I’d like to thank the Council for inviting me to be a part of this panel, and also to acknowledge the leadership role the Council is playing – this discussion is both timely and critical.

I was asked to talk today about our learnings from the outbreak of SARS in Toronto, and also to discuss our thinking about an appropriate role for our Foundation in the event of an influenza pandemic. To put my comments into context, I’d like to start by saying a few words about Toronto, about the Ontario Trillium Foundation, and about SARS, as the context is obviously relevant to my remarks.

Toronto is Canada’s largest city, with a population of 2.5 million people, and the population of the greater metropolitan area exceeds 4 million. It is the centre of Canada’s financial sector, home to the majority of the nation’s corporate head offices, and also the provincial seat of government for Canada’s largest province, Ontario.

We’re proud of our ethnic and community diversity…Toronto is often referred to as the most diverse city in the world. The economy of the Greater Toronto Area is driven by financial services, manufacturing, tourism, culture and public services. We have a successful and well-structured philanthropic sector. Our local Community Foundation is growing from strength to strength, and this year celebrates its 25th anniversary. Our United Way is celebrating its 50th anniversary with a 2006 campaign goal of $100 million.

The Ontario Trillium Foundation, the organization I represent, is quite unique as a philanthropic grant-making organization: we are an arms-length agency of the Government of Ontario, created to distribute a portion of the province’s casino revenues through capacity-building grants to not-for-profit and voluntary organizations in Ontario. Our grants help to strengthen organizations in the social services, arts and culture, sports and recreation, and environment sectors. With an annual grant-making budget of $100 million a year, we play a vitally important role in building the capacity of the sectors we support. We have a staff of 100, and are organized in a grassroots-community structure, with 15 small offices across the province in addition to our main office in Toronto.

SARS – or Severe Acute Respiratory Syndrome – is a viral respiratory illness. About 8,000 people in two dozen countries developed SARS in 2003, and about 800 of them died – most of the cases were in southern and eastern Asia. The virus is highly contagious, and it was apparently difficult to diagnose, but the worldwide outbreak was ultimately contained by isolating and treating patients. 

Having briefly outlined the context, I’d now like to turn to our experience with SARS. The outbreak in Toronto, between March and May of 2003, came as a shock. It was a shock because it caught us unprepared, it exposed a number of warts in the system, and it dealt a severe blow to the economy – in particular, to the health care and the tourism and hospitality sectors. Indeed, some would argue that some segments of the economy have not fully recovered, even today.

It is worth noting that SARS in Toronto in 2003 was not a pandemic, by any stretch of the imagination. There were fewer than 250 diagnosed cases in Toronto. Forty-four people died. The numbers were small, but the pressures on our health care system were unprecedented. The contagious nature of the disease, the difficulty in diagnosing it, and the risk to health-care workers (almost half the reported Toronto cases were people who worked in health-care fields) – all these factors contributed to the strains on the system.

The two numbers I just quoted – 250 cases and 44 deaths in Toronto – were indeed quite small, but a few other numbers will provide an idea of the scope of the crisis. There were approximately 2,000 case investigations, each taking about nine hours to complete. More than 23,000 people in Ontario were identified as contacts, and some 13,000 were placed in quarantine. Two hundred staff worked on a SARS hotline, which took over 300,000 calls over three months, and logged 47,000 calls on their highest single day.

Hospitals in the area coped – and in many cases struggled – with the outbreak in a variety of ways, including finding new methodologies to share services and treat patients, placing many of their workers in quarantine, or so-called “working quarantine”, cancelling non-emergency surgery, closing the doors to patients’ visitors, sourcing and distributing more effective protective gear to staff.  

Beyond the health-care sector, the economic impact was considerable. Toronto’s tourism industry experienced a 28 per cent drop in 2003, and is only just recovering (although other factors, such as international concerns about air travel, and a strong Canadian dollar are now taking their toll on the industry). In 2003, there were some 27,000 Ontario job losses, mainly in the hospitality industries. Our film industry, another major player in the local economy, lost 20 per cent of its business between 2002 and 2003.

So, what were our learnings, particularly in the context of planning for a possible pandemic? I will start with five key findings of the Official Enquiry reports – the Campbell Commission and the Walker Expert Panel, both set up by the Government of Ontario, and the Naylor Report, which was commissioned by the Government of Canada.

1. The most positive finding, noted again and again in media reports and the official commission reports, related to the extraordinary efforts of hundreds of dedicated individuals in hospitals and other health-care settings. Without their heroic efforts, Toronto’s experience would have been far worse.

2. There is a consensus that there was poor collaboration between provincial and federal health organizations, and long-standing funding and workforce shortages in the field of public health care.

3. Public Health in Ontario required a new mandate, new leadership, and new resources.

4. Local medical officers of health needed greater independence to speak out and to manage outbreaks when they occur.

5. Emergency planning and preparedness were required to protect against the next outbreak of infectious disease. For example, when SARS hit in 2003, Ontario had no pandemic influenza plan.

Now we all know that it’s easy for governments to create official enquiries, and that follow-through does not always, well, follow. I’m pleased to say that there have been some very encouraging developments, as a result of which we are better prepared in Ontario today than we were three years ago. I will touch on five outcomes that illustrate this progress.

