"Serious failures": British study slams Canada's COVID-19 pandemic response
A new report from the British Medical Journal examines where Canada went wrong in its COVID-19 pandemic response.
The report found that despite Canada creating and strengthening its public health agencies, it still experienced “serious failures” during the pandemic.
The report breaks down several “lows” from Canada’s pandemic response and notes that the country’s public health system was “insufficiently prepared” for the pandemic mainly due to its decentralization of public health decision-making and a lack of data sharing and access.
The impacts of COVID-19
As of June 2023, Canada’s cumulative confirmed COVID-19 death rate was 1,372 per million population, notes the report.
This “fared worse” than many other countries with similar countries that have decentralized healthcare, including Australia (814 deaths per million) and the US (3,332 deaths per million).
The deaths in Canada may have varied compared to other countries due to “social norms that reflect compliance with public health measures.”
“Globally, countries with stricter norms and punishments for deviating from those norms experienced fewer cases and deaths,” states the report.
What went well
The report notes a few examples of what Canada handled well in its pandemic response.
Canada’s vaccination rate was strong, with over 83% of the population receiving at least one COVID-19 vaccine dose as of February 2023.
There was rapid research and collaborations, such as the COVID-19 Immunity Task Force.
The report also highlights that public health leadership included women experts at each level of decision-making throughout the pandemic.
Where we failed
The study breaks down several low points of Canada’s COVID-19 pandemic response.
These include the failure to learn from previous reports, which led to a severe lack of care and protection for seniors and staff in long-term care homes.
Additionally, Canada experienced an “exodus of exhausted and distressed” healthcare workers, leading to severe staffing shortages.
The report also highlights Canada’s lack of research infrastructure, which impacted its ability to participate or lead in clinical trials.
When distributing medications, provinces, and hospitals had challenges accessing and delivering critical drugs, such as tocilizumab and remdesivir.
The study also emphasizes significant issues related to data collection and sharing.
Canada lacked a “clear and standardized approach” to testing and case definitions, which hindered the ability to share data and make decisions.
A lack of data-sharing agreements between federal, provincial, and territorial jurisdictions also led to limited information shared, specifically around case reporting, genomics, and viral sequencing data.
While most jurisdictions reported COVID-19 case numbers, more detailed data, such as demographics or locations where the infection spread rapidly, was not available.
This meant that in many cases, public health authorities failed to respond to tailor COVID-19 responses to the needs of specific communities.
“Lack of local data contributed to a lack of understanding of local transmission dynamics and contributed to a loss of public trust over time,” states the report.
As the pandemic progressed, there was confusion around jurisdictional inconsistencies in public health guidance and how cases were reported.
Why did this happen?
The report says that much of Canada’s poor COVID-19 response is due to fragmentation and decentralization in its healthcare system governance.
The Public Health Agency of Canada (PHAC) was established in 2004 to streamline Canada’s response to public health threats. However, the federal agency “lacks the powers to direct provincial and territorial health agencies or other bodies with similar mandates to implement its recommendations.”
With each province and territory having its respective public health officer, there was overall fragmentation regarding jurisdictional decision-making.
Each province or territory was responsible for devising its protective measures and public health response plans, “leading to substantial variation in policy and practices across the country, widely varying hospital admission rates, and public confusion,” states the report.
Inquiry needed
The report calls for a national inquiry into Canada’s pandemic response and notes that improvements in the country’s data collection and sharing systems are essential.
“Consistent with reports both before and after this pandemic, we call for a culture of data sharing that enables diverse use by a broader range of users,” states the report.
“Public health in Canada will benefit from a common vision and harmonized approach to generation, use, and analysis of data to guide public health decision making and population health benefit.”
The report adds that a tailored public health response to emergencies — including transparent data collection — is critical.
While the federal government has committed to providing $505 million over the next five years for national data partners to work with provinces and territories to improve the collection and sharing of health information, the authors of the report say they are “skeptical that this further call for collaboration on data sharing will be sufficient.”
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