The Time to
Act is Now
Report of the Expert Panel for the
Review of the Federal Approach
to Pandemic Science Advice and
Research Coordination
Health Canada is the federal department responsible for helping the people of Canada
maintain and improve their health. Health Canada is committed to improving the lives of all
of Canada’s people and to making this country’s population among the healthiest in the world as
measured by longevity, lifestyle and effective use of the public health care system.
Également disponible en français sous le titre :
Il est temps d’agir : Rapport du groupe d’experts pour l’examen de l’approche fédérale en matière d’avis scientifiques et de
coordination de la recherche sur la pandémie
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Foreword by the Chair
The key message of this report is that Canada needs to take further action now if it is to be adequately
prepared for future health emergencies. Now is the time to build on the unprecedented collaboration and
actions taken during the COVID-19 pandemic and to act on the important lessons learned from this crisis and
previous outbreaks of infectious diseases.
This requires better monitoring, understanding, and communication of the most important infectious diseases
and other public health risks that face the country. These risks must be mitigated in order to minimise their
impact when they transpire, including addressing factors that result in disproportionate impacts on certain
populations including those in poverty, those experiencing homelessness, Black and other racialized groups,
and Indigenous communities.
New approaches are needed so that research in Canada as far as possible anticipates, and is able to
immediately respond to, public health needs during an emergency. Ever-ready systems must be put in place so
that the best scientific evidence is available and can be generated rapidly to inform decision makers and all
Canadians as soon as an emergency strikes. Finally, strong action by and collaboration between all levels of
government is required to address Canada’s longstanding and increasingly urgent need to put in place health
data systems that are capable of alerting the country to an emerging threat, and enabling the most effective
response to it.
Canada has the key ingredients needed to be a global leader in health emergency-related science advice and
research coordination, including world-class research and public health care systems. The recommendations in
this report are aimed at building on these strengths and creating a cohesive approach. Effective implementation
of our recommendations will also pay dividends in terms of improved overall health for Canadians.
A central and prime duty of government is to protect the health, wellbeing, and security of its population. While
COVID-19 sadly led to significant death, illness, and wellness and society-wide impacts across the globe, a future
pandemic or other health emergency could be swifter and more severe, leaving no room for error. Governments
that do not adequately prepare for the most important risks put their countries and the rest of the world in grave
danger, exposing their citizens to potentially disastrous health, social, and economic consequences.
I want to thank Health Canada, and specifically Deputy Minister Stephen Lucas, for asking an independent
expert panel to take stock of lessons learned and provide recommendations for the future of health
emergency-related science advice and research coordination in Canada. Thank you to my fellow panel
members, whose expertise was invaluable and dedication was unwavering. Thank you also to the secretariat at
Health Canada who supported the panel in its work. Finally, many thanks to the many people across the
country who spent time to provide their perspectives. Their contributions informed our findings and
recommendations aimed at better preparing Canada for the next health emergency.
Sir Mark Walport
Chair, Expert Panel for the Review of the Federal Approach
to Pandemic Science Advice and Research Coordination
May 9, 2024
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
1
Table of Contents
Panel Members................................................................................................................... 4
Recommendations and Summary of Key Findings.......................................................... 6
1.0 Introduction and Context................................................................................. 25
1.1
Panel Mandate and Scope of Review....................................................................... 25
1.2
Approach and Consultation................................................................................... 26
1.3
Guiding Principles for Recommendations................................................................ 26
1.4
Report Structure.................................................................................................. 27
2.0 Major Findings........................................................................................................... 28
3.0 National Health Risk Governance............................................................................ 32
3.1
Perspectives on National Risk Registers.................................................................. 33
3.2
A Comprehensive National Health Risk Management System for Canada .................. 37
3.3
Surveillance Infrastructure..................................................................................... 38
3.4
Effective Surveillance Systems and Timely Surveillance Data Sharing ........................ 42
4.0 Science Advice Mechanisms................................................................................... 43
2
4.1
Features of Effective Science Advisory Bodies........................................................ 44
4.2
Diversity of Expertise and Perspectives................................................................... 46
4.3
First Nations, Inuit, and Métis Expertise .................................................................. 47
4.4
Equity Considerations in Science Advice................................................................. 49
4.5
A Ready and Robust Science Advisory Mechanism .................................................. 50
4.6
Effective Communication of Scientific Advice ......................................................... 52
4.7
National Clinical Guidelines and Public Health Guidance............................................ 53
4.8
The Role of the Chief Science Advisor of Canada..................................................... 55
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
5.0 Health Research Prioritization, Funding, and Coordination ................................. 57
5.1
Health Research Coordination................................................................................ 58
5.2
Research Networks, Infrastructure, and Investments................................................ 60
5.3
Emergency Preparedness and the Federal Research Granting Councils...................... 66
5.4
Health Equity ....................................................................................................... 69
5.5
Research to Improve Indigenous Health Outcomes................................................... 71
5.6
Indigenous Health Expertise in the Health Portfolio.................................................. 72
6.0 Health Data Availability and Use ............................................................................. 73
6.1
Data Limitations and Advancements During the Pandemic.........................................74
6.2
Health Data Systems: Cultural Challenges............................................................... 75
6.3
Moving from a Custodianship to a Stewardship Model.............................................. 76
6.4
Sociodemographic, Race and Ethnicity Data to Inform Science Advice...................... 78
6.5
Health Data Standards and Interoperable Data Sets................................................. 79
6.6
Dedicated Indigenous Peoples Health Data Strategies............................................. 80
7.0 Conclusion................................................................................................................ 83
Glossary ............................................................................................................................ 84
Appendices.......................................................................................................................88
Appendix A: List of Permanent and Ad hoc Federal Research Coordination and
Science Advisory Groups that Supported the COVID-19 Pandemic Response..................... 88
Appendix B: COVID-19 Timeline...................................................................................... 90
Appendix C: Permanent and Ad hoc Federal Research Coordination and Science
Advisory Groups that Supported the COVID-19 Pandemic Response.................................. 92
Appendix D: Canada’s Health Research and Science Advice Ecosystem:
Roles and Responsibilities in a Federated Context............................................................ 105
Appendix E: Experts who contributed to the Review of the Federal Approach
to Pandemic Science Advice and Research Coordination...................................................113
References...................................................................................................................... 120
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
3
Panel Members
Sir Mark Walport: Chair
Sir Mark has extensive experience in the life sciences, government, and
national research and innovation organisations, including as Director of the
Wellcome Trust, Chief Scientific Advisor to the UK Government, and the
founding Chief Executive of UK Research and Innovation. In his recent roles
he has provided national and international leadership at the highest level on
biomedical research and policy issues. He chairs Imperial College Health
Partners and is Foreign Secretary and Vice President of the Royal Society.
Dr. Éric A Cohen
Dr. Cohen is Head of the Human Retrovirology Laboratory at the Institut de
recherches cliniques de Montréal and Professor of Virology at the Université de
Montréal. Since 2014, he has led the Canadian HIV Cure Enterprise, CanCURE,
a multidisciplinary research consortium dedicated to studying HIV reservoirs
and developing effective therapeutic strategies for a cure. He is a Fellow of the
Royal Society of Canada and the Canadian Academy of Health Sciences.
Dr. Bev Holmes
Dr. Holmes has 20+ years’ experience in the funding, production, and use of
research evidence to improve health. As President & CEO of British Columbia’s
health research agency, Michael Smith Health Research BC, she works to
strengthen the province’s health research system. She is a member of the
National Alliance of Provincial Health Research Organizations, an adjunct
professor at Simon Fraser University’s Faculty of Health Sciences and
University of British Columbia’s School of Population and Public Health, and a
Chartered Director at the Degroote School of Business, McMaster University.
4
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Dr. Thomas Marrie
Dr. Marrie is a retired infectious diseases physician whose research focused
on community acquired pneumonia. He was Dean of Medicine at the University
of Alberta and Dalhousie University, and served as interim Deputy Minister
of Health in Nova Scotia. His internationally renowned work on pneumonia
has resulted in the definitive textbook on this infection, altered the way it is
handled in hospitals and clinics, and led to evidence-based guidelines for its
management and treatment.
Dr. Shannon McDonald
Dr. McDonald is the former Chief Medical Officer at the First Nations Health
Authority in British Columbia. She is proudly Métis/Anishinabe with deep roots
in the Red River Valley of Manitoba and a trained physician with post-graduate
medical training in Community Medicine and Psychiatry. She has worked for
more than 20 years in the area of Indigenous health, with broad experience at
multiple levels of health care service delivery and health administration in both
provincial and federal contexts.
Dr. Allison McGeer
Dr. McGeer is a Professor in the Departments of Laboratory Medicine and
Pathobiology and Public Health Sciences at the University of Toronto. In addition
to her position as Director of Infection Control at Mount Sinai Hospital, she is an
infection control consultant to the Scarborough Hospital and the Baycrest
Centre for Geriatric Care. She currently serves on Canada’s National Advisory
Committee on Immunization and on the infection control subcommittee of the
Ontario Provincial Infectious Diseases Advisory Committee.
Dr. Fahad Razak
Dr. Razak is an internist at St Michael’s Hospital (Unity Health Toronto), and
Canada Research Chair in Healthcare Data and Analytics at the University of
Toronto. He co-founded GEMINI, the largest hospital research network in
Canada, and one of few such examples globally. He was the Scientific Director
of the Ontario COVID-19 Science Advisory Table and co-authored >50 science
and policy briefs that shaped the policy, public health, and clinical response to
the COVID-19 crisis.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
5
Recommendations and
Summary of Key Findings
The COVID-19 pandemic reinforced the critical importance of scientific research and advisory systems to
support timely responses to an uncertain and evolving public health emergency. In reaction to the pandemic,
Canada’s federal government quickly activated existing emergency coordination structures, made research
investments to enhance understanding of the virus and its impacts, and sought scientific evidence and advice
through a wide range of mechanisms. These actions supported the country’s overall response and relatively
positive outcomes as compared with other G10 countries.1 However, the pandemic had disproportionate
impacts on Canadians who have historically experienced systemic barriers to health care access, higher rates
of underlying health conditions, and increased adverse social determinants of health that can exacerbate the
impact of health emergencies.2 The pandemic also highlighted important gaps and inefficiencies in science
advisory and research coordination systems. It is important to reflect on what has been learned, to improve
readiness well in advance of the next pandemic or other public health emergency.
Mandate and Approach
In August 2023, Health Canada asked an independent expert panel to conduct a review of the federal
approach to pandemic science advice and research coordination, take stock of the lessons learned, and
provide concrete recommendations to strengthen Canada’s preparedness in these areas for future health
emergencies. The scope of the review was developed in consultation with the Public Health Agency of Canada,
the Canadian Institutes of Health Research, the Office of the Chief Science Advisor, and other federal
departments and agencies. The panel’s work is also relevant to other emergencies and to the management of
research and science advice in general. Its mandate did not extend to an evaluation of the impact of research
funding, how science advice factored into government decision-making processes, or the outcomes of
government policies and actions.
6
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Through interviews and roundtable discussions, the panel consulted with more than 300 individuals across
the country, from government departments, public health agencies, academia, and the private sector, and
Indigenous knowledge holders and health practitioners. It also reviewed relevant national and international
literature on research coordination in emergencies and the provision of scientific advice to government.
The panel found a high level of consistency between the views expressed in its consultations and the research
it undertook.
Major Findings
Four broad, cross-cutting findings emerged from the panel’s consultations, research, and deliberations.
These underpin its recommendations:
⚫
Canada must act now to be prepared for the next health emergency: A common thread running
through the panel’s recommendations is the urgent need to improve and sustain readiness in advance of
the next emergency. The pandemic exposed and exacerbated the weaker elements of Canada’s health
research and science advisory systems. It also highlighted severe shortcomings of health data systems
and an inability to conduct timely and adequate observational studies, including infectious disease
surveillance, and clinical trials. To overcome these challenges, the federal government and other levels
of government implemented a wide range of supplemental ad hoc mechanisms. See Appendix A,
Appendix B, and Appendix C for a full inventory of bodies and timelines. However, these took time to
put in place. The lack of ready infrastructure and processes delayed the generation of evidence and
synthesis of knowledge to inform urgent policy decisions. The long-term funding for newly created
critical infrastructure and networks is uncertain; a lack of continued investment could return Canada
to a pre-2020 state of readiness. Immediate and sustained actions are required to address these issues
to prevent possible disastrous health, social, and economic consequences of a future emergency,
which could be faster moving and more severe than the COVID-19 pandemic. Advance preparation for
pandemics and other key threats to public health is a more cost-effective approach than waiting for the
next emergency to strike before acting. It will also improve the overall health of Canadians during times
of stability.3
⚫
Greater pan-Canadian coordination of research and science advice is required: The response
to the COVID-19 pandemic spurred unprecedented collaboration among governments, public health
officials, researchers, and other relevant groups and partners across Canada and abroad. Wellestablished federal-provincial-territorial health, public health, laboratory, and other coordination bodies
were quickly activated in early 2020 (see Appendix B for a COVID-19 timeline) and met regularly to
support information exchange. However, there was a lack of sufficiently robust systems for specifically
coordinating research and science advice across the country in response to a nationwide emergency
of such scale.4 This led to duplication of efforts and challenges in areas including identifying,
communicating, and funding research priorities. New mechanisms are needed to bring together national
efforts on key issues, and coordinate internationally, both in preparation for and in response to future
national and global emergencies. More effective pan-Canadian collection and triage of public health
research questions are required, along with better coordination of intramural and extramural research,
knowledge synthesis, guidance development, and advisory processes. Canada must also harness a
broader range of expertise, including from social, economic, behavioural, and applied sciences, and
remove barriers to interdisciplinary, transdisciplinary, and cross-sectoral collaboration. These processes
must be put in place now and tested and refined through simulations and exercises before the next
health emergency.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
7
⚫
A greater focus needs to be placed on equity and addressing social and structural determinants
of health: COVID-19 disproportionately negatively impacted communities already experiencing
inequities and health disparities.5 This included lower-income Canadians, homeless and under-housed
populations, Black and other racialized populations, and individuals living in vulnerable conditions. People
living in congregate living settings, such as long-term care homes, were also heavily impacted. The social
and economic conditions that are well known to influence differences in health status greatly shaped
differential exposure and vulnerability to the SARS-CoV-2 virus and access to treatment.6 While the
importance of these social determinants and underlying structural determinants of health is well
understood, a greater focus must be placed on reducing their impacts before the next pandemic strikes.
This requires greatly increased research on the effectiveness of public health and other interventions,
accompanied by science advice to policy makers. Such prior research is essential to guide equitable
preparation for, mitigation of, and responses to future health emergencies, as well as efforts to address
the underlying inequities.
⚫
Indigenous health expertise must be embedded in research coordination and science advice
processes: Indigenous populations were disproportionately negatively impacted by the COVID-19
pandemic due to longstanding health inequities with well-documented differential access to health
and social services.7 In addition, the advice of Indigenous health experts and engagement with their
communities were not sought early enough in decision-making processes. Before the next health
emergency strikes, Indigenous health expertise and considerations for the unique needs of their
communities must be integrated in data collection, risk assessment, expert advice, and research
funding processes to support their health and wellness and advance reconciliation.
Many previous expert panels dating back decades have called for action in these areas. For example,
the 2003 report of the National Advisory Committee on SARS and Public Health chaired by Dr. David Naylor
noted the following:
“
There have been many calls to strengthen public health infrastructure in Canada over the last
decade. For example, in late 1993, given the global spread of HIV, Health Canada organized an
Expert Working Group on Emerging Infectious Disease Issues. This ‘Lac Tremblant’ group called
for “a national strategy for surveillance and control of emerging and resurgent infections”, support
and enhancement of “the public health infrastructure necessary for surveillance, rapid laboratory
diagnosis and timely interventions for emerging and resurgent infections”, coordination and
collaboration in “setting a national research agenda for emerging and resurgent infections”,
“a national vaccine strategy”, “a centralized electronic laboratory reporting system to monitor
human and non-human infections”, and strengthening “the capacity and flexibility to investigate
outbreaks of potential emerging and resurgent infections in Canada”. A decade later, very similar
recommendations are repeated in our report.8
Considerable progress has been made on these issues, but important gaps remain. Many of the 2003 report’s
recommendations remain salient and are echoed in the recommendations of this panel.
8
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Recommendations
Building on the major findings, the panel developed 12 recommendations organized into four areas.
1. National health risk governance
2. Science advisory mechanisms
3. Health research prioritization, funding, and coordination
4. Health data availability and use
These recommendations aim to build on the wide range of actions taken by the federal government in response
to the COVID-19 pandemic. If effectively implemented, they will enable a stronger and more systematic Canadian
response to future health emergencies. The panel made two additional recommendations, strongly related to its
findings but broader than the remit of its review.
National Health Risk Governance
Following the lessons from HIV, SARS-CoV-1, MERS, and Ebola, the COVID-19 pandemic was a forceful
reminder of the critical importance of robust and effective mechanisms for the identification, assessment,
mitigation, and management of natural hazards and human threats. Plans need to be prepared in advance to
guide rapid and efficient resource allocation, including for research funding, infrastructure, and timely sourcing
of scientific evidence to inform urgent policy decisions during an emergency.
National risk registers offer a systematic approach to help countries identify, plan for, and address populationlevel health risks. A risk register’s four main purposes are to i) prevent risks from transpiring as far as is possible;
ii) mitigate the worst effects of risks through advance preparation; iii) handle risks when these transpire; and iv)
support recovery. This requires an active process, led centrally within government, working with the relevant
government departments for each risk (and recognizing that, in catastrophic emergencies, risks can cascade
across the activities and responsibilities of many government departments). Continuous horizon scanning is
essential to ensure the continuing salience of a national risk register.
Public Safety Canada is currently leading the development of a National Risk Profile9 (similar to a risk register)
that includes considerations relating to pandemics but omits consideration of biological and health hazards
and threats in and of themselves. The Public Health Agency of Canada has also invested to bolster its internal
capacity and governance relating to risk assessment and response. These are important steps towards a more
comprehensive assessment and preparedness plan to address the full range of the most serious health
hazards and threats facing the country. Risk analysis needs to be made available to inform research priorities
and other preparedness actions by all levels of government and other relevant groups. Canada’s emergency
management plans,10 pandemic plans,11 and federal-provincial-territorial public health emergency response
plans12 do not currently outline protocols for science advice or research coordination. Other countries—such as
the United Kingdom, New Zealand, and the Netherlands—maintain and publish more comprehensive national
risk assessments and response plans.13,14,15
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
9
Well-coordinated surveillance systems are critical to inform health risk assessment. The 2003 report of the
National Advisory Committee on SARS and Public Health called for the development of an integrated risk
assessment capability for public health emergency response, and a comprehensive and national public health
surveillance system to collect, analyze, and disseminate laboratory and health care facility data on infectious
diseases and non-infectious diseases to relevant groups.8 Yet, the panel heard that during the COVID-19
pandemic, surveillance data were incomplete and not consistently available to the public health officials,
researchers, and relevant groups who required them. Since many jurisdictions did not collect demographic
information, they did not know which segments of the population were disproportionately impacted.
In response to the pandemic, the federal government funded new surveillance networks, including wastewater
monitoring networks that provided critical data on infection. However, the panel heard that the future of some
of these networks is uncertain because they have not received long-term funding and that processes for
real-time clinical surveillance and data sharing are lacking. Given the federated nature of the Canadian health
care system, solutions to these problems require actions by all levels of government and strong
intergovernmental collaboration.
Recommendation 1: Put in place a comprehensive national health risk
management system
a.
Develop a national health risk register and preparedness plan including mitigation, response, and recovery
elements. This should encompass the health implications of environmental, zoonotic, chemical, biological,
radiological, nuclear, and other natural hazards and human threats that could originate domestically or
internationally. It should be updated regularly based on horizon scanning, and an external version should be
published at least annually. The Health Portfolio should lead this process in coordination with Public Safety
Canada and other departments and agencies as required. The plan should be developed in collaboration with
provincial/territorial public health agencies and health departments.
b.
Incorporate the health risk register and preparedness plan within broader national emergency protocols, clearly
outlining the roles and responsibilities of relevant departments and agencies. Plans should be rehearsed and
refined through regular table-top simulations and exercises.
c.
Establish a standing health risk assessment and planning advisory body to inform the health risk register and
preparedness plan. This should include a dedicated standing expert advisory committee on infectious diseases
and pandemic preparedness.
Recommendation 2: Ensure that surveillance systems adequately
support real-time assessment and public health security
10
a.
Provide sufficient long-term funding for clinical, public health, and laboratory surveillance networks and
infrastructure for emerging infectious diseases and risks to public health, accompanied by the underpinning
technical infrastructure, in coordination with provincial/territorial governments and First Nations, Inuit, and
Métis partners.
b.
Systematically provide the results of all federally managed and funded public health surveillance efforts to
provincial/territorial, local, and Indigenous health agencies and pursue reciprocal sharing agreements.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Science Advisory Mechanisms
Effective mechanisms for the transmission of scientific advice to senior policy makers are crucial to a
government’s ability to make informed, timely policy decisions during health and other emergencies. This is
especially important when the threat is novel and rapidly emerging, where there is significant uncertainty, and
where the full extent of the health, social, and economic impacts is not clearly understood. In response to
COVID-19, the federal government went to great lengths to seek science and expert advice through both
established structures and newly created ad hoc advisory bodies. See Appendices A, B, and C for a full
inventory of bodies and timelines.
The effectiveness of federal advisory structures varied depending on many factors including the timing of their
establishment, membership, mandate, access to data, how advice was delivered, and whether that advice
related to matters within federal jurisdiction or to that of other levels of government. The panel heard that
among federal advisory bodies, those relating to vaccines were the most effective. For example, the expert
roster, strong secretariat, and clear mandate of the Vaccine Task Force created in June 2020 enabled it to
rapidly deliver advice directly to Ministers, which was vital to making critical procurement decisions.16 The
pre-existing National Advisory Committee on Immunization17 provided important guidance on vaccine
administration and sped up its processes during the pandemic; however, its advice was not consistently timely
due to a shortage of surge capacity.
Roundtable participants highlighted the insufficient guidance for diagnostics, therapeutics, non-pharmaceutical
interventions, and patient care in Canada. Australia,18 France,19 Germany,20 the United Kingdom,21 and the United
States,22 for example, had more robust processes for providing national clinical guidance, informed by the best
available clinical trial results and international studies.
Overall, the absence of pre-existing emergency protocols for science advice in Canada caused significant
delays, with time being of the essence in an emergency, as well as coordination issues within and across all
levels of government. Various science advisory tables led by the Health Portfolio, other federal departments
and agencies, and the Chief Science Advisor of Canada resulted in multiple streams of advice. Given the rapidly
changing knowledge environment, this advice was sometimes conflicting and there was a lack of capacity to
coordinate the advice. As a result, additional ad hoc coordination mechanisms were developed for this
complex landscape of advisory tables.
Science and expert advisory structures should be established and ready to be activated in advance of an
emergency, rather than created in response to one. An emergency is not the time to decide on the nature of
the bodies, identify and secure experts, establish terms of reference, put in place organizational support, and
establish efficient and effective work patterns. Other countries have systems that are ready to provide advice
in response to an emergency, such as the United Kingdom’s Scientific Advisory Group for Emergencies.23
This system was immediately activated in January 2020 to support COVID-19 decision-making.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
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The panel’s experience, insights collected in consultations, and a literature scan conducted by the Public
Health Agency of Canada24 point to four key features of effective science advisory bodies. First, they operate
with a high degree of independence, yet have strong ties to government and a clear “customer” in the form of
senior government policy makers who are receptive to their advice. Second, they are properly resourced, have
access to required data, and are populated with a diversity of perspectives and expertise. This enables the
provision of interdisciplinary advice based on the best available evidence at the time. Third, they provide timely
advice that observes principles of effective science communication,25 with advice publicly released soon after
its provision to government. Finally, they are sufficiently connected to government to understand the context
in which science information for decision making is needed.
The panel observed considerable duplication of experts across the various federal advisory bodies active
during the pandemic. Certain bodies lacked sufficient diversity and breadth of expertise, including in relation
to Indigenous health, behavioural sciences, and health equity. In addition, the output of many federal advice
bodies was not publicly released in a timely manner. In contrast, the Ontario COVID-19 Science Advisory Table
(which operated largely independently while having strong links into government) publicly released more than
70 briefs during its operation from July 2020 to September 2022. However, this ad hoc advisory body also
took time to establish and was stood up after the first wave of the pandemic was largely over.26
It is critical that scientific advice, including clarity on the level of certainty of the underlying evidence, be
publicly communicated (except for information that is confidential in nature or could jeopardize security).
During an emergency, the time interval between the delivery of the advice to policy makers and its public
release should be as short as possible. The information benefits all levels of government, provincial/territorial
and local public health officials, public and private organizations, other relevant groups, and citizens. Its
accessibility is important for maintaining trust in the policy-making process and combatting misinformation
and disinformation.
Canada requires a more structured approach to science advice for future emergencies. Independent advice,
which benefits from a broad range of interdisciplinary expertise and considers health equity and Indigenous
health implications, must be quickly and widely available at any time. A more coordinated, streamlined, and
transparent federal advisory process, with advice flowing in real time to other levels of government, and
publicly in a timely fashion, will reduce duplication and improve efficiency by providing a foundational resource
for provinces and territories, local public health units, and others.
Recommendation 3: Establish a science advisory system
for emergencies
a.
12
Create a central federal mechanism that is designed to immediately activate a specialized expert advisory
group in response to a health emergency to provide the best independent scientific advice directly to Cabinet.
This system should be co-led by the Privy Council Office and the Health Portfolio, in collaboration with the
Office of the Chief Science Advisor, Public Safety Canada, and other departments and agencies as required.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
b.
Ensure that this mechanism is ever-ready by establishing a standing interdepartmental government
secretariat with sufficient ongoing and surge capacity. The secretariat should have knowledge mobilization and
communications expertise, and access to all required intelligence. It should maintain a roster of experts relating
to key health risks (as per the proposed health risk register in recommendation 1). Preparedness work should
include training the roster of experts, secretariat members, and government decision makers on best practices
for providing, receiving and communicating evidence; as well as simulations and exercises.
c.
Designate the activated expert advisory group as the main federal science advisory body for health emergencies.
This group should typically be convened jointly by the Chief Public Health Officer and Chief Science Advisor.
Members should be assembled based on the nature of the emergency, drawing from the roster of experts,
standing advisory committees, and elsewhere as required. The majority of members should be independent
experts, chosen solely for their expertise. Expertise should be diverse with health, social, behavioural, humanities,
and applied sciences as required, and cut across sectors, including intramural, extramural, industry, health equity,
Indigenous health, and other relevant experts. Other relevant senior government officials should participate as
liaisons. Supporting sub-groups and task forces should be formed as required.
d.
Embed this advisory system in overall government emergency protocols; establish strong links with other
domestic health advisory bodies, federal-provincial-territorial health and emergency networks, and
international emergency advisory systems; and invite provincial/territorial governments and Indigenous
partners to name liaisons.
e.
Expand this advisory system over time to cover all emergencies, not just health emergencies.
Recommendation 4: Improve external communication of advice from
federal advisory bodies
a.
Stipulate in terms of reference that during an emergency, advisory bodies should publicly release evidence and
advice briefs in a timeframe commensurate with the urgency of the situation, typically within days of their
provision to government unless there are extenuating circumstances.
b.
Develop corresponding internal emergency communications protocols that accelerate and streamline release
processes to achieve releases in this timeframe.
c.
Include provisions to protect sensitive and confidential information, and require that the level of uncertainty
of evidence and advice is clearly communicated in all outputs.
Recommendation 5: Improve national guidance for the use of
diagnostics, non-pharmaceutical interventions, and therapeutics in
response to an emergency
a.
i
Put in place sufficient emergency capacity and protocols to develop and release timely clinical and community
guidance in these areas as reliable evidence emerges, in a similar fashion to the National Advisory Committee
on Immunization’s role on vaccines.i
However, as noted, NACI did not have sufficient surge capacity during the COVID-19 pandemic.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
13
14
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Indigenous partner
representatives
Provincial / territorial
government representatives
Recommended new
Recommended new / inactive
Existing
Legend
Standing secretariats led by
Health Portfolio
Standing health equity
advisory body
(Recommendation 9.b)
Standing infectious
diseases and pandemic
preparedness advisory body
(Recommendation 1.c)
President
Canadian Food
Inspection Agency
Health Portfolio
Standing health
risk assessment and
planning advisory body
(Recommendation 1.c)
President
Canadian Institutes
of Health Research
Federal-provincial-territorial
coordination bodies
Standing secretariat led by PCO
and Health Portfolio
Chief Public Health
Officer (CPHO)
President
Public Health Agency
Scientific advisory group
for emergencies
(not activated)
(Recommendation 3)
Deputy Minister
Health Canada
Public Health
Network Council
Conference of FPT
Deputy Ministers of Health
Cabinet
Minister of Health
Other departments and
agencies as required
Federal research
granting councils
Indigenous Services
Canada
National Research
Council
Innovation, Science and
Economic Development Canada
Office of Chief Science
Advisor (OCSA)
Public Safety Canada
Privy Council Office (PCO)
Figure 1: Proposed inter-emergency standing advisory bodies, and “sleeping” emergency advisory group for health
emergencies
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
15
Indigenous partner
representatives
Provincial / territorial
government representatives
President
Canadian Institutes
of Health Research
Federal-provincial-territorial
coordination bodies
Legend
Recommended new
Standing health equity
advisory body
Standing infectious
diseases and pandemic
preparedness advisory body
Standing health risk
assessment and planning
advisory body
Standing secretariat led by PCO
and Health Portfolio
Recommended new / inactive
Existing
Health Portfolio
President
Canadian Food
Inspection Agency
Chief Public Health
Officer (CPHO)
President
Public Health Agency
Scientific advisory group
for emergencies
Activated Typically convened
by CSA and CPHO
(Recommendation 3)
Deputy Minister
Health Canada
Special Advisory
Committee
Conference of FPT
Deputy Ministers of Health
Cabinet
Minister of Health
Other departments and
agencies as required
Federal research
granting councils
Indigenous Services
Canada
National Research
Council
Innovation, Science and
Economic Development Canada
Office of Chief Science
Advisor (OCSA)
Public Safety Canada
Privy Council Office (PCO)
Figure 2: Proposed central scientific advisory group for emergencies activated in response to a health emergency
to provide advice directly to Cabinet
Health Research Prioritization, Funding, and Coordination
In response to the COVID-19 pandemic, the federal government quickly mobilized to make additional research
funding available through rapid response funding competitions starting in February 2020. However, the panel
heard that research was not sufficiently directed and coordinated to address the most important and urgent
knowledge gaps, including how the pandemic was manifesting across Canada; modes of transmission;
appropriate use of non-pharmaceutical interventions; development of rapid diagnostic tools, therapeutics, and
vaccines; and understanding and addressing issues of misinformation, disinformation, and vaccine hesitancy.
Concerns included the lack of a central voice for research prioritization across the federal government; the
need for better coordination among federal, provincial, and territorial governments, including their funding
agencies; and the limited ability of the granting councils to coordinate research efforts at a national scale or
insist on enhanced sharing of suitably anonymized data.
Expert panels dating back to 1993 have called for a national research agenda for emerging and resurgent
infectious diseases. The National Advisory Committee on SARS and Public Health reflected on research
coordination issues during the 2002–03 SARS outbreak and recommended that the federal government
establish mechanisms with provincial/territorial health agencies to set research priorities for emerging
infectious diseases, and clear protocols for the management of future epidemic research responses.8 Despite
previous warnings, processes in place when COVID-19 emerged in 2020 were unable to quickly identify key
research priorities, effectively communicate these to all relevant groups, and direct funding accordingly and
promptly. No federal body was able to set out a clear overall research agenda for many months to support the
varying needs of public health practitioners, health care providers, industry, and policy makers.
In response, and in a similar fashion to the establishment of the many ad hoc scientific advisory bodies,
the federal government facilitated and supported a broad range of new research coordination, knowledge
synthesis, and modelling networks. The panel heard that many of these efforts played important roles during
the pandemic. However, their funding and implementation took time (see Appendices A, B, and C for a full
inventory of bodies and timelines) and researchers struggled to overcome administrative challenges to starting
their work expeditiously, including accessing facilities and obtaining the ethics approvals and data sharing
agreements required to access biological samples and data. In contrast, pre-existing bodies and networks with
federal funding, such as Genome Canada27 and the Canadian Immunization Research Network,28 were able to
leverage established expertise, relationships, and agreements, and immediately pivot to pandemic priorities.
This demonstrated the importance of maintaining capacity in inter-emergency periods, rather than attempting
to establish new mechanisms during an emergency.
In January 2022, the federal government created the Centre for Research on Pandemic Preparedness and
Health Emergencies within the Canadian Institutes of Health Research,29 with a mission to grow Canada’s
capacity to research and mobilize knowledge to prevent, prepare for, respond to, and recover from existing and
future pandemics and public health emergencies. However, the panel heard repeatedly that a more robust
interdepartmental and intergovernmental undertaking is required to achieve this critical mission.
16
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
The research needs of public health practitioners, health care providers, industry, and policy makers in pandemics
extend far beyond infectious diseases. They encompass other areas of medical research, including consideration
of the mental health and other health consequences; social and behavioural considerations; operational research
related to the maintenance of critical national infrastructure; economics; education; and more. Answering many
of the questions about these wider consequences requires a transdisciplinary approach. Researchers noted that
federal granting council eligibility requirements, including finely delineated subject-matter boundaries between
councils,30 were not fit for purpose during an emergency. In addition, funding restrictions for researchers affiliated
with government agencies presented barriers to collaboration between academia and intramural scientists. The
2023 Advisory Panel on the Federal Research Support System31 and others32 have provided related observations
and recommendations on Canada’s research funding processes.
There were also major gaps in the research response to COVID-19. More work needed to be done to
determine vaccine efficacy in different population demographics across Canada, which should have been
possible using routinely collected clinical data. While the federally funded COVID-19 Immunity Task Force
did seroprevalence studies33,34,35,36 and Canada had some major randomized control trials37,38 and vaccine
effectiveness studies,39,40,41,42 the federated health system and a lack of coordination and timeliness hampered
the effectiveness and impact of this important work. There is a need for continued investment in Canada’s
clinical trial infrastructure, including streamlining research ethics approval and data and specimen sharing
processes for anticipated areas of research, and for the establishment of emergency processes for working
with industry. In response to the pandemic, the federal government has invested heavily in medical
countermeasure research and development and clinical trial infrastructure via its Biomanufacturing and Life
Sciences Strategy.43 Investments under this strategy should be systematically informed by the panel’s
proposed new health risk register to maximize the likelihood that they will most effectively prepare Canada
for future health emergencies.
