Minutes - July 14, 2022 - Board of Health Meeting

Members Present: 

Mr. Matt Reid (Chair)
Ms. Kelly Elliott (Vice-Chair)
Mr. John Brennan
Mr. Selomon Menghsha
Ms. Mariam Hamou
Ms. Maureen Cassidy (arrived 6:06 p.m.)
Ms. Aina DeViet
Mr. Michael Steele

Regrets:

Ms. Tino Kasi

Others Present:

Ms. Carolynne Gabriel, Executive Assistant to the Board of Health and Communications Coordinator (Recorder)
Dr. Alexander Summers, Medical Officer of Health
Ms. Emily Williams, Chief Executive Officer/Director, Health Organization
Ms. Maureen MacCormick, Director, Healthy Living
Ms. Heather Lokko, Chief Nursing Officer (Attended Virtually)
Mr. David Jansseune, Assistant Director, Finance
Ms. Lindo Stobo, Manager, Chronic Disease Prevention and Tobacco Control
Ms. Kendra Ramer, Manager, Strategy, Risk and Privacy
Mr. Christian Daboud, Manager, Health Equity
Mr. Alex Tyml, Online Communications Coordinator
Mr. Parthiv Panchal, Information Technology, End User Support Analyst

Chair Matt Reid called the meeting to order at 6:01 p.m.

Disclosure of Conflict of Interest

Chair Reid inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

It was moved by Mr. Michael Steele, seconded by Ms. Kelly Elliott, that the AGENDA for the July 14, 2022 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by Ms. Mariam Hamou, seconded by Ms. Elliott, that the Board of Health approve:
1) the MINUTES of the June 16, 2022 Board of Health meeting; and,
2) the MINUTES of the July 7, 2022 Special Meeting of the Board of Health.
Carried

It was moved by Mr. Steele, seconded by Ms. Aina DeViet, that the Board of Health receive:
1) the MINUTES of the June 16, 2022 Governance Committee meeting; and,
2) the MINUTES of the July 7, 2022 Finance and Facilities Committee meeting.
Carried

Reports and Agenda Items

Finance & Facilities Committee Meeting – July 7, 2022 (Report No. 43-22)

This report was introduced by Mr. Michael Steele, Chair of the Finance and Facilities Committee.

It was moved by Ms. Elliott, seconded by Mr. Steele, that the Board of Health review and approve the audited Financial Statements for the Middlesex-London Health Unit for the year ending December 31, 2021.
Carried

MLHU Q2 2022 Risk Register (Report No. 44-22)

This item was advanced to before agenda item “Performance Appraisal Committee Meeting – July 7, 2022” as Ms. Maureen Cassidy, lead for this report, had not yet arrived.

Ms. Emily Williams, Chief Executive Officer introduced Ms. Kendra Ramer, Manager, Privacy, Risk and Project Management.

Highlights of this report include:

• Thirteen (13) of the 14 high risks identified on the Risk Register were mitigated during Q1 and Q2 to achieve either a moderate or low residual risk rating in Q2 2022.
• One (1) high risk will be removed in Q3 due to successful contract negotiations with CUPE and the ratification of a new collective agreement.
• Two (2) medium risks and one (1) low risk continue to be mitigated to remain at minor residual risk in Q2.
• One (1) new high risk has been reported in Q2 in the political category due to the recent Provincial election. No current actions have been taken to mitigate this risk pending future direction from the Province with regards to the potential modernization of public health.

It was moved by Ms. Hamou, seconded by Ms. DeViet, that the Board of Health:
1) Receive Report No. 44-22, re: “MLHU Q2 2022 Risk Register” for information; and,
2) Approve the Q2 2022 Risk Register (Appendix A).
Carried

Performance Appraisal Committee Meeting – July 7, 2022 (Verbal Update)

This report was introduced by Ms. Cassidy, chair of the Performance Appraisal Committee.

The Performance Appraisal Committee met for the first time on July 7, 2022 during which they appointed Ms. Cassidy as Chair.

There was one item for discussion, Report No. 01-22PA, re: “2022 Medical Officer of Health and Chief Executive Officer Performance Appraisals Procedures.”

