ARCHIVED - Public Health Agency of Canada

1. Public Health Agency of Canada

Infectious Disease Prevention and Control

HIV/AIDS

Ongoing

$30.6M

$24.2M

Increased awareness of HIV/AIDS epidemic in Canada and the factors that contribute to its spread through:
• development of an Agency-led social marketing campaign;
• augmented risk behaviour surveillance; and
• targeted epidemiologic studies (e.g., expansion of I-TRACK and M-TRACK) and development of programs in other at-risk populations

Improved quality assurance in HIV testing through:
• maintenance and improved quality of HIV testing in Canada;
• enhanced ability to monitor the performance of testing kits and algorithms used in provincial public laboratories;
• enhanced HIV reference services; and
• improved knowledge and characterization of the transmission of drug-resistant HIV in Canada.

Strengthened pan-Canadian response to HIV/AIDS through:
• the development of a population specific framework, with approaches for gay men, women, and people from countries where HIV/AIDS is endemic; and approaches for Aboriginal people, people who use injection drugs, street youth, federal inmates and people living with HIV/AIDS; and
• Government of Canada readiness to support the development and distribution of vaccines through the implementation of the vaccine plan.

Increased and improved collaboration and networking through:
• the review and re-design of committees and advisory bodies; and
• improved reporting on progress through the development and implementation of the Federal Initiative's performance management framework.

Improved access to quality prevention, diagnosis, care, treatment and support through:
• increased availability of evidence-based HIV interventions which address the determinants of health; and
• increased availability of evidence-based HIV interventions which address co-infections that increase the susceptibility to acquiring and transmitting HIV (e.g., other sexually transmitted infections [STIs]) and other infectious diseases that increase disease progression and morbidity in people living with HIV/AIDS (e.g., hepatitis C, STIs, tuberculosis).

Increased capacity (knowledge and skills) of individuals and organizations through support for health and education professionals by providing evidence based guidelines, training and technical assistance on issues related to HIV/AIDS and other infectious diseases.

Outcomes are planned for the longer term.  Interim results are reported below.

Stigma and discrimination prevent people from accessing HIV testing, care, treatment and support.  The campaign to change stigmatizing and discriminatory behaviours of 18-25-year-old males is in the last stage of development.  This planned campaign is based on evidence that young men in this age group will change their attitudes and behaviours in response to an appropriately-focussed campaign.

New surveillance information was made available through 2007 publications: HIV and AIDS in Canada: Surveillance Report (June, December), Inventory of HIV Prevalence and Incidence Studies in Canada, HIV/AIDS Epi Updates

A nationally-based sentinel behavioural surveillance system to track HIV and associated risk behaviours in key populations by means of cyclical cross-sectional surveys at selected sites across Canada is well underway. M-track (men-who-have-sex-with-men) and I-track (people who use injection drugs) projects are established, with advisory groups, and study sites in high risk areas in key cities. A-track (Aboriginal peoples), E-Track (people from countries where HIV is endemic) and P-track (people living with HIV/AIDS) projects are at the exploratory stage, with feasibility and scope under discussion with population-specific expert working groups

In 2007-08 PHAC’s HIV labs:

• assessed the performance of 42 clinical laboratories across Canada, and 500 laboratories in 50 resource-limited countries around the world, providing training where needed, to ensure consistent high quality of HIV testing.
• provided quality control software to all provincial health ministries and laboratories
• developed tests and gained new knowledge to detect, characterize and quantify novel HIV genetic variants.
• characterized 800 blood samples for drug resistance from collaborating provinces to assist provinces to improve treatment options for people living with HIV/AIDS.
• achieved WHO accreditation as specialized HIV drug resistance testing laboratory (one of four labs worldwide).
• with PHAC’s  Surveillance and Risk Assessment Division, published HIV Strain and Primary Drug Resistance in Canada (August).

The work on a population-specific framework to guide program development and all population-specific status reports moved ahead, with planned publication of the reports starting in 2008.

The vaccine plan is being implemented through the work of the Canadian HIV Vaccine Initiative, launched in 2007.

In 2007-08, consultations were held on the development of a pilot-scale manufacturing facility, and the social and discovery research program, clinical trial capacity-building and networks program, and policy development and community engagement program.

The review of Federal Initiative committees has been deferred to 2009.

Progress has been made on the further development and implementation of the performance management framework.  An implementation evaluation of the Federal Initiative will be completed by December 2008, and a process evaluation is underway to test performance indicators.

A horizontal pilot project with the Homelessness Partnering Secretariat will demonstrate whether or not a culturally-appropriate case management approach can improve health and housing outcomes for Aboriginal persons who are homeless or at risk of homelessness and living with HIV/AIDS.

Fact sheets and a website discussion forum were made available for street youth to learn about STIs , HIV, and associated acquisition and transmission risks.

In 2007-08, with the support of provinces and territories, the groundwork was laid for the updating of national HIV and STI testing policies and guidelines.  Underpinning this work was the publication of HIV Testing and Counselling: Policies in Transition, a synthesis of research in Canada and around the world.  New national HIV testing guidelines were published.  Point-of-Care HIV Testing Using Rapid HIV Test Kits: Guidance for Health Care Professionals can be adapted by provinces and territories for use within their specific jurisdictions.  The Canadian Guidelines on Sexually Transmitted Infections were updated and distributed across the country.  Training sessions were provided to education and health professionals in the application of these guidelines.  National anti-homophobia resources were developed to decrease the impact of homophobia in health and medical care settings.  There is strong evidence that homophobia deters people from accessing HIV and STI testing, care, treatment and support.

Explanation of variance ($6.4M): The variance represents a reallocation of $2.3M to Canadian HIV Vaccine Initiative and the balance relates to reductions required by the Expenditure Review Committee.

Regional HIV/AIDS Program

Ongoing

$13.5M

$12.4M

Increased and improved collaboration and networking through multi-sectoral partnership development.

Increased awareness of HIV/AIDS through funding projects to engage target populations in awareness raising (promotion and prevention) events, presentations and campaigns on HIV/AIDS.

Increased capacity (knowledge and skills) of individuals and organizations through funding projects to provide skills building sessions for staff and volunteers.

Improved attitudes and behaviours towards people living with HIV/AIDS through policy changes and other initiatives that create a more supportive environment for people living with HIV/AIDS.

Improved access to quality HI/AIDS prevention, diagnosis, care, treatment and support through strengthened population-specific funding programs delivered through regional community based organizations.

The Public Health Agency’s regional offices are responsible for administering the AIDS Community Action Program (ACAP).  In 2007-08 ACAP provided $10.4M in funding for 52 time-limited and 74 operational community-based projects across Canada. These 126 projects aim to create supportive environments for those living with HIV/AIDS, prevent HIV/AIDS in key populations (gay men, people who use injection drugs, Aboriginal peoples, prison inmates, youth at risk, women and people from countries where HIV is endemic), facilitate health promotion for those living with HIV/AIDS, and strengthen community based organizations that work with the key populations.

Seven of the above mentioned ACAP projects are integrated with hepatitis C funding to target people who use injection drugs to prevent the spread of blood-borne pathogens.

Explanation of variance ($1.1M): G&C reduction exercise and reallocation to CHVI

2.Health Canada (HC)

First Nations Inuit Health Branch (FNIHB)

First Nations in-reserve and Inuit Community Health

Ongoing

$3.3M

$3.1M

Increased awareness of HIV/AIDS epidemic in Canada and the factors that contribute to its spread through increased support for on-reserve First Nations in their efforts to develop and deliver targeted prevention, education and awareness programs for health professionals, community leaders and community members.

Increased capacity (knowledge and skills) of individuals and organizations through provision of HIV/AIDS and hepatitis C guidelines for nurses working on reserve; and training on HIV/AIDS and hepatitis C for health professionals and nurses working on reserve.

FNIHB provided $3.1M funding to First Nations (FN) and Inuit community organizations across seven regions to develop and deliver targeted prevention, education and awareness programs for health professionals, community leaders and community members, and to increase the capacity (knowledge and skills) of individuals and organizations.

In Atlantic Region, projects focused mainly on youth and women. For example, STI testing was offered during routine pap testing to increase testing of HIV/AIDS. Prevention education workshops took place in classrooms for grades 7-12 on STI/AIDS/HIV sexual health for Innu communities; women’s workshops on violence prevention were presented in communities and also included youth. An evaluation of Healing Our Nations programs was completed. New collaborative relationships were established with Tu’kn communities, Cancer Care Nova Scotia (for data collection) and the population health research unit of Dalhousie University. This collaboration with the provincial government and district health authorities will contribute to improving First Nations youth health; and, to improving community leaders’ knowledge of HIV/AIDS. This is the First Canadian On-Reserve Youth Health Centre that will meet provincial standards. In the area of capacity building, 21 Innu and 2 Micmac “Youth Train the Trainer” sessions took place involving training on-reserve youth to become peer educators on issues of sexuality, hepatitis C, STIs and HIV/AIDS. School based education of sexual health was carried out. The Labrador Friendship Centre hosted a conference on sexual health delivered for community members from Sheshatshui and Natuashish. Support was provided for Aboriginal PHAs (APHAs) living in First Nations communities through workshops dealing with Death and Dying.

In Quebec, projects focused on training on HIV/AIDS and hepatitis C for health professionals and nurses working on reserve These included training on Youth Sexual Health, and Notification of Sexual Partners, for nurses and community health nurses (CHNs). An information flyer on HIV/AIDS and pregnant women was produced with the collaboration of women from various groups involved in HIV / AIDS activities. The Circle of Hope Newsletter was distributed to First Nations and their health care workers.

