Minutes - September 18, 2025 - Board of Health Meeting

Thursday, September 18, 2025 at 7 p.m.
MLHU Board Room – CitiPlaza
110-355 Wellington Street
London, ON N6A 3N7

Members Present: 

Michael Steele (Chair)
Michelle Smibert (Vice-Chair)
Matthew Newton-Reid (attended virtually)
Aina DeViet
Howard Shears
Skylar Franke
Peter Cuddy
Michael McGuire (attended virtually)
Emily Williams, Chief Executive Officer (ex-officio) (Secretary and Treasurer)
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Regrets:

Selomon Menghsha

Others Present:

Stephanie Egelton, Clerk to the Board of Health (recorder)
Sarah Maaten, Director, Public Health Foundations
Dr. Joanne Kearon, Associate Medical Officer of Health
Ryan Fawcett, Associate Director, Operations/Privacy Officer
Omar Ozaldin, Director, Environmental Health, Infectious Diseases and Clinical Services
Jennifer Proulx, Director, Family and Community Health
Cynthia Bos, Associate Director, Human Resources and Labour Relations
Andrew Powell, Manager, Safe Water, Tobacco Enforcement & Vector Borne Disease
Abha Solanki, End User Support Analyst, Information Technology
Allison Aspinall, Manager, Infectious Disease Control
Melissa Thompson, Manager, Vaccine Preventable Disease
Alison Locker, Manager, Population Health, Assessment and Surveillance
Sue Clarke, Community Member
Katie denBok, Partner, Audit, KPMG LLP (exited at 7:45 p.m.)

Chair Michael Steele called the meeting to order at 7 p.m.

Disclosure of Pecuniary Interest

Chair Steele inquired if there were any disclosures of pecuniary interest. None were declared.

Approval of Agenda

Chair Steele noted that Report No. 60-25 re: 2024 Middlesex-London Health Unit (MLHU1) Financial Statements – Draft was being removed and replaced with a report of the same name (Report No. 64-25) due to a change regarding a misstatement.

Further, Chair Steele noted that Report No. 63-25 re: Preparing for the 2025-2026 Respiratory Season was being removed and replaced with a report of the same name and catalogue number due to a change regarding misalignment of data.

It was moved by P. Cuddy, seconded by A. DeViet, that the AGENDA for the September 18, 2025 Board of Health meeting be approved as amended.
Carried

Approval of Minutes

It was moved by M. Smibert, seconded by S. Franke, that the MINUTES from the July 24, 2025 Board of Health meeting be approved.
Carried

Closed Session

At 7:01 p.m., it was moved by P. Cuddy, seconded by M. Smibert, that the Board of Health will move into a closed session to consider matters regarding:
• personal matters about an identifiable individual, including municipal or local board employees;
• labour relations or employee negotiations;
• litigation or potential litigation, including matters before administrative tribunals, affecting the municipality or local board; and
• to approve previous closed session Board of Health minutes.
Carried

At 7:28 p.m., it was moved by A. DeViet, seconded by M. Smibert, that the Board of Health return to public session from closed session.
Carried

Consent Agenda

It was moved by P. Cuddy, seconded by S. Franke, that the Board of Health receive Consent Agenda items 1.1 (a and b) and 1.2 (a, b, c) for information:
1.1 Board of Health Committee Minutes
a) July 24, 2025 Performance Appraisal Committee
b) July 24, 2025 Finance and Facilities Committee

1.2 Information Reports
a) Medical Officer of Health Activity Report for July and August (Report No. 57-25)
b) Chief Executive Officer Activity Report for July and August (Report No. 58-25)
c) Board of Health Chair and Vice-Chair Activity Report for July and August (Report No. 59-25)
Carried

External Communications and Correspondence

It was moved by S. Franke, seconded by H. Shears, that the Board of Health receive items a), b), c) and e) for information:
a) Middlesex-London Board of Health External Landscape for August and September
b) Ministry of Children, Community and Social Services re: Getting closer to communities and services
c) Ontario Nurses Association re: Fair, Sustainable Funding for the Middlesex-London Health Unit
e) Lakelands Public Health re: Lakelands Public Health Launches New Brand Identity Following Merger of HKPR District Health Unit and Peterborough Public Health
Carried

Board Member Skylar Franke requested that item d) be endorsed and that the Board of Health writes a similar letter with Middlesex-London data to ministry and municipal partners.

