The BMJ, journal of the British Medical Association, recently gave Canada some nice pats on the back, followed by several well-deserved kicks in the ass.
The journal’s entire July 25 issue was devoted to Canada’s response to COVID-19. Most of the back-patters and ass-kickers were Canadian health experts, veterans of the pandemic.
In two editorials, an opinion piece and four analytical articles, the experts argued for an independent national inquiry that would present us with clear guidelines to improve Canada’s public health system and prevent or mitigate the next pandemic.
Three of them followed up with an article in the Conversation, saying an inquiry would identify problems in the use of pandemic data — problems that eventually resulted in a serious loss of public trust in the system, not to mention at least 53,000 Canadian lives.
In the lead editorial, the authors write: “Compared with the shambolic U.K. response and the chaos and divisiveness of its southern neighbour, the U.S., Canada may seem to have risen to the occasion of COVID-19. We wouldn’t know because no pandemic inquiry has been established by its federal government. This is a mistake.”
Yes, Canada did better than the U.S. and U.K. in terms of case counts and mortality and vaccination uptake. Both federal and provincial governments were quick to make discreet comparisons with the public health disasters under Donald Trump in America and Boris Johnson in Britain. It was easy to look good compared to them.
The experts writing in The BMJ did see some positives. In an article on Canada’s decentralized COVID-19 response, the authors noted that “Public health leadership included women at each level of decision-making.”
As well, “Canada became one of the most vaccinated countries with greater than 83 per cent of the population receiving at least one vaccine dose in February 2023.” When vaccines became available, Indigenous peoples and persons living or working in long-term care homes received priority.
Researchers, the authors said, quickly formed teams to attack “urgent questions of seroprevalence (eg., COVID-19 Immunity Task Force), correlates of infection and immunity, and outbreak mitigation factors and engagement of patients in research conduct such as knowledge synthesis.”
A strong Indigenous response
Two authors in The BMJ wrote that the Indigenous peoples of Manitoba remembered the government’s botched response to the H1N1 pandemic in 2009. It had consisted largely of body bags and the withholding of alcohol-based sanitizers out of fear someone might drink them.
This time, Indigenous health experts took matters into their own hands and created a very effective Manitoba First Nations Pandemic Response Coordination Team.
The team reviewed earlier reports and acted on them, developing rapid response teams which “included physicians, physician assistants, nurses, physiotherapists, occupational therapists and advanced care paramedics. They supported local health and community teams with contact tracing, testing and active daily monitoring. They also supported the transfer of people with COVID-19 and close contacts to alternative accommodation to isolate and interrupt transmission chains and they positioned people at higher risk of severe illness closer to tertiary care as needed.”
The team took charge of medical testing and of vaccination when vaccines became available; the result was “vaccine uptake of 90.3 per cent for the first two doses in First Nations communities by Dec. 1, 2022, an uptake higher than many other jurisdictions or countries.”
But that was one unified group, one that understood the seriousness of the threat. Canada’s public health system is fragmented, The BMJ authors also pointed out, and the lessons of the SARS outbreak in 2003 and H1N1 in 2009 had been forgotten by 2020. The provinces and territories run their own little fiefdoms in health, and public health in 2019 “accounted for only 5.2 per cent of Canada’s total health spending.”
Multiple, chaotic responses
So we had not one response but 14: federal, provincial and territorial, each developing its own response to issues like school closings, gatherings, masking, vaccination requirements and so on. The BMJ authors conspicuously avoid naming politicians, public health officers or governments.
Each jurisdiction also had its own data. But, the authors said, “data were in short supply to support public health decision-making during COVID-19. This situation will persist without major reform.”
Health information systems weren’t integrated, and some provinces deliberately refused to collect data on race — a kind of misguided virtue signalling that ignored the vulnerability of Indigenous people and other people of colour.
“More detailed information about the demographics or location of cases,” the authors wrote, “was often more guarded because of privacy concerns, meaning that public health agencies did not respond to community interest about local risk and tailoring of implementation strategies to mitigate COVID-19 risks was slow or non-existent. Lack of local data contributed to a lack of understanding of local transmission dynamics and contributed to loss of public trust over time.”
We certainly saw that here in B.C. After a long honeymoon with the public in the spring of 2020, provincial health officer Dr. Bonnie Henry began telling us less and less about the state of the pandemic. Her updates were more like lullabies, and eventually they ceased altogether.
A very tall order
As harsh as The BMJ critiques are, they are based on a minuscule scrap of all the data we have acquired (or failed to acquire) since January 2020. That’s why The BMJ authors call for a truly independent, non-partisan inquiry by expert scientists.
Establishing such an inquiry in 2023 would be a very tall order.
The inquiry would need competent staff, a large budget and the power to compel sworn testimony in public hearings, held across the country over a period of at least a year. Staff would need another year to review their findings and present them — with recommendations. The inquiry report would identify strengths and successes, and recommend ways to keep them in the health-care system. It would also identify weaknesses and failures, with recommendations to eliminate them.
Given the behaviour of both federal and provincial governments since early 2020, I cannot believe that any of them would authorize such an inquiry.
The next federal election must be held on or before Oct. 20, 2025. If Justin Trudeau were to create an inquiry today, he could foresee its report as a time bomb set to go off close to the election.
Pierre Poilievre’s Conservatives and Jagmeet Singh’s New Democrats would echo the report’s criticisms of the federal Liberals, but they would fall oddly silent about the inquiry’s criticism of provincial Tory and New Democrat governments.
If the inquiry’s report came out after the election and Poilievre were now prime minister, he would dismiss its findings, however negative, as a whitewash that ignored the tyranny of Liberal vaccine mandates and the chaos caused by closing schools.
Scared of voters, not of viruses
Even an inquiry based on firm science would have little chance of being accepted and turned into policy by any future federal or provincial government, or of restoring trust in public health. Canadian governments, like governments around the world, got their worst pandemic scare not from the SARS-CoV-2 virus but from their voters.
Too many people succumbed to disinformation, which had already eroded their trust in government in general and public health in particular. They confronted governments with convoys and border blockades. The economic and political damage of the pandemic drove politicians to relax public health measures, and then, grotesquely, to convert public health itself from “doctor’s orders” to “personal responsibility.”
Governments also learned they could get away with reduced information: fewer medical tests, fewer tallies of confirmed cases, hospitalizations and deaths. Peer-reviewed reports keep coming out about the continuing damage the pandemic was doing, but few people read the medical journals. Even fewer want to be reminded about the pandemic at all.
Cleaning up the mess
Even if an inquiry is politically unlikely, we already know our patchwork health “systems” are a mess. Cleaning it up will require not an inquiry but intense pressure from health-care workers (especially through their professional associations and unions), researchers, advocacy groups and ordinary voters.
If politicians fear the embarrassment of an inquiry into their pandemic failures, they should also fear the embarrassment of relentless questioning and criticism about their failures to build a capable, resilient health-care system. When emergency departments close, or waiting times lengthen, we should be twisting governments’ arms to boost health-care funding, not just open boutique clinics.
The arm-twisting should start now. A new surge in COVID-19 cases seems likely, given recent wastewater monitoring. On top of that, H5N1 avian flu is infecting a growing range of mammalian species, especially domestic cats in South Korea and the Nordic countries. After our experience with COVID-19, we should expect it to jump to us sooner rather than later, and to be really dangerous.
If our present system had to cope with a new pandemic while continuing to neglect the old one, we’ll lose far, far more than 53,000 Canadians.