Johanu Botha is pursuing a Social Sciences and Humanities Research Council-supported PhD at Carleton University's School of Public Policy & Administration.
Health officials have repeatedly told Canadians that the risk for Ebola spreading widely in this country is low. This does not mean Canada shouldn't be planning for exactly such a scenario. Healthcare providers and public health agencies have come a long way since the SARS crisis in the early 2000s, but a number of challenges remain. A key one is the lack of coordination among provincial health emergency management offices.
Much media attention has been focused on Dr. Gregory Taylor, the federal government's chief medical officer. He is connecting regularly with his provincial counterparts through the Council of Chief Medical Officers of Health (CCMOH) table. But this group, as their name and training suggests, focuses largely on the medical aspects of the virus – its impact on the immune system, how it spreads, etc. Key operational issues such as ensuring enough – and the right – disease-specific supplies or smooth communication within the health system is the purview of health emergency managers in each province, and so far the federal government has not kick-started its equivalent of the CCMOH table.
This leads to at very least a lack of consistency among provinces and at worst a serious gap in disaster planning for the entire country. The huge need for proper personal protective equipment (PPE) for healthcare workers may become such a gap. Given the current worldwide demand for PPE (courtesy of the Ebola crisis), supply is barely keeping up and prices are skyrocketing. Suppliers are looking to big markets where they can cash in. Canada is a small country population-wise and could benefit from all the provinces bargaining together. This won't happen if each province independently works out a unique PPE acquisition process.
Strong federal leadership that provides a forum for provincial coordination will also have the benefit of smoother communication between provincial health emergency managers and the federal agencies relevant to a given event. The feds, for example, have direct contact with other countries facing a disaster. In the Ebola case, they will have greater details on what U.S. federal agencies are doing or the details on how the Spanish nurse's positive test was handled. The feds do not, however, necessarily share this information with the provinces. Containing an Ebola-like disease would be more effective in a decentralized country like Canada, where the provinces have hefty jurisdictional responsibilities, if information flowed more freely from the federal to other levels of government.
Almost all the information Canadians are receiving on Ebola preparedness is province-specific and coming from medical experts. Medical experts, like the lawyer President Obama recently appointed as the United States' 'Ebola Coordinator,' have specific skill sets that do not always include systematic planning, such as how to seamlessly incorporate a number of different government agencies across governmental levels into one action plan. The expertise required here is a fusion of sophisticated public administration and health emergency management. Canadians should be hearing a lot more from such managers and how provinces are working together.
President Obama's appointment of the new 'Ebola Coordinator' should receive particular attention in Canada. The American Federal Emergency Management Agency (FEMA) thrived under president Bill Clinton and FEMA director James Lee Witt, and struggled under president George W. Bush and Michael Brown, because the former treated the branch like a merit-based, apolitical public service that warranted cabinet-level status, while the latter saw it as a mere wing within the mega-agency of Homeland Security where lobbyists could be as valuable as disaster management experts. We should keep our disaster management appointees non-political north of the border.
Canada is a strong performer in a number of health emergency management areas. This country's screening process, for example, would likely have flagged Thomas Duncan, the Liberian man who died of Ebola in a Texas hospital, as a likely Ebola case right away. His quarantine would have started much sooner. But Canada's federal structure and assumption that medical expertise automatically translates to planning expertise does pose some challenges. One way of meeting these challenges would be for strong federal leadership on the health emergency management file, where health emergency managers from the provinces can get into one room and discuss best practices.