Replace Captain Arruda or repair the ship?

Quebec has lost control over transmission of the Omicron variant. And, in these difficult times, we see the same reflex appear that drives any general manager whose hockey team defeats: dismiss the coach.

This is how calls to replace Doctor Horacio Arruda have been making themselves heard for some time. The question is legitimate. In a crisis like the one we are going through, the population must have confidence in their national director of public health.

It would be wrong, however, to personalize the question too much around the D^r Arruda. This man is the captain of a ship that has lacked love over the years.

A ship – Public Health – whose very design needs to be rethought.

In short: to eject Horacio Arruda to install someone else in his chair without asking broader questions would be a mistake.

We must question the role of the national director of public health and the level of independence we want to give him vis-à-vis the political apparatus.

We must also think about the best way to take advantage of centers of expertise such as the National Institute of Public Health of Quebec (INSPQ) and the National Institute of Excellence in Health and Social Services (INESSS). And how decisions are made and communicated to the public.

No one questions the dedication of D^r Arruda, who has worked tirelessly for almost two years. Man has the difficult task of interface between scientists and government in a context of high uncertainty.

Some are now having fun listing its contradictions for 22 months. This is partly unfair, and it is awfully easy to bring your case to trial after the fact, in the comfort of your living room.

But it is clear that several statements by D^r Arruda are quickly contradicted by independent experts (performance of rapid tests, effectiveness of N95 masks). And that the national director could be losing his moral authority with part of the population.

There is also an obvious communication problem. At a press conference, the national director talks too much and regularly tangles his brushes.

In addition, there are questions of its independence from the Legault government.

” [Le] D^r Arruda finds himself not only explaining the science, but explaining the government’s choices. That must be stopped, ”comments Patrick Fafard, a professor at the Graduate School of Public and International Affairs at the University of Ottawa who has analyzed the work of the eleven provincial and federal public health directors in the country.

Professor Fafard rightly underlines that the population must be able to clearly distinguish three things. First, the state of scientific knowledge on a question. Then, the opinions of the national director of public health, who may take into account other factors such as social acceptability. Finally, the decisions of the government, which must be assumed by him and him alone. In Quebec, let’s face it, these aspects often mix in an opaque magma.

We have already written: the fact that the national director of public health is also assistant deputy minister sows confusion and ensures that we never know whether it is the scientist or the member of the government who is speaking to us.

Governance experts are divided on the best formula to adopt, but it is clear that some thought is needed on this subject.

One day we will also have to ask ourselves how to make public health positions in government attractive. The D^r Arruda is the public face of a team weakened by many departures before and during the pandemic. Recourse to independent experts from the INSPQ and INESSS can compensate to a certain extent. But for the INSPQ in particular, their ability to adapt to emergencies and provide advice in a context of uncertainty has been variable.

Changing captains in the midst of an Omicron storm would be perilous. It is when the waves ease that we will assess who is best placed to take the helm. And, above all, how we can provide him with a boat to face the future.