[00:00:00]
Most of the people that we were expecting. I'm just checking the list.
[00:00:42]
All right. Well done. all right, so we're good to go. Thank you, everyone, for joining and particularly to our BCC colleagues who are, you know, in the earlier hours of the morning and, I didn't know who were we were expecting specifically because I know it's it was in the meeting was sort of pulled together at fairly short notice. And, so I think, I'm just grateful everybody can make it. I think the, just, I'll do a bit of contextual context setting and then I'll turn to Sarah. Sarah Rebeck, our chief science officer. and perhaps doctor Don Shepherd as well, who's on the call for, to to just start the round table going, if you like. but the purpose of the call is really to bring together the four public health agencies, you know, the public health agency and the three provincial ones, at the start of what we think might be an interesting moment in the HPI, trajectory, the high, the avian influenza H5n1, really, taking into account the lessons learned about, you know, enhanced surveillance, epidemiologic studies and scientific, endeavors and see if we couldn't, you know, increase our abilities to collaborate and coordinate some of the activities, in this area. I don't think we spent an agenda except for a list of the things that we thought would be of interest to discuss. But I think, I would ask all of you to feel free about, you know, adjusting that list of areas of interest. as we go through our conversation today, prior to the pandemic, I had pulled together heads of the agencies, on a fairly regular basis just so that we can increase our linkages, share what's happening with, the agencies, in terms of priorities and direction, etc.. but, during Covid 19, of course, everything kind of fell apart a bit as we all try to work within our own context with, I would say less, opportunities to connect than I would have liked. but I think this is part of the lessons learned during the pandemic. And I want to see if we couldn't, set up something, some mechanism, by which we can continue to share information, to collaborate, etc.. I thought that another trigger that point prompted me to set up the call today was actually at pH. NC, the Public Health Network Council. I, you know, of course, got the sense that people were already beginning activities. Right. As one might expect with dairy cattle in the United States. and usually, getting infected in and we're still trying to find out the, epidemiology and some of the scientific research, in the United States and linking with that, you know, I heard well, some people might be doing wastewater surveillance, other people are testing milk and, you know, so when, when, when we get to this stage, I think it's useful for us to have this call. I thought that that it would be impossible, at least from my perspective, to get a handle on all the research going on in Canada, and all the researchers doing things. But we do now have different settings and tables that Sarah could go through where we are trying. what I wish for this table is looking our intramural activities. And to be able to share that and see if we can collaborate, given that you do science and, but also knowledge synthesis and then knowledge translation and risk assessments, for example, you are also, agencies that might be setting up expert panels to, so if all of this is going on, it would be nice to know and then see if we couldn't, coordinate with each other and then we can and Sarah and, with Don can tell you about a little bit about how we are pulling, people together to get a bit of a handle on the extramural, researchers as well, including our discussions with the. Funding agencies. but it is meant to be a bit of a round table. So essentially, you know, maybe I'll get the public health agencies to start and then we'll just go around, the, the other three, organizations, just to get an update and then we can have a discussion if that sounds okay. with everyone.
[00:06:04]
Right. And there's, I, I know that we might not all know each other, so that's the only other thing that I thought as as I move across the different organizations, maybe the head of the organization or whoever is leading this call could just introduce your team. Maybe that's the easiest thing. because I think part of this call is about getting to know each other as well. and then and then have linkages and share contact information of that sort of thing, as we go along. But it's it's great to see Michael and Luke. I know that, Jason has sent me a note yesterday, to to say that, of course, the, the CEO and and the head of Bcdc couldn't quite join us today, but, we will link up with her afterwards as well. And then we have the chief medical officers. so without further ado, I'm going to hand the mic over to Sarah, assuming people already know quite a bit about the epidemiology, what's happening in the States, etc.. I won't go through all of that. but, Sarah, would you do you want to start?
[00:07:14]
sure. Merci. Theresa. Martin. colleague pour en colombie-britannique. Sarah Quebec. And I'm the chief science officer and vice president of data surveillance and foresight for the Public health agency. I've met many, but not all of you before. but I thought I would give a very short overview of some of the activities that we've initiated, as well as areas where we could expand or would be interested in collaboration across public health agencies, especially given, constrained resources. And, I think value of coordination, where we can respectively lean forward or lean back knowing that another part of the system is picking it up, for, for joint learning and benefit. so the first is that, a number of months ago, we did establish an expert panel, in H5, and one and, I'll just thank, each of your organizations for sending representatives to that panel. we, have, met most recently on May 3rd, where we got an overview of both the animal and human, epi and situation. we had an overview from CfiA of the enhanced poultry surveillance, as well as some of their plans, related to cattle and milk. And Don will speak to that. And, we also had a presentation from the UK Health Security Agency around their asymptomatic, human surveillance pilot, which has been ongoing for a number of months, and their lead investigator presented. We. I do intend on upping the tempo of those meetings, and would be really pleased to have, input around agenda development as well as folks that would be really good to bring that. the second area that, is tied to that is around the identification of knowledge gaps and research needs. And, we've worked, both with intramural experts within the public health agency and the Food Inspection Agency, as well as with members of the expert panel to identify emerging knowledge gaps and research needs. we do intend on posting those. And, that's another area where I think that there could be some benefit in, in, sharing knowledge. And we're going to treat that as a living document. And as Doctor Tam said, as we become aware of activity that's actually going on to address those gaps and including activity which can really only be done in government labs, we'll want to make that evident and apparent to others in the system. And also capitalize on recent federal investments in biomanufacturing and life sciences, which many of you may have seen the announcement of or be partnered or implicated in. and so I think there's some good opportunity there.
