Monthly Archives: March 2020

A War Plan to Fight the Pandemic

 

Authored by Barbara Martin former diplomat, Fellow with Canadian Global Affairs Institute, (CGAI) and Adjunct Professor in the School of Policy Studies at Queen’s University

(Originally published by Canadian Global Affairs Institute (CGAI) – March 30, 2020)

This work was written on March 30, 2020. Due to the rapid evolution of the situation, some numbers might no longer reflect those at the time of reading.


What to do? This is the fundamental question facing global leaders as a devastating COVID-19 pandemic spreads at exponential rates around the globe. UN Secretary General, Antonio Guterres, says the world is at war with a virus, with 100,000 cases after three months, 200,000 in the next 12 days, 400,000 in the next four days, and 500,000 in the next day and a half.1 At time of writing, identified cases had topped 690,000. There is urgency to finding common ground on the measures and approaches that work to treat those infected, to slow the spread of disease, and to mitigate the impact on global economies and global well-being.  Our international networks and institutions have never been so vital as they are now.

G7 and G20 leaders held virtual meetings on March 16 and March 26 respectively, issuing statements each replete with promises to act together to strengthen health systems, coordinate research, increase availability of medical equipment, and address the economic impact of the crisis. But promises mean little until they are translated into an agreed strategic approach, comprising commitments to undertake specific actions with timelines and firm funding commitments. The UN Secretary urged G20 leaders to adopt a war time plan to tackle the pandemic, a coordinated strategy to suppress the virus.2 So, how will the world come together on such a plan?

Canada has a reputation for coming up with bold ideas, from peacekeeping to the ban on landmines to the International Criminal Court. Canada knows how to negotiate, to identify what is essential, to compromise and to build the bridges needed to reach agreement. And, we can do that from the backseat, even if we are not the leader of the G7 or the G20 at this time. Good ideas and strategies win support. Canada should lean in.

While the U.S. leadership of the G7 in 2020 creates some challenges in reaching agreement on a coherent approach, G7 countries remain a powerful economic and intellectual force in the world today, working together and within the larger G20. The conversations within G7 can serve as a valuable core towards building a wider consensus within the G20, where all the world’s major economies come together. Over nearly 50 years, the G7 has shared similar perspectives on global challenges and its members have demonstrated a readiness to take coordinated action on both economic and security issues. The structures of both the G7 and G20 include ministerial meetings and working groups that can hammer out granular strategies across policy fields. And, both the G7 and G20 engage regularly with key international organizations – in particular the World Health Organization (WHO), the International Monetary Fund (IMF), the World Bank and the Organisation for Economic Co-operation and Development (OECD) – to seek expert advice, coordinate strategies and implement programs.

The UN Secretary General’s call for a war plan underscores that agreement is needed – and soon – on a broad strategic policy framework and an accompanying action plan that can energize and bring cohesion to the multiplicity of efforts underway. The recent discussions within the G7 and G20 are a beginning, but more is clearly needed.

In their statement, the G7 leaders agreed to:

  1. Coordinate on necessary public health measures to protect people at risk from COVID-19;
  2. Restore confidence, growth and protect jobs;
  3. Support global trade and investment; and
  4. Encourage science, research and technology cooperation.3

While there is mention of “appropriate border measures,” “enhancing efforts to strengthen health systems in our countries and globally,” and making “efforts to increase the availability of medical equipment where it is needed most;” there is little specificity. The language is vague: “We will work hard;” “We stress the value of ….” There is only passing reference to the needs of countries outside the G7, with emerging and developing economies added almost as an afterthought to the call for G7 finance ministers to work with the IMF and World Bank to provide international financial assistance. There are no hard commitments, and, most particularly, there is no shared message to G7 publics about what they need to do to limit the spread of the virus. Containment depends on individual action. It is time to overcome the disagreement between advocates for a strategy of herd immunity and the experts arguing for social distancing. Apparently, it was a study by Imperial College London that caused a change of direction in the U.K., and for a while in the U.S.4 Clarity is needed, especially in the light of the disinformation spreading on the internet.

With the advantage of an additional 10 days to prepare, the G20 on March 26 was able to develop a somewhat more comprehensive and inclusive statement focussed on three priorities:

  1. Fighting the pandemic;
  2. Safeguarding the global economy;
  3. Addressing international trade disruptions; and
  4. Enhancing global cooperation.

