The incoming president of the Public Health Agency of Canada faces a daunting task in the months ahead, trying to quell the frustrations of scientists within the department, while also bracing the country for a second pandemic wave.
On Monday, Prime Minister Justin Trudeau named former National Research Council head Iain Stewart the new president of Public Health. The move follows the sudden resignation of agency president Tina Namiesniowski on Friday.
Public Health has been beset by problems in recent months surrounding key aspects of its response to COVID-19, including weaknesses in its intelligence-gathering and decision-making capacity, which critics have said led the government to underestimate the threat of the virus.
Doctors and epidemiologists inside the agency have told The Globe and Mail they struggled to get urgent and critical messages up the chain of command in the early days of the outbreak. Complex information often had to be “oversimplified” or “dumbed down” for senior officials who lacked a background in public health, said one scientist in an interview.
By appointing Mr. Stewart to run the agency, the government appears to be attempting to strike a balance between a president who has worked with scientists before, and an administrator to run the department, with an eye to quelling some of that criticism.
When he took the reins of the NRC in 2016, Mr. Stewart was tasked with reinvigorating the government’s billion-dollar research division and addressing concerns among researchers that it had lost its way. Mr. Stewart told The Globe at the time that his job involved rebuilding morale among scientists who had grown concerned about the strategic direction.
He will face a similar challenge in his new role. Though Mr. Stewart does not come to the job with a background in public health, the government is hoping he will be seen as someone who can work closely with scientists and experts, and who will listen. Perhaps more importantly, NRC and Public Health have partnered on projects in the past, including the build-out of Canada’s pandemic early warning and surveillance unit.
The unit, known as the Global Public Health Intelligence Network, or GPHIN, has been at the centre of controversy since a Globe and Mail investigation in late July revealed that senior Public Health officials cut back much of its outbreak detection and surveillance capacity in late 2018 and early 2019, less than a year before the pandemic hit.
Amid shifting government priorities, analysts within the highly specialized unit were reassigned to other work that didn’t involve pandemic readiness – a decision they blamed on civil servants failing to grasp the fundamentals of public health. This curtailment of GPHIN’s operations is said to have contributed to a series of botched risk assessments of the virus by the federal government. Throughout January, February and much of March, Canada’s official risk assessments labelled the outbreak as a “Low” threat to the country, even as it spread aggressively around the world and new evidence emerged that human-to-human transmission was a major problem.
When the World Health Organization declared the virus a high risk to the world in late January, and warned countries to begin preparing, Canada continued to state the risk level was low for another month and a half. That miscalculation is said to have delayed key responses, such as locking down long-term care homes, where Canada has had the bulk of its fatalities from COVID-19, and stockpiling personal protective equipment for hospitals, among other crucial mitigation efforts.
Canada’s Auditor-General is now probing the agency’s oversight of GPHIN and Health Minister Patty Hajdu has ordered an independent federal investigation into the matter.
Ms. Namiesniowski said in an e-mail to staff that she was stepping down to take a break from the rigours of the job. The fact that a new president was named so soon after her sudden departure suggests the government had a replacement in mind when her resignation was announced.
Amid the problems at the agency, Public Health has seen two senior managers depart in recent weeks. In addition to Ms. Namiesniowski’s resignation, the government said vice-president Sally Thornton retired this month. Ms. Thornton oversaw GPHIN, including a decision that silenced its pandemic alerting capacity last year, as well as the national emergency stockpile of protective equipment, which was unable to meet surging demand in the early months of the outbreak.
Current and former scientists have told The Globe the agency needs senior officials to have a better understanding of public health within its administrative ranks in order to deal with a crisis such as COVID-19. Neither Ms. Namiesniowski, who has a background in political science and previously worked at the Border Services Agency, nor Ms. Thornton, a lawyer who served in the Treasury Board, had a background in public health before being appointed to key roles.
Mr. Stewart, who has a master’s degree in public administration, served as assistant vice-president of research at Dalhousie University in 2009 and 2010. His career has mostly involved stints at Industry Canada, including one as deputy minister of science and innovation in 2008-09.
In 2016, Dalhousie University’s then-vice-president of research, Monica Crago, described Mr. Stewart in an interview as a person with "a genuine curiosity and respect for research and science.”
As PHAC president, he must now navigate an agency where scientists have felt marginalized, while also overseeing the administrative demands of the agency.
The Chief Public Health Officer (CPHO) is the face of the agency, and current chief Dr. Theresa Tam is often the one speaking directly to Canadians. But structural and strategic decisions for the department, which have the greatest influence over how it operates, are made by the president.
Public Health was led for years by the CPHO alone, after the agency was formed as an independent voice inside government in the wake of the 2003 SARS outbreak. However, the agency has undergone significant change over the years, including a move by the Conservative government in 2014 to alter the Public Health Act, which created the president’s role.
That shifted the power balance away from the CPHO, who is a public-health doctor, and put it in the hands of a senior official appointed by government. The Conservatives said the move was done to lessen the CPHO’s workload, but the Liberals warned it would hurt the agency over time. However, when the government changed in 2015, the structure remained intact.
With files from Ivan Semeniuk
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