Public Health
Response Committee
Strategy Report
UNIVERSITY OF ALBERTA
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UNIVERSITY OF ALBERTA PUBLIC HEALTH RESPONSE COMMITTEE
STRATEGY REPORT
JANUARY 2007
Introduction
The Public Health Response Committee (PHRC) is responsible for developing a Strategy, including a decision-making model, business continuity plans, human resource plan, and a communications plan that will be operationalized in the event the University of Alberta faces a public health event, in particular an influenza pandemic. The Committee, which started work in January 2006, is a cross-organizational team with representatives from key areas of the University and from external agencies including Capital Health and the provincial government.
In carrying out its mandate, the Committee’s priorities have included an emphasis on planning for and ensuring the health and safety of staff and students, maintaining the essential services of the University, and communicating effectively with partners, including all levels of government, and stakeholders.
The Public Health Response Strategy is being developed at the same time as the new Integrated Emergency Management Program (IEMP), and is aligned with ongoing work on overall business continuity planning for the University. Indeed, a business continuity plan focused on a major health emergency such as a pandemic flu is being developed as an annex to the University-wide business continuity plan. Both the Strategy and the University-wide business continuity plan will be operationalized within the IEMP.
This report summarizes a more comprehensive draft document, “Public Health Response Committee Pandemic Strategy,” which details the ongoing work by the Committee to develop the Strategy and implement the measures necessary to ensure the University is prepared to respond to and manage a public health emergency. The more detailed document is currently a work-in-progress and will be for some time as the various initiatives outlined below are implemented over the coming months. Once the Strategy is finalized, it will be posted on the PHRC website and feedback sought.
A public health event is characterized by a severe threat to personal health and safety of a large population, which may result in high rates of sickness and/or death, occurs over a period of time, and involves partnering of a number of sectors within and external to the University to respond to and manage the event.
As noted, the focus of the PHRC is to have the University in a state of readiness and preparedness for any possible public health event, and in particular a possible Avian Flu pandemic. Influenza is a common virus that is present in our community primarily on a seasonal basis. A pandemic is a worldwide epidemic, which constitutes a global health emergency. Influenza pandemics have the capacity to cause serious morbidity and mortality as the population has little or no immunity to the novel circulating strain of influenza. Historically, influenza pandemics have occurred approximately 3 or 4 times per century. Although there is no way to predict when the next influenza pandemic will occur, many health experts believe that it is overdue and planning should take place to deal with such an emergency. In Canada, the provincial and federal governments are coordinating efforts from the international to the local levels to be prepared.
Models based on epidemiologic data show that over 50% of the population could become infected with a pandemic flu virus. Thousands of students, staff and faculty in the University community would be personally affected and rates of absenteeism would be unprecedented. The impact of a major health event may result in the implementation of severe access restrictions, partial closure and, in worst-case scenarios, the closure of the entire University.
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Table 1 shows the coordination of World Health Organization (WHO) pandemic phases, Capital Health region and University of Alberta stages as outlined in the detailed Strategy.
Table 1. Coordination of WHO Pandemic Phases, University of Alberta
Action Matrix, and Capital Health Stages of Action.
WHO Phase / Description / U of A Stage / Description / CH StageINTERPANDEMIC PERIOD / 1 / No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, risk of human infection or disease is considered to be low. / 0 / WHO concerns are increasing – actions may be required for staff and students outside of Canada. / 0
2 / No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.
PANDEMIC ALERT PERIOD / 3 / Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.
4 / Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting the virus is not well adapted to humans.
5 / Larger cluster(s), but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). / 0
Level 1 / Increasing sustained transmission in general population outside of Canada. New virus sub-type.
PANDEMIC PERIOD / 6 / Pandemic: increased and sustained transmission in general population. / 0
Level 2 / Suspected/confirmed cases in Alberta/Canada
1 / Sporadic cases within University/health region / 1
2 / Absenteeism increasing, minor impacts / 2
3 / Absenteeism increasing, major impacts or Government mandates suspension of public gatherings / 3
4 / Pandemic event is ending and recovery /resumption of normal operations under way / 4
University of Alberta Public Health Emergency Response
Governments and institutions, including the University, would be called on to make difficult decisions (for example, regarding the allocation of scarce resources) in the event of a serious public health event such as a flu pandemic. Thus, a key component of the Strategy has been to identify a set of ethical principles to enable decision-making in the best interests of the University and the larger community. The following “NOFLU” ethical principles have been adopted by the PHRC in its approach to developing the Strategy and would be useful to guide decisions in the event of an emergency. The principles are among the most widely recognized in the literature on pandemic planning:
1. Need to protect: While there is a need or duty to take steps to protect the community generally (see utilitarianism below), there is also the need or duty to protect those who incur risk for the benefit of the community, to protect vulnerable populations within the community, and to uphold or protect individual rights and freedoms.
2. Openness: Decisions should be made in an open and transparent manner, with clear lines of accountability. Decision-makers should provide information on how decisions are made and on what basis they are made as much as is reasonably possible. The University community (and, where appropriate, the larger community) should be kept informed and decision-makers should be open to revisiting and revising policies as new information arises.