In Ontario, partnerships were enhanced and linkages with major stakeholders (local health units, First Nations HIV/AIDS Education Circle) were increased. Thirty seven communities received support for programs which included the distribution of HIV/AIDS education material. Political Tribal Organizations (PTOs), Tribal Councils and Chief Councils received funding for HIV/AIDS initiatives.

In Manitoba, Two conferences on Education and Collaboration were delivered. One was attended by more than 150 CHNs and community representatives; the second conference was attended by 120 CHNs. Through the evaluations the nurses reported that they learned a great deal about HIV/AIDS and Hepatitis C and requested further conferences and workshops.

In Saskatchewan: All 84 SK communities accessed funding and delivered HIV/AIDS prevention education and awareness programs with community specific objectives and activities. As a result, 70 people attended 3 workshops on HIV in which personal and community values were explored and became the basis for HIV planning & activity implementation. CHNs, health directors, National Native and Alcohol & Drug Abuse Program (NNADAP) workers, mental health, youth workers, and health councillors participated in this formal education.  Enhanced HIV Surveillance was carried out using the Social Network Analysis tool with newly HIV diagnosed clients. This tool enabled enhanced social data collection and information, resulting in increased knowledge of HIV. Harm Reduction and Needle Exchange Programs (NEP) incorporated culture and aboriginal teachings. NEP programs are operating in 10 FNs Holistic and culturally competent objectives were developed that target FN at risk and marginalized people. SK is unique and strategies need to meet the needs of the people in our communities.

In Alberta: Blood borne pathogen and sexually transmitted infection (BBP/STI) funding was provided to 36 communities for community developed and driven activities, including: BBP/STI prevention workshops, awareness/safer sex poster contests at jr/sr high in 3 communities, and Healthier Sexuality presentations made at youth and community workshops by “the Condom Queens” (2 elders). Male/female condoms and dental dams were distributed in health centres, recreation facilities; and pow-wows. BBP/STI 1O1 and BBP/STI Prevention train the trainer sessions were delivered to all Treaty areas nurses, CHRs and NNADP workers in Northern Communities. 

In British Colombia, FNIHB (BC Region) partnered with the First Nations Leadership Council and the Government of British Columbia (through the formal Tripartite Agreement) to develop the Tripartite First Nations Health Plan. Community training and education sessions were held with positive evaluations. For example, the Carrier Sekani Family Services held a Youth Conference in Prince George “Mobilizing on HIV/AIDS and STIs in Aboriginal Communities”. The Northern Aboriginal Task Force and Healing Our Spirit (HOS) held the 12th Annual Provincial HIV/AIDS Conference in Prince George with an attendance of over 300. ‘Around the Kitchen Table’, is a  project that empowers Aboriginal women, with an emphasis on those living in remote communities, to fight the spread of HIV/AIDS by reinstating their traditional roles, and joining them in a community network of support and education. Healing Our Spirit developed and disseminated educational print and video materials; and partnered in project that provided care, treatment and support to on-reserve band members when in Vancouver undergoing treatment for HIV/AIDS.  The Headquarters office completed and translated into French the HIV/AIDS and hepatitis C reference tool for nurses working on reserve. In addition to the planned results, FNIHB has increased the availability of evidence through work on a Performance Measurement Strategy (implementation of evaluation tools and mechanisms at regional levels), and the initiation of work on a pilot HIV sentinel surveillance system for First Nations on reserve and Inuit.(A-Track).

Explanation of variance ($0.2M): FNIHB/PHAC Letter of Agreement - funds not retrieved by PHAC due to new rules for funds transfers between HC and PHAC. Funds lapsed. FNIHB also provided an additional $2.6M from its core budget to support its HIV/AIDS programs.

International Affairs Directorate

Global Engagement

Ongoing

$1.2M

$0.6M

Improved coherence of Federal response through increased policy coherence across the Federal Government's global HIV/AIDS activities.

Strengthened pan-Canadian response to HIV/AIDS through support projects that engage Canadian organizations in the global response to HIV/AIDS.

The International Affairs Directorate convened and provided leadership to the Federal AIDS 2008 Secretariat, an interdepartmental co-ordinating committee which is guiding the Government of Canada’s participation in the XVII International AIDS Conference (Mexico, 1-8 August 2008). A strong co-ordinated Canadian presence will ensure that Government of Canada priorities are communicated and well-represented at this important forum that brings together political leaders, health professionals, scientists, policy-makers and community members from around the world to address key issues in the global response to HIV/AIDS.

Global information sharing opportunities and collaborative activities related to HIV/AIDS were expanded through support for Canadian participation in relevant international organizations and international fora.

Five grants were awarded to qualified organizations through an open and competitive process, to enhance Canadian engagement in the global response to HIV/AIDS. Organizations who have received funding are able to better serve their communities and members by transferring the knowledge, skills and lessons learned they have gained in pursing their international work.

Understanding of the implications, challenges and opportunities of recognizing HIV infection as a disability and of seeking such an interpretation of the UN Convention on the Rights of Persons with Disabilities was improved.

Explanation of variance ($0.6M): -Reallocation to the Canadian HIV Vaccine Initiative; and challenges in staffing had implications for overall capacity to use resources.

Departmental Program Monitoring and Evaluation Directorate

Program Evaluation

$0.1M

$0.0M

Improved coherence of Federal response through the provision of strategic performance management framework: ongoing performance measurement, monitoring, evaluation and reporting of performance results.

Increased capacity (knowledge and skills) of individuals and organizations through developing the capacity for monitoring and evaluation of the HIV/AIDS epidemic in Canada

Corporate evaluation provided evaluation support to Health Canada’s Federal Initiative partners and advice on the Federal Initiative implementation evaluation.

Explanation of variance ($0.1M): Staff support to file was paid from DPMED’s core budget, not from Federal Initiative funds. As of April 1, 2008 $100K of Federal Initiative funds were transferred to PHAC.

3. Canadian Institutes of Health Research (CIHR)

Institute of Infection and Immunity

HIV/AIDS Research Projects and Personnel Support

Ongoing

$19.4 M

$18.8M

Increased and improved collaboration and networking through:
• funding of and participating in HIV/AIDS conferences/ workshops; and
• participating in FI Accountability Working Group and Responsibility Center Committee and engaging appropriate federal partners in CIHR activities.

Increased availability and use of evidence through:
• funding HIV/AIDS research projects across a broad spectrum including socio-behavioural, biomedical, clinical, and community-based research.; and
• providing new research funding opportunities for scientists in strategic areas of HIV/AIDS research;

Increased capacity (knowledge and skills) of individuals and organizations through launching strategic capacity building initiatives and providing funding for training and salary awards

Strengthened pan-Canadian response to HIV/AIDS through:
• developing a strategic plan for CIHR HIV/AIDS Research Initiative;
• initiating the process to renew and enhancing infrastructure for clinical HIV research; and
• building effective partnerships with and engaging meaningful dialogue with key stakeholders.

The Health Systems, Services and Policy and Resilience, Vulnerability and Determinants of Health expert working group developed the Centres for Population Health and Health Services Research Development in HIV/AIDS Request for Applications (RFA).  This funding will enable the development of an integrated network of centres in Canada specializing in HIV/AIDS health services and policy research and research on the social, cultural and environmental determinants affecting the HIV/AIDS epidemic.

In 2007-08, with combined CIHR and Federal Initiative funding, CIHR funded 182 grants, 139 awards and 17 Canada Research Chairs in the area of HIV/AIDS. This investment totalled $37.1 million in HIV/AIDS research in 2007-08.  This funding flowed directly to HIV/AIDS researchers in universities and research institutions across Canada.  Through the Community-based Research Program, 11 new grants (3 Aboriginal Stream; 8 General Stream) and 8 capacity-building grants and awards (5 Aboriginal Stream; 3 General Stream) were approved in 2007-08.  CIHR also renewed funding for the Canadian HIV Trials Network after an open, competitive, peer-reviewed process.

HIV/AIDS researchers supported by CIHR made significant achievements in addressing the HIV/AIDS epidemic both in Canada and globally. CIHR-supported outcomes in this area included: an international research study that found that male circumcision is an effective way to reduce the incidence of HIV among young men.  The study was named the top medical breakthrough of 2007 by Time Magazine,

• the identification of immune cells that give rise to a fungal infection commonly found in HIV patients called candidiasis. This new knowledge will help in the development of more powerful and effective treatments for the fungal infection, which can limit food consumption, leading to weight loss that threatens patients' general health and well being;
• the definition of a new and unexpected pattern of gene expression in HIV-1, which has the potential to produce a new protein. The discovery of this protein and identification of its function might provide a new target for antiretroviral therapies and in addition, due to its proposed membrane-associated characteristics, could provide new possibilities for vaccine design;
• the development of a tool to measure patients' readiness to adhere to Highly Active Anti-retroviral Therapy (HAART). The Antiretroviral Readiness and Motivation Scale (ARMS) could allow physicians and other caregivers to better predict which patients will adjust quickly to HAART and take steps to help those who will face more challenges in adhering to the regimen;
• important findings that suggest that people at risk of HIV become less worried about it the longer they test negative, believing the high-risk behaviour they engage in is safe. The results underscore the need for enhanced counselling for those who repeatedly test negative for the virus and continue to engage in high-risk behaviour; and
• clinical trials that have led to the development and use of antiretroviral therapies that have allowed many HIV-infected people to live longer, healthier lives.

