Examining the enigmatic Dr. David Williams
Praised by Doug Ford, vilified by critics, is top medical health officer simply misunderstood?
Throughout the pandemic, after Doug Ford cajoles or assures the public at his daily news conference, he inevitably gestures to the man standing to his right and cedes the podium to Dr. David Williams.
Grandfatherly and mustachioed, reserved and at times bewildering, the province’s chief medical officer of health has reminded us to wash our hands and stay two metres apart while touting a framework for COVID-19 restrictions that some critics claimed was dangerous or delusional.
Williams, whose tenure has been extended to take us through September , has been praised by Ford as an “absolute champion” and vilified by others for his sometimes confused messaging and policy choices.
He has become one of the most public and divisive figures in Ontario’s COVID-19 response — criticized this week by the auditor general in a report the premier dismissed as inaccurate for the way he has handled the worst health crisis in a century — and yet eight months in, he remains somewhat of an enigma.
The man whose 30-year public health career had him leading the public through the listeria crisis and swine flu has almost no presence on Google, save for what he says in the pressers. It doesn’t help that he bears a similar name to Dave Williams, storied Canadian astronaut. He rarely speaks to media outside of COVID-19 press briefings. (He was too busy to be interviewed for this article.)
Williams was thrust into the limelight in March when COVID-19 began to rapidly spread across Ontario, sparking the first lockdown on March 23. He had to quickly transition from a “peacetime” medical officer of health, focused on long-term policy shifts, to a leader in a crisis, forced to make snap assessments of emerging science and regularly address the public on live television.
Ford has repeatedly expressed his confidence in Williams, saying in a recent press conference, “There is absolutely zero — from day one — zero daylight between myself and Dr. Williams.” Meanwhile, infectious disease experts criticize what they describe as Williams’s jumbled communications and ineffective leadership.
With Ontario’s second wave numbers surpassing the first — the province recorded a new daily high of1,855 casesFriday — and the challenge of vaccine distribution looming on the horizon, many say he’s not the right person to see Ontario through the pandemic. Others say he’s limited by the powers of the job that tie him more closely to the government than the public.
“In a lot of ways, his decisionmaking and leadership have caused COVID to get worse not better,” said Colin Furness, an epidemiologist with the University of Toronto, citing Williams’s “repeated refusal and lack of interest” in collecting race-based demographic data despite evidence from other jurisdictions showing racialized people disproportionately die from COVID-19.
Furness was initially optimistic about Ontario’s capacity to tackle COVID-19 after learning from SARS, but has become increasingly disillusioned with William’s muddled communications and what Furness sees as a poor understanding of how viruses spread. He’s now encouraging health professionals to join him in calling for Williams to step down.
On paper, Williams is more than qualified to be the top doctor, who reports directly to the minister of health about public health issues in the province.
He had been acting chief medical officer for eight months when the Liberal government tapped him for the role in 2016. Previously, he was medical officer of health in Thunder Bay for two decades and held various other posts in the provincial Health Ministry, including acting chief medical officer of health between 2007 and 2009, where he oversaw the 2008 listeriosis outbreak and the swine flu pandemic. He has a medical degree, a master’s in community health and epidemiology, and fellowships in community medicine/public health and preventative medicine, all from the University of Toronto.
There is likely much more to the stoic top doctor we see on TV. Before entering public health, Williams served remote First Nations communities at Sioux Lookout Zone Hospital, and he spent eight years in Nepal as director of the United Mission Hospital in Tansen.
Former colleagues from Nepal remember him as a kind, hardworking man who encouraged fellow staff and helped build up the hospital. The queen of Nepal visited while Williams was there and was pleased with what she saw, hospital staff say. He speaks Nepalese and is apparently quite a talented mountain climber.
The 69-year-old grandfather
now lives in a pitch-gabled home in Stouffville, 40 minutes northeast of Toronto, with his wife of four decades, Lois. In 2019, he earned nearly $414,000 according to the province’s public sector salary disclosure.
