Dr David Butler-Jones
The Chief Public Health Officer of Canada
Jul 15, 2006

Dr. David Butler-Jones has presided over Canadian and North American professional associations, and participates in international professional work sessions and has worked in many parts of Canada. As Canada’s Chief Public Health Officer, he heads the newly created Public Health Agency of Canada, providing leadership on the government’s efforts to protect the health and safety of all Canadians. After 18 months in this position, FrontLine Security had the opportunity to interview him about his responsibilities with the new Public Health Agency.

Dr. Butler-Jones, having read through much of your web site, I get a glimpse of just how very important your Agency is to the health of all Canadians. After 18 months at the helm, can you share with our readers what you see as your main and secondary priorities and the challenges that you face in meeting these?

As you know, the federal government stated in their National Security Policy that the first role of government is to ensure the safety and security of its citizens. In that context the Public Health Agency and my role as its Chief Public Health Officer is to ensure the health safety and security of Canadians.

In these first years, my first priority has been getting the Agency credibly established. Such issues as getting its voice heard, ensuring that it has a visibly useful and effective leadership role, and establishing the Public Health Network across the country have been my principal focus. Internally, we have had to establish the processes and structures to allow us to manage the myriad of information necessary for us to perform our dual role of prevention and preparedness.

Externally, we have hit the ground running and have been reasonably effective in communicating pertinent information quickly and accurately across the country. I am personally amazed at the level of visibility we have garnered in such a short time. With this visibility have come some very real expectations that we must be geared to satisfy. Most public health activities are carried out by the provinces and territories at the local level.  We work closely with them to help ensure a well connected and supported system of public health.  

My second priority would be a focus on improving our national capabilities in Emergency Public Health preparedness, be it resources and mechanisms for mounting the health response to a national pandemic, or support for a specific regional or national Public Health crisis caused by a flood or other natural disaster.

Maintaining a sterile environment is critical in medical research.

My third priority is to improve our chronic disease prevention across Canada. There is a lot of work, research and advocacy required, and possible, to reduce the causes, frequency and acuteness of chronic diseases such as cancer, diabetes, lung and heart conditions in the Canadian population. It is a primary responsibility of the Agency to use all means to encourage Canadians to do this. It should not only be about adding a year or two to our general life-expectancy but geared rather to ensuring a better quality of life, and reducing the number of years of disability or ill health. We must remember that, in a crisis such as a major influenza outbreak, it is the chronically ill who will be our first and greatest victims. To accomplish all of these, we retain focus on the six elements of Public Health. And we do this in concert with the provinces and territories, other departments, the non-governmental and private sectors alike:

  1. Public Health Assessment – understanding what makes people healthy or not, and what to do about it;
  2. Maintain surveillance on patterns of diseases of significance such as bird flu, chronic diseases as risk factors, influenza or even mumps as we have seen just recently. We must watch these at home and abroad so they can be addressed before they become an insurmountable problem. In this day and age we must not be surprised. For example, in our first few months, the Agency relaunched the Global Public Health Intelligence Network (GPHIN) which is a secure, Internet-based “early warning” system that gathers preliminary reports of ­public health significance in seven ­languages on a real-time, 24/7 basis.
  3. Encourage the prevention of disease and injury.
  4. Engage Canadians in Health Promotion by creating more health supportive policies, programs and environments so that “healthier choices can be easier choices,” such as the importance of not smoking, of washing heads, eating well and staying active.
  5. Health Protection, which is the majority of Provincial and Territorial work and other jurisdictions, is shared with Health Canada and the Canadian Food Inspection Agency and involves maintaining ­standards and a focus on safer water, environments, and food and sewage treatment.
  6. Emergency Health Preparedness and Response. This involves having human and material resources in place and the barrier free flow of information ­necessary to cater to major medical emergencies and large scale Public Health challenges throughout Canada. It also involves having a capacity to help internationally, as we did in the Tsunami relief effort and Hurricane Katrina.

This is indeed a major challenge. What initiatives in the Public Health Agency will Canadians view as milestones in making them safer?

There have been many that are obvious, such as the information available on our Web Site (www.phac-aspc.gc.ca), but there are others that are less obvious but no less important.

The first has been the establishment or revitalization of the Public Health Network, a joint federal, provincial and territorial body that oversees public health in the country and reports to the conference of Deputy Ministers of Health.  It includes joining, through regular information exchange, policy development research, specialist expertise, labs, universities, hospitals and public health institutions at the federal, provincial, municipal and local levels. This allows public health practitioners and different jurisdictions to help   break down the obvious structural barriers, in order to gain access to and deal more quickly and effectively at all levels with their respective challenges.

Modern cell culture methods are being researched, however, influenza vaccines are still created the traditional way. Fertilized chicken eggs are injected with seed strains of the particular flu virus. The virus is injected into the egg white and the tiny hole is resealed. The virus then infects the lungs of the developing chicken embryo, and the resulting antibodies will multiply enough to be harvested within several days.