It was moved by S. Franke, seconded by A. DeViet, that the Board of Health:
1) Endorse item d) Windsor Essex County Health Unit re: Addressing Opioid and Substance Harms and
2) Direct the Board of Health Chair, the Medical Officer of Health and Chief Executive Officer to write a letter with Middlesex-London opioid and substance harm data to the Ministry of Health, City of London Council and Middlesex County Council.
Carried

New Business

2024 Middlesex-London Health Unit (MLHU1) Financial Statements - Draft – amended (Report No. 64-25)

Katie denBok, Partner, Audit, KPMG LLP presented the draft 2024 MLHU1 Financial Statements for the Board of Health’s approval.

K. denBok reviewed the audit findings report and noted the Board of Health had the draft statements in their agenda package. K. denBok summarized the audit highlights, which is required under Canadian Auditing Standards and highlights matters for the Board’s awareness.

K. denBok noted that as of the time of the report being prepared, there are a few items pending which include updated schedules for deferred revenue, final review between management and KPMG, completing discussions with the Board (which will be completed once this meeting has ended), approval of the financial statements and the signed management letter.

K. denBok reviewed the uncorrected and corrected misstatements. There is one (1) uncorrected misstatement related to the reconciliation of accumulated surplus from the prior year period. The opening accumulated surplus balance did not agree to the prior year closing accumulated surplus as reported in the prior year financial statements, as a result of management’s process for recording the MHU2 revenues as at December 31. Management has made the adjustment to correct the opening accumulated surplus amount through the current year statement of operations. Accordingly, the closing accumulated surplus balance is correct as at year end however, the other expenses are overstated in the current year for the same. It was noted that control deficiencies included a lack of a second layer of review for journal entries to prevent management override of control and gaps in reconciliation processes monthly, quarterly and at year end.

Board Member Matthew Newton-Reid sought clarification on what an unbudgeted liability was (noted within the draft financial statements).

Emily Williams, Chief Executive Officer explained that annually, the Health Unit has to estimate (using actuarial methods) future employee benefits. E. Williams noted that historically the Health Unit has not included this in the budget, but going forward it will be included. E. Williams added that this would not be a “bill” received requiring payment but a future liability. K. denBok added that this matter is not considered a cash outflow for the Health Unit, and the estimate is an accounting requirement, which includes assumptions such as the age of the workforce and any discount rates afforded to the agency by the benefit provider.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 64-25 re: “2024 Middlesex-London Health Unit (MLHU1) Financial Statements - Draft” for information; and
2) Approve the Financial Statements for the Middlesex-London Health Unit (MLHU1) for the year ending December 31, 2024.
Carried

K. denBok exited the meeting at 7:45 p.m.

Q2 2025 Financial Update, Borrowing Update and Factual Certificate (Report No. 61-25)

E. Williams presented the Board of Health with the Q2 2025 Financial Update, Borrowing Update and Factual Certificate.

E. Williams explained that in Q2, there was a favourable variance of $177,244 after accounting for the organizational gap. Q2 expenses were lower than budgeted, which resulted in a favourable variance across all divisions in the organization. In Q2, the period ended with a cashflow of $5.8 million. The Health Unit’s line of credit has not been used and has the full $8 million in availability. The Health Unit holds a fixed loan and a variable loan, with $2.4 million and $387,000 owing on these loans respectively.

