Minutes - October 17, 2024 - Board of Health Meeting

Thursday, October 17, 2024, 7 p.m.
Microsoft Teams

Members Present: 

Michael Steele (Vice-Chair) (presiding)
Peter Cuddy (exited at 7:58 p.m.)
Matthew Newton-Reid (exited at 7:58 p.m.)
Howard Shears
Michael McGuire
Selomon Menghsha
Aina DeViet
Dr. Joanne Kearon, Acting Medical Officer of Health (ex-officio)
Emily Williams, Chief Executive Officer (ex-officio)

Regrets:

Skylar Franke
Michelle Smibert
Dr. Alexander Summers, Medical Officer of Health (ex-officio)

Others Present:

Stephanie Egelton, Executive Assistant to the Board of Health (recorder)
Cynthia Bos, Associate Director, Human Resources and Labour Relations
Dale Percival, Senior Audit Manager, KPMG LLP (exited at 8:12 p.m.)
Katie DenBok, Partner, Audit, KPMG LLP (exited at 8:12 p.m.)
Jennifer Proulx, Director, Family and Community Health/Chief Nursing Officer
Sarah Maaten, Director, Public Health Foundations
Ryan Fawcett, Manager, Privacy, Risk and Client Relations
Melissa Thompson, Manager, Vaccine Preventable Disease
Dr. Amanda Perri, Epidemiologist

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

Closed Session

At 7:01 p.m., it was moved by P. Cuddy, seconded by H. Shears, that the Board of Health will move into a closed session to consider matters regarding 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, a trade secret or scientific, technical, commercial, financial or labour relations information, supplied in confidence to the municipality or local board, which, if disclosed, could reasonably be expected to prejudice significantly the competitive position or interfere significantly with the contractual or other negotiations of a person, group of persons, or organization and to approve previous closed session Board of Health minutes.
Carried

At 7:58 p.m., it was moved by H. Shears, seconded by A. DeViet, that the Board of Health return to public session from closed session.
Carried

Disclosure of Conflict of Interest

Vice-Chair Steele inquired if there were any disclosures of conflicts of interest. None were declared.

Approval of Agenda

It was moved by S. Menghsha, seconded by A. DeViet, that the AGENDA for the October 17, 2024 Board of Health meeting be approved.
Carried

Approval of Minutes

It was moved by M. McGuire, seconded by S. Menghsha, that the MINUTES of the September 19, 2024 Board of Health meeting be approved.
Carried

It was moved by A. DeViet, seconded by H. Shears, that the MINUTES of the September 19, 2024 Performance Appraisal Committee meeting be received.
Carried

It was moved by M. McGuire, seconded by S. Menghsha, that the MINUTES of the September 19, 2024 Finance and Facilities Committee meeting be received.
Carried

New Business

2023 Draft Audited Financial Statements (MLHU1) (Report No. 72-24)

Dale Percival, Senior Audit Manager and Katie DenBok, Partner, Audit, both of KPMG presented the Draft Audited Financial Statements (MLHU1) to the Board of Health.

D. Percival reviewed the audit findings for the Health Unit’s audit and noted the following:
• Auditors are required to report materialities. Materiality of $890,000 (2022 - $1,080,000) was determined based on preliminary total expenses resulting in an audit misstatement posting threshold of $44,500 (2022 - $54,000).
• There were no significant unusual transactions.
• There were no controlled efficiencies or audit misstatements corrected or incorrected identified during the audit.

D. Percival noted that KPMG substantially completed the audit as of October 17 and added that there are some minor supports that are being sought but will not take long to complete the audit. Once these final supports (documents) are provided, the Chief Executive Officer can sign the management representation letter, where the final statements can be issued.

There were no questions or discussion.

It was moved by M. McGuire, seconded by H. Shears, that the Board of Health:
1) Receive Report No. 72-24 re: “2023 Audited Financial Statements-Draft” for information; and
2) Approve the audited Financial Statements for the Middlesex-London Health Unit for the year ending December 31, 2023.
Carried

Emily Williams, Chief Executive Officer reminded the Board that voluntary retirement incentives were a part of the 2023 restructuring that the Health Unit conducted. E. Williams noted that in the Q2 update, the retirement incentive payments had been reported as included in 2024 but upon the advice of our auditors, these payments were moved back into 2023 as appropriate, which resulted in restated financials for the year.

