Ethics and COVID-19: A Book Review

Distribution Ethics re Canada – Preparation

Vulnerable: The Law, Policy and Ethics of COVID-19
Eds. Colleen M. Flood, Vanessa MacDonnell, Jane Philpott, Sophie Thériault, and Sridhar Venkatapuram

In spite of the Naylor and other reports, I wrote about the failure to implement the comprehensive and efficacious recommendations of post-SARS reports. David Naylor Co-Chair of the Federal COVID-19 Immunity Task Force in his cover comment on the book wrote, “Assembled in the midst of an unprecedented epidemic, this collection of 43 short essays examines vulnerabilities in Canada’s defences against COVID-19, and the resultant consequences for vulnerable populations at home and abroad. It should be required reading for anyone who cares about Canadian public health policy, law, and ethics.” Katherine Fierbeck and Lorian Hardcastle contributed an essay entitled: “Have the post-SARS Reforms Prepared Us for COVID-19? Mapping the Institutional Landscape.” (A1) I found that my conclusions on failure were largely supported by the authors. There was a major difference in the norms used and this review will concentrate on the differences.

I wrote the following:

Why was Canada seemingly caught unawares when it had its own terrible experience with SARS? Canada, too, had responded to the 2003 crisis with a provincial thorough investigation and a detailed report by Justice Archie Campbell and the federal government with the Naylor Report. The final report of the Ontario independent commission was completed in 2006. The Minister of Health and Long-Term Care made it public on 9 January 2007. The report documented how the SARS virus came into the Province of Ontario, spread and the inadequate response of the health authorities. The report documented the need to isolate and quarantine, to test and track contacts, how to work on treatments and vaccines, but the greatest stress and emphasis of the report was on the measures needed to protect public and health workers. Quality tested masks, gowns and other protective equipment had to be purchased and stockpiled.

Katherine Fierbeck and Lorian Hardcastle argue that the federal structure of the Canadian political system undercut any effort to manage the pandemic effectively on the basis of a clear and straightforward structure of communication and accountability. However, before you can get good communications, before you can even have accountability, you have to have initiative. You have to have action. And you have to have a plan. In my reading of the discussions among civil servants and with politicians, the issue of communication appeared to be the foremost concern followed by accountability. Fierback and Hardcastle appear to have bought into the civil service value system, and, I would add, the Canadian preoccupation with good communications and effective accountability.

The essayists may be correct – the structure of the Canadian federal polity is both the cause of that value priority as well as the explanation of why Canadian officials never achieve those goals. What about the goal of measuring success or failure by whether the results of past studies are taken into consideration and even followed? What about the goal of a fast start in identifying an impending crisis? What about the values of initiative and creativity to measure Canadian actions? What about even efficacious results?

The authors do claim that, “The fundamental theme of pandemic management in Canada is thus the tension between the need to make clear, coherent, and timely decisions, on the one hand, and the need to involve an exceptionally large array of political actors across different levels of government, on the other.” They are right, I believe, that the very high value placed on participatory decision-making undercut the possibility of timely action. But clarity? Coherence? My studies indicated that both of these were present in spades, but the priority of these two values sabotaged speed and creativity. The Canadian absolute priority for an Apollonian system undercut the possibility of a Dionysian approach required in a crisis.

However, this does not explain why lessons learned from the SARS scare in 2003 and the H1N1 flu pandemic in 2009 were not implemented since the source of the failures had been exposed and recommendations made to prevent a repetition. The 2009 H1N1 pandemic, according to Fierbeck and Hardcastle, tested the reforms following SARS in 2003 and identified new issues underlying the coordination of governmental actors. However, correcting for coordination was neither the major and certainly not the only problem. It may be a constant of Canadian political life, but Canadians have achieved great things when initiative was taken and coordination was largely an afterhtought – the Hungarian refugee movement in 1956 and the Indochinese refugee movement in 1979.

“A fundamental aspect of pandemic management is effective coordination between key units of governance within a state.” That is indeed a Canadian preoccupation. That indeed is a ley evaluation marker of the writers. But in the face of emergencies, the crisis must first be clearly recognized and identified by someone and a fast response that is comprehensive and effective developed. We did not do this in the 2003 SARS crisis or the H1N1 2009 flu crisis and the beed, indeed demand for full coordination was part of the rason for the failure the second time round.

In my blogs, the implementation measures were widely distributed.

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