Feds and provinces need to clarify roles and responsibilities, says Ontario’s chief medical officer of health
Dr. David Williams, Ontario’s chief medical officer of health, released his own report in April on the 2008 Listeriosis outbreak.
The report caused some controversy after it was released. The Canadian Food Inspection Agency, the Public Health Agency of Canada and Health Canada, the subjects of the report, have all demanded revisions.
Williams cited the agencies for hampering the investigation, not sharing information with other levels of government, sending samples to incorrect locations and not taking leadership roles.
Williams’ report says that Ontario’s public health system detected the outbreak swiftly, but “more needs to be done to clarify roles and responsibilities at the federal and provincial levels to better manage foodborne outbreaks in the future.”
Four key steps
Williams outlined four key steps he says are required to strengthen Ontario’s and Canada’s capacity to respond to provincial and cross-jurisdictional foodborne outbreaks. They are:
1. Clarify roles and responsibilities in outbreak management.
Williams says Public Health should take the lead in outbreak management. In the event of a provincial outbreak, the provincial chief medical officer of health should establish an Outbreak Coordinating Committee whose mandate is to provide him/her information and advice to manage the outbreak.
In the event of a suspected or declared national/international outbreak, the federal chief public health officer should establish a National Outbreak
Coordinating Committee (NOCC), which would include all the provincial/territorial Chief Medical Officers of Health.
2. Strengthen laboratory capacity.
Williams says the newly created Ontario Agency for Health Protection and Promotion (OAHPP) should develop a plan to increase the public health laboratories’ capacity to conduct a wider range of tests, monitor strains of bacteria and other organisms that pose a threat to public health, and educate public health units about sampling techniques.
The federal government should review the existing strategic approach to advanced molecular testing, addressing such items as the acceptable turnaround time for lab results (including transportation), the ability to address higher demand for molecular testing, and the importance of having appropriate alternatives should the National Microbiology Lab not be available.
3. Enhance Ontario’s capacity to detect foodborne outbreaks.
Williams says Ontario is now better able to detect non-localized foodborne outbreaks thanks to the introduction of electronic case management systems. For the surveillance system to be fully effective, public health units must provide timely, complete data, and the public health system must have the skilled staff and other resources to investigate any signs of a possible outbreak.
4. Improve communication.
Williams says effective, clear and timely communication is essential in managing a foodborne outbreak and in maintaining public confidence. During cross-jurisdictional outbreaks, partners must work closely together to coordinate communications.
The chief medical officer of health or designate should be the official media spokesperson during a provincial outbreak. Similarly, the federal chief public health officer or designate should be the official media spokesperson for the federal government during a national outbreak.
The listeriosis outbreak began in the summer of 2008 and ended in December of the same year, affecting people in seven provinces across Canada (Ontario was the hardest hit with 41 of the 56 cases and 16 of the 22 deaths).
Most of the Ontarians who fell ill were elderly (their average age was 78) and 88 per cent were either living in a long-term care home or hospitalized before they became ill.