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Name of Lead Department(s): Public Health Agency of Canada (PHAC)
Lead Department Program Activity: Infectious Disease Prevention and Control
Start Date of the Horizontal Initiative: January 13, 2005
End Date of the Horizontal Initiative: Ongoing
Total Federal Funding Allocation (start to end date): $72.6M ongoing.
Description of the Horizontal Initiative (including funding agreement): The FI to Address HIV/AIDS in Canada is the Government of Canada’s response to HIV/AIDS in Canada. The initiative strengthens domestic action on HIV and AIDS, builds a coordinated Government of Canada approach and supports the global health response to HIV/AIDS. It focuses on prevention and access to diagnosis, care, treatment and support for those populations most affected by HIV and AIDS in Canada—people living with HIV and AIDS, gay men, Aboriginal peoples, people who use injection drugs, people in prison, youth, women, and people from countries where HIV is endemic. The FI also supports and strengthens existing multi-sectoral partnerships to address the determinants of health. It supports collaborative efforts to address factors which can increase the transmission and acquisition of HIV and it also addresses co-infection issues with other infectious diseases (e.g., hepatitis C and tuberculosis) from the perspective of disease progression and morbidity in people living with HIV/AIDS. Gender-based analysis and human rights analysis are fundamental to the approach. People living with and vulnerable to HIV/AIDS are active partners in shaping policies and practices affecting their lives.
First level outcomes:
Second level outcomes:
*Shared Outcomes have been refined in response to a June 2009 Federal Initiative (FI) to Address HIV/AIDS in Canada Implementation Evaluation Report, which recommended strengthening of the FIs performance measurement framework.
Governance Structure(s): The Responsibility Centre Committee (RCC) is the governance body for the Federal Initiative to Address HIV/AIDS in Canada (FI). It comprises representatives from the nine responsibility centres that receive funding through the FI. Led by PHAC, the RCC promotes policy and program coherence among the participating departments and agencies, and ensures that evaluation and reporting requirements are met.
PHAC is the federal lead for issues relating to HIV/AIDS in Canada and is responsible for overall coordination, national and regional programs, policy development, surveillance and laboratory science, communications, social marketing, reporting, and evaluation.
Health Canada (HC) supports community-based HIV/AIDS education, capacity-building, and prevention for First Nations on-reserve and some Inuit communities; and provides leadership on international health policy and program issues. As the Government of Canada’s agency for health research, the Canadian Institutes of Health Research (CIHR) sets priorities for and administers the extramural research program.
Public Safety Canada provides health services, including services related to the prevention, diagnosis, care and treatment of HIV/AIDS, to offenders sentenced to imprisonment for two years or more.
|Federal Partners||Federal Partner Program Activity (PA)||Names of Programs for Federal Partners||Total Allocation (from start to end date)||Planned Spending for
|Actual Spending for
|Variance for 2009-10 (from planned to actual expenditure)||Expected Results (ER) for
|Results Achieved (RA) in
|Public Health Agency of Canada||Infectious Disease Prevention and Control||a. HIV/AIDS||Ongoing||$28.0||$23.5||$4.5|| ER 1.1
| RA 1.1
|b. AIDS Community Action Program||Ongoing||$14.4||$14.7||($0.3)|| ER 2.1
| RA 2.1
|Health Canada||First Nations Inuit Health Programming and Services||a. First Nations in-reserve and Inuit Community Health||Ongoing||$4.0||$4.0||$0.0|| ER 3.1
| RA 3.1
|International Health Affairs||b. Global Engagement||Ongoing||$1.4||$0.8||$0.6|| ER 4.1
| RA 4.1
|Canadian Institutes of Health Research||HIV and AIDS Research Projects and Personnel Support||a. HIV/AIDS Research Projects and Personnel Support||Ongoing||$20.6||$21.6||($1.0)|| ER 5.1
| RA 5.1
|Correctional Services Canada||Custody
|a. Institutional Health Services Public Health Services||Ongoing||$4.2||$4.2||$0.0|| ER 6.1
| RA 6.1
|Horizontal Initiative Total||N/A||$72.6||$68.8||$3.8|
Expected Results (ER)/Results Achieved (RA):
Partner: Public Health Agency of Canada
RA 1.1: Knowledge of the factors that contribute to the spread of HIV infection was advanced through augmented HIV and risk behaviour surveillance programs. HIV/AIDS sentinel surveillance programs continue to be established and implemented among at-risk populations, in order to develop targeted studies to address questions and gaps arising from case-reporting surveillance, and to provide statistical support for HIV/AIDS modelling efforts to assess the hidden epidemic and produce national HIV estimates.
Targeted epidemiological studies were developed and enhanced, including: I-Track (national enhanced surveillance systems that focus on people who inject drugs, e.g., Intravenous Drug Users (IDU)); M-Track (national enhanced surveillance systems that focus on gay, bisexual and other men who have sex with other men (MSM)); A-Track (focused on Aboriginal peoples); E-Track (focused on persons who originate from countries where HIV is endemic); and P-Track (focused on persons with HIV infection). Work with P/Ts to enhance HIV surveillance and reporting continued.
Memoranda of agreement were developed to support the province-based work of Field Surveillance Officers and the tracking of HIV strain and drug resistance in Canada.
The National HIV and Retrovirology Laboratory (NHRL) provides highly specialized diagnostic services for provincial, national and international stakeholders, and manages a range of laboratory quality assurance and monitoring programs for patient care and treatment. The NHRL recently became accredited to the ISO 15189 standard (Medical Laboratories - Particular Requirements for Quality and Competence) and is currently the first and only Canadian lab to be accredited to this standard.
HIV co-infection and risk factor surveillance, epidemiology and research services were also provided. Federal partners work closely to ensure an integrated approach to surveillance and research and to provide data, analysis and interpretation to inform and support prevention, policy and programming activities. In concert with health, education and other inter-sectoral partners, the FI promotes the physical and psychosocial well being of Canadians through sexual health promotion activities. Such activities include the: development of national guidelines; publication of national consensus statements and policy recommendations; development of targeted research studies; and coordination of the dissemination and exchange of information, increasing knowledge and awareness in order to prevent and control HIV and associated co-infections.
Nineteen projects were funded under the National Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS projects Fund, and contributed to increased knowledge and awareness for both Aboriginal population and their service providers. As a result, service providers were better equipped to deal with HIV/AIDS related aboriginal emerging issues, sexual health prevention and harm reduction initiatives in a culturally appropriate manner.
The National HIV/AIDS Knowledge Exchange Fund supported the Canadian AIDS Treatment Information Exchange (CATIE) as the knowledge exchange broker to strengthen responses of front-line organizations involved in the delivery of prevention, diagnosis, care, treatment, and support to people living with and at risk of HIV/AIDS by incorporating an active and continuous exchange of HIV/AIDS-related knowledge.
The Population-Specific HIV/AIDS Status Report– People from countries where HIV is Endemic–Black people of African and Caribbean descent living in Canada was released. The report can be found at: http://www.phac-aspc.gc.ca/aids-sida/publication/ps-pd/africacaribbe/index-eng.php. The Population-Specific HIV/AIDS Status Report– Aboriginal Peoples was completed and approved and will be released in fall 2010.
RA 1.2 In response to the recommendations from the January 2009 implementation evaluation of the FI to Address HIV/AIDS in Canada, a horizontal performance measurement framework and a tool to implement the framework was developed. Horizontal management and collaboration was strengthened for the governance body for the FI and among the four federal partners through joint priority setting and increased information sharing.
In 2009, a review of current and emerging needs for advice and coordination in support of the FI was conducted. The Summary Report of Findings and Conclusions for the Review of Advisory and Coordination Mechanisms under the Federal Initiative confirmed the value of coordination and advisory mechanisms, and highlighted the need for both structural and process changes in the current advisory and coordination bodies. Work with committee members and stakeholders is on-going in order to respond to the report recommendations.
The Federal/Provincial/Territorial Advisory Committee on AIDS (F/P/T AIDS) and the Sexually Transmitted and Blood Borne Infections Issue Group (STBBI Issue Group) established a joint work plan solidifying their commitment to increase efficiencies and effectiveness through collaborative action, identifying and acting upon issues of common interest while respecting the focus and mandate of their respective committee.
RA 1.3: PHAC contributed toward global efforts to mitigate the spread of HIV/AIDS, through the provision of technical expertise abroad, including technical support for bilateral and multilateral projects in the global response to HIV/AIDS. Technical expertise was provided through the Pan American Health Association (PAHO) for the development of HIV strain and drug-resistance surveillance in Latin America and the Caribbean region. Technical expertise was also provided through United Nations AIDS (UNAIDS) and the World Health Organization (WHO) for the more effective utilization of surveillance data using modelling software to estimate HIV incidence.
RA 1.4: The National Aboriginal Council on HIV and AIDS hosted a symposium on various aspects of HIV and hepatitis C (HCV) co-infection called Getting It Together during the 5th National Aboriginal Hepatitis C Conference held February 2010. Aboriginal people including a family physician, an executive director of a community-based agency and a researcher delivered the presentations focused on issues of HIV and co-infection among Aboriginal peoples, HCV treatment, harm reduction, and int
RA 2.1: The AIDS Community Action Program (ACAP) contributed to increased knowledge and awareness of specific strategies to reach priority populations; it also addressed issues of co-infections with hepatitis C, tuberculosis (TB) and sexually transmitted infections (STIs). ACAP reaches many vulnerable populations that are at risk for HIV and AIDS and also for hepatitis C, TB and STIs. In 2009-10, there were 16 ACAP-funded projects co-funded by the Hepatitis C Prevention, Support and Research Program. In addition to co-funding, of the 131 ACAP projects that were funded in 2009-10, it has been estimated that 63 address issues of co-infection. For example, ACAP funded many gay men HIV-prevention projects that also include STI prevention; it also funded projects that included outreach and prevention work for sex trade workers and drug users.
