Principles and policies for a national pandemic response

What does success look like in our COVID-19 response? Nine months into the crisis, and the day after an important First Ministers’ Meeting, we still don’t have an answer from our political leaders.

It seems, though, that they are relying on the promise of a vaccine. It’s a tempting answer that sidesteps the debate we’re mired in, based on the false narrative that economic re-opening and slowing the pandemic are in opposition to each other. That’s simply not so — they are the same objective, as the prime minister, to his credit, finally said two weeks ago.

To meet that objective, we need to crush the pandemic — getting the community transmission rate well below one new infection per case — with aggressive, co-ordinated and common measures across the country to dramatically limit transmission and scale up testing and tracing. We need a national plan that actually learns from and applies the lessons of the failures of the spring and the fall — that selective lockdowns do not work.

Instead, we’re continuing to “manage” the pandemic with a series of welcome, but discrete, policy and spending announcements, not related to a clear set of objectives, priorities or timelines. With exhortations — to families, businesses and other governments — to do things. All in the hopes that not only will the vaccine resolve the pandemic, but that its rollout will be quick, orderly and welcomed by everyone.

In recent days, we’ve seen a robust economic support package that will last well into 2021, the quick approval of one vaccine, the preparation of vaccine rollout plans, even the resumption of regular news conferences from the prime minister — all necessary pieces to fight the virus.

But on top of these discrete policy announcements, we need a real, cohesive plan: a comprehensive national plan, or a unified set of provincial/territorial/ municipal/Indigenous-led plans. Only such a plan can aggressively slow the spread of the virus. Developing this plan and getting support for it is a job for our political leadership, and a project of incomparable national urgency.

That could have been the subject of yesterday’s First Ministers’ Meeting. But instead, we had the usual bickering over jurisdiction and spending responsibilities, sometimes on issues that go well beyond pandemic response.

The federal government and the provinces may not be entirely on the same page, but neither of them is on the page of Canadians who are looking for a path between today’s grim reality and widespread vaccinations. Neither is seized with what a comprehensive pandemic response needs to look like.

Yes, the federal government has used its borrowing power to provide the vast majority of income supports to individuals and organizations, occasionally butting up against some areas of provincial jurisdiction in the process. It is procuring vaccines centrally. It is setting international border policy. But is it organizing and driving a national response? Is it using the money to drive shared national goals around testing and tracing (at which we’ve now failed twice, spring and fall), around driving a shared communications message (ditto), and around equity for the most at-risk populations (ditto)? No.

Provincial governments are spending that federal money (eight out of every 10 government dollars spent on the pandemic comes from Ottawa, as the federal government is fond of pointing out), adding their own spending, and generally attempting — with limited success — to stem outbreaks of the virus in workplaces, schools and long-term care facilities. The protections are not widespread enough; they are not accompanied by rapid testing, tracing and re-tracing; they have generally not taken an equity lens; and they do not share messages and policy approaches across the country, apart from aggressive messaging around personal responsibility. And so provinces are failing to stem the tide.

In many ways, the country is working exactly as designed — a federal country, with highly devolved powers. Provinces have decided to devolve further, to allow variable and highly divisive regionally-focussed shutdowns — measures that did not stop virus spread this fall, and which reduced solidarity within provinces and at the national level. Citizens are not being protected; and what’s worse, the message Canadians get from differential shutdowns is that some regions are more worthy than others.

The fall infection rate, the return of the virus (in particular, to long-term facilities) and the ongoing failure to dramatically scale and target testing-and-tracing infrastructure — these are all signs of a national tragedy. Signs that while the country is working as designed, it is not working as it should.

But we don’t need to reimagine federalism. We just need our leaders to do their jobs.

And we need everyone pulling together on a national plan, wherever it originates from, because it will need to be built on clear, common, fundamental principles.