[00:10:16]
the other dimension tied to that is that, federal funding, through the Canadian Institutes of Health Research, has been mobilized in order to start addressing some of those gaps. so there may be opportunities. I'm sure there will be opportunities for collaboration with, public health officials on applications to that funding. And that will be released later this spring. in terms of, knowledge synthesis work, we do have, a couple of opportunities there. One is through the National Collaborating Centers for Public Health. All of you are familiar with that program. there's some readiness capacity there. but the other is through a contract that we have for rapid evidence synthesis and profiles. And so, we are looking already at refreshing earlier conducted knowledge synthesis, treating those as kind of living documents, given how quickly the situation is evolving. one relates to, just understanding, transmission and characterizing the virus. The other relates to interventions, focused on reducing risk of human spillover.
[00:11:29]
there are our risk assessment activities happening. Folks will have seen that we and the phn was, was, told as well we did release, an update to our risk assessment looking at livestock, risk. And that will be updated in, as it's expected to be updated again in a couple of months time. will flag, there that we've also got really good engagement across RTS in, assessing that risk as well as our ongoing risk scenarios. So I'll stop there. in the in the interest of leaving time for discussion, Don, I would invite you to chime in on some of the enhanced surveillance activities going on, by CfiA and also our, our existing instruments for that.
[00:12:20]
Thanks, Sarah. And, good morning, colleagues. For those who don't know me, Don Shepherd, I'm the vice president for the Infectious Diseases and Vaccination Programs branch at the agency. So when we look at surveillance activities across the board, I in my mind, I break it down into kind of three big buckets and I'll go through them. The first, of course, is humans. So on the human side, what we've been doing is thinking about our existing flu watch and sentinel surveillance networks that are monitoring for severe respiratory illness and flu, and looking about extending their activities past their normal cycle, where they would be sunsetting, and then trying to balance the resources and energy required to do that versus the yield. So that's the existing work that we have in flu surveillance. Then options for enhanced surveillance. Sarah had outlined we've been doing some work on this for a while, actually. In fact, when I was out in BC at Ami, I was speaking to some of the people out there that have done this in the past. And the big questions are what? How far to go and in what populations and then with what techniques and whether this is a molecular based program, molecular plus sero surveillance in the sero surveillance space. There's lots of technical questions about is there an assay? What kind of an assay? How robust is it? How do you validate an assay in the absence of serum from humans with H5n1 disease, which as we all know, we don't have a large number of and we have no access to that serum from people with bovine exposures, at least at this point. So if you a lot to be worked out in that space and a lot of conversations and work going on to develop that as a minimum, we feel protocol development, having everything ready in the event that some testing comes back positive would be the minimum that we would like to see, and implementation would be a question that would be addressed. Once we have some of the information from the testing I'll talk to you about in a second. So that's the surveillance side. On the human side, I should say the other two big pieces are cows and milk from the cow side. What is going on is, as you will have heard, there is a border testing for all cows coming into Canada. Now aligned with the interstate requirements. That's molecular testing done on all cows coming in. There's always been a symptomatic cow testing pathway. And that.
[00:14:29]
Can I ask you a quick question? Sure. Just, you say all cows. Does that mean, I guess this is my non veterinarian. So does that mean lactating cattle or just all lactating milk cows.
[00:14:43]
Yeah, right. Lactating dairy I should be very specific on.
[00:14:46]
CfiA was very clear that we're not doing any testing on most of the cattle who come into the country. It's only lactating dairy.
[00:14:54]
And in fact, in the US they've had very little testing of Non-lactating dairy. What they have done is all negative, including ground beef surveys. but, no one has gotten great, great surveys. Of course, you all know that this is been largely found in, ma'am and mammary epithelial cells. And so there is actually a reason why it might be less prevalent in beef cattle, but, beef cattle, are not exclusively male. So it isn't a zero. Okay. so that has been going on. and that's a dating now, but almost two weeks. the other thing is they've opened an asymptomatic cow testing pathway and a testing at slaughter pathway to start getting at that asymptomatic cow reservoir. and that I don't have numbers for you yet as to how many cows have been tested in there. but I think we're approaching a dozen, total symptomatic cows now that have been tested and have all tested negative. so that's the cow testing pathway. The big one, of course, that you're interested in is, milk. Jason, it's, nine states, 36 herds don't know the number of cows in the US. Assuming that's what the the end of that text I didn't see was so on milk. You all are aware, we put out that notification at a very high level, that, milk testing would begin in Canada. But to unpack that a little for you, because I'm sure you're curious what that really means. there are two things that are being done with milk experimental studies to validate pasteurization efficacy and effectiveness that is like has been done in the US. Those are being done in benchtop simulated conditions because we're still level three, restricted at this point. Those are ongoing results should be available. the interim egg culture results should be available on May 21st with finals on May 28th. But we are, of course, anticipating nothing different than the US has found. and one thing is going on is the US is trying to wheel a pasteurizer a commercial pasteurizer into a level three to do this in commercial conditions. we're going to let them do that. instead of trying to figure out how to put a commercial pasteurizer in the animal. So that is the, pasteurization experimental testing. But then there's actual sampling of commercial milk samples. And the current experimental plan is 300 samples representative across the country. that will all be tested at centralized laboratories at CfiA. They're already in process of having been selected. Many of them have actually arrived. Testing is ongoing and the first batch of results is anticipated 40 of the 300 samples probably Monday. So give you a timeline. We do plan to release the results as they come in, and obviously not