Review of Ebola Virus Disease (EVD) Emergency Response Process

Final Report

Introduction

Background

The Office of Audit and Evaluation (OAE) initiated a review of the Agency's work with respect to the Ebola Virus Disease (EVD) emergency response process, building on the results of the emergency management real-time review of PHAC's COVID-19 response. The review covers the period of February 7, 2021, to April 21, 2021.

Aim

The aim of this review was to examine the Agency's processes and overall readiness for an EVD health emergency, with a specific focus on key emergency management principles and processes and to confirm if lessons learned from the COVID-19 response were being leveraged and applied. This report is intended to be a summary of main observations related to the EVD response over the review period, and to outline how this work can be used and leveraged to assist with overall emergency management improvement, as well as work required to address some areas identified in the Auditor General of Canada 2021 Report 8 (AG report).

Focus Areas and Approach

To achieve the review aim work focused on the following two key areas:

• Area 1: EVD Response Process - to include, but not limited to:
  • staffing, integration of teams, and clarity with respect to roles and responsibilities;
  • communication and situational awareness;
  • risk assessment;
  • potential challenges related to multiple events/activations occurring at the same time;
  • application of lessons learned from the COVID-19 response and integration with ongoing response; and
• Area 2: Continuous Improvement of Emergency Management - aspects from the EVD response that can be leveraged to assist with overall enhancements to emergency management at PHAC.

The review approach included:

• meetings with key individuals;
• documentation review;
• attendance at weekly situational awareness meetings; and
• ongoing review of overall continuous improvement activities related to emergency management.

Summary of Results

Observations

The EVD did not result in a response that needed to progress past the Initial Assessment and Alerting Phase of the response process. We found that a number of the general opportunities for improvement that were identified in the COVID-19 real-time review appear to have been leveraged and applied in the Agency's EVD response.

Key observations are as follows:

• The Agency was quick to act when the EVD threat emerged;
• Strategic direction was clear, an optimally staffed cross-functional team was formed, and roles and responsibilities were clear;
• An existing emergency response plan, the Health Portfolio Emergency Response Plan (HPERP), was used to help guide the process. The F/P/T Public Health Response Plan for Biologic Events was also leveraged, as were documentation and processes that were used in previous EVD responses;
• There was effective reporting, situational awareness, and coherency of action across the Agency;
• While escalation to an emergency response operation for EVD was not required, effective situational awareness and ongoing monitoring position the Agency to quickly scale up operations if required. Leaders and staff who were engaged in COVID-19 response were also active in the EVD work and were able to manage; however, if the situation would have escalated, there would have been challenges in staffing for two simultaneous response operations;
• A key opportunity exists to leverage detailed lessons learned from the EVD response (Phase 1 of the documented response process in the HPERP), as well as the work being done on enhancements in risk assessment processes for Variants of Concern (VOC), and to begin updating the HPERP immediately. Taking advantage of this opportunity would not only be an efficient and effective way to begin completing plan updates, but it would also demonstrate progress towards paragraph 8.37 of the AG report (plan updates) and paragraph 8.85 (risk assessment). In addition, the plan updating process itself helps to increase awareness of emergency management, and can serve as a training opportunity. All of which are objectives of the emergency management program.

Key Recommendation

Update Phase 1 (Initial Assessment and Alerting) and begin updating Phase 2 (Situational Assessment) of the emergency response process in the HPERP. Updates should leverage the expertise, lessons learned from the work being done by the teams currently responding to EVD and the VOC risk assessment process, and relevant information from previous EVD response operations, but not included in the HPERP process.

Management Response

The Emergency Management Branch is committed to updating key Health Portfolio Emergency Management plans, in line with commitments made in the Office of the Auditor General's report on pandemic preparedness (March 2021).

The Health Portfolio Emergency Response Plan (HPERP) will be updated first and, per this recommendation, work will begin on Phases 1 and 2 of this plan. This work will begin in Fall 2021.

