Table 1 General interview guide for stakeholders involved in a human case of influenza A H1N2v

Introduction

- “To begin, can you tell us about your position and role?

- “Thank you again for meeting us today. Our overall objective is to strengthen the use of information for decision making about health risks across human and animal health surveillance systems, in a One Health perspective. We want to understand how information is currently shared or not shared, and to document barriers, opportunities and structural links between and within animal and human health surveillance networks and systems in Canada. As a [role/position], your role is central for these networks, and we would like to understand your perspective and experience of how the information flows.

- “To do so, we will briefly talk about the general structure and information flow in case of [animal/zoonotic] emergency health event, and then ask you to describe how it played out in the case of the case of influenza A H1N2v that happened in 2020.

Global structure and information flow

- “Can you first tell us how information about a possible emergency [animal/zoonotic] health event flows to you and from you?

- What are your main sources of information?

- Do you use GPHIN? CEZD? Social media?

- “Once the information comes to you, what happens? How is the information shared?

- “What determines whether the information is shared more broadly to [animal/public health] surveillance systems?

- “What do you think could facilitate your work regarding sharing information in case of a possible [animal/zoonotic] health event?

Case study

 Transition

- “An example is likely going to help me better understand the specifics of the flow of information. If I am correct, you played a role when the influenza A H1N2v case was identified in a human patient who did not have contact with pigs.

 Information flow

- “Can you tell us how you heard about this case first?

- Was through an official channel? Can you explain how this works?

- “What happened with this information?

- How did you assess whether this information was a concern, something that needs to be shared with others so that it can be acted on?

- What were the triggers for information sharing, and to whom?

- What information was shared with other surveillance systems, agencies (e.g., public health, environmental health), experts (e.g., labs and universities)?

- When? How?

- How did you get additional information if needed?

- If so, was it from different sources of information? Which ones?

- Were you involved in discussion or work group(s) to address the issue?

- What happened/what were the results of these?

 Barriers and facilitators

- “Working in a bureaucratic system can have its challenges, were there elements that prevented you from obtaining or sharing key information?

- “Were there elements that, on the other hand, helped the information to flow?

- “What are the most important lessons that have been learned that you think would be important to use for future events?

- “I bet a human case of swine influenza is not the only time you receive information about the flu. What is the flow of information for suspected or confirmed [swine] influenza cases in [pig farms/the population]?

- How do you get this information?

- Are you responsible for sharing this information? To whom? What are the triggers?

- When is this information shared to [animal/public] health?

 Wrap-up

- “Considering we want to document barriers, opportunities and structural links between, and within animal and human health surveillance networks and systems in Canada, is there anything I have not asked about, that you think is important for me to know?

- “Are there people you think would be useful to interview about these objectives?