by single samples, but by batches so that no one is waiting on the edge of their seat wondering. So I anticipate the first set of milk test results to be next week. that of course, then brings open the question as to what to do with those results, which is something we'd be very interested in discussing with you. I just throw out a couple of points and then I'll go over to you, Michelle. But, the the points obviously, to discuss are the follow up to a positive result in the milk system and then tracing that back to the actual, farm system, how far back that can go, what measures would be appropriate to implement and what international measures of communication would be necessary from an Ihr equivalent perspective? The animal version of an Ihr? yes. Whoever popped up communication, I missed the name. There is a robust communication plan which is accompanying the test plan. I have both draft documents on my desk, that has been put together, and obviously there's a lot of messaging that will have to happen with that, starting with the fact that we told you when we were doing this that all the evidence suggests that milk is safe, even if we detect RNA. We are doing this to try and understand the burden of disease. Milk is still safe if it's pasteurized. But doubling down on the non-pasteurized milk messaging, which obviously is something we've been doing already. The big reason I'm mentioning this all, though, of course, is that this is a very important area for federal provincial territorial collaboration since many of the activities that will happen would be that would happen around farms, it would happen after a positive result would indeed be led by your colleagues on the agricultural, I guess, and most ministries in the provinces, the chief vets. and I'm certain many of you are in conversation with your chief vet colleagues, and this would be a good place to make sure that thinking is done ahead of next week, within all of our jurisdictions. So that might be something we want to chat a little bit about. So, I'll pause there because I think it'd be more efficient to answer questions before we go to a roundtable, rather than just trying to think of little details I haven't mentioned. And.
[00:19:55]
Don, did you want to make any comments about wastewater? That's the only other. And the lab and the lab samples?
[00:20:01]
Sure. I can talk about that. I actually had that on my list, but I thought I was using up too much time. so, wastewater is something we've looked at. We've talked to some experts. I'll be, very clear that, we can do wastewater, we can detect H5n1 in wastewater. We don't know where that H5n1 in wastewater has come from. Guillaume tells me in a very detailed conversation that, the sequences that are robust enough or that are, yeah, robust enough, stable enough for us to detect out of wastewater are not variable between avian origin strains and the bovine strains. So we would not be able to determine if this was environmental contamination from avian source, bovine source or milk dumping, as has been the case in the US, or frankly, even human source, based on the sequences that we would be obtaining. So the challenge really is not so much one of could we do it? It's how would we do it? What would the use case be? What would the question be that we're trying to answer? and watching carefully because if there's sufficient sequence divergence over time between these various isolates, that that may not be, that may, may evolve to a place where we could actually distinguish them. But at this point, the bottom line is we're viewing milk sampling as the equivalent to wastewater sampling, frankly, as a way to do large scale population testing in a sort of an unbiased manner. other lab capacity issues. There's some work going on about strain sharing and certification. There's some challenges there, of course, because this is a CfiA led issue. It's a it's a strain that is of, agricultural origin. It is their certification process. and they're strains that need to be shared. And their capacity to do that is not aligned with what our capacity has been on the human pathogen certification and sharing side. So we're, working with them to try and figure out ways that we can improve the ability for strains to move. and there are very real biosecurity implications here. Obviously, we don't want someone playing with a human, avian, human and avian influenza strain on the same benchtop and reproducing pig mixing, in the comfort of their own lab. And I'm sure you all are very, very live to that. other than that, I think I am told that, again through Guillaume. So this is second hand that, testing capacity from a molecular level has been downloaded, to all of the jurisdictions who have the capacity to do that testing and that QC panels and all the good stuff that you need to do, it is available. And so we should be ready for that. There are no indications there's anything particularly special about these sequences. I mean, we know it's an avian strain. We've been able to PCR avian strains before we can PCR them. Now we're just PCR ING them from a different sample. Well RT PCR to be very specific.
[00:22:43]
maybe we'll take the three hands, as it were, and then we should move on to the other organization. So Michelle.
[00:22:54]
Yeah, thanks for that. Don. I think our question is really around the the milk sampling since it's happening as of Monday. I mean, we have heard from our vet colleagues that it's, probably Eastern Ontario, where they're collecting specimens from. I'm not sure. Has there been a call or maybe I missed it around bringing together all the BTS that where the milk has been collected from to have sort of common expectations on where is this happening? What's the turnaround time between the CfiA positive to the local like or agri ministries to do the follow up with the farms? And, you know, what's the expectation for being able to find which farms this might have been coming from? What are human health expectations are going to be for, you know, once we do find those farms, I just I'm not sure that we've actually it sounds like you have a communication plan about that first announcement of a positive, from a CFI retail sampling. I think there's a lot of steps after that that we are working with our agri colleagues on. But but I think it would be good to harmonize because you might have multiple positives across the country at the same time. And are we all doing this in a similar way?
[00:23:50]
No. And that's the reason for this call. This is obviously as you can so is it just.
[00:23:54]
These three provinces that are getting. No, no.
[00:23:56]
It's uh across the country, it is a representative sample across the country. So it should be in all jurisdictions that may be an exception of the territories. Obviously, it's all jurisdictions that actually have milk production. They're, they're sampling from so it won't be just the big three. I don't have the, the by by, province, allocation of the samples, but it is it is not focusing on specific, jurisdictions. It's all jurisdictions where they think, milk could be coming from.
