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F e bruary 8, 2021 | T he Hill T im e s

    PO L I CY B R I E F I N G
24                                                                                                                                            MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES

Health Policy Briefing

Supply delay offers opportunity to get mass
vaccination campaign right, experts say
                                      on Moderna shipments past the          a little less than 250,000 Astra-         to administer vaccines, in theory         Prof. Ray said that winter tem-
With Canada’s                         week of Feb. 1 to Feb. 7.              Zeneca vaccines, South Korea              it should be easier to do than a      peratures will act as a constraint.
supply of COVID-19                        Prime Minister Justin Trudeau
                                      (Papineau, Que.) was pressed in
                                                                             will receive less than 2.6 million,
                                                                             and Indonesia a little more than
                                                                                                                       mass vaccination campaign.
                                                                                                                           According to a vaccination
                                                                                                                                                                 “Until May, indoor is perhaps
                                                                                                                                                             better. Perhaps by May there can
vaccines dropping                     Question Period on Feb. 3 on how
                                      much the Moderna supply will be
                                                                             13.7 million.
                                                                                 Canada is lagging behind most
                                                                                                                       tracker by University of Sas-
                                                                                                                       katchewan student Noah Little,
                                                                                                                                                             be more of an opportunity for go-
                                                                                                                                                             ing outdoors,” he added.
below initially                       affected in weeks to come, but he      G7 countries on vaccination pace.         86.4 per cent of vaccines deliv-          Accessibility will be another
                                      didn’t offer a direct answer.          Canada is only doing better than          ered to the provinces have been       major constraint, Prof. Nagarajan
expected numbers                          He was visibly frustrated by       Japan, which has not begun its            administered. That varies wildly      said.
                                      the questions.                         vaccination campaign yet. The             depending on the jurisdiction,            “You want to have an equitable
in the coming weeks,                      “I have already said this 15       country plans to begin vaccina-           with Nunavut having adminis-          measure. You don’t want people to
experts argue this                    times in Question Period today,
                                      but I am happy to continue reas-
                                                                             tions for health-care workers in
                                                                             late February, and priority groups
                                                                                                                       tered just more than half of its
                                                                                                                       vaccines, while Quebec, B.C., and
                                                                                                                                                             be driving 40 miles to come to a
                                                                                                                                                             stadium,” he said.
period presents an                    suring Canadians. We will receive
                                      the six million doses promised
                                                                             like seniors in late March or early
                                                                                                                       Saskatchewan have administered            Many schools and major
                                                                                                                       upwards of 90 per cent.               stadiums, like NHL arenas, will
opportunity to ensure                 by the end of March. We are on             NDP health critic Don Davies              The tracker shows that 871,323    only be available for mass vac-
                                      track to receive 20 million doses      (Vancouver Kingsway, B.C.) said           Canadians have received at least      cinations in the summer once the
the mass-vaccination                  in the spring and we will ensure       he does not have confidence in            one dose, while 129,664 Canadi-       regular occupants are out, Prof.
                                      that every Canadian who wants          Mr. Trudeau’s statements that all         ans are fully vaccinated.             Ray said, but that shouldn’t stop
campaign runs                         it can be vaccinated by the end of     Canadians will be vaccinated by               For all Canadians to receive      the planning from starting now,
smoothly.                             September 2021,” he said.
                                          “The week of [Feb. 22] will also
                                                                             September.                                at least one dose by Sept. 1, a       Prof. Zwerling said.
                                                                                                                                                                 Schools are particularly well
                                      be impacted, but Moderna cannot                                                                                        suited, because the location is
                                      confirm allocations for that week                                                                                      based on population density, Prof.
BY AIDAN CHAMANDY                     yet,” the PHAC document said.                                                                                          Zwerling said. Major sporting
                                          Mr. Trudeau also previously                                                                                        arenas and concert venues are of-

