Allison McGeer, MD, an infectious disease specialist in the Sinai Health System and a professor at the University of Toronto, was on the front lines when SARS-1 hit the city in 2003.
Hospital Infection Control & Prevention (HIC) asked her about emerging infections and other issues in the following interview, which has been edited for length and clarity.
HIC: What do you see as some of the keys to preventing the next pandemic?
McGeer: Very clearly, we have a global problem with public health infrastructure. Our best bet for preventing what can be prevented and mitigating what can’t be prevented is doing something about public health. How we do that, I don’t know, because our history in Canada is that we are just incapable, as far as I can tell.
I don’t know how to strengthen public health departments now, because all of the crises of the past umpteen years in Canada have not resulted in us investing in public health infrastructure at all.
HIC: But after SARS-1, you received funding for acute care infection control programs in Toronto and the Ontario province.
McGeer: Yes, we got a lot of support for infrastructure in acute care, which was great and has really made a difference. But we didn’t get public health investment. Post-COVID, I really don’t foresee a big push to do that either. I don’t. Yet one of the things that COVID has illustrated very effectively is that partnerships across the health system, including public health, are very valuable for managing both lesser outbreaks and a pandemic. That’s something that is, relatively speaking, easy to build. The integration, the partnerships between acute care and public health have been very helpful.
HIC: You say this partnership has not been as strong between public health and nursing homes?
McGeer: No, we don’t have that between long-term care and public health. That’s something we need to work on, and, again, you don’t need a lot of funding to do that, necessarily. You just need the understanding and the will, so I think that’s possible. But it still leaves us with the stupidity in Canada of not funding public health adequately. And I think in the United States, recent years have really done a lot of harm to the CDC (Centers for Disease Control and Prevention). The U.S. has, in many ways, had better public health than Canada for a long time, in part because of some very strong state health departments, but also because of the leadership of the CDC. It wasn’t until COVID happened that I kind of woke up to how much damage has been done to the CDC in recent years.
HIC: The Resolve to Save Lives group reports that local collaborations between public health and clinicians have prevented many possible pandemics, and could very well have prevented COVID-19.1 Do you agree with that?
McGeer: I think controlling the spread of COVID would have required really good public health infrastructure everywhere in the world, and that seems somewhere this side of impossible. The essence of public health is prevention. If you are willing to invest in prevention, if you have the expertise to tell you what you need to be doing and the political will to do things, you can do it — control of wild animal markets, thinking about what we know about zoonotic transmission, and trying ahead of time to put things in place to reduce introductions. There is clearly stuff we can do, but we need two things to do it. We have to want to do it, and it’s prevention, so it’s hard. And we have to have the public health strength and expertise to tell us what we ought to be doing. Secondly, we have to have governments who will listen to them. And both of those things are hard. There’s no question that it’s hard to get governments to listen to science, and it’s even harder to get governments to listen to prevention science.
HIC: If these infections keep emerging, what do you see as the role of infection control departments in hospitals? It would seem they could play a key role in recognizing cases, getting travel histories, and the like.
McGeer: I think it depends on what you mean by infection control. Most of us who are trained in infection control are trained in the acute care system, and there’s a very specific content expertise that goes with understanding that. But that’s very different from, say, vector-borne diseases. When the Zika virus started, a number of people said to me, “Allison, you’re not really that involved in the response.” I explained that my expertise is not in mosquito-borne diseases. I don’t know the content areas related to talking to affected communities and getting them to respond. The whole issue of vector-borne diseases is a completely different expertise.
But, yes, there is some overlap, and I think that the training in infectious disease epidemiology and understanding prevention is, to some extent, a portable skill. But the issues outside of institutions are quite different from issues inside institutions. One of the interesting things, I think, is trying to build that expertise. We haven’t, at least in Canada, really thought about infection prevention much outside of healthcare. I think at least at a system and organizational level, it is possible for those of us who believe in infection prevention to be advocating for, and trying to contribute to, the strengthening of infection prevention outside of institutions.
- Resolve to Save Lives. Epidemics that didn't happen. 2022. https://preventepidemics.org/epidemics-that-didnt-happen/