COVID-19: lessons learned and the path forward

It is said that one should never waste a good crisis. If that is received wisdom—and I believe it is—there is a treasure trove of lessons to be learned and addressed in Canadian health care from the COVID-19 pandemic. They come in different forms. Some include the accelerated adoption of technologies and practices that would likely not have been accepted in the absence of necessity. Others represent the exposure of long-standing, but equally long-ignored, structural problems in our health research, technology and service delivery landscape. In the first category, we have the example of the rapid proliferation of virtual care. The widespread adoption of virtual care as a common feature of primary care and long-distance diagnostics has come at an astounding rate. Doctors and other health professionals now routinely engage in telephone consultations and virtual examinations that would have been unthinkable (and likely resisted) just a few short years ago. Besides injecting a welcome dose of efficiency into the system in every community, this practice has also extended quality care to many rural and remote areas of our country that tend to be inadequately served. I believe we must retain and expand upon the opportunities to provide health care using virtual technology in the post-pandemic environment, both to improve and widen the availability of services in a more equitable manner across our vast land. The second category contains many examples. For one, the COVID-19 crisis has profoundly emphasized the importance of mental health as a core component of Canadians’ overall health. Long-neglected by federal policy-makers, Canada’s persistent lack of access to timely, effective, and affordable mental health services has been rendered crystal clear over the course of the pandemic. Isolation, financial insecurity, family separation, and discord, lack of adequate housing and other social determinants of health have exacerbated mental health issues and underscored the implications of leaving these conditions untreated. It is time to recognize that mental health is critical to Canadians, and we must address Canada’s historic underfunding in this area which significantly lags other OECD countries. It’s clear we must make access to mental health care part of our universal system. For another, COVID-19 has revealed a troubling lack of national self-sufficiency in essential medical technology, equipment, and therapeutics. From shortages of personal protective equipment and life-saving ventilators to our lack of ability to produce domestic vaccines, Canadians have seen first-hand how vulnerable we are to foreign governments and multinational corporations. It is critical that we address these life-and-death areas, as it is only a matter of time before another emergency hits. We can start by establishing a public drug and vaccine manufacturer to make essential medicines by Canadians for Canadians. It is also imperative to address Canada’s chronic under-funding of research, both in fundamental and applied science. Canada’s inability to locate a domestic lab with good manufacturing practices and decades-long underfunding of the National Research Council were prime reasons Canada was unable to manufacture a domestic COVID-19 vaccine. Research and development are foundational parts of a modern G7 economy, create many high-quality jobs and lead to commercial technologies and products that can be exported. It’s time we invested accordingly. A third deficiency resides in the complicated and disjointed federal-provincial relationship in health care. As is clearly apparent, viruses know no borders. Yet COVID-19 revealed constant buck-passing and responsibility-shirking between the feds and provinces leading to a balkanized and often contradictory approach. The lack of strong national coordination led to regional flare-ups that jeopardized everyone and prolonged the lockdowns. It is time to make it clear that despite constant confusion about jurisdiction—often expressed by politicians themselves—health is in truth a shared jurisdiction (the word “health care” does not exist in Canada’s Constitution, but only the establishment and administration of hospitals). We cannot achieve our full potential in constructing a world-class healthcare system without all governments contributing and working together. It is very clear that Canada would benefit from a thoughtful review of responsibilities for the 21st century and an enhanced federal role in critical national health-care areas. These could include developing a national health-care human resources strategy, constructing a federally coordinated national data information system and establishing national standards in crucial programs like long-term care. Using the federal spending power and resources to incentivize provinces to meet elevated health standards in new areas like pharmacare and dental care—just as we do for other medically-necessary insured services—is desperately needed and long overdue. If COVID-19 taught us anything, it is that we are capable of rapid, profound change. Canadians have proved to be resilient, adaptable and responsive to innovative policies that improve our health. So let’s be good students, learn our lessons, and work together to improve Canadian healthcare for the 21st century. Don Davies is the NDP’s health critic and Member of Parliament for Vancouver Kingsway, B.C. The Hill Times