[00:24:25]
I guess. And is there a call with all the jurisdictions between now and Monday where. yeah. So that could be happening to, to talk about, you know, what's our expectations for turnaround times at local level and response. Yeah.
[00:24:36]
So CfiA is handling the communications on the veterinary side and I don't know where they are on their um on their bringing together the stakeholders. Obviously like like I say this, the the communication plan we're talking about was the draft form generated at 10:00 last night. That's the, the level of. That this is moving at and, but they, they will obviously be doing exactly that. And there is a is part of what we're looking at for the communications plan is ensuring that we do the notifications in the order that you're getting at, which is making sure that the first people to find out are, all of you, and your, agricultural colleagues, so that we are joined up on what to do next from the human health side. This is what we're having. The conversation now is to understand what things we need to lock down between now and when we actually have results in hand.
[00:25:33]
Thank you. I think we're going to have to do a bit more work after this call and make sure everybody knows you know, the exact rollout, etc. we'll reach over to the CFI. They hadn't really even provided us with any details. but we'll we'll make sure we do that. And then exactly what's going to happen. the after the announcements, I mean, I think CFI, the way that I understood them is okay. Well, over to the jurisdictions. Well, not you know, we got to really figure this out. And I suspect, you know, they're only communicating to the animal health people, right? The agricultural people. And then we have to get it, and then we have to loop back with each other as to, you know, on the human health communications response as well. except for the, you know, pasteurized milk is safe, all that kind of stuff. But, the investigation that, ensues because we all actually know there are gaps as it stands on human health, people being notified if a certain farm is infected. So imagine the milk, which is like more difficult to figure out which farm, perhaps, I don't know. and and then, you know, how would you know which farm? You know the connections. I'm sure you have connections with your animal health people. And you found that that way we will not know. I mean, at fact, I'm sure it goes, a sort of circuitous route. So we will we will, basically follow up very closely with CfiA and, maybe I'll there's many hands and very little time. So, Eve and Jessica and then we'll switch to maybe BK could get ready for your round. Eve.
[00:27:27]
Yes, thanks. a quick one. the samples that will be batch tested is it pasteurized milk or not? Pasteurized?
[00:27:37]
Yeah, only pasteurized at this point. Should we find it's actually it's a good point that there's a big information evidence gap that no one's actually tested in egg culture. Unpasteurized milk yet. Or if they're doing it, they haven't released the results to prove that those ridiculously low CT values are actually representative of live virus that we're all assuming it is, and certainly fits with the epidemiology because we think it's milk is the vehicle of of, transmission. So it's an excellent point. And if we find positives, obviously we'll make sure we do that if no one else has done it.
[00:28:16]
Sorry again. Yeah.
[00:28:18]
Thanks. Jessica Hopkins, public health Ontario. I was just wondering. So in the event there is a positive for milk, do we have a plan to start, active surveillance in humans? I think that, you know, I'm just sort of thinking about, like, what's the next step? Are we just going to wait, or do we have something that's kind of keyed up or queued up and ready to go? once. Once we see a positive. Thanks.
[00:28:43]
So, Jessica, that's exactly the protocol I was talking about in the enhanced surveillance that we're working to put together that we won't use if I. Well, I shouldn't say we won't use. There's some potential ways we could use it. We could get baseline. We could do it on pigs. We could do it on avian, even though it's been done by the BC folks. So but obviously the preoccupation is to land something so that if we do find a positive farm, we can get in there. and it may be staged, it may be that we do molecular while we're waiting to get some sort of a zero assay that we all feel is comfortable that we're, we're is robust and, and high throughput enough to support it. But that's, that's where our work right now, has been focused on trying to develop something that would be implementable around those farms. I will flag that, you know, there's the science part and the lab part and the thinking through the epi part. And then there's the enormous. Sensitivities around who's going on farms. Are these quarantined areas? the farmers, the, undocumented workers or migrant workers document like that whole sensitivity area about we're here from the government and we're here to help you. Testing that has been very challenging in other jurisdictions, who have attempted to do this.
[00:29:55]
So, Don, I, I think maybe by the end of this call, we just make sure we know all the right people are connected in the, in this protocol development. And, you know, as you send the documents around, etc.. I know you've already connected with some of the colleagues that are on this call, and but we should see if we couldn't look at that protocol and see if it couldn't be done in a more sort of systematic way across the country. with your inputs. I am going to go to BC quickly. I know we're really running out of time. and is it Jason or.
[00:30:32]
I'll start and then I'll turn it over to Jason. So we have, the team here from BC, CDC, including our public health veterinarian and some of our researchers, including the head of the lab, Linda Huang. Danuta Skowronski, who's done surveillance and, on influenza, as we know, for a long time, the seroprevalence work that we've done, we we can put a protocol together around that. My biggest concern is the communications, like Michelle was talking about and the notification from CfiA so that we can actually have contact with the farm families and workers. That has been an ongoing issue where they've refused to give us the the information, and it's made it very challenging and trying to connect with the farm workers for the, for the poultry farms that we've had. But, Jason, I'll turn it over to you.
[00:31:27]
I don't think I had much to add, but, um. Yeah, other than I think we've set up some of this team who I believe weekly to have these types of conversations. And, I've also connected with some folks from Public Health Ontario and trying to create some coordination. So I think speaking to some of the things that you were talking about, Theresa, how do we, coordinate our activities across the country a little bit? better. yeah. So I just don't know if Aaron. Amir, or I did bring quite a big team in, and, Diane.