It was moved by Ms. Cassidy, seconded by Mr. Steele, that the Board of Health
1. Receive Report No: 01-22PA, re: “2022 Medical Officer of Health and Chief Executive Officer Performance Appraisals Procedures” for information;
2. Revise the Appendices to Policy G-050 “MOH and CEO Performance Appraisals Procedure” to reflect the Performance Appraisal Committee as a standing committee (Appendix A), as amended by the Performance Appraisal Committee;
3. Approve the performance appraisal process, supporting documents, and timelines (Appendix A), as amended by the Performance Appraisal Committee; and,
4. Direct staff to action the activities outlined in the MOH and CEO Performance Appraisal Checklist, as amended by the Performance Appraisal Committee (Appendix A).
Carried

MLHU’s Anti-Black Racism Plan: Implementation Update (Report No. 45-22)
This report was introduced by Ms. Heather Lokko, Chief Nursing Officer who introduced Mr. Christian Daboud, Manager, Health Equity.

Highlights of this report included:

• The Middlesex-London Health Unit declared racism a public health crisis in 2020. In 2021, the Health Unit introduced the Anti-Black Racism Plan (ABRP), developed in partnership with an external consultant and endorsed by the Board of Health.
• In June 2021, a health promoter was recruited to assist with engaging the diverse African, Caribbean, and Black (ACB) community members and organizations. This health promoter also supported and coordinated pandemic response strategies within this community, including a focused town hall event with health care experts from the Black community and delivery of five mobile vaccination clinics in collaboration with ACB groups and community partner agencies.
• In the fall of 2021, the Healthy Equity team conducted a community consultation process to develop an advisory committee to guide the implementation of the ABRP. Based on feedback from the community, a draft ABRP Advisory Committee Terms of Reference and recruitment of committee members was completed by the last quarter of 2021.
• To date, three advisory committee meetings have been held with a focus on MLHU’s new Employment Equity Policy and its initiative related to the collection of race-based and other social determinants of health (SDOH) data.
• The Advisory Committee’s first community co-chair was recruited and will serve a two-year term.
• An Employment Equity Policy has been developed that will support the future recruitment of ACB and other equity deserving community members into the workforce of MLHU at all levels.
• Next steps include the prioritization of remaining recommendations from the ABRP.

Ms. Hamou inquired if the Health Unit is targeting specific areas within the city and county, or the community more broadly with regards to interventions. Mr. Daboud indicated that part of the ongoing work includes collecting race-based and social determinants of health data to inform which areas of the community are high need. This data is part of the work to make evidence-based decisions.

It was moved by Ms. Cassidy, seconded by Ms. Hamou, that the Board of Health receive Report No. 45-22, re: “MLHU’s Anti-Black Racism Plan: Implementation Update” for information.
Carried

Feedback on Proposed Disclosure Requirement for Vaping Product Manufacturers Under the Tobacco and Vaping Products Act (Report No. 46-22)

This report was introduced by Ms. Maureen MacCormick, Director, Healthy Living who introduced Ms. Linda Stobo, Manager, Chronic Disease Prevention and Tobacco Control.

Highlights of this report include:

• A couple months ago, a report was presented to the Board of Health seeking endorsement of a response to Health Canada’s request for comment on its review of the federal Tobacco and Vaping Products Act. The federal government is now considering regulatory amendments to require manufacturers of vaping products to report sales data and ingredient lists, both of which are already required by tobacco product manufacturers.
• In addition to applauding the federal government for this regulatory change, the Health Unit’s submission recommends the federal government pursue additional actions and requirements.
• At the time of drafting this submission, it was announced that the FDA in the United States had issued market denial orders to JUUL, a vaping product manufacturer, indicating that the products were not safe for sale and a public concern and that the manufacturer was not doing their due diligence to prevent youth uptake and were breaking marketing rules. The market denial orders have since been paused by a court, but the federal government should consider the actions of the FDA.
• Philip Morris International just released a new product called Veeba, which is a single-use vaping product that provides more nicotine juice than would be in a JUUL pod, is cheaper than a JUUL vaping device, and is easier to access. This could make Veeba more appealing to youth who are price conscious. Currently in Canada it is up to the industry to market new products and there is no requirement for Health Canada authorization prior to selling and marketing vaping devices.
• Vaping products are regulated federally, while the retail and sale of vaping products is regulated provincially.

Ms. Cassidy inquired how the recommendations included in the Health Unit’s submission might impact sales of vaping devices on the black market. Ms. Stobo indicated that some of the recommendations made in the Health Unit’s submission to the federal government address enforcement. Currently there is a lot of availability of vaping products online and much of black-market sales are conducted online. Research into online sales of vaping products indicate that stringent measures to ensure age controls are neither legislated nor enforced.

