Section 3: Evaluation of the National Emergency Stockpile System (NESS) – Findings
This section provides a summary of the findings organized under two broad headings: domestic and international roles. This summary is based on an analysis of the descriptive information provided in available documents and on the themes that emerged from interviews, focus groups and surveys with key informants.
3.1 Domestic role
The need for a stockpile of emergency supplies
The federal, provincial and territorial (FPT) Ministers Responsible for Emergency Management joined efforts to produce the Emergency Management Framework For Canada (2011). It states that "... the accumulating risks associated with factors such as increased urbanization, critical infrastructure dependencies and interdependencies, terrorism, climate change, environmental change, animal and human diseases, and the heightened movement of people and goods around the world, have increased the potential for various types of catastrophes."[Link to footnote 6]
While relatively few catastrophic events have taken place on Canadian soil in recent memory, this country is not impervious to these threats:
- There is a history of natural and man-made disasters, including pandemic events, in urban and remote communities in Canada.
- Terrorist threats on western nations are likely to persist.
Around the world these types of risks, and subsequent events, can be expected to recur. Domestic and international public health events can change rapidly. These events, if and when they do happen, can have enormous and detrimental consequences for Canadians. These challenges require well-thought-out emergency response plans, including timely access to essential provisions.
As seen in the previous section, over the past 25 years NESS supplies have been deployed domestically to respond to a wide variety of events. The principal activity of the NESS program has been to have sufficient quantities of medical and social service supplies, strategically located across Canada, in a state of readiness for immediate response to a natural or human-caused disaster.
Given the increased possibility of a range of natural and man-made disasters, the NESS program has adopted an "all-hazards" approach, meaning that decisions about the composition and management of this national reserve of provisions are to be based on up-to-date risk assessments. The NESS reserve of medical resources such as hospital equipment and pharmaceuticals could be critically important in a major response effort.
Federal role for domestic emergency preparedness and response
It is the responsibility of local, provincial and territorial governments to respond first in an emergency; the federal government provides assistance at the request of provinces and territories.
There is a Government of Canada role to coordinate emergency management activities across jurisdictions, where appropriate, and among the various players. There is considerable documentation that confirms the broader federal role in emergency preparedness and response in Canada (see Appendix E for further information on legislative changes):
- The Emergency Management Act (2007) states, "The Minister [of Public Safety Canada] is responsible for exercising leadership relating to emergency management in Canada by coordinating, among government institutions and in cooperation with the provinces and other entities, emergency management activities."
- Through the Federal Emergency Response Plan (2009), the Government of Canada mobilizes and coordinates resources and capabilities from the following organizations: federal departmental headquarters and federal regional departments, Crown corporations and agencies, provincial and territorial emergency management organizations, industry and the private sector, and non-governmental organizations.[Link to footnote 7]
However, there is little documentation that specifies the federal role in the provision of emergency supplies in response to a domestic disaster:
- As a signatory to the World Health Organization-led International Health Regulations (2005), Canada is required at the national level to have the capacity to provide support for logistical assistance (e.g. equipment, supplies and transport) for its citizens in case of a domestic public health event.[Link to footnote 8]
- The NESS antivirals are mentioned specifically in the Canadian Pandemic Influenza Plan for the Health Sector (2006):
"In addition to the National Antiviral Stockpile, the National Emergency Stockpiling System (NESS) also contains oseltamivir, which could be used during domestic avian influenza outbreaks or for P/T support during the Pandemic Alert or Pandemic Period."[Link to footnote 9]
The Government of Canada's commitment to the safety of Canadians in the face of human and natural threats has been reiterated in a variety of communications, instruments and agreements. In the 2010 Speech from the Throne, the Governor General highlighted again that "Our peaceful, prosperous and pluralistic society is one of the safest places in the world to live. Yet Canada faces real, significant and shifting threats. ...Protecting the health and safety of Canadians and their families is a priority of our Government."[Link to footnote 10]
Public Health Agency roles and priorities
The Emergency Management Act (2007) also requires all Ministers accountable to Parliament for a government institution to identify the risks that are within or related to his or her area of responsibility, including those related to critical infrastructure, and to do the following in accordance with the policies, programs and other measures established by the Minister:
- prepare emergency management plans in respect of those risks
- maintain, test and implement those plans
- conduct exercises and training in relation to those plans.[Link to footnote 11]
Annex A of the Federal Emergency Response Plan (2009) outlines the federal emergency support functions. The Minister of Health is listed as the Minister with primary responsibility for public health and essential human services.
