September 2023 Board of Health Meeting

Event Date
Related Content

Meeting Documents

  1. Call to Order - F. Costante, Chair (4:00pm)
    1. Land Acknowledgement
    2. Quorum​​
    3. Declaration of Conflict of Interest
  2. Approval of Agenda
  3. Approval of Minutes: June 15, 2023
  4. Presentations (4:05pm)
    1. Student Immunization Coverage and Vaccine Opportunities (K. McBeth) (for information)
  5. Consent Agenda (for approval)
    1. Information Reports
      1. Annual Service Plan Q2 2023 Reporting and accompanying Report
      2. 2022-2025 Strategic Plan Q2 Report and accompanying Report
      3. Monthly SafePoint Site Operations Updates:
        1. July 2023
        2. August 2023
      4. Windsor-Essex Community Opioid and Substance Use Strategy  Update
      5. Immunization Coverage in 7, 12 and 17 year olds in W-E County
      6. Seasonal Influenza and COVID-19 Season 2023/2024
      7. Q2 2023 Board of Health Feedback Survey Results
      8. Communications Reports:
        1. June 2023
        2. July 2023
        3. August 2023
    2. Correspondence (4:40pm)
      1. Municipality Chatham-Kent Public Health - Letter to Hon. Doug Ford, Premier, and Hon Sylvia Jones, Deputy Premier and Minister of Health - Universal, No-cost Coverage for all Prescription Contraceptive Options to all People Living in Ontario - for support
      2. Windsor-Essex County Health Unit - Federal School Food Policy and Advocacy Letter - Letter to Hon. Chrystia Freeland, Minister of Finance and Deputy Prime Minister, Hon Jenna Sudds, Minister of Families, Children and Social Development, Hon. Lawrence MacAuley, Minister of Agriculture and Agri-Food, and Hon. Jean-Yves Duclos, Minister of Policy and Procurement - Investing in a Sustainable Federal School Food Policy - for approval
  6. Resolutions/Recommendation Reports (4:45pm)
    1. HPV Vaccine Coverage in Ontario (K. McBeth) (for approval)
  7. New Business
    1. CEO Report (K. Blanchette) (for information) 
    2. Ministry of Health, Public Health Announcement (K. Blanchette) (for information)
      1. Correspondence from Association of Local Public Health Agencies (alPHa)
      2. Correspondence from Association of Ontario Public Health Business Administrators (AOPHBA)
    3. Review of 2023 Ministry of Health Funding Approval Presentation (K. Blanchette) (for information)   
  8. Committee of the Whole (Closed Session in accordance with Section 239 of the Municipal Act) (5:00pm)
  9. Next Meeting:  At the Call of the Chair, or Tuesday, October 3, 2023 - 2:30 pm, University of Windsor
  10. Adjournment (5:25pm)

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

September 21, 2023

SUBJECT:

Annual Service Plan Q2 2023 Reporting


BACKGROUND/PURPOSE

In 2018, the Ontario Ministry of Health (MOH) introduced a new Annual Service Plan (ASP) that Health Units are required to submit each year. In order to ensure a single and integrated approach to planning the Planning and Strategic Initiatives (PSI) department worked with the Information Technology (IT) department to align our planning system with the provincial Ontario Public Health Standards requirements.

CURRENT INITIATIVES

Q2 Intervention Work Plan Progress

Project Leads have provided individual progress reports for work plans in their programs for Q2, 2023. The 2023 Operational Plan Reporting – Q2 Status Report indicates that:

  • For external client facing programs, there are 138 workplans in progress and 83% are on track.
  • For internal organizational programs, there are 38 workplans in progress, 2 were completed, and 63% are on track.

Plan Development for 2024

Planning for 2024 began in July, 2023. Program descriptions, planned major activities, and priority population groups have been updated. Program leads have also begun to create their individual workplans with expected completion this Fall.


2023 Operational Plan Reporting 
Q2 STATUS REPORT

Reporting Structure

This report provides a status summary for intervention work plans (IWP) in the 2023 Annual Service Plan that were in progress during Q2 (April 1 to June 20).

The project lead for each active IWP was asked to provide a progress report on their work. The status updates consisted of the following categories:

  • On Target (the intervention is progressing at the planned pace)
  • Variance (the intervention is behind the planned pace)
  • Complete (the intervention has been completed)
  • Deferred (current work on the intervention has been stopped – with potential to continue next year)
  • Cancelled (the intervention will no longer occur)

If the intervention was identified as ‘Variance’, ‘Deferred’, or ‘Cancelled’, a reason was provided. In these cases, the most relevant reason was selected from the following list:

  • Adjusted Program Priorities (program priority alterations resulted in changes to the IWP)
  • Human Resource Issue (staffing circumstances resulted in changes to the IWP)
  • Partnership Limitations (external partner(s) did not to meet their obligations)
  • Public Health Emergency (a significant emergency resulted in changes to the IWP)
  • Internal Resource Limitation (financial, material, or internal support limitations resulted in changes to the IWP)
  • External Resource Limitation (External financial, material, or internal support limitations occurred with partnerships, collaborations, funding, or regulations)

It is important to note that reporting reflects a summary of progress made on interventions based on the predetermined milestones for the intervention. This does not necessarily represent the amount or scope of work captured under each program.

Operational Plan Status Summary

Part 1: External Community Facing Programs

Overall Quarterly Status Summary

There were 138 external interventions in progress in Q2 2023, and 115 (83%) of the interventions were on target.

Figure 1 displays the percentage of interventions that were on target, reported a variance, deferred, cancelled, or were completed.

PREPARED BY:

Communications Department

DATE:

September 21, 2023

SUBJECT:

July 15, 2023 – August 14, 2023, Communications Update


BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

SOURCE July 15 - August 14 June 15 - July 14 DIFFERENCE
News Releases, Media Advisories and Statements, or Notices Issued 6 10 -4
Media Requests Received 10 20 -10
Wechu.org pageviews 95,692 94,832 860
YouTube Channel Subscribers 1,745 1,741 4
Email Subscribers 7,309 7,353 -44
Emails Distributed 12 16 -4
Facebook Fans 19,133 19,128 5
Facebook Posts 57 71 -14
Twitter Followers 8,637 8,679 -42
Twitter Posts 57 69 -12
Instagram Followers 1,568 1,557 11
Instagram Posts 31 45 -14
LinkedIn Followers 1,563 1,546 17
LinkedIn Posts 15 22 -7
Media Exposure 91 97 -6

Data Notes can be provided upon request

Media Exposure Overview Graph

Media exposure overview - July - August 2023

Notes: Between July 15 – August 14, we experienced one large peak, and a few smaller peaks in media exposure:

July 19 – Beach water results were shared via email and social media posts on these two dates, resulting in 6 stories.

July 21 – Dr. Mehdi provided guidance and an update on COVID-19 boosters in the fall, for 3 stories.

July 26 – An extended heat warning was issued. This resulted in 18 news stories.

August 2 – We issued beach water testing results and an opioid overdose alert, which resulted in 10 total stories. August 10 – Beach water testing results were issued, and stories around the need to recruit physicians to Windsor- Essex County, resulting in 10 stories.


Website Overview Graph

Website overview chart - July - August 2023

Notes: During the timeframe of July 14 – Aug 15, we saw similar website traffic as the previous period. Over this timeframe, our Safe Water pages consistently took spots in our weekly top ten (test results page as well as individual beach pages).


Social Media Overview Graph

Social media overview - July to August 2023

Lighter blue line represents the current month, darker blue line represents the previous month.

Note: Overall, our social media followers / fans remained consistent over the month.


DISCUSSION

STI Campaign graphic

The Communications Department worked closely with the Infectious Disease Prevention Department on a campaign to reduce the stigma of sexually transmitted and blood borne infections. The campaign was multi- faceted, including components such as paid social media posts and a full- page ad in Biz X magazine.

There were two boosted posts on Facebook which reached 15,018 people and resulted in 215 total link clicks, which took viewers to https://www.wechu.org/STI.
 

