Page - 43 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

43Have the Post-SARS Reforms Prepared Us for COVID-19? These concerns with decentralization are also illustrated by post-H1N1 changes to Ontario’s Health Protection and Promotion Act, which gave the Chief Medical Officer of Heath (CMOH) more author- ity to respond to diseases in a coordinated manner. For example, these amendments empowered the CMOH to direct boards of health and local medical officers of health to adopt measures “if he or she feels that Ontarians would be better protected by a coordinated response to an outbreak.…”35 However, the tension between Ontario’s Premier and the public health authorities regarding responsibility for COVID- 19 testing illustrates that there is still lack of clarity regarding key roles and responsibilities within the province. In most provinces, the deployment of health care workers across health regions was another concern. The nature of decentralized health authorities meant that it was difficult to move health care personnel where they would be needed. While collective bargaining provisions could generally be suspended in the event of a pandemic, unions were concerned about provisions that might require their members to drive long distances to report to work. These same challenges arose dur- ing COVID-19, with Ontario’s Premier issuing an emergency order that allowed health service providers to redeploy staff to different locations, change the assignment of work (including assigning non- bargaining unit employees bargaining unit work), change scheduling, and defer vacations, among other measures.36 But if the decentralization of health authorities had led to dif- ficulties in pandemic management in 2009, the more recent recen- tralization of health authorities in many provinces led to other kinds of issues. One was the effect on public health systems within these provinces. While the organization of public health varies considerably across provinces, most provinces had embedded public health at the municipal level, where it could most effectively provide guidance and assistance to local offices. With the centralization of health authorities, public health offices were increasingly amalgamated and expected to cover larger catchment areas. The concern here, as the Canadian 35. Ontario, Legislative Assembly, Standing Committee on Social Policy, “Health Protection and Promotion Amendment Act, 2011”,  Official  Report  of  Debates  (Hansard),  No  SP-17 (22 March 2011), online (pdf): Ontario  Legislative  Assembly <https://www.ola.org/sites/default/files/node-files/hansard/document/pdf/2011/ 2011-03/committee-transcript-2-EN-22-MAR-2011_SP017.pdf>. 36. Order  Made  Under  Subsection  7.0.2(4)  of  the  Emergency  Management  Act, O Reg 74/20; Order  Made  Under  Subsection  7.0.2(4)  of  the  Emergency  Management  Act O Reg 77/20.