Observations and Recommendations

Area #1: EVD Response Process

Summary of Observations

• PHAC was quick to identify the emerging EVD threat through ProMed and GPHIN. The IDPCB-CFEZID Zoonoses Report, dated 4 March 2021, provides a summary and timeline that demonstrate there was early identification, monitoring, and action.
• The Agency's senior management formed the EVD coordination working group, with appropriate membership from key areas (CFEZID, EMB, NML, CBTH, OIA, and CPAB). Staffing the EVD coordination group did not appear to be an issue and the right expertise was engaged early. This type of cross-branch integration of teams was a challenge noted during the early months of COVID-19 response.
• The President and CPHO were briefed three days after the EVD coordination group was formed and clear strategic level direction was provided. This direction was reviewed on an ongoing basis.
• The EVD coordination working group had a clearly identified lead with the DG of CFEZID, and he effectively led and coordinated efforts. Overall roles and responsibilities were clear.
• The EVD coordination working group used the response process and supporting tools found in the HPERP. Use of the documented plan and response process, even if the plan had yet to be updated, provided structure and clarity for all involved and across the Agency. Not only did the use of the existing HPERP assist with the EVD response activities, it can also be viewed as validation of plan components and a guide for plan updates (see Area 2 below).
• Communications and overall situational awareness with respect to the EVD response across the Agency appear to have been very good. The effective situational awareness and communications are a result of the process and structure used for the EVD response. The EVD coordination working group met regularly and EVD information was included as part of the Daily Updates.
• Comprehensive and effective Statements of Facts were produced weekly and this reporting contributed a great deal to situational awareness and coherency of action. This type of response cycle and communication sharing is a key emergency management leading practice that, not only helped to manage current and immediate items, but enabled PHAC to be forward looking and proactive with planning should the situation have escalated.
• Clear triggers for escalation were identified and used to assist with ongoing risk assessment and monitoring.
• Due to the fact that the EVD response has not progressed past Phase 1 Assessment and Alerting challenges, currently multiple activations are not occurring at the same time. With EVD, the Agency did a degree of mobilization, while continuing with the COVID-19 response. The fact that there was a specific cross-functional group (the EVD coordination working group), effective situational awareness, continuous monitoring, and ongoing risk assessment mean that PHAC, and EMB specifically, are well positioned to react should operations in the HPOC need to be scaled up. However, if EVD cases had been detected in Canada, it would have been a significant draw on resources during COVID-19, when many staff were already maximized as part of the pandemic response.

Recommendations

• Apart from continuing with the response process used thus far, and continued use of existing plan documents, there are no specific recommendations to improve the EVD response at this time.
• The primary recommendations relate to leveraging the EVD experience to assist with overall improvements to the emergency management system at PHAC, as detailed in Area 2 below.

Area #2: Emergency Management Continuous Improvement

Summary of Observations

• A number of improvement and change initiatives are underway, in addition to the requirement to respond to the AG report. It is therefore important that activities are coordinated and synergies be found wherever possible.
• The EVD response has been at Phase 1, Initial Assessment and Alerting, of the response process, as described in the HPERP. Paragraph 8.37 of AG report speaks to the requirement for the Agency to review and update emergency management plan documents and planning is underway in EMB to complete these updates. With the EVD response being, in effect, a real-life experience using Phase 1 of the response process, there is an opportunity to update that portion of the HPERP immediately. The input and recent experience of those involved in the EVD response will assist with this update. Updating Phase 1 plan content now is equally important, as it would help ensure PHAC is prepared, should another emergency situation arise that requires initial assessment and alerting.
• The CPHO has initiated a project to develop an enhanced and systematic approach with respect to risk assessments for Variants of Concern (VoC). A cross-functional, specialist team was formed and is delivering on this project. Similar to the EVD response, there is an opportunity to leverage the VOC risk assessment work to update the HPERP, specifically Phase 2 – Situational Assessment, in almost real time, while also addressing aspects of the risk assessment finding in paragraph 8.85 of the AG Report.

Recommendation

Begin updating Phases 1 and 2 (Initial Assessment and Alerting, and Situational Assessment) of the emergency response process in the HPERP immediately, leveraging the expertise, lessons learned, and work being done by the teams currently working on EVD and the risk assessment process for VOCs.