Meeting #48 of the CSA COVID-19 Expert Panel

As part of the response to the COVID-19 pandemic, the Chief Science Advisor of Canada created the Expert Panel on COVID-19 to advise her on the latest and most relevant scientific developments. This information assists the CSA in providing current, cross-disciplinary and independent advice to the Prime Minister and government.

 

Held by MS Teams on July 19th, 2023.

 

Acknowledging that science evolves, the following discussion reflects evidence and scientific knowledge up to July 19th, 2023.

Summary

  • Urgent situations stemming from climate change, including zoonotic diseases, extreme weather, toxin release, floods, and wildfires are becoming more frequent around the world. Reflecting on the experience of the COVID-19 pandemic can inform actions and enhance the use of science to address future threats.
  • The objective of the Expert Panel meeting was to reflect on science and science advice in the context of managing the COVID-19 pandemic in order to strengthen emergency prevention, preparedness, response, and recovery.
  • The following elements were deemed to be critical for emergency preparedness and response: science advice and research prioritization processes; public engagement and communication strategies; robust and timely data sharing protocols; and data modelling capacity.
  • Other key elements specific to health emergency preparedness, including climate change-induced disasters were also flagged. They include: basic and clinical research capacity; knowledge of drivers and risk mitigation of health threats; planned human and physical surge capacity; adequate stockpiling; secure supply chains; and manufacturing capabilities for medical countermeasures and protective equipment.
  • Five recommendations, requiring cross-sectoral and cross-jurisdictional collaboration are proposed to improve the use of science and science advice for emergencies in Canada:
    1. Improve science advisory mechanisms in Canada by creating an agile, comprehensive and multidisciplinary science advice framework that can support federal, provincial and municipal authorities, as relevant.
    2. Strengthen research & development prioritization and coordination for preparedness and during response.
    3. Enable and support high quality data analysis and scenario modelling through coordinated protocols for timely data and sample collection and sharing.
    4. Improve science literacy and societal understanding of science through dialogue, openness and transparency.
    5. Mitigate health crises and climate-related disasters by adopting a One Health approach.

Participating expert panel members:

  • Mona Nemer PhD, Chief Science Advisor of Canada (chair)

Disease modelling

  • Caroline Colijn PhD, Simon Fraser University
  • Daniel Coombs PhD, University of British Columbia

Risk and behavioural sciences

  • Daniel Krewski PhD, University of Ottawa
  • Kim Lavoie PhD, Université du Québec à Montréal (as of November 27, 2020) – post-meeting
  • Louise Lemyre PhD, University of Ottawa – post-meeting

Biomedical and clinical sciences

  • Eleanor Fish PhD, University of Toronto
  • Joanne Langley MD, Dalhousie University
  • Allison McGeer MD, Mount Sinai Hospital
  • Guillaume Poliquin MD, PhD, Public Health Agency of Canada
  • Supriya Sharma MD, Health Canada
  • Cara Tannenbaum MD, Université de Montréal, Health Canada Departmental Science Advisor

Invited guests

  • Sarah Viehbeck, PhD, Public Health Agency of Canada

Other attendees:

  • Lori Engler-Todd MSc, Office of the Chief Science Advisor (support)
  • Husayn Jessa MSc Candidate, Office of the Chief Science Advisor (support)
  • Andreea-Diana Moisa BSc, Office of the Chief Science Advisor (support)

Context

As part of a forward looking exercise to strengthen emergency preparedness, response and recovery for future pandemics and emergencies, the Chief Science Advisor (CSA) convened her COVID-19 Expert Panel on July 19, 2023. In this context and drawing on their experience of the past three years of the COVID-19 pandemic, participants provided observations and suggested priority actions to consider for the effective integration of science and science advice into decision making, including for research prioritization.

