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Why A Pandemic Inquiry Is a Good Idea. And a Tough Sell

A Toronto MP is calling for an investigation of Canada’s pandemic response. Here’s what it’s up against if it goes ahead.

Crawford Kilian 20 Oct 2022TheTyee.ca

Tyee contributing editor Crawford Kilian blogs about the pandemic and other public health issues.

Nathaniel Erskine-Smith, a Liberal MP for Toronto’s Beaches–East York riding, introduced a private member’s bill last June called C-293. It was an eminently sensible proposal to create an advisory committee to look at Canada’s response to COVID-19, and to require a detailed plan to prevent the next pandemic.

The bill got nowhere in the spring session at the House of Commons. But in an email to The Tyee, Erskine-Smith had this to say: “The bill is moving forward, with an initial debate on Nov. 4. I expect we’ll see a vote in the spring of 2023 to send the bill to committee.”

The bill seems intended to nudge the government to produce a similar one in the tradition of what Erskine-Smith has done before. “I previously introduced net-zero legislation to encourage the government to develop its own, and we ultimately realized that promise through the government’s own climate accountability law,” he told The Tyee. “I hope we see similar action here, with government action to strike a committee to review our pandemic response and to pass pandemic prevention and preparedness legislation modelled on C-293.”

The purpose of C-293 would be to recommend improvements in preparedness and response to mitigate the effects of future pandemics. The advisory committee would be gender-balanced and “reflect a wide range of backgrounds and disciplines.”

The committee would look at the responses of the Public Health Agency of Canada and of the Ministry of Health. It would also, “in collaboration with provincial and municipal governments, assess the public health and pandemic response capabilities of those governments.” And it would assess how effectively governments exercised their legal powers “before, during and after the pandemic” — assuming the pandemic ever does end.

As its final goal, the advisory committee is to “analyze the health, economic and social factors relevant to the impact of the pandemic in Canada.” This is critical, because we aren’t in this pandemic together, and never were. Class, gender, race and ethnicity protected some of us and exposed others to disease and death.

Who would co-operate?

Given the politics of the pandemic since early 2020, it’s reasonable to wonder whether any level of government — federal, provincial or municipal — would seriously co-operate with such a committee. The responses on all levels have generally been bad to terrible.

Last month, the Lancet Commission on lessons for the future from the COVID-19 pandemic summed up the pandemic’s first two-and-a-half years as “both a profound tragedy and a massive global failure at multiple levels.” The commission did not add “except for Canada.”

The advisory committee would have to go through masses of government reports and to interview hundreds of officials, scientists and politicians — all eager to make themselves look good. Their evidence would often be contradictory. Some of it would be withheld on grounds of privacy, cabinet confidentiality or even national security.

Following the science

Suppose, for example, the committee wanted to know what the Trudeau government meant in 2020 when it said it was “following the science and evidence” on border management in the weeks and months after the pandemic was declared. And suppose Trudeau or members of his cabinet were asked about a particular report on that subject by researchers at Simon Fraser University, published in the spring of 2022.

The SFU report found that, in accordance with the current science and World Health Organization advice, the government did not limit travel. But the then-current science and WHO advice wasn’t actually relevant, as we were dealing with what the report’s authors described as “a novel and highly transmissible respiratory virus, capable of asymptomatic transmission,” whose powers “were heightened in a world interconnected by travel.”

According to the SFU study, the government also failed to keep up with rapidly changing evidence and WHO advice, while feeling intense pressure from international travel and trade groups. The researchers cited the Office of the Auditor General, which found that the Public Health Agency of Canada had “limited institutional capacity, data collection and analysis challenges, resulting in an inability to act swiftly in response to shifting evidence.” Ottawa listened more to vested interests like the travel industry than to medical experts, and decided to create travel “exemptions” benefiting “government, private industry and certain communities” rather than protecting public health.

The SFU researchers argue that the government was trapped in “path dependency” — once it adopted a policy, changing it was almost impossible. They concluded that “the reliance on science-driven narratives, in this context, increased politicization in ways that ultimately undermined the use of science. There is a need to better understand these complex dynamics in national policy-making during the COVID-19 pandemic if we are to prevent the unco-ordinated and chaotic use of travel measures in future.”