To achieve more equitable health outcomes, greater focus and investment is needed to support transdisciplinary
research to identify the best ways to implement public health and other interventions to tackle well-documented
inequalities. The panel heard that additional research is required before the next health emergency to examine the
effectiveness of interventions aimed at reducing the disproportionate risk posed to certain populations such as
those experiencing homelessness. The panel also heard that federal research grant funding processes do not
adequately value Indigenous knowledge and processes and are not compatible with the realities of Indigenous
communities including those in northern Canada. Overall, better prioritization and coordination of research will
increase the efficiency of government funding and improve health outcomes for Canadians.
While optimization of research coordination structures will pay significant dividends, Canada needs to
substantially increase its overall investment in scientific research and support of trainees (an area where it
objectively lags behind peer nations)44 to ensure that the necessary expertise exists and to fully realize the
benefits of these changes for Canadians. Over the last 20 years, Canada’s public investment in research and
development as a percentage of gross domestic spending has steadily declined; it currently sits at 1.55%,
compared with the G7 and OECD averages of 2.6% and 2.7%, respectively.44 Without an adequate foundation
of expertise, Canada cannot effectively prepare for and respond to future health and other emergencies.
While these issues are outside the remit of this panel, they have been addressed by other expert panels
including the Advisory Panel on the Federal Research Support System. Its report emphasized that a modern
research enterprise must be equipped to respond to the needs of government in order to provide benefits to
Canadians, and increased funding for research and talent must be a top priority to make the Canadian system
globally competitive.31
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
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Recommendation 6: Improve pan-Canadian coordination of health
emergency-related research
a.
Establish a central interdepartmental mechanism within the federal government to work with other levels of
government, academia, industry, First Nations, Inuit, and Métis health experts, and international partners to
identify research priorities relating to the preparation for, and response to, health emergencies, and coordinate
with provincial health research funders. This mechanism should be led by the Health Portfolio in collaboration
with federal research granting councils and other departments and agencies.
b.
Use the proposed new national health risk register and response plan, including the standing health risk
assessment and planning advisory body (in recommendation 1), to inform this research prioritization during
periods of stability. In response to an emergency, the activated special scientific advisory group for that
emergency (as per recommendation 3) should take the lead advisory role in supporting the prioritization
of new research questions as these arise in real time.
c.
Establish a mechanism (linked to the above) for the prioritization of medical countermeasure research and
development, working closely with industry and other relevant groups, informed by supply chain intelligence
and coordinated with international allies.
Recommendation 7: Enhance the readiness of research and clinical
trial networks and infrastructure
a.
Create and maintain domestic and international research networks during inter-emergency periods. Some of
these networks can be maintained in the form of “sleeping protocols”, capable of rapid activation in the event
of an emergency, while others should operate continuously and be used to address ongoing health priorities.
These networks should put in place, as much as possible, the required inter-organizational agreements and
ethical and other approvals, considering what may be required in response to potential future health
emergencies including those identified in the proposed national health risk register (in recommendation 1).
b.
Ensure that critical intramural and external health research infrastructure and human capacity are available and
can operate during the next health emergency through sufficient and sustained funding. This should include
creating an inventory of relevant assets, establishing protocols for the operation of federal facilities during an
emergency, and publishing guidance for external labs.
c.
Continue to increase the speed, scale, and inclusiveness of clinical trial infrastructure and processes by
ensuring sufficient funding for the human capacity and necessary infrastructure required across the country.
Recommendation 8: Strengthen the emergency preparedness of the
federal research granting councils
18
a.
Put in place processes and protocols so that granting councils operate collectively in an emergency, with rapid
decision making, streamlined review processes, and processes to facilitate collaboration on projects that are of
sufficient scale to address national priorities. Funding conditions should include the timely completion of new
inter-institutional agreements between collaborating research institutions as required, and the timely release
of research data and results where appropriate.
b.
Facilitate interdisciplinary research by removing subject-matter boundaries currently specified in very fine
detail between the granting councils, and through capacity building where necessary.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
c.
Remove barriers to intramural and extramural research collaboration including federal funding eligibility
restrictions for provincial and territorial intramural researchers. Operating funding envelopes for federal
intramural researchers collaborating with recipients of grants and contributions should also be put in place.
Recommendation 9: Increase investments in research on actions
required to better support and prioritize the needs of groups
disproportionately impacted by health emergencies
a.
Provide sufficient funding for research on the implementation of public health, government policy, and other
interventions to mitigate inequities and address the underlying health needs of priority groups, including
those in poverty or experiencing homelessness, Black and other racialized communities, and residents and
employees of long-term care facilities. This research should be developed and conducted in concert with
affected communities.
b.
Establish a standing science advisory body of independent experts on health equity, supported by a secretariat
within the Health Portfolio, to inform government policies and public health measures in this area.
Recommendation 10: Increase investments to advance research on
actions required to improve Indigenous health outcomes
a.
Co-develop health priorities with First Nations, Inuit, and Métis health experts and communities and provide
sufficient funding for research on actions to address these priorities. This should include increased investments
to advance Indigenous-led research and training in areas including epidemiology.
b.
Cultivate and invest in the development of expertise in the coordination and funding of Indigenous health
research, in and among federal departments and agencies.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
19
Figure 3: Proposed central research coordination mechanism in relation to proposed
national health risk register and advisory bodies
Standing surveillance networks
(Recommendation 2)
New standing advisory
bodies or scientific advisory
group for emergencies
(during an emergency)
(Figures 1 and 2)
National health risk register
Led by Health Portfolio in coordination with Public Safety Canada
(Recommendation 1)
Central research coordination mechanism
Federal-provincialterritorial health and public
health coordination bodies
Legend
Facilitates consensus and publishes research priorities in preparation
for and response to health emergencies
Interdepartmental—led by Health Portfolio, federal research
granting councils (Recommendation 6)
Provincial
health research
funders
Federal research
granting councils
(Recommendation 8)
Federal
intramural funding
processes
Existing/with enhancements
Recommended new advisory bodies
(Figures 1 and 2)
Recommended new risk
management and research
coordination processes
20
Intramural and extramural researchers / standing research networks
(Recommendation 7)
Improved health data systems
(Recommendations 11 and 12)
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Health Data Availability and Use
Many previous reports have outlined the deficiencies in the Canadian health data system and the harms that
Canadians are experiencing from an inability to properly collect, share, and use health data.5,8,45,46,47 The panel
consistently heard about challenges in collecting and accessing both public health and health care data, which
are essential for important research, scientific advice, and health delivery. The timely collection of key data, and
the sharing of these data between health care systems, levels of government, and research institutions, was a
key barrier to a well-coordinated and consistent national response to the pandemic. While these issues remain
unsolved, all Canadians are vulnerable. The most disadvantaged will remain the most vulnerable to the worst
health outcomes; health research and policy advice will be hampered; and Canadian scientific innovation will
not reach its full potential.
The most effective health data systems globally operate as data stewards, providing appropriate real-time
access to clinicians, researchers, public health officials, and public servants. They protect the privacy of
individual citizens as an integral part of promoting public health research. In these systems, research is seen as
an intrinsic part of care. Canada is currently operating a health data custodianship model, primarily concerned
with data security and privacy.47 Its fragmented data system means that it is less equipped to make evidenceinformed decisions, including during a health emergency.47
Provincial/territorial health data systems vary greatly in their ability to collect data and make them available.
During the COVID-19 pandemic, some provinces made detailed anonymized health data available to researchers
and advisory bodies, enabling critically important insights. These successes demonstrate that essential data are
available in some provinces and can be responsibly accessed by researchers. They also raise further questions as
to why real-time, disaggregated data cannot be leveraged inter-emergency to better support the provision of
health services and prepare for and mitigate the effects of future health emergencies. The panel heard that some
jurisdictions had to collect basic data manually, leading to delays and inconsistency in reporting. One of the most
important predictors of infection exposure and outcomes–basic sociodemographic data at the individual level
including information on race and ethnicity–was largely absent in almost all jurisdictions.
Some provincial governments are currently winding down the vaccine registries they created during the
pandemic despite their potential to capture accurate and precise information on the distribution, uptake, and
effectiveness of vaccines. There are compelling reasons for this type of routine data collection. The United
Kingdom has recently published work, using routine information collected from approximately 59 million people,
to examine the effectiveness of different numbers of vaccine doses in relation to the risk of hospitalization for
severe clinical manifestations of COVID-19.48 The results showed that even missing one recommended vaccine
dose was associated with a substantially increased risk of severe infection requiring hospital admission.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
21
In recent years, the federal government has worked with provinces and territories to receive advice from an
Expert Advisory Group.49 As a condition of their federal funding provided through the 2023 Working Together
to Improve Health Care for Canadians Plan,50 provinces and territories have committed to work with the federal
government and other partners to improve the collection, sharing, use, and reporting of health information.
Health data priorities are being implemented through a Joint Federal-Provincial-Territorial Action Plan on Digital
Health and Health Data51 and a Pan-Canadian Health Data Charter.52 The federal government has also provided
funding to the Canadian Institute for Health Information, Canada Health Infoway, and Statistics Canada to
support this health data agenda. However, many individuals expressed skepticism to the panel that these
measures would be sufficient in the absence of strong and sustained federal, provincial/territorial, and
Indigenous political leadership and support.
Given the substantial challenges to data sharing, close monitoring of the impact of these investments on
improving the scope, scale, interoperability, and responsiveness of the health data structure, as well as
accountability for expected outcomes, is critical.
The federal government must continue to take a leadership role and place an even higher priority on these
efforts. For the efforts to effectively support health emergency preparedness and response, Canada needs
to be able to generate, and make available to researchers, real-time health and related data from across the
country, including sociodemographic and race-based data, de-identified in such a way as to protect individual
privacy. This will enable characterization at a national scale of the incidence and prevalence of infection,
hospitalizations, deaths, therapeutic interventions, vaccination data and possible adverse effects, and other
critical issues at all times. Efforts to do so will provide benefits in crisis periods and in periods of stability, further
improving health outcomes and addressing inequalities. Ultimately, sustained political leadership across federal
and provincial/territorial governments is essential to overcome the barriers to the collection and use of data
that have great potential to provide health benefits to all Canadians.
A critical piece of transforming Canada’s health data systems is the co-development of culturally relevant,
distinction-based health data systems for First Nations, Inuit, and Métis peoples. An Expert Advisory Group49
on health data stressed that jurisdictions must demonstrate support for First Nations, Inuit, and Métis data
sovereignty across geographies. It also highlighted the importance of meaningful Indigenous participation and
representation on senior health data committees and governance tables to ensure support for, and alignment
with, First Nations, Inuit, and Métis data principles and strategies.45 The recently endorsed Pan-Canadian Health
Data Charter also commits to support and respect First Nations, Inuit, and Métis data sovereignty and
Indigenous-led health data governance frameworks.52 The federal government must continue efforts to
meaningfully engage with Indigenous Peoples to support their respective health data strategies and advance
shared digital health and health data priorities.
22
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Recommendation 11: Resolve the longstanding issue of the nonavailability and fragmentation of essential public health and clinical data
a.
Accelerate dedicated efforts with the provinces and territories to establish data standards, interoperable data
systems and data sets, and provide access to data that are essential for assessing and managing public health
between and during emergencies, reducing the health disparities between sociodemographic groups, and
enabling the conduct of innovative and important research. This should include the systematic collection and
availability of de-identified routinely collected health data, including vaccination data, across the country.
b.
Provide sufficient resources to the Public Health Agency of Canada, the Canadian Food Inspection Agency,
other relevant departments and agencies, and federally funded health data research networks to build and
maintain interoperable data systems and data sets and make these available to provinces and territories,
Indigenous health authorities, and researchers.
Recommendation 12: Continue efforts to meaningfully engage with
Indigenous Peoples and their communities to support their respective
health data strategies and advance shared digital health and health
data priorities
a.
Support and collaborate with First Nations, Inuit, and Métis communities and authorities across the country to
bring their health data systems in line with the most robust systems in Canada, while preserving Indigenous
data sovereignty and ensuring data integration and interoperability with provincial/territorial and federal
systems, further to the commitment in the Pan-Canadian Health Data Charter.
Broader Recommendations
The panel proposes two additional recommendations that relate to its key findings but are broader than the
scope of its remit.
Unlike the role of the Chief Public Health Officer, the position of the Chief Science Advisor of Canada is not
enshrined in legislation and its mandate does not have a formal role in the event of an emergency. In an
increasingly complex and interconnected world, scientific information is critical to inform government decision
making during and between emergencies. To support science advisory processes at all times, it is imperative
that the role of the Chief Science Advisor be clarified and set in legislation.
Broader recommendation A: Pursue legislation to formalize the role of the Chief Science
Advisor of Canada. This should include defining the role in preparation for and response to health
and other emergencies.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
23
The panel’s consultations pointed to insufficient Indigenous health expertise within the Health Portfolio.
Discussions also highlighted that efforts to seek this expertise through contractual and advisory roles
were inadequate to properly factor health considerations for Indigenous populations into health research
prioritization and other processes during the pandemic. A plan to recruit this expertise is needed, and this
should include creating a new dedicated senior role in the Public Health Agency of Canada.
Broader recommendation B: Create a new Deputy Chief Public Health Officer position that is
fully dedicated to Indigenous health. This role should be held by an Indigenous person and have the
mandate to ensure that First Nations, Inuit, and Métis health issues are integrated into the priorities
and processes of the Public Health Agency of Canada. It should interface with other areas of the
Health Portfolio, Indigenous Services Canada, and other departments and agencies as required.
Addendum
The work of the Expert Panel was completed prior to the release of the 2024 federal budget, which included
commitments relating to research funding and coordination in general. The panel has not assessed these
commitments but notes that the implementation of the envisioned measures will benefit from the findings
and recommendations of this report.
Conclusion
To be prepared for the next health emergency, and improve overall health outcomes for Canadians, there
is an urgent need for the federal government to act now to build on previous efforts and make significant
improvements to the approach to science advice and research coordination. The panel’s recommendations
centre around the need for a more sophisticated national risk assessment and preparedness planning process;
a more robust science advisory system that is ready to immediately activate in response to an emergency;
ongoing research infrastructure that is ready to mobilize; centralized leadership to facilitate the prioritization
and coordination of major public research investments; and improved health data systems.
The panel considers its recommendations to be cost effective, especially when compared with the
consequences of inadequate preparedness. The actions will also improve the effectiveness and efficiency of a
broad range of government investments. To achieve success, these efforts require enhanced interdepartmental
and international coordination, and, given the federated nature of Canadian health systems, actions by and
collaboration with provincial and territorial governments. Success also requires increases to ongoing public
investment in health research. Previous expert panels, dating back at least 30 years, have called repeatedly for
action in these areas. The government must take action now to comprehensively address these shortcomings
and to prevent or mitigate, as far as possible, the potentially disastrous health, social, and economic
consequences of a future health emergency.
24
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
1.0 Introduction and Context
1.1
Panel Mandate and Scope of Review
In August 2023, Health Canada asked an independent expert panel to conduct a review of the federal
approach to pandemic science advice and research coordination. The scope of this review was developed in
consultation with the Public Health Agency of Canada, the Canadian Institutes of Health Research, the Office
of the Chief Science Advisor, and other departments and agencies.
The panel’s mandate was to take stock of domestic and international learnings and best practices and provide
concrete recommendations for better federal preparedness for future pandemics and health emergencies in the
areas of science advice and research coordination. Its review included the structures and processes in place to
prioritize, fund, and coordinate science advice and research and extended to research across and between all
disciplines (e.g., health, natural, engineering, social sciences, the humanities); sectors (intramural and
extramural); functions (e.g., data collection, analysis, clinical trials, knowledge synthesis); and the prioritization
and coordination of these structures and processes. The panel determined that to comprehensively address its
mandate, it needed to take a close look at two inter-related areas of health emergency preparedness: i) the
monitoring and assessment of risks and threats and the plans to address them when they arise, and ii) the health
data ecosystem, with a focus on the collection and use of timely and interoperable data.
The review did not include an assessment of the formulation, implementation, or public communication of
government policies during the pandemic or the outcomes of them. It also did not extend to an evaluation of
the impact of research funding or how science advice factored into government decision-making processes.
While the goal of the review was to provide recommendations to strengthen Canada’s preparedness for health
emergencies, the panel’s work also has implications for improving the health of Canadians overall, and to better
prepare for emergencies more broadly. These include the roles of surveillance and risk assessment, research,
data, and science advice during and between emergencies
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
25
1.2
Approach and Consultation
The panel, supported by a secretariat at Health Canada, was convened in August 2023 and had its first
meeting that same month. Its work ended in April 2024. The panel’s approach comprised four elements:
⚫
Retrospective assessment and evidence synthesis of the overall lessons learned from the Canadian
approaches to science advice, research coordination, health risk governance, and health data collection
and use at different stages of the COVID-19 pandemic;
⚫
Examination of the current situation and future needs;
⚫
Identification of approaches, best practices, and national and international lessons learned; and
⚫
Development of recommendations for federal departments and agencies.
In addition to the individual and collective expertise and experience of its members, the panel relied on three
main evidence streams to conduct its analysis and develop its recommendations:
⚫
National and international reports on the provision of scientific advice to government, research
coordination, health risk governance, and health data collection and use, both in preparation for and
during emergencies;
⚫
National and international lessons-learned reviews, assessments, studies, and other relevant source
materials related to the response to the COVID-19 pandemic specifically; and
⚫
Interviews and roundtables with participants in key federal, provincial, and territorial departments and
agencies, Indigenous knowledge holders and health care practitioners, and a wide range of external
experts from academia and the private sector involved in pandemic scientific advice and research.
In identifying international comparators, the panel focused on countries where the policy context or
governance system was similar to that of Canada, in order to improve the likelihood of effective policy transfer
to a Canadian context.
Between August 2023 and February 2024, the panel met about 300 individuals from across the country,
virtually or in person. See Appendix E for a complete list of organizations represented in this process. In
addition, the panel received and considered 55 written submissions from individuals and groups. This report
relies heavily on evidence collected through interviews and roundtable meetings and the first-hand
experiences of individuals involved in Canada’s COVID-19 pandemic response.
1.3
Guiding Principles for Recommendations
The following key principles guided the panel’s deliberations and formulation of recommendations:
⚫
26
Build on successes: The panel’s work acknowledges the processes, organizations, and elements of
Canada’s scientific advice and research coordination system that worked well during the COVID-19
pandemic. Its recommendations seek to build on these successes by addressing the gaps and
weaknesses in the approach.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
⚫
Be practical: The panel’s focus is how to improve Canada’s preparedness for the next health emergency.
While noting the jurisdictional responsibilities of the federal and provincial/territorial governments in
health emergencies, the panel encourages creative yet practical approaches to further collaboration and
coordination. The panel proposes solutions that can be realistically implemented and achievable within
Canada’s federated system.
⚫
Reinforce findings and recommendations of previous expert panels: The panel acknowledges
the many reports of previous expert panels and committees, whose valuable work–on strengthening
both Canada’s health emergency response and health research system generally–is relevant to this
review.45,46,47,53,54,55 This report does not seek to duplicate their efforts; rather it aims to reinforce relevant
findings and recommendations.
⚫
Focus on the functions and roles required: While some of the panel’s recommendations name
specific federal departments and agencies that are seen to be instrumental, the focus is to identify the
roles, functions, and mechanisms that must be set up and ready, within a coherent science advice and
research coordination system, for the next health emergency.
⚫
Foster greater inclusivity and diversity: The panel acknowledges the critical importance of
incorporating a diverse range of perspectives in advisory and coordination structures and mechanisms.
To inform its recommendations, the panel met with a broad range of experts, including in the areas of
health equity and Indigenous health.
1.4
Report Structure
Chapter 2 presents four major findings that emerged from the panel’s analysis and deliberations on the evidence.
These findings underpin the panel’s detailed recommendations.
Building on the major findings, the next four chapters present the panel’s analysis supporting its
12 recommendations on how Canada can be better prepared for future health emergencies across
four key areas:
⚫
Chapter 3: National health risk governance
⚫
Chapter 4: Science advice mechanisms
⚫
Chapter 5: Health research prioritization, funding, and coordination
⚫
Chapter 6: Health data availability and use
For each recommendation, the panel offers its rationale, highlighting key evidence from its consultations and
literature review. Best practices and lessons learned from domestic and international bodies are also highlighted.
Chapter 7 provides a brief conclusion. Various appendices contain inventories, timelines, and other contextual
information.
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2.0 Major Findings
This section summarizes four cross-cutting findings that emerged from the panel’s consultations, research,
and deliberations. They underpin and inform the panel’s analysis and recommendations in the areas explored
in Chapters 3 through 6.
Canada must act now to be prepared for the next health emergency.
A common thread running through the panel’s recommendations is the urgent need to build on and refine the
extensive actions taken during the COVID-19 pandemic to coordinate research and effectively provide and use
science advice. This is required to improve and sustain readiness in advance of the next emergency. The
pandemic exposed and exacerbated the weaker elements of Canada’s health research and science advisory
systems, requiring federal departments to implement a wide range of supplemental ad hoc mechanisms. See
Appendices A, B, and C for a full inventory of bodies and timelines. However, these took time to put in place
and the lack of ready infrastructure and processes delayed the generation of evidence and synthesis of
knowledge to inform decisions.
The pandemic also highlighted the shortcomings of Canada’s health data systems, particularly the welldocumented structural barriers to sharing surveillance data and an inability to conduct timely and adequate
observational studies and clinical trials for medical countermeasures, such as vaccines and therapeutics.
To trial critical vaccines and therapeutics, global life sciences companies chose countries with well-prepared
clinical trial and emergency regulatory infrastructure and processes, resulting in lost opportunities for Canadians.
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The Time to Act is Now Report of the Expert Panel for the Review of the Federal
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Many of the networks created during the pandemic have not received long-term funding and their future
remains uncertain. This situation may return Canada to a pre-2020 state of readiness and puts Canada’s
preparedness for future emergencies at risk. It also results in a host of missed opportunities to leverage these
networks during inter-pandemic periods of stability to address other public health issues. The panel’s
recommendations in the chapters that follow call for immediate and sustained actions to address these issues
to prevent possible disastrous health, social, and economic consequences of a future emergency that could
be faster moving and more severe than the COVID-19 pandemic. Advance preparation for pandemics and
other key threats to public health is a more cost-effective approach than waiting for the next emergency to
strike before acting.3 It can also improve the health of Canadians in periods of stability.
Greater pan-Canadian coordination of research and science advice is required.
The response to the COVID-19 pandemic spurred unprecedented collaboration among government policy
makers, public health officials, researchers, and other relevant groups and partners across Canada and abroad.
Well-established federal-provincial-territorial public health bodies, such as the Pan-Canadian Public Health
Network, were quickly activated in early 2020 and met regularly to support information exchange. However,
there was a lack of sufficiently robust and tried systems for specifically coordinating health research and
science advice across the country in response to a nationwide emergency of such scale.4 This made it even
more challenging to coordinate the many new permanent and ad hoc bodies created during the pandemic,
and the information flowing to and from them.4
Inadequate national coordination of science advice and research efforts, across sectors and geographies,
as the pandemic evolved led to duplication of efforts in many areas of research and knowledge synthesis,
as well as challenges in identifying, communicating, and funding COVID-19 research priorities. Duplication of
knowledge synthesis and modelling activities to inform science advice, with different advice coming from
different sources, also occurred within some jurisdictions. While some level of duplication and redundancy was
to be expected and could potentially improve thoroughness and contextualization, the right balance was not
achieved between larger national efforts on key priorities and smaller-scale projects. Provinces and territories
had varying internal capacity to review and assess the emerging literature and to build models that could
project possible outcomes under different scenarios. Those with limited capacity relied heavily on federal
advice as well as advice from provinces with more advanced synthesis, modelling, and advisory resources.
The panel’s recommendations urge greater pan-Canadian coordination in a number of areas to prepare for
and respond to the next health emergency more effectively. For example, new federal mechanisms are
required to bring together national efforts on key issues and coordination internationally, as well as more
effective pan-Canadian collection and triage of public health research questions across jurisdictions with more
direct targeted funding to answer those questions and share the resulting outputs. Intramural and extramural
research, knowledge synthesis, and science advisory processes must be better coordinated. The government
must place an even higher priority on its recent efforts with provincial/territorial governments to advance the
use of health data and digital tools and require health data sharing as part of bilateral health funding transfer
agreements. Finally, Canada must harness and embed a broader range of expertise, including from social,
economic, behavioural, and applied sciences, into advisory bodies, and remove barriers to interdisciplinary,
transdisciplinary, and cross-sectoral collaboration.
These processes must be put in place now and tested and refined through simulations and exercises before
the next health emergency.
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A greater focus needs to be placed on equity and addressing social and structural
determinants of health.
COVID-19 disproportionately negatively impacted communities in Canada already experiencing inequities and
health disparities.2,5 This included lower-income Canadians, homeless and under-housed populations, Black and
other racialized populations, and individuals living in vulnerable conditions. People living in congregate living
settings, such as long-term care homes, were also heavily impacted. The social and economic conditions that
contribute to differences in health status, such as income, employment, education, food insecurity, and housing,
greatly influenced differential exposure and vulnerability to the SARS-CoV-2 virus and access to treatment.
The pandemic exposed many of the structural and systemic factors that contribute to inequities. Research
on the effectiveness of public health interventions to address health inequities and the social and structural
determinants of health was generally not well funded, prioritized, or coordinated in advance of or during the
pandemic. In some cases, advisory bodies themselves were not sufficiently diverse or their members did not
have enough expertise in these areas to identify recommendations that would improve health equity outcomes.
Before COVID-19, there was insufficient collection and sharing of disaggregated data on the determinants
of health. As the virus spread, municipal public health units across the country began to collect relevant data
to better understand the needs of populations that were heavily or more severely affected by the virus and
the wider consequences of public health measures. In many cases, this work came too late in the pandemic.
The National Advisory Committee on Immunization’s use of a framework and a validated equity tool to identify
priority populations for vaccination is an example of effective use of health equity principles, with the
subsequent wide adoption of its guidelines by provinces and territories.56,57,58
The importance of social and structural determinants of health is well documented and understood in Canada.
However, efforts to lessen their impacts have been insufficient to date, as has systematic measurement of
these factors to allow for targeted policy action in a timely manner. A greater focus must be placed on reducing
these impacts before the next pandemic or other health emergency strikes. This requires embedding an equity
lens into scientific advisory processes and health emergency research, including comprehensive adoption of
broader collection and sharing of disaggregated sociodemographic and race-based data. Further research on
interventions, in addition to activities that build trust with communities, is essential to guide equitable
preparation for, mitigation of, and responses to future health emergencies, as well as efforts to address the
underlying inequities. Many of the panel’s recommendations reflect the urgent need to improve Canada’s
performance in these areas.
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Indigenous health expertise must be embedded in research coordination and science
advice processes.
Indigenous populations were disproportionately impacted by the COVID-19 pandemic due to longstanding and
well-documented health inequities linked to social and structural determinants of health such as differential
access to health services, proper housing, and clean water, among others6 Indigenous health considerations
and expertise were also not adequately integrated into science advice and research coordination structures
and processes, despite the government’s efforts to quickly leverage pre-existing structures relating to
Indigenous health. These included the Canadian Institutes of Health Research Institute of Indigenous Peoples’
Health and the National Collaborating Centre for Indigenous Health. There is a need for broader Indigenous
inclusion at many science advisory and research tables convened by Health Canada, the Public Health Agency
of Canada, the Canadian Institutes of Health Research, and other federal government departments, both
during and between emergencies.
The view of Indigenous health leaders is that the health of the communities they serve is treated as an add-on
responsibility for federal advisory bodies, rather than as an overall priority that incorporates Indigenous
methodologies, perspectives, and priorities from the outset. In addition, federal research grant funding
processes do not adequately value Indigenous knowledge and ways of knowing, being, and working, and are
not compatible with the realities of Indigenous communities including those that are remote and isolated.
Leadership issues and changes, particularly at the Canadian Institutes of Health Research Institute of
Indigenous Peoples’ Health, also exacerbated mistrust and coordination challenges that were already present
due to the history of health-related abuses of Indigenous people in Canada.59
Many of the panel’s recommendations reflect the urgent need for the federal government to integrate and
embed Indigenous health expertise and considerations in surveillance, data collection, risk assessment, expert
advice, and research funding processes. First Nations, Métis, and Inuit communities each need to be integrated
into the broader systems in their own right using a “distinctions-based”ii,60 approach, rather than as part
of a pan-Indigenous approach. This integration of knowledge and decision making is critical to advance
reconciliation with Indigenous Peoples, build meaningful relationships, and overcome mistrust related to
historical data collection and misuse by governments. Research coordination and data use must reinforce the
right to self-determination and principles of data sovereignty.8
ii
Distinctions-based is defined as “an approach that aims to avoid conflating the Indigenous Peoples within Canada, and instead
recognizes First Nations, Inuit and Métis as separate groups, each with their own diverse cultures, traditions, communities and histories.
A distinctions-based approach ensures that the unique rights, interests and circumstances of each of these groups are acknowledged,
affirmed and implemented.”
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3.0 National Health Risk
Governance
Past public health emergencies, such as HIV, SARS-CoV-1, MERS, and Ebola, have demonstrated the vital
importance of emergency preparedness and response structures to the effectiveness of the overall response.
The COVID-19 pandemic reinforced the need for surveillance, monitoring, and risk assessment to populate
data ecosystems and support science advice and research coordination.
Canada has made strides in the development of a risk governance system, but still has challenges to
overcome. It does not yet have a comprehensive, centralized system that assesses the most pressing health
and public health risks, let alone one that is integrated with other types of threats and hazards.iii Efforts to
enhance Canada’s science advisory and research coordination structures must also consider how risk
governance structures and their functions, including surveillance, monitoring, and risk assessment, can
support experts and decision makers. Together, these elements can form a comprehensive national health risk
management system.
This chapter explores the need for Canada to develop more robust governance mechanisms for the
identification, assessment, mitigation, and management of natural hazards and human threats. Drawing on
best practices in countries such as the United Kingdom (UK), the Netherlands, and New Zealand, the panel’s
recommendations focus on strengthening the risk governance system and integrating it with science advisory
and research coordination mechanisms.
iii
32
In the context of this report, hazards refer to events that occur in the natural world, such as volcanic eruptions and forest fires. Threats
generally refer to human activities, such as an attack. The term risk is used to encompass hazards and threats; and risk analysis is the
study of the probability and severity of these occurrences.
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
3.1
Perspectives on National Risk Registers
Federal government departments are mandated to develop emergency management plans in their respective
subject areas, which must align with the government-wide Federal Emergency Response Plan.61 The panel heard
that federal emergency management protocols are siloed and disjointed across departments, and lack
provisions for science advice and research coordination. See Appendix D for more information on the Federal
Emergency Response Plan and associated Health Portfolio emergency plans.
This section outlines ongoing work across the federal government to address gaps in risk governance and
suggests how the distinct areas of expertise in departments and agencies can be integrated to develop a more
robust approach. It also discusses the elements or lenses necessary to conduct effective risk assessments and
produce a comprehensive health risk register for Canada.
3.1.1
Canada’s Current Approaches to Risk Assessment
In 2019, Public Safety Canada (PSC) released an Emergency Management Strategy for Canada: Toward a Resilient
2030.62 The strategy builds on the foundational principles articulated in previous emergency management
frameworks and emphasizes the need to consider different vulnerabilities, resilience factors, and the culture
of risk assessment and response in Canada.
In accordance with the strategy, PSC began work in 2021 to lead the development of a National Risk Profile,
which is similar to what other jurisdictions call a risk register (UK) or risk assessment (Netherlands). Intended to
fill a gap in Canada’s risk governance structures, the National Risk Profile uses an all-hazards risk assessment
methodology to consider the impacts of risks in five areas:
⚫
People (fatalities, injuries, and psychological illnesses);
⚫
Economy (direct and indirect economic losses);
⚫
Environment (all forms of environmental damage);
⚫
Government (damage to influence or ability to govern); and
⚫
Social function (disruptions to societal functions).
The methodology assesses the impact and likelihood of a risk and uses cost estimates to develop realistic
scenarios and standardized comparisons of all scenarios (with the expected loss caused by the hazard,
per year, and averaged over a set period). This allows PSC to compare risks across sectors in a standardized
way and determine where to focus emergency management system changes.63
PSC’s report from its first round of research, released in May 2023, focused on the three most costly natural
hazards: earthquakes, wildland fires, and floods. The report includes a section that takes a “pandemic lens”,
and considers the impacts a pandemic (as a broad, society-wide emergency) can have on emergency
responses to the three natural hazards. The second round, currently underway, focuses on heat events,
hurricanes, and space weather due to their significant impacts on public health, critical infrastructure, the
economy, and ecosystems.9
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Figure 4: Public Safety Canada’s National Risk Profile Research Phases64
Potential Hazards for Future Rounds of Assessment
National Risk
Profile Round One
(2021–22)
National Risk
Profile Round Two
(2022–23)
Natural Hazards
Natural Hazards
(future rounds)
Non-Malicious
Hazards
(future rounds)
Adaptive and
Malicious Hazards
(Future Rounds)
Human-Induced Hazards
The development of the National Risk Profile is an important step towards a more comprehensive assessment
and preparedness plan for Canada. However, the panel has identified a gap in the type of risks assessed. The
analysis considers the health impacts of emergencies on a population, but does not recognize and assess
biological threats in and of themselves. This omission indicates a potential lack of risk assessment that
considers health security, or how pathogens, pandemics, and other illnesses can harm the population of
Canada, as the National Risk Profile may not address biological or health-related emergencies among the most
important risks facing Canadian populations until future rounds, if at all.
The UK’s National Risk Register demonstrates how a national risk register can be effectively used in risk
assessment and analysis. First published in 2008, the publicly available National Risk Register includes an
assessment of 89 risks across nine themes. iv,13 These risks include natural disasters, pandemics, cyber threats,
and other emergencies that could impact the wellbeing of the population. This all-hazards approach
acknowledges that all risks, including biological and health-related hazards and threats, can result in similar
direct effects and pathways of cascading consequences on a population. This is why it is critical for Canada’s
National Risk Profile to take a common approach to assessing all major risks that may transpire at a national
level, regardless of which federal portfolio would be implicated in a response.
At present, the Public Health Agency of Canada (PHAC) and the Canadian Food Inspection Agency (CFIA)
prepare assessments of risks related to their individual mandates. However, there is no publicly available
comprehensive register of health-related risks. The panel considers the Health Portfolio as best placed to
conduct the analysis of health-related risks and to produce a comprehensive health risk assessment. There is
an opportunity within the Health Portfolio to leverage the work of PHAC, CFIA, and other departments and
agencies such as Environment and Climate Change Canada to integrate a One Health approach in risk
assessment processes, and track pathogens and zoonoses, whether they originate from humans, plants,
or animals. In doing so, PHAC would expand its current approach to risk analysis from the traditional public
health approach (considerations of long-term public health and prevention of chronic disease) to adopt a
health security focus that monitors all biological and health threats. This approach would address the
previously mentioned gap in the PSC National Risk Profile.
iv
34
Accidents and system failures; Conflict and instability; Cyber; Geographic and diplomatic; Human, animal, and plant health; Natural and
environmental hazards; Societal; State threats; and Terrorism.