I ssues with COVID-19 vaccine
  manufacturing in Europe has
left Canada receiving fewer doses
                                      assured Canadians that the first
                                      delay won’t affect the total num-
                                      ber of vaccines the country is sup-
                                                                                                                                                             ten only in major cities and might
                                                                                                                                                             not be in a place that is easily ac-
                                                                                                                                                             cessible, “so I’m not sure if those
in recent weeks than the federal      posed receive in the first quarter.                                                                                    are really the best approaches to
government initially predicted,           “This temporary delay doesn’t                                                                                      doing these mass vaccinations,”
but the drop in supply offers an      change the fact that we will still                                                                                     she said.
opportunity for governments to        receive two million doses of the                                                                                           Prof. Zwerling cautioned
get the planning right for when       Moderna vaccine before the end                                                                                         against relying too heavily on big
mass vaccinations begin later in      of March,” he told reporters at a                                                                                      buildings.
the year when supply ramps up         press conference last week, in                                                                                             “Successful mass vaccina-
again, experts say.                   reference to the initial cutback.                                                                                      tions in the past have employed
    “We should use this time,             Canada is also set to re-                                                                                          and engaged pharmacists, family,
when supply is low and demand         ceive far fewer doses of the                                                                                           doctors, local clinics, a much
is restricted to certain sectors of   Pfizer/BioNTech vaccine after                                                                                          more decentralized approach, as
the population, to make ourselves     the company began retooling its                                                                                        opposed to having one central-
ready for the mass vaccination,”      manufacturing plant in Belgium                                                                                         ized facility that requires logisti-
said Saibal Ray, professor of         to produce more vaccines. The          Maj.-Gen. Dany Fortin, right, and Deputy Chief Public Health Officer            cal support and infrastructure,
operations management at McGill       company said the renovations           Howard Njoo, pictured on Dec. 8, 2020, speaking with reporters about the        which, unfortunately has not been
University.                           will cut Canadian shipments by         government’s vaccine rollout. The Hill Times photograph by Andrew Meade         developed,” she said.
    “We have an opportunity now,      around 80 per cent, but that the                                                                                           Another key component will
all governments, to learn the         renovations will allow them to                                                                                         be the information technology
lessons from the initial rollout,     produce around two billion total           “Given that they have failed          little more 200 days away, around     infrastructure used to coordinate
see where the challenges are, but     vaccines in 2021, up from the          to meet any of the targets that           180,000 Canadians will need to        scheduling mass vaccinations
really prepare for the summer         initial promise of 1.3 billion. Mr.    they’ve stated so far, and, frankly,      receive at least one dose per day,    and following up, Dr. Wilson
when we’re going to have to start     Trudeau said he discussed the          the fact that they’ve misled Ca-          which far outstrips the current       said.
administering millions of doses,”     possibility of Canada receiving        nadians and actually been wrong           pace. In the past three weeks,            “The ideal system will have the
said Kumanan Wilson, a professor      more Pfizer/BioNTech vaccines          so many times, that can’t give            Canada’s daily vaccinations           vaccine recipient, the health-care
of epidemiology at the University     in the second quarter after Pfizer     anybody confidence,” he said.             peaked at just less than 40,000 on    provider and the public health
of Ottawa and doctor at The Otta-     CEO Albert Bourla told him in a            “There’s a serious credibility        Jan. 20 and have dropped to just      provider with the same data in
wa Hospital. Dr. Wilson is also the   call that the company could “move      problem,” he added.                       more than 15,000 on Feb. 3, ac-       real time and shareable. The in-
founder and CEO of CANImmu-           up the delivery of some doses that         The lack of vaccine supply is         cording to the vaccination tracker.   dividual has to be part of the solu-
nize, a digital logistics company     were earmarked for later in the        making is difficult to gauge how              By the time the vaccine supply    tion, they have to be able to have
that has helped some provinces        year.”                                 effective Canada’s actual vaccine         steadies, the mass vaccination        access to their vaccine records.
and territories with information          Maj.-Gen. Fortin later said that   rollout has been, Dr. Wilson said.        plans should already be in place      And health-care providers need to
technology infrastructure associ-     Pfizer is expected to send up to           Canada’s limited vaccine supply       “so that when we come to April        know exactly which vaccine this
ated with the rollout.                335,000 doses the week of Feb. 15,     “is making it really hard to judge        and the most vulnerable have          individual is given, that individual
    Both Pfizer/BioNTech and          which is 91 per cent of the initial    right now how we’re doing. It’s           already been vaccinated, and we       needs to be able to report adverse
Moderna products, the only two        allocation for that period. The        apparent that the systems need to         go to vaccinate a more general        events as they would occur,” he
vaccines currently approved for       shipment is expected to increase       be further developed. It’s a bit of a     population, we can do the mass        said.
use in Canada, announced deliv-       to up to 395,000 doses the week of     double-edged sword, that the delay        vaccination as quickly as pos-            Dr. Wilson said one of the key
ery delays in the past weeks.         Feb. 22.                               getting our vaccine is an opportunity     sible,” said Prof. Ray.               things he learned in running trials
    Canada is expected to receive         The Health Canada website          to be better prepared,”Dr. Wilson said.       Prof. Ray pointed to sites like   using his CANImmunize platform
around 180,000 shots of the Mod-      also removed the table outlining           “We have not had the volume           the Palais des Congrès in Montre-     and from other jurisdictions is
erna vaccine in the second week       Pfizer’s shipments.                    [of vaccines] that a country like         al as prime targets for mass vac-     that effective scheduling “is one of
of February, down from an initial         The global vaccine-sharing ini-    the United States has had where           cinations. Quebec Health Minister     the most important aspects. The
promise of more than 230,000. A       tiative COVAX released a docu-         we know how good our logistical           Christian Dubé said the conven-       scheduling processes really sped
Jan. 29 document prepared by the      ment on Feb. 3 showing Canada          systems are actually working,”            tion centre is ready to administer    up the clinic management.”
Public Health Agency of Canada        will receive 1.9 million doses of      said Mahesh Nagarajan, profes-            more than 1,000 doses per day.            “It helps from two perspec-
obtained by CBC News said the         the AstraZeneca vaccine by the         sor of logistics at the University            Prof. Ray said in the com-        tives. Booking online is easy, but
second shipment pegged for the        end of June. The COVAX program         of British Columbia.                      ing months, when winter is still      you can also start to auto-popu-
week of Feb. 22 will also be af-      was created with the intention of          For Alice Zwerling, an epide-         keeping temperatures low, indoor      late the data needed at the time
fected, but the company cannot        providing equitable access to the      miologist at the University of Ot-        sites that haven’t had much           of vaccination when the person
confirm to what extent. The docu-     vaccine for middle- and lower-         tawa, the lack of transparency on         traffic because of the pandemic,      fills in that data. So the vaccina-
ment was signed by Maj.-Gen.          income countries. Canada is one        vaccination targets and how long          like convention centres, malls,       tion is so much quicker—there’s
Dany Fortin, who is in charge of      of the wealthiest countries, and       it has taken to vaccinate people in       universities, hockey arenas, and      not much data entry at the point
federal vaccine logistics. Moderna    the only G7 country, listed as a       priority groups, like those in long-      concert venues will be extremely      of vaccination, because already
was originally set to send 249,000    recipient in the document. It also     term care homes, suggests the             important.                            most of the information is auto
doses doses the week of Feb. 22. A    shows other wealthy countries          rollout “has not been ideal.”                 “Anything that is covered,        populated,” he said.
table on Health Canada’s website      are set to draw on the COVAX               She said that given long-term         empty, and accessible we should            achamandy@hilltimes.com
no longer provides information        supply. New Zealand will receive       care homes provide a single site          use,” he said.                                    The Hill Times
26                                                                                                                                             MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES

Health Policy Briefing

No time to waste on health-care reforms
                                                                                                                                                                               Green Party
                                                                                                                                                                               leader Annamie
                                                                                                                                                                               Paul, pictured,
                                                                                                                                                                               says that
                                                                                                                                                                               the structural
                                                                                                                                                                               weaknesses in
                                                                                                                                                                               health care,
                                                                                                                                                                               rather than
                                                                                                                                                                               merely reacting
                                                                                                                                                                               to each crisis as
                                                                                                                                                                               it arises, is the
                                                                                                                                                                               best strategy
                                                                                                                                                                               going forward.
                                                                                                                                                                               courtesy of the
                                                                                                                                                                               Green Party of

                                       outbreak. While we will be reckon-       crisis affects both long-term care     how to provide the right support       addictions. We must also priori-
It is not too late for                 ing with this pandemic and its           residents, staff, and the loved ones   where it is most needed.               tize the expansion of rehabilita-
                                       accompanying health-care failures        who provide essential care. This is        If we are serious about ad-        tion services. A harm-reduction
Canada to convene                      for some time, we must still begin       a humanitarian crisis, and there is    dressing health-care shortcom-         approach is the only way to
an intergovernmental                   planning for the future. Modern-
                                       izing our health-care systems
                                                                                overwhelming consensus among
                                                                                experts on what needs to be done.
                                                                                                                       ings in Canada more broadly, we
                                                                                                                       cannot overlook the skyrocketing
                                                                                                                                                              address this emergency and save
COVID-19 task force,                   should be high on the agenda, and
                                       the federal government can and
                                                                                    The short-term solutions to
                                                                                our LTC crisis are clear, imple-
                                                                                                                       costs of pharmaceuticals. Canada
                                                                                                                       is the only country with a univer-
                                                                                                                                                                  A through-line of the conver-
                                                                                                                                                              sation about health in Canada
led by health experts,                 should lead the way.                     mentable, and would have an            sal medicare system that does not      is mental health. The COVID-19
                                           As we continue to grapple with       immediate positive effect on           include doctor-prescribed medica-      pandemic has negatively im-
to develop and                         Canada’s greatest health crisis in       reducing deaths: accelerated vac-      tion, and one in three Canadians       pacted many Canadians’ mental
                                       over a century, there is no time to      cination, rapid testing, increased     is forced to pay for their prescrip-
deliver a coordinated                  waste. The Green Party has asked         staffing, improved training and        tions. To achieve lifesaving goals,
                                                                                                                                                              health, straining an already
                                                                                                                                                              overburdened mental healthcare
national response to                   the prime minister to convene
                                       an intergovernmental COVID-19
                                                                                pay for workers, and four hours
                                                                                of regulated daily care for each
                                                                                                                       and economies of scale, we must
                                                                                                                       establish a national universal
                                                                                                                                                              network. Establishing a national
                                                                                                                                                              mental health strategy is com-
the pandemic                           task force, led by health experts,       resident. We need an urgent first      pharmacare program, a bulk drug        mon sense—we need to address
                                       to develop and deliver a coordi-         ministers’ meeting to agree on a       purchasing agency, and shorter         the very real stressors plaguing
                                       nated national response to the           plan to end the mounting deaths        patent protection times for new        Canadians such as inequality and
BY GREEN PARTY LEADER                  pandemic. Countries that have            in long-term care that includes        drugs. The drug assessment             affordability, the precariousness
ANNAMIE PAUL                           been more successful in protect-         the immediate implementation           process must be free of conflicts      of work and housing, the climate
                                       ing their populations have adopt-        of these recommendations. There        of interest, and bulk purchases        crisis, social isolation, and the

