Chief medical officer of health must do right thing and resign
Dr. David Williams will finish his fiveyear term as Ontario’s Chief Medical Officer of Health (CMOH) next February. He has great qualifications to stay on. He is a physician, a mandatory requirement, and a public health master’s degree. He has been a regional medical officer of health and even served a stint as acting CMOH (2007-09) — there is no better preparation for a job, than the job itself.
Public health policy distils slowly from research over years. Individual case reports lead to small studies, then large experiments, and eventually systematic reviews articulate definitive new knowledge.
In public health “peacetime,” the CMOH studies this research, recommends public policy, and reports annually on “the state of public health in Ontario.” With his civil service experience, Dr. Williams is the consummate CMOH. His avuncular style — mild, reserved, indirect, and cautious, one might also say — embraces the ideal tone to convince the public to eat more fibre, or drink less alcohol.
But this isn’t peacetime, it is a major emergency, and the effective time window to act is tiny. We are learning about COVID-19 quickly, through real-time case reports and small, rapid studies. Collectively, these provide converging, urgent guidance about what to do — and not do — to save lives.
If the CMOH dithers when urgent action is needed, then politicians with zero understanding of public health may fill the vacuum with political reasoning.
That is what the Ford administration is doing right now.
The awful spectre of a public health emergency being mismanaged by politicians in Ontario was clearly identified in the wake of SARS. In 2004, the role of the CMOH was transformed to become powerful and wholly independent from political interference.
These changes were announced to “… clarify that the CMOH is the central authority during times of potential health emergencies, free to act on his/ her own initiative based on assessed risk … This amendment removes authority for these powers from the minister and vests them with the CMOH.”
Ontario’s CMOH has the power and the obligation to act independently and quickly in an emergency. However, Dr. Williams’ approach been marked by inaction and passivity.
By early February, case reports told us that COVID-19 spreads asymptomatically, requiring broad proactive testing based on occupational and demographic risk.
But Dr. Williams opted for the classical approach of strictly limiting testing to those with severe symptoms. The result: a lot of avoidable illness and avoidable death.
We stayed blind to who is most vulnerable, because Dr. Williams would not collect demographic data from cases. We stayed blind about who the virus kills because Dr. Williams refused to order post-mortem testing for those who died before diagnosis. New evidence tells us that mandatory masks prevent transmission. But the gentle Dr. Williams “prefers” a voluntary approach.
Most damningly, Premier Ford citing the advice of Dr. Williams in opening bars, in stark conflict with emerging global evidence that is disastrously dangerous. Dr. Williams has strikingly failed the articles of his office.
Worse still, those most aware of how our CMOH has been failing are physicians. But like most licensed professions, they won’t criticize or even contradict each other publicly, let alone call for the dismissal of one of their own. Our associate CMOH, Dr. Barbara Yaffe, seems cut from the same cloth as Dr. Williams, making a solution to this problem even harder to conceive.
What can be done? Physicians and public health professionals must write to Drs. Williams and Yaffe to beg them both to step down. An urgent conclave of Ontario’s 34 regional Medical Officers of Health — which include some brilliant public health leaders — could then elevate a new CMOH for the lieutenant governor’s approval.
The right CMOH would act quickly on emerging evidence. They could give us mandatory masks, close bars, and get our children back to school safely with daily screening. And they could direct real support to Ontario’s marginalized, racialized communities still being ravaged every day.
What Ontario needs to manage the second wave of COVID-19 is clear. We just need a CMOH who is willing to do it.