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Canadian Medical Journal, Population Health Expert Call For Greater Pandemic Powers

More advisers are coming forward to provide suggestions on how to enforce powers across all jurisdictions on Canada's pandemic plan.

Without a "big stick" to hold over the provinces, the federal government's pandemic response plans could fail, an expert on population health warned during a panel on H1N1 swine flu at the University of Ottawa.

"As good as co-operation is, when the carrot fails, you need the stick," Amir Attaran, a professor of both medicine and law, said last week.

When there is a major health issue like SARS or the listeria outbreak, one level of government points fingers at the other. It's especially a problem when the response has to be agile, said Attaran, who holds the Canada Research Chair in law, population health and global development policy at the University of Ottawa.

"If there is a breakdown, someone has to hold the big stick. That's what's missing in Canada right now," he said. "Aspects of the pandemic plan are good on paper; but when it comes to the operational level, there can be troublesome gaps."

Attaran points out, for example, that when the World Health Organization was seeking timely information about SARS transmission in Toronto during the 2003 outbreak, Health Canada had to turn the questions over to Queen's Park.

"There is still no law under which Ontario could be told, 'You give us that information or someone goes to jail.' "

Attaran was one of three speakers on Thursday's panel who spoke about the need for federal power to bridge gaps in the system.

In an editorial last month, the Canadian Medical Association Journal called for a flu "czar" to lead the response to the H1N1 pandemic. The czar would have executive powers across all jurisdictions and would be "ultimately accountable to the highest office in the country," the editorial said.

"We need a better-co-ordinated plan," said Dr. Paul Hébert, a critical-care physician at The Ottawa Hospital and an epidemiology researcher who was one of the authors of the CMAJ editorial.

The next wave of H1N1 has already hit the West Coast, said Hébert, who fears the pandemic could tax capacity in intensive-care units. This flu has proven to be unusual in that it hits a few people very hard.

"Our plans are very good. But they're organized around a public-health perspective. It's turning out to be an ICU problem," Hébert said. He questions whether there would be enough ventilators or medical staff to handle a surge in patients.

In Canada, ICUs are already at 98- to 100-per-cent capacity, he said. If H1N1 cases end up in ICUs, it might create problems. Meanwhile, Kumanan Wilson, a medical professor and Canada research chair in public health policy, said while vaccination is one of the most effective ways to prevent the spread of H1N1, many people won't be willing to take it -- and a change to the law might help.

He said some people are hesitant to be vaccinated for fear they will have to fight through the court system for compensation if they suffer serious side-effects. Compensation programs exist in the U.S. and most of the G8 countries, as well as in Quebec, but not the rest of Canada, he said.

"You don't want that in the forefront or even in the background of people's minds. You want people to respond to the emergency," he said. "It's a case where our laws are very, very backward."

Attaran said the best way to persuade more people to get vaccinated for the good of all would be to challenge the leaders of political parties to get vaccinated publicly. It worked in Africa when leaders stepped forward to help public-health authorities trying to encourage people get tested for AIDS, he said.

"I would like to see every MP line up and roll up their sleeves."


Reference Source 210
September 24, 2009

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