Not one Canadian government has held a truly comprehensive ‘lessons learned’ inquiry into how it handled the COVID-19 pandemic. A reminder came in the form of a very quiet release by Health Canada last week of a report it received five months ago.
The expert panel was chaired by Sir Mark Walport, a former Chief Scientific Advisor to the UK government and contained six other very qualified medical and health experts. Its mandate was “to conduct a review of the federal approach to pandemic science advice and research coordination, take stock of the lessons learned, and provide concrete recommendations to strengthen Canada’s preparedness in these areas for future health emergencies.”
No mistake, this is a solid, serious, and welcome assessment on this key aspect of Canada’s pandemic response. Its recommendations are far-reaching and yet, unsurprisingly obvious to any Canadian who cares enough to think back to those fraught times.
I was Clerk of the Executive Council and Cabinet Secretary in Manitoba during that period. In effect, I became the ‘COVID Desk Officer’ for the government’s response, coordinating across all departments and agencies. Having lived (and re-lived) every searing moment of those years, I can vouch for both the salience of the Walport report’s findings and their blinding obviousness (meant in a nice way!)
They set out four key findings:
1 – “Canada must act now to be prepared for the next health emergency”. Yes, please. Although governments responded relatively quickly once the scale of the pandemic threat became real, there was no playbook prepared in advance that would have helped. That meant inadequately resourced public health organizations were called upon to figure out a not just a whole-of-government response but a whole-of-society response to the virus which continually upended expectations. As Clerk, I had to create specific governance bodies to make up for this and ensure information was being shared and acted upon as quickly and effectively as we could.
2 – “Greater pan-Canadian coordination of research and science advice is required.” Again, yes. Canada is a federation with core health service delivery and local population health responsibilities embedded with provincial and territorial governments. All have, in turn, different health governance systems and processes. Intergovernmental collaboration was a successful aspect of the country’s COVID response. But the lack of pre-existing mechanisms to foster this across the research and science ecosystem meant there was duplication of efforts, overlapping inefficiencies, and delays in necessary coordination. A desire, for example, in Manitoba to fully align vaccination priorities to advice from the federal government’s National Advisory Committee on Immunization fell apart given conflicting timelines and conflicting information.
3 – A greater focus needs to be placed on equity and addressing social and structural determinants of health. Absolutely. A virus that could infect everyone went on to infect some populations differently. While we were all at risk of catching COVID, that risk was higher for some Canadians depending on their income, racial status, and how they lived, such as homeless persons and seniors living in congregated institutions. Given the need to contain the virus from spreading by containing it at source, this health reality made it all the more difficult to do so. In Manitoba, we pushed data boundaries to get a better handle on what we called “COVID hot spots” to see where we had to prioritize vaccine administration in vaccine-resistant and vulnerable sub-populations. The report states on page 79: “For example, the Manitoba government was able to prioritize vaccination by postal code area during the pandemic.”
4 – Indigenous health expertise must be embedded in research coordination and science advice processes. A big lesson learned. Indigenous communities and sub-populations, on and off-reserves “were disproportionately negatively impacted by the COVID-19 pandemic due to longstanding health inequities with well-documented differential access to health and social services”, as the report puts it. Manitoba’s Indigenous health professionals stepped up uniquely, as the report states on page 81: “The pandemic, however, did spur some jurisdictions to collect and share distinctions-based Indigenous health data. For example, the Manitoba government began collecting First Nations, Métis, and Inuit identifiers in April 2020.159 Individuals who tested positive for COVID-19 were asked to volunteer information about their Indigenous status. This data collection stemmed from the establishment of a data sharing agreement between Manitoba Health and the Assembly of Manitoba Chiefs, which recognized and abided by the principles of First Nations self-governance and data sovereignty (ownership, control, access, and possession).” This allowed pandemic response decisions, such as setting age priorities for vaccine administration to Indigenous persons, not to mention Indigenous-led vaccine sites, flowed naturally from this approach once it was established.
The panel developed 12 recommendations organized into these four areas:
- National health risk governance
- Science advisory mechanisms
- Health research prioritization, funding, and coordination
- Health data availability and use.
Here’s the report’s overall conclusion: “The panel’s recommendations centre around the need for a more sophisticated national risk assessment and preparedness planning process; a more robust science advisory system that is ready to immediately activate in response to an emergency; ongoing research infrastructure that is ready to mobilize; centralized leadership to facilitate the prioritization and coordination of major public research investments; and improved health data systems.”
I won’t detail or assess the Expert Panel’s recommendations here, but I would note that in instances they mirror the recommendations of another report called: Resilient Institutions: Learning from Canada’s COVID-19 Pandemic, a joint effort of the Institute on Governance and the Institute for Research on Public Policy. Our second recommendation was for the creation of “more integrated and efficient data-sharing pathways”. Two of the expert panelists for the Walport report, Dr. Shannon McDonald and Dr. Fahad Razak, spoke at our own event.
Sadly, our most crucial recommendation – “The federal government should initiate a comprehensive pan-Canadian, collaborative lessons-learned examination” – has not been taken up. Nor has any provincial or territorial government take an equivalent step. While there have been a number of assessment reports on individual aspects of governments’ COVID responses (all by Auditors-General), nothing has been initiated on assessing and learning from how governments performed as a whole.
Why not? It’s being done in the United Kingdom. They began their inquiry just as the pandemic concluded in June 2022.
The absence in Canada is to our collective detriment. As the pandemic recedes in memory and people in decision-making positions change, we will lose the moment to truly learn from the crisis and make our governments better in serving Canadians. Worse, negative and one-sided viewpoints fomented by disinformation will take root making any future pandemic response all the more difficult.
This new pandemic ‘lessons learned ‘report on science and research advice by the Walport expert panel is good. An independent, public national ‘lessons learned’ examination of how governments performed would be even better.
