How prepared is Canada for a potential H5N1 pandemic?

In February, the Public Health Agency of Canada (PHAC) announced that it had secured an initial supply of 500,000 doses of the human vaccine against avian flu, made by pharmaceutical company GSK. PHAC said that 60 percent of the doses would go to the provinces and territories to be distributed in accordance with their needs, with the other 40 percent kept back in a federal stockpile. Meanwhile, PHAC has reiterated that the overall risk to the broader public remains low, and that broad vaccine deployment isn’t necessary for now. 

Still, the situation remains fluid. H5N1 continues to spread in wild bird populations and farm animals like cattle and chickens. As it does, there remains the possibility that H5N1 could mutate into a virus that is more transmissible between humans, raising the risk of a pandemic.

Lessons have been learned from the COVID pandemic that have increased readiness, but still a range of challenges exist that could complicate any response to a wider bird flu outbreak, from rising vaccine hesitancy to the impact of U.S. tariffs to misinformation around public health.

How widespread is avian flu?

The H5N1 virus evolved in domestic birds in 1996, but is now circulating widely worldwide, including in Canada, and has killed millions of wild birds and mammals. The virus has also spread widely through U.S. farm animals, including poultry and dairy cattle, and is also being frequently found in cats. So far, there have been few human cases of H5N1, with the bulk occurring in farm workers in close proximity to infected animals, and who have had mild symptoms, including conjunctivitis. 

One human death in Louisiana has been linked to an H5N1 infection, and, late last year, a teenager in British Columbia who had contracted H5N1 became seriously ill when the virus mutated, causing significant respiratory issues. That mutation occurred after the virus entered the teen’s body and was the first known instance of the H5N1 virus changing to better adhere to human lung cells. A team of public health researchers that published the data on the B.C. teen’s infection called the mutation “worrisome.” 

Does Canada have enough vaccines?

During the Covid-19 pandemic, Canada worked to secure access to hundreds of millions of doses of the vaccines — millions of which were then donated to other countries when it was clear Canada wouldn’t need them. In that context, 500,000 doses of bird flu vaccine is just a start.

If Canada needs more doses, it would turn to GSK first. PHAC currently has an agreement with GSK for domestic vaccine manufacturing, and the agency maintains that, should the H5N1 risk profile evolve, its current contract with GSK would allow it to procure additional doses. 

But the capacity for domestic vaccine production is only one piece of a robust response effort to a pandemic. A coordinated approach across government and industry is the only way that those vaccines, once produced, can get to Canadians — as well as other things, like therapeutics and diagnostics, that might help save lives.

Did the pandemic leave Canada better prepared?

In September, the Canadian government announced the creation of Health Emergency Readiness Canada (HERC) to make that coordination possible, dedicated to, among other things, “bridging the gap between research and commercialization.” 

The intent is that HERC will enable integrated decision making to build life science capacity, strengthen partnerships with industry, academia and international counterparts, and develop and maintain an “industrial game plan to mobilize research and industry in the event of a health emergency.” 

“I think the establishment and standing-up of HERC is a really important step to prepare for the next pandemic,” says Mark Lievonen, former co-chair of Canada’s COVID-19 Vaccine Task Force, adding that it is a “significant step forward.”

A year after the COVID-19 pandemic began, the Office of the Auditor General of Canada released an audit of Canada’s pandemic preparedness, surveillance and border control measures. It also made a set of recommendations to PHAC, including that it needed to evaluate its response performance and use lessons learned to update its future plans, as well as test its readiness for another pandemic. 

PHAC says those recommendations and others have not only guided the formation of HERC, but prompted it to adopt “innovative approaches” like wastewater surveillance, and to update its Health Portfolio Emergency Response Plan, “an ‘all hazards’ plan that defines the framework within which the [PHAC] and Health Canada will operate to ensure an appropriate response to any emergency.” 

More recently, PHAC launched the Expert Panel on Avian Influenza A(H5Nx) in Canada, which last met in November. PHAC has also launched its rapid risk assessment — the barometer that still maintains that the overall risk of H5N1 to the broad public is low. That assessment was also made in November. The next update is expected in April. And still awaiting completion is Canada’s new Pandemic Preparedness Plan, scheduled to be finished in 2026, though PHAC did not say whether a change in government might impact that date.

Will the new Trump administration pose a risk to health security?

There are other unknowns to contend with too, beyond the virus’s own evolution. One is geopolitics. The Trump administration’s threat to impose significant tariffs on Canada is a problem, Lievonen says. “If you were to say: ‘What is the impact of the potential tariffs and U.S. policy…on this area?’ I think it’s potentially huge,” noting further that U.S. isolationism is something that Canada’s pandemic planning must account for. “I think that’s the single biggest threat at this point to what we’re doing.”

Medical products and research partnerships will be — and already are, in the latter case — victims of this change in U.S. policy. 

Related to the shift of power in the U.S. is the issue of vaccine hesitancy.

The pandemic saw a rise in overall skepticism about all vaccines, not just those for COVID-19, successful though they were. Since the pandemic, other diseases, like measles, have been resurgent, with the blame for its return put squarely on a decline in vaccine uptake.

The new administration in the U.S., including the new director of the Department of Health and Human Services, noted vaccine cynic Robert F. Kenney Jr., has already done little to actively advocate for more immunizations, despite a large measles outbreak in Texas and New Mexico. 

What about the spread of misinformation?

Indeed, one of the most significant challenges for PHAC and its partners in preparing for the next pandemic is the information sphere and, subsequently, public and political interest. PHAC has said that one of its lessons learned from the COVID-19 pandemic is that “misinformation and disinformation present a significant challenge to public policy making and public health interventions during a pandemic.” Among other things, PHAC has since created the Behavioural Science Office to help it understand both mis- and dis-information better and to help build and maintain public trust. 

Public discourse is also fickle in other ways, shifting to meet immediate priorities. As pressing as the potential for another pandemic may be, it could still fall by the wayside against more daily challenges for governments. “When I was co-chairing the COVID vaccine task force, it was the crisis of the day,” Lievonen says. “Government acted on our recommendations and things moved forward. Now, COVID and pandemic threats have dropped down the scale. There’s so much else going on… so it’s almost understandable. But our preparations could go back in time.”

That’s why, Lievonen says, it’s important to support the many preparation efforts that are underway.