accelerate Canada's vaccine and therapeutics production. 2023. [Cited Apr 10, 2024]. Available from: https://www.canada.ca/en/research-chairs/news/2023/03/government-of-canada-establishes-new-research-hubs-to-accelerate-canadas-vaccine-and-therapeutics-production.html
- Footnote 228
-
Innovation, Science and Economic Development Canada. Meeting Summaries of the CSA Expert Panel on COVID-19. 2024. [Cited May 4, 2024]. Available from: https://ised-isde.canada.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/meeting-summaries-expert-panels-groups-and-task-forces/meeting-summaries-csa-expert-panel-covid-19
- Footnote 229
-
Innovation, Science and Economic Development Canada. Council of Expert Advisors. 2024. [Cited Apr 11, 2024]. Available from: https://ised-isde.canada.ca/site/biomanufacturing/en/council-expert-advisors
- Footnote 230
-
Canada Health Act R.S.C., 1985, c. C-6. [Cited Mar 7, 2024]. Available from: https://laws-lois.justice.gc.ca/eng/acts/c-6/page-1.html
- Footnote 231
-
Indigenous Services Canada. Indigenous health care in Canada. 2023. [Cited Mar 20, 2024]. Available from: https://www.sac-isc.gc.ca/eng/1626810177053/1626810219482
- Footnote 232
-
Health Canada. Canada's Health Care System. 2019. [Cited Mar 19, 2024]. Available from: https://www.canada.ca/en/health-canada/services/health-care-system/reports-publications/health-care-system/canada.html
- Footnote 233
-
Public Health Agency of Canada. Health portfolio emergency response plan. 2023. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/services/publications/health-risks-safety/health-portfolio-emergency-response-plan.html
- Footnote 234
-
Public Health Agency of Canada. National Collaborating Centres for Public Health. 2022. [Cited Mar 20, 2024]. Available from: https://www.canada.ca/en/public-health/services/public-health-practice/national-collaborating-centres-public-health.html
- Footnote 235
-
Public Health Agency of Canada Act S.C. 2006, c. 5. [Cited Mar 7, 2024]. Available from: https://lois-laws.justice.gc.ca/eng/acts/P-29.5/page-1.html#h-401108
- Footnote 236
-
Quarantine Act S.C. 2005, c. 20. [Cited Mar 7, 2024]. Available from: https://laws-lois.justice.gc.ca/eng/acts/q-1.1/page-1.html#h-419250
- Footnote 237
-
Human Pathogens and Toxins Act S.C. 2009, c. 24. [Cited Mar 7, 2024]. Available from: https://lois-laws.justice.gc.ca/eng/acts/h-5.67/fulltext.html
- Footnote 238
-
Department of Health Act S.C. 1996, c. 8. [Cited Mar 7, 2024]. Available from: https://lois-laws.justice.gc.ca/eng/acts/h-3.2/page-1.html
- Footnote 239
-
Office of the Auditor General of Canada. Report 8—Pandemic Preparedness, Surveillance, and Border Control Measures. 2021. [Cited Mar 7, 2024]. Available from: https://www.oag-bvg.gc.ca/internet/English/parl_oag_202103_03_e_43785.html
- Footnote 240
-
Pan-Canadian Public Health Network. Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector. 2018. [Cited Mar 7, 2024]. Available from: https://www.canada.ca/en/public-health/services/flu-influenza/canadian-pandemic-influenza-preparedness-planning-guidance-health-sector.html
- Footnote 241
-
Innovation, Science and Economic Development Canada. COVID-19 Joint Biomanufacturing Subcommittee. 2022. [Cited Mar 20, 2024]. Available from: https://ised-isde.canada.ca/site/biomanufacturing/en/covid-19-vaccine-task-force/covid-19-joint-biomanufacturing-subcommittee
- Footnote 242
-
Statistics Canada. Federal personnel engaged in science and technological activities, by major departments and agencies - Intentions. 2023. [Cited Mar 12, 2024]. Available from: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=2710002901&pickMembers%5B0%5D=2.1&cubeTimeFrame.startYear=2018+%2F+2019&cubeTimeFrame.endYear=2022+%2F+2023&referencePeriods=20180101%2C20220101
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