This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 04 OTTAWA 003482 
 
SIPDIS 
 
STATE FOR OES/IHA (CRODDY, FOSTER, SINGER, DALEY), 
WHA/CAN (NELSON), M/MED/DASHO (TRIPLETT) 
 
DHHS FOR KAREN BECKER 
 
DHHS FOR BILL STEIGER AND ROSE BROWNRIDGE, OFFICE OF 
GLOBAL HEALTH 
 
CDC FOR ROBERT BALDWIN, OFFICE OF GLOBAL HEALTH 
 
USDA FOR APHIS 
 
E.O. 12958: N/A 
TAGS: TBIO KSCA SOCI CA WHO KSTH
SUBJECT: Canada's Pandemic Influenza Plans 
 
Ref. (A) State 209622 
     (B) Ottawa 2827 (Public Health Governance) 
     (C) Ottawa 3448 (Avian Influenza Report 1) 
 
¶1. Summary: Canada has a national pandemic flu plan 
dating from early 2004; an updated version is expected 
in December 2005. Preparing for an influenza pandemic 
is a top priority for the government of Canada. Canada 
is working with many partners, including the United 
States, to enhance global capacity to respond to a 
pandemic. Canada's experience with SARS in 2003 and 
with outbreaks of Avian Influenza in domesticated fowl 
in 2004 and 2005 have given public health officials 
recent experience in detecting and managing significant 
infectious disease outbreaks. We think that Canada's 
medical science and public health infrastructure is 
capable of timely and effective disease detection and 
outbreak response. End summary. 
 
A) Preparedness and Communication 
 
¶2. Canada has a strategy that addresses Pandemic 
Influenza.  The Public Health Agency of Canada (PHAC), 
in conjunction with Health Canada (HC) and the Canadian 
Food Inspection Agency (CFIA) maintains the Canadian 
Pandemic Influenza Plan. The Canadian Pandemic 
Influenza Plan is designed for: federal, provincial and 
territorial departments of health; emergency workers; 
public health officials; and health care workers. The 
plan includes guidelines and checklists that these 
groups can use in emergency response planning and 
creates a framework that guides the actions of all 
levels of government in the event of influenza 
pandemic.  The plan describes the different phases of a 
pandemic and the roles and responsibilities for each 
level of government at each phase. The phases described 
in Canada's plan are based on the World Health 
Organization's model. The plan covers three activities: 
 
     -- Prevention activities such as surveillance 
     programs and the establishment of an 
     infrastructure for manufacturing sufficient 
     vaccines to protect all Canadians at the time of a 
     pandemic. 
 
     -- Preparedness activities include the preparation 
     of actual plans for a pandemic. The preparedness 
     section addresses key activities, such as vaccine 
     programs, surveillance and public health measures 
     in terms of their current status and future 
     requirements. 
 
 
     -- Response/Implementation activities for 
     controlling the pandemic, minimizing deaths and 
     any social disruption it causes, including 
     communication activities. Implementation also 
     involves documenting the current activities and 
     outcomes to determine if any changes need to be 
     made to the response. 
 
-- The plan was drafted in 2004 and PHAC continues to 
modify the plan based on new information that comes 
available; we expect an updated plan to be released in 
December 2005. The plan also provides a model for 
responding to other infectious disease outbreaks. 
British Columbia, Alberta, Ontario and Manitoba have 
their own pandemic plans, which build on the national 
model.  We think that Canada is fully capable of 
mounting an effective, internationally coordinated, 
plan to address an avian influenza pandemic. 
 
-- The Canadian Pandemic Influenza Plan is available 
at: 
http://www.phac-aspc.gc.ca/cpip-pclcpi/index. html 
 
 
¶3. We think that the Government of Canada will be fully 
truthful in the reporting of disease outbreaks in both 
animal and human populations. Already the Government of 
Canada has been forthright with the Canadian public 
about cases of low pathogenic avian influenza found in 
wild and domestic fowl (Ref C). Officials in the 
Canadian and United States human public health and 
animal health communities are in frequent and frank 
communication about this and other infectious disease 
issues, which further ensures transparency. 
 