PREPARED BY:

Communications Department

DATE:

September 21, 2023

SUBJECT:

June 15, 2023 – July 14, 2023, Communications Update


BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

SOURCE June 15 - July 14 May 15 - June 14 DIFFERENCE
News Releases, Media Advisories and Statements,or Notices Issued 10 8 2
Media Requests Received 20 25 -5
Wechu.org pageviews 94,832 90,097 4,737
YouTube Channel Subscribers 1,741 1,731 10
Email Subscribers 7,353 7,419 -66
Emails Distributed 16 10 6
Facebook Fans 19,128 19,097 31
Facebook Posts 71 65 6
Twitter Followers 8,679 8,691 -12
Twitter Posts 69 66 3
Instagram Followers 1,557 1,555 2
Instagram Posts 45 31 14
Linked In Followers 1,546 1,511 35
Linked In Posts 22 17 5
Media Exposure 97 99 -2

Data Notes can be provided upon request

Media Exposure Overview Graph

Media exposure overview chart

Notes: Between June 15 – July 14, we experienced one large peak, and three smaller peaks in media exposure:

June 15 & 21 – Beach water results were shared via email and social media posts on these two dates, resulting in 11 and 5 stories, respectively.

June 28 – An air quality statement for our region was issued due to the forest fires in Northern Ontario and Quebec, as well as beach water testing results. Combined, this resulted in 21 news stories.

July 5 – We issued beach water testing results, a heat alert, and an opioid overdose alert, which resulted in 17 stories (total).

July 12 – Beach water testing results were issued, resulting in 8 stories.


Website Overview Graph

Website traffic overview chart

Notes: During the timeframe of June 14 – July 15, we saw similar website traffic as the previous period. There was a small uptick on July 5, corresponding with the release of the weekly beach water testing results.


Social Media Overview Graph

Social media overview graph

Note: Overall, our social media followers / fans remained consistent over the month.


DISCUSSION

Be Mpox Aware graphic

The Communications Department worked closely with the Infectious Disease Prevention Department on a campaign to raise awareness of, and educate people about, MPox. The campaign was multi-faceted, including components such as paid social media posts and a full-page ad in Windsor Life magazine.

There were three paid posts on Facebook which resulted in 702 total link clicks, which took viewers to https://www.wechu.org/mpox. This achieved the goal of boosting web traffic.

Windsor Life magazine has a reach of 60,922 via the printed edition.

PREPARED BY:

Communications Department

DATE:

September 21, 2023

SUBJECT:

May 15, 2023 – June 14, 2023, Communications Update


BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

SOURCE July 15 - August 14 June 15 - July 14 DIFFERENCE
News Releases, Media Advisories and Statements, or Notices Issued 8 5 3
Media Requests Received 25 22 3
Wechu.org pageviews 90,097 86,896 3,201
YouTube Channel Subscribers 1,731 1,729 2
Email Subscribers 7,419 7,438 -19
Emails Distributed 10 7 3
Facebook Fans 19,097 19,069 28
Facebook Posts 65 58 7
Twitter Followers 8,691 8,697 -6
Twitter Posts 66 59 7
Instagram Followers 1,555 1,539 16
Instagram Posts 31 31 -
LinkedIn Followers 1,511 1,456 55
LinkedIn Posts 17 17 -
Media Exposure 99 57 42

Data Notes can be provided upon request

Media Exposure Overview Graph

Media exposure graph - May - June 2023

Notes: Between May 15 – June 14, we experienced one large peak, and four small peaks in media exposure:

Friday May 19 – At the Board of Health meeting the night before, three presentations were given, including a  SafePoint update, a new mental health training program, and water testing programs. A total of 26 news stories were released based off the information shared.

May 28 – 30 – We issued a news release announcing the official start of the beach water testing, following incorrect dates reported by the media. Additionally, Dr. Aloosh participated in five media interviews as an introduction to the position. A total of 15 stories were released in this date range on these topics.

Friday June 2 – The media were invited to an active tick dragging event to announce the start of the surveillance program. This resulted in 11 stories.

Thursday June 8 – Environment Canada issued a Special Air Quality Statement for our region due to smoke from wildfires, and we issued a media statement regarding the topic. Eight news stories featured this topic.

Wednesday June 14 – We issued the first set of beach water testing results, resulting in 8 stories.


Website Overview Graph

Website overview graph - May - June 2023

Notes: During the timeframe of May 14 – June 15, we saw similar website traffic as the previous period of April 14 – May 15. There was a small uptick on June 8, corresponding with the media statement regarding the wildfires and air quality (the statement and the webpage ranked second and third, respectively, in page views that day).


Social Media Overview Graph

Social media graph - May to June, 2023

Note: Overall, our social media followers / fans remained consistent over the month.


DISCUSSION

tick dragging photo

Communications Department worked closely with the Environmental Health Department to announce the start of the active tick surveillance program which will ast throughout the summer and early Fall months. Two members of the Communications team attended the event on Friday, June 2, 2023 to assist with the media, and capture photos and videos of the activity.

A media advisory was released inviting the media to an event at the Ojibway Nature Centre, of which three different media outlets attended. Additionally, a news release was issued, which included tips to help prevent tick bites. The email sent to our General Subscribers list had an open rate of 54%.

A social media post went out on Monday, June 5 which included a short video of a Public Health Inspector dragging for ticks. The video received 571 views on Facebook, 992 views on Twitter, and nearly 400 views on Instagram.

Prepared By:

Planning and Strategic Initiatives Department

Date:

September 21, 2023

Subject:

Q2 2023 Board of Health Feedback Survey Results


BACKGROUND/PURPOSE

The Ontario Public Health Standards (2021), under the Good Governance and Management Practices Domain, states: “the board of health shall have a self-evaluation process of its governance practices…”.

In addition to a yearly self-evaluation process, the WECHU has developed a quarterly self-assessment survey for Board of Health (BoH) members. The survey provides an opportunity for feedback on BoH operations and is used to inform quality improvement efforts.

DISCUSSION

Responses in the second quarter of 2023 related to BoH operations were generally positive. In most cases, 80% or more of the responses were Agree or Strongly agree regarding the aspects queried. The one exception was related to the item ‘All material notices of wrongdoing or irregularities were responded to in a timely manner’, where 78% of the responses were Agree or Strongly Agree. In terms of overall perceived BoH effectiveness, 78% of the responses were either a 9 or a 10 (on a 10-point scale), where all responses were greater than an 8.

Suggestions for improvement included providing a complete summary of the reports when they are given to the BoH, providing suggested actions by administration resulting from presentations to the BoH, increased frequency of BoH meetings, and additional information about marketing and communication information.
 

Prepared By:

Healthy Schools Department - Immunization

Date:

September 21, 2023

Subject:

Seasonal Influenza and COVID-19 Season 2023/2024


BACKGROUND

Influenza (flu) Vaccine

The Windsor-Essex County Health Unit (WECHU) plays a key role in the implementation of the Ministry of Health’s Universal Influenza Immunization Program (UIIP) which offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work, or attend school in Ontario.

Under the UIIP, the provincial supply of influenza vaccine doses is received from the Ontario Government Pharmacy (OGP) in predetermined increments dependent on vaccine availability. The WECHU receives influenza vaccine shipments from OGP and is responsible for the distribution to health care providers and facilities in the community. Allocation to providers is based on total community allocation, number of clients to be served, past usage by the provider, available fridge space, and the proportion of high-risk clients the provider is responsible for. Community Immunization Providers (e.g., primary care providers, hospitals, long-term care homes (LTCH) and retirement homes (RH)) order influenza vaccine from the WECHU, starting in September.

COVID-19 Vaccine

In July 2023, the Ontario Ministry of Health, recommended that Ontarians aged 5 years and older delay getting a COVID-19 booster until the fall. Receiving a booster dose in the fall, as respiratory season commences, will maximize protection against COVID-19 outcomes when peak circulation of the virus is likely to occur with other seasonal respiratory viruses.

Currently, the WECHU is administering primary doses of COVID-19 vaccines at their in-house clinics at the Windsor and Leamington offices. The Healthy Schools Immunization Team is supporting families of school aged children this summer by offering COVID-19 education and immunizations to individuals who want to be vaccinated at upcoming School Readiness Events.

In addition, any pharmacy that is participating in the annual UIIP is encouraged to also participate in the COVID-19 vaccine administration program. Pharmacies who have been approved to administer COVID- 19 vaccine are required to have a cold chain inspection on the vaccine refrigerator(s) that will be storing publicly funded influenza vaccines.

CURRENT INITIATIVES

Throughout the year, the WECHU has completed 366 vaccine fridge inspections throughout Windsor and Essex County (WEC) for health care providers, pharmacies, agencies, long-term care and retirement homes planning to administer influenza and COVID-19 vaccines this fall.