We also have implemented a revised and more effective Quarantine Act to cater to updated threats in a more global environment. In October 2005, at their annual conference, Federal, Provincial and Terri­torial Ministers of Health approved the Integrated Pan-Canadian Healthy Living Strategy, dedicated to reducing chronic illness levels in Canada and a new Pandemic Plan that has incorporated much that we have learned from our own experiences since SARS as well as lessons learned internationally. We also constantly update the measures, as our plan must always be ­current if it is to prove effective.

I would also mention the work of the Conference of Deputy Ministers of Health, the Conference of Health Ministers, and the provinces and territories that meets to coordinate and direct work on the overall health system in Canada, and Public Health issues that might impede routine coordination at each level. I was particularly pleased at the development and approval of the Health Goals for Canada and at the collaborative work in learning from SARS and how to respond better in dealing with emerging infectious diseases.

Canadians should be aware that we are one of the few vaccine producing countries capable of catering to long term influenza pandemics and that we already have substantial anti-viral inventory for such events in our collective Provincial, Territorial and Federal stockpiles. The Agency also maintains the National Emergency Stockpile System that contains everything that you would expect to find in a hospital, from beds and blankets and a supply of pharma­ceuticals and other emergency supplies.

That leads to the obvious next question, and that is, how ready are we to face a potential pandemic?

This is a very current concern and the ­federal government has put up an inter­departmental web site to deal specifically with this (www.influenza.gc.ca). It deals with travel advisories, flu shots and all details that Canadian citizens should know about the flu.

We also have new Pandemic Influenza Plan at the federal level that forms the carcass of a body of plans that are then produced regionally. We of course have our Centre for Emergency Preparedness and Response linked to other federal and provincial agencies as well as in live contact with our own and international agencies such as the WHO and CDC in the United States. Visit www.phac-aspc.gc.ca/influenza/avian_e.html

I think, at this time, it is important that I reiterate our role, which I consider vital in any pandemic. As you are well aware, during SARS in Toronto, besides the tragic loss of life, the country lost a great amount of economic benefit due to the reduced tourism. The fear-factor brought about by the disease highlighted the essential need for accurate information. One of my roles as Chief Public Health Officer will be to lend reasoned analysis and relevant advice to such events.

In my role as the senior Canadian medical professional for the government of Canada, I must explain to Canadians what is occurring, or about to occur, based on evidence, explain what can be done to improve the situation, show them that we are doing it, and explain what they can do as well. Hence, my focus is on the six elements of Public Health that I mentioned earlier.

There are some ironies that do occur when you know the facts. For instance, during SARS, Toronto was one of the safest cities from infectious ­diseases as everyone became very aware of personal hygiene and took measures to avoid others if they were ill. However, it it important to remember that 2,000 to 8,000 Canadians die every year due to influenza in one form or another, especially among the chronically ill. So many of these deaths could be reduced significantly through vaccination, proper hygiene such as hand washing, avoiding others when you are ill, and the reduction of chronic illness in the population. Washing hands regularly is a simple and very effective way to reduce many infectious diseases.  

As to the H5N1 Asian virus, or bird flu, at this time it is a serious disease in birds and has rarely caused human casualties. It is being very closely monitored internationally. Most commonly, influenza pandemics occur when a bird virus combines with a human virus, creating a new human virus to which we have no immunity. This is what might occur with the H5N1 Asian virus, though it could be another virus as well – we need to be vigilant for all possibilities. This is why so much attention is being paid to its working and understanding, to finding a ­vaccine or prophylactic. We don’t know when for sure this strain will arrive in birds, nor do we know when the next human pandemic will be. But expect we will see H5N1 Asian strain here in birds perhaps as early as this fall. This does not mean a human pandemic, because nature is unpredictable. But our preparations will assist us in dealing with a pandemic influenza or other emerging diseases, as well as bioterrorism or natural disasters.  

We at the Public Health Agency recognize the threat, share resources and information at all levels, and I believe we are well prepared to respond. We also remain ever alert. On the other hand, there is a civic and personal responsibility that must be taken by all individuals and levels of government to mitigate the risks. We cannot do this alone.

As a closing question, what international involvement and coordination is going on with the U.S., UN, WHO and others?

Our relationships with the World Health Organization and with other national public health ­organizations are excellent. Canada receives much from and contributes greatly to both. All are part of our sharing of expertise, talent and best practices in a broader Public Health Network, as are many other international agencies and governments. We are also very much attuned to the fact that our public health assistance to others overseas will reduce potential threats to the health of Canadians in this more globally connected world. Therefore, we train laboratory workers from other countries at our facilities here in Canada. We also deploy portable labs to South East Asia and elsewhere, in cooperation with CIDA and Foreign Affairs. These lab deployments have helped to identify and control outbreaks of strains of hemorrhagic fever (Marburg) in Angola, Bird Flu in Vietnam, and other viruses that might have posed a future threat to Canada, but just as importantly, we have helped these less well-equipped nations to resolve serious public health concerns of their own.

Clive Addy is a retired Major-General, Chair of the National Security Group and Executive Editor of FrontLine Security magazine. He can be reached at caddy@frontline-canada.com
© FrontLine Security 2006