University of Ottawa professor of medicine Dr. Kumanan Wilson has received a CIHR grant of $212,397 to examine Canada’s preparation for, and response to, the coronavirus outbreak. Dr. Wilson is part of an international team of five researchers who will conduct the study over the next 18 months.
Four additional uOttawa researchers received grants as part of the Government of Canada’s $26.8M in rapid-response COVID-19 funding, including the Faculty of Medicine’s Drs. Marc-André Langlois and Ronald Labonté; Dr. Maxim Berezovski of the Department of Chemistry and Biomolecular Sciences; and Dr. Patrick Fafard of the Graduate School of Public and International Affairs.
We spoke to Dr Wilson, a physician and senior scientist in the clinical epidemiology program at The Ottawa Hospital and Innovation Advisor for Bruyère Research Institute, about his research project.
The purpose of your grant is to “examine Canada’s preparation for and response to the coronavirus outbreak with a focus on its obligations under ... the International Health Regulations (2005).” Can you briefly summarize what are Canada’s obligations?
The IHR are the set of rules that are meant to protect the world from public health emergencies. The countries in the World Health Organization all agreed to build the capacity to identify, evaluate, report and respond to potential global public health threats that emerge within their borders.
We will look at the literature, at documents, to see where we are, with respect to having this capacity. We would follow up with interviews with individuals who are responsible, who have knowledge of this area. If we identify any potential problems that should be addressed we will communicate these with Canadian officials.
The purpose of the International Health Regulations is to “provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade.” Can you explain that?
The IHR is both a public health and an economic document. It balances protecting the economy, and international traffic and trade with protecting public health.
Why were these international rules developed?
This all came out of the cholera outbreaks in Europe in the 19th century. Every time an outbreak occurred, countries would shut their borders, and trade would stop. And that isn’t good, because the damage economically is sometimes worse than the damage from the disease. So they needed to create a set of rules: when can you shut your borders?
How does a country balance the need to contain a disease outbreak, with the need to allow international traffic and trade to continue?
The way this is supposed to work — and to be honest it hasn’t worked how it is supposed to work — is that the WHO is supposed to be the decision-maker. An emergency is identified, the WHO declares an emergency, and the WHO sets rules for how we are supposed to respond. And we are not supposed to exceed those rules.
The WHO has an emergency committee, who has all the data in front of them, who says: These are the measures that will effectively protect your country. Anything beyond that will not add any additional protection to your country, but will unnecessarily affect trade and travel.
That’s in theory, what’s supposed to happen. If you look at what’s happened with the coronavirus, several countries took action before the WHO even declared it an emergency.
According to its website, the WHO “continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks,” yet 38 countries have already applied such restrictions. Why aren’t countries following the recommendations of the WHO in this case?
The IHR were approved in an era when we believed in global arrangements. Now we’re in an era of populism. Many countries are less likely to cede their sovereignty to an organization like the WHO. They’re going to make decisions they believe are in the best interests of their country. But the reality is that these decisions can create a collective loss. COVID-19 has already cost $6 trillion off the stock market. The economic consequences are very real.
Beyond identifying potential gaps in Canada’s response to the coronavirus, what else do you hope will come out of your study?
If there is something that I’m hoping for, I think there is an opportunity for Canada to help the world in this.
What’s gone kind of wrong with the IHR — which the 2014 Ebola outbreak exposed — is that low- and middle-income countries developed a perception of: why should we take all of this effort to detect and report these diseases? Are we really going to get any help? Or is it just going to use up our scarce resources, and serve as an early warning system to wealthy countries so they can shut their borders? And then Ebola 2014 reinforced to them that they didn’t get the help that they were hoping to receive.
So one of the thoughts is that the wealthy countries should be investing in developing the public health capacity in these countries. Because if these countries identify, detect and respond, it will help control these diseases. In the process, we prevent these threats from spreading to our countries. This means better public health for poorer countries, prevention of the global spread of disease and protection of the global economy.
Canada is one of the leaders in public health security and many important public health breakthroughs have happened in this country. We are well positioned to help and lead in this global effort.
Since the publication of this article, Dr. Wilson and his colleagues have received funding from The Ottawa Hospital Foundation’s COVID-19 Emergency Response Fund to harness their electronic vaccine-tracking platform CANImmunize to let Canadians report potential adverse events from a COVID-19 vaccine through their mobile device. This will be crucial in ensuring both the safety of a COVID-19 vaccine and enhancing public trust in the vaccine. The team has already built and tested a proof-of-concept pilot app in partnership with the Canadian Vaccine Safety Network for monitoring adverse events from the seasonal influenza vaccine. This reporting function will be activated for testing during the fall flu season for use by participating employees at The Ottawa Hospital, in preparation for a probable COVID-19 vaccine in 2021.
Read the article from Bruyère Research Institute.
Read an article in the Ottawa Citizen by Kumanan Wilson, University of Ottawa, and Sam Halabi, Georgetown University: How global health rules are being challenged by coronavirus
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