US Cuts Injure Canada's Infectious Disease Surveillance
One of the most concerning challenges might be the consequent loss of invaluable surveillance efforts and data, Jasmine Pawa, MD, a public health and preventive medicine specialist physician and adjunct lecturer of clinical public health at the University of Toronto, Toronto, told Medscape Medical News. Pawa is co-author of a recently published editorial on the effects of the US federal government's dismantling of the structures that Canada has long relied on to keep its population healthy and safe.
Jasmine Pawa, MD
'We wanted to focus specifically on the health data around numbers and how they relate to communicable diseases,' she said. 'In the short term, we're losing access to a lot of information on US websites that we might have referenced or used, and I'm aware that people might now be using archived or older sources.'
In the long term, the ability to track pandemic threats or mitigate the spread of diseases like HIV or avian influenza will likely be impaired. 'If those data don't exist, it means that we cannot measure trends,' she said, which, in turn, affects response planning.
Communicable Diseases Increasing
While US surveillance and data collection have declined, Canada has been facing an infectious disease crisis. The country has seen substantial increases in the rates of preventable sexually transmitted diseases like syphilis; adult infections rose by as much as 109% and congenital syphilis by as much as 599% between 2018 and 2022. New HIV cases have also been a cause for concern, rising by almost 25% between 2021 and 2022.
'We're also seeing a surge in measles cases in Canada, which you could say is an emerging infectious disease, in the sense that it's previously been controlled,' said Zahid Butt, PhD, Canada research chair in Interdisciplinary Research for Pandemic Preparedness at the University of Waterloo in Waterloo, Ontario.
Butt is especially worried about the spread of vaccine-preventable childhood diseases, including pertussis. 'We're seeing more cases because vaccine coverage is not at optimal levels,' he said.
Avian flu has also been on the minds of public health officials, said Butt. Though the CDC continues to monitor confirmed human cases, reporting frequency has declined to once monthly, and the responsibility for detection in animals has been transferred to the US Department of Agriculture.
'We've seen an increase in physical cases, mostly in birds, but there's a potential to jump from birds to humans and cause outbreaks,' he said.
Pawa and her coauthor wrote that they expected to see rising rates of drug-resistant tuberculosis, which has long been considered a pandemic of the 'poor.' Similar increases (especially local outbreaks) in hepatitis B and imported Oropouche are also anticipated.
Widespread Misinformation
The surge in health misinformation during the COVID-19 pandemic was largely attributed to social media and conservative news sources such as Fox News . In addition, US government officials during the first Trump administration sought to tamper with data sharing that other countries had long relied on.
Fears about health misinformation have returned, according to the coauthors, who pointed to current deliberate efforts by Trump's cabinet to promote misinformation and publicly discredit national health institutions.
'People living in Canada are vulnerable to a cross-border bleed of not only microorganisms, but also of attitudes, health misinformation, and exposure to biased US media,' they wrote.
'In addition to the loss of data, the changes at the US Department of Health and Human Services, especially with regard to Robert F. Kennedy Jr and Make America Healthy Again, green light a lot of dis- and misinformation and falsehoods about health in general,' said Amy Kaler, PhD, professor of sociology at the University of Alberta in Edmonton. Kaler's expertise is the confluence of infectious diseases and social determinants of health.
Amy Kaler, PhD
'It doesn't stop at the US-Canada border,' said Kaler, explaining that local media capacity has been dwindling, while platforms like Facebook have banned Canadian news sources. 'The availability of local, reliable, journalistically sound information has declined at the same time exposure to stuff ranging from outright crazy to just plain misinformed coming from the US has increased,' said Kaler.
Though research has shown that Canadians trust their healthcare providers, Kaler also pointed out that many Canadians don't have access to primary care (a recent survey showed that more than 1 in 5 adults lacked a primary care physician). 'That gap gets filled by social media nonsense,' she said.
Dwindling media sources are only one part of the problem. Kaler teaches in Alberta, which has a far-right government that 'imitates some of the worst of what's happening in the US, in terms of health and infectious diseases.'
'The big problem that I see is their willingness to entertain or give more respect than should be given to the extreme voices that say things like, 'Don't get vaccinated because your DNA will mutate,'' said Kaler.
'While our minister of health has said that people should get vaccinated, it's couched in rhetoric like 'This is a personal and private decision, and every family should weigh the risks and benefits of vaccination,'' explained Kaler. 'It's not vaccine denialism; it's a soft way of encouraging hesitancy.'
Strengthening National Capacity
Public health experts have long called for a stronger national infrastructure that supports interoperable systems that easily share health data between provinces, territories, and the federal government. Factors that affect equity (eg, socioeconomics or demographics) should also be considered, said Pawa. This type of robust, evolving surveillance system is needed to support domestic public healthcare efforts.
'They're something that we've needed to do anyway, but being focused and pushing it forward now is really important,' she said.
At the same time, 'there needs to be a higher accountability for dedicated public health services, a mechanism that requires provinces and territories to pay attention to this, as distinct from other services that they are currently providing,' said Gaynor Watson-Creed, MD, preventive medicine specialist, physician, and associate dean of medicine at Dalhousie University in Halifax.
Gaynor Watson-Creed, MD
Watson-Creed, a former deputy chief medical officer of health at the Nova Scotia Health Authority, Halifax, recalled that during the first severe acute respiratory syndrome outbreak, public health officials believed that they could create a 'CDC North' that would provide data and surveillance to the world just as CDC had done.
'Now that we're seeing the decline of the collaboration between CDC and its international partners, including Canada, that need is real. And it's not just the need for communicable disease surveillance but a new need for chronic disease surveillance, injury surveillance, and well-being surveillance in this country,' said Watson-Creed.
'We called for federal public health legislation [in 2017] similar to the way that we have federal legislation for acute care services (ie, the Canada Health Act), she added, citing a decline in Canada's public health systems. 'The trouble is that the provincial governments, ministers of health, etc., may not know enough about public health to even know what they don't know.'
Clinicians must step up to the plate, said Watson-Creed. 'Clinicians have not stopped long enough to consider what's at the end of the spectrum after primary prevention. Now would be a good time for them to lend their voices to continued efforts to strengthen the primordial prevention end of public health,' which targets the root causes of disease.
No funding for the editorial was reported. Pawa, Butt, and Kaler reported having no relevant financial relationships. Watson-Creed provides consultation services through her company, Sweetfire Consulting.
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