The Second Wave: Science Meets Leadership

Good nuanced discussion of the complexities in finding a balance between public health, economic and other concerns:

When the pandemic first hit, none of us knew what to expect. Medical experts called for a lockdown and governments took their advice. This time round it’s different. Our political leaders are being called on to protect both our health and our economy. As Doug Ford noted on Tuesday, that can be an unpleasant place to be.

In his press conference, Ford commented on his decision to reinstate Stage 2 measures in three key regions of Ontario, much as François Legault has done in Quebec. It was, he says, one of the hardest decisions of his career. We get it but, frankly, he should get used to it. Governments everywhere may be called on to make lots more decisions like this in the months ahead.

Businesses are hurting badly, and many are stepping up the pressure on politicians to help them get through these tough times. This is not just about financial support. In Ottawa, for example, business groups have challenged Ford to produce the data that justifies stricter measures. There is a growing sense that politicians have the tools to open the economy without putting the public at risk, but do they?

We think this is a discussion worth having – cautiously and respectfully. We’re not disputing that public health is the No 1 priority. The hard question is whether it can be better aligned with other priorities. A recent poll from the Innovative Research Group helps us get at the issue:

The response to Question 1 caught our attention. It shows that Canadians are almost evenly split on whether they think experts have too much influence on governments. This sheds important light on the tensions Ford is dealing with, and why other premiers will likely face the same issues, as the second wave grows. Some, such as Legault, already are.

Basically, during the first wave, political leaders deferred to public health officials on how to respond to the pandemic. This served us well, but governments have come a long way over the last eight months. New knowledge and new tools like rapid testing and contact tracing now allow leaders to manage the risks in ways that were not possible before.

For example, experts now know enough about how the virus spreads to contain it within a region, so that governments don’t have to shut down a whole province. This is currently the approach in Ontario and Quebec.

However, there is a price to pay for plans like this. Generally, the more complex they get, the less likely they are to be guided by medical science. In Ontario, for example, the government’s decision to shut down bars, restaurants, and gyms while leaving schools open has raised eyebrows.

There are serious questions about how far the science on COVID-19 can help decision-makers assess the importance of getting children back to school. Striking a balance between public health risks and learning involves weighing lots of things that are outside the purview of medical science.

So, how are these tradeoffs getting made?

In a second slide, IRG reveals an important feature of our political culture. The slide uses a scale of 1 – 100 to assess how strongly Liberals, Conservatives, and NDP members feel about the role of experts in government decision-making. The poll finds a 24-point spread between Liberals and Conservatives, with the NDP in the middle. (See the line on Political Populism.)

Basically, the data show that our political leaders are predisposed to treat expert opinion differently: progressives are more inclined to accept it and conservatives to question it.

Neither predisposition is wrong, but predispositions of any kind can be a barrier to a thoughtful, informed discussion of the issues. They incline us to trust some views more than others and this can shape how we think and talk about the issues.

This is a critical consideration as the second wave advances. When health experts declare that “the evidence” calls for actions that favour health over, say, the economy, political leaders need a reliable way to weigh this advice against other concerns and priorities. And they shouldn’t look to health experts to provide it.

Health experts view the world through a health lens. Their role doesn’t train them to consider how this affects other priorities, such as the economy or learning. That is what elected officials are supposed to do – but they need a reliable way of thinking through the issues.

As things stand, the poll suggests that these decisions often come down to a leader’s predispositions – whether they are a conservative or a progressive. We don’t think that’s not good enough.

Increasingly, our governments are being called on to respond to all aspects of the pandemic, not just public health. Predisposition are not a reliable guide to this. They will not disappear, but we can be conscious of them and keep them in check.

Different priorities should be publicly discussed and balanced against public health. To be clear, we are NOT disputing that public health is the No 1 priority, but we do believe that governments need the flexibility to experiment with different options and to respond to other priorities.

That is the way forward.

Andrew Balfour is Managing Partner at Rubicon Strategy in Ottawa.

Source: The Second Wave: Science Meets Leadership

2016 report warned about public health data reporting problems Canada is facing with COVID-19

Apparently, an ongoing issue, and hard to see any rationale for not having consistent national data across all provinces (Quebec will always be difficult in this regard given the health jurisdiction arguments and jurisdictional issues cannot be tossed aside). And of course, more desegregated data, including ethnic and racial backgrounds, is needed:

A clear picture of the fight against COVID-19 is being hampered by lack of consistent data about the virus across the country, Canada’s Chief Public Health Officer Theresa Tam said Wednesday.