E. Williams further noted that the Health Unit has insufficient surplus to cover the entire amount (of retirement incentive payments) from last year and requested the use of $66,296 in reserve funds from the employment cost reserve to cover the remaining balance.

There were no questions or discussion.

It was moved by A. DeViet, seconded by S. Menghsha, that the Board of Health approve the use of reserve funds $66,296 from 2023 to cover the outstanding amount of the unfunded/unbudgeted Voluntary Retirement balance of $292,000.
Carried
At 8:12 p.m., D. Percival and K. DenBok exited the meeting.

Q3 2024 Risk Register Update (Report No. 67-24)

Ryan Fawcett, Manager, Privacy, Risk and Client Relations presented the Q3 2024 Risk Register Update to the Board of Health.

R. Fawcett noted there are six (6) risks identified in Q3. Three (3) are high risk, two (2) carry significant residual risk related to continued financial pressures and reduced productivity and resilience post restructuring. R. Fawcett noted that for the second risk, this has been mitigated through the introduction of the Associate Manager position and priority setting exercises to focus on critical functions not competing initiatives. Priorities for Q4 of 2024 are continued support for staff, cyber security, reducing the financial gap and business continuity planning.

There were no questions or discussion.

It was moved by M. McGuire, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No.67-24 re: “Q3 2024 Risk Registry” for information; and
2) Approve the Q3 Risk Register (Appendix A)
Carried

2023-24 Compliance with the Immunization of School Pupils Act in Middlesex-London Schools (Report No. 68-24)

Dr. Joanne Kearon, Acting Medical Officer of Health introduced Melissa Thompson, Manager, Vaccine Preventable Disease and Dr. Amanda Perri, Epidemiologist to provide information on the immunization compliance rates for pupils within the Middlesex-London community.

Dr. Perri noted that preliminary estimates indicate that the ongoing efforts by the Vaccine Preventable Disease team are having a significant positive impact on both vaccine compliance and coverage rates. These rates are either comparable to or have surpassed the pre pandemic levels, however noting that the Health Unit observed a slight decrease in polio vaccination coverage among younger populations. The decline for this vaccination is likely attributable to the recent update from the Ministry of Health, which invalidated all doses of the oral polio vaccine administered after April 1, 2016. Further, vaccinations exemptions range from 3.1% to 4.2% and may be granted for medical reasons, personal or religious beliefs. It was clarified that compliance refers to the extent to which individuals have adhered to the recommended vaccination schedules, whereas immunization coverage measures the proportion of the population that is vaccinated.

Data for compliance and coverage was extracted on August 31, 2024 by the Population Health and Surveillance Team. The compliance estimates for the 2023-2024 school year have increased by 9.5% to 23.3% across the various diseases compared to the previous year, resulting in overall compliance rates ranging from 90.6% to 98.6%. When looking at the preliminary coverage data, an increase by 0.2% to 2.3% for the 2023-2024 academic year is observed, although coverage for polio decreased by just under 1%. Overall, the coverage estimates for this year are between 87.4% and 94.7% in Middlesex-London.

M. Thompson explained that students will come up on the overdue list (for vaccination) for a variety of reasons related to their immunization record status, such as no record on file (this mostly occurs with junior kindergarten students and newcomers coming into Middlesex-London), the record does not have all doses required for each antigen and students who did not receive all vaccines required by their age. Last year, there were 6000 students that had no record on file at the beginning of the school year. The Vaccine Preventable Disease team sends a letter to the parents and guardians of these children and are compliant either with suspension or without. Close to 22% of students received letters, and the majority of these students complied.

M. Thompson explained that the Vaccine Preventable Disease team has partners and collaborations to achieve compliance rates for vaccination and to support those in the community seeking vaccination for students. The team works with other areas of the Health Unit to employ collaboration and communication strategies, as well as with community partners such as London Inter-Community Health Centre, the London Cross-Cultural Learner Centre and with settlement workers in schools. These partners provide some access to specific populations, interpretation and some assistance with newcomers to help them understand the process. M. Thompson further noted that the Vaccine Preventable Disease team also provides resources, support and vaccine to healthcare providers in the community.