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One Health
A One Health approach acknowledges that the health of humans, animals, and ecosystems are
interlinked. This includes pathogens and zoonoses and the analysis of other areas of the humanecosystem interface, including urbanization, international travel and trade, and food production–all of
which can contribute to the emergence of new diseases.65 In the Canadian context, the widespread
wildfires in summer 2023 demonstrated the benefits and necessity of a One Health approach, as both
ecological and human health concerns were critical in the response. The 2024 H5N1 influenza
outbreaks in dairy cattle also underscore the need for a fully coordinated approach to risk assessment
and surveillance.
3.1.2
Federal-Provincial-Territorial Coordination
The panel observed a lack of coordination and alignment between federal and provincial/territorial risk
assessment and emergency response plans and activities. Infectious agents do not recognize political
boundaries. Therefore, a lack of coordinated responses across borders increases both health risks and other
adverse consequences of outbreaks and pandemics. Since all jurisdictions and levels of government are
implicated in many major health emergencies, a common understanding of and consistent approach to
coordination for emergency response protocols will greatly enhance emergency response across Canada.
Early in the pandemic, the Federal-Provincial-Territorial Public Health Response Plan for Biological Events12 guided
action to activate a Special Advisory Committee and associated Technical and Logistics Advisory Committees
under the Pan-Canadian Public Health Network. However, the panel heard that current guidance and
structures were not robust enough to coordinate a response to an emergency of such scale and multi-sectoral
scope, and did not include sufficient provisions for science advisory and research coordination processes.
The UK National Risk Register provides an example of how Canada can integrate provincial and territorial
partners into this work. The register highlights the processes and risks that the UK government considers most
pressing, enabling local and regional governments to prioritize their own risk assessment and mitigation plans.
Moreover, the associated Civil Contingencies Secretariat produces guidance for local administrations on how
to interpret the National Risk Register at their level.66 This approach can also be adapted to account for
jurisdictional boundaries.
The proposed Canadian health risk management system must be linked to emergency protocols at all levels of
government. Isolating risk assessment and response processes at different levels of government (federal,
provincial/territorial, regional, or municipal) may create unnecessary gaps in assessment and response. Reducing
gaps and maintaining readiness across all levels of government also requires regular table-top exercises where
participants can test protocols, complemented by ongoing updates and revisions to plans based on emerging
threats and ongoing governance changes. Practice simulations also ensure that participants are familiar with the
process and working with one another. This idea is explored further in Chapter 4.
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The Netherlands’ National Risk Assessment demonstrates how Canada can integrate expertise from outside
of government into its risk governance mechanisms. The panel heard that expertise in some scientific and
technical fields in Canada is primarily concentrated in the private or academic sectors with limited expertise
found within the federal government. The Netherlands addressed a similar challenge through its National
Steering Committee for National Safety and Security, which features representatives from 16 national
ministries and determines which risks to prioritize and address. Notably, the Steering Committee also includes
representatives from the private sector and industry, acknowledging that public-private partnerships are
necessary to safeguard national security.67 The Network of Analysts for National Safety and Security, a
knowledge network composed of experts and representatives from outside government, develops scenarios
based on the identified risks.67 This approach also ensures that the development of the National Risk
Assessment is a collaborative exercise between government representatives and external experts, and that
scientific and governance expertise drives the risk analysis process.
3.1.3
Application of an Equity Lens to Risk Assessment
The panel frequently heard that the impacts of emergency events are not evenly distributed across
populations in Canada, and that social and economic status results in differential risk and capacity to respond.
Incorporating an equity lens into risk assessment functions across the Government of Canada is essential for
a risk management system to be able to support analysis of the most pressing risks for diverse populations.
This idea was also introduced in the Chief Public Health Officer’s 2023 report.68 An equity lens would also
ensure that disproportionally impacted groups are involved earlier in the planning process and are familiar with
the response protocols.
New Zealand provides an example of how Canada’s Health Portfolio can integrate Indigenous perspectives
into a new health risk register. New Zealand’s National Intelligence and Risk Coordination69 uses a National Risk
Approach70 to proactively and comprehensively manage the most significant risks to national security in the form
of a National Risk Register.14 The National Risk Register supports government departments in risk assessments
and encompasses a wide array of hazards and threats spanning various domains, including natural, biological, and
technological hazards; malicious threats; and economic crises. The Manual for Communicable Diseases,71 for which
the Ministry of Health is responsible, outlines the need for a strong focus on Māori health and the health of other
Pacific peoples, refugees, and asylum seekers. It recognizes the higher rates of infectious disease and increased
risk of severe communicable disease among those populations.72 The principles for guiding this work originate
from a broader treaty articulating the responsibilities of the New Zealand government in relation to Māori peoples,
and includes Māori representatives and those with expertise in Māori ways of knowing early in the planning and
response processes, and works in partnership with kaumātua (Elders) and communities throughout the process.73
In the Canadian context, it is critical for Indigenous Services Canada and Indigenous peoples and communities
to be included in health risk assessments and planning. This includes considerations for how First Nations, Inuit,
and Métis expertise and cultural contexts can be embedded in emergency planning, and not only for
Indigenous communities.
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3.2
A Comprehensive National Health Risk
Management System for Canada
The current approach to national risk assessment is fragmented. It isolates the assessment of health risks
within the Health Portfolio, with other risks assessed separately, including through the National Risk Profile
process. It also does not provide a comprehensive basis for developing the collective, interdepartmental
understanding of all risks that is required to respond to an emergency that spans departmental mandates. It is
crucial to acknowledge that multiple types of threats and hazards can (and do) occur in complex systems, and
to address the gaps in Canada’s current approach, which silos the assessment of certain risks within individual
portfolios. A shared approach to risk assessment activities across government will create a shared foundation
for interdepartmental collaboration and integration of disparate risk assessment products and preparedness
plans moving forward.
Recommendation 1: Put in place a comprehensive national health risk
management system
a.
Develop a national health risk register and preparedness plan including mitigation, response, and recovery
elements. This should encompass the health implications of environmental, zoonotic, chemical, biological,
radiological, nuclear, and other natural hazards and human threats that could originate domestically or
internationally. It should be updated regularly based on horizon scanning, and an external version should be
published at least annually. The Health Portfolio should lead this process in coordination with Public Safety
Canada and other departments and agencies as required. The plan should be developed in collaboration with
provincial/territorial public health agencies and health departments.
b.
Incorporate the health risk register and preparedness plan within broader national emergency protocols, clearly
outlining the roles and responsibilities of relevant departments and agencies. Plans should be rehearsed and
refined through regular table-top simulations and exercises.
c.
Establish a standing health risk assessment and planning advisory body to inform the health risk register and
preparedness plan. This should include a dedicated standing expert advisory committee on infectious diseases
and pandemic preparedness.
Developing a health risk register–and integrating it with other aspects of emergency response–would give
federal, provincial, territorial, and Indigenous partners a common understanding of which risks are most critical,
facilitating collaboration and coordination in the areas of science advice and research coordination, among
others. In this context, the risk register should also be used to inform research priorities, developed by a central
research coordination mechanism (discussed further in Chapter 5).
The panel considers the formation of three new standing advisory structures instrumental to integrating
external expertise into Canada’s health risk management system during inter-emergency periods: a health risk
assessment and planning advisory committee, a specialized infectious diseases and pandemic preparedness
advisory body, and a health equity advisory body (discussed further in Chapter 5). The Health Portfolio is best
positioned to lead the processes for these new bodies. PSC, the Office of the Chief Science Advisor,
Indigenous Services Canada, and other departments and agencies (as required) should be involved to ensure
strong interdepartmental, intergovernmental, and broader coordination. Representatives from provincial and
territorial governments and First Nations, Inuit, and Métis partners should be invited to name liaisons to attend
sessions, provide important context to members, and report back to their organizations.
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The health risk assessment and planning advisory body should be composed of intramural and extramural
experts on health risks, and on their potential outcomes, consequences, and challenges, who can guide the
development and maintenance of a national risk register. Membership should be based exclusively on individual
areas of expertise and include experts who can speak to health equity and community health in the context of
risk assessments and prioritization. This ensures that the risk register meaningfully considers groups who are
most likely to be disproportionately impacted by an emergency in its preparedness, mitigation, response, and
recovery strategies.
The standing expert advisory committee on infectious diseases and pandemic preparedness should be
composed of federal and provincial/territorial intramural and extramural researchers who advise Health
Portfolio leaders and decision makers on the emerging threats, trends, and research. Representatives from
federal research organizations such as the National Research Council and granting councils should attend
committee meetings to ensure awareness of research priorities and trends. The support of secretariats is
critical to ensure tangible progress in inter-emergency periods and readiness for emergencies.
Linking the health risk register and broader risk profile beyond health-related risks should be a next step in
strengthening Canada’s emergency preparedness and risk governance structures. The integration of the work
of the Health Portfolio and other science-based departments and agencies with PSC’s in-progress National
Risk Profile would facilitate additional cross-governmental collaboration, streamlined processes, and clear
reporting structures in a future crisis.
Surveillance Infrastructure
3.3
During the COVID-19 pandemic, the federal government funded new surveillance networks, including
wastewater monitoring, which provided crucial data on infection rates. Well-coordinated surveillance systems
are critical to inform health risk assessment and science advice and direct future areas of research. The panel
heard, however, that processes for real-time clinical surveillance and data sharing were lacking and impeded
timely coordination among federal, provincial, and territorial governments.
The 2003 National Advisory Committee on SARS and Public Health raised similar issues, calling for the
development of a comprehensive national public health surveillance system that leveraged capacity from
all levels of government and different sectors. It envisioned a system that:
“
…would begin by collecting data on communicable diseases, and extend its ambit to noncommunicable diseases as well as relevant population health factors. The surveillance system must
be relevant at the local level, with timely reporting and analysis, and flexible enough to adapt to
changing needs and different local and institutional circumstances. Such a system must be built
so that databases can communicate with one another, and be sufficiently ‘low tech’ to maximize
uptake in hospitals (not least hospital emergency rooms where renewal and upgrading of
information systems is urgently needed), clinics and public health units.8
The development of such a system that feeds into the risk governance system more broadly requires the
ongoing efforts of many surveillance programs and networks established during the COVID-19 pandemic.
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3.3.1
Surveillance Using Routinely Collected Health Care Data and Public Health Data
At the federal level, health surveillance is a PHAC responsibility; however, the jurisdictional realities of collecting
public health data and combining and sharing routinely collected health care data in Canada present challenges
for integrating these data into national health surveillance functions. Many public health data are generated
locally and routinely collected from individual care settings (e.g., hospitals, laboratories, clinics, pharmacies).
Critically important data related to infectious diseases are collected by public health units across the country,
both for surveillance and case and contact/outbreak management. Integrating data from many sources is
critical to the development of a robust and effective surveillance structure in Canada.
The panel heard that the separation of public health and clinical care may be impeding Canada’s ability to
harness routinely collected clinical data to feed into broader surveillance efforts. At a local level, partnerships
of public health with primary care teams, hospital laboratories, school nurses, environmental health officers,
and others directly involved in health services delivery are common and are recognized to improve response
to outbreaks.24 At a federal level, PHAC supports some longstanding and effective surveillance networks that
take advantage of data from health care delivery, such as IMPACT (Canada’s Immunization Monitoring Program
ACTive)74 and the Canadian Nosocomial Infection Surveillance Program,75 and incorporates routinely collected
data into other systems (e.g., the Respiratory Viral Detection component of FluWatch).76 Further work is
needed for the federal government to take best advantage of routinely collected health data in its national
surveillance structures. The current rapid advances in the ability to automate the aggregation of routinely
collected data mean that major advances in this area of surveillance will be possible over the next few years,
if data sharing challenges can be overcome.
Effective use of routinely collected health data for surveillance at a national level requires that data collected
locally and provincially be standardized to permit national aggregation, and shared across jurisdictions. Currently,
barriers to interprovincial data sharing are a major limiting factor, as discussed in Chapter 6. Routinely collected
health data also have other limitations. Many such data that are important for infectious disease surveillance are
not currently available: for instance, results of some microbiology laboratory testing have only become available
in Ontario provincial databases in the last five years. Routinely collected health care data also provide little to no
insight into cases of low severity occurring in the community for which medical care is not sought.
The systems used for routinely collected health data are complex and aggregate data from many sources
(e.g., individual hospitals) that may require manual coding and entry; for these reasons, data quality and
reproducibility challenges exist. These complexities result in additional challenges for real-time data collection.
For example, in April 2020, the Canadian Institute for Health Information (CIHI) started collecting hospital
occupancy and capacity data from provinces and territories to support the COVID-19 response, which it then
provided to Health Canada and PHAC in its COVID-19 Hospital report. This provided federal departments with
near real-time indicators of COVID-19 hospital occupancy and hospital capacity to assess health system
impact. However, the challenge associated with providing real-time data in current systems is often that data
are incomplete in initial reports. Real-time data for more complex information, such as hospital discharge data,
are much more challenging to provide in close to real time, and repeated downloads with varying degrees of
incompleteness and data quality make analysis more difficult and complex.
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The panel heard that public health surveillance and data management capacity differs greatly across provinces
and territories. Some jurisdictions noted that much of the case reporting was done manually in hospitals during
the early days of the pandemic, and in northern, remote, and isolated communities throughout the pandemic.
The panel also heard that the complete absence of surveillance and data infrastructure in some regions meant
that confirmed case counts were often only available by calling frontline health care workers. Federal funding
under the Safe Restart Agreement was used to improve provincial and territorial data systems, including
enhancing clinical information systems and supporting integration of primary care and public health
functions,77 but the panel observes that there is much more work required in this area.
3.3.2
Wastewater and Other Surveillance
The use of wastewater surveillance for infectious disease risks other than polio was very limited prior to the
pandemic. However, it has proved to be a valuable component of COVID-19 surveillance programs. In Canada
wastewater monitoring had important benefits for northern, remote, and isolated communities because it
enabled early detection of local COVID-19 activity, permitting more effective implementation of interventions
to limit the spread. For example, Nunavut’s Chief Public Health Office reported the first positive COVID-19
wastewater signal in Ranken Inlet on August 27, 2021 before any cases were identified, indicating that
unrecognized infections were occurring.
The initial challenge in northern communities was delayed reporting, as samples had to be sent to the National
Microbiology Laboratory (NML) in Winnipeg for testing. Further innovations by NML and regional partners allowed
field-deployable point-of-care devices to be adapted for local use, without requiring new infrastructure.78
Point-of-care devices were deployed to multiple locations, including First Nations communities, and a federal
correctional site. For example, the Taiga Environmental Laboratory in Northwest Territories could run up to five
samples within two hours.79
The panel also learned that a pilot program conducting wastewater surveillance at airports was instrumental
in identifying some of the new variants of concern one to four weeks prior to clinical cases being identified.
Established by NML in January 2022, in partnership with the Greater Toronto Airport Authority, the Universities
of Waterloo and Guelph, and the Ontario Ministry of Environment, Conservation, and Parks, the program
collected samples from airport terminals and a waste management building for airplane sewage. Despite the
success of detecting variants from airport wastewater testing and the cost-saving advantages (one sample
of wastewater is more cost and labour effective than testing individual travellers or community members),
the panel heard that local public health and industry partners did not have access to the data and the results
were not published.
Narrowly focusing emergency preparedness efforts and associated research on the subject of the most recent
emergency was a concern following the 2003 SARS outbreak and continues to apply more than 20 years later
in the wake of COVID-19. As described by the National Advisory Committee on SARS and Public Health,
“Focusing on smallpox, SARS or pandemic influenza raises the risk of over-investing limited resources in
managing a restricted range of public health emergencies rather than engineering a system that can be flexible
and responsive as well as sustainable”8 The panel heard that flexibility and adaptability are core components
of successful risk governance structures. Wastewater has also proven its value in monitoring Mpox activity,80
and is being investigated for potential wider use for monitoring of influenza A(H5N1), a highly pathogenic avian
influenza. Ongoing research is needed to realize the value of wastewater surveillance and how to best integrate
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it into an overall surveillance strategy for Canada. Despite this, the panel heard that long-term funding for some
wastewater networks is not yet confirmed, including those funded through the Health Portfolio and other
federal initiatives during the pandemic. The pandemic demonstrated that developing physical and governance
infrastructure in the middle of an emergency situation is costly and delays response. Maintaining and improving
surveillance infrastructure would help ensure both Canada’s preparedness for a future health emergency and
effective public health surveillance in inter-emergency periods.
Many other data sources (e.g., microbiology laboratory networks, vital statistics databases, volunteer
population cohorts), which are included in provincial and federal surveillance programs in Canada as well as
programs in other countries in specific areas, were used during the pandemic. These sources have different
advantages, but many of them also faced challenges with timely reporting during the pandemic. For example,
despite substantial efforts to shorten the timeline for mortality reporting, significant time lags persisted
because of the time required to centralize data, verify records, and categorize causes of death. The pandemic
also resulted in other novel approaches to surveillance. For instance, Canadian researchers validated the use
of cremation data as a more timely surveillance tool for all-cause mortality during a public health emergency
than vital statistics data.81 Encouraging and supporting the creation and validation of new approaches to
surveillance is another important requirement for the development of Canada’s overall surveillance strategy.
The panel did not hear evidence for surveillance, other than for human infections, but a One Health approach is
necessary to guide Canada’s infectious disease surveillance strategy. The current H5N1 avian influenza
outbreak emphasizes the need to build and maintain strong linkages between animal and human health
surveillance systems.
3.3.3
Sharing Surveillance Data among Federal, Provincial, and Territorial Partners
Challenges and barriers related to data sharing (explored in greater detail in Chapter 6) continue to impede
effective and coordinated surveillance efforts in Canada. While some provincial roundtable participants
expressed their desire to have conducted more surveillance during the pandemic, the panel heard that some
provinces and territories do not have the capacity or training to carry out public health surveillance functions.
The same is true for other jurisdictions and organizations: municipal public health offices and Indigenous or
regional governments do not consistently possess the resources to conduct independent surveillance or
analysis of clinical case reporting. In addition, synthesized information shared by federal departments, such as
PHAC and CFIA, is critical to supplement provincial and territorial capacity to conduct public health analysis.
The panel heard that existing federal government open data and open science policies and processes,82,83 with
surveillance data sets and analyses reported regularly, do not allow for real-time assessment, coordination, or
action during an emergency. Federal government employees expressed concern about sourcing information
from provincial and territorial governments, while some individuals from provincial and territorial governments
described federal data collection as a one-way valve: provinces and territories gave information to the federal
government but could not always access federal surveillance data sets in return.
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The challenges in sharing surveillance data stem from, at least in part, the gaps in agreements between PHAC
and provincial/territorial governments. The 2003 report of the National Advisory Committee on SARS and
Public Health raised the same issues for the SARS outbreak, describing challenges in communicating case
information through provincial/territorial governments to the federal level.8 The Multilateral Information Sharing
Agreement, for example, is intended to define why, how, what, and when information and biological substances
can be shared between health authorities in Canada.84 The panel heard that this agreement (established in
2016 and not adapted since) is not robust or comprehensive enough to guide surveillance data sharing,
especially during a public health emergency. The agreement requires PHAC to give 30 days’ notice to a
province or territory before publishing any data or analysis.85 This requirement limits PHAC’s ability to publish
real-time and current epidemiological analysis, which is an essential source of information during a quickly
evolving public health emergency. This limitation was demonstrated during the pandemic with PHAC’s inability
to share real-time provincial/territorial vaccine adverse effects surveillance data with Health Canada,
biomanufacturing industry partners, and the World Health Organization.86
The challenges with vaccine surveillance data sharing also extended to the type of data shared. Although
PHAC’s COVID-19 Vaccination Coverage Surveillance System compiled the data that provinces and territories
voluntarily supplied, these did not include population or demographic data (such as race or Indigenous status),
which are not always collected or shared. (Chapter 6 further explores the gaps in data systems and the limited
availability of disaggregated sociodemographic and race-based data.)
3.4
Effective Surveillance Systems and
Timely Surveillance Data Sharing
Strengthening Canada’s preparedness for future health emergencies requires maintaining and leveraging the
surveillance expertise and data sharing mechanisms developed during the pandemic. Successful development
and long-term use of surveillance infrastructure requires jurisdictions to create a culture that prioritizes public
health surveillance as a tool for use during a public health emergency and to track chronic health issues at the
population level. Moreover, it requires all levels of government to shift away from the prevalent “culture of
caution” and data protectionism to one where data are appropriately handled to protect individual privacy and
security while enabling the seamless sharing of surveillance data. (This is explored further in Chapter 6.)
Recommendation 2: Ensure that surveillance systems adequately
support real-time assessment and public health security
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a.
Provide sufficient long-term funding for clinical, public health, and laboratory surveillance networks and
infrastructure for emerging infectious diseases and risks to public health, accompanied by the underpinning
technical infrastructure, in coordination with provincial/territorial governments and First Nations, Inuit, and
Métis partners.
b.
Systematically provide the results of all federally managed and funded public health surveillance efforts to
provincial/territorial, local, and Indigenous health agencies and pursue reciprocal sharing agreements.
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4.0 Science Advice
Mechanisms
Effective mechanisms for the transmission of scientific advice to senior policy makers are crucial to a
government’s ability to make informed, timely decisions during health and other emergencies. This is especially
important when the threat is novel or rapidly emerging, where there is significant uncertainty, and where the
full extent of the health, social, and economic impacts are not clearly understood. In response to COVID-19, the
federal government went to great lengths to seek science and expert advice through both established
structures and newly created, ad hoc advisory bodies. See Appendices A, B, and C for a full inventory of bodies
and timelines.
The process of providing science advice includes collecting and analyzing data and other information,
evaluating the information for significance and relevance, synthesizing multiple types of scientific evidence,
applying context to the evidence, and communicating the result–advice–to policy makers to inform the
government’s decisions.25 Specific types of scientific information, and their synthesis, were critical to
formulating science advice throughout the COVID-19 pandemic due to the scale and rapid pace of the virus’
evolution. The need to draw from different disciplines evolved over time and while biomedical publications
dominated the early COVID-19 literature, the number of social and behavioural science articles published
subsequently increased.87 Knowledge synthesis of emerging research findings, health surveillance, and
predictive epidemiological modelling imparted foundational information.
This chapter focuses on the urgent need to create a new science advisory system for emergencies, including
the required structure and components, diversity of expertise and perspectives, and support from effective
secretariats. The panel also reflects on effective science communication and the types of science advice that
may be required in future health emergencies.
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4.1
Features of Effective Science Advisory Bodies
Canada’s emergency management plans,10 pandemic plans,11 and federal-provincial-territorial public health
emergency response plans12 do not currently outline protocols for science advice. The federal government has
an opportunity to establish a science advice mechanism for future pandemics and emergencies that leverages
the lessons learned domestically and internationally from the COVID-19 pandemic and previous health
emergencies.
The effectiveness of science advisory structures that operated during the pandemic varied depending on
multiple factors including the timing of their establishment, mandate, membership, access to data, how advice
was delivered, and whether that advice was to be acted upon within a federal jurisdiction or at other levels of
government.
The panel’s experience, consultations, and a literature scan conducted by the Public Health Agency of Canada
(PHAC)24 point to four key features of effective science advisory bodies. First, they operate with a high degree
of independence, yet have strong ties to government and a clear “customer” in the form of senior government
policy makers who are receptive to their advice. For example, the COVID-19 Vaccine Task Force, an ad hoc
group stood up by Innovation, Science and Economic Development Canada and Health Canada in June 2020,
operated with a high degree of independence, yet had clear customers in the Minister of Innovation, Science
and Industry, the Minister of Health, and other Ministers.16 These features, along with its expert roster, strong
secretariat, and clear mandate enabled the rapid delivery of vital advice to inform critical procurement
decisions. The Ontario COVID-19 Science Advisory Table was established in July 2020 as an independent
advisory science body supported by the Dalla Lana School of Public Health at the University of Toronto, with
strong links into government. For both bodies, mechanisms were put in place to safeguard their autonomy—
allowing them to meet privately and work independently—while providing advice directly to the government as
and when required.24 Both of these bodies were formed when the first wave of the pandemic was largely over.
Second, effective science advisory bodies are properly resourced, have access to required data, and are
populated with a diversity of perspectives and expertise. They provide interdisciplinary advice based on the
best available evidence at the time. The concepts of diversity of perspective and expertise are discussed in
greater detail in Sections 4.2 through 4.4.
Third, effective science advisory bodies provide timely advice that observes principles of effective science
communication (Section 4.6), with advice publicly released soon after its provision to government. Many
countries–such as the UK and Norway–activated science advisory bodies more quickly than Canada. The UK’s
Scientific Advisory Group for Emergencies (SAGE), notable for its readiness,88 offers an example of a standing
mechanism that can be quickly activated in response to a health emergency. Before the COVID-19 pandemic,
the UK had already activated SAGE nine times between 2009 and 2019 to advise on infectious disease
outbreaks, natural disasters, nuclear incidents, and other matters.23 Due to existing structures, the UK
government was able to rapidly operationalize SAGE in January 2020 to respond to COVID-19. SAGE briefs
were publicly released with increasing speed, following their provision to government. The Norwegian
Institutes of Public Health began developing rapid COVID-19 reviews for decision making on March 20, 2020,
and by April 10, had published eight rapid reviews on its website.89
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The UK’s Scientific Advisory Group for Emergencies (SAGE)
The SAGE23 system allows for the immediate convening of multidisciplinary experts in response
to an emergency to provide science and technical advice to Cabinet. SAGE does not have a standing
membership; rather, it maintains a roster of experts with relevant expertise to be called forward
depending on the nature of the emergency. The Cabinet Office Briefing Rooms activate SAGE in
response to a national emergency. The system provides critical advice on risk assessment, strategy
development, data analysis and modelling, resource allocation, and communication.
Fourth, science advisory bodies must be sufficiently connected to government so that members understand
the context in which science information for decision making is needed and the role and limitations of science
advice in decision-making processes, and so that government officials receiving technical advice can properly
interpret it. For example, the Federal Pandemic Science Coordination and Action Group was co-chaired by the
Deputy Minister of Health and the Executive Vice President Science and Research of the University Health
Network; its members had previously or were concurrently working together on other COVID-19 and health
initiatives. This integration of governance and technical expertise in a single advisory body allowed it to identify
key response areas that could benefit from enhanced coordination and targeted research efforts.
National Advisory Committee on Immunization (NACI)
NACI,17 established in 1964, provided essential advice for immunization program planning, prioritization,
and administration during the pandemic. It used its well-established processes to monitor evolving
evidence on COVID-19 vaccines and to issue new or updated vaccination recommendations. It was often
able to issue vaccine advice concurrently with or within days of Health Canada regulatory vaccine
authorizations due to its confidential direct access to vaccine regulatory submission data throughout the
pandemic.90 However the panel also heard that NACI lacked surge capacity to keep pace for the duration
of the pandemic.
Canada can look to Australia as a strong international example of this feature. During the pandemic,
the National COVID-19 Health and Research Advisory Committee, which included community leaders,
parliamentarians, clinicians, researchers, and representatives of priority populations, provided advice to the
Commonwealth Chief Medical Officer.91 The National Health and Medical Research Council provided the
Committee with secretariat support. The Australian Committee is notable for its breadth of interdisciplinary
experience and expertise.
This understanding between policy and science can also be built when advisory bodies work together regularly,
refining their processes and building relationships and trust. Based on the panel’s experiences, this is critical in
an emergency that requires rapid development and delivery of science advice.
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4.2
Diversity of Expertise and Perspectives
Many of the science advisory bodies created during the pandemic to support one or more aspects of the
response were created quickly. The urgency of the emergency limited the time available to consider the full
breadth and depth of expertise required and to ensure diversity. The panel heard a great deal about the need
for more diverse advisory bodies and the types of diversity and expertise that should be considered. This
section explores the various types of diversity that should be considered well in advance of an emergency.
Section 4.3 focuses on the need for more First Nations, Inuit, and Métis representation on advisory bodies.
The panel heard that relevant individuals with expertise in infectious diseases or biomedicine were asked to
serve on multiple federal science advisory bodies with overlapping mandates during the pandemic. This drew
heavily on the time of individuals with other professional responsibilities (including to provincial or territorial
advisory bodies). For example, expert advisory groups on modelling were established by both PHAC and the
Office of the Chief Science Advisor, less than one month apart (February and March 2020, respectively), with
significant overlap in membership: 9 out of 10 members of the latter were also members of the former. Overall,
according to the panel’s analysis, 23% of federal COVID-19 advisory body members served on more than one
federal body, with some participating in up to 10 bodies. Some membership overlap between groups was a
strategic choice, and by design to improve governance and coordination. While multiple memberships
potentially enriched the scope of information to which an individual was exposed, the panel heard concerns
about a lack of diversity and broad perspectives on these advisory bodies and concerns about leaning too
heavily on certain types of evidence as well as incidences of “groupthink.”
The panel also heard that having mainly clinical experts on advisory bodies, and not enough individuals with
broader expertise from areas such as behavioural science, engineering, economics, and the social sciences,
affected how problems were defined and which solutions were deemed acceptable. Transdisciplinary
perspectives help inform science advice that considers the biological, psychological, social, and behavioural
mechanisms underlying health emergencies, in addition to structural factors that influence health inequities,
and benefit from the experiences of community leadership and lived experiences.24 There was a clear need for
more expertise in knowledge mobilization and translation, as well as in the natural sciences and engineering
(e.g., ventilation and aerosols).
A diversity lens must be applied to existing and future bodies to ensure they contain a breadth of expertise and
perspectives. For example, the panel heard that scientific advice structures across the country lost months
during the pandemic as the evidence on the benefit of masking unfolded because the dominant clinical and
public health perspectives were that masks in public settings did not work for COVID-19. Advance preparation
of a database of experts, who can be called upon during an emergency, would help ensure that a broader and
more diverse group of individuals are invited to participate. Supports such as honorariums and teaching release
reimbursements should also be put in place, in recognition of the need to reduce barriers to participation.
Provisions should be made to rotate experts, to avoid burn out and recognize the many demands placed on
these individuals in times of crisis.
Science advice in Canada must be customized and adapted to the local context, with membership of national
science advisory tables reflecting the country’s geographic diversity. Doing so will help bring local perspectives
into national advisory processes and enable members to bring back the advice to their regions to adapt
as needed.
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4.3
First Nations, Inuit, and Métis Expertise
Various reports have called for greater representation of Indigenous perspectives in science advice bodies to
widen the scientific evidence base to include other ways of knowing and varied methodological approaches.5,87,92
The panel’s analysis of the leadership and membership of 14 federal COVID-19 science advisory bodiesv (N=204)
highlighted the severe underrepresentation of First Nations, Inuit, and Métis experts. Only 14% of these bodies (2
out of 14) had First Nations, Inuit, and Métis representation within their membership. First Nations, Inuit, and Métis
peoples represent 5% of the total Canadian population (2021), yet made up only 1.4% of the total membership of
these federal advisory bodies. The analysis is limited, however, as it only captures individuals who have publicly
self-identified as First Nation, Inuit, or Métis.
There was also general agreement among the Indigenous health experts and knowledge holders who met with
the panel that science advisory structures and research processes do not always work for Indigenous Peoples.
Many noted that existing equity, diversity, inclusion, and anti-racism frameworks do not accurately represent their
needs and priorities. These frameworks fail to reflect their histories in Canada, knowledge systems and ways of
being, and lived experiences, including the socioeconomic challenges and structural barriers they often face.
The panel’s discussions with Indigenous health experts revealed a systems-level disconnect between the
health priorities of their communities and those that science advisory bodies identified during the pandemic.
This disconnect extends more broadly than science advice. During the pandemic, the mandates of advisory
bodies were often predetermined prior to the request for Indigenous participation. They did not allow for the
level of nuance required to explore the relevant subjects in the context of the history and ongoing realities of
Indigenous Peoples. Indigenous knowledge holders and health care practitioners noted a history of academic
tokenism in the processes for selecting scientific advisory body members, both before and during the
pandemic. The limited number of qualified First Nations, Inuit, and Métis health practitioners and researchers
in Canada imposes a burden on those individuals repeatedly asked to participate in engagement activities.
Many of them highlighted a repetitive cycle of discussion followed by minimal concrete action, which offers
them little reward or benefit for taking on this additional and often unpaid or underpaid work. In addition,
First Nations, Inuit, and Métis populations must be recognized as diverse; one person cannot be expected to
represent the health priorities of all Indigenous Peoples.
Indigenous knowledge holders and health practitioners communicated their concern to the panel about how
PHAC and other government departments and agencies sought Indigenous health expertise during the
pandemic. Due to the low number of full-time Indigenous staff within the federal Health Portfolio, Indigenous
health leaders were often asked to attend meetings and engagements on short notice on topics of critical
importance. The inadequate in-house expertise and foundational work before engagement with Indigenous
representatives on committees was perceived as a lack of government effort and respect. First Nations, Inuit,
and Métis knowledge holders and health care practitioners stated that it was unacceptable to ask them to work
to amend the public health care system and incorporate Indigenous perspectives and practices on their own in
a piecemeal fashion without adequate supports and resources. The perception was that they were asked to
simply “Indigenize” policies and programs after the fact and their efforts would be sufficient to satisfy the need
to fully engage and provide fully informed and prior consent of First Nations, Inuit, and Métis peoples to the
plans, policies, and programs that were being acted upon.
v
Ad-hoc COVID-19 Clinical Pharmacology Task Group; Council of Expert Advisors; COVID-19 Exposure Notification App Advisory
Council; COVID-19 Therapeutics Task Force; COVID-19 Vaccine Task Force; Expert Advisory Group on the Pan-Canadian Health Data
Strategy; Expert Group on Health Systems; Expert Group on Modelling Approaches; Industry Advisory Roundtable on COVID-19
Testing, Screening, Tracing and Data Management; Minister’s COVID-19 Expert Group; National Advisory Committee on Immunization;
Chief Science Advisor COVID-19 Expert Panel; Public Health Ethics Consultative Group; Testing and Screening Expert Advisory Panel
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To mitigate these challenges, Indigenous knowledge holders and health care practitioners called for the
integration of First Nations, Inuit, and Métis health perspectives into science advice functions. The objective
should be to incorporate their priorities in the early stages of identifying scientific priorities, to avoid creating
the necessary structures and capacity anew in an emergency context. They also expressed strong support
for increasing Indigenous representation in public health offices, at both the leadership and working levels.
The integration of First Nations, Inuit, and Métis health priorities would also more effectively engage their
communities in guiding and pursuing research and emergency planning on their own public health priorities,
while respecting concerns around data sovereignty and collecting biosamples.7,92
As the Government of Canada pursues reconciliation with Indigenous Peoples, the United Nations Declaration on
the Rights of Indigenous People,93 the United Nations Declaration on the Rights of Indigenous Peoples Act,94 and the
United Nations Declaration on the Rights of Indigenous Peoples Act Action Plan95 present important implications for
the design and implementation of science advisory mechanisms and research.
