A warning system’s tragic failure
The recently released final report of the independent panel reviewing the Global Public Health Intelligence Network (GPHIN) — Canada’s pandemic early warning system — is a harbinger of the challenges to come once we turn our full attention to preventing future outbreaks of disease and other biosecurity threats.
GPHIN (pronounced gee-fin) was a toothless cog in the machinery of the federal government’s response to biological risks. In responding to COVID-19, it failed — or, more charitably, had little chance of success from the outset. GPHIN was prevented from issuing warning reports to a global audience and its internal reporting lacked any clout.
The circumstances that neutralized a system once considered a leading example of Canadian innovation in global health security point to the scale of reform that’s needed if Canada is to be better prepared to meet the next biological threat. Such reforms will need to include better leadership, better organization, better integration of efforts across government, more resources and enhanced use of technology.
Reform also means a genuine desire to achieve excellence and to position Canada as an effective global leader in health security. It means embracing the reality that health security cannot be effectively achieved within national boundaries and that we must have the ability to gather information from around the globe and be prepared to rapidly respond to emerging biological threats.
The reality, which has been long known and was directly experienced by Canada during the 2003 SARS epidemic, is that health threats emerge outside our borders, magnify rapidly and easily cross geographic boundaries.
GPHIN was meant to be our ace in the hole. It was a true innovation when it was established in the late 1990s, as it was one of the very first platforms created to utilize the internet as a source of global information about emerging health threats by curating digital media reporting.
Its premise was that warning signals would likely first emerge unofficially and that we could get a head start on identifying biological risks and responding appropriately. It proved its worth over and over again — that is, until COVID-19 struck. While GPHIN was able to identify a new and unknown pneumonia-like disease in China as early as Dec. 30, 2019, it was unable to play a larger role in the Canadian or international response.
Its ability to disseminate alerts, or early warning messages, to a global audience had been stymied by some mysterious organization-level fiat. The information that it produced through an intensive process of technological collection (capturing some 7,000 global news items per day) and human editing, conducted by a ludicrously small team of 10 analysts, made virtually no impact on higher-level decision-making.
It had, in government-speak, been “siloed” into invisibility and irrelevance. This reflected a cultural problem at the Public Health Agency of Canada (PHAC), an inward turn that abandoned a oncestrong global commitment. In the
years before COVID, GPHIN followed this drumbeat by turning its attention to disease outbreaks closer to home, including the opioid crisis in Canada and the United States.
The Independent GPHIN review panel, led by Margaret Bloodworth, a former national security adviser to the prime minister, has good ideas about how to fix these issues. The panel’s final report characterizes GPHIN as an essential element of global health surveillance and argues that it must be maintained by the federal government — to outsource it would be wrong.
GPHIN’S ability to send alerts must be one of its core functions in the future. GPHIN needs to become more nimble, with the ability to quickly adapt to technological change. It must find a way to exploit social media in its search for early warning signals.
It must get better at tailoring its products for an audience of decision-making consumers. It must actively train the next generation of experts, starting with students. And in the face of emerging zoonotic diseases and antimicrobial drug resistance, it must expand its repertoire to include domestic syndromic surveillance, as well.
Over and above these recommendations, three things stand out in the final report. One is that GPHIN is useless unless its reports are properly integrated into an adequate risk-assessment process to inform decision-makers in a timely fashion.
This underscores the auditor general’s urgent call to reform the broken and dysfunctional risk-assessment system at PHAC. The auditor general’s performance report on PHAC’S pandemic preparedness painted a devastating portrait of a risk-assessment system that was unfinished, untested and not fit for purpose, despite years of work. In response, PHAC promised an internal review to improve the system, but urgency on this file seems missing.
A second point, not fully elaborated in the panel’s report, is that health intelligence needs to be better integrated into the government’s national security process, including through better connectivity with the security and intelligence community.
A third finding is that GPHIN needs to be reconnected to the global ecosystem of health surveillance and early warning systems. The World Health Organization and several of our strongest allies — including the U.S., United Kingdom and Germany — have all taken important steps in this regard. Canada needs to reassert its global role.
The independent panel makes clear that Canada cannot afford to waste this opportunity to improve our early warning systems, if we hope to be prepared for the next major health threat. It is high time to commit to a sweeping, independent review of all aspects of our response to COVID-19, while attention levels are high and before complacency sets in.
IT HAD... BEEN ‘SILOED’ INTO INVISIBILITY AND IRRELEVANCE.