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I disagree with the conclusions of this otherwise excellent article written by Prof Attaran and Prof @Lorian_H. I do not feel that most chief medical officers of health (exception with Dr Williams) deserve the blame for the complete mismanagement of the COVID-19 pandemic.
1/ https://twitter.com/profamirattaran/status/1327334851502960640
1/ https://twitter.com/profamirattaran/status/1327334851502960640
The authors are right when they set out the powers that Alberta’s CMOH has. There are some variances, which they note, from province to province as to what powers CMOHs can exercise and when, but this isn’t material. So, I do agree with most of what they have written.
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In particular, when an Act specifies an official who can make certain decisions, it is up to that official at the end of the day. When Alberta’s CMOH issues an Order, it is because she has decided to do so, and not because the Minister of Health has told her to do so.
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And so it does beg the question as to why, when Alberta is seeing catastrophic numbers of cases, is the CMOH not making those Orders? In Alberta’s case especially, the Orders made in the spring that led to the lockdown were almost all done by her, not the Minister or Cabinet.
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The answer, I posit, lies in the nature of the CMOH’s position. In Alberta (again, there is some variance in other provinces), the CMOH is appointed by the Minister of Health. She holds that title at the pleasure of the Minister.
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Now, I seriously doubt that even the Minister of Health is idiotic enough to fire his CMOH in the midst of a pandemic were she to order restrictions that he doesn’t like. Or, at least, someone would stop the Minister if he is enough of an idiot.
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But the CMOH is more than just one person. She would also have staff. But because she lacks any degree of independence, those staff are first and foremost public servants serving the Minister. Operationally, she is always at risk of marginalization.
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This is especially the case when it comes to the types of restrictions that are needed to stop the uncontrolled spread. Large scale restrictions on businesses raise non-health related considerations (e.g., economic ones) that are outside her and her staff’s expertise.
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That expertise likely comes from other departments, most likely Finance and Treasury Board. And the CMOH would have no control over the direction of that advice. She would not be able to seek other advice even if she doesn’t trust what is being given to her.
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The very nature of the broader restrictions needed means that the CMOH is likely to be highly reticent about issuing those Orders unless and until a body better able to weigh the wider considerations and provide guidance. And the only body that can do that is the Government.
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I have argued before and continue to hold that decisions regarding large scale lockdowns and similar measures are best made by the Lieutenant Governor in Council, that is, Cabinet (the capital G Government). Only they can consider the full public interest.
11/ https://twitter.com/tim4hire/status/1297578978870538240
11/ https://twitter.com/tim4hire/status/1297578978870538240
So, while the authority and hence decision rests with Alberta’s CMOH, she is most unlikely to go rogue and issue that Order when the Government is telling her that it isn’t in the public interest to do so.
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Add to this the general rule that public servants defer to their political masters and any fear that going rogue would result in marginalization of her role, the CMOH becomes more of an advisor and less of an official able to independently exercise authority.
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The Government is always responsible for, and should be held accountable for, decisions made or not made. As much as we would want public servants to overrule the Government’s bad decisions, democracy doesn’t work that way.
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Perhaps, if there is an after-times to this pandemic, we can rethink and redesign the roles of CMOHs and ensure they can have more independence (or perhaps be more transparent in what they are telling the Government). But I doubt that this will solve much.
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What I really hope is that people realize that their lives can literally depend on who they elect to public office. We need people going to polling stations thinking who will be the best leader in a crisis like what we’re enduring today.
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Unfortunately, there are quite a few provinces that are being led right now by the wrong people. And because enough people voted for these guys, thousands have needlessly died with no end in sight.
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So, we should make sure that we are laying the blame, laying all the deaths, the lingering health problems, the stress, etc., etc., at the feet of the provincial governments that have failed us so badly. DO NOT LET THEM DODGE ACCOUNTABILITY.
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Post-script: while I offer a nuance that somewhat challenges the conclusions of their column, I have huge respect for @Lorian_H and @profamirattaran. There are many good reasons why they are academics and experts in this field and why I’m just some panda on twitter.