Eighty-four out of 120 local pharmacies that applied to manage and administer fall vaccines were approved by the Ontario Ministry of Health to provide both influenza and COVID-19 vaccine. Thirty-six pharmacies that were approved to provide influenza did not apply to administer COVID-19 vaccine.
Participating pharmacists may only administer publicly funded influenza vaccine to individuals 2 years of age and older. While pharmacists can administer COVID-19 vaccine for individuals 6 months and older, they generally administer COVID-19 vaccine to individuals 2 years and older.

In preparation for, and over the course of the respiratory virus season, the WECHU maintains ongoing communication with all health care providers and pharmacies and relays information about the timelines for vaccine availability. Tailored information packages including vaccine product information, ordering information, and promotional materials are also compiled and distributed to providers by the WECHU each influenza season.

Community immunization providers are encouraged to help increase access and uptake of influenza and COVID-19 vaccines by offering co-administration of COVID-19 and influenza vaccine. To support widespread availability of both the influenza and COVID-19 vaccine in our community, the WECHU is working collaboratively with many community partners, including hospitals, operators of congregate living facilities, and primary care, to identify service gaps and opportunities to increase vaccine uptake. The WECHU will be supporting COVID-19 vaccine clinics, with a focus on prioritized populations and high-risk individuals; individuals attending these clinics will also have an opportunity to receive influenza vaccine at the same time.

The Ontario Ministry of Health has indicated that the timeline for the influenza and COVID-19 vaccine rollout will be aligned in the coming months. Initial inventory shipments are expected by the end of September/early October. The first allocation would target vaccine administration in hospitals, long-term care, and retirement homes. The second allocation would target high-risk groups for influenza and COVID- 19 related complications or hospitalization. The third allocation targets the entire population and is expected in November.

The WECHU will be running a communication campaign from October to December to raise awareness of the risks of contracting seasonal respiratory illnesses (e.g., influenza and COVID-19), and the importance of getting vaccinated, especially for individuals who are part of a high-risk group. Targeted, organic social media ads and print materials, and articles will be developed to communicate key messages.

Prepared By:

Healthy Schools Department - Immunization

Date:

 September 21, 2023

Subject:

Immunization Coverage in 7, 12 and 17-year-olds in Windsor-Essex County


BACKGROUND/PURPOSE

The compliance rates of students in elementary and secondary schools were assessed as part of the Immunization of School’s Pupil Act (ISPA) enforcement during the 2022-2023 school year. Students born in 2008 were not included in this compliance review due to the timing of their transition from elementary to high school and the planned implementation process. This compliance data, apart from the rates of students born in 2008, was presented in the  April 2023 Board Report.

Local available temporal trends of immunization coverage rates among 7- and 17-year-olds is presented on the WECHU’s Healthy Schools Immunization dashboard. The dashboard also provides comparisons to provincial coverage rates and national coverage goals.

This report is in follow-up to the April 2023 commitment to the Board of Health and the community to provide updated and expanded immunization coverage rate data as an outcome of the completed process in the previous school year.

Immunization Coverage Rates

Immunization coverage rate describes the proportion of a population that is appropriately immunized against a vaccine preventable disease (VPD) at a point in time. Achieving and maintaining high immunization coverage is essential for effective prevention and control of VPDs.

Vaccine coverage rates for ISPA required vaccines and strongly recommended school ages vaccines are presented below.

Of interest is the HPV vaccine coverage rate among 17 year olds, which is higher than the provincial rate of 64.1% (as of August 31, 2022). While the WEC region surpasses the provincial coverage rate for HPV, WEC is below the  national coverage goal of 90% vaccination coverage by 17 years of age. Also interesting to note, is the vaccine coverage for Hepatitis B among 17 year olds, which is higher than the provincial rate of 74.9%, is also lower than the desired national goal of 90%. Both of these vaccines, in addition to Meningococcal disease vaccine, is provided to all students in grade 7 as a part of the WECHU’s school-based vaccine program.

Discussion

The coverage rates for 7-year-olds reflect families who have completed the immunization record review process, including notification of immunizations missed and catch-up vaccination clinics as part of the 2022-2023 ISPA enforcement process.

During the 2016-17 school year, the Grade 7 HPV vaccination program was expanded to include provincially funded coverage for males. While these students have since graduated high school, it is likely that the HPV coverage rate among young males is impacted by societal norms, which may take some time to increase the rate of HPV coverage.

The coverage rates for diphtheria, tetanus and pertussis among 17-year-olds is lower than many immunizations listed below. This suggests many students missed receiving their adolescent tetanus-diphtheria-pertussis (Tdap) booster dose during the pandemic, typically administered between 14-16 years of age by primary care providers. The WECHU continues to work with local primary care providers to promote adherence to Ontario’s Routine Immunization Schedule.

Also of note, effective September 2014, the ISPA was amended to require children born on or after 2010 to be vaccinated against Varicella-zoster – a herpes virus that causes chickenpox. The publicly funded immunization schedule outlines this dose of Varicella vaccine should be administered when the child is 15 months old. Students who are 17 years old in 2023, reflected in much lower rates upon review, were born in 2006, before the ISPA requirement was instituted.

Vaccine Coverage Rates for ISPA Required and Recommended Vaccines(HPV and HepB) among 7, 12and 17-year-olds in Windsor and Essex County
Vaccine-Preventable Disease Required by ISPA in Ontario Lead Vaccine Provider 7-year-olds as of... 12-year-olds as of... 17-year-olds as of...
Aug 31, 2022(%) 2022-23 School Year (%) Aug31, 2022(%) 2022-23 School Year (%) Aug 31, 2022(%) 2022-23 School Year (%)
Diphtheria1,2 Yes Primary Care Provider 84.5 88.95 Data not available at this interval 95.12 32.0 82.49
Hepatitis B2 No WECHU/ Primary Care Provider These vaccines are recommended and offered to 12-year-olds, during their Grade 7 year. 37.0 71.22 73.2 76.65
HPV2 No WECHU 26.0 61.31 60.6 68.79
Measles1 Yes Primary Care Provider 85.6 89.78 Data not available at this interval 95.16 86.0 91.98
Meningococcal Disease2 Yes WECHU/ Primary Care Provider 94.83 95.583 61.64 86.644 85.14 93.344
Mumps1 Yes Primary Care Provider 85.4 89.68 Data not available at this interval 95.12 85.6 91.84
Pertussis1,2 Yes Primary Care Provider 84.5 88.92 Data not available at this interval 94.97 31.9 82.20
Polio1 Yes Primary Care Provider 85.7 89.95 Data not available at this interval 95.35 79.7 91.67
Rubella1 Yes Primary Care Provider 95.9 95.94 Data not available at this interval 95.95 92.1 94.75
Tetanus1,2 Yes Primary Care Provider 84.5 89.23 Data not available at this interval 95.18 32.0 82.49
Varicella Yes Primary Care Provider 82.9 88.02 Data not available at this interval 93.28 Data not available at this interval 34.57
  1. National goal to achieve 95% vaccination coverage by 7 years of age, highlighted in green above.

  2. National goal to achieve 90% vaccination coverage by 17 years of age, highlighted in green above.

  3. Vaccination with Meningococcal C conjugatevaccine.

  4. Vaccination with Quadrivalent meningococcal conjugate vaccine.

Note: Cells in orange above, highlight the coverage rates for vaccine-preventable diseases that are below the national goal.

Improved coverage rates can be attributed to several WECHU interventions that were implemented during the ISPA enforcement activities of the 2022-2023 school year. An improved level of human resources was dedicated to the school aged vaccine administration and the ISPA enforcement process compared to what was previously available. This enabled increased capacity to accomplish:

  • comprehensive immunization records review and updating
  • enhanced communication and support for families
  • improved technologies to support parent/guardian consent process
  • increased catch-up vaccinations administered via in-house clinics and in collaboration with health care providers.

Conclusion

There is a significant opportunity in Windsor and Essex County to improve the existing vaccine coverage rate for HPV among 12- and 17-year-olds. The HPV vaccine is safe and over 95% effective in protecting students against 9 types of HPV that can cause head and neck cancers, genital cancers, and warts. The best protection against these diseases is receiving the HPV vaccine before a person engages in sexual activity. The WECHU will be implementing future communication campaigns to raise uptake of the HPV vaccine in eligible populations (Grades 7-12 students) based  on current criteria for access to free vaccine (until the end of Grade 12) and explore advocacy efforts to expand current provincially funded eligibility requirements.