[00:32:00]
When I noticed it was, the, the, the network of, of agencies, I thought we'd better have our whole team here. So we have, Agatha, who does our water and wastewater testing. Amir, who's the head of the Epidemiology and Communicable Disease Unit. Now, Erin, who I mentioned is our and and Jason, of course, is the medical director of the AU. And Diane is here as well, who's one of our physician epidemiologist.
[00:32:27]
Yeah. If I could just add a few points, from a BC perspective. So we are connecting very closely with the Ministry of Agriculture and meeting regularly with our chief vet, sharing information around, we've got some established protocols in terms of notification that we have ironed out over the last several years with, with, detections in poultry. The on farm, information sharing is still a challenge. And some of that is also sort of resistance from producers to to engage in public health. Follow up. But one of the key things around the dairy issue. So we're, you know, working closely with Theresa and the Ministry of Agriculture around, just, you know, what are the communications, the different stakeholder groups? One of the key things that we're, struggling or grappling with is if we have a detection on a dairy premise, what does that milk management look like? And trying to really get a handle on the key stakeholders, the different types of processors that we have, you know, we've got producer processors. What would happen if we have, you know, an infected farm? We've got some clinically normal animals that the milk could be, you know, diverted to pasteurization because we do have processors that, that, process raw milk cheeses in the province. So, you know, the simple answer is yes, divert to pasteurization. But it's actually much more complicated than that as we're learning about this system. So, you know, any information around, yeah. You know, certainly the additional evidence around pasteurization, but but more system level, approaches in other jurisdictions, anything we can learn from, from counterparts in the US, on that matter would be really important for us. what was the other. Yeah. So we really are relying on the, the Sierra Group in terms of the risk assessment. I think that's been an important piece here. We've been reaching out to different colleagues around. Yeah. Any additional information on on Thermalized milk? milk that goes into, cheeses, those types of things.
[00:34:40]
Yeah.
[00:34:40]
Can I add one other thing that, you brought up, Don? It's about, the CfiA certification. This is something that our animal health lab was flooded. Catastrophically flooded, two years ago. And we have had joint, work in the lab on high path AI. And we are still. And correct me if I'm wrong, Agatha and Linda, but we're still trying to get CfiA to certify our lab to be able to do backup for our animal health lab. And we're having challenges with that. So anything we can do that will enable us to work together on these things for future pathogens would be really helpful.
[00:35:21]
Yeah, very much heard I think. Aaron, I just want to make that I want to highlight that one point that you brought up, which is that, and then we're very live to this is understanding what happens with milk. in the event that we have positives, because all the US protocols have focused on symptomatic cows and diversion of milk from symptomatic cows, but treating that milk as highly infectious, it's a different universe with asymptomatic cows walking this back into a system, and that the, the, the not knowing which cows are responsible on a whole farm basis, even if we can walk it back to individual farms. So there will need to be some thinking, on guidance around milk, that we need to work with CfiA and other colleagues to, to figure out how we would approach. And I have I haven't heard much from the US on this, because they haven't really been walking back to farms, so they haven't really been able to do much other than when, work with their symptomatic based approach and the milk when it's from symptomatic cows, as you know, it looks like colostrum. It's this cloudy, weird, clumpy stuff that they throw away and is discarded. And there's no question of including it in the milk system.
[00:36:30]
Yes, that disposal piece is really critical. Like, well, how is that not getting disposed on premises that's not infecting wild birds and other animals is a is a huge issue.
[00:36:41]
Yeah. That's where we think the cats got sick was.
[00:36:48]
Okay, so, can I just ask a logistics question? Are people available to continue to the to the hour to like 11 if necessary? Get. Thank you. Seems to be a lot to discuss. Linda.
[00:37:10]
Yeah, thanks. I just wanted to answer.
[00:37:12]
Some of the questions that's raised and provide some more detail. So with regards to the milk walk back done. There's some conversations here in BC around wastewater and and and you know, looking at sort of a larger scale. And if it's a positive then walking the wastewater testing to to to be able to identify the the appropriate farm. So very early conversations I think we need some, you know, organized need to organize ourselves in order to, to sort out a protocol and approach to that. Bonnie mentioned CfiA testing our laboratory. Well, we do have very large capacity for human influenza testing as a result of the pandemic. we have not been certified for CfiA testing, in a large scale event. if that is a priority, we can look into the possibility of getting CfiA certified. That will take some time. however, we are connected with a with the animal health Center from a genomics perspective. So they're doing a lot of their animal PCR testing. and we're also supporting their avian influenza testing. for, for surveillance purposes. and we have set up a cloud based environment so that animal health is able to access their genomics data and be able to analyze that. So we're we're in conversation with genome BC to seek additional funding. And they've they're they're very keen on giving us money. They basically um their request is a one pager in bullet form, with a very fast turnaround time. So we're looking at that, to, to enhance our cloud capacity so that animal health can actually access their data as close to real time as possible. The second part, part of the genome BC proposal is serial surveillance. So we're seeking funding to support serial surveillance in BC. The third part is, a strategy for animal testing that's outside the scope of CfiA and others. So working with Aaron and folks to to address that third part. The fourth part is actually quite interesting and still and very early, but I thought I'd share with you. there's a BC company called Sea Polar, that is developed, a polymer that has been demonstrated to be able to sequester pathogens. So they're looking at this in the US, at Massachusetts, at Massachusetts Hospital to, for for infection control and building it into their PPE, etc.. And it's, it's proven in the laboratory setting to be effective. It's also helpful in air filtration. we had a conversation literally last night with them around this role initially in Amr sequestration, but there may be a role in influenza sequestration as well. So what I'm thinking of is contaminated milk or wastewater or sewage, with avian influenza. So we're starting so laboratory trials and looking for funding to do that. any laboratory testing, validation development from this group, please include me and Agatha as your point of contacts. Thank you.