United Nations Declaration on the Rights of Indigenous Peoples Action Plan
This Action Plan, published by the Government of Canada in 2023, outlines specific roles and
responsibilities for all federal departments and agencies.95 The responsibilities assigned to Health
Canada and PHAC include improving bilateral mechanisms with Indigenous partners and linkages across
public health and health care systems, and better aligning strategic direction among these partners.
They do not include, however, any actions related to advisory committees. As such, the Health Portfolio
should consider collaborating with other government departments with action items related to advisory
committees, to learn from those processes and ensure any future design and implementation of federal
science advisory bodies adheres to principles embedded in the United Nations Declaration on the Rights
of Indigenous Peoples. These include Indigenous Peoples’ right to self-determination (article 3) and the
right to determine and develop priorities (article 23). Specifically, article 23 states that “Indigenous
peoples have the right to determine and develop priorities and strategies for exercising their right to
development. Indigenous peoples have the right to be actively involved in developing and determining
health, housing, and other economic and social programmes affecting them and, as far as possible,
to administer such programmes through their own institutions.”93
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4.4
Equity Considerations in Science Advice
The panel acknowledges the unique challenges and disparities faced by Black and other racialized communities
in relation to pandemic preparedness and response. As highlighted in Chapter 2, these communities were,
among others, disproportionately negatively impacted by the COVID-19 pandemic. They also have historically
experienced systemic barriers to health care access, higher rates of underlying health conditions, and
increased adverse social determinants of health that exacerbate the impact of health emergencies.
Intersectional analysis, which includes a multitude of factors and characteristics, including overlapping social,
economic, and biological characteristics, can help identify groups who may be negatively affected by a viral
outbreak or other health emergency. For example, older adults were at greater risk of negative outcomes
following COVID-19 infection due to their biological status. Among this group, individuals who also lived in
congregate or crowded settings such as long-term care homes were further impacted due to increased potential
exposure to the virus. Some intersectional considerations are specific to the novel nature of an emerging health
emergency and science can be used to gather information that can inform subsequent analyses.
Health equity should be emphasized across all stages of the research and science advice continuum, including
by embedding equity analyses in science advice development to identify the groups most likely to be impacted
by an emergency and who should be prioritized for early interventions. For example, NACI used a framework
and validated equity tool to guide prioritization for COVID-19 vaccination and identify the groups most at risk of
adverse outcomes from the virus.56,57,58 Provinces and territories widely adopted its advice on prioritization.
While identifying priority groups for early vaccination is positive, the panel heard that NACI should have tailored
preliminary guidance96 to specifically include new and low-income Canadians. These groups were often
disproportionately exposed to the virus through their living and working conditions.
Literature emphasizes the need for science advice provided during an emergency to account for inequities.24
It is also important to learn from the lived experience of communities to ensure that the science used to
develop the advice does not harm community members. Language guides, such as the British Columbia Centre
for Disease Control COVID-19 Language Guide97 and the Glossary of Essential Health Equity Terms,98 can help ensure
that communications are non-stigmatizing and there is an appropriate focus on the structural and social
determinants of health that underlie inequities. A 2023 report from Canada’s Chief Public Health Officer
recommended centring “equity in emergency science, evidence, and technology.”68 Focusing on equity during
a health emergency can help decision makers understand how different communities may be affected.
Equity-informed advice can be supported by community knowledge, disaggregated data, and research on the
wider impacts of emergencies on health and health determinants. Equity tools and frameworks can also help
identify the possible wider impacts of policies intended to mitigate health emergencies.68
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4.5
A Ready and Robust Science Advisory Mechanism
The panel proposes the creation of a comprehensive science advisory system in Canada that is ready to mobilize
quickly and operate effectively and efficiently when a health emergency strikes.
Recommendation 3: Establish a science advisory system
for emergencies
a.
Create a central federal mechanism that is designed to immediately activate a specialized expert advisory
group in response to a health emergency to provide the best independent scientific advice directly to Cabinet.
This system should be co-led by the Privy Council Office and the Health Portfolio, in collaboration with the
Office of the Chief Science Advisor, Public Safety Canada, and other departments and agencies as required.
b.
Ensure that this mechanism is ever-ready by establishing a standing interdepartmental government
secretariat with sufficient ongoing and surge capacity. The secretariat should have knowledge mobilization and
communications expertise, and access to all required intelligence. It should maintain a roster of experts relating
to key health risks (as per the proposed health risk register in recommendation 1). Preparedness work should
include training the roster of experts, secretariat members, and government decision makers on best practices
for providing, receiving and communicating evidence; as well as simulations and exercises.
c.
Designate the activated expert advisory group as the main federal science advisory body for health
emergencies. This group should typically be convened jointly by the Chief Public Health Officer and Chief
Science Advisor. Members should be assembled based on the nature of the emergency, drawing from the
roster of experts, standing advisory committees, and elsewhere as required. The majority of members should
be independent experts, chosen solely for their expertise. Expertise should be diverse with health, social,
behavioural, humanities, and applied sciences as required, and cut across sectors, including intramural,
extramural, industry, health equity, Indigenous health, and other relevant experts. Other relevant senior
government officials should participate as liaisons. Supporting sub-groups and task forces should be formed
as required.
d.
Embed this advisory system in overall government emergency protocols; establish strong links with other
domestic health advisory bodies, federal-provincial-territorial health and emergency networks, and
international emergency advisory systems; and invite provincial/territorial governments and Indigenous
partners to name liaisons.
e.
Expand this advisory system over time to cover all emergencies, not just health emergencies.
Figures 1 and 2 (see Recommendations and Summary of Key Findings) illustrate the proposed structure for
science advice to prepare for and respond to future emergencies. The panel proposes the creation of three
standing advisory bodies to address gaps in the current science advice system (discussed in Chapters 3 and
6), and a standing mechanism that can quickly activate a specialized, interdisciplinary, expert advisory group to
provide independent science advice to Cabinet in the case of a health emergency.
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The Privy Council Office’s co-leadership of the scientific advisory group for emergencies mechanism, and its
secretariat in inter-emergency periods and during an emergency, is critical because of its responsibility for
managing the delivery of information to Cabinet and the Prime Minister. This would be paramount during an
activation of the advisory group to ensure timely information flow. The Privy Council Office’s central
coordination role is also essential given that a health emergency may lead to much broader implications,
including for the movement of people and goods and national security. Its leadership also allows the scientific
advisory group for emergencies to extend to all emergencies, not just health emergencies.
During a health emergency, relevant Deputy Heads should be invited to meetings of the scientific advisory
group for emergencies to provide internal policy and public health decision-making context. The embedding
of this mechanism into emergency protocols and creation of strong linkages with international and domestic
advisory bodies would help ensure its quick activation and the effectiveness of its work to support and
enhance Canada’s science advisory capacity. Inviting liaisons from provinces, territories, and Indigenous
partners would improve timely and transparent sharing of evidence and advice.
An interdepartmental standing secretariat is essential to ensure that the advisory group can be rapidly
convened. The expertise required may vary depending on the health emergency. To enhance preparedness,
the secretariat should maintain an active roster of experts who can be called upon in response to a health
emergency, as well as an expedited process to recruit additional experts who may be required given the
bespoke nature of an emergency. It should also maintain standing protocols, oversee emergency simulations,
and coordinate training exercises for expert advisors on communications and other pertinent interdisciplinary
science topics. Canada’s two top public health and science advisors, the Chief Public Health Officer and the
Chief Science Advisor, should jointly convene the advisory group in response to a public health emergency.
For non-health-related emergencies, the Chief Science Advisor is best placed to chair the group.
The secretariat staff must have the right technical skills and expertise to support both the preparedness of the
advisory structure and the work of experts during an emergency. This includes the capacity for knowledge
mobilization and conducting regular preparedness exercises and workshops for researchers and policy makers
on how to provide and receive scientific evidence. Expertise in risk communications, with an emphasis on
proactively addressing misinformation and disinformation, is also important.
Close connectivity with the Office of the Chief Science Advisor and the Departmental Science Advisors will
facilitate secretariat access to intramural evidence syntheses. The panel heard that the capacity of civil
servants to support the provision of science advice was affected by policies that led to a loss of permanent
technical content expertise in favour of rotating public servants. In the future, organizations should adapt hiring
and training to ensure that additional technical expertise is ready to provide support during an emergency.
The expected outcome of the science advisory system for emergencies is a ready and more structured
approach to science advice for future emergencies. Independent advice that benefits from a broad range of
interdisciplinary expertise, and that considers health equity and Indigenous implications, must be quickly and
widely available at any time.
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4.6
Effective Communication of Scientific Advice
Health emergencies, especially those with rapidly evolving evidence, require skilled nuanced communication of
the latest information upon which updated advice is based. Communication must also reinforce that science
advice is only one factor of many that feed into decision making. As evidenced during the COVID-19 pandemic,
governments often have to make difficult choices while considering trade-offs between issues such as health,
economic, and social considerations, and individual liberty.
In Canada, many reports have stressed the importance of communication in creating public trust in scientific
evidence. For example, a 2023 Council of Canadian Academies report emphasized the importance of trust in
knowledge institutions and health experts in combatting misinformation, and that communicating research
accurately can help build trust.99 In addition, 20 years prior, the National Advisory Committee on SARS and
Public Health recommended that Canada create real-time alert systems for SARS and other respiratory
illnesses that included mechanisms to inform Canadians rapidly of developments in other jurisdictions and
of the evolving domestic and international scientific data.8
Some federal science advisory bodies publicly released evidence briefs on COVID-19, but they were often
delayed for a variety of reasons including the use of standard federal government communication approval
protocols. The panel heard that inconsistent approaches to the public communication of scientific evidence
and related uncertainties contributed to public confusion and reduced confidence and trust in governments
and their decision making. The evidence and methodologies used to develop science advice that informs
decision making need to be more transparent. As well as helping to foster public trust, increased transparency
would also facilitate discussions on evolving evidence and diverging analytical assessments.
Ontario COVID-19 Science Advisory Table
The table produced more than 70 evidence briefs between July 2020 and September 2022 on a wide
variety of topics including epidemiology, public health and implementation, health equity and social
determinants of health, infectious diseases and clinical care, and public policy and economic impact.
Only NACI issued more publications during this period.26 The panel heard about the value and benefits
that Canadians derived from the evidence briefs, which were publicly released shortly after Ontario
decision makers received them. Public health officials across Canada used the briefs to support work
in their respective jurisdictions. The table also produced modelling forecasts and clinical guidelines and
its COVID-19 Dashboard was accessed more than three million times.
As noted in Section 4.1, the communication of advice should be i) understandable to a non-specialist
audience;vi and ii) observe the key principles of effective science communication: honesty, accuracy,
transparency, and addressing of uncertainties in the evidence,100 which includes clearly outlining what is known
and not known. There is emerging evidence that although communication of uncertainty can result in lower
uptake and action on scientific advice in the short term, it can enhance trust and its durability over the long
term. This is critical in maintaining the ability to galvanize and guide the public on crises that unfold over many
months or years (such as the COVID-19 pandemic).101
vi
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Recognizing that many decision makers and members of the public do not have formal training in areas of health or science.
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The advice must be publicly communicated with two caveats: i) advisory bodies may be privy to sensitive
government data that are not appropriate to reveal externally; and ii) when communicating advice in a fastmoving emergency, policy makers need time to consider the advice before it is released publicly. During an
emergency, the time interval between the communication of scientific advice to policy makers and its public
release should be as short as possible, in line with the principle of open by default. This supports the public
release of government information with information being withheld only due to privacy, confidentiality, or
security considerations.102
Scientific advice must be accessible to the public to maintain trust in the policy-making process and to combat
misinformation and disinformation. A more coordinated, streamlined, and transparent federal advisory
process, with timely advice flowing in real time to other levels of government and all relevant groups, is needed
to provide a foundational resource for provinces and territories, local public health units, and others.
Recommendation 4: Improve external communication of advice from
federal advisory bodies
a.
Stipulate in terms of reference that during an emergency, advisory bodies should publicly release evidence and
advice briefs in a timeframe commensurate with the urgency of the situation, typically within days of their
provision to government unless there are extenuating circumstances.
b.
Develop corresponding internal emergency communications protocols that accelerate and streamline release
processes to achieve releases in this timeframe.
c.
Include provisions to protect sensitive and confidential information, and require that the level of uncertainty of
evidence and advice is clearly communicated in all outputs.
The panel considers the timely communication of science advice across all jurisdictions to be essential in an
emergency to reduce duplication. The overall expected outcomes of more timely and clear communication of
scientific evidence and science advice are improved pan-Canadian coordination and enhanced transparency
to build public trust.
4.7
National Clinical Guidelines and Public
Health Guidance
The panel heard that there was a shortage of guidance relating to diagnostics, therapeutics, patient care,
and non-pharmaceutical interventions during the COVID-19 pandemic. Canada does not have a mechanism
to frequently update clinical management guidelines at the national level.5 As a result, no national clinical
guidelines were issued for the treatment of COVID-19 and much of the available guidance was developed on
an ad hoc basis. Physicians themselves had to search for guidance on appropriate treatments and alternative
options when, for example, there were shortages of particular medications.
Some organizations developed their own guidance. In Quebec, for example, the Institut national d’excellence
en santé et en services sociaux, an independent government agency that assesses the clinical advantages and
costs of medications, health technologies, and interventions in social services and health care, developed
clinical practice recommendations and guidelines. It played a critical role during the pandemic in disseminating
scientific publications to health and social service workers.
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Similarly, pre-existing intramural networks such as the Canadian Public Health Laboratory Network used
existing infrastructure to establish consistent national practices for clinical testing. This network, which is a
forum where federal, provincial, and territorial stakeholders address issues of concern for public health
laboratories, published materials on best practices for COVID-19 detection.
Some roundtable participants identified the need for a body (similar to NACI) to provide national guidance
on therapeutics. They noted that the Canadian Agency for Drugs and Technologies in Health (CADTH), the
national health technology assessment agency, lacked the resources, emergency protocols, and capacity to
provide such guidance on a sufficiently broad range of topics, and to release the advice in a timely fashion. The
panel also heard that if COVID-19 vaccines had been less effective, therapeutics would have had heightened
importance. In this case, the national response would have been further challenged by the limited capacity
available to provide rapid advice on treatments. The federal government has developed the new Canada’s Drug
Agency103 which will incorporate and expand on CADTH’s expertise, with several new workstreams including
“improving the appropriate prescribing and use of medications.”104 The panel recognizes the need for national
guidance on therapeutics but does not have particular views on where the responsibility for the provision of
timely and comprehensive guidance relating to diagnostics, therapeutics, non-pharmaceutical interventions,
and patient care should lie.
In countries such as Australia,18 the UK,21 the US,22 Germany,20 and France,19 national clinical guidelines for
COVID-19 treatment were developed by various entities and reflect a diversity of approaches and partnerships.
Taken together, they highlight the internationally recognized value of developing such guidelines during a
health emergency.
In Australia, the National Clinical Evidence Taskforce, a multidisciplinary collaboration of medical colleges and
membership and health organizations, worked to continuously update clinical guidelines for COVID-19 throughout
the pandemic.18 In the UK, the national health technology assessment agency, the National Institute for Health
and Care Excellence, provided independent assessments of new health technologies and rapid guidelines for
managing COVID-19, including information on therapeutics.21 The National Institutes of Health in the US
developed COVID-19 treatment guidelines with the support of a COVID-19 Treatment Guidelines Panel22 and
the national health technology assessment agency, the Institute for Clinical and Economic Review, conducted
special assessments for COVID-19 treatments as part of its role in assessing the clinical benefit and cost
effectiveness of treatments.105
In Germany, the Robert Koch Institute played a key role in developing and updating national guidance for
COVID-19 diagnostics and non-pharmaceutical interventions. Specifically, it provided evidence-based
recommendations on testing strategies, diagnostic methods, infection control methods, and public health
interventions. It also collaborated with the Association of Scientific Medical Societies and other medical experts
to develop clinical practice guidelines.20 The French National Authority for Health, responsible for issuing rapid
guidelines during the COVID-19 pandemic, surveyed 800 health care professionals on the effectiveness and
impact of its guidelines.19 Most respondents saw the rapid responses as helpful (84%), were aware of the
guidelines in their field of study (94%), and believed that they respected scientific integrity (90%).19
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Canada needs a mechanism with appropriate expertise on non-pharmaceutical interventions. During public
health emergencies, these interventions are frequently implemented to reduce infection, with guidance
required for various settings such as businesses and communities. Formally, the federal government does
not develop national guidelines for these public health measures, beyond infection prevention and control
guidance for health care settings. PHAC led the development of non-pharmaceutical intervention guidance
documents for COVID-19 public health measures in collaboration with representatives from some provinces
and territories. These documents were designed to be considered alongside jurisdiction specific
considerations. The panel notes that emergency preparedness could be enhanced by putting processes in
place for the federal government to quickly develop guidance for non-pharmaceutical interventions during a
health crisis and to rapidly publish supporting evidence briefs.
Recommendation 5: Improve national guidance for the use of
diagnostics, non-pharmaceutical interventions, and therapeutics
in response to an emergency
a.
Put in place sufficient emergency capacity and protocols to develop and release timely clinical and community
guidance in these areas as reliable evidence emerges, in a similar fashion to the National Advisory Committee
on Immunization’s role on vaccines.vii
The panel considers expert advisory protocols, for developing national clinical and public health guidance on
the use of diagnostics, non-pharmaceutical interventions, and therapeutics, to be an essential element of
emergency preparedness. Once an emergency is declared, swiftly activated capacity and protocols can
support clinicians and public health professionals by quickly generating guidance that they can use to treat
patients and protect their communities and institutions. Provisions should also be made to allow for real-time
updates during emergencies, as required.
4.8
The Role of the Chief Science Advisor of Canada
The panel offers an additional recommendation related to its analysis and findings but broader than its remit.
Since 1964, Canada has experimented with various models for providing science advice to the Prime Minister,
Cabinet, and Members of Parliament. At times, such a mechanism has been absent. As the panel reflected on
the existing and necessary mechanisms for science advice in health emergencies, it often heard about the
broader federal landscape of science advice, and specifically about the role of the Chief Science Advisor.
The current Chief Science Advisor role was established in 2017 through a Governor in Council appointment,
with a mandate to provide advice to the Prime Minister and Minister of Science and “serve primarily in an
advisory and coordinating capacity.”106 Budget 2017 stated that the “Chief Science Advisor will provide advice
on how to ensure that government science is open to the public, that federal scientists are able to speak freely
about their work, and that science is effectively communicated across government.”106 Subsequent text from
2018 indicates that the Chief Science Advisor will “provide and coordinate expert advice to the Minister of
Science and members of Cabinet, as appropriate and requested.”107 The Chief Science Advisor chairs a
network of science advisors from government departments and agencies.108 The network meets monthly to
support the coordinated provision of science advice to government as well as other science initiatives.
vii
However, as noted, NACI did not have sufficient surge capacity during the COVID-19 pandemic.
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The role of the Chief Science Advisor, however, has no formal responsibility to proactively raise issues or
documented responsibilities in response to an emergency. Despite this, during the COVID-19 pandemic, the
Chief Science Advisor proactively created a number of science advisory bodies, resulting in a lack of clarity
about the relative responsibilities of the Chief Science Advisor and the Chief Public Health Officer (whose role
is documented in legislation and has authority to raise issues of relevance and concern). There have been calls
to clarify and formalize the role of the Chief Science Advisor in legislation.109,110,111,112
Broader recommendation A: Pursue legislation to formalize the role of the Chief Science
Advisor of Canada. This should include defining the role in preparation for and response to health
and other emergencies.
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5.0 Health Research
Prioritization, Funding,
and Coordination
Expert panels dating back to 1993 have called for a national research agenda for emerging and resurgent
infections. The National Advisory Committee on SARS and Public Health, in its reflections on research
coordination during the 2002–03 SARS outbreak, recommended that the federal government establish
mechanisms with provincial and territorial health agencies to set research priorities for emerging infectious
diseases, and clear protocols for leadership and coordination of future epidemic research responses.8 Despite
this and other warnings, the processes in place when COVID-19 emerged were unable to quickly identify
research priorities, effectively communicate them to all relevant groups, and direct funding accordingly and
promptly. No federal body was able to set out a clear overall research agenda for many months to support the
varying needs of public health practitioners, health care providers, industry, and policy makers.
Recent reports and studies have identified how the pandemic exposed the research system’s gaps, inefficiencies,
and inequalities, and made recommendations to address them in the areas of governance, financing, capacity
building, and research production and use.113 The Report of the Advisory Panel on the Federal Research Support
System31 made recommendations to modernize the federal system that supports academic research. While
these and other reports have informed this review, the panel’s work focused specifically on research prioritization,
funding, and coordination in the context of health emergency preparedness and response.
This chapter identifies and assesses the critical challenges and gaps in the areas of research funding,
prioritization, and coordination. See Appendix D for an overview of health research governance in Canada.
It also presents the panel’s recommended actions to better prepare Canada for the next health emergency.
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5.1
Health Research Coordination
In response to the COVID-19 pandemic, the federal government quickly made additional research funding
available, including through rapid response funding competitions starting in February 2020. Despite these
efforts, the panel heard that research was not sufficiently directed and coordinated to address the most
important and urgent knowledge gaps, including how the pandemic was manifesting across Canada; modes
of transmission; appropriate use of non-pharmaceutical interventions; development of rapid diagnostic tools,
therapeutics, and vaccines; and understanding and addressing issues of misinformation, disinformation, and
vaccine hesitancy. Roundtable participants expressed concerns about the lack of a central mechanism for
research prioritization across the federal government, including the granting councils; the federal capacity
to lead a cohesive and targeted national research agenda in response to the crisis; and the need for better
coordination among federal, provincial, and territorial governments including their funding agencies.
Government officials and Indigenous experts specifically noted the longstanding absence of a dedicated
federal-provincial-territorial-Indigenous coordination body for health research investments.
The Advisory Panel on the Federal Research Support System found that the fragmentation of the federal
research funding system (with a focus on the Canadian Institutes of Health Research (CIHR), the Natural
Sciences and Engineering Research Council of Canada, and the Social Sciences and Humanities Research
Council) has resulted in a lack of clarity about roles and responsibilities, and gaps in interdisciplinary and
transdisciplinary research support.31 Its report suggested that although the Canada Research Coordinating
Committee (created in 2017) had contributed to a better understanding of the needs and constraints of the
granting councils, it was implemented within a system that was not designed to drive coordination and
broaden strategic perspectives or address urgent issues.31 While internal government participants told the
panel that the Canada Research Coordinating Committee was active during the pandemic, the results of those
coordination efforts were not evident to the research community.
5.1.1
Federal-Provincial-Territorial Coordination
The shared federal-provincial-territorial responsibility for health in Canada poses challenges to pan-Canadian
health research coordination, efficiency, and action during an emergency. Provincial and territorial roundtable
participants emphasized the need for more coordination between the federal government and provinces/
territories. Efforts during the pandemic did not support sufficient coordination among health research funders
or allow members of science advisory groups to contribute to identifying research priorities to inform the
broader research agenda.
Coordination between CIHR and the provincial research funding bodies—both bilaterally and collectively,
as the National Alliance of Provincial Health Research Organizations—was improving before the pandemic due
to a dedicated effort, but the challenges posed by COVID-19 made partnership difficult. Provincial funders
expressed appreciation for coordination efforts, but no structures or mechanisms existed to enable input into
the design of federal research funding calls and consideration of provincial priorities. Others reported that the
rapid response structures made it difficult for provinces to mobilize and engage with federal funding initiatives.
CIHR used World Health Organization frameworks to guide various mechanisms and competition formats,
such as strategic investments based on focused needs and funding calls for investigator-driven projects.
Many provincial funders indicated they were unaware of CIHR’s efforts to align its investments with the Global
Research Collaboration for Infectious Disease Preparedness (GLOPID-R).114 The focus on international priorities
and lack of domestic coordination led to major gaps in the domestic research response. This posed challenges
in Canada as global priorities did not correspond to the social and structural determinants of health, rural and
remote communities, and misinformation and disinformation in the Canadian context.
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The 2017 Federal/Provincial/Territorial Public Health Response Plan for Biological Events, which is intended to
guide a coordinated response to public health emergencies, states that during a national-level public health
response, the federal, provincial, and territorial governments’ responsibilities should include “identifying and
addressing rapid research response priorities and leveraging existing research undertakings.”12 However this
plan does not assign direct responsibility to any party or contain specific provisions or protocols for research
coordination or prioritization. It also does not envision a rapidly evolving emergency of the scale of COVID-19.
Provincial roundtable participants noted that during the pandemic, in the absence of another forum for
identifying and prioritizing new areas of research, public health officials in smaller jurisdictions and provinces
brought their questions forward to the Pan-Canadian Public Health Network’s Special Advisory Committee
and Technical Advisory Committee, which were created to coordinate public health policy and technical
information respectively, but not designed to coordinate a national research response. This further
demonstrates the need for a dedicated, centralized mechanism to prioritize research.
In January 2022, the federal government created the Centre for Research on Pandemic Preparedness and Health
Emergencies within CIHR29 to grow Canada’s capacity to research and mobilize knowledge to prevent, prepare
for, respond to, and recover from existing and future pandemics and public health emergencies. While this effort
is nascent, the panel is of the view that a more robust interdepartmental and intergovernmental undertaking with
appropriate resourcing is required to achieve the critical mission currently assigned to this centre.
5.1.2
Coordination of Medical Countermeasures Research and Development
The panel heard that there is a need for central coordination of Canada’s investments in medical countermeasure
research and development. In 2021, in response to the pandemic, the federal government invested heavily in
medical countermeasure research and development and clinical trial infrastructure via its Biomanufacturing
and Life Sciences Strategy.43 To advance the strategy, Budget 2021 announced $2.2 billion in funding, including
$500 million over four years to support the bioscience infrastructure needs of post-secondary institutions and
research hospitals; and $250 million over four years, starting in 2021–22, for the federal granting councils to
create a new Tri-Agency Biomedical Research Fund.
Investments under this strategy should be systematically informed by the panel’s proposed new health risk
register (outlined in recommendation 1) to maximize the likelihood that they will most effectively prepare
Canada for future health emergencies. This work in medical countermeasures can be further strengthened
through increased collaboration and coordination with international counterparts.
5.1.3
Improved Health Research Coordination and Prioritization
In the panel’s view, the concerns outlined in Chapter 5 stem from Canada’s need for a preparedness research
plan for emergency response that includes components for identifying research priorities, rapidly funding
necessary research areas, and implementing clinical trials in an emergency.
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Recommendation 6: Improve pan-Canadian coordination of health
emergency-related research
a.
Establish a central interdepartmental mechanism within the federal government to work with other levels of
government, academia, industry, First Nations, Inuit, and Métis health experts, and international partners to
identify research priorities relating to the preparation for, and response to, health emergencies, and coordinate
with provincial health research funders. This mechanism should be led by the Health Portfolio in collaboration
with federal research granting councils and other departments and agencies.
b.
Use the proposed new national health risk register and response plan, including the standing health risk
assessment and planning advisory body (in recommendation 1), to inform this research prioritization during
periods of stability. In response to an emergency, the activated special scientific advisory group for that
emergency (as per recommendation 3) should take the lead advisory role in supporting the prioritization
of new research questions as these arise in real time.
c.
Establish a mechanism (linked to recommendations 6.a and 6.b) for the prioritization of medical countermeasure
research and development, working closely with industry and other relevant groups, informed by supply chain
intelligence and coordinated with international allies.
The panel recommends that the proposed mechanism (see Figure 3 in Recommendations and Summary
of Key Findings) be led by the Health Portfolio in coordination with Innovation, Science and Economic
Development Canada and the federal research granting councils. The body would work with experts across all
relevant fields, from the social and natural sciences to mathematics, bioengineering, technology, life sciences,
and health, to determine how best to leverage collective resources to address identified research priorities.
The inclusion of industry representatives ensures that priorities are aligned with innovation and economic
considerations. Representation from non-profit organizations and advocacy groups ensures that priorities
reflect the diverse needs of communities already experiencing inequities and health disparities and that
attention to inequalities is maintained during an emergency.
The expected outcome is an inclusive approach to identifying research priorities as well as the publication
of these priorities in a consensus manner. The creation of such a mechanism is not a recommendation to
deprioritize discovery research, investigator-driven projects, and broader federal research granting processes.
Rather, it is an argument to sharpen the country’s ability to identify and direct resources to specific areas of
research that are required to adequately prepare for and respond to the most likely health emergencies.
5.2
Research Networks, Infrastructure,
and Investments
In response to the pandemic, the federal government directed funding to support a broad range of new and
existing research networks. See Appendices A, B, and C for a full inventory of bodies and timelines. The panel
heard that while many of these networks played important roles in the pandemic response, there are still
lessons to be learned. And, even with this additional funding, Canada continues to fall behind in overall research
funding levels compared to its global counterparts (see Section 5.2.2). This section delves into these
investments made in research and clinical trial networks and infrastructure, highlighting both strengths and
areas for improvement.
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5.2.1
Pan-Canadian Research Networks
Many of the most effective pan-Canadian networks were in place prior to the pandemic, or came together
quickly as a result of strong, pre-established relationships. This section explores four such examples: the
Canadian COVID-19 Genomics Network (CanCOGeN), Canadian Immunization Research Network (CIRN),
Mathematical Modelling of COVID-19 Task Force, and National Collaborating Centres for Public Health pre-date
the pandemic or were born quickly from pre-existing relationships.
Genome Canada’s expertise and relationships enabled it to receive and deploy surge funding to create
CanCOGeN, which has since strengthened genomic sequencing capacity, skills, data sharing, and
collaboration across the country, bolstering capacity to tackle other major public health challenges and future
pandemics. CanCOGeN has increased public health sequencing capacity by training more people and
producing soft infrastructure to conduct genomic surveillance. This has led to nine provinces sequencing
in-province compared with four at the onset of COVID-19. The new capacity helped provinces better respond
to local outbreaks of COVID-19 and positions them to quickly address future pathogen outbreaks with local
public health solutions.
CIRN28 drew on its pre-existing infrastructure, expertise, and partnerships to quickly pivot to tackle pandemic
research priorities. CIRN comprises public health experts, epidemiologists, clinicians, researchers, and
community groups from across Canada. During the pandemic, CIRN contributed to immunization research,
clinical trials, vaccine acceptance and uptake, monitoring of vaccine effectiveness, and vaccine safety evaluation.
CIRN research also informed public health decision making. It shared data and resources with PHAC and
collaborated with other groups and organizations, such as the National Advisory Committee on Immunization to
provide recommendations for vaccine prioritization and administration; and the COVID-19 Immunity Task Force
(CITF) to study population immunity and vaccine effectiveness and conduct serological studies.115,116
Investments in the internal modelling capacity of the Public Health Agency of Canada (PHAC) during the
pandemic enabled it to conduct short-range and long-range projections for outbreak trajectories, assess
transmission risk, evaluate the effectiveness of medical countermeasures and conduct scenario-based
modelling, and strengthen internal modelling capacity overall. The extramural Mathematical Modelling of
COVID-19 Task Force was created as a partnership between the four members of the Canadian Network of
Mathematics Institutes (The Fields Institute,117 Atlantic Association for Research in the Mathematical Sciences,118
Centre de Recherches Mathématiques,119 and Pacific Institute for the Mathematical Sciences120); PHAC; the
National Research Council; and Vaccine and Infectious Disease Organization (VIDO-Intervac).121 The task force
acted as a review function for PHAC’s internal modelling capacity and supported other Canadian jurisdictions with
limited modelling capacity. A 2023 report that highlighted the gaps in the pandemic response underscored a
need for investing in lasting research capacity and recommended the creation of an independent institute of
emerging infectious disease modellers and policy experts to ensure continued capacity.122
The National Collaborating Centres for Public Health identified knowledge gaps and fostered collaborative
relationships and knowledge mobilization throughout the pandemic. They have ongoing funding and focus on
Indigenous Health, Determinants of Health, Healthy Public Policy, Environmental Health, Infectious Diseases,
and Methods and Tools. While the panel heard that the Centres’ priorities diverged from federal health
agencies at times during the pandemic, they facilitated networks and provided the public health system with
evidence-based resources and knowledge mobilization services.
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The panel heard from roundtable participants across the country that a greater focus should have been
placed on building on the momentum of longstanding networks and on large, coordinated research projects
during the pandemic. An internal synthesis prepared by PHAC’s Office of the Chief Science Officer reinforced
this finding and highlighted the need for longstanding networks to be in place before an emergency strikes.
Strong relationships allow for an adaptive, capable, and robust health research ecosystem. The focus during
the inter-emergency periods should be on building relationships, investing in people, and increasing capacity.24
5.2.2
Investments in Canada’s Research Ecosystem
In general, the panel observes that Canada is falling behind on overall research funding levels. Organisation for
Economic Cooperation and Development (OECD) data44 indicates that Canada’s overall spending on research
and development as a percentage of gross domestic spending is the second lowest of the G7 countries and
has been steadily declining over the 20 years of data (Figure 5), with the gap between Canada’s overall
spending and the OECD average expanding over the same period. Canada’s public investment in research and
development as a percentage of gross domestic spending currently sits at 1.55% compared with G7 and OECD
averages of 2.6% and 2.7%, respectively. The panel heard that the overall Canadian research ecosystem needs
more support to ensure it has the capacity to meet future needs. Through increased investments in research
and development, Canada will become more competitive in attracting and retaining research talent, thus
fostering a more vibrant and diverse research community.
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Figure 5: Percentage of gross domestic spending on research and development,
G7 countries (2001–21)
4.0
3.5
3.0
OECD
2.5
2.0
Canada
1.5
1.0
Italy
Canada
France
Germany
United Kingdom
United States
European Union—27 countries (from 01/02/2020)
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
0
2001
0.5
Japan
OECD—Total
Source: OECD (2024), Gross domestic spending on R&D (indicator). Doi: 10.1787/d8b068b4-en (Accessed on 05 April 2024)
5.2.3
Clinical Trial Infrastructure
As a signatory to the 2021 G7 Therapeutics and Vaccines Clinical Trials Charter,123 the Government of Canada
committed to supporting international efforts for improved clinical trial collaboration and cooperation to
respond to future health emergencies. Canada is a leader in clinical trial productivity (number of trials per
capita), capturing 4% of global clinical trials.124 It also boasts various clinical trial networks spanning different
disease areas and offering access to specialized research expertise. A 2020 global mapping exercise of
articles related to randomized trials published in high-impact-factor medical journals ranked Canada third for
global productivity (n=4548 articles), following the US (n=18,393) and UK (n=8028), despite only ranking 38th
in population size.125 This ranking was primarily due to the strength of Canada’s clinical trialists. Despite this
strength, when the COVID-19 pandemic struck, it became clear that Canada’s capacity for the rapid
implementation of clinical trials, especially through mechanisms such as harnessing health system data and
centralized coordination and prioritization of research questions, did not match that of global leaders such
as the UK.
