Walport ahoy!

White smoke over the Health Canada rooftops. But Dr. Naylor has questions.

Sir Mark Walport: The Time To Act Was Five Months Ago

1. How hard was that?

The Walport report is now public. If you’re new around here, this will take some explaining.

On Thursday afternoon I looked at the website for the federally-appointed Review of the Federal Approach to Pandemic Science Advice and Research Coordination, to see whether its report was up yet. This has become routine. Lately when the page shows up in my Google searches (I find it by googling the three words Walport COVID Canada), it carries a little annotation: “You Visit This Page Often.” On Thursday afternoon the report was not yet online.

A few hours later, at the close of business Thursday, I received an email from somebody at Health Canada. The report was now online.

At the end of the work day. At the beginning of a Thanksgiving holiday long weekend. Accompanied by no news release, news conference, announcement, nothing.

Regular readers will recall that I have written about this panel, which is led by the eminent UK health administrator Sir Mark Walport, before. Here and here and here. Long story short: the government of Canada wanted fairly narrow technical advice about the way the country handled science and data during the COVID-19 pandemic, which was, among other things, an urgent and wicked problem in genetics and epidemiology. The apparent purpose of asking for advice was to do better next time, a goal I have made myself a pest about. So, that was encouraging.

The government asked one of the most distinguished health administrators on this entire spinning planet for his input. When I found out about this, all accidentally, the government refused to give me information or even to confirm what I already knew. FOR MONTHS. Questioned by an opposition MP, the government finally admitted Mark Walport exists. They said his report was due “in the first quarter of 2024” “and would be made public.” The first and second quarters of 2024 passed. As of two weeks ago, I could not even get a simple answer to the simple question of when the government would make public a report it had received and promised to make public.

But we turn the page. Today I have a full summary of the report for you. Plus commentary from one of Canada’s leading public-health experts, Dr. David Naylor, who is impressed with the report but not with the government’s response to it. I’ll also give you my best guess about why the government is low-bridging this thing, if it isn’t simply force of habit.

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2. The fierce urgency of last May

Here’s the report. Here it is in .pdf, if you prefer. Here’s the cover. What would you notice about the cover, if you were looking for something a little funny, ha-ha?

That’s right! You’d notice that the title of the report was “The Time To Act Is Now,” even though the report was submitted to government five months ago. Walport’s “Forward By The Chair” continues the fun.

“The key message of this report is that Canada needs to take further action now if it is to be adequately prepared for future health emergencies,” Walport writes. And also: “Now is the time… to act on the important lessons learned from this crisis and previous outbreaks of infectious diseases.”

The word “now” appears 11 times in the report.

“New approaches are needed,” Walport writes. This isn’t boilerplate: it means something specific and potentially controversial, as I’ll explain. “Ever-ready systems must be put in place.”

And most significant: “Strong action by and collaboration between all levels of government is required to address Canada's longstanding and increasingly urgent need to put in place health data systems that are capable of alerting the country to an emerging threat, and enabling the most effective response to it.” Note that this sentence contains the words “collaboration” and “all levels of government,” which is reason enough for pessimism.

Why bother? Because, as this expert whose advice Justin Trudeau’s government used to want reminds us, “A central and prime duty of government is to protect the health, wellbeing, and security of its population.” COVID was bad. But “a future pandemic or other health emergency could be swifter and more severe, leaving no room for error.”

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3. Statement of Work

Walport’s mandate: “Conduct a review of the federal approach to pandemic science advice and research coordination.” This is important but it’s not everything. It’s about learning, quickly, how an unfamiliar bug works and how populations respond to the bug and to various attempts at treatment.

Not in the mandate: “An evaluation of the impact of research funding, how science advice factored into government decision-making processes, or the outcomes of government policies and actions.” The second and third topics were the source of just about all the controversy in 2020-2022. They’re about what happened between Doug Ford or François Legault or Justin Trudeau and the people in lab coats — and whether it worked. This narrow mandate spares elected governments from having to worry, and also avoids most of the federalism issues that would have made an investigation difficult. Doug Ford, after all, lawyered up rather than testify to a federal commission of inquiry.

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What he found:

• “Severe shortcomings of health data systems and an inability to conduct timely and adequate observational studies, including infectious disease surveillance, and clinical trials.”

• “A lack of continued investment could return Canada to a pre-2020 state of readiness. Immediate and sustained actions are required to address these issues.”

• Federalism as an obstacle to good, fast science in a crisis. “More effective pan-Canadian collection and triage of public health research questions are required, along with better coordination of intramural and extramural research, knowledge synthesis, guidance development, and advisory processes.” This next part is important, and almost certain to be ignored, so I’m gonna put some of it in bold: “These processes must be put in place now and tested and refined through simulations and exercises before the next health emergency.”

• People who were already poor and marginalized suffered disproportionately. Fixing that requires “greatly increased research on the effectiveness of public health and other interventions.” Note that Walport’s panel could have commissioned some of that research, if “the outcomes of government policies and actions” had been part of his mandate.

• There’s language about Indigenous health expertise, which might make some readers impatient, and “considerations for the unique needs of their communities,” which really shouldn’t, considering the devastating effect of two public-health crises in a decade.

Walport (and his panel colleagues; there are six of them, they have impressive CVs, and I bet they helped him get the lay of Canadian land quickly) is plainly taken aback by the relative disorder and backwardness of Canada’s health information by the terrible state of coordination in this federation. He says things like, “Canada's emergency management plans, pandemic plans^, and federal-provincial-territorial public health emergency response plans do not currently outline protocols for science advice or research coordination. Other countries — such as the United Kingdom, New Zealand, and the Netherlands — maintain and publish more comprehensive national risk assessments and response plans.”

