Reviews of Canada’s pandemic response must take a comprehensive, global approach

The momentum to learn lessons from Canada’s lacklustre response to the COVID-19 outbreak is gathering some speed at last, 15 months into the crisis. Conservative Leader Erin O’Toole has recently pledged that his party, if it wins the next federal election, would order a public inquiry into the Liberal government’s pandemic response. The Liberals have responded with a repeat of vague promises to do the same “at an appropriate time.” But we are well short of a concrete plan guided by a determination to be much better-prepared for the next (inevitable) pandemic or biosecurity threat.

What we have seen are some initial efforts by both the auditor-general and a government-appointed independent panel to get at some answers. But these early efforts have been narrowly focused and piecemeal.

Last fall, the health minister, under pressure from opposition critics, announced an independent panel to review the functioning of our early-warning and surveillance system, known as Global Public Health Intelligence Network (GPHIN). One concern was that “GPHIN alerts” – global media-sourced red flags about major infectious disease outbreaks – stopped in the spring of 2019. The GPHIN system couldn’t provide the urgency needed to alert the government to the COVID-19 outbreak in Wuhan, China, in January 2020.

The federal government’s independent panel, chaired by a former national security adviser, Margaret Bloodworth, released an interim report on March 19, 2021, several weeks after its submission to the minister. It confirmed that alert-reporting had been halted prior to COVID-19 and found an alarming pattern of senior leadership confusion over the function and purpose of GPHIN. For its final report, to be provided in May, the panel promises a deeper dive into a host of issues surrounding GPHIN and its future, including the state of risk assessments at the Public Health Agency of Canada (PHAC) and the provision of “useful public health intelligence to stakeholders across Canada.”

A second step has been the tabling in Parliament of the auditor general’s initial performance audit of the government’s pandemic preparedness, released on March 25, 2021. This report, which concerned itself primarily with PHAC, found problems with many aspects of the agency’s pandemic preparedness. It also zeroed in on faulty risk assessments, which consistently rated the threat from COVID-19 to Canada as low from January 2020 to mid-March 2020, despite the huge toll the disease outbreak took in China, and its regional and then global spread.

By the time that PHAC changed the needle on its assessment on March 16, 2020, from low to “serious” there were already more than 400 cases in Canada. Two and a half months, during which strong measures could have been taken, were lost. Timely response to a pandemic is everything but Canada moved at a snail’s pace, disbelieving the threat.

One strong feature of an auditor general’s report is that the government department or agency under study is obliged to respond to all of the report’s recommendations and findings. PHAC did a mea culpa with regard to all eight of the AG’s recommendations and promised fixes. With regard to risk assessments specifically, PHAC promised to conduct a lessons-learned review but set a deadline of December 2022 to complete the review and added a caveat that meeting the deadline might not be possible, given other capacity issues during the ongoing COVID crisis.

This sign of potential half-heartedness was echoed in comments made by Dr. Theresa Tam, Canada’s chief public health officer and her deputy, Dr. Howard Njoo, at a press briefing on March 26, 2021, the day after the tabling in Parliament of the AG’s report. Tam admitted that PHAC needed to do a better job at making its risk assessments predictive, but at the same time argued that they were not wrong.

This was a baffling assertion, as the risk assessments did amount to predictive statements, just extremely faulty ones that suffered from an entirely inappropriate methodology. Dr. Tam herself was prepared to make predictive statements about the risk of COVID-19, notably in testimony before the health committee of the House of Commons on January 29, 2020: “Canada’s risk is much, much lower than that of many countries. Its going to be rare, but we are expecting cases. It doesn’t matter how few those cases are.…Its going to be rare but you’re going to have some.”

That prediction, alas, proved faulty. It came three days after the World Health Organization had raised the global risk for COVID 19 to “high” and one day before the WHO director general, using his authority under WHO’s international health regulations, declared a “public health emergency of international concern,” a declaration which was meant to stimulate action by all member countries but caused no ripples in Canada.

Waiting in the wings is a study of the government’s handling of “medical intelligence,” to be conducted by the National Security and Intelligence Review Agency (NSIRA). The terms of reference of this study have yet to be finalized but whatever shape it takes by the fall of 2021, it promises to be another important investigation into the government’s handling of the COVID-19 response. The NSIRA study is potentially potent because it has the capacity to “follow the thread” and explore the roles of multiple federal departments and agencies, including the Department of National Defence and its medical intelligence cell.

But NSIRA also admits this will be an unprecedented study for the new review body – NSIRA absorbed the functions of the Security and Intelligence Review Committee, and the commissioner for the Communications Security Establishment – with no previous reporting experience to draw on.

What characterizes many of the lessons-learned exercises to date is their siloed nature. They also show a tendency to be divorced from any global picture of investigations and reforms afoot in other countries or in major international bodies such as the WHO. These preliminary Canadian investigations may provide important pieces of a lessons-learned puzzle, but larger issues around how the government responded as a whole and how it should respond to a pandemic crisis in future, in a global context, must be studied.

We must also learn from the past, lest we repeat a damning cycle. Both the federal government and the Ontario provincial government took important steps after SARS to gather lessons from that experience –the impact of which at the time in 2003 was alarming, but which pales in comparison to the extreme damage caused by COVID-19.

The terms of reference provided to the National Advisory Committee on SARS and Public Health (Naylor Commission) were straightforward: to provide a “third-party assessment of current public health efforts and lessons learned for ongoing and future infectious disease control.” The committee worked quickly – it was established in May 2003 and reported in October of that year. Its report led to a major restructuring of public health in the federal system.

Here is a model for what is needed now: The government needs to make good on its repeated promises to learn lessons from the response to COVID-19 and needs to do so now, in an independent and transparent manner. Maybe the Conservative leader’s effort to steal this headline will finally prompt action.

The only other ingredient needs to be a promise to ourselves not to forget the lessons that are eventually learned, as happened in the years after SARS, when we entered the amnesiac phase officially known as the “inter-pandemic.” We will at some point arrive at another “inter-pandemic” phase with the worst of COVID-19 behind us, but this time we must treat it as purely temporary, with an unknown and dangerous future barreling towards us.

Disclosure: The author contributed an independent expert report to the Office of the Auditor General on aspects of the government’s pandemic preparedness and response

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