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In the fall of 2022, CIHR conducted an online consultation with the research community and stakeholders
involved in clinical trials (140 individuals representing more than 100 organizations) to gather insights for the
development of a long-term strategy to support Canada’s clinical trials ecosystem.126 Participants made
several recommendations about improving funding for clinical trials, including creating a pan-Canadian
structure that coordinates efforts and leverages existing infrastructure. They also recommended the
expansion of clinical trial priorities in Canada’s Biomanufacturing and Life Sciences Strategy43 to include preclinical and translational research and funding of early (pilot, phase I, phase II) trials to build Canada’s drug
development and biomanufacturing sector.
Canada must continue investing in, maintaining, and enhancing its clinical trial capacity and infrastructure
to be better prepared for the next pandemic or health emergency. This includes streamlining research ethics
approvals and data and specimen sharing processes for anticipated areas of research, and the establishment
of emergency processes for working with industry, as well as investing in processes that can be leveraged for
other health emergencies.
In 2022, CIHR created the Clinical Trials Fund as a part of the Biomanufacturing and Life Sciences Strategy to
support the full spectrum of clinical trials, including the development and testing of new drugs, treatments,
and public health interventions related to various diseases or medical conditions. It subsequently launched
three funding streams.127 The Clinical Trial Fund’s funding envelope has already been allocated towards building
infrastructure for clinical trials in Canada, with no further budget yet identified to maintain or build on these
investments following the expiry of funding agreements.
Industry representatives communicated to the panel that while Canada’s size (population and geography)
is a challenge, smaller nations (such as Israel) successfully attracted important mandates for medical
countermeasure development through strong coordination structures that partner with industry to provide
access to ready trial infrastructure and facilitate communication with regulators.
Roundtable participants called for a national strategy to better coordinate and guide investments in clinical
trials to ensure Canada’s readiness to contribute domestically and internationally. They highlighted some
examples of international collaboration and adaptive trial designs that facilitated the rapid evaluation of
therapeutics for COVID-19 and led to evidence-based treatment recommendations and improved patient
outcomes: the Randomised Evaluation of COVID-19 Therapy trial (RECOVERY)128 in the UK; the Solidarity Trial129
coordinated by the World Health Organization (the Canadian branch of which was one of the largest COVID-19
studies in Canada); and the Randomized Embedded Multifactorial Adaptive Platform for Community-acquired
Pneumonia (REMAP-CAP) COVID-19 trial in 25 countries including Canada.130
A 2021 article131 recommended the creation of a Canadian clinical research network modelled on the UK’s
National Institute for Health and Care Research.132 The Institute’s Clinical Research Network infrastructure
enabled rapid research production and knowledge dissemination during the pandemic. Its streamlined ethics
and governance processes also significantly reduced barriers.
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The UK Randomised Evaluation of COVID-19 Therapy (RECOVERY) Trial
The RECOVERY clinical trial, developed in March 2020, is the world’s largest study of COVID-19
treatments and has redefined how clinical research is undertaken.128 It aimed to quickly compare
potentially beneficial treatments for patients hospitalized with COVID-19 and/or influenza pneumonia.
The UK government approved funding for the RECOVERY trial in nine days, allowing frontline medical
professionals to be trained and ready to recruit patients before COVID-19 patients overwhelmed
hospitals. The fastest-recruiting trial in medical history, it recruited more than 10,000 patients within a
two-month period.133 The team developed easy-to-use forms for participants, a select number of key
outcomes, and streamlined data collection processes to enable researchers to investigate the longterm effects of severe COVID-19. The trial focused on affordable and readily available drugs with
well-established safety.
One of its most important discoveries has been the effectiveness of dexamethasone, a widely available
corticosteroid. In June 2020, the trial reported that dexamethasone reduced the risk of death among
COVID-19 patients on mechanical ventilation by 35%, and by 20% for those receiving oxygen only.
There was no benefit for patients who did not require respiratory support. Dexamethasone rapidly
became part of the global standard-of-care for hospitalized COVID-19 patients.
Canada can learn from Israel’s effective use of its health system data infrastructure, medical research
capabilities, researchers, scientists, and clinicians. The Israeli government has fostered an environment
conducive to evaluating novel treatments and therapies. Its ability to harness health system data to do rapid
observational studies of vaccine effectiveness led to its country-level partnership with Pfizer and resulted in
critical vaccine effectiveness studies conducted during the pandemic. In addition, the focus on streamlining
the regulatory process and bureaucratic hurdles enabled researchers to initiate clinical trials expeditiously.134
5.2.4
Ready Research Networks and Infrastructure
The panel considers that dedicated and ongoing funding and investments in research networks, human
capacity, and other necessary clinical trial infrastructure are critical to enable rapid and robust clinical trials
that can yield reliable results. Continuous funding allows for the maintenance and development of physical
infrastructure such as specialized laboratories and medical equipment. It also supports the development
and enhancement of non-physical infrastructure such as networks and collaborations to promote overall
preparedness.
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Recommendation 7: Enhance the readiness of research and clinical
trial networks and infrastructure
a.
Create and maintain domestic and international research networks during inter-emergency periods. Some of
these networks can be maintained in the form of “sleeping protocols”, capable of rapid activation in the event
of an emergency, while others should operate continuously and be used to address ongoing health priorities.
These networks should put in place, as much as possible, the required inter-organizational agreements and
ethical and other approvals, considering what may be required in response to potential future health
emergencies including those identified in the proposed national health risk register (in recommendation 1).
b.
Ensure that critical intramural and external health research infrastructure and human capacity are available and
can operate during the next health emergency through sufficient and sustained funding. This should include
creating an inventory of relevant assets, establishing protocols for the operation of federal facilities during an
emergency, and publishing guidance for external labs.
c.
Continue to increase the speed, scale, and inclusiveness of clinical trial infrastructure and processes by
ensuring sufficient funding for the human capacity and necessary infrastructure required across the country.
5.3
Emergency Preparedness and the Federal
Research Granting Councils
Many roundtable participants observed that the federal granting councils were simply not designed or
prepared to respond rapidly to a crisis of the scale of COVID-19. At the very outset of the pandemic, the three
granting councils worked quickly to fund pandemic-related research. CIHR, for example, swiftly activated
the Emerging Health Threats Fund and went into Business Continuity Mode, shifting its focus to pandemic
program delivery and adjusting its rapid research funding to meet the needs of the research community
such as expedited funding competitions. However, in June 2021, CIHR shifted out of Business Continuity
Mode to deliver both regular competitions and COVID-19 focused funding, which posed challenges to overall
operations. The panel heard that the Business Continuity protocols were insufficient to effectively guide how
the granting councils should operate differently–and in a unified fashion–during a crisis. The protocols lacked
the flexibility to direct funding to specific communities or areas of expertise and to promote interdisciplinary
and transdisciplinary collaboration to address complex challenges.
Roundtable participants cited many standard aspects of research funding and coordination processes–such
as grant competitions, peer review processes, and research ethics approvals–that are necessarily rigorous,
but need to be adjusted to reflect the urgency of an emergency. They also noted that federal granting councils
have traditionally focused on funding investigator-driven research, which could not fully meet the country’s
pandemic needs.
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The National Advisory Committee on SARS and Public Health highlighted these same challenges in 2003 and
called for a balance of mission-oriented and open funding competitions:
“
Canada has generally produced research on emerging infectious diseases through the academic
model…These normal processes for planning, approving, funding, conducting, analyzing, and
communicating research are ill-suited to meet the early research needs of an epidemic response.
Changes must be made during an epidemic investigation, just as changes in the health system’s
hierarchical structures must be made for effective outbreak management.8
The panel heard that the granting councils should have the authority to exercise greater control over the
research they fund, particularly during an emergency. Many roundtable participants highlighted the benefits
of the approach taken by the federally funded COVID-19 Immunity Task Force (CITF).33 The CITF sought to
facilitate a national approach in various areas (including serology) that addressed changing priorities as the
pandemic evolved. Roundtable participants also noted that, although CITF was established in April 2020,
it took time to put this external body in place and to overcome challenges in establishing governance and
operational procedures, during a rapidly escalating pandemic. The task force’s research outputs therefore
ultimately came later in the pandemic. Overall, the panel heard that it should have been possible for CIHR to
execute such health research coordination, rather than it needing to be outsourced.
COVID-19 Immunity Task Force (CITF)
In April 2020, the Government of Canada supported the establishment of CITF33 and provided it with
$300 million in funding.135 CITF mobilized 120 serological and vaccine surveillance studies to determine
the extent of SARS-CoV-2 infection and immune response in the Canadian population and in specific
priority groups. It supported research about the impact of the pandemic on Canadians including
providing the only nationally representative picture of seroprevalence. Its insights also improved
understanding of the safety and effectiveness of vaccines across different subpopulations, and the
degree and duration of immune protection arising from infection and/or vaccination. The task force
completed its mandate on March 31, 2024.
A 2022 review of health research systems in seven countries (Australia, Brazil, Canada, Germany, New Zealand,
the UK, and the US) during the COVID-19 pandemic found that existing or rapidly established research
coordination was necessary for effective responses and reduced risk of wasted resources. The study
delineated three categories of research coordination: i) pre-pandemic efforts aimed at bolstering research
preparedness and response readiness; ii) endeavours during the pandemic to establish mechanisms for
enhanced coordination in research efforts; and iii) mobilization of existing coordination mechanisms within
health research systems, aligned with established health research strategies.136 Coordinating with partners in
these areas can help reduce duplication of efforts on a global scale.
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5.3.1
Intramural and Extramural Research Collaboration
Intramural and extramural researchers need to be able to work together as seamlessly as possible. It is
important that this collaboration be in place at all times to prepare for and respond effectively to emergencies.
Coordination between extramural academic and industry researchers and intramural researchers within
provincial and federal governments is important to achieve synergies. These researchers often have access
to different data sets and research infrastructure, and they are funded through different mechanisms.
Roundtable participants highlighted the lack of protocols to facilitate collaboration between intramural and
extramural researchers. The National Advisory Committee on SARS and Public Health emphasized the need
to improve linkages between infectious disease research in government and in academic institutions.8 In 2003,
it proposed enabling the combination of enhanced intramural research and development capacity with
intramural funds to allow for contracting out of research and development functions through partners such
as CIHR. Federal/provincial/territorial intramural research and development activities should be linked to
academic health institutions and major municipal health units through co-location, joint venture research
institutes, cross-appointments, joint recruitment, and interchanges, as well as networks and other
collaborative research activities.
Longstanding barriers to research collaboration between government, academic, and industry researchers
include i) the federal research granting councils’ practice of restricting the eligibility of researchers employed
by or affiliated with a provincial/territorial government department or agency, and ii) federal government
financial rules that prevent grant and contribution funding from flowing to federal intramural scientists.
The panel also learned that the perception of some intramural research organizations within federal
departments and agencies was that they could not collaborate with extramural researchers who had received
grants or contributions from their department or agency. This is not consistent with the Treasury Board of
Canada Secretariat’s Guide to Departmental Collaboration with Recipients of Grants and Contributions, which
clearly outlines that such collaboration is permitted in many situations. This guide notes that collaboration
provides opportunities to leverage capacity across sectors, transfer knowledge, and further shared
objectives.137 These goals are important at all times, but even more critical during an emergency.
Federal Transfer Payment Policy rules restrict the use of funding that has been earmarked for grants and
contributions for external recipients. However, programs can be designed to also include operating funding
for internal researchers and thus promote intramural-extramural collaboration. The National Research Council
of Canada’s Collaborative Research Program structure is an example of such a design.138
National Research Council’s Collaborative Research Programs
The programs explicitly seek proposals for collaborative research projects that involve extramural
collaboration with federal researchers and include separate funding envelopes–both internal operating
funding for intramural researchers and grant and contribution funding for external researchers. An
independent National Program Office within the National Research Council administers the funding
envelopes to keep funding processes separate from those implementing the research, thus
respecting Treasury Board policy and guidance.138
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In addition to the underfunding of extramural research noted in section 5.2.2, there is a deficit in Canada of
intramural researchers working on public health, including infectious diseases work. This was a particular issue
in the case of both PHAC and some provincial/territorial and Indigenous public health agencies and authorities.
For example, the panel heard that the overall COVID-19 response in Ontario was hampered by a lack of
intramural capacity because of budget cuts to Public Health Ontario over the years leading up to the pandemic.
In contrast, investments in intramural research capacity at the British Columbia Centre for Disease Control
strengthened the overall provincial response.
5.3.2
An Emergency Preparedness Plan for the Federal Research Granting Councils
The panel recommends the development of an emergency preparedness plan for the granting councils that
considers all researchers across Canada. The granting councils must also operate as a unified whole in an
emergency, prioritizing streamlined review processes, rapid decision making, and larger-scale national
research projects as appropriate, and ensuring the timely sharing of research results.
Recommendation 8: Strengthen the emergency preparedness
of the federal research granting councils
a.
Put in place processes and protocols so that granting councils operate collectively in an emergency, with rapid
decision making, streamlined review processes, and processes to facilitate collaboration on projects that are of
sufficient scale to address national priorities. Funding conditions should include the timely completion of new
inter-institutional agreements between collaborating research institutions as required, and the timely release
of research data and results where appropriate.
b.
Facilitate interdisciplinary research by removing subject-matter boundaries currently specified in very fine
detail between the granting councils, and through capacity building where necessary.
c.
Remove barriers to intramural and extramural research collaboration including federal funding eligibility
restrictions for provincial and territorial intramural researchers. Operating funding envelopes for federal
intramural researchers collaborating with recipients of grants and contributions should also be put in place.
5.4
Health Equity
As highlighted in Chapter 2, COVID-19 disproportionately negatively impacted communities already
experiencing inequities and health disparities.5 This included lower-income Canadians, homeless and underhoused populations, Black and racialized populations, and individuals living in vulnerable conditions or in
long-term care homes or other congregate living settings. The panel heard that a greater pre-pandemic focus
on domestic research relating to populations already experiencing health inequities could have provided for a
more effective COVID-19 response. The lack of pre-pandemic progress in this area can be attributed, in part,
to limits on available data (discussed in Chapter 6).
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Recent reports by Canada’s Chief Public Health Officer and the Royal Society of Canada have called for more
research and action on the social and structural determinants of health to improve community wellbeing
before, during, and after emergencies, and to understand the long-term impacts of public health crises.68,139
This would increase graduate and postdoctoral training capacity and enhance the knowledge base across all
health-related disciplines.139 However, a greater focus on the structural and social determinants of health is
only part of the challenge. Populations that were most negatively impacted during the pandemic also,
historically, have experienced the greatest barriers to health care, and may have lower than average trust in
Canadian institutions and research processes due to differences in history and experiences. According to
experts who presented to the panel, a concerted effort on the social and structural determinants of health
must also include building trust with these communities.
The pandemic also disproportionately impacted the older adult population in Canada where the intersection
of many vulnerabilities (biological and social) resulted in a significant number of deaths in retirement and
long-term care homes. Future work must consider the intersection of such impacts; although they are not
predetermined social impacts in nature, they demonstrate that disproportionate impacts can be generated by
other factors that still require research to inform targeted interventions.
Recommendation 9: Increase investments in research on actions
required to better support and prioritize the needs of groups
disproportionately impacted by health emergencies
a.
Provide sufficient funding for research on the implementation of public health, government policy, and other
interventions to mitigate inequities and address the underlying health needs of priority groups, including
those in poverty or experiencing homelessness, Black and other racialized communities, and residents and
employees of long-term care facilities. This research should be developed and conducted in concert with
affected communities.
b.
Establish a standing science advisory body of independent experts on health equity, supported by a secretariat
within the Health Portfolio, to inform government policies and public health measures in this area.
In the panel’s view, the implementation of these recommendations is essential to understand, address, and
eventually alleviate the impacts of health emergencies on communities and populations already experiencing
inequities and health disparities, and improve their long-term health outcomes.
The panel considers the creation of a multidisciplinary body with expertise in the social and structural
determinants of health research, including representatives from government agencies, Indigenous
communities and leadership, academia, and nongovernmental organizations, essential to guide the work of
the Health Portfolio in this area. This science advisory body should develop a comprehensive research agenda,
prioritize research on the structural and social determinants, identify research gaps, facilitate collaboration,
provide evidence-based recommendations to policy makers on strategies to address health inequities, and
engage with communities.
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5.5
Research to Improve Indigenous Health Outcomes
As reported earlier, the panel’s discussions with Indigenous health experts and knowledge holders revealed a
systems-level disconnect between the health priorities of their communities and those identified by science
advisory bodies. This disconnect extends to how research is funded and conducted with Indigenous
communities, and the data that inform research and science advice (discussed in Chapter 6).
The panel’s analysis of the leadership and membership of 22 COVID-19 research and governance bodies in
Canadaviii (with a total of 286 members) highlights the severe underrepresentation of First Nations, Inuit, and
Métis knowledge holders and health practitioners. Only 18% of these bodies had Indigenous representation in
their membership. In 2021, First Nations, Inuit, and Métis peoples represented approximately 5% of the total
Canadian population,140 but made up less than 1.5% of the total membership of research advisory bodies during
the pandemic (2020–23).ix The underrepresentation of Indigenous knowledge holders and health practitioners
in research coordinating bodies contributed to the challenges faced by many Indigenous scholars in adapting
pandemic initiatives to the needs of their communities. Applying a one-size-fits-all approach does not
accurately capture the impact on First Nations, Inuit, and Métis populations.
The panel heard that research capacity and knowledge dissemination were unevenly distributed across the
country during the pandemic and that, in general, research processes do not recognize or value Indigenous
ways of knowing or research methods, or accommodate the realities of Indigenous communities, especially
those in northern Canada. For example, the lack of universities and research ethics boards in the territories
limited the ability of their governments to encourage and facilitate research during the pandemic. Similarly,
interprovincial/territorial pandemic travel restrictions prevented researchers from travelling to the territories.
The lack of northern institutional capacity means that territorial governments cannot effectively participate in
the traditional research funding system, which often prioritizes clinical medicine and research.
Indigenous knowledge holders and health practitioners who met with the panel reaffirmed the need for
self-determination through research, as articulated in the United Nations Declaration on the Rights of Indigenous
People,93 the Government of Canada’s Action Plan95 to respond to the Declaration (discussed in Chapter 4), and
the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans TCPS2.x,141 Indigenous scholars
noted that continued long-term support and strong leadership for the CIHR Institute of Indigenous Peoples’
Health is necessary to ensure that First Nations, Inuit, and Métis issues are a priority, and that the institute
participates meaningfully during health crises.
viii
Canada Research Coordinating Committee; Canadian COVID-19 Genomics Network (CanCOGeN); CanCOVID; Centre for Research
on Pandemic Preparedness and Health Emergencies Steering Committee; Coordination Forum on Major COVID-19 Initiatives;
Coronavirus Variants Rapid Response Network (CoVaRR-Net); COVID-19 Immunity Task Force; Deputy Minister Committee on Medical
Countermeasures and Research Initiatives; Federal Pandemic Science Coordination and Action Group; Special Advisory Committee on
COVID-19; Technical Advisory Committee on COVID-19; Variants of Concern Leadership Group; Wastewater Working Groups; and the
Office of the Chief Science Advisor’s Task Force on Long-Term Care; Task Force on Optimal Use of Health System Capacity; Task Force
on Long-Term Care Systemic Issues; Task Force on Data Analytics; Task Force on Post-COVID-19 Condition; Task Force on COVID-19 in
Children; Task Force on Ventilators; Task Force on Reprocessing of Respirators/N95 Masks; and Task Force on Virtual Care.
ix
The analysis is limited to individuals who publicly identify as First Nation, Inuit, or Métis.
x
See “Chapter 9: Research Involving First Nations, Inuit, and Métis Peoples of Canada” of the Tri-Council Policy Statement: Ethical Conduct
for Research Involving Humans TCPS2.
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Recommendation 10: Increase investments to advance research on
actions required to improve Indigenous health outcomes
a.
Co-develop health priorities with First Nations, Inuit, and Métis health experts and communities and provide
sufficient funding for research on actions to address these priorities. This should include increased investments
to advance Indigenous-led research and training in areas including epidemiology.
b.
Cultivate and invest in the development of expertise in the coordination and funding of Indigenous health
research, in and among federal departments and agencies.
This research should be co-designed and implemented in a culturally appropriate manner for each community
and build capacity and understanding for future generations to enable local retention of new knowledge. The
government should also develop expertise in the coordination and funding of Indigenous health research, within
and across federal departments and agencies, including Indigenous-led research and supports for trainees.
5.6
Indigenous Health Expertise
in the Health Portfolio
The panel offers an additional recommendation related to its analysis and findings but broader than its remit.
Its consultations pointed to insufficient Indigenous health expertise within the Health Portfolio. Discussions
with Indigenous knowledge holders and health care practitioners also highlighted the inadequacy of efforts to
seek this expertise though contractual and advisory roles. As a result, health considerations for Indigenous
populations were not properly factored into health research prioritization and other processes during the
pandemic. A plan to recruit this expertise is needed, and this should include creating a new dedicated senior
role in the Public Health Agency of Canada.
Broader recommendation B: Create a new Deputy Chief Public Health Officer position that is
fully dedicated to Indigenous health. This role should be held by an Indigenous person and have the
mandate to ensure that First Nations, Inuit, and Métis health issues are integrated into the priorities
and processes of the Public Health Agency of Canada. It should interface with other areas of the
Health Portfolio, Indigenous Services Canada, and other departments and agencies as required.
This role would need support from an adequate number of Indigenous staff with experience across nations and
geographies. It would also require diverse public health expertise and sustained funding, to allow for ongoing
engagement and relationship building.
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6.0 Health Data Availability
and Use
During a health emergency, researchers, science advisors, and public health and government officials all
require comprehensive health data to understand the scope of a crisis, guide decision making to provide better
care for patients, and improve the overall efficiency of health systems. Researchers—in universities, teaching
hospitals, and government labs—rely on available data sets to rapidly perform analysis and answer pertinent
questions that ultimately allow health care providers to implement effective treatments and practices, or halt
ineffective or harmful ones. Science advisors use these data, combined with evidence syntheses, to provide
relevant and contextually appropriate advice. Data are also critical during times of stability, to help prepare for
health emergencies, and can be used to identify vulnerabilities, health risks, and opportunities to build
community resilience.
Public health data and routinely collected health care data are often distinct sources of information that
support an effective emergency response. Public health data include data about vaccines, outbreaks, and
contact tracing that are held by provincial and territorial public health units. Health care data are collected in
clinical settings such as hospital and doctor visits, and through outpatient prescriptions, laboratory results,
and vital statistics. Public health surveillance data build a national picture of the emergency and its impact on
different geographic areas and segments of the population.
This chapter explores various aspects of Canada’s health data challenges and complexities and offers
recommendations for a more efficient and equitable path forward. The focus is on both improvements to data
systems and adaptations to ensure that the right types of data are available during an emergency. These
improvements and adaptations include accelerating federal government efforts with the provinces and
territories to establish data standards and interoperable data sets, providing access to data that are essential
for assessing and managing public health, and meaningfully engaging with Indigenous Peoples and their
communities to support their dedicated distinctions-based health data strategies.
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6.1
Data Limitations and Advancements
During the Pandemic
Canada’s federated structure leads to significant complexities in how, when, and whether health data are
collected, stored, shared, and used, as well as how they are protected by statutes and legislation. Many
reports, such as the first report from the Expert Advisory Group for the Pan-Canadian Health Data Strategy,45
have outlined the deficiencies in the health data system and the resulting harms to Canadians.54,55 A recent
report from the Chief Public Health Officer of Canada highlighted the resulting challenges of collecting and
sharing health data and information during the COVID-19 pandemic.5 The panel consistently heard about
challenges in accessing health data essential for important research, scientific advice, and health delivery.
The timely collection and sharing of data between health care systems, levels of government, and research
institutions was a barrier to a well-coordinated and consistent national response to the pandemic. The panel
heard that capacity for surveillance data collection varied greatly among subnational jurisdictions. The lack of
data in some regions prevented public health officials from analyzing the full impact of the pandemic on various
segments of the population. For example, several provinces noted challenges in reporting real-time mortality
data given that death certificates took months to prepare and were often first developed as paper copies for
subsequent entry into digital systems.
Throughout the pandemic, organizations across the country mobilized to build better processes and structures
to promote better access to health information. For example, in Quebec, the Fonds de recherche du QuébecSanté and Génome Québec funded the development of Biobanque Quebecoise de la COVID-19142 to improve
researchers’ access to samples and data related to COVID-19 to support research on SARS-CoV2 infection.
Despite these efforts, data systems across the country continue to be fragmented. The panel also heard
sobering recounts from clinical settings about the repercussions of poor or no data to inform patient care.
While this issue remains unsolved, all Canadians are vulnerable. The most disadvantaged will remain vulnerable
to the worst health outcomes; health research and policy advice will be hampered; and Canadian scientific
innovation will not reach its full potential.
In recent years, Canadian health systems have undergone significant transformation through digitization of
health information, accelerated by the adoption of virtual tools during the pandemic. However, considerable
amounts of information continue to be siloed and are not readily accessible or exchangeable. Public health data
and health care data are typically kept in different systems that often do not intersect. For example, medical
hospitalization records are collected by provinces and territories and held by the Canadian Institute for Health
Information (CIHI), while vaccination information is held by public health units and shared with the Public Health
Agency of Canada (PHAC). As noted in Chapter 3, during the pandemic, CIHI began collecting and providing
hospital occupancy and capacity data to Health Canada and PHAC.
The third report of the Expert Advisory Group for the Pan-Canadian Health Data Strategy recommended that
information from health care and public health must be linked, and suggested that this requires a common
plan.45 There are multiple examples of the benefits of linking these types of data. For example, health care data
can help determine the level of strain on the health care system during a health emergency and the associated
analysis can help inform a public health emergency response.143 Public health data on infection rates may also
be used for planning purposes to help anticipate the number of individuals who may need health care services.
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6.2
Health Data Systems: Cultural Challenges
Canada lags its international comparators on health data infrastructure.144 According to the Health Data
Interoperability Working Group of the Alberta Virtual Care Coordinating Body, “[Canada’s] ineffectual approach
to health data interoperability is an obstacle to everything from individual patient care to the advancement of
our understanding of the complex relationship between health, wellbeing, and the social determinants of
health.” The same report emphasized that “maintaining the status quo is NOT an option.”46
Singular electronic patient records, which follow a patient for all care, have not been implemented in all
provinces and territories. Data inadequacies impact patients directly. Information scattered across different
health providers can lead to delayed diagnoses and treatment, and to poor health outcomes. Provinces and
territories do not use consistent formats for data sets and the ability of their health data systems to collect and
make data available varies greatly. Clear plans and protocols that guide data identification and collection could
improve the interoperability of data between systems as well as the ability to reuse them to further research
inquiries. FAIR (Findable, Accessible, Interoperable, and Reusable) data principles have been developed and
adopted internationally to support data reuse and feature prominently in the US National Institutes of Health
strategic plan for data science.145,146
The panel heard that the absence of an effective public health information system in the territories is one of the
biggest hindrances to effective data management. During the pandemic, some territorial governments relied
on antiquated methods and systems, including calling individual contacts on the front line and manually
reconciling information from disparate sources. While real-time data may exist in larger provinces, the panel
heard that the Government of Nunavut, for example, does not have data on childhood vaccination rates, let
alone have access to real-time, emerging data during a pandemic. Efforts are currently underway to enhance
these health information systems, but the panel heard that territorial governments are severely underresourced for this work. They are not always included in national reporting due to insufficient data systems.
During the panel’s consultations, many individuals classified data sharing challenges in Canada as largely
cultural and political. Many attributed them to the disproportionate power of the legal “middle management,”
often referred to as data custodians, in identifying, assessing, and balancing risks. The Expert Panel on Health
Data Sharing convened by the Council of Canadian Academies found that unclear guidance in privacy laws
has generated a “culture of caution” that impels data custodians to approach data management more
conservatively than may be necessary by law.47 This culture can perpetuate harms at the levels of the
individual, population, and health system.46 The panel heard that the resulting lack of health care data has
serious implications for patient care and therefore the health and wellbeing of Canadians. Clinicians expressed
their frustration and fear of making mistakes based on incomplete information.
The panel heard a clear need for national coordination to establish a standard structure that harmonizes health
data systems, increases transparency in data sharing, and creates a culture of collaboration.
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6.3
Moving from a Custodianship
to a Stewardship Model
Canadian health data legislation and governance is currently based on a custodianship model, emphasizing
privacy rights and limiting the ability to link individual health data with sociodemographic information and
associated analysis to inform population-level priorities. Custodian-centric privacy laws provide rules for
organizations that collect, use, and disclose public health information.147 The panel heard that Canada needs to
shift to a patient-centric “data stewardship” approach that balances privacy and security considerations with
enabling access to data. Adopting this model would help build trust with the expectation of using data to
improve clinical care. The 2023 Expert Panel on Health Data Sharing report also pointed to the benefits of a
stewardship model and identified that the transition to this governance model requires national leadership to
establish a structure “that harmonizes health data systems and facilitates cross-jurisdictional data sharing.”47
Canada can learn from the health data systems of countries such as Australia and Germany that operate as
data stewards, and from the US, which has adopted a legislative approach to compel data sharing. In the
Australian and German systems, data are available to help inform policy decisions, and government institutions
make comprehensive health data sets available to researchers while maintaining privacy protections. The
Australian Institute of Health and Welfare manages more than 150 data sets covering a diverse range of fields
including hospital activity, disease, disability, drugs, perinatal health, mental health, homelessness, and the
needs of Aboriginal and Torres Strait Islander people.148 The Australian Institute of Health and Welfare publishes
more than 250 statistical products and provides data to government agencies, researchers, and the
community while maintaining data privacy and confidentiality. Accredited users from Australian state and
territory governments and universities can obtain government data (that are not publicly available) from the
Australian Institute of Health and Welfare under the Data Availability and Transparency Scheme149 established
under the Data Availability and Transparency Act 2022.150 Data are treated to minimize potentially identifying
information and can be shared with authorized individuals to i) deliver government services, ii) inform
government policies or programs, and iii) conduct research and development.
The Australian Institute of Health and Welfare also manages and provides access to three linked data assets that
bring together data from multiple sources, including across states and territories: i) National Integrated Health
Services Information, ii) National Disability Data Asset, and iii) COVID-19 Register and Linked Data Set. These
assets make it easier for researchers to conduct complex cross-sector and cross-jurisdictional research.151
The Robert Koch Institute, the national public health institute within the German Federal Ministry of Health
portfolio, uses research to generate data for decision making and the provision of independent advice to public
health officials and policy makers. During the pandemic, the coordinated and strategic integration of public
health research, science advice, and surveillance in a single institution provided Germany with a centralized
source of emerging information, while ensuring science advice and research were continually informed by
surveillance efforts and risk assessments.
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Robert Koch Institute (RKI)
In Germany, RKI regularly conducts studies that provide reliable and extensive data on i) the current
health situation, ii) health promoting and risk behaviour, iii) health care and prevention, and iv) the
environment and living conditions of different population groups. RKI uses the data in its federal health
reporting and epidemiological research and provides them to researchers through public use files. It also
maintains the SurvStat Disease Database, which tracks cases of notifiable diseases and pathogens
reported under the Act on the Prevention and Control of Infectious Diseases in Humans.152 Local and state
health departments report most of these cases to RKI. The SurvStat allows researchers to retrieve
aggregated data directly from a limited version of the German notification system database.153
RKI developed daily surveillance reports on COVID-19, beginning in January 2020, and risk assessments
and technical guidelines for testing, contact tracing, and disease management. It also developed one
of the first diagnostic tests in the world, allowing Germany to start increasing its testing capacity.
Laboratories already had the expertise, accreditation, and equipment to conduct polymerase chain
reaction (PCR) assays and quickly deliver diagnoses.
The US has pursued a defined legislative approach to health data interoperability with the US Trusted Exchange
Framework and Common Agreement establishing common governance, policy, and technical standards.154 This is
in stark contrast to Canada, where interoperability has largely been attempted on an optional, regional, and
sectoral basis, without being grounded in a vision for, or accountability to, person-centric health data.46
In recent years, the federal government has worked with provinces and territories to receive advice from an
Expert Advisory Group.49 As a condition of their federal funding provided through the 2023 Working Together
to Improve Health Care for Canadians Plan,50 provinces and territories have committed to work with the federal
government and other partners to improve the collection, sharing, use, and reporting of health information.
Health data priorities are being implemented through a Joint Federal, Provincial and Territorial Action Plan on
Digital Health and Health Data,51 and a Pan-Canadian Health Data Charter,52 which highlights principles for personcentric health information, equity, public engagement, trust, and Indigenous data sovereignty and Indigenousled health data governance (see Section 6.6). The federal government has also provided funding to CIHI,
Canada Health Infoway, and Statistics Canada to support this health data agenda. A Pan-Canadian
Interoperability Roadmap,155 endorsed by federal, provincial, and territorial governments (except Quebec),
outlines the path forward for connected care where health information can flow easily between different parts
of the health care system, allowing patients to access their health information and improving care coordination
between providers. Through the implementation of the Roadmap, Infoway is collaborating with federalprovincial-territorial governments and other partners to establish common standards that will enable digital
systems to connect, so that health information can be shared effectively with those who need it, in an easy
to use format.
The panel proposes that the federal government maintain its leadership role and place greater priority on
health data initiatives. While recent efforts to move towards a data stewardship model are positive, this work is
nascent. Sustained long-term efforts are needed to bring systems and processes to a level where health data
can be quickly used in an emergency to inform research and science advice. Monitoring of the impact of these
investments on improving the scope, scale, interconnectivity, and responsiveness of Canada’s health data
structure, as well as accountability for expected outcomes, is critical.
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6.4
Sociodemographic, Race and Ethnicity Data
to Inform Science Advice
The panel heard that one of the most important predictors of infection exposure and outcomes was largely
unavailable at the national level during the pandemic: disaggregated data, including basic sociodemographic
information on race and ethnicity. The absence of these data reduced the contextual information available to
decision makers to identify the groups disproportionately impacted by COVID-19 and the wider consequences
of the pandemic response.
In certain cases, advisory bodies such as the Ontario COVID-19 Science Advisory Table were able to access
critical real-time, anonymized, provincial health data. Several municipal public health departments in Ontario,
including Toronto Public Health, began collecting and publishing disaggregated COVID-19 data. The level of detail
in the disaggregated data available through the Manitoba Population Research Data Repository at the Manitoba
Centre for Health Policy played a significant role in the provision of science advice. This comprehensive and linked
health data set collection, for use by Manitoba Health and researchers, holds de-identified, individual-level data
from multiple provincial government departments (health, social services, education) and links them further to
provincial registries and population databases. The panel heard that access to real-time data allowed provincial
public health officials to gauge the effectiveness of various measures.
The Nova Scotia Fair Care Project
Launched in 2022, the project is an example of an effective provincial initiative for collecting racebased and linguistic identity data in health care. Individuals can opt-in to share their information when
they renew their provincial health card, or online at any time. The project, which aims to improve equity
in health care, will help decision makers understand which communities require better health care
support. A community-based working group, with members from racialized communities, helped lead
consultations and provided feedback throughout the development process.156
These provincial and municipal examples demonstrate that essential data are available in some provinces and
can be responsibly accessed by researchers to inform better decision making and improve patient care. They
also raise further questions as to why real-time, disaggregated data cannot be leveraged more broadly during
inter-emergency periods to better support the provision of health services and prepare for and mitigate the
effects of future health emergencies.
