In the Canadian federation, pandemic response is hyper-local

The federal government could provide greater clarity to citizens and provincial health authorities around containment measures and step up to the plate in the country’s time of need. (File photo: Clay Banks/Unsplash)

This article has been translated into French.

Despite having markedly lower COVID-19 death rates than most G7 nations, Canada is on track to record 20,000 COVID-19 cases a day across all age groups by the end of December. A growing chorus of pundits are calling for the federal government to compel the provinces to adopt a more stringent pandemic response. The idea is that invoking greater federal control – particularly as we enter the winter months – could help stem the rising second wave.

These interventionists argue that a national response with clear, systematic health and lockdown guidelines should overwrite the current mixed-bag of provincial policy responses. The federal government could provide greater clarity to citizens and provincial health authorities around containment measures and step up to the plate in the country’s time of need.

While some see the decentralized federation as a bug, others see it as a feature. Those who stand behind the current system point out that a national response won’t be as attentive to the situation on the ground. Federalism permits each province to enact policies based on the local context.

But has this actually happened?

Since March, the Centre of Excellence on the Canadian Federation has been tracking Canadian policy responses to the pandemic with the goal of measuring the variations in stringency between the provinces. Our data demonstrates that COVID-19 may be a global pandemic, but the variations in local restrictions makes people’s lived experience quite different.

The Stringency Index

To capture provincial confinement and public restriction measures, we followed the team at Oxford University’s COVID-19 Government Response Tracker, who have been tracking the different approaches taken by countries since the beginning of the pandemic. Our focus is on measures within provinces’ control.

Table 1 outlines what policies we measured and how we coded them. For each policy we also accounted for whether it applied province-wide or is targeted. We then followed the Oxford group in calculating a stringency index, coding each province’s policy environment based on these eight measures.

Though this is not an exhaustive list of public health measures in place, we believe they do give an accurate picture of the relative stringency across the country. To better show how these measures map on to a particular provincial context, Figure 1 displays how stringent measures are in each province in relation to the average number of cases over the last five reporting days (cases per 100,000) and how these have evolved just over the last week. The clear dots show Nov. 18 and the solid dots show Nov. 25.

Note that our analysis is purely descriptive and does not represent a causal claim about degrees of stringency and caseload trends. Some provinces and territories have decided to remain at a medium level of stringency even without many cases per capita – most of the Atlantic provinces, for example.

Other provinces have opted for a less stringent approach even with comparatively higher caseloads (Alberta and Saskatchewan). Until mid-November, Nunavut and Manitoba were also part of this latter group, but have substantially ramped up restrictions as cases have increased.

For some, Figure 1 demonstrates exactly why the federal government should play a bigger role, and that provinces like Alberta and Saskatchewan should be forced to strengthen measures and reach levels of stringency comparable to provinces with similar cases per capita.

But it is important to note that this index only offers a partial snapshot of the reality on the ground. Some provinces have left it to municipalities to bring in more stringent public health measures using local bylaws. Mask-wearing in public spaces is one such example.

Whereas Manitoba, Quebec, Ontario and Nova Scotia require masks to be worn in all public spaces, Alberta and Yukon do not. Mask mandates in B.C. and P.E.I. were introduced less than a week ago. Despite this, the majority of Albertans find themselves living in a situation that is somewhat similar to that experienced by most Quebecers. Both Calgary and Edmonton have municipal bylaws mandating public mask-use.

While some provinces may not have enacted policies as stringent as others, most city-dwellers find themselves living with similar restrictions. Figure 2 shows how some of Canada’s major cities compare to provinces on the stringency index.

Regional variation hasn’t been without confusion 

Tailoring response to the local context is not without its pitfalls, however. Since the spring, provinces have created regional zones and colour-coded response levels that are meant to match variations in caseloads across regions. One by-product of this approach has been to create some confusion both within provinces and across provinces. A snapshot of how the least restrictive “green zones” vary across Canada captures how this targeted approach may generate confusion and bolster the call for unified national guidelines.

In Manitoba, to reach green (“limited risk”) a vaccine and effective treatment would have to be available. In Ontario, green (“prevent”) still requires masks to be worn in most indoor spaces and limits public gatherings to 100 people. New Brunswick will go to green after a vaccine and herd immunity or effective clinical treatment is available, or more is learned about how to protect people from the virus. And in Quebec green (vigilance) still limits bar capacity to 50 per cent, prohibits dancing, and limits private indoor gatherings to 10 people. Today, no provincial zone is in green or at the lowest stringency level.

With provinces starting from such divergent baselines, could new standards communicated from Ottawa easily overwrite that of provincial leaders? Probably not. Public health officials and leaders have all had problems communicating these different measures within their own province. There is little reason to believe that the federal government wouldn’t further muddy the waters.

But that does not mean that more intergovernmental coordination aimed at providing a more unified and clearer public message is not possible. The German example here could be useful. German federal and Länder (state) governments have shifted from the policy asymmetry that had characterized their response last spring to a more coordinated approach aimed at unifying their response to the pandemic. But even there, some level of variation has remained. Paying attention to context will likely make a one-size-fits all approach less than ideal to implement.

As second-wave caseloads mount, calls for the federal government to step up have intuitive appeal. But in practice, federal intrusion in health care would blur the lines of accountability and see Ottawa operating outside of its depth with little promise of better outcomes. The decentralized nature of our federation and norms of intergovernmental collaboration resist change.

Appreciating that the lived experience of the pandemic has been hyper-local should ground pandemic responses. Before the pandemic, only 19 per cent of Canadians favoured transferring greater decision-making power from the provinces or territories to the federal government. COVID-19 may go on to change people’s views on centralization, but our current reality is that province-driven pandemic responses are local and would be slow to adapt to an approach led from Ottawa. Rather than upending provincial authority, the federal government should work within existing frameworks to explore conditional fiscal transfers and lead the discussion on possible inter-provincial travel restrictions.

A clear separation of powers and responsibility has defined the Canadian pandemic response, highlighting an important feature: accountability. Canadians in every province know who is responsible for ramping up (or not) health measures: their provincial government. In the end, it’s those governments that will have to face the music post-pandemic.

Photo: Ontario Premier Doug Ford examines COVID-19 Rapid Test Device kits at Humber River Hospital in Toronto on Nov. 24, 2020. THE CANADIAN PRESS/Frank Gunn

This article first appeared on Policy Options and is republished here under a Creative Commons license.