Infectious Disease Prevention and Control
( http://www.phac-aspc.gc.ca/id-mi/index.html )

The increase in the speed and volume of global travel places Canadians within 24 hours of almost any other place in the world - less than the incubation period for most communicable diseases, which can be transported by individuals or products such as food. This fact, combined with the realization that several previously unknown or rare diseases have appeared or re-appeared around the world in recent years, highlights the need for the Agency to be involved in activities aimed at reducing and preventing the spread of infectious diseases.

The Agency provides an enhanced pan-Canadian capacity to conduct policy development, surveillance, investigation, research and program response to food- and water-borne diseases, zoonoses, health care-acquired infections, community-acquired diseases, including sexually transmitted infections, hepatitis C and HIV/AIDS, respiratory infections such as tuberculosis, and vaccine-preventable diseases.

The Agency assists and/or coordinates investigations of disease outbreaks in provincial/territorial jurisdictions and internationally when requested. It facilitates, carries out and coordinates risk analysis and risk management activities with international, federal, provincial/local partner organizations and identifies emerging threats to the health and safety of Canadians.

More specifically, the Agency provides pan-Canadian guidance in efforts to reduce the risk of bloodborne infections, including transfusion-transmitted infections and infections resulting from transplantation.

Enhanced infection control and prevention programs in health care facilities and other community settings are helped by the Agency's collection, analysis, interpretation and dissemination of epidemiological information on occupational and nosocomial infections in the Canadian population.

The Agency also promotes access to services and programs, including sexual health education, that help Canadians improve and maintain their sexual and personal health. This work involves the joint efforts of the provinces and the territories, non-governmental organizations and health care providers in preventing and controlling sexually transmitted diseases and their complications, including infertility and cancer.

In collaboration with the provinces, the territories and partners, the Agency designs, develops and implements programs that will prevent hepatitis C infection, support people who have or are affected by the disease, and increases public awareness about it. In cooperation with several stakeholders, the Agency also supports research to further hepatitis C related knowledge, to transfer and disseminate it, and to apply research findings to other program activities. The Agency also provides leadership and coordination in the prevention and control of tuberculosis in collaboration with governments and partners at the regional, provincial/territorial, national and international levels.

Agency laboratories provide expert microbiological reference testing and carry out innovative research to improve our capacity to identify viruses and bacteria and support surveillance and outbreak investigation. These laboratories also provide policy-makers and other stakeholders with scientific information and advice on minimizing the risks of human illnesses arising from the interface between humans, animals and the environment. Their expertise in laboratory biosafety is in part based on the high-level containment capacity of the Canadian Science Centre for Human and Animal Health in Winnipeg, which houses both the Agency's National Microbiology Laboratory ( http://www.nml.ca/english/index.htm ) and the Canadian Food Inspection Agency's National Centre for Foreign Animal Disease.

The Agency's focus on infectious disease prevention and control supports its priority to develop and lead Canada's long-term strategic public health initiatives and to develop, enhance and implement integrated and disease-specific strategies.

HIV/AIDS
( http://www.phac-aspc.gc.ca/aids-sida/hiv_aids/federal_initiative/monitoring/index.html )

According to HIV/AIDS estimates from the Joint United Nations Programme on HIV/AIDS, almost five million people became newly infected with HIV in 2003, more than in any other year since the beginning of the epidemic. Around the world, the number of people living with HIV was estimated at 38 million. The total number of AIDS-attributed deaths since the disease was identified in 1981 is more than 20 million. At the end of 2002, an estimated 56,000 people in Canada were living with HIV infection, 12% more than at the end of 1999. About 30% of these individuals were unaware of their infection. This "hidden" aspect of the epidemic means that about 17,000 infected individuals are not able to access treatment, support or prevention services. HIV/AIDS is still a fatal disease, and there is no vaccine to prevent new infections.

While homosexual men remain the group most affected by HIV/AIDS in Canada, the epidemic has also gained a foothold in other populations, including Aboriginal people, inmates, injection drug users, youth, women and people from countries where HIV is endemic.