[00:40:04]
All right. Thank you. So I'm. I know we can look back in the end about research and tri councils and all that kind of thing in terms of, linkages of funding research. all I can say is the CFA has major limitations on lab certification in terms of their capacity to do this with numerous labs wanting them. So certifying them. so, so I'll have to see how they prioritize whatever, you know, schedule that they have. the so I know that, Doctor Boileau has to leave, quarter to. So I'm going to go to you and the Inspq.
[00:40:51]
well, I think we are, currently, continuing to test workers who are coming in close contacts with, wild birds, symptomatic, birds and who are getting sick. we are subtyping influenza A for through our usual surveillance protocol and, sent to nml that type of all influenza. we are in discussion with, our animal health counterpart to check if there are some environmental surveillance that could be done, in dairy farms or pig farms. but those discussions, these discussions are ongoing, and we are looking to find fundings for that. there are some discussions with academicians as well to see if we could put up, a workers cohort, for surveillance use. but, for that project as well, we are still looking for fundings. And there are, as Dan said, a lot of unanswered questions as, how we could test those workers. with what assay? If we want to do a logical assay, will we be able to, to validate it? So those are some questions. So that's about it for this week.
[00:42:21]
This debacle. Anything to add, Luke?
[00:42:29]
I'm sorry. No. Thank you.
[00:42:30]
Thank you. Yeah.
[00:42:32]
Just to just to just to share. Maybe that, it seems to be. And it's really relevant. and I really appreciate last week, a discussion around this, but it is not seen as a very large and, I mean, preoccupying problem inside the population in at least in Quebec. I don't know if it's it's the same elsewhere. It is in the backyard of of the information, but not seen as a big problem. in the meantime, in the same time, it's, it's a concern for the authorities and namely the, the premier or their office to make sure that we're not missing anything. So it's just I'm not sure if it's the same everywhere in Canada, but it is not seen as something very, worrying for the population so far. Thank you.
[00:43:26]
So, Don, did you want to respond?
[00:43:28]
Yeah, just a sample. Look, we're seeing the exact same thing. Is that the, agricultural stakeholders are very alive to it, and the usual academics are very alive to it. But the general population here in Canada has not, really latched on to this story. The only thing I will say to that, though, is that in the US, it started like that. And then it flipped very rapidly with the announcement of positive milk, and suddenly there was a huge groundswell of attention. So I wouldn't want to underestimate what would happen if we did find positive milk samples in Canada. I think it was the initial messaging also of it's not here, we haven't found it. Granted, we haven't been looking very hard, but we haven't found it yet and therefore there's nothing to see here. So we will definitely, I think we should prepare for the worst and hope for the best. Yeah. No. So.
[00:44:14]
No, that's this is a very good, perspective. And I'm not saying that we should, rest on it. not not at all. It's just to inform that, at least in our own context, it's not that heavy for the population. But you're absolutely right. So thank you very much. And I'm sorry I have to leave you, but, Judith and Eve will continue. Thank you, thank you.
[00:44:36]
Thank you. And I guess we didn't introduce Eve, but, uh.
[00:44:44]
Is he still on? Anyone else? You just want to. Hi, Eve. Hi.
[00:44:55]
I'm leaving the premise that I'm in because it will kick me out at 11. So, uh. so I'm medical director for public health in Quebec. Hi, everyone.
[00:45:07]
Hi. So, I'm going to go over to Ontario Public Health Ontario and Kieran.
[00:45:16]
Uh. Thanks, Theresa. I could start, and, so Michelle Murthy's online, doctor Michael Scherer, I see Jessica, both from pH. Oh, so we do have a one health committee that has been struck, in Ontario with the chief veterinary officer co-chaired with Michelle Murthy. that is, bringing together expertise in Ontario, to report directly to Emergency Management Ontario, from Emergency Management Ontario to the Cabinet Committee on Emergency management. so there is interest from our political leaders to be on top of this. the committee includes, emergency management Ontario Omafra, our ministry, mainly from the chief medical officer of health office public health Ontario. Ontario health as our health system response partners, some local public health agencies that have high, milk production within their jurisdiction, some clinical academic advisors and, animal health academic advisors. Omafra, I believe, has some research dollars as well. and so, so a very much an operational committee, if you have to contact anyone, it would be Doctor Greg Morley, our chief vet, with Michelle as the leads of this committee. and then they would farm out any work. I won't speak for the science that Omafra is endorsing with the University of Guelph. but I do believe they're doing some work in this realm, and I could hand it over. I believe, Jessica, you're probably best positioned to speak on those initial work on this from a human health vantage point.
[00:46:52]
Maybe I'll just make a comment first. Kerry. Michael. Yeah, maybe I'll just make a comment first. One of the things, Theresa, that I think would be useful here is, you know, some of us are organizing at the provincial level to have a kind of overall response to this, but I, I don't see it at the national level, that we need we this table should include, your national, agricultural colleagues, that, you know, this the response to this cross is agriculture and human surveillance and human disease. And I think nationally we need that. And provincially we need that so that we're seen to be providing a coordinated response to this. I'm worried that very quickly, we will be doing different things in different provinces when we get a positive milk sample. And and I don't believe from what I've heard today, we're prepared. I don't think we're coordinated. We don't have a we don't have a plan of what's going to happen. And this could happen very quickly. So I think we need we do need clear communication nationally and provincially across agriculture and human surveillance here. And I don't see it.