T    he COVID-19 pandemic has
     taught us painful lessons
about the weaknesses in Can-
                                       ed such an approach, including
                                       the new president of the United
                                       States, who appointed a national
                                                                                should not be one more death in
                                                                                long-term care facilities caused
                                                                                by inaction and lack of political
                                                                                                                       of prescription drugs must be
                                                                                                                           The opioid crisis is a national
                                                                                                                                                              trauma and anxiety the pandemic
                                                                                                                                                              has caused. A suicide prevention
                                                                                                                                                              plan and immediate investments
ada’s health-care system. Low-         COVID-19 coordination team on            leadership.                            tragedy that has skyrocketed           in both community-based service
income and racialized communi-         his first day in office. It is not too       Throughout the past year, we       during the COVID-19 pandemic.          organizations and provincial and
ties have been disproportionately      late for Canada to do the same.          have been reminded of the impor-       From 2016-2020, nearly 18,000          municipal mental health services
impacted, as have seniors and the          When we search for answers           tance of evidence in guiding public    Canadians died from opioid             are a critical first step.
disabled.                              on why the pandemic’s death toll         health decisions—a standard that       overdose, many of which were               The COVID-19 pandemic has
    More than ever, the current cri-   in Canada continues to rise, one         should be adopted well beyond          due to fentanyl contamination. We      highlighted health issues, but
sis demonstrates why preventive        answer stands out: conditions in         this pandemic. Science and data        need to declare a national health      they are unfortunately not new.
health care plans are best made in     long-term care facilities. More than     have been critical to understand-      emergency to address the opioid        Addressing the structural weak-
ordinary times, rather than in the     80 per cent of Canada’s COVID-19         ing how different communities          crisis as a health-care issue, not     nesses in health care, rather than
middle of a crisis with all the ad-    deaths have been in long-term            are impacted by the pandemic. We       a criminal issue. Drug posses-         merely reacting to each crisis as it
ditional pressures it brings. Health   care, and Canada ranks second            must collect socio-demographic         sion should be decriminalized,         arises, is the best strategy.
promotion and disease prevention       amongst wealthy countries for the        data in government-funded re-          and users should have access to a          Annamie Paul is the leader of
in times of stability are the best     proportion of COVID-19 deaths            search moving forward in order to      screened supply and the medical        the Green Party of Canada.
preparation for times of crisis or     in long-term care facilities. This       make evidence-based decisions on       support they need to combat their                  The Hill Times
THE HILL TIMES | MONDAY, FEBRUARY 8, 2021                                                                                                                                                               27

                                                                                                                                        Policy Briefing Health

Why healthy aging must be the
upshot of the COVID-19 pandemic
                                                       In contrast to a common misperception,               days of the pandemic inadvertently fuelled     volunteer work. Those aged 65 and up
It would be in everyone’s best                     aging alone isn’t what sidelines older people—           ageist attitudes. In its most extreme form,    volunteered 223 hours a year, well above
                                                   frailty is. While aging is inevitable, frailty is not.   some people wrongly concluded that the         the national average of 156 hours. In 2012,
interest to focus now on ways                          Frailty is defined as a medical condition            economy should not have to shut down just      baby boomers and senior adults clocked
to prevent frailty by investing                    of reduced function and health; it becomes
                                                   more common as we age. Frailty increases
                                                                                                            to prevent the virus from killing the eldest
                                                                                                            members of society. After all, this demo-
                                                                                                                                                           one billion volunteer hours.
                                                                                                                                                               This informal support is a gift to commu-
in policies that ensure healthy                    vulnerability to disease, resulting in the               graphic contributes the least, right?          nities and is especially true in rural Canada
                                                   need for intensive and costly health-care                    From both a moral and economic stand-      where the loss of a community-minded el-
aging for all Canadians.                           interventions. Today, 1.6 million Canadians              point, this is a deeply flawed viewpoint.      ders often leaves an unrepairable social gap.
                                                   live with some form of frailty. In 10 years,                 More and more, out of choice or                In strictly fiscal terms, Canadians aged
                                                   it will be 2.5 million.                                  necessity, healthy older Canadians are         65 and older also have money to spend.
                                                       Living within the guardrails of a pan-               remaining engaged in paid labour beyond        Many continue to benefit from earnings-
                                                   demic has aged everyone. And we are get-                 conventional retirement age. In 2010, 14       based retirement plans and other progres-
                                                   ting a glimpse into how the seeds of frailty             per cent of people 55 and over were active     sive senior-focused social and financial
                                                   are sown—through loneliness and isolation,               in the labour force. By 2031, this number is   policies launched in the late 20th century.
                                                   loss of structure and routine, mental and                expected to rise to almost double.                 Older Canadians are an economic pil-
                                                   emotional stress, physical exhaustion, loss                  More recently, we also saw experienced     lar, one that will crumble in the absence
                                                   of freedom and a sense of control, disrup-               health-care workers risking their lives by     of supports for healthy aging that enable
                                                   tions in eating and sleeping habits, weight              coming out of retirement to work on the        people to remain active and engaged in
                                                   gain, muscle loss and deferring routine                  front lines of the pandemic.                   their communities.
John Muscedere                                     medical appointments to avoid the virus.                     The unpaid labour of this age-group            The past year has been a valuable lesson
Opinion                                                Our response to the global pandemic                  often goes unrecognized. A life of accu-       on the importance of nurturing our func-
                                                   now, and in the coming years, should                     mulated skills and knowledge is poured         tional ability, especially in older people. Let’s
                                                   include robust policies for healthy aging                freely into raising funds for community        turn insight into action. It would be in every-

L   ast month, while the world was distracted by
    political turmoil and the pandemic’s roaring
second wave, a very significant proclamation
                                                   which in large part are composed of strate-
                                                   gies to address these contributors to frailty.
                                                       Most COVID-related deaths in Canada to
                                                                                                            projects and organizations, coordinating
                                                                                                            events, caring for children in the absence
                                                                                                            of childcare options, coaching sports and
                                                                                                                                                           one’s best interest to focus now on ways to
                                                                                                                                                           prevent frailty by investing in policies that
                                                                                                                                                           ensure healthy aging for all Canadians.
came and went with little fanfare.The United       date have occurred in people over the age of             passing knowledge and skills on to young           John Muscedere is the scientific director
Nations General Assembly launched 2020-2030        70. It’s a glaring statistic—one that, left unfil-       people. Or even worse, we sideline these       and CEO of the Canadian Frailty Network
as the Decade of Healthy Ageing, calling for a     tered, might prejudice people’s understand-              skills by not putting in place ways that we    (CFN) and a professor in the School of Med-
decade of concerted global action to extend the    ing about this age group and its capacity.               can better harness this experience.            icine at Queen’s University and an intensiv-
health and well-being horizons of the world’s          Persistent news coverage about the                       Statistics Canada reported that, in        ist at Kingston Health Sciences Centre.
one billion people over the age of 60.             vulnerability of older people in the early               2013-14, 36 per cent of seniors performed                        The Hill Times