In 2007-08, the CIHR launched the development of a strategic plan for the CIHR HIV/AIDS Research Initiative;  The final document will position Canada’s strategic HIV/AIDS research priorities in the context of an overarching strategic plan that will serve as a useful guide for future CIHR HIV/AIDS Research Initiative investments.  As part of the process, the CIHR invited its HIV/AIDS stakeholder community to play a leading role in shaping its strategic plan.  Consultations revealed that Canada’s HIV/AIDS research community overwhelmingly supported the directions being taken and funding mechanisms used by CIHR.

Through the CIHR Community-Based Research Program, Aboriginal communities and organizations are involved in the design and implementation of research projects. This approach provided study populations with control of the research they were involved in and allowed for improved dissemination of knowledge created back to the community.

Explanation of variance ($0.6M): Internal levies and reallocation to CHVI.

4. Correctional Service of Canada

Health Services

Ongoing

$3.1 M

$1.9M

Improved collaboration and networking through expanded information sharing opportunities and collaborative activities within the F/P/T/ Heads of Corrections Working Group.

Increased awareness of HIV/AIDS through increased awareness of the need for innovative research initiatives on infectious diseases within the federal offender population.

Increased capacity (knowledge and skills) of individuals and organizations through continued support of and participation in training and learning opportunities for correctional health care professionals.

Improved access to quality prevention, diagnosis, care, treatment and support through:
• improved coordinated discharge planning programs for federal offenders with infectious diseases and other physical health problems being released into the community;
• enhanced, gender specific infectious disease care, treatment and support, in accordance with professionally accepted health standards for women offenders through the development of a framework for a women offender infectious disease strategy;
• culturally appropriate health programs and services for Aboriginal offenders in federal correctional institutions;
• reduced transmission of infectious diseases among federal offender populations through innovative harm reduction programs and measures; and
• expanded health promotion initiatives to encourage healthy behaviours with the federal correctional environment.

Increased availability and use of evidence through:
• augmented surveillance and data collection activities in order to better inform infectious diseases policy and program initiatives; and
• better informed internal policies and programs using results of an extensive inmate survey on risk behaviours.

F/P/T/ Heads of Corrections Working Group shared information on areas of mutual interest including the development of national HIV Point of Care testing and counselling guidelines, BC’s Youth HIV/HCV Study, and CSC’s Discharge Planning Guidelines.

Ongoing consultation with PHAC has resulted in research/ collaborative activities such as the inmate survey on risk behaviours, which was conducted in early summer 2007. The results are currently being tabulated and analysed.

CSC’s national, regional and institutional nurses participated in the annual CANAC (Canadian Association of Nurses in AIDS Care) conference. 
Hepatitis C and HIV medical specialists conducted educational sessions for staff and inmates on site throughout the year.

Infectious diseases training needs for Infectious Disease Nurses in CSC was reviewed. A plan is under development that will be integrated with an overall annual training strategy for CSC nurses.

New Discharge Planning Guidelines were implemented in all Regions in February 2008. They provide direction to staff on the discharge or transfer of offenders with ongoing infectious disease issues.

Consultations are taking place to improve infectious disease services for women offenders. An Infectious Disease Strategy will be finalized and implemented in 2008-09.

The A-PEC (Aboriginal National HIV/AIDS Peer Education and Counselling program) trains First Nations, Inuit and Métis offenders to be peer resource helpers in the area of infectious disease and harm reduction measures. One national and two regional Aboriginal Health Coordinators, with the assistance of Aboriginal Service Organizations, implement the program in all five CSC regions.

In March 2008 consultations took place for the development of a National Aboriginal Health Strategy.

Seven inmate-led projects were funded under the Special Initiatives Program to educate offenders on the risks associated with certain behaviours.

The National HIV/AIDS Peer Education and Counselling (PEC) Program trains selected inmates to become "peer educators"; and to offer support and infectious disease information to other inmates.

43 CSC institutions are required to deliver PEC. In 2007, there were peer educators in 37 of 43 (86%) facilities.

A newsletter on infectious disease, including HIV/AIDS surveillance data, was released.

Surveillance data analysis was enhanced through better coordination and management of data collection activities.

The inmate survey was administered in late spring-summer 2007. Preliminary results are currently under review/analysis. Implications for policies and programs will be determined in 2008/09.

Explanation of variance ($1.2M): Challenges in recruitment activities have had implications for overall capacity to use resources. The creation of the Public Health Branch will give CSC a firm base from which to further solidify HIV/AIDS activities under the Federal Initiative.

Comments on Variances:  See individual program responses to variance

Results to be Achieved by Non-federal Partners: Major non-governmental stakeholders are considered full partners in the Federal Initiative to Address HIV/AIDS in Canada. Their role is to engage and collaborate with all levels of government, communities, other non-governmental organizations, professional groups, institutions and the private sector to enhance the Federal Initiative to Address HIV/AIDS in Canada's progress on all outcomes identified above.

Contact Information:  Dr. Howard Njoo   613-948-6799    howard_njoo@phac-aspc.gc.ca

Description of the Horizontal Initiative (including funding agreement): Canada is facing the potential for two major, inter-related animal and public health threats: the potential spread of avian influenza virus (H5N1) to wild birds and domestic fowl in Canada and the potential for a human-adapted strain to arise, resulting in human-to-human transmission, potentially triggering a human influenza pandemic. A coordinated and comprehensive plan to address both avian and pandemic influenza is required.

In 2006 the Health Portfolio received $422 million over 5 years (2006-07 to 2010-11) and $64 million per year ongoing to improve preparedness for avian and pandemic influenza. The bulk of the initiatives are ongoing. Initiatives are being launched in the areas of vaccines and antivirals; surge capacity; prevention and early warning; emergency preparedness; critical science and regulation; risk communication; and inter-jurisdictional collaboration. Efforts also will be undertaken to fill gaps in Aboriginal on-reserve planning and preparedness and to enhance federal capacity to deal with an on-reserve influenza pandemic.

Under the umbrella of "Preparing for Emergencies", in 2006 the Canadian Food Inspection Agency (CFIA) was allocated $195 million to be spent over 5 years (2006-07 to 2010-11) and $30 million per year ongoing to enhance Canada's state of Avian Influenza preparedness. Canada's Avian Influenza Working Group was established in 2006 to update policies, protocols, operating procedures, and systems to enhance Canada's state of preparedness—through collaborations and partnership – in 5 pillars of strategies and processes for prevention and early warning, emergency preparedness, emergency response, recovery, and communications.

Shared Outcome(s): These initiatives will allow the federal government to strengthen Canada's capacity to prevent and respond to immediate animal health and economic impacts of avian influenza while increasing preparedness for a potential pandemic. Greater Protection for Canadians will come about with improved vaccines and antivirals, improved emergency preparedness, and increased surge capacity to better address peak periods, as well as through critical science and regulation processes in the area. There will be enhanced on-reserve planning and preparedness and improved federal capacity to deal with an on-reserve pandemic. Response Speed and Understanding will be enhanced through prevention and early warning measures, risk communication and inter-jurisdictional collaboration.

Governance Structure(s): In January 2008, the Agency, Health Canada (HC), the Canadian Institutes for Health Research (CIHR), CFIA finalized The Avian and Pandemic Influenza Preparedness Interdepartmental/Agency Governance Agreement. The primary scope of this agreement is the management of specific horizontal issues and/or initiatives stemming from the $1 billion for avian and pandemic influenza preparedness emanating in Budget 2006. This agreement is supported by a structure that falls within the auspices of the Deputy Ministers” Committee on Avian and Pandemic Influenza Planning (CAPIP).The implementation of this agreement is led by the Avian and Pandemic Influenza Assistant Deputy Ministers Governance (API ADM Governance) Committee focussing on the implementation of funded initiatives. An Avian and Pandemic Influenza Operations Directors General (APIO DG) Committee supports the API ADM Governance Committee, makes recommendations to it and oversees the coordination of initiatives. The APIO DG committee keeps the DG Steering Committee under the CAPIP informed of its activities as well as through cross membership. The APIO DG Committee is chaired by the Agency and CFIA and its members include DG level representatives from HC and CIHR and chairs of established working groups. Working groups are established for areas that cross departmental/agency activity. Working groups report to the API ADM Governance Committee through the APIO DG Committee.

Federal Partners

Federal Partner Program Activity

Names of Programs for Federal Partners

Total Allocation (from start to end)

Planned Spending for 2007-08

Actual Spending for 2007-08

Expected Results for 2007-08

Results Achieved in 2007-08

1. Public Health Agency of Canada

Disease Prevention and Control

a.  Vaccine readiness and clinical trials

ongoing

$21.0 M

$1.2 M

Support for expanded production capacity and production of clinical trials of a mock H5N1 vaccine will help ensure timely availability of a safe and effective vaccine to all Canadians in the event of a pandemic, helping to reduce the extent of illness and death. Improved vaccine adverse event reporting for both annual flu vaccine campaigns and the use of a vaccine in a pandemic will allow a timely response to any adverse effects and increase public confidence in Canada's public health system.

Supported the expanded production capacity for vaccines:
• Worked with vaccine manufacturer to increase production capacity as per contractual arrangements. (Manufacturer now has the technology in place to produce the vaccines needed by Canadians in the shortest time technologically possible at this time.); and
• Performed regular reviews of contract to ensure continuity of production capacity.

