Section 4: Evaluation of food-borne enteric illness prevention, detection and response activities at the Public Health Agency – Conclusions

4. Conclusions and recommendations

The synthesis and analysis of the findings from this evaluation resulted in conclusions about both relevance and performance. In turn, this led to three recommendations for senior management of the Public Health Agency.

4.1 Conclusions

Relevance

Food safety is a federal government priority and there is a need for a federal public health role in food-borne enteric illness prevention, detection and response.

There are many cases of food-borne illness each year in Canada and the Public Health Agency of Canada Act guides the Agency’s roles and responsibilities for the prevention and response to infectious disease outbreaks. The federal government has a public health role in coordinating and facilitating the response to multi-jurisdictional outbreaks. The guiding source for this is the Foodborne Illness Outbreak Response Protocol (FIORP).

There is a federal public health role in detecting and responding to food-borne enteric illness. There is also a role in certain upstream prevention activities. Antimicrobial resistance and source attribution surveillance work is a recognized role for the Public Health Agency and this mirrors activities that are undertaken by the Centers for Disease Control and Prevention in the United States. However, the Public Health Agency’s activities in other upstream activities, namely risk modelling and research synthesis which focus on animal and food products, do not clearly align with a typical public health role.

Performance

Detection and response activities are well coordinated and integrated within and outside of the Public Health Agency. The evaluation found limited integration of activities between some upstream prevention activities with other food-borne enteric illness activities conducted within the Public Health Agency.

There have been significant improvements made following the 2008 Listeriosis outbreak. For instance, exercises have been conducted which have led to increased knowledge of roles and processes, and key communication tools have been developed to be better prepared to communicate to the public. However, key challenges remain, including the lack of epidemiological capacity building activities and surge capacity planning, and the absence of data-sharing agreements.

The Public Health Agency has worked with its federal food safety partners such as the Canadian Food Inspection Agency and Health Canada, as well as the provinces and territories, to improve the food safety system, especially in the area of detecting food-borne illness and responding to multi-jurisdictional outbreaks. There has been clear use of the evidence produced from these activities, as well as from data produced from antimicrobial resistance surveillance.

Although some upstream prevention activities have generated a lot of information, there is limited evidence showing it was used by food safety partners to improve the food safety system.

In terms of performance measurement, although some performance data are collected, there is no overarching performance measurement strategy for food-borne enteric illness activities.

4.2 Recommendations

4.2.1 Strategic approach to food-borne illness

When the Public Health Agency’s role is clear and understood, it appears that evidence is used in a timely and efficient manner.

As previously mentioned, there are certain Public Health Agency activities that do not clearly fit within a typical public health mandate. When the role is not as clear, there is limited use of any evidence that is produced. This is apparent in upstream prevention activities such as research synthesis and risk modelling which focus on animal and food products. Other activities do clearly fall within a typical public health mandate (e. g. source attribution surveillance work) but are not yet fully operational, limiting their capacity to provide fulsome national data that can be used by federal food safety partners.

These activities should be reviewed to ensure that they are meeting a need or addressing a gap. Priority setting should be done in conjunction with food safety partners, both with federal partners, as well as provinces and territories. This could be done through formal governance mechanisms, such as the Committees on Food Safety, which already discuss cross-cutting food safety policy issues and include the Director-General level Committee on Food Safety, the Assistant Deputy Minister Committee on Food Safety, and the Special Committee of Deputy Heads. Members include representatives from the Public Health Agency, Health Canada, the Canadian Food Inspection Agency and Agriculture and Agri-Food Canada.  With regards to provincial and territorial governments, the Federal, Provincial and Territorial Food Safety Committee may be the best mechanism as it includes representatives from health and agriculture departments.

As reported in section 2.4, there is no specific financial coding for ongoing food-borne enteric illness prevention, detection and response activities. Although an exercise was carried out by the Infectious Disease Prevention and Control Branch to determine food safety funding, it was difficult to conduct a proper assessment of resources given this limitation. The exercise, however, did show that core funding makes up a substantial base for all food-borne enteric illness activities in the Public Health Agency. When examining the combination of time-limited and ongoing funding, around half of all dollars spent on food-borne enteric illness is dedicated to upstream prevention activities.

Recommendation 1

Take a more strategic Agency-wide and interdepartmental approach to food-borne enteric illness, which includes but is not limited to:

  1. priority setting mechanisms for determining key Public Health Agency food-borne activities
  2. a shared understanding of the role of upstream prevention activities and their link to the Public Health Agency’s broader food-borne activities
  3. a mechanism for tracking ongoing food-borne enteric illness expenditures that reflects the horizontality of this program area.

4.2.2 Capacity to respond to food-borne outbreaks

In addition to reporting limited core capacity to monitor and respond to food-borne outbreaks, the Public Health Agency does not have an overarching surge capacity plan to respond to large food-borne enteric illness outbreaks, specifically focusing on epidemiologists. Food-borne outbreak epidemiology uses specific tools and methods. Trained human resources need to be available in the event of an outbreak. There are two types of epidemiological surge capacity to respond to large outbreaks:

  • internal Public Health Agency surge capacity
  • provincial and territorial surge capacity.

Providing provinces and territories with epidemiological and laboratory tools and methods is part of the Public Health Agency’s capacity building role. This is well appreciated by the provinces and territories, as well as by the federal food safety partners. There appears to be a gap in providing the provinces and territories with standardized tools and techniques to conduct epidemiological investigations.

Recommendation 2

Address capacity issues in detecting and responding to food-borne outbreaks:

  1. maintain Public Health Agency core capacity for daily operations in detecting and responding to outbreaks
  2. develop a Public Health Agency-wide surge capacity plan to respond to large outbreaks with a particular focus on Public Health Agency and provincial/territorial epidemiological capacity
  3. continue to develop and implement capacity-building activities, including tools and methods, to assist provinces and territories in conducting their own laboratory and epidemiological investigations.

4.2.3 Exercising of the food-borne illness protocol and emergency plan

Exercising of the Foodborne Illness Outbreak Response Protocol resulted in a better understanding of roles and processes during a multi-jurisdictional outbreak. The FIORP exercises were recommended in the Weatherill Report after the 2008 Listeriosis outbreak and identified in the Public Health Agency’s Listeriosis Lessons Learned Review. More bilateral exercises were carried out than planned and all exercises were designed in collaboration with the provinces and territories. These exercises clearly resulted in learning. Participants reported a much better understanding of key elements of the Protocol.

The development and exercise of FI ERP was also recommended in the Weatherill Report. This has been developed and is expected to be fully exercised in February 2013.

Exercising plans and protocols helps ensure that roles and responsibilities remain clear to all involved. In addition, it provides an opportunity for all partners to develop and maintain relationships, which has proven to be a key contributing factor to the success of the detection and response activities.

Recommendation 3

Continue with exercises of the Foodborne Illness Outbreak Response Protocol (FIORP) and the Food-borne Illness Emergency Response Plan (FI ERP).

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