E. Williams noted two (2) items in the factual certificate for the Board’s attention. In item 5, the Health Unit’s charitable tax return to Canada Revenue Agency was slightly delayed but has now been completed. In item 10, this statement has been updated to reflect other reporting to the Board and Ministry of Health that the Health Unit is unable to fulfill all obligations under the Ontario Public Health Standards.

Board Member M. Newton-Reid inquired if the Health Unit pays off the variable loan, if the organization can borrow later if required and if we are paying interest. E. Williams noted that the Health Unit is accruing interest on cash in the bank and that accelerated payments on the variable loan were not budgeted for in the current year. E. Williams noted that there is a meeting scheduled with the banking provider (CIBC) to discuss the potential for short-term investments such as GIC with the current cash available. E. Williams noted that the interest on the bank loans are eligible expenses according to the Ministry, and that prior year settlements with the Ministry had not been completed and funds may be requested back by the Ministry following the conclusion of those discussions.

It was moved by P. Cuddy, seconded by M. Newton-Reid, that the Board of Health receive Report No. 61-25 re: “2025 Q2 Financial Update, Borrowing Update and Factual Certificate” for information.
Carried

Animal Bite Trends in Middlesex-London (Report No. 62-25)

Omar Ozaldin, Director, Environmental Health, Infectious Diseases and Clinical Services presented the report on Animal Bite Trends in Middlesex-London. Andrew Powell, Manager, Safe Water, Tobacco Enforcement & Vector Borne Disease was also present to answer questions.

O. Ozaldin explained that rabies remains a fatal preventable disease. Per the Health Protection and Promotion Act, the Health Unit is required to investigate every potential human exposure to rabies. In Middlesex-London, animal bites and rabies investigations have increased 49% since 2026. As of September 2, the Health Unit has recorded 255 more investigation from 2024. While most cases involve domestic animals and pose low risks, each case requires full investigation and follow up, creating a growing workload. O. Ozaldin noted that the Health Unit has implemented a very low risk rabies investigation algorithm, allowing staff to close extremely low risk cases more efficiently. Further, the Health Unit is also enhancing communication with healthcare providers to support better risk assessment and appropriate use of rabies post exposure prophylaxis.

Chair Steele noted that Board Member Selomon Menghsha was unable to attend this meeting, but provided some questions for public session. Chair Steele (on behalf of S. Menghsha) inquired on what is considered a low-risk rabies investigation versus a high-risk rabies investigation. A. Powell explained that the risk level depends on the animal involved. For example, high risk could be exposure to a bat, which is known in the area to have rabies. A low-risk exposure would be a domestic animal such as a dog, that has been vaccinated and has had no contact with wildlife.

It was moved by M. Smibert, seconded by P. Cuddy, that the Board of Health receive Report No. 62-25 re: “Animal Bite Trends in Middlesex-London” for information.
Carried

Preparing for the 2025-2026 Respiratory Season (Report No. 63-25) – amended

O. Ozaldin presented the amended report on preparing for the 2025-2026 respiratory season. O. Ozaldin noted that the amendment was a result of misalignment of data regarding outbreaks in congregate settings, which has been corrected.

O. Ozaldin explained that this report reviews trends from the previous respiratory season and outlines the Health Unit’s preparation for this season. It was noted that COVID-19 remains the most common institutional outbreak. Influenza activity nearly doubled compared to the prior season with over 1400 cases and 26 institutional outbreaks. Respiratory Syncytial Virus (RSV) immunization is being expanded this year to include all adults 75 years or older, in addition to existing high-risk groups that were previously vaccinated last year.

O. Ozaldin introduced Allison Aspinall, Manager, Infectious Disease Control and Melissa Thompson, Manager, Vaccine Preventable Disease to review data and information.

A. Aspinall provided a summary of the previous respiratory seasons. There were 55 COVID-19 deaths over five (5) years that were laboratory reported. There were 105 confirmed COVID-19 institutional outbreaks. There was an increase in influenza cases in the region, with 1442 reported cases (the majority being influenza A). Respiratory outbreaks continued throughout the year and even throughout the summer.

