Vulnerable: The Law, Policy and Ethics of COVID-19

Journal of Public Health Policy

The COVID-19 pandemic-with its wide-reaching social, political, and economic implications-showcases the importance of public health governance. Governmental accountability is at the forefront of societal preoccupations, as state actors attempt to manage the pandemic by using sweeping emergency powers which grant them significant discretion. Though emergency measures have tremendous impacts on citizens' lives, elected officials and civil society have little input in how governments wield these powers. We reviewed available mechanisms in Canadian private, constitutional, and criminal law and found them to be unlikely sources of muchneeded accountability. Therefore, we propose that provincial and territorial legislatures modify public health legislation to expand mechanisms to foster public confidence in decision-makers, and bolster accountability to parliaments and citizens.

In this paper, we provide a brief forensic of the SARS crisis in Toronto and analyze the effectiveness of Canada's health care system in response to that crisis. We conclude that it is difficult to draw concrete conclusions about the cause and effect of the SARS epidemic. Nevertheless, there is an obvious governance problem in Canada's system, largely centering on the fragmentation of fiscal and political accountability through multiple levels of government, which needs remedy. We then look at international public health governance and question whether the World Health Organization's issuance of travel advisories will encourage greater transparency in reporting and responding to instances of contagious diseases.

Health Economics, Policy and Law, Vol. 17, no. 1, 2022

Canada's experience with the coronavirus disease-2019 (COVID-19) pandemic has been characterized by considerable regional variation, as would be expected in a highly decentralized federation. Yet, the country has been beset by challenges, similar to many of those documented in the severe acute respiratory syndrome outbreak of 2003. Despite a high degree of pandemic preparedness, the relative success with flattening the curve during the first wave of the pandemic was not matched in much of Canada during the second wave. This paper critically reviews Canada's response to the COVID-19 pandemic with a focus on the role of the federal government in this public health emergency, considering areas within its jurisdiction (international borders), areas where an increased federal role may be warranted (long-term care), as well as its technical role in terms of generating evidence and supporting public health surveillance, and its convening role to support collaboration across the country. This accounting of the first 12 months of the pandemic highlights opportunities for a strengthened federal role in the short term, and some important lessons to be applied in preparing for future pandemics.

Frontiers in Public Health, 2021

Objectives: According to the World Health Organization (WHO), an early and consistent international and national response is needed to control a pandemic's spread. In this analysis, we evaluate the coordination of Canada's early response to the coronavirus (COVID-19) pandemic in terms of public health interventions and policies implemented in each province and territory.Methods: Retrospective data was obtained from publicly accessible websites maintained by federal, provincial and territorial governmental agencies. Consistent with WHO's spreading of the disease pandemic action, individual and community-based public health interventions and policies were the focus. Time of intervention or policy, and COVID-19 cases per million at time of intervention was recorded for each province and territory.Results: Most public health interventions and policies demonstrated wide time ranges of implementation across individual provinces and territories. At time of implementation, there...

Frontiers in Public Health

The magnitude of the COVID-19 pandemic challenged societies around our globalized world. To contain the spread of the virus, unprecedented and drastic measures and policies were put in place by governments to manage an exceptional health care situation while maintaining other essential services. The responses of many governments showed a lack of preparedness to face this systemic and global health crisis. Drawing on field observations and available data on the first wave of the pandemic (mid-March to mid-May 2020) in Quebec (Canada), this article reviewed and discussed the successes and failures that characterized the management of COVID-19 in this province. Using the framework of Palagyi et al. on system preparedness toward emerging infectious diseases, we described and analyzed in a chronologically and narratively way: (1) how surveillance was structured; (2) how workforce issues were managed; (3) what infrastructures and medical supplies were made available; (4) what communicatio...

