The big hole in Canada’s public health leadership needs to be filled

Posted on August 9, 2014 in Health Delivery System News/Politics
Aug. 09 2014.   André Picard

That sucking sound you hear coming from Ottawa? It’s the void in public health leadership.

The two most important positions in Canadian public health circles – chief public health officer and scientific director of the National Microbiology Laboratory – are vacant. They have been for months.

Worse yet, there is no indication that the federal government is in any rush to fill these positions quickly, or with high-profile candidates these jobs require.

The Harper government’s indifference to health care has veered from political pettiness to a level of contempt that could put the public in danger.

God help us if Ebola comes to Canada, or if there is another outbreak of pandemic influenza.

Preventing an outbreak of infectious disease – and promoting population health more generally – requires leadership.

But the leaders are gone.

David Butler-Jones, who headed the Public Health Agency of Canada since it was created in 2004, was a powerful advocate for public health. He played a key role in help mopping up the mess after SARS – which led to the creation of the PHAC – and in overseeing the response to the H1N1 pandemic.

But he suffered a stroke in May 2012 and never returned to work full-time. The post of chief public health officer has, for all intents and purposes, been vacant since then.

It needs to be said, however, that Dr. Gregory Taylor, the acting CPHO, has done yeoman’s work and his statements on Ebola have been a model of common sense and professionalism. But having someone, no matter how talented, hold down the fort, is not the same as giving them a permanent position.

Frank Plummer, a world-renowned HIV-AIDS researcher, stepped down as the head of the National Microbiology Laboratory in March of this year. He had held that position since 2001.

Both Dr. Butler-Jones and Dr. Plummer made their mark nationally and internationally.

Obviously, there are some big shoes to fill there.

So what has Ottawa done?

There were standard job postings and an executive head-hunting firm, Renaud Foster, was employed to seek candidates.

But still we wait.

And, while we wait, the health of Canadians is vulnerable. In public health, lack of vigilance means vulnerability.

Sure, there is some fine work going on in the provinces. They all have great plans for dealing with public health threats, up to and including Ebola.

But for a plan to be implemented there needs to be a leader. And in Canada, with its multitude of jurisdictions, there needs to be a leader (or leaders) who can co-ordinate centrally in case of a crisis.

That leadership should come from the chief public health officer and the chief scientific officer of the microbiology lab.

Let’s face it, the number of people who could fill either of these positions is limited. You could probably count them on your fingers.

So why would the qualified candidates hesitate?

To begin with, the pay is a joke. The federal government pay scale for the chief scientific director is in the $132,600 and $155,900 range. A medical microbiologist can earn more than twice as much in some provinces, and in private laboratories.

Dr. Plummer had an $8.3-million research grant from the Bill and Melinda Gates Foundation and a secondment from the University of Manitoba that bolstered his income and gave him job security. These kinds of arrangements are the norm for top-flight researchers but there was push-back from Ottawa, which is one of the reasons Dr. Plummer stepped down. (Though he is too classy to say so publicly.)

The chief public health officer has a similarly modest pay scale, unless s/he is also a medical doctor (which is actually not obligatory for the post), in which case the pay scale ranges from $195,599 to $231,924.

You are not going to attract a top-notch public health official for that salary unless the candidate is willing to make a personal sacrifice.

Public health officials are among the lowest-paid physicians, so they’re not in it for the money.

But what a CPHO needs to do the job properly is independence – the freedom to speak bluntly to the public and to speak truth to power within the government.

That freedom does not exist under Stephen Harper. This government has notoriously muzzled scientists and bureaucrats.

If there is one lesson we can retain from SARS – an outbreak that exposed the gaping holes Canada’s public health infrastructure and led to its revamping – it is that infectious diseases (and other public health threats) exploit vulnerabilities.

A leadership vacuum leaves us vulnerable to something nasty filling the void. There is really no excuse for that kind of public policy Russian roulette.

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