The G20 uses the language of commitment: “We commit to take all necessary health measures…” and “We will expand manufacturing capacity to meet the increasing needs for medical supplies.” Importantly, the G20 has tasked their health ministers to share national best practises and develop a set of urgent actions on jointly combatting the pandemic by the time of their ministerial meeting in April. The G20 has also said it will work quickly to close the financing gap in the WHO Strategic Preparedness and Response Plan and provide resources to the WHO COVID-19 Solidarity Response Fund, the Coalition for Epidemic Preparedness, and Innovation and to GAVI, the Vaccine Alliance.5 These are concrete actions that will provide essential support to some key institutions that are on the front lines fighting the pandemic. And, the G20 leaders have said that they “commit to do whatever it takes and to use all available policy tools to minimize the economic and social damage from the pandemic, restore global growth, maintain market stability and strengthen resilience.” These are strong words. But, like the G7 statement, there is no common message to the public – to individuals – about what they should be doing to fight the spread of the virus: that to slow down its spread, social distancing, self-isolation, or quarantine are necessary in any comprehensive strategy.

As to the developing world, while the G7 was clearly focussed on itself, the G20 at least acknowledged the need to help, especially the countries in Africa, and made passing reference to refugees and displaced persons, saying it “stands ready” to mobilize financing. However, the message lacks the conviction and commitment to action that the G20 gives to those things that most affect their own countries. This despite the launch by the UN, on March 25 – the day before the G20 leaders’ virtual meeting – of an appeal for $2 billion for its global humanitarian response plan to fight COVID-19. At the launch, the UN top official for humanitarian affairs, Mark Lowcock, said that “countries battling the pandemic at home are rightly prioritizing people living in their own communities. But the hard truth is they will be failing to protect their own people if they do not act now to help the poorest countries protect themselves.”6 Further, neither the G7 nor the G20 directly address conflict areas, such as Syria (especially Idlib) and Yemen. Both these conflicts have created serious human vulnerabilities from displacement, congestion in refugee camps and poverty, as well as dysfunctional health systems – conditions ripe for the spread of the virus across Northern Africa, the Middle East, and into Europe.7

So, what could Canada do to help the G7 and the G20 work towards a clear and comprehensive action plan – a war plan?

  1. First, Canada can advocate for a clear, succinct statement on what individuals should do to protect themselves and constrain the spread of the virus. The virus is spread by individuals, and individuals are the first line of defence. They need to know what they should do. The message needs to be firm and clear to everyone around the globe. Canada could propose that the G7 and the G20 adopt a single message regarding social distancing/ self-isolation/ quarantine and hygiene (hand washing, coughing into a tissue and not touching eyes, nose, or mouth). The WHO website contains comprehensive advice in multiple formats. It could be asked to provide a succinct and easy to grasp statement to get the message out in both developed and developing countries. The statement needs to embody the best practises, not the lowest common denominator. The statement needs to be endorsed by both the G7 and G20 and disseminated across their countries, as well as all others through the UN.
  2. Second, Canada could work actively within the G7 and G20 to “unpack” the general commitments in the leaders’ statement, and develop a document setting out strategic direction, concrete actions, funding needs, and timelines. The categories in the G20 statement can form the structure for the action plan: a) Fighting the Pandemic; b) Safeguarding the Global Economy; c) Addressing International Trade Disruptions; d) Enhancing Global Cooperation. This work should be undertaken in time to be endorsed at the G7 leaders’ virtual meeting June 10-12, and through the G20 health ministers meeting in April and leaders’ meeting November 21-22. It will take behind the scenes work by experts from departments of health, finance, trade, development, and foreign affairs to negotiate and fine tune the text. Canadian officials could use their diplomatic skills to gather a ‘friends of the chair’ group in the G20 to spearhead this work. They can lean in. The World Health Organization, which is the key international body able to lead the response effort, should be actively engaged.
  3. Third, Canada could engage in diplomacy to press for an end to hostilities – even if only temporary – in Syria and Yemen in order to focus on humanitarian assistance to fight the pandemic. It is a credit to Israel and the Palestinian Authority that they are cooperating to combat the virus. It is time for others to also lay down their weapons, particularly in Syria (including Iran and Russia) and in Yemen (including Iran and Saudi Arabia).

Canada has a long and proud history of being an effective multilateral player. It is time to put those skills forward, to work closely with others in the international community – to persuade, cajole, and press others – in order to build a consensus on the war plan that the UN Secretary General rightly believes is essential to protect lives and rebuild the global economy.


