Sometimes I wonder if public sector health marketers are being made to look like a bunch of incompetents ( “keystone cops “). H1N1 communications, at least in Canada, has been an unmitigated disaster and the big question mark is why is this happening? Many of the public health communicators I have had the opportunity to work with over 25 years are the best communicators you will ever meet. They are extremely professional, very experienced and are excellent communicators. Add to this that public health departments across Canada at all levels of government have been planning for this pandemic for close to three years. How with all this experience and planning can we have one of the worst communication screw-ups in the history of the public sector?
Was it a coordination problem? Do we have too many levels of government involved in public health who speak a different language… is this our “Tower of Babel’? Did the public health administrators responsible for H1N1 overrule communication advice from their communications people. Did the political folks at all levels of government get involved in and refuse to take advice from their communication experts in public health? This will not be the first time this has happened. Did the media overplay the H1N1 story and panic Canadians unnecessarily? Did the original pandemic communications plans and strategies get overtaken by panicked officials who over reacted to the situation?
Did the local public health administrators underestimate the potential for a larger population wanting the vaccine , even if they were not in the priority group? ( I won’t go into hockey players and people with money jumping the queue.).
Understandably a mass vaccination of this type has never happened in anyone’s lifetime. The closest comparator is the polio epidemic in the 1950s where schools were the chief locations for inoculation. The target groups were school-age children not the general population. This was a relatively easy task compared to H1N1. However, there’s a lesson to be learned from polio inoculation… implementation was highly decentralized. Today, people are being funneled into too few spots as in a traffic jam when the on-ramps feed into a narrower highway. Where were the computer-modelers and experts when we needed them?
Some people suggested that the military should have taken over this operation as they are renown for handling crisis with precision and more important they have a chain of command. Yes a “chain of command” is that what’s missing in public health? Did it occur to us that maybe Canada with its layers of bureaucracy is not set up for managing crisis and emergencies.
Our Auditor General states in her most recent report that the federal government has not moved quickly enough to get ready for pandemics, natural disasters and terrorist attacks that can cause major damage to the country. She states that the government still reacts to matters such as the H1N1 pandemic or major blackouts on a “case-by-case basis,” eight years after the Sept. 11 terrorist attacks in the United States highlighted the need to prepare for emergencies. She states the Department of Public Safety, created in 2003 to co-ordinate how different branches of the federal government work together in emergencies, has not carved out the appropriate leadership role.”Canada needs to have a planned and coordinated approach in place so that federal, provincial and municipal agencies know what part they will play in managing a crisis. AMEN!!!
A report of the National Advisory Committee on SARS and Public Health October 2003 in response to the circumstances surrounding the outbreak of Severe Acute Respiratory Syndrome [SARS] provided a “third party assessment of current public health efforts and lessons learned for ongoing and future infectious disease control.”
Here is what the report said 6 years ago:
“The Committee sees an urgent requirement for multijurisdictional planning to create integrated protocols for outbreak management, followed by training exercises to test the protocols and assure a high degree of preparedness to manage outbreaks ( That’s a mouthful). The SARS experience highlights the need to mobilize selected groups of skilled personnel into epidemic response teams . Last, the Committee determined that neither Health Canada nor most jurisdictions and institutions have developed sophisticated frameworks for risk communication during a public health crisis. The CDC has a comprehensive crisis communications training program that, in our view, bears close study and early adaptation by Canadian governments and institutions.
A key requirement for dealing successfully with future public health crises is a truly collaborative framework and ethos among different levels of government. The rules and norms for a seamless public health system must be sorted out with a shared commitment to protecting and promoting the health of Canadians. Systems-based thinking and coordination of activity in a carefully planned infrastructure are integral in public health because of its population-wide and preventive focus. They are also essential if we are to be effective in managing public health emergencies. Indeed, Canada’s ability to contain an outbreak is only as strong as the weakest jurisdiction in the chain of P/T public health systems. Infectious diseases are an essential piece of the public health puzzle, but cannot be addressed in isolation, particularly since in local health units, the same personnel tend to respond to both infectious and non-infectious threats to community health. The Committee has accordingly recommended strategies that will reinforce all levels of the public health system as well as integrate the components more fully with each other.
So after the SARS epidemic and a significant report with many recommendations, did we learn anything? Keep in mind that this report was responsible for the creating of the Public Health Agency of Canada.
As usual I would love to hear from readers of this blog.