GSL Publishes Op-Ed in the Globe and Mail discussing role of chief medical officers of health

Chief medical officers of health can’t be all things to all people

On September 13, GSL Investigators Margaret MacAulay, Patrick Fafard and Adèle Cassola published an op-ed in the Globe and Mail discussing the roles of CMOHs during COVID-19 and how their relationship with the public has gotten strained the longer the pandemic has been going on.

In the article, they outline that at the outset of COVID-19, Canada’s chief medical officers of health (CMOHs) were veritable rockstars to the Canadian public. But now, 18 months later, some have now experienced the disadvantages of viral fame: personal attacks, targeted harassment and calls for their resignations.

CMOHs are simultaneously tasked with interpreting complex scientific evidence to advise ministers on these choices, explaining government policies, sometimes managing health departments, and reassuring citizens that their governments are prepared to lead them back to “normal.” Their independent scientific expertise and authority serve to enhance public trust in government decisions.

However, CMOHs’ role as the government’s central public health and scientific adviser has been challenged. In some cases, this is because other expert bodies have become prominent (e.g., Ontario’s Science Table). In others, it is because CMOHs are being framed as decision-makers. For example, Alberta’s Health Minister Tyler Shandro argued that the decision to end isolation requirements for COVID-19 cases and contacts “came from [Alberta’s CMOH] Dr. Hinshaw.” This reflects a common pattern of politicians claiming to “follow the science.” But this is not how governments make important policy decisions. CMOHs may play a key role in the process, but we elect politicians to make the tough choices.

Some argue that CMOHs should be watchdogs holding governments to account rather than serving as advisers. Concerns regarding the pace of reopening in several provinces in order to bolster the economy have led some to describe CMOHs as “toothless” and in need of greater autonomy. However, the same person cannot advise the minister in the morning and publicly criticize the government in the afternoon.

According to MacAulay et al., these issues have not only emerged in Canada. GSL’s analysis of the CMOH role in Canada, AUS, NZ, the UK and Ireland reveals common tensions in the design of the office and questions about when officials should speak out, resign, or exercise independent authority. Across jurisdictions, the increased scrutiny of CMOHs draws our attention to the importance of institutional design in public health policymaking. How the CMOH is appointed, their degree of autonomy and the scope of their management and advisory roles shape the role’s trajectory.

These are, according to the authors, more important than whether an individual CMOH is charismatic, courageous, or a gifted communicator. We must ask why the role exists and whether the pandemic requires that we rethink what they do and how they do it.

Read the full piece here.


September 3, 2021

GSL Research Fellow co-publishes book chapter on Global Health Law in new Public Health Law book


September 20, 2021

GSL Associate Director discusses institutional design of CMHO role on 630CHED