Canada's Minister of Health (responsibilities include the Public Health Agency) 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 or man-made disasters, or major chemical, biological or radio-nuclear events.
The Public Health Agency was established in 2004 in direct response to concerns about the capacity of Canada's public health system to anticipate and respond effectively to public health threats. Its mandate is to protect and promote the health and safety for all Canadians through leadership, partnership, innovation and action. The Agency works closely with provinces and territories to keep Canadians healthy by focusing on effective efforts such as preventing chronic diseases like cancer and heart diseases, preventing injuries, and responding to public health emergencies. The Public Health Agency has a federal leadership role and has identified the management of public health emergencies as one it its key priorities.
To address this responsibility, the Public Health Agency undertakes specific activities, including:
- manage international aspects of public health emergency preparedness and response, including liaising with the World Health Organization and acting as the focal point for coordinating implementation of the International Health Regulations (2005)
- provide regional coordination of federal public health emergency activities
- support provinces and territories when requested, or to respond to complex emergencies on a national scale, by:
- providing access to materials from the federally controlled stockpile to assist provinces and territories with surge capacity
- facilitating the procurement of additional emergency supplies to complement provincial and territorial stockpiles.
The NESS program is mentioned specifically in both the Public Health Agency's Strategic Plan 2007-2012 and more recently in the 2010-11 Report on Plans and Priorities:
- Strategic Plan 2007-2012: "Enhancements will be made to the National Emergency Stockpile System, ensuring that sufficient supplies of appropriate and modern products and materials are available in the event of a public health emergency."
- 2010-11 Report on Plans and Priorities: "... operate the National Emergency Stockpile System and ..., as required, to respond to infectious disease emergencies and bioterrorism incidents in Canada or around the world."
Moving forward: Focusing the domestic role of the NESS
Supporting an integrated approach
While a major focus of the NESS program has been about buying, storing and disposing of supplies, some work has been undertaken to seek and support an integrated, coordinated pan-Canadian approach to the management of provisions for emergency public health response. Discussions with other federal departments revealed:
- Several federal departments manage similar (although limited) stockpiles of emergency medical supplies and/or pharmaceuticals to meet their own operational needs, including: the Department of National Defence, Canadian Food Inspection Agency, the Department of Foreign Affairs and International Trade, and Health Canada. The current management of these federal stockpiles is largely focused on their respective departmental requirements. For example, the Canadian Food Inspection Agency stocks personal protective equipment (respirators, rubber boots, disposable clothing, sprayers) for employees responding to foreign animal disease.
- One key department noted that there appears to be a lack of shared understanding among Departments of the current scope of the Agency's stockpile. They suggested that an education campaign aimed at clarifying questions, affirming responsibilities, and raising awareness amongst other government departments would be beneficial to clarify roles and responsibilities associated with the National Emergency Stockpile System.
- Some departments felt it would be helpful to share information on stockpile management. Information and/or collaboration could occur in the areas of inventory management systems, stockpile management, the sharing of evidence, experience and knowledge, joint purchasing, and disposal of outdated medical equipment/supplies and pharmaceuticals.
Part of the value added for the federal role in this area is to draw on existing expertise through partnering, collaboration and communication:
- The sharing of knowledge and expertise across jurisdictions is critical to the success of emergency preparedness in Canada; this is no less true for the coordination and management of surge supplies. It is about knowing what other jurisdictions are doing, both domestically and internationally, including the introduction of cutting-edge products and protocols, and being synthesizers, transmitters and users of that information. These efforts will allow the Public Health Agency to propose good models and practices, provide opportunities for information sharing, and ensure the most appropriate and efficient systems and knowledge are in place.
