Dr David Butler-Jones
Improving the Public Health
Jul 15, 2009

In our Spring 2006 issue, Dr. David Butler-Jones, then recently appointed Public Health Officer of Canada, expressed to FrontLine Security, the goals and aspirations of his newly minted agency.  Since then, many public health issues have come to the fore, such as the ongoing H1N1 swine flu and the recent Listeriosis outbreak, to name but two. He very generously agreed to give us, once again, his personal perspective on the agency, its achievements and ongoing challenges.

Q. What do you view as your key challenges and achievements at the head of the Public Health Agency of Canada over the last three years?

Well, as you recall, we went rapidly through the avian flu (H5N1) scare, the major Listeriosis outbreak, and are now dealing with the effects of swine flu (H1N1). In other words, what was a threat is now a pandemic and we have fortunately been hard at work preparing for just such an eventuality. We try to maintain in place the right and effective relationships, connections, resources and capacities to respond to plans which we constantly examine and review. I remember some four or five years ago, having said that we should not put all our eggs in one basket when dealing with a theoretical pandemic originating in North America… well here we are.

Where, when and how it will occur is usually unpredictable. We must be as ready as possible for everything, and capable of determining the threat as soon as possible after it shows up. Take for instance the cases of Listeriosis through poisoning of meat. Though there is indeed much to improve upon, since 22 people died, my own take on this is that, five or so years ago, we did not have the technical and human links in such a broad network to so quickly pinpoint, from only five or six cases a week across Canada, the ­common strain of these illnesses and to rapidly identify and correct the source. I also know that this ability has already improved since then, as it should!

From SARS to the H1N1 (swine flu) pandemic, it is the progress in the kinds of thinking – the ‘what ifs’ and the resulting coordination, planning, communication from these discussions at all levels – that it has been my pleasure to witness over my tenure. The ­forming and maintaining of trusted relationships at home and abroad to handle the responses to these theoretical situations has paid great dividends when actual challenges arise. This ongoing process allows us to monitor, warn, respond and act ever more quickly and effectively to all types of health threats. For instance, our web site includes some 23 Major Health Issue Networks ­providing daily or slightly less regular updates on specific and more general public health issues. I have also benefitted greatly from the sage advice of my Scientific Committee, both individually and ­collectively as required, throughout all of these events.

We have regular meetings with Deputy Ministers of Health from across Canada, and I am in regular contact with Chief Medical Officers throughout our country at most levels. We exchange valuable information to increase our awareness of possible threats and update our planned responses and review shared and potential resources. Within North America we have similar outstanding ­relationships and do similar exchanges as part of the Security and Prosperity Partnership framework. Our own Minister of Health, Leona Aglukkag, joined colleagues recently at a swine flu preparedness summit in ­Cancun. We also partake in international exchanges and help those less fortunate. These are enormous improvements that have proved most helpful to our national well-being.

Q. How prepared are we for a pandemic in Canada? There have been reports in the press of not enough beds and respirators and of lacking sufficient time for a safe vaccine to be distributed? What is your perspective on our level of preparedness?

As you know, we must plan for and learn from all eventualities and, in this particular event, we learned much from the SARS (H5N1) experience. We were very much involved in the North American identification of the H1N1 (swine flu) strain and ­seeing the likely spread pattern.

The President of Mexico’s own plane was used early to fly samples to our lab in Winnipeg to analyze the strain. We identified the strain and its characteristics early. We could thus start focussing our own ­planning early. These outbreaks usually start slowly and slow down even more, before what is the normal flu season when major illness strikes many.

Our vaccine development is on track to provide an effective prophylaxis by November, and to have a large portion of our most vulnerable population inoculated before Christmas.

We are, of course, preparing to use anti-virals, such as Tamiflu and others, to treat those with chronic diseases, such as diabetes and lung disease, even before this if necessary. In essence, these measures reduce the number of vulnerable people.

There are of course, for each of us, our own personal measures that can and should be implemented to slow the spread and reduce the burden on our public treatment facilities in case of major needs. Not going out in public when sick, effective use of personal hygiene around our eyes, nose and mouth, and the washing of hands all help enormously. We must each do our share.

This particular flu virus [H1N1] seems to attack the elderly less than have others, and the normally healthy and younger sector of our population appears particularly targeted. As well, the vulnerability of pregnant women is also recognized. We are planning to make much more use of general hospital beds and not solely the ICU facilities in our concept. Plans are evolving, and I am comfortable that good work is going on at all levels to mitigate the eventualities outlined in recent reports. It is indeed through this free-flow of information that we achieve the early identification of such challenges, and these in-turn result in other mitigating strategies to reduce the number of those that will need close and isolated treatment. Though we can never be 100% sure, I am most reassured that we have developed and continue to refine excellent contingencies to minimize the effects of the potential H1N1 flu for this coming winter.

