Page - 37 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

37Have the Post-SARS Reforms Prepared Us for COVID-19? But “the single largest impediment” to addressing SARS was “the lack of a collaborative framework and ethos among different levels of govt.”17 Patient confidentiality requirements made it diffi- cult to release critical patient information to Health Canada (while a memorandum of understanding on data sharing between Ontario and Ottawa had been discussed, it was never finalized). Because roles for each government were not clearly spelled out, expertise was not optimally utilized. The Naylor Report catalyzed a major restructuring of public health institutions in Canada. During SARS, public health units both within provincial governments and Health Canada (as the Population and Public Health Branch) were poorly coordinated. Because of this, Canada lacked the kind of integrated and comprehen- sive health objectives and strategies that characterized other federal states. What was needed, suggested the report, was a new Canadian agency for public health led by a Chief Public Health Officer (CPHO).18 The report argued that this federal government body should be answerable to Health Canada, in order to keep the chain of account- ability clear, but be arm’s length and thus not directly under the con- trol of Health Canada. At the same time, however, the political realities of Canadian federalism meant that it was also essential to bring the provincial gov- ernments on as equal partners in the development of a comprehensive national public health strategy. While the report discussed the pos- sibility of a more hierarchical approach grounded in Ottawa’s con- stitutional authority, the final blueprint was for a more collaborative system of horizontal governance sitting athwart the basic structure of vertical hierarchical accountability. Not only would the new orga- nization have regional bodies geographically situated in each prov- ince, but at the heart of the agency would be a national “advisory board” with representative voices from each region of Canada. This horizontal integration would be reinforced by the secondment of fed- eral public health officials to provincial public health units (and vice versa) to foster greater understanding of how public health policies 17. Ibid at 212. 18. Similarly, the Standing Senate Committee on Social Affairs, Science and Technology called for an arm’s-length “Health Protection and Promotion Agency” that was national in scope and mandated to address public health emer- gencies. Reforming  Health  Protection  and  Promotion  in  Canada:  Time  to  Act (Ottawa: Senate of Canada, 2003), online: Senate of Canada <https://sencanada.ca/content/ sen/committee/372/soci/rep/repfinnov03-e.htm>.