Pan-canadian public health network council report and policy recommendations on the use of antivirals for prophylaxis during an influenza pandemic

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Annex 2: Task Group on Antivirals for Prophylaxis

a) TGAP Origins

An early step in implementation of The Canadian Pandemic Influenza Plan was a decision to establish a National Antiviral Stockpile (NAS) for early treatment of pandemic influenza. Subsequently, in February 2006, the Public Health Network Council and the Council of Chief Medical Officers of Health agreed that “a national process should be developed, including broad consultation, to facilitate more informed and open decision-making regarding the advisability of factoring in the potential use of antivirals for prophylaxis purposes (prevention), in the National Antiviral Stockpile”.⁴ At the May 2006 Conference of F/P/T Ministers of Health, officials were directed “to immediately begin a process aimed at the creation of a national policy recommendation on the provision of prophylactic antivirals (prevention) for use during an influenza pandemic”.⁵

A more detailed plan of work, including methodology and questions to be considered, was proposed by TGAP and endorsed by PHNC in June 2006. TGAP was directed to proceed with “three parallel tracks of work”, to include:

1. A detailed review and analysis of current scientific and technical evidence and other related considerations on antivirals and their use for prophylaxis; and
2. a public consultation process which provides an opportunity to gauge Canadian attitudes on the subject, understand the priorities of Canadians relevant to these decisions, consider stakeholder issues and views, and how they might weigh and consider various options; and
3. the development of the options and recommendations for the national policy.⁶

Context

The Antiviral Strategy is one component of the Canadian Pandemic Influenza Plan for the Health Sector. TGAP’s work on antivirals for prophylaxis is one element of the antiviral strategy, which also includes early treatment.

TGAP was not tasked to provide recommendations on the use of antivirals during outbreaks of avian influenza. Public Health Guidelines on avian influenza, outbreaks including the use of antivirals, have already been developed and published by PHAC (Human Health Issues related to Avian Influenza in Canada is available at: http://www.phac-aspc.gc.ca/publicat/daio-enia/index.html.

Also beyond the scope of the mandate of TGAP were recommendations on development of a strategy for containment at source, which would be expected under the International Health Regulations should a novel human strain of influenza arise in Canada with the potential for human to human transmission. It is anticipated that the PHAC will lead the development of a containment strategy for Canada, which would involve the use of antivirals for early treatment of cases and prophylaxis of contacts in the context of commitments under the North American Plan for Avian and Pandemic Influenza, and in accordance with the World Health Organization interim protocol on this issue, which was posted in May 2007 and is available at: http://www.who.int/csr/disease/avian_influenza/RapidContProtMay07.pdf

TGAP Terms of Reference

The Pan-Canadian Public Health Network (the Network) provides policy advice to the Conference of F/P/T Deputy Ministers of Health (CDMH) on public health matters. The Task Groups within the Network will receive their respective mandates and roles from the Public Health Network’s Council. The Council will hold all Task Groups accountable for the deliverables and performance of their respective Task Group.

1.0 Mandate

The mandate of the TGAP is to:

a) develop a proposal to initiate an F/P/T process to develop a national policy recommendation, including public and stakeholder consultation, on whether to provide prophylactic antivirals during an influenza pandemic (by June 2006);

b) consider all the issues that pertain to antivirals and their use for prophylaxis, including a commissioned review of all the relevant scientific evidence;

c) oversee the F/P/T consultation process with citizens and stakeholders; and

d) synthesize the results of all the analyses, evidence and consultations, identify the options and propose a national policy recommendation for consideration by the PHN Council and the CDMH (by the Fall of 2006).

2.0 Goals and Strategic Priorities

Identify strategic priorities and processes to develop a national policy recommendation on whether to provide prophylactic antivirals during an influenza pandemic.

Identify options for public and stakeholder involvement, consultation, dialogue on the provision of prophylactic antivirals during a pandemic influenza, including priority groups such as health care workers.

Identify the level of resources required for successful implementation.

Facilitate and coordinate activities leading to the development of a proposal on requirements to develop a national policy recommendation.

Provide advice and recommendations to the Public Health Network Council.

3.0 Governance

3.1 Accountability

The TGAP is accountable to the Public Health Network Council.

The TGAP will have authority to implement decisions that promote convergence and collaboration on public health issues of mutual interest where participating members voluntarily agree to joint actions.

3.2 Membership and Participation

The Task Group will be co-chaired by one provincial/territorial government member and a representative of the Public Health Agency of Canada.

Other members, not to exceed twenty, will be drawn from federal, provincial, and territorial governments in the areas of public health, emergency management, emergency health sector, Aboriginal health, communications, policy, legal, ethics, social science, and others as required.

3.3 Meetings, Quorum and Decisions

The Task Group on Antivirals for Prophylaxis meetings will be held as required between the period of May 24 and December 2006. Records of Decisions will be recorded by the Secretariat and distributed to members.

Quorum for TGAP meetings shall be attendance by a simple majority of members.

Decisions shall be made by consensus defined as general agreement.

3.4 Changes to the Terms of Reference

Changes to the Task Group on Antivirals for Prophylaxis Terms of Reference require approval by the Public Health Network Council.

4.0 Support

4.1 Secretariat

The Government of Canada, through the Public Health Agency of Canada, provides the Secretariat for the TGAP. The Secretariat is also responsible for facilitating information sharing between the Council, the Public Health Network components, and other stakeholders.

4.2 Resourcing

The Public Health Agency of Canada will provide the resources necessary to support the work of the TGAP.

TGAP membership

Co-Chairs
Horacio Arruda, Ministère de la santé et services sociaux
Arlene King, Public Health Agency of Canada

Aboriginal Health
Kim Barker, Assembly of First Nations

Communications
Elaine Chatigny, Public Health Agency of Canada
Kevin Finnerty, Ontario Ministry of Health and Long-Term Care
Natasha Manji, Public Health Agency of Canada

Emergency Health
Wayne Dauphinee, British Columbia Ministry of Health Services
Allison Stuart, Ontario Ministry of Health and Long-Term Care

Emergency Management
Wayne Cotgreave, Emergency Management Ontario
Julie Cranton, Public Safety Canada

Ethics
Caroline Alfieri, Hôpital Ste-Justine

Legal
Mara Pollock, Justice Canada

Public Health
Eilish Cleary, Manitoba Health, Office of the Chief Medical Officer of Health
Donna Forbes, Manitoba Health
Patricia Huston, Public Health Agency of Canada
Sylvie Poirier, Ministère de la Santé et des Services sociaux
Shelley Sarwal, Nova Scotia Department of Health Promotion and Protection
Jill Sciberras, Public Health Agency of Canada

Secretariat
Alena Fraser, Public Health Agency of Canada
Pierre Génier, Public Health Agency of Canada
Sonia Le Bris, Public Health Agency of Canada

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