Canadian Journal of Public Health

Faced with the extraordinary global public health crisis of COVID-19, governments across Canada must decide, often with limited and imperfect evidence, how to implement measures to reduce its spread. Drawing on a health and human rights framework, this commentary explores several features of the Canadian response to date that raise human rights concerns. Our discussion focuses on criminal law, fines, data collection, and so-called snitch lines. We argue that the approach of governmental and public health authorities must be grounded in the best available scientific evidence and align with human rights standards. Our aim is to encourage dialogue within the public health community in Canada about the importance of human rights-based responses to COVID-19. Résumé Face à la crise de santé publique sans précédent que représente la COVID-19 à l'échelle mondiale, les gouvernements des provinces et territoires du Canada doivent décider, souvent en se fondant sur des preuves limitées et imparfaites, comment mettre en oeuvre des mesures pour réduire sa propagation. En s'appuyant sur un cadre de travail relatif à la santé et aux droits de la personne, cette analyse explore plusieurs éléments de la réponse canadienne apportée à ce jour qui soulèvent des préoccupations en matière de droits de la personne. Notre analyse porte en particulier sur le droit criminel, les amendes, la collecte de données et ce qu'on appelle les « lignes de dénonciation ». Nous estimons que l'approche des autorités gouvernementales et de santé publique doit être fondée sur les preuves scientifiques disponibles les plus solides et s'aligner sur les normes en matière de droits de la personne. Nous avons pour objectif d'encourager le dialogue au sein de la communauté du secteur de la santé publique au Canada sur l'importance des réponses à la COVID-19 fondées sur les droits de la personne.

Nico STEYTLER, ed, Comparative Federalism and Covid-19: Combatting the Pandemic, Routledge, 2021, pp. 200-219

English: Canada’s federal structure has undeniably impacted the management of the Covid-19 pandemic. Innumerable policy areas, implicating both federal and provincial/territorial actors, are engaged in a pandemic response. Despite a formally dualist constitutional structure, grey zones – where jurisdictions overlap – exist. Effective public health responses require actors to sort out “who does what” and coordinate their actions. This paper examines federal dynamics in the first six months of the Covid-19 pandemic, encompassing the initial outbreak in March 2020 and first wave, the summer months’ partial lull and the start of the second wave in the fall of 2020. Focusing primarily on health and public safety (including emergency power), it describes the constitutional and legislative frameworks shaping each order of government’s actions, as well as the existing institutional intergovernmental frameworks. The article surveys the response measures taken at the federal and provincial levels and analyzes intergovernmental relations during this initial period. It also examines what measures were not taken – notably the invocation of the federal emergency power. The federal narrative of Canada’s initial pandemic response is one of parallel action by various orders of government, in line with the dualist nature of the federation. Both the provinces and the center remain strong actors. Surprisingly, there have hardly been any jurisdictional turf battles. Still, initial convergences in public health measures have given way to greater variations as provinces re-opened in the summer of 2020. With infection rates and deaths differing radically across the country, relations between provinces have been strengthened and, in some cases, tested. Unlike some federations, which saw either centralisation (temporary or not) or the creation of new multilateral bodies often under federal leadership, intergovernmental relations have been real, particularly at the operational level, but muted. Consultations occurred via a number of both already established and more ad hoc intergovernmental channels, often with quiet and largely behind-the-scenes cooperation. New regional blocks have also emerged, to improve public health measures but also to maximize bargaining power and political pressure on the federal government. Generally, intergovernmental relations remain widespread, executive-led, and relatively effective. But opaque as ever. French: La structure fédérale du Canada a un impact indéniable sur la gestion de la pandémie de Covid-19. D’innombrables sphères de politiques publiques sont mobilisées dans la lutte contre la pandémie. Elles relèvent tant des autorités fédérales que des provinces et territoires. Malgré une structure constitutionnelle formellement dualiste, des zones grises, où les compétences se chevauchent, existent. Des réponses efficaces en termes de santé publique exigent que les acteurs clarifient « qui fait quoi » et coordonnent leurs actions. Ce texte examine les dynamiques fédérales des six premiers mois de la pandémie de Covid-19, couvrant le déclenchement de l’épidémie en mars 2020 et la première vague, l’accalmie partielle des mois d’été et le début de la deuxième vague à l’automne 2020. S’intéressant principalement aux domaines de la santé et de la sécurité publique (y compris les mesures d’urgence), il décrit les cadres constitutionnel et législatif structurant les actions de chacun des ordres de gouvernement ainsi que les arrangements intergouvernementaux mis en place avant et pendant la pandémie. L’article survole les mesures adoptées aux niveaux provincial et fédéral et analyse la teneur des relations intergouvernementales dans cette période initiale. Il examine aussi quelles mesures n’ont pas été prises – notablement l’invocation des mesures d’urgence par l’ordre fédéral. Le récit qui émerge met en exergue les actions parallèles prises par divers ordres de gouvernement, conformément à la nature dualiste de la fédération. Tant les provinces que le centre demeurent des acteurs forts. Fait surprenant, la période n’a été marquée par aucun conflit de compétences significatif. Cela étant, la convergence initiale entre les mesures de santé publique a cédé le pas à de plus grandes variations lors du « décloisonnement » des provinces à l’été 2020. Avec des taux d’infection et de mortalité variant radicalement à travers le pays, les relations entre provinces ont été à la fois renforcées et, dans certains cas, mises à l’épreuve. Contrairement à d’autres fédérations, qui ont vécu une centralisation (temporaire ou non) ou la création de nouveaux organes multilatéraux souvent sous la direction du fédéral, les relations intergouvernementales se sont manifestées, particulièrement au niveau opérationnel, mais de manière discrète. Des consultations ont eu lieu via des canaux préexistants ou plus ad hoc. Des formes de coopération ont émergé mais souvent de manière fort peu transparente. De nouveaux blocs régionaux sont apparus, pour améliorer les mesures de santé publique, mais aussi pour maximiser le pouvoir de négociation et la pression politique sur le gouvernement fédéral. De manière générale, les relations intergouvernementales sont répandues, dominées par les pouvoirs exécutifs et relativement efficaces. Mais toujours aussi opaques. Note : l'article est uniquement en anglais.