The WECHU continues to focus on parent/guardian communication strategies to increase awareness of their duty to report immunizations to the health unit and to help address vaccine hesitancy concerns. These interventions will focus on reporting prior to entry to school and using an online reporting tool that parents can use to update their child’s immunization from infancy. The WECHU is also planning to expand our efforts to work with families of pre- school age children, prior to their entry to school, to ensure protections are in place even sooner than the start of elementary aged attendance.

The WECHU implemented and completed ISPA assessment, enforcement (including the suspension processes) for elementary and secondary school students (except for those born in 2008) in the 2022-2023 school year. Any student who was overdue for their age-appropriate ISPA-vaccine (and did not have an exemption) by the deadline; was suspended from school for up to 20 days. Currently, any student born in 2008 (Grade 10 students for the 2023- 2024 school year) has received a notification letter informing them of any vaccines they’re overdue for; catch up clinics took place over the entire summer to provide students with an option to get those vaccinations prior to the new school year.

The WECHU will be implementing a robust maintenance strategy for all school aged children in the spring. Student immunization records, in all grades, will be assessed this fall and winter and the WECHU will implement the enforcement process for any student enrolled in WEC elementary and secondary schools that are overdue for required ISPA vaccines (based on age eligibility). Although highly resource intensive, this maintenance process will take place annually, and is the most effective and sustainable way to support ongoing protections and improved immunization coverage for our community.

To ensure ongoing protections for vaccine preventable illness, the WECHU remains committed to working with primary care providers helping them adhere to the publicly funded immunization schedule. Following the schedule will help ensure infants start on the right timetable for important childhood immunizations, and can help get students’ vaccination back on schedule, if there are gaps in coverage. The WECHU continues its work in ensuring access to publicly funded vaccines for students who currently do not have access to primary care providers.   
 

Prepared By:

Chronic Disease and Injury Prevention Department

Date:

September 21, 2023

Subject:

Windsor-Essex Community Opioid and Substance Use Strategy Update


BACKGROUND

The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) was established in 2018 by the Windsor-Essex County Health Unit (WECHU) to bring together leadership representatives from across the region to address increasing rates of opioid use and overdose. The WECOSS is a four-pillar approach that leverages the knowledge and resources of more than 40 agencies and individuals with lived experience to address the harms of substance use at the community level through Prevention and Education, Harm Reduction, Treatment and Recovery, and Enforcement and Justice interventions.

Since the Strategy began, an Annual Report has been released as part of the WECOSS’ commitment to information sharing. The purpose of each Annual Report is to highlight the work being done to address substance use in the community through the collaborative efforts of our WECOSS partners. In 2021, an evaluation of the WECOSS was conducted by engaging members and the public to assess the level of awareness and early impact of the WECOSS in the community. The findings from this evaluation were used to form recommendations as presented in the WECOSS Modernization (2021) to guide the pathway forward for the WECOSS, including highlighting priority areas, and emphasizing a collective impact approach.

CURRENT INITIATIVES

Each of the four WECOSS pillars develops and implements at least one project per year, which are outlined in Annual Reports. In 2022, the development of these projects were guided by the six priority areas for focus and action. Future initiatives will continue to address and expand upon these priorities as the Strategy evolves.

The Addressing Substance Use in Corrections Reintegration Supports project was a key initiative undertaken in 2022 by the Enforcement and Justice Working Group. This involved collaborating with the South West Detention Centre, Windsor Probation and Parole, and the Canadian Mental Health Association Windsor-Essex County Branch. The goal of the project was to improve access to substance use and harm reduction supports and services for justice-involved individuals who had a history of problematic  substance use.

Through this project, 179 individuals were engaged, 138 of which were justice-involved individuals and 41 of which were justice system staff. This highlighted that justice-involved individuals released from custody required more knowledge and information in six (6) key areas:

  • Housing support;
  • Job skills or help getting a job;
  • Community support groups;
  • Help with obtaining identification;
  • Referral to mental health and substance use services;
  • Referral to withdrawal management or treatment for substance use

Additionally, justice-involved individuals expressed that their preferred methods for obtaining this information included one-on-one discussions with staff at intake, appointments, or during education sessions.

FUTURE PLANS

The findings from Addressing Substance Use in Corrections Reintegration Supports project resulted in the development of a wallet card resource containing information on more than 35 relevant supports and services. These will be distributed by various partners involved in the project and other relevant law enforcement partners to people involved with the justice system. There is also opportunity to work with partners to develop the necessary policies and procedures to facilitate discussions about relevant supports for successful reintegration. To support the educational needs of justice system staff, a hub of resources and educational materials was also compiled and will be made available through the WECOSS website.

Substance use supports and harm reduction approaches are critical for justice-involved individuals, especially during release from custody as this is when individuals are at an increased risk for drug-related deaths.1 Additionally, addressing the basic needs of justice-involved individuals who use substances can aid in successful reintegration following incarceration.2

Subsequent work will focus on addressing barriers and building trust with people who use substances to enhance coordination between law enforcement and health services. To facilitate this, an online inventory of more than 200 local substance use, addictions, and mental health services will be designed through an ongoing WECOSS Treatment and Recovery Pillar Working Group project. The inventory will assist service providers in making referrals to relevant services for their clients.

References

  1. Cooper, J. A., Onyeka, I., Cardwell, C., Paterson, E., Kirk, R., O’Reilly, D., & Donnelly, M. (2023). Record linkage studies of drug-related deaths among adults who were released from prison to the community: A scoping review. BMC Public Health, 23(1), 826. https://doi.org/10.1186/s12889-023-15673-0
  2. McKiernan, A. (2017). Supporting reintegration in corrections by addressing problematic substance use: An environmental scan. Canadian Centre on Substance Use and Addiction. Retrieved from:   https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Reintegration-Corr…- Environmental-Scan-2017-en.pdf
     

BACKGROUND

Overview

  • SafePoint officially opened on Wednesday, April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 6:00 p.m. daily.
  • In order to ensure transparency related to SafePoint operations, the Board of Health will be provided with regular updates.

Application Status

  • The WECHU’s application to operate SafePoint under a Supervised Consumption Services (SCS) exemption was approved by Health Canada on July 21st, 2023.
  • The SCS exemption was shared with the Ministry of Health immediately following approval and in doing so, the Ministry confirmed that there are no outstanding elements in the WECHU’s application to operate a fully funded Consumption and Treatment Services (CTS) site at SafePoint.
  • As it stands, the Ministry of Health application for CTS funding remains under review.

CURRENT INITIATIVES

Operational Data

It has been four months since SafePoint opened on April 26th, 2023. From opening to August 31st, there have been 418 client visits amongst 119 unique clients, with no overdoses reported on-site to date. Additional details about the services provided at SafePoint during the month of August are presented in Tables 1-3.

Table 1.   
Brief overview of unique clients at SafePoint over the period of August 1st to August 31st.

Total Unique Clients: 26

Demographic

Number of Unique Clients

Age

Under 25

4

 

25-64

19

  65+ 2

 

Unknown

1

Gender

Man

20

 

Woman

6

Race

White

22

 

Indigenous

2

 

Latin American/Hispanic

1

 

Black, African, or Caribbean

1


Table 2.   
Brief overview of client visits at SafePoint over the period of August 1st to August 31st, 2023.

Total Number of Client Visits: 130

Indicator

Number of Visits

Visit by Time of Day

10:00 – 11:59 a.m.

27

 

+12:00 – 2:59 p.m.

50

 

3:00 – 6:00 p.m.

53

Type of Visit

Consumption

65

  Other 65

Consumption Visits Reported

methamphetamine

 

 

Dilaudid

1

Consumption Visits by Method of Consumption

Injection

65

  Intranasal -
  Oral -
Table 3. 
Brief overview of other services provided at SafePoint over the period of August 1st to August 31st, 2023.

