Dr David Butler-Jones,
Chief Public Health Officer
Photo credit: Public Health
Agency of Canada |
Late last month Canada celebrated
a grim anniversary. Five years ago, on March 28, 2003,
Ontario declared a state of emergency in response to
the SARS outbreak. The country was in a state of panic,
caught completely unawares by its worst health crisis
in a generation. By the time it was over, the epidemic
had claimed 44 lives, including several healthcare workers.
It was also a big wake-up call and showed that Canada's
public health system was a shambles. That scare, coupled
with warnings of imminent bird flu outbreaks, led to
the creation of the Public Health Agency of Canada in
September 2004. NRM spoke to Dr David Butler-Jones,
the country's first Chief Public Health Officer, to
ask where we stand, five years on from SARS.
Are we better prepared for a
pandemic now than we were in 2003 when SARS struck?
Our government is far more focused [pandemic preparedness]
than it was five years ago. The key is to have done
enough planning to minimize the destruction and get
to the point where we can get the information out there.
What toll will the next pandemic
take? That's impossible to predict. The next pandemic
could be mild or could be worse than the bird flu, that's
why we need to be thinking about any potential. We need
to look at all the possibilities, not just natural causes
but also bio-terrorism.
During a pandemic, aggressive
decisions are sometimes made without consulting the
public. Who should be held responsible for those decisions
in the aftermath? It depends on the situation —
that's why it's good to have things in place. When planning
for these situations, you need to involve the private
sector, make sure there's a connection and meet the
people you need to work with. This way when you have
to make decisions in an instant, you bring expertise
and experience to those judgements.
What if those actions are out
of proportion to the threat? We tend to err on the
side of caution. Pilots make that sort of decision all
the time, when they delay a flight for instance. It's
a tremendous inconvenience but most of us would prefer
to be delayed than risk getting ill or have the plane
go down.
Last winter there was a lot
of talk about stockpiling Tamiflu. People were worried
about avian flu. This year, barely a peep. Were we panicking
then or are we complacent now? At the time, some
of the stories focused on the worst case scenarios,
which were worse than what actually happened, so at
one level, yes, it was alarmist. But we have to pay
attention to these things, because at some point we
will face another outbreak that we can't anticipate,
so the government has to continue to prepare for when
we do see another crisis. This way we'll be in a good
position to respond.
What's your worst case scenario?
If the 1918 influenza pandemic, which wiped out
nearly 50,000 people in Canada, were to happen today,
you'd see about 10 to 15 thousand deaths. That's bad
enough without having to exaggerate the numbers. At
the time, people were less healthy, less prepared and
there weren't any vaccines.
What did you make of the case
of Andrew Speaker, the American lawyer suspected of
having XDR-TB who sparked an international manhunt when
he travelled to Europe and Canada while infected?
Well, every once in a while, there's someone who is
not interested in anyone else, that's where the law
comes in. If necessary, they can order someone to seek
treatment or to be quarantined. That's why we have legislation
that relates to that. When people are at risk of infecting
others with something dangerous, the vast majority of
them are cooperative, they follow the advice public
health officials give them.
It turned out he didn't even
have XDR-TB. Does public safety always outweigh an individual's
rights? Sometimes, we do have to override the individual's
rights. There are legislative provisions in place, and
there are times when we have to use them.
Are strong-arm tactics OK in
these cases, like throwing someone in jail? The
principle is to use the least invasive, most effective
method possible to protect the public.
What about healthcare providers
— will they be forced to report for duty during
pandemic? A lot of doctors aren't too happy about the
way their health was looked after during the SARS outbreak.
Healthcare workers continued to show up to work during
SARS — without being forced, their first concern
was for their patients and their families. We need to
appropriately protect the workers and look after their
families. In the case of an influenza outbreak, for
example, we have a stockpile of anti-virals so the healthcare
workers and their families can get immunized. That would
ensure that people would come and do what is needed.
Interview conducted
by Judah Issa
|
