The missing provincial health data

Here’s what we're following in the world of health security this week, including an investigation revealing a dearth of provincial health data, the staggering rate of health-care ransomware attacks and a ‘mind-blowing’?vaccine for Marburg.??

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Canada’s health data dearth

A Globe and Mail investigation into ER wait times across Canada revealed that many Canadians are suffering long waiting times when they visit a hospital in an emergency. At the start of 2024, for example, The Globe found that just 10 percent of Ontario hospitals met the provincial target of an eight-hour maximum stay in ER for admitted patients —?down from 25 percent prior to the pandemic. The worst of the bunch was Toronto’s Sunnybrook Hospital, where wait times in July for admitted emergency patients hit an average of 25.9 hours.??

But while some provinces were able to provide that kind of data, many weren’t, suggesting a significant lack of vital up-to-date information about the state of Canada’s health-care system. The Globe’s investigation noted that critical data from multiple provinces is missing from databases at the Canadian Institute of Health Information (CIHI), which was established by the federal and provincial governments with the intention that it would be a repository for multi-jurisdictional data. For example, CIHI’s National Ambulatory Care Reporting System (NACRS) has 20 million records from over 85 percent of ER departments in Canada. But information from New Brunswick, Newfoundland and Labrador, the Northwest Territories and Nunavut is missing from the system, and only partial data exists for P.E.I., Nova Scotia, Manitoba, Saskatchewan and B.C.

“As we pour tens and maybe hundreds of billions of dollars into health care, we should know what we’re paying for,” one expert told The Globe.?

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State of ransomware in health care?

A new survey of 5,000 cybersecurity and IT leaders, including hundreds in health care, has found that a staggering 67 percent of health-care organizations were hit by ransomware in 2024, up from 60 percent in 2023, and more than double the reported rate in 2021, when just 34 percent reported being hit.??

This bucked the global trend of an overall decrease in total ransomware attacks from 66 percent to 59 percent over the last two years. The manner in which criminals are gaining entry is also changing slightly. The proportion of attackers that gained entry via a malicious email or phishing attempt dropped in the last year, while the proportion of entries made via compromised credentials or an exploited vulnerability went up.?

The annual survey, conducted by U.K. security software and hardware company Sophos, also revealed that just over half (53 percent) of health-care organizations that had data stolen paid a ransom to get it back. The study also found that, of the 155 respondents who were willing to say how much ransom was demanded of them, the median payment made was about US$1.5 million.?

But ransom payments are only part of the cost of recovery for health-care organizations hit with a cyberattack. The survey also found that the average cross-sector recovery costs in 2024 were $2.73 million —?up from $1.82 million in 2023. It’s also now taking longer than ever to recover from a ransomware attack?— 42 percent of respondents said that it took up to a month to recover (up from 24 percent last year), and 29 percent said it took between 1 and 3 months (up from 22 percent who said the same thing last year).

Storm-ravaged supply chain

Health-care supply chain fragility has been highlighted in the wake of successive storms hitting the southeastern United States, specifically when it comes to IV fluids. Flooding from Hurricane Helene forced a Baxter International facility that produces around 60 percent of the U.S. supply of IV solutions to close. That has already meant that some hospitals across the country are having to stretch their remaining IV fluid reserves or rely on a sports drink like Gatorade to hydrate patients. At one point last week, 86 percent of U.S. health-care providers were reportedly experiencing IV shortages. About half of providers surveyed said they had only 10 days or less of supplies, down from an average of 15-22 days.?

The situation has threatened to become more dire as Hurricane Milton, which slammed into Florida last week, affected the second-largest IV solution supplier in the U.S., a plant owned by B. Braun. While Baxter was caught off guard by Helene, which had a larger impact on North Carolina than had been expected (specifically around Asheville, close to the Baxter plant), B. Braun had fair warning and moved to secure its supply. Nevertheless, the storms have again highlighted the often tenuous threads of the health-care supply chain. In 2023, a tornado damaged a Pfizer plant that produced a quarter of the nation’s sterile injectable drugs.??

In the wake of the shortages, the U.S. Department of Health and Human Services issued a letter saying it was co-ordinating a government-wide response and working with public and private partners to support the supply chain while the Baxter facility is brought back up to capacity. In the meantime, the HHS also recommended that providers could mix their own fluids to relieve shortages.?

Rapid Marburg response

Rwanda has imposed a travel ban on anyone who reports any potential symptoms of the deadly Marburg virus within 24 hours of departure. At the same time, the U.S. has said it will now screen all travellers from that country for the virus.??

Rwandan health officials have also announced that the country will begin distributing a vaccine currently under trial to health workers and emergency responders, along with people who have been in contact with confirmed Marburg cases.??

Rwanda has also received 700 doses of the drug from the Sabin Vaccine Institute in the U.S. The Institute, a non-profit focused in part on developing vaccines for viruses that disproportionately affect the world’s poorest populations, developed the single-dose vaccine and said in a release that its previous trial of the drug in Uganda and Kenya indicate it’s “safe and elicits rapid, robust immune responses.”??

The speed of the vaccine’s delivery —?shipping just a week after the outbreak was announced — is notable. One doctor who worked in West Africa during its last Ebola outbreak (and survived Ebola), Craig Spencer, called it “incredible” in a post on X. "Truly a mind-blowing achievement and an exemplar for future outbreak response."?

AI inequity

A new paper from researchers at the University of British Columbia and the University of California Santa Cruz says that AI is likely not a game changer when it comes to improving global health inequities. The power dynamics that “underpin AI’s expansion in global health”?means that it, like many tech advancements in health that have come before AI, “avoids addressing the fundamental determinants of health inequities,” Leah Shipton of UBC and Lucia Vitale of UC Santa Cruz write.??

They call this phenomenon the “politics of avoidance”?— or the “tendency for the field of global health to favour technological interventions as a workaround for addressing the more contentious commercial, economic and political determinants of health.”??

The problem with AI, as they see it, is primarily that — being developed in high-income countries by private enterprise — it is inherently biased to specific diseases, health infrastructures and regulations, among other things.?

“We could say these [AI] tools are ... addressing ‘proximal’?or downstream determinants of health. The disparity was already created by the underlying determinant and AI is trying to minimize the negative impact of it — but it’s not stopping it from happening in the first place,”?Shipton told PPF. “To stop those disparities, we have to dig into thorny issues like how we distribute resources for health care and regulate the private sector’s impact on health.”?

For example, an AI assessment app “could help improve the efficiency of clinics by suggesting potential diagnoses for nurse practitioners or doctors to consider ahead of a patient's visit. Thus ideally increasing the number of patients that can access care per day. This would be a downstream intervention. But that tool isn’t going to help address the underlying causes of these shortages, such as inadequate provincial and federal policy for health workforce planning and pathways for immigrant health professionals to practice in Canada,“?Shipton explained via email.??

Instead, AI is likely to be leveraged as a form of policy evasion. “These are political decisions that are hard to make and build consensus around — hence why my co-author, Lucia and I argue that we see technologies like AI being used to avoid having to confront them. Ultimately though, smart policymaking and adequate resourcing would have much more impact on individual and group health outcomes.“?

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This newsletter is produced by journalists at PPF Media. It maintains complete editorial independence.