Public Health Ontario suffered exodus of senior leaders and budget cuts before the pandemic struck
Tuesday, 23 June 2020
Thirteen years ago, Dr. Natasha Crowcroft, a Cambridge-trained physician and expert in infectious disease surveillance, moved to Toronto from London to help rebuild Ontario’s public health system after SARS. For 11 years, Crowcroft worked inside the agency known as Public Health Ontario (PHO) in a series of progressively more senior roles. During the 2009 H1N1 pandemic, she led the agency’s surveillance epidemiology group. Last year, in April, she was named PHO’s chief science officer and senior scientist.
The public health system Crowcroft found in Ontario was “a bit of a dog’s breakfast,” she said. Over the years, there were constant squabbles between the Ministry of Health and PHO about issues like jurisdiction and independence. Crowcroft wasn’t shocked by any of that. To an extent, it just goes with the territory in her field. “Governments really don’t like independent public health organizations that evaluate what’s going on and tell them when they’re not doing things right,” she said. They’re constantly trying to trim their wings and pull them back into the cage.
“I sometimes say it’s a bit like the Death Star in Star Wars,” Crowcroft said. “You know you have to do everything you can not to get sucked into the tractor beam.”
For all her frustrations, Crowcroft enjoyed working in public health. She thinks it’s vitally important work, and interesting too. But two years ago, after the election of Doug Ford’s Progressive Conservative government, the situation at Public Health Ontario, and in the Ontario public health system at large, began to deteriorate, she said.
The Ford government quickly froze PHO’s budget and signalled that deeper cuts, to PHO and local health units, were on the way. The new administration also proved uninterested in some core public health missions, things like basic science. That hostility isn’t entirely new. Some of it predates this government. “But it did get worse under this government,” Crowcroft said. “The government has made it almost impossible for science to function within a public health organization.”
It wasn’t just science, either. Public Health Ontario was set up as an independent agency as a response to Ontario’s failures during SARS. Crowcroft was specifically recruited to help with that effort. But the new government didn’t want to hear about that part of PHO’s history and mission, according to Crowcroft. “The other message that was around before this happened was that people were saying, ‘Don’t talk about SARS anymore. The government doesn’t want to hear about SARS,” she said, “which is supremely ironic right now.”
Hayley Chazan, a spokeswoman for Health Minister Christine Elliott, said in an email that that direction “was never provided by the office of the minister of health.” She also pointed to numerous ways the lessons learned from SARS have guided the provincial response to COVID-19 .
Last summer, Crowcroft left Public Health Ontario to head up a new Centre for Vaccine Preventable Diseases at the University of Toronto. In June, she joined the World Health Organization. She hasn’t been replaced at PHO. Her old job, chief scientist, no longer appears in the agency’s leadership chart.
Crowcroft wasn’t alone, either. In the year before the COVID-19 pandemic struck, Public Health Ontario lost a host of senior leaders in crucial roles. Some were pushed out due to budget constraints or organizational restructuring. Others took early retirement. Some were replaced. Many were not. “I think there was maybe one person who was probably going to retire anyway,” said Crowcroft. “But my impression from the people I do know is an overwhelming majority were not necessarily planning to go at that time.”
The loss of all that leadership, expertise and experience left Public Health Ontario undermanned in several areas crucial to pandemic response as the SARS-CoV-2 virus began to sweep the province earlier this year, according to multiple former senior PHO officials.
The province has been repeatedly criticized for its efforts on data collection and sharing during the pandemic. In early June, the government appointed former federal Liberal cabinet minister Dr. Jane Philpott as a special advisor on data in an effort to clean up the problem.
But until last year, Public Health Ontario had its own senior-level expert on data collection, presentation and sharing. Julian Martalog was hired as PHO’s first director of informatics in 2016. “My role was really just to make sure the organization had a way of transforming all the data they were collecting into information and knowledge,” he said. Martalog was laid off last year. He hasn’t been replaced. His position no longer appears on PHO’s leadership chart.
“I think it was a little bit strange that they decided to eliminate that role in particular,” he said. “I like to think that with this situation now, I would have been able to continue to make an impact and provide strong leadership, but it is what it is.”
Martalog has watched the provincial pandemic response with some unease and confusion. “There’s stuff that comes out every day that makes me scratch my head,” he said. He doesn’t understand why critical information on things like deaths, infection rates and locations hasn’t been better presented and easier to access. He believes that, if he was still at PHO, he could have made a difference.
“I would have been heavily involved in that whole effort just to make sure that the right information is presented in a timely way,” he said.
Communication in general has been a sore spot for the province during the pandemic. Premier Ford and Chief Medical Officer of Health David Williams have at times presented conflicting messages in back-to-back to press conferences. Williams in particular has come under fire for his dry and sometimes convoluted delivery.
Ironically, Public Health Ontario had one of the country’s leading experts on what’s known as “ risk communication ” on staff until the end of March. Dr. Ray Copes was the agency’s chief of environmental and occupational health. Part of his job was to train other public health units and officials on how to speak to the public about health risks and crises in ways that are coherent, calming and easy to absorb. There is no one left in the agency with that level of expertise, according to one senior official still in public health.