The Government of Canada has been actively addressing HIV/AIDS since 1983. The Canadian Strategy on HIV/AIDS ( http://www.phac-aspc.gc.ca/aids-sida/hiv_aids/federal_initiative/monitoring/can_strat2.html ) set out to create an ongoing, nationally shared approach to HIV/AIDS, with increased collaboration across all sectors of society. It brought legal, ethical and human rights issues to the fore while continuing to support the work of local and national non-governmental organizations, HIV/AIDS researchers and epidemiologists.

Building on recommendations from the House of Commons Standing Committee on Health report, Strengthening the Canadian Strategy on HIV/AIDS (2003) ( http://www.parl.gc.ca/InfocomDoc/37/2/HEAL/Studies/Reports/healrp03-e.htm ), on lessons learned from previous federal HIV/AIDS strategies, and on stakeholder and provincial/territorial consultations, the Government of Canada announced in May 2004 that the federal funding for HIV/AIDS would increase from $42.2 million to $84.4 million annually by 2008-2009.

The launch of the Federal Initiative to Address HIV/AIDS in Canada in January 2005 signalled a renewed and strengthened federal role in the Canadian response to HIV/AIDS. The Federal Initiative is a partnership among the Public Health Agency of Canada, Health Canada, the Canadian Institutes of Health Research, and Correctional Service Canada.

The goals of the Initiative are to prevent new infections, slow the progression of the disease and improve quality of life, reduce the social and economic impact of HIV/AIDS and contribute to the global efforts against HIV. Key activities involving the Agency include strengthening our knowledge of HIV/AIDS to better inform HIV prevention, care, treatment and support programs and developing discrete approaches for those populations most vulnerable to HIV/AIDS; increasing public awareness of HIV/AIDS and factors such as stigma and discrimination, which fuel the epidemic; integrating HIV/AIDS programs and services with those for other diseases such as hepatitis C and sexually-transmitted infections as appropriate; broadly engaging other federal departments to address factors that influence health, such as housing and poverty; increasing Canadian engagement in the global response to HIV/AIDS; and improving the communication of outcomes achieved from federal investments in HIV/AIDS.

Pandemic Influenza Preparedness

An influenza pandemic will likely be the largest public health infectious disease emergency we will face in Canada and globally. In light of this, the Agency has worked with the provinces, the territories and other stakeholders to develop the Canadian Pandemic Influenza Plan (CPIP). The goal of the CPIP is to minimize serious illness and death and societal disruption during an influenza pandemic. The CPIP is updated on an ongoing basis as new knowledge and planning guidance is incorporated but remains a basis for provincial and territorial pandemic plans and outlines the various responsibilities for all levels of government.

Even though the timing of the next pandemic cannot be predicted, it is important to work with our global partners on disease surveillance and threats that could signal the onset of a pandemic, and to ensure that the necessary global cooperation is already in place prior to a pandemic. The Agency, along with the provinces and territories through the Federal/Provincial/Territorial Pandemic Influenza Committee, collaborates with the World Health Organization and members of the Global Health Security Action Group to increase pandemic influenza preparedness in Canada and worldwide. The Agency will also continue to take a leadership role in updating the CPIP, in collaboration with the provinces and the territories, and in promoting implementation by all levels of government of any update to the Plan. By leading and participating in the implementation of surveillance activities, the Agency can help ensure better preparation and response to a pandemic.

Part of the preparation for an influenza pandemic is ensuring that there is an adequate domestic supply of vaccines. A 10-year contract (2001-2011) for developing and maintaining the capacity for domestic production of pandemic vaccine with ID Biomedical helps strengthen our state of readiness in advance of an influenza pandemic. The Agency and the provinces and territories have contributed to the creation of a stockpile of antiviral medication for use against a pandemic.

Making the right decisions on surveillance and preparedness requires research and knowledge translation. Some of the ongoing research activities related to pandemic influenza planning include the Evaluation of Influenza Immunization Programs in Canada, in collaboration with the Canadian Institutes of Health Research and other partners inside and out of the health portfolio, and a modelling workshop on the potential impact of the pandemic vaccine and antivirals. This research helps to inform public health responses and contributes to professional and public education.

