The successful early procurement and equitable distribution of vaccines have contributed to the health and well-being of people in Canada, allowing for widespread protection against severe COVID-19 outcomes and the safe re-opening of our economy and society.

As of November 24, 2023, over 184M vaccine doses have been brought into Canada with over 137.5M doses delivered to PTs. Over 99M doses have been administered in Canada as of Sept 10.

· Based on a study published by PHAC in July/August 2022, Canada’s collective efforts up to April 2022, to achieve high vaccine coverage and adhering to public health measures may have saved or prevented up to an estimated:

o 800,000 lives

o 1.9 million hospitalizations

o 34 million COVID-19 cases

b. Canada's COVID-19 Supply Contracts

· At the start of the COVID-19 pandemic, there was uncertainty about which
COVID-19 vaccines would be developed and authorized and when quantities of individual vaccines would be available for distribution. This uncertainty created high global demand for safe and effective vaccines across the world and put pressure on governments to secure advance agreements with vaccine companies.

· In Canada, public health is a shared responsibility between the federal government, provinces and territories. Vaccine distribution and logistics are usually provincial and territorial responsibilities.

· However, during the COVID-19 pandemic, federal buying power was leveraged to ensure full funding and timely access to COVID-19 vaccines for Canada amidst high global demand, supply constraints, uncertainty about the success of vaccine candidates/new technology and limited domestic biomanufacturing.

· To help the Government make the necessary evidence‑based decisions on matters related to COVID-19 vaccines, the COVID-19 Vaccine Task Force (VTF) was established in April 2020, comprised of a multidisciplinary group of experts and industry leaders in the fields of vaccines and immunology.

· Guided by the advice of the VTF, Canada adopted a diversified vaccine strategy to secure access to the most promising COVID-19 vaccines that were assessed as most likely to be successful and established partnerships with a variety of vaccine manufacturers using different technologies and from different parts of the world.

Advanced Purchase Agreements

· To ensure the best chance for success, Canada built its vaccine portfolio through Advance Purchase Agreements (APAs) with seven suppliers to mitigate risks surrounding product development and timely delivery, with the goal of securing various types of COVID-19 vaccines and enough doses to fully vaccinate every eligible person in Canada.

· This COVID-19 vaccine procurement approach was focused on building a diverse vaccine portfolio to maximize our odds of securing access to safe and effective COVID-19 vaccines.

· APAs have the obligations of a contract but are more flexible in structure. This flexibility was needed given the uncertainties around when new vaccines would be developed. Having APAs meant that we could purchase vaccines that didn't yet exist.

· The agreements with the vaccine manufacturers also required initial investments to support vaccine research and development, testing and at-risk manufacturing. These were novel vaccines and companies needed advance funding for research, development and clinical trials.

· By signing memorandums of understanding with manufacturers, Canada was able to access an early supply of the first vaccines available. We also looked for ways to secure quicker deliveries of approved vaccines.

· Given the complexity of COVID-19 vaccine products and the scale of the vaccine rollout, the federal government also paid for and managed the distribution logistics for vaccine delivery to the provinces and territories.

Results: Early Procurement and Vaccination

· Our strategy worked, giving people in Canada early access to safe and effective vaccines. We were among the first countries to start vaccinating in December 2020 and we now have one of the highest coverage rates in the world. This has been the largest mass vaccination program in Canadian history.

· Several of the vaccines in our portfolio—from AstraZeneca, Janssen, Moderna, Novavax and Pfizer – received regulatory authorization and have been rolled out nationally.

· Canada’s response to COVID-19 involved significant and positive collaboration between the federal government, provinces, territories, Indigenous partners, the private sector, and others.

· The successful early procurement and equitable distribution of vaccines have contributed to the health and well-being of people in Canada, delivering millions of vaccine doses to Canadians, and allowing for widespread protection against severe COVID-19 outcomes and the safe re-opening of our economy and society.

· The unprecedented success of these vaccines speaks to the significant research and development efforts undertaken by the companies, as well as the tireless work of individuals and organizations around the country, including the regulator, Health Canada, and other government departments at all levels, logistics providers, health professionals and a diverse range of community partners.

· A continued working relationship between the government and vaccine manufacturers has enabled us to ensure vaccine supply is aligned with Canada’s program requirements, the most recent scientific data, and evidence-based expert advice.

· Managing Canada’s vaccine supply has been a complex challenge. The Public Health Agency of Canada is continually adjusting its approach based on disease trajectory and viral evolution, emerging scientific evidence, timing of regulatory approvals, novel formulations, product availability, guidance from the National Advisory Committee on Immunization (NACI) and fluctuating vaccine uptake and population demands.

· Going forward the Government of Canada will continue to review lessons learned and collaborate with implicated departments and stakeholders to optimize COVID-19 vaccine supply management and reduce COVID-19 vaccine surpluses and wastage throughout the duration of the contracts, including adjusting contractual commitments and delivery schedules, where possible.

c. Vaccine Supply Management

· Despite diligent vaccine supply management efforts and responsible stewardship of goods, both in Canada and globally, wastage is unavoidable as doses expire before they are used or are eligible for donation, or as new product formulations are included in our vaccine portfolio.

· Vaccine wastage is a reality and is expected and planned for at all levels of the immunization supply chain.

If pressed on wastage:

As of November 24, 2023, a total of 29M doses held domestically in federal inventory have been disposed of or were awaiting disposal due to expiry.
Approximately 10.3M doses are estimated to have expired in PT holding.
As of November 24, 2023, a total of 13.6M doses held off-shore (AstraZeneca) have been disposed of due to expiry.

· Wastage was almost zero for the first 6 months of the rollout as demand for primary vaccination of the entire population in a supply-constrained environment meant that every effort was made to conserve doses and maximize usage.

· Through 2021, wastage was steady at around 5% which is significantly lower than wastage generally expected for similar campaigns. As additional vaccines were authorized for use in Canada, manufacturers increased production capacity and demand from Canadians decreased, overall wastage has increased. Additionally, as new formulations have been authorized for use to address variants of concern wastage of older formulations has increased.

· A number of actions are being taken to optimize Canada’s COVID-19 vaccine supply and minimize wastage:

o We continue to work with provinces, territories, Indigenous partners and diverse national and community organizations to address vaccine hesitancy and promote vaccine uptake and staying up to date on vaccinations among eligible populations.

o We continue to work with vaccine suppliers to adjust contractual commitments and delivery schedules, where possible.

o We continue to explore options for the international donation of doses deemed surplus to Canada’s domestic needs in response to direct requests from countries (contingent on international demand for donated doses).

o PHAC also monitors COVID-19 vaccine product shelf-life and expiration dates and works closely with FPT partners to track and monitor expirations to prioritize and maximize vaccine campaign efficiency in the absence of an end-to-end integrated supply chain system across all levels of government and community partners involved in COVID-19 vaccination.

PHAC does not intend to procure additional COVID-19 vaccines once firm contractual deliveries under existing APAs are completed at the end of calendar year 2024 for mRNA vaccines and in 2025 for non-mRNA vaccines.

Federal support will remain available via the Bulk Procurement Program (BPP), should PTs wish to leverage it to facilitate access to competitive pricing, facilitate contract negotiations, and support security of supply, in line with the established approach to routine vaccine procurement.
During this transition, PHAC will ensure lessons learned from the pandemic inform how to better clarify FPT roles and responsibilities, and put processes in place, to support future pandemic vaccine procurement.

d. International Donations

· The Government of Canada recognizes the importance of a global response to the COVID-19 pandemic and supports efforts to promote global access to vaccines.

· Globally, the Government of Canada has donated the equivalent of over 201M doses, exceeding Canada’s 200M dose donation commitment.

· This included 46.6 million doses deemed surplus from Canada's domestic supply and donated to COVAX, as well as more than 3.7 million doses donated directly to countries through bilateral agreements.

· Canada also provided financial contributions to COVAX towards the purchase of the equivalent of 150.7 million vaccine doses for low- and middle-income countries.

· The Government will continue to collaborate with GAVI, the Vaccine Alliance, and through bilateral engagement with other counties to identify opportunities to donate surplus doses to support global vaccine equity.

e. Domestic Biomanufacturing - investments for preparedness and response

· The COVID-19 pandemic has reinforced the importance of strengthening domestic capacity to rapidly access vaccines to protect all people in Canada against pandemics and other health emergencies.

· In 2021 the Government of Canada launched Canada’s Biomanufacturing and Life Sciences Strategy which presents a long-term vision to protect Canadians against future pandemics and other health emergencies and help grow Canada’s domestic life sciences sector and biomanufacturing capacity.

· With support from the Government, the Canadian biomanufacturing landscape is actively evolving. For example, Moderna is in the process of building a state-of-the-art mRNA vaccine production facility in Quebec and Sanofi Pasteur is establishing an influenza vaccine manufacturing facility in Ontario to increase the supply of its differentiated seasonal influenza vaccines and to enhance influenza pandemic preparedness efforts.

· The Biologics Manufacturing Centre is an end-to-end biomanufacturing facility, supporting the growth of domestic biomanufacturing production capacity for the future, ensuring that vaccines and other biologics can be safely manufactured in Canada for Canadians. Designed to produce biopharmaceuticals like viral vector, protein subunit, and virus-like particle vaccines and other biologics, the Biologics Manufacturing Centre is an important part of Canada's future biomanufacturing infrastructure.