Work on the design and conduct of clinical trials of a mock H5N1 vaccine: started clinical trials of mock vaccine.

Used real-time vaccine safety and effectiveness pilot studies during the regular annual influenza season to increase capacity to gather knowledge and evidence for use during a pandemic:
• Conducted real time safety and effectiveness post-market surveillance studies of the influenza vaccines at 4 study centres across Canada. (Results of the surveillance study were shared informally within the Federal/Provincial/Territorial (F/P/T) Vaccine Vigilance Working Group and arrangements were made to share results with vaccine regulators at HC); and
• Used the study to perform exercises to enhance capacity to conduct post-marketing field studies – a requirement during a pandemic episode.

Disease Prevention and Control

b.  Rapid vaccine development and testing

ongoing

$1.0 M

$0.5 M

Enhanced domestic ability for research and development of vaccines for novel influenza viruses and other emerging infectious diseases and an improved body of knowledge will contribute to the development of new strategies for influenza vaccines, which will help allow a more timely and effective response to future influenza threats.

Work on enhanced domestic ability for research and development of vaccines for novel influenza viruses and other emerging infectious diseases:
• Helped Canada's major vaccine manufacturer to upgrade their technology to allow production of the vaccines needed by Canadians in the shortest time technologically possible at this time.

Emergency Preparedness and Response

c.  Contribution to National Antiviral Stockpile

ongoing

$53.1 M

$40.1 M

An increased national stockpile of antivirals for the use of health care professionals/institutions will allow treatment to all Canadians who need it, helping to bridge the gap until a pandemic vaccine can be produced and thereby reducing the number of deaths in the event of a pandemic.

Increased the national stockpile of antivirals and strengthened response potential through diversification:
• Increased the National Antiviral Stockpile to 53.7 M doses; and
• Diversified the National Antiviral Stockpile by including 2 different types of antiviral medications.

Emergency Preparedness and Response

d. Additional antivirals in NESS

$12.5 M

$12.5 M

$21.9 M

An antiviral reserve beyond the national antiviral stockpile will give the Government of Canada the flexibility to support the initial containment of a potential pandemic influenza outbreak, either domestically or abroad, to backstop P/T efforts against an outbreak or to provide appropriate protection to federal employees, therefore ensuring a more timely and effective response to a pandemic situation and better protection of Canadians.

Built-up an antiviral reserve beyond the National Antiviral Stockpile:
• Received 5 million doses of Tamiflu and 4 million doses of Relenza.

Disease Prevention and Control

e. Capacity for Pandemic Preparedness

ongoing

$4.9 M

$3.6 M

Strengthened capacity and a central focal point for pandemic issues will allow the Agency to provide more effective leadership, coordination, advice to the Minister and collaboration on avian and human influenza issues across the Government, with provinces and territories, across sectors and internationally. More specifically, strengthened capacity for the Agency in F/P/T liaison, policy analysis and executive briefing will allow for more timely identification of issues and responsive decision making in a changing environment. Enhanced support will allow the F/P/T Communicable Disease Control Expert Group to deliver on its mandate, support the several Pandemic-related issue groups which report to it and continue work on new strategic initiatives (e.g. National Policy Recommendations on Antivirals for Prophylaxis, updating the Canadian Pandemic Influenza Plan, and developing a Cross-sectoral Avian Influenza Response Plan). Finally, strengthening the Agency's correspondence function will allow more timely replies to address the influenza-related concerns of Canadians.

Strengthened the Agency's capacity to provide more effective leadership, coordination, advice to the Minister and collaboration on avian and human influenza issues across the Government, with provinces and territories, across sectors and internationally: 
• Conducted professional and public consultation on the use of antivirals and published findings;
• Had the Task Group on Antiviral Prophylaxis (TGAP); (1) review multiple considerations, including scientific evidence, and (2) make recommendations for the use of antivirals for prophylaxis during a pandemic.  Advanced the TGAP recommendations by gaining approval from the Public Health Network Council and Council of Deputy Ministers of Health and have placed them as an item for approval at next (FY2008-09) F/P/T Ministers of Health Meeting;
• Provided $1 million to the Global Action Plan through World Health Organization (WHO) to increase the international supply of pandemic influenza vaccines;
• Assisted WHO in its pandemic influenza program by providing expertise through participation on the Advisory Committee to WHO Director General and the WHO Global Health Security Action Group on pandemic influenza;
• Worked on the implementation of the August 2007 Agreement signed by Canada, Mexico and the United States that approved a North American Plan for Avian and Pandemic Influenza;
• Reviewed the Canadian Pandemic Influenza Plan for the Health Sector (CPIP) and identified areas for updating in FY 2008-09 following expected policy announcements and new guidance from the WHO;
• Provided leadership in the revision/updating of three technical annexes of the CPIP, specifically the annexes dealing with clinical care, laboratory issues, and pandemic vaccine. Facilitated appropriate consultation with F/P/T colleagues and technical experts and oversaw progress through the briefing and approval process; and
• Reviewed and approved the inclusion of a new technical annex in the CPIP on the role of Emergency Social Services in pandemic preparedness and response.

Disease Prevention and Control

and

Strengthen Public Health Capacity

f. Surveillance Program

ongoing

$8.5 M

$3.9 M

Improved the interoperable components of the Canadian public health surveillance system. This improved reach into a broader range of settings/issues such as surveillance in health care settings and ensuring the safety of the blood supply. This system, supported by a robust systems platform, new and/or improved policies and information sharing agreements, and the efficient analysis and interpretation of the data collected will allow more timely identification of potential outbreaks. This moves towards a more effective response and thus reducing illness and death in the event of an avian influenza outbreak or human pandemic.

Enhanced the National Immunization Strategy (NIS):
• Assisted with the interim evaluation of the NIS. Final report was presented to Canadian Immunization Committee and will be presented to the Agency Evaluation Committee in fiscal year 2008-09.

Establishment of a National Vaccine Supply strategy through the F/P/T Vaccine Supply Working Group: No progress in fiscal year 2007-08.

Expanded the reach of the surveillance system:
• Completed recruitment process for 4 positions;
• Held consultations with multiple stakeholders on enhanced surveillance and arranged for these to be ongoing; and
• Arranged for joint (HC and the Agency) assessment of the feasibility of enhancing surveillance capacity in First Nations communities.

Educated/Prepared front-line workers (physicians and public health professionals) in surveillance (rapid detection) and response to an Influenza Pandemic:
• Negotiated and signed a multi-year contract with Canadian Public Health Association for the development of an internet course on the Management of Infectious Disease Outbreaks for front-line clinicians with a planned launch in fiscal year 2008-09 and developed an agreement with Public Health Network Council and Canadian Council of Ministers of Health to make this course available to front-line clinicians;
• Drafted the core competencies for management of infectious diseases.  Once finalized they will be recommended for integration into the health professional core curricula; and
• Worked on developing partnerships for social marketing;

Developed surveillance systems through collaboration with provinces and territories on a number of projects:
• Through both the Canadian Immunization Committee and the Pandemic Influenza Committee a collection of surveillance/related activities were implemented;
• Through both the Canadian Immunization Registry Network and Canada Health Infoway new standards were established for immunization registries and a new national registry, Panorama, will be rolled out in fiscal year 2008-09;
• Established the Vaccine Working Group of the Canadian Immunization Committee.  Standard Operating Procedures for adverse event reporting were developed. Procedures are awaiting F/P/T approval;
• The Agency continued to participate in design and development work related to Infoway's Panorama tool.  This direct participation is a follow-up from the previous year's item on the development of options to address gaps in readiness for the deployment of EHRs and their related components;
• It supported the integrated public health information system (iPHIS) and undertook necessary enhancements such as the improved capability to extract pertinent data thereby enhancing its robustness and ensuring that jurisdictions using it are ready for its optimal usage while responding to any outbreaks and health emergencies; and
• An Agency-wide Surveillance Strategic Plan was developed including the creation of governance bodies and a corresponding multi-year work plan to address areas of concern (integrated surveillance, knowledge management, partnerships and collaboration, evaluation).

Ongoing surveillance:
• Of infectious diseases in Canada and in the international environment including the regular review of applicable scientific evidence.

Tested surveillance systems through the following activities:
• With HC conducted a survey to assess respiratory illness surveillance on outbreak management in First Nations communities. Will be reported in fiscal year 2008-09; and
• Supported an evaluation of the Respiratory Virus Detection Surveillance System (RVDSS) that will be reported on in fiscal year 2008-09.

Emergency Preparedness and Response

g. Emergency preparedness

ongoing

$15.1 M

$11.1 M

A more robust, efficient, effective response to a human influenza pandemic through improved communications, integrated and tested plans, and improved local capacity will result in reduced mortality and morbidity among Canadians, and demonstrate Government of Canada leadership and foresight in the event of an avian or pandemic influenza outbreak.

Three exercise activities related to pandemic influenza were developed and exercised:
• The first, exercise judicious alert was developed and presented for the Public Health Network Council to test communications and notification mechanisms during the initial period of an influenza pandemic;
• The second was a Ministerial level exercise named Exercise Noble Exchange; and
• The third was a pandemic influenza toolkit that was developed in partnership with the provinces and territories to provide them with the means necessary to develop their own pandemic exercises.

Quality control was exercised over the stockpile of critical counter measures stored in order to respond to all hazard type events:
• The rotation, replacement of expired drugs and replacement and/or refurbishment of medical devices and supplies in the NESS;
• The purchase of any outstanding supplies required for the NESS to meet a 20% surge capacity such as medical devices and personal protective equipment; and
• The engagement of the product manufacturer to test for shelf-life extension of NESS antivirals.