Total Number of Client Visits: 130

Indicator

Number of Times Service Offered

Drug Checking

On-site fentanyl drug checking

1

Basic Care

First aid

22

  Wound/abscess 26
  Foot care 4

Wraparound Services

 

On-site

Referral

 

Addictions treatment

-

2

 

Mental health

1

3

 

Primary care

18

16

  Social services 57 3


Client Experience Narrative

Beyond the number of client visits recorded in the month of August, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client #1

SafePoint staff connected with the Wellness Program for Extended Psychosis with the Transitional Stability Centre (TSC) on behalf of a SafePoint client. Staff walked with the client to the TSC so that they could be administered their medication that was overdue.

FUTURE PLANS

SafePoint has continued to expand the wraparound services available on-site. The Mobile Medical Support (MMS) Team and their Dental Hygienist will be on-site of SafePoint on Friday, September 8th, 2023 to provide clients with dental services. SafePoint has also developed a procedure with Family Services Windsor-Essex to dispatch Homelessness Outreach Workers to SafePoint as needed.

SafePoint is preparing to launch its business engagement strategy as part of the site’s ongoing commitment to community engagement. The business engagement strategy will involve regular outreach and resource distribution to the area businesses to learn about and address their concerns about the site.     
 

BACKGROUND

Overview

  • SafePoint officially opened on Wednesday, April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 6:00 p.m. daily.
  • In order to ensure transparency related to SafePoint operations, the Board of Health will be provided with regular updates.

Application Status

  • On July 21st, 2023, the WECHU received a letter from the federal government authorizing the requested Supervised Consumption Services (SCS) exemption.
  • The SCS exemption granted by Health Canada has since been shared with the Ontario Ministry of Health, and in doing so, the WECHU confirmed with the provincial Ministry of Health that there are no elements outstanding in its application to operate a fully funded Consumption and Treatment Services (CTS) site.
  • As it stands, the Ministry of Health application for CTS funding remains under review.

CURRENT INITIATIVES

Operational Data

It has been three months since SafePoint opened on April 26th and there have been 288 client visits amongst 93 unique client visits, with no overdoses reported on-site to date. Additional details about the services provided at SafePoint during the month of July are presented in Tables 1-3.

Table 1. Brief overview of unique clients at SafePoint over the period of July 1st to July 31st.

Total Unique Clients: 30

Demographic

Number of Unique Clients

Age

Under 25

3

 

25-64

25

 

Unknown

2

Gender

Man

23

 

Woman

6

 

Gender not listed

1

Race

White

20

 

Indigenous

2

 

Arabic

2

 

Latin American/Hispanic

3

 

SouthEast Asian

2

 

Declined to answer

1


Table 2. Brief overview of client visits at SafePoint over the period of July 1st to 31st, 2023.

Total Number of Client Visits: 114

Indicator

Number of Visits

Visit by Time of Day

10:00 – 11:59 a.m.

32

 

+12:00 – 2:59 p.m.

50

 

3:00 – 6:00 p.m.

32

Type of Visit

Consumption

38

Consumption Visits Reported

Crystal

25

 

Morphine

1

 

Fentanyl

10

 

Ritalin

1

Consumption Visits by Method of Consumption

Injection

38

Table 3. Brief overview of other services provided at SafePoint over the period of July 1st to July 31st, 2023.

Total Number of Client Visits: 114

 

Indicator

Number of Times Service Offered

Drug Checking

On-site fentanyl drug checking

2

Basic Care

First aid

4

  Wound/abscess 10
  Foot care 6

Wraparound Services

 

On-site

Referral

 

Addictions treatment

-

9

 

Mental health

-

6

 

Primary care

15

11

  Social services 6 9


Client Experience Narrative

Beyond the number of client visits recorded in the month of July, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client #1

SafePoint security staff witnessed a person using a substance in the area surrounding SafePoint and encouraged them to access the site. The person was informed that if they entered the site that the nursing staff would monitor them to reduce their risk of harm. After staff educated the client about the services available on site, the client agreed to remain inside and be monitored. The client was able to be monitored under the supervision of medically trained staff and was provided the option to access wraparound services.

FUTURE PLANS

As part of SafePoint’s continued commitment to community engagement, the WECHU will work closely with the SafePoint Advisory Committee members, including the Downtown Windsor Business Improvement Association (DWBIA), to expand efforts in offering support to surrounding businesses and address concerns related to the site's operations. A “SafePoint Toolkit” will be distributed as part of active outreach to area businesses, which contains resources that outline services offered at SafePoint, who to contact if a business-related concern is identified, and other supports made available to businesses as the site operates.

Since opening, SafePoint staff have attended 6 community events where resources and information about SafePoint have been shared. This has led to connections with various community partners for client referrals.

SafePoint has continued in its efforts to expand the wraparound services available on-site. The Recovery Education for Addictions and Complex Trauma (RE/ACT) team will now be on-site every Wednesday from 4:00          
p.m. – 5:00 p.m. to support clients through their holistic substance use recovery program. The program focuses on the numerous ways in which trauma shapes people’s lives, thought patterns, behaviours, and health. To view the full wraparound service schedule for the site, please visit the WECOSS webpage: Consumption and  Treatment Services Site.          
 

PREPARED BY:

Planning and Strategic Initiatives Department

DATE:

September, 21 2023

SUBJECT:

2022 - 2025 Strategic Plan Q2 Report


BACKGROUND/PURPOSE

The WECHU’s 2022-2025 Refreshed Strategic Plan provides strategic direction to the organization. The plan defines the organizational vision, goals, and objectives to engage staff and support local public health outcomes within the community- with a specific focus on priority populations.

The Good Governance and Management Practices Domain of the Ontario Public Health Standards (2021) requires the Board of Health to provide governance direction and remain informed about the activities for organizational effectiveness through evaluation of the organization and strategic planning.

DISCUSSION

The 2023 Q2 Strategic Plan Progress Report provides the objectives under each strategic priority with corresponding updates to measure our advancement towards achieving the goal.

Progress has continued on a majority of the strategic objectives. The epidemiological report on the incidental impactsof COVID-19 has been completed, and the Equity, Diversity, and Inclusivity (ED&I) Committee has been organized.

The information collection process to assess and evaluate individual program priorities has been recently started and a significant portion of the work will be completed in Q3.


2023 Q2 STRATEGIC PLAN PROGRESS REPORT

WINDSOR-ESSEX COUNTY

HEALTH UNIT

DEPARTMENT OF PLANNING AND STRATEGIC INITIATIVES


2023 Q2 WECHU Strategic Plan Progress - At a Glance

 

Partnerships

Advancing meaningful partnerships that focus on health equity and priority populations.

2023

Q1

2023

Q2

2023

Q3

2023

Q4

1.1 Increase the number of collaborations

 

Objective met or is on track

 

 

1.2 80 %f emerging public health issues have partners

 

Progress being made towards achieving objective 

 

 

1.3 90%of partners serving priority populations satisfied with relationship with the WECHU

 

Progress being made towards achieving objective 

 

 

 

Organizational Development

Advancing operational excellence by increasing employee capacity and knowledge, and through continuous quality improvement efforts.

2023

Q1

2023

Q2

2023

Q3

2023

Q4

2.1 Equity, Diversity, and Inclusivity (ED&I) framework is developed and implemented by 2025

 

Objective met or is on track

 

 

2.2 Leadership Training Series completed by all managers and succession planning

 

Objective met or is on track

 

 

2.3 100% of departments have a developed CQI plan in place

 

Progress being made towards achieving objective 

 

 

2.4 Leadership Team direct engagement and communication with staff

 

Objective met or is on track

 

 

2.5 Staff mental assessment score improves year over year

 

Progress being made towards achieving objective

 

 

 

Effective Public Health Practice

Advancing programs and services through evidence informed decision-making, effective planning, and evaluation.

2023

Q1

2023

Q2

2023

Q3

2023

Q4

3.1 50% of programs w/ integrated priority population steering group feedback into plans & implementation

 

Progress being made towards achieving objective

 

 

3.2 100% of programs in cost-shared budget have been assessed for requirements, needs, and impacts

 

Work needed towards objective

 

 

3.3 Bi-Monthly Corporate Content Marketing Plan is on track

 

Work needed towards objective

 

 

3.4 Epidemiological report on the incidental impacts of COVID-19

 

Objective met or is on track

 

 

Legend

Work needed towards objective

 

Progress being made towards achieving objective

 

Objective met or is on track

 

PARTNERSHIPS

OBJECTIVE GOAL Q2 UPDATE
1.1 Increase collaborations to support equitable long-term approaches to addressing local public health needs. Increase the total number of collaborations.

