Appendix C: Evaluation of the National Emergency Stockpile System (NESS) – Context

Appendix C: Current context, roles and responsibilities

This appendix provides a broad overview of the roles of various domestic and international authorities and stakeholders in emergency preparedness and response, specifically those related to the NESS program.

Domestic

Provincial and territorial governments, local responders and non-governmental organizations

Emergency management in Canada is a shared responsibility and requires the involvement of many players. When a significant public health event happens, emergency management begins with a response at the local level. When a community is unable to manage the impact, it will request support from its provincial or territorial government, which, in turn, asks for support from the federal government when required.

Public health practice relies heavily on collaboration among government and non-governmental organizations, such as professional associations and humanitarian organizations. These groups may be health-focused or may have primary interests in other related areas, such as social services.

Non-governmental organizations play essential roles in responding to an emergency and actively contribute in a manner consistent with their mandate. For example, various organizations may be involved by providing assistance through health services, water safety or first aid, by responding to and preparing for events, and by delivering services in the community.

Federal/provincial/territorial collaboration

Pan-Canadian Public Health Network

The (Pan-Canadian) Public Health Network (PHN) was established by Canada's federal, provincial and territorial Health Ministers in 2005. Led by a 17-member Council, with representatives from each province and territory and the federal government, the PHN enables different levels of government and experts to work together to improve public health in Canada. The Network takes a collaborative approach to public health that is critical at all times, but is especially important for coordination and collaboration during public health events. The Public Health Agency acts as the Secretariat for the Council and its groups and committees.

The leading PHN group that supports implementation of the NESS program is the Emergency Preparedness and Response Expert Group (EPREG)^{[Link to footnote C]}. EPREG is responsible for coordinating and strengthening federal, provincial and territorial health emergency preparedness policy and planning, as well as providing technical advice and assistance as required. Working groups of EPREG involved in shaping the direction of the NESS program include the Council of Health Emergency Management Directors (CHEMD) and the Council of Emergency Social Services Directors (CESSD).

In December 2010, the Deputy Ministers of Health approved a streamlined Public Health Network governance structure which establishes three Steering Committees reporting to the Council dedicated to: Health People and Communities, Communicable and Infectious Diseases, and Public Health Infrastructure. These Steering Committees will replace the existing six expert groups. As of April 1, 2011, the mandate of the Emergency Preparedness and Response Expert Group (EPREG) will migrate to the newly established Steering Committee on Public Health Infrastructure.

Canadian Pandemic Influenza Plan for the Health Sector

Currently being updated post-H1N1, the Canadian Pandemic Influenza Plan for the Health Sector (2006) is intended to provide a broad frame for Canada's collaborative response to pandemic influenza, and guides the roles and responsibilities of the Public Health Agency, Health Canada, the provinces and territories. Its goal is to help minimize serious illness, death and societal disruption during and after a pandemic by assisting with and facilitating a coordinated planning and response effort. It is the product of extensive dialogue and collaboration with representatives from all provinces and territories; Chief Medical Officers of Health; epidemiologists; virologists; communicable disease specialists; clinical, public health and laboratory specialists; and a wide group of stakeholders, including non-governmental organizations, local governments, emergency planners and bioethicists.

Federal government roles

The federal government, through Public Safety Canada, exercises leadership at the national level related to emergency management responsibilities, with different federal departments taking the lead on specific functions.^{[Link to footnote 30]} The Emergency Management Act states that the Public Safety Minister is responsible for leading "emergency management in Canada by coordinating, among government institutions and in cooperation with the provinces and other entities, emergency management activities."^{[Link to footnote 31]}

While the health portfolio (comprised of Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Hazardous Materials Information Review Commission, the Patented Medicine Prices Review Board and Assisted Human Reproduction Canada) plays a leading role in public health events, other federal departments and agencies have specific roles in response to major emergency events, including the following:

• The Canadian Food Inspection Agency has the lead role in responding to animal health emergencies. It works with provinces and territories, the animal and food industries and private sector veterinarians to enhance monitoring for signs of illness and to maintain enhanced bio-security measures on farms across Canada. It maintains a stockpile of personal protective equipment for its staff.
• The Canadian Forces has the mandate to provide its own health care. It maintains an emergency stockpile to meet potential operational requirements primarily related to providing care to its personnel in the areas of chemical, biological and radio-nuclear (CBRN) response and pandemic preparedness. The Canadian Forces also has supplies available for humanitarian operations and disaster response.
• The Department of Foreign Affairs and International Trade coordinates Canada's international response, including international aid from national stockpiles.
• The Canadian International Development Agency leads Canada's international effort to help people affected by poverty or disasters.
• The health portfolio also works with the Royal Canadian Mounted Police, the Canada Border Services Agency and Citizenship and Immigration Canada to manage screening of travelers and events at the U.S. border and international points of entry.

