Looking at the pandemic response: Global Health Professor Steven Hoffman

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At a time when trust depends on leaders’ ability to make decisions based on evidence and science, global health researchers and epidemiologists are helping to lead the pandemic response. Steven J. Hoffman, the Dahdaleh Distinguished Chair in Global Governance & Legal Epidemiology and a Professor of Global Health, Law, and Political Science, explains the challenges faced by governments and the World Health Organization (WHO) during the ongoing COVID-19 pandemic.

What is the role of a legal epidemiologist in analyzing and providing information during a global health crisis like a pandemic?

A legal epidemiologist’s role is to examine whether policies, laws, and regulations implemented by governments are both effective and legal.

During a pandemic, the government is looking at all of its policy instruments to see how it can best address this emergency. Increasingly, we're seeing governments rely on law and regulation to help achieve their goals such as physical distancing or enforcing mandated quarantine for citizens returning from abroad or who have COVID-19 symptoms.

Governments need to be able to look at the full range of policy instruments available, not only from a perspective of what's legal, but also what's going to be effective. I think if we’re only looking at it from an epidemiology perspective, we might miss opportunities to figure out how we can achieve our public health goals while simultaneously upholding the requirements and values of our legal system and the Canadian Charter of Rights and Freedoms.

What are the challenges the WHO faces in their duties to manage a pandemic like COVID-19 globally?

The World Health Organization is the leading agency for public health within the United Nations system, but it's been hampered by challenges for decades. One such challenge is that most of its budget is earmarked for specific issues by those who are contributing to it financially. Therefore, during the context of a pandemic, the agency doesn't have the full flexibility to pivot its activities to where they are needed most.

Another challenge, as I've described in my own research, is that the WHO was institutionally designed in a way that makes it very difficult to simultaneously be the world's leading technical agency for health while serving as the convener and coordinator of global health politics and diplomacy.

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For example, when pursuing both mandates, it becomes difficult for WHO to plainly state what the evidence says versus what is practically most helpful for negotiating compromises and political agreements. During this outbreak, many people have been questioning the way that the World Health Organization has been praising the Chinese government. I think it’s more complicated. On one hand, it's clear that the Chinese government has done some great things like releasing the genetic sequence of the virus back in mid-January so that everyone could develop a diagnostic test. But on the other hand, there have been questions raised about the veracity of the Chinese government’s data and certainly many people are concerned about the civil liberties implications of throwing millions of people into a mass quarantine all at once. This highlights the challenge that the World Health Organization faces, to walk that very difficult tightrope between making sure it has the engagement of its member states, including China, in the response, and at the same time holding true to the evidence and to the agency’s obligation to uphold human rights around the world.

You were part of a panel of researchers to help inform research strategies for COVID-19 earlier this year. How will strategies in a pandemic change and how can researchers make an impact?

One of the great things that the World Health Organization did early in this outbreak was to convene research funders and leading scientists in Geneva for input on the most important research strategies needed to address the outbreak. No one wants this virus to spread until enough of the global population is infected to produce herd immunity. Instead, we want to do what has never been done before: leverage the power of science to change the course of this pandemic’s trajectory for everyone’s benefit. Since we can’t research everything, we need to set research priorities to enable the greatest progress. Indeed, in February, before substantial research resources had been allocated, the World Health Organization had already published a report from the panel’s input honing in on the areas identified as research priorities. The report enabled research funders to target their investments within their countries and across their organizations. It set the global COVID-19 research agenda and was actually an incredible thing to be part of.

 How did the experience with COVID-19 in other countries impact Canada?

We're seeing different scenarios being played out in different countries. Some of it is luck. We're lucky in Canada that this virus came to us later – after we saw it first emerge and then spread within other countries. This gave us a bit more time to prepare but also time to learn from other jurisdictions. So that luck is combined with some advanced planning. In Canada, we are fortunate to have one of the strongest systems for public health in the world and we're seeing that our country’s initial responses were indeed handled extremely well.  It’s only recently that we’ve seen community transmission and that actually came much later than what many other countries saw. In part, we learned harsh lessons from SARS in 2003 and made changes to our system for public health afterwards. During SARS we didn't have a Public Health Agency of Canada or a chief public health officer for the country – now we do. The creation of different institutions has translated into much better communication across the country with a much more coordinated response.

While there are slight differences in communication across the provinces and federal governments, we’re actually seeing a remarkable level of consistency in messaging and consistency in the response.  Any residual differences in the messaging are often due to the fact that there are different scenarios happening on the ground in each province.

How did the response in different countries impact the pandemic globally?

Different countries reacted at different speeds to this outbreak. For example, there are some countries that still haven't taken the kind of robust measures that the majority of experts in the public health community think are desperately needed at this time. Understanding that cases of the virus basically double around every five days without significant mitigation measures means that a delay of five days could actually cause quite a difference in how fast this outbreak could spread. Having said that, we've also seen different governments rely on research evidence in different ways. There are lots of things that governments are doing around the world that are not based on the best available evidence. For example, early in the outbreak and continuing presently, we see a lot of targeted travel bans against specific countries which we know does not work from past outbreaks. As this outbreak is extraordinarily different, past evidence can't always be directly applied to this current outbreak. However, based on existing evidence, we know at least that's one measure from which we would not expect to see much effect.

There are also many countries in the world that made investments to boost diagnostic testing. Canada is one of those countries, but there are other countries that didn't make these investments before the pandemic. We have seen massive divestment from public health in the United States over the last few years and indeed recently the executive branch of the US government cut its funding for the World Health Organization which is exactly the opposite of what's needed. We need to make investments in public health at all times so that our public health infrastructure is ready.

What is the role of the Quarantine Act and can it be used effectively?

The Quarantine Act is an act of Canada’s parliament that is in effect and used every day of the year. This is the law that allows border officials to ask health questions of people entering the country as well as require people who might pose a health risk to see a quarantine officer at airports and other border crossings. Now it’s most relevant because of the power it gives to the federal government, specifically the Minister of Health, to mandate people into quarantine. It's quite a significant law because ordering quarantine is a limitation on people's right to liberty and it's essentially forcing people to remain at home or in another place designated by the Minister of Health for a set period of time. It’s legal when implemented appropriately because it's a limited restriction and one that is deemed necessary to protect the public’s health.

What we're seeing right now is the Quarantine Act being used in an extraordinary way to mandate everyone returning from abroad into quarantine. It’s not a request. If people break that mandatory order, the potential fines and jail time are rather significant. This law is a serious act of parliament for serious times and it's being used accordingly.

What should countries be doing to mitigate human rights violations related to COVID-109? 

Countries need to make sure their responses to COVID-19 reflect their core values and human rights obligations. It’s not about balancing human rights versus public health, but rather about using human rights to inform a better and more effective public health response. The two are mutually synergistic even if they sometimes can appear to be at odds with each other. Ultimately, we need to make sure we can all recognize ourselves when we emerge on the other side of this pandemic. We have no better guides than public health science and human rights which must go hand-in-hand during any health emergency of the kind we are facing today. In Canada, upholding human rights is not only a constitutional obligation but a smart public health strategy.

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