The Harvey Interview – A Conversation with David Naylor, Co-Chair of Canada’s COVID-19 Immunity Task Force

I initially reached out to Dr. David Naylor, co-chair of Canada’s COVID-19 Immunity Task Force and professor and former dean of medicine at the University of Toronto, to talk about Canada’s COVID-19 response.

The conversation we ended up having was far more fluid, touching on an expansive range of subjects, from recent changes to our society, our economy, and our health-care system, to the lessons learned from previous national crises. It was an opportunity for us both to reflect and think positively about the future, while contemplating growing concerns that loom large, such as inequity, polarization, and an increasingly competitive global landscape.

Dr. Naylor brings a sober perspective on the challenges that lie ahead, as well as optimism about Canada’s potential to use this inflection point for the better. I hope you will enjoy the following sections from our conversation in December, which has been edited for length and clarity.

 

Nearly two years into the COVID-19 pandemic, the changes we have seen in Canada are striking. As an insider to government’s response, what have you seen and what do you think it means for the future?

The epidemic has been a personal transformative experience for huge numbers of people. It’s surprising when you speak with individuals, how they reset in personal ways, how they reset their relationships with family and how they reset their view of their external social relationships. You also get the continuing psychology of fear, fear of infection, fear of not only death, but long-term symptomatology from COVID. And all that underpinning of anxiety that besets people is like a trepidation about the social sphere.

Oddly, a fair number of people, instead of a risk-averse response, are now picking up new things that challenge and stretch them in different ways. Almost as if the constraints on normalcy liberated them. People travelling more in the region, looking for space that’s green and clean, where they can be outdoors, movement away from big cities to rural areas. All these changes are byproducts of the individual, family unit or community responses to unprecedented social stress.

 

What do you think it has meant for our thinking and our relationship with science?

This is a period when science has shone and when public faith in the importance of investing in science, investing in research, building strong public health and healthcare systems, has been heavily reinforced. It has also changed our relationship with science in a variety of ways that are surprisingly personal. There’s a real appreciation of the extraordinary breakthroughs that have led to rapid access to effective vaccines on a scale we’ve never seen before. Of course, it also means there’s a group that has always been hesitant about vaccines or about medicine. There’s been a polarization because of the fact that we have had mass intervention. Not only one that’s been encouraged, but one that is being mandated.

 

While that polarization is clearly evident, we have also seen cooperation between all levels of government, and worldwide cooperation when it came to the sharing of knowledge and information. How do you see leaders balancing those two things?

That’s a challenge that will only be met if the winning conditions are set in advance for collaboration. There was indeed global collaboration on clinical trials and on sharing immunological information. The fact that the genome sequence of the virus was shared so quickly by Chinese scientists, despite attempts by Chinese authorities to downplay the SARS-CoV-2 threat initially, is another example of that ethos of sharing scientific evidence.

But we’re still struggling with callbacks to gain traction to get large swaths of the world’s population even a first dose of a vaccine. A really interesting challenge is finding ways to create a situation where the local and global or at least multilateral institutions become intertwined positively. Frankly, Donald Trump’s sort of nativist presidency, in terms of setting a tone, reinforced a lot of the worst instincts of many countries in the OECD. We did pretty well, considering that powerful counterforce, the world’s most influential nation.

 

What do we need to do better as a country?

We’re now paying a massive premium to bring mRNA vaccines back to Canada. This is a story that recurs time and again with discoveries made in Canada. Problem is that we assume that the only thing we need to do is focus on the development and commercialization and we do not recognize that we have to be competitive in generating the ideas and discoveries that will feed that whole pipeline and keep it flowing. Other countries have gotten very good at taking Canadian discoveries and capitalizing on them, we want a world where Canada is very good at taking other people’s discoveries and capitalizing on them, as well as making the highest and best use of our own discoveries.

Let me focus on one topic, however, that is often overlooked. We’re now paying billions of dollars to deliver M-RNA COVID-19 vaccines to millions of Canadians. Much of the core technology underpinning those vaccines was actually developed in Canada. This is a story that recurs time and again with discoveries made here. We need to get much better at development and commercialization of discoveries, even as we remain competitive in generating the ideas and discoveries that will feed the pipeline of innovation and keep new products and services flowing. Other countries have become very adept at taking Canadian discoveries and capitalizing on them. We want a world where Canada is very good at assimilating international discoveries and capitalizing on them, as well as making the highest and best use of an ever-growing number of our own discoveries and ideas.

 

Is our challenge, in part, that we’re not very good at looking and thinking long term?

This is a challenge with democracy. Individuals who run governments are asked to reapply for their jobs every few years, and we have the opportunity to turn down their applications and find another set of people to govern. That’s a blessing in most cases.

