Should Canada conduct a national COVID response inquiry? The BMJ thinks so

Open this photo in gallery:

Does Canada need a national inquiry into its COVID-19 response?

The prestigious BMJ (British Medical Journal) thinks so, and makes five key arguments in favour of a large-scale review: one, that failing to look at the past will ensure an unchanged future; two, that a lack of independent inquiry allows others to fill the void, citing the National Citizens’ Inquiry, a ridiculous exercise mounted by anti-vaccine and anti-lockdown dogmatists; thirdly, it would help deliver on Canada’s ambition to be a global leader; fourth, it could provide an “actionable framework” for reforming Canada’s health care system; and finally, that a public inquiry would provide accountability for the horrible losses the country suffered, including more than 50,000 COVID-19 deaths.

It’s hard to argue with any of those points, but there are two key elements missing: Would we actually learn anything new from the exercise? And would we act on what we learn?

The BMJ, in a series of articles dissecting Canada’s failings (and successes) during COVID-19, shows that we already know quite well what happened and why. So why stage a lengthy, costly inquiry if we’re unlikely to learn substantially new information?

Well, history tells us that Canada has a horrible habit of big talk, with no action.

In the wake of the 2003 SARS crisis (which, with 44 deaths, now pales in comparison to COVID), there were two massive reports published, one from the National Advisory Committee on SARS, headed by David Naylor, and another from the Ontario SARS Commission, led by the late Justice Archie Campbell.

There were important actions taken in the wake of those reports, notably the creation of the Public Health Agency of Canada and Public Health Ontario. But, between 2003 and 2020, we otherwise lost interest in public health, leaving it understaffed, underfunded and largely unprepared when COVID-19 landed on our shores.

“Memories faded rapidly,” the BMJ notes dryly.

Nevertheless, Canada conducted itself moderately well in response to the worst pandemic in a century. Our COVID-19 death rate, 1,372 per million population, was worse than the global average of 855, but markedly better than the 3,332 per million deaths in the U.S. and 3,362 in the U.K.

Yet, “beneath the surface of a general sense of satisfaction lie major pandemic failures,” the BMJ notes.

Death and illness rates were two-to-four times higher in low-income and racialized communities in Canada, underscoring persistent health inequalities, despite a universal health system.

The death rate in Canada’s long-term care homes was also, proportionally, the worst in the world. Despite knowing this demographic was at high risk – there were more than 100 published reports warning of the vulnerability of elders in institutional care during a pandemic over the past 50 years – little was done to protect them.

Will another inquiry change that?

On the global stage, Canada shamed itself by becoming one of the world’s worst hoarders of vaccines. By December, 2020, the country had secured 429 million doses of seven different vaccines (about 11 doses for each citizen) while failing to meet its promises to share with low-income countries.

The BMJ articles also remind us that Canada’s health system is fragmented and unco-ordinated, and this harmed the COVID response. Data-sharing was particularly poor, and the often-contradictory pandemic advice between provincial jurisdictions undermined public confidence.

COVID-19 also exacerbated long-standing cracks in the health system, a crisis we’re now seeing play out across the country.

But, again, is the best route to health reform a retrospective COVID-19 inquiry?

The U.K. COVID-19 inquiry, which has been under way for more than six weeks, should serve as a cautionary tale. It has become a forum for partisan sniping and recriminations, with a focus on the effects of Brexit and austerity measures. It’s not clear how its health system is going to emerge stronger from this exercise.

On the health care front, Canada doesn’t need more introspection and self-flagellation, never mind a public forum for partisan bloviating by those with 20/20 hindsight.

What we need is some sort of implementation commission to provide us with a tool kit for introducing changes we already know all too well are needed, from better staffing in long-term care homes through to interoperability of health data systems, to more robust public-health responses.

We don’t need to be reminded, once again, of the weaknesses of the health system and their consequences. We need a political commitment to fixing them, and a road map for getting there.

Yet another long-winded inquiry followed by the publication of a weighty tome of recommendations alone is not going to get us there.