1. The province’s Chief Medical Officer of Health was granted additional powers and greater independence, and must report directly to the legislature on Ontario’s state of public health each year;

2. A new Ministry has been created within government, the Ministry of Health Promotion, to place greater focus on prevention strategies.

 3. Planning is under way for the creation of Ontario’s first province-wide Public Health Agency.

 4. There is enhanced funding and infrastructure behind a strengthened capacity to control infectious diseases; and

5. Ontario now has an updated and detailed plan for an influenza pandemic, as does the city of Toronto.

Outside of the official reports, personal experience, and informal discussion with acquaintances in the field, indicate a few other anecdotal learnings that are worth noting:

1. Asking people to go into quarantine is all very well, but it has limited impact. In one case, an entire high school was closed while one of the students was being tested for SARS. On the second day of the quarantine, many of the kids were seen congregating in the local mall.

2. Child care became an issue for many health-care workers in “working quarantine” – workers who were ordered to travel only between work and home, avoid contact with others, and have limited contact with family. A nurse who was a single parent, for example, could be ordered by her employer to go into “working quarantine”, but without the support to provide care for her children. In some cases, hospitals set up ad-hoc day care centres on-site to assist staff – counter-intuitive, perhaps, in the midst of a health crisis, but probably the only efficient way of dealing with the issue.

3. Meals-on-Wheels and transportation services for vulnerable adults were examples of social services that came under strain, as some citizens and volunteers sought to limit their exposure to vulnerable members of the community.

4. Economically, Toronto’s China Town areas were particularly badly hit, and the community and economic impacts were unfortunately very difficult to assess.

5. Employers found themselves having to improvise human resource policies, or apply their policies in unpredicted circumstances – for example, dealing with a special leave request for the spouse of a quarantined nurse, or dealing with individuals who did not want to come to work because of fear of contamination.

These anecdotal observations each formed part of the Toronto experience in 2003, and each serves as a reminder of the kinds of issues we need to think about in preparing our pandemic plans. 

And that brings me to our discussions at the Ontario Trillium Foundation – OTF – regarding our plan and our role in the event of a pandemic.

I was fortunate to have the opportunity to attend the special meeting on the Avian Flu and pandemic planning, convened by the Council this past January in Washington. I felt it was a critically important issue, and in discussion with my senior staff colleagues back in Toronto, we decided initially to focus on two objectives. The first was to re-visit and update our own contingency plans for dealing with emergencies, and the second was to use our plan to develop a template that might be helpful if shared with not-for-profit organizations in Ontario.

Our thinking was that, as an organization with an ongoing relationship with close to 1,000 grant applicants and 4,000 grantees at any point in time, we had a responsibility to ensure the continuity of certain core business functions. As well, our scope in Ontario suggests that we have an important leadership role in the sector. As an organization with a volunteer Board, volunteer committees, and as an employer of about 100 paid staff, we would have critical responsibilities regarding the Foundation’s human resources. 

I have to say that updating our own plan has proven to be much more daunting than I had at first imagined. We have had to consider which of our services would be essential to retain if a third of our staff – or more – was absent for an extended period of time. For example:

1. Would we have enough trained staff who can issue cheques due to grantee organizations, and could grantees rely on their regular Foundation contact for advice and discussion?

2. Do we have contingency plans as to who would communicate with key stakeholders, such as the Government of Ontario or our Board of Directors?

3. How could we ensure that our website is kept up to date for time-sensitive information?

4. How could we ensure that our computer and telephone networks are maintained, so that vital lines of communication with staff and external stakeholders remain intact? 

5. What are the implications for our critically important one-or-two person field offices dotted across the province?

A fundamental question that we have yet to consider relates to our granting strategy. As I mentioned earlier, our focus today is enhancing the capacity of not-for-profit organizations that work on building healthy and vibrant communities. In a pandemic emergency, will this role still be appropriate, or will we need to shift our focus to emergency assistance? And if we did that, would we be ready to contribute meaningfully to the recovery phase that follows a pandemic? These are questions that our Board of Directors and our government funder will need to be actively engaged in.

In moving to wrap-up my remarks, I will say that we are making good progress on our own plan at OTF, but it clearly is much more complex than I at first had imagined. Every department within the organization has been involved, as we work to identify critical services, and the back-ups that either currently exist or require strengthening. So my message to those of you who have yet to start developing your own organizational pandemic plan is that it can take a lot of time

– particularly when everyone around you already has a busy full-time job.

The second step – developing a template that may be helpful to others in the not-for-profit sector, and sharing that template – awaits completion of our first step. Our sense is that, while many branches in our federal, provincial and municipal governments, and most parts of the health-care sector, have been working hard on their own pandemic planning, the not-for-profit sector has not been actively engaged in this discussion. And given that so many players in the not-for-profit sectors either deliver government programs or support government priorities, this gap is cause for serious concern. 

Many in the community are still assuming that the Avian Flu is purely a health-care issue, and that Canada’s health care system exists in part to find solutions to disease outbreaks and epidemics.

Then there is the segment of the community that believes that the “Avian Flu scare” is a repeat of the “Y2K scare” – in other words, something blown out of proportion by the media. Although, as most of us who worked on Y2K know, in the end there was no crisis because of the many months of hard work that went into preventing one.

Will our leaders, the media, the medical research and health care professionals – and the Foundation sector – help to avert an Fvian Flu crisis? Just the fact that we’re having this discussion today is reason for optimism, but there is much work to be done.

Thank you.