Initiated a Community of Practice as part of the Infection Prevention and Control (IPAC)Hub Engagement to build capacity with IPAC leads of LTCH/RH/CLS to better manage local infectious diseases among our senior aged populations.

Promoting preconception health in a collaboration with Jamieson Laboratories, which provides donated vitamins that WECHU distributes to prenatal mothers.

Collaboration with Windsor Regional Hospital Family Birthing Centre to develop collaborative breastfeeding resources.

1.2 Foster strategic partnerships that advance and support action plans on emerging public health issues that reflect and advance WECHU’s core valuesand priorities.

80% of emerging public health issues have partners.

Current emerging public health issues include:

  • Opioids
  • Extreme Weather – Emergency Preparedness
  • Mpox
  • Respiratory Illnesses
  • Vector Borne Diseases
  • School Aged Immunization
  • HPV
  • Syphilis
  • Food Insecurity

63% of public health issues have identified partners (5 out of 8).

Onboarded 4 community-based organizations into the Ontario Naloxone Program in response to opioid overdose.

Finalized Service Agreement to formalize partnership with Hotel-Dieu Grace Healthcare for operations of the Safepoint Supervised Consumption site.

Providing parental education with the New Canadian Centre of Excellence on Immunization of School Pupils Act (ISPA) vaccine requirements for students.

Partnership with the Mennonite Central Committee Ontario to educate staff on pertussis with a focus on the Low German (Plattdeutsch) population.

Partnership with South Dougall Healthcare &Family Practice and TMC to address tuberculosis, and partnered with Sexual Health Windsor, Byng Clinic, and weCHC in relation to syphilis.

The WECHU Mpox campaign partnerships with Pozitive Pathways, wePride, and Gay Men’s Health Alliance.


ORGANIZATIONAL DEVELOPMENT

OBJECTIVE GOAL Q2 UPDATE
2.1 Develop and implement a framework for embedding diversity, equity, and inclusive (ED&I) approaches across the organization. Under the direction of the Human Resources Department, develop a singular overall ED&I framework for the organization and implement it by 2025. The Equity, Diversity, and Inclusion Selection Committee has been formed and is reviewing a list of interested internal staff to form the Committee.
2.2 Establish a structure for leadership development to ensure continuity of programs and services, supportive environments, and operational excellence. Completion of Leadership Training Series for all Managers and select staff. Currently 100% of applicable management staff have completed the Leadership Training Series. Additional staff are being identified as candidates to enroll in this course.
2.3 Incorporate continuous quality improvement (CQI) into organizational processes to ensure effective operations, resource management (human and physical), and adaptation to change. 100% of programs in cost-shared budget have been assessed for requirements, needs, and impacts. Exploring approaches and best practices to develop a Quality Improvement plan for corporate and departmental implementation. The plan will provide a framework for corporate and departmental quality improvement.
2.4 Advance internal communications efforts to improve employee knowledge and transparency of organizational goals, objectives, and priorities. Leadership Team directly engages all staff through various internal communication channels three(3) times per quarter.

During this quarter we engaged staff on:

  • Announcing the Equity, Diversity, and Inclusion Committee.
  • Work From Home Policy and the end of the COVID-19 Emergency Plans.
  • Updated IPAC Facility Policy regarding COVID-19 protocols.
2.5 Support employee mental health and well-being through effective and evidence informed strategies. Improvement on staff mental health assessment scores. Work has been started with the University of Windsor to identify potential opportunities for alignment related to employee mental health and well-being.

EFFECTIVE PUBLIC HEALTH PRACTICE

OBJECTIVE GOAL Q2 UPDATE
3.1 Ensure the inclusion of priority populations in the planning, development, and implementation of programs. 50% of programs w/ integrated priority population steering group feedback into plans & implementation.

Agreement with University of Windsor for research student involvement is being explored.

Priority Population Engagement Plan project scope and requirements document developed and reviewed with Leadership Team for implementation.

3.2 Evidence-based processes are embedded within the organization for planning, implementation, and evaluation to inform locally relevant programming. 100% of programs in cost-shared budget have been assessed for requirements, needs, and impacts.

Initiated the process of an organizational priority setting exercise process in cooperation with Departmental Directors and Managers to systematically assess program requirements, needs, and impacts.

This process will inform priorities for programs based on legislative requirements, severity of the health problems it addresses, community gaps in coverage, as well as equity and the social/economic burden associated with the negative health outcomes.

3.3 Continue to support and advance public communication of local health data and information. Bi-Monthly Corporate Content Marketing Plan is on track. Key public health messages for the quarter included linking the public to disclosure reports on wechu.org, 24-hour Movement Guidelines for adults, Oral Health month, Vision Health month, and Mental Health month. Additionally, active tick surveillance began with a media event, and SafePoint (Windsor’s Urgent Public Health Need site) officially opened its doors with a series of open house tours for the public.
3.4 Assessing and reporting on disproportionate health impacts related to COVID-19 and other key health indicators. Complete the report on the Incidental Impacts of COVID-19.

The Epidemiology and Evaluation Department has completed their report on the incidental and disproportionate impacts of the COVID-19 pandemic.

The report included the findings that some populations were more susceptible to, and disproportionately affected by, the impacts of public health measures. These populations include women, school-aged children,

Households of low socioeconomics (SES), racialized groups, young adults, frontline and healthcare workers, people who use substances, and individuals with pre-existing physical and/or mental health conditions. This report will be used to inform post- pandemic program planning. This priority is now deemed to be complete and will no longer be reported upon in future quarterly reports. Key health indicator reports and dashboards have been published on the WECHU.org webpage (https://www.wechu.org/reports) and will be continually updated.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Michael Horrobin, Judy Lund, Angelo Marignani, Michael Prue, Rob Shepley

Board Member Regrets:

Hilda MacDonald, Robert Maich

Administration Present:

Dr. Ken Blanchette, Dr. Mehdi Aloosh, Kristy McBeth, Eric Nadalin, Dan Sibley, Linda Watson, Lee Anne Damphouse

WECHU Guests:

Joanne Hegazi, Manager, Healthy Schools   
Marc Frey, Manager Planning & Strategic Initiatives


  1. Call to Order     
    Board of Health Chair, Fabio Costante, called the Regular meeting to order at 4:01 pm
    1. Quorum – Confirmed
    2. Land Acknowledgement - Read by Board Chair, F. Costante
    3. Declaration of Conflict of Interest – No conflicts declared
  2. Introduction:  New Board of Health Member, Provincial Appointee, Michael Horrobin   
    Board Chair, F. Costante, introduced and welcomed the WECHU’s newly appointed Provincial member, Michael Horrobin, to the Board of Health.  M. Horrobin noted that he was very interested in the needs of public health in the community and is happy to be serving in the capacity of a Provincial appointee to the Board of Health.
  3. Approval of Agenda     
    Motion:       That the agenda be approved.     
    CARRIED
  4. Approval of Minutes:  June 15, 2023     
    Motion:       That the minutes be approved.     
    CARRIED
  5. Medical Officer of Health Topical Update:  Respiratory Season (Dr. M. Aloosh) (for information)     
    Dr. M. Aloosh spoke on the upcoming respiratory virus season, and currently the risk in our local community is low to moderate.  Ontario’s Chief Medical Officer of Health spoke about Ontario being in a wave of COVID, although it is not severe at this time.  As we venture further into the fall, colds, RSV, COVID, and influenza will begin to circulate.  We continue with our messaging of staying home if you are sick, cover your nose and mouth when you cough, and wearing a well-fitted mask in indoor spaces based on an individual risk assessment..  We expect flu season to start earlier and end later this year. Flu strains are different every year and we have this years vaccines are predicated to work well to protect against the current virus.   Vaccines for flu and COVID will be available and individuals should speak with their health care providers around co-administering both flu and COVID vaccines.  The WECHU has a dedicated IPAC Hub team to work with high risk congregate living settings, including long-term care homes and retirement homes.  Public health is here to serve the community and we ask that Board of Health members help to circulate and advocate our messaging.   

    The question was asked if individuals tested positive for COVID-19 are they still required to isolate on top of other protocol such as staying home if you are sick.  There is some confusion with the general public.   