No doubt the federal Liberals would beg to differ. But similar academic analyses of different aspects of the government response can be found in many scientific journals. Brought into committee hearings, they would collectively put the government in a very poor light.

And of course the government would follow the science and evidence only so far.

Explaining excess deaths

The committee would find similar problems when it turned to provincial responses to the pandemic.

In mid-October, Statistics Canada reported that “provisional data show an estimated 47,727 excess deaths in Canada from the end of March 2020 to the beginning of June 2022, 7.4 per cent more deaths than expected without the pandemic. During this period, at least 38,265 deaths were directly attributed to COVID-19.”

How would the provinces explain their own mortality rates, especially when linked to their policies on masking, opening schools and permitting large gatherings? Last spring, a study in the Canadian Medical Association Journal found that B.C., Alberta and Saskatchewan had much higher non-COVID excess mortality rates in 2021 than Ontario and Quebec. What were the underlying cases, apart from the 619 heat dome deaths in B.C. that summer?

B.C. would also have to explain the finding of the BC COVID-19 Modelling Group, which recently reported that we’ve been counting only about one in 100 cases.

The provinces would also have to explain how their case counts contributed to a 50 per cent increase in cases in 2022 so far. This year’s official numbers are already counting 2.1 million cases of COVID-19 in Canada, almost doubling the 1.63 million recorded in 2021 and more than tripling the 583,254 recorded in 2020, the first year of the pandemic. (The true count is likely far higher.)

The provinces would have to explain the grim situation in their emergency rooms. And they would need to explain the near-collapse of their health-care systems due to attrition, overwork and outright abuse of health-care workers.

And could we expect a new provincial premier like Alberta’s Danielle Smith to offer a balanced, science-based assessment of the previous government’s response?

No politician or chief medical officer would be eager to take part in a serious, independent inquiry into the pandemic response. Among other topics they’d want to avoid would be excess deaths in long-term care facilities. In 2020, excess mortality was 16,333. About three out of four excess deaths were in older adults living in long-term care facilities and nursing homes. Failure to protect vulnerable elders was just one of the provinces’ pandemic-era lapses.

Worst of all would be the advisory committee’s mandate to examine the “health, economic and social factors relevant to the impact of the pandemic in Canada.” Erskine-Smith is absolutely right to include this. It’s part of a new independent Australian pandemic inquiry, “Fault Lines,” which condemns the Canberra government’s neglect of the poor and the old.

The pandemic has only confirmed what we’ve known for decades: that wealth and health are closely related, and unequal societies impose the greatest burden of illness on the poor and the marginalized.

Canada’s chief medical officer, Dr. Theresa Tam, has known it for a long time too. Two years ago — a long time in this pandemic — she published a report on the inequality that let COVID-19 spread most easily among the poor, thereby creating a reservoir of disease that threatens everyone else. We could drain that reservoir, she suggests, but it would require a far more equal society, with a much narrower gap between the richest and poorest. It would be a society where all were economically secure, well housed, well fed and well cared for.

This has been understood by countless Canadians besides Tam. But we have made no move toward such a society. We have effectively abandoned the idea of public health and left it to individuals to spread infection or not, as they choose.

So an advisory committee that recommended a more equal Canada would get as cool a reception as Tam’s forgotten report.

Nathaniel Erskine-Smith understands this very well. In his email to The Tyee, he writes: “More than anything, we need significantly more resources dedicated to prevention efforts. There is, of course, prevention work required in relation to pandemics and climate change. But we also need to refocus our policy lens to see health in all policies, with an explicit focus on poverty reduction, housing and the social determinants of health.”

But as I recently learned, we prefer the “loud” policy of curative response to the “quiet” policy of proactive prevention. Some of us prefer freedom from vaccination and masking over freedom from disease.

If Erskine-Smith and his parliamentary colleagues seriously want to understand how we responded to this pandemic, and how to prevent the next one, they have a lot of work ahead of them.  [Tyee]

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