A sign reading "wearing a mask is recommended," is shown on a door in Montreal's Old Port, Jan. 1, 2023.Graham Hughes/The Canadian Press
Tania Bubela, dean of health sciences, Faculty of Health Sciences, Simon Fraser University
Colleen M. Flood, dean of law, Faculty of Law, Queen’s University
Kimberlyn McGrail, professor of health services and policy, School of Population and Public Health, University of British Columbia
Sharon E. Straus, director of knowledge translation programme, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto
Sharmistha Mishra, associate professor of infectious disease epidemiology, Department of Medicine, University of Toronto, Li Ka Shing Knowledge Institute, St. Michael’s Hospital-Unity Health Toronto
Canada has now faced two novel coronaviruses. The first outbreak in 2003 caused the Severe Acute Respiratory Syndrome (SARS) and was the worst outside of Asia. Our response to SARS was described as an “international embarrassment”. But it led to large-scale reforms to public health systems across Canada. The COVID-19 pandemic tested these reforms, and Canada’s failures and successes are set out in a recently published series in The BMJ.
In 2003, David Naylor, chair of the National Advisory Committee on SARS and Public Health, described: “squabbling among jurisdictions, dysfunctional relationships among public-health officials from the three levels of government (federal, provincial/territorial, and municipal), an inability to collect and share epidemiological data, and ineffective leadership” – which, taken together, held hostage the health of Canadians. Not much has changed.
As we argue in The BMJ , Canada faces many, seemingly intractable, challenges to evidence-informed public health decision-making. Some are structural, due to Canada’s mix of federal, provincial and local jurisdiction over health and public health. Some are financial – Canada’s public health budget accounts for a tiny 5.2% of total health spending, despite the massive social and economic consequences of public health threats.
Other challenges relate to access and use of data. Data are not shared consistently between municipal, provincial and Federal governments to prepare or respond to public health threats.
We have learned throughout the COVID-19 pandemic that fragmentation of data and public health decision-making leads to different public health measures in different places without any justifying rationale. Lack of clarity in the rules in place across the country (vaccination, masking, school closures, social distancing, etc.) resulted in confusion and an erosion of public trust over time. Differences may be warranted. However, insufficient data and/or comparative analyses during the pandemic resulted in a lost opportunity to understand the impact of these variations across communities. It did not enable sharing of the reasoning for the public health measures with the public. Variability across the country contributed to a loss of public trust in public health leadership over time, which must now be repaired.
Since 2003, federal auditors, have consistently raised concerns about data. Despite large federal investments in data and announcements of more to come, we still face technical, human and social challenges. Technical challenges include outdated health information systems and the lack of integration between the sources and the form of data. Beyond this, we do not have clear regulations and agreements on how to collect public health data in consistent ways, what data to collect to reflect diversity, and how to make data available for shared use. Our privacy laws are outdated; saying “no” is the safest option to avoid privacy harms but ignores the many potential benefits (and lives saved) from sharing data.
We need a shift in mindset from data protectionism to data stewardship. Data stewards are responsible both for protecting data and ensuring that the risks of privacy breach are low and ensuring access and use of data for the public good. One way to do this is by using technological advances that let data from across Canada be used without moving everything to a central location. Another is to include diverse public representation in data governance decisions.
To re-build trust, we call for an inquiry in 2023 on Canada’s COVID-19 response. In part this inquiry must address public health data collection, access, and use across Canada and be inclusive of public voices. An inquiry needs to be willing to move past tired calls for federal-provincial-territorial collaboration and insist that all levels of Canadian governments use all constitutional powers at their disposal to overhaul antiquated data systems and infrastructure as part of a commitment to a common objective of preparedness.
Memories faded too quickly after SARS in 2003. If history is not to repeat itself, we need to look back at the past three years and see what worked and what didn’t. We know pandemic threats will come, but we do not know when, nor predict their cause. Our next challenge may not look a lot like our last. The only way to be prepared for what may come is to have the best pipeline of data as an engine for decision-making and from which to ensure transparency and trust.