But the problem of sharing such data among provinces was flagged four years ago in a report commissioned by the nation’s top public health officers.

Failure to put in place a mechanism for data surveillance across the country would have negative consequences for people’s health, said the 2016 report.

Despite that report inadequate data sharing information has been a problem during the COVID-19 crisis, Tam admitted Wednesday.

“Data is extremely important obviously to any outbreak,” she said. “There’s obviously some gaps particularly in reporting to the national level that we do have to address.”

The 2016 report was commissioned by the Pan Canadian Public Health Care Network, a group designed to coordinate the work of the nation’s top public health officers. It flagged that Canada’s public health surveillance system was inadequate, with inconsistent data sharing between provinces, a lack of common standards and gaps that could hamper a response to a virus like COVID-19.

The network’s report was a blueprint for how to create a more unified system for public health, one where all provinces looked for similar problems and collected data in a similar way. It found provinces collected data differently and didn’t have consistent standards when it came to monitoring for disease outbreaks.

“The lack of a mechanism to align surveillance standards across Canada is a missing pillar of surveillance infrastructure that holds the potential to delay the early detection of outbreaks and is a barrier to better understanding chronic diseases and injuries, resulting in negative consequences for the health of Canadians,” reads the report.

Since the outbreak began, not only have Canadian provinces counted their COVID-19 data in different ways, they have also switched their methodologies during the outbreak.

While some provinces use fully electronic systems to report new cases and trace the contacts of people who are infected, it has been revealed that others still use fax machines to report the information.

The network’s report found data sharing was done on an ad hoc basis with informal agreements, but no consistent rules. Tam said that has been a barrier during this crisis and policy makers at all levels are trying to address it.

Before the pandemic, the network aimed to bring together public health agencies across the country into a common set of standards by 2022. Health care is a provincial jurisdiction and provinces have consistently resisted any efforts for the federal government to regulate any part of their systems.

Tam said some of the issues around information sharing have been addressed, food-borne illnesses as an example are well tracked with good information sharing between provinces. In the case of COVID-19, a respiratory illness, she said there are still barriers.

“It is absolutely recognized also at the first ministers level that this is another chance for us to improve on what we are doing,” she said. “Capitalizing on the crisis that we have, we need to give it another good go for the next piece.”

She said the data on COVID-19 now comes from a wide-array of sources.

“It’s the complexity of the Canadian landscape of data, some data has to come from hospitals, some comes from labs, some comes from local public health units.”

The network’s report noted that the European Union had managed to pull together a more uniform surveillance system over a five year span, creating the European Centre for Disease Control, despite having to merge 27 countries and 23 official languages into one system.

A report into the SARS crisis in 2003 made similar recommendations about sharing information, arguing that a disease outbreak required a federal response and it should have all the necessary data to make decisions.

It called for a stand-alone public health agency with the authority to gather data from the provinces, which led to the creation of the Public Health Agency of Canada.

Testifying at the House of Commons health committee on Wednesday, Amir Attaran, a law professor at the University of Ottawa, said this jurisdictional issue should be tossed aside.

“It is good for the federal government to let provinces run their show, and that’s normally how it should work,” he said. “ But I’ll suggest that a pandemic is not normal times, and there comes a point where the federal government must step in — the point where provincial actions are killing Canadians.”

Attaran said the federal government has the power to step in and demand sharing of data and it could also use that authority to demand better testing from the provinces. He said both these steps should be taken despite the jurisdictional challenges because lives are at risk.

“If our country cannot show that once-in-a-century flexibility, then, yes, we are turning the Canadian Constitution into a suicide pact.”

Tam said where good data is most needed, the local level, it is available and accessible to decision makers. Local public health officials are able to track the virus in their communities and use it to do contact tracing and make other decisions.

She said what is missing is the bigger picture on how the virus is spreading across the country.

“It is important to get the national picture and to be able to provide that to policymakers as well.”

She said they need a deeper level of data than what is currently available to get a better picture of how vulnerable groups are being hit by the disease.

“We have the basic information, but I think what people need, and are asking for now is for what we call this aggregation, more in depth analysis,” she said. “Those are the kinds of things that we need to work on.”

Source: 2016 report warned about public health data reporting problems Canada is facing with COVID-19