In addition to several other CSA-led subject-specific task forces and expert meetings, the multidisciplinary CSA COVID-19 Expert Panel met 47 times through 2020 to 2022 to consider pressing topics of the day related to the state of science and the management of COVID-19. The breadth of science and science advice considered bridges many domains, from basic research, engineering, technology development and applications, to social and behavioural science, clinical research, medical countermeasures, care models and implementation science.

Background materials shared in advance of the meeting also informed this summary report:

  • A background document with the draft agenda (see Annex 1);
  • A table summarizing all the meetings of the Chief Science Advisor COVID-19 Expert Panel, and;
  • A power point presentation that included slides on key COVID-19 gaps and lessons learned revealed by the COVID-19 pandemic.

Issue and objective

Issue: Threats that include urgent situations stemming from climate change, such as zoonotic diseases, extreme weather, toxin release, floods, and wildfires are becoming more frequent around the world. Reflecting on the experience of the COVID-19 pandemic can inform our preparedness and response to emergencies and enhance the use of science to address future threats.

Objective: The objective of the meeting was to reflect on using science and science advice in the context of managing the COVID-19 pandemic in order to strengthen emergency prevention, preparedness, response, and recovery in Canada.

Observations

It was acknowledged that we were unprepared for the magnitude of a complex global crisis. Observations included elements that worked well with respect to science and science advice during the COVID-19 pandemic. The deliberations also included aspects that require strengthening going forward.

1. What Worked Well

Science Advice

  • Throughout the pandemic, scientific experts in Canada proved they are willing to volunteer to help and share their respective expertise when called upon by governments and participated in several expert committees on various COVID-19 related topics.
  • The CSA COVID-19 expert panel functioned well in several ways:
    • The panel was able to nimbly focus on the most pressing issues as they arose and was convened when scientific advice was necessary for decisions, often with very little advanced notice.
    • As a result of engaging a broad spectrum of expertise from multiple constituencies across Canada, the panel was able to navigate an incredible amount of rapidly evolving scientific evidence from research across many discipline, flag new scientific studies of interest and communicate the current state of science, understanding quality and data limitations as well as knowledge gaps for policy relevant issues.
    • Having regular and ad hoc meetings over time allowed for panel experts to learn about the scientific knowledge generated from a variety of domains and the inter-domain ripple effects which led to a consolidated knowledge base for science advice.
    • The panel had the leadership of an expert chair/co-chair connected to both broader networks of experts beyond panel members as well as direct lines to decision makers at the highest levels and other COVID-19 committees, with appropriate secretariat expertise and support.
    • The “call for expertise” from the COVID-19 pandemic continued through the 2022 monkeypox outbreak and should be considered as a best practice.

Data and Modelling

  • Health Canada, the Public Health Agency of Canada and other government departments published data used for COVID-19 decision making, enhancing transparency around evidence used in policy.
  • Mathematical modelling played an important role in the management of the COVID-19 pandemic in CanadaFootnote 1. As a SARS-1 legacy, mathematical modelling for infectious diseases was quite strong in Canada and was further reinforced through a network grant for the Emerging Infectious Diseases Modelling InitiativeFootnote 2.
  • Research funds were rapidly delivered and researchers mobilized to address urgent knowledge needs.
  • Canadian experts and science advisors were able to access relevant global data and knowledge in a timely manner through international network connections and the open COVID-19 science framework.
2. What Should Be Improved

The Role of Science In Decisions

  • Clarity on the policy making framework and the role of science therein should be better communicated. Science is one of many inputs into decision making, besides logistics, legal and socioeconomic considerations, among other. Transparency as to the basis of policies and actions improves public trust and compliance.