Federal Emergency Response Plan

The Federal Emergency Response Plan outlines the processes and mechanisms to facilitate an integrated Government of Canada response to an emergency and to eliminate the need for departments to coordinate a wider Government of Canada response. The aim of the Federal Emergency Response Plan is to harmonize emergency response efforts by the federal, provincial and territorial governments, non-governmental organizations and the private sector. In the Plan, Public Safety Canada is identified as the federal coordinating department, with responsibility for engaging relevant federal departments.

Federal Nuclear Emergency Plan

The aim of the Federal Nuclear Emergency Plan (2002) is to provide the structure for federal nuclear emergency preparedness and response to protect the public from immediate and delayed health effects due to exposure to uncontrolled sources of radiation; minimize the impacts of a nuclear emergency on property and the environment; and maintain public confidence in the ability of responsible authorities to protect public health.

Federal Healthcare Partnership – Pandemic Planning Working Group

The ad hoc Federal Healthcare Partnership – Pandemic Planning Working Group was created on May 11, 2009, to provide coordination between partners and federal organizations currently providing health care to federal populations. Federal partners include Citizenship and Immigration Canada, the Correctional Service of Canada, the Department of National Defence, Health Canada, the Public Health Agency of Canada, the Royal Canadian Mounted Police and Veterans Affairs Canada. The Working Group was designed to answer questions posed by partners and to provide strategic guidance on issues related to H1N1 vaccination and access to the National Emergency Stockpile System and the National Antiviral Stockpile.

Health Portfolio

Under the Department of Health Act, the Minister of Health has a broad mandate to promote and preserve the physical, mental and social well-being of Canadians, as well as to protect the people of Canada against risks to health and the spread of diseases. Also, the Minister of Health is responsible for ensuring cooperation with provincial authorities, with a view to coordination of efforts made or proposed for preserving or improving public health.

The Minister of Health is supported by the Health Portfolio, which comprises Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Hazardous Materials Information Review Commission, the Patented Medicine Prices Review Board and Assisted Human Reproduction Canada. Within the Health Portfolio, the response to a public health crisis is managed primarily by the Public Health Agency of Canada.

Health Portfolio Emergency Response Plan

The Health Portfolio Emergency Response Plan is structured as an "all-hazards" plan for emergency response. It defines the scope, framework, roles and responsibilities within which the Public Health Agency of Canada and Health Canada operate to ensure an appropriate response to a range of emergencies that could affect the health and well-being of Canadians.

Canada's Minister of Health (Public Health Agency of Canada and Health Canada) is primarily responsible for developing and maintaining the federal health portfolio emergency plans for national public health threats or events such as major disease outbreaks, natural disasters or major chemical, biological or radio-nuclear events.

Within the Health Portfolio, the Public Health Agency of Canada (PHAC) acts as the principal public health advisor to the Minister and has emergency management responsibilities, in the areas relating to:

• Public health emergencies involving natural and human induced disasters, including infectious disease outbreaks
• Legislative and regulatory issues for quarantine
• Implementation of legislation for the importation of human pathogens
• Laboratory biosafety and biosecurity
• Emergency Operations Centre activation
• Mobilization of the National Emergency Stockpile System.

Health Portfolio Chemical Emergency Response Plan

The Health Portfolio Chemical Emergency Response Plan is used by health portfolio staff involved in responding to a chemical emergency and provides information on how response to a chemical emergency is coordinated throughout the Health Portfolio. In the majority of cases, chemical emergencies will be localized and dealt with by regional resources. The health portfolio provides support for responses to chemical emergencies only when requested by a province or territory; when requested by another federal department or agency; when requested by an international counterpart; or when the chemical emergency occurs within a federal jurisdiction.