A past colleague and mentee of Williams from Thunder Bay describes him as a quiet, loyal leader, focused on nurturing those below him.
“He is a high-level, subtle thinker, and a highly ethical, humble and moral man,” said the colleague, who didn’t want to be named out of fear of adding to the controversy surrounding Williams. “He trusts his staff and encourages them to develop their own thought processes and decision-making, rather than just telling them what to do.
“Unlike some egodriven leaders, he will never throw you under the bus. If he gives you the opportunity to make a decision, he’ll stand behind you when you make that decision.”
As calls for Williams’s resignation have grown louder, the premier’s loyalty to him has only grown stronger.
“They have been calling for. Dr. Williams’s head since the beginning and I take personal offence to that,” Ford said when asked about calls for the top doctor to step down. With loyalty has also come unquestioned support of Williams’s expertise. “I think an earlier question was ‘why didn’t you listen to the 100 other doctors?’ This is who I listen to. I listen to Dr. Williams.”
Some take Ford’s unequivocal support of Williams as evidence of the top doctor’s quiet acquiescence of the politician’s agenda.
Doris Grinspun, CEO of the Registered Nurses Association of Ontario and one of Williams’s loudest critics, said she has no doubt Williams’s motivations are pure. “That’s why then, you wonder if it’s an issue of weak character that cannot stand up to political pressure. I don’t know. I cannot explain that. All I know, is that this is not good for Ontario.”
Williams’s critics say he’s been slow to act on the science, accepting asymptomatic transmission long after it became clear it was significant and only directing health units to strengthen protections for migrant workers two months after the first farm outbreak in April.
It was six weeks after the tragic long-term-care outbreak — which claimed nearly half the residents at a home in Bobcaygeon — when Williams issued the order prohibiting personal support staff from working in multiple homes. In those six weeks and thereafter, thou
sands of seniors would contract COVID-19 in nursing homes across the province, many of them succumbing to the virus.
For weeks after the first outbreak, Grinspun says, she demanded Williams provide proper PPE to nursing home staff and received only “musings” in response.
More than 2,200 long-termcare residents have died from COVID-19 in Ontario.
The rumblings of discontent came to a loud roar when after months of health officials, journalists and businesses demanding a transparent plan for workplace and social restrictions, the province came out with a colour-coded framework with thresholds some experts called scarily high. Broader-scale closures would not occur until a region was placed in the red zone, quantified as more than100 cases per 100,000 residents and a positivity rate of at least 10 per cent, targets that critics said would be too late to contain spread.
When the Star reported that one of the province’s expert COVID-19 advisory groups was never consulted on the plan and a member of the other said she never saw the final numbers, Ford reiterated that there had been consultation but put it at the feet of Williams.
“The fact is, Dr. Williams came to us with a framework and cabinet approved it,” he said. The next day, the thresholds were lowered.
Meandering, vague statements have become a staple of Williams’s appearances in press conferences, and he’s known to respond to questions with more questions.
Following the revised framework, reporters asked what it would take to move Toronto and Peel from red zone to lockdown, which still didn’t have specific targets. Williams responded, “The question is, when would one do a lockdown? What would the lockdown consist of? Does it consist of closing certain aspects — all aspects? Does it include closing schools, yes or no? What do you do with long-term-care visitations?”
While Williams may lack the communications prowess of counterparts like B.C. chief medical officer Dr. Bonnie Henry, now facing criticism as cases grow in B.C., experts say the nature of the chief medical officer role in Ontario means Williams has less freedom to speak independently.
“When we see Dr. Williams on TV, many Ontarians might expect him to speak truth to power, but the reality is (the chief
medical officer) is closer to a government spokesperson than he is to a public advocate,” said Steven Hoffman, director of the Global Policy Lab at York University. Hoffman, who coauthored a 2018 study on Canada’s chief medical officers.