A. Aspinall explained that the Infectious Disease Control team is focused on prevention and control of outbreaks in congregate living settings. Prevention and control is conducted through activities such as education and training, development of infection, prevention and control (IPAC) programs, onsite assessments, supporting the congregate living settings to implement IPAC recommendations and outbreak investigation and management. A. Aspinall noted that the focus of outbreak management is to identify the cause of outbreaks to reduce transmission through declaring outbreaks, supporting control measures, leading outbreak management, monitoring and completing summary reports.

M. Thompson provided information on the Vaccine Preventable Disease team’s support during respiratory season. M. Thompson explained that public health units remain the distribution centre for ordering vaccines except for pharmacies. At this time, pharmacies can administer COVID-19 and influenza vaccines but cannot administer RSV vaccines. Recently, the eligibility for the RSV vaccine has opened, and the Health Unit will be distributing more of this vaccine this season. Over the next three months, the Health Unit will have more than 80,000 doses of immunizing products come through, which will be prioritized and processed through online ordering systems to go out to providers in the area.

M. Thompson noted that as the number and type of respiratory season immunizing products expand and the eligibility continues to evolve yearly, it is imperative that communications are clear, consistent and easily accessible for residents and healthcare providers who immunize. The Health Unit will also be holding a 2025 respiratory exercise on September 25 with healthcare system partners.

S. Franke inquired whether the increase in respiratory cases last year was attributed to an event. A. Aspinall explained that this increase was seen post pandemic, however control measures have been effective against all respiratory illnesses. Dr. Alexander Summers, Medical Officer of Health added that there is a plateau in seasonal vaccination, which is being observed.

S. Franke inquired if there has been communications from the Health Unit regarding vaccine disinformation. Dr. Summers noted that this is an area that public health struggles, however the Vaccine Preventable Disease and Social Marketing and Health Systems Partnerships teams have been working on strengthening vaccine messaging.

Board Member Howard Shears noted that there are some provinces choosing to charge for vaccines and sought clarification if vaccines are free in Ontario. Dr. Summers noted that influenza and COVID-19 vaccines are publicly funded in Ontario, but noted that the RSV vaccine is a paid vaccine if an individual is outside of the current eligibility.

It was moved by P. Cuddy, seconded by A. DeViet, that the Board of Health receive Report No. 63-25 re: “Preparing for the 2025-2026 Respiratory Season” for information.
Carried

Quality and Governance Committee Meeting Update (Verbal Report)

Committee Chair Aina DeViet presented reports heard at the September 18, 2025 Quality and Governance Committee meeting earlier in the evening.

There were no questions or discussion.

It was moved by A. DeViet, seconded by M. Smibert, that the Board of Health:
1) Receive Report No. 12-25QGC re: “Risk Register Reporting Dashboard” for information;
2) Receive Report No. 13-25QGC re: “Q2 2025 Risk Register Update” for information;
3) Approve the Q2 Risk Register Reporting Dashboard (Appendix A);
4) Receive Report No. 14-25QGC re: “Governance Policy Review for September 2025” for information;
5) Approve the governance policies as amended in Appendix B;
6) Receive Report No. 15-25QGC re: “2025 Board of Health Self-Assessment Results” for information;
7) Receive Report No. 16-25QGC re: “2023-25 Provisional Plan 2025 Q2 Status Update” for information; and
8) Receive Report No. 17-25QGC re: “Q2 2025 Organizational Performance Reporting” for information.
Carried

Current Public Health Issues (Verbal Report)

Dr. Summers and Dr. Joanne Kearon, Associate Medical Officer of Health, provided the Board of Health with an update on current public health issues.

Legionella Outbreak
Dr. Kearon noted that the likely outbreak source has been identified. The outbreak originally was declared over, but more cases came through and the outbreak had to be re-declared. Dr. Kearon explained that the investigation to identify the source goes through a few steps. These steps are learning common patient exposures, analysis of timing and geographic spread, and laboratory matching of legionella subtypes.