The ACAP Evaluation Report 2007-09 was completed in the spring of 2009-10 and will be released in fall of 2010. The report increased knowledge of how the program can better reach vulnerable populations including Aboriginal people, people from countries where HIV/AIDS is endemic, immigrants and refugees, and MSM. The report also provides data to support realigning ACAP within the broader context of sexually transmitted and blood-borne infections, with an integrated approach to funding to address hepatitis C, HIV and links to actions on health determinants that also address other sexually transmitted infections.
RA 2.2: Through funding provided to community-based organizations, PHAC’s FI transfer payments improved access to more effective HIV/AIDS prevention, diagnosis, care, treatment and support for eight key populations most affected by HIV and AIDS in Canada—gay men, people who use injection drugs, Aboriginal peoples, inmates, youth at risk, women, people from countries where HIV is endemic, and people living with HIV and AIDS. In 2009-10, PHAC’s National Transfer Payment Funds supported 29 projects, for a total of $9.6M in grants and contributions. PHAC’s Regional Transfer Payment Funds, through the ACAP, supported 47 time-limited and 84 operational projects across Canada, for a total of $12.1M. An evaluation report summarizing AIDS Community Action Program 2007-09 was finalized and will be released in the fall of 2010.
RA 2.3: The Government of Canada Assistant Deputy Minister Committee on HIV/AIDS hosted the first Interdepartmental Policy Forum on the Determinants of Health and HIV/AIDS gathering 14 federal government departments and agencies representing health and non-health sectors to: forge linkages and a shared understanding of synergies across federal mandates; target populations and priorities; and identify common barriers to horizontal collaboration and strategies to overcome them. Consensus was reached to build an all-of-government approach to promote health and well-being for all Canadians by collaborating to address the broader social and economic determinants of health.
Horizontal partnerships between PHAC and other federal government departments actively seek to reduce vulnerability to HIV and AIDS, including the Horizontal Pilot Project for Aboriginal Homeless People Living with HIV/AIDS completed in 2009. The partnership between PHAC, Human Resources and Social Development Canada and the Nine Circles Community Health Centre in Winnipeg, Manitoba supported this project goal aimed to improve the health outcomes for Aboriginal persons living with HIV and AIDS and prevent them from becoming homeless. Results and lessons learned from this project informed the development of three additional horizontal projects.
ACAP projects were involved in a number of initiatives to increase awareness of the social and economic factors that create barriers for people at risk and those living with HIV/AIDS. In 2009-10, approximately 52 ACAP projects had an objective to address stigma or discrimination. For example, many ACAP projects addressed homophobia and public attitudes towards people living with HIV and AIDS. ACAP projects also hold community events such as AIDS walks and candle-light vigils to raise awareness of the disease and its impacts.
Provinces and territories, through their involvement in the F/P/T Advisory Committee on AIDS, facilitated coordination and convergence of policy across jurisdictions to better address the societal and health system factors that inhibit the ability to promote resiliency and reduce vulnerability to communicable diseases.
Partner: Health Canada
RA 3.1: Research and surveillance-related activities supported by the Regions often involved active First Nations community participation. For instance, community health nurses in the Atlantic region collected quality data on HIV, blood borne pathogens and sexually transmitted infection (STI) cases through Teleform reports. The Quebec Region funded a survey on sexual behaviour, attitudes and knowledge related to STIs among First Nations youth and adults in ten communities. A community-based participatory research project, through a partnership agreement between participating Ontario First Nations communities and the University of Toronto, gathered STI data and conducted focus-group sessions on STI risks in order to improve existing sexual health services.
RA 3.2: As part of the joint Health Canada and PHAC Youth Messaging Initiative, the Canadian Aboriginal AIDS Network (CAAN) undertook a social marketing campaign based on youth-generated messages that include the promotion of HIV testing among their peers. The messages created by CAAN’s National Aboriginal Youth Council on HIV/AIDS for their peers in the form of posters and postcards will be distributed to community organizations, youth groups, and schools on reserve.
In the Regions, efforts were directed towards increasing access to testing, with special attention to pre- and post-counselling and confidentiality, as well as raising awareness of the risk factors that would call for HIV testing. These efforts have been supported either through contribution agreements with Regional Aboriginal Organizations or by ensuring that ongoing training is provided to health-care workers in Aboriginal communities.
ER 3.3: Increased access to prevention education, care and support networks, and supportive environments.
RA 3.3: One of Health Canada’s main national partners in the area of HIV and AIDS is the Canadian Aboriginal AIDS Network (CAAN). CAAN members include Aboriginal People Living with HIV/AIDS who share their story to put a human face to this epidemic as a first step to engendering compassion, acceptance and support, especially for those who remain silent. CAAN’s contribution agreement with the Government of Canada produced resources such as the strategic document Take Me to Your Leader, which is a strategy for reaching elected and non-elected Aboriginal Leaders on HIV/AIDS issues and recommends directions on how to address HIV and AIDS-related priorities and gaps faced by Aboriginal populations.
Another national partner is the Assembly of First Nations (AFN), which is implementing leadership engagement initiatives to address stigma and discrimination. In December 2009, AFN’s National Chief declared: “Most of all, leaders have a clear duty to break the stigma that continues to plague HIV and AIDS. We must take steps to heal divisions within our communities and embrace all members especially those needing our concern and our care.” He also called on First Nations leaders to pass a resolution in their respective communities to protect the rights of members living with HIV and AIDS and their families. AFN prepared an HIV and AIDS awareness kit, Leadership in Action: A Community Response to HIV and AIDS, as well as awareness-raising material such as postcards, posters, and videos, as part of its overall strategy to create a supportive environment.
Regional Coordinators have been working with Regional Aboriginal Organizations and/or Aboriginal communities to make available educational resources, for youth and for the community in general, and to reduce stigma and discrimination. Among prevention/awareness activities are public announcements, community prevention workshops, presentations at schools and health fairs, and
training sessions for community members, including youth peer-educators.
ER 3.4: Increased collaboration among partners to achieve a coordinated and integrated response.
RA 3.4: At the national level, new partnerships have been established with the Canadian Institutes of Health Research to build research capacity among community-based researchers and with Health Canada’s National Native Alcohol and Drug Addiction Program to engage in joint skill-building activities for front-line workers.
Regional-level collaboration with respective provinces, Aboriginal organizations, and local community representatives is maintained and strengthened through networks, engagement in multi-sector committees/working-group meetings, and pooling of resources. As a result, the HIV/AIDS program leveraged its resources for a greater impact on the communities.
RA 3.5: Cooperation amongst Regional Offices and Tribal Councils is ongoing. Among newly established cooperative arrangements is the one between the Saskatchewan Region and the Northern Inter-Tribal Health Authority.
RA 3.6: The Health Canada First Nations and Inuit Health Branch (FNIHB) provided support towards the International Policy Dialogue on HIV/AIDS and Indigenous Peoples, held in Ottawa, Canada, October 21-23, 2009. This Dialogue, which was hosted by Health Canada’s International Affairs Directorate in partnership with PHAC, offered an opportunity for key stakeholders to come together to discuss the impact of HIV and AIDS on indigenous peoples and to explore a way forward in terms of research, policy and programme development.
RA 3.7: The British Columbia (BC) Regional Office supported the BC Centre for Disease Control’s Chee Mamuk Program in developing the Guide to Wise Practices for HIV/AIDS Education and Prevention Programs, which is based on success stories that revealed what worked best in the communities. This key resource can be shared to inspire other communities.
As an additional example, the Chee Mamuk Program project - Around the Kitchen Table was aimed at empowering Aboriginal women to reinstate their traditional role and start their own peer support groups on HIV/AIDS and healthy sexuality in their communities. Informal sessions offered by local facilitators led participants to engage more in self-care practices and to share their new knowledge with others. Participants also gained a deeper understanding of the human side of the illness and were inspired with ideas of how to better support HIV-positive people in their communities; and reported decreased stigma related to HIV in their communities.
RA 4.1: Outcomes were shared from the March 2009 International Policy Dialogue on HIV/AIDS and disability at a WHO/UNAIDS international meeting in Geneva in April 2009. Health Portfolio advice was provided at the June UNAIDS Programme Coordinating Board (PCB) meeting in Geneva, to inform health-related agenda items. The department served on the UNAIDS core working group to organize the thematic session on migration and HIV/AIDS.
In 2009-10, eleven Canadian organizations received a total of $0.4M in grant funding to implement HIV/AIDS initiatives under the International Health Grants Program. Those projects facilitated the creation of partnerships and the sharing of resources and best practices to improve awareness, prevention and treatment of HIV/AIDS.
RA 4.2: Support was provided to South American and Oceania countries on policy and programme directions relating to HIV/AIDS and indigenous peoples via participation in the International Policy Dialogue on HIV/AIDS and Indigenous Peoples in October 2009. Hosted by Health Canada with support from UNAIDS and PHAC, participants included UNAIDS, PAHO and the UN Permanent Forum on Indigenous Issues. Best practices were discussed by participants in the policy dialogue.
As follow-up to the March 2009 International Policy Dialogue on HIV/AIDS and disability, the Department provided support towards the development and implementation of an international survey to determine the global needs for strengthening communication and collaborative policy development activities between disability and HIV/AIDS networks. Regional and national organizations from Africa representing people with disabilities and people living with HIV/AIDS were included in the survey.