Q.You have championed the aspects of prevention and healthy living throughout your tenure, what challenges do you see in this domain?

I am very worried about the issue of childhood obesity. As I have said so often, if trends continue, the next generation will fall victim to childhood obesity and will be the first ­generation in our history that does not live longer than its predecessor. Our eating habits and life styles have to adjust to this possibility and change for the better.

In recent meetings, I am getting some satisfaction that we are getting political focus at the provincial and territorial health minister and Chief Medical Officer levels on the seriousness of this issue, but I am less sure that we are getting the public awareness, understanding and concern about the pervasiveness and danger that this state of affairs poses to our individual and collective well-being and precious health resources.

This colorized negative stained transmission electron micrograph (TEM) depicts some of the ultrastructural morphology of the A/CA/A/09 swine flu virus. (Photo: C.S. Goldsmith and A. Balish)

This idea of prevention and promotion must go beyond an advertizing ­campaign, it must capture the parents, teachers and leaders at all levels because it is through education and better habits being inculcated early in our lives that we can reduce the potential of this self-inflicted public health tsunami.

There are of course the challenges of our ageing population and our first nation public health challenges and ensuring that we have the resources and plans to look after them, but it is our future generation and their obesity that most concerns me.

Q.What do you view as the most challenging public health threats from a potential climate change perspective and what measures in respect of dangerous vectors in health should we be watching?

As you know, in Emergency Preparedness we deal on an all-hazards basis. We have seen the forests of BC depleted due to the pine beetle and we are witnessing variable parasite cycles in Muskox in the North. These are some vectors that we have already witnessed and I would expect that the concern about water will lead to environmental emigration that will challenge our entire public health system.

For the moment, we must learn from what we know, and can predict, to mitigate the effects of climate change. For instance, we have an obvious need to ensure that our potable water supply is protected and that sewage and other pollution do not ­further impede our most precious resource.

For the moment, seniors are a most vulnerable sector when it comes to weather extremes. We saw this a few years ago when, unknown to family and neighbours, elderly people dehydrated in their apartments during an extreme heat wave. We initiated our Friendly Cities program at that time which seems to be going well. It is based essentially on being concerned for our own neighbours. Such cultural change is important as we face the kinds of challenges we can foresee with climate change. The state can neither provide all, nor alone, the assistance we all need.

It is interesting in this context that, when I first began addressing these issues with Climate Change experts, I found after a while that we used the word ‘mitigate’ to mean different things. In the public health domain, we try and eliminate the effects by mitigation, whereas the climatologists mean reducing the impact in time, space or intensity to survive with the change. Again, as communication and connectedness are so important to our working effectively together, such nuances can prove important in emergency management.

Climate Change is a major issue that requires serious and detailed discussion from anyone involved in the public policy field.

Q. What improvements in federal-provincial-territorial-municipal public health standards and preparedness coordination have you witnessed? Are you satisfied with it?

We have been through periods, such as at the outset of the Public Health Agency and during the H5N1 virus scare, when we had daily Deputy Minister-level and even ministerial-level meetings. These were repeated recently as we determined together what we had in store with H1N1. We have since reduced the number but maintained the free-flow of information, reinforced, as I stated, with excellent input from my scientific committee and friends in North America and around the world, so that we might share as timely and accurate a picture as time and technology permit.

I am quite pleased but certainly not self-satisfied at our mutual progress. I note, in that vein, that the recently elected First Nations Chief, Shawn Atleo, was elected on a platform that included dealing with H1N1 on reserves high on his list. I applaud this, and I agree that he and all chiefs must deal with these serious public health issues. Our agency stands ready to assist in any way we can.

Q. We have dealt with our own public health… what is our ability and experience with helping others?

We are a very active member of the World Health Organization and many other international public health dialogues and organizations. It is very difficult to provide help if we concentrate on what divides us – but how do we address what divides us?

Belonging to groups like the International Public Health Institute helps. We assist the WHO [World Health Organization] and other like-minded nations to help less fortunate ones to set up public health organizations and emergency planning and response.

We deploy our very unique portable lab world-wide to work in spartan conditions to track such things as the Ebola virus. It was also loaned to China for the Olympics.

We have an exchange officer in Beijing for instance to help with their Centre for Disease Control and act as a liaison with ours, and we maintain liaison in the U.S. and Australia. We have helped in many emergencies providing resources in North America, Asia and Africa.

We help whenever we can – and we are often asked. Our centre in Winnipeg frequently answers requests for scientific help and assistance. We are very much involved internationally.  

Clive Addy is the Executive Editor of FrontLine Security magazine.
© FrontLine Security 2009