A national plan needs to articulate the things that are most important in our pandemic response. That involves a set of easily understood principles and objectives that are public, based on our national and community values, and can win public support. These, in turn, will help explain many of the decisions and choices that are underpinned by those principles. Call those principles and objectives the rock on which the entire foundation of our approach rests. 

Principles for a national crisis response

I’ll take a shot, and say those principles are something like the following:

1. This is a national emergency that requires a national response, and the prime ministers, first ministers, mayors/councils and Indigenous leaders are in charge

This is a given, maybe, but do we have a national response?

Too often our political leaders point fingers at each other, or say simply that they are “following best advice” of public health leaders, without (a) giving a full public accounting of what that advice is; (b) acknowledging that public health leaders get their authority from political leadership; or (c) admitting that the biggest decisions — around funding, lockdowns, and allocation of resources towards the greatest needs — are political.

Perhaps more importantly, without this level of solidarity from political leaders, we just won’t be able to do the politically difficult work of demanding similar levels of solidarity of our populations, and making life a bit harder for some who feel they deserve to have their economic livelihood entirely untouched.

 

2. The most at-risk populations deserve the most attention

This, too, ought to be obvious by now, but have we aggressively directed our resources this way? Do we have sufficient shutdowns of indoor public places to protect at-risk populations? Do we have paid sick leave policies guaranteed beyond the current (and time-limited) $500 a week under the national Canada Recovery Sickness Benefit? Do we have enough supports for small businesses — not typically defined as at-risk, but clearly under existential threat — so they know we are all in this together?

 

3. We need to solve for families, for the heart, and for a holiday

Public policy is not good at emotion, though politicians are often good at emoting. Public policy solutions for families, for the heart, for a holiday would recognize the profound human need to connect safely. These policies would have us collectively plan and set goals for when we can gather indoors in smaller family units — with whatever inventive approaches that might require. These policies would create new holidays and intersperse them across 2021 by region. And they would bring all the resources available to help bring a sense of connection to the lonely, to allow people to grieve, and to start to bring justice for those who have lost loved ones.

 

4. Otherwise, we need the maximally protective measures in place until the vaccine is here. All defaults, questions and exceptions to our policy positioning should receive a full airing and debate. But when in doubt, err on the side of maximally protective measures and the three principles above.

This is the cold reality of pandemic response, at least as we know it now with high community transmission.

Based on these four principles, we need a set of public policy and funding approaches, guided by the latest evidence on pandemic spread and policy effectiveness, that (a) virtually eliminate community transmission and (b) can win public support. The plan must last not just a month, but get us through the next six months, all the way through to a period when the vaccine is being distributed in sufficient quantities across the country that community spread has abated.

Policies for a national crisis response

Those policies could look something like the following:

1. Keep only the most important indoor work and living spaces open

This means that public schools and childcare centres should be the last frontier for institutional closure; that we should target long-term care, and any other in-person caregiving settings, for the greatest security, connectivity and testing-and-tracing measures; and that we should, as a corollary, relax the policing on some contacts and lower-risk outdoor activities that we need to be well and happy.

 

2. Provide support and ensure fairness

We have some, but not all, the policies in place to do this. To be consistent with our principles above, adequately supporting and resourcing schools, childcare and long-term care isn’t enough. We need to resource the rest of the health-care system, including with new surges of human resources to make sure other lives aren’t lost needlessly. And we need to ensure income and sectoral support for the people we are asking not to work — indeed, enough of those targeted and broad supports to reassure them that their sacrifice is manageable and time-limited. None of this works without sufficient paid sick-leave policies and benefits for those who must work.

 

3. Plan for the next set of problems and issues

We need to debate and engage on a second, just as aggressive, set of plans. This next phase is the transition to the hoped-for return to normal when the vaccine starts to become widely available, but which will in turn require public health, public policy and political measures. Those measures could be just as controversial as the ones that have been required for the previous and current shutdowns. They’ll involve choices around who gets the vaccine first, how to deal with misinformation about the vaccine, and how to rectify the way in which we created — reluctantly, inadvertently or intentionally — winners and losers during the pandemic.