End Notes

1 UN Secretary General, “This war needs a war-time plan to fight it,” Statement to G20 Leaders’ Summit, (United Nations, 26 Mar 2020), https://www.un.org/en/coronavirus/war-needs-war-time-plan-fight-it

2 UN Secretary General, Letter from UN Secretary General to G20 Leaders (United Nations, 23 March 2020), https://www.un.org/sg/en/content/sg/note-correspondents/2020-03-24/note-correspondents-letter-the-secretary-general-g-20-members

3 “G7 Leaders’ Statement,” Website of the Prime Minister of Canada (March 26 2020) https://pm.gc.ca/en/news/statements/2020/03/16/g7-leaders-statement

4 COVID 19 Response Team, “The Global Impact of COVID-19 and Strategies for Mitigation and Suppression,” Imperial College London (26 March 2020), https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Global-Impact-26-03-2020.pdf

5 “G20 Leader’s Statement,” Extraordinary G20 Leader’s Statement, Statement on COVID-19 (March 26 2020) https://g20.org/en/media/Documents/G20_Extraordinary%20G20%20Leaders%E2%80%99%20Summit_Statement_EN%20(3).pdf

6 UN OCHA, “UN Issues $2 billion appeal to combat COVID-19” (25 March 2020), https://www.unocha.org/story/un-issues-2-billion-appeal-combat-covid-19

7 Pinar Dost, “Coronavirus is exacerbating the precarious situation of Syrian refugees and IDPs”, Atlantic Council (27 Mar 2020), https://www.atlanticcouncil.org/blogs/menasource/coronavirus-is-exacerbating-the-precarious-situation-of-syrian-refugees-and-idps/; Stephen A. Cook, “Syria’s Revenge on the World Will Be a Second Wave of Coronavirus,” Foreign Policy, (26 March 2020), https://foreignpolicy.com/2020/03/26/syrias-revenge-on-the-world-will-be-a-second-wave-of-coronavirus/


Authored by Barbara Martin former diplomat, Fellow with Canadian Global Affairs Institute, (CGAI) and Adjunct Professor in the School of Policy Studies at Queen’s University

(Originally published by Canadian Global Affairs Institute (CGAI) – March 30, 2020)

This work was written on March 30, 2020. Due to the rapid evolution of the situation, some numbers might no longer reflect those at the time of reading.

Is the “business liberal” extinct?

 

Authored by Eugene Lang,  Adjunct Professor, School of Policy Studies, Queen’s University and Fellow, Canadian Global Affairs Institute

(Originally published by  IRPP Policy Options  – March 18, 2020)


 

Photo: At a January 1995 press conference in Ottawa, Finance Minister Paul Martin talked about how his federal budget for that year would be available on the Internet. The Canadian Press/Tom Hanson

Photo: At a January 1995 press conference in Ottawa, Finance Minister Paul Martin talked about how his federal budget for that year would be available on the Internet. The Canadian Press/Tom Hanson

C.D. Howe. Mitchell Sharp. Donald Macdonald. Charles “Bud” Drury. Edgar Benson. Don Johnston. Robert Winters. Bob Andras. Paul Martin. John Manley. Doug Young. Roy MacLaren. Anne McLellan.

Some of these names are long forgotten; others remain in our collective political memory. All were once prominent members of a species known as “business Liberals” or “blue Liberals”; Don Johnston once described himself as a “blue Grit.” Business Liberals flourished and occasionally dominated in the governments of Louis St. Laurent, Lester Pearson, Pierre Trudeau, Jean Chrétien and Paul Martin.

The breed seems to be extinct in Ottawa today. And this is a problem.

The federal Liberals are often considered the archetypal brokerage party, if not the world’s most successful practitioners of the brokerage craft. By this I mean they are skilled at coalition building across different interests within a political party that contains a wide range of views.

The Chrétien government was a good example. During Chrétien’s first mandate as Prime Minister, his caucus consisted of a broad mix of outlooks and ideologies, from social democrats like Charles Caccia at one end of the spectrum to social conservatives (a group of MPs known as “the God Squad”) at the other, and everything in between. These varied interests were successfully brokered to ensure the government remained functional, stable and effective.

Historically, business has been an important brokered interest within Liberal governments. Canadian business has normally had a voice, respect and power at Liberal cabinet tables through the so-called business Liberals. These people were often in business themselves before becoming politicians. Some were lawyers who had business clients. Many had an appreciation and respect for the challenges of the business owner, manager or executive, in small, medium-sized or large firms. All thought a lot about the economy and the government’s impact on business through its trade policy, tax policy, broader fiscal policy and regulