How Canada could boost disease surveillance to make up for U.S. health cuts

Canada should do more to strengthen its health surveillance systems as cuts to U.S. health institutions threaten access to crucial monitoring data, experts say in an editorial published in the Canadian Medical Association Journal (CMAJ) this week.

The editorial says cuts within the U.S. Centers for Disease Control (CDC), the National Institutes of Health and the federal Department of Health and Human Services could strip Canada and other countries of valuable health data.

"We've had a decades-long relationship with the Centers for Disease Control and other organizations in the States," said co-author Dr. Shannon Charlebois, a family physician and CMAJ's medical editor. "As those are dismantled, we're not going to have our early warning systems."

For example, when the mpox virus broke out in the U.S., Charlebois said the CDC formally notified the Public Health Agency of Canada.

This comes, the authors say, as a "crisis of communicable diseases is unfolding in North America," pointing to increasing rates of syphilis and HIV in Canada, along with measles outbreaks and livestock culls due to avian influenza.

"We can't obviously control everything that happens in the U.S., but we can improve our own systems," said co-author Dr. Jasmine Pawa, public health and preventive medicine physician at the Dalla Lana School of Public Health at the University of Toronto.

There have long been calls for Canada to improve surveillance of infectious diseases.

"This should really light a fire under policymakers to take very seriously this question of public health surveillance," said Dr. Lorian Hardcastle, associate professor in the Faculty of Law and Cumming School of Medicine at the University of Calgary who specialises in health law and policy.

What the U.S. does in public health has a ripple effect, she said.

"When you have this major world player pull back out of public health surveillance and is no longer resourcing public health in the manner that they've historically done, then there's a call to others to step up their game."

Beyond formal warnings, Charlebois said there are also informal links between the two countries that can help in planning. But with layoffs and budget cuts, now "we don't know who to call to get that informal information," she in an interview with CBC Radio's All in a Day.

WATCH | Yukon doctors say territory is vulnerable after U.S. health cuts:

Earlier this month, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. announced thousands of job cuts at the CDC, FDA and National Institutes of Health. Yukon doctors are now saying these cuts leave the territory vulnerable.

In Canada, one of the major hurdles to increasing surveillance is getting provinces and territories to collaborate and share data in a timely, uniform way, said Hardcastle.

"A lot of it is just needing the political will to make it happen, which is a huge challenge," she said.

But she said there are also tools Canada could implement, including electronic medical records, and better waste water surveillance for antimicrobial resistance.

Hardcastle said that kind of surveillance was done during the COVID-19 pandemic and stepping it up could be beneficial not only for infectious disease monitoring, but for public health in general.

That would give policymakers an early alert of problems, she said, "rather than waiting for things to really snowball."

Others, like Charlebois, are calling for a national vaccine registry, so patients and medical professionals can keep track of immunizations and pinpoint who is protected and who is at risk.

"We don't have a national vaccine registry and we are not meeting our obligation to the World Health Organization on that," said Charlebois.

The CMAJ editorial said all of this is compounded by another concern: misinformation.

"People living in Canada are vulnerable to a cross-border bleed of not only microorganisms, but also of attitudes, health misinformation and exposure to biased U.S. media," the authors wrote.

Misinformation can further challenge the health system, said infectious disease physician Dr. Michael Gardam, who has watched as the issue has undermined efforts to control the spread of illnesses, like measles.

"People have stopped following what were highly effective control measures. Why have they stopped? Because people are telling them through social media not to follow them anymore," said Gardam.

With the changes to health institutions in the U.S., Gardam said Canada and other countries will have a void to fill, but it will take time and effort.

"We didn't build up our surveillance because the U.S. had our back," he said. "If they don't have your back anymore, you have to create it yourself or you have to create new partnerships with other countries to do it."