               WHY NOT
               Hundreds of thousands of
           Canadians rely on chiropractors
             to assess, diagnose, and treat
               spine, muscle and nervous                                                        In December 2018, the House of Commons
           system conditions. This includes                                                     Standing Committee on Finance acknowledged this
             back, neck, and knee pain, as                                                      oversight and recommended that the government
           well as osteoarthritis. But unlike                                                   address it by amending the Income Tax Act.
             other primary care providers,
            chiropractors are not authorized                                                    Budget 2021 offers an opportunity to close this
                to assess and certify the                                                       gap and streamline access for eligible patients.
                  Disability Tax Credit.
                 That needs to change.
28                                                                                                           MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES

Health Policy Briefing

Vaccination, trust in science and patience
is the only way out of this pandemic
                                                                                               As Canada's        vaccine when they become eligible. We
                                                                                               nurses, we         also urged governments across Canada to
                                                                                               want to            speed up the rollout of the vaccine, espe-
                                                                                               encourage all      cially to those most likely to experience
                                                                                               those living       severe illness, such as seniors, Indigenous
                                                                                               in Canada          people and racialized people—all of whom
                                                                                               to receive         have been shown to be most at risk of
                                                                                               the vaccine        infection.
                                                                                               as soon as             Nurses have also signalled that they
                                                                                               they are able.     are ready and willing to step up and help
                                                                                               Together, we       the government with the vaccine rollout
                                                                                               can contain        by joining health care teams at vaccina-
                                                                                               this virus, end    tion clinics across Canada. While the news
                                                                                               the pandemic       of some delays in delivery of the Pfizer
                                                                                               and take part      vaccine may give us pause, governments
                                                                                               in Canada’s        must strive to speed up the immunization
                                                                                               post-pandemic      and rapidly increase the number of clinics
                                                                                               recovery, writes   where the vaccine is available. This is how
                                                                                               Linda Silas.       we will contain this virus and counter its
                                                                                               Image courtesy     spread.
                                                                                               of Pixabay             What’s also been lacking in Canada’s
                                                                                                                  vaccine delivery program is evidence-
                                                                                                                  based information. Within this vacuum,
                                                                                                                  misinformation, vaccine myths and mis-
                                                                                                                  trust have thrived. Sadly, many Canadians
                                                                                                                  are hesitant to get vaccinated, particularly
                                                                                                                  among marginalized communities who, we
                                                                                                                  recognize, have all too often experienced
                                                                                                                  negative interactions with the medical
                                                                                                                      As nurses, we believe that any risk
                                                                                                                  posed by the vaccine is far outweighed
                                                                                                                  by the benefits in being protected from
                                                                                                                      As with any other medical treatment,
                                                                                                                  informed consent is required. It’s our job,
                                                                  We will need Canadians to                       as health professionals, to provide facts—
                                            Novel                 roll up their sleeves and                       and yes, empathy—when patients express
                                                                                                                  concerns about being vaccinated. Every-
                                         Diagnostics              get vaccinated. But we will                     one who gets the vaccine must understand
                                                                                                                  the benefits of immunization, as well as
                                                                  also need to be patient.                        any potential risks. All Canadians should
                                                                                                                  be empowered to make an informed deci-
                                                                  Immunizing the country                          sion.
                                                                                                                      Some individuals have expressed con-
                     Therapeutics                                 won’t happen overnight.                         cerns about the record turnaround time
                                                                  It will be an incremental                       for these vaccines. Producing multiple
                                                                                                                  vaccines in less than a year was the result
                                                                  process informed by science                     of a momentous global effort, harnessing
                                                                                                                  the ingenuity of a scientific community
                                                                  and one that seeks to                           united in a common objective. Large-scale
                                                                                                                  trials on the efficacy of vaccines involved
     Canada’s                              Vaccines               immediately stem the loss                       tens of thousands of participants, includ-
                                                                                                                  ing many from diverse backgrounds. The
     life sciences                                                of life.                                        trials resulted in high rates of protection
                                                                                                                  with few or no reported serious adverse
     companies.                                                                                                   events. Despite the compressed time-
                                                                                                                  lines, no shortcuts were taken: the same
                                                                                                                  standards were applied to these vaccines
     Where discovering                                                                                            as for any other vaccines that have been
     solutions essential to                                                                                           In Canada, we know the approval
                                                                                                                  process by Health Canada is safe and ef-
     our health and economy                                                                                       fective; their assessment of scientific and
                                                                                                                  clinical evidence is done independently
     is the new normal.                                           Linda Silas
                                                                                                                  and is known to be stringent. We also know
                                                                                                                  that historically, immunization programs
                                                                  Opinion                                         have saved countless lives worldwide.
                                                                                                                  The COVID-19 vaccines approved thus far
     The research Canada’s life sciences companies are doing is                                                   have the potential to provide much-needed

     laying the groundwork for novel diagnostics, vaccines and    A    COVID-free future is within our reach,
                                                                       a future where it’s safe to hug again
                                                                                                                  protection against the continued spread
                                                                                                                  of the SARS-CoV-2 virus but this will only
     therapeutics. Canada has built an extraordinary knowledge    and where our smiles no longer need to be
                                                                  hidden behind a mask. To get there, we will
                                                                                                                  happen if sufficient numbers choose to be
     infrastructure, and we must not lose momentum in making      need a robust vaccination drive. We will            As Canada’s nurses, we want to encour-
                                                                  need Canadians to roll up their sleeves and     age all those living in Canada to receive
     our country a global life sciences leader.                   get vaccinated. But we will also need to        the vaccine as soon as they are able.
                                                                  be patient. Immunizing the country won’t        Together, we can contain this virus, end the
     Get updates about our                                        happen overnight. It will be an incremental
                                                                  process informed by science and one that
                                                                                                                  pandemic and take part in Canada’s post-
                                                                                                                  pandemic recovery.
     essential work at                                            seeks to immediately stem the loss of life.         Linda Silas is a nurse and president of
                                                                     Earlier this month, the Canadian Fed-        the Canadian Federation of Nurses Unions,
     canadalifesciences.ca                                        eration of Nurses Unions encouraged all         representing nearly 200,000 nurses and
                                                                  health-care workers, all essential work-        student nurses across the country.
                                                                  ers and the general public to receive the                       The Hill Times
THE HILL TIMES | MONDAY, FEBRUARY 8, 2021                                                                                                                                                                  29