Health Care/Hospital Acquired (Nosocomial) Infections

Estimates have shown that about 5 - 10% of all patients who enter a health facility will develop a nosocomial (health care/hospital acquired) infection. While the provision of direct health care is almost all under provincial and territorial jurisdiction, the Nosocomial Infections Program works with the provinces and the territories to focus on the public health impact of infectious agent transmission during the provision of health care. One particular nosocomial infection, Clostridium difficile (C. difficile) , has received greater public attention in recent months ( http://www.phac-aspc.gc.ca/c-difficile/index.html ). C. difficile is the most common cause of infectious diarrhea in the industrialized world, with approximately 20% of the cases occurring in people who are taking antibiotics.

The Agency has established Infection Control Guidelines (ICG), a widely used set of recommendations that give health care providers, governments and other institutions best-practice information for the prevention and control of infections that occur during the provision of health care. The Agency will focus on expanding the scope of its recommendations to include the entire spectrum of health care provision, such as acute care, long-term care, office and outpatient care, and home care.

The Agency is also attempting to minimize the impact of nosocomial infections through the Canadian Nosocomial Infection Surveillance Program (CNISP). CNISP is a national surveillance program that provides statistics and data on nosocomial infections in Canada for use in the development and evaluation of guidelines. CNISP is currently conducting an incidence project with major teaching hospitals and some of their affiliates in nine provinces to determine the rates of C. difficile associated diarrhea and the incidence of adverse outcomes in various regions of Canada. The study began on November 1, 2004, and runs until April 30, 2005. As part of this study, the Agency will determine whether there is a way of differentiating severe cases from mild cases and whether there is a "new" strain of C. difficile that increases the severity of illness.

In January 2005 the Agency began to survey all of the hospitals in Canada to get a better understanding of their infection prevention and control practices for C. difficile . The Agency will use this information to refine the infection prevention and control recommendations for C. difficile in its Infection Control Guidelines.

Over the next three years, CNISP will expand the number of active surveillance projects and policy activities related to critical health care-acquired infections. CNISP will also establish ongoing surveillance in intensive care units in the 30 CNISP-affiliated hospitals across Canada and begin work to expand the CNISP network to key community hospitals and long-term care agencies.

The Antimicrobial Resistance and Nosocomial Infections Unit at the National Microbiology Laboratory in Winnipeg works closely with the Nosocomial Program to help design surveillance studies and provide laboratory information about the bacteria collected during the studies. As well, the Laboratory identifies and "fingerprints" antimicrobial resistance genes in common nosocomial pathogens to track the spread of these organisms within and between hospitals. The Unit also works closely with hospital laboratories to detect and understand emerging forms of antibiotic resistance. This information is used to develop rapid tests that identify new resistance patterns and increase the Agency's understanding of how to prevent the resistant strains from spreading.

National surveillance efforts have been complemented with program support to the provinces and territories and health care organizations in investigating nosocomial infection outbreaks such as SARS and avian influenza. The Agency is also conducting an in-depth analysis of infectious disease outbreaks in Canadian health care facilities and developing contingency plans for emerging infectious agents in health care environments.

Animal to Human (Zoonotic) Diseases

Zoonotic diseases (those transmissible between animals and humans) include a very diverse group of pathogens that arise from animals and the agro-environment. This situation is expected to continue. In addition to direct health effects and associated health care costs, the ongoing economic and social effects of zoonoses are tremendous, ranging from lost productivity to international trade and travel restrictions. The Centre for Infectious Disease Prevention and Control (CIDPC), the National Microbiology Laboratory (NML) and the Laboratory for Foodborne Zoonoses (LFZ) all conduct activities to intervene in the threat of zoonotic diseases.

CIDPC intervenes by conducting surveillance of specific zoonotic diseases and takes part in outbreak response and management. It provides expertise on the public health risks linked to zoonotic and emerging diseases, and provides targeted information and advice to the public and to health communities. The Agency continues its research and surveillance work related to the West Nile virus (WNV), collaborating with Canada's blood agencies to minimize risks to Canada's blood supply. The initial effort by the Agency on WNV is being adapted to the development of provincial and territorial WNV response plans and will be the model for other zoonotic infections. Over the next three years, CIDPC will continue to provide the necessary infrastructure and scientific expertise to support basic surveillance, science, research, coordination and leadership in specific zoonoses.

