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opinion

Colleen M. Flood FRSC, FCAHS, is the Director of the Centre for Health Law, Policy and Ethics and University Research Chair at the University of Ottawa. Martin Pergler is Principal at Balanced Risk Strategies, an international consultancy based in Ottawa specializing in risk management and decisions under uncertainty.

Let’s review the past seven weeks, since the Omicron variant was identified. Poorly implemented restrictions on international arrivals to Canada. A shambolic rollout of rapid testing and booster vaccines and then a collapse of our testing system altogether. Confusing guidance on social gathering. Now, after a mad scramble over the New Year’s holiday weekend, schools have closed again, and a plethora of lockdown measures are back in place.

So, is this Omicron variant a completely unprecedented crisis event? Clearly not, as we’ve faced three such events in the past 2 years – the original COVID, Alpha, and Delta. Yet we have responded in exactly the same way: governments scrambling in confusion, clearly completely unprepared with any sort of contingency plans, and hesitant to make any sort of decision, especially a potentially unpopular one.

Booster shots are now more readily available. Hopefully testing can be fixed soon and the current batch of lockdown restrictions (whether optimal or not) will buy our health system some time. However, we also urgently need to insist that our governments, at all levels, start managing risk and uncertainty better, so we screw up less next time. Because there will be a next time.

Stephen Hawking said, “Intelligence is the ability to adapt to change.” Looking from the outside and recognizing patterns we’ve seen elsewhere; our governments can become more intelligent by jettisoning at least three outdated beliefs:

The first is that scenario planning is too cumbersome to use in a crisis and that the only option is improvisation. Actually, uncertain, ambiguous, changing situations, as seen during the COVID pandemic, are exactly when anticipating alternative possible realities is a crucial risk management tool. Of course, reality never matches any prior scenario perfectly, but simultaneously considering multiple scenarios with appropriate contingency plans provides a head start when changing course is needed. Our governments have occasionally commissioned scenarios, such as the case number and ICU utilization projections from the Ontario Science Table (similarly in other provinces) and post-COVID recovery scenarios by Innovation, Science and Economic Development Canada, Canada’s Industry Strategy Council. However, what is sorely lacking is the planning and risk management component: taking multiple possible realities forward, anticipating course corrections, and building the flexibility to respond quickly.

If our governments had taken such an approach months ago, we would not be having such a mad scramble now.

The second outdated belief is that visible disagreement among experts creates noise, so keep a lid on differences of opinion, especially once a decision has been made. Given the level of uncertainty, of course there is disagreement, and it is foolish to pretend otherwise. Managed well, experts’ boundless energy will create (and update) thoughtful scenarios and differences of opinion that are precisely how risks are identified and contingency plans germinate! Open, inclusive, deliberative public policy decision-making that embraces meaningful discussion of differences of opinion on policy trade-offs large and small is important and this approach has already been applied elsewhere in the context of COVID. Sadly, our institutions tend to push their experts toward a consensus view. If that is not possible, they choose one version and, if necessary, use the others to justify their decision: “if the experts can’t agree, don’t blame us if something goes wrong.”

The third outdated belief is that decisiveness means sticking to your guns, and that preparing and updating contingencies is disloyal to decision-makers. In fact, doing so is prudent risk management as it allows all of us to make the best possible trade-offs swiftly and then refine them as new information becomes available. When navigating uncertain, changing times, policy-makers will make mistakes but will be wrong for less time overall if they encourage their staff, advisory boards, and others to actively explore risks and refine contingencies as this will make changing course easier and faster.

In contrast, our leaders and institutions tend to discourage contemplating alternatives to chosen orthodoxy. Asymptomatic transmission in schools? No, it can’t be happening, as this would require that we rethink our protocols about whether schools should stay open, and we promised they would. Airborne transmission? No, because then hand sanitizing, droplet masks, and physical distancing wouldn’t be that effective. Boosters for everyone? No way, the logistics are too complicated to contemplate, and we promised people they would only need 2 shots. Unfortunately, evolving reality doesn’t care whether the decision previously made was right at the time, or that you liked it better that way.

These are difficult times, and imposing new restrictions on a frustrated population and mobilizing already stressed resources to roll out boosters and tests more quickly is particularly challenging. But we need to call out our governments for repeatedly dithering, choosing to wait, and then scrambling when it becomes cryingly obvious that something already ought to have been done. We need to start risk managing our crisis response.