- There is a great deal of variability across Canada in knowledge about, and capacity for, surge response. In building a community of experts across jurisdictions, the Public Health Agency demonstrates its leadership role in bringing together different partners and expertise to build tools to support dialogue, share resources and facilitate evidence-based decision making in a public health context. For example, expert groups could be established or enhanced for medical equipment and for pandemic, food-borne, CBRN risks, etc. To ensure the NESS inventory meets current standards of care, and is operationally relevant to end users, the continued engagement of experts from across Canada is critical to focused decision making.
International highlight: Partnering
There are potential efficiencies to be gained by partnering with organizations that already have well-established infrastructures, e.g. non-governmental organizations, other government departments and other administrations. The Norwegian Emergency Preparedness System (NOREPS) promotes a collaborative approach among a group of humanitarian organizations in Norway. In Australia, the Australian Red Cross Society (ARCS) is a major partner in responding to events. The Department of Health and Ageing provides funding to ARCS to support a broad range of health-related humanitarian work and community activities, including disaster preparedness, first aid, disaster response and refugee services, and the society's work in the Asia-Pacific region.
There are opportunities to partner with organizations for other purposes. For example, in 2009, the Centers for Disease Control and Prevention and the American Association of Respiratory Care partnered to offer a webcast training module for doctors and first responders on how to best use the LTV 1200 ventilator in an emergency.
The NESS program is as relevant as its ability to meet the real needs of its primary users, that is, to support provinces and territories in their emergency responses:
- There has not always been consistent provincial and territorial involvement in decisions on acquisitions, positioning and deployment of materials for the NESS program. There needs to be consultation with and information shared by a broad base of provincial and territorial experts to ensure that cross-jurisdictional and individual provincial and territorial considerations are well understood by the Public Health Agency. Enhanced information about stock held in other jurisdictions could facilitate the exploration of options on partnered federal/provincial/territorial stockpile initiatives, such as planning, procurement, stock rotation, quality control, distribution, facility management and life-cycle issues.
- Along the same lines, the Memoranda of Understanding with provinces and territories established in the 1960s and 1970s (there is no MOU with Nunavut) are outdated and do not match today's complex operational and business environment. The Public Health Agency has engaged a task group with provincial/territorial representatives to discuss this matter. Task group members have confirmed that these agreements need to be renegotiated with each of the provinces and territories. Updated agreements need to outline current expectations, as well as accountability and security for NESS supplies.
- There could be better communication about the supplies that are available in the stockpile. Representatives from the provinces and territories stated that, in some jurisdictions, little information was available to them regarding processes and products. Some were not aware of which supplies are available to them. One option for achieving this goal is to develop an electronic database, accessible to provinces and territories, which will provide a clearer understanding of NESS supplies and the Public Health Agency's role in the provision of these supplies. This electronic database could also serve as a tool to provide a consistent avenue of communication among federal, provincial and territorial counterparts.
International highlight: Electronic inventory
In the United States, the Centers for Disease Control and Prevention (CDC) have an electronic database (an extranet site), which allows states to view specific items held in the stockpile. A similar system could be considered for the NESS program, whereby users/clients (provinces and territories) could search the database either by event (e.g. a chemical accident) or by product (e.g. ventilators).
Updated surge support for provinces and territories
The concept of "surge" needs to be revisited given the current requirements for emergency preparedness and response in Canada.
As defined almost 60 years ago, the mandate of the NESS program was to provide surge capacity to provinces and territories: NESS social service and medical supplies were only to be deployed when provincial and territorial resources had been exhausted. The intent of the NESS program was to bolster the response of provincial, territorial or local governments in the event of a medical emergency.
Prior to the "9-11" terrorist attacks in the United States (2001) and the more recent SARS (2003-04) and H1N1 influenza (2009) pandemic events, the primary role of the NESS program had been to respond to a broad base of man-made and natural disasters. The more recent events have accelerated efforts to address more contemporary and specific public health threats.
Updating the program has meant the acquisition of provisions that are more expensive and harder to acquire and store (not widely available, strict licensing restrictions) or that require a long lead time for procurement. Pharmaceuticals typically have a shelf life – legal limit on length of storage time before it is considered unsuitable for use. Shelf life can create challenges for stockpiling as these supplies may expire before they are needed and may require replacement.
