Canada's COVID-19 response: A critical analysis

At first glance, Canada appears to have responded adequately to the covid-19 emergency, but beneath the surface lie major pandemic failures, warns a series of articles published by The BMJ today.

The BMJ Canada Covid Series provides a critical analysis of what worked and what didn't in Canada's covid-19 response and calls for a national independent review to learn lessons and ensure accountability for the past and future preparedness.

The articles, written by leading clinicians and researchers representing 13 institutions across Canada, highlight long-standing weaknesses in Canada's public health and healthcare systems, including fragmented health leadership and poor data-sharing across the federal and provincial and territorial governments, that hampered a coordinated response.

For example, despite a universal healthcare system, communities experiencing social and economic marginalization in Canada were hardest hit in each wave of the pandemic, and those living and working in long-term care homes were particularly affected, which led to a national shame.

Lessons from a previous outbreak, due to SARS-CoV-1, which in 2003 impacted more Canadians than anywhere else outside of Asia, also went unheeded and made the country's governments and health authorities ill-prepared for covid-19.

And while Canada achieved high vaccination coverage domestically, it hoarded covid vaccine, failed to support measures intended to increase global supply, and contributed to profound global vaccine inequity.

"The picture that emerges from the Series is an ill-prepared country with out-dated data systems, poor coordination and cohesion, and blindness about its citizens' diverse needs," write Jocalyn Clark, International Editor, The BMJ and colleagues in an editorial to launch the series.

Were lives lost as a result of the broken systems, they ask? Were decisions by governments taken appropriately and equitably? Will Canada be better prepared for the next public health emergency?

They outline several reasons why an independent, national inquiry is needed, including learning from decisions and actions that failed or faltered, providing an actionable framework for reforming Canada's healthcare and public health systems, and delivering on Canada's ambition to be a global leader.

But they say most important is accountability for losses. They point out that 53,000 direct covid deaths occurred in Canada and close to 5 million cases leave families affected and a legacy of long covid in their wake. "A million lives in 2021 alone might have been saved in poorer countries had rich nations like Canada shared more covid vaccine," they add. "Are such losses not worth preventing in the future?"

The editors say they hope this work "informs and advances an independent, comprehensive, and probing review of Canada's covid-19 response to ensure transparency and accountability from governments and health authorities, and commits leaders to actions that support and sustain preparedness for current and future needs."