Federal/Provincial/Territorial Memorandum of Understanding (MOU) on the Sharing of Information During a Public Health Emergency
- 1. DEFINITIONS
- 2. PURPOSE
- 3. SCOPE
- 4. JURISDICTIONAL COORDINATION AND IMPLEMENTATION
- 5. INFORMATION SHARING
- 6. ROLE OF THE PAN CANADIAN PUBLIC HEALTH NETWORK COUNCIL
- 7. GENERAL
- Annex A - Principles for Information Sharing
- Annex B - Proposed criteria to determine a Public Health Emergency of national or international concern
- Annex C - Jurisdictional Coordination and Implementation
- Annex D - Proposed Notification Process for a Public Health Emergency
- The parties that are signatories to this MOU (the “Jurisdictions”) wish to enter into an understanding regarding information sharing during a Public Health Emergency;
- Canada ratified and committed to the early adoption of the World Health Organization’s International Health Regulations (2005);
- The Federal / Provincial / Territorial Deputy Ministers of Health recognize certain principles for sharing information during a Public Health Emergency, (Annex A to this MOU (the “Principles”));
- To give effect to the Principles, the Federal / Provincial / Territorial Deputy Ministers of Health tasked the Pan-Canadian Public Health Network to work with the Jurisdictions to develop this “MOU on the Sharing of Information during a Public Health Emergency” in a coordinated and cooperative manner across Canada;
- This MOU is supplementary to other bilateral and multilateral MOUs, protocols, guidelines and agreements which have been or may be established pursuant to other mandates; and
- This MOU describes the general intentions of the parties. It does not create or describe legally binding obligations and does not limit or derogate from the exercise of any statutory power or legislative authority of a party.
Disease means an illness or medical condition, irrespective of origin or source, that presents or could present significant harm to humans.
Event means a manifestation of Disease or an occurrence that creates a potential for Disease.
Party (ies) means a government that is a signatory to this MOU.
Public Health Emergency meansan extraordinary, unexpected, or unusual health event which is determined by the application of the criteria in Annex B.
Public Health Risk means the likelihood of an event that may have a serious adverse impact on the health of a population, with an emphasis on one that may spread to another province or territory in Canada or internationally.
The purpose of this MOU is to establish a framework for the sharing of information between and among the parties during a Public Health Emergency in accordance with the Principles set out in Annex A, and in accordance with the following Understandings, namely:
- This MOU is an expression of intent by the parties to explore, review and undertake the measures set out in this MOU with a view to making appropriate administrative, policy and legislative changes considered advisable by each party to give effect to the intentions expressed in this MOU.
- Each party has full power and authority to enact legislation within its sphere of constitutional competence and this MOU does not aim to commit a Jurisdiction to the exercise of its legislative function.
- In moving forward with the intentions expressed in this MOU to enable an effective response to a Public Health Emergency, each party must take into consideration the need to respect privacy rights and to comply with existing privacy legislation.
- Not all information that may be required during a Public Health Emergency is under the direct management and control of parties, and the parties acknowledge that they may have limited authority to compel those who may hold the information (e.g., such as private sector laboratories) to disclose it for the purposes of this MOU.
- Each party may, if considered advisable, enter into bilateral or multilateral MOUs or agreements with other jurisdictions for the purpose of describing in greater detail the information sharing arrangements as between or among them or with third parties to ensure timely access to information that may be necessary during a Public Health Emergency.
This MOU applies only to the sharing of information between and among parties during a Public Health Emergency. It is not intended to apply to the sharing of information within a Jurisdiction.
It is the intent of the parties to facilitate the implementation of this MOU by collaborating to develop or provide the protocols, processes and strategies identified in Annex C.
5.1 Upon declaration of a Public Health Emergency in accordance with Annex D, it is the intent of each party, while respecting the privacy laws applicable to that party, to share with other parties timely, accurate and sufficiently detailed information regarding the Public Health Emergency, including where necessary case definitions, case information, laboratory results, source and type of the risk, number of cases and deaths, conditions affecting the spread of the Disease and the health measures employed. A party will report, as necessary, the difficulties faced and support needed in responding to the Public Health Emergency.
5.2 Parties recognize that the collection, use and disclosure of personal information, including personal health information, is to be carried out in the most limited manner necessary as authorized by law or an individual’s consent, on a need-to-know basis, with the highest degree of anonymity possible in the circumstances and using the least invasive means.