They’ll involve considerations around vaccine certification and immunity passports. They’ll involve continued testing and contact tracing, because we will continue to need it to re-open workplaces.

If we are solving for loss, for grief, for the need to restore connection, then we need to start planning now to rebuild devastated sectors, and rebuild human capital in all of those whose education was interrupted, or whose careers or connections to the workforce were knocked off track. And again, we will need to target supports to the neediest sectors and the people with the most to lose if they are not connected to economic opportunity.

 

4. Demonstrate that we’re all in this together

The Atlantic provinces have already demonstrated, for a time, that they can do this, and they reaped the benefits. And it would be naïve to think that it was only the border closure or the Atlantic Bubble that protected them — their co-ordinated policies within the bubble also made a big difference.

Political leaders could go further though an intense, war-time level of co-operation. New Brunswick demonstrated this by bringing its opposition party leaders into the regular decision-making process with the premier. There was some outside rationale for this measure, as that government had a minority — but so does our current national government. While such attempts might fall short of a “government of national unity,” as we had during the First World War, there’s a strong case for a level of engagement and co-operation, with daily briefings of opposition leaders and co-operation on the construction and roll-out of the plan. A further necessary measure would be similar measures in provincial capitals.

A supplement to this must be much more regular First Ministers’ Meetings, on a public schedule, to check against progress, to update them on preparations for the work to come, and to check on the solidarity that is required; and regular meetings with municipal leadership, municipal organizations, and Indigenous, First Nations, Métis and Inuit governments, again on a public schedule.

Some revenue-raising and power-dispersing measures may be necessary. These are, transparently, more important for public support for the full set of measures, not because they contribute in a significant way to the bottom line of the effort. These policies need to be implemented and communicated because shared sacrifice is part of the foundation for dealing with this in a co-ordinated way, and it’s been the basis for success in responding to past national emergencies.

Shared sacrifice does not mean equal sacrifice. But many small businesses and frontline workers (in health care and retail, in particular) observe that sacrifice is not being shared, and are rightly questioning pandemic response measures at a result. All Canadians should be prepared to make sacrifices, and we should use public policy tools to help them get there.

We can do this

We have resources to set a new course and do it quickly. Public support is ready to attach itself to the maximum set of confidence-producing measures, even if they produce some immediate additional hardships. Our ingenuity and the fundamental resilience of much of our infrastructure also present advantages. So, too, does our robust public square, in which people and institutions that have proven to be right have had a clear chance to make their case. Their solutions remain on the table. We’ve adopted some of them. It’s not too late to pick them all up, stitch them together and hold to them for the medium-term.

Exponential increases of COVID-19 mean not only more cases, but an ever-faster increase in the rate of cases. Today’s delay in bringing forward a national plan is more costly than yesterday’s delay. And every day of delay or half-measures decreases trust — trust which can plummet at rates almost as exponential as the virus’s spread.

Is there too much to do right away? Yes, though we’ve known this for months. Politically naïve? Perhaps, but the pandemic has made the bounds of what is politically possible pretty elastic.

At the very least, as a start, we could start to muster national goodwill through plans that do the following, co-ordinated at the federal level or through other levels of government with the private sector, labour and community sectors:

1. Co-ordinated vaccine delivery and prioritization;
2. Co-ordinated rental market supports for residential and commercial tenants;
3. Co-ordinated financial system support to locked-down businesses;
4. Co-ordinated increase in testing and tracing at a common set of institutions across the country;
5. Co-ordinated messaging to get Canadians enjoying the winter outdoors, and the resources and supports they need to do so.

Let’s start with these efforts, at least, in the next month. Let’s recognize this for the crisis it is, which requires dramatic interventions that build national solidarity. And let’s give our political leaders licence to lead, and not follow, in the months until the vaccine and all of the heroes involved in pandemic response have had the time to do their work.