Emergency Preparedness and Response

h. Emergency human resources

ongoing

$0.4 M

$0.2 M

A viable response plan for the HR capacity of the Agency and effective operational support to meet Agency requirements during a health crisis will allow the quick mobilization of Agency staff members in the event of a health crisis. Supporting preparedness measures will ensure that the Agency's services to Canadians can continue uninterrupted in the event of a public health emergency, reinforcing public confidence in the Canadian health system.

Work towards development of a response plan for the HR capacity of the Agency and the effective operational support needed to meet Agency requirements during a health crisis included:
• Drafting a Human Resource Emergency Plan,
• Initiating the planning to test the feasibility of the HR Emergency Plan with simulation exercises, and
• Staffing two positions within HR Operations to assist in pandemic preparations (hiring was completed).

Disease Prevention and Control

i. Winnipeg lab & space optimization

ongoing

$13.7 M

$6.1 M

Additional biocontainment research space will allow additional efforts on diagnostic testing and research on avian and human influenza, resulting in more timely identification of a pandemic virus and a better understanding of its characteristics, thus helping to reduce illness and death in the event of an outbreak or pandemic.

Acquisition of additional biocontainment research space activities included:
• Acquisition of the Ward Lab in Winnipeg, Manitoba;
• Developed plans for retrofit and initiated the work;
• Initiated preliminary programming and design of the Ward Lab to match specific needs of selected future occupants;
• Appointed PWGSC project manager of the physical retrofit; and
• Arranged for PWGSC to have a contractor assume responsibility for the building physical plant.

Disease Prevention and Control

j. Strengthening the public health lab network

ongoing

$4.7 M

$5.8 M

An increased and better linked and coordinated capacity across jurisdictions for laboratory diagnostic testing, with a focus on antiviral, immunization and surveillance issues, will help to ensure the more timely identification of new or emerging viruses, allowing a pandemic virus to be more quickly isolated so that vaccines and more effective treatment options can be developed, thus reducing illness and death in the event of an avian influenza outbreak or human pandemic.

Work performed by the Canadian Public Health Laboratory Network through its Pandemic Influenza Laboratory Preparedness Network included:
• Consultations with Pandemic Influenza Committee working groups (antiviral, surveillance, vaccine efficacy, public health measures, and clinical care) to plan laboratory support in terms of diagnostic testing during a pandemic;
• Developed components of the Laboratory Annex (Annex C) of the Canadian Pandemic Influenza Plan as well as operationalized details within the Pandemic Business Continuity Plan for laboratories;
• Developed Severe Respiratory Infection Requisition Sheet (for triaging of specimens);
• Defined Laboratory Specimen Rejection Criteria (for triaging of specimens);
• Published a technical paper on use of Point of Care  (POC) testing (to provide guidance on POC testing kits);
• Established the Minimum Laboratory Diagnostic Requirements to create a minimum standard of technical requirements for influenza diagnostic testing; and
• Surveyed laboratory diagnostic capability and capacity to gauge preparedness of Canadian public health labs for diagnostic testing capability, capacity, and understanding of their roles during a pandemic.

Disease Prevention and Control

k. Influenza research network

ongoing

$7.1 M

$3.8 M

Improved decision-making respecting pandemic preparedness, control and treatment through systematic identification of research priorities along with mechanisms to rapidly generate research findings and promote access to and utilization of new knowledge through effective translation strategies.

Advanced the establishment of national public health research priorities in partnership with the Canadian Association for Immunization Research and Evaluation (CAIRE) and other research partners: No progress made in fiscal year 2007-08
Improved decision-making respecting pandemic preparedness, control and treatment through systematic identification of research priorities:
• Led a consultation with CIHR, Canadian Food Inspection Agency and HC that built on the 2005 Influenza Research Priorities Workshop to develop a multi-year, priority-driven research agenda; and
• Concluded agreement to invest $5.5 M in research in collaboration with CIHR in key research areas of vaccine and antiviral use, prevention of influenza transmission, and fostering compliance with public health control measures.

Developed the Influenza Research Network:
• Launched Request for Applications for the Establishment of an Influenza Research Network; and
• Reached agreement with CIHR to invest $10.8 M over 3 years in the Influenza Research Network starting fiscal year 2009-10.

Improved decision-making by promoting access to and utilization of new knowledge results translation initiatives:
• Initiated planning process for first Annual Meeting of Researchers and End-Users of Research Findings. (Scheduled for November, 2008); and
• Initiated with HC planning for the first First Nations, Inuit and Métis Health Research Meeting planned for fiscal year 2008-09.

Disease Prevention and Control

l. Pandemic influenza risk assessment & modelling

ongoing

$0.7 M

$0.4 M

An improved federal capacity for mathematical modelling, statistical analysis, and operations research on pandemic influenza issues will allow a better understanding of the spread of influenza and the effect of epidemics or pandemics on Canadians, allowing timelier and evidence-based decision making on public health responses. This will help reduce the extent of illness or death in the event of an avian influenza outbreak or human pandemic.

Work to improve federal capacity for mathematical modelling, statistical analysis, and operations research on pandemic influenza issues:
• Augmented the modeling team with a senior mathematician and additional graduate students with specializations in spatial statistics/mathematical modeling; 
• Continued and expanded the Synchrony, Waves & Spatial Spread of Influenza in Canada project;
• Developed models and methods based to address emerging issues will focus on vaccination strategies, societal and economic impacts, cost/benefit analyses and disease burden impacts;
• Augmented capacity for real-time modelling for pandemic events;
• Strengthened the national modeling and analysis research network with international linkages (i.e., WHO and CDC) on topics of evidence-based decision-making and results translation;
• Published several scientific reports in peer-reviewed international journals on the use of mathematical modeling to evaluate intervention effectiveness;
• Conducted international workshops on operational research in public health as it applied to the prevention and control of pandemic influenza;
• Conducted, in collaboration with academic partners, multiple training sessions on the use of modelling in public health, including one at the US CDC; and
• Produced in-house publications on modeling and on analysis of transmission patterns and disease trends, evaluations of control effectiveness, risk assessments of potential emerging drug-resistant strains and their transmission patterns, and on operations research.

Disease Prevention and Control

m. Performance and evaluation

ongoing

$0.6 M

$0.4 M

Collection of relevant information to effectively measure the design, management, implementation, and impact of the Pandemic Influenza Strategy. Future evaluation activities and outcomes will contribute to decision making that reflects best practices and ensures value for money, thereby ensuring that avian and pandemic influenza preparedness measures are providing Canadians with the protection they need and reinforcing public confidence in Canada's public health system.

Prepared for the development and implementation of systems to collect relevant information for evaluation:
• Established an inter-departmental evaluation working group;
• Drafted the Evaluation Framework, the Performance Measurement Framework, and the Evaluation Plan; and
• Completed a viability study for technology-based data management systems.

Disease Prevention and Control

n. Pandemic influenza risk communications Strategy

ongoing

$1.8 M

$2.0 M

Accurate and timely information in the event of a pandemic, along with enhanced networks and tools for dissemination, will provide Canadians with the protection they need, and support the federal government's leadership role, credibility, and authority with citizens and partner organizations, thereby helping to reinforce public confidence in Canada's public health system, before, during, and after a pandemic situation.

Continued to advance the Agency's risk communications strategy to ensure consistent and accurate messaging on pandemic preparedness in response to Canadians and stakeholders:
• Conducted a national follow-up survey on Canadians’ attitudes and awareness levels about pandemic influenza;
• Completed a deliberative dialogue process with citizens and stakeholders on the use of antivirals for prevention during an influenza pandemic as part of a larger F/P/T process to develop national recommendations on this issue;
• Initiated the development of an F/P/T communications operational plan to facilitate coordinated communications among jurisdictions during an influenza pandemic or comparable public health emergency;
• Advanced the development of a public guide for preparing for seasonal and pandemic influenza;
• Developed and focus-group tested ad concepts for television, radio, print and Internet to be used during an influenza pandemic;
• Established a national direct mail strategy and purchased the paper for distributing information to every household in Canada within 48 hours in the event of a pandemic or comparable public health emergency;
• Developed a pan-Canadian social marketing framework for pandemic influenza in cooperation with F/P/T counterparts;
• Initiated the development of a strategy to implement a Geospatial Information System mapping tool for the website that will make a range of information available to Canadians, health professionals and other stakeholders during an influenza pandemic or comparable public health emergency;
• Developed a comprehensive media relations plan and a media relations table top exercise with F/P/T partners to test readiness for an influenza pandemic; and
• Advanced work with international stakeholders, including the Global Health Security Action Group, the Security Prosperity Partnership, and the WHO, that included common message development and communications planning.

Disease Prevention and Control

o. Skilled national public health workforce

ongoing

$4.3 M

$2.0 M

A strengthened public health workforce in both competencies and numbers, both within the Agency and elsewhere in Canada's public health system (e.g. F/P/T and local public health offices), with a focus on professional development to address key P/T and local gaps in the planning, surveillance and management of diseases, risks to health and emergencies, which will result in more timely detection and effective management of a range of disease outbreaks, including those related to avian or pandemic influenza, reducing the extent of illness and death in the event of a pandemic.

