Canada’s federal election results had barely been counted when the Premiers resumed making their well-worn demands for more federal health care money. Instead of thanking Ottawa for the billions it has already provided for fighting COVID-19, or asking for short-term pandemic-related funding, the ritual chorus seeks ever-increasing amounts of money for decades to come. Granted, the need for more money certainly feels urgent right now. A number of provinces are having difficulty even staffing their hospitals, after almost two years of burnout-inducing working conditions for front-line health care workers. However, the premiers’ multibillion-dollar asks have been for unconditional long-term funding, well beyond the scope of the current crisis. It is entirely reasonable to ask them to explain how the money will be used—especially since spending more on health care does not automatically mean better health outcomes. CHLPE's Michael Wolfson writes.
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Ontario's health care system has been battered by COVID-19, medical staff have been pushed to their limits, and there's a massive backlog of diagnostic and surgical procedures built up due to shutdowns. Has the time come for private health care to help fill the gaps? CHLPE Director Colleen M. Flood appeared in a panel on TVO's The Agenda.
Chair of CHLPE's Advisory Board, Professor David Sweanor, as well as CHLPE member Patrick Fafard were among 100 signatories of an open letter to the 182 parties (countries) to the Framework Convention on Tobacco Control to take a more positive stance on tobacco harm reduction. The letter pushes back against WHO’s drive for prohibition or excessive regulation and taxation of vaping products, heated and smokeless tobacco products, and novel oral nicotine products: "Cigarettes and other smoked tobacco products are responsible for the vast majority of the deaths caused by tobacco use globally. Smoke-free nicotine products offer a promising route to reducing the harms arising from smoking. There is compelling evidence that smoke-free products are much less harmful than cigarettes and that they can displace smoking for individuals and at the population level."
While the world’s wealthiest countries are paying hesitant citizens to get vaccinated against COVID-19 and stockpiling vaccine supply for potential booster shots, the developing world is struggling to get even a first vaccine into the arms of its citizens. The fact that some of this supply is about to reach its expiration date just adds insult to injury. Adam Houston writes in BioSpace...
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CHLPE's first Summer Institute in Health Law ran in August, focussing on issues of COVID-19. The Institute was comprised of 11 morning/afternoon sessions helmed by 14 professors. 33 attendees including students, nurses, physicians, lawyers, policymakers, researchers, and more completed the program. We had hundreds of applications for a very limited number of spots. But this was only the first in an annual series of Summer Institutes, so we look forward to welcoming a new cohort next year. Congrats to our first round of alumni!
Michael Da Silva, Post-Doctoral Fellow at CHLPE and Lead Research Associate on the AI + Society Initiative, has been appointed to a Health Canada external reference group to tackle how to regulate "adaptive machine learning" artificial intelligence (AI) in medical devices. Such AI changes its operation in response to data acquired over time, with the aim of improving its performance. For example, a device for diabetes management could adapt based on how a patient’s body responds to treatment. This is an exciting advance but it also prevents us from fully know how a device's risks will evolve with use. By current Health Canada regulations, this effectively bars such devices from the Canadian market. The reference group will advise on ways to evolve our regulations to open the door to adaptive AI without unduly compromising safety standards.
As the COVID-19 pandemic took hold in 2020, Chief Medical Officers (CMOs) entered the public spotlight like never before. Amidst this increased visibility, the role is deeply contested. Much of the disagreement concerns whether CMOs should act independently of the government: while some argue CMOs should act as independent voices who work to shape government policy to protect public health, others stress that CMOs are civil servants whose job is to support the government. Such debates about the CMO role can be explained by its inherently contradictory nature, which requires incumbents to balance their commitments as physicians with their mandates as civil servants...
Margaret Macaulay, Patrick Fafard and Adèle Cassola write in the Globe and Mail as well as a deeper take in the Journal of Epidemiology & Community Health.
CHLPE's Colleen M. Flood and Bryan Thomas are public health sub-editors for Lex-Atlas: COVID-19 (LAC19). With nearly 200 jurists participating, this large-scale international project builds a report and analysis of national legal responses to COVID-19 around the world. National responses have varied considerably. Epidemiological performance is but one measure, and a difficult one to judge when transparency is doubtful. Countries have employed emergency powers differently, but understanding them requires attention to the broader constitutional structure in which they are situated. It is hoped LAC19 will assist policy makers in future pandemic preparedness, to fashion ongoing responses to COVID-19, and to assist scholars and historians to come to evaluative judgments of state responses. The project is also a great source for original news and analysis articles, blog posts, and more.