[00:48:12]
The thanks for the participate. Oh, sorry.
[00:48:16]
That I don't disagree, Michael. So, I think we all know that we're each joined up with our ag and animal health people. So I think if we all think we should invite them all to this call, it's just to initiate the coordination obviously, between our agencies, but that can be set up. It's one of the questions that I had. but of course.
[00:48:41]
I would say a formal table at the national level that pulls, pulls the agricultural and human health leads from each province, plus you at the federal level to a formal table, just like Kieran's described we've got in Ontario. So the key people from across the country meeting together regularly, at least for a period of time.
[00:49:02]
Yeah. So, so in pandemic protocols, we have methods to escalate. Right. And you have special advisory committees. But this is a one health construct. So, you know, this is a little bit new. So we need to kind of morph what we have into that. and it's prevention rather than, you know, an actual pandemic response. So the three of these different, let's say, context means that this is actually something a bit different to what we had before. So I think setting it up right, would be important. And, so in any case, we're trying to get a handle on the research and the additional, you know, enhanced surveillance pieces from the provinces that we think might be doing studies and research. But what you're talking about is the overarching response, which, you know, the point taken. we'll bring that back. so, um.
[00:50:04]
Jessica might want to just speak a little bit about the detail of what we're doing in Ontario.
[00:50:09]
Um.
[00:50:11]
Yeah. Thanks very much. Happy to do so. in terms of laboratory testing. So we are conducting testing and obviously similar to the other provinces sending those, anything we can't subtype over to NML for further testing. If there are any persons who have had potential exposure on a farm, to sick animals, we are, testing those, collecting further information on those folks as well. so far have all been, negative. And then from a scientific standpoint, we are participating in the tables that, Michelle and Kieran have spoke to already. we have a number of different scientific and technical reports that are underway, and I have touched base with, with Sarah before so that we can coordinate and make sure that we're not duplicating. I think we're very open to collaborating with, other agencies on any of our scientific and technical reports to make sure that we have an appropriate input, as well as, less duplication. So anyone can feel free to reach out to me. If you'd like to talk further about details of what you're working on and what we're working on. Thanks.
[00:51:23]
Thank you. anything from you, Michelle? Before we.
[00:51:28]
it's not directly sort of through either for the ministry, but we are aware a couple researchers, Samira Mubareka and Allison McGeer, who have undertaken and are also concurrently doing retail, commercial milk sample testing, in parallel to the CfiA testing that's being done. So they have collected a number of specimens and, I think will be also, they can only test for influenza. So their process would be any detection of influenza would go to the CFA lab for that confirmation for H5, and then would need to have the same sort of follow up process that, the CfiA samples would have.
[00:52:01]
And I think our veterinary colleagues at Guelph would are also looking at some additional lab, animal testing options that they have there, too, for kind of closer to the farm, milk sampling testing as well. But I haven't heard specific details yet on whether they've been able to progress that. And I think they are similarly looking for funding.
[00:52:20]
Great. You brought up a very good point. I was trying to see if other people are doing well, sampling, because that's really important, right? So to try, because the same communication challenges arise and some at least you're in contact with the people in Ontario doing additional testing. I hope all of you will be of, you know, there are academic people out there who might just do something right. And so we were a bit concerned that we don't really know. So that's really great information to share. So if there's anyone else in the country, doing additional testing, I think that would be helpful information. and then, looking at the communication and the subsequent, management of that situation. done.
[00:53:15]
Yeah. And just to be helpful to also coordinate with some of those individuals. We're doing it at the federal level. But just to mention for those of you doing it at the provincial level, that it would be useful to, direct some of their energies to expanding rather than just duplicating the large scale work that is going on. So, for example, you know, there were reports of goats being positive in the US, a single report of goats, they could test goat milk or sheep milk. That would be a way to expand, at least to do some kind of sentinel work and understand things beyond what are already going on at a large scale. So feel free to leverage your communications and creativity to expand our knowledge base.
[00:53:53]
For clarification, we're not directing them. They are independent research and they are cihr funded, so they've let us know what they're doing. But they should also let their funders know what they're doing. and if we hear, of Cihr funded research in this realm, we can let you know as well. Yeah, but we're not directing.
[00:54:13]
Suggest rather than command because just people may not think of it and may not know that this is already being done.
[00:54:19]
So maybe this time to wrap up and go back to Sarah on the extramural, what we're trying to do to get a handle on the extramural funded, research as well.
[00:54:35]
Sure. Thanks. Teresa, I'll just say a few words here. first, there will be funding issued into the system, around, knowledge gaps. So that is something that, we'll have a good handle on, for the biomanufacturing and life sciences strategy investments which have been made federally. we are intending on convening the hubs of those, of the, investment in order to understand both the capabilities and activities that may be going on, given the intention behind those hubs is certainly to be focused in on pandemic preparedness. And so there's a good opportunity to leverage, intramurally across government departments. We've had a good discussion federally, and this has been very helpful in terms of filling in, capabilities, at the provincial level, around what, the lab, both our national lab, but also the National Research Council, the lab at CfiA and other parts of the federal system are well positioned to do and capabilities to be brought to bear both in the immediate term but also in terms of surge capacity, if needed, down the line. And there's certainly a strong precedent for that. so we'll also be working through the inter-departmental governance there. we're hopeful that we'll be able to track that in an ongoing way. And we're just working on how to do that. And so it's not a question of whether we will sort of gather who's responding to what is just a question of how. And that work is in progress.