Health Canada's role in public health emergencies

Through its Emergency Preparedness and Occupational Health Directorate, Health Canada is responsible for preparing and responding to requests from federal departments and agencies related to alleged or actual terrorist acts. It also develops plans and policies to ensure Health Canada's emergency preparedness and effective interaction with the Public Health Agency at a portfolio-wide level.

Health Canada is responsible for the regulatory regime governing the safety of products including food, drugs, medical devices, natural health products, consumer products, chemicals, radiation-emitting devices, cosmetics and pesticides.

In recognition of the unique status and needs of on-reserve First Nations people in Canada, Health Canada collaborates with on-reserve First Nations communities to address health barriers and disease threats, and to attain health levels comparable to other Canadians living in similar locations. In preparing for and responding to a public health threat in on-reserve First Nations communities, among its many roles Health Canada is responsible for the following: ensuring that health services are available and accessible to on-reserve First Nations communities, including maintaining a personal protective equipment stockpile for health-care workers and support staff assisting in the delivery of health-care services.

Public Health Agency of Canada's role in public health emergencies

The Public Health Agency of Canada Act came into force in December 2006. The legislation establishes the Agency as a separate entity within the Health portfolio, with the mandate to assist the Minister of Health fulfilling his public health responsibilities. It also establishes the position and sets out the unique dual role of the Chief Public Health Officer. The Act highlights that the Agency should be responsible for the following: immunization; chronic disease prevention; and emergency preparedness.

The Act also highlights that "The Chief Public Health Officer of Canada would be a leading national voice for public health, particularly in outbreaks and other health emergencies, and a highly visible symbol of a federal commitment to protecting and improving Canadians' health."

The Public Health Agency of Canada is the lead federal agency mandated to manage public health emergencies and regional coordination of federal health emergency activities. It plays a coordinating function in emergency planning, and training and activities that engage all levels of government, as well as the voluntary and private sectors. It works with international partners, provinces and territories, and other federal partners to monitor international and domestic public health threats and to mobilize a pan-Canadian response to public health events of national or international concern.

With respect to its emergency response role, the Public Health Agency of Canada leads and/or undertakes the following broad activities:

• provides national leadership and coordination for public health emergencies, in collaboration with other federal departments and agencies, and with provinces, territories and municipal officials
• provides support and coordination, through the Government of Canada's health portfolio Operations Centre, for preparing for and responding to national and international health events
• initiates and participates in emergency management exercises, within Canada and internationally.

Within the Public Health Agency of Canada, the Centre for Emergency Preparedness and Response is Canada's central coordinating point for public health security issues. Its mandate is to maintain the safety and national health security of Canadians through emergency preparedness and response, and protection from all hazards, including natural and human caused disasters. It is accountable for the NESS program. Among its many responsibilities, the Centre:

• develops and maintains national emergency response plans for the Public Health Agency of Canada and Health Canada
• monitors outbreaks and global disease events
• assesses public health risks during emergencies
• contributes to keeping Canada's health and emergency policies in line with threats to public health security and general security for Canadians, in collaboration with other federal and international health and security agencies
• is responsible for the important federal public health rules governing quarantine and similar issues
• is the health authority in the Government of Canada on bio-terrorism, emergency health services and emergency response.

Within the Centre for Emergency Preparedness and Response, the Office of Emergency Response Services (OERS) is responsible for supporting emergency health and social services in the provinces, territories or abroad. It responds to natural and man-made disasters by carrying out the following activities:

• supporting provincial, territorial and foreign agencies that provide health and social services during national emergencies
• managing and maintaining the National Emergency Stockpile System, which stores pharmaceutical products, emergency medical and social services supplies and equipment
• maintaining a roster of Health Emergency Responders who are ready to be deployed to assist provincial, territorial and other local authorities in providing health emergency medical support during a health crisis and/or disaster.

The Office also supports federal, provincial, territorial and municipal partners and stakeholders through the development and delivery of a full spectrum of public health emergency management training and exercise services.