Higher security risks for mass gatherings have led to a federal role in pre-positioning medical supplies for these events in case medical supplies are not readily available locally.
When responding to many of these new public health threats, especially those that require very rapid responses, such as the release of a chemical agent, the NESS program may be required to take on the role of a primary supplier at the request of the provinces and territories rather than a resource of last resort once provincial and territorial supplies have been exhausted.
New threats, updated responses
A more up-to-date NESS program requires more focused decision making that emphasizes the acquisition and distribution of more strategic supplies, based on risk assessments that reflect modern risks and the Public Health Agency's role in emergency response. The NESS program's procurement and asset plan must be adjusted in anticipation of a broader range of threats. A comprehensive health portfolio risk assessment is currently in development.
International highlight: Regular reviews
Stockpile systems are constantly evolving and updated in response to regular review.
- The Centers for Disease Control and Prevention in the United States indicated that they regularly review their threats and risks and, on that basis, add medicine and medical supplies (e.g. antivirals, respirators, masks and gloves) to the Strategic National Stockpile to help fight against pandemic flu.
- Australia is currently conducting a strategic review of issues such as procurement, stock rotation, logistics and transportation.
As outlined in the Canadian Pandemic Influenza Plan for the Health Sector (2006), the Public Health Agency is the lead federal agency responsible for addressing pandemic influenza preparedness and response.
Key activities include the following:
- conducting scientific research to better identify, understand and track the virus
- obtaining surveillance (or tracking) information from its federal, provincial, territorial and local partners, as well as non-governmental organizations (influenza surveillance helps to determine: when, where and which influenza viruses are circulating; their intensity, spread and impact; and if specific population groups are at higher risk for illness)
- providing information and advice to the general public and particular groups, such as vulnerable populations, as well as issuing guidance for health professionals and other stakeholders
- providing regional coordination of federal health emergency activities
- managing international aspects of pandemic preparedness and response, including liaising with the World Health Organization and acting as the focal point for coordinating the implementation of the International Health Regulations
- developing and supporting the process required to update and maintain the Canadian Pandemic Influenza Plan for the Health Sector, in cooperation with health portfolio and provincial/territorial representatives
- ordering sufficient vaccine for the Canadian population, in collaboration with the provinces and territories
- stockpiling pharmaceuticals, equipment and supplies to assist the provinces and territories with surge capacity.[Link to footnote 12]
Since the SARS outbreak, the NESS program has been increasing its supply of pandemic response materials. As part of this expansion, NESS stockpiled these materials prior to and during the 2009-10 H1N1 outbreak. Pandemic supplies include: antiviral agents, antibiotics specific to pandemic response, syringes, ventilators and related oxygen supply equipment, personal protective equipment (masks, face shields, gloves), and other supplies such as gowns, disposable sheets, pillows, needles, syringes and body bags.
The NESS program has supported provinces and territories during times of emergency and also during planned contingencies such as papal visits (1984, 1987, 2002), World Youth Day (2002), the Winter Olympic and Paralympic Games in British Columbia (2010), the G8/G20 Summits in Ontario (2010), World Youth Day (2011) in Nova Scotia, and other nationally hosted events in Canada.
There are now higher security requirements for these types of mass gathering events. The Public Health Agency has been proactive in the past 10 years, offering preparations and pre-deployments for these types of planned events, with a more flexible, scalable and interoperable modular concept of emergency medical service delivery (mini-clinics) should local emergency health services become overwhelmed. Deploying these mini-clinics also provides an opportunity to field test this asset and make refinements.
Chemical, biological and radio-nuclear (CBRN) risks:
Federal leadership is always expected in rare crises such as terrorist threats. Since the "9-11" events, many countries have become better prepared for these threats. Many of the medical countermeasures for potential bioterrorist attacks do not exist in the hospital system or in the pharmacy system in Canada. Because they are expensive, difficult to acquire (few manufacturers, licensing restrictions, many not approved for sale in Canada), and their life cycle is very distinctive, the Public Health Agency started to acquire and store them in the NESS.
As the lead for the Federal Nuclear Emergency Plan (2002), the health portfolio is accountable for action to address CBRN risks. This role encompasses planning, preparedness activities, and response structures, processes and linkages for a coordinated federal, provincial and territorial response to nuclear emergencies affecting Canada or Canadians at home or abroad.