Copes’ departure from PHO was planned last year. But his final day on the job wasn’t until the end of March, when the pandemic was already in full flight. He wouldn’t say specifically why he left or if he was asked by PHO to stay on until the crisis waned. But he did say this about the general situation at the top of his former workplace: “There certainly are some folks that aren’t there anymore, who I think really could have made a contribution to the response had that been requested,” he said. “I’m not aware that that was done in the case of Public Health Ontario.”
Asked about risk communication in general during the pandemic, Copes was effusive in his praise for British Columbia’s Dr. Bonnie Henry. She benefits from being atop a coherently organized, well-managed public health system, something Ontario lacks, Copes said. But she’s also a great communicator who’s been given the space on most days to be B.C.’s sole voice on scientific, technical and health matters.
In Ontario, Copes said — and this predates the current government — politicians have a habit of putting themselves out front, even when that’s not the best strategy. That’s something, if he was still on the job, he would have advised against. “How credible, ultimately, is a lay elected representative speaking about medical or scientific matters?” he said.
It’s true Williams himself isn’t much of a speaker. But there’s no reason Williams had to be the province’s only, or even lead, expert voice on the pandemic. PHO used to have a deep roster of scientists who were both experts and experienced crisis communicators.
That hasn’t been the case with COVID-19. Many of those experts, including Crowcroft, have since left the agency. “I’ve done tons of this kind of stuff. If I would have been there, I’m sure I would have been pulled into it,” Crowcroft said. “But it’s not just about having the right person. You have to have the environment and the vision and the commitment to meet the mandate of the organization, which is protecting the health of Ontarians.”
Several other senior leaders — in addition to Crowcroft, Martalog and Copes — have left the agency in the past year. PHO’s former chief of health promotion, Dr. Brent Moloughney, is now Ottawa’s Associate Medical Officer of Health. His departure was a personal decision, he said. He wanted to be in Ottawa to be closer to his aging parents.
Nicholas Paul, who as recently as January of this year, was PHO’s laboratory operations director, was removed from the agency’s online leadership chart sometime before March. He couldn’t be reached for comment.
John McLaughlin, Crowcroft’s predecessor as chief scientist, retired from PHO last year, on schedule, after turning 65. “I regret seeing that other people have left,” he said. “Sometimes there was illness, sometimes there was opportunity, but it seemed that just a coincidence of things has led to a lot of senior people not being there at a time like this.”
There are other, temporary, absences, too. Mike Mendaglio, the agency’s chief laboratory operations officer, is on medical leave, as is Peter Donnelly, PHO’s president and CEO.
Overall, according to PHO’s organizational charts, the agency eliminated six leadership positions between June 2019 and January 2020. Since then, at least two more senior leaders, Copes and Moloughney, have left the agency, while a third, Paul, no longer appears on the online version of the chart.
In an email, Janet Wong, a spokeswoman for the agency, said that, as “with the majority of publicly funded organizations in Ontario, Public Health Ontario has had to streamline our operations to align with fiscal realities.” That restructuring has led to the departure of some staff, she added. “However, these staff changes have not impacted PHO’s ability to respond to the pandemic.”
Elliott’s spokeswoman, Hayley Chazan, said PHO has served “as a valued partner” throughout the COVID-19 outbreak. “We have benefited immensely from the advice and counsel from many of the organization’s leaders, including Dr. Peter Donnelly, who helped lead the release of initial modelling, Dr. Shelley Deeks, who has helped develop our case and contact management plan, and Dr. Vanessa Allen, who is playing a key role in guiding Ontario’s testing strategy and has also played a critical role in setting up our provincial laboratory network.”
But that appreciation for the agency did not predate COVID-19, according to multiple sources both inside and outside PHO. “Certainly there was no love shown to public health in Ontario by the government,” said Dr. Bob Bell, a medical doctor and health care administrator who served as Ontario’s deputy minister of health and long-term care between 2014 and 2018. “The funding cuts at Public Health Ontario cannot have been useful to the response to COVID-19. And when you look at the pennies saved compared to the dollars cost — that Ontario is going to suffer by delaying its reopening because of a lack of organized public health effectiveness — it’s like, ‘boy, was that ever stupid.’”
Some who have left the agency, meanwhile, believe the funding freeze and the institutional changes in the first years of the Ford administration may have compounded existing problems within the agency to such a degree that, in a year’s time, PHO may not exist at all. “Which would be a real shame because of all the effort that went in to creating it,” said Crowcroft. “And the reasons for needing it are still there.”
On a certain level, the COVID pandemic is the just the bottom swing of a public health yo-yo that has happened over and over again in Ontario. “You run in these circles where public health advocates get silenced gradually, and then there’s a crisis. And then everyone goes ‘Oh my God, what happened? Why didn’t we have the lab testing we needed? Why didn’t we have the right scientific advice? Why was there no good public health leadership? And it’s like, ‘Oh yeah, we shut that down, remember?’” Crowcroft said. “These aren’t new stories. It just seems like Ontario is doomed to relive its history again and again.”
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