5.3 Once a Public Health Emergency has ended, parties will return to the routine information sharing processes that were in place prior to the Public Health Emergency.
6.1 As the senior and central governance body of the Pan-Canadian Public Health Network, the Pan-Canadian Public Health Network Council (the “Council”) will support the implementation of this MOU to achieve the principles set out in Annex A.
6.2 The Council will report such findings to the Conference of Deputy Ministers of Health.
7.1 Additional Agreements - Nothing in this MOU precludes any party from entering into agreements relating to the sharing of information during Public Health Emergencies, nor does this MOU affect any other agreements already in force.
7.2 Harmonization with Other Agreements - The parties intend to harmonize, where appropriate, with this MOU any other applicable MOUs or agreements relating to the sharing of information during a Public Health Emergency entered after the coming into effect of this MOU.
7.3 Effective upon execution - This MOU is effective upon being signed by any two parties, and is effective in respect of any other party upon its signing by that party.
7.4 New Parties - A Province or a Territory may become a signatory to this MOU at any time.
7.5 Withdrawal - Any party may withdraw from this MOU by providing written notice to all other Jurisdictions. The withdrawal is effective 30 days after written notice is provided.
7.6 Amendment - This MOU may only be modified by the mutual consent of all parties. To be effective, all proposed amendments must be in writing and must be accepted in writing by all parties within 90 (ninety) days of the initial proposal. If accepted, the amendments will come into effect on a date agreed upon by all parties.
7.7 Review – This MOU will be reviewed by the Public Health Network Council every two years and the Council will recommend any revision (made in accord with section 7.6) to the Conference of F/P/T Deputy Ministers of Health.
Principles for Information Sharing
- An effective response to a Public Health Emergency may require that health information (including aggregate information, anonymized information and personal information) be disclosed among parties beyond what is routinely shared between them for public health purposes.
- F/P/T governments recognize that the collection, use and disclosure of personal information, including personal health information, are to be carried out in the most limited manner necessary as authorized by law or an individual’s consent, on a need-to-know basis, with the highest degree of anonymity possible in the circumstances and using the least invasive means.
- F/P/T governments will work together to determine what kinds of information, including personal health information, need to be shared among governments during a Public Health Emergency.
Proposed criteria to determine a Public Health Emergency of national or international concern
NOTE: the test to determine whether a “Public Health Emergency” exists is derived and adapted from Annex 2 of the IHRs as adopted by the 58th World Health Assembly on May 23, 2005.
Public Health Emergency:
An extraordinary, unexpected, or unusual health event…
Q. 1) Is the health event extraordinary, or unusual?
The following are examples of extraordinary or unusual events:
- The event is caused by an unknown agent or the source, vehicle, route of transmission is unusual or unknown.
- Evolution of cases more severe than expected (including morbidity or case-fatality) or with unusual symptoms.
- Occurrence of the event itself is unusual for the area, season, or population.
Q. 2) Is the health event unexpected from a public health perspective?
The following is an example of an unexpected events:
- Event caused by a Disease/agent that had already been eradicated from the jurisdiction or not previously reported.
If the answer to either Q1) or Q2) is yes, then the health event should be considered extraordinary, unexpected, or unusual.
... determined to i) constitute a Public Health Risk to other jurisdictions and/or internationally through the spread of Disease
Q. 3) Is there a significant risk of spread to other Canadian provinces or territories and/or internationally?
Q. 4) Is there evidence of an epidemiological link in other jurisdictions?
Q. 5) Is there any factor that should alert health authorities to the potential for cross border movement of the agent, vehicle, or host.
The following are examples that may predispose Canadian provincial or territorial and/or international spread:
- Where there is evidence of local spread, an index case (or other linked cases) with a history within the previous month of:
- inter-jurisdictional and/or international travel (or time equivalent to the incubation period if the pathogen is known)
- participation in an inter-jurisdictional and/or international gathering (pilgrimage, sports event, conference, etc.)
- Close contact with an inter-jurisdictional and/or international traveller or a highly mobile population.
- Event caused by an environmental contamination that has the potential to spread across inter-jurisdictional and/or international borders.
If the answer to either Q3), Q4) or Q5) is yes, then the health event is determined to constitute a public health risk to other jurisdictions and/or internationally through the spread of Disease
... ii) have a serious adverse impact on the health of the population
Q. 6) Is the number of cases and/or number of deaths for this type of health event large for the given place, time, or population?
