Supplementary Information Tables: 2013–14 Departmental Performance Report

Preparedness for Avian and Pandemic Influenza (AI/PI) Initiative

Note: This Horizontal Initiative is now part of ongoing programming and, in the future, will be reported on in Sections I and/or II of Departmental Performance Reports on an as-required basis, rather than separately in the Supplementary Information Tables.

Name of horizontal initiative: AI/PI Initiative
Name of lead department: The Agency
Lead department PAA Program: 1.1 Public Health Infrastructure, 1.2 Health Promotion and Disease Prevention, and 1.3 Health Security
Start date: June 21, 2006
End date: Ongoing
Total federal funding allocation (from start to end date): Ongoing

Description of the horizontal initiative (including funding agreement): This initiative is directed at mitigating Canada’s risk from two major, inter-related animal and public health threats: the potential spread of avian influenza virus (e.g., H5N1) to wild birds and domestic fowl in Canada; and, the potential for a human-adapted strain to arise resulting in human-to-human transmission potentially triggering a human influenza pandemic. A coordinated and comprehensive plan to address both avian and pandemic influenza is maintained.

The bulk of the initiative is ongoing. Activities have been launched in the areas of vaccines and antivirals, surge capacity, prevention and early warning, emergency preparedness, critical science and regulation, risk communication, and inter-jurisdictional collaboration. To enhance the federal capacity to address an on-reserve pandemic, efforts have been made to increase surveillance and risk assessment capacity to fill gaps in planning and preparedness.

Shared outcomes:

Immediate outcomes:

• Strengthened Canadian capacity to prevent and respond to pandemics; and
• Increased internal and external awareness, knowledge and engagement with stakeholders.

Intermediate outcomes:

• Increased prevention, preparedness and control of challenges and emergencies related to AI/PI; and
• Strengthened public health capacity.

Long-term and strategic outcomes:

• Increased/reinforced public confidence in Canada’s public health system; and
• Minimization of serious illness, overall deaths, and societal disruption as a result of an influenza pandemic.

Governance structures:
Each federal department is responsible for their own specific programs.

Performance highlights:
The Agency continued to work collaboratively with its federal partners toward preparedness measures for the risks of an avian influenza or human influenza pandemic. This was accomplished through:

• The review and revision of the Canadian Pandemic Influenza Plan which is intended to be an evergreen document that will be continually reviewed and revised based on evolving information and experiences;
• Monitoring and reporting vaccine safety in a timely manner;
• National capacity and capability to identify novel pathogens; and
• Federally-funded laboratory personnel hosted in provincial public health jurisdictions.

Comments on variances: N/A

Expected results and results achieved for 2013–14:

ER 1.1: Public Health Officers (PHOs) address a range of public health issues across Canada and increase the capacity of partner organizations to fulfil their identified public health needs through the continuous applied transfer of acquired, experiential and ongoing development of skills.
RA 1.1: The Agency strengthened the Canadian public health capacity by placing 13 PHOs across Canada, including in the North. Eighty-nine percent of placement sites reported that PHOs contributed to non-routine public health issues including outbreaks. As well, 88% of sites reported that PHO’s site placement workplan was successfully achieved and enhanced the transfer of knowledge and experience to stakeholders.

ER 2.1: Strengthen the capacity for public health surveillance and data coordination in Canada to support prevention and response to pandemic influenza.
RA 2.1: The Agency completed the Multilateral Information Sharing Agreement (MLISA) for the surveillance of infectious diseases and management of public health events/emergencies.

ER 3.1: Canada conducts relevant research to better understand influenza pathogenesis (how the virus produces disease), further interrogate the virus (antiviral susceptibility, vaccine effectiveness), develop possible vaccine candidates, and epidemiology (how the virus spreads) to mitigate impact and improve capacity against future pandemic influenza viruses.
RA 3.1: The Agency continued to evaluate the safety and immunogenicity^{Footnote 11} of a universal seasonal influenza vaccine in the elderly through a Phase I clinical trial. A second phase evaluating the safety and immunogenicity of an H7N9 vaccine began in January 2014.The Agency also participated in vaccine efficacy studies in selected Canadian populations to determine protection levels and to evaluate vaccine effectiveness.