¶4. We are of the opinion that preparing for an avian 
flu pandemic is among the top priorities of the 
Canadian government.  Prime Minister Martin raised the 
issue in June 2005 during his first meeting with 
Ambassador Wilkins and identified it as one of the most 
important issues that Canada and the United States, and 
the global community, must address. Minister of Health 
Ujjal Dosanjh hosted the "Global Pandemic Influenza 
Readiness" meeting of international Health Ministers in 
Ottawa in late October 2005, further emphasizing the 
significance that Canada places on pandemic 
preparation. Both the Prime Minister and the Minister 
of Health would be appropriate officials to engage. 
 
¶5. According to Foreign Affairs Canada (the foreign 
ministry), Canada has fully accepted the International 
Health Regulations and a recent review of Canadian law 
indicates that they comply with the IHRs.  In our 
estimation Canada's national laws do not pose any 
barriers to avian influenza detection, reporting, 
containment or response.  The Canadian provinces play 
the most significant role in monitoring public health 
and administering public health responses (ref B); most 
of Canada's ten provinces have updated their public 
health and quarantine laws in the wake of the SARS 
crisis of 2003 to make them more flexible and 
effective. 
 
¶6. Canada is collaborating with the WHO, other 
international organizations and other countries to 
improve global pandemic preparedness, for example, via 
the Global Pandemic Influenza Readiness meeting of 
Ministers of Health in October 2005 in Ottawa.  As 
well, Canada is a member of the Global Health Security 
Initiative (GHSI) of the G7 plus Mexico and within that 
forum is co-leading with the United Kingdom discussions 
related to the supply and use of antiviral medications. 
Also under the aegis of the GHSI, Canada leads the 
Global Health Security Laboratory Network.  Under the 
Security and Prosperity Partnership (SPP) Canada, the 
United States and Mexico have agreed to develop a 
continental "North American plan" for pandemic 
influenza by 2006. Canada is a core member of the 
United States led International Partnership on Avian 
and Pandemic Influenza. 
 
¶7. Annual flu shots are administered in Canada. Over 
the past few years Canada has typically had 10 to 11 
million doses of the flu vaccine available annually for 
publicly funded programs. The Canadian supply comes 
from manufacturing facilities in Quebec (ID Biomedical 
produces about 75% of the supply) and France (Aventis 
which produces about 25% of the supply). ID Biomedical 
received a ten-year mandate from the Government of 
Canada in 2001 to assure a state of readiness in the 
event of an influenza pandemic and provide sufficient 
influenza vaccine for all Canadians (approximately 60 
million doses) in such an event. ID Biomedical is 
currently in the process of expanding and upgrading its 
Canadian manufacturing facilities, which are expected, 
beginning in 2007, to produce around 75 million doses 
per year of their "Fluviral" brand trivalent, 
inactivated split-viron egg based influenza vaccine. 
Although the specific avian influenza vaccine itself 
cannot be produced until the new pandemic strain 
emerges, the contract with ID Biomedical allows Canada 
to build the infrastructure and systems to produce 
sufficient pandemic vaccine for all Canadians. In 
addition, in its March 2005 Budget, the federal 
government provided C$34 million (approximately US$29 
million) over five years to assist in the development 
and testing of a prototype pandemic influenza vaccine. 
According to Foreign Affairs Canada there is currently 
no liability shield for foreign makers or donors of 
vaccines.  The question of how to facilitate 
development, production, access and distribution of 
vaccines and antiviral drugs is, however, a subject of 
on-going discussions as seen, for example, at the 
recent Pandemic Flu Ministerial in Ottawa. 
 
-- Canada does not produce an influenza vaccine for 
poultry. 
 
¶8. The Canadian population is well informed of the 
avian influenza threat and of global developments in 
the progress of the disease and response.  Mass media 
including television, radio and newspapers are 
reporting on the influenza phenomenon.  Government of 
Canada websites present comprehensive information on 
the Avian Influenza threat, as well as provide 
practical guidelines to poultry farmers and the general 
public regarding poultry management, Biosecurity and 
food handling to minimize the risk of infection.  We 
fully expect Canadian efforts to inform the public to 
be as effective as similar measures in the United 
States. 
 
B) Surveillance/Detection 
 
¶9. We have observed the recent Canadian experience of 
detection of avian influenza in wild birds and domestic 
fowl (ref C).  We understand that the medical and 
agricultural sectors are fully capable of detecting a 
new strain of influenza among people or animals in a 
timely fashion. Canada possesses a Biosafety level 4 
facility in Winnipeg, Manitoba capable of sub-typing 
influenza viruses.  This facility, the Public Health 
Agency's National Microbiology Laboratory (www.nml.ca) 
is co-located with the CFIA's National Centre for 
Foreign Animal Diseases at the Canadian Science Centre 
for Human and Animal Health.  Foreign Affairs Canada 
has indicated to us that the international community is 
considering the Canadian facility for inclusion as a 
WHO Reference laboratory. 
 