                                                                                                                                              Policy Briefing Health

What’s up (or down) with drug shortages?
                                                 portation of drugs that may not fully meet            effectively legislating a rollback in income.            a statement recommending several actions,
Our chronic shortages and                        regulatory requirements in order to protect           The policy eventually melted away.                       including more domestic production.
the current vaccine situation                    supplies of threatened medications. Why
                                                 is the Canadian medication supply chain
                                                                                                           Unlike more than 100 other countries,
                                                                                                       Canada still does not have an essential
                                                                                                                                                                    Our chronic shortages and the current
                                                                                                                                                                vaccine situation remind us to ask why
remind us to ask why must                        so fragile that we needed this stop gap
                                                 measure? Another interim order came in
                                                                                                       medicines list (EML)—critical medications
                                                                                                       for which the government is mandated to
                                                                                                                                                                must we be buffeted about by unpredict-
                                                                                                                                                                able shortages, originating elsewhere
we be buffeted about by                          late November 2020 to protect vulnerable              protect supply, much in the same way as                  and often impacting well-established yet
                                                 stocks from American poaching                         the recent interim orders aspire to do. At               critical products, the recipes for which are
unpredictable shortages,                             Without a national strategy for respond-          least one Canadian team is working on                    neither secret nor protected. In the face of
                                                 ing to shortages, pharmacists initially resort-       developing an EML, but the effort is not yet             pandemic threats to our medication supply,
originating elsewhere                            ed to invoking the tried-and-true mechanism           recognized by our government. Nor does                   Canada has shown it can take temporary
and often impacting well                         of restricting dispensed quantities to 30 days.
                                                 But they encountered outrage and political
                                                                                                       Canada do much to understand the extent
                                                                                                       and impact of shortages. It does not ana-
                                                                                                                                                                steps to protect our most critical medicines.
                                                                                                                                                                Shouldn’t we now move to properly and
established yet critical                         interference. Citizens, especially those out          lyze the shortages, year-by-year, month-by-              permanently secure our supply with a na-
                                                 of work, objected to paying extra dispensing          month, or by type, to uncover whether or                 tional essential medicines list and revival
products, the recipes for                        fees and to the inconvenience and risk of             not its feeble policy gestures are making                of our own industry?
                                                 more frequent trips to the pharmacy. Some             any difference. And, as the public has be-                   Jacalyn Duffin, MD PhD, is professor
which are neither secret nor                     provinces opted to cover the extra fees, but          come painfully aware, Canada lost its own,               emerita at Queen’s University, and Jon
protected.                                       pharmacists were shocked when various
                                                 provincial governments intervened, ordering
                                                                                                       once robust drug- and vaccine-making
                                                                                                       capacity long ago. Even the Ontario Medi-
                                                                                                                                                                Pipitone, MD, MSc, is a resident in psychia-
                                                                                                                                                                try at Queen’s University.
                                                 an end to the practice or canceling extra fees,       cal Association has exceptionally released                              The Hill Times

W       ith complaints and fears swirling
        around COVID-19 vaccine supply, we
take up our devices once again to report on
drug shortages in Canada. When we last
communicated in Hill Times back in April

                                                             Mental Health and Economic Parity for Canada
2020, Canada had already spent a decade
facing severe shortages of prescription
drugs. We argued that COVID-19 might ex-

acerbate those shortages and, at the same
time, serve as a wake-up call to get to the
bottom of the problem.                                            he COVID pandemic has exposed our vulnerability --                     This past year, the pandemic has touched the lives of every
     Alas, nothing much has happened.                             not just to the threat of emerging pathogens, but also              single Canadian. Through this, we have witnessed global
     Today, Canada reports more than 1,500                        to our inability to face the threat while maintaining the           suffering matched by rapid responses from governments
actual drug shortages. The good news is                           economic and mental health of our nation.                           around the world. This has also highlighted the lack of pre-
that this number is 400 fewer than last
                                                             Social workers see it every day: even prior to the COVID                 emptive action on behalf of Canada’s government to move on
April. The bad news is that no matter how
you look at it, it is still a shocking number,            pandemic, the mental health of our nation was steadily                      the desperate need for universal economic and mental health
and worse, it is misleading. Our national                 declining -- and without visionary leadership by all political              parity.
shortage database is woefully thin, as it                 parties, the road to recovery will leave many behind. The                      The Canadian Association of Social Workers (CASW),
doesn’t account for provincial, regional or
hospital-level shortages. We also wonder
                                                          time has come to stop reacting with short-term solutions                    alongside many of our colleagues from other health and
if the decline since April is more apparent               and to make the permanent changes necessary to meet the                     social professions, are bitterly disappointed that the federal
than real. After all, in that same time, 197              challenges of this new normal. Canada must lead the world                   government has failed to provide the visionary leadership so
drugs were reported to be discontinued,                   by adopting a Universal Basic Income and legislating Mental                 many Canadians call for, and are dismayed -- and, frankly,
and 330 drugs were cancelled post-market.                 Health Parity, so we may not only recover, but thrive.                      mystified -- that the official opposition has not used this
If a drug is no longer on the market, it                                                                                              opportunity to present the kind of bold ideas required to actually
is not “in shortage”—it remains utterly                      Even at the best of times, it is illogical and ineffective to rely
                                                          on corporate Canada to lead the way on mental health. Long                  change conditions in our country.
unavailable. Additionally, over the last
two years, nearly a third of our shortages                before COVID, cracks were showing in Canada’s piecemeal                         The time has come to no longer rely on corporate Canada
involve medications that we would deem                    and largely privatized mental health services: individuals                  to lead the way. To truly end stigma and the lack of access
critical or “essential”, priority medicines               and associations, like ours, have been urging the federal                   to mental health services, the Government of Canada, in
needed for effective function of a basic
                                                          government to make change.                                                  collaboration with all national political parties and Indigenous
health-care system: items such as antibiot-
ics (cefalexin, amoxicillin), common heart                   And now, COVID has only intensified the existing ‘shadow                 leaders, must lead the way and champion mental health and
medications (amlodipine, ramipril, can-                   pandemics’ of skyrocketing opioid-related deaths, escalating                economic parity.
desartan). These individual shortages are                 domestic and intimate partner violence, and growing income
numerous and long-lasting.
                                                          inequality. Social Workers have consistently called for a
     Early in the pandemic, Canada did ex-
perience temporary shortages of drugs for                 Universal Basic Income and for Mental Health Parity in Canada
managing COVID-19 symptoms and ICU                        because they know how gaping the holes in our ‘safety net’
patients needing intubation—epinephrine,                  really are. Now, they are witnessing, and experiencing first
midazolam, propofol, phenylephrine, etc.                  hand, the compounding effects of the COVID pandemic on
And like the hydroxychloroquine example                   their clients’ and their own families and communities.
of last spring (when Donald Trump’s
evidence-free claims spawned panic buy-                      Mental Health Parity requires creating a system that supports
ing and shortages for those who relied on                 mental health care equal to physical health care. Adopting
it), shortages have emerged in Canada (and                Mental Health Parity right now will force the system change
elsewhere) for every remedy, old or new,                  required to support the long-term recovery of our nation with
thought to be helpful in the pandemic: rem-
                                                          the same urgency and resources as we have for physical
desivir, dexamethasone, ivermectin and os-
eltamivir. Possibly we’ll soon see the same               health.
for the ancient gout treatment, colchicine,
recently reported effective by researchers
at the Université de Montreal.
     Numerous American and European
studies have documented the negative
                                                                                                                                  Joan Davis-Whelan,
impact of shortages on patient outcomes
and health-care budgets. But the reasons                                                                                          MSW, RSW
for shortages, according to manufacturers,                                                                                        President
reveals a pattern, dominated by manufac-
turing disruptions, that has gone basically                                                                                       Canadian Association
unchanged during the pandemic.                                                                                                    of Social Workers
     In March 2020, the minister of health
signed an interim order to monitor poten-
tial and actual shortages and allow im-
30                                                                                                                                   MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES

Health Policy Briefing
                                                                                                                                 If the disaster    and sustain the data analytics
                                                                                                                                 that has           infrastructure needed to lever-
                                                                                                                                 befallen long-     age AI. Believe it or not, patients
                                                                                                                                 term care in       who go to these hospitals already
                                                                                                                                 Canada during      benefit from the use of data ana-
                                                                                                                                 the COVID-19       lytics tools that aren’t available
                                                                                                                                 pandemic           elsewhere.
                                                                                                                                 has taught us          It may surprise some to learn
                                                                                                                                 anything, it is    there are hospitals where AI is
                                                                                                                                 that we must       already in use. These are research
                                                                                                                                 demand greater     hospitals though, so we should
                                                                                                                                 oversight and      expect that they will take risks
                                                                                                                                 accountability     as they try to innovate. What we
                                                                                                                                 in health care,    need to focus on now is ensuring
                                                                                                                                 particularly       that these AI tools can be equi-
                                                                                                                                 when already       tably integrated across different
                                                                                                                                 disadvantaged      sites. Failing to ensure equitable
                                                                                                                                 communities        access to these tools that can help
                                                                                                                                 might be           us to personalize health care will
                                                                                                                                 impacted by        only serve to exacerbate already
                                                                                                                                 our decisions,     existing inequalities.
                                                                                                                                 writes Ian             Because we do not yet have
                                                                                                                                 Stedman. Image     an explicit regulatory pathway in
                                                                                                                                 courtesy of        place, health-care AI in Canada
                                                                                                                                 Pexels.com         is being developed and deployed
                                                                                                                                                    in an ad hoc, site-by-site man-
                                                                                                                                                    ner. Hospitals are taking it upon
                                                                                                                                                    themselves to determine what
                                                                                                                                                    AI is needed and how to conduct
                                                                                                                                                    fairness assessments, mitigate
                                                                                                                                                    risk from bias, ensure equitable
                                                                                                                                                    access, demonstrate accountabil-
                                                                                                                                                    ity to stakeholders, integrate AI
                                                                                                                                                    tools into care, and generally earn
                                                                                                                                                    the public trust needed to deploy
                                                                                                                                                    AI in the hospital.
                                                                                                                                                        Recognizing that a laissez-
                                                                                                                                                    fair approach to health-care AI is
                                                                                                                                                    inadequate, a task force convened
                                                                                                                                                    by CIFAR published a report
                                                                                                                                                    in July 2020 called, “Building a
                                                                                                                                                    Learning Health System for Ca-
                                                                                                                                                    nadians.” In this report, the task
                                                                                                                                                    force calls for the development of
                                                                                                                                                    a national strategy and a “col-
                                                                                                                                                    laborative vision for AI for health

Maybe artificial intelligence
                                                                                                                                                    in Canada.” A national strategy
                                                                                                                                                    is needed to address things like
                                                                                                                                                    inter-provincial data sharing,
                                                                                                                                                    ethical protocols for developing
                                                                                                                                                    and deploying AI, and consen-

will drastically change health
                                                                                                                                                    sus frameworks that can help
                                                                                                                                                    accelerate the design of regula-
                                                                                                                                                    tory standards in order to ensure
                                                                                                                                                    accountability for how healthcare
                                                                                                                                                    AI is implemented. Meaningful

care, but who will benefit?
                                                                                                                                                    oversight could also help us focus
                                                                                                                                                    on ensuring that healthcare AI is
                                                                                                                                                    deployed across many different
                                                                                                                                                    sites, rather than only being able
                                                                                                                                                    to benefit patients at a select few
                                                                                                                                                        If the disaster that has befallen
                                                                        privacy, but if governments want     printing, and genome editing. The      long-term care in Canada during
Our federal and provincial governments                                  taxpayers to buy in to the great     question should no longer be if,       the COVID-19 pandemic has
                                                                        hope of an advanced AI economy,      but how can we use AI to help us       taught us anything, it is that we
have proven they can unite around issues of                             then they also need to be clear      effectively and equitably person-      must demand greater oversight
                                                                        about what that economy might
national importance in health care and they                             look like and how Canadians
                                                                                                             alize our health-care systems?
                                                                                                                 To build a personalized health-
                                                                                                                                                    and accountability in health care,
                                                                                                                                                    particularly when already dis-
must do so again if we are going to have any                            stand to benefit. The content of
                                                                        our modernized privacy laws will
                                                                                                             care system we will need to
                                                                                                             collect, store, and analyze more
                                                                                                                                                    advantaged communities might
                                                                                                                                                    be impacted by our decisions.
chance of AI playing the role many believe it                           send clear signals about where       data than we ever have. Not just       It is not good enough to allow
                                                                        our governments think AI has the     patients’ personal health infor-       health-care AI to develop in what
can in helping us move toward personalized                              most potential to benefit society.   mation, but also data about how        is effectively a leadership and
                                                                           At present, the idea that AI      socio-economic factors can have        regulatory vacuum. Our federal
health care.                                                            has the potential to improve our     an impact on patient experiences       and provincial governments have
                                                                        everyday lives is perhaps most       and health trajectories. We will       proven they can unite around
                                  the country’s economic future.        widely acknowledged within the       also need to make deeper invest-       issues of national importance
                                  Major investments have attracted      health-care space. We have long      ments into building and sustain-       in health care and they must do
                                  more computer scientists to our       heard from people affected by        ing the infrastructure, the talent,    so again if we are going to have
                                  post-secondary institutions and       rare diseases, for example, that     the tools, the policies, the regula-   any chance of AI playing the role
                                  have benefitted the private sector    we need a more personalized          tory oversight, etc., needed for       many believe it can in helping us
                                  by opening up a growing pool of       approach to health care because      a personalized, learning health-       move toward personalized health
                                  AI talent. If we want to build this   one size does not in fact fit all.   care system.                           care.
                                  data-driven economy in a respon-      By using AI in health care we            But did you know that artifi-          Ian Stedman is an assistant
                                  sible manner, however, then we        will be better able to predict and   cial intelligence is already being     professor of Canadian public law
                                  also need to protect Canadians by     prevent disease, to make quicker     used in some Canadian hospitals?       & governance in the School of
Ian Stedman                       modernizing our information and       diagnoses, to understand disease         Many computer scientists           Public Policy and Administration
Opinion                           privacy laws.                         progression and even to discover     who were inspired to pursue an         at York University. He also serves
                                     But as we move to strengthen       new therapies that could improve     education and build their career       on York University’s Artificial
                                  our privacy laws, we must also        patient outcomes. It may also        in Canada are working in labs          Intelligence & Society Task Force

G    overnments across Canada
     have signalled that they
believe artificial intelligence
                                  pay close attention to the impact
                                  those strengthened laws have on
                                  AI innovation. We should not pri-
                                                                        be possible for AI to operate in
                                                                        conjunction with other new and
                                                                        emerging technologies like DNA
                                                                                                             that are connected to research
                                                                                                             hospitals. Some of these hospi-
                                                                                                             tals also have foundations that
                                                                                                                                                    and sits as a legal member of the
                                                                                                                                                    research ethics board at the Hos-
                                                                                                                                                    pital for Sick Children in Toronto.
will play an important role in    oritize unbridled innovation over     sequencing, gene therapy, bio-       are fundraising in order to build                  The Hill Times
THE HILL TIMES | MONDAY, FEBRUARY 8, 2021                                                                                                                                                            31