ER 3.2: Canada is able to prepare for and anticipate risks associated with novel influenza strains and is therefore able to identify, and mitigate and control disease transmission at the initial outbreak stage in order to reduce the potential impact of influenza epidemics and pandemics.
RA 3.2: As the WHO-designated National Influenza Centre in Canada, the Agency collaborated with the WHO, the Centers for Disease Control and Prevention, and the provincial public health laboratories and hospitals to conduct national surveillance on seasonal influenza viruses. This surveillance monitored influenza activities, detected and described antigenic changes and determined drug-susceptibility in the circulating strains of influenza virus in Canada. This information is vital for developing influenza prevention and treatment strategies for annual epidemics as well as for pandemics. Enhanced surveillance was also conducted for the detection and control of new emerging respiratory viruses such as H5N1, H7N9 and MERS-CoV.

Demonstrating the ability to identify, mitigate and control disease transmission, the Agency collaborated with ProvLab Alberta to identify the first case of H5N1 in North America.

ER 4.1: Predictive and assessment models used for pandemic preparedness are developed and established.
RA 4.1: Pandemic influenza models have been developed to support decision making regarding the renewal of the National Antiviral Stockpile (NAS) and the impact of demographic factors on the transmission of pandemic influenza in remote and isolated communities. More specifically, a dynamic, compartment model for pandemic influenza in Canada was structured by age and underlying chronic health conditions to calculate the potential demand for antivirals to treat these subpopulations with consideration of transmission dynamics, disease severity, and intervention strategies. This included: assessment of planning assumptions and interventions for pandemic influenza and emerging acute respiratory infections using models and simulation, estimations of the annual number of deaths, and other measures with respect to disease burden in Canada attributable to seasonal and pandemic influenza. In 2013–14, a number of high quality scientific papers were peer-reviewed in addition to high-level information exchanges in the form of major presentations to senior management and F/P/T officials.

ER 4.2: Respiratory and vaccine preventable diseases and vaccine safety are monitored and reported in a timely manner.
RA 4.2: The annual report on acute flaccid paralysis surveillance in Canada was published through the Canadian Paediatric Surveillance Program, and included comprehensive, epidemiologic reports on pertussis and invasive meningococcal disease. As well, vaccine preventable disease epidemiologic summaries were updated to support the National Advisory Committee on Immunization statements which were provided to F/P/T stakeholders to inform vaccine innovation and immunization policy discussions.

ER 5.1: Further strengthen F/P/T capacity to respond to an influenza pandemic by facilitating and supporting PT and National Emergency Stockpile Services (NESS) in the maintenance of national antiviral stockpiles.
RA 5.1: Canada has access to a supply of antivirals for pandemic influenza in the NAS held by provinces and territories and in the federally held NESS. In March 2014, the Agency concluded a three-year federal cost-sharing arrangement supporting provinces and territories in maintaining their NAS.

ER 5.2: Canada has the capacity to carry out public health interventions by ensuring Canada has access to a supply of vaccines in the event of a pandemic influenza, as well as emergency response and a maintained state of readiness of the Health Portfolio’s Emergency Operations Centre.
RA 5.2: The Agency maintained its capacity to identify, prepare and respond to public health events including contracted access to pandemic influenza vaccines and the ongoing 24/7 surveillance and response capability of its Health Portfolio Operations Centre and its International Health Regulations National Focal Point office.

ER 6.1^{Footnote 12}: Coordination of policy and programs (including the emergency call system) for emergency preparedness and response related to pandemic influenza, quarantineable events and public health emergencies of international concern for conveyances, goods, cargo, and ancillary services.
RA 6.1: The Agency’s Office of Border Health Services provided a 24/7 mechanism to the conveyance industry, federal departments/agencies, domestic and international partners to support responses to public health events related to travellers, conveyances, goods, cargo and ancillary services.

Comments on variances: N/A

Expected results and results achieved for 2013–14:

ER 7.1: Policies, guidance and protocols are relevant for pandemic influenza; coordinated communications among jurisdictions with stakeholders and the public.
RA 7.1: A Pandemic Influenza Working Group was created to develop guidance on the regulatory considerations for the development of vaccines. This Working Group developed recommendations for changes to seasonal influenza vaccine clinical licensure requirements. A guidance document was finalized on submission and information requirements for Extraordinary Use New Drugs (applied to pandemic influenza vaccine submissions). A vaccine cluster committee was created with the United States Food and Drug Administration and the European Medicines Agency to share information on vaccine regulatory issues and potential pandemic vaccines that are under development.

In addition, HC actively participated in the drafting of WHO guidelines for vaccine adjuvants.^{Footnote 14}

ER 8.1: Provision of timely decisions for antiviral and vaccine regulatory submissions that meet the highest standards of safety, quality and efficacy.
RA 8.1: Nine meetings dealt with viral and influenza vaccines (pre-clinical trial and pre-New Drug submissions) resulting in the authorization of three influenza vaccines and six annual strains. Two new drug submissions related to viral vaccines were authorized and 55 lots of seasonal vaccines were released. A clinical trial application for a vaccine to a potential pandemic virus was approved and a clinical trial lot was released. A Clinical Trial Application for a novel adjuvant system for influenza vaccine was also approved using guidelines jointly developed by HC and the WHO. A proof of concept was established for a novel analytical procedure which measures contaminants in pandemic vaccines as an additional check of vaccine quality during a pandemic.

A collaborative study is underway with the Canadian Food Inspection Agency (CFIA) to develop a more rapid analytical procedure for the preparation and quality analysis of influenza vaccines. The United States Department of Health and Human Service extended an invitation to present this work at an international meeting of WHO collaborating centres, international regulators, and international pharmaceutical associations. Studies are underway for the development of automated tools for assessing influenza vaccine potency and determining the factors impacting the shelf-life/stability of influenza vaccines.

ER 9.1: Timely and effective post-market monitoring and assessment of health products.
RA 9.1: A crisis management plan was developed and implemented in the event of a pandemic. Ongoing surveillance was undertaken of preventive and therapeutic products that could be used in the event of an influenza pandemic.

ER 10.1: Enhanced collaboration with Aboriginal Affairs and Northern Development Canada and the Agency as well as P/T partners on joint emergency preparedness and response (EPR) activities (including strengthening, testing and revising on-reserve First Nation pandemic plans). Strengthened links with key stakeholders to facilitate the integration of pandemic plans into all-hazards EPR plans.
RA 10.1: HC’s national and regional Communicable Disease Emergency (CDE) staff worked closely with F/P, regional, and First Nations partners to ensure that the needs of First Nations communities are well-integrated into public health emergency preparedness and response efforts, and that pandemic planning is integrated into all-hazards emergency preparedness and response planning.

The Health Portfolio Emergency Response Plan, which reflects the new HC/Agency Shared Services Partnership approach to emergency management, underwent a comprehensive review and revision and was approved by the Partnership Executive Committee in December 2013.
The roles and responsibilities of Aboriginal Affairs and Northern Development Canada (AANDC) and HC for emergencies on reserve were also clarified during an Agency-led table-top exercise in February 2014. At a January 2014 meeting of HC and AANDC, it was decided that HC would be included as a member of the Public Safety-led Aboriginal Community Resilience Working Group (which also includes representation from the Assembly of First Nations). Through this and other fora, AANDC and HC will review current practices and documents to work toward integrating pandemic planning into all-hazard emergency preparedness and response planning.
HC is also working closely with AANDC to develop a mechanism at the National level for this work to continue. Also, HC regional offices are now better positioned and able to link with their AANDC counterparts to promote the integration of community-level pandemic influenza plans with all-hazard emergency preparedness and response plans. HC regional offices, to varying degrees, continue to collaborate with their AANDC counterparts to promote the integration of community-level pandemic influenza plans with all-hazard emergency preparedness and response plans.

HC maintained its support to communities by sharing best practices and distributing templates for pandemic plans. HC’s regional programs held approximately 55 workshops in 2013–14 with many communities participating at each workshop. This allowed communities to network and share their approaches with other groups responsible for emergency preparedness and response and pandemic planning, and to offer them time to work on their respective plans in a supportive environment with their peers.

As a member of the F/P/T Sharing of Health Professional Task Group, HC helped finalize the Operational Framework for Mutual Aid Surge Requests for Health Care Professionals to facilitate the movement of health professionals between jurisdictions during a public health emergency. The proposed Framework was approved by the Agency and the PHN in 2013 and is now being implemented.

ER 11.1: Continue to support the testing and revision of community pandemic plans based on H1N1 lessons learned.
RA 11.1: The internal protocol, The Expedited Pandemic Influenza Drug Review, is in place and ready for implementation as needed.

HC reviewed:

• The main body of the Canadian Pandemic Influenza Plan for the Health Sector (CPIP) to encourage that roles and responsibilities for pandemic planning and response are clear and relevant to First Nations communities;
• The CPIP laboratory and vaccine annexes to promote the integration of First Nations considerations into F/P/T planning efforts;
• The content of the Module 5 - Exercise Builder for First Nations in order to provide a practical tool for on-reserve First Nations communities for the testing of pandemic plans; and
• The CDE program, in collaboration with HC regional programs, developed and validated a tool for assessing the completeness of community pandemic plans. This tool is based on the main preparedness components of the CPIP and comprised of 28 elements based on pandemic planning best practices identified in CPIP.