Over the next three years, the National Laboratory for Zoonotic Diseases and Special Pathogens (ZDSP), a specialized part of the NML in Winnipeg, will continue to provide research and development, diagnostic and reference services, and national and international surveillance for zoonotic diseases and related biocontainment agents. The ZDSP program is unique in Canada, offering laboratory support for a wide variety of zoonotic disease pathogens, most of which are not dealt with at any other level within Canada. ZDSP will provide the appropriate level of laboratory monitoring for zoonotic diseases to help the Agency develop and enact appropriate prevention, response and control strategies.

National surveillance programs to monitor trends in antimicrobial resistance in selected enteric pathogens and indicator bacteria isolated from humans, animals and food sources is a necessary and important element in public health. The Laboratory for Foodborne Zoonoses ( http://www.phac-aspc.gc.ca/lfz-llczoa/index_e.html ) currently generates, synthesizes and communicates science- based information for the prevention and control of public health risks associated with enteric infectious diseases. The Agency will continue to enhance and develop this capacity to respond to issues such as antimicrobial resistance at the human, animal and environmental interface through integrative programs involving surveillance, research, risk assessment and policy effectiveness advice.

Over the next three years, the LFZ is planning specific research on major enteric pathogens with respect to virulence and host adaptation, and novel interventions at human/animal interface. The LFZ will coordinate, along with CIDPC and the NML, the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS), working with Health Canada and other federal and provincial/ territorial counterparts, academia, industry partners and stakeholders to develop a pan-Canadian surveillance program for monitoring trends in antimicrobial resistance in selected enteric pathogens and indicator bacteria isolated from humans, animals and food sources.

Public Health Tools and Practice

Infrastructure is another key element of a strong public health system.

In Budget 2004, the Government of Canada committed resources to enhance public health on the front lines, including an investment of $500 million to assist in the development and implementation of a public health surveillance system, to help support a national immunization strategy and to help enhance public health capacity at the provincial and territorial levels.

The Agency contributes to this infrastructure enhancement through the development and provision of tools and applications that support front-line health care professionals and of practices and programs to build the long-term capabilities of public health professionals. For example, the Agency provides data management tools and access to the data and information necessary for evidence-based decision-making while ensuring that privacy risks are effectively managed.

The Agency also contributes major elements to enhance public health human resources capacity by delivering online programs and sponsoring training programs in epidemiology. Health professionals in local public health departments and regional health authorities across Canada access the Agency's programs to increase their skills in the areas of epidemiology, surveillance and information management.

In particular, the Agency is a leader in field epidemiology, which is the application of epidemiological methods to unexpected health problems when rapid on-site investigation is necessary. Field epidemiologists are disease detectives, invited to study diseases in order to better understand and control them. This involves helping investigation teams define, find and interview cases, coordinate the collection and analysis of specimens, apply statistical methods to assess factors responsible for illness and recommend control measures.

These efforts to develop, promote and enhance public health tools and practices support the Agency's priority to develop and lead Canada's long-term strategic public health initiatives as well as to develop, enhance and implement integrated and disease-specific strategies.

Public Health Tools and Applications Development

To respond to the major information challenges that face public health care professionals in Canada, the Agency has developed, among others, two valuable public health applications: the Canadian Integrated Public Health Surveillance (CIPHS) program and the Geographic Information Systems (GIS) Infrastructure program.

CIPHS ( http://www.ciphs.ca ) is the Agency program that develops suites of integrated computer and database applications to enable the systematic collection, integration, analysis, interpretation and dissemination of public health surveillance data. The CIPHS program works with provincial/territorial public health professionals in the CIPHS collaborative strategic alliance to build the capacity for public health surveillance at local, provincial, territorial and national levels.

CIPHS's main product to date is the integrated Public Health Information System (i-PHIS - http://www.phac-aspc.gc.ca/csc-ccs/ciphs_e.html ), a unique web-based software suite consisting of customized health information management modules used by front-line public health providers, health managers, epidemiologists and health researchers. The i-PHIS modules provide tools for both client assessment and case management. i-PHIS enables the recording, storage, access and management of patient-specific health information, treatments and outcomes.

The i-PHIS application, through an integrated jurisdiction client registry and other key data sources, supports all aspects of public health service, including timely information sharing, response coordination and effective action. It enhances the ability of public health professionals to anticipate, control and prevent public health threats. It integrates client health records, referrals, scheduling and reporting to support effective case management, surveillance, screening, tracking and follow-up. In this evolving suite of tools, improvements to i-PHIS (such as comprehensive Outbreak and Quarantine Management capabilities) are under way. Work has also begun on the potential uses of i-PHIS in the Electronic Health Record.

As a collaboratively developed tool, CIPHS engages partners and other stakeholders in the development of i-PHIS at all levels, including the requirements definition level. This ensures that partners and stakeholders receive the public health information tool they need.

The GIS Infrastructure program ( http://www.phac-aspc.gc.ca/csc-ccs/gis_e.html ) promotes a user- friendly online tool for public health professionals called the Public Health Map Generator. The Public Health Map Generator will address current public health GIS needs for a cost-effective solution by providing a bilingual web site for public health professionals to create their own maps in a simple and timely manner. Public health professionals can now map their tabular health data using spatial data from an integrated spatial data warehouse, with little or no previous GIS skills or knowledge.

The GIS Infrastructure program enables public health professionals to visualize and analyze health data in a spatial context and to support their evidence-based decision making in program planning and evaluation, disease outbreak investigation, disease and injury surveillance, emergency preparedness, resource allocation, intervention program implementation and evaluation, public awareness and policy. The GIS Infrastructure is recognized as a critically important and evolving tool.

By employing these tools, we expect that health care professionals will be able to make better decisions based upon empirical evidence derived from tested methodologies and technologies.

Building Public Health Human Resource Capacity

The Canadian Field Epidemiology Program (CFEP - http://www.phac-aspc.gc.ca/cfep-pcet/index.html ) was established in 1975 and provides specialized training for health professionals in the practice of applied epidemiology. The program was the first field epidemiology training program to successfully follow the model program in the U.S., and more than 100 graduates are now working domestically and internationally, and contributing to increased public health capacity.

Since the Program's inception, its field epidemiologists have investigated close to 250 outbreaks and other public health issues, and provided epidemiological assistance to every jurisdiction in Canada and abroad.

The Program develops skills and competencies not easily taught in academic or workplace settings. Field epidemiologists complete eight professional experience guidelines in the two-year program. Upon graduation, they receive an internationally recognized certification in field epidemiology.

The Program plans to expand its operations in the next two years, doubling the places available for incoming students, thus increasing the long-term capacity and responding to existing and future demands.

The Skills Enhancement Program ( http://www.phac-aspc.gc.ca/csc-ccs/skills_e.html ) complements the Canadian Field Epidemiology Program by providing high-quality and relevant distance learning opportunities to the public health workforce across Canada. The Program addresses significant knowledge gaps in the areas of epidemiology, surveillance and health information management. It is delivered through the collaborative efforts of the Agency, the provinces, the territories, professional associations and academic institutions, and it provides pathways for recognition of the enhanced knowledge by universities, professional associations and public health authorities.

The enhancement of public health human resource skills, knowledge and capacity will allow us to better undertake effective surveillance and respond to health threats and emergencies at the local, provincial, territorial, federal and global level.

Other Programs and Services

Laboratory Security
http://www.phac-aspc.gc.ca/ols-bsl/index.html

Childhood and Adolescence
http://www.phac-aspc.gc.ca/dca-dea/main_e.html

Aging and Seniors
http://www.phac-aspc.gc.ca/seniors-aines/index_pages/whatsnew_e.htm

Canadian Health Network
http://www.canadian-health-network.ca

Health Surveillance and Epidemiology
http://www.phac-aspc.gc.ca/hsed-dsse/index.html

Voluntary Sector
http://www.phac-aspc.gc.ca/vs-sb/voluntarysector/

Chronic Disease Surveillance
http://www.phac-aspc.gc.ca/ccdpc-cpcmc/surveil_e.html

Countrywide Integrated Noncommunicable Disease Intervention (CINDI)
http://www.phac-aspc.gc.ca/ccdpc-cpcmc/cindi/index_e.html

