Ont. listeria report finds “public confusion”

Public agencies’ response to last summer’s listeriosis outbreak suffered from a lack of co-ordination that led to “public confusion” that shook people’s confidence in the public health system, a new report finds.

Ontario’s chief medical officer of health, Dr. David Williams, on Friday released his report into the outbreak, urging that “more needs to be done to clarify roles and responsibilities at the federal and provincial levels to better manage foodborne outbreaks in the future.”

In a separate release Friday, federal Liberal agriculture critic Wayne Easter described Williams’ report as “damning evidence of the Harper government’s incompetence and failure to protect the health and safety of Canadians… The findings point to their failure to properly manage this outbreak, putting lives at risk.”

The outbreak began last August involving a specific listeria monocytogenes strain, which sickened 57 people in seven provinces from B.C. to New Brunswick, including 41 people in Ontario. The strain was tracked to prepared deli meats from Maple Leaf Foods’ Bartor Road meat plant No. 97B in Toronto.

Among those 57 cases, strain in question was ruled to be the “underlying or contributing cause” in the deaths of 22 people, including 16 in Ontario alone, as of Friday.

Maple Leaf responded last summer by launching a major and well-publicized product recall that crossed over into other food brands using product from the facility. The Toronto plant was shut down Aug. 20 and has since been cleaned and resumed production.

Cross-jurisdictional outbreaks are more complex to investigate than localized outbreaks, Williams said in his release Friday. “They require different epidemiological and food source identification strategies. They rely more heavily on complex new laboratory testing technologies. They also involve more partners and more communication.”

But in last summer’s outbreak, he wrote, “the lack of co-ordination (between various federal and provincial agencies) contributed to public confusion and created the impression that the outbreak was not being well managed, which affected public trust and confidence in the public health system.”

The lack of co-ordination “was due in part to the different levels of evidence required by different partners to trigger action, but it was also due to the fact that the office of the Chief Public Health Officer at (the federal Public Health Agency of Canada, or PHAC) did not appear to have a clear mandate for leadership in a cross-jurisdictional foodborne outbreak.”

Generally, Williams recommended Friday that:

  • the various levels of government and their public health and food inspection agencies work to clarify their roles and responsibilities in management for any future food-borne disease outbreaks;
  • laboratory testing capacity be strengthened within Ontario, by boosting provincial public health labs’ capacity to conduct a wider range of tests and monitor organisms that pose a threat to public health — and also that Ottawa work to address federal labs’ turnaround time for results and come up with “appropriate alternatives” if its National Microbiology Lab in Winnipeg is unavailable;
  • boost Ontario’s capacity to detect foodborne outbreaks, so provincial public health units can provide” timely, complete data” and the public health system has the skilled staff and other resources to investigate any signs of a possible outbreak; and
  • government agencies improve communication during cross-jurisdictional outbreaks, making the federal Chief Public Health Officer or designate the official media spokesperson for the federal government during a national outbreak, while the province’s Chief Medical Officer of Health or designate assumes that role during a provincial outbreak.

Most of the Ontarians who fell ill during the listeria outbreak were elderly, at a mean age of about 78, and 88 per cent were either living in a long-term care home or hospitalized before they became ill, Williams wrote.

At the beginning of the 2008 outbreak, molecular typing of listeria monocytogenes was unavailable at the Ontario Central Public Health Laboratory, but was later introduced there, Williams said.

Had the Ontario lab conducted its own molecular typing, the time required to transport samples and request tests “could have been eliminated, and the time it took to obtain test results might have been reduced by, at most, two to three days,” Williams wrote.

“Consideration should be given by the federal government to the need for greater regional capacity as molecular typing moves from a research tool into more standardized usage. Further, reliance on a single laboratory for advanced testing may compromise time frames for testing in some areas of the country.”

“Hampered”

Williams’ report had harsher words, however, on the matters of co-ordination and communication between local, provincial and federal-level public health officials.

“During the investigation the Canadian Food Inspection Agency (CFIA)– the lead federal agency for food recalls — was the sole intermediary between Maple Leaf Foods and the public health officials responsible for investigating the outbreak,” he wrote. “Toronto public health inspectors were not able to enter the plant until almost three weeks after CFIA first identified Maple Leaf Foods as the manufacturer of the food that tested positive for listeria.”

The provincial ministry of health and long-term care had asked CFIA for “comprehensive information” on the distribution of the products implicated in the outbreak, but that information “was never received,” Williams wrote.

“As a result, it was not until Aug. 14 that public health officials were informed that contaminated products might have been distributed to restaurants and Aug. 17 that they were informed that contaminated products might have been distributed to some retail stores and deli counters. During the investigation, they were not able to obtain complete information on the number or location of establishments in Ontario that had received products implicated in the outbreak.”

Had public health officials had “timely access” to such information, “they might have been able to take additional targeted steps to reduce possible exposure among the general public,” Williams wrote. “The lack of information about the national distribution of affected products also hampered the national investigation of the outbreak.”

Moreover, he wrote, “no mandatory food recall was issued by CFIA” although Maple Leaf put out its voluntary recall, which started with two products and expanded to over 220 products made in the same plant.

“The ever-expanding list of products and stores affected created the impression that the response was not well organized, and contributed to the public’s sense of unease and confusion. It also made it more difficult for public health units to plan and organize their efforts to monitor the effectiveness of product recalls.”

It was also unclear, he wrote, which responsibilities rested with PHAC and the federal Chief Public Health Officer, and which ones with the province’s Chief Medical Officer of Health. “It was also not clear whether the lead federal agency was PHAC or the CFIA, or to what extent local medical officers of health or the Chief Medical Officer of Health in Ontario could act alone to protect public health.”

What with large-scale manufacturing and processing and complex distribution networks for food, Williams warned, “Ontario and Canada are likely to see more non-localized outbreaks of foodborne illnesses. The current processes and structures for investigating and managing outbreaks are not adequate to support a co-ordinated response among different jurisdictions and levels of government. Roles and responsibilities at the federal, provincial and local levels are not clear.”

In the Liberals’ release, opposition health critic Carolyn Bennett said “it would appear that (Ottawa’s) lack of communications with the Ontario Ministry of Health stemmed from their desire to limit political damage — rather than putting the lives of Canadians first.”

The Conservative government’s “ideological opposition to regulation and the role of government in the food safety system blinds them to the most effective ways to protect food safety,” Easter said.

“Agriculture Minister Gerry Ritz not only failed Canadians on food safety — he was busy making jokes while people were dying of listeriosis. And the prime minister rewarded him by re-appointing him as minister — instead of asking for his resignation as he should have.”

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