The Health Portfolio Chemical Emergency Response Plan (2010) outlines the role of the health portfolio for chemical emergencies. The Portfolio provides scientific and public health support to assist response efforts. The support is primarily intended for the provinces and territories. It can also extend to other federal departments and international counterparts when required.
One of the Public Health Agency's roles within the health portfolio is the acquisition, storage and distribution of highly specialized pharmaceuticals in response to CBRN risks. The NESS program acquires and holds medical countermeasures, but its mandate is less clear in the distribution of these centrally held, highly specialized pharmaceuticals.
Some key informants questioned the value of the central storage of these types of pharmaceuticals and wondered if they would be deployed in time to be of benefit during a public health event. Given the rapidly devastating nature of CBRN events, it would be challenging to get these medical countermeasures out to the various jurisdictions in time to be of assistance. In the recent past, some of these medical countermeasures have been pre-positioned for mass gatherings.
International highlight: Location and response time need to be balanced
- The Norwegian Emergency Preparedness System has found that the nearer stocks are to a crisis site, the more effective they are in saving lives and preventing suffering; however, representatives stress that this must be balanced against the cost of maintaining stocks at a lot of different locations and the longer turnover period.
- In Australia, every state and territory has its own stockpile, including an inventory of antiviral agents. Australia's planning and response to pandemics relies on partnerships between the Department of Health and Ageing and its state and territory counterparts.
- The Centers for Disease Control and Prevention in the United States has established CHEMPACK, a voluntary participation project with states, for the "forward placement" of sustainable repositories of nerve agent antidotes. Thirty-nine states already have containers and seven others are in the process of obtaining them.
Rural, remote and/or northern communities:
Rural, remote and/or northern communities face numerous gaps and challenges in emergency management because of their unique circumstances. Factors such as inadequate housing for some populations, the travel time to acute-care hospitals, and limited access to running water may impact emergency response for those living in remote or isolated communities. During the H1N1 outbreak in 2009, Health Canada worked with the provinces and territories to pre-position anti-virals in or near isolated communities prior to the second wave of H1N1, which occurred in the fall of 2009. It ensured more timely access to needed supplies. The report on Canada's Health Portfolio response to H1N1 stressed that pre-positioning of anti-virals for these types of communities should be taken into consideration in future planning efforts.[Link to footnote 13]
During provincial and territorial consultations, unique challenges for storage, transportation, training and the availability of skilled professionals for stockpiles were mentioned as considerations for storing stock in isolated communities. Storage specifically could be problematic if stock required specialized facilities, such as heating.
Social service supplies:
As outlined in the 2010 Audit of Emergency Preparedness and Response, a strategic long term plan is needed to guide the procurement and management of supplies within the stockpile.
As noted in section 2.3, just under half of the supplies deployed to respond to domestic events have been social service supplies (46%) over the past 25 years. Just over four in ten deployments have responded to meterological or hydrological events, where social service supplies are more likely to be deployed. Both provincial and territorial respondents as well as other government departments indicated that there is a need for a social service response to natural and man-made events.
Provincial and territorial partners indicated that they perceived the stockpile as the last resort provision of additional supplies when the provinces and territories are overwhelmed during an emergency response (such as a mass casualty event), which is consistent with the NESS mandate. Some indicated that in the past, the stockpile had been deployed in their jurisdictions for natural disasters (floods, forest fires, etc.) and prepositioned for mass gatherings (G8/G20, Olympics, etc.). This response included primarily the use of cots and blankets, reception centre kits/forms, some use of N95 masks and ventilators during H1N1, and the prepositioning of mini-clinics, antidotes for CBNRE (niche capability that requires specialized equipment and training), and the national antiviral stockpile.
However, many respondents also indicated that they have agreements with non-governmental organizations (such as the Canadian Red Cross) for assistance during an event. The Canadian Red Cross's domestic disaster management services are focused on provision of emergency social services, such as family reunification (evacuee registration, searches and inquiry matching), basic needs (food, shelter, clothing and personal needs) and information management (call-centre operations and service information). There are currently 800 agreements between the Canadian Red Cross and municipalities across Canada to assist public authorities in emergency preparedness and response.
