The version has evolved.
Posted at 5:00 a.m.
To read the letter of resignation from Dr Horacio Arruda, one would have thought he was leaving on his own initiative. But the decision was taken by “mutual agreement”, admitted Prime Minister François Legault.
Nothing suprising. After all, it serves him well.
Someone pays for the mistakes and the face of the Crisis Staff changes. This gives the impression of renewal without the government admitting that it is wrong. However, Mr. Legault remains ultimately responsible.
The national public health director has been shaken by media criticism, but there is more.
Other voices would have made him think: those of colleagues, such as regional directors of public health.
I am told that at a conference on Monday last fall, several called for severe measures to deal with the Omicron variant. But at the same time, Mr. Legault dreamed aloud of gatherings of 20 or 25 people to spend a beautiful Christmas. The Dr Arruda then became the sandwich man. Sitting on an electric fence once more.
At the end of December, Quebec announced that children or educators who had been in contact with a positive case could return to daycare if they were asymptomatic. It took a few hours for the Montreal Public Health Department to refuse to apply this measure.
The Dr Arruda did not see it as a mark of confidence …
That said, a somewhat caricatured vision of the crisis unit has taken hold.
Its members vary according to the topics covered. And contrary to what the opposition claims, Dr Arruda was not the only doctor. We could find another Deputy Minister Doctor, Lucie Opatrny, as well as several doctors from the Public Health Department (DSP), the National Institute of Public Health (INSPQ) and the National Institute of Excellence in Health and in social services (INESSS), like the Drs Litvak, Raynault, Sauvé and De Guire. In addition, there are a handful of clinicians consulted informally.
We cannot therefore say that the pandemic is managed only by a bunch of accountants and communicators. But obviously there is a problem. Otherwise, the College of Physicians would not ask that the successor of Dr Arruda has “the greatest possible independence”.
How to strengthen it?
Let me start with the obvious: the national director will not cease to be deputy minister. A bill should be drafted, studied and voted on before the election campaign in the fall. We will not play in structures in the midst of a crisis.
Better to think carefully before reinventing the formula. The national director of public health is not a government puppet. On the contrary, the law gives it enormous powers. In particular, it can impose compulsory vaccination or close a factory that is dangerous for air quality.
Anecdote told by the former Minister of Health and Social Services, Réjean Hébert: after the Lac-Mégantic rail disaster, Quebec wanted to evacuate the city because of the fumes. The minister did not have this power. Only the Dr Arruda could.
The current structure did not prevent Montreal Public Health from loudly denouncing the Peel Basin casino project in 2006. And even if the INSPQ reports to the Ministry of Health, it criticized the Caquist approach. repressive with cannabis.
Either way, it’s impossible to depoliticize decisions. In public health, there is no such thing as pure science. Political factors must also be considered, such as the applicability of a measure, its social acceptability and its ethics. Another example given by Réjean Hébert, geriatrician and professor at the School of Public Health of the University of Montreal: science obviously recommends wearing a bicycle helmet, but if it is made compulsory, the disadvantages (reducing the number of cyclists ) could outweigh the benefits.
What we call “Public health” is in fact a tandem. At the risk of simplifying things, the INSPQ produces expert opinions, while the Public Health Department applies them. Even though the two collaborate, their work remains parallel.
This formula has one merit: the national director participates in decisions instead of commenting on them from the outside.
Everything was working pretty well, until the pandemic.
The INSPQ has become very cautious. He does not dare to contradict the government for fear of harming adherence to the measures.
And he does not want to make the inevitably political trade-offs, in particular to manage the return to class. Its opinions relate to more specific scientific questions.
Those of Dr Arruda are even rarer. The crisis unit decided as a group, sometimes very quickly, after informal discussions. It is normal that not every decision is preceded by a formal written report. Still, we would have liked to know more often what the national director himself thought. Thanks to the questions of the Péquiste Pascal Bérubé, we learned in December 2020 that the Dr Arruda did not recommend closing the restaurants. Was this an isolated case?
Of course, we cannot demand that the national director participate in decisions while asking him to criticize them. How to find the right balance?
Without changing the current structure, we could make the process more clear and transparent.
By ensuring that each measure is announced and explained at a press conference. By also specifying which experts or studies we are relying on. And by offering more technical briefings, conducted only by scientists.
It will depend on the interim successor to Dr Arruda, Luc Boileau. A doctor trained in public health, he headed the INSPQ and INESSS. This rare expertise made him a highly qualified candidate. But it is not the man on the ground who comes to shake up the cage. A career administrator, a few years ago he advocated a controversial merger between INESSS and INSPQ.
Hopefully the Dr Boileau will now be able to share all the expertise of Public Health with the population. That he won’t be a sandwich man.