The collection of race and ethnicity data is a standard global practice, commonly used in the US and the UK.
It has been suggested that the federal government should work with provinces and territories to ensure the
availability of high-quality sociodemographic data, including race and ethnicity data, to support their health
systems.157 During the pandemic, the same expert proposed legislation specifying that “COVID-19 sociodemographic and race and ethnicity data should be collected at all levels of government. Data collection,
data analysis and subsequent actions should be undertaken in partnership with impacted communities.”157
Decisions about the use of these data must be made in an inclusive way, so that work is done with an
identifiable group, rather than about them.
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6.5
Health Data Standards and Interoperable
Data Sets
The panel highlights the critical need to strengthen health data sharing standards, platforms and protocols,
surveillance networks, and data sharing agreements to enhance Canada’s preparedness for the next
emergency. Canada must be able to generate and make health and related data from across the country
available to researchers in real time and de-identified in such a way as to protect individual privacy. This would
enable characterization at a national scale of the incidence and prevalence of infection, hospitalizations,
deaths, therapeutic interventions, vaccination rates and possible adverse effects, and other critical issues at all
times. Efforts to do so would improve research, scientific advice, overall response during crisis periods, and
generate important benefits in inter-emergency periods, further improving health outcomes by helping to
address the many inequalities.
As one example, vaccine registries are valuable for their potential to capture accurate and precise information
on the distribution, uptake, and effectiveness of vaccines at both the individual and population level. For
example, the Manitoba government was able to prioritize vaccination by postal code area during the pandemic.
Researchers also articulated a desire for greater access to expanded government vaccination registry data to
conduct effectiveness and safety studies using real-time linked cohort analysis.
A recent UK study demonstrated the power of the effective use of routinely collected data at a population
level. It used routine information collected from approximately 59 million people to examine the effectiveness
of different numbers of vaccine doses in relation to the risk of hospitalization for severe clinical manifestations
of COVID-19.48 The results showed that even missing one recommended vaccine dose was associated with a
substantially increased risk of severe infection requiring hospital admission.
The panel heard a strong consensus among researchers and health experts that comprehensive de-identified
vaccination information should be regularly collected and reported across Canada. This would allow for the
identification of populations and geographic areas with low vaccination rates for re-emerging infectious
diseases (e.g., measles) and enable public health and health care to better prepare for future outbreaks.
The panel recognizes the leadership role of the federal government in advancing pan-Canadian data
infrastructure, data sharing, and interoperability. It encourages the federal, provincial, and territorial
governments to continue to work together to realize the objectives of the Pan-Canadian Health Data Charter
and the Shared Pan-Canadian Interoperability Roadmap.155 Advancements to improve access to data requires
political will and collaboration.
Canada must realize the Chief Public Health Officer’s vision for a Pan-Canadian data ecosystem that is
interoperable and equitable.5 To achieve this vision, all levels of government need to use every available lever
to encourage standardized approaches to collecting and sharing data.
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Recommendation 11: Resolve the longstanding issue of the
non-availability and fragmentation of essential public health
and clinical data
a.
Accelerate dedicated efforts with the provinces and territories to establish data standards, interoperable data
systems and data sets, and provide access to data that are essential for assessing and managing public health
between and during emergencies, reducing the health disparities between sociodemographic groups, and
enabling the conduct of innovative and important research. This should include the systematic collection and
availability of de-identified routinely collected health data, including vaccination data, across the country.
b.
Provide sufficient resources to the Public Health Agency of Canada, the Canadian Food Inspection Agency,
other relevant departments and agencies, and federally funded health data research networks to build and
maintain interoperable data systems and data sets and make these available to provinces and territories,
Indigenous health authorities, and researchers.
The panel considers the creation of an interoperable data system that provides real-time access to data an
essential component of an efficient and effective health care system. Researchers, science advisors, and
public health and government officials all depend on data: to indicate promising areas of research, inform
future decisions, evaluate promising treatments, and cease ineffective treatments. The realization of many
recommendations in this report is contingent on the ability to collect good data and store it in a robust,
interoperable data system.
The expected overall outcomes of an interoperable data system and data sets are to provide better and more
timely information to guide public health and public policy decisions, and to improve health care during health
emergencies as well as inter-emergency periods.
6.6
Dedicated Indigenous Peoples Health
Data Strategies
Health data from Indigenous people are essential to support Indigenous communities and all levels of
government in Canada, to inform action during a health emergency, and to support health and wellbeing
between emergency periods. According to the National Collaborating Centre for Indigenous Health, “Achieving
our shared goal of healthy, vibrant Indigenous peoples requires robust Indigenous health data that makes it
visible where we are and where we need to go.”92
Specific First Nations, Inuit, and Métis data governance principles govern Indigenous population health data
control and emphasize self-determination and self-governance. Principles guiding the use of data must
ensure that data remain in the care of Indigenous communities and advance the rights, jurisdictions, and
interests of distinct Indigenous populations.92,93,94 Canada’s United Nations Declaration on the Rights of
Indigenous Peoples Act Action Plan “provides a roadmap of actions Canada needs to take in partnership with
Indigenous peoples to implement the principles and rights set out in the Declaration and to further advance
reconciliation in a tangible way.”95
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Indigenous health experts consistently raised concerns about data collection, use, and sharing, including
the processes through which data are analyzed. They stressed the importance of data sovereignty and
custodianship related to both population- and individual-level health data. Historical harms, particularly
through biological/medical sampling, have contributed to a lack of trust in the federal government in this area.
Although Indigenous knowledge holders and health care practitioners emphasized to the panel that Indigenous
data sovereignty must be upheld, they also noted that this has sometimes led to silos between independent
Indigenous communities and health authorities. They recommended the creation of mechanisms to build
linkages in public health systems that can safely and effectively link data possessed by Indigenous
communities. They also expressed significant interest in exploring how federal and provincial/territorial
governments can increase interoperability and collaborate with communities to provide them with the data
needed in ways that they can functionally use. There was general acknowledgement that work to develop
dedicated health data strategies requires trust building and reconciliation of data principles more broadly.
Indigenous knowledge holders and health care practitioners also noted the inherent differences between what
governments and Indigenous communities consider as important data; the divide extends to the frameworks
and principles themselves. For example, metrics used in institutional public health do not necessarily align
with the values or priorities of Indigenous practitioners and communities. As discussed in section 4.3, equity,
diversity, inclusion, and anti-racism frameworks that may work for other equity-deserving populations do not
necessarily reflect the needs and priorities of Indigenous Peoples. This extends to designing data processes
and systems which must be Indigenous led and respect Indigenous sovereignty. The panel also heard about
the need for Indigenous-specific public health and epidemiological training models and data systems.
Indigenous data infrastructure suffers from uneven geographic coverage and capacity and a lack of
distinctions-based disaggregated data. The panel heard that it is often restricted to provincial governments
and organizations and in some provinces, only encompasses First Nations people living on-reserve. The
exclusion of urban Indigenous populations has resulted in flawed public health data and statistics. For example,
the frequently cited federal statistics of high vaccination rates of First Nations people do not include data from
Indigenous populations in urban areas who have significantly lower uptake of vaccines compared with the
general population.158
The pandemic, however, did spur some jurisdictions to collect and share distinctions-based Indigenous
health data. For example, the Manitoba government began collecting First Nations, Métis, and Inuit identifiers
in April 2020.159 Individuals who tested positive for COVID-19 were asked to volunteer information about their
Indigenous status. This data collection stemmed from the establishment of a data sharing agreement between
Manitoba Health and the Assembly of Manitoba Chiefs, which recognized and abided by the principles of First
Nations self-governance and data sovereignty (ownership, control, access, and possession). The agreement
also specified how First Nations COVID-19 data are accessed, how reports are generated, and how information
is shared. The Manitoba Keewatinowi Okimakanak emphasized the importance of this agreement in capturing
COVID-19 data on community members who would have been excluded from previous data collection efforts,
including non-status First Nations.160
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Manitoba researchers observed that the use of Inuit health identifiers, particularly in the health administrative
data system, would positively benefit Indigenous health reporting and planning activities in the province.161
Manitoba Health also established and published data sets on vaccination rates in the First Nations population,
broken down by tribal council region and health authority. This included data on community members who had
received vaccinations both on- and off-reserve, a key gap identified in this section.
The panel strongly agrees with the multiple reports that have emphasized a need to take action that supports
and aligns with Indigenous data principles and strategies.92,162,163 An Expert Advisory Group49 on health data
stressed that jurisdictions must demonstrate support for First Nations, Inuit, and Métis data sovereignty across
geographies and highlighted the importance of meaningful Indigenous participation and representation on
senior health data committees and governance tables to ensure support for, and alignment with, First Nations,
Inuit, and Métis data principles and strategies.54 The Pan-Canadian Health Data Charter, which was recently
endorsed by federal, provincial, and territorial Ministers of Health (except Québec), also commits to support
and respect First Nations, Inuit, and Métis data sovereignty and Indigenous-led health data governance
frameworks.52 The panel urges the government to continue to strengthen existing efforts to support dedicated
and robust distinctions-based Indigenous Peoples health data strategies.
Recommendation 12: Continue efforts to meaningfully engage with
Indigenous Peoples and their communities to support their respective
health data strategies and advance shared digital health and health
data priorities
a.
Support and collaborate with First Nations, Inuit, and Métis communities and authorities across the country to
bring their health data systems in line with the most robust systems in Canada, while preserving Indigenous
data sovereignty and ensuring data integration and interoperability with provincial/territorial and federal
systems, further to the commitment in the Pan-Canadian Health Data Charter.
The expected overall outcome is culturally distinct and relevant health data systems that advance the digital
health and data priorities of Indigenous Peoples and contribute to improved health for all Indigenous people
across Canada.
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7.0 Conclusion
To be prepared for the next health emergency, and improve overall health outcomes for Canadians, there
is an urgent need for the federal government to act now to build on previous efforts and make significant
improvements to the approach to science advice and research coordination. The panel’s recommendations
centre around the need for a more sophisticated national risk assessment and preparedness planning process;
a more robust science advisory system that is ready to immediately activate in response to an emergency;
ongoing research infrastructure that is ready to mobilize; centralized leadership to facilitate the prioritization
and coordination of major public research investments; and improved health data systems.
The panel considers its recommendations to be cost effective, especially when compared with the
consequences of inadequate preparedness. The actions will also improve the effectiveness and efficiency of a
broad range of government investments. To achieve success, these efforts require enhanced interdepartmental
and international coordination, and, given the federated nature of Canadian health systems, actions by and
collaboration with provincial and territorial governments. Success also requires increases to ongoing public
investment in health research. Previous expert panels, dating back at least 30 years, have called repeatedly for
action in these areas. The government must take action now to comprehensively address these shortcomings
and to prevent or mitigate, as far as possible, the potentially disastrous health, social, and economic
consequences of a future health emergency.
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Glossary
A list of jargon and often used terms, accompanied by brief definitions. In most cases, definitions have been
adopted and adapted from other sources and not unique to this report.
All-hazards: “Referring to the entire spectrum of hazards, whether they are natural or human-induced.”164
Biomanufacturing: “Biomanufacturing is a type of manufacturing that utilizes biological systems (e.g., living
microorganisms, resting cells, animal cells, plant cells, tissues, enzymes, or in vitro synthetic (enzymatic)
systems) to produce commercially important biomolecules for use in the agricultural, food, material, energy,
and pharmaceutical industries.”165
Clinical guidelines: “Clinical guidelines are recommendations on how to diagnose and treat a medical
condition. Guidelines summarize the current medical knowledge, weigh the benefits and harms of diagnostic
procedures and treatments, and give specific recommendations based on this information.”166
Clinical trial: “A clinical trial is a research study involving human participants that evaluates the safety and/or
effects of one or more interventions on health outcomes.”167
Data custodian: “As defined in Canadian health legislation, an individual or organization responsible for the
secure collection and/or storage of health data and the curation of health data use, disclosure, retention and
disposal. Primarily concerned with security and privacy of health data.”45
Data steward: “An entity or senior government role responsible for assuring the quality, integrity and access
arrangements of data and metadata in a manner that is consistent with applicable law, institutional policy and
individual permissions. Includes entities and positions that deal primarily with personal health information, and
those that deal with other health information.”45
Disaggregated data: Data “that has been extrapolated (taken) from aggregated data and divided and broken
down into smaller information units.... Disaggregating data involves delving more deeply into a set of results
to highlight issues that pertain to individual subsets of results and/or outcomes of aggregated data. Collective
or aggregate data can be broken down or disaggregated, for instance, by: gender, urban/ rural location,
income, socio-cultural or ethnic background, language, geographical location, political/ administrative units,
or age groups.”168
Distinctions-based: “An approach that aims to avoid conflating the Indigenous Peoples within Canada, and
instead recognizes First Nations, Inuit and Métis as separate groups, each with their own diverse cultures,
traditions, communities and histories. A distinctions-based approach ensures that the unique rights, interests
and circumstances of each of these groups are acknowledged, affirmed and implemented.”60
Expert: An individual “having, involving, or displaying special skill or knowledge derived from training or
experience.”169 Expertise includes both codified and tacit knowledge.
FAIR data principles: Guidelines to support scientific data management and stewardship. FAIR Data are
Findable, Accessible, Interoperable and Reusable.146
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Health care data: Data or information collected during and related to the health care provided to an individual
person. It is distinguished from public health data (see definition), although there may be some overlap
(e.g., vaccination data).
Health data system: A health data or information system refers to a system designed to manage health care
data. This includes primarily systems that collect, store, manage and transmit patients’ electronic medical
records related to any care within a health system.
Health equity: “Means that all people (individuals, groups and communities) have fair access to, and can act
on, opportunities to reach their full health potential and are not disadvantaged by social, economic and
environmental conditions, including socially constructed factors such as race, gender, sexuality, religion and
social status. Achieving health equity requires acknowledging that some people have unequal starting places,
and different strategies and resources are needed to correct the imbalance and make health possible. Health
equity is achieved when disparities in health status between groups due to social and structural factors are
reduced or eliminated.”98
Health data: “Observations, facts or measurements–captured for possible further analysis, calculation or
reasoning–which relate to the physical or mental health status of individuals, health system performance and
socio-economic, community and health system characteristics.”45
Health data interoperability: Refers to “the ability of different information systems, devices and applications
(systems) to access, exchange, integrate and cooperatively use data in a coordinated manner to optimize the
health of individuals and populations.”46
Health outcome: “Health outcomes are defined as those events occurring as a result of an intervention.
These may be measured clinically (physical examination, laboratory testing, imaging), self-reported, or
observed (such as gait or movement fluctuations seen by a health care provider or caregiver).”170
Health Portfolio: A group of federal government departments that support the Minister of Health, namely
Health Canada, Public Health Agency of Canada, Canadian Institutes of Health Research, Patented Medicine
Prices Review Board and Canadian Food Inspection Agency.”171
Health research system: “The people, institutions, and activities whose primary purpose in relation to
research is to generate high-quality knowledge that can be used to promote, restore, and/or maintain the
health status of populations; it should include the mechanisms adopted to encourage the utilization of
research.” 172
Indigenous and First Nations data sovereignty : “The concept of First Nations authority, right, power to
govern as sovereign Nations and make decisions or laws on the ownership, control, collection, access, analysis,
application, possession and use of their own data.”162
Interdisciplinary: An interdisciplinary research approach involves the interplay and reconciling of
methodologies, theories, and knowledges from distinct disciplines in the pursuit of addressing new scientific
questions or societal challenges.173
Knowledge mobilization: Knowledge mobilization encompasses “a wide range of activities relating to the
production and use of research results, including knowledge synthesis, dissemination, transfer, exchange, and
co-creation or co-production by researchers and knowledge users.”174
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Learning health system: Drives better outcomes for individuals with their own health data and personalized
insights while improving overall system quality, population health, evaluation, planning, and public health,
aligned with data user needs and supporting equitable health.45
Medical countermeasure: “Medical countermeasures are medicines and medical supplies that can be used
to diagnose, prevent, or treat diseases related to chemical, biological, radiological, or nuclear threats.”175
Multidisciplinary: Multidisciplinary approaches draw “on knowledge from different disciplines but stays within
their boundaries.”176
Non-pharmaceutical intervention: “Non-pharmaceutical Interventions (NPIs) are actions, apart from getting
vaccinated and taking medicine, that people and communities can take to help slow the spread of illnesses like
pandemic influenza (flu).”177 NPIs are also referred to as public health measures.
One Health Approach: “One Health is an integrated, unifying approach that aims to sustainably balance and
optimize the health of people, animals, and ecosystems. It recognizes the health of humans, domestic and wild
animals, plants, and the wider environment (including ecosystems) are closely linked and interdependent.
The approach mobilizes multiple sectors, disciplines, and communities at varying levels of society to work
together to foster well-being and tackle threats to health and ecosystems, while addressing the collective
need for healthy food, water, energy, and air, taking action on climate change and contributing to sustainable
development.”178
Person-centric health data: “Data follows the individual across points of care to support individual, clinical,
and analytical access and use while respecting individual privacy with regard to the handling of their information
under existing privacy legislation.”52
Personal health information: “Health data or information that is specific to a unique and identified individual.”45
Public health data: Public health data are data collected by local, provincial/territorial or federal public health
departments/professionals in exercising their mandate to help protect and improve people’s health. These
data include data about individuals (collected, for instance by surveillance or surveys or contact tracing),
as well as other information (e.g., wastewater surveillance data).
Research: “Research is defined as an undertaking intended to extend knowledge through a disciplined inquiry
and/or systematic investigation.”141 Research may be led by practitioners, communities or researchers and is
inclusive of a wide variety of theoretical and methodological approaches, including but not limited to
Indigenous research methods, clinical research practices and epidemiological investigations.141
Risk governance: The system developed to manage the identification, assessment, and plan to address
various risks when they arise. This includes taking measures to prevent their occurrence or to minimize their
impacts.179
Risk register: “A register that contains a list of identified risks and related information used to facilitate the
monitoring and management of risks. Note: The risk register is generally in the form of a table, spreadsheet or
database and may contain the following information: statement or description of the risk, source of risk, areas
of impact, cause of the risk, status or action of sector network, existing controls, risk assessment information
and any other relevant information.”164
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Science advice: “The provision of advice from scientific experts to key stakeholders such as policy makers,
crisis managers and the public, based on their scientific evidence and expertise. The process can include
collecting and analysing evidence, providing advice, and communicating with key stakeholders in appropriate
and timely manners.”25
Seroprevalence: “Seroprevalence is a type of health information surveillance that indicates infection history in
a population, based on a measure of blood proteins (known as antibodies).”180
Social determinants of health: “The non-medical factors that influence health outcomes. They are the
conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping
the conditions of daily life. These forces and systems include economic policies and systems, development
agendas, social norms, social policies and political systems.”181
Structural determinants of health: “Structural determinants of health are processes that create inequities
in money, power and resources. They include political, cultural, economic and social structures; natural
environment, land and climate change; and history and legacy, ongoing colonialism and systemic racism.
Structural determinants, also known as structural drivers, shape the conditions of daily life (social determinants of
health) including education, work, aging, income, social protections, housing, environment and health systems.”98
Surveillance: “Tracking health events and determinants through the collection, analysis and reporting of data.”182
Table-top simulation: Teaching and training exercise based on fictious scenarios.183
Therapeutics: “Therapeutics are treatments used to alleviate or prevent a particular disease. Examples of
therapeutics include drug therapy, medical devices, nutrition therapy and stem-cell therapies. Therapeutics
can be used in patients with active disease–to treat the disease itself or its signs and symptoms–in preventive
medicine, or as palliative care.”184
Transdisciplinary: “Transdisciplinary research, which is necessarily interdisciplinary, goes further; it integrates
knowledges from different disciplines as well as knowledge and perspectives which may be viewed as
‘non-scientific’, such as local and traditional knowledge, cultural norms, and social values.”173
Variant of interest: “A SARS-CoV-2 variant with changes that are known to affect how the virus behaves or
its potential impact on human health. This can include, for example, its ability to spread, its ability to cause
serious disease, or how easily it may be detected or treated.”185
Variant of concern: “A SARS-CoV-2 variant that meets the definition of a [Variant of Interest], but also meets
at least one of the following criteria when compared with other variants: it can cause a detrimental change in
disease severity; it can have a substantial impact on the ability of health systems to provide care to patients
with COVID-19 or other illnesses and therefore require major public health interventions; or there is a significant
decrease in the effectiveness of available vaccines in protecting against severe disease.”185
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
87
Appendices
Appendix A: List of Permanent and Ad hoc Federal
Research Coordination and Science Advisory Groups
that Supported the COVID-19 Pandemic Response
Governance
Canada Research Coordinating Committee
Coordination Forum on Major COVID-19 Initiatives
Deputy Minister Committee on Medical Countermeasures and Research Initiatives
Federal Pandemic Science Coordination and Action Group
Special Advisory Committee on COVID-19
Technical Advisory Committee on COVID-19
Variants of Concern Leadership Group
Variants of Concern Scientific Advisory Council
Expert Advice
Ad-hoc COVID-19 Clinical Pharmacology Task Group
Chief Science Advisor COVID-19 Expert Panel
Chief Science Advisor Expert Groups and Task Forces
Council of Expert Advisors
COVID-19 Exposure Notification App Advisory Council
COVID-19 Testing and Screening Expert Advisory Panel
COVID-19 Therapeutics Task Force
COVID-19 Vaccine Task Force
Expert Advisory Group on the Pan-Canadian Health Data Strategy
Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management
National Advisory Committee on Immunization (NACI)
National Collaborating Centres for Public Health
Public Health Ethics Consultative Group
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Approach to Pandemic Science Advice and Research Coordination
Mission-focused Networks
Canadian Public Health Laboratory Network
Wastewater Working Groups
Research funding
Canadian COVID-19 Genomics Network (CanCOGeN)
Canadian Institutes of Health Research COVID-related initiatives:
⚫
Rapid Response Research
⚫
Emerging COVID-19 Research Gaps and Priorities
⚫
Centre for Research on Pandemic Preparedness and Health Emergencies
Canadian Network of COVID-19 Clinical Trials Networks
Canadian Post COVID-19 Condition Research Network
Coronavirus Variants Rapid Response Network (CoVaRR-Net)
COVID-19 Immunity Task Force (CITF)
Natural Sciences and Engineering Research Council of Canada (NSERC) COVID-related initiatives
⚫
Alliance COVID-19 Grants Initiative
⚫
Emerging Infectious Diseases Modelling Network (with the Public Health Agency of Canada)
Social Sciences and Humanities Research Council (SSHRC) COVID-related initiatives
⚫
Partnership Engage Grants COVID-19 Special Initiative
Knowledge Synthesis
CanCOVID
COVID-19 Evidence Network to support Decision-making (COVID-END)
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
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The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
Jan
Feb/20: External
COVID-19 Expert
Modelling Group
2020
Jan
2020
Dec/20: Expert
Advisory Group on the
Pan Canadian Health
• Nov/20: COVID-19 Testing and
Data Strategy
Screening Expert Advisory Panel
Apr
2020
Apr
2020
Led by Chief Science Advisor of Canada
2021
Apr
2021
Deputy Minister of Health
Reporting date
Chaired/co-chaired by
Reporting date
Jan
2021
Jan
2021
Led by Innovation, Science, and Economic Development Canada
Oct
2020
Oct
2020
Oct
2021
Oct
2021
Graph and data from World Health Organization (weekly)
Jan
2022
Jan
2022
• Mar/23: Council
of Expert
Advisors
Concept adapted from: Bhatia, D., Allin, S. & Di Ruggiero, E. Mobilization of science advice by the Canadian
federal government to support the COVID-19 pandemic response. Humanit Soc Sci Commun 10, 19 (2023).
Jul
2021
Jul
2021
Concept adapted from: Bhatia, D., Allin, S. & Di Ruggiero, E. Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response. Humanit Soc Sci Commun 10, 19 (2023).
Led by Health Canada and Innovation, Science,
and Economic Development Canada
Jul
2020
Jul
2020
Sep/20: Advisory Council
May/20:
Industry
• Mar/20:
COVID-19
Expert Panel
to FPT Governments on
Strategy Council
the National COVID-19
• Mar/20: Expert Group on Modelling Approaches
Exposure Notification App
• Mar/20: Expert Group on Health Systems
Apr
Led by Health Canada and Innovation, Science, and
Economic Development Canada
Feb/21: Variants of
Nov/20: COVIDConcern
19 Testing and
• Oct/20:
Industry
Advisory
Roundtable
Leadership Group
Screening Expert
on COVID-19
Testing, Screening,
•
May/20:
Industry
Strategy
Council
Advisory
Panel
Jul/20: Therapeutics
Mar/20: Expert
Jun/20: Minister’s
and Data Management
Task Force
Group on Modelling COVID-19 Expert
Feb/21: Variants of
Approaches
Group COVID-19 Immunity Task Force
• Apr/20:
Concern Scientific
Oct/20: Industry Advisory
Advisory Committee
Roundtable
on COVID-19
•
Sep/20:
COVID-19
Exposure
Jun/20:
COVID-19
•
Mar/20:
DM
Committee
for
COVID
Mar/20: Expert
Testing, Screening,
and
Notification
App Advisory
Council
Clinical
Pharmacology
Management
Medical
Countermeasures
Group on Health
Data
Management
Task Group
and Research
Initiatives
Systems
Mar/20: COVID-19
Expert Panel
Jul/20: DM
CommitteeVaccine
on
• June/20: COVID-19
Task Force
Vaccine Roll-out
Mar/23: Council of
Expert Advisors
Jan/22: Federal
Pandemic Science
Coordination and
Action Group
• Feb/21:
Variants
of Concern Science, and Economic
• Jan/22:
Federal Pandemic Science
Led
by Innovation,
Development
Leadership Group
Coordination and Action Group
Jan/22: Centre for
Led
by Chief
Science Advisor of Canada• Jan/22: Centre for Research
• Feb/21:
Variants
of Concern
on Pandemic
Research
on Pandemic
Scientific Advisory Committee
Preparedness and Health
Emergencies
Preparedness
and Health
Chaired/co-chaired by Deputy Minister of Health
Emergencies
• Dec/20: Expert Advisory Group on the Pan Canadian
Health Data Strategy
Led by Health Portfolio
• Jul/20: DM Committee
on Vaccine Roll-out
(Amalgamated
Oct/20)
Jul/20:
DM
Committee
on
• Jul/20: Coordination
Forum
advance
purchase
on Major
COVID-19 Initiatives Dec/20: Vaccine
agreements
Surveillance
• Jul/20: COVID-19 Therapeutics
Reference Group
Task Force
agreements
• Jun/20: Minister’s COVID-19
Expert Group
Jul/20: Coordination
Forum onClinical
Major
• Jun/20: COVID-19
June/20: Vaccine
COVID-19
Initiatives
Pharmacology
Task Group
Task Force
Mar/20: DM Committee
for COVID Management
Medical
Countermeasures and
Research Initiatives
Led by Health Portfolio
Graph and data from World
Health Organization (weekly)
0 0
100,000
100,000
200,000
200,000
Jan/20:
Special
Advisory
300,000
300,000
Committee
and
Technical
Advisory
Committee
Task
Force
• Feb/20: External
COVID-19
Expert Modelling Group
Apr/20: Immunity
Ministers of Health and FPT Conference
Jan/20: COVID-19
of DeputyFPT
Ministers
Conference of Ministers
•
Jan/20:
of Health and
FPTSpecial Advisory Committee
and
Conference
of Technical
Deputy Advisory Committee
Ministers
Timeline of science
advisory
and coordination
bodies
response to COVID-19
• Jan/20: COVID-19
FPT Conference
of
• Dec/20: Vaccine Surveillance Reference Group
on advance in
purchase
• Jul/20: DM Committee
Federal
Approach
to Pandemic
Science
Advice
andtoResearch
Timeline
of science advisory
and coordination
bodies
in response
COVID-19 Coordination
Federal Approach to Pandemic Science Advice and Research Coordination
Figure 6: Timeline of science advisory and coordination bodies in response to COVID-19
Appendix B: COVID-19 Timeline
Confirmed
cases/week
Confirmed
cases/week
90
The Time to Act is Now Report of the Expert Panel for the Review of the Federal
Approach to Pandemic Science Advice and Research Coordination
91
Jan
2020
Jan
2020
Modelling Group
Apr
2020
Apr
2020
Research Funding
Jun/20: COVID-19
Mar/20: Expert
Clinical Pharmacology
Group on Health
Task Group
Systems
• Feb/20: COVID-19 Rapid
Research funding
May/20:
competition (Round
1) Industry
Feb/20: External
Strategy Council
COVID-19 Expert
• Apr/20: Canadian Treatments
Mar/20: Expert
Jun/20:
Minister’s
for COVID-19
trial (CATCO)
Group on Modelling COVID-19 Expert
Approaches
Group
• Apr/20: COVID-19 Rapid
Mar/20: COVID-19
June/20: Vaccine
competition
Expert PanelResearch funding
Task Force
(Round 2)
• Apr/20:
CanCOVID
Mar/20:
DM Committee
for COVID Management
• Apr/20: Canadian COVID
Medical
Genomics Network
Countermeasures and
Research(CanCOGeN)
Initiatives
Apr/20: Immunity
Task Force
• Apr/20: COVID-19 Immunity
Task Force
Jul
2020
Jul
2020
Other
Oct
2020
Oct
2020
Jan
2021
Jan
2021
Reporting date
Reporting date
• Aug/20:
Canadian
Sep/20:
AdvisoryImmunization
Council
Research
(vaccine
to FPTNetwork
Governments
on readiness)
the National COVID-19
Exposure Notification App
Research
grants
Testing,
Screening, and
Data Management
Apr
2021
Apr
2021
Jul
2021
Jul
2021
Oct
2021
Oct
2021
• Jul/22: CIHR Clinical
Trials Fund – Accelerating
Clinical Trials (ACT)
Consortium
Graph and data from World Health Organization (weekly)
Jan
2022
Jan
2022
• Aug/23: CIHR Clinical
Trials Fund Extension
• Mar/23: Biomanufacturing
Research Hubs
• Mar/23: Canadian Post
COVID-19 Condition
Research Network
• Jul/22: Canadian
ADAptive Platform
Trial of COVID-19
Therapeutics in
Community Settings
• Jul/22: CIHR Clinical
Trials Fund – Clinical
Jan/22: Centre for
Trials Training Grants
Research on Pandemic
Preparedness and Health • Jul/22: CIHR Clinical
Trials Fund – Clinical
Emergencies
Trials Projects
Jan/22: Federal
Pandemic Science
Coordination and
Action Group
Mar/23: Council of
Expert Advisors
• Oct/21: COVID-19
Evidence Network to
support Decision-making
(COVID-END) extension
• Jul/21: Emerging COVID-19 research
gaps and priorities funding (Round 3)
• Jul/21: Canada’s Biomanufacturing
and Life Sciences Strategy
• Mar/21: Emerging COVID-19 research
gaps and priorities funding
Chaired/co-chaired
by (Round
Deputy2)Minister of Health
Led by Chief Science Advisor of Canada
Led by Innovation, Science, and Economic Development
Response Network (CoVaRR-Net)
Feb/21: Variants of
Nov/20: COVIDConcern
19 Testing and
• Oct/20: Emerging Infectious Diseases
Leadership Group
Screening Expert
Modelling
Initiative
Advisory
Panel
Expert
• Nov/20:Dec/20:
Emerging
Advisory
Group
on the
COVID-19
research
gaps
Pan Canadian
and priorities
funding Health
(Round Data
1) Strategy
• Nov/20:Dec/20:
Canadian
Vaccine
NetworkSurveillance
of COVID-19
Reference Group
Clinical Trials
Led by Health Canada and Innovation, Science, and
EconomicVariants
Development
• Feb/21: Coronavirus
Rapid Canada
Led by Health Portfolio
• Oct/20: Knowledge Synthesis Network
Feb/21: Variants of
Concern Scientific
Oct/20: Industry Advisory
• Sep/20:
Indigenous
COVID-19 Rapid Advisory Committee
Roundtable
on COVID-19
Jul/20: Therapeutics
Task Force
Jul/20: Coordination
Forum on Major
COVID-19 Initiatives
Jul/20: DM
Committee on
Vaccine Roll-out
Jul/20: DM
Committee on
advance purchase
agreements
to support Decision-making
(COVID-END)
• Apr/22: Canadian
Network of COVID-19
Clinical Trials Extension
federal government to support the COVID-19 pandemic response. Humanit Soc Sci Commun 10, 19 (2023).
Concept adapted from: Bhatia, D., Allin, S. & Di Ruggiero, E. Mobilization of science advice by the Canadian federal government to support the COVID-19 pandemic response.Concept
Humanit
Socfrom:
SciBhatia,
Commun
(2023).E. Mobilization of science advice by the Canadian
adapted
D., Allin,10,
S. &19
Di Ruggiero,
Research Network
Graph and data from World Health Organization (weekly)
0 0
100,000
100,000
200,000
200,000
Jan/20:
Special
Advisory
300,000
300,000
Committee
and
Technical
Advisory
Committee
Jan/20: COVID-19 FPT
Conference of Ministers
of Health and FPT
Conference of Deputy
Ministers
Timeline of science advisory and coordination bodies in response
to COVID-19
• Jan/21:
COVID-19 Evidence Network
Timeline
of researchto
coordination
initiatives
in response
COVID-19
Federal
Approach
Pandemic
Science
Advicetoand
Research Coordination
Federal
Approach
to Pandemic
Scienceinitiatives
Advice and
ResearchtoCoordination
Figure
7: Timeline
of research
coordination
in response
COVID-19
Confirmed
cases/week
Confirmed
cases/week
Appendix C: Permanent and Ad hoc Federal Research
Coordination and Science Advisory Groups that
Supported the COVID-19 Pandemic Response
Section 1: Canada’s Pre-COVID-19 Health Research and
Science Advice Ecosystem that Supported the Government
of Canada’s Pandemic Response
Prior to the COVID-19 pandemic, there were established institutions and processes in place to manage national
emergencies. Canada’s ecosystem for health research and science advice proved crucial in aiding decision
makers during the initial stages of the pandemic, prior to the implementation of more comprehensive
procedures. Further information about this ecosystem is outlined in this section.
Health Canada186 plays a leadership role in managing health crises by promoting research collaboration,
providing funding support, overseeing ethical considerations, and facilitating knowledge mobilization to
advance public health in Canada. The department:
⚫
Works with various groups, including federal, provincial and territorial (FPT) partners, academic
institutions, and international organizations, to foster research collaborations and support science
innovation that helps mitigate emerging health threats.
⚫
Supports and funds research related to health crises, including epidemiological studies, clinical trials,
and health system evaluations.
⚫
Works with other federal departments and agencies to ensure the availability of high-quality data for
research purposes that allows for a cohesive and effective response.