Support was also provided in the development of an international resource kit for lawyers handling criminal cases related to HIV non-disclosure. The kit assisted legal professionals to better handle such cases by providing the latest scientific developments or other research that would be useful in arguing these cases.
RA 4.3: Policy coherence on global HIV and AIDS issues was achieved in a number of ways. The Consultative Group on Global HIV and AIDS Issues, which is made up of Government of Canada federal departments working on global HIV and AIDS issues, and Canadian NGOs, met twice in 2009-10. The meeting agendas allowed for participating federal departments to share strategic policy information on HIV and AIDS activities and directions. As well, the Federal Secretariat, an interdepartmental committee made up of all Government of Canada departments engaged in the 2010 International AIDS Conference, was launched. It met twice in 2009-10 to begin to develop coordinated engagement and policy positions to inform the Government in the International AIDS Conference set for July 2010 in Vienna, Austria. For example, a policy paper was produced outlining the Government of Canada strategic engagement in the conference.
Partner: Canadian Institutes of Health Research
RA 5.1: On behalf of the FI, the Canadian Institutes of Health Research (CIHR) invested a total of $20.4M in HIV/AIDS research. This amount includes funding for the CIHR Canadian HIV Trials Network (CTN) and funding for the CIHR HIV/AIDS Community-Based Research (CBR) Program grants and awards.
In total, including both the Federal Initiative funding and additional CIHR funding, CIHR supported approximately 277 grants, 200 awards, and 14 Canada Research Chairs for a total investment of $41.7M in HIV/AIDS research in 2009-10.
CIHR-supported HIV and AIDS researchers made significant achievements in addressing the HIV and AIDS epidemic both in Canada and globally. For example, a CIHR-funded researcher was one of eight recipients honoured with the first ever CIHR-CMAJ (Canadian Medical Association Journal) Top Canadian Achievements in Health Research Awards. The award is in recognition of individuals who had the biggest impact on the health of Canadians and people around the world. The winners, selected by a peer review panel, were announced in 2009 and included CIHR-supported researcher who demonstrated the effectiveness of male circumcision in reducing the transmission of HIV in Africa.
In 2009, following the development of a strategic funding opportunity in 2007 and a competitive application process in 2008, the CIHR HIV/AIDS Research Initiative commenced funding for two CIHR Centres for Research Development in HIV/AIDS. This investment represents a new strategy for supporting health services and population-health HIV and AIDS research, which is anticipated to have significant effects on how this research is conducted in the future in Canada.
Overall CIHR-funded individuals and groups are involved in a wide variety of research activities supporting the Federal Initiative areas of interest such as determinants of health, prevention, improved health services, knowledge exchange and global collaboration.
RA 5.2: The translation of HIV/AIDS research results into action was promoted as part of a knowledge translation (KT) strategy which included: integrated KT requirements in team grants; direct funding support for knowledge synthesis grants; knowledge to action grants; meeting, planning and dissemination grants; end of grant KT funding; travel grants; and partnerships for health system improvement grants. The two newly-created CIHR Centres for Research Development in HIV/AIDS also engaged in the development of novel integrated KT strategies.
In addition to supporting knowledge translation activities, the HIV/AIDS Research Initiative is developing effective partnerships and enduring relationships that are resulting in new partnership opportunities all the time. For example, the successful Family Front and Centre community forum was co-hosted by the Ontario HIV Treatment Network and The Teresa Group in partnership with the U.S. National Institute of Mental Health and the CIHR Institute of Infection and Immunity (HIV/AIDS Research Initiative) as a satellite of the American Psychological Association’s 2009 convention. Included in the audience were academics, researchers, service providers, policy makers, community members, and people living with HIV.
The CIHR HIV/AIDS Research Initiative continues to support many innovative partnerships including the Positive Spaces, Healthy Places study which involved many partners and was a catalyst for developing local, national and international partnerships leading to better housing and other supports for people living with HIV. This work was recognized in a CIHR publication, Healthier Together: The Canadian Partnership Casebook, highlighting innovative partnerships.
RA 5.3: The CIHR HIV/AIDS Research Initiative continues to ensure its programs are well designed and meeting the needs of the HIV/AIDS research community through on-going consultation, notably through the CIHR HIV/AIDS Research Advisory Committee and the Community-Based Research Steering Committee. The four meetings of these committees in 2009-10 involved many stakeholders from different sectors who provided advice on the investment of funds and future directions.
The CIHR HIV/AIDS Research Initiative initiated additional consultative processes to guide the development of new funding programs. In particular, a Working Group involving researchers, community-based organizations and clinicians was created to help address the identified priority research area of co-infection and co-morbidities in HIV and AIDS. The Working Group provided advice on the process by which CIHR will seek comprehensive input from a wide range of stakeholders on this important topic.
The Initiative also followed up on a major evaluation of the CIHR HIV/AIDS Community-Based Research (CBR) Program which was undertaken in 2008-09 to ensure the program was meeting its stated objectives. Overall, the evaluation concluded that the program was helping communities and academia respond to the HIV and AIDS, building research capacity at the community level and in academic circles. At the same time, a number of specific recommendations were proposed to improve the program. Based on the recommendations received, the Institute of Infection and Immunity developed an implementation plan in 2009, which is now in its final stage of completion.
RA 5.4: Conferences and workshops are a valuable means to share information and to engage stakeholders from multiple sectors in addressing important issues in HIV/AIDS. In 2009-10, the CIHR HIV/AIDS Research Initiative provided funding for 15 conferences and workshops. It also participated in events to share information on our programs and foster participation in HIV and AIDS research.
Examples of events that the CIHR HIV/AIDS Research Initiative contributed to include:
Recognizing the importance of open dialogue and exchange, the CIHR HIV/AIDS Research Initiative held a Café Scientifique in November 2009 in partnership with the Ontario HIV Treatment Network and the Mental Health Commission of Canada. This event, open to the public, addressed the on-going need to reduce HIV/AIDS related stigma and discrimination affecting priority populations and to improve attitudes and behaviours towards HIV/AIDS and people living with the disease. Researchers and members of the public joined in discussions about early influences on the development of vulnerability to HIV in gay men.
RA 5.5: In order to further support high quality HIV research and knowledge translation activities, the CIHR HIV/AIDS Research Initiative launched the following funding opportunities: Operating Grants: Priority Announcements, Catalyst Grants, Meetings, Planning and Dissemination Grants, Knowledge to Action Grants, Partnerships for Health System Improvement Grants and Knowledge Synthesis Grants.
In the area of Community-Based Research, Catalyst and Operating Grant funding opportunities were launched in 2009-10.
RA 5.6: The CIHR HIV/AIDS Research Initiative is fostering the next generation of HIV and AIDS researchers by providing a range of capacity-building funding opportunities including: priority announcement funding for New Investigator, Fellowship and Doctoral Research awards across all areas of HIV research; and master’s and doctoral awards specifically targeted to both the Aboriginal and General streams of the Community-Based Research Program.
The priority area of Issues of co-infection and co-morbidity in HIV/AIDS was identified as the next priority area to be further addressed through targeted funding opportunities. In 2009, a Working Group dedicated to this topic was created and, working with the CIHR HIV/AIDS Research Advisory Committee, has explored options to advance the priority area. A broad national consultation involving a range of stakeholders and partners was recommended. This consultation process will culminate in 2010 with a Roundtable session involving a group of experts who will provide advice to CIHR on new research funding programs and partnerships.
In 2009-10, as part of the partnership with PHAC, the CIHR HIV/AIDS Research Initiative contributed to Population-Specific Status Reports, by providing information confirming CIHR-funded research grants and awards that are addressing issues in the target populations.
In addition, the CIHR HIV/AIDS Research Initiative continued to collaborate with PHAC and the other federal partners, to further strengthen coordination by participating in numerous activities, including committees and the on-going development of a cohesive strategy and mechanism for FI reporting.
Partner: Correctional Services Canada
RA 6.2: Work continued to analyze main research questions from the inmate survey with a view to better understanding risk behaviours in order to enhance public health policies and programs, e.g., health education, access to harm reduction measures such as condoms, dental dams and bleach.
RA 6.4: The F/P/T Working Group had two face-to-face meetings in 2009-10 and several conference calls to share information and best practices on correctional health issues. Pandemic planning was a major focus during 2009-10.
RA 6.6: A Request for Proposal was prepared and posted for the development of five days of nursing training on infectious diseases. The contractor will be selected from the submissions received and work will begin in May 2010.
RA 6.7: Correctional Services Canada continued to implement its harm reduction strategy. Focus was on enhancing health promotion programs to reinforce harm reduction messages as well as sharing health promotion materials with and among P/T partners. Partnerships developed with various stakeholders to share and enhance harm reduction strategies, i.e., Ottawa public health stakeholders.
RA 6.8: The implementation of an Infectious Disease Strategy for Women continued. A Women’s Health Kit was designed and manufactured with CORCAN for implementation in 2010-11. A multi-sector women’s health working group was established to strategize and develop collaborative approaches to address health issues facing the women offender population.
Comments on Variances:
PHAC: The $4.2M variance in spending is the result of internal reallocations and delays in the approval of National Specific Population HIV/AIDS Initiatives and other initiatives, such as social marketing, caused by the Agency’s redirecting its focus to address the containment of the H1N1 outbreak, an unexpected public health priority.
Canadian Institutes of Health Research: Funds not used in CHVI initiatives by CIHR were used to support ongoing FI supported HIV/AIDS research efforts, resulting in an additional $1.1M spent on the FI.
Results to be achieved by non-federal partners (if applicable): 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.
