Don't let public health fall victim to boom and bust cycles: Ontario's top doctor

Ontario can't let public health preparedness fall by the wayside again once COVID-19 fades from memory because the arrival of the next pandemic is not a question of if, but when, the chief medical officer of health said in his annual report.

Dr. Kieran Moore released the report Tuesday, the first one from that office since the pandemic hit, and in it he stressed the need for Ontario to maintain its investment in public health preparedness, including in workforce, testing, surveillance and addressing socioeconomic inequities.

"It seems impossible that we could forget the hard lessons that COVID-19 taught us about the importance of being prepared. But history has often proved otherwise," the report said.

"Memories fade, life goes on, and societies become complacent about a theoretical future threat. But we no longer live in a time when future disease threats are theoretical. The emergence of new pathogens, and the resurgence of old ones mean we now live in a time when we must be constantly vigilant."

People may not want to hear about another pandemic right now, Moore acknowledged, but it is important in the long term.

"I was on the expert panel of SARS-1 in 2004 and saw the enthusiasm of government to create Public Health Ontario, to improve our responsiveness, but then the interest faded relatively quickly, within three to five years," he said in an interview.

"Then H1N1 in 2009, the same happened. I don't want to see any decrease in our level of preparedness. I want us to maintain the gains that we've achieved as a province, so that we can try to mitigate the unintended and negative consequences of any infectious disease threat or pandemic."

Moore said he plans to publish a separate annual report, starting in about October, on the state of the province's pandemic preparedness.

Report says Ontario shouldstrengthentesting,training

Among the priorities highlighted in Moore's report are to strengthen testing, surveillance and data systems.

During the pandemic, some progress was made to integrate vaccination and case and contact management data, but the resulting system COVAX can only be used for COVID-19, the report said. It couldn't be adapted for mpox, formerly known as monkeypox, when it emerged last year.

"Public health agencies had to revert to cumbersome, time-consuming manual processes for case and contact investigations and vaccinations, and mpox case and vaccination data cannot be easily linked," the report said.

COVAX set the standard by which all vaccine information should be available for all Ontarians and government is working "diligently" to bring that to fruition, Moore said.

"The next piece is having the electronic data from laboratory testing feed into our case and contact management system and that is progressing well," he said.

"But it's progressing well for COVID. We'd like it to be able to be enacted for all the other major pathogens like measles or polio or mpox and have a really up-to-date electronic suite of tools to enable public health to respond to any infectious disease threat."

As well, the province doesn't have systems to automatically report hospitalizations and deaths of people with "diseases of public health significance," the report said.

"As a result, public health agencies had to use labour-intensive manual processes to assess the number of individuals with COVID-19 who had been hospitalized, were in the intensive care unit, or had died due to COVID-19."

Health equity a priority

COVID-19 test requisitions were also being completed by hand, leading in some cases to delayed or missing results, the report said.

Another priority in the report is ensuring health equity. Communities with a low socioeconomic status or with a higher proportion of immigrants, Black people and other racialized populations had a higher incidence of COVID-19 cases and deaths and faced greater barriers to accessing COVID-19 vaccines, the report said.

Ontario should develop systems to support the "responsible and respectful collection, linkage, governance and use" of health outcome data, including information such as age, gender, sexual orientation, race, ethnicity, language, income and occupation to help the public health sector identify and address health inequities, the report said.

As well, the public health sector doesn't have adequate surge capacity, the report said. The workforce needs to be cross-trained in skills such as vaccination, case and contact management and infection prevention and control so all workers can step into those roles if need be, the report said.