People wait at a COVID-19 testing clinic in Montreal on Oct. 11, 2020.Graham Hughes/The Canadian Press
An independent panel commissioned by the World Health Organization to investigate the failures of the global response to COVID-19 is preparing to call on governments to invest in better pandemic early warning systems, similar to the one Canada let falter a year before the outbreak hit.
The final report is not yet complete, but the experts leading the probe, including a top Canadian doctor, plan to argue that such systems are crucial to bolster the world against future crises because governments and the WHO itself acted too slowly this time.
The panel’s findings echo concerns about Canada’s handling of its own operation, known as the Global Public Health Intelligence Network, or GPHIN. A Globe and Mail investigation found that Ottawa curtailed its pandemic early warning unit prior to COVID-19, which federal scientists have said hurt the country’s ability to respond to the outbreak.
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“I think we owe it to all of the people who have lost their lives that we learn from what happened,” Dr. Joanne Liu, the Canadian representative on the panel, told The Globe in an interview. “Every single minute and day counts when you’re trying to beat an epidemic.”
Dr. Liu, a Montreal physician and the former international president of Médecins sans frontières (Doctors Without Borders), is one of 13 experts on the panel, which has found that early opportunities to contain the outbreak were missed and signals of the growing problem went undetected.
Dr. Liu said the panel will emphasize the importance of such systems in its final report in May, because early warning can lead to faster containment. “It’s vital,” she said. “Because it is so much easier to get the upper hand on an epidemic when there’s a very low community transmission. The longer you wait, then the bigger the problem is.”
Created in the 1990s, GPHIN was one of the world’s premier pandemic early warning systems. However, Ottawa began to pare back GPHIN’s operations a few years ago, amid shifting government priorities, and silenced its international alert capacity in early 2019. With seemingly no pandemic threats on the horizon, the department believed GPHIN’s resources could be put to better use on projects that did not involve outbreak detection.
GPHIN was created to analyze thousands of data points from around the world each day, including medical information, local news reports and first-hand accounts from doctors on the ground, searching for hints of problems, which it would then investigate further. It was one of Canada’s contributions to the WHO before it was curtailed, providing the organization with 20 per cent of its epidemiological intelligence, according to federal records.
Looking back at the earliest days of the crisis, the panel believes measures weren’t implemented fast enough by the WHO and governments around the world, including the WHO’s delay in sounding its biggest alarm – declaring a “public health emergency of international concern.” That step wasn’t taken until Jan. 30 last year, even though some scientists say evidence shows the virus had been circulating since November. Canada didn’t elevate its own official risk assessment for the virus from “low” to “high,” until March 16, when it finally urged Canadians to begin physical distancing.
“Speed for me is the most important variable,” Dr. Liu said, adding that the declaration of an emergency should be done in a matter of days, not weeks.
The panel believes pandemic early warning systems such as GPHIN play an important role, and need to be upgraded to deal with modern technology, including analyzing vast amounts of information on social media faster, where early rumblings of a problem are likely to surface. When New York-based outbreak tracker ProMed issued the first worldwide alert on the outbreak on Dec. 30, 2019, it did so after discovering chatter on social media in Asia about an emergency inside hospitals in Wuhan, China. By that time, the virus had been circulating for some time and the earliest signals were missed by GPHIN and other systems.
“The initial chronology of the early phase of the outbreak suggests that there was potential for early signs to have been acted on more rapidly, with an escalation of response tied more immediately to the emerging information about the spread of the virus,” the panel said in its interim report in late January. However, “The global pandemic alert system is not fit for [its] purpose. Critical elements of the system are slow, cumbersome and indecisive,” the report said.
In previous crises, GPHIN was credited with detecting some of the earliest signals of SARS and H1N1. Dr. Liu said the panel discussed the Canadian operation, and the role such systems can play.
The COVID-19 pandemic has cast new light on the importance of such networks. U.S. President Joe Biden has issued a national security directive calling for the White House to secure funding to create a centre for “early warning and trigger systems.” Meanwhile, Canada’s Minister of Health Patty Hajdu has ordered an independent review of GPHIN that will look at ways to rebuild the operation.
Dr. Liu said she believes such systems should work together as a network, rather than the WHO trying to preside over a cumbersome global operation.
The goal is to inject urgency into government decisions. For example, Prime Minister Justin Trudeau has said he regrets not bolstering Canada’s emergency supplies of personal protective equipment sooner, which left hospitals and long-term care homes exposed. But providing the intelligence to move quickly on those decisions is what GPHIN was intended to do.
In its interim report, the panel said upgraded systems are needed “to enable reaction at the speed required – which is days, not weeks – to confront epidemic risk.” Helen Clark, the former prime minister of New Zealand who is co-leader of the panel, said the international system for alert and response “has the trappings of an analog system in a digital age.”
“Our job is to look back, with the benefit of hindsight, at areas that emerge as gaps in the response; and to look forward to recommend ways to fill those gaps,” Ms. Clark said. “The scale of social and economic devastation brought about by the pandemic make it clear that the world must do two things: act more decisively now to curb the pandemic, and fundamentally reset its preparedness and response systems to help ensure that this doesn’t happen again.”
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