Ms. Cassidy inquired if the retail of vaping products could be affected by the federal government. Ms. Stobo indicated that Health Canada could take a similar stance as the FDA and issue a broad order against vaping product manufacturers.

Ms. Hamou inquired how the Board of Health can promote regulatory changes to Health Canada. Chair Reid indicated that the Board of Health endorsing the submission is one thing the Board can do. Ms. Stobo stated that there were two recommendations included in the report, the first being for the Board to endorse the submission which would then proceed along the normal submission process, and the second being to endorse sending the submission and a letter directly to Minister Bennett. The Board of Health could include any other requests or recommendations for the federal government within that letter to Minister Bennet.

Chair Reid suggested copying the provincial Minister of Health on the letter. Ms. Stobo deferred to Dr. Summers who indicated that including the provincial Minister of Health would be appropriate and stated given that part of the Health Unit’s ongoing work is enforcement, and the resources for these activities have been stretched due to the expansion in vaping and cannabis retailers.

Ms. Elliott suggested including local MPs and MPPs on the letter as well, so they are aware of it when speaking with local officials.

Ms. Williams indicated an opportunity for City of London councilors would be to support the CLIF funding when it comes forward for renewal during municipal budget deliberations. The CLIF funding supports enforcement work.

It was moved by Ms. Elliott, seconded by Ms. Hamou, that the Board of Health:
1) Receive Report No. 46-22 “Feedback on Proposed Disclosure Requirements for Vaping Product Manufacturers under the Tobacco and Vaping Products Act” for information;
2) Endorse and submit feedback prepared by the Middlesex-London Health Unit staff, attached at Appendix A, to the Tobacco Control Directorate of Health Canada, expressing its feedback on the proposed regulations regarding vapour product manufacturer reporting requirements; and
3) Send a copy of the Middlesex-London Health Unit submission, attached as Appendix A, to the Honourable Carolyn Bennett, Minister of Mental Health and Addictions and Associate Minister of Health, copying the Ontario Minister of Health and local MPs and MPPS, recommending that Health Canada publish peer reviewed evidence regarding product safety and health consequences from the use of vaping products within six months.
Carried

Current Public Health Issues (Verbal Update)

Dr. Alexander Summers provided this verbal report and shared a PowerPoint presentation.

Highlights of this report include:

• The title of this report was changed from “Verbal COVID-19 Disease Spread and Vaccine Campaign Update” to “Current Public Health Issues” to allow for updating on a broader range of current public health issues.
• The rates of COVID-19 have increased in the community over the past number of weeks, demonstrating a seventh wave. As COVID-19 continues to circulate in the community, there will be additional waves with changing magnitudes.
• Recent COVID-19 activity is being driven by the BA.5 Omicron subvariant which is more transmissible, more socializing within the community with socializing and mobility reaching pre-pandemic levels, and waning population immunity against COVID-19.
• Hospitalization rates for COVID-19 have levelled off but not decreased.
• Wastewater signals are rising, which is indicative of an increased viral presence; however, wastewater data does not always correlate with severe outcomes. Within Southwestern Ontario, wastewater rates had risen rapidly but are beginning to decline.
• Eligibility for a second booster dose for anyone aged 18 years and above was announced. Dr. Summers is receiving many questions about whether individuals should get their second booster dose now or wait until the fall when a bi-valent vaccine is anticipated. Dr. Summers indicated that those with three doses of the vaccine will have significant protection against severe outcomes, but likely no protection against symptomatic infection. Receiving a second booster now will provide some benefits to that effect. Some people are concerned that if they receive their second booster dose now, they will not be eligible for the potential bi-valent vaccine in the fall; however, the timing of the bi-valent vaccine is not yet known. Should it be in October, those who receive their second booster dose now will have a time interval of three months before the bi-valent vaccine is available and three months has been the minimum interval between booster doses. Dr. Summers unequivocally encourages those who do not yet have their first booster dose to get it as soon as possible.
• Health Canada has approved the first COVID-19 vaccine for children between the ages of six months and fives year. Shortly thereafter, NACI released its recommendation. This vaccine has proved as effective as for all other age groups. NACI’s recommendation is for a two dose primary series, with a three dose primary series for those with underlying immunocompromised conditions. NACI’s recommendation states that this population “may” get the vaccine as opposed to “should” because children generally do well if they become infected with COVID-19; however, children do get sick from COVID-19, miss school, and potentially experience severe outcomes, all of which are still worth preventing.
• The Health Unit does not yet know when the COVID-19 vaccine for children six months to five years of age will be available in the region; however, the local vaccination infrastructure is already in place for when the vaccine is available.
• Monkeypox is an emerging public health issue and as of July 11, 2022, there have been four confirmed cases in London and Middlesex County. Several vaccination clinics have been held for individuals who are most vulnerable. MLHU has provided the third most vaccine of all Ontario public health units.
• Opioids and substance misuse continues to be a public health issue. Overdoses and morbidities are continuing, particularly within the downtown core of London.
• CarePoint Supervised Consumption and Treatment has moved from its temporary location to a trailer on its permanent site. This transition has gone well; however, some people who had a routine accessing the services at their temporary location have not yet transitioned to the new location and may be experiencing barriers transitioning. As such, there is currently vulnerability within this community.