Q. 7) Has the event the potential to have an adverse impact on public health?
The following are examples of circumstances that contribute to an adverse impact on public health:
- Event caused by a pathogen with high potential to cause epidemic.
- Indication of treatment failure.
- Event represents a significant public health risk even if no or very few human cases have been identified.
- Cases reported among health care staff
- The population at risk is extremely vulnerable (children, elderly, etc.)
- Event in an area with high population density.
- Concomitant factors that may hinder or delay the public health response (natural catastrophes, unfavourable weather conditions
If the answer to either Q6) or Q7) is yes, then the health event is determined to have a serious adverse impact on the health of the population
... potentially require a coordinated response.
Q. 8) Is assistance needed to detect, investigate, respond and control the health event, or prevent new cases?
The following are examples of when assistance may be required:
- Inadequate human, financial, material or technical resources, in particular:
- Insufficient laboratory or epidemiological capacity to investigate the event (equipment, personnel, financial resources)
- Insufficient antidotes, drugs and/or vaccine and/or protective equipment, decontamination equipment
- Existing surveillance is inadequate to detect new cases in a timely manner.
If the answer to Q8 is yes, then potential assistance and/or a coordinated response may be required.
In view of the foregoing:
A “yes” response by a jurisdiction to any one of Parts I - IV would indicate that a Public Health Riskexists.
A “yes” response to any two of Parts I - IV would indicate that: a Public Health Emergency exists.
Jurisdictional Coordination and Implementation
It is the intent of the parties to collaborate in developing or providing:
- Protocols and processes for declaring that a Public Health Emergency exists and when it ends.
- Protocols and processes for the notification of parties, national coordinating bodies (e.g. Pan-Canadian Public Health Network), Foreign National or International Health Regulation Focal Points and the World Health Organization during a Public Health Emergency.
- Strategies to address potential legal, regulatory and policy constraints to information sharing during a Public Health Emergency.
- Definitions, protocols, guidelines and agreements to share information between and among the parties during a Public Health Emergency and a communication strategy to be specified to ensure their effective implementation.
Proposed Notification Process for a Public Health Emergency
A government will need to notify the other parties when it believes that a Public Health Risk or a Public Health Emergency may exist within its territory. The following process will be used for such government-to-government notification:
- When the Chief Medical Officer of Health of a P/T government determines that a Public Health Risk or a Public Health Emergency may exist on the territory of such government, or when the Chief Public Health Officer of Canada (CPHO) determines that an emergency may exist relating to responsibilities in an exclusive field of federal jurisdiction or occurring on lands and properties under federal responsibility, that Officer will immediately notify:
- The Deputy Minister and Minister of Health of the jurisdiction
- The Chief Public Health Officer of Canada, when the latter is not the notifying officer
- Others as required by the Jurisdiction’s internal processes.
- The CPHO will then request that the Chair of the Council of Chief Medical Officers of Health (CCMOH) convene a meeting of the CCMOH to formally acknowledge, for the record, whether a Public Health Emergency of many provinces and/or territories or international concern exists.
- When the CCMOH acknowledges that a Public Health Emergency of multi-jurisdictional or international concern exists, the Chair of the CCMOH will inform the Pan-Canadian Public Health Network Council (PHNC) of such a determination.
- Should the CCMOH fail to reach consensus that a Public Health Emergency of multi-jurisdictional or international concern exists, the CPHO and where applicable the Officer who has determined that a Public Health Risk or a Public Health Emergency may exist will recommend to the PHNC that a Public Health Emergency be formally acknowledged by the PHNC.
- Upon formal acknowledgement of a Public Health Emergency as described in steps 2 to 4, the PHNC will inform the CDMH of the determination and the CPHO will notify the World Health Organization and others as required by Federal Government internal reporting processes, such as those set out by Public Safety Canada.
- Upon indication, from the Chief Medical Officer of Health of the F/P/T government who had determined that a Public Health Risk or a Public Health Emergency existed within its jurisdiction, that a Public Health Emergency may no longer exists, the Chair of the CCMOH will convene a meeting of the CCMOH to determine, for the record, whether a Public Health Emergency no longer exists. Communication of this determination will be provided as described in steps 2 to 5 above.
Flowchart of the Proposed Notification Process for a Public Health Emergency
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