2009

This paper evaluates efforts to establish an integrated and functional countrywide epidemic detection and reporting system in Canada following the 2003 SARS outbreak. The purposes and products of epidemiologic surveillance are reviewed, as are the intersectoral and international dimensions of infectious disease control, and the ambiguity in Canadian law of related public health roles and responsibilities. An analysis of current networks, policies and programs, augmented by key-informant interviews, demonstrates that progress toward developing national real-time capacity in epidemic surveillance has been limited. Although a blend of disentangled and collaborative approaches to this issue was effective in developing consensus between levels of government on the need and agenda for coordinated changes in the pre-SARS era, as well as in the immediate aftermath of the crisis, the same intergovernmental strategy appears to have made little actual progress achieving such changes in subsequent years. Counterproductive respect for jurisdictional boundaries, limited resources at the Public Health Agency of Canada, and the use of weak policy instruments in pursuit of intergovernmental collaboration have done little to alter the reality that epidemic surveillance in Canada is characterized by duplication and competition, conducted within institutional "silos" that use incompatible information systems and produce incommensurable data, and shared through informal and voluntary rather than mandated and automatic mechanisms. The impact of federalism on surveillance policy effectiveness has thus not been positive, and in fact undermines the obligation to protect domestic and international health. A federal trust model, based on the combination of national guidelines and flexible ongoing federal funding, may present a politically feasible option for restructuring intergovernmental relations on this issue. This approach will help secure the transfer of epidemiological information during public health emergencies, the importance of which has been reinforced by more recent infectious disease outbreaks, notably the epidemic of listeriosis in 2008 and the global influenza H1N1 pandemic of 2009.

Journal of Global Health, 2021

The global coronavirus pandemic has taken the world by surprise. Though such a pandemic was anticipated, it has hit countries with force, which both national and international health institutions were unprepared for. Known as COVID-19, this newly emerging virus exhibits high transmissibility, an alarming fatality rate, and few proven medical countermeasures, all of which pose a challenge to its governance. The enormity of the situation caused by COVID-19 is putting global institutions to the test with regards to governance during pandemics. The Viewpoint calls for revision of the international guidelines and national approach towards an assertive institutional environment for pandemic governance. An assertive institutional environment is about the actors stepping back to take decisions as an external viewer for the welfare and security of humanity and their ecology nationally and globally. It is not about having proactive policy response with predictable concrete events but rather drawing attention to potentially relevant developments on an everyday basis recognizing the prevailing uncertainty, unpredictability, and availability of resources with strong leadership. This requires stronger international cooperation, adequate foresight, enhancing social solidarity, and optimizing resources with strong leadership and effective communication.

An increasing number of Canadians are concerned about how the COVID-19 crisis was handled by our governments and institutions. We are alarmed by the serious consequences of their decisions and, at times, their apparent indifference to the costs. Those consequences include tragic impacts on the personal lives of many, violations of constitutionally guaranteed rights and freedoms in the name of health security, and economic impacts of lockdown measures, which subjected millions of Canadians to business closures, loss of income, and unemployment.Canadians are asking many questions: Were the measures taken by governments in Canada appropriate to the perceived threat? Were they based on sufficient clinical and statistical evidence? Were they suitably focused? How effective were they? Were there any conflicts of interest at play? Was there enough emphasis on prevention and early treatment? On informed consent? Was sufficient debate permitted? In attempting to prevent COVID-19, what other ...