3. Fairness: The principle of fairness should inform both the process of decision-making and its substantive and procedural outcomes. Decision-making and priority setting should be fair processes and include consultation with stakeholders where appropriate. Outcomes should reflect a fair distribution of the benefits and costs. Procedural fairness carries an obligation to provide protections to those whose rights or liberties are restricted in an attempt to protect the wellbeing of the community.
4. Least-Restrictive/Proportionate: In the process of decision-making, if there is more than one option that would achieve a particular aim, the least restrictive alternative should be chosen. This does not mean that decision-makers must choose the least restrictive means if it may lack effectiveness compared to other options in a given situation. Rather, the choice must be proportionate. In the absence of full information, decision-making should be taken on a precautionary rather than evidence-based model.
5. Utilitarianism: Decisions should be made to achieve the greatest benefit to the community.
As noted above, the Strategy aligns with the Integrated Emergency Management Program and key components such as response systems, structures and procedures including the Emergency Master Plan, the Emergency Operations Centre, Crisis Communications Plan and Faculty/Department Unit Action Plans.
Depending on the severity of a public health emergency, these systems, structures and procedures would be activated for assessment, decision-making, liaison with external partners, communications and management. Work is also underway to embed the universal “Incident Command System” into the University’s emergency response procedures, providing a shared language and protocol of response throughout the University and alignment with external agencies that provide or are associated with the provision of emergency services such as: rescue, fire suppression, hazardous materials, emergency medical care, policing and other emergency operations to ensure a coordinated response.
In the event of a pandemic or other serious public health emergency, the Strategy provides for the creation of a Public Health Response Team to provide leadership and management. The team would operate in conjunction with the Emergency Operations Centre (EOC), the overarching structure for managing emergency response at the University (see Chart 1 below). The EOC provides the central hub and oversight body for the university during a major emergency. The EOC provides support for faculty(s) and department(s) experiencing the emergency in addition to protecting the interests of the University as a whole (both in terms of infrastructure and personnel) for communications, coordination and support activities and implementing overall policy direction during serious emergencies. The PHR Team Branch Director and the EOC Director are charged with keeping senior University administrators on the University’s Crisis Management Team informed and briefed to make critical decisions, give policy direction and undertake communications in the event of an emergency.
Taken together, the systems, structures and process outlined in the Strategy will enable the University to be as ready and effective as possible in its response to a flu pandemic (or other public health event), including containing transmission of the virus, maintaining essential services and business continuity where possible, and providing timely and effective communications to internal and external stakeholders. The Strategy will also guide recovery following an event, including identifying needs for services and support in the University population, including the need for mental health services, restoring operations to normal, and assessing the effectiveness of the response.
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Chart 1: University of Alberta Emergency Response Structures with Public Health Response Team Position
*The Crisis Management Team includes senior Academic, Finance and Administration and External Affairs management and the Office of the President. The University Emergency Master Plan notes that the CMT is constituted to advise the Emergency Operations Centre (EOC) on strategy and provide policy guidance from a University-wide perspective.
**The Emergency Master Plan notes that the role of the EOC is to provide the central hub for communication, coordination and support activities during the emergency, overall policy direction, authority for emergency response actions and coordination with external agencies.
Managing University-Wide Priorities: Maintaining Essential Services and Business Continuity
The priorities for the University in an event of a pandemic or other public health event reflect the overall priorities identified in business continuity planning in the event of any major emergency. They are to maintain, insofar as is possible, the following:
Ø Health, safety and security of students, faculty, staff, contractors, renters and visitors on University premises;
Ø Continuation of patient care services within the responsibilities of the University;
Ø Communications to deliver critical messages to internal and external audiences, in a timely, accurate, and comprehensive way;
Ø Continuity of essential services on the main campus and essential support for remote campus locations, including learning/teaching and related student services, research programs and activities, essential administrative services (regulatory compliance, pay, benefits, leave, student financial aid, student records), supply management, and security and preservation of University facilities, equipment, collections, and archives;
Ø Effective partnerships with key external agencies and contribution to the community in keeping with the University’s vision, mission, values and preservation of reputation.
Business continuity planning is essential to achieving an acceptable level of emergency preparedness, response capability and capacity and, recovery and resumption measures in the event of a major emergency or interruption of critical services. Therefore, a key part of the public health response Strategy is the development of faculty and department business continuity plans specifically dealing with a flu pandemic. All departments will be asked to complete a detailed planning tool (see attached) that enables them to identify critical services and functions, personnel and backups, consider options to continue to deliver critical services in the event of disruption, work in partnership with other departments, faculties or external partners regarding planning for shared critical services, and identify inventory requirements such as equipment needs to deliver critical services. The tool asks departments and faculties to plan for emergency communications. The completed planning tool will form an annex to the overall business continuity plans.
Human Resource Considerations
A pandemic or other public health emergency event would greatly impact individuals and their working relationships within the organization and, for this reason, the human resource considerations will be a critical success factor when managing a public health event.
During the pandemic, a redeployment centre will be established to help maintain essential services. Risk communication, training and awareness programs will be essential to provide information on pandemic influenza. Senior management and members of the PHRC will have specific responsibilities. Tabletop testing exercises to enable learning in a simulated event have been undertaken with Public Affairs, the PHRC, and other departments and will continue to be staged. Occupational health and safety standards and related legal considerations would need to be taken into account when dealing with a pandemic.