⚫
Oversees regulatory guidelines and approves drugs, vaccines, medical devices, and other health
products.
⚫
Manages specific regulatory guidelines for the use of new drugs for emergency treatments, allowing for
drugs not authorized in Canada to be used for health emergencies, including facilitating stockpiling of
new drugs by the Government of Canada during a public health emergency.
The Public Health Agency of Canada (PHAC)187 is responsible for governing public health functions including
emergency preparedness and response and has laboratory science capacity at its National Microbiology
Laboratory in Winnipeg, as well as surveillance and epidemiological expertise across branches. PHAC also
funds the National Collaborating Centres for public health and manages Canada’s public health through an
intergovernmental FPT collaboration via the Pan-Canadian Public Health Network. The National Advisory
Committee on Immunization is a permanent external advisory committee to PHAC.
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The Chief Public Health Officer (CPHO) of Canada188 position was created in 2004 to improve public health
in Canada and strengthen the country’s ability to respond to the public health threats, outbreaks and
emergencies. The CPHO provides advice to the Minster of Health and the President of PHAC on health issues,
works with other governments, jurisdictions, agencies, organisations, and countries on health matters, and
speaks to Canadians, health professionals, relevant groups and the public about issues affecting the
population’s health.
As Canada’s health research granting council, the Canadian Institutes of Health Research (CIHR)189 funds
the research and knowledge mobilization needed to inform the evolution of Canadian health policy and
regulation. This is achieved by funding strategic research priorities–such as population and public health, and
infection and immunity–through its 13 virtual institutes. CIHR’s Institutes form national research networks
linking researchers, funders, and knowledge users across Canada in order to work collaboratively on priority
research areas. CIHR also works with many partners domestically and internationally for research coordination.
The Pan-Canadian Public Health Network (PHN)190 is the formal governance for federal-provincial-territorial
governments across Canada. The PHN is composed of the PHN Council, the Council of Chief Medical Officers
of Health, the PHN Secretariat, and three steering committees. The PHN Council is accountable and reports to
the Conference of Federal-Provincial-Territorial Deputy Ministers of Health, which is, in turn, accountable to
Federal-Provincial-Territorial Ministers of Health. The Network supports horizontal linkages across public health
science, policy, and program priorities through collaboration with federal, provincial, and territorial Chief
Medical Officers of Health/Chief Public Health Officers, senior government officials, and other key groups
across the Federal-Provincial-Territorial public health system. The PHN works to strengthen the public health
policy and practice in Canada, anticipate, prepare for, and respond to public health events, and enable federal,
provincial, and territorial governments to work together to address public health priorities. A key function of the
PHN is to activate time-limited Special Advisory Committee that is activated in response to a public health
emergency and includes PHN members and the Council of Chief Medical Officers of Health. The PHN structure
and governance also includes permanent steering committees (e.g., Healthy People and Communities,
Communicable and Infectious Disease, etc.).
The Canadian Public Health Laboratory Network (CPHLN)191 is a forum where representatives from federal,
provincial, and territorial public health laboratories address issues of common concern, including public health
infrastructure, surveillance capabilities, and emergency preparedness. The Network is supported by PHAC’s
National Microbiology Laboratory (NML). During the COVID-19 pandemic, the Canadian Public Health
Laboratory Network published materials on best practices for the detection of the virus; including for specimen
collection, transportation, testing, and biosafety to ensure a consistent national approach.
The Canadian Immunization Committee (CIC),192 which consists of federal, provincial, and territorial
government representatives, provides strategic, operational, and technical advice on immunization program
planning to the PHN. The CIC is supported by technical governance bodies including the Canadian
Immunization Registries and Coverage Network and the Vaccine Vigilance Working Group. The Vaccine
Vigilance Working Group works to implement post-market vaccine safety surveillance in Canada.
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93
The National Advisory Committee on Immunization (NACI)17 provides ongoing scientific, medical, and
public health advice for routine and urgent programs related to Canada’s use of vaccines. The Committee is
composed of experts in varied fields (e.g., infectious diseases, immunology, social science, pharmaeconomics,
nursing, etc.) and reports to PHAC, Vice President of the Infectious Disease and Vaccinations Programs
Branch. NACI’s knowledge syntheses, analyses and recommendations on vaccine use in Canada are included in
published literature reviews, statements, and updates. NACI recommendations are also published in the
Canadian Immunization Guide.193 NACI played a significant role during the COVID-19 pandemic as a publisher of
recommendations surrounding the distribution, prioritization, and use of vaccines. This includes guidance on
dose scheduling amidst vaccine shortages and limited availability, preference of mRNA vaccines as opposed to
viral vector vaccines, and mixed vaccine schedules.
Canada’s Drug and Health Technology Agency (CADTH)194 was established jointly by Canada’s federal,
provincial, and territorial governments as a trusted source of independent information and advice for the
country’s publicly funded health care systems. During the COVID-19 pandemic, CADTH provided advice to
health administrators and policy experts on drugs, devices, and services used to prevent, diagnose, and treat
medical conditions. In May 2024, CADTH became Canada’s Drug Agency.103
The National Advisory Committee on Infection Prevention and Control (NAP-IPC)195 is a longstanding
external advisory body that provides subject matter expertise and advice to PHAC on the prevention and
control of infectious diseases in Canadian healthcare settings. The NAP-IPC provides advice to inform the
development of comprehensive or concise guidelines, quick reference guides and interim guidelines (usually
for emerging pathogens), working closely with PHAC’s national Healthcare-Associated Infections surveillance
programs for Canadian healthcare facilities.
The National Collaborating Centres (NCCs) for Public Health196 are funded through PHAC and work
together to promote the use of scientific research to strengthen public health practices, programs, and
policies in Canada. The NCCs for Public Health identify knowledge gaps, foster networks, and provide the
public health system with evidence-based resources and knowledge mobilization services. The NCCs for
Public Health are focused on: Indigenous Health, Determinants of Health, Healthy Public Policy, Environmental
Health, Infectious Diseases, and Methods and Tools.
PHAC’s Public Health Ethics Consultative Group197 is composed of academic and health care professionals
with experience in ethical theory, and public health or research ethics. They support PHAC decision-making,
service delivery, and response to public health emergencies as they relate to ethical considerations. The Public
Health Ethics Consultative Group established the Framework for Ethical Deliberation and Decision-making in Public
Health: A Tool for Public Health Practitioners, Policy Makers and Decision Makers198 and issued further COVID-19
specific guidance.
The Canadian Task Force on Preventive Health Care199 is an arms-length group funded by PHAC to develop
and publish evidence-based primary care guidelines. The group was leveraged by PHAC early in the pandemic
for guidance on personal protective equipment.
The Canadian Immunization Research Network200 was established in 2009 through a PHAC and CIHR
partnership to be a national network of key vaccine researchers who develop and test methodologies related
to the evaluation of vaccines as they pertain to safety, effectiveness, and program implementation and
evaluation. The Canadian Vaccine Safety Network, which is a research sub-network of the Canadian
Immunization Research Network, was established in 2009 and provides active surveillance capacity by quickly
identifying any safety signal or adverse events following immunization.
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The role of the Chief Science Advisor of Canada201 was created in 2017 with the mandate to support the
Government of Canada’s science function and improve the flow of scientific advice to decision makers.
The Chief Science Advisor’s key functions are to provide advice on the development and implementation
of guidelines to ensure that government science is fully available to the public and that federal scientists are
able to speak freely about their work; provide advice on creating and implementing processes to ensure that
scientific analyses are considered when the Government makes decisions; assess and recommend ways to
improve the existing science advisory function within the federal government; and assess and recommend
ways for the Government to better support quality scientific research within the federal system.
In 2018, the Chief Science Advisor established the Departmental Science Advisors (DSA) Network108—a
network of lead science officials and subject matter experts within each of the government’s science-based
department and agencies. The DSA network promotes a community of practice by sharing information and
best practices, developing cross-departmental partnerships, and promotes a coordinated approach to
providing science advice to government. The network recommends approaches that enable high standards
of research, champion departmental science portfolios, and support a culture of scientific excellence and
collaboration. Finally, the DSA network serves as a major conduit in timely development and provision of
science advice to senior departmental decision makers and to the Chief Science Advisor. In the Health
Portfolio, both Health Canada and PHAC have Departmental Science Advisors that advise the Deputy Minister
of Health and President of PHAC, respectively.
The Presidents of the granting councils, CIHR, the Natural Sciences and Engineering Research Council of Canada,
and the Social Sciences and Humanities Research Council, form the Tri-Council. The table promotes highquality research in a wide variety of disciplines at post-secondary institutions in Canada.
The Canada Research Coordinating Committee202 advances federal research priorities and the coordination
of policies and programs of Canada’s federal research granting councils and the Canada Foundation for
Innovation. It provides a strategic forum for sharing information, building consensus, and making decisions
on forward-looking initiatives that strengthen Canada’s research enterprise, foster world-leading research,
and advance Canadians social and economic well-being. This includes focusing on key priority areas such
as enhancing equity and diversity in research, increasing the capacity of First Nations, Inuit, and Métis
communities to conduct research and partner with the broader research community, and improving support
for the next generation of researchers. The Committee consists of the Presidents of the federal granting
councils, the Chief Science Advisor, Presidents of the Canada Foundation for Innovation and the National
Research Council of Canada (NRC), and Deputy Ministers of Health Canada and Innovation, Science and
Economic Development Canada (ISED).
The National Alliance of Provincial Health Research Organizations’203 primary role is to facilitate
coordination, communication, strategic alignment, convergence, and quality leadership through inter-provincial
and national efforts. The Health Charities Coalition of Canada204 supports member organizations working
together on common issues related to health research and health policy to achieve better health outcomes for
Canadians. CIHR also plays an advisory role on research and innovation issues through an extensive and growing
set of linkages with Health Canada and PHAC, providing decision makers with access to high-quality and timely
health research outcomes and results.
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95
Section 2: Health Research and Science Advice Ecosystem
Established During Various Stages of the COVID-19
Pandemic (2020—2023)
As part of Canada’s evolving pandemic response, significant research investments were made through
multiple federal departments and agencies including Health Canada, PHAC, ISED, the NRC, and CIHR to
improve the understanding of, and ability to respond to, COVID-19. Various initiatives were funded to enhance
the understanding of the virus and scientific evidence was collected and analysed in real-time to support
evidence-based decisions.
In addition to governance bodies that were activated as part of existing pandemic response protocols, it was
quickly determined that a more comprehensive response to the Government of Canada’s approach to
collecting and facilitating science advice and research coordination was required. Health Canada played a
central role in this regard, collaborating with other federal departments and agencies to ensure that Canada’s
scientific ecosystem adequately supported the creation of knowledge and advancement of technology.
Various governance and coordination bodies were established across disciplines at various stages of the
pandemic. The Deputy Minister of Health played a leadership role in this regard, defining needs, designing
structures, and supporting the evolution of governance. The actions taken are summarised in this appendix.
The Deputy Minister of Health had a chairing or similarly critical role on many different committees and had
direct or indirect visibility into all others. As Portfolio Head, the Deputy Minister of Health also engaged in
continuous coordination with the Presidents of PHAC and CIHR, in addition to other Deputy Heads and the
Chief Science Advisor of Canada; and formed numerous Deputy Minister-level committees to coordinate the
receipt of scientific advice and the translation of guidance to inform policy and decisions, including
recommendations to Cabinet.
Health Research and Science Advice Ecosystem Established During
the Early COVID-19 Pandemic Period (2020)
i. Governance bodies
Existing Federal-Provincial-Territorial governance committees such as the Conference of FederalProvincial-Territorial Ministers of Health and Conference of Federal-Provincial-Territorial Deputy
Ministers of Health played a critical role in the Canadian pandemic response, also met frequently and served
as a focal point to coordinate the federal-provincial-territorial response to the pandemic.
PHN’s Special, Technical, and Logistics Advisory Committees4: In response to the first case of COVID-19
in Canada, PHAC initiated its Incident Management System in mid-January 2020. As part of the emergency
response, an ad hoc COVID-19 Special Advisory Committee, Technical Advisory Committee, and Logistics
Advisory Committee were stood up under the Pan-Canadian PHN framework to provide an active forum for
discussion on various shared jurisdiction public health issues. The Special Advisory Committee met regularly to
discuss the evolution of COVID-19 in Canada and public health measures being undertaken to manage the
pandemic. The Special Advisory Committee also developed the Federal/Provincial/Territorial Public Health
Response Plan for Ongoing Management of COVID-19,205 in 2020, in collaboration with First Nations, Inuit, and
Métis governments, and other health partners. Subsequent updates have focused on the transition from the
acute waves of COVID-19 activity towards a more sustainable long-term response.
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Deputy Minister Committee on Medical Countermeasures and Research Initiatives (Health Canada
and ISED led, May 2020): The Deputy Minister and Assistant Deputy Minister Committees for Medical
Countermeasures aimed to provide strategic oversight and decision making based on scientific advice related
to diagnostics, treatments, therapies, and vaccines required for the Canadian health care system and national
health security. This included advising Ministers on large-scale investments and coordinating direction of
procurements and other investments to ensure supply.
The Coordination Forum on Major COVID-19 Initiatives (Health Canada led), established by the Deputy
Minister of Health to coordinate efforts, exchange information, maximise COVID-19 intelligence to support
research and experimentation efforts, identify options and opportunities to enhance the effectiveness of
COVID-19 efforts across the country, and avoid duplication between the major governance, research and
manufacturing initiatives, focused on medical countermeasures and immunity. Co-chaired by the Deputy
Ministers of Health and ISED, the forum membership included a wide range of experts including the chairs of
other expert panels and task forces.
ii. Establishment of expert advisory committees
COVID-19 Expert Panel206 (Office of the Chief Science Advisor-led, established March 2020): The Chief
Science Advisor led the creation of multidisciplinary science panel to provide the government with advice on
the latest scientific developments relevant to COVID-19. The Expert Panel met 40 times in its first year;
participants included federal Ministers and Deputy Ministers, as well experts from across Canada’s scientific
community to provide evidence-based advice on issues such as disease modelling, risk management,
diagnostics, and clinical research. Subgroups of experts co-chaired with the Deputy Minister of Health were
further formed to provide advice, such as Health Systems and Modelling Approaches. Subject-specific task
forces and special meetings of experts were also convened on a variety of timely topics. These task forces
allowed the Expert Panel to benefit from additional, focused expertise in gathering practical and scientific
information and formulating advice. Six public reports have been published by the Expert Panel on emerging
COVID-19 issues, including COVID-19 in children, bioaerosols and indoor ventilation, COVID-19 vaccination
certificates, and long COVID, amongst others.
COVID-19 Vaccine Task Force16 (Health Canada and ISED led, June 2020–March 2023): The Vaccine Task
Force was established in June 2020 to provide advice on COVID-19 vaccine development, commercialization,
and manufacturing. The Task Force was made up of key external experts, and ex officio members (e.g., the
Deputy Ministers of ISED and Health Canada, the President of PHAC and the Chief Science Advisor). The Task
Force ultimately advised decision makers on promising domestic vaccine development candidates, priority
international vaccines for procurement and supply chain coordination, recommended investments to expand
domestic biomanufacturing capacity, and other related public health priorities. The Task Force provided over
50 letters of advice to Ministers. The Deputy Minister Committees on Vaccine and Therapeutics Procurement
integrated advice from different sources and coordinated recommendations.
COVID-19 Therapeutics Task Force207 (Health Canada and ISED led, July 2020–February 2021): The task
force was created by ISED to provide expert advice to decision makers on developing and/or producing
treatments for COVID-19 and bring new therapies into the Canadian market. The Task Force worked to assess
and prioritize COVID-19 therapeutic projects seeking government support and drew from their expertise as
industry leaders and researchers in drug research, development, and commercialization. The task force
provided advice to the Ministers of Health Canada and Innovation, Science and Industry, with Deputy Ministers
of ISED and Health Canada, the President of PHAC, and the Chief Science Advisor as ex officio members.
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Joint Biomanufacturing Subcommittee208 was convened in June 2020, comprising members of the
Therapeutics Task Force and Vaccine Task Force, with a mandate to provide Ministers of Innovation, Science,
and Industry and Health Canada with recommendations on bio-manufacturing investments. This included
assessing bio-manufacturing projects proposed to the government under the Strategic Innovation Fund,
developing an overall strategy to increase domestic bio-manufacturing capacity, and advising the government
on efforts to attract international vaccine candidates to manufacture vaccines in Canada.
Industry Strategy Council209 (ISED led, May 2020): The Minister of ISED established the Industry Strategy
Council to evaluate the effect of COVID-19 on Canada’s economy. The Council’s purpose was to identify the
extent of pandemic impact on the industry, communicate sector-specific challenges to the government, and
gather input from the industry. The council held multiple meetings and presented detailed suggestions to the
Minister on restarting, recovering, and reimagining Canadian businesses in the aftermath of the pandemic.
COVID-19 Testing and Screening Expert Advisory Panel210 (Health Canada led, established October 2020):
Recognizing the need to stay on top of the latest science developments, Health Canada established a Testing and
Screening Expert Advisory Panel to provide evidence-informed advice to the federal government and provincial
and territorial partners on science and policy related to innovative approaches to testing and screening for
COVID-19. The Panel comprised 13 individuals with expertise in epidemiology, virology, advanced data analytics,
pediatrics, health care provision, and technology assessment, both internationally and in Canada, and included
the Deputy Minister of Health Canada and other senior leadership from across the Health Portfolio as ex officio
members. The Panel released five reports in 2021—the first focused on broad strategies to optimize self-testing in
Canada, while others focused on discreet issues, such as testing and screening, long-term care, educational
institutions, and border management with timely and relevant guidance to the Minister based on the best
available science, data, and experiences. Based on the advice from the panel and roundtable, the Health Canada
Testing Secretariat looked to expand the distribution of rapid tests across Canada to support workplace and
individual screening in addition to provincial and territorial efforts to help limit the spread of the virus and
workplace/community outbreaks. Health Canada and the NML worked on developing guidelines and workflows
related to testing in support of Safe Restart and broader re-opening efforts.
Industry Advisory Roundtable on COVID-19 Testing, Screening, Tracing and Data Management211
(Health Canada led, November 2020): As it became apparent that Health Canada needed a better understanding
of industry and civil society needs on testing, the Department launched the Industry Advisory Roundtable on
COVID-19 Testing, Screening, Tracing and Data Management, which provided recommendations on testing
and screening and its role in the resumption of the economy. The Roundtable was launched in consultation
with the Industry Strategy Council and allowed the federal government to hear directly from and collaborate
with leaders from across Canadian industry sectors. The expert panel published reports to recommending the
implementation of screening protocols using rapid antigen tests at scale in Canada and providing free support to
organizations to implement workplace screening programs and navigate procurement of tests through various
available channels.
COVID-19 Exposure Notification App Advisory Council212 (Health Canada and ISED led, August 2020–
July 2021): The COVID-19 Exposure Notification App Advisory Council was established in August 2020 by ISED
and Health Canada to support the effective roll-out and operations of Canada’s national exposure app (COVID
Alert), with the aim of building public trust in the initiative and ensuring provincial and territorial governments
benefit from related expert advice and guidance. The Advisory Council consisted of experts with technological
and/or health governance expertise and oversaw the technical development of the app including providing
design methodology and behavioural science to maximize public uptake, roll-out and necessary guidance,
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and wind-down. The Council provided reports to the Deputy Ministers of Health Canada, ISED, and
Intergovernmental Affairs, as well as the Secretary of the Treasury Board of Canada and relevant provincial
and territorial Deputy Ministers; and published three reports outlining the social and economic determinants
of the app, and the use of COVID Alert as a government service and as a public health tool.
Ad hoc COVID-19 Clinical Pharmacology Task group (CPTG)213 (PHAC led, summer 2020–March 2021):
Composed of volunteers from various Canadian medical associations, the CPTG was convened by PHAC in
mid-2020 to inform decision makers and health care professionals on the use of pharmaceuticals for the
treatment or chemoprophylaxis of COVID-19, including the determination of appropriate allocation of limited
supplies to provinces and territories.
Minister of Health’s COVID-19 Expert Group (June 2020–2021): This was an informal mechanism created with
an interdisciplinary group of experts for the purpose of open, informal discussion with the Minister of Health,
Deputy Minister of Health, and senior Health Portfolio officials on a wide range of strategic issues related to
COVID-19 (e.g., second wave preparations, epidemiology, behavioural science, risk communications, etc.).
iii. Mission focused networks
In October 2020, the Natural Sciences and Engineering Research Council of Canada launched the Emerging
Infectious Disease Modelling214 initiative to establish multi-disciplinary networks of specialists in modelling
infectious diseases to be applied to public needs associated with emerging infectious diseases and pandemics
such as COVID-19. Jointly delivered with PHAC, this initiative provided $10M in funding to five research networks.
COVID-19 Immunity Task Force (CITF)33 (Health Canada and PHAC led, established April 2020): The CITF
was created with the goal of catalyzing, supporting, funding, and harmonizing research into COVID-19
immunity to inform evidence-based decisions. The CITF made recommendations to Health Canada and PHAC
through its Executive Committee (dissolved in December 2022) regarding research projects to be funded, and
supported a series of serological, immunity, and vaccine surveillance studies aimed at the Canadian population
and priority sub-groups. The CITF membership consists of expert researchers/academics in relevant fields and
senior government representatives (Chief Science Advisor of Canada, Health Canada, PHAC’s Chief Science
Officer). The Vaccine Surveillance Reference Group, a subcommittee of CITF, identified specific issues in
vaccine surveillance, based on inventories of existing resources and networks, and helped develop and support
additional surveillance initiatives to address these gaps in coordination with the provinces and territories.
Canadian COVID-19 Genomics Network (CanCOGeN)215: In April 2020, Genome Canada launched
CanCOGeN to establish a coordinated pan-Canadian, cross-agency network for large-scale SARS-CoV-2 and
human host sequencing to track viral origin, spread and evolution, characterize the role of human genetics in
COVID-19 disease, and to inform time-sensitive critical decision making relevant to health authorities across
Canada during the pandemic. CanCOGeN is a Genome Canada-led consortium of Canadian federal, provincial
and regional public health authorities and their health care partners, academia, industry, hospitals, research
institutes and large-scale sequencing centres. The network contributed to building national capacity to
address future outbreaks and pandemics.
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Coronavirus Variants Rapid Response Network (CoVaRR-Net)216: CoVaRR-Net was established in March
2021 at the request of the Deputy Minister of Health Canada with funding from CIHR to help address growing
concerns around emerging COVID-19 variants. CoVaRR-Net is a network of interdisciplinary researchers that
work with the PHAC NML, CanCOGeN, and provincial, territorial, and international institutions to understand
the impact of COVID-19 variants on the immune response to the virus and the potential for vaccine escape.
In addition to research on variants of concern, CoVaRR-Net also developed resource and data sharing
platforms (e.g., BioBank and data platforms and laboratory safety guidance (Canadian Consortium
of Academic Biosafety Level 3 Laboratories)). CoVaRR-Net’s work also includes the Computational Analysis,
Modelling and Evolutionary Outcomes (CAMEO) group; composed of academic researchers and members
of PHAC, CAMEO uses computer modelling to evaluate the genetic evolution of COVID-19 variants.
Wastewater surveillance217 (Health Canada and PHAC led, 2020): Using early funding from Health Canada’s
Safe Restart Agreement, PHAC established a pan-Canadian wastewater surveillance network to detect
COVID-19 levels in communities; the four Working Groups provided a forum to discuss sampling, laboratory
methods, data models, modelling, and public health action and response. These included i) SARS-CoV-2
Variants of Concern in Wastewater; ii) Wastewater Laboratory Detection of SARS-CoV-2 Working Group; iii)
Wastewater SARS-CoV-2 Surveillance Updates; and iv) Data Modelling and Epidemiological Interpretation
Working Group.
COVID-19 PHAC Modelling Expert Group218 (PHAC led, 2020): PHAC’s senior officials and the PHN’s
Technical Advisory Committee requested the establishment of a COVID-19 PHAC Modelling Expert Group to
include members from the wider modelling community. This group established linkages between experts in
federal, provincial, and territorial government public health organisations and academic experts across
Canada, allowing further collaboration and benchmarking of modelling activities. The working group
contributed knowledge, advice and expertise to inform the public health response to the COVID-19 outbreak
through the analysis of information available internationally and nationally.
iv. Knowledge synthesis and evidence gathering bodies
During the pandemic, a significant amount of scientific information was generated to advance basic and applied
knowledge related to COVID-19 within various academic, industry, and governmental institutions, nationally and
internationally. Initiatives were funded to provide regular updates on best emerging evidence pertaining to public
health measures, clinical management, and socio-economic impacts, as well as undertaking horizon scans on
emerging new technologies (therapeutic and diagnostic) and approaches/challenges other jurisdictions have
identified to support decision-making.
CanCOVID219 (April 2020-March 2023): CanCOVID, a transdisciplinary, open science initiative, committed to
giving a line of sight on existing and emerging COVID-19 science and research, was launched with funding from
ISED and support from the Chief Science Advisor. The initiative helped expedite communication and
collaboration between the scientific, health care, and policy communities during the COVID-19 crisis. The
network’s activities include: a weekly virtual speaker series on topics related to COVID-19 science, a searchable
digital library of reports and other research products from trusted sources, misinformation tools, and resources
to help people identify trustworthy information on COVID-19. In addition, CanCOVID made its expertise
available to the Chief Science Advisor, Health Canada, and PHAC upon request, providing analysis, advice, and
support to policy makers. CanCOVID’s theme lead advisors, a team of experts in the fields of public health,
clinical research, behavioural science and health policy, worked with their respective networks to mobilize
scientific knowledge for government and public policy responses.
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COVID-19 Evidence Network to Support Decision-making (COVID-END)220 (PHAC and CIHR-led,
2020-March 2023): COVID-END was a time-limited network created in April 2020 that brought together more
than 50 of the world’s leading evidence-synthesis, technology-assessment, and guideline-development
groups. It covered the full spectrum of the pandemic response, from public-health measures and clinical
management to health system arrangements and economic and social responses. Sharing of this information
on an open platform reduced duplication of research efforts and provided opportunities for scientific
collaboration and coordination.
CIHR led a series of Virtual Investigator Meetings to provide a platform for funded researchers to discuss
barriers or accelerators to their research with relevant Government of Canada departments. CIHR developed
an evergreen compilation of COVID-19 Resource Briefs, in collaboration with government departments and
other key groups, containing regulatory and policy levers to further facilitate and accelerate Canada’s health
research response to COVID-19. CIHR was also able to support federal researchers in accessing the best
available evidence related to specific aspects of the COVID-19 pandemic response through its Best Brains
Exchanges program, which was adapted to be delivered virtually. For example, CIHR hosted a Best Brains
Exchange with the Office of the CPHO to inform the State of Public Health in Canada 2020 report.
v. Intramural research and surveillance initiatives
In addition to external science advice and research coordination activities, federal departments and agencies
were involved in science advice, technical expertise provision and access to capacity. Examples include the
NRC’s work with partners to advance research and technology development for COVID-19 therapies and
vaccines, its construction of a Biomanufacturing Centre and Clinical Trial Material Facility, the testing of
new-to-market critical personal protective equipment for front-line health care workers, and NRC researchers
working with Canadian and international researchers to fast-track R&D aimed at pressing gaps and challenges;
the many roles that the PHAC NML played in vaccine development, diagnostic testing and supporting
wastewater surveillance; the PHAC Behavioural Science Office, which worked with the Privy Council Office to
embed behavioural science fellows across the PHAC to address emerging needs, scientific capacity within the
PHAC Vaccine Rollout Task Force branch engaged external experts and integrated surveillance and science
activities to address key issues related to coverage, safety, effectiveness, vaccine confidence/hesitancy, and
guidance for Canadians.
This work often involved creation of highly-focused technical groups to bring intramural scientists and experts
from across PHAC branches, federal departments, Federal-Provincial-Territorial public health systems, and/or
academia together. This included technical groups on modelling, vaccine confidence, and ventilation, for
example, and Health Canada’s regulatory review of proposed therapies and vaccines and post-market safety
data collection, analysis, and risk management activities. Interdepartmental groups and committees were
assembled to leverage and share expertise across the federal system.
In May 2020, Health Canada launched regular engagement sessions with CIHR and the Canadian Association
of Research Ethics Boards. The forum brought relevant organizations together and provided support for
provincial and territorial Research Ethics Boards through enabling discussions on issues related to COVID-19
clinical trial oversight and ethics reviews, including lessons learned, best practices, challenges, and novel trial
platforms or approaches.
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vi. Data sharing
There are systemic challenges to effective health data collection, access, sharing, and use in Canada, and the
COVID-19 pandemic highlighted the critical importance of timely access to clinical, surveillance, administrative,
and research data. To support data sharing for large-scale and near real-time analyses, the deployment of
existing and new health data technologies and data infrastructure increased substantially, to varying degrees
of success.
The Expert Advisory Group on the Pan-Canadian Health Data Strategy221 published three reports
between June 2021 and May 2022 that reflected on barriers, advised that substantial coordinated investment
in governance, policy, interoperability, data literacy and public trust was needed to strengthen the health data
foundation, and provided recommendations for the path forward.
To inform the work of a Federal-Provincial-Territorial Virtual Care/Digital Table, a Virtual Care Expert Working
Group,222 which included both relevant group and government official experts, was struck to provide advice
and guidance on issues related to the deployment of virtual care in Canadian health systems. A virtual care
summit was held in June 2021 to discuss the policy enablers underpinning virtual care and to identify key
considerations for a national action plan to maintain the unprecedented momentum spurred by the pandemic
in the delivery of virtual care services. Nearly 80 participants from federal, provincial, and territorial
governments, pan-Canadian health organizations, First Nations, Inuit, and Métis representatives, rural and
remote community representatives, provincial and territorial medical associations, health profession regulatory
bodies, patient representatives, and other relevant groups, participated in the summit. The summit was
grounded on the findings of Will Falk’s Diagnostique,223 and a report developed by the Task Team on Equitable
Access to Virtual Care.
How the federal approach facilitates the timely dissemination of research results to inform scientific advice and
improve research coordination has been the subject of granting council efforts including the Tri-Agency
Research Data Management Policy,224 and is also being examined as part of CIHR’s lessons learned
assessment.
Health Research and Science Advice Ecosystem Established During Later
Stages of the COVID-19 pandemic (2021–2022)
The Variants of Concern Leadership Group (VOC LG) and associated Scientific Advisory Council (VOC
SAC) were established by Health Canada in February 2021 to support the Government of Canada’s variants
of concern strategy and rapidly scale up surveillance, sequencing, and research efforts of new and emerging
variants. The Leadership Group was co-chaired by the Deputy Minister of Health and the Executive Vice
President Science and Research of the University Health Network. The groups met frequently to drive the
Variants of Concern Strategy forward and inform public health responses to variants of concern as well
as research to further understand the shifting implications. Membership consisted of researchers and
Government of Canada officials; and advanced new scientific techniques, and received updates from relevant
research networks (e.g., CoVaRR-Net). The VOC SAC advised on the scientific work of the Variants of Concern
Strategy and integration of public health, sequencing, and research across a range of disciplines to ensure rapid
identification, characterization, and responsive action to emerging variants of concern.
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In July 2021, the Government of Canada launched Canada’s Biomanufacturing and Life Sciences Strategy
(BLSS),43 with a $2.2 billion investment from Budget 2021. The Strategy, co-led by the Ministers of Health
and Innovation, Science and Industry, stemmed from the work of the Vaccine Task Force, Therapeutics Task
Force, and Joint Biomanufacturing Subcommittee, and was informed by public consultations in winter 2021.
The Strategy focuses growing a strong, competitive domestic life sciences sector with cutting edge
biomanufacturing capabilities and ensuring preparedness for pandemics or other health emergencies. To guide
this work, a dedicated and coordinated governance structure which includes a Deputy Head Steering Committee
and Assistant Deputy Minister Oversight Committee, was established to enable aligned priority-setting, linked
through strategic planning, decision making, performance monitoring, and risk management, and is directly
shaped by internal and external experts from academia, industry, and public health.
The BLSS included a new Biosciences Research Infrastructure Fund (BRIF) delivered by the Canada
Foundation for Innovation, to support the bioscience capital and infrastructure needs of post-secondary
institutions and research hospitals. The Strategy also included the Canada Biomedical Research Fund
(CBRF), created in October 2021 and delivered by the federal research granting councils. The CBRF supports
translational and applied research, training and talent development, and develop the pipeline that drives
downstream manufacturing capacity.
As part of Budget 2021, CIHR was allocated $250 million to establish the Clinical Trials Fund.225 Through this
fund intended to strengthen the clinical trials ecosystem, CIHR has funded a pan-Canadian clinical trials
consortium to improve coordination, training platforms to build clinical trials capacity, and a number of trials
to support pandemic preparedness and response and new vaccine and treatment development.127 CIHR also
continues to fund research networks on COVID-19 Clinical Trials and Post COVID-19 Condition and develop a
long-term clinical trials strategy for Canada.
In January 2022, the Federal Pandemic Science Coordination and Action Group (FPSCAG) was launched
to enhance coordination, collaboration and foster collective action to address and advance Canada’s COVID-19
pandemic science plan and actions. This committee, co-chaired by the Deputy Minister of Health and the
Executive Vice President Science and Research of the University Health Network, met frequently to identify
and advance key areas for the pandemic response, such as wastewater surveillance, long COVID, and vaccine
strategies, which could benefit from enhanced coordination and targeted research efforts.
In January 2022, the Minister of Health formally announced the creation of the Centre for Research on
Pandemic Preparedness and Health Emergencies (CRPPHE).29 Since its launch, the CRPPHE has enabled
CIHR to implement more than $65 million in investments to support a diverse array of research on pandemic
and health emergencies, such as projects related to COVID-19, post COVID-19 condition, monkeypox, Ebola,
behavioural sciences to address misinformation and improve vaccine confidence, building multidisciplinary
teams that work across the human, animal and environmental health pillars (e.g., building capacity in One
Health), and health human resource planning in preparation for the next emergency.
In July 2022, CIHR invested $10 million in the Canadian ADAptive Platform Trial of COVID-19 Therapeutics
in Community Settings (Can-ADAPT COVID)226 initiative intended to enhance research on novel COVID-19
treatments for non-hospitalized patients, including nirmatrelvir/ritonavir (PaxlovidTM). The focus was on
determining the effectiveness and addressing clinical challenges associated with these treatments.
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Section 3: Current Health Research Coordination and
Science advice Ecosystem (March 2023 onwards)
In March 2023, PHAC deactivated the COVID-19 Incident Management System due to a significant decrease
in new COVID-19 positive cases, which were being managed with the current provincial and territorial healthcare
systems. The Health Portfolio Operations Centre’s functions have become integrated into various branches
of Health Canada and PHAC as part of regular programming. Furthermore, various advisory committees,
task groups and expert panels have sunset as they completed their mandates.