It does, however, create a horizon problem by its very nature. The pandemic is provoking that same type of defensive response. It has been exacerbated because some of our provincial juniors have been less than assiduous in following science advice, with tragic consequences, unfortunately.

Many of the problems facing the planet instead require a big vision, a long-term view, multilateral collaboration, and a different way of doing business involving the public and private sectors. Retreating into a shell is understandable given what we’ve faced with the pandemic, but it’s exactly the wrong response.

 

While we aspire to plan for the long term, the threat of omicron is immediate. what are the implications?

Omicron is a big problem on two fronts. It can infect a substantial proportion of people who’ve had two COVID-19 shots or a previous COVID-19 infection. And it has genetic mutations that enable much faster spread.

Omicron appears less virulent than Delta but even if on average it’s milder, the spread is so fast that the numbers of those severely ill might still overrun ICU capacity with many deaths and health-care disruptions. other seasonal respiratory viruses. To ice that victory, we need a huge push to vaccinate the world. And thereafter, I expect we’ll need COVID-19 shots every year or two just as happens with flu.

 

The push to vaccinate the world is a difficult one for political leaders, who only face electoral consequences from local voters. what role should canada be playing?

Canada needs to share some of the supplies of vaccines for which we have advance purchase agreements, or provide more funds to support global COVID-19 vaccine delivery, or some combination of both strategies. One way or another, Canada should make generous commitments to help ensure the whole world is immunized against SARS-CoV-2, not just — as the WHO argues — to prevent the emergence of more mutations, but motivated by basic decency and a sense of our shared humanity.

 

In what ways do you think covid-19 changed the way we think about public health?

I expect we will see the federal and provincial governments make
major investments in pandemic preparedness. As for the general public, I would not be surprised to see ongoing behaviours that are commonplace in Asia. People in flu or cold season wearing masks in public places much of the time, and masking up even in summer when in closed spaces like a subway car. While I do think SARS-CoV-2 will recede with intermittent outbreaks and seasonal flares like other respiratory viruses, I’m also hoping for a permanent reset of our attitudes towards issues like the social determinants of health.

 

Over the last year, we’ve spoken much more holistically about the impact of lockdowns on mental health, about negative health outcomes that come from income insecurity. we’ve talked about basic income, universal child care, workplace protections. as the pandemic recedes, do you think our focus on “being in this together” will last?

As I mentioned, I would like to think that we’ve had a hard lesson on the social determinants of health. This has been an acute example of the extent to which income inequality, homelessness, job sites and being racialized have all come into play as factors that have been associated with an inequitable or differential burden of disease and adverse outcomes.

Some of those lessons are likely to be enduring in their impact. I really hope some of them are when it comes to combating systemic racism and when it comes to thinking about the social determinants in a more holistic way.

But I would caution that a lot of this is being magnified by the pandemic. We’ve had big experiments.

People say, well, SARS was small. And this is the big one that we’ve all read about for decades in the public health sphere. And that’s true. But remember, after each of the world wars, there was a similar flowering of socially directed policy-making. It lasted a few years and it faded.

While I do feel encouraged by a lot of what’s happened in the way of debate, discussion and policy discourse, and I think some of it will stick, I would say, realistically, people will slip back into their old ways of thinking and acting over time. I simply hope that some of the constructive and progressive things we have learned from the pandemic are baked in.

 

How do we avoid slipping back into old ways of thinking when some of the reflections of the past two years have transformed the way we think about social policy and social good?

Programming and consideration around combating systemic racism need to be sustained for many years to begin to have an impact. And if we can make sure that none of this is treated as short-term values, we will be well served. This gets back to the horizons problem, which requires that these issues be treated not as partisan chips to be played at the electoral table, but rather as part of a shift in the ethos of the country that is embraced by all parties, just as universal health care was decades ago.

 

You have been at the centre of so much advanced thinking in this country, whether it was SARS or Covid, and through your medical and scientific work. what has been most interesting about this work?

It’s been interesting to see how often Canada has been in a position to do things that were globally transformative and somehow looked away at the wrong moment. That’s been true when you examine issues and health policy and social policy, when you think about innovation more generally. We still have one of the lowest private sector expenditure levels on R&D.

We’re fortunate because we have abundant natural resources. Above all, we have abundant human resources because we have managed to be open to immigration when we scoop spectacular talent from across the world.

So much of what has lifted the country is trying to be open and inclusive, and maintain a multicultural society. We have work to do with Indigenous reconciliation. We have work to do in combating systemic racism. We had the classic Canadian response where we felt we were morally superior to the U.S. because we didn’t collect race- based data on many social and health issues, which is willful blindness.

Look at the data. Yes, we look better than our neighbour to the south. But we have a huge amount to do. My generation watched opportunities slip by for the country to be even better than it is. Nonetheless, look around the world right now. For all the frustrations of being a Canadian, it’s hard to imagine a better place to be.