[00:56:05]
Right. So, in summary, I think there's actually quite a lot to discuss. both on an urgent basis, you know, relatively urgent basis. And, in the, short and medium term, given the evolution of H5n1 situation, particularly in the United States, I think it is also an opportunity for us to just set up the right kind of structures and governance to enable the connectivity, across, provinces and territories. So I think, Michael, your point is really important. I know we focus on the science and the research and the, you know, studies for this call. now Bonnie is here, Kieran is here. I mean, we actually, you know, connect with chief veterinary officers. That's the quickest way is, like, chief medical officers and chief veterinary officers. we don't have a protocol, to be honest, to be, escalating in the time of prevention, as I said. But things can be done, you know, it can be done. and test some of these structures out. I still think it's important for all of our organizations to connect, so we'll maybe make sure we send each other the leads in these components. you can sort of look at what was listed on the agenda ahead of the call. But based on the discussion today, maybe I'll also loop back to Sarah and Don and see if we couldn't send out an email just to make sure we know what we're requesting, who we think should be, part of the team for the group for information sharing and nothing else. and communications. but we will work on, you know, we'll get back to the CfiA and do the sort of make sure that they know the urgency to the communication, approach. and of course, I was just thinking, you know, if results are projected, put it this way, to be released on Monday. We don't have a lot of time. And there's a sort of weekend between. It's like a really, you know, not a great moment. and I'll see what they're what flexibilities they have to, you know, consider the getting the comms bit ready before they post something. And I would ask that, if possible, from the other people, whether they're writing, I don't know, preprints or whatever, to know that there's a communication, and response and action that goes along with that. and so Sarah, is, you know, finalizing the actual research gaps and knowledge gaps, research agenda, if you like. And what we are trying to do is maybe map capabilities and capacities so that we can use like a table at least for people to slot in, you know, what those are and what they're doing. as a sort of ongoing piece of update, I think, we'll try and do that with the federal family. And if you could do what you can at the provincial level, that would be great. There will be other jurisdictions also doing research. Perhaps we have not reached out to them. We just thought this will be a tighter group just to start and see what's needed. so those are some of the next steps. And I'll certainly, you know, maybe talk to Bonnie and Kieran. Do you think that, you know, we should be setting up the like that construct, at least with the CBOs? because they because trying to deal with the data is really tricky.
[00:59:55]
And we need to have a communication strategy. The first positive milk there. There may not be a lot of outrage in Quebec, but there's certainly a lot of interest in the BC because of the high path. I in poultry that we've been through in the last two years. So it's it's on people's minds. If we have a positive milk, people will want to know that we know what it's about and that we're on it and that we're watching and that we're working together. So I to me, that's the most important thing we need in the short term.
[01:00:26]
That is absolutely.
[01:00:27]
The consistent feedback we get from cabinet and the relevant ministers. Yeah. You must have a communication strategy. Yeah.
[01:00:34]
Yeah, absolutely. I think in some ways people are thinking, oh well it's only pasteurized samples and we expect it to be negative. Well there will be the odd thing, you know, the unexpected. so we'll sort of press on with that, with our colleagues. And I keep telling people I feel I'm more worried than they are, you know, I'm not sure. Maybe it's all hidden underneath, but, I've preferred to be much more forward leaning and maybe. Anticipate that something is positive in Canada and we can manage it, you know, as long as we. You know, set it out with a degree of thoughtfulness. yes. And then we should sort of, again, have a bit of a focus on the, on the raw milk people, because that's probably, you know, dealing with the pasteurized bit is fine. I think this might actually go fairly smoothly. But then the, you know, we probably need a discussion on how to address all the people who are, you know, counter anti pasteurization. And then let's go. I know nothing about cheese. I don't eat cheese. But apparently goat goat milk products are, you know, frequently, more frequently unpasteurized, slightly scary as well. and then there's all the other layers of surveillance that we thought might be useful for, the other mammals, that swine, etc.. Right. But the animal health people are not quite as interested as we are. And it may be in the research domain that we're going to be examining the swine and, and other, relevant farm and farm animals in particular. Yes. The cats don't do well. Do not feed your cats with raw milk products. I don't know who messages on that, but I also know that there's a gap. You know, we always seem somehow left with holding the bag, as it were, on the pets. So I'm assuming farm cats are pets. So we do have to think about that as well. In terms of messaging. yes, there's a whole other. Can I have one other thing?
[01:02:49]
Sorry. Yes. On a positive note, the we shut down mink farms in BC. As you may know, Ontario, be aware, you still have them. but, and they, launched a lawsuit against us that was just thrown out yesterday, so.
[01:03:08]
One less thing to deal with. You hope in terms at least in terms of AI, not in terms of lawsuits. okay. Well, we will do some follow up and try and set up, a call that's, you know, more wide across Canada. But at least we've got a bit of our ducks in a row on the, the investigation side. And if we can put, you know, if we're all doing risk assessments or we're all doing, you know, reviews and things like that, let's try and figure out there's some efficiency that we can look at on that front. Okay. Thanks everyone. Bye.
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