Established the Canadian Public Health Service (CPHS) to address public health gaps in Canada in order to have effective planning and preparedness for a pandemic.  Gaps were addressed through the placement and continuous training and development of Public Health Officers (PHO):
• Held consultations in all provinces and territories to develop and establish the  CPHS;
• Developed CPHS promotion material including a web site through which proposals for PHO placement sites could be received;
• Established an Advisory Working Group to assist in the evaluation of placement site proposals;
• Established a link with several the Agency recruitment programs to support upcoming CPHS hiring requirements;
• Provided input and support to select the Agency training initiatives related to pandemic planning and other public health preparedness and response initiatives that could link with the planned PHO training in 2009;
• Established linkages to existing recruitment and placement initiatives to hire the 24 planned PHOs that resulted in 1 PHO placement and initiation of 5 others; and
• Developed protocols and piloted communication with universities to place graduate students in remote locations across Canada.  This led to 5 placements.

2. HC

a. Regulatory activities related to Pandemic Influenza Vaccine

Ongoing
(Ongoing status effective starting FY 2010-11 w/ $1.2 M)

$1.4 M

$1.1 M

By end of 2007-08 new laboratory tests and assays will be implemented for the evaluation of pandemic influenza vaccine, permitting more rapid access to a vaccine against the new pandemic strain of a virus.
By the end of 2007-08 HPFB will have addressed any gaps identified during the WHO assessment visit of National Regulatory Authority for vaccines completed in January 2007 [WHO is conducting an assessment in order to pre-qualify vaccines which will be purchased by UN agencies.] WHO has discussed a separate pandemic pre-qualification as part of the international initiative on regulatory preparedness.
Interim orders for regulations will have been developed for a variety of scenarios. These orders will be ready for implementation when needed upon the declaration of a pandemic

• Methods for testing vaccine lots have been vastly improved in collaboration with the WHO. This has ensured higher standards of safety and efficacy of the pandemic vaccines.
• A formal agreement with the Agency has been established in order to improve post market vaccine surveillance for adverse reactions. This will provide an enhanced ability to take quick actions regarding product warning and public advisories.
• Collaborated with WHO in the pre-qualification assessment of a Canadian company for WHO supply of a vaccine.
• Mechanisms for rapid and bulk release of pandemic vaccines have been developed down to the operational level of appropriate interim orders. Progress on the drafting of interim orders is continuing.

b. Resources for review and approval of antiviral drug submissions for treatment of pandemic influenza

Ongoing
(Ongoing status effective starting FY 2010-11 w/ $0.2 M)

$0.3 M

$0.2 M

HC will develop an "accelerated review process" based on the current review process models and will apply this new process for reviewing the influenza drug submissions. This accelerated review process will be posted on our regular channels of communication, including on the Web, as a guidance document to the Industry. The reviewers will be trained on the aspects of the "accelerated review".

• Draft version of “Expedited Pandemic Influenza Drug Review” (EPIDR) protocol has been completed. Internal consultations and issue analysis are continuing prior to external stakeholder consultations.
• In collaboration with the Agency, a mechanism for analysis of shelf-life of the antiviral stockpile such as Tamiflu and extension of expiry date is being developed. This has improved stockpile management overall.
• Provided comments on various pandemic preparedness documents.
• Attended various technical conferences to gather intelligence.

c. Establishment of a crisis risk management unit for monitoring and post market assessment of therapeutic products

Ongoing (Ongoing status effective starting FY 2010-11 w/ $0.3 M)

$0.3 M

$0.3 M

Emergency preparedness plans specific to pandemic influenza will be put into place for dealing with staff shortages and lack of trained personnel for pharmacovigilance and product vigilance.
Strategies will be developed for expedited surveillance, assessment and risk communication for antivirals and other relevant health products.
Recruitment and cross training of existing staff will provide for a limited incremental increase to risk surveillance/assessment/management capacity to deal with anti-viral adverse reaction information.
Communication links with federal, provincial/territorial and other stakeholders will be established.

• Draft Pandemic Annex to the Business Continuity Plan for Marketed Health Products Directorate (MHPD) at HC has been developed.
• Table top exercise of Pandemic Annex was conducted in December 2007.
• Work by MHPD Pandemic Planning Working Group to further develop the Pandemic Annex is ongoing.
• Draft Standard Operating Procedures (SOPs) have been developed for expedited receipt, processing, and analysis of Adverse Reaction (AR) reports for antiviral drugs and other health products that will be used for the prevention or treatment of a pandemic strain of influenza.
• Processes for risk communication of antiviral safety information have not yet been formalized, but the key stakeholders have been identified and this will be undertaken in 2008-09.
• Crisis Management Unit was staffed with one dedicated FTE (MOF 02) in January 2008.  Work has been ongoing to staff currently available positions (non-pandemic specific) within MHPD, so as to build a resource base that will allow for surge capacity and cross training where applicable.
• Linkages with key federal, provincial/territorial and other stakeholders have been established via the Antiviral Implementation Strategy Working Group, under the aegis of the Agency.  MHPD has presented to stakeholders and provided informational materials on how to report ARs for pandemic related products
• Further work is underway to increase communication with these key stakeholders.

d. FN/I Surge Capacity

$1.48 M (2007-08 to 2009-10)

$0.7 M

$0.7 M

Development and delivery of an effective and appropriate training package for FN/I communities will allow them to build an increased capacity to respond to avian influenza or a human pandemic with the health care workers already in those communities, helping to ensure a more rapid identification of and immediate response to any outbreaks, and thus reducing illness and death in the event of a pandemic.

• Pandemic planning presentations were delivered in all Regions at the community level. Nurses, CHR, home and community care nurses and workers along with Tribal council members attended the pandemic planning presentations.
• Each Region conducted an informal needs analysis for education and training gaps.
• All Regions have developed or adapted pandemic influenza educational materials such as posters for health centres and nursing stations, self-care booklets, infection control posters, hand washing posters, pandemic preparedness checklists and manuals on how to develop and write pandemic plans.

e. Strengthening Federal Public Health capacity

Ongoing

$0.7 M

$0.7 M

Enhanced capacity to deal with outbreaks/emergencies in FN/I communities, along with strengthened links to other public health and emergency preparedness actors, will allow a more timely response to avian/pandemic influenza outbreaks in these communities, thus reducing illness and death in the event of a pandemic.

• Developed strong collaborative relationships at all levels with key partners and stakeholders including the AFN and Inuit Tapiriit Kanatami (ITK), as well as other government departments and agencies (INAC, PSC and the Agency) to ensure integration, seamless response, and interoperability to public health emergencies.
• Formalized Health Emergency Management agreements, processes and systems inclusive of FN/I interests have been reached or fully implemented in several jurisdictions.
• Collaborated with the Agency’s National Office for Health Emergency Response Teams to ensure a coordinated response to health emergencies.
• Collaborated with the Agency and discussed creating a pilot project for Flu-watch.

f. First Nations & Inuit emergency preparedness, planning, training and integration

ongoing

$0.4 M

$0.4 M

Completed, tested, and maintained pandemic influenza preparedness plans in all FN/I communities, along with established emergency management communication pathways among local communities and health authorities, regional, provincial and national partners and stronger linkages with federal efforts will ensure a more effective response in the event of an outbreak in an FN/I community, and thus contribute to reduced illness and death in the event of a pandemic.

• Approximately 400 FN/I communities have developed a pandemic plan. Nearly half of these have been table-top tested.
• Ongoing collaboration and coordination with the provinces, other federal departments, local public health authorities, and regional and national Aboriginal organizations to ensure that FN/I considerations are taken into account in preparing for and responding to a public health emergency.
• Continued work between the Agency, HC's First Nations and Inuit Health Branch and the Assembly of First Nations (AFN) to develop pandemic preparedness and responses, with activities categorized to align with the Canadian Pandemic Influenza Plan.

g. Public health on passenger conveyances

ongoing

$0.1 M

$0.4 M

A trained and prepared cadre of EHOs and other partners at points of entry will help to ensure more timely detection, identification and remediation of avian or pandemic influenza as public health threats onboard conveyances or at ancillary service sites, thereby helping to reduce illness or death in the event of a pandemic. These measures also help improve Canada's compliance with the International Health Regulations, although some gaps will still be present.

• Designated Environmental Health Officers (EHOs) under the Quarantine Act doubled in the second year of Pandemic funding;
• Developed training materials. Delivered basic and enhanced training to all designated EHOs;
• Developed and engaged in ongoing planning and protocol improvements for HC EHOs and other qualified resources;
• Created active partnership with the  Agency’s Quarantine Program in place to provide a cohesive response capacity;
• Established contacts and agreements with other federal departments, jurisdictions and stakeholders (this in progress); and
• Participated on or lead working groups on preparedness.

3. CIHR

Pandemic Preparedness Strategic Research Initiative

a. Influenza research priorities

$21.5 M (2006-07 to 2010-11)

$2.5 M

$2.1 M

Review and fund second round of research projects.

• Peer reviewed a total of three funding opportunities, including two team grant funding opportunities, one operating grant funding opportunity and one catalyst funding opportunity. A total of 15 grants were approved and funded.

Launch additional request for research proposals, if needed.

• Worked with collaborators and partners to develop and launch four new targeted funding opportunities focused on public health and outbreak research.

Hold first meeting of funded researchers and stakeholders to facilitate networking and consultation.

• Constituted the organizing committee and began planning the first annual meeting to be held on November 6-8, 2008.

4. CFIA

a. Animal Vaccine Bank

ongoing

$0.5 M

$1.0 M

Preparedness for the possible use of poultry vaccination as a disease control tool during an avian influenza outbreak in order to control avian influenza in animals and prevent its spread to humans.