A former chief medical officer in the 1990s, David Mowat knows the challenges of the job well. “It’s a very, very unusual role,” Mowat said, “because it’s a combination of a public servant and a health professional.”
Like a civil servant, the chief medical officer is responsible for determining provincial health needs, providing recommendations to government, and implementing public health programming, working closely with Public Health Ontario and the 36 local health units, and reporting directly to the health minister. But crucially, the chief medical officer also has the right to speak directly to the public on important health matters, without the minister’s consent. The CMOH can also act unilaterally when there is a risk to Ontarians’ health.
The role is all about maintaining “a complex and subtle balance,” Mowat says, and that guides who the government picks to fill it. “Does the government want high flyers in these positions? Who knows? They may not. It’s very much a matter of fit.”
The competing responsibilities of the role came to light during the 2003 SARS crisis when the chief medical officer at the time, Dr. Colin D’Cunha, was criticized for being too close to government. An independent commission report on the crisis noted there was “a perception among many who worked in the crisis that politics were at work in some of the public health decisions.” That prompted legislative changes by Dalton McGuinty’s Liberal government, giving greater power and independence to the chief medical officer.
The changes were meant to “clarify that the CMOH is a central authority during times of potential health emergencies, free to act on his/her own initiative based on assessed risk.”
But in 2018, the province made changes that chipped away at this independence. As part of a Health Ministry restructuring meant to boost efficiency, the chief medical officer became responsible for implementing public health programming, pushing him further into the civil servant camp. The new structure makes it near-impossible for the chief medical officer to be the independent authority the McGuinty Liberals intended.
“When you’re expected to be an executive responsible for program delivery … it then becomes untenable to effectively do that while simultaneously criticizing your own government,” Hoffman said.
Ford himself has denied the notion that Williams is his lackey. “Never once Dr. Williams has ever come to me from the beginning of this pandemic and said ‘Premier, I think you need to do that’ and I’ve said no, never once,” he said in a November press conference.
Hoffman says much of the criticism surrounding Williams fails to recognize the structural reality of the CMOH role. “I think that what a lot of criticism doesn’t realize is how difficult it is to be a chief medical officer of health in Ontario, where the role is designed in such a way that it makes it very difficult to be a leader that stands separate from the government of the day.”
By contrast, Bonnie Henry is not responsible for delivering government programs, which puts her in a better position to convey health information to the public, because she is not constrained by internal commitments to the government’s agenda.
Profiled in the New York Times, Henry’s quintessential Fluevogs and masterful handling of the first wave of the pandemic have made her part of the zeitgeist while Williams’s ordinariness makes him less of a star, yet Toronto Life named him one of the 50 most influential Torontonians in 2020.
While most top doctors don’t have to contend with the spotlight, the role is difficult at the best of times, and it’s tough to recruit people to fill it.
“You might assume that ‘oh, this is the top job, and the top people are fighting to get this job,’ ” Mowat said.
“Not true, not true. These are very difficult positions to fill in many provinces and in many provinces there’s high turnover.”
There have been seven different chief medical officers in Ontario since Mowat held the position in the late 1990s, and many filled the role temporarily due to long hiatuses between permanent appointees, including Williams himself from 2007-2009.
Even Williams’s harshest critics understand the challenges of maintaining independence in a bureaucracy. “Professionals who end up being institutionalized can end up identifying more with their employer than their profession,” Furness said.
But he says that’s no excuse for failing to advocate for sound health measures in a pandemic.
“He’s the guy who’s supposed to stand up … He needs to hold the premier accountable.”
Mowat says you run into problems when the chief medical officer is forced to make value judgments, for example, regarding the balance between protecting businesses and protecting health.
“You can’t have the doc taking over for the elected officials.”
“In a lot of ways, his decisionmaking and leadership have caused COVID to get worse not better.”
COLIN FURNESS EPIDEMIOLOGIST, UNIVERSITY OF TORONTO