ARCHIVED - Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic

1. Introduction

Purpose and scope of the Lessons Learned Review

The Lessons Learned Review examined the response of the Public Health Agency of Canada and Health Canada to the 2009 H1N1 influenza pandemic. The purpose of this joint Review was to gain an understanding of what worked well and what requires action. Management and staff should use the findings and recommendations of this internal review for planning and decision-making in preparation for future pandemics and other types of national public health events.

The Review examined nine broad areas of the Health Portfolio’s pandemic response:

• surveillance, science and research
• collaboration with provinces and territories
• guidance
• stakeholder engagement
• communicating with Canadians
• federal response in on-reserve First Nation communities
• emergency stockpile
• vaccine
• operational management.

This report devotes separate sections to each area above. Their order is not intended to reflect their relative importance and some sections overlap in content. For example, issues about vaccine distribution and use are discussed in section 3.3, Guidance; section 3.6, Federal response in on-reserve First Nation communities; and section 3.8, Vaccine. To avoid duplicating content, some sections direct the reader to related content elsewhere in the report.

This report:

• provides a description of the H1N1 context
• documents the response of the Public Health Agency of Canada and Health Canada to the pandemic
• identifies what worked well, as well as areas for action, within each of the nine broad areas of pandemic response listed above, culminating in three cross-cutting recommendations for improvements within existing roles, responsibilities and structures at the Public Health Agency of Canada and Health Canada.

Methodology

The Review was conducted by the Evaluation Services Directorate, a group internal to the Public Health Agency of Canada but not involved in the program areas that responded to the pandemic.

The Review analyzed information from multiple sources.

• Key internal documents including:
  • assessments of pandemic response conducted by various operational areas within the Public Health Agency of Canada and Health Canada (sometimes known as after-action reports or ‘hotwashes’)
  • assessments of the H1N1 experience carried out by various groups within the response structure, including provincial/territorial officials and expert advisors
  • a synthesis of H1N1-related public opinion research
  • an analysis of media coverage of the pandemic.
• Reviews of the H1N1 response completed by other organizations (for example provincial governments and/or their Chief Medical Officer of Health, other Canadian organizations, as well as other countries). In some instances, direct quotes from these reviews have been included in the report (sources are cited in the endnotes in the References section).
• Written feedback from domestic stakeholders engaged by the Public Health Agency of Canada and Health Canada during the H1N1 pandemic including:
  • national Aboriginal organizations
  • health professional associations
  • private sector representatives (engaged through the Private Sector Working Group on Avian and Pandemic Influenza Planning)
  • emergency response organizations
  • organized labour for the health sector.
• Interviews with key senior managers from the Public Health Agency of Canada and Health Canada. Verbatim quotes from some of these interviews have been integrated into the report to help illustrate key points and patterns that emerged from the analysis. Quotes from these interviews have not been attributed to the source.

The project was supported by two internal groups that provided advice to the project team: an Assistant Deputy Minister Project Advisory Committee and a Director General Reference Group.