Canadian CDC proposed

SARS investigation prompts call for new agency to enhance and coordinate research capacity | By Ed Ungar

Calling the chaos and lack of collaboration among various levels of government and agencies during Canada's SARS outbreak "an international embarrassment," a Ministry of Health panel called this week for a restructuring of Canada's public health system featuring an agency roughly modeled on the US Centers for Disease Control and Prevention (CDC). The new agency would act as the "quarterback" in response to future outbreaks, said panel chairman David Naylor, dean of the University of Toronto Faculty of Medicine.

"We have a lot to atone for," Naylor said of Canada's response to severe acute respiratory syndrome (SARS), the subject of his group's 224-page report released Tuesday (October 7), following the Yom Kippur holiday.

"At issue is the fact that no doubt had we managed it better, there might have been fewer ill, fewer dying, better management—a long list of things would have been better controlled," said panel member Allison McGeer, an infectious diseases expert at Mount Sinai Hospital. McGeer was herself stricken by SARS. She recovered, but 44 people died in the Toronto area last spring, and authorities quarantined thousands.

Unlike the CDC, the proposed Canadian agency for public health would not locate major facilities in one city. Rather, it would build on and enhance agencies such as the British Columbia Centre for Disease Control and viral labs in Winnipeg.

The report observed that "public health agencies and governments have often regarded research capacity as academic, irrelevant, and discretionary rather than the core public health function that it is."

It noted that in disease outbreaks, research is especially multidisciplinary, involving epidemiology, biostatistics, mathematics, medical microbiology, clinical medicine, laboratory science, health systems research, social science, and health policy.

The report concluded that during the SARS outbreak, clinical and epidemiologic data did not reach the right people so that they could make better informed etiologic, diagnostic, and clinical decisions. The committee believes that a revamp of the public health system should address that deficiency.

The panel called for a C$700 million annual increase in funding for public health, which would include C$100 million for communicable disease surveillance and control.

In July, the European Commission also took note of the SARS outbreaks and called for the establishment of a European center for disease prevention and control modeled on the American CDC. But like Canada's proposed agency, it would be more decentralized than its US counterpart.