The CITF33 was later overseen by the PHAC Program Oversight Committee who, in collaboration with the CITF
Secretariat, provided ongoing support to research studies currently in progress, the transitioning of CITF
research and platforms to appropriate agencies where possible, and the securing ongoing arrangements
for the CITF Databank. This includes two reviews of the initiative, led by PHAC and the CITF Secretariat
respectively. All activities were completed by March 2024.
In March 2023, the Government of Canada announced the creation of five new research hubs227 across the
country to accelerate Canada’s vaccine and therapeutics research and development. Research hubs will have
access to up to $570 million in available funding, through the CBRF and BRIF, for proposals aimed at cuttingedge research, talent development and research infrastructure projects. Funding decisions were made in
March 2024. Funding through these programs is approximately five years in duration.
The Centre for Research on Pandemic Preparedness and Health Emergencies (CRPPHE)29 has ongoing
funding of $18.5 million per year to protect the health of people living in Canada by funding and mobilizing
health research for pandemic and health emergency preparedness, prevention, response, and recovery that
contributes meaningfully to timely, equitable, and effective responses and recovery. The CRPPHE is seeking to
coordinate research responses to pandemics and health emergencies by collaborating with other federal
departments and agencies, as well as relevant groups domestically and internationally.
The Chief Science Advisor COVID-19 Expert Panel228 had a final meeting in July 2023 and discussed
emergency preparedness for the future, in the context of the scientific deliberations during the COVID-19
pandemic. All expert meeting summaries and are available online.228 Subject-specific task forces and expert
groups reporting to the Chief Science Advisor’s COVID-19 Expert Panel have also concluded.
The Council of Expert Advisors229 was established in 2023 by ISED and Health Canada; and acts as the
foremost advisory body on enhancing Canada’s biomanufacturing, biopharmaceuticals, and life sciences
sectors. Its primary role is to provide expert guidance on the implementation of Canada’s BLSS. The Council of
Expert Advisors is composed of scientific researchers and leaders in the biomanufacturing/biopharmaceutical
industry and builds upon the work of the Vaccine Task Force.
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Appendix D: Canada’s Health Research and Science
Advice Ecosystem: Roles and Responsibilities in a
Federated Context
This section briefly describes the roles and responsibilities of various federal departments and agencies and
levels of government charged with the delivery of health care and public health. Please see Appendix C for
additional background on organizations mentioned within this appendix. It is intended as context for the panel’s
analysis and recommendations. As such, it does not assess the performance and effectiveness of individual
organizations. (For more detailed information about the many task forces and advisory bodies activated or
created to address elements of science advice and research coordination components of Canada’s COVID-19
response, please see Appendix A and Appendix C.)
Section 1: Governance of Health Care and Public Health
The delivery of health care in Canada is a shared responsibility between the federal government, provincial and
territorial governments, and some First Nations organizations that have taken on a health care mandate from
the federal government.
The federal government’s health care responsibilities are spread across Health Canada, Public Health Agency
of Canada (PHAC), and Indigenous Services Canada (ISC). The federal government funds health care, fosters
innovation and health research, and sets national principles to ensure quality.
Health Canada is responsible for policy priorities, and promotes and helps protect the health and safety of
Canadians by overseeing and regulating products such as drugs, vaccines, diagnostics, medical devices,
consumer products, and food. It also supports universally accessible, publicly-funded health care for
Canadians through stewardship of the Canada Health Act, leadership on emerging issues (such as legalizing
cannabis and medical assistance in dying), and collaboration with provinces, territories and First Nations, Inuit,
and Métis-led organizations on the health system.230
PHAC promotes health through the surveillance, prevention, and control of chronic and infectious diseases;
prepares for and responds to public health emergencies; strengthens intergovernmental collaboration on
public health; and facilitates national approaches to public health policy and planning. PHAC provides guidance
on health promotion and health security, and builds partnerships with community-based organizations and
equity-deserving groups.
Health Canada and PHAC collaborate with ISC and provinces and territories to improve access to health
services for Indigenous Peoples. There is an ongoing process to enable communities to have greater control
and decision-making power over the design, management, and administration of health services. There are
various funding and governance models through which this progress toward cultural safety and selfdetermination in health care services for First Nations, Inuit, and Métis peoples is being accomplished, guided
by The United Nations Declaration on the Rights of Indigenous Peoples.93 Co-funding arrangements by federal and
provincial governments support organizations such as the Athabasca Health Authority and Northern InterTribal Health Authority in Saskatchewan. The British Columbia First Nations Health Authority works to design
and deliver health programs and services for First Nation communities through a governance structure that
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addresses health and other inequities. Other health transformation projects are underway across Canada to
support First Nations-led institutions and organizations to improve health outcomes and access to services
depending on the communities’ unique needs and priorities.231
Provincial and territorial governments have the mandate to organize, manage, and deliver health services to
their residents.232 This includes administering health insurance plans; planning and funding of care in medical
facilities; governing services provided by doctors and other health professionals; and implementing public
health initiatives within their jurisdiction. Although the basics of health care are identical across Canada,
specific services, administration, and funding vary by jurisdiction. These differences can be attributed to
variable geography, finances, and labour forces.
Section 2: Governance of Public Health Emergencies
In a public health emergency, the federal Health Portfolio, overseen by the Minister of Health, provides national
leadership as follows:
Under the Federal Emergency Response Plan, the Health Portfolio leads the response to the health
consequences of natural and human-caused emergencies, including situations where the emergency itself is
health-related or biological.61
Within Health Canada, emergency preparedness and planning functions are largely divided by program area
expertise, with individual program areas developing and managing preparedness plans for specific
emergencies within the broader federal emergency management framework. For example, the Healthy
Environments and Consumer Safety Branch at Health Canada consists of independent teams with specific
expertise (e.g., nuclear, air and water, chemical) that maintain emergency plans for their subject areas that are
annexes to the broader Health Portfolio Emergency Response Plan.233
PHAC, formed in 2004, governs public health emergency preparedness and response. It has laboratory
science capacity at its National Microbiology Laboratory, as well as surveillance and epidemiological expertise
across branches. These functions, along with the mandate to promote collaboration with provincial and
territorial partners as it relates to public health, are outlined in the Public Health Agency of Canada Act. PHAC also
funds the National Collaborating Centres (NCCs) for Public Healthxi and manages intergovernmental federalprovincial-territorial collaboration in anticipation of, preparation for, and response to public health events via
the Pan-Canadian Public Health Network (PHN).234 The network’s governance structure includes steering
committees, working groups, and time-limited Special Advisory Committees that are activated in times of
crisis (e.g., the Special Advisory Committee on COVID-19). The PHN is governed by a Council, which reports to
the Federal-Provincial-Territorial Conference of Deputy Ministers of Health.
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National Collaborating Centres have specific areas of expertise, including Indigenous Health, Determinants of Health, Environmental
Health, Infectious Diseases, Healthy Public Policy, and Methods and Tools.
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PHAC’s Chief Public Health Officer (CPHO), a position created specifically to strengthen Canada’s ability to
respond to public health threats and emergencies, provides “the Minister [of Health] and the President [of
PHAC] with public health advice that is developed on a scientific basis.”235 The role is accountable or has
delegated responsibilities for related provisions of federal health legislation, including the Public Health Agency
of Canada Act, Quarantine Act, Human Pathogens and Toxins Act, and Department of Health Act. 235,236,237,238 The
CPHO works with other governments, jurisdictions, agencies, organizations, and countries on health matters,
and speaks to Canadians, health professionals, relevant groups, and the public about issues affecting the
population’s health.
The federal government’s various emergency plans drive the public health emergency response. PHAC is
responsible for the development and maintenance of emergency management plans within the Health
Portfolio, including the Health Portfolio Strategic Emergency Management Plan and a subset of it, the Health
Portfolio Emergency Response Plan, created in 2013 to provide a policy-governance framework to guide
emergency management activities.233 The Health Portfolio Strategic Emergency Management Plan outlines the
approach to responding to single, dual, or multiple emergencies. It provides guidance on when the scope and
intensity go beyond program-level normal operations and therefore require a coordinated Health Portfolio
response. It also informs response coordination and contains the operational guidance and procedural tools
applicable to an all-hazard response. As needed, it is supplemented by a hazard-specific plan. The plan itself
specifies that it should be reviewed every two years. In 2019, the year before the pandemic struck, PHAC
identified the need to review and update the plan. However, in 2021 the Office of the Auditor General found
that PHAC had not reviewed it since 2016. Similarly, PHAC had not updated the Health Portfolio Emergency
Response Plan, despite the stipulation that it should be reviewed and updated regularly.239 PHAC subsequently
updated the plan in 2023.
The federal government also maintains joint plans with provinces and territories, such as the Federal-ProvincialTerritorial Public Health Response Plan for Biological Events (last updated October 2017) and the Canadian
Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (last updated August 2018).12,240 The
Canadian Pandemic Influenza Preparedness guidance document outlines how jurisdictions will work together to
ensure a consistent health-sector approach to pandemic preparedness and response.
The Federal-Provincial-Territorial Public Health Response Plan for Biological Events stipulates that PHAC is
responsible for conducting an initial risk assessment (rapid risk assessment and situational analysis) upon
receiving notifications of public health events through monitoring or surveillance networks. While the plan is
robust in its procedures for pathogen-related and epidemic public health events, its scope is based on the
accountabilities of the responsible departments/agencies. It is “intended for the situations where the principal
issue is human health and includes biological agents found in the environment, or diagnosed in animals, that
have the potential for transmission to humans (zoonoses)”.12 The plan does not include other biological or public
health emergencies that may arise from natural or environmental hazards, such as wildfires and respiratory
consequences for population health. However, its stated intention is to be a model for an all-hazard federalprovincial-territorial framework, especially for the health sector, related to natural disasters or chemical,
biological, radiological/nuclear, and explosive events.
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Section 3: Evolution of the Ecosystem During COVID-19
When the first COVID-19 cases were confirmed in Canada in January 2020, followed by the World Health
Organization declaration of a pandemic in March, the Health Portfolio activated its existing pandemic response
controls to target the emerging threat.
The PHN immediately activated the time-limited Federal/Provincial/Territorial Special Advisory Committee on
COVID-19 governance structure, including the Technical and Logistical Advisory Committees, the Public Health
Network Communications Group and the Working Group on Remove and Isolated Communities, to provide a
regular federal-provincial-territorial forum for discussion. The Special Advisory Committee on COVID-19
developed and updated the Federal/Provincial/Territorial Public Health Response Plan for Ongoing Management of
COVID-19 in collaboration with provincial/territorial and First Nations, Inuit, and Métis governments and other
health partners.205 It included an appendix outlining the response planning efforts and plans with First Nations,
Inuit, and Métis communities.
The Chief Science Advisor and the CPHO, along with permanent external advisory groups such as the National
Advisory Committee on Immunization, the Public Health Ethics Consultative Group, Infection Prevention and
Control, and networks such as the Canadian Public Health Laboratory Network and the NCCs for Public Health
began developing and sharing science-based advice on various aspects of pandemic response. The Canadian
Institutes of Health Research (CIHR) participated in Canada’s delegation to the World Health Organization/
GloPID-R COVID-19 Research & Development Blueprint, and in February 2020, was among the first globally to
issue an open call for COVID-19 rapid response research funding in response to those globally set research
priorities, distributing $55.3 million. Another call followed in April with $123.5 million; various federal research
granting council funding initiatives were launched soon after, informed by coordinated research priority-setting
processes led by CIHR which PHAC and others provided input to in order to address gaps in platform funding
for knowledge syntheses, Canada’s participation in the World Health Organization Solidarity Trial, variants of
concern, and other areas. A series of new research funding groups and initiatives were also formed by hospital
foundations, universities and provincial/territorial governments–adding to response efforts, but further
complicating the coordination of evidence generation.
The speed at which the virus spread and its widespread health, social, and economic impacts, overwhelmed
existing public health emergency response plans and systems. The federal government had to quickly adapt
existing strategies and structures and put new ones in place to augment and coordinate the evolving
understanding of and response to COVID-19. This led to new and sharpened mandates for existing permanent
bodies and groups, along with the rapid creation of 38 new and ad hoc groups, many of them issue-specific
and time-limited, by various departments and decision makers. These included various governance bodies,
expert advisory committees, mission-focused networks, research initiatives, knowledge synthesis/evidencegathering bodies, intramural research groups, surveillance initiatives, and data-sharing mechanisms. (A full list
of these groups and their mandates are included in Appendices A and C).
These new groups had to be rapidly integrated into the existing, and changing, advice-giving and information
flow system. The government also had to create or modify secretariats to manage the interface between
specialized technical discussions within scientific forums and the non-technical language of advice to decision
makers. Health Canada and PHAC also increased the number of federal employees engaged in science and
technological activities during the pandemic. In addition, provincial and territorial governments established
their own advisory bodies and structures to focus on the scientific issues and evidence most relevant to their
regions at specific points in the pandemic.
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As hospitalization and death rates climbed in 2020, the development and production of targeted COVID-19
vaccines and therapies, and Canada’s biomanufacturing capacity, was a top priority. In response, the government
created three new expert advisory groups (made up of external experts and ex officio members) in June and July:
the Vaccine Task Force, Therapeutics Task Force, and Joint Biomanufacturing Subcommittee.207,241 Many other
subject-specific expert groups, both formal and informal, were struck by various individuals and departments on
timely topics as needed, e.g., COVID-19 Testing and Screening Expert Advisory Panel in October 2020. (See
Appendix B for a timeline of the creation of new bodies and groups.)
The need for more targeted research and greater research collaboration and harmonization in efforts to track
the virus’s origin, spread, and evolution was identified early in 2020. As a result, the government established
two mission-focused networks: the COVID-19 Immunity Task Force and the Canadian COVID-19 Genomics
Network (CanCoGeN). The former was given a budget to directly fund targeted research on immunity within
the Canadian population and priority subgroups. Additional networks followed over time, focusing on, for
example, modelling, wastewater surveillance, and tracking and responding to emerging variants of concern.
CoVaRR-Net, a network focused on variants of concern, was created in March 2021 with funding from CIHR,
and received renewal funding as part of the Government of Canada’s Variants of Concern Strategy. Canada’s
$2.2 billion Biomanufacturing and Life Sciences Strategy was launched in July 2021 to establish coordinated
governance structures to enable timely decision making informed by experts and to build public capacity to
produce vaccine or other biologics.43
The need for a robust rapid knowledge synthesis function also became clear in the first few months of the
pandemic with the rapid generation, both nationally and internationally, of a significant amount of scientific
information related to COVID-19. The NCCs for Public Health program was designed for this purpose and a
recent evaluation showed that they met this purpose and served the needs of different levels of the public
health system. However, their baseline capacity was exceeded by demand. In response to the need for
increased capacity, the government created two important bodies in April 2020: CanCOVID (an open
information-sharing platform) and the COVID-19 Evidence Network to Support Decision-making (COVID-END).
The aim was to facilitate scientific information dissemination; promote collaboration between the scientific,
health care, and policy communities; reduce duplication of efforts; and mobilize scientific knowledge for public
policy responses. The time-limited COVID-END shut down in March 2023, however, has maintained an online
repository of work. CanCOVID remains active. A timeline denoting the activation of permanent bodies and
creation of new ad hoc bodies is found in Appendix B.
In addition to CIHR’s ongoing open research funding calls throughout the pandemic, the federal government
set up a range of new research initiatives to fill gaps in Canada’s COVID-19 response with dedicated long-term
funding for some projects. For example, Budget 2021 allocated $250 million to CIHR to establish the Clinical
Trials Fund, a pan-Canadian clinical trials consortium to improve coordination and training platforms to build
clinical trials capacity to support current and future pandemic preparedness and response. While this funding
ends in 2027, Budget 2021 also allocated $65 million to CIHR to create a permanent, dedicated interdisciplinary
Centre for Research on Pandemic Preparedness and Health Emergencies in January 2022.
The use of existing and new health data technologies and data infrastructure increased substantially during the
pandemic with the growing need for critical data sharing for large-scale and near real-time analyses. To better
support the effective creation, exchange, and use of critical health data for the benefit of Canadians, the
government created the Expert Advisory Group on the Pan-Canadian Health Data Strategy in Fall 2020. Its
three reports, published between June 2021 and May 2022, made recommendations on the need for more
substantial coordinated investment in governance, policy, interoperability, data literacy, and public trust to
strengthen the health data foundation.45,54,55
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Section 4: Science Advice in a Federated Context
The federal, provincial, and territorial governments share the responsibility to develop and communicate public
health guidance to respond to a pandemic.239 Provinces and territories are responsible for communicating
messages within their jurisdictions while the federal government helps develop technical guidance, as well as
technical and policy recommendations, to facilitate the multi-jurisdictional response.
During a pandemic, the federal government is responsible for preparing risk assessments and coordinating the
overall federal-provincial-territorial response. Within this context, the development and provision of science
advice to inform pandemic public health guidance can be considered a shared federal-provincial-territorial
responsibility. However, joint emergency plans, such as the Federal/Provincial/Territorial Public Health Response
Plan for Biological Events and the Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health
Sector, do not articulate roles and responsibilities for science advice provision during an emergency.12,240
First Nations, Inuit, and Métis, municipal, or regional public health departments may also have responsibilities
for public health guidance; the division of municipal powers, authorities, and resources varies by province.
The mandate of the Chief Science Advisor is to support the federal science function and improve the flow
of scientific advice to decision makers. The Chief Science Advisor ensures that government decision making
considers scientific analyses and federal science is fully available to the public; recommends how the
government can better support quality research within the federal scientific system; promotes a positive
and productive dialogue between federal scientists and academia in Canada and abroad; and raises public
awareness of scientific issues. The mandate of the Chief Science Advisor does not have a formal role in
an emergency.
Section 5: Research Coordination in a Federated Context
Canada’s complex research landscape features multiple funders and producers of research. The federal and
provincial governments fund research directly or through arms-length agencies (known as extramural research).
At the federal level, all science-based departments and agencies fund and perform research (intramural
research). These departments and agencies, including Innovation, Science and Economic Development
Canada and the National Research Council Canada (NRC), help build capacity in research, talent, infrastructure,
and biomanufacturing, and support innovative companies and technologies to bring health products to market
during a crisis. The Department of National Defence and Defence Research and Development Canada also
fund research initiatives in emergency situations.
Extramural research
The federal government funds research at universities and colleges through four at-arms-length granting
agencies—CIHR, the International Development Research Centre, the Natural Sciences and Engineering
Research Council, and the Social Sciences and Humanities Research Council—and various nongovernmental
organizations such as the Canada Foundation for Innovation and Genome Canada.
CIHR, the federal health research investment agency, works to advance both priority-driven and investigatorinitiated research across all four pillars of health research: biomedical, clinical, health systems services, and
population health. It aims to strengthen Canadian health research capacity; accelerate the self-determination
of First Nations, Inuit, and Métis Peoples in health research; pursue health equity through research; and
integrate evidence in health.
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CIHR funds and coordinates the knowledge mobilization needed to inform the evolution of health policy and
regulation during a crisis. This is achieved by funding strategic research priorities, such as population and public
health, and infection and immunity, through its 13 virtual institutes. The institutes form national research
networks that enable researchers, funders, and knowledge users to collaborate on these priorities. CIHR also
advises on research and innovation issues through linkages with Health Canada and PHAC, providing decision
makers with access to high-quality and timely health research outcomes and results during a crisis.
The Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities
Research Council also fund research related to health emergencies. The presidents of the three granting
agencies, as well as the presidents of the Canada Foundation for Innovation and the NRC, Deputy Ministers of
Health Canada and Innovation, Science and Economic Development Canada, and the Chief Science Advisor
constitute the Canada Research Coordinating Committee. As the pandemic progressed, the Government of
Canada formed additional research bodies and networks to respond to the need for more directed research to
answer critical questions.
Seven provinces–British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick,
Nova Scotia, and Newfoundland and Labrador–have health research funding organizations. Collectively, they
make up the National Alliance of Provincial Health Research Organizations, which facilitates and coordinates
funding across the country, with a yearly investment of $500 million. Its membership enables national and
inter-provincial collaborations, which inform strategic research funding, and the sharing of best practices.203
Intramural Research
Intramural research generally refers to the portion of the federal government employed as performers of
research. The Government of Canada employs around 40,000 personnel242 across a range of science-based
departments and agencies on science and technology activities including research and development and
data collection.
These activities may be undertaken in partnership with other federal departments, provinces and territories,
universities, nongovernmental organizations, the private sector, or international partners.
The science and technology activities are generally associated with five responsibilities: informing regulatory
and policy decisions and standards, producing public good products and services, maintaining expertise in
areas supporting public security and welfare, ensuring capacity to anticipate and respond quickly to adverse
events, and supporting innovation to improve the economic well-being of Canadians. Intramural research
capacity within PHAC, Health Canada, and the NRC expanded by around 16% to meet capacity needs during
the pandemic, from 8,834 full time employees in fiscal year 2018/19 dedicated to science and technology
activities, to 10,222 in fiscal year 2021/22.242,xii At 52%, PHAC had the greatest growth rate over that period.242
xii
This was the last year that complete data was reported to Statistics Canada, year 2022/23 represents preliminary estimates and
intentions.
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Section 6: Health Data Governance
Various federal, provincial, territorial, and nonprofit organizations collect national, provincial, and territorial
health and administrative data. The lack of interoperability of these systems and organizations, however,
contributes to barriers in accessing this data. Obtaining consistent, timely, interoperable data and
comprehensive national health information has consistently been a challenge given that provincial and
territorial jurisdictions do not always collect or report information in the same way. Additionally, public health
surveillance data is primarily collected under the jurisdictional responsibilities of provinces and territories
and is shared with the federal government through data sharing agreements.
Health care data is collected by health care organizations and similar to mortality data, it is held at the provincial
or territorial level. Health care data is sent to the Canadian Institute of Health Information, as well as provincial
organizations such as ICES (formerly known as the Institute for Clinical Evaluative Sciences). Researchers can
access de-identified data from these and other organizations, despite a long time lag before information is
available to researchers.
Privacy and data protection in Canada are subject to federal and provincial/territorial legislation. No single law
governs personal health information across Canada; instead, unique provincial and territorial laws offer similar
but varying levels of privacy protection. These laws vary even on, for example, permitted uses and specified
disclosures, making it impossible to achieve a consistent national picture of health data. Health privacy
protection supports patient confidentiality, a fundamental pillar of patient care. Many health privacy laws also
account for secondary uses of personal health information to support health system planning, evaluation,
and research. However, it is difficult to pinpoint the exact differences between each jurisdiction’s specific
legislation. As a result, researchers, research institutions, and organizations conducting national research or
collecting national data must address the differences directly or invest resources in detailed jurisdictional scans
to prepare data requests and data collection practices that comply with all laws and approval processes across
Canada. As the protections imposed by each law can vary, those compiling national data are also tasked with
upholding each law, potentially placing highly sensitive information at risk for non-compliance due to the
challenging nature of sorting the various requirements.
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Appendix E: Experts who contributed to the Review of
the Federal Approach to Pandemic Science Advice and
Research Coordination
Between August 2023 and February 2024, the panel met with about 300 individuals from across Canada,
virtually or in person. In addition, the panel received and considered 55 written submissions from individuals
and groups. While the panel’s consultations were extensive, the process necessarily represented a small
tranche of Canadians.
This is a list of all organizations and institutes represented in these engagement sessions, as well as written
submissions. There are also a number of individuals unaffiliated with a group or institution that participated in
these consultations. The panel would like to thank all participants for their time and contributions to this process.
Acuitas Therapeutics
Alberta Innovates
Amplitude Ventures
Atlantic Veterinary College
Baycrest Centre, Centre for Aging + Brain Health Innovation
Biologics Manufacturing Centre Inc.
British Columbia Cancer Research Institute, Genomic Sciences Centre
British Columbia Children’s Hospital Research Institute
British Columbia Network Environment for Indigenous Health Research
Canada Foundation for Innovation
Canadian Academy of Health Sciences
Canadian College of Health Information Management
Canadian Food Inspection Agency
Canadian Health Information Management Association
Canadian Indigenous Nurses Association
Canadian Institute for Advanced Research
Canadian Institutes of Health Research
Canadian Institutes of Health Research, Centre for Research on Pandemic Preparedness
and Health Emergencies
Canadian Institutes of Health Research, Institute of Indigenous Peoples’ Health
Canadian Institutes of Health Research, Institute of Infection and Immunity
Canadian Institutes of Health Research, Institute of Population and Public Health
Canadian Medical Association
Centre for Addiction and Mental Health, Institute for Mental Health Policy Research
Centre Hospitalier Universitaire de Sherbrooke
Centre intégré de santé et de services sociaux de Laval
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City of Ottawa, Ottawa Public Health
City of Toronto, Toronto Public Health
College of Physicians and Surgeons of Alberta
Concordia University
Council of Canadian Academies
Dalhousie University
Dalhousie University, Faculty of Medicine
Dalhousie University, Faculty of Medicine, College of Pharmacy
Dalhousie University, Faculty of Medicine, Department of Community Health and Epidemiology
Dalhousie University, Faculty of Medicine, Department of Medicine
Dalhousie University, Faculty of Medicine, Department of Microbiology and Immunology
Dalhousie University, Faculty of Medicine, Department of Pathology and Laboratory Medicine
Dalhousie University, Faculty of Medicine, Department of Pediatrics
Defence Research and Development Canada
DIGITAL Supercluster
Environment and Climate Change Canada
Fields Institute for Research in Mathematical Sciences
First Nations Health Authority
Fonds de recherche du Québec – Santé
Fraser Health Authority
Fusion Genomics
Genome Canada
Gouvernement du Québec, Institut National de santé publique du Québec
Gouvernement du Québec, Ministère de la Santé et des Services sociaux
Gouvernement du Québec, Ministère de l’Économie, de la Science et de l’Innovation
Government of Alberta
Government of Alberta, Alberta Health
Government of Alberta, Alberta Health Services
Government of Alberta, Alberta Health Services, Provincial Public Health Laboratory
Government of Alberta, Alberta Health, Health Protection
Government of Alberta, Alberta Health, Health Standards, Quality, and Performance
Government of British Columbia, British Columbia Centre for Disease Control
Government of British Columbia, Ministry of Health
Government of British Columbia, Provincial Health Services Authority
Government of Manitoba, Manitoba Health
Government of Manitoba, Shared Health Manitoba
Government of New Brunswick, Department of Health
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Government of Newfoundland and Labrador, Department of Health and Community Services
Government of Northwest Territories, Department of Health and Social Services
Government of Nova Scotia, Department of Health and Wellness
Government of Nova Scotia, Nova Scotia Health
Government of Nunavut, Department of Health
Government of Ontario, Ministry of Health
Government of Ontario, Public Health Ontario
Government of Prince Edward Island, Department of Health and Wellness
Government of Prince Edward Island, Health PEI
Government of Saskatchewan, Ministry of Health
Government of Saskatchewan, Saskatchewan Health Authority
Government of Yukon, Department of Health and Social Services
Hamilton Health Sciences
Health Canada
Health Data Research Network Canada
HealthCareCAN
Hôpital Montfort, Institut du Savoir Montfort
Immune Biosolutions
Indigenous Physicians Association of Canada
Indigenous Services Canada
Innovation, Science and Economic Development Canada
Island Health
IWK Health
JML Advisory Services
Lakehead University, Faculty of Health and Behavioural Sciences, Department of Psychology
Laurent Pharma
Lawson Health Research Institute
Life Sciences BC
London Health Sciences Centre
McGill University
McGill University, Faculty of Medicine and Health Sciences, Department of Global and Public Health
McGill University, Faculty of Medicine and Health Sciences, Department of Biomedical Engineering
McGill University, Faculty of Medicine and Health Sciences, School of Biomedical Sciences
McGill University, McGill International TB Centre
McGill University, McGill University Health Centre Research Institute
McMaster University, Faculty of Health Sciences, McMaster Immunology Research Centre
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McMaster University, Faculty of Health Sciences, Department of Health Research Methods,
Evidence, and Impact
McMaster University, Faculty of Health Sciences, McMaster Centre for Transfusion Research
McMaster University, Faculty of Health Sciences, Michael G. DeGroote Institute
for Infectious Disease Research
McMaster University, Faculty of Medicine, Department of Medicine
McMaster University, Faculty of Social Sciences, Department of Anthropology
McMaster University, McMaster Health Forum
Memorial University, Faculty of Medicine, Division of Population Health and Applied Health Sciences
Memorial University, Faculty of Nursing
Memorial University, School of Pharmacy
Memorial University, Newfoundland and Labrador Centre for Applied Health Research
Métis National Council
Mi’kmaq Confederacy of Prince Edward Island
Michael Smith Health Research BC
Middlesex-London Health Unit
Moderna Canada
Montreal Heart Institute
Mount Allison University, Faculty of Science, Department of Mathematics and Computer Science
Mount Saint Vincent University, Faculty of Arts, Department of Family Studies and Gerontology
Mount Sinai Hospital
National Collaborating Centre for Environmental Health
National Collaborating Centre for Healthy Public Policy
National Collaborating Centre for Indigenous Health
National Collaborating Centre for Infectious Diseases
National Research Council Canada
Natural Resources Canada
Natural Sciences and Engineering Research Council Canada
New Brunswick Health Research Foundation
Nimbus Synergies
Northern Ontario School of Medicine University, Division of Human Sciences
Novavax
Office of the Chief Science Advisor of Canada
Ontario Hospital Association
Ottawa Hospital Research Institute
Pfizer Canada
Privy Council Office
Providence Health Care Research Institute
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Public Health Agency of Canada
Public Health Network
Public Safety Canada
Public Services and Procurement Canada
Queen’s University
Research Manitoba
Research New Brunswick
Research Nova Scotia
Research Universities’ Council of British Columbia
Roche Diagnostics
Saskatchewan Cancer Agency
Saskatchewan Health Research Foundation
Sick Kids Hospital
Simon Fraser University, Faculty of Health Sciences
Simon Fraser University, Faculty of Health Sciences, Centre for Collaborative Action
on Indigenous Health Governance
Sinai Health, Lunenfield-Tanenbaum Research Institute
Sinai Health, Mount Sinai Hospital, Department of Medicine
Social Sciences and Humanities Research Council
St. Paul’s Hospital, Center for Advancing Health Outcomes
STEMCELL Technologies
Sunnybrook Hospital
Teralys Capital
The Hospital for Sick Children, Division of Infectious Diseases
The Ottawa Hospital
The Royal, Institute for Mental Health Research
Thompson Rivers University, Faculty of Education and Social Work, All My Relations Research Institute
Thunder Bay Regional Health Sciences Centre
Toronto General Hospital Research Institute
Unity Health Toronto
Unity Health, St. Michael’s Hospital
Unity Health, St. Michael’s Hospital, Li Ka Shing Knowledge Institute
Université de Montréal
Université de Montréal, École de santé publique, Département de médecine sociale et préventive
Université de Montréal, Faculté de médecine, Département de microbiologie, infectologie, et immunologie
Université de Montréal, Faculté des Arts et des Sciences, Département de psychologie
Université de Montréal, Institut de recherche Robert-Sauvé en santé et en sécurité du travail
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Université Laval
University Health Network
University Health Network, Science and Research
University Health Network, Toronto General Hospital Research Institute
University of Alberta
University of Alberta, Faculty of Medicine and Dentistry
University of Alberta, Faculty of Medicine and Dentistry, Department of Psychiatry
University of Alberta, Faculty of Medicine and Dentistry, Department of Biochemistry
University of Alberta, Faculty of Medicine and Dentistry, Department of Laboratory Medicine and Pathology
University of Alberta, Faculty of Medicine and Dentistry, Department of Family Medicine
University of Alberta, Faculty of Medicine and Dentistry, Department of Medicine
University of Alberta, Faculty of Medicine and Dentistry, Li Ka Shing Institute of Virology
University of Alberta, Faculty of Nursing
University of Alberta, School of Public Health
University of British Columbia
University of British Columbia, Faculty of Medicine, Department of Medical Genetics
University of British Columbia, Faculty of Medicine, Department of Psychiatry
University of British Columbia, Faculty of Medicine, Department of Pathology and Laboratory Medicine
University of British Columbia, Faculty of Medicine, Department of Obstetrics & Gynaecology
University of British Columbia, Faculty of Medicine, Department of Medicine
University of British Columbia, Faculty of Medicine, School of Population and Public Health
University of British Columbia, School of Population and Public Health, Centre for Health Services
and Policy Research
University of Calgary
University of Calgary, Cumming School of Medicine, Department of Medicine
University of Calgary, Cumming School of Medicine, Department of Pathology and Laboratory Medicine
University of Calgary, Cumming School of Medicine, Department of Community Health Sciences
University of Calgary, Faculty of Arts, Department of Anthropology and Archaeology
University of Calgary, Faculty of Science, Geomicrobiology, Enviromics, and Microbial Markets
University of Calgary, Schulich School of Engineering, Department of Biomedical Engineering
University of Calgary, Schulich School of Engineering, Department of Mechanical
and Manufacturing Engineering
University of Manitoba
University of New Brunswick
University of New Brunswick, Institute for Research, Data and Training
University of New Brunswick, New Brunswick Institute for Research, Data and Training
University of Northern British Columbia, Faculty of Human and Health Sciences, Northern Medical Program
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University of Northern British Columbia, Faculty of Indigenous Studies, Social Sciences and Humanities
University of Northern British Columbia, Faculty of Medicine
University of Ottawa
University of Ottawa, Faculty of Medicine, Department of Biochemistry, Microbiology, Immunology
University of Ottawa, Faculty of Medicine, Department of Family Medicine
University of Ottawa, Ottawa Health and Life Sciences Innovation Hub
University of Oxford, Medical Sciences Division, Nuffield Department of Population Health
University of Prince Edward Island
University of Prince Edward Island, Atlantic Veterinary College, Department of Health Management
University of Regina
University of Regina, Faculty of Arts, Psychology
University of Regina, Faculty of Education, Educational Psychology and Counselling
University of Regina, Faculty of Science, Institute for Microbial Systems and Society
University of Regina, Johnson Shoyama Graduate School of Public Policy
University of Regina, Saskatchewan Population Health and Evaluation Research Unit
University of Saskatchewan
University of Saskatchewan, College of Arts and Science, Department of Anthropology
University of Saskatchewan, College of Medicine, Community Health and Epidemiology
University of Saskatchewan, College of Medicine, Northern Medical Services
University of the Fraser Valley, Faculty of Health Sciences
University of Toronto
University of Toronto, Dalla Lana School of Public Health
University of Toronto, Dalla Lana School of Public Health, Centre for Global Health
University of Toronto, Faculty of Arts and Science, Department of Statistical Sciences
University of Toronto, Institute of Health Policy, Management & Evaluation
University of Toronto, Temerty Faculty of Medicine, Department of Medicine
University of Victoria, Faculty of Science, Department of Mathematics and Statistics
University of Victoria, Institute on Aging and Lifelong Health
University of Waterloo
University of Western Ontario
Urban Public Health Network
Vaccine and Infectious Disease Organization
Vancouver Coastal Health Research Institute
Wellesley Institute
York University, Faculty of Science, Department of Mathematics and Statistics
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