Walport lists forty ad hoc bodies that were set up in a panic to sift through emerging science and suggest responses to the crisis. Since they all wound up throwing pasta at a wall, “this advice was sometimes conflicting and there was a lack of capacity to coordinate the advice.”

Walport couldn’t help noticing that Canada is a sucking black hole for information-sharing, although I bet he never imagined his own report would gather dust for half a year for no reason anyone has ever explained nor ever will. “The output of many federal advice bodies was not publicly released in a timely manner,” he writes. “In contrast, the Ontario COVID-19 Science Advisory Table… publicly released more than 70 briefs during its operation from July 2020 to September 2022.”

Then there’s this paragraph, which I am currently in a mood to chisel into the top of Mark Holland’s desk:

“It is critical that scientific advice, including clarity on the level of certainty of the underlying evidence, be publicly communicated (except for information that is confidential in nature or could jeopardize security). During an emergency, the time interval between the delivery of the advice to policy makers and its public release should be as short as possible. The information benefits all levels of government, provincial/territorial and local public health officials, public and private organizations, other relevant groups, and citizens. Its accessibility is important for maintaining trust in the policy-making process and combatting misinformation and disinformation.”

Next, Walport becomes the latest of several panel heads to ignore a request from this government not to lecture it on science funding. “Over the last 20 years, Canada's public investment in research and development as a percentage of gross domestic spending has steadily declined; it currently sits at 1.55%, compared with the G7 and OECD averages of 2.6% and 2.7%, respectively.”

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4. Forests of servers

I’ll skip to the most interesting thing.

Walport calls for a fundamental change to the way Canadian governments treat health data, one that would permit assembling vast amounts of health data — with the personal identifying information removed — so they could be analyzed as natural experiments.

Canadian laws now in place assume a “custodianship model, emphasizing privacy rights,” Walport writes. “The panel heard that Canada needs to shift to a patient-centric ‘data stewardship’ approach that balances privacy and security considerations with enabling access to data.”

Here’s a random TedX Talk I found on Youtube that explains these concepts well. It comes down to this: If millions of people are behaving in different ways that can be analyzed — staying home or going out; taking this or that medicine; eating this or that diet — do you keep all of that information in the filing cabinet of each patient’s doctor, or do you dump it into a supercomputer so the impact of all those choices can be analyzed?

Walport says Germany, Australia and the United States lately prefer the latter model. Aren’t there privacy concerns? Advocates say it’s easy to anonymize the data, so you get a statistical model of patient behaviour without knowing a thing about any particular patient. Says Walport:

“In the Australian and German systems, data are available to help inform policy decisions, and government institutions make comprehensive health data sets available to researchers while maintaining privacy protections.”

I suspect how people feel about this idea will depend on how much they believe the last four words of that sentence. Stripping identifiers from health data and aggregating it into giant data sets is all the rage, though. On a recent trip to Alberta, I heard that Danielle Smith’s government was in the advanced stages of planning to do that with data about the treatment and habits of drug users.

But would Pierre Poilievre’s Conservatives long resist the urge to treat this as another massive privacy invasion for social control? Will my own comment board? Guess we’re about to find out.

Of course nobody in the government of Canada has given me any information at all about the stupid five-month wait to release a report that says NOW 11 times. But if I had to guess, I’d guess this recommendation has a lot to do with it.

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5. Dr. Naylor: “I am at a loss to explain”

I sent the report to David Naylor and asked for his thoughts. A few hours later he sent me a polished, angry statement for the record. See how easy it is to communicate when you’re not getting communications advice?

Naylor is a leading medical researcher, physician, university administrator. When he became University of Toronto president a couple of decades ago, he stood out from the field, is the least I can say. Most important, he wrote the federal report on the 2003 SARS outbreak, which led to the creation of the Public Health Association Agency (oops!) of Canada.

Here’s what Naylor wrote. I’ve taken the liberty of putting key passages in bold, here as elsewhere in this post, to help readers wade through some dense information:

“This is a superb report. It is a major review of vitally important aspects of Canada’s response to COVID-19 — a public health emergency that disrupted all our lives, sickened millions of Canadians, and killed tens of thousands of our family members and friends.  It drew on countless hours of volunteer time by Canadian experts. It also enlisted as chair Sir Mark Walport, an internationally recognized leader in health research, research governance, and the provision of scientific advice for public policy formulation.  The report is direct in pinpointing opportunities for improvement and calls out a depressing number of instances in which past advice has been ignored.  However, its overall tone and thrust are relentlessly constructive.

“In the circumstances, I am baffled that the review was released with no fanfare, just posted on a website. But perhaps that is naïve.  If there was a press conference, some cheeky journalist might have asked a terribly inappropriate question, e.g. Where is the official response indicating what exactly you are doing about each of the recommendations?  

“It is also widely known that the report was submitted many weeks ago, and I am at a loss to explain why it wasn’t released earlier.  I can certainly cut Health Canada some slack here given that the commissioning Deputy Minister, Steve Lucas, retired, and the new Deputy, Greg Orencsak, did not take office until August 19, 2024. That said, a full brief and plan for actions in response to the Walport report should have been on the new Deputy’s desk on Day 1.   

“This isn’t an isolated instance. Canada’s federal and provincial governments have fallen into a pattern of commissioning and then largely ignoring the output of expert reviews and reports. Countless Canadians with relevant experience and expertise are continuing to volunteer their time to help various levels of government sort through difficult policy problems. It would be a sad day when future volunteers must always ponder whether they are participating in an ‘issues management’ sideshow or an important exercise that might make Canada a better country.”

If Mark Holland wants to hop on a Zoom interview to explain the delay and describe his plans to follow up in detail, I’ll take that call. Having spent a year and change dealing with his department already, I won’t hold my breath.