As the Omicron wave shows signs of subsiding, public discussions about lifting COVID-19 measures have taken centre stage. In part, this is due to the vehement opposition of a small minority of citizens, such as those who have opposed vaccine mandates and who joined the convoy movement that occupied Ottawa and blockaded border crossings in several provinces.
Debates about public health policy have accompanied every wave of the pandemic, although they seem increasingly heated now. Recently, Liberal MP Joël Lightbound complained it is hard to know “when public health stops and where politics begins.”
But policy-making is political: it involves making judgments that weigh competing values and interests alongside evidence.
For instance, the question of whether to mandate vaccination is not a purely scientific one. Scientific evidence shows that vaccines substantially reduce the risk of hospitalization and death. But deciding on vaccine mandates also involves weighing risks to the health-care system, the effectiveness and cost of other non-pharmaceutical interventions, and disagreements about the appropriate role of the state.
What is at stake is not merely the substantive policies, but the question of who ought to make public health decisions. For the last two years, public health officials have been the face of government responses to the pandemic. As a result, many politicians have claimed that they are “following the science” which can obscure the underlying value judgments that are inherent in the advice they receive from public health officials.
We elect governments to establish a democratically legitimate process for making such decisions about matters of collective importance even in the face of disagreement. Yet, vaccine mandates were one of the few substantive public health policies discussed in the last federal election. For instance, there was little debate about issues such as funding global vaccination efforts to reduce the emergence of new variants and considerable discussion of the appropriateness of a pandemic election or the vaccination status of candidates.
Lightbound claimed his own government’s policies have been divisive and that perhaps there is a more widespread appetite to rescind COVID-19 measures. However, recent polling shows that only about one-third of Canadians agree that all restrictions should be lifted now, while about 64 per cent appear to oppose such a move. Provinces such as Ontario, Alberta and Saskatchewan have recently decided to remove most COVID-19 measures, including vaccine passport programs and mask mandates.
Their premiers justified these recent policy changes with reference to the alleged divisiveness of public health measures. For example, Alberta Premier Jason Kenney noted that “We have to begin to heal,” implying that the removal of restrictions might reduce disagreement. However, the removal of restrictions may generate its own forms of protest and conflict. For instance, tension arose when convoys were met with counterprotests. Additionally, students in Calgary planned walkouts after mask mandates were lifted.
Shifting management of pandemic risk from institutions designed to make collective decisions to individuals might not be the best strategy for reconciling those with different views on COVID measures. Rather, we might consider whether our political leaders can improve the legitimacy of the policy-making process by providing citizens with the relevant resources and opportunities to influence decision-making.
One way to preserve trust would be for politicians and public health officials to be more explicit about uncertainty. The future of the pandemic is unknown. Despite Ford’s claim that the world’s “done with it,” governments across the country have repeatedly lifted rules — only to find their reimplementation necessary.
For instance, British Columbia removed its mask mandate on July 1, 2021, only to reinstate it less than two months later. While some critics have pointed to Denmark as a model for removing restrictions, Denmark has explicitly tried to preserve public trust by acknowledging that measures may need to be reintroduced and is currently facing a surge in COVID-related deaths.
Overly confident predictions can create an impression of arrogance. Predictions that don’t come true — perhaps especially when they are overly optimistic — can erode trust. Avoiding these outcomes might be particularly important since people who distrust experts are more likely to be misinformed and less likely to comply with public health measures.
Another way to improve policy debates might be to avoid binary language – using terms like open or closed – that can be polarizing and lead people to talk past one another. Demands for the elimination of all rules seem guided by an understandable desire to return to a pre-pandemic world while opponents object that we are still in a pandemic.
Both agree that repealing all existing rules now will have consequences. This likely includes more people sick, more strain on hospitals, more cases of long-COVID and more people dead than we would have with the rules in place. It might also mean that some people can return to work and certain social functions can resume.
Governments seem to have sought compromises between these competing perspectives. Some of the resulting policies – such as vaccine passports – have been widely accepted but have stoked intense backlash from a small proportion of Canadians. Their value in the face of more transmissible variants has been questioned. Other compromises – such as wearing masks to be seated at a restaurant only to remove them while eating or drinking at tables – have been ridiculed as performative half-measures both by those who wish for more restrictive and more permissive rules.
Instead of accusing their political opponents of stoking division, political leaders might consider developing win-win policies that appeal to a variety of interests. Consider one possibility: Many experts recommend improving air filtration and ventilation in indoor public spaces to address the airborne spread of the virus.
Such a measure might be accepted by those opposed to mandates that require individual action, such as mask-wearing or vaccination, as well as those who want to see a stronger public health response. Improving air quality might have other positive benefits, such as removing car exhaust and wildfire smoke that kill people, make people sick and reduce cognitive performance. Building coalitions in favour of such policies might address concerns about both social division and public health.
Developing public health measures that are both effective and relatively non-intrusive may seem less satisfying to some people than imposing harsher restrictions on unvaccinated Canadians. But Canadians likely hold a wide array of beliefs regarding the pandemic – some may get vaccinated while disapproving of mandates – and we should consider measures that might be broadly acceptable.
Perhaps, it is also time to involve citizens more formally in pandemic policy-making. A sense of disempowerment and exclusion might lead to more radical opposition to public health policies. The hard task of weighing the costs and benefits of various measures has largely been left to experts and elected officials, although they are rarely transparent about the values that guide their decisions. Citizens are capable of taking on this task and some jurisdictions have recently included citizens in pandemic planning to develop effective and legitimate public policy. Canadian governments should consider doing the same through dialogue-based forms of public engagement that might generate creative recommendations.
Public health policy-making is political and marked by disagreement about values, interests and evidence. Simply repealing COVID-19 measures is unlikely to resolve these disagreements. Elected representatives and public health officials should facilitate a broader public discussion about future policy responses to the pandemic and its consequences.