1. Ontario Health Plan for an Influenza Pandemic Overview Emergency Management Unit Ministry of Health and Long-Term Care June 2005

2. Table of Contents Background Ontario Health Plan for an Influenza Pandemic (OHPIP) Overview Context for Influenza Pandemic Potential Impact in Ontario Ethical Framework Roles and Responsibilities Planning Assumptions Surveillance Vaccines and Antivirals Health Services, including Occupational Health and Safety Emergency Response Public Health Measures Communications Highlights: New in the Next Version of OHPIP (June 2005) Future Planning/Implementation Issues

3. Background Canadian Pandemic Influenza Plan released February 2004 Ontario Health Pandemic Influenza Plan released end of May 2004 following series of health stakeholder consultations Work underway to: (1) further develop OHPIP for version 2 release in June 2005 and (2) develop government-wide Coordinating Plan for Pandemic Influenza (led by Emergency Management Ontario)

4. OHPIP Overview Goals: Minimize serious illness and overall deaths through appropriate management of Ontarios health care system Minimize societal disruption in Ontario as a result of influenza pandemic Strategic Approach: Be ready – establish comprehensive influenza pandemic contingency plans at provincial and local level Be watchful – practice active screening and monitor emerging epidemiological and clinical information Be decisive – act quickly and effectively to manage the epidemic Be transparent – communicate with health care providers and Ontarians The following slides provide an overview of key components of the current Ontario plan

5. Context for Pandemic Influenza Planning Activities correspond to new World Health Organization pandemic phases (Inter-pandemic, Pandemic Alert and Pandemic) Aligned with direction in Canadian Pandemic Influenza Plan (CPIP) Provides detail on federal, provincial and local roles/responsibilities and commitments Identifies expectations re. local planning activities Outlines health emergency management approach (e.g. use of Incident Management System and coordination with EMO/other levels of government) Ethical framework for decision-making underscores approach Evergreen document that will continue to be updated with emerging clinical, epidemiological, and operational information

6. Ethical Framework Open and Transparent: decision-making process open to scrutiny and the basis for decisions explained Reasonable: decisions should be based on evidence and be made by people who are credible and accountable Inclusive: decisions should be make with stakeholder views in mind and stakeholder should have opportunities to be engaged in process Responsive: decisions should be revisited and revised as new information emerges and stakeholder have opportunities to voice any concerns they have about decisions Accountable: mechanism should be established to ensure that ethical decision-making is sustained throughout the epidemic

7. Roles and Responsibilities Federal Government Vaccine/antiviral procurement and supply to provinces/territories International liaison with World Health Organization (WHO) and other national agencies (e.g. US Centres for Disease Control) Provincial Government Establishment of provincial pandemic plan aligned with CPIP in consultation with Ontarios health stakeholders Outline provincial commitments and activities for pandemic planning and response Provide overall direction and advice on local preparedness and response activities for pandemic influenza (no direct statutory authority to require compliance) Local Government Led by local public health units, establish local pandemic influenza contingency plans congruent with the provincial influenza pandemic plan Provide input, advice and required surveillance data to provincial health authorities Each level of government will operate within the authority of their jurisdiction and work collaboratively to ensure integration of provincial and local responsibilities within the framework of the Canadian, Ontario and local pandemic influenza plans to ensure a seamless response

8. Planning Assumptions One – three month lead time with additional waves likely Vaccine likely unavailable for first wave/limited supply thereafter Antiviral supply limited and focused on priority groups Centralized supply distribution of personal protective equipment (PPE), vaccines/antivirals, and other equipment through Ontario Government Pharmacy and pre-established distribution points Health Human Resources (HHR) availability during a pandemic severely curtailed (reduced by 40 – 60% reflecting attack rate, family responsibilities, reluctance to be at risk); HHR planning to use skills-based vs. discipline-based approach Health services severely curtailed to focus on necessary services Emergency Management Ontario to provide provincial emergency management/EMU & PHD to coordinate response with health sector Provincial Infectious Diseases Advisory Committee (PIDAC) to provide expert scientific/technical advice during pandemic

9. Surveillance The surveillance section provides information on: Monitoring influenza-like illness (ILI) to detect the pandemic strain early in Ontario through a variety of mechanisms (Febrile Respiratory Illness surveillance, FluWatch Program, laboratory diagnostic testing) Comparing new strains with vaccine composition Tracking the occurrence and severity of outbreaks (based on WHO pandemic phases) Sharing surveillance information with responders to help guide efforts to track, contain and treat the disease

