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Monday, 18 August 2014

A celebration of Canada’s contribution to vaccines.

Those following the Ebola outbreaks are aware that Canada came riding as a white knight into the fray with an offer to utilize an untried vaccine developed at the National Metabolic Laboratories in Winnipeg. 

Such an international spotlight opens the curtains on celebrating Canada’s storied contributions to vaccines.  Fostered through the University of Toronto Connaught Laboratories  established in 1914 and best known for development of insulin.  The academic laboratories subsequently morphed into Connaught industries and helped lead the global effort to develop a polio vaccine post WWII which resulted in a candidate inactivated vaccines that formed the basis for the renowned Salk vaccine first trialed in 1952.  Connaught was instrumental in ramping up production to population scale levels within four years and directly contributed to outbreak cessation in the early 1950s. Connaught was well positioned to export vaccine internationally and quickly grew to an international industrial player and renowned as a major player in controlling polio globally.

Connaught’s production efforts have gone through multiple corporate purchases initially by Institute Mérieux in 1989, then merging with Pasteur Institute.  Morphing in 1999 to Aventis- Pasteur and purchased by Sanofi in 2004.  It continues to operate in Canada as Sanofi-Pasteur and is celebrating its 100th year in the business of vaccine development and production.  The Canadian branch of the company remains foundational in domestic production of the majority of routinely provided vaccines in Canada. 

Canadians have been involved in the production of an acellular pertussis vaccine in 1996,  an Alzheimer of vaccine Dr. Peter St George-Hyslop in 2000, bovine E. Coli vaccine Drs. Brett Finlay and Andy Potter in 2004, the hemorrhagic fever vaccines for Ebola, Marburg, and Lassa were trialed in 2005 by Drs. Heinz Feldmann and Steven Jones.  Canada is currently highly active in HIV vaccine development   http://www.chvi-icvv.gc.ca/index-eng.html

Expertise in vaccinology has developed in multiple centres with specific mention to the Canadian Accelerated Vaccine Development initiative led by the PREVENT coalition formed from Halifax Centre for Vaccinology, University of Saskatchewan Vaccine and Infectious Disease Organization, and BC Centre for Disease Control, who in working with industry are fronting early vaccine development activities and early phase trials before commercialization efforts are ascribed to private sector partners. The current work focused on Group A Streptococcus, Chlamydia, influenza, RSV and an animal spongiform encephalopathy vaccine.

While PREVENT is still in its formative stages, phase 1 studies have already commenced.

With the cost of vaccine development, licensing and commercialization estimated at $200-600 Million, such efforts are costly, high-tech and high risk.  However, with large consumer basis for many of the products long term returns are of significant value.

While until this year the market for an Ebola vaccine was very limited, Canada’s rich resource in skill, technology and experience in the vaccine field deserves much greater recognition and celebration than perhaps its surprising arrival on the humanitarian Ebola scene suggests.  

Wednesday, 13 August 2014

One year of Minister what’s-her-name? Ambrose’s first year.

In previous postings we have reviewed Rona Ambrose’s credentials  for the job as  Minister of Health and then evaluated her 8 month performance.  With just over a year under her belt, has she started to gel?

Not that she has come out of her shell, however there are sparks of activity beginning to emanate from the core.  Her predominate activity remains in acknowledging certain special events and disease specific entity announcements and doing the public relations work of a politician.  

Early July brought a huge leap forward when announcing a public consultation process on nutrition labelling – promised in the 2013 speech from the throne.  Albeit the  process  is vague and the benefit of public consultation likely to reinforce preconceived thoughts, it is huge leap for a Minister who rarely glimpses beyond the confines of her shell.

She has announced and supported the Advisory Panel on Healthcare Innovation  with a mandate to provide a blueprint for some federal action on making health care sustainable – and loaded with conservative-leaning members and a few with track records in health privatization. It would appear that Minister Ambrose has been given the role of acting as government pigeon for introduction of actions that are more in keeping with the war on drugs than on a health-driven approach to misuse of legal drugs.  

Overall her media output  has increased to 1 to 1.5 releases per week.

