Page - 41 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

41Have the Post-SARS Reforms Prepared Us for COVID-19? three-quarters of the cases presenting in those under 30.28 While the public health community had anticipated that a major influenza pan- demic would be a form of avian influenza, with a potential mortal- ity exceeding 50% in humans,29 H1N1 turned out to be a much less virulent strain. Nonetheless, it challenged the response capacity of Canada’s federal system in two ways: first, it was present throughout all provinces and territories; second, it was the first pandemic that involved the development and distribution of both an adjuvanted vaccine and an antiviral.30 H1N1 containment required three discrete forms of coordina- tion: between federal institutions; between federal, provincial, and ter- ritorial jurisdictions; and across regional and municipal bodies within each province and territory. Collectively, these institutions comprised a sprawling fascia providing a comprehensive and responsive network linking vital information-gathering, analytical, and decision-making bodies throughout the country in real time. Key federal departments included not only Health Canada but also the Privy Council Office (representing the Prime Minister), Public Safety Canada (emergency management), the Canadian Food Inspection Agency (food safety), the Department of Foreign Affairs and International Trade (coordi- nating international communication), RCMP (domestic security), and the Canada Border Services Agency and Immigration Canada (to monitor cross-border movement), among others. These bodies were largely coordinated through the Federal Healthcare Partnership— Pandemic Planning Working Group and were guided by the Avian and Pandemic Influenza Preparedness Program. Intergovernmental coordination occurred through the Conference of Deputy Ministers of Health and the young PHAC. Central to PHAC’s organization was the Pan-Canadian Public Health Network, includ- ing the Council of Chief Medical Officers of Health embedded within it. These units had created the Pandemic Preparedness Oversight Committee in 2007 to streamline pandemic management. Existing public health network groups provided expert advice when needed. New task groups were set up to support the Pandemic Coordination 28. Donald E Low & Allison McGeer, “Pandemic (H1N1) 2009: Assessing the Response” (2010) 182:17 CMAJ 1874. 29. Harvey V Fineberg. “Pandemic Preparedness and Response: Lessons from the H1N1 Influenza of 2009” (2014) 370:14 New England J Medicine 1339. 30. An adjuvant is an ingredient added to a vaccine that helps promote a better immune response (and can thus reduce the amount of virus needed).