Dr. Howard Njoo
130 Colonnade Road
Name of Lead Department(s): Public Health Agency of Canada (PHAC)
Lead Department Program Activity: Infectious Disease Prevention and Control
Start Date of the Horizontal Initiative: February 20, 2007
End Date of the Horizontal Initiative: March 2013
Total Federal Funding Allocation (start to end date): $111M
Description of the Horizontal Initiative (including funding agreement): The 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 Canadian International Development Agency (CIDA), PHAC, Industry Canada (IC), Canadian Institutes of Health Research (CIHR), and Health Canada (HC). 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.
Immediate (Short-Term) Outcomes:
The Minister of Health, in consultation with the Minister of Industry and the Minister of International Cooperation, will be the lead 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 is provided by an Interdepartmental Steering Committee consisting of representatives from the participating federal departments and agencies. The Interdepartmental Steering Committee is responsible for providing strategic directions and priorities, and reviewing progress. Multi-stakeholder engagement, involving governments, the private sector, international stakeholders, people living with HIV/AIDS, researchers and Non-Governmental Organizations (NGOs) and other relevant stakeholders, have been, and will continue to be established to inform the CHVI. The role of participating departments and agencies involved in the CHVI are:
|Federal Partners||Federal Partner Program Activity (PA)||Names of Programs for Federal Partners||Total Allocation (from Start to End Date)||Planned Spending for
|Actual Spending for
|Variance for 2009-10 (from planned to actual expenditure)||Expected Results for
|Results Achieved (RA) in 2009-10|
|Public Health Agency of Canada||Infectious Disease Prevention and Control||a. Public Health Contributions Program||$27.0||$10.7||$2.4||$8.3|| ER 1.1
| RA 1.1
|Health Canada||International Health Affairs||a. Grants to eligible non-profit international organizations in support of their projects or programs on health||$1.0||$0.2||$0.0||$0.2||ER 2.1||RA 2.1|
|Industry Canada||Industry Sector – Science and Technology and Innovation||a. N/A||$13.0||$3.2||$0.0||$3.2|| ER 3.1
| RA 3.1
|Canadian International Development Agency||Institutions – Enhanced capacity and effectiveness of Multilateral institutions and Canadian/ International organizations in achieving development goals||a. International Development Assistance Program||$60.0||$6.2||$1.2||$5.0|| ER 4.1
| RA 4.1
|Canadian Institutes of Health Research||HIV/AIDS Research Initiative – Program Activity Architecture Code: 12300||a. HIV/AIDS
|$10.0||$1.3||$0.9||$0.4|| ER 5.1
| RA 5.1
Expected Results (ER)/Results Achieved (RA):
Partner: Public Health Agency of Canada
RA 1.2: The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility given a shift in landscape which demonstrated that there was sufficient manufacturing capacity. Subsequently, in July 2010, the Government of Canada and the Bill & Melinda Gates Foundation announced the renewal of the CHVI, with the establishment of the Research and Development Alliance as its cornerstone.
Partner: Health Canada
Partner: Industry Canada
RA 3.2: The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility given a shift in landscape which demonstrated that there was sufficient manufacturing capacity. Subsequently, in July 2010, the Government of Canada and the Bill & Melinda Gates Foundation announced the renewal of the CHVI, with the establishment of the Research and Development Alliance as its cornerstone.
Partner: Canadian International Development Agency
ER 4.1: Under the discovery and social research component, and in collaboration with CIHR, successfully completed the letter of intent and development grant stages of the Team Grant program to support collaborative teams of Canadian and LMIC researchers.
ER 4.2: Establishment of a program to support teams of Canadian and LMICs researchers and research institutions to strengthen their capacity to conduct high-quality clinical trials of HIV vaccine and other related prevention technologies.
RA 4.5: The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility given a shift in landscape which demonstrated that there was sufficient manufacturing capacity. Subsequently, in July 2010, the Government of Canada and the Bill & Melinda Gates Foundation announced the renewal of the CHVI, with the establishment of the Research and Development Alliance as its cornerstone.
Partner: Canadian Institutes of Health Research
RA 5.1: Three catalyst grants were awarded to Canadian researchers to support novel activities that represent a first step towards the pursuit of more comprehensive funding opportunities (e.g., operating grants and team grants) and which will ultimately contribute to international efforts in HIV vaccine development. Funding also continued for five previously awarded operating grants across Canada. Five Emerging Team Grant applicants were successful in receiving start up funds that will allow them to design full proposals outlining how their team of Canadian investigators will contribute important knowledge to the global search for HIV vaccines. Full funding for two teams will begin in summer 2010.
ER 5.2: Under the discovery and social research component, and in collaboration with CIDA, successfully completed the letter of intent and development grant stages of the Team Grant program to support collaborative teams of Canadian and LMIC researchers.
Comments on Variances:
Public Health Agency of Canada: The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility given a shift in landscape which demonstrated that there was sufficient manufacturing capacity. Subsequently, in July 2010, the Government of Canada and the Bill & Melinda Gates Foundation announced the renewal of the CHVI, with the establishment of the Research and Development Alliance as its cornerstone.
Health Canada: In 2009-10, a Request for Proposals (RFP) was held for CHVI projects under the Community Initiatives Fund, which is funded through the International Health Grants Program. The RFP did not produce sufficient proposals to proceed and so funds for 2009-10 were deferred to future years.
Industry Canada: The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility given a shift in landscape which demonstrated that there was sufficient manufacturing capacity. Subsequently, in July 2010, the Government of Canada and the Bill & Melinda Gates Foundation announced the renewal of the CHVI, with the establishment of the Research and Development Alliance as its cornerstone.
Canadian International Development Agency: The variance is largely a result in delays to the launch of the Clinical Trials component resulting in less funds being requested from the International Development Research Center (IDRC), the executing agency. In addition, the Large Team grants have not yet been launched, and as a result there has been no spending under the Discovery and Social Research program component.
Canadian Institutes of Health Research: The variance is a result of less than an expected number of catalyst grants being funded. In addition, the Large Team grants have not yet been launched, and as a result there has been no spending under the Discovery and Social Research program component.
Results to be achieved by non-federal partners (if applicable): 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 Bill & Melinda Gates Foundation and other funders to contribute to CHVI objectives and to a significant Canadian contribution towards the Global HIV Vaccine Enterprise.
200 Eglantine Driveway
Name of Horizontal Initiative: Preparedness for Avian and Pandemic Influenza
Name of Lead Department(s): Public Health Agency of Canada (PHAC)
Lead Department Program Activities:
Start Date of the Horizontal Initiative: Late 2006
End Date of the Horizontal Initiative: Ongoing
Total Federal Funding Allocation (start to end date): $422M for Health Portfolio and $195M for Canadian Food Inspection Agency (CFIA) for 2006-07 to 2010-11. Note that CFIA’s Avian and Pandemic Influenza funding was reduced due to Strategic Review but this had no impact on the H1N1 response. Planned Spending figures for 2009-10 in the table below reflect these reductions; however, the preceding $195M total funding allocation does not.
Description of the Horizontal Initiative (including funding agreement): Canada is facing 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 $422M over five years 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 will also be undertaken to fill gaps in on-reserve planning and preparedness and enhance federal capacity to deal with an on-reserve pandemic.
Under the umbrella of Preparing for Emergencies, in 2006 CFIA obtained $195M to be spent over five years to enhance Canada’s state of Avian Influenza (AI) 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 five pillars of strategies and processes for prevention and early warning, emergency preparedness, emergency response, recovery and communications.
Since inception of the horizontal initiative, the partners, which include Health Canada (HC), CFIA, Canadian Institutes of Health Research (CIHR) and PHAC have been working collaboratively at a governance level on the Avian and Pandemic Influenza Horizontal Initiative. As a result of the pandemic H1N1 in April 2009, the horizontal governance model was set aside and will be resurrected in fall 2010.
Shared Outcome(s): These initiatives will allow the federal government to strengthen Canada’s capacity to prevent and respond to the 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 scientific and regulatory 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, PHAC and Health Canada finalized The Avian and Pandemic Influenza Preparedness Interdepartmental/Agency Governance Agreement. The primary scope of the Agreement is the management of specific horizontal issues and/or initiatives stemming from the $1B for avian and pandemic influenza preparedness emanating from Budget 2006. Ministerial accountability is not altered by this agreement and departments and agencies maintain their responsibilities to manage their mandated areas and the funds entrusted to them.
The agreement is supported by a structure that falls within the auspices of the Deputy Minister’s Committee on Avian and Pandemic Influenza Planning (CAPIP). The implementation of the agreement is led by the Avian and Pandemic Influenza Assistant Deputy Ministers Governance (API ADM Governance) Committee focusing on the implementation of the initiatives funded through Budget 2006.
The API ADM Governance Committee provides strategic direction and oversight monitoring. It authorizes and facilitates overview reporting to the TBS. Members of this committee ensure support for the pursued initiatives in their departments/agencies. The API ADM Governance Committee keeps the Committee of ADMs under the CAPIP process informed of its activities through cross membership.
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 the exercise. The APIO DG committee keeps the DG Steering Committee under the CAPIP process informed of its activities through cross membership. The APIO DG Committee is chaired by PHAC and CFIA and its members include director general-level representatives from HC and CIHR and chairs of established working groups.
Working groups are established for areas that cross departmental and agency activity. Working groups report to the API ADM Governance Committee through the APIO DG Committee.