The Canadian Red Cross has its own regionally managed, volunteer-run inventories of basic emergency social service supplies, consisting mainly of cots that are returned after use and items that are given away, such as comfort kits, blankets, water bottles and teddy bears. Locally and regionally, inventory levels and locations vary (see Appendix F for conditions) and respondents from the provinces and territories recognize that supplies may be limited in their own jurisdiction.
Federal public health organizations in other countries do not tend to stock social service supplies within their own stockpile. Instead, this service is supplied by other government departments responsible for welfare or through non-governmental organizations who specialize in that type of response (see below).
International highlight: Provision of social service supplies
As highlighted in each of the international case studies, Appendix G, the provision of social service supplies is not typically the purview of a federal Department of Health. This response may be led by:
- non-governmental organizations (e.g. the Australian Red Cross Society, funded by the Australian government, states and territories for both domestic and international emergencies)
- another government department (e.g. the United States' Federal Emergency Management Agency under the Department of Homeland Security)
- a public/private partnership (e.g. Innovation Norway's consortia of public/private partners for the Norwegian Emergency Preparedness Stockpile System).
It is estimated by the program that a significant proportion of the supplies and equipment in the current NESS stockpile is out of date and/or is not in accordance with current medical standards or practices. For example, many of the cots in stock are considered to be difficult for seniors and people with disabilities to use because they are too low to the ground. Some of the blankets supplied by the NESS program are wool-based and considered by some users to not be desirable. Medical technology has advanced significantly since many of the medical components of the 200-bed hospitals and CCUs were acquired in the 1960s. This equipment is unsafe to use by modern medical standards or uses technology that is no longer relevant to modern medical practice.
Provincial and territorial representatives are aware of this issue and feedback indicated that this situation has to some extent eroded confidence in the overall value of the entire complement of NESS supplies. Provinces and territories are responsible for providing the space for storing these supplies; some jurisdictions expressed frustration that they are paying to store products that can never be used.
Disposal will be time consuming and expensive, but is necessary to update the stockpile. The Centre for Emergency Preparedness and Response has begun disposal; however, the process is complicated. In addition to disposal of supplies at the Ottawa warehouse, the process may involve shipping all or many of the products back to the Ottawa warehouse from the pre-positioned sites in provinces and territories and sorting in accordance with the Treasury Board of Canada Directive on the Disposal of Surplus Material (2006). There are a number of different disposal avenues for each product, depending upon its resale value and material composition (i.e. recycle, resale, or disposal).
An Agency commitment to clearing the NESS warehouses of outdated supplies will help to rebuild confidence among provinces and territories in the overall program.
3.2 International role
International public health events require different types of responses. Some require a domestic response, some require an international response and some may require both. For example, the H1N1 pandemic was an international health event and the Public Health Agency led a domestic response.
Federal role for international responses
There is a Government of Canada role in international health emergency response, specifically in the deployment of emergency supplies, including cross-border arrangements with the United States.
The domestic Emergency Management Act (2007) indicates that the responsibility of the Minister of Public Safety Canada includes "... participating, in accordance with Canada's foreign relations policies, in international emergency management activities." Furthermore, "In consultation with the Minister of Foreign Affairs, the Minister may develop joint emergency management plans with the relevant United States' authorities and, in accordance with those plans, coordinate Canada's response to emergencies in the United States and provide assistance in response to those emergencies."[Link to footnote 14]
There are also numerous cross-border agreements between Mexico, Canada and the United States, as well as between various American states and Canadian provinces for the reciprocal exchange of information and/or support during a public health event or emergency (see Appendix C, international sections on trilateral relations and bilateral relations).
The Public Health Agency mandate
While there is a defined mandate for NESS in responding to domestic public health events, no mandate has been stipulated for responding to public health events that take place outside Canada − under the current mandate of the NESS program, the Public Health Agency has no specific authority to deploy NESS supplies internationally on behalf of the Government of Canada.
