Open the black-box relationship between public health officers and politicians

Hill Times April 19, 2021

Did you know that about 140 countries had zero new COVID cases last week? Canada has suffered about 67 deaths per one million population and ranks 60th in the world. Canada is falling behind with poorly executed and politicized public health measures, complicated by each jurisdiction making up its own rules.

Some provinces and territories have managed much more successfully than others. The Atlantic bubble was the right thing to do, but national leaders can’t bring themselves to follow the evidence to effectively close inter-provincial and international borders. All three territories are currently doing very well with forced 14-day isolation measures, but some provinces continue to refuse to close travel effectively.

We have an issue about public health communication. If a jurisdiction makes the decision to protect its citizens’ lives, the uptake and effectiveness of such decisions is then based on mass communication. So it might come as a surprise that the art and skill of communication is not a core competency of most public health masters’ degrees. Not only do we need public health experts to excel in communicating with citizens, we also need them to excel in managing communication with elected politicians. And then we need politicians to listen and understand the basics of public health.

Should chief public health officers be decision-makers? Yes, though our elected politicians have the authority to make the final decisions. But are the chief medical officers the advisers, regulators, or both? This is the black box that needs to be cracked open. Until we clearly line up the responsibilities and mandates of chief medical health officers and elected politicians, we will have a mess of approaches which are sometimes poorly communicated.

There’s another issue at play. The Canadian Public Health Association’s recent review of Canada’s initial responses to the pandemic made a number of recommendations to nationalize data systems so we can track things like vaccinations, national testing protocols, national health human resource capacity and so we can manage ICU nurses across jurisdictions.

The key is to work like a single country, together. But Canada’s health system turns out not to be a system at all. We don’t have a national vaccine registry. We didn’t have a vaccine distribution system until recently—thanks to the anonymous policy people who pulled this together during a crisis. There’s no national COVID tracing strategy so we don’t even have useful data on spread. There’s no national health human resources approach to plan for surge capacity in the case of emergency, so every jurisdiction is on its own right now. The question is whether we are ready to talk about fundamentally changing the structure of health and public health in Canada to do better next time.

None of this has any meaning for the 23,475 families grieving the deaths of loved ones. Families of the approximately 1,250 registered critical care nurses (Canadian Institute of Health Information) probably don’t have any time for this either.

The political approach of trying to balance the economy and public health has turned out to be wrong. We just dragged it out longer in Canada, that’s all. Decisive action based on public health evidence, supported strongly by politicians happened in Australia, New Zealand, and many other countries. It also happened in Nunavut, the Northwest Territories, and Yukon. But it didn’t happen consistently in southern Canada. And now we simply don’t have time. The third wave is upon us, and it is big.

We need chief public health officers and elected politicians to do consistent communication and action against this threat to our collective safety. Imagine if there was a national and consistent approach, we might just get through this together.