    Dr. M. Aloosh advised that COVID-19 can still cause many individuals to get very ill and, for some, it can be fatal, especially those that are compromised or at high risk.  It has been softened because of anti-viral medication and vaccines, but the messaging is still stay home if you are sick, get up to date on your vaccines, and if you are symptomatic or at risk speak with your health care provider.  We have information on the WECHU website and the province provides individual health supports and advice through Telehealth. He also suggested using a Rapid Antigen Test (RAT) to test for COVID. The question was asked how would one know if these tests were still effective, and Dr. Aloosh advised that these RATs have an expiry date and to check those dates.
  6. Presentation (4:14 pm)
    1. Student Immunization Coverage and Vaccine Opportunities (K. McBeth) (for information)   
      K. McBeth introduced the WECHU Manager of Planning and Strategic Initiatives, Marc Frey, and Manager, Healthy Schools, Joanne Hegazi.  She noted the great work accomplished by both of their  teams in student immunization and the reports included in todays package. Through their efforts, school age individuals in Windsor-Essex are over 90% compliant with Ontario’s Immunization of School Pupils Act (ISPA) and provided the following information through slides:   
      The role of Public Health:   
      •    Public health units are required under the ISPA to review student immunization records for students in their areas to ensure compliance   
      •    Routine immunizations to Grade 7 students in Windsor-Essex (vaccine series Hepatitis B, Human Papillomavirus (HPV) and Meningococcal Disease)   
      •    The WECHU offers immunization catch-up clinics and strategies for missed vaccination and works with local health care providers to ensure the provision of school aged vaccines and those that are required to attend school    
      •    WECHU in-house catch up clinics were quite full over the summer   

      Current School Aged Immunization coverage:   
      •    Immunization coverage for students in Windsor-Essex varies by disease, ranging from 61.5% for HPV to 95.3% for Rubella   
      •    Coverage rates for all diseases (except Rubella) fall below the national target of 95% for childhood vaccines and 90% for adolescent vaccines   

      Next Steps:    
      •    Over the next 12 months we will start the first round of grade 7 school based immunization clinics (round 1), once concluded in December we will resume catch up immunization strategies and a full record review for all grades (JK-12).    
      •    Enforcement of the ISPA for both elementary and secondary school students will take place in March (each separate dates) as the start of our maintenance strategy.    
      We will then complete the second round of grade 7 immunizations and during the summer months focus proactively on readiness for  JK/SK students and local daycares.   

      Outcomes of Completed Process in 2022-2023 and Opportunities for the Board of Health:   
      •    Improved immunization coverage for school aged individuals is a direct outcome of the completed enforcement process    
      •    Maintenance is the only way to keep up – it is resource intensive but important for public health    
      •    Our commitment needs to be barrier-free access to vaccines to improve protection    
      •    Catch up immunization and timely initiation of childhood vaccines should be a priority for those with missing doses   
      •    The Board of Health can encourage ongoing resource support for public health in the area of school age immunization to maintain and improve coverage rates (WECHU goal is to reach national immunization targets – 90- 95% coverage dependant on disease), as well as advocate for improved access for HPV vaccine coverage under the provincially funded vaccine program   

      HPV Vaccination:   
      •    Approximately 61.5% of eligible students in Windsor-Essex are immunized against HPV – this varies by age and coverage is slightly higher in females than in males   
      •    The cost of the HPV vaccination series (3 doses at $215/dose) is covered by the Ontario government for students in Grade 7-12 and the WECHU offers this vaccine to all Grade 7 students annually   
      •    The HPV vaccine is also available to some high priority individuals at no cost (covered by the province) including self identified men who have sex with men, individuals who identify as gay or bisexual and some people who identify as transgender, up to the age of 26.   
      •    For individuals who do not meet these criteria, the vaccine can be purchased with a prescription through a health care provider.    
      •    K. McBeth directed the Board to Section 8.0, Resolution, Recommendation Reports, Item 8.1, HPV Vaccine Coverage in Ontario.   

      Moved:        That the above information be received.   
      CARRIED
  7. Consent Agenda (for approval)     
    F. Costante asked if there were any items under the Consent Agenda that the Board would like to discuss prior to approval. There were none.
    1. Information Reports (for approval)
      1. Annual Service Plan Q2 2023 Reporting and accompanying Report
      2. 2022- 2025 Strategic Plan Q2 Report and accompanying Report
      3. Monthly SafePoint Site Operations Updates:
        1. July 2023
        2. August 2023
      4. W-E Community Opioid and Substance Use Strategy Update 
      5. Immunization Coverage in 7, 12 and 17 year olds in W-E County
      6. Seasonal Influenza and COVID-19 Season 2023/2024
      7. Q2 2023 Board of Health Feedback Survey Results
      8. Communications Reports
        1. June 2023
        2. July 2023
        3. August 2023   
          Motion:               That the above information be approved.     
          CARRIED        
    2. Correspondence
      1. Municipality of Chatham-Kent Public Health - Letter to Hon. Doug Ford, Premier, and Hon. Syvia Jones, Deputy Premier and Minister of Health - Universal, No-cost coverage for all Prescription Contraceptive Options to all People Living in Ontario - for support 
      2. Windsor-Essex County Health Unit - Federal School Food Policy and Advocacy Letter - Letter to Hon. Chrystia Freeland, Minister of Finance and Deputy Prime Minister, Hon. Jenna Sudds, Minister of Families, Children and Social Development, Hon. Lawrence MacAuley, Minister of Agriculture and Agri-Food, and Hon. Jean-Yves Duclos, Minister of Policy and Procurement - Investing in a Sustainable Federal School Food Policy - for approval   

        Motion:    That the Board support the Municipality of Chatham-Kent’s letter to The Hon. Premier Doug Ford and The Hon. Sylvia Jones for No-cost coverage for all Prescription Contraception Options for all people living in Ontario   
        CARRIED   
        Motion:    That the Windsor-Essex County Health Unit’s Letter to The Hon. Chrystia Freeland, and various ministers advocating for a Federal School Food Policy be approved.   
        CARRIED
  8. Resolutions/Recommendation Reports
    1. HPV Vaccine Coverage in Ontario (K. McBeth) (for approval)   
      K. McBeth spoke of HPV Vaccine Coverage in Ontario in Section 6.1 above, and that Board of Health advocacy is where we may see changes at the provincial level.  WECHU Resolutions are also shared with other public health units for their information and/or support.  The following motion was put forth for the Board’s consideration:   
      Motion:               That the Windsor-Essex County Board of Health recommends that the Province of Ontario extend the coverage for HPV vaccine through the publicly funded vaccine schedule to include all individuals up to the age of 26 (at minimum), and to eligible individuals from all high-risk populations (age limit based on product monograph).    

      Further that the Windsor-Essex County Board of Health recommends local health care providers in Windsor and Essex County engage all clients under the age of 45 and parents/guardians of children in grades 6-12 to discuss: HPV vaccine status, review the benefits of HPV vaccination, and discuss options for those eligible and unvaccinated/undervaccinated. 
  9. New Business
    1. CEO Report (K. Blanchette) (for information)     
      K. Blanchette provided the following CEO updates:      
      •    He attended the Association of Public Health Business Administrators Conference on September 10-12, 2023, continuing to build on relationships with other public health units and one-on-one connections with those in charge of our funding  
      •    Letters of Support were sent to the City of Windsor and County of Essex in support of ProsperUs Advocacy Working Group’s letter regarding increased access to Primary Care Providers in the Windsor-Essex Region  
      •    K. Blanchette has met with the Executive Director of the Childrens’ Aid Society, and continues to build a strong relationship.  
      •    He has been asked to participate in the International Association for Great Lakes Research Annual Conference (IAGLR) in May 2024 “Shared Lakes: One Water, One Health”. The conference will highlight the environment and public health, and they are looking to the Ministry for key note speakers  
      •    The WECHU participated in and supported the Windsor-Essex Pride Fest  
      •    The WECHU participated in a Fall Respiratory Disease Exercise in August  
      •    K. Blanchette provided a brief update on SafePoint, the Consumption and Treatment Services Site, noting that we are still awaiting provincial approval.  At this time we are uncertain of the delay and there has been ongoing and excellent communication with the province.  We have provided what was required and the province continues to stay in touch.  This is a very detailed process but we have not yet been provided a timeline.  The WECHU and Family Services Windsor-Essex (FSWE) have submitted a joint proposal to the High Priority Community Funding Committee (HPCF) for joint funding, and we recently received a letter from the HPCF Committee that joint funding will be forthcoming for SafePoint.
    2. Ministry of Health, Public Health Announcement (K. Blanchette) (for information)   
      K. Blanchette referred to the presentation, 2023 Ministry of Health Funding Approval and noted the following:  
      •    The Ministry of Health’s 1% increase in funding for public health units of 1%, each year for 3 years.  With the funding announcement coming later in the year, our funding was pro-rated for this year at 0.75%.  
      •    We have received the MOH/AMOH compensation initiative of $28,200, which is 100% funded by the Ministry.  
      •    We were awarded $651,400 for the Ontario Seniors Dental Care Program (OSDCP) to assist in staff and resources to reduce wait times.  We are outsourcing as well.  The WECHU’s move to the University of Windsor will increase the size of our dental operatories from 3 to 7, also reducing that impact.  The OSDCP is also 100% funded by the Ministry.  
      •    One-time funding was also discussed and we are participating in conversations with the Ministry around mitigation funding.   

      Correspondence from the Association of Local Public Health Agencies (alPHa) and the Association of Public Health Business Administrators noting the 1% increase in funding was presented to the Board for information.
      1. Correspondence from Association of Local Public Health Agencies (alPHa)
      2. Correspondence from Association of Ontario Public Health Business Administrators  
        Motion:               That the information be received as presented.  
        CARRIED
  10. Committee of the Whole (CLOSED SESSION, in accordance with Section 239 of the Municipal Act)     
    The Board moved into Committee of the Whole at 4:50 pm     
    The Board moved out of Committee of the Whole at 5:53 pm
  11. Next Meeting: At the Call of the Chair or To be Determined
  12. Adjournment     
    Motion:               That the meeting be adjourned.     
    CARRIED

    The meeting adjourned at 5:53 p.m.


RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU BOH – November 20, 2023

ISSUE/PURPOSE

Human Papillomavirus (HPV) is a very common virus that can cause many types of cancers. HPV can infect both males and females. Without immunization, approximately 3 out of 4 people will have at least one HPV infection in their lifetime 2. The Ontario government covers the cost of the HPV vaccination series for students in Grade 7-12 through the school-based immunization program.  The WECHU offers this vaccine to all grade 7 students in Windsor and Essex County schools each year. In Ontario, this vaccine is also available for free to men who have sex with men, individuals who identify as gay or bisexual, and some people who identify as transgender, up to the age of 26. For individuals not meeting these criteria, the vaccine can be purchased privately with a prescription. The HPV-9 vaccine currently used in the province is approximately $645 for a complete series ($215/dose)[i]. This cost may be covered through some private insurance plans, but would be considered prohibitive for many individuals considering vaccination.

Each year 3,800 new cancer cases in Canada are attributed to HPV; by 2042, this number will increase to 6,600[ii]. HPV infection increases the risk of developing six different types of cancer. Cervical cancer is almost exclusively caused by HPV and is the leading cause of most oropharyngeal cancers. It usually takes years after being infected with HPV for oropharyngeal cancer to develop, and not all oropharyngeal cancers are caused by HPV. While population-level Ontario data on the incidence of oropharyngeal cancers caused by HPV has only just begun to be collected, research has shown that the incidence of oropharyngeal cancers caused by HPV has increased in Canada since 2000. [iii] [iv]

As a part of an equity-based initiative, all strategies to reduce cervical and other cancers must consider health disparities and minimize existing barriers, such as cost, to be effective. The 2019–2029 Canadian Strategy for Cancer Control and the Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 address the health inequities and barriers in accessing preventative care such as HPV vaccination that are experienced by rural and remote communities, people with low income, recent immigrants, First Nations, Inuit and Métis and other populations, such as LGBTQ2S+ individuals. 

The HPV vaccine product currently used in Ontario as a part of the publicly funded vaccine program, is authorized for use by the manufacturer in males and females aged 9 to 45 years old. The National Advisory Committee on Immunization (NACI) recommends this vaccine for all individuals between the ages of 9 to  26. According to Health Canada, HPV vaccination is recommended for females aged 9 to 45 and for males aged 9 to 26. For best protection from the vaccine, it should be administered before an individual becomes sexually active.

The current provincially funded vaccination schedule provides limited access to this free of charge important vaccine,  and creates a missed opportunity for an important preventative, protective, and evidence based public health strategy. 

BACKGROUND

HPV infection does not often show symptoms and can be spread easily by intimate skin to skin contact. In some cases, symptomatic HPV infections may even clear up on their own without treatment over time. Some infections cease to disappear and can lead to cancer. Certain high-risk HPV strains (i.e., types) can cause cervical cancer and are often associated with cancers of the penis, anus, vulva, vagina, mouth, and throat. Certain low-risk strains can cause warts. The virus can be passed from an infected mother to baby before and during birth. Newborns with HPV are at risk of developing respiratory papillomatosis. 

The current HPV vaccine used in Ontario can protect against nine strains of HPV infection. Vaccination works best when it is received prior to exposure to HPV and will not protect against existing HPV infections or HPV strains not included in the vaccine. Additional prevention activities for women include receiving regular Pap tests (the current recommendation in Ontario is a Pap test every 3 years[v]), even after receiving HPV vaccine. Since 2007, 99 countries and territories have developed comprehensive human papillomavirus vaccination programs. In 2019, a Canadian study demonstrated strong evidence that HPV vaccination prevents infections, genital and anal warts, and precancerous lesions at a population level. The impacts were seen in both females and males. [vi]

The best way to prevent HPV is getting the HPV vaccine. Not only is immunization the best preventative strategy, it’s also cost effective. In a recent study, it was found that the Return on Investment for HPV vaccination was consistently above 1 (range: 1.4–3.58), which means for every dollar spent on HPV vaccination up to 3.58 dollars are saved.[vii]

PROPOSED MOTION

Whereas, the NACI recommends HPV vaccination in all individuals ages 9 to 26, inclusively, and 

Whereas, the Government of Canada’s HPV vaccination rate coverage target of 90% is based on disease reduction targets, program impact, disease characteristics, achievability, and jurisdictional variation in vaccination programs, as well as quality and effectiveness of the vaccine, and

Whereas, HPV vaccination is an evidence informed, cost-effective strategy to reduce related cancer risks, and

Whereas, the HPV vaccine is a critical component of the Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 which aims to eliminate cervical cancer by 2040, and

Whereas, the WECHU’s current HPV vaccination coverage rate for individuals 12-17 years old is 61.47%.

Therefore be it resolved that the Windsor-Essex County Board of Health recommends that the Province of Ontario extend the coverage for HPV vaccine through the publicly funded vaccine schedule to include all individuals up to the age of 26 (at minimum), and to eligible individuals from all high-risk populations (age limit based on product monograph). 

Further that the Windsor-Essex County Board of Health recommends local health care providers in Windsor and Essex County engage all clients under the age of 45 and parents/guardians of children in grades 6-12 to discuss: HPV vaccine status, review the benefits of HPV vaccination, and discuss options for those eligible and unvaccinated/undervaccinated.


[i] Habbous S, Chu KP, Lau H, et al. Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centers using multiple imputation. CMAJ. 2017:189(32);E1030–40.

[ii] Canadian Population Attributable Risk of Cancer ComPARe) study. Get vaccinated against HPV 

to reduce your cancer risk [internet]. Prevent. cancer.ca [cited 22 October 2020] Available from https://prevent.cancer.ca/wp-content/ uploads/2019/05/CMPR_1pgr_HPV-EN.pdf

[iii] Nichols AC, Palma DA, Dhaliwal SS, et al. The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population. Curr Oncol. 2013;20(4):212–9.

[iv] Habbous S, Chu KP, Lau H, et al. Human papillomavirus in oropharyngeal cancer in Canada: analysis of 5 comprehensive cancer centers using multiple imputation. CMAJ. 2017:189(32);E1030–40.

[v] https://www.ontario.ca/page/cervical-cancer-testing-and-prevention, Ontario Ministry of Health. October 2021.

[vi] Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Mélanie Drolet, PhD, Élodie Bénard, MSc, Norma Pérez, MSc, Prof Marc Brisson, PhD. June 26, 2019.

[vii] Return on Investment (ROI) of Three Vaccination Programmes in Italy: HPV at 12 Years, Herpes Zoster in Adults, and Influenza in the Elderly. Marco Barbieri and Sara Boccalini. April 2023.