TORONTO - Canada needs an independent health czar to co-ordinate the country's response to the swine flu pandemic, the Canadian Medical Association Journal said Monday.
In an editorial signed by editor-in-chief Dr. Paul Hebert, the journal called for the appointment of someone who would serve as an independent "national champion" with the necessary legislative powers to be able to facilitate the response across provincial and territorial boundaries.
The position would have different - and broader - powers than those of the current federal point person for pandemic response, Canada's Chief Public Health Officer Dr. David Butler-Jones.
"That's definitely not David's job. I mean, it could be. But it's not set up that way. And arguably that's the issue," Hebert said in an interview.
The publication of the editorial coincided with the start of the annual meeting of the Canadian Medical Association, held this year in Saskatoon. The pandemic is among the hot topics being discussed at the meeting.
Federal Health Minister Leona Aglukkaq addressed the group Monday. But she refused to answer questions about the CMAJ's call for a health czar after her speech, brushing past reporters on her way out of the hall.
Hebert said that while federal, provincial and territorial governments have done a lot of pandemic planning, the early experience with the new virus shows there are holes that need fixing.
As well, there's a potential for problems that could arise as a consequence of the fact that health-care delivery is a provincial and territorial responsibility, Hebert suggested, noting Butler-Jones' authority relates strictly to public health and doesn't cross into delivery of health care.
"He cannot cross a provincial (power) boundary, except with just making guidelines," Hebert said, offering an example of how the lack of anyone with the power to address health-care delivery problems in a pandemic might be problematic.
"Let's say Province A, B and C don't do what they're supposed to. ... who can force them to do it? Well, no one," he explained.
"What if in the middle of the epidemic it really breaks out badly and certain things need to be done and it's clear at a national level they have to be done?... We have nobody who has legislative authority to say: 'You're going to do this."'
"To me, it's OK when the whole system works," Hebert continued.
"And it may well (work), and we may not get anything here that's really serious.... But if we don't, we have no ability to manage the crisis the way it needs to be managed. Because there's no one who can step up and say: 'This is what we have to do and you have no choice."'
Dr. Andre Corriveau, Alberta's chief medical officer of health, disagreed with the proposal, saying he saw no need at present for such a position.
"We already have a chief public health officer in Canada, and also we are working collaboratively in Canada," Corriveau said Monday.
"In our federal system, the responsibility for delivery of health services is a provincial or territorial responsibility, so although we work closely with our federal colleagues and we depend on their support for many of our programs ... the final decision even when we get guidelines on priority groups or other issues, they're really guidelines that we have to make our own at the provincial level."
Hebert said the health czar should convene a summit to link public health officials, critical care staff, first responders and other decision makers and community planners to ensure actions taken will work in practice.
Pandemic planning at the top has been well executed, he said. But it's not clear the message has trickled down to certain constituencies, including groups such as family doctors, and the public at large. Hebert said he's heard lots of complaints that family doctors feel they aren't being adequately prepared for the role they are going to play.
"The top has done its job well. Many communities have done their job well. But rest assured that everybody needs to do their job well this time coming. And that's not so self-evident," he said. The time to get the message out to those groups is now, Hebert said. "You don't do it in the fall, when you're really in the mess."
The editorial, which was co-written by Dr. Noni MacDonald, the journal's public health section editor, also called for the development of priority groups for vaccination when pandemic vaccine is ready as well as plans to ensure health professionals and specialized medical equipment can be moved across provincial and territorial borders if needed.
The ability to move personnel and equipment across jurisdictions is critical, said Dr. Anand Kumar, an intensive care specialist from Winnipeg, where ICUs were swamped in the spring by a heavy load of swine flu patients. Kumar supports the position laid out in the CMAJ editorial.
"I think if we're really going to plan, at least have some plans for a worst case scenario, then I think you've got to talk about the problem of the way there are barriers between provincial responses," he said.
"Personally I think that a really important thing will be the ability to move resources from one place to another."
Butler-Jones has said the Public Health Agency of Canada will recommend priority groups for vaccine closer to the time of vaccine availability, in order to be able to incorporate the latest evidence on who is being hit hardest by the virus. Butler-Jones projects pandemic vaccine is likely to be available to Canadians in November.
The licensing restrictions that limit the ability of health-care professionals to pitch in temporarily in another province in a medical emergency came to light during Canada's SARS crisis in 2003.
Some provinces such as Ontario have since put measures in place to ensure doctors and other health-care workers from other provinces can come to help in future medical emergencies, Hebert said. But he said others haven't, noting Manitoba faced problems in this regard this spring when it was hard hit by swine flu.
Source:
Mon Aug 17, 7:46 PM
By Helen Branswell
The Canadian Press
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