Using the assessment tool, the CDE program assessed the completeness of 42 community pandemic plans, all of which were part of reporting requirements for contribution agreements. Regional input was provided on these assessments. Currently, the CDE program is developing a more formal process so that all community pandemic plans can be assessed for completeness.

Comments on variances: The CFIA has completed the AI/PI program for the eighth year and has integrated AI expenditures into ongoing core program activities. CFIA faced an inherent challenge to track and report specific initiative expenditures in their entirety as they have become an integral component of expanded regular ongoing program activities. In recent years, the management and application of all CFIA program resources, including those initially received in support of the AI program, have been adjusted in response to Agency operational requirements, initiatives, and priorities, as well as savings initiative undertaken by the government.

Expected results and results achieved for 2013–14:

ER 12.1: Increased human resource capacity to support risk mitigation procedures (such as enhanced screening of live birds or poultry products) at Canada’s ports of entry.
RA 12.1: The CFIA and Canadian Border Services Agency (CBSA) work together to manage that risk indicators for animals and animal products in the Tactical Information Targeting Analysis and Notification System (TITAN) are current and relevant. TITAN is a CBSA risk management system that supports advance commercial information and is used by CBSA targeters in marine and air modes. In addition, national commercial and traveller stream border lookouts for avian influenza are in place for continuous monitoring of shipments of live birds, hatching eggs and poultry products at ports of entry from affected countries.

ER 12.2: Enhanced stakeholder and general public knowledge and awareness of the poultry industry service sector.
RA 12.2: The Poultry Service Sector Biosecurity Guide was approved for external release by the Avian Biosecurity Advisory Committee and CFIA. Stakeholder organizations provided support to adopt the guidance document as a national approach to proactive farm level biosecurity for poultry farm services. The document has been distributed to stakeholders.

ER 12.3: Enhanced/integrated Canadian surveillance system to ensure timely identification of potential outbreaks and response to AI situations. Targeted wild bird surveillance plan for 2013 is currently being reviewed.
RA 12.3: Two key surveillance activities continued within the CFIA:

• Surveillance for notifiable avian influenza (NAI) in domestic poultry was ongoing in the Canadian Notifiable Avian Influenza Surveillance System. Modern epidemiological tools are applied to: calculate the probability that the Canadian poultry are free from NAI; and provide a tool to regularly adjust the sampling plan to keep the surveillance efficient.
• Canadian wildlife surveillance also continued during the reporting period. In additional to characterizing any H5/H7 positive samples from a dead bird survey (1,392 samples tested), the CFIA also surveyed approximately 1,218 live birds from Alberta and Saskatchewan. Forty-five samples were positive for the AI virus; however, none of them belonged to H5 or H7 subtype.

ER 12.4: During inter-pandemic periods, strengthen regulatory capacity, utilize performance measurement tools to identify areas for improvement, and continue proactive and coordinated risk communications related to biosecurity and disease prevention.
RA 12.4: The Health of Animals Act and Health of Animals Regulations were amended and came into force on January 1, 2013. The amendment related to the disease control zones and, once a Ministerial declaration is made, provides more flexibility in the creation of administration zones within the Primary Control Zone. The NAI Hazard Specific Plan was reviewed, updated, and posted to reflect these changes.

ER 12.5: A trained, skilled and equipped workforce ready to respond to potential AI and animal disease outbreaks.
RA 12.5:

Skills and Training

Ten learning events were held for the Specialized Emergency Response Force. The seminars gave participants information on the disease control process, including the premises investigation questionnaire, the incident command system, and specific disease control procedures. Incident Command Training was delivered to staff at the national level upon request.

In order to increase human resource surge capacity, the CFIA continued to explore and develop training opportunities for reservists. Where possible, reservists were engaged in animal health exercises and drills.

In 2013–14, two reservists participated in the Foreign Animal Disease Recognition course.
Two disease control drills were held in 2013–14 to enable participants to practice disease control procedures in a physical environment.

The CFIA completed a project to update the platform for the Canadian Emergency Management Response System. A “train-the-trainer” session was held with staff from across Canada to facilitate the deployment of the updated system.

Stockpile

Approximately 60 ready-kits, containing personal protective equipment and 72 hours of supplies, were purchased and distributed to potential disease outbreak responders.

The CFIA continued to access a stockpile of antivirals and personal protective equipment that could be deployed nationally.

ER12.6: Improve, through investment in research, federal capacity for the control, risk assessment, diagnostics, modelling, and vaccine component of AI issues to enhance evidence-based decision-making on AI responses and the effectiveness of disease control measures to help mitigate risks to human health and economic loss.
RA 12.6:

Vaccine

The Vaccination Specialized Emergency Response Force validated several procedures related to vaccination during an outbreak.

