In Ontario, the local Medical Officer of Health (MOH) has five specific functions to lead or carry out, with the assistance of his/her health unit, in the event of an influenza pandemic. As the development of pandemic plans is proceeding at many levels by services, agencies, businesses and other organizations, it is helpful to understand the breadth and the limitations of local public health capacities and responsibilities.
1. Overall Jurisdictional Coordination
The local MOH has been designated by the Ministry of Health and Long-Term Care as the health lead for pandemic planning. The MOH engages all aspects of the health care system in coordinated planning including hospitals, long-term care homes, emergency medical services, community-based service providers and public health laboratories in the jurisdiction of the health unit. During an actual pandemic, the local MOH would continue to function in a leadership and coordination role.
The local public health unit has primary responsibility for the collection, analysis and dissemination of disease surveillance information during a pandemic. It is legally necessary that some surveillance information regarding the course of the pandemic (e.g. who is diagnosed with influenza) be reported to the health unit which in turn is required to report that information to provincial authorities (who then pass it on nationally and internationally). In order to carryout public health surveillance, monitoring systems, including voluntary monitoring (e.g. school or workplace absences) may be set up to aid in the collection of information. All subsequent decisions and recommendations for action, at all levels, in a pandemic will be based on surveillance information.
Ontario, through its provincial pandemic influenza plan, has given local public health units sole responsibility for the local storage and distribution of the provincial supply of pandemic influenza vaccines. Depending on the supply situation at any particular time during the pandemic, the health unit will either directly administer vaccines (through mass immunization clinics) or distribute them to physicians and health care institutions for administration to the public.
4. Public Health Measures
The local MOH has authority to order certain public health measures that, in his /her opinion and based on surveillance information, are necessary to control the spread of the pandemic locally. These may include such actions as the closure of schools or businesses, or the cancellation of mass social, cultural or sporting events. It also could involve orders for the isolation of ill individuals or families, restrictions on movement between areas or other similar measures to reduce contact between individuals or groups of people. Public health measures as well include more general voluntary recommendations such as frequent hand washing or the maintaining of a recommended minimum physical distance when speaking to another individual.
The MOH will play a leadership role in communicating authoritative public health information and recommendations to individuals, the public and other stakeholders throughout the pandemic emergency.
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