10. Vaccines and Anti-virals Provides information on Components of effective antiviral and vaccine programs (security of supply, ability to store, allocate and administer vaccine and antiviral supplies efficiently and appropriately, monitoring safety/efficacy and any adverse events) Emergency Mass Prophylaxis Plan Provincial/federal efforts to secure vaccine/antiviral supply for Ontario Describes priority groups identified by the F/P/T Pandemic Influenza Committee Vaccine Priority Groups: 1.Frontline health care workers and key decision-makers 2.Essential health care providers, public health responders & essential health support services 3.Essential service workers 4.Persons at high risk of fatal outcomes (e.g. elderly, immunocompromised) 5.Healthy adults 6.Children 24 months to 18 years of age

11. Vaccines and Anti-virals Anti-viral Priority Groups: Treatment (must be administered within 48 hours of onset of symptoms) 1.Persons hospitalized for influenza 2.Ill health care workers and first responders/emergency service workers 3.Ill high-risk persons in the community 4.Ill high-risk persons in institutions Prophylaxis 1.Frontline health care workers and key decision-makers 2.Remaining health care workers 3.Emergency/essential service workers 4.High-risk residents of institutions 5.Person at high risk hospitalized for illness other than influenza

12. Public Health Measures This section outlines required public health measures to help limit the spread/impact of an influenza pandemic, including: Individual measures such as the use of PPE, case and contact management, isolation and individual activity restriction Community measures such as cancelling public gathering and closing schools Ensuring consistency in the provincial approach to influenza containment measures in collaboration with local public health units

13. Health Services Health services outlines approach/activities to: Ensure health settings maintain appropriate occupational health and safety standards through use of PPE and infection control measures Identify necessary health services that will be provided during a pandemic and services that can be curtailed Identify Health Human Resources required during a pandemic and how they will be deployed (focusing on necessary skill sets) Develop an effective system for purchasing, storing and distributing equipment and supplies before and during a pandemic Implement admission/discharge and triage criteria for individuals ill with influenza Guide community, public health and hospital laboratory services

14. Emergency Response This section outlines the provincial health emergency response, including: Coordination/collaboration between emergency response personnel and health authorities in pandemic planning and response activities (communication mechanisms, clarification of roles/responsibilities, etc.) Establishment of Business Continuity/Continuity of Operations Plans to ensure continuity of necessary services Identification of emergency response resources that can be mobilized to help the health sector respond to a pandemic (including support from Emergency Management Ontario and other Ministries) Activation of the Ministry Emergency Response Plan

15. Communications This section outlines communications measures to: Ensure that Ontario is prepare to respond to public and health care provider communication needs Educate Ontarians about the pandemic plan Provide consistent, coordinated and effective public and provider communications Ensure health care providers have access to transparent, access accurate real time information to help them respond Ensure mechanisms for health care providers to share information with each other and decision-makers to continuously improve Ontarios pandemic response

16. Highlights: New in the Next Version of OHPIP Operational Measures (pre-hospital, community, hospital) Admission/discharge criteria for hospitals and critical care units Clinical management guidelines Occupational Health and Safety/Infection Control measures Role of TeleHealth, Infoline, CCACs in triaging people ill with influenza Necessary Health Services Delivery Framework Laboratory guidelines (for public health, community and hospital laboratories) Algorithm for assessing the quantity/type of PPE and clinical supplies required in a range of health care settings Public Health Measures Emergency Mass Immunization Plan & Vaccinators Manual Necessary Public Health Programs Delivery Framework Enumeration Tool for determining vaccine/antiviral supply requirements Communications Fact Sheets & backgrounders for public and health stakeholders Communications plan including Information Cycle

18. Feedback to Date Positive response to new layout, cover design, use of diagrams, more user friendly Strong recommendation for in-depth Table of Contents or mapping Support for ethical framework; some question re practicality of appeal mechanism Support for Occupational Health/Infection Prevention and Control Measures During the Pandemic Period Role for non-acute and community sectors needs enhancement

19. Release of Plan Planned release in April/May deferred to allow for greater content Release planned for week of June 13 Stakeholder support in place Method of release not finalized

20. Future Planning & Implementation Issues Financial Costing at provincial and local levels not yet determined Provincial sources of funding for pandemic influenza preparedness (supplies, capital equipment, etc) not identified Emergency funding/compensation policy for workers, businesses during pandemic not established Other Additional operational, public health and communications work/products Consultation with primary care/community health providers re. role in a pandemic Broadening provincial health influenza pandemic plan to government-wide Coordinating Plan for an Influenza Pandemic under the auspices of EMO Managing public expectations; balancing fear and complacency Development of workplan for next iteration