• Established a Canadian avian influenza vaccine bank of 10 million doses of both H5 and H7 subtypes:
    • 5 million doses of H5N3 subtype killed virus;
    • 5 million doses of H7 subtype killed virus: H7N2 and H7N3
• Discussions took place with USDA concerning mechanisms to access additional supplies of Avian Influenza (AI) vaccine if needed as one of the Security Prosperity and Partnership initiatives.
• Discussions started on what to do with existing vaccine bank supplies prior to current expiry date of July 2009.

b. Access to Antivirals

ongoing

$0.1 M

$0.2 M

Development of protocols and strategies to provide access to antivirals to enhance the Government of Canada's flexibility to support the initial containment of a potential avian influenza outbreak and provide appropriate protection to federal employees. This would ensure a more timely and effective response to an avian influenza situation and better protection of Canadians.

• Completed protocols to acquire, access and implement use of antivirals. Additional supplies of antivirals to be purchased annually to add to the existing bank.

c. Specialized Equipment

$33.7 M (2006-07 to 2008-09)

$8.2 M

$1.2 M

Investments to provide ready access to specialized supplies and equipment to enhance capacity and allow a more timely and effective response to possible avian influenza outbreaks, containing the spread and contributing to better protection of Canadians.

• Completed the acquisition of Mobile Telecommunications Vehicles for each of the areas which would allow for on-site coordination in the event of an emergency. The vehicles are being deployed.
• The national stockpile inventory continues to be maintained and augmented as necessary. This stockpile gives ready-access to necessary equipment and supplies within hours of a declared emergency.
• Four Modified Atmospheric Chambers, for the humane destruction of infected poultry, have been constructed and delivered.
• Specifications were developed for emergency response equipment trailers.  A prototype has been purchased and is being evaluated.  
• A transportable gasifier (mobile incinerator) prototype was developed with collaboration of US Department of Homeland Security and USDA – EPA. The testing of the prototype was done in North Carolina and proof of concept testing results are being analysed.

d. Laboratory Surge Capacity and Capability

ongoing

$9.7 M

$6.8 M

Development of increased and better linked and coordinated capacity across jurisdictions for laboratory diagnostic testing to help ensure the detection of AI as early as possible.

• Good progress has been made in implementing the Canadian Animal Health Surveillance Network.  Training has been carried out.  Laboratories have been equipped.  Progress has been made in implementing QA systems and in retrofitting the network labs to meet containment standards.

e. Field Surge Capacity

ongoing

$1.2 M

$3.8 M

Development of a viable response plan for urgent needs to increase HR capacity to respond to emergency animal disease and emergency response situations.

• Operations Branch Management Services worked on the development of a human resources skills inventory.  In the event of an emergency, there will be one centralized information source to identify appropriately trained individuals to respond to the event.
• Operations Branch Management Services also worked with the Canadian Veterinary Medical Association on the development of the Canadian Veterinary Reserve to increase specialized capacity in the event of a large scale emergency.
• Retired CFIA staff have been identified to return to active duty during an emergency disease outbreak as required.

f. National Veterinary Reserve

ongoing

$2.7 M

$0.6 M

Establishment of a reserve of professional veterinarians to enhance domestic and international surge capacity, expertise and rapid response capability for animal disease control efforts.

• A Canadian Veterinary Reserve was established in partnership with the Canadian Veterinary Medial Association to increase specialized capacity in the event of a large scale emergency. A total of 340 applications were received and 140 reservists have received initial training.  It is anticipated that an additional 130 reservists will be trained within 2008-09.

g. Enhanced Enforcement Measures

ongoing

$1.5 M

$2.1 M

Increased capacity to support enhanced screening procedures for live birds or poultry products at Canada's ports of entry to mitigate the risk of future avian influenza outbreaks in Canada.

• An ongoing border lookout, within the CBSA system, for products that could vector AI from countries known to have the disease, has been implemented.

h. Avian Biosecurity on Farms

ongoing

$6.8 M

$1.9 M

Implementation of the National Avian Biosecurity Strategy (NABS) including on-farm biosecurity standards, flock management, governance, and stakeholder engagement to mitigate the introduction or spread of avian influenza and build a foundation for a sustainable industry that minimizes economic and production losses

• Ongoing work by the Avian Biosecurity Advisory Council (ABAC) comprised of the Office of Animal Biosecurity (AOB) and stakeholder representatives to draft avian on-farm biosecurity standards.
• Ongoing communication and outreach activities to engage stakeholders.
• Projects funded under Avian Biosecurity Technology Development Fund (ABTDF).
• Information sessions held in British Columbia, Ontario and Nova Scotia to provide information to small flock owners about how to protect the health of their birds.
• Produced animated video outlining “Bird Health Basics” for small flock owners.
• Produced 2008 calendar, which included monthly tips on biosecurity and disease prevention for small flock owners.

i. Real Property Requirements

$4.04 M (2006-07 to 2007-08)

$1.4 M

$2.9 M

Investment in real property and accommodation to support efficient work environments and locations to support the CFIA's action plan for AI.

• Investments were made in the fit-up of leased accommodations to support the delivery of AI programs.

j. Domestic and Wildlife Surveillance Program

ongoing

$3.1 M

$3.9 M

Development of a better integrated Canadian surveillance system, supported by a robust systems platform and the analysis and interpretation of the data collected to allow more timely identification of potential outbreaks, and more timely response to avian influenza situations.

• Wild bird surveillance continued which identified a number of low pathogenicity North American strains of avian influenza.
• The 2008-2009 wild bird survey was developed and is underway.
• The work to establish a notifiable avian influenza surveillance program continued with anticipated implementation in 2008-09.

k. Field Training

ongoing

$2.0 M

$1.0 M

Investment in development and delivery of an effective and appropriate training package that will contribute to a skilled and experienced workforce ready to respond to an AI outbreak.

• Three National Training Initiatives are underway: Competency development for Biocontainment Officers - individuals who will provide oversight and process control required to contain the spread of disease during an outbreak; General Biocontainment training – safety and containment training for all CFIA responders allowing them to enter, work on and exit infected premises; and Infection control and basics of disinfection modules – on line training modules designed for all CFIA program staff for use during routine and outbreak work.
• Produced Border Services training video to help officers detect potentially harmful products entering the country.

l. AI Enhanced Management Capacity

ongoing

$1.0 M

$3.4 M

Investment in infrastructure, tools, enhanced emergency management informatics systems and staff training to increase the Agency's capacity to track, monitor and respond to outbreaks; and help provide emergency response teams with the ability to quickly deploy the necessary equipment and resources and to establish a local command centre.

• Mobile Telecom Vehicles (MTVs) were purchased and equipped with the necessary communication tools to enable response teams to set up quickly in the event of an emergency. 
• Training manuals and procedures for the use of the MTV's and associated equipment have been drafted to ensure that responders can quickly and efficiently mobilize the units and establish a command centre in the event of an outbreak. 
• Incident Command System (ICS) training was conducted in support of consistent communication and management in the event of an emergency.

m. Updated Emergency Response Plans

ongoing

$2.5 M

$1.6 M

Update of the comprehensive emergency response plans to strengthened capacity and achieve the desired state of readiness as rapidly as possible. This will allow CFIA to provide more effective leadership and support the provinces and territories and promote an integrated, collaborative response to possible avian influenza issues or outbreaks. Strengthened capacity for the Agency in F/P/T liaison, policy analysis and executive briefing will allow for more timely identification of issues and responsive decision making in a changing environment.

• The Notifiable Avian Influenza Hazard Specific Plan was updated and published on the CFIA website. Work continues to update the plan consistent with the available scientific knowledge. 
• Several exercises were conducted at the field/regional levels to test plans and procedures, along with a national exercise with provincial/territorial and industry partners to clarify roles and communication mechanisms. 
• The Animal Health Functional Plan was reviewed to ensure consistency with the outdated Foreign Animal Disease Manual of Procedures. 
• Work to finalize the two outstanding Foreign Animal Disease Emergency Support agreements continued.

n. Risk Assessment and Modelling

ongoing

$2.7 M

$1.1 M

Investment in an improved federal capacity for mathematical modelling, statistical analysis, and operations research on avian influenza issues will allow a better understanding of the spread of influenza and the effectiveness of disease control measures. These investments will allow more timely and evidence-based decision making on avian influenza responses, thus helping to reducing the risk of transmission to humans and mitigating economic and production losses.

• Risk assessment, science advice and modelling capacities for AI have all been strengthened. 
• A paper was prepared examining illegal bird imports as a possible route of infection for H5N1 into Canada.

o. AI Research

ongoing

$1.7 M

$1.6 M

Investment in an improved federal capacity for mathematical modelling, statistical analysis, and operations research on avian influenza issues will allow a better understanding of the spread of influenza and the effectiveness of disease control measures. These investments will allow more timely and evidence-based decision making on avian influenza responses, thus helping to reducing the risk of transmission to humans and mitigating economic and production losses.

• A research project was commissioned with the University of Guelph on the Humane Euthanasia of the birds in an event of AI outbreak. The research project was designed to test the use of various gas mixtures on different species of birds. A report will be produced on best possible combinations and times to euthanize the birds.
• A databank of Highly Pathogenic Avian Influenza outbreak scenarios using the current model was developed for Canada (Ontario). Data collection on interaction among farms, poultry and wild birds is still taking place. The data is to be used for the development of a method for modelling the contact structure among farms and to improve the existing mathematical model for AI. Work on applicability to other regions continues.

p. Strengthened Economic and Regulatory Framework

ongoing

$1.2 M

$0 M

Strengthened capacity for increased regulatory review including analysis of current legislative/regulatory framework, capacity to address regulatory developments and economic options associated with Avian Influenza outbreaks, and consult with stakeholders, provinces and territories. Increased regulatory review capacity will also support stronger leadership and coordination on Avian Influenza issues across government, provinces and territories, industry and internationally.