Granted she has been much more active in the Twitterverse  (@MinRonaAmbrose) with over 3000 Tweets in 3 years about her daily actions averaging at least a couple a day.  Great photo collection,  on a Twitter banner which has her standing in scrubs with six good looking guys, wearing a stethoscope (she is not a health care worker having graduated with a masters in political science, and Canada’s health care workforce is 85-90% female ).  One might even think she is a masterful politician; she is developing a marketable image for herself be it one that slightly skews reality. 

The best news is that despite Ebola, despite measles outbreaks, despite a plethora of issues she could have wandered into, she has quickly demonstrate her agility in sidestepping controversy and letting the professionals speak.  That is probably the best skill a federal Minster of Health could demonstrate.  May her reign as Minister rival her predecessor's longevity.  

Monday, 11 August 2014

Mid-August has arrived. Are you ready for the public health year to start in the fall?

September is notoriously busy and the most loathed statement of the month is “We should have started working on that before September”.  Loathed but too frequently verbalized.   Through the summer the chant is repeated, “too many people on vacation we will have to wait until they come back”.

When in public health will we get our act together?   Admittedly the health system tends to follow a fiscal year, however too much of public's health work is cyclically based on the seasons and school year.  

Schools starts in just a few weeks.  Influenza vaccine will usually hit the shelves late September, budget cycles will swing into full force.  The academic year brings added teaching opportunities, conferences are in the works, and the usual surge in communicable diseases can be expected late September. 

How prepared are you?
·         Letters to school superintendents and principals on public health programming should be in draft form ready to go by late August
·         University/college education and lecture schedules mostly ready?
·         Are influenza policies and procedures in place?
·         Documentation to support influenza vaccines written and ready for distribution
·         Budget “A” list proposals scoped out for a wishful 5% lift.  “B” list proposals should always be ready in the drawer.  In addition, should budget contractions occur, are the plans for a 5% reduction ready?
·         Have conferences been selected, requested and/or approvals underway?
·         Have summer turnover vacancies been filled and orientation will be completed prior to the fall?

In public health we have a sense of pride in prevention. 

Take a few minutes to prevent the annual September downpour and position yourself for thriving come the fall.  

Tuesday, 5 August 2014

Positioning public and population health: An optimistic view for the future

A few items have crossed over the desk lately that may bolster the spirits of those tired of banging the public and population health drums with their heads. 

A best practice analysis from Canadian Institute of Health Information begins to flag examples where health system administrators (not public health clones) are incorporating population health thinking into their routine business.  Moreover the report flags four areas of commonality and set an agenda for facilitating population health change

·         Support the collection of population health data though the health system.
·         Offer a population health perspective on major health care policies.
·         Rebalance the performance picture
·         Build momentum through a national coalition.

The subtitled areas of emphasis do not clearly reflect the intent – so catch the detailed descriptions in the executive summary or read the full report details by downloading the report from CIHI Population Health and Health Care

Some 200 participants joined an intriguing session hosted by CHNET-works and sponsored by the National Collaborating Centre on the Determinants of Health   NCCDH on “Moving Upstream in public health”.    

 Catch the July 23rd webinar when it is posted at Webinar archives.   An analysis of the ways that managers can move upstream and some suggested practical actions such as

·         Start thinking upstream and asking what do I need to go there?
·         Shift thinking from behavior and risks to determinants
·         Challenge assumptions about causes of health and illness
·         Analyze the current status relative to where resources are located on the “stream”
·         Engage those beyond the normal circles
·         Develop explicit teams that focus on moving upstream
·         Be sure current staff have the skills to move upstream
·         Share successes
·         Advocate, advocate,  advocate

Finally to further bolster your spirits is to look south of the border and the impacts of the Affordable Health Care Act.   For the past decade the Robert Woods Johnston Foundation has been underwriting significant public health research and work in the US.   With the passage of the Act under the Obama administration, significant dollars were earmarked to evaluate public health progress.   This is starting to pay off big time, and the full December 2012 J Public Health management is dedicated to the agenda.  Regrettably published in a pay journal but for those with access, keep an eye out some incredible work looking at comparisons between US  public health systems and outcomes.   

That the systems are speaking in a positive mode might just be enough to convert a few skeptics to optimists.