 
¶10. The Science Section of the Immunization and 
Respiratory Infections Division, Centre for Infectious 
Disease Prevention and Control (CIDPC) of PHAC produces 
weekly (October thru May) or biweekly (June thru 
September) FluWatch reports, summarizing influenza 
surveillance activities in Canada.  Influenza 
surveillance is a collaborative effort between 
provincial and territorial ministries of health, 
participating laboratories, the College of Family 
Physicians of Canada, sentinel practitioners, and 
CIDPC. For the 2005-2006 season, the FluWatch website 
includes graphical representation of the data collected 
through the three main components of the influenza 
surveillance system: 1) laboratory-based influenza 
virus identification, 2) influenza-like illness 
reporting by sentinel physicians across the country and 
3) reporting of influenza activity by provincial and 
territorial epidemiologists. Influenza activity level 
maps enable the user to select single or dual map 
views, zoom in to look at the activity levels for a 
specific province/territory and to view a dynamic map 
depicting changes in activity levels for user-defined 
time periods 
 
-- The FluWatch website is at: 
http://www.phac-aspc.gc.ca/fluwatch/index.htm l 
 
¶11. We think that Canada's medical science and public 
health infrastructure is capable of timely and 
effective disease detection and outbreak response.  We 
do not think there is any critical gap at this time 
that need be filled by U.S. or international 
organizations. 
 
C) Response/Containment 
 
¶12. Canada has a national antiviral stockpile; in 
February 2005 the Minister of Health announced a 
federal contribution of C$24 million (approximately 
US$20 million) towards the creation a national 
antiviral stockpile of oseltamivir.  As of November 1, 
2005 federal, provincial and territorial governments 
together currently own 35 million capsules (75 
milligrams each) of oseltamivir (Tamiflu), with another 
five million on order.  The national antiviral 
stockpile will be used to treat identified priority 
groups agreed upon by a national expert advisory 
committee on pandemic influenza. The priority groups 
include, for example, those hospitalized for influenza. 
 
¶13. The National Emergency Stockpile System (NESS) 
contains everything that one would expect to find in a 
hospital: beds, blankets, personal protective gear such 
as masks and gowns, surgical and medical devices and a 
supply of pharmaceuticals. This includes a stockpile of 
antiviral medication. 
 
¶14. We believe that the rapid response capacity for 
animal and human outbreaks is comparable to that in the 
United States. Federal and provincial guidelines are in 
place for preventing the spread of avian influenza on 
farm premises and for implementing on-farm Biosecurity 
precautions. The CFIA implemented preventative and 
precautionary control measures in response to the 
discovery of avian influenza in a domestic duck in 
British Columbia (Ref C) to limit and prevent the 
spread of the virus to other commercial premises - 
including quarantine, culling and disinfection. The 
CFIA actions are consistent with the recommendations 
agreed to by governments and industry following the 
2004 Abbotsford British Columbia outbreak of Avian 
Influenza and reflect the guidelines of the World 
Organization for Animal Health. 
 
¶15. Canada's National Pandemic Influenza Plan 
explicitly describes actions authorities would take, 
such as quarantine and social distancing measures, 
including closing schools and restricting public 
gatherings to address a pandemic.  Canadian authorities 
are willing and capable of imposing these measures. 
The National Pandemic Influenza Plan provides for 
military assistance in preparing "alternate care sites" 
(auxiliary hospitals) for infected individuals. The 
GoC, however, has not made any explicit mention of 
using its armed forces to enforce quarantine; 
nevertheless this option exists as the Canadian federal 
system allows for the military to provide "aid to the 
civil power".  Typically "aid to the civil power" would 
involve a province asking the Chief of Defence Staff 
for military assistance during natural disasters (the 
Great Ice Storm of 1998) or civil unrest (Quebec 
Separatist FLQ crisis of 1970).  The federal government 
could also deploy the military in areas where it has 
sole jurisdiction such as at ports of entry, including 
airports and seaports or along the frontier to maintain 
a cordon sanitaire. 
 
Wilkins