World Health Organization Collaborating Centre for Non-Communicable Disease Policy  
http://www.phac-aspc.gc.ca/ccdpc-cpcmc/international_e.html

Hepatitis C
http://www.phac-aspc.gc.ca/hepc/hepatitis_c/index.html

Blood Safety Surveillance
http://www.phac-aspc.gc.ca/hcai-iamss/index.html

Immunization and Respiratory Infections
http://www.phac-aspc.gc.ca/dird-dimr/index.html

Network for Health Surveillance
http://www.phac-aspc.gc.ca/csc-ccs/network_e.html

Section III:
Supplementary Information

Management Representation Statement

I submit, for tabling in Parliament, the 2005-2006 Report on Plans and Priorities (RPP) for the Public Health Agency of Canada.

This document has been prepared based on the reporting principles contained in the Guide to the Preparation of Part III of the Estimates: Reports on Plans and Priorities .

• It adheres to the specific reporting requirements outlined in the TBS guidance;
• It is based on the department's approved accountability structure as reflected in its Management Resources and Results Structure (MRRS);
• It presents consistent, comprehensive, balanced and accurate information;
• It provides a basis of accountability for the results achieved with the resources and authorities entrusted to it; and It reports finances based on approved planned spending numbers from the Treasury Board Secretariat in the RPP.

David Butler-Jones MD
MHSc, CCFP, FRCPC, FACPM
Chief Public Health Officer

Public Health Agency of Canada

Proposed organizational information as of February 2005

The decrease in the net planned spending of $81.3M from 2004-2005 to 2005-2006 is due to incremental funding of $3.8M for HIV/AIDS, an increase of $2.9M in the transfer from Health Canada for corporate support, incremental funding of $2.8M for the Pan-Canadian Public Health System, new funding of $1.7M for the creation of a contribution program for Fellowships/ Bursaries/Scholarships and of $0.8M for Bovine Spongiform Encephalopathy (BSE), reduced funding for Sectoral Involvement in Departmental Policy Development ($1.1M), a reduction caused by an adjustment to Employee Benefit Plans ($1.5M), a decrease due to the sunsetting of the Biotechnology Strategy for Genomics ($1.8M), reduced funding for the Centre of Excellence for Children's Well-Being ($1.8M), a decrease due to recently approved collective agreements not reflected in 2005-2006 ($2.0M), a reduction related to the $1B governmental reallocation exercise ($6.5M), a reduction for adjustments reflected in the 2004-2005 Supplementary Estimates for 2005-2006 ¹ ($28.5M) and reduced funding for Hepatitis C - Health Care Services ² ($50.1M).

The increase in the total planned spending of $16.0M from 2005-2006 to 2006-2007 is due to additional funds of $10.2M caused by the end of the five-year agreement with the Canadian Institutes of Health Research (CIHR) for HIV/AIDS, incremental funding of $7.4M for the Pan-Canadian Public Health System, incremental funding of $4.4M for HIV/AIDS, incremental funding of $2.5M for the contribution program for Fellowships/Bursaries/Scholarships, sunset of Bovine Spongiform Encephalopathy (BSE) ($0.8M), reduced funding for Canada's Drug Strategy ($1.0M), a funding reduction due to the sunsetting of the Centre of Excellence for Children's Well-Being ($1.7M) and a reduction caused by an increase in PHAC's share of the $1B governmental reallocation exercise ($5.0M).

The increase of $3.5M in planned spending from 2006-2007 to 2007-2008 is due to $4.7M in incremental funding for HIV/AIDS and a reduction caused by an increase in PHAC's share of the $1B governmental reallocation exercise ($1.2M).

¹ Includes Canadian Diabetes Strategy, Hepatitis C Disease Prevention Support and Research Program, an operating budget carry-forward, the Interdepartmental Partnership with the Official Language Communities (IPOLC) and government advertising programs (Healthy Pregnancy). Budget 2005 provides for new funding for the Canadian Diabetes Strategy of $18M per year (replacing the $15M per year that was due to sunset in March 2005) and a one-time funding of $10.7M in 2005-2006 for the Hepatitis C program.

² This reduction is due a cyclical advance in 2004-2005 that will not occur in 2005-2006. This advance is budgeted every five years. This item will appear again in 2009-2010.