Ms. Cassidy inquired how Canada compares with other countries with regards to the vaccinating of young children. Dr. Summers indicated that Canada is in lockstep with the rest of the world.

Ms. Cassidy inquired if vaccination has any impacts on the possible longer-term consequences of COVID-19 infections. Dr. Summers indicated that analyses on this question are currently happening; however, given the number of people who have been infected with COVID-19, determining a causal relationship will be difficult. Studies have shown that those who are vaccinated experience less severe illnesses and when illnesses are less severe, longer-term and chronic outcomes decrease.

Ms. Cassidy indicated that children are regularly vaccinated for illnesses which generally do not result in severe outcomes for the children, for example the measles and chicken pox and inquired how that might compare to COVID-19. Dr. Summers indicated that COVID-19 would be very similar to other diseases for which children are regularly vaccinated with regards to the severity of illness for children. Therefore, the justifications for having children vaccinated for diseases like chickenpox and measles are the same for COVID-19.

Ms. DeViet inquired if the Middlesex and London region will have a sufficient supply of vaccine for future demands. Dr. Summers indicated that the anticipated bi-valent vaccines will be a new vaccine product and therefore may experience a slower production and distribution as the manufacturers increase their production. As a result, the roll-out of these vaccines may be in stages, but probably with shorter delays than with the first vaccines and the manufacturing infrastructure is already in place.

Mr. Steele inquired when a fifth dose (third booster dose) may be available. Dr. Summers indicated that fifth dose eligibility will likely not be until the fall, and will likely be with the bi-valent vaccines.

It was moved by Ms. Hamou, seconded by Ms. Elliott, that the Board of Health receive the Verbal update re: “Current Public Health Issues” for information.
Carried

Medical Officer of Health Activity Report for June (Report No. 47-22)

Dr. Summers presented this report.

Ms. Cassidy thanked Dr. Summers for attending a Ward 5 meeting.

It was moved by Mr. John Brennan, seconded by Ms. DeViet, that the Board of Health receive Report No. 47-22 re: “Medical Officer of Health Activity Report for June” for information.
Carried

Chief Executive Officer Activity Report for June (Report No. 48-22)

This report was presented by Ms. Williams who highlighted that an all-staff BBQ was held, planned by the Be Well committee. The BBQ had over 300 attendees and received great feedback.

It was moved by Mr. Steele, seconded by Ms. Cassidy, that the Board of Health receive Report No. 48-22 re: “Chief Executive Officer Activity Report for June” for information.
Carried

Correspondence

It was moved by Ms. Elliott, seconded by Mr. Steele, that the Board of Health endorse items a) and b) and receive item c).
Carried 

Other Business

It was moved by Mr. Selomon Menghsha, seconded by Ms. Elliott, that the August 18, 2022 Board of Health meeting be cancelled, such that the next meeting of the Board of Health will be September 15, 2022.
Carried

Confidential

At 7:04 p.m., it was moved by Ms. Cassidy, seconded by Ms. Elliott, that the Board of Health will move in-camera to approve previous confidential Board of Health minutes, and to consider matters regarding personal matters about an identifiable individual, including municipal or local board employees and labour relations or employee negotiations.
Carried

At 7:19 p.m., it was moved by Ms. Hamou, seconded by Ms. Elliott, that the Board of Health return to public session from closed session.
Carried

Adjournment

At 7:19 p.m., it was moved by Ms. Cassidy, seconded by Ms. Elliott, that the meeting be adjourned.
Carried

Matt Reid
Chair

Emily Williams
Secretary