Remarks for
Dr. David Butler-Jones

Chief Public Health Officer of Canada
At the Subcommittee on Food Safety

April 22, 2009

Mr. Chair

I want to thank this committee for the opportunity to speak, and to acknowledge this important examination into the listeriosis outbreak of the Summer of 2008.

Here with me today are Dr. Frank Plummer, the Public Health Agency's Chief Science Advisor and head of the National Microbiology Laboratory, and Dr. Mark Raizenne, Director General of our Centre for Foodborne, Environmental and Zoonotic Infectious Diseases.

The work of this subcommittee is a critical step to improving our ability to protect the food supply and the health of our population. While we did much right, there are lessons to be learned as we continue to improve the way we respond to such human health events.

The listeriosis outbreak was, without a doubt, a tragic event – 22 people died, and at least 57 more fell ill. Any preventable illness or premature death is a concern for us at the Public Health Agency.

Speaking as Canada's Chief Public Health Officer, I can say that dealing with events such as this one is never easy – either personally or professionally.

As a physician, I've spent countless hours with patients and their families. So I understand the feelings of pain, fear and concern that accompany the many illnesses and injuries a body can endure.

I know as well that those who were affected by this outbreak and the officials that managed it all want to better understand the circumstances around it.

What we can do is ensure that we learn from these events and apply those lessons -- using the right information, shared with the right people, at the right time.

Let me turn briefly, Mr. Chair, to how the Public Health Agency goes about responding to an outbreak.

Broadly, the Public Health Agency of Canada is mandated to promote and protect the health of Canadians and to build public health capacity across the country.

This, of course, includes preparing for and responding to any outbreaks that threaten human health.

Public Health is, at its heart, a local activity.

Events happen in communities, and by and large, are managed locally.

As you know, this particular outbreak was first identified in Ontario and was first managed by the Ontario public health authorities – as was appropriate.

When an outbreak spreads beyond a jurisdiction, or exceeds its capacity, the Public Health Agency takes the national lead on the human health side.

So, when the National Microbiology lab linked listeriosis cases in other provinces to the Ontario outbreak, the Agency took the lead in coordinating the national investigation and response.

I'd like to speak for a moment now about the role of the Chief Public Health Officer in an outbreak.

From the very beginning, I was actively managing the Agency's response.  As both Deputy Head of the Public Health Agency and as Canada's Chief Public Health Officer, I have a dual role to play during an outbreak.

As such, I directed our staff, including our medical professionals, our scientists, and our epidemiologists as they conducted their emergency response activities.

I also advised the Minister of Health on the outbreak itself and finally, I spoke directly to Canadians, stakeholders, and public health partners about issues affecting their health.

We communicated frequently, and in a number of ways, to the general public and to those groups most at risk. But you can never communicate too much.

For all our actions and preparations,  there are always challenges inherent in any public health crisis.

We anticipate and overcome those challenges as best we can.

Mr. Chair, I'll now talk a bit about the challenges we face in investigating and responding to outbreaks.

When public health, as a system, is dealing with foodborne illnesses, the identification of a source is a particularly complex process:

We might be sifting through evidence in towns or cities separated by thousands of kilometres…

We try to find people with the same symptoms so we can then fingerprint the bacteria to find out whether or not they're the same.

Then we ask people to identify everything that was eaten over the previous weeks to hopefully find a common source.

Then, those sources need to be investigated and connected back to the illness.

We were able to do this in this Listeriosis outbreak thanks to recent enhancements to our tracking and surveillance systems and to collaboration with our federal and provincial partners.

If this had happened five years ago, we would've had real difficulty in establishing links as fast as we did --- if at all.

The technological advances we've made, the systems put in place, and the collaborations we've established since the Agency was created have made huge differences in our ability to share and compare data and to plan our responses.

One of the constant challenges with foodborne outbreaks is that authorities are only notifiedonce people have already started getting sick. We usually know we're dealing with a severe outbreak only when people are reporting illness in higher than normal numbers. And in that case there might already be deaths.

The listeriosis outbreak was more of a challenge than usual because affected food was being consumed largely by those people who were most vulnerable to infection – specifically, seniors in long-term care facilities and hospitals.

And unlike most foodborne outbreaks, only a tiny percentage of those overall who ate the food became ill.

It was through our ability to connect the dots across many institutions and provinces that the pattern suggestive of a common problem emerged.

The food supply chain is an intricate web that links many parts of the food chain together…

From the time food is harvested, through processing, production, delivery, purchase, storage, and preparation – and including when we put it in our mouths -- there are people and organizations involved in our safety and health:  Government departments and agencies at all levels… industry… individuals. We're all partners in food safety.

And while we did find the source, and relatively quickly, much of the criticism centred around the public's need to be informed sooner and more quickly.

Clearly, there are lessons here, to be sure.

One point I would like to emphasize however, is the importance of getting it right.  Speculation on possible causes during an investigation can actually do more harm than good.

Take the example of the salmonella outbreak in the U.S. that led to hundreds of people in most states, including some in Canada, getting sick.

In the US it was publicly communicated that the cause was felt to be tomatoes. These were removed from the market and people stopped eating tomatoes, thinking the problem was solved, only to find out later that the outbreak was actually caused by jalapeno peppers.

Mr. Chair -- ultimately, we all have to take stock after any event, especially one such as this.

There are always lessons to be learned when we look at what went wrong, what went right, what can be improved, and what can be applied going forward.

That's why following the outbreak I asked for the Agency to develop a Lessons Learned report, a process both Health Canada and the CFIA have also undertaken.

The report did note that we did many things right. Our outbreak and emergency management staff worked well to manage the human health component of the outbreak …  the partnerships between departments, agencies, and levels of government were strong… and our public communications were effective.

But it is very clear that there is much that needs to improve.

It was found that PHAC should improve its advanced planning and formalize its outbreak policies and practices as well as its communications protocols.

We also must work on clarifying our roles and responsibilities in outbreaks, for the public as well as our partners.

We also need to strengthen capacity --  both in terms of day-to-day operations, but also for surge capacity during outbreaks.

Now, going forward … I take each and every one of these recommendations very seriously.

I've tasked the Agency with the implementation of an action plan in response:

We're reviewing our disease surveillance systems.

We're updating our response protocols.

We're strengthening capacity for epidemiological analysis and lab testing.

We're updating our communications protocols

We're strengthening our capacity at the National Microbiology Lab.

We've also kept working with the Council of Chief Medical Officers of Health on a Listeriosis Working group to maintain public health messaging on listeriosis and food safety.

A coordinated approach is key

In order to engage all agencies and levels of government, a Federal-Provincial-Territorial engagement strategy is being planned.

This will ensure that we get everybody's input in designing a strengthened system that is more effective and efficient for everyone to use.

In conclusion, Mr. Chair, let me say that I await with interest the recommendations that will result from this sub-committee and from the Investigator.

Independent investigation and analysis is tremendously important to us – as a complement to our own reviews and work.

Canadians expect that we constantly improve our abilities, and that we learn from the past, anticipate the future and respond to the unexpected.

This is our work.

Thank you. Merci.