PHAC provides secretariat support for the API ADM Governance and APIO DG Committees.
|Federal Partners||Federal Partner Program Activity (PA)||Names of Programs for Federal Partners||Total Allocation (from Start to End Date)||Planned Spending for
|Actual Spending for
|Variance for 2009-10 (from planned to actual expenditure)||Expected Results for 2009-10||Results Achieved (RA) in 2009-10|
|Public Health Agency of Canada||Infectious Disease Prevention and Control||a. Vaccine readiness and clinical trials||Ongoing||$15.9||$0.7||$15.2|| ER 1.1
| RA 1.1
|Infectious Disease Prevention and Control||b. Rapid vaccine development and testing||Ongoing||$1.7||$1.6||$0.1||ER 2.1||RA 2.1|
|Infectious Disease Prevention and Control||c. Contribution to National Antiviral Stockpile||Ongoing||$7.4||$0.3||$7.1||ER 3.1||RA 3.1|
|Infectious Disease Prevention and Control||d. Capacity for pandemic preparedness||Ongoing||$4.8||$23.1||($18.3)|| ER 4.1
| RA 4.1
|Infectious Disease Prevention and Control||e. Surveillance||Ongoing||$8.2||$4.3||$3.9||ER 5.1||RA 5.1|
|Infectious Disease Prevention and Control||f. Emergency human resources||Ongoing||$0.4||$0.4||$0.0||ER 6.1||RA 6.1|
|Infectious Disease Prevention and Control||g. Winnipeg lab and space optimization||Ongoing||$7.2||$3.3||$3.9|| ER 7.1
| RA 7.1
|Infectious Disease Prevention and Control||h. Strengthening the public health lab network||Ongoing||$1.2||$0.9||$0.3||ER 8.1||RA 8.1|
|Infectious Disease Prevention and Control||i. Influenza research network||Ongoing||$2.2||$0.6||$1.6|| ER 9.1
| RA 9.1
|Infectious Disease Prevention and Control||j. Pandemic influenza risk assessment and modelling||Ongoing||$0.8||$0.6||$0.2|| ER 10.1
| RA 10.1
|Infectious Disease Prevention and Control||k. Performance and evaluation||Ongoing||$0.6||$0.5||$0.1|| ER 11.1
| RA 11.1
|Infectious Disease Prevention and Control||l. Pandemic influenza risk communications strategy||Ongoing||$1.8||$2.2||($0.4)|| ER 12.1
| RA 12.1
|Infectious Disease Prevention and Control||m. Skilled national public health workforce||Ongoing||$6.0||$3.2||$2.8|| ER 13.1
| RA 13.1
|Emergency Preparedness and Response||a. Emergency preparedness||Ongoing||$6.6||$5.9||$0.7|| ER 14.1
| RA 14.1
|Health Canada||Access to safe and effective health products and food and information for healthy choices||a. Regulatory activities related to pandemic influenza vaccine||Ongoing||$1.5||$1.5||$0.0||ER 15.1||RA 15.1|
|Access to safe and effective health products and food and information for healthy choices||b. Resources for review and approval of antiviral drug submissions for treatment of pandemic influenza||Ongoing||$0.3||$0.3||$0.0||ER 16.1||RA 16.1|
|Access to safe and effective health products and food and information for healthy choices||c. Establishment of a crisis risk management unit for monitoring and post market assessment of therapeutic products||Ongoing||$0.4||$0.4||$0.0||ER 17.1||RA 17.1|
|Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians||a. FN/I surge capacity||$1.5
(2007-08 to 2009-10)
|$0.4||$0.4||$0.0||ER 18.1||RA 18.1|
|Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians||b. Strengthening federal public health capacity||Ongoing||$0.7||$0.7||$0.0|| ER 19.1
| RA 19.1
|Better health outcomes and reduction of health inequalities between First Nations and Inuit and other Canadians
||c. First Nations and Inuit emergency preparedness, planning, training and integration||Ongoing||$0.4||$0.4||$0.0||ER 20.1||RA 20.1|
|Reduced health and environmental risks from products and substances, and healthy sustainable and working environments||a. Public health emergency preparedness and response on conveyances||Ongoing||$0.3||$0.4||($0.1)|| ER 21.1
| RA 21.1
|Canadian Institutes of Health Research||Pandemic Preparedness Strategic Research Initiative||a. Influenza research priorities||$38.2 (2006-07 to 2010-11)||$10.7||$13.0||($2.3)|| ER 22.1
| RA 22.1
|Total||$38.2 (2006-07 to 2010-11)||$10.7||$13.0||($2.3)|
|Canadian Food Inspection Agency||Disease Prevention and Control||a. Enhanced enforcement measures||Ongoing||$1.5||$2.3||($0.8)||ER 23.1||RA 23.1|
|Disease Prevention and Control||b. Avian biosecurity on farms||Ongoing||$2.7||$0.9||$1.8||ER 24.1||RA 24.1|
|Disease Prevention and Control||c. Real property requirements||Ongoing||$0.0||$0.0||$0.0||ER 25.1||RA 25.1|
|Disease Prevention and Control||d. Domestic and wildlife surveillance||Ongoing||$3.1||$ 2.1||$1.0||ER 26.1||RA 26.1|
|Disease Prevention and Control||e. Strengthened economic and regulatory framework||Ongoing||$0.9||$0.1||$0.8||ER 27.1||RA 27.1|
|Disease Prevention and Control||f. Performance evaluation||Ongoing||$1.1||$1.0||$0.1||ER 28.1||RA 28.1|
|Disease Prevention and Control||g. Risk communications||Ongoing||$1.6||$0.0||$1.6||ER 29.1||RA 29.1|
|Emergency Preparedness and Response||a. Field training||Ongoing||$1.1||$0.1||$1.0|| ER 30.1
| RA 30.1
|Emergency Preparedness and Response||b. AI enhanced management capacity||Ongoing||$1.0||$2.1||($1.1)||ER 31.1||RA 31.1|
|Emergency Preparedness and Response||c. Updated emergency response plans||Ongoing||$2.0||$0.9||$1.1||ER 32.1||RA 32.1|
|Emergency Preparedness and Response||d. Risk assessment and modelling||Ongoing||$2.1||$0.3||$1.8||ER 33.1||RA 33.1|
|Emergency Preparedness and Response||e. AI Research||Ongoing||$1.5||$0.9||$0.6|| ER 34.1
| RA 34.1
|Emergency Preparedness and Response||f. International collaboration||Ongoing||$1.6||$0.3||$1.3||ER 35.1||RA 35.1|
|Emergency Preparedness and Response||g. Animal vaccine bank||Ongoing||$0.0||$0.0||$0.0||ER 36.1||RA 36.1|
|Emergency Preparedness and Response||h. Access to antivirals||Ongoing||$0.1||$0.0||$0.1||ER 37.1||RA 37.1|
|Emergency Preparedness and Response||i. Specialized equipment||Ongoing||$0.0||$0.2||($0.2)||ER 38.1||RA 38.1|
|Emergency Preparedness and Response||j. Laboratory surge capacity and capability||Ongoing||$3.8||$2.5||$1.3||ER 39.1||RA 39.1|
|Emergency Preparedness and Response||k. Field surge capacity||Ongoing||$1.0||$1.9||($0.9)||ER 40.1||RA 40.1|
|Emergency Preparedness and Response||l. National veterinary reserve||Ongoing||$0.9||$1.4||($0.5)||ER 41.1||RA 41.1|
|Horizontal Initiative Total||N/A||$105.5||$81.7||$23.8|
Expected Results (ER)/Results Achieved (RA):
Partner: Public Health Agency of Canada
RA 1.1: A clinical trial was conducted through a contract with ID Biomedical Corporation (GlaxoSmithKline Biologicals or GSK) to assess an accelerated two-dose immunization schedule for a pre-pandemic (H5N1) vaccine. The final report of the clinical trials was provided to PHAC in 2009-10. The results of the clinical trials were also included in GSK’s rolling submission to Health Canada seeking authorization of the H1N1 vaccine. The clinical trials contributed to the timely authorization of an effective vaccine in response to the H1N1 pandemic.
RA 1.2: Vaccine adverse event surveillance was improved through a high degree of collaboration with P/Ts and messaging to health care providers such that there was a five-fold increase in reporting of adverse events and an improvement in timeliness of reporting compared to previous years.
RA 2.1: ID Biomedical Corporation has conducted clinical trials on different H5N1 virus strains and has produced a commercial H5N1 vaccine that is intended for government stockpiling purposes. Authorization of the vaccine has not yet been obtained in Canada as the authorization process was superseded by the need to review and authorize a suitable H1N1 vaccine in response to the pandemic. Under the vaccine contract, Canada has purchased a GSK-held stockpile of H5N1 vaccine components; the H5N1 antigen and AS03 adjuvant which could be packaged together and delivered to Canada if needed in response to an H5N1 pandemic and pending final vaccine authorization from Health Canada.
RA 3.1: The efforts by ID Biomedical Corporation in developing a pre-pandemic H5N1 vaccine, including the clinical trial funded by the Government of Canada, contributed to the knowledge base allowing for rapid development of an H1N1 vaccine. Significant information on the pre-pandemic vaccine was compiled and submitted by GSK to Health Canada for use in approval of the H1N1 vaccine. The availability of this data on the pre-pandemic vaccine contributed leading to a timely authorization of the H1N1 vaccine, greatly reducing the time between the development of a suitable pandemic vaccine and the availability for use of that vaccine.
RA 4.1: During the H1N1 pandemic, daily briefings took place among the Minister of Health, the Chief Public Health Officer and the Deputy Minister of Health, to ensure that information was shared on a regular basis.
A Federal, Provincial and Territorial (F/P/T) Memorandum of Understanding (MOU) on roles and responsibilities was created for pandemic planning which the Minister of Health approved prior to implementation.
