Despite nearly two decades of warnings, planning and government spending, the Public Health Agency of Canada was not ready for the global pandemic and did not appreciate the threat it posed in its early stages, Canada's auditor general says.
In a hard-hitting review released today, Auditor General Karen Hogan took the country's primary pandemic response agency to task for failures in early warning, surveillance, risk assessments, data-sharing with the provinces and follow-up on Canadian travellers who were ordered into quarantine.
"The agency was not adequately prepared to respond to the pandemic, and it underestimated the potential impact of the virus at the onset of the pandemic," said the AG's review — one of three that looked at the Liberal government's management of the COVID-19 crisis, which as of Thursday had killed 22,780 Canadians and brought the country's economy to its knees.
The auditor also reviewed federal COVID emergency benefit programs such as the Canada emergency response benefit (CERB) and the Canada emergency wage subsidy (CEWS) to determine whether the benefits reached people in need and whether the government imposed enough controls to limit abuse.
Her most critical comments, however, were reserved for the topic of pandemic preparedness. Hogan said PHAC, which was established to ensure the country was ready for a major outbreak, "was not as well prepared as it could have been" because major contingency plans and issues related to surveillance had not been resolved or dealt with — even though some of them had been pointed out by previous auditors.
WATCH | PHAC caught unprepared, AG says:
"I am discouraged that the Public Health Agency of Canada did not address long-standing issues, some of which were raised repeatedly for more than two decades," Hogan said.
"These issues negatively affected the sharing of health surveillance data between the Agency and the provinces and territories."
'Much more work to do'
While the agency took steps to address some of these problems during the pandemic, she said, "it has much more work to do on its data sharing agreements and information technology infrastructure to better support national disease surveillance in the future."
The report found that the agency's Global Public Health Intelligence Network (GPHIN), a surveillance system that scours the internet for reports of infectious disease outbreaks in other countries, did not issue an alert to provide an early warning when COVID-19 first emerged in Wuhan, China.
The network, which is part of PHAC, did email a daily report to domestic subscribers, including the provinces, with links to related news articles.
Officials at the public health agency defended the low-key approach by saying that at the end of December 2019, other international sources had already shared news of the virus, making it unnecessary to issue an alert.
The auditor also criticized the risk assessments the agency put together after COVID-19 began spreading around the globe — reports which key leaders used to make decisions on public health measures such as closing the border. She said those assessments were oblivious to the unfolding global crisis.
Failed to appreciate threat
"The agency assessed that COVID‐19 would have a minimal impact if an outbreak were to occur in Canada," said the audit.
In fact, right up to the point when the World Health Organization declared coronavirus a global pandemic — on March 11, 2020 — those risk assessments continued to rate the threat to the country as "low."
It wasn't until the day after — in response to escalating case counts in Canada and rising concerns among provincial governments — that Chief Public Health Officer Dr. Theresa Tam ordered an upgrade to the risk rating, the review said.
Health Minister Patty Hajdu defended the decisions during question period on Thursday, pointing to a separate internal evaluation by her department which said the changes made to GPHIN did not impact the federal government's response to the crisis.
Nevertheless, she accepted the auditor general's criticism.
"We have reviewed the auditor general's report, we agree that this country, along with all countries, will need to review our response to the pandemic and make investments in public health, as we have been doing since the beginning of the pandemic," said Hajdu, who also pledged to hire more public health staff and insisted that gaps are being plugged with $690 million in new funds.
Speaking prior to the release of the report, Dr. Howard Njoo, the deputy chief public health officer, said the audit offers a snapshot of a particular moment in the pandemic's trajectory and the agency has worked hard to address the problems.
"Certainly, this pandemic is unprecedented," said Njoo. "We haven't had a pandemic like this ... in at least over 100 years."
A lot of countries around the world are learning lessons, he said, and "I think we're all learning from each other ..."
Drawing a blank on the border
The audit also found out that PHAC and the Canada Border Services Agency did not know whether two-thirds of incoming travellers followed quarantine orders.
"The agency referred few of the travellers for in‐person follow‐up to verify compliance with orders," said the review.
Part of that problem could be due to the limits of public health information.
"Of the individuals considered to be at risk of non‐compliance, the agency referred only 40 per cent to law enforcement and did not know whether law enforcement actually contacted them," said the audit.
The auditor said PHAC also fell down on data sharing. The public health agency did have an agreement with the provinces and territories to share data, but it was not fully implemented when the pandemic hit.
The auditor general also said the federal government didn't do enough to ensure the "integrity" of the Canada emergency wage subsidy program (CEWS).
'Integrity' of CEWS program 'at risk'
CEWS was launched in March 2020 to subsidize up to 75 per cent of wages for workers who were kept on their employers' payrolls.
To get the program out the door as quickly as possible, the CRA was only able to conduct limited tests before approving payments, said the audit.
"Without effective controls for validating payments, the integrity of the program is at risk and ineligible employers might receive the subsidy," the audit concluded.
It also said the agency did not have up‑to‑date earnings and tax data for assessing applicants. For example, 28 per of applicants did not file a GST/HST return for the 2019 calendar year.
"We noted that the subsidy was paid to applicants despite their history of penalties for failure to remit and other advance indicators of potential insolvency," said the audit. "Indeed, the agency held no legislative authority to deny access to the subsidy on the basis of an employer's history of non‑compliance with tax obligations."