International

Major emergency events do not respect borders, nor do they occur at convenient times. The magnitude of human suffering can be huge, affecting many aspects of people's lives, including health, security, housing and access to food or water. When responding to an international public health event, the Government of Canada works with its international partners through organizations such as the World Health Organization (WHO) and mechanisms such as the Global Health Security Initiative. The Government of Canada also works closely with its North American partners, the United States and Mexico.

World Health Organization

The World Health Organization leads the international public health response to major events and also helps to build the capacity of member states in emergency preparedness. The WHO's strategy is based on an "all-hazards/whole-health" concept. An all-hazards approach entails the development of management strategies for the full range of likely threats and risks. A whole-health approach works toward unified and coordinated emergency planning, through coordination of surge and operational platforms between health and other sectors.

In 2005, the World Health Assembly revised the International Health Regulations (IHRs). The IHRs are an international legal instrument that is binding on 194 countries. The aim is to help the international community prevent and respond to serious public health threats that have the potential to cross borders and put people in danger worldwide. This legally binding agreement, to which Canada is a party, requires members to improve their capacity to detect, assess, notify and respond to public health threats.

Global Health Security Initiative

Canada is a member of the Global Health Security Initiative, an international partnership among France, Germany, Italy, Japan, Mexico, the United Kingdom and the United States, intended to strengthen preparedness and global response to public health threats. In 2001, the Global Health Security Action Group (GHSAG) of senior officials was established by health ministers of these countries to develop and implement concrete actions to improve global health security. The GHSAG also serves as a network of rapid communication/reaction in a crisis. Of note are two projects in progress: (a) Public Health Aspects of Radiological and Nuclear Threats, and (b) Capacity Building and Training for Emerging Infectious Diseases.

Trilateral Relations: Canada, the United States and Mexico

Canada works closely with its North American neighbors, the United States and Mexico. One priority of this relationship is to protect people from disease.

Guided by the North American Plan for Avian and Pandemic Influenza (NAPAPI), Canada, Mexico and the United States work together to prepare for and manage an outbreak of avian influenza or pandemic influenza in North America. Recognizing that the social and economic health of the three countries is closely intertwined, the Plan outlines a collaborative and coordinated North American approach to controlling the spread of avian influenza or a novel strain of human influenza.

The NAPAPI describes joint activities to be carried out through six lines of action: health promotion and risk communications, coordination, epidemiological surveillance and laboratory practices, health care provision, strategic stockpile, and research and development. Its aims are to detect, contain and control an avian influenza outbreak and prevent transmission to humans; prevent or slow the entry of a novel strain of human influenza to North America; minimize illness and deaths; and sustain infrastructure and mitigate the impact to the economy and the functioning of society.[Link to footnote 32]

The Public Health Emergency Mutual Aid Declaration (2007) is a declaration among the Department of Health and Human Services of the United States of America, the Ministry of Health of the United Mexican States and Health Canada, including the Public Health Agency of Canada. It highlights the intent to cooperate by sharing information as well as supplies, such as medical and pharmaceutical supplies in national stockpiles.

Bilateral Relations: Canada and the United States

The domestic Emergency Management Act (2007) authorizes the Minister of Public Safety, in consultation with the Minister of Foreign Affairs, to coordinate Canada's response to an emergency in the United States.

The Agreement between the Government of Canada and the Government of the United States of America on Emergency Management Cooperation was signed in 1986 and re-signed in 2008 to facilitate civil emergency operations in both countries. The Agreement recognizes the importance of strengthening cooperation in emergency management in relation to natural and man-made incidents, emergencies and disasters, and declares that the government of the two countries will use their best efforts to facilitate movement of evacuees, refugees, civil emergency personnel, equipment and other resources.

There are numerous cross-border agreements that arrange for the exchange of information and/or supplies during an emergency; for example, the Pacific Northwest Emergency Management Agreement (PDF) (2007) executed by Alaska, British Columbia, Idaho, Oregon, Washington and Yukon; the International Emergency Management Memorandum of Understanding (PDF) (2000) executed by the states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, and the provinces of New Brunswick, Newfoundland, Nova Scotia, Prince Edward Island and Quebec; and the Erie–Niagara Cross Border Contingency Plan (PDF) (2004) executed by Regional Municipality of Niagara, the Province of Ontario and the Counties of Erie and Niagara in the State of New York.