Read Editorial (part I): Mandatory vaccination and the law (Bryan Thomas, co-author) >
Read Editorial (part II): Conditional policies and vaccine passports (Bryan Thomas, co-author) >
CHLPE's Michael Wolfson is Principal Investigator on WellCare, a CIHR-funded project investigating the future of elder care. WellCare is part of a broader international endeavour headed by the EU under the banner Better Lives, Better Years.
An increasing proportion of the population at higher ages combined with increasing life expectancies and declining birth rates could generate major tensions for meeting Canada's elder care needs by 2050. Such needs are approached by some combination of informal care provided by family members and formal care either privately purchased or from publicly funded government programs. The WellCare project will compare the many ways formal and informal care is provided across four countries—Spain, Austria, the U.K., and Canada. With this analysis, complemented by computer modelling, the project will illuminate alternative approaches to meeting caring responsibilities. A central aspect of the analysis will be inter-generational equity. The results will include new insights and actionable policy ideas for Canada. If you would like to learn more, please get in touch at healthlaw@uottawa.ca.
Five authors including CHLPE's Bryan Thomas, Colleen Flood, and Kumanan Wilson examine vaccine passports in the context of Charter rights, privacy rights, and implementation in this C.D. Howe Institute report. The report concludes that a well-designed vaccine passport regime, backed by an equitable vaccine distribution scheme, will likely withstand a Charter challenge. And that privacy issues raised by vaccine passports can be adequately addressed through careful design and regulation. The report suggests some broad principles for the design of a vaccine passport regime, including that passport gating should be limited to non-essential services and that wherever feasible, unvaccinated persons should be accommodated with rapid testing.
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See also COVID-19 Vaccine Certificates: Key Considerations for the Ontario Context by the Ontario COVID-19 Science Advisory Table (Colleen Flood, Kumanan Wilson members).
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And Ottawa Board of Trade Supports Vaccination Passports as a Boon for Businesses in the Ottawa Citizen, interviewing Kumanan Wilson.
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As the COVID-19 pandemic continues, the World Health Organization (WHO), the International Health Regulations (IHR) and countries’ adherence to IHR guidance are coming under scrutiny and review. The IHR require states parties to designate or establish national "focal points" to facilitate information sharing about disease events with WHO. Focal points are responsible for timely notification to WHO of relevant health events, responding to WHO Secretariat requests for event-related information, and ensuring that messages and advice from WHO are disseminated to the relevant sectors within the country. At the request of WHO, a team led by CHLPE's Dr. Kumanan Wilson evaluated the ability of focal points to carry out their functions through in-depth interviews and quantitative surveys.
Read summary findings and recommendations >
Canada’s response to the COVID-19 pandemic has been plagued by many of the same challenges that have affected its response to public health threats over the past two decades. These challenges largely relate to how the federal, provincial and territorial governments work together in a federal system in which responsibility for public health duties is provincial, territorial or local, but in which pan-Canadian coordination is critical. Creating a Canadian Immunization Services using the model for the Canadian Blood Services could address historical challenges related to variability in immunization practices and sharing of data across Canada. Kumanan Wilson, Graham Sher & Jane Philpott write in CMAJ.
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The University of Ottawa has been awarded four new Canada Research Chairs (CRC), one of which is CHLPE's Emmanuelle Bernheim. Emmanuelle's research looks at improving access to the justice system for diverse groups, particularly those living with mental health issues. Read in Droit Inc. about Professor Bernheim's new Social Rights Interdisciplinary Clinic, aiming to help persons with mental health issues and in conditions of homelessness in the Ottawa area.
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Professor Marie-Eve Sylvestre is co-author of Red Zones: Criminal Law and the Territorial Governance of Marginalized People, which recently won the 2021 W. Wesley Pue Prize. Congratulations Marie-Eve! In Red Zones, Marie-Eve Sylvestre, Nicholas Blomley, and Céline Bellot examine the court-imposed territorial restrictions and other bail and sentencing conditions that are increasingly issued in the context of criminal proceedings. Drawing on extensive fieldwork with legal actors in the criminal justice system, as well as those who have been subjected to court surveillance, the authors demonstrate the devastating impact these restrictions have on the marginalized populations—the homeless, drug users, sex workers and protesters—who depend on public spaces. On a broader level, the authors show how red zones, unlike better publicized forms of spatial regulation such as legislation or policing strategies, create a form of legal territorialization that threatens to invert traditional expectations of justice and reshape our understanding of criminal law and punishment.
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Indigenous patients who have had surgery are nearly a third more likely to die after their procedures than other populations in Canada and face higher risks of complications, new research suggests. The Canadian Medical Association Journal published a systematic review consisting of 28 separate studies. The research involved roughly 1.9 million participants, about 10 per cent of whom identified as Indigenous, to assess the surgical outcomes for Indigenous patients in Canada across a range of procedures. CHLPE's Jason Nickerson is co-author.
