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How Ontario can recover from Doug Ford’s COVID-19 governance disaster

Published in The Conversation, April 27, 2021

The past week has been one of the bleakest in a dark year for Ontario residents. The variant-driven third, and most serious, COVID-19 wave as brought the province’s hospital system to the edge of critical breakdowns. Yet the province’s government, led by Premier Doug Ford, seems incapable to formulating an effective response to the situation. It has again failed to act on clear warnings from health experts. It has then been left to individual local Medical Officers of Health, especially in the hard-hit City of Toronto and Peel Region, to take direct action against key sources of outbreaks of the virus, like industrial and warehousing and distribution facilities.

The government has seemed unable to act on the consistent advice of its own science advisory table, preferring instead to avoid offending the industrial and business “stakeholders” to which the government does consistently listen.  The Premier, despite his undoubtedly good intentions, has seemed unable to stand up to own cabinet and push through measures that he has been advised are necessary to contain the epidemic.

Instead, when confronted with the worst public health disaster in the province’s modern history, the government’s de facto governance model of trying to run a province of 14 million people by the seat of your pants in the way you might a municipal councillor’s office has, predictably, led to disaster, if not catastrophe.

The situation has, not surprisingly, led to calls for the Premier’s resignation. Whether such a step would really help the situation or not, particularly in the absence of an obvious competent successor within the governing party, is an unknown. An election at the current stage of the pandemic seems almost unimaginable, diverting energy and attention from the immediate crisis at hand, further disabling decision-making processes. The more critical issue at this point is what to do to bring an effective governance structure to the province’s response to the situation.

At the political level, one option might be to move to a wartime-like coalition government.  Among other things, that would mean opposition party representation in cabinet. Such an approach could have considerable advantages. It might strengthen the legitimacy of the provincial government’s leadership in the crisis, while widening the range of perspectives and pool of talent available at the political level. The Liberal and NDP caucuses include individuals with previous government experience and in-depth understandings of government operations.

At the same time, whatever form of government emerges, the cabinet needs to step back from the day-to-day management of the pandemic. A new Chief Medical Officer of Health needs to be appointed. This needs to be someone younger, more engaged, energetic, and willing and able to stand up to the political level, publicly, if necessary, than the position’s current occupant – Dr. Dave Williams. The role also needs an individual better able to understand, integrate and act on the scientific advice being provided to the province. The cabinet needs to give a new CHOH a mandate and the backing to do what is necessary to get the situation under control, including providing support to the local MOH’s in the most affected areas. That is what is supposed to happen around the CMOH in a situation like the one the province faces, but has not.

The basic menu of other actions is otherwise well-known: paid sick leave for workers; a serious re-examination of what are truly "essential" workplaces, particularly in hard-hit areas; vigourous   enforcement of the rules around PPE, physical distancing, outbreaks and other critical practices in the workplaces that are deemed truly essential; better targeting of vaccine rollout to vulnerable populations and locations; limiting mobility while allowing safe outdoor activities to occur; and doing whatever is necessary to support local health units and hospitals through this (hopefully) worst phase of the pandemic.

Beyond the province’s own incompetence, other factors have contributed to the current disaster and need to be addressed. The federal government’s failure to impose and enforce serious travel restrictions, even to and from high-risk locations such as Brazil, India and Pakistan, until far too late, has been a significant contributor to the current, variant-driven COVID wave in Ontario.  Steps need to be taken to address that situation immediately. Better income support from the federal government is going to be needed for those whose jobs are affected by tighter definitions of what constitutes essential workplaces.

A final, and largely unnoticed but significant factor in the circumstance in which Ontario finds itself as been the absence of a consistent voice from the province’s medical profession.  In past the Ontario Medical Association, aside from its role as an advocate for the province’s doctors, has at times been a powerful and highly influential voice around public health matters. The OMA has played a major role on advancing anti-smoking policies.  It was deeply involved in drinking water safety issues in the aftermath of the Walkerton disaster. The association’s interventions around the health impacts of smog and air pollution were instrumental to the implementation of the phase-out of coal-fired electricity in the province.  The OMA’s relative silence through the pandemic has left a serious gap. The association could play a role as a consistent voice on the pandemic from the medical profession, and provide political support to the front-line Medical Officers of Health. These functions have instead fallen to individual, front-line physicians and academic researchers.

COVID’s third wave has brought the Ontario to the brink of catastrophe, approaching its worst public health disaster in more than a century. The best options for controlling the situation are well-understood, but whether the province can find a way to implement them effectively remains an open question.