Risk Assessment

In 2013–14, six risk assessments were completed on AI risk issues. Among these assessments were those related to the importation of live birds from various AI-infected countries, and those related to the importation of animal products that might contain the AI virus.

Research

Some of the research projects undertaken in 2013–14 included virus infection in chickens; next generation sequencing technology; and evaluation of the efficacy of possible disinfectants of AI under conditions encountered in the field.

ER 12.7: Continue to provide assistance to World Organization for Animal Health (OIE) Central Bureau in the Communications Department in an effort to promote the development and implementation of science-based standards. CFIA continues to support the OIE’s mandate and efforts to assist member countries in the control and eradication of animal diseases, including zoonotics, through its annual contribution to the OIE. In addition, the CFIA continues to support the development of capacity to address emergence of risk at the animal level through the Canadian Chapter of Veterinarians Without Borders. Work continues to harmonize diagnostic approaches, response and market access related issues associated with AI.
RA 12.7: The CFIA continued to participate in the trilateral health and security working group (Canada, United States, and Mexico) by prioritizing objectives in support of the North American Plan for Animal and Pandemic Influenza. Each country engaged their respective public health agencies and solicited partners for participation in developing case definitions and guidance for viruses of significance. Work also continued on the objectives related to communications since they were critical to any response effort.

The Government of Mexico requested that their conventional polymerase chain reaction (PCR) technology be tested at the National Centre for Foreign Animal Disease (NCFAD) against CFIA’s AI isolate^{Footnote 15} collection. NCFAD confirmed that the conventional PCR test met the test validation criteria and Mexico’s National Laboratory is now using the validated method for diagnostic purposes.

The CFIA continued its annual contribution to the OIE to support science-based, international standard setting for animal health underpinning trade in animal products.

The CFIA continued to invest in the Canadian Chapter of the Veterinarians Without Borders to strengthen animal health leadership and capacity building in Canada and developing countries.
This funding enabled Canada to be well-placed to addressing disease emergence at home and abroad in the face of globalization. Another benefit to this investment is the promotion of sustainable and integrated animal, human and ecosystem health in parts of the world where it is needed to safeguard the food supply and promote food security.

ER 12.8: Maintaining, coordinating and managing the Canadian Animal Health Surveillance Network (CAHSN), an integrated network of federal, provincial and university laboratories. This network allows for rapid testing, detection and reporting of AI.
RA 12.8: The CFIA acquired next-generation sequencing technology that enabled rapid sequencing and detection of unknown isolates leading to the development of mitigation strategies that strengthened the management of AI.

ER 12.9: Continued development of a viable response plan for AI and animal disease outbreaks, including human resource capacity and data management tools.
RA 12.9: Plans continue to be developed to mobilize effective and adequate human and material resources in the event of an emergency. This includes the development of national strategies for the national stockpile of emergency equipment, the deployment procedure for response staff, and the development of specially trained responders in each area for national deployment.

The CFIA continued to update emergency response procedures and relevant sections of the Terrestrial Animal Health Common Procedure Manual. As well, the CFIA continued to revise the Animal Health Functional Plan to reflect a common approach to emergency preparedness and response. Once finalized, these changes will contribute to the development of responders to enhance surge capacity.

An inventory of Personal Protective Equipment stockpiles was developed. These stockpiles are available to CFIA front-line inspectors responding to an outbreak are now being stored in various locations in the regions.

The CFIA Humane Destruction and Disposal Special Response Force worked on a humane destruction and disposal report which includes an inventory of destruction and disposal legislation, equipment, sites, and methods.

Comments on variances: N/A

Expected results and results achieved for 2013–14:

ER 13.1: Progress on funded projects and outcomes of research are reviewed.
RA 13.1: The Annual Report from the PHAC-CIHR Influenza Research Network (PCIRN) detailing research activities and outcomes was received and reviewed.

ER 13.2: Uptake of research results is facilitated, and consultations on future research needs are completed through reports and meetings of researchers, stakeholders and decision makers.
RA 13.2: Research conducted by PCIRN continued to be communicated through peer-reviewed publications and conference presentations. Research results were shared directly with stakeholders through the PCIRN Annual Report and during the PCIRN Annual General Meeting.

Results to be achieved by non-federal partners: N/A

Contact information:
Dr. John Spika
Director General, Centre for Immunization and Respiratory Infectious Diseases
130 Colonnade Road
Ottawa ON K1A 0K9
613-948-7929
john.spika@phac-aspc.gc.ca