Prior to the H1N1 pandemic the Minister of Health and her staff were briefed on pandemic preparedness issues including the acquisition of H5N1 vaccine and the influenza fill line capacity.
A formal H1N1 Business Cycle was implemented through which the Minister’s office, the Health Portfolio Executive Group, Senior Government Officials and the Chief Public Health Officer were briefed on H1N1 related issues.
RA 5.1: The Canadian Network of Public Health Intelligence (CNPHI) Alert module through the Canadian Integrated Outbreak Surveillance Centre (CIOSC) has been used regularly for reporting any unusual events related to H5N1 or novel influenza to F/P/T and local public health partners. In fact, CIOSC was used extensively in the four days preceding the announcement of the emergence of pandemic H1N1 virus in Mexico.
The Global Public Health Intelligence Network (GPHIN) was used to analyse informal and formal sources of information for early detection and reporting of any unusual events related to pandemic influenza, H5N1 and respiratory events of unknown etiology.
RA 6.1: In June 2009 after the first wave of H1N1 had ebbed, the Human Resources Directorate updated the Agency’s resourcing plan. The resulting outcome was the PHAC Emergency Operations Resourcing Implementation Plan 2009-10 (PEORIP). While the purpose of the Health Portfolio Emergency Response Plan serves as a guide on how to coordinate the planning of actions and the response to events and emergencies for the Health Portfolio managers/respondents in meeting mandated responsibilities, the PEORIP concentrates on enabling the required rapid response from a human talent acquisition, mobilization and management perspective.
The PEORIP resulted in outcomes that included:
The PEORIP was reviewed following the H1N1 second wave and the Vancouver 2010 Olympics, and consequently an HR Model for Emergency Preparedness and Response is currently under development, for expected implementation in 2010-11.
RA 7.1: The JC Wilt laboratory schematic design has been completed by Smith Carter Architects. Phase One of demolition includes removal of obsolete equipment such as partitions, ceiling and flooring tiles, and salvation of equipment that can be refurbished and reused was completed. Phase Two, including modification of exterior walls,
will be done by a construction firm upon contract award to realize cost savings.
ER 7.2: Canada’s laboratory research and response capacity increased.
Space in the National Microbiology Laboratory (NML) for laboratory research and response capacity has been increased with the move of shipping/receiving and storage functions to the off-site location. Following this move, the vacant space underwent renovations to provide additional research and research support capacity for program storage and the freezer room. As a result of these renovations, space was created to relocate the medial preparation area into the new NML expansion space to increase the space of the Contaminant Level (CL) 2 laboratory.
ER 8.1: Federal laboratory liaison technicians in provinces and territories (P/Ts) are trained, equipped and put in place to contribute to improved communications between provincial and territorial labs and the NML and strengthen national laboratory capacity. Components of the Canadian Pandemic Influenza Plan (CPIP) Annex C are in operation.
RA 8.1: Laboratory Liaison Technical Officers (LLTOs) have been placed in seven of the 10 provincial public health laboratories. The LLTOs proved to be an essential asset during the response to H1N1 pandemic. Response to H1N1 pandemic validated Annex C: Pandemic Influenza Laboratory Guidelines of the Canadian Pandemic Influenza Plan. The response also led to the following initiatives that were completed during 2009-10;
RA 9.1: As of April 1, 2010, the PHAC Centre for Immunization and Infectious Respiratory Diseases assumed responsibility for maintaining PHAC’s research agenda related to avian and pandemic influenza. The current research agenda classifies each research project based on the following themes: Antivirals; Biology of the Virus and Host; Clinical Care; Diagnostic Testing; Disease Severity; Ethics; Infection Prevention and Control; Information Technology and Training; Modelling/Predicting/Planning; Public Opinion Research; Surveillance; Transmission; Vaccines; and Zoonosis/Human-Animal Health.
Original funding of $10.8M over three years was announced June 5, 2009. An additional $2.7M over three years was announced August 27, 2009 to accelerate planning and to have procedures in place to evaluate the H1N1 vaccine within the context of the declared pandemic.
This network involved five theme groups and three support groups: Rapid Vaccine Trials; Rapid Program Implementation; Vaccine Coverage; Vaccine Safety; Vaccine Effectiveness; Laboratory Support; Information Technology Support; and Curriculum and Knowledge Translation.
PCIRN research will focus rapid testing for safety and effectiveness of the H1N1 vaccine in high risk populations - Aboriginal children and adults, adults with chronic illness, infants six to 35 months old and adults diagnosed with HIV.
Influenza Research Priorities was a joint initiative with Canadian Institutes of Health Research that became the Pandemic Preparedness Strategic Research Initiative (PPSRI). PHAC contributed $5.15M in grants from 2008-09 through 2010-11. This has funded over 100 pandemic related research projects including such areas as:
RA 10.2: The Agency conducted 10 training sessions in formal university and college settings to strengthen public health technical expertise and competencies both within PHAC as well as in the broader F/P/T fora. This focus on professional development will result in more timely detection and more effective management of a range of disease outbreaks (including those related to avian and/or pandemic influenza) and contribute to reducing the extent of illness and death in the event of a pandemic.
RA 11.2: All Preparedness for Avian and Pandemic Influenza Responsibility Centres were engaged in defining and appropriating performance indicators and in providing performance measurement information.
RA 11.3: A common Web-based data collection system was prepared, finalized and piloted with users, but has been suspended due to unforeseen technical problems with data outputs. An interim electronic data-gathering system was implemented and used. It is not expected that a Web-based system will be employed in the near future.
RA 11.4: Performance monitoring and measurement data and evidence was gathered in the final quarter of the 2009-10 fiscal year and will be used for management, reporting and evaluation purposes in 2010-11. The data collected addresses outputs and outcomes achieved or not in support of training, policy and procedures, clinical trials, planning and frameworks, partnerships, resource capacity building, communications / information development and dissemination for the Initiative.
However, with the emergence of H1N1, the CRC was revised to:
RA 12.2: The Communications Operational Plan was developed to support Annex K: Communications, of The Canadian Pandemic Influenza Plan, which can be found at: http://www.phac-aspc.gc.ca/cpip-pclcpi/ann-k-eng.php#tphp.
The operational plan helped facilitate:
RA 13.1: Four MOUs for the placement of PHOs in public health organizations across Canada are completed and signed. These MOUs are with Eastern Health Authority in St. John’s, Newfoundland, the Nova Scotia Department of Health Promotion and Protection in Halifax, the Prince Edward Island Department of Health and Social Services in Charlottetown and the Northwest Territories Department of Health and Social Services in Yellowknife. A further 14 Letters of Agreement (LOA) with placement sites are ready for signature. One letter of agreement is required for each PHO placement site. Currently, 26 are targeted for staffing by the end of fiscal 2010/2011. The recent changes in the CPHS , particularly the requirement for PHOs to do two-year rotations, have caused delays in agreements with placement sites and necessitated the use of the LOA. These LOA are an interim measure to PHAC umbrella agreements that will be used in the future for as many PHAC field services staff in each province as possible.
Despite unanticipated internal and external challenges encountered in the overall staffing process, the effort to complete the placement of all 26 PHOs by the end of 2010-11 is underway with three collective staffing actions completed and a total of 50 successful candidates across three classification levels. Nine additional Letters of Offer were in process or signed by April 30, 2010. Eight other candidates have been matched to positions for a total of 23. As of March 31, 2010, six PHOs had been hired and are placed in various sites across Canada. The staffing processes for the remaining PHO positions are at various stages of completion.
RA 13.2: Six CPHS Regional Coordinators are hired and currently operational in the PHAC Regional Offices in British Columbia/Yukon Territory; Alberta/Northwest Territories; Saskatchewan/Manitoba; Ontario/Nunavut; and Quebec and Atlantic regions.
RA 13.3: Twenty-three training modules were developed for presentation at the first annual Field Service Training Institute in May 2009. However, due to the H1N1 pandemic and associated requests for field services assistance, the training was postponed to May 2010. All 10 PHOs in place at that time were in attendance for the full five days of the event and took advantage of the selection of courses offered and of the opportunity to network with other PHAC field staff.
RA 13.5: During fiscal 2009-10, Canadian Public Health Service worked with two Research Affiliate Program (RAP) students and placed six co-op graduate students, all in sites across the North. Six additional co-op students and one RAP student were recruited for project placements in Northern public health organizations during summer 2010 to work on a wide variety of public-health projects. Placement sites are solicited through contact with Northern public health stakeholders, and students are recruited through established co-op and RAP processes. While there were plans to hire the same or greater numbers of students for the winter 2010-2011 term, budget constraints are such that further employment offers are on hold. Students were placed in non-PHAC, non-federal government locations, similar to the PHO placements, but only across the three northern territories which are the focus of the CPHS student- placement efforts.
RA. 14.1: The Agency trained 800 health care professionals in public health emergency preparedness and response including Chemical, Biological and Radio Nuclear response. Three hundred federal employees were trained to respond to a public health emergency. PHAC’s National Emergency Stockpile System (NESS) added a number of significant assets to its inventory as part of its on-going modernization strategy and the response to the H1N1 influenza outbreak in spring 2009. For example, over 400 ventilators, including those with paediatric capabilities were added.
ER 14.2: Laboratories capable of working with certified influenza strains.
RA 14.2: Each province has a minimum of one laboratory capable of working with influenza strains. Laboratories working with H1N1 pandemic samples must be certified at CL2; laboratories working with H1N1 pandemic viral cultures must be certified at CL2 plus; 23 labs are currently participating in the NML’s influenza virus proficiency testing programs; and 20 labs are currently participating in the NML’s influenza polymerase chain reaction (PCR) proficiency panel.
RA 14.3: Maritime Quarantine Stations at Montreal and Halifax Ports are fully integrated with traditional Quarantine Services. Establishing and resourcing these three marine Quarantine Stations contribute to emergency preparedness and emergency response surge capacity at airports and other points of entry.
RA14.4: In order to maintain readiness, PHAC acquired additional warehouse space to store and manage pandemic supplies, including additional antivirals procured during H1N1. The NESS continues to ensure the ability to respond 24/7 as it maintains an on-call schedule.
NESS warehouses and distribution depots are secured in accordance with the TBS Operational Security Standard on Physical Security, RCMP guidelines, and additional measures identified through site security design and Threat and Risk Assessments.
RA 14.5: During the H1N1 outbreak, 44 guidance documents were created, in collaboration with P/Ts and NGOs for use by the provinces and territories across Canada, under the following headings: Clinical Guidelines; H1N1 Flu Virus Vaccine; Infection Prevention and Control; Treatment and Clinical Care; Remote and Isolated Communities; Continuing Medical Education; Laboratories; Public and Event Organizers; Schools; Day Cares; Post-Secondary Institutions and Camps; Surveillance; and Managing H1N1 Flu Virus in Various Settings.
The Canadian Pandemic Influenza Plan is an F/P/T evergreen document which provides the foundation for pandemic planning in Canada. The following four annexes were updated in 2009-10:
RA 14.6: Efficient and effective information flow between F/P/T jurisdictions and with NGOs was achieved with the implementation of the Canadian Pandemic Influenza Plan during the H1N1 pandemic. This plan contains mechanisms for collaboration and coordinated outbreak response. The execution of this plan was facilitated by:
The Incident Management Structure (IMS) structure was also set up to help coordinate the pandemic response within the-Agency, between federal departments and P/Ts. In addition, the Multi-lateral Information Sharing Agreement (MLISA) is an initiative currently underway to complete a pan-Canadian public health information system to facilitate the timely sharing of information in preparing for and responding to public health emergencies.
Partner: Health Canada
RA 15.1: Health Canada (HC) participated in a variety of activities to prepare for and respond to H1N1 influenza in Canada. Health Canada participated in the World Health Organization’s (WHO) Networks of Influenza Vaccine Regulatory and Public Health Authorities to facilitate response to H1N1 pandemic and was part of the trilateral Health Canada/European Medicines Agency/United States Food and Drug Administration group established to help respond to H1N1 pandemic. Clinical development and pharmacovigilance sub-groups were also established to help coordinate a harmonized approach to vaccine regulation and information-sharing. Five Standard Operating Procedures were updated for the lot release testing of the H1N1 vaccine and planning was undertaken for contingencies such as analytical reagents not being available, or a genetic shift in the H1N1 virus resulting in the development and verification of alternative assays to be used in emergency situations. Health Canada also developed the first technique in the world capable of quantifying the neuraminidase (NA) component of influenza (the N in H1N1), the NA slot blot immunoassay. Health Canada scientists applied a wide range of analytical techniques to Canadian H1N1 vaccine samples to provide additional information in order to assist the regulatory decision makers. Health Canada prepared for a possible fall pandemic with a revised contingency planning and coordination with international regulatory agencies as well as risk assessments and planning for both the seasonal flu vaccine and the pandemic flu vaccine.
Laboratory infrastructure was retrofitted to accommodate the volume of pandemic lots. The Laboratory Information Management System infrastructure was also adapted to handle the pandemic vaccine lot data. Information Technology backup contingency plans were also drafted.
On October 21, 2009, the H1N1 pandemic vaccine was authorized under an interim order respecting the sale of the vaccine. Health Canada reviewed simplified Periodic Safety Update Reports from the vaccine manufacturer and collaborated with the PHAC to investigate any adverse events of special interest. The program
continues to monitor post-market commitments for the H1N1 vaccine, including submission of data from ongoing clinical trials and enhanced monitoring of the stability of the vaccine to confirm its shelf-life.
Lot release testing/evaluation for the pandemic vaccine for Canada and for international markets was performed as part of WHO’s Pre-Qualification Programme. An investigation was initiated in response to a higher than normal incidence of anaphylaxis observed with one particular lot of pandemic vaccine. Extensive testing was performed by the biologics program scientists to determine whether a quality issue could have contributed to a higher rate of anaphylaxis. Independent investigations were also conducted by GlaxoSmithKline Incorporated and PHAC. The investigation was concluded on March 19, 2010. Further to Health Canada analysis, no correlation could be found between the vaccine lots in question and a higher rate of anaphylaxis. These findings were shared with PHAC, the public and provinces and territories.
RA 16.1: An interim order was issued for the sale of antivirals for children under one year of age in a pandemic situation. This enabled PHAC to publish in collaboration with the provinces and territories a clinical treatment guidance document. This interim order has now expired.
Also developed during the H1N1 pandemic was an amendment providing guidance on disinfectant efficacy claims related to H1N1.
During the H1N1 pandemic, the draft Expedited Pandemic Influenza Drug Review was used and, based on the H1N1 experience, revisions were made to the protocol. Final approval and implementation of the protocol is on target for 2010-11.
HC received and conducted expedited reviews on four influenza-antiviral submissions and authorized the products for use in the Canadian market.
Staff continued to be involved in various working groups across the Health Portfolio to provide regulatory/clinical expertise, to contribute to the national flu drugs stockpile management strategies, and to collaborate on the planning of and execution of pandemic emergency exercises.
RA 17.1: The Crisis Management Unit was established and staffed. Oversight and coordination activities were conducted for post-market surveillance and risk management of antiviral drugs and other therapeutic health products used for the prevention or treatment of pandemic influenza. Additionally, significant progress was made with the HC Business Continuity Plan (BCP). Ongoing communication regarding safety of antivirals and vaccines occurred with PHAC and other partners.
RA 18.1: First Nations and Inuit Health Regions continued to develop educational materials (e.g., posters, pandemic preparedness templates, modules, and manuals). There was an increase in delivery of educational sessions on infection prevention and control, self-care measures, surveillance, and pandemic planning and testing for First Nations which also included testing mass immunization plans.
Furthermore, First Nations communities across the country have been supported in the development and testing of pandemic plans. In response to H1N1, an F/P/T Remote and Isolated Communities Task Group, co-chaired by the HC’s First Nations and Inuit Health Branch, generated several guidance documents which address the unique circumstances of remote and isolated communities. The Task Group included several National Aboriginal Organizations; Indian and Northern Affairs Canada (INAC); and provincial and territorial representation.
RA 19.1: Relationships have been established with other federal departments (e.g., PHAC and INAC); national and regional Aboriginal organizations; and provinces to ensure a comprehensive and coordinated response to public health emergencies, including an influenza pandemic, in on-reserve First Nations communities.
The First Nations and Inuit Health Branch participated in several task groups of the Pandemic Coordination Committee to ensure that guidance reflected First Nations circumstances.
The federal ministers for HC and INAC, with the Assembly of First Nations National Chief signed a communications protocol that affirms the government’s partnership with the Assembly of First Nations. A major focus of the protocol is the joint development of culturally appropriate communication products for First Nations communities.
Significant efforts were made during the H1N1 response to engage National and Regional Aboriginal Organizations, and First Nations communities. For example, regular teleconferences were held to share information.
Health Canada provided support to communities in the development and strengthening of their pandemic plans and response efforts. For example, communicable disease emergency nurse coordinators delivered a number of training sessions to communities. Furthermore, nurse coordinators developed and distributed a number of tools and templates to support developing and testing pandemic plans.
RA 19.3: The First Nations and Inuit Health Branch has developed and maintained links with Health Canada’s Regions and Programs Branch, PHAC and INAC. For example, a joint action plan was developed with INAC’s emergency management program. The First Nations and Inuit Health Branch has also developed and implemented a three year (2008-11) trilateral pandemic work plan with the Assembly of First Nations and PHAC.
Communicable disease emergency nurse coordinators are employed in all First Nations and Inuit health regional offices. Regional plans were activated and tested as a result of H1N1. Based on the H1N1 experience, these plans are currently being updated.
There was excellent collaboration and seamless work between most regional First Nations and Inuit Health regional offices and their provincial counterparts. The successful rollout of the vaccine and prepositioning of antivirals in remote and isolated communities are examples of this collaboration.
A reported 98 percent of all First Nation communities across Canada have a community pandemic plan and over 86 percent of communities have tested elements of these plans.
Several Regional Aboriginal Organizations, provinces and other federal departments have been engaged in the development and testing of community pandemic plans.
RA 21.1: Several training sessions were held (marine training, Incident Command System or ICS, and designation training) to enhance knowledge of EPR response activities and enhance knowledge of roles and responsibilities. Two employees attended ICS training levels 100-300.
RA 21.2: Hosted three scenario-based training sessions in three regional locations to test response plans; and participated in exercises Silver and Gold to ensure an active role during the 2010 Olympics from an EPR conveyances perspective.
Continued to enhance partnership with PHAC to ensure cohesiveness of response capacity. Joint training sessions were hosted (i.e., marine training) and attended by both Health Canada Environmental Health Officers and PHAC Quarantine Officers. As well, bi-monthly teleconference meetings were held with PHAC counterparts.
RA 21.3: Participated in Program Management Framework (PMF) document developed in consultation with other Preparedness for Avian Influenza and Pandemic Influenza Responsibility Centres. Data was provided for 2006-10. The PMF process is providing an evaluation tool.
It should be noted that Health Canada’s surge capacity was severely reduced due to the loss of the Environmental Health Officers in the Emergency Preparedness and Occupational Health Directorate (formerly the Workplace Health and Public Safety Programme) program. Reassessment of alternative surge capacity enhancement options will be conducted in 2010-11.
Partner: Canadian Institutes of Health Research
In total, $12.9M in strategic funds was managed by the Pandemic Preparedness Strategic Research Initiative (PPSRI) in 2009-10.
RA 22.2: Following the first H1N1 outbreak in March/April 2009, the pandemic preparedness outbreak research response catalyst grants were developed, launched and funded by the PPSRI to rapidly respond to this new specific threat.
ER 22.3: Review progress on funded projects and research outcomes. Facilitate uptake of research results and consult on future research needs through reporting and meetings of researchers, stakeholders and decision makers.
RA 22.3: Progress reports were collected from funded principal investigators in May, December of 2009 and January of 2009-10, and used to prepare the March 2010 PPSRI Report on activities and outcomes.
The Canadian Pandemic Preparedness Meeting: H1N1 Research Response was held in July 2009, and brought together 185 researchers and knowledge users from 75 organizations. This meeting not only served to communicate research results to the community but to facilitate networking between investigators.
Partner: Canadian Food Inspection Agency
ER 23.1: Increased capacity to support enhanced screening procedures for live birds or poultry products at Canada’s ports of entry with a view to mitigating the risk of future avian influenza outbreaks in Canada.
RA 23.1: CFIA implemented a border look-out on avian influenza (AI) with the Canada Border Services Agency (CBSA) to target marine shipments potentially containing AI related commodities and to deliver the Be Aware and Declare campaign for travellers where CBSA reports on the number of birds intercepted by the Canadian Food Inspection Agency (CFIA).
ER 24.1: Implementation of the National Standards for Avian Biosecurity, continuation of public education, communications and outreach programs and development of a governance framework surrounding the standards.
RA 24.1: The National On Farm Avian Biosecurity Standard outcomes have been incorporated into provincial biosecurity implementation and incentive programming for both provincial and federal outreach communication campaigns, and are disseminated through poultry industry sector magazines and national associations. The implementation of the Biosecurity Standard is voluntary; implementation is assisted by provincial biosecurity programming and private sector support through incorporation of the outcomes into existing frameworks such as the On Farm Food Safety Program.
ER 26.1: Enhanced/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 a more timely response to avian influenza situations.
RA 26.1: CIHR continued with the second year of the Canadian Notifiable Avian Influenza Surveillance System (CanNAISS), providing an AI surveillance system for domestic birds that meets international trade requirements (European Union). In total, 382 commercial poultry flocks were sampled across Canada from September 2009 to March 2010.
ER 28.1: Management and evaluation of CFIA’s AI activities, including ongoing performance measurement to monitor results and a formative evaluation. The evaluation will assess the AI Initiative’s design, delivery, and management. In addition, it will assess the likelihood of it achieving its objectives, as well as the adequacy of its performance measurement and reporting strategy.
RA 28.1: A formative evaluation of CFIA’s Avian Influenza/Pandemic Influenza Preparedness Initiative was completed in March 2010. The evaluation determined that the Initiative was implemented mostly as planned and greatly enhanced CFIA’s capacity to respond to all animal health emergencies. It also identified opportunities to enhance overall coordination, performance monitoring and financial reporting.
ER 29.1: National on-farm biosecurity information sessions and maintenance of Bird Health Basics outreach campaign. Continued implementation of the Be Aware and Declare international border biosecurity outreach campaign. Ongoing media monitoring and training and risk communications related to AI prevention, preparedness and response activities.
RA 29.1: Face-to-face interactions continued with key stakeholders in 2009-10 as part of a broader animal health awareness campaign. These interactions were at public venues such as agricultural fairs as well as targeted venues such as national industry association conferences and meetings. The Be Aware and Declare international outreach campaign continued and included public service announcements on more than 20 airlines. There was also enhanced collaboration with the provinces in providing producers with biosecurity information and guidance. Media monitoring and risk communications related to AI prevention, preparedness and response activities also continued.
RA 30.1: CFIA increased capacity on training issues by delivering multiple training sessions for Incident Command System (ICS), equipment monitoring and use, venipuncture, Transportation of Dangerous Goods and First Assessment and Sampling Team training. Furthermore, CFIA completed a poultry epidemiological and sampling exercise in the Western Area to evaluate the field staff’s equipment and methodology as well as the national protocols and training delivered.
RA 31.1: The Canadian Emergency Management Response System (CEMRS) application has recently been updated to the extent possible in order to enhance its functionality in capturing and querying the emergency response data provided by the field. There are ongoing efforts towards the design, development and implementation of a new application to replace CEMRS, the Disease Investigation and Response Management System (DIRMS), with a different basic design and a much larger scope and functions set.
RA 32.1: CFIA completed after action reports for exercises and responses. The National Disease Control Expert Working Groups continued the development and/or the revision and updating of disease response protocols for all aspects for the detection, containment and eradication of incursions of highly pathogenic avian influenza.
RA 33.1: A critical literature review which identifies modelling approaches and modelling parameters used for modelling the spread of influenza in animal and human populations was commenced. A total of 315 articles passed all the screening steps of the critical review and data was extracted from 32 of the 315 articles. This critical review will be completed in summer 2010.
ER 34.1: Investments 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 the mitigating economic and production losses.
RA 34.1: Through the assessment of the ability of the North American Animal Disease Spread Model (NAADSM) to model zoonotic diseases (i.e., H1N1) and the creation of a conceptual framework to link human and animal disease spread models, an initial conceptual framework to link humans and animal disease spread models using NAADSM and EpiFlex has been developed. The main differences and similarities between these two software platforms have been outlined. Further work is required to develop the required epidemiological parameters and computer codes needed to link these programs. This will be completed during 2010.
RA 34.2: CFIA continued to apply the rapid detection and identification techniques for avian influenza virus (AIV) instituting rapid sequencing techniques and planning for pyro-sequencing. CFIA participated in the USA/Mexico/Canada research forum which included AIV research prioritization and review. CFIA continued improvement to polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) tools for the 2009 AIV outbreak and distributed updated tests to the Canadian Animal Health Surveillance Network (CAHSN).
RA 34.3: The National Humane Destruction Working Group continued the development and revision of procedures for whole barn gassing, barn sealing and venting, non-commercial flocks, monitoring, legislation and modified atmosphere container for the humane destruction of avian species. Research was also conducted with the University of Guelph on the use of carbon dioxide and other gas mixtures for the humane destruction of poultry, turkeys, ducks and geese.
RA 35.1: The CFIA continues to be active internationally. For example, CFIA assisted in the preparation for the Canadian delegation attending the Seventh International Ministerial Conference on Animal and Pandemic Influenza, Hanoi, April 2010.
ER 37.1: Maintenance of access protocols and bank of antivirals to provide appropriate protection to federal employees, ensuring a more timely and effective response to an avian influenza situation and better protection of Canadians.
ER 39.1: Increased coordination capacity with the creation of an integrated lab network across the country (federal, provincial and university labs). This network will allow for rapid testing, detection and reporting of AI.
RA 39.1: CFIA continued to improve the diagnostic capacity of CAHSN in the face of the pandemic H1N1 2009 outbreak. On-site training was provided to 11 labs where 22 new analysts were trained in six assays. Previously certified analysts were re-trained in AI virus PCR assays as it concerns protocol changes and were newly trained in avian paramyxovirus (APMV) PCR. CFIA also created, produced and quality controlled PCR and ELISA panels, recombinant PC controls and ELISA controls for six assays.
Due to the established AIV laboratory network CFIA was able to establish SIV Matrix RRT-PCR assay for use in network labs quickly during the start of the outbreak. Pandemic H1N1 2009 SIV Matrix RRT-PCR protocol and primer/probe sequences were also distributed nationally and internationally. In addition, CFIA distributed ISO/IEC and internal audit training material to CAHSN labs (e.g., CDs and Web-based applications) and distributed National Centre for Foreign Animal Disease (NCFAD) standard operating procedures. The syndromic surveillance application was completed and is a novel system allowing the development of indicators for real time detection of diseases based upon laboratory submissions. The Influenza application for swine was programmed on a database built for emergency response and demonstrated the ability of the system to quickly build efficient tools in an emergency situation.
RA 41.1: Continued to work 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. The number of reservists trained in 2009-10 was 46, bringing the total trained to 206.
Comments on Variances:
Public Health Agency Canada: The variance of $17.2M from Planned Spending is related mainly to funding reallocated to subsequent years for the JC Wilt Laboratory construction project, delays in spending for the installation of a vaccine fill-line, transfers to CIHR, strategic review reductions, and funding that lapsed due to delays in activities resulting from the H1N1 flu outbreak.
Canadian Institutes of Health Research (CIHR): Planned Spending was $10.7M, but following the H1N1 outbreak, CIHR launched some unexpected funding opportunities for H1N1 pandemic specific projects, which increased spending to $13.0M.
Canadian Food Inspection Agency: In 2009-10, CFIA reallocated resources from Avian Influenza to other Agency priorities, such as operating costs associated with laboratories and additional inspection-related activities. This reallocation was done without affecting the 2009-10 Avian Influenza deliverables and results.
Results to be achieved by non-federal partners (if applicable): Non Governmental Stakeholders (including provincial and territorial governments,) are integral to the planning and implementation of the Preparedness for Avian and Pandemic Influenza horizontal initiative. Collaboration and partnership mechanisms include the Pan Canadian Public Health Network and its supporting F/P/T technical expert groups.
Dr. John Spika
130 Colonnade Road