Early Identification of Science-Policy Gaps and Risk Assessment

  • The broader and longer term health and social impact of interventions aimed at limiting disease spread should be appropriately considered using robust evidence and multidisciplinary experts. This includes impact on learning outcomes, population mental and physical health, as well as family and social cohesion.
  • Greater attention should be given to understanding community needs and empowering the public with the knowledge and ability to act. Avenues for community dialogue should be developed during peace time to inform community relevant communications and interventionsFootnote 3.
  • Unbiased consideration and review of policy relevant scientific knowledge by multidisciplinary experts beyond the field of public health should be strengthened. Where gaps and uncertainties exist, the precautionary principle should be considered while research aimed at addressing the gap is enabled. As an example, the airborne component SARS-CoV-2 virus transmission was slow to be considered and significantly underestimated due, among other, to historic debate within the public health community. It resulted in inadequate attention to indoor ventilation and appropriate personal protective equipmentFootnote 4.

Science Advisory Processes

  • Clear processes for the development and delivery of scientific evidence and science advice during emergencies should be established for Canada.
  • A framework with appropriate accountability is needed to synthesize and integrate scientific data, evidence and expert advice into decisions from across a broad range of disciplines in a timely manner. A science advisory framework would also avoid inefficient proliferation of committees, siloed approaches and unnecessary duplication of efforts in emergencies.
  • Systematic ways to integrate equity and perspectives of the most vulnerable across the life course into decision making in emergencies are needed. This includes the elderly, disabled, residents of long-term care homes, racialized, and Indigenous populations in both urban and remote settings.

Data, Modelling and Research Coordination

  • Coordination of research priorities to inform policy and needs in emergencies requires an agile and efficient approach with clear leadership and processes. Suboptimal research coordination during the COVID-19 pandemic reduced the timely effectiveness of research efforts and caused significant knowledge gaps to persist.
  • Processes for timely allocation of research funds, taking into account human and physical resource capacity and excellence, should be set up. At the same time, processes to channel back research findings to inform science advice, policy and planning need to be in place to maximize research benefits.
  • Timely data and biological sample collection, management and sharing need to be strengthened to inform prevention and response. For this, pre-agreed upon protocols and sustainable infrastructure (such as for data and biobanking) must be developed.
  • Noting that international data sharing is essential in a global pandemic, Canada should promote global efforts aimed at setting up systems for equitable and ethical data sharing during health emergencies.

Healthcare Systems, Infrastructure and Surge Capacity

  • Healthcare systems were severely tested by the scale and duration of the pandemic. Their resiliency to complex emergencies needs to be strengthened using evidence and health innovation.
  • Advanced planning for surge capacity in emergencies is required. This spans the capacity for diagnostics (testing) and care in multiple settings including for the administration of medical countermeasures.
  • The lack of pathogen-agnostic therapeutic strategies to limit transmission on first contact or reduce disease severity contributed to uncontrolled virus spread and human mortality and morbidity. Research aimed at developing broad based antivirals targeting priority virus families should be a key focus of an integral pandemic prevention/early response plan.
  • Future climate or global health emergencies may generate health and food insecurities; policies aimed at strengthening resilience must be considered and regularly reviewed. This includes research and development, manufacturing and supply chains.

Communication and Science Literacy

  • Community-sensitive coherent communication plans are essential to address diverse communities and avoid public confusion and distrust. During the pandemic, the onslaught of information from many different sources caused public perplexity and tested public trust.
  • Better public understanding and communication of the input of science and the many other considerations into policy is needed to mitigate mis and disinformation and maintain public trust in times of crisis. In addition to the increased hospitalizations and deaths, Canada may have incurred an excess of a $300 million dollar loss due to misinformation during the course of the pandemicFootnote 5.
  • Transparent communication of uncertainty and the limits of interventions is essential to empowering public actions and compliance with public health measures. For example, messaging such as “masks prevent transmission” falls short as masking reduces but does not prevent all transmission given multiple other factors such as wearing habits, fit and quality of the mask which all contribute to effectiveness.
  • Transparent communication of the basis of decisions, including socioeconomic perspectives and values contribute to better public understanding and compliance with recommendations during a crisisFootnote 6,Footnote 7.