M. Thompson noted that while the process is successful, the Vaccine Preventable Disease team has several challenges each year during the vaccination compliance process for students. These challenges include:
• Using mail as communication method to families
• Timeframe required to complete screening / suspension
• Exemptions
• Increased school enrollment
• Increased newcomers with out-of-country immunization records
• Increased students from outside of Middlesex-London
• Other programming priorities

M. Thompson concluded with planning for 2024-2025. It is known that about 23% of students are overdue for their vaccinations, and ongoing communications are being conducted with schools, healthcare providers, families and social media. The team will expand clinic appointments when suspension letters have gone out, and the team continues to do summer screening. The team has also reached out to more than 4000 families through letters or phone calls to advise of specific overdue status for their students and for confirming addresses and phone numbers. M. Thompson added that the team is currently halfway through the first round of screening and off to a great start.

Board Member Howard Shears inquired why children in Gaza have been immunized against polio this summer with oral vaccinations, while Canada has invalidated some of the polio vaccinations. M. Thompson explained that the doses of oral polio vaccine were invalidated after 2016 because these vaccine doses protected against only two types of polio, when polio vaccinations should protect against three different types. With the invalidation of these doses, the community is being encouraged to receive the polio vaccine that protects against three strains of polio. M. Thompson added that in Canada, no oral polio vaccine is provided and only the IPV containing injectable vaccine is provided.

It was moved by A. DeViet, seconded by H. Shears, that the Board of Health receive Report No. 68-24 re: “2023-24 Compliance with the Immunization of School Pupils Act in Middlesex-London schools” for information.
Carried

Governance Committee Meeting Summary (Verbal Report)

Selomon Menghsha, Acting Governance Committee Chair reviewed the reports and proposed changes to governance policies to the Board of Health.

The Governance Committee reviewed 12 policies for the Board’s consideration:
• G-190 Asset Protection
• G-220 Contractual Services
• G-230 Procurement
• G-240 Tangible Capital Assets
• G-250 Reserve and Reserve Funds
• G-310 Corporate Sponsorship
• G-320 Donations
• G-330 Gifts and Honoraria
• G-370 Board of Health Orientation and Development
• G-380 Conflicts of Interest and Declaration
• G-470 Annual Report
• G-500 Respiratory Season Protection

It is noted that there were queries and comments made regarding changes to G-210 Investing and G-320 Donations that require further research specific to finance. These policies will be brought for consideration to a future meeting. All other policies had housekeeping amendments or amendments that are minor in nature, which the Committee supported.

There were no questions or discussion.

It was moved by S. Menghsha, seconded by A. DeViet, that the Board of Health:
1) Receive Report No. 03-24GC re: “October 2024 - Governance Policy Review” for information;
2) Defer the review of G-210 Investing and G-320 Donations to a later date; and
3) Approve the governance policies as amended in Appendix B.
Carried

2025 Board and Committee Meeting Dates (Report No. 69-24)

E. Williams introduced the 2025 Board and Committee meeting dates for the Board of Health’s consideration. Staff are proposing to move the January and April meetings by one (1) week to accommodate for the office closure and the Easter statutory holidays, to not have an August meeting and to move all meetings in 2025 to be in-person. E. Williams noted that under the Municipal Act and the Board of Health’s procedural by-law that Board Members may attend meetings virtually as required.

There were no questions or discussion.

It was moved by M. McGuire, seconded by S. Menghsha, that the Board of Health:
1) Receive Report No. 69-24 re: “2025 Board of Health and Committee Meeting Dates” for information; and
2) Approve the 2025 Board of Health and Committee Meeting Dates as presented in Appendix A.
Carried

Current Public Health Issues (Verbal Report)

Dr. Joanne Kearon, Acting Medical Officer of Health presented the “Current Public Health Issues” update to the Board of Health.

Legionella Outbreak Update
The Legionella outbreak update was declared over as of October 11. It was determined the outbreak period was May 1 to September 26 and in that time frame there were 30 confirmed Legionella cases. All of those cases were hospitalized, with nine (9) in the intensive care unit and two (2) deaths. The age range was between 37 and 87 years old. For someone to be diagnosed with Legionella, it typically means that their symptoms were severe enough that they went to the hospital and were tested, which is the only way to be diagnosed.

