Health

Genome Canada and the future of pandemic preparedness

By - World Healthcare Journal

Genome Canada and the future of pandemic preparedness

Genome Canada’s CEO, Rob Annan, and Head of Communications, Nicola Katz discuss the lessons learned in Canada over the pandemic and the future of pandemic preparedness.  


Even though Canada remains outside of the top 10 countries worst effected by the pandemic, Covid-19 has more than left its mark. Over one million cases have been recorded and 25,000 people have died since the outbreak last year. As part of its national response to Covid-19, Genome Canada launched the Canadian Covid-19 Genomics Network (CanGOGeN) in April 2020 with $40 million in federal funding. The mission is to establish a coordinated, cross-agency network to track viral origin, spread and evolution.


The re-building of a national response  

Like most of the world, Canada was caught flat footed by the Covid-19 pandemic and it took time for the country to develop a response from a genomics perspective. While lessons were learned from the SARS outbreak (where Canada was the worst affected country outside of Asia), Rob suggests that the structures required to manage global, national, and even regional surveillance were not maintained after SARS. A lack of attention meant that many resources and infrastructure began to “wither on the vine” according to Rob, this compounded the need to develop a rapid response when Covid struck.

Unlike the UK, which predominately has a single health care system, Canada’s system is far more decentralized across its 10 provinces. As Rob explains, “healthcare is a provincial responsibility”; thus, creating jurisdictional divisions between the federal government and provincial governments, which means there are a dozen or more health care systems across the country, and even within provinces, it is often fragmented. Therefore, when something like a global pandemic hits and a coordinated national response is essential, there is no integrated national mandate for public health and healthcare delivery. “Instead” Rob continues, “you have a set of disparate systems that need to come together”.

“CanGOGeN was created from a bottom-up effort by public health, provincial public health labs, the National Microbiology Laboratory, which works at the federal level, as well as research institutions, hospitals, academics and industry to come together and work in a coordinated way to build what would effectively be a national response. ” As Rob continues to explain, the newly formed network was not driven by a central authority, but rather by the community.

The decentralised nature of Canada’s province-based health system presented unique set of challenges when the time came to create a national genomics response to Covid-19. Rob reflects on how when funding was received from the federal government, there was a “naïve” assumption that most of the time and resources would be spent on sequencing analysis. “But in fact,” he says, “a lot of the time and energy, especially in the early going, was spent building out all the soft infrastructure that was required”.

The development of CanGOGeN, Rob recognises, was highly dependent upon committees and working groups “which could coordinate on sharing of best practices, of identifying areas of where capacity was needed, of working on things like ethics, governance, and equity. ” Given that there was no mandate that required people to be at the table, we had to make sure that regional needs were represented and that the resources and benefits were shared equitably.


Beyond the ability to just sequence 

Rob outlines three central priorities in creating the new national genomics response system. Firstly, there needs to be a strong policy foundation from which a response can be built. From effective governance models to processes for the allocation of funds, an effective response system stretched far beyond the ability to just sequence the collected genomic data. In a federated system, ensuring inclusivity was essential. “We had to be very deliberate and pretty open about how we were going to establish those policies to help guide our activity” Robs explains, “we needed to ensure all voices that were at that table”. Such an inclusive approach was prioritized, as it accounted for the needs of both the large metropolitan areas, such as Toronto, as well as smaller remote communities.

The second factor concerns issues surrounding equity, a key factor in securing public buy-in and support. “How are we making sure that we are balancing the work we're doing on a surveillance side, in terms of resources and attention across the system, so that people feel that their concerns are being adequately reflected? ”

The third aspect, public trust, and engagement, plays a central role in ensuring the introduced responses are successful. In a world where people have not historically been engaged with genomics, “communication,” Rob explains, “is crucial”. AS Nicola, Genome Canada’s head of communications says “taking a really collaborative approach with the media” and “adapting our language to make sure that it is accessible and comprehensible have played key roles in ensuring public engagement and trust has remained constant through the last year”. Considering genomics has only recently entered the national narrative, “putting information out there that our audiences are interested in,” Nicola continues, “has been really successful in helping them understand this highly complex initiative”.


Preparing for the next pandemic 

What is ultimately the greatest societal and political challenge, is that of sustaining investment in peace time

Covid-19 is far from over in Canada, but that hasn’t halted preparation for the next pandemic. Rob reflects on how the “Canadian Covid-19 Genomics Network was a very short-term response to a crisis where we needed to bring these pieces together. ” Attention has already shifted to building out capacity where there were previous gaps. Such investment stretches beyond genomic surveillance and into data and data management, personnel and the building of infrastructure. All of which must be done in a way which fits the decentralised nature of the nation’s health system.

“What is ultimately the greatest societal and political challenge” Rob continues, “is that of sustaining investment in peace time”. A challenge not unique to Canada. As countries eventually recovover from the pandemic, governments and health providers must ask: What is the level that will need to be sustained with regards to capacity? And how is it maintained to be able to effectively respond? Creating a system that possesses the ability to adapt to other functions, for example to antimicrobial resistance (AMR) surveillance, “so that if we do face, or when we face, another pandemic, it's easier to pivot and respond more quickly”.

As Rob continues to explain, “one thing we know with certainty is that there will be more pandemics. Pandemics have been with humans as long as humans have roamed the earth. ” Now that countries are vaccinating their populations, it is therefore imperative we do not assume that the world is through the thick of it. In Rob’s mind it is clear that “the biggest risk right now is that Western countries—the UK, the US, Canada, and others—are in the process of vaccinating their populations and will emerge from Covid-19. But this is not the case in other parts of the world”. It is vital to keep in mind that until we are all out of it, none of us are out of it.

Looking ahead, the Canadian government looks set to continue its commitment to genomics, having just released a budget containing C$400 million for a new pan-Canadian genomics strategy. “This represents a big step forward for Canada,” says Rob “and is building on a lot of the work that we have been doing all along”. Even though the potential of genomics, and related science and advancements, are evident to those in the field, a clear and continued commitment from national government is essential. The budget allocation is, as Rob explains, “a bit of a shot in the arm for Canadian genomics, certainly, and a signal that the Canadian Government is very serious about continuing to make progress in this area”.


A “silver lining” to the pandemic?  

From a communications perspective, this is a golden opportunity to share compelling stories on the power and potential of genomics to benefit people’s daily lives

The challenge that lies ahead is huge. It is impossible to predict when the next pandemic or public in health crisis will occur, therefore maintaining sustained public trust in the system poses a challenge. In terms of public awareness, the past year has proven to be massively beneficial to the gloal genomics community and Canada is no exception to this increased interest. In commenting on this “silver lining” Nicola observes that “people are actually asking about what we  are doing. They know the word genomics. They are starting to understand sequencing and they are talking about variants in viruses.

“From a communications perspective, this is a golden opportunity to share compelling stories on the power and potential of genomics to benefit people’s daily lives. ” The socialising of genomics, or the beginning of its dissemination into the public psyche could have major implications for advancing genomics for years to come.

Although, as Rob comments, the national rhetoric and conversation will shift with time onto the pressing matter of the day. The minds of the public will be consumed “quite rightly with climate change. It will be consumed with whatever is going on with Brexit or the royal family or whatever, and that is just a natural thing. ” It is logical and common that other priorities and crises will come up and infiltrate public discourse. “But that is when those of us who are in positions of influence and leadership cannot lose sight of the long term and cannot forget the risks that come from not maintaining vigilance. ”


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