· The Government of Canada continues to explore opportunities to grow the domestic life sciences sector and biomanufacturing capacity and, at the same time, augment Canada’s ability to access international vaccine supply for ongoing routine immunization programs and outbreak response to emerging or re-emerging infectious diseases.

· In January 2022, the Government announced the creation of the Center for Research on Pandemic Preparedness and Health Emergencies, housed within the Canadian Institutes of Health Research, to focus on growing Canada’s capacity to research and mobilize knowledge to prevent, prepare for, respond to, and recover from existing and future pandemics and public health emergencies.

· In Budget 2023, the Government of Canada committed to exploring new ways to be more efficient and effective in the development and production of the vaccines, therapies, and diagnostic tools that will be required to address future health emergencies. As a first step, Canada will further consult with domestic and international experts on how to best organize preparedness efforts for the years to come.

f. Medicago

· A $150M non-refundable advance payment was made to Medicago in accordance with the COVID-19 vaccine Advance Purchase Agreement;

§ Medicago met all the terms for the payment; and

§ the contract was terminated by mutual consent and Medicago was released of its obligations under the APA

g. Novavax COVID-19 Vaccine Supply Contract Amendment

· On July 7, 2023, Novavax filed a report to the Securities and Exchange Commission (SEC), which included details on Canada’s COVID-19 vaccine supply contract, that was made public upon submission.

· The SEC report included certain financial information, including the amount paid by Canada for forfeited COVID-19 doses, valued at $349.6M USD, and notes that the total value of the APA is unchanged.

· The report highlights Novavax’s commitment in support of future longer-term investments in Canada for an amount equal to the remaining payments to be made under the contract. The details of these obligations will be formalized in a memorandum of understanding (MOU).

· The recent amendment of the Novavax contract contributes to Canada’s COVID-19 vaccine strategy by ensuring access to a non-mRNA vaccine and delivering value to Canada through a commitment by the company to produce doses in Canada and to invest in Canada in the future.

· Canada chose to forfeit these doses, as it supported our strategy to align vaccine supply with demand, reduce wastage and other associated costs for storage and eventual destruction of unused doses.

h. OAG Audit of COVID-19 Vaccines

· PHAC acknowledges the comprehensive report by the Officer of the Auditor General of the COVID-19 vaccine response.

· The Agency has agreed to all recommendations put forward in the report and a number of actions have been underway for some months to build on our lessons learned through COVID-19 immunization efforts including those related to:

o Optimizing vaccine supply management,

o Work to improve FPT vaccine data sharing, including development of the pan-Canadian Health Data Strategy

o Improvements to the VaccineConnect system modules for FPT vaccine supply/inventory management, and technology supports for ongoing vaccine safety information sharing.

· As noted by the Auditor General, Canada’s vaccine procurement was undertaken with the goal of protecting the health and safety of Canadians at a time of a competitive global race to obtain COVID-19 vaccines in 2020-21 and considerable uncertainty as to which, if any, vaccine candidates, including new technologies, would ultimately be safe, effective or available, and when.

· The audit highlighted that actions performed by Public Services and Procurement Canada and the Public Health Agency ensured efficient procurement and sufficient COVID-19 doses obtained to support Canada’s COVID-19 pandemic response.

· On Canada’s COVID-19 vaccine supply picture, it is constantly changing based on doses distributed to and administered by PTs, vaccine shelf-life extensions, vaccine expiries, new deliveries of doses, including the addition of new formulations, international donations, as well as avoidable and unavoidable wastage.

I. Pandemic Response/Review

The Government of Canada remains steadfast in its commitment to protecting the health and safety of Canadians by working to support public health transformation, facilitating building adaptive health human resources, and strengthening relationships with key communities and other stakeholders.
Departments and agencies have been conducting their own reviews, and the Government is taking all lessons learned into account to strengthen its pandemic preparedness, planning and response. These efforts will build on significant investments made in response to COVID-19, respond to external audits and evaluations, such as those conducted by the Office of the Auditor General, and be evidence-based, using the best available research.

PHAC’s Continuing Work to Improve

PHAC is continuing its work to improve in response to the lessons identified over the course of the pandemic. Key areas include addressing health inequalities, data collecting and sharing of research, jurisdictional coordination, biomanufacturing capabilities, and vaccine deployment.
The Agency’s ongoing review of its COVID-19 response has resulted in major organizational improvements, for example the establishment of the Centre for Integrated Risk Assessment, enhanced support for domestic vaccination capacity, and improvements to the National Emergency Strategic Stockpile.
PHAC is continuing to stock-take and monitor lessons and best practices, and to learn from others, including our provincial and territorial counterparts and other G7 nations to draw insights that inform a made-in Canada approach.
PHAC continues to work with federal, provincial, and territorial partners to improve our collective governance and work on the development of shared priorities, such as modernizing the health system with data and digital tools. PHAC is also updating our domestic and international emergency response plans, including the Health Portfolio Emergency Response Plan and the North American Preparedness for Animal and Human Pandemics Initiative.

2. Hot Issues Cards

a. COVAX - Participation

CANADA’S PARTICIPATION IN THE COVAX FACILITY

ISSUE

Canada was a strong supporter of the COVID-19 Vaccine Global Access (COVAX) Facility, a global procurement mechanism that helped to deliver fair and equitable access to COVID-19 vaccines. The Public Health Agency of Canada continues to work closely with Gavi, the Vaccine Alliance, and Global Affairs Canada to offer surplus doses for donation.

KEY FACTS

Canada announced its participation in the COVAX Facility in September 2020. Canada invested in COVAX to provide COVID-19 doses around the world, for people in Canada, and for people in middle- and low-income countries.
Canada began donating its surplus COVID-19 vaccines, through COVAX and bilaterally, in late summer 2021. It has been decided that Gavi will cease to administer the COVAX Facility beyond December 31, 2023; however, the provision of COVID-19 vaccines will continue through Gavi for the 2024-2025 vaccination program.
Including both COVAX donations and bilateral donations, 28.8 million of Canada’s donated doses have been delivered to 36 recipient countries.

KEY MESSAGES

The Government of Canada recognizes the importance of a global response and recovery to the COVID-19 pandemic and supports continued efforts to increase equitable global access to vaccines.
Canada has successfully donated the equivalent of over 201 million doses to date and will continue to make doses available as country requests are received. This includes:
46.6 million doses deemed surplus from Canada’s domestic procurement made available to COVAX.
more than 3.7 million doses donated directly to countries through bilateral agreements.
financial contributions to COVAX towards the purchase and delivery of the equivalent of 150.7 million vaccine doses to low- and middle-income countries.
Where additional country demand materializes, Canada will continue to donate doses deemed surplus to Canada’s domestic needs.
Of the 46.6 million doses made available to COVAX, over 25 million doses have been delivered to recipient countries.

IF PRESSED ON THE BREAKDOWN OF DONATED DOSES

Canada has donated approximately 46.6 million doses deemed surplus from Canada’s domestic supply to COVAX. This includes:

At least 10 million Moderna doses
14.8 million Janssen doses

9.8 million doses from our bilateral APA
4.98 million doses from our COVAX APA

21.8 million AstraZeneca doses, which includes approximately:

17.7 million doses from our bilateral APA
4.1 million doses from our COVAX APA

Additionally, Canada has shared more than 3.76 million doses through direct, bilateral agreements with countries. This includes:

0.7 million AstraZeneca
3 million Pfizer doses

IF PRESSED ON WHY THE NUMBER WAS REDUCED FROM 50 MILLION TO 46.6 MILLION DONATION NUMBER AS PREVIOUSLY REPORTED

Canada had originally communicated publicly that 50 million surplus doses had been offered for donation to COVAX. Developments in the contractual relationship between COVAX and Novavax have affected this donation therefore Canada is no longer able to account Novavax doses as being offered to COVAX.

IF PRESSED ON HOW MANY DOSES HAVE BEEN DECLARED SURPLUS

Canada has made available 46.6 million surplus doses to COVAX. Additionally, Canada has shared 3.7 million surplus doses directly with recipient countries through bilateral agreements.

IF PRESSED ON WHY DOSES DELIVERED TO COVAX WERE NOT DELIVERED TO RECIPIENT COUNTRIES

In some instances, COVAX accepted doses for donation from Canada that the Facility was unable to allocate at country-level due to a number of factors. This led to the eventual expiry of these doses.
We have and continue to work closely with Gavi and manufacturers to minimize wastage. This includes ensuring the longest possible shelf life on doses and reinforcing country health system capacity to deliver vaccines.
In a pandemic some wastage is inevitable. This is due to complex factors like epidemiology, public health factors, and product requirements that are constantly evolving.

IF PRESSED ON EXPIRED DOSES OFFERED TO COVAX

Due to limited demand for the AstraZeneca vaccine and recipient country challenges with distribution and absorption of approximately 21.8 million AstraZeneca doses offered to COVAX, only 8.2 million were accepted for donation, and 13.6 million doses could not be used and expired offshore.
The 13.6 million doses that expired were offered to COVAX with full shelf life, and in some cases, before they were even manufactured. However, demand for the product diminished drastically as the doses were made available by the manufacturer and were consequently not accepted for donation by recipient countries.

Background

Canada has committed close to $3.5 billion in international assistance in response to the COVID‑19 pandemic. This includes over $1.2 billion to the Access to COVID‑19 Tools (ACT) Accelerator vaccine pillar. Canada also committed to donate the equivalent of 200 million doses by the end of 2022. To date, Canada has donated the equivalent of 201 million doses. Canada is committed to sharing its surplus vaccine supply through the COVAX Facility to ensure an equitable and efficient allocation to the countries that need them most. In some circumstances, we also shared doses directly with recipient countries through bilateral agreements.

The COVAX Facility is a global pooled procurement mechanism for COVID-19 vaccines designed to foster equitable global vaccine access to help end the acute phase of the pandemic. It is co-led by Gavi, the Vaccine Alliance, the Coalition for Epidemic Preparedness Innovations, and the World Health Organization (WHO).

Canada has also provided $50 million CAD to the Pan American Health Organization (PAHO) to support efforts to facilitate access to COVID-19 vaccines for those living in situations of vulnerability across the Caribbean and Latin America. Portions of this grant are being used to procure vaccine doses for countries through PAHO, which are in addition to Canada’s commitment to COVAX.

On June 22, 2022, Canada announced $200 million in funding for a new signature initiative. Canada's Global Initiative for Vaccine Equity (CanGIVE) is designed to support vaccine delivery and distribution, as well as health systems strengthening in 12 countries, most of them in Africa. On January 13, 2023, Minister Sajjan announced additional allocations to CanGIVE, bringing the total value of the program to $275 million. Through CanGIVE, Canada is partnering with UNICEF, the WHO, PAHO and Medicines Patent Pool.

In November 2022, Canada announced $15 million CAD to PAHO for Improving Manufacturing Capacities for Vaccines in Latin America and the Caribbean as part of a larger CanGIVE funding envelope.

b. COVID Audits

OAG AUDIT REPORTS DURING THE PANDEMIC

ISSUE

Since summer 2020, the Office of the Auditor General (OAG) has been auditing the Public Health Agency of Canada‘s (PHAC’s) responses/activities related to the COVID-19 pandemic. The first four COVID-19 performance audits that were tabled in Parliament include the:

Audit of Pandemic Preparedness, Surveillance, and Border Control Measures (March 25, 2021);
Audit of Securing Personal Protective Equipment (PPE) and Medical Devices (May 26, 2021);
Audit of Enforcement of Quarantine and COVID-19 Testing Orders (December 9, 2021); and
COVID-19 Vaccines (December 6, 2022).
PHAC is addressing all of the recommendations from these audits, and implementation is on track. A fifth COVID-19 related performance audit (Audit of ArriveCAN) is underway and is expected to be tabled in early 2024.

KEY FACTS

PHAC officials agreed to all recommendations from the four COVID-19 audits that were tabled in 2021 and 2022.
For each audit, a Management Response and Action Plan (MRAP) was developed and includes interim milestones. The President approved the MRAPs in response to the recommendations addressed to PHAC.
PHAC is currently completing actions to respond to these audit recommendations.
The status of MRAPs is monitored on an ongoing basis and progress on deliverables and deadlines is reported quarterly to the Departmental Audit Committee.

KEY MESSAGES

We recognize the importance of incorporating lessons learned throughout the Pandemic and working with other government departments and partners, as required. The Public Health Agency of Canada accepted the recommendations from the four Auditor General reports related to the pandemic response that involve the Agency and is already working on implementing the recommendations made by the Auditor General of Canada.
The Public Health Agency of Canada continues to consider audit and evaluation findings, along with best practices and lessons learned from lived experiences responding to COVID-19, to inform and improve our planning and to position Canada to successfully respond to future global health events.

IF PRESSED ON HOW PHAC HAS ADDRESSED THE RECOMMENDATIONS FROM THE AUDITS

The Agency continues to focus on the planned actions that respond to audit recommendations. These actions include pandemic planning, improving surveillance systems, integrated risk assessments, reducing barriers to access vaccines, managing stockpiles, and enforcing emergency orders.

Audit of Pandemic Preparedness, Surveillance, and Border Control Measures

In the Audit of Pandemic Preparedness, Surveillance, and Border Control Measures, the Auditor General made seven recommendations for the Agency related to pandemic planning, health surveillance information, early warning of public health threats, and border measures.
The Agency is addressing recommendations related to health surveillance information and early warning of public health threats.
Work is already underway and an After-Action Review of the COVID-19 Incident Management System has been launched to assess how emergency plans were used in the pandemic within the Agency. These reviews are standard practice; and are always conducted following an emergency response to identify gaps and best practices to help inform future responses.

Audit of Securing PPE and Medical Devices

The Audit of Securing PPE and Medical Devices resulted in two recommendations for the Public Health Agency of Canada related to assessing needs and managing the National Emergency Strategic Stockpile.
The Agency has already completed one recommendation, specifically related to documenting and enforcing a contract management protocol and governance structure.
PHAC is advancing the development of a comprehensive management plan for the NESS as recommended by the Office of the Auditor General:

PHAC is engaged with its provincial and territorial partners in the development of the plan, which will provide a roadmap for systemic and agile transformation of the NESS with overall objectives of improving readiness to respond to future pandemics and other emergencies and driving continuous improvement in the management of the NESS.
In parallel, NESS continues to identify and implement incremental improvements stemming from lessons learned in response to COVID-19, mpox and other public health emergencies
Actions in the process of implementation include the development of a modern Warehouse Management System to track and manage NESS assets through their lifecycle, and a NESS portal to facilitate information sharing on NESS assets, including upcoming deployments of supplies with provinces, territories, and other Government departments.
As this work develops, we continue to manage the disposal and divestment of supplies including looking for innovative ways to recycle unwanted inventory and ensuring the regular review of expiry dates of medical equipment as part of routine lifecycle management.

Audit of Enforcement of Quarantine and COVID-19 Testing Orders

For the Audit of Enforcement of Quarantine and COVID-19 Testing Orders, the Public Health Agency of Canada has developed a corresponding action plan to address the recommendations.
Action plans, slated for completion by the beginning of 2024, involve improving the Agency’s enforcement of emergency orders imposed to limit the spread of COVID-19 by improving data quality and ensuring that it has agile and fit-for-purpose platforms as warranted to ensure preparedness for future public health emergencies and by continuing to mature policies tied to its Compliance and Enforcement program.

Audit of COVID-19 Vaccines

The Public Health Agency of Canada has developed action plans in response to the recommendations identified in the Auditor General of Canada’s audit report on vaccines. The Agency has:

· worked closely with federal, provincial and territorial (FPT) partners to better understand their vaccine needs. This allows the Agency to identify dose surpluses which opened the doors to renegotiate contracts with vaccine suppliers. It also results in amended contracts that better align with expected demand.

· implemented the Intelligent Supply Chain module of VaccineConnect. This includes making enhancements to support more robust data quality procedures such as inventory management and demand planning.

· received commitments from FPT officials to improve how health information is collected, shared, used, and reported to Canadians to promote greater transparency on results, and to help manage public health emergencies. These commitments build on the work by FPT officials over the past several years in the co-development of the Pan-Canadian Health Data Strategy. Additionally, the Pan-Canadian Interoperability Roadmap was endorsed in March 2023 by all FPT governments except Quebec, and under the leadership of Canada Health Infoway, FPT governments are now implementing the Roadmap, collaborating on common standards needed to improve patient access to their electronic health information and remove barriers to data sharing among health care professionals through a secure, digitally connected system. Moreover, a joint FPT Action Plan and Health Data Charter was endorsed by health ministers (except Quebec) in October 2023, outlining key deliverables to advance the health data commitments and principles which focus on a person-centered approach to data management and an integrated governance structure has been established to advance the work and facilitate decision making under the accountability of the Conference of Deputy Ministers.

IF PRESSED ON HOW PHAC WILL ADDRESS STANDING ISSUES AND BE BETTER PREPARED FOR THE NEXT PANDEMIC

There are and will be many lessons for everyone from this pandemic, in Canada and around the world, which we are learning from in order to adjust our approach and ensure we remain well positioned and prepared to respond to future global health events.
The Public Health Agency of Canada’s response, its guidance, and its advice evolved during the pandemic and were informed by the latest available scientific evidence, epidemiology, and expert opinions, which can change as new information becomes available.
Many lessons learned have already been implemented in real time.
Work will continue in the context of ongoing implementation of the Management Response and Action Plans associated with related audits.

IF PRESSED ON IF PHAC WILL COMMIT TO AN INDEPENDENT REVIEW OF THE GOVERNMENT’S HANDLING OF THE PANDEMIC

There are already scores of studies going on reviewing Canada's pandemic response, which was among the best in the world with one of the lowest death rates in the world. We are committed to having a pandemic review. We are looking forward to talking about that, but it's essential that it be forward-facing and constructive so that we can be ready to prepare and protect Canadians to the greatest extent of our ability.

background

Audit of Pandemic Preparedness, Surveillance, and Border Control Measures

On March 25, 2021, the Auditor General of Canada tabled a performance audit of Pandemic Preparedness, Surveillance, and Border Control Measures. Both PHAC and the Canada Border Services Agency were implicated in this audit. The audit objectives were to:

Determine whether PHAC was prepared to respond to a pandemic to protect the health and safety of Canadians, supported by accurate and timely public health surveillance information;
Determine whether PHAC and the Canada Border Services Agency implemented border control and quarantine measures to limit the introduction and further spread in Canada of the virus that causes COVID‑19.

Taking into consideration the OAG’s recommendations, PHAC’s response, its guidance, and its advice have evolved during the pandemic and have been informed by the latest available scientific evidence, epidemiology, and expert opinions, which can change as new information becomes available. PHAC has been actively working to address the OAG’s recommendations to be better prepared in the future.

Audit of Securing Personal Protective Equipment (PPE) and Medical Device

On May 26, 2021, the OAG tabled their audit on PPE and Medical Devices, which implicated PHAC, Health Canada, and Public Services and Procurement Canada. This audit focused on:

whether PHAC and Health Canada, before and during the COVID-19 pandemic, helped meet the needs of provincial and territorial governments for selected PPE and medical devices; and
whether Public Services and Procurement Canada provided adequate procurement support. Selected equipment for this audit included N95 respirators, medical gowns, testing swabs and ventilators. These items were considered to be at risk due to high global demand, limited suppliers, specific technical requirements and limited domestic production.

PHAC recognized that this audit identified areas for improvement to be better prepared for future health events, including for the management of the National Emergency Strategic Stockpile. PHAC is committed to acting on these recommendations to enhance its preparedness for future public health emergencies.

Audit of Enforcement of Quarantine and COVID-19 Testing Orders

Within the same year of the first two audits, the OAG conducted their third PHAC audit, the audit of Enforcement of Quarantine and COVID-19 Testing Orders. This audit, concentrating solely on PHAC, was the follow-up on the Audit of Pandemic Preparedness, Surveillance, and Border Control Measures. This audit focused on:

Whether PHAC improved its administration of mandatory orders to limit the introduction of the COVID-19 virus and its variants in Canada;
Whether PHAC implemented and enforced additional border measures introduced in early 2021 (such as COVID-19 testing for travellers entering Canada and quarantine of air travellers at government-authorized hotels pending the results of their on-arrival COVID-19 tests).

PHAC is working on improving its automated tracking and data quality so it can better follow up with travellers who are subject to border measures and is implementing gender-based analysis plus (GBA+) considerations to mitigate any potential adverse impacts of existing and future programs on diverse and vulnerable groups.

Audit of COVID-19 Vaccines

On December 6, 2022, the OAG tabled the Audit of COVID-19 Vaccines. This audit concentrated on PHAC, Health Canada, and Public Services and Procurement Canada. This audit focused on whether:

Public Services and Procurement Canada provided adequate procurement support to secure COVID-19 vaccines;
the Public Health Agency of Canada and Health Canada efficiently provided access to COVID-19 vaccines; and
the Public Health Agency of Canada and Health Canada’s surveillance of COVID-19 vaccines was effective and timely.

Based on their four findings, PHAC committed to:

· reducing vaccine wastage and continue working with stakeholders to adjust the management of COVID-19 vaccine surpluses;

· completing the implementation of VaccineConnect, the national vaccine management information technology system;

· expediting its work with provinces and territories to complete the Pan-Canadian Health Data Strategy in order to improve access to quality data;

· resolving barriers to sharing vaccine surveillance data and provide access to the Canadian Adverse Events Following Immunization Surveillance System for Health Canada and case-level details, as needed, to the World Health Organisation and vaccine companies in a timely manner.

PHAC will continue to address the action plans and complete them accordingly, taking into consideration the ongoing response to the pandemic.

c. COVID Response Highlights

COVID-19 RESPONSE HIGHLIGHTS

UPDATE ON COVID-19 RESPONSE HIGHLIGHTS

The successful early procurement and equitable distribution of over 174.4M vaccine doses have contributed to the health and well-being of people in Canada, allowing for widespread protection against severe COVID-19 outcomes and the safe re-opening of our economy and society.
We have strengthened key surveillance programs, behavioural science and risk assessment capacity both to be better able to detect, understand, and act on public health threats in collaboration with provinces and territories, and to better understand the wider impacts of the COVID-19 pandemic on Canadians.
We also continue to work to ensure systems are in place to rapidly generate and access the science and evidence that are necessarily at the core of any pandemic response, while enhancing how this information and all public health risks are communicated to Canadians.

ISSUE

The COVID-19 pandemic was a watershed moment for Canada and the Canadian Government addressed this unprecedented situation with an equally unprecedented response.
For the Public Health Agency of Canada, the COVID-19 pandemic pointed to the need to build upon pandemic-related successes and address longstanding gaps and criticisms of the Agency since its inception in 2004.
While PHAC adapted in real time and assumed many new or enhanced functions to help protect Canadians, there is continued public concern about the Government of Canada’s readiness for the next pandemic.

KEY FACTS

Within the Health Portfolio, the Public Health Agency of Canada (PHAC) leads on 16 Mandate Letter Commitments, 12 of which are under the leadership of the Minister of Health, and 4 of which fall under the Minister of Mental Health and Addictions and Associate Minister of Health, or the Minister of Public Safety.
Of these 16 commitments, half (8) are linked to Canada’s response to the COVID-19 pandemic.

KEY MESSAGES

The COVID-19 pandemic was a watershed moment for PHAC, pointing to the need to build upon pandemic-related successes and address longstanding gaps and criticisms.
Together, we:

Launched Canada’s largest and most complex mass immunization campaign, with more than 99 million doses administered as of September 10, 2023;
Developed and progressively implemented a comprehensive border strategy with layers of precautionary measures, including establishment of a compliance and enforcement regime; and,
Strengthened emergency surge support capabilities to our provincial and territorial partners.

We continue to monitor and respond to COVID-19 while integrating lessons learned to maintain and enhance preparedness, including areas such as data, monitoring, stockpiling, as well as ensuring access to vaccines and therapeutics.

IF PRESSED ON VACCINE ROLLOUT

Vaccine Distribution and Administration

The Public Health Agency of Canada led Canada’s largest mass immunization program in history. With significant collaboration between the federal government, provinces, territories, Indigenous partners, health professional associations, the private sector and a diverse range of community partners, Canada was able to secure over 174.4 million doses of the latest formulations of vaccines for distribution in Canada, and administer over 99 million doses as of September 10, 2023.

IF PRESSED ON VACCINE GUIDANCE

Since 2020, the National Advisory Committee on Immunization (NACI) has developed and released 56 COVID-19 vaccine guidance products.
Canada and NACI were leaders on vaccine safety, sharing important data with the world about how to reduce the risk of rare events through longer intervals between doses, now adopted by WHO and others.
PHAC most recently issued NACI’s Addendum to the guidance on the use of COVID-19 vaccines in the fall of 2023 on September 12, 2023.

IF PRESSED ON DOMESTIC SUPPLY OF THERAPEUTICS AND PERSONAL PROTECTIVE EQUIPMENT (PPE)

National Emergency Strategic Stockpile (NESS)

The Government of Canada proactively distributed incoming medical supplies and equipment, such as personal protective equipment and vaccine supplies, to provinces and territories to support Canada’s COVID-19 response.
Over the course of the pandemic:

Procured and distributed, free of charge, over 2.1 million treatment courses of safe and effective therapeutics.
Purchased 4.1 billion units of medical equipment and supplies (e.g., PPE, vaccine ancillary supplies, biomedical equipment and test kits).
Distributed over 2 billion units of medical equipment and supplies (e.g. personal protective equipment, biomedical equipment and vaccine ancillary supplies).

IF PRESSED ON CANADA’S BORDER POSTURE

During the pandemic, the Government of Canada put in place emergency border measures, in order to reduce the risk of the importation and transmission of COVID-19 and new variants in Canada related to international travel. The measures included entry restrictions, testing and quarantine requirements.
As epidemiological situation improved, the Government of Canada gradually lifted COVID-19 entry restrictions, as well as testing, quarantine, and isolation requirements for individuals entering Canada. The elimination of border measures was facilitated by several factors, including surveillance and modelling that indicated Canada had largely passed a peak of infections, high vaccination coverage, lower hospitalization and death rates, as well as the availability and use of additional vaccine doses, rapid tests, and treatments for COVID-19.
The Agency implemented enhanced border measures in collaboration with federal partners, industry, provinces/territories and Indigenous leaders, which included:

providing over 18 million handouts detailing entry requirements to travellers at ports of entry; conducting health screenings for over 400,000 travelers at ports of entry (March 20, 2020 to September 20, 2022); and admitting over 22,000 travelers to quarantine facilities (February 2020-September 30, 2022).

IF PRESSED ON PROOF OF VACCINATION CREDENTIALS

The Government of Canada collaborated with the provinces and territories to develop a Canadian COVID-19 proof of vaccination. The document is issued by provinces and territories and provides people vaccinated in Canada with a simple, consistent, and secure record of their COVID-19 vaccination history.
The Government of Canada also established a $300M COVID-19 Proof of Vaccination Fund to support provinces and territories for costs to implement a COVID-19 proof of vaccination credential program.

To date, 11 provinces and territories have received their allocation under the Fund.

IF PRESSED ON INTERNATIONAL EFFORTS

International Collaboration

COVID-19 has demonstrated the need to take bold action through international collaboration to ensure we are better prepared for the next pandemic.
Since the beginning of the COVID-19 pandemic, Canada has engaged with international partners bilaterally and multilaterally, through the G7, the G20, the World Health Organization (WHO), and the Pan American Health Organization (PAHO) to help inform our domestic response and to contribute to global efforts on fighting COVID-19. Canada is committed to working with the broader global community to strengthen global health security.

Vaccine Donations

Canada has supported equitable access to COVID-19 vaccines by:

donating our surplus doses
supporting the delivery and distribution of vaccines
investing in the COVID-19 Vaccine Global Access (COVAX) Facility
strengthening health systems, regional production capacity and pandemic preparedness

We exceeded our commitment by donating over 201 million doses by the end of 2022. This donation included 46.6 million doses deemed surplus from Canada's domestic supply and donated to COVAX, as well as more than 3.7 million doses donated directly to countries through bilateral agreements.

IF PRESSED ON FPT RELATIONS

FPT Surge Support

PHAC provided an unprecedented level of surge capacity and provided a critical backstop to PT public health systems including:

PT infrastructure and the human talent and expertise (including the NESS, laboratory capacity, public health and epidemiological support);
Procuring and funding broad population vaccination; and
Funding safe voluntary isolation sites for individuals who could not safely isolate due to crowded accommodations and/or resource constraints.

FPT and Indigenous Collaboration

Canadians benefit from a long-standing and positive intergovernmental environment that supports information-sharing, collaboration, cooperation, and joint action across governments to address public health event readiness.

Collaborations FPT et autochtones

Les Canadiens bénéficient d’un environnement intergouvernemental de longue date et positif qui soutient le partage de l’information, la collaboration, la coopération et l’action conjointe entre les gouvernements pour gérer l’état de préparation aux événements de santé publique.

IF PRESSED ON DATA AND SURVEILLANCE

Wastewater Surveillance

The Public Health Agency of Canada worked in collaboration with other federal departments, and provincial, territorial, and municipal governments to establish a pan-Canadian wastewater surveillance network for timely detection and monitoring of emerging COVID-19 variants of interest and concern.
The Agency and its partners also established a pilot project to monitor wastewater from airports and a short-term aircraft wastewater testing program to assess the COVID-19 variants coming into Canada from various regions of the world.

Pan-Canadian Health Data Strategy

Building off lessons learned from the pandemic and recognizing the critical importance of timely access to health data, FPT governments collaborated on the development of a Pan-Canadian Health Data Strategy (PCHDS).

Global Public Health Intelligence Network (GPHIN)

In response to findings from the Independent Review of GPHIN, the Public Health Agency of Canada is taking a number of actions to enhance the systems’ technical aspects and decision-making processes including:

improved Alerts;
upgraded information technology platform; and
established a Centre for Integrated Risk Assessment.

Covid-19 Vaccine Surveillance

As part of the Government’s continued commitment to openness and transparency, Health Canada and the Public Health Agency of Canada provide Canadians with monthly online updates on reported adverse events following immunization (AEFI) on Canada.ca.
57.4K AEFIs reported – 0.058% of all COVID vaccines administered (September 2023).

11.2K of these AEFIs were serious representing 0.011% of all COVID vaccines administered. (September 2023).

PHAC established a new surveillance system for monitoring of COVID-19 vaccination coverage and doses administered with F/P/T partners.

IF PRESSED ON LONG-TERM HEALTH IMPACTS OF COVID-19

The Government invested $20 million into Long COVID Web – a Canadian Post COVID-19 Condition Research Network – that will work to understand and address the biological, clinical, mental health, and health system and population health impacts of the condition.
The Government of Canada also invested $9 million to support the development, dissemination, and evaluation of evidence-based guidelines and tools on post COVID condition focusing on the Canadian context.

SI L’ON INSISTE SUR LES EFFETS À LONG TERME DE LA COVID-19 SUR LA SANTÉ

Le gouvernement a investi 20 millions de dollars dans Le Web COVID Longue – un réseau de recherches sur le syndrome post-COVID-19 – qui permettra de comprendre et de traiter les conséquences de la maladie sur la biologie, le milieu clinique, la santé mentale, le système de santé et la santé de la population.
Le gouvernement du Canada a également investi 9 millions de dollars pour soutenir l’élaboration, la diffusion et l’évaluation de lignes directrices et d’outils fondés sur des données probantes sur le syndrome post-COVID centrés sur le contexte canadien.

IF PRESSED ON MENTAL HEALTH INTERVENTIONS AND SUPPORTS FOR PEOPLE DISPROPORTIONATELY IMPACTED BY COVID-19

The Government of Canada is committed to addressing these disparities and promoting positive mental health for everyone, particularly those who face social and health inequities, or have been uniquely impacted by the pandemic.
That is why the Government Canada provided $100 million through Budget 2021, to support projects that promote mental health and prevent mental illness in populations disproportionately impacted by the COVID-19 pandemic.

Background

Globally, the COVID-19 death rate has slowed from a peak of more than 100,000 people per week in January 2021 to under 750 in the week of August 21, 2023, according to WHO data. These numbers reflect global efforts of widespread vaccination and treatments available, along with population immunity from prior infections.

The Government of Canada’s top priority is the health and safety of Canadians. Collective actions made by all Canadians and efforts by all levels of Government were estimated as of April 2022 to have saved nearly 800,000 lives and prevented up to 1.85 million hospitalizations during the pandemic.

The SARS-CoV-2 virus will continue to circulate and evolve worldwide for the foreseeable future. While overall COVID-19 activity remains low globally, some countries continue to report increased activity, including newly reported cases, hospitalizations and deaths.

Since early July, COVID-19 activity has continued to increase in Canada, but hospitalizations are at moderate levels and are highest among older populations, and deaths remain low. Our models are forecasting that infections and hospital admissions are at peak and will likely decline in the coming months. Of note, we are not yet seeing a clear seasonal pattern of COVID-19.

Provinces and territories have shifted public health priorities to focus on a more sustainable response for the long-term management of COVID-19 in Canada that includes integrating COVID-19 activities into the overall management of respiratory viral infections and continued efforts to build pandemic preparedness capacity and resilience for any future emergencies.

Fall 2023 Preparations

At the same time, all provinces and territories are ensuring the availability of preventative measures like running and promoting their vaccine programs and public health messaging and will continue to monitor changes to COVID-19's epidemiology.

PHAC’s efforts campaign began in September and will include media outreach, advertising, webinars with health care professionals, social media, web content and stakeholder engagement.

d. GPHIN – Mandate Commitments

GLOBAL PUBLIC HEALTH INTELLIGENCE NETWORK (GPHIN)

ISSUE

In the fall of 2020, the Minister of Health announced an independent review of the Public Health Agency of Canada’s (PHAC’s) Global Public Health Intelligence Network (GPHIN). PHAC created and is implementing an action plan to address the recommendations of the Final Report of this GPHIN Independent Review, as well as recommendations contained in the Auditor General of Canada’s “Report 8—Pandemic Preparedness, Surveillance, and Border Control Measures”. There has been significant media and parliamentary interest in GPHIN since early 2020.

KEY FACTS

GPHIN is a surveillance system that relies on publicly available information on disease outbreaks and other events, and provides early-warning for potential public health threats worldwide.
GPHIN analysts conduct a daily review of more than 3,500 articles in nine languages (Arabic, Farsi, English, French, Portuguese, Russian, Spanish, and simplified and traditional Chinese) and produce a daily report.
GPHIN creates several different products to communicate health events of potential interest, including the GPHIN Daily Report, which includes articles related to potential public health threats; and GPHIN “Alerts”, which highlight articles of particular concern based on specific criteria.
GPHIN Alerts do not include a risk assessment or recommendations for specific actions or responses.
Despite media claims in the early period of the COVID-19 pandemic, the GPHIN Independent Review confirmed that the program was never “shut down”. While GPHIN did not issue an Alert, it provided early warning of COVID-19 to Canadian public health professionals through other information sharing channels, and continues to operate as Canada’s event-based public health surveillance system.
PHAC created a plan to respond to all 36 recommendations proposed by the Independent Panel, to be fully addressed by March 2025, and has addressed recommendations in the Auditor General Report pertaining to GPHIN.
The Agency has already made measurable improvements to GPHIN’s online platform and products; workforce development; vision, mission, and mandate; and subscriber outreach.
This contributes to the Minister of Health’s mandate letter commitment to work with the Minister of Innovation, Science and Industry to continue demonstrating leadership in public health by strengthening surveillance and capacity to detect and act on public health threats.

KEY MESSAGES

In looking at the successes and challenges of Canada’s response to the COVID-19 pandemic, we have learned many lessons.
Some of these important lessons relate to Canada’s Global Public Health Intelligence Network, or “GPHIN”, an early warning system designed to identify potential public health threats to Canada.
Through an independent review of this network in fall 2020, as well as an Auditor General Report released in March 2021, several recommendations were made to strengthen GPHIN.
We are responding to all recommendations, and continue to improve GPHIN as part of our ongoing commitment to protect the health and safety of Canadians.
These actions include improving GPHIN reporting, investing in workforce development, strengthening collaboration with provincial, territorial and international partners, and upgrading our information technology systems.
Improvements to the GPHIN program are an important component of the $436 million investment by the Government of Canada in public health, announced in Budget 2022.

Background

About GPHIN

The Public Health Agency of Canada’s (PHAC) Global Public Health Intelligence Network (GPHIN) is an open-source early-warning and situational awareness system for potential chemical, biological, radiological, and nuclear public health threats worldwide, including outbreaks of infectious disease. GPHIN users include non-governmental public health agencies and organizations, as well as government authorities who conduct public health surveillance. GPHIN’s products and services are freely available to eligible users. GPHIN is an important contributor to the World Health Organization’s (WHO) Epidemic Intelligence from Open Sources.

GPHIN consists of two critical components:

an Information Management Tool that uses machine learning and natural language processing to automatically collect and filter data from multiple open sources; and
a professional multidisciplinary team of analysts that reviews and refines the filtered data, and also monitors additional open sources to scan for signals of potential public health threats.

Every day, the GPHIN system automatically collects about 7,000 articles, half of which are filtered out before the GPHIN analysts conduct their daily review of the remaining 3,500 articles in nine languages (Arabic, Farsi, English, French, Portuguese, Russian, Spanish, and simplified and traditional Chinese). Articles are collected from open sources and are validated and assessed for inclusion in reports, including the GPHIN Daily Report. This report goes directly from GPHIN to Canadian public health practitioners at the federal, provincial, territorial, and regional levels, including senior management at PHAC and other government departments.

In addition to the GPHIN Daily Report, if an article meets specific criteria related to a potential public health threat, the GPHIN team issues what is known as an “Alert” – an email with a highlighted article about a health event of potential interest that is sent to international and domestic subscribers. Such Alerts do not include a risk assessment or recommendations for specific actions or responses.

Independent Review of GPHIN

In the fall of 2020, the Minister of Health announced an Independent Review of GPHIN, in part in response to media claims that GPHIN had been “shut down” by the Government of Canada and failed to provide appropriate alerts when COVID-19 was first detected. The review concluded that this was not accurate, and GPHIN did provide timely information allowing the Public Health Agency to prepare for COVID-19.

PHAC finalized and is implementing its Management Response and Action Plan (MRAP) responding to the recommendations outlined in the Final Report of the GPHIN Independent Review.

The independent review considered:

The capabilities of the existing system;
Its role in detecting and informing PHAC’s response to COVID-19, and in global and domestic public health surveillance;
Opportunities to improve the system; and
The future of Canada’s global health surveillance system, including advice on the next generation of intelligence systems and lessons learned from COVID-19, so that the Government of Canada is well-positioned to respond to future public health events.

The Review also looked beyond GPHIN and examined opportunities to improve how the Agency synthesizes, shares, and leverages all of its key information sources for early detection of potential public health threats.

The Independent Review Panel consisted of Margaret Bloodworth, Dr. Mylaine Breton, and Dr. Paul Gully, who were selected based on their expertise in public health, governance, health security, and intelligence. The panel interviewed more than 55 individuals, including former and current program staff, provincial officials, international partners, and technical experts from the public and private sectors.

The final report was published online on July 12, 2021, and the 36 recommendations therein relate to:

The role and purpose of GPHIN, including better articulating its role and functions as part of PHAC, the Government of Canada, and the international community’s public health surveillance activities;
Extending its partnerships and subscriber outreach and regularly evaluating its processes and products;
Enhancing development, training, and recruitment of GPHIN staff;
Modernizing technology, considering new sources of data, and planning for the next generation of public health intelligence systems;
Improving the flow of information from all relevant surveillance systems across PHAC; and
Establishing a central risk assessment hub at PHAC.

To date, the Agency has undertaken the following actions to address the Panel’s recommendations:

Improved decision-making process around Alerts and other communication products;
Upgraded the existing GPHIN platform via migration to a cloud environment and resolved outstanding “bugs”, and launched a project management process for development of a new, modern, and modular platform;
Created strengthened partnerships between GPHIN and external stakeholders, including partners in security and public safety fields;
Increased staffing levels and provided improved professional training to GPHIN analysts and epidemiologists;
Improved the communication and coordination of GPHIN signals with PHAC subject matter experts and risk assessment professionals to better coordinate PHAC’s response to health events of concern; and
Established a new Centre for Integrated Risk Assessment to lead integrated public health risk assessments, working in partnership with surveillance and risk assessment experts Agency-wide.

Auditor General Report on Pandemic Preparedness, Surveillance, and Border Control Measures

The Office of the Auditor General of Canada (OAG) tabled a report in Parliament on March 25, 2021, titled COVID-19 Pandemic: Report 8 – Pandemic Preparedness, Surveillance, and Border Control Measures. This included an audit of PHAC’s and the Canada Border Services Agency’s pandemic response. The report notes that GPHIN Alerts play a key role in early warning and that overall, PHAC quickly mobilized and adapted its response as the pandemic progressed.

With regard to GPHIN, the following recommendation was made: “The Public Health Agency of Canada should appropriately utilize its Global Public Health Intelligence Network monitoring capabilities to detect and provide early warning of potential public health threats and, in particular, clarify decision making for issuing alerts.”

The OAG audit found that no alert was issued when news of an unknown pneumonia was first reported, when the virus had spread outside of China, or when domestic cases were first suspected and confirmed. GPHIN did include a signal about a “mystery pneumonia outbreak” in the Daily GPHIN report, published before 8 am on December 31, 2019, and sent to Canadian partners including federal, provincial, and territorial public health officials. GPHIN thus performed its key function of providing early warning within Canada. By the evening of December 31, 2019, the significance of this event was clear in the public health surveillance community. Because the information was being disseminated widely through a number of other mechanisms, and Canadian officials and international and domestic partners were already aware (including through the GPHIN Daily Report), it was unnecessary to issue an alert to further flag this event.

While the audit concluded it was problematic that PHAC did not issue an alert, it is clear that the lack of issuing an alert in no way impeded the actions and response of PHAC. The Interim report noted “documents received by the Panel show that both PHAC’s former President and Chief Public Health Officer (CPHO), took action upon receipt of the January 1 Special Report from GPHIN’s management shortly after 9:00 am that day. The President shared information with the Minister of Health’s office, as well as counterparts at the Privy Council Office (PCO), Global Affairs Canada (GAC) and Public Safety Canada (PSC). The following day (January 2), the CPHO notified the Council of Chief Medical Officers of Health (CCMOH), and PHAC alerted the federal/provincial/territorial (F/P/T) Public Health Network Communications Group and the Canadian Public Health Laboratory Network (CPHLN). The first meeting of CCMOH related to this viral pneumonia outbreak took place on January 14.”

The OAG report also notes that the approval process for issuing alerts changed in 2018, after which the number of alerts decreased significantly.

PHAC officials confirmed this change was to ensure appropriate awareness of, and response to, emerging issues, but GPHIN subscribers were not informed of this operational change in alert reporting.
In recognition of the need for clear decision-making processes, a standard operating procedure was put in place in fall 2020 regarding the issuance of GPHIN alerts.

PHAC has addressed the OAG’s recommendations and continues to take actions to improve GPHIN policies, procedures, and operations in response to the recommendations from the GPHIN Independent Review.

e. NESS - Mandate Commitments

NATIONAL EMERGENCY STRATEGIC STOCKPILE MANAGEMENT

UPDATE ON MANDATE COMMITMENTS

The Public Health Agency of Canada (PHAC) supports whole of government emergency response under the leadership and coordination of Public Safety Canada.
PHAC works with its partners, including provinces and territories, to improve pan-Canadian readiness for future public health emergencies or events.

Through the National Emergency Strategic Stockpile (NESS), PHAC facilitates access to medical assets required for emergency response when provincial and territorial resources are exhausted or not immediately available.

PHAC is advancing the development of a comprehensive management plan for the NESS to improve readiness to respond to public health emergencies.
PHAC supports Government of Canada efforts, including work in international fora to monitor supply chain vulnerabilities to inform preparedness and planning for future public health events.

ISSUE

The Public Health Agency of Canada (PHAC) manages the National Emergency Strategic Stockpile (NESS) which supports provinces and territories as a surge capacity when their own resources are insufficient. The NESS continuously works with provincial and territorial governments to assess the ongoing needs for priority medical assets to proactively identify and mitigate gaps as required.

KEY FACTS

The NESS contains supplies that provinces and territories can request in emergencies, such as infectious disease outbreaks, natural disasters, and other public health events, when their own resources are exhausted or not immediately available. The NESS facilitates access to a variety of assets such as personal protective equipment (PPE); biomedical equipment (e.g. ventilators); niche pharmaceuticals; and social service supplies, such as beds and blankets.

KEY MESSAGES

PHAC remains committed to supporting Canadians facing public health emergencies and events through timely and equitable access to safe, effective, and quality medical assets.
Assets managed by the NESS are deployed in response to urgent requests for assistance from provinces and territories.
PHAC works closely with federal, provincial, and territorial partners along with industry to assess ongoing surge requirements and to proactively identify and mitigate gaps, as required, including the monitoring of key commodities that may be vulnerable to supply chain issues.

IF PRESSED ON THE DEVELOPMENT OF A COMPREHENSIVE MANAGEMENT PLAN FOR THE FUTURE OF THE NESS

PHAC is advancing the development of a comprehensive management plan for the NESS as recommended by the Office of the Auditor General.

PHAC has initiated engagement with its provincial and territorial partners and has begun development of the plan, which will provide a roadmap for systemic and agile transformation of the NESS with overall objectives of improving readiness to respond to future pandemics and other emergencies and driving continuous improvement in the management of the NESS.
In parallel, NESS continues to identify and implement incremental improvements stemming from lessons learned in response to COVID-19, mpox and other public health emergencies, such as the development of a modern Warehouse Management System to track and manage NESS assets through their lifecycle, and a NESS portal to facilitate information sharing on NESS assets, including upcoming deployments of supplies with provinces, territories, and other Government departments.

IF PRESSED ON ACTIONS TO ADDRESS GLOBAL SUPPLY CHAIN CHALLENGES

PHAC is committed to working with federal, provincial, and territorial partners, along with industry to monitor global supply chains, including exploring opportunities to mitigate supply vulnerabilities and diversify supply through a strategic and sustainable made-in-Canada market.

To support security of supply for N95 respirators and medical masks, the NESS maintains two multi-year domestic contracts with 3M Canada and AMD Medicom.

Innovation, Science and Economic Development Canada (ISED) is the lead for advancing Canada’s Biomanufacturing and Life Sciences Strategy. The Strategy aims to rebuild Canada’s domestic biomanufacturing sector by focusing on both quick strategic actions and a long-term vision.

PHAC is working closely with ISED on considerations related to public health priorities to inform investments and further implementation of the Strategy.

Background

NESS Mandate

The fundamental basis underpinning federal emergency management and the NESS is that provincial, territorial and local governments are prepared to respond in a reasonable manner to the most common emergencies in their jurisdictions.

As such, the federal government’s role in facilitating access to emergency health assets is twofold:

To provide surge capacity support to provinces and territories at their request when their own resources are not sufficient

As the sole provider of certain assets, for example, to provide costly and rarely used vaccines or antidotes, required for rare public health emergencies

NESS Funding

Prior to 2020-21, the NESS had a budget of approximately $4.7M per year.

From the onset of the COVID-19 pandemic to March 23, 2023, PHAC spent $5 billion on the procurement of over 4 billion units of medical supplies and equipment (e.g., personal protective equipment, vaccine ancillary supplies, biomedical equipment, sanitizers, and disinfectants) to stock the NESS to support the needs of provinces and territories.

Budget 2020: $64.9M per year for the procurement of niche medical countermeasures for CBRN threats.

Budget 2023: $80 million over two years starting in 2024-25 ($60 million in 2024-25; $20 million in 2025-26) to help sustain core capacities implemented during the COVID-19 pandemic that are needed to support day-to-day operations, and advancement of the work required to define long-term needs and resources.

Global Supply Challenges – COVID-19

The COVID-19 pandemic resulted in severe shortages of key medical equipment and supplies required to support Canada’s domestic response efforts. To manage Canda’s response, the collective buying power of the Health Portfolio was leveraged on behalf of provinces and territories. This included NESS bulk procurement of personal protective equipment, biomedical equipment such as ventilators, as well as vaccine ancillary supplies.

The COVID-19 pandemic exposed significant supply chain risks across all levels of government and a lack of domestic self-sufficiency. Building strategic and sustainable domestic manufacturing capacity is a key lesson learned as articulated in Government of Canada initiatives such as the Biomanufacturing and Life Sciences Strategy as led by Innovation, Science and Economic Development Canada.

OAG Audit

The Office of the Auditor General (OAG) undertook a performance audit on the Government of Canada’s ability to meet the needs of provinces and territories, and the healthcare sector, for PPE and medical devices to respond to the COVID-19 pandemic. The audit period covered January 2020 through August 31, 2020, and implicated the PHAC, PSPC, and HC.

Overall, the OAG found that PHAC, PSPC, and HC helped to meet the needs of provincial and territorial governments for PPE and medical devices during the pandemic. The report does however highlight that as a result of long-standing unaddressed problems with the systems and practices in place to manage the NESS, PHAC was not as prepared as it could have been to respond to the needs of provinces and territories for PPE and medical devices.

PHAC and HC have both committed to addressing the recommendations from the OAG as per the set deadlines on the Management Response Action Plan.

f. COVID Posture

CURRENT COVID POSTURE AND PREPAREDNESS

ISSUE

On May 5, 2023, the World Health Organization (WHO) announced that COVID-19 no longer constitutes a Public Health Emergency of International Concern as the data showed that the death rate and hospitalizations globally had slowed.
Most indicators of COVID-19 activity in Canada remain low to moderate with stable or decreasing trends. Following increases in activity over the summer months, there is some indication of stabilizing COVID-19 activity recently.

KEY FACTS

The Public Health Agency of Canada continues to work in collaboration with the WHO, international partners, provinces and territories, and health care organizations to transition critical emergency response activities to longer-term, sustainable COVID-19 prevention, control, and management.
The SARS-CoV-2 virus will continue to circulate and evolve worldwide for the foreseeable future. As expected, COVID-19 is co-circulating with other respiratory viruses such as seasonal influenza (flu) and respiratory syncytial virus (RSV) this fall/winter. It is difficult to predict how the season will progress and it is necessary to carefully assess and remain prepared for potential surges.
While COVID-19 activity varies across countries, some countries continue to report increased activity, especially in older age groups.
While Canada saw an increase in COVID-19 indicators across many areas of the country beginning in early July, there is some indication of slowing COVID-19 activity. National percent positivity remains relatively stable (as of November 11). Most recent wastewater signals were stable or decreasing and were at medium or high levels in most cities. Hospitalizations and deaths remain low.
As with other health emergencies, the unpredictable nature of infectious disease pandemics necessitates ongoing action to support prevention and preparedness. Therefore, Canada’s response, which includes vaccination programs, the adoption of personal protective equipment, and continued efforts to expand pandemic preparedness capacity and medical countermeasures supply strategies, will need to continue to adapt.

KEY MESSAGES

Protecting the health and safety of Canadians remains a top priority for the Government of Canada and this includes ensuring preparedness for future pandemics and global health events.
The COVID-19 pandemic has shown that a collaborative response is crucial to address public health threats and to keep Canadians safe.
Investments made during the pandemic have increased Canada’s ability to plan for and respond to viral respiratory threats and other public health emergencies.

IF PRESSED ON WHO STATEMENT

The WHO statement on May 5, 2023 declaring an end to COVID-19 as a Public Health Emergency of International Concern, reflects the collective progress made to date, both in Canada and around the world, in responding to the COVID-19 pandemic.
While the emergency phase is over, the WHO has not yet declared an end to this pandemic.
Moving forward, we will continue to work with the WHO, international and domestic partners, the provinces and territories, and health care organizations to monitor COVID‑19 and other respiratory viruses while building on lessons learned during the COVID-19 pandemic.
We will also be adjusting Canada’s approach to remain well-positioned and prepared to respond to emerging disease threats, as well as other future global health events, and strengthen global health security.

IF PRESSED ON WORK BEING DONE ON PANDEMIC PREPAREDNESS AND RESPONSE TO LESSONS LEARNED

The Government will be taking all lessons learned into account to be prepared for potential future pandemics. These efforts will build on significant investments made in response to COVID-19. We are committed to continue working together with the provinces and territories towards a sustainable and integrated approach to public health that will promote health, prevent disease and better protect Canadians against future public health threats.
In 2022, we announced the creation of a Centre for Research on Pandemic Preparedness and Health Emergencies at the Canadian Institutes of Health Research to develop and mobilize health research for pandemic and health emergency preparedness, prevention, response, and recovery.
We also announced that Moderna would build a state-of-the-art mRNA vaccine manufacturing facility in Quebec, to strengthen the domestic biomanufacturing sector and pandemic preparedness.
In 2021, the Public Health Agency of Canada established the Centre for Integrated Risk Assessment to bolster the Agency’s public health risk assessment capacity to anticipate, detect, and assess potential public health risks to Canadians.
The Public Health Agency of Canada has improved the functions of the Global Public Health Intelligence Network (GPHIN) by revising the procedures for issuing alerts and other early warning communication products, and working towards modernizing the current GPHIN platform.
Our National Emergency Strategic Stockpile (NESS) is well stocked and we continue to engage with our provincial and territorial partners on developing a comprehensive management plan that will provide a roadmap for systematic and agile transformation of the NESS.
The Public Health Agency of Canada will continue to work with federal, provincial, and territorial partners to improve our collective governance and work on the development of shared priorities, such as modernizing the health system with data and digital tools.

IF PRESSED ON EXISTING PREPAREDNESS FRAMEWORKS AND PLANS

The Auditor General recognized that the Public Health Agency of Canada had developed plans to guide a response to a pandemic and building on this, updated plans should incorporate lessons learned.
In October 2023, a revised Health Portfolio Emergency Response Plan (HP ERP) was published, which incorporates learnings from COVID-19 and other public health emergencies. The Agency tested the revised Plan and its preparedness posture to the Avian Influenza H5Nx in October 2023.
The Agency continues to test and adapt its emergency management plans and processes informed by lessons learned, through exercises including a recent internal Exercise ‘H5Nx Vigilance 2023’, as well as from recent events such as the outbreak of mpox, and the 2023 wildfire season.
Lessons learned from the COVID-19 pandemic response and other recent public health events are informing Canada’s ongoing preparedness and response, including the need to revisit the Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP), specifically to include a wider range of pathogens of pandemic potential. An assessment and lessons learned of the CPIP, including stakeholder consultations across all levels of government and sectors, is currently underway to determine the future disposition of the CPIP and to inform pandemic preparedness planning going forward.
The Agency is working with partners, including the provinces and territories, to incorporate lessons and practical application from the COVID-19 experience, among others, to support a robust approach to emergency management for future health emergencies.

IF PRESSED ON WASTEWATER SURVEILLANCE

The Public Health Agency of Canada worked in collaboration with other federal departments, and provincial, territorial, and municipal governments as well as academic partners to establish a pan-Canadian wastewater surveillance network for timely detection and monitoring of emerging COVID-19 variants of interest and concern.
Wastewater surveillance in Canada covers approximately 60% of the Canadian population on a sewer system. Data from this program has successfully detected new and emerging COVID-19 variants circulating in Canadian communities and continues to monitor COVID-19 trends, which has been critical to informing public health responses. In addition to the COVID-19 pathogen data, the national wastewater database now includes data for other pathogens such as Influenza, RSV, and mpox.
The Agency continues to track and compare COVID-19 levels in some large urban centers and northern, remote, and isolated communities across Canada.
The Agency and its partners have also established a pilot project at 2 Canadian airports to sample wastewater from airport terminals and pooled aircraft wastewater depots to monitor for new or emerging COVID-19 variants coming into Canada from various regions of the world.

Background

While the world continues to learn and apply lessons learned for the management of COVID-19, countries are working to maintain the significant gains that have been made during the past 3 years.

De-Escalation of COVID-19 Operations within Canada

Following the Omicron-driven maximum peak in January 2022, COVID-19 activity declined and the previous pattern of distinct waves of infection began to subside. All provinces and territories shifted public health priorities to focus on a more sustainable response for the long-term management of COVID-19 in Canada that includes integrating COVID-19 activities into the overall management of respiratory viral infections and continued efforts to build pandemic preparedness capacity and resilience for any future emergencies.
Provinces and territories have de-escalated many public health measures recommendations and requirements and reduced surveillance and laboratory testing capacities specific to COVID-19. Provinces and territories largely shifted to rapid testing programs, allowing residents to self-test and take action as individuals. At the same time, all provinces and territories are ensuring the availability of preventative measures such as COVID-19 vaccines, and continue to monitor changes to COVID-19's epidemiology. Canada is prepared for public health surveillance during the upcoming respiratory illness season. Canada continues to comprehensively monitor COVID-19 activity while continuing to integrate the surveillance approach across respiratory viruses.

Activity on PMB C-293: An Act Respecting Pandemic Prevention and Preparedness

Bill C-293 was studied by HESA in October 2023, and reported back to the House of Commons on October 27 without substantive discussion having taken place. The House of Commons is expected to have an opportunity to examine the Bill in December 2023, and will potentially consider amendments, in advance of third reading.

3. Vaccine Stats

Key Points

Vaccine Coverage

(total population)

· 99.0M doses of COVID-19 have been administered in Canada (as of Sept 10, 2023)

· 80.5% primary series coverage (Sept 10, 2023)

· The 2023 Fall vaccination campaign is now underway, and number doses administered will be available on (date).

As of September 10,2023:

· Pediatrics: 6 months-4 years (Proportions are relative to the 0-4 year age group due to population size estimates)

· 9.0% of children aged 6 months to 4 years have received one dose of a COVID-19 vaccine.

· 5.6% of children in this age group have completed primary series.

· Pediatrics: 5 to 11 years

· 48.4% of children aged 5 to 11 years have received one dose of a COVID-19 vaccine.

· 37.7% of children in this age group completed primary series.

· Adolescents: 12-17 years

· 82.2% of adolescents aged 12-17 have received one dose of a COVID-19 vaccine.

· 77.1% of adolescents in this age group completed primary series.

Vaccine Supply

· 184M doses imported (Nov 24, 2023) and 137.5M doses delivered to PT.

· As of November 24th, Canada has received 18M doses of new mRNA formulation (XBB.1.5) of 19.4M total to be received.

· Moderna: 8.25M doses have arrived in Canada. A total of 6.5M doses of have been delivered to PTs.

· Pfizer: 9.75M doses have been delivered to Canada including: 9.34M adult, 348K pediatric, and 53.8K infant doses being delivered to PTs.

· 17M doses of mRNA have been requested by jurisdictions for their vaccination campaigns.

· A surplus of 7.3M mRNA doses will be addressed through planning for donations where possible, and retaining a limited federal reserve to support FPT partners as required.

· There are 3.9M doses of adult bivalent BA. 4/5 vaccine and 13.3K of Novavax original formulation available in Central Inventory to support Fall campaigns as required.

Vaccine Safety

· 57k AEFIs reported – 0.058% of all COVID vaccines administered (Sept 2023).

· 11.2k of these AEFIs were serious representing 0.011% of all COVID vaccines administered (Sept 2023).

· Most adverse events are mild and include soreness at the site of injection or a slight fever.

· Serious adverse events are rare, but do occur.

· All serious adverse event reports undergo medical review to see if there are any safety issues needing further action. These processes include meeting regularly to review the data with provincial and territorial partners, the regulator, research networks and medical advisors. Any unexpected safety concerns are detected quickly and acted upon immediately.

Vaccine Expiries/Wastage

· Approximately 29M doses expired in federal inventory

· 13.6M AZ doses expired offshore

· Total expired doses: 42.6M, not including doses expired in PTs holding.

· Wastage can occur due to many factors:

o Expiry

o Cold chain excursion

o Open vial wastage (once thawed/punctured)

o Damaged vials

Vaccine Injury Support Program

· $75M earmarked for the program over five years, including funding to QC ($7.5M over five years) to administer its program.

· $49.6M over 5 years has been allocated to OXARO for administration and claim payments.

· From June 2021 (program start) until June 2023.

· 1,859 claims received

· 1,553 claims deemed admissible and proceeding to causality assessment

· 467 claims assessed by medical review board.

· 103 claims approved for financial support

· 64 appeals received

· <5 appeals resulting in financial support

· $6.7M in compensation paid to claimants.

Vaccine Donations

Canada has donated the equivalent of more than 201 million doses.
This includes at least 46.6 million doses deemed surplus from Canada’s domestic supply and donated to COVAX.
Of the 46.6 million doses donated to COVAX, over 25 million doses have been delivered to recipient countries. [Note: 13.6M doses of AZ doses donated could not be placed by COVAX and expired offshore.]
Additionally, Canada has donated more than 3.76 million doses through direct, bilateral agreements with countries.
Donations to 36 different countries

Impact of Vaccines

PHAC Study (2022): 800k lives saved; 1.9M hospitalizations prevented; 34M COVID cases prevented.
CD Howe (2022): up to $2.1B in savings associated with missed work and treatments.
CD Howe: A six month delay in vaccination in Canada would have lead to a loss of $156B in economic activity in 2021.

Vaccine Equity

Immunization partnership fund: Approximately $52M to support COVID-19 community-led projects from 2021-23, with many focused on promoting vaccine uptake within marginalized and underserved populations (Indigenous, Black Canadians, racialized communities), as well as combatting vaccine-related mis- and dis-information.
NACI advice has consistently considered equity considerations and prioritized those most vulnerable, including seniors, those who are immunocompromised and Indigenous peoples, when appropriate.
Allocation of vaccines at the start of the roll out were adjusted to ensure access to product for indigenous populations; easier to logistically manage product was allocated to the North and remote locations
Outreach to key stakeholder groups (settlement groups, faith leaders) to understand barriers to vaccination.
Worked with ISC on targeted strategies for FN, Inuit and Metis.

Vaccine Connect

· Three modules:

· Intelligent supply chain (inventory mgt) at a module cost of $15,818,627.26.

· Immunization Information System (replaces CAEFIS) – cloud based reporting of adverse events at a module cost of $13,859,328.60.

· Immunization Program Management – clinic management at a module cost of $2,105,380.00

· The total estimated contract cost for the VaccineConnect build was $59.1 million and $63,669,222.40 has been spent

*all totals excluding tax

NACI

Since 2022, NACI has strongly recommended a primary series of an mRNA COVID-19 vaccination for everyone 5 years of age and older, with a discretionary recommendation for children 6 months to under 5 years of age.
For fall 2023, NACI recommends an additional dose of an XBB.1.5-containing formulation of COVID-19 vaccine for people in the authorized age groups if it has been at least 6 months from the previous COVID-19 vaccine dose or known SARS-CoV-2 infection (whichever is later). Vaccination for individuals at higher risk for severe COVID-19 is particularly recommended and will help reduce their risk of severe disease
XBB.1.5-containing vaccine can be used to start a vaccination series for those who are previously unvaccinated, or to continue a vaccine series started with a different COVID-19 vaccine.
COVID-19 vaccines may be given concurrently (i.e., same day), or at any time before or after, non-COVID-19 vaccines (including influenza and other routine vaccinations).

Shelf Life

· Remaining Moderna bivalent BA. 4/5 products expire in early 2024.

· Pfizer bivalent in country expires in early 2024.

· Expiries for newly arriving XBB1.5 product will be communicated upon their arrival and distribution to PTs.

· Refrigerated shelf life of frozen product depends:

· Can be up to 10 weeks for Pfizer mRNA; 30 days for Moderna mRNA

· Once product is thawed, it cannot be re-frozen (must be discarded if not used)

· Once product is punctured, it must be used within 6-24 hours.

Strategies to Manage Supply

Work with PTs on forward supply planning, informed by science, expert advice and evolution of the pandemic
Work with companies to adjust delivery schedules, while ensuring access to latest formulations, and new presentations such as single-dose vials to reduce wastage
Collaborating with GAVI, and bilateral efforts, to identify opportunities to donate surplus doses to support global health equity
Promote vaccine uptake for eligible populations in Fall and Spring in line with NACI recommendations and PT implementation, and address mis/disinformation and vaccine hesitancy