During the investigation, the Health Unit collected 71 environmental samples from 18 different cooling tower sites. Legionella was detected at 11 sites and were non-viable or a species that were less likely to cause an outbreak. The clinical samples can be used to indicate where the outbreak was coming from, however some samples are still pending from the Public Health Ontario laboratory. A common source has still not been confirmed; however, all of the clinical samples do have the same subtype of Legionella. This suggests that the individuals all were infected from a common source.

The outbreak was declared over because there were no new cases for 24 days, which is the incubation period of Legionella.

Respiratory Vaccines
Vaccination programs in 2024-2025 for COVID-19, Influenza, and RSV are all active and generally aligned with eligibility criteria and availability timelines.

For COVID-19, the approved vaccines are Pfizer and Moderna to protect against the KP2 variant that is more likely to be circulating the community currently. As of October 8, it is available for the highest risk individuals and priority populations. The general population will be eligible on October 28 to receive the vaccine. For influenza, there are four available vaccines. Individuals older than 65, priority populations and highest risk individuals can receive the vaccine now, with the general population being eligible on October 28. It is noted that both the COVID-19 and influenza vaccines can be received at the same time. Further, the Health Unit will not be conducting mass vaccination clinics this year and it is encouraged to get vaccinated at a pharmacy or healthcare provider.

For respiratory syncytial virus (RSV) vaccines, there are two separate programs. One is for high-risk adults, primarily those in long term care homes, in-patients at hospitals and certain priority populations. The other program is for infants, as they are the highest risk population for severe outcomes related to RSV. Infants can be vaccinated at the hospital after birth and children can be vaccinated at their healthcare provider. The RSV vaccine can be administered at the same time as the COVID-19 and influenza vaccines. Pharmacies are not administering RSV vaccines for publicly funded individuals.

Respiratory Season Update

The Middlesex-London region is not yet in a high-risk period. New outbreaks continue to be high, and it is mainly due to COVID-19. New hospitalizations have low severe outcomes due to improved immunity from vaccination and natural infection. Percent test positivity for COVID-19 peaked last month, however, we are not yet seeing cases of influenza in the emergency department. As the community is in respiratory season, there are other viruses circulating and being tested in emergency departments, so the Health Unit is aware of the said circulating respiratory illnesses.

MLHU in the News
The Middlesex-London Health Unit was in the media many times this month. There were interviews given regarding Legionella, awareness of COVID-19 risks, and vaccines.

There were no questions or discussion.

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

Acting Medical Officer of Health Activity Report for September (Report No. 70-24)

Dr. Kearon presented her activity report for September and noted that this would be her last report as Acting Medical Officer of Health. Dr. Kearon will resume the duties as Associate Medical Officer of Health upon Dr. Summers’ return at the end of October.

There were no questions or discussion.

It was moved by A. DeViet, seconded by M. McGuire, that the Board of Health receive Report No. 70-24 re: “Acting Medical Officer of Health Activity Report for September” for information.
Carried

Chief Executive Officer Activity Report for September (Report No. 71-24)

E. Williams presented her activity report for September. E. Williams thanked Dr. Kearon for her partnership and leadership over the past three (3) months.

There were no questions or discussion.

It was moved by H. Shears, seconded by M. McGuire, that the Board of Health receive Report No. 71-24 re: “Chief Executive Officer Activity Report for September” for information.
Carried

Correspondence

It was moved by S. Menghsha, seconded by M. McGuire, that the Board of Health receive items a) through d) for information:
a) Public Health Sudbury and Districts re: New measures to help prevent harms to youth from nicotine replacement therapies
b) Peterborough Public Health re: Support for Bills S-233 and C-233 “An Act to develop a national framework for a guaranteed livable basic income”
c) Haliburton, Kawartha and Pine Ridge District Health Unit re: Support for Bills S-233 and C-233 “An Act to develop a national framework for a guaranteed livable basic income”
d) Middlesex-London Board of Health External Landscape for October 2024
Carried

Other Business

The next meeting of the Middlesex-London Board of Health is Thursday, November 21, 2024 at 7:30 p.m. Vice-Chair Steele noted that a Special Meeting of the Board of Health will also be occurring on Thursday, November 21, 2024 at 6 p.m.

Adjournment

At 8:40 p.m., it was moved by M. McGuire, seconded by H. Shears, that the meeting be adjourned.
Carried

Michael Steele
Vice-Chair

Emily Williams
Secretary