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Breast cancer risk has conventionally been assessed using family history and rare high/moderate penetrance pathogenic variants (PVs). In addition to these PVs, it is now possible to use increasingly predictive polygenic risk scores (PRS) as well. PRS information would be the most important advance in enabling effective risk stratification for population-wide breast cancer screening. CHLPE's Michael Wolfson is first author in Genetics in Medicine...
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Key Policy Issues in Organ Donation & Transplantation took place June 17–18 2021, with 200 attendees and 30 speakers spread over 9 panels. The conference was chaired by CHLPE Interim Director Professor Jennifer Chandler, with panels chaired by various CHLPE members as well as members of the Canadian Donation and Transplantation Research Program (CDTRP). Full videos of all panels are available to stream at www.ottawahealthlaw.ca/odtconference. See also www.ottawahealthlaw.ca/pastevents for videos of all our other recent events.
Canadian leadership on vaccine equity was an early casualty of COVID-19. A year into the pandemic, Canada's international image is that of a country who secured over ten doses of scarce vaccine per capita. Weeks after its vaccine portfolio made headlines worldwide, Canada remained silent on what would happen to its extra few hundred million projected doses; Prime Minister Justin Trudeau finally made a vague commitment to share surplus, not in an official policy but in a television interview. Little has happened since... Adam Houston writes in The Lancet (open access).
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The global initiative COVAX was meant to ensure poorer countries weren't left behind as COVID-19 vaccines rolled out. But wealthy countries struck their own agreements to jump to the head of the line, says CHLPE's Jason Nickerson, the humanitarian representative to Canada for Doctors Without Borders. Jason discusses Canada's role in how COVAX fell short on CBC's The Current for June 23.
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As demonstrated during the first wave of COVID-19, and subsequent waves, significant gaps remain in Canada’s health data ecosystem, from timely reporting of basic data on individual cases and outbreaks, to genomic surveillance for new variants, or assessment of vaccine coverage, safety, and effectiveness in real-time. There is no doubt that our response to the pandemic has been severely limited as a result. Numerous high-profile reports and recommendations over many decades have repeatedly outlined what needs to be done. Put simply, our systems, processes and policies are geared towards an analog world, while we live in a digital age.
Read the first report of the Pan-Canadian Health Data Strategy Expert Advisory Group, of which CHLPE's Michael Wolfson is a member.
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Reflecting on state efforts in Canada to normalize HIV/AIDS and fold it into a more integrated response to sexually transmitted infections and bloodborne illnesses, we examine how "end of HIV/AIDS exceptionalism" narratives obscure the new ways in which state power is being deployed such that, at the level of bodies and community organizations, actors are still subjected to exceptional state surveillance and control. Suzanne Hindmarch & Michael Orsini write in Critical Policy Studies.
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CHLPE's Professor Jennifer Chandler was invited to deliver a keynote lecture in the III International Colloquium on the Philosophy of Neuroscience, organized by the ANPOF Working Group on the Philosophy of Neuroscience. Her presentation addressed legal challenges arising at the cutting edge of neurological therapies: The Tyrannical or Vulnerable Self: Should Ulysses Agreements Be Used to Address Significant Personality and Behavioural Change in Capable Patients Receiving Deep Brain Stimulation?
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Artificial intelligence (AI) will transform and democratize health care systems. Yet at the same time it presents clear risks and implementation issues, such as those connected to discrimination, informed consent, safety/quality (and liability for harm), and privacy. This report from a group of experts across AI, law, ethics, policy, and medicine, addresses the core question: How can Canada maximize the potential benefits of the use of AI in health care while minimizing potential dangers?
High-quality scientific evidence, and the data and analysis on which it is based, is essential to inform the immediate needs of COVID-19 policy and effective health policy more generally. In the current emergency pandemic context, it could have saved lives and reduced serious illness. This situation is not new. Canada’s health information has been sub-standard for decades. The pandemic has only served to make the problems more visible. It’s time the federal government provided much stronger leadership so Canada can finally have an effective health data infrastructure. Professor Michael Wolfson writes in Policy Options...
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See also Professor Wolfson's recent op-ed in the Ottawa Citizen:
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Safe, high-quality care for patients is tied to safe, high-quality work for health workers. Although COVID-19 has heightened our concerns, many health workforce planning issues predate the pandemic. Without essential health workforce data, we will continue to make decisions in the dark, with incomplete, misleading and non-standardized information that is disconnected from the real-world experience of those at the point of care. The result is inadequate planning for population needs, inefficient deployment of health workers, persistent maldistribution of services, and a perpetuation of current inequities.
Join the call on the Government of Canada to support health workers by making significant and immediate investments to enhance the data infrastructure that provinces, territories, regions and training programs need to better plan for and support the health workforce.