For a number of past deployments, official Cabinet authorities have had to be sought to support each of these deployments. Section 61 of the Financial Administration Act and Orders in Council have been used, whereby "... the Governor in Council on recommendation of Treasury Board may authorize or make regulations for the transfer, lease or loan of public property other than federal property."[Link to footnote 15]
These approval processes can be time consuming in situations where timely responses are critical. Moving forward, if an international role was determined for NESS, ongoing policy and financial authority would be required.
Although it has no direct mandate to respond to international events, as described in section 2.3, over the past 25 years the NESS stockpile has been deployed internationally at least 22 times to 19 different countries (see Figure 5).
Figure 5: International Deployment of NESS, 1985 to 2010
Text Equivalent - Figure 5
Figure 5 illustrates the international deployment of NESS between 1985 and 2010. Over the past 25 years Canada joined international humanitarian relief effort in countries affected by major disasters. The NESS stockpile has been deployed at least 22 times to 19 different countries.
Between 1985 and 1990, the emergency supplies were sent in South America (Columbia and Mexico) to support earthquakes relief efforts, and Africa (Ethiopia and Sudan) to help fight epidemics. From 1991 to 1995, Canada sent medical and humanitarian supplies in war-torn countries such as Rwanda, Chechnya and Kurdistan, as well as earthquake hit, Japan. From 1996 through 2000 emergency supplies were deployed in Cuba to assist in a meteorological disaster, to Zaire and Yugoslavia to help people affected by war, as well as Turkey and Honduras to support earthquake relief effort. In 2001-2005, NESS was deployed mostly for immediate assistance in geophysical disasters in Turkey, Asia and Maldives; in 2005 United States benefited from Canada’s support after Hurricane Katrina. Between 2006 and 2010, emergency supplies were used for humanitarian relief in Taiwan and Haiti earthquake.
The potential public health threats faced by other countries are not unlike the threats Canada can be expected to face. The Public Health Agency can anticipate future requests for the international deployment of NESS supplies. Some of them may be at the request of the Government of Canada, others at the request of the World Health Organization, the Pan-American Health Organization or a national government.
Moving forward: Considering a potential Public Health Agency international role for the stockpile
The mandate, as outlined in 1952 and 1965, does not describe any international use of NESS supplies and, while the Public Health Agency has an obligation to respond domestically to an international public health event such as H1N1, there is no mandate to provide medical supplies internationally. Any consideration of a formal international role would require interdepartmental consultations and formal authorities to do so.
Obligations and opportunities:
The primary purpose of the NESS program is to provide surge capacity for the provinces and territories. If an international role was considered for the stockpile, this role should be ancillary, with domestic response continuing to be the primary role of NESS. The first priority for the NESS program should be to formalize its domestic mandate and update its domestic inventory and operations. However, key informants did raise some issues that should be taken into account when considering an international role for the stockpile.
- The implications for an international role will need to be well understood and formally acknowledged by all partners and stakeholders. The NESS program would need to be able to meet both domestic and international needs.
- Some stakeholders identified a need to look at the Public Health Agency's international emergency response programs as a whole, along with the infrastructure that needs to be put in place. For example, the Public Health Agency could consider the implications of the deployment of human resources and physical supplies together.
- Given the current risks of asset obsolescence in stockpile management, a number of NESS stakeholders observed that potential benefits of continuing international deployments include opportunities to rotate stock and refine response protocols and supplies.
Preparation for an international response:
Requests for assistance are typically coordinated through the Canadian International Development Agency or the Department of Foreign Affairs and International Trade, as these federal organizations have the lead on international responses. Currently the NESS management team and staff maintain informal relationships with these key partners, as well as the international arm of the Canadian Red Cross.
- The need for formal relationships and a clear definition of roles and responsibilities would need to be considered as part of the exploration of a more formal international mandate. In particular, this role could be linked with the existing international assistance roles of both the Canadian International Development Agency and the Department of Foreign Affairs and International Trade.
- A formal international role would require collaboration with other stakeholders in advance to ensure planning for an international role reflects the wealth of information from those most practiced in this field. If the NESS program has a formalized international role, then it could have the planning and processes in place to support that role. Criteria governing the NESS role could be established (i.e. what could be provided and under what circumstances should supplies be sent abroad).
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