• Work to write regulations associated with a Control Area Declaration caused by an animal disease emergency continued.

q. Performance and Evaluation

ongoing

$1.1 M

$1.4 M

Evaluation of activities and outcomes will allow future decision making that reflects best practices and ensures value for money, thereby ensuring that avian and pandemic influenza preparedness measures are providing Canadians with the protection they need and reinforcing public confidence in Canada's food inspection system.

• Funding was used to hire new personnel in the Evaluation and Risk Oversight directorates. The development of the corporate risk profile integrating the management of AI resulted from this hiring. These additional personnel were also mandated to support the internal coordination for the AI projects as well as support the research and writing of various reports.
• An evaluation of the “Be Aware and Declare!” campaign was conducted. It confirmed that participants understood intended messages. Further work is needed to help Canadians understand importation rules.

r. Risk Communications

ongoing

$2.9 M

$2.4 M

A risk communication and public education strategy focussed on AI prevention and preparedness, which engages stakeholders and P/T governments and informs and reassures Canadians, will support the federal government's leadership role, credibility, and authority. It will help to reinforce public confidence in Canada's inspection systems, before, during, and after an avian influenza situation.

• CFIA in partnership with CBSA delivered an advertising and outreach campaign, which included: television, print and online advertisements; posters and the distribution of brochures. CFIA also participated in four exhibit events. 

s. International Collaboration

ongoing

$1.8 M

$2.4 M

Contribution to the global effort to slow the progression of avian influenza in support of Canada's leadership role and international commitments designed to slow the progression of avian influenza.

• Participated in a number of international fora to provide expertise and assistance in developing AI response plans for other countries as well as conferences where international strategies to control AI were discussed.

Comments on Variances:

The Agency

• $12.5 million for the contribution to the National Antivirals Stockpile was reprofiled to 2008-09.
• $6.5 million was reprofiled for the Winnipeg Laboratory and Space Optimization due to delays in negotiating the purchase of the Ward Laboratory with officials from the Government of Manitoba.
• The Agency was not able to complete negotiations with a domestic manufacturer to support expanded vaccine production capacity and production of clinical trials of a mock pandemic vaccine. Negotiations with the manufacturer are on-going. Surplus funding from this component was used primarily to increase the surge capacity of antivirals in the National emergency Stockpile System (NESS) to 12 million doses and to enhance activities related to risk communications and strengthening the public health laboratory network.

There are significant challenges in ramping up human resources capacity which has impeded the Agency’s ability to advance many of the program components for this initiative.

CFIA

An amount of $2.0 million was  transferred to Western Economic Diversification Canada for the International Vaccine Centre's (InterVac) Biosafety Level III Containment Facility in Saskatoon

Contact Information:
Dr. Arlene King
(613) 948-7929

Description of the Horizontal Initiative: The Canadian HIV Vaccine Initiative (CHVI), Canada’s contribution to the Global HIV Vaccine Enterprise, is a collaborative undertaking between the Government of Canada and the Bill & Melinda Gates Foundation to contribute to the global effort to develop a safe, effective, affordable and globally accessible HIV vaccine. This collaboration builds on the Government of Canada’s commitment to a comprehensive, long-term approach to address prevention technologies. Participating federal departments and agencies are the Public Health Agency of Canada, Industry Canada, Health Canada, the Canadian Institutes of Health Research, and the Canadian International Development Agency. The CHVI’s overall objectives are to: strengthen HIV vaccine discovery and social research capacity; strengthen clinical trial capacity and networks, particularly in low and middle income countries (LMICs); increase pilot scale manufacturing capacity for HIV vaccine clinical trial lots; strengthen policy and regulatory approaches for HIV vaccines and promote the community and social aspects of HIV vaccine research and delivery; and ensure horizontal collaboration within the CHVI and with domestic and international stakeholders.

Shared Outcome(s):
Immediate (Short Term 1 - 3 years) Outcomes: Increased and improved collaboration and networking; Enhanced knowledge base; and Increased readiness and  capacity in Canada and LMICs
Intermediate Outcomes: Pilot Scale vaccines clinical trial lot manufacturing is fully operational and globally accessible; Strengthened contribution to global efforts to accelerate the development of safe effective, affordable, and globally accessible HIV vaccines
Long Term Outcomes: The Canadian HIV Vaccine Initiative contributes to the global efforts to reduce the spread of HIV/AIDS particularly in LMICs.

Governance Structure(s): The Minister of Health, in consultation with the Ministers of Industry and of International Cooperation, will be the lead Minister for the CHVI for the purposes of overall coordination. Communications for the CHVI will be handled jointly. In support of the Ministers, coordination for the Government of Canada will be provided by an Interdepartmental Steering Committee consisting of representatives from the participating federal departments and agencies. The Interdepartmental Steering Committee will be responsible for providing strategic directions and priorities and reviewing progress. Multi-stakeholder advisory committees and working groups, involving governments, the private sector, international stakeholders, people living with HIV/AIDS, researchers and NGOs and other relevant stakeholders, will be established to inform the CHVI. The role of participating departments and agencies involved in the CHVI are:

•  The Public Health Agency of Canada contributes its public health scientific, policy and program expertise and provides secretariat support for the CHVI.
•  Health Canada applies its wider range of expertise, including vaccine related policy, regulations and protocols; facilitate collaborative networks of specialists with a particular focus on the community and social dimensions of vaccine research, development and delivery; and enhance international collaborations.
•  Canadian Institutes of Health Research provides scientific leadership and strategic guidance through its linkages to the Canadian research community, as well as brings critical expertise in peer review mechanisms and related professional support services to identify and fund eligible HIV vaccines projects.
•  Industry Canada applies its industry specific knowledge and experience to provide linkages to the Canadian and International vaccine industry, as well as assist with industry-related issues, including the appropriate engagement of potential private sector collaborators.
•  Canadian International Development Agency provides effective linkages to international development efforts and ensures consistency with Canada’s international commitments. Moreover, CIDA will provide strategic guidance to ensure that the goals of the CHVI promote the development and delivery of HIV vaccines that benefit the needs of the highly endemic HIV/AIDS countries in the developing world.

Federal Partners

Federal Partner Program Activity

Names of Programs for Federal Partners

Total Allocation (from start to end)

Planned Spending for 2007-08

Actual Spending for 2007-08

Expected Results for 2007-08

Results Achieved in 2007-08

1. PHAC

Disease Prevention and Control

Public Health Contributions Program

$27 M

$0.9 M

$0.7 M

• Planning, coordination and communications strategy and tools
• Joint consultation on pilot scale HIV vaccine manufacturing facility for clinical trial lots (with CIDA, IC and Gates Foundation) and on Policy Development and Community funding program (with Health Canada)

• CHVI interdepartmental steering committee operational.
• CHVI website developed and launched.
• Stakeholder consultations completed on manufacturing facility (web-based) and on Policy Development and Community Engagement Fund (face to face)

2. HC

Program Activity 1.3 International Health Affairs

Grants to eligible non-profit international organizations in support of their projects or programs on health

$1 M

$0.2 M

$0.2 M

• Provide grants to Canadian and  international organizations involved in HIV vaccines policy development
• Joint consultation on Policy Development and Community funding program (with PHAC)

• Two projects implemented focussing on legal ethical and human rights frameworks and good participatory practices for community involvement in HIV vaccines research
• Stakeholder consultations completed on Policy Development and Community Engagement Fund

3. IC

Strategic outcome: innovative economy.  Program Activity: Industry Sector - Science and Technology and Innovation

N/A

$13 M

$0

$0

• Joint consultation on pilot scale HIV vaccine manufacturing facility for clinical trial lots (with CIDA, PHAC and Gates Foundation)

• Stakeholder consultations completed on manufacturing facility

4. CIDA

Program Activity 1.4, Institutions - Enhanced capacity and effectiveness of Multilateral institutions and Canadian/ International organizations in achieving development goals

International Development Assistance Program

$60 M

$0

$0

• Joint consultation on pilot scale HIV vaccine manufacturing facility for clinical trial lots (with PHAC, IC and Gates Foundation), on Discovery and Social Research (with CIHR) and on Clinical Trial
• Capacity Building and Networks funding program.

• Stakeholder consultations completed on manufacturing facility, discovery and social research and Clinical Trial Capacity Building and Networks funding program

5. CIHR

HIV/AIDS Research Initiative - Program Activity Architecture

HIV/AIDS
Research Initiative

$10 M

$0.5 M

$0.1 M

• Joint consultation Discovery and Social Research (with CIDA).

• Stakeholder consultations completed on discovery and social research

Comments on Variance: N/A

Results to be Achieved by Non-federal Partners: Results to be achieved by Non-Federal Partners) Non-governmental stakeholders (including research institutions and not-for-profit community organizations) are integral to the success of the CHVI. Their role is to engage and collaborate with participating departments and agencies, the Gates Foundation and other funders to contribute to CHVI objectives and to a significant Canadian contribution towards the Global HIV Vaccine Enterprise.

Contact Information:
Steven Sternthal.  Tel: (613) 952-5120