Disturbing report shows need to invest in Public Health Agency of Canada

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University Health Network's expanded COVID-19 vaccination centre at MaRS Discovery District in Toronto. Image credit: Premier of Ontario Photography/Flickr

The Public Health Agency of Canada (PHAC), the fulcrum of national efforts to combat COVID-19, has been struggling to fulfil its role since the onset of the pandemic. That's the shocking conclusion of an internal federal government review of PHAC's pandemic response.

The Health Canada/PHAC Office of Audit and Evaluation conducted the review and completed its report in September 2020.

In late January 2021, PHAC released that report to the House of Commons committee examining Canada's COVID-19 response. The majority of members of Parliament voted to set up that special committee in October 2020, even though the governing Liberals opposed the idea.

The pandemic response review is merciless in its observations of PHAC's shortcomings. It should engender much public discussion, given the Public Health Agency's importance at this time.

So far, there have been a few news media stories on the report and, in the House, the NDP's Don Davies put one question about it to Health Minister Patty Hajdu. But this document deserves more attention.

Not enough scientific and specialized staff

At the outset, the review states bluntly that PHAC has lacked "the breadth and depth of human resources required to support an emergency response of this never-seen-before magnitude, complexity and duration."

The report identifies what it calls "skills capacity gaps across the agency." Of greatest concern is the lack of medical expertise at PHAC.

The evaluators find that the federal agency charged with coordinating all national efforts to counter epidemics, pandemics, and similar widespread health threats lacks "public health expertise, including epidemiologists, psychologists, behavioural scientists and physicians at senior levels."

In the case of senior-level physicians, the review notes they would be "of particular importance for any type of response coordinated through PHAC."

And such high-level medical expertise is not the only area where PHAC falls short. The review also notes gaps "with respect to specific operational requirements, including specialized resources such as quarantine officers, personal protective equipment (PPE) specialists, nurses, environmental health officers, and project managers."

During the period of the pandemic examined by the evaluation -- from late 2019 to September 2020 -- this lack of "operational capacity" affected "several areas of PHAC's COVID-19 response, especially its border presence."

Prior to the pandemic, PHAC could support federal government border services staff at all points of entry to Canada from one central office, its Ottawa headquarters. The pandemic changed that, but PHAC, and the government of Canada more generally, were not prepared for that change.

Because of the new requirement that travellers quarantine or self-isolate upon arrival in Canada -- and the resulting need to set up regional quarantine facilities, infrastructure, and processes -- PHAC had to quickly and significantly ramp up its front-line, border operations. It was a challenge the agency had difficulty meeting.

A big part of the problem was staff, and PHAC tried hiring new people to fill the urgent new needs.

"However," the review points out, "because of the unique requirements of certain positions (such as quarantine officers and environmental health officers) it was challenging to identify those with the required qualifications for immediate deployment." The evaluators add that it can take "several months before new staff are fully qualified."

Inability to undertake strategic planning

Outside of operations, on the policy and planning side, the review identifies significant weaknesses within PHAC.

The agency's office of strategic policy and planning, the review comments, was a small shop before the pandemic, which "did not have the capacity to address the significant increase in the volume of requests from cabinet and parliamentarians regarding the COVID-19 response."

This lack of strategic capacity has hobbled PHAC's efforts to determine priority activities and assign the right people to handle those priorities.

Even with the addition of new professionals from other government departments, the evaluators are not sure the agency has the staff with the required expertise it needs to plan and assign resources efficiently and effectively.

Indeed, the evaluators express significant concern with staffing for PHAC's COVID-19 response in all its dimensions. Their report paints a picture that should raise alarm bells at the highest levels in government:

"Most positions associated with the response are staffed for a short time (i.e., a few weeks to a few months). This may create difficulties attracting and mobilizing staff and individuals with the required expertise to join the response. Individuals may be reluctant to leave their substantive position (within or outside of government) for a short-term position, and managers may be reluctant to release staff as they often cannot backfill positions for such short periods."

Money cannot solve all problems. But the evaluation does identify a way in which targeted spending could make a vast difference to PHAC's staffing challenges.

One of the main staffing issues is that PHAC is not funded to offer individuals, particularly from outside government, long-term, full-time positions. As well, for lack of funds, the agency has been unable to hire staff for specific positions that require significant training.

In this case, there is a solution.

The Trudeau government has readily embraced the need to invest heavily in order to counter the pandemic and mitigate its impacts. Recently announced new government spending covers everything from acquisition of PPE and vaccines to income supports to assistance for small business.

Somehow, however, the government seems to have overlooked the need to adequately finance the key federal agency at the heart of Canada's pandemic fight.

Getting PHAC the money it needs to staff itself adequately -- either by re-allocating existing money or voting for new money -- would not be brain surgery. If the Liberals needed legislation to achieve this aim, they would not have trouble finding support in Parliament to pass it.

Need to rethink PHAC

There is much more in this exhaustive report, which should be made available online, in its entirety, soon.

PHAC is still a young agency. The Liberal government of the day set it up in 2004, in the wake of the SARS outbreak of the previous year. While the Public Health Agency has other responsibilities, dealing with pandemics is an essential and central part of its mandate.

The previous Harper Conservatives were not overly keen on PHAC. That's in part because, except for the northern territories and First Nation communities, health-care delivery is almost entirely a provincial domain in Canada. The federal role in health is limited to providing financial transfers to the provinces and to such ancillary services as testing and approving new drugs, and inspecting food.

The Conservatives were suspicious of a costly federal agency that seemed to them to intrude on provincial jurisdiction. As well, they argued that much of what PHAC did, such as health promotion, was already on Health Canada's plate.

The Harper folks were also highly dubious of all government-financed scientific research, which they cut ruthlessly, especially in such areas as the environment.

Not surprisingly, when they had the chance, the Conservatives chipped away at PHAC's funding. During the Harper era, the agency's budget went from a high of over $900 million to a low of under $600 million.

Before the 2015 election that brought them to power, the Liberals were harshly critical of Harper's cuts to PHAC. Trudeau even referred to those cuts in October 2020, when explaining the agency's difficulties in fully confronting the current COVID-19 pandemic.

The truth is, though, that PHAC's total funds are the same today as they were at the end of the Harper era. As well, when they were in opposition the Liberals disapproved when the Conservatives named a bureaucrat president of the agency, over the chief public health officer. Once in office, however, the Liberals continued that practice.

Around the world, and in Canada, the pandemic is provoking some major rethinking about a long list of public policy priorities.

The management and role of Canada's public health agency should be high on that list in this country.

Karl Nerenberg has been a journalist and filmmaker for more than 25 years. He is rabble's politics reporter.

Image credit: Premier of Ontario Photography/Flickr

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