                                                                                                                                 Policy Briefing Health

Aging? What’s to be done?
                                                 much less expensive health-support services       nomic circumstances, continuing with the
The pandemic is exposing                         needed to meet the needs of most seniors.         same policy choices defies comprehension.
                                                     That Canadians are living longer is good      First, as COVID-19 has made clear, care-
many cracks in Canada’s                          news. What’s not to like about living to a ripe   homes are both expensive and dangerous
already porous seniors’ care                     old age provided you can age well—happily
                                                 settled in housing appropriate to your needs,
                                                                                                   places; some 80 per cent of deaths in the first
                                                                                                   wave in Canada were in LTC-homes. Second,
system. We don’t have much                       with a stimulating social life with old friends   they are not where our senior citizens want
                                                 and new, where you can pursue an active,          to be. Third, the numbers make it clear that
time to fix the problem, so                      lifestyle, and have available the reliable sup-   continuing with our warehousing propen-
                                                 port and care needed to maintain the activi-      sity is just not on; the care-home beds that
we better get started.                           ties of daily living and robust good health?      would be required is simply beyond what we        Minster of Seniors Deb Schulte, pictured on the
                                                     The problem is that it is not easy to meet    could afford. And fourth, adding together the     Hill on Sept. 25, 2020, is tasked with working with
                                                 those provisos in Canada. Relative to many        capital and ongoing operating cost of institu-    provincial and territorial governments to manage
                                                 other countries, notably Japan, Denmark,          tional accommodation and care to the resi-        long term care issues stemming from the pandemic.
                                                 and others noted for enabling seniors to age      dents, their families, and to the public purse,   The Hill Times photograph by Andrew Meade
                                                 happily and well, Canada and its provinces        exceeds by far what it would cost to provide
                                                 and territories do not score well. We spend       an extended range of seniors’ needs through       the 2017 budget in which it was proposed to
                                                 far less on long-term care overall and dis-       beefed-up home and community support              invest $6-billion over 10 years for home care
                                                 proportionally much more on institutional         services. That will be expensive too, but it’s    and the fall 2020 fiscal statement with its
                                                 ($6) than on home and community ($1) care,        an approach that would both help seniors          offer under conditions of $1-billion between
                                                 the reverse of comparable ratios in Den-          age well, certainly better than at present, and   this year and next for long-term care. The
                                                 mark and other leading nations. There, the        one that our country could afford.                provincial and territorial governments at
Don Drummond & Duncan Sinclair                   predominant policy thrust is not to institu-          What do we need to do to get to it?           the very least have to refocus their policy
Opinion                                          tionalize or, crudely,“warehouse” seniors, but        Governments have to work together,            objectives from institutionalization to ageing
                                                 to facilitate their “aging in place.” Canadian    federal, provincial and territorial, and          in place and work with one another and the
                                                 seniors, like others, strongly prefer to retain   municipalities, given latter’s funding of         federal government, with the provinces and

S  ome 60 years ago, about the time the last
   of the baby boomers were being born,
people over 65 made up about 7.5 per cent
                                                 their independence and to age in place for
                                                 as long as possible in their own homes and
                                                 communities with the support of an ex-
                                                                                                   so many community services out of the
                                                                                                   property tax base and the charitable giving
                                                                                                   of the residents.
                                                                                                                                                     territories, on the development of appropriate
                                                                                                                                                     national standards and with municipalities on
                                                                                                                                                     their implementation and enforcement.
of Canada’s population. Now they are 17.5        panded range of home care and community               Solutions and their implementation are            And we have to hurry! The problem is
per cent and will be nearly 25 per cent (10.8    support services with which they are familiar     primarily under provincial and territorial        real, here right now, and time is short.
million) in twenty years. And they are living    and comfortable. Ironically, meeting their        ownership, apart from our Indigenous com-             Don Drummond is the Stauffer-Dunning
longer. Currently the fastest growing cohort     preferences would be much cheaper for both        munities where the feds are on the hook. The      Fellow at Queen’s University. He is a former
are centenarians, people over 100. Soon the      the affected seniors and for the public purse;    federal government must decide what role          senior official at Finance Canada and the
majority will be 75 and over, at ages when       daily care in a hospital costs upwards of $850    it wants to carve out in facilitating a coor-     chief economist at TD Bank. Duncan Sinclair
the manageable but incurable chronic dis-        to $950, in an LTC-home $150 or more, and         dinated response to a problem that is both        is an adjunct professor and distinguished fel-
eases of old age make necessary more costly      with support and care at home about $45.          bigger and will extend well beyond what was       low at Queen’s University and a member of
and frequent hospitalizations and physi-             Given the still building wave of aging        foreseen in the 2015 election platform and        the Canadian Medical Hall of Fame.
cians’ services, health care as opposed to the   seniors and the Canada’s foreseeable eco-         its promise of $3-billion over four years, and                      The Hill Times

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32                                                                                                                                           MONDAY, FEBRUARY 8, 2021 | THE HILL TIMES

Health Policy Briefing

Pandemic exposing critical gaps                                                                                                                             parliamentary standing commit-
                                                                                                                                                            tee recommended a designated
                                                                                                                                                            health workforce agency, and this
                                                                                                                                                            call was endorsed across all par-

in health workforce planning
                                                                                                                                                            ties and by several stakeholder
                                                                                                                                                            organizations that provided
                                                                                                                                                            testimony to the committee. Since
                                                                                                                                                            then, almost nothing has hap-
                                                                                                                                                            pened on this front.
                                     the population. Increasingly,           human resource. We need to ad-         in older adult care and mental              The absence of central coor-
Burnout was far                      health workers are significantly        vance health workforce science in      health care—two sectors heavily         dination and implementation of
                                     reducing their hours worked,            Canada now.                            impacted by the pandemic.
too common in the                    just to cope, or leaving their jobs         Canada lags behind compa-              What we need are a standard
                                                                                                                                                            integrated health workforce data,
                                                                                                                                                            analytics and planning activities,
healthcare workforce                 altogether.
                                        That was before the pandemic.
                                                                             rable OECD countries, including
                                                                             the U.K., Australia and the U.S.
                                                                                                                    set of data across a broader range
                                                                                                                    of health workers in support of
                                                                                                                                                            combined with diffuse governance
                                                                                                                                                            responsibilities inherent in a fed-
before the pandemic.                 With COVID-19, we are witness-          on big data analytics and a digital    inter-professional and inter-juris-     erated health system leave us with
                                     ing levels of stress, overload and      research infrastructure that           dictional planning.                     blurred lines of responsibility and
COVID-19 has made                    burnout among health workers            would give us vital information            Ideally these data would be         poorly coordinated efforts.
                                     previously unimaginable.                for health workforce planning.         collected uniformly, include diver-         Other countries have managed
it much worse. Poor                     Downstream responses of              Significant gaps in our knowl-         sity (racial, Indigenous and more       to overcome these challenges.
                                     mindfulness and free access to          edge have caused serious system-
health workforce                     psychotherapy, albeit helpful,          ic risks for planners to manage
                                                                                                                    inclusive gender identity), and
                                                                                                                    address practice characteristics
                                                                                                                                                            Now that the pandemic has made
                                                                                                                                                            the need crystal clear, Canada no
planning is to blame.                are at best band-aid solutions.
                                     We have to look upstream to the
                                                                             during this health crisis.
                                                                                 Absent timely and relevant
                                                                                                                    (e.g., setting, scope and service
                                                                                                                    capacity). These data should
                                                                                                                                                            longer has any excuse.
                                                                                                                                                                The federal ministers of health,
                                     source of the crisis.                   health workforce data, decision-       also be linked to relevant patient      labour, and innovation need to
                                        Health worker burnout is             makers cannot optimally deploy         information, including healthcare       make the health workforce data
                                     directly linked to poor health          health workers to where, when          utilization and outcome data.           infrastructure a top priority. The
                                     workforce planning. That we             and how they are most needed. As           Robust data would allow us to       pandemic may be the impetus
                                     continue to operate our health          a result, health workforce plan-       better understand the range and         that enables us to make necessary
                                     system blindfolded to very basic        ning activities across Canada re-      characteristics of health workers       significant advances in health
                                     data about our systems key              main ad hoc, sporadic and siloed,      caring for patients, the types of       workforce data infrastructure.
                                     resource—its health workers—is          generating significant costs and       care they provide and the out-              We need to stop simply clap-
                                     remarkable.                             inefficiencies. The consequences       comes experienced by patients.          ping our hands in support of
                                        Health workers account for           include everything from sub-opti-          Right now, we are making deci-      health workers—and start plan-
                                     more than 10 per cent of all em-        mal health workforce utilization       sions in the dark, without using        ning to create better workforce
Ivy Lynn Bourgeault                  ployed Canadians and over two-          and poor population health out-        essential data that most other de-      conditions for them. Let’s make
Opinion                              thirds of all health care spending,     comes to health worker burnout.        veloped nations have had for years.     improved health workforce sci-
                                     not including the personal and              What data do we have?                  So how do we get there?             ence in Canada a key legacy in
                                     public costs for their training.            The data we have are profes-           Canada needs a more robust          support of our health care work-

H   ealth workers in Canada
    experience endemic levels
of burnout directly related to
                                     This amounts to $175-billion
                                     (2019) or nearly eight per cent of
                                     Canada’s total GDP.
                                                                             sion-specific and say little about
                                                                             how health workers function
                                                                             as teams in ‘real world’ patient
                                                                                                                    and centrally coordinated health
                                                                                                                    workforce data, analytics and sci-
                                                                                                                    ence infrastructure. This would ad-
                                                                                                                                                                Dr. Ivy Lynn Bourgeault is a
                                                                                                                                                            professor of sociological and an-
understaffing and work overload.        Health workforce science—            care pathways. The data are also       dress a critical gap that has held us   thropological studies at the Uni-
Leaves of absence from work for      and the data research infra-            collected differently by various       back, and which has become only         versity of Ottawa and the lead of
mental health and stress related     structure necessary to support          stakeholders, so are not easy          more apparent, since COVID-19.          the Canadian Health Workforce
issues are 1.5 times higher among    it—is critical to making the best       to analyze across jurisdictions.           We can’t claim to have been         Network.
health workers than the rest of      decisions about this essential          Notable absences are workers           blindsided. Already in 2010, the                   The Hill Times

Vaccines give long-term care crisis a brief                                                                                                                 more than just an ask for “nice
                                                                                                                                                            things to have.”
                                                                                                                                                               Rather these calls foreshad-

reprieve, but cannot stand as the solution
                                                                                                                                                            owed the reality we know today,
                                                                                                                                                            that we have been playing a
                                                                                                                                                            dangerous game of Jenga in the
                                                                                                                                                            care of our older citizens within
                                                                                 As we do in the aftermath of       Ontario patients’ ombudsman,            the long-term care sector. In defi-
Returning to normal cannot be an option because                              any disaster, we seek emergency        Nova Scotia’s first wave review,        ance of evidence, we continue to
                                                                             relief. In this case, relief arrived   Quebec’s ombudsman report.              undervalue care work, maintain
the normal we operated within in delivering long-                            in the form of a vaccine—which         The list goes on and the refrain is     outdated staff levels and models,
term care was not only unjust, but unsustainable.                            has prioritized long-term care
                                                                             residents to be among the first
                                                                                                                        The reports’ call to immediate-
                                                                                                                                                            ignore sector pleas for support
                                                                                                                                                            while continuing to add more
The vaccine is a reprieve, a gift that will step in to                       recipients. To be clear, vaccines      ly address staff needs—including        stress and pressure by admitting
                                                                             are an absolute necessity, but we      more direct care staff, increased       higher acuity residents , relying
protect older Canadians after we failed to live up                           cannot fool ourselves into believ-     training, better pay, stronger fo-      only on a whim and a prayer that
                                                                             ing they will address the horren-      cus on recruitment and retention,       the whole thing won’t crash to the
to the job; but it is just that, a reprieve.                                 dous shortfalls we bore witness to     and mental health support.              ground.
                                                                             throughout the pandemic.                   The reports’ highlight the sig-        The façade has indeed
                                     our current challenges in long-term         Vaccines are not the panacea       nificant gap in mandatory infec-        crumbled.
                                     care (LTC) in Canada,” I noted in       that will fix the long-term care       tion control and prevention prac-          Returning to normal cannot
                                     that opinion piece.“It is the cumula-   system; yet, I worry we will tell      tices, the need for comprehensive       be an option, because the normal
                                     tive effect of years not prioritizing   ourselves it is.                       plans to prevent and to manage          we operated within in delivering
                                     resources to support quality of life        SALTY (Seniors Adding Life to      infectious disease outbreaks, as        long-term care was not only un-
                                     for older residents. Consequently,      Years), a research initiative I lead   well as access to supplies (PPE         just, but unsustainable. The vac-
                                     LTC is not prepared for or equipped     alongside some of Canada’s most        and safe work).                         cine is a reprieve, a gift that will
                                     to meet the complex care realities of   acclaimed researchers and aca-             In addition, the Royal Society      step in to protect older Canadians
                                     today’s and tomorrow’s residents.”      demics, has evidence on how we         report and others have called for       after we failed to live up to the
                                         In reading this today, after we     can improve the quality of life of     the development and implemen-           job; but it is just that, a reprieve.
Janice Keefe                         have seen what we have seen,            long-term care residents. Moreover,    tation of national standards in            “LTC is not adequately pre-
Opinion                              these words relay an eerie premo-       I was privileged to work on the        LTC, as well as allocating addi-        pared or equipped to meet the
                                     nition of the chaos and havoc that      Royal Society of Canada’s report       tional, and targeted, LTC fund-         complex care realities of today’s
                                     would soon rage through long-           ‘Restoring Trust: COVID 19 On          ing to provinces to execute the         and tomorrow’s residents.” I said

T    his time last year, I had the
     great privilege of authoring
another editorial for The Hill
                                     term care residences from one
                                     coast to another.
                                         I would argue that for most
                                                                             the Future of Long-Term Care in
                                                                             Canada,’ which provided thorough
                                                                             recommendations on how we can
                                                                                                                    recommendations above.
                                                                                                                        There should be no doubt that
                                                                                                                    this collaboration among govern-
                                                                                                                                                            this a year ago, and I will repeat it
                                                                                                                                                            again today.
                                                                                                                                                               Changing this truth is entirely
Times in an effort to amplify the    people reading that piece, there        address the gaps in how we ap-         ments is needed.                        up to us and the policy decisions
call for change within our na-       would be tacit agreement to the         proach care for older Canadians in         To date, over 70 per cent of        we must be bold enough to make.
tion’s long-term care sector. Like   position I was asserting. I am          both the short and long-term.          COVID-19 fatalities have taken             Janice Keefe is professor of
others, I struggle to reflect back   equally as confident that this base         These recommendations have         place in our long-term care facili-     family studies and gerontology,
on the relative innocence of 12      acknowledgement in no way pre-          been followed by countless other       ties. This reflects the precarious      the Lena Isabel Jodrey Chair in
short months ago, in the “before     pared Canadians for the horror          reports, a number of them written      state of the sector in Canada,          Gerontology and director of the
times” of the pandemic.              that was about to unravel when          as part of provincial inquiries        and that the calls to action being      Nova Scotia Centre on Aging at
    “The sheer number of individu-   the pandemic made a landing in          conducted following the first          repeated like a broken record           Mount Saint Vincent University
als turning 65 is not the cause of   these long-term care facilities.        wave of COVID-19, including: the       by advocates such as myself are                     The Hill Times
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