In the 2025 outbreak, there were 106 cases, 61 cooling towers samples, 166 tests performed and 24 cooling towers positive on culture. At this time, the outbreak is not declared over. The investigation has been a collaborative effort at the Health Unit with the Infectious Disease Control, Safe Water, Tobacco Enforcement and Vector Borne Disease, Population Health Assessment and Surveillance, Communications, and Privacy and Risk teams, Public Health Ontario and local hospitals.

S. Franke inquired if an individual has to be in the same building to be at risk for legionella and if legionella can travel to different cooling towers. Dr. Kearon explained that legionella can spread in the wind up to 6 kilometers and while the bacteria can go to different cooling towers, it is rare and did not occur in this outbreak.

A. DeViet inquired about preventative measures to prevent the spread of legionella in a cooling tower. Dr. Kearon explained that there are limited regulations that enforce the guidance of stopping the spread of legionella bacteria. There are guidance and standards for operators on the Health Unit’s website and information is provided to support operators.

2025-2026 Respiratory Vaccine
Dr. Kearon noted that the eligibility for the RSV vaccine has been expanded to individuals older than 74, however infants and those high risk over 60 can also receive the vaccine. Infants will be able to receive the vaccine on October 1, and others will be able to receive the vaccine on October 27. The RSV vaccine is a one-time vaccine in one’s lifetime.

For influenza and COVID-19 vaccines, there is alignment with the same dates of availability.

Chief Medical Officer of Health 2024 Annual Report
Dr. Kearon noted that the Chief Medical Officer of Health released their 2024 Annual Report, with a focus on vaccination. The report highlighted the current immunization landscape and identified three (3) challenges – gaps in immunization data, disparities in access and uptake, and declining vaccine confidence.

Recommendations from the report include building a provincial and national immunization registry, addressing access to vaccine, strengthening surveillance systems, strengthening vaccine confidence and investing in innovation and preparedness.

Food Insecurity Snapshot (PHO)
Dr. Summers provided an update on recent data provided by Public Health Ontario on Food Insecurity. This data included key indicators by region – food insecure households and individuals, and food secure households and individuals.

Middlesex-London has seen an increase in food insecurity, with 28.9% of individuals being food insecure and 28.2% of individuals being food insecure. Middlesex-London is outpacing the province with food insecurity.

Opioid and Stimulant-related Harms (Health Canada)
Dr. Summers provided an update on recent data provided by Health Canada on opioid and stimulant related harms. Within Canada, there has been a 17% decline in opioid deaths from 2023, along with a decline in poisonings and paramedic response related to overdoses. Dr. Summers noted that while trends are declining, the rates remain high. Dr. Summers concluded that a report on opioids in the region would be presented to the Board of Health in November.

AMO Conference
Dr. Summers noted that E. Williams and himself attending the Association of Municipalities of Ontario Conference in Ottawa in August, and received delegations from the New Democratic Party of Ontario, the Parliamentary Assistant to the Minister of Health and the Parliamentary Assistant to the Minister of Children, Community and Social Services.

MLHU in the News
Dr. Summers highlighted that the Health Unit had been in the news for closure of the Strathroy office, legionella, the iHeal program, and tips on selling prepared food.

Board Member P. Cuddy noted that he was pleased to have participated in supporting the Health Unit with their delegation at the AMO conference with the Ministry of Children, Community and Social Services.

It was moved by S. Franke, seconded by M. Smibert, that the Board of Health receive the verbal report re: Current Public Health Issues for information.
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, October 16, 2025 at 7 p.m. Chair Steele added that there is a Special Meeting of the Board of Health being called on Thursday, September 25 at 4 p.m. on Microsoft Teams.

Adjournment

At 8:28 p.m., it was moved by S. Franke, seconded by A. DeViet, that the meeting be adjourned.
Carried

MICHAEL STEELE 
Chair 

STEPHANIE EGELTON
Clerk

EMILY WILLIAMS
Secretary