Back to reality: The return of the Chief Medical Officer of Health

Posted on Monday, September 20, 2021

Author: Margaret MacAulay, Patrick Fafard and Adèle Cassola

Research Associate
Global Strategy Lab

Core Member, ISSP and Associate Professor, uOttawa
Associate Director, Global Strategy Lab

Research Director, Public Health Institutions
Global Strategy Lab

A modified version of this blog was originally published in the Globe and Mail on September 13, 2021.

Few public servants are as well-known as Canada’s Chief Medical Officers of Health (CMOH). Once the stars of daily press conferences, some became less prominent over the summer. However, as the Delta-driven fourth wave of the COVID pandemic continues, we can expect these high-profile doctors to resume their regular media appearances.

For many CMOHs, a fourth wave of the pandemic not only marks the return of vigilance but also the pressures of the spotlight. Several of these officials were initially celebrated in the media as public health heroes and charismatic parental figures. But inevitably some experienced the disadvantages of viral fame: personal attacks, targeted harassment, and calls for their resignation. 

Each provincial government chooses their preferred mix of public health measures. CMOHs are simultaneously tasked with interpreting complex scientific evidence to advise ministers on these choices, explaining government policies, sometimes managing health departments, and reassuring citizens that their governments are prepared to lead them back to “normal”. Their independent scientific expertise and authority serve to enhance public trust in government decisions.

However, CMOHs’ role as the government’s central public health and scientific advisor has been challenged. In some cases, this is because other expert bodies have become prominent (e.g., Ontario’s ‘Science Table’). In others, it is because politicians are framing their CMOHs as decision-makers. For example, Alberta’s Health Minister Tyler Shandro argued that the decision to end isolation requirements for COVID cases and contacts “came from [Alberta’s CMOH] Dr. Hinshaw”. This reflects a common pattern of politicians claiming to “follow the science”. But this is not how governments make important policy decisions. CMOHs may play a key role in the process, but we elect politicians to make the tough choices.

Some argue that CMOHs should be public health watchdogs holding governments to account rather than serving as their trusted advisors. In Fall 2020, many called for Ontario’s CMOH to push harder and more publicly for stricter public health measures. Concerns regarding the pace of re-opening in several provinces in order to bolster the economy have led some to describe CMOHs as “toothless” and in desperate need of greater autonomy. However, the same person cannot advise the minister in the morning and publicly criticize the government in the afternoon. 

These issues have not only emerged in Canada. Our analysis of the CMOH role in Canada, Australia, New Zealand, the United Kingdom, and Ireland reveals common tensions in the design of the office and questions about when public health officials should speak out, resign, or exercise independent authority. These similarities point to the shared role of these countries’ CMOHs as public servants. Yet we can also learn from the significant variation in how the role is structured in different places. For example, in the Australian state of Queensland the government moved to enhance the CMOH’s decision-making power during the pandemic.

Across jurisdictions, the increased scrutiny of CMOHs during pandemic times draws our attention to the importance of institutional design in public health policymaking. How the CMOH is appointed, their degree of autonomy, and the scope of their management and advisory roles all shape the trajectory of the CMOH. These are more important than whether an individual CMOH is charismatic, courageous, or a gifted communicator. We must ask why the role exists and whether the pandemic requires that we rethink what they do and how they do it. Can the CMOH simultaneously be a senior government advisor, public expert, policy advocate, public health manager, and government spokesperson? In times of crisis, when should we rely on the independent authority of the CMOH? How do we balance the need for robust science-informed policy with the need to make decisions that respond to the electorate’s diverse and competing needs and concerns?

With politicians approaching the podium this fall to make perhaps daily announcements, they will share the limelight with their CMOHs. As we turn to evaluating government performance during the pandemic, we need to consider not just the choices made by elected leaders but also the role of the CMOH and whether changes are necessary for the next time this happens. Because there will be a next time.

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