Moving forward

Canada boasts first class scientists and research infrastructure that can be mobilized to inform and support emergency preparedness and response as evidenced during the COVID-19 pandemic. However, clear and agile frameworks must be developed to strengthen the use of science in emergency preparedness and response. Key among them is the need for science advice and research prioritization processes; robust and timely data collection and sharing protocols; as well as evidence-informed engagement and communication plans tailored to communities.

Additional elements specific to health emergency preparedness must be considered, including those arising from climate change. They include: basic and clinical research capacity; knowledge of drivers and risk mitigation of health threats; planned human and physical surge capacity; adequate stockpiling; secure supply chains; and manufacturing capabilities for medical countermeasures and protective equipment.

The above considerations, together with the lived experience of the pandemic, led to the five priority recommendations outlined in the following section.

Recommendations for the use of science and science advice in emergencies

  1. Improve science advisory mechanisms in Canada by creating an agile, comprehensive and multidisciplinary science advice framework for action that can inform federal, provincial and municipal authorities, as relevant. The science advice framework for action should:
    1. Be supported with dynamic processes and aligned with the science priorities pertinent to Canada’s National Risk Profile and other relevant threats.
    2. Clarify the roles and responsibilities for science advice across all stages of emergency management.
    3. Support an integrated approach to science and science advice in emergencies between Canadian federal, provincial, and municipal jurisdictions and international collaboration.
    4. Consider risk assessment of both direct and indirect impacts of threat response, including potential health and socioeconomic consequences over the short and longer term.
    5. Integrate implementation science approaches into emergency or pandemic management at the outset.
    6. Explicitly incorporate the role and place of science advice and science advisory structures in pandemics and other health emergencies into planning instruments.
    7. Clarify the process and governance mechanisms for the rapid establishment of inclusive multi and interdisciplinary science advisory committees as emergencies arise, ensuring strong linkages between science, science advice, public health authorities and policy makers.
    8. Enhance receptor capacity for science advice within government.
    9. Modernize the federally approved Framework for Science and Technology Advice (2000), based on current context and future needs.
    10. Take other practical steps to improve science-informed decision making in emergencies, including actions such as maintaining lists of multidisciplinary experts and regular emergency simulation exercises incorporating science advice.
  2. Strengthen prioritization and coordination of research and development for emergency preparedness and response through:
    1. Developing and implementing priority setting mechanisms that support well-coordinated and rapid federal funding for research, development and manufacturing across different types of emergencies and threats.
    2. Strengthening the human, digital and physical infrastructure that interconnects and supports research, care and emergency management.
    3. Planning and rehearsing communication channels with protocols and procedures.
    4. Taking a “made in Canada” approach with a strategy that encompasses discovery and applied research, as well as technology transfer and knowledge mobilization, while monitoring progress annually.
    5. Fostering partnerships between the private government and academic sectors to enhance national security and achieve strategic objectives as for example those outlined in Canada’s bio manufacturing and life sciences strategyFootnote 8.
    6. Ensuring effective research coordination to address major threats notably for the development of medical countermeasures (diagnostics, vaccines and therapeutics), in domestic and global contexts.
    7. Promoting effective research coordination and collaboration with international counterparts in areas related to emerging health and environmental threats. This includes clarity on Canada’s international science lead.
  3. Enable and support high quality data collection, analysis and scenario modelling
    1. Improve timely data and biological sample collection, storage, sharing, and analysis through coordinated protocols and standard agreements.
    2. Identify and prioritize critical data sharing processes and partners within and between jurisdictions.
    3. Implement the Pan-Canadian Health Data Strategy to help strengthen Canada’s health data foundations and modernize health data collection, sharing and interoperabilityFootnote 9.
    4. Establish a sustained mathematical and statistical modelling of disease network, building on modelling groups that were developed during the COVID-19 pandemic, taking a One Health approach. This network must bring together multidisciplinary researchers and practitioners including environmental, health and policy experts to proactively identify science and evidence gaps, including those related to environmental and climate change health threatsFootnote 10.
    5. Ensure that Canada contributes to global emergency preparedness and response efforts and is part of global alert systems.
  4. Improve public trust and societal understanding of science through dialogue, transparency and increased science literacy.
    1. Be clear on how values and scientific evidence are used to reach a decision.
    2. Make science advisory committee memberships, roles, mandates, and activities publicly available.
    3. Improve approaches to managing real or perceived conflicts of interest, such as regular transparent disclosure and tracking of declarations of interest as done at the World Health Organization.
    4. Incorporate learnings from effective open committees such as the U.S. Centers for Disease Control and Prevention public virtual meetings of the Advisory Committee on Immunization Practices.
    5. Improve science literacy and encourage participatory science to reduce the risks of mis and disinformation.
    6. Provide opportunities to decision makers to learn about science and for scientists to learn about the complexity of policy making through various means such as “Science Meets Parliament” events and on-line initiatives.
    7. Publish case studies from different crises for different audiences, such as researchers, scientists, decision makers, journalists, and students.
    8. Establish a transparent behavioral science and risk communication advisory table as a centralized resource that can be tapped into during emergencies.
  5. Mitigate health crises and climate-related disasters by adopting a One Health approach.
    1. Support inter-related One Health approaches to prevent and mitigate human, animal and environmental impacts of climate-induced disasters and the rapid detection of emerging infectious disease threats.
    2. Develop a framework of fundamental ethical principles in risk assessment to reduce indirect impacts and unintended consequences of threats and proposed interventions over the short and long-term with special consideration for marginalized and at-risk populations.
    3. Establish and maintain emergency stockpiles that combat a diverse set of threats and emergencies beyond floods, wildfires, toxins and viruses, recognizing threats from climate-related events, population mobility and loss of natural habitats.
    4. Increase prevention efforts such as through preserving biodiversity and reducing deforestation, mitigating land use-induced spillover (LUIS)Footnote 11.
    5. Align infection prevention and control strategies with dominant modes of transmission for infectious diseases, considering the latest scientific evidence. where there is scientific uncertainty or debate, consider the precautionary principle.
      1. Improve ventilation and air quality systems, as required, in buildings where people gather, like schools, theatres, long-term care, clinics and hospitals during peacetime to reduce disease burden now and for future pandemic events. Respiratory diseases have an important airborne component of transmissionFootnote 12, Footnote 13.
    6. Identify and enhance critical infrastructure, systems, tools and surge capacity to manage a wide range of health emergency situations. This includes those enabling interconnected care and research networks, as well as training and human resources for logistics and operations such as testing and vaccination, in addition to the elements outlined above.
      1. A plan should be developed in collaboration with health professionals to ensure readiness of health surge capacity for emergencies.

Conclusion

Urgent situations stemming from climate change, including emerging and adapting zoonotic diseases, toxin release, extreme weather, floods, droughts and wildfires are becoming more frequent around the world. The experience of the global COVID-19 pandemic can and must inform emergency preparedness and response including the use of science to address a broad range of future threats.

Science and science advice have a place across all stages of the emergency management cycle from prevention and preparedness to risk assessment, response and recovery. Establishing research and data monitoring and collection priorities to address knowledge gaps required for decision making is an essential component of effective science advice.

Going forward, priority actions should be taken to improve the dynamic integration of evolving scientific knowledge into emergency management. Processes and frameworks are needed for the timely selection of quality evidence, real-time access to laboratory samples and data, rapid gap identification, appropriate priority setting and coordination of research, while engaging affected communities so decisions are made considering who is most at risk. Mobilizing science into action also requires critical infrastructure and tools, sustainable systems, and trained people including to support surge capacity readiness for monitoring, diagnostic and other health and social needs. Science can also support effective communication and policy implementation, both of which are critical for emergency management.

No country was prepared for the magnitude of the COVID-19 pandemic. How each will use the lessons learnt from the pandemic to strengthen resilience and emergency response will determine how well they manage future global health and environmental crises.

Annex 1: Meeting background document

Chief Science Advisor COVID-19 Expert Panel - Providing scientific advice for effective decision-making: Looking forward from COVID-19

Current Context:

Scientific input is a key element of decision making and was essential for the emergency management of the COVID-19 pandemic caused by a novel circulating virus, SARS-CoV-2. On May 5, 2023, the World Health Organization ended the COVID-19 Public Health Emergency of International Concern, declared on 30 January, 2020.

As part of Canada’s COVID-19 response, in early 2020, the Chief Science Advisor of Canada (CSA) assembled a multidisciplinary science expert panel to advise her on the latest scientific developments relevant to COVID-19. This information assisted the CSA in providing current and cross-disciplinary advice to the Prime Minister and government. The Chief Science Advisor COVID-19 Expert Panel met forty-seven times between May 2020 and December 2021. Some of the Expert Panel members also participated in the seven special meetings of experts in 2021 and 2022 and/or other task forces and expert groups, such as the Task Force on Post-COVID-19 Condition. The science and science advice contributions of the Expert Panel during the COVID-19 crisis and how it was done can be leveraged and built on for the future.

The experience of COVID-19 can be considered as part of a broader emergency context. As outlined in his mandate letter, the Chief Science Advisor of Canada is supporting Minister Blair to further incorporate the use of science and science advice across all elements of emergency preparedness.

Looking forward, key elements and learnings from the COVID-19 Expert panel throughout the COVID-19 pandemic will be especially useful for continued emergency preparedness, with broad applicability to other pathogens and emergency situations.

The final meeting(s) will bring closure the Expert Panel while articulating key learnings for the future.

Meeting Objectives:

  1. The Chief Science Advisor Expert Panel will convene for a final meeting(s) in summer 2023 and release a final, forward looking report by early fall, 2023.
  2. The aim will be to discuss and report on science and science advice in the context of managing the COVID-19 pandemic, with a focus on looking forward to strengthen emergency preparedness, response and recovery for future pandemics and emergencies.

Background documents:

  • Table compiling all COVID-19 Expert Panel meetings , including a summary of key points (to follow)
  • A brief discussion deck for presentation at the meeting to set the context
  • OECD Summary report of a GSF virtual workshop held on 3-4 March, 2022 - Scientific advice in crises: Lessons learned from COVID-19

Draft agenda and guiding discussion questions:

  1. Welcome and introduction – Dr. Nemer (4 to 4:05 pm ~5 minutes)
  2. Context setting presentation – Dr. Nemer (4:05 to 4:15 pm ~5 to 10 minutes)
  3. Discussion guiding questions – All (4:15 to 5:50 pm ~100 minutes)

All input, and suggestions are welcome. As a guide, reflecting on your experience as a COVID-19 Expert Panel member, and as a scientific expert more broadly during the evolution of the COVID-19 pandemic:

  1. How can we address gaps and improve the use of science and science advice for emergency preparedness? Consider elements, such as:
    • Science coordination, such as accelerating priority flow of necessary data, partnerships/networks
    • Science and data , such as research priorities, scenario modelling, data sharing, open science, implementation science
    • Science capacity, including expertise and support across multiple disciplines and partnerships
    • Science advice, such as evidence, risk assessment, management of direct and indirect consequences, receptor capacity
    • Communication, including risk and uncertainty, promoting protective behavior
  2. What best practices, models or frameworks should be considered for the timely and transparent provision of science and science advice in this context, for Canada?
  3. Looking forward, what are your top 3 to 5 recommendations to improve the integration of science and science advice into decision making to support emergency preparedness, response, and recovery in Canada?
  1. Closing remarks – Dr. Nemer (5:55 to 6:00 pm – 5 minutes)


 

Final version November 24, 2023

Date modified: