Prominent public health experts have called on Canada to launch an inquiry into its Covid response, arguing that the country’s failure to collect and share data masked issues and inequalities that – if properly addressed early on – could have saved lives.
The call to action came alongside a scathing editorial in the British Medical Journal, titled “The world expected more of Canada”, which argues that Canada’s “overall impression of adequacy” conceals important inequalities.
“The picture that emerges is an ill prepared country with outdated data systems, poor coordination and cohesion and blindness about its citizens’ diverse needs,” read the editorial.
“What saved Canada was a largely willing and conforming populace that withstood stringent public health measures and achieved among the world’s highest levels of vaccination coverage. In other words, Canadians delivered on the pandemic response while its governments faltered.”
Inequitable vaccine access, misuse of research and jurisdictional squabbling between provinces are among the topics in a series of articles by university deans and professors, epidemiologists and health advocates.
Covid has killed more than 52,000 Canadians and infected 4.6 million, giving it a death rate of 1,372 per million, compared with a global average is 855 per million.
Although Canada was not alone in Covid failures, the BMJ’s international editor, Jocalyn Clark, said the country is a good case study for several reasons.
“Canada is a unique country in the world. It had to deliver a pandemic response to a small but diverse population dispersed across a huge land size. It is known internationally for multiculturalism and for valuing health and its universal healthcare system,” Clark told The Guardian.
As a G20 country, it also has global influence on matters of health, she said.
Tania Bubela, dean of health sciences at BC’s Simon Fraser University and a series co-author, said that Canada could have done much better on examining how income and racial inequality influenced Covid outcomes.
“One of the things that surprised me was the lack of nuance in the data – to be able to make decisions that were more reflective of the diversity of Canadian populations, because the burden of the pandemic was not equitably shared across the population,” said Bubela.
In Ontario, rates of Covid-19 hospital admissions and deaths were three times higher in the lowest-income neighbourhoods.
And in Toronto – Canada’s largest city – 69% of reported Covid cases said they belonged to a racialised group. The majority were Black or south Asian.
Collection of that data in Ontario only came after pressure from community activists, said Kim McGrail, a professor of health services and policy at the University of British Columbia and a co-author on the project.
McGrail said that intentionally collecting that data across Canada – along with data on people’s occupations, household sizes and neighbourhoods, among other factors – could have helped Canada understand who and which areas were experiencing the greatest degrees of risk and harm related to Covid.
But as a federated country, each province and territory in Canada is in charge of its own healthcare. McGrail said hospital data was actually quite good, but primary care and community data was harder to come by, and often had interoperability challenges – and political ones, too.
Quebec, for instance, flat-out refused to collect race-based Covid data despite persistent calls from the community to do so.
Canada was also “not great at all” on sharing things like genomic profiling which “would have actually helped accelerate the scientific understanding of the virus, its mutations, its effects and so on”, said McGrail.
Failure to fund early pandemic research on the virus was a missed opportunity to create a stronger, evidence-based public health framework, the papers’ authors argue. Instead, a mishmash of policy and pivoting priorities created confusion and chipped away at the public’s trust.
The authors said Canada urgently needs to reform privacy legislation that currently makes it difficult to share health data. They also argue that building a data governance programme – and consulting Canadians on health data-sharing – should be done now, ahead of the next pandemic.
• This article was amended on 26 July 2023. Jocalyn Clark is the international editor of the British Medical Journal, not the editor-in-chief.
