Ontario to boost top medical officer's powers

The Ontario government plans to arm the province's top medical officer with new powers aimed at avoiding the missteps of last year's mass immunization program against the H1N1 influenza pandemic.

Governments and public health officials learned hard lessons during the pandemic that swept across Canada, leaving more than 400 Canadians dead and thousands hospitalized. At its peak in October, 2009, confusion reigned over who would be able to get the flu shot, caused not only by the differing schedules on which various jurisdictions rolled out inoculation programs, but by Ottawa's inability to keep the provinces up to date on the weekly supply of vaccine, which stalled planning and led to long lineups.

The Ontario government introduced legislation on Tuesday designed to allow the province's Chief Medical Officer of Health to set up a central command post and take control during a pandemic or other public health emergency.

In essence, the medical officer would have the power to direct every local health unit in the province to make a vaccine available to the public at exactly the same time, and also determine who would be at the front of the line.

Health experts say the public wants a central voice co-ordinating a health emergency. But some experts wonder how such co-ordination would work, because each local health unit must contend with its own challenges. Others say legislation is not the only solution. What's needed, they say, is better communication at all levels of government.

Michael Gardam, medical director of infection prevention and control at the University Health Network, said that while central co-ordination would be helpful, a lot of other problems presented themselves during last year's pandemic that were out of the control of provinces and local health units.

As well, he said, many health units were dealing with problems particular to their regions, and did not have the capacity to move as quickly as others.

"For some of them, it was easy to roll it out [the H1N1 vaccine] and for others, it was very difficult for them to roll it out," Dr. Gardam said. "I'm not sure central co-ordination will necessarily solve those problems."

Had the proposed legislation been in place a year ago, it would have allowed Ontario's medical officer to speak for the province and respond to the pandemic in a manner that was less confusing to the public, Health Minister Deb Matthews told reporters.

"That's exactly why we're doing this," she said. "We're responding to the issue that came up during the H1N1 pandemic."

Other provinces have similar legislation. British Columbia's Public Health Act allows the Minister of Health to delegate powers to the provincial health officer in an emergency such as a pandemic. These powers were never used during the H1N1 outbreak.

Ontario's Chief Medical Officer, Arlene King, recommended the legislation. She acknowledged in a report last June that public health officials neglected to organize a mass immunization program properly.

As a result, she said, a campaign to protect Canadians against H1N1 failed in parts of Ontario, Manitoba and Alberta, where just over a third of residents were inoculated.

"I certainly would acknowledge that there was public confusion during the immunization," Dr. King said in an interview. "That probably led to reduced public confidence in the province's response."

Richard Schabas, medical officer of health for Ontario's Hastings and Prince Edward Counties Health Unit, and an outspoken critic of governments' handling of H1N1, said the legislation in Ontario implies that local public health authorities were at fault for not following directions.

"I think what's really going on here is an attempt to cast the blame for the perceived problems with the vaccine rollout away from the government and onto local health departments," he said.

Rather, he said, what is needed is strong direction from the province, which was not present during the H1N1 pandemic.

The legislation does not address measures to improve the lines of communication between the federal government and the provinces.

Asked about the supply-demand mismatch, Ottawa deflected the question, saying the H1N1 vaccination campaign was a success. Further, a spokeswoman for the Public Health Agency of Canada said in an e-mail that the vaccine rollout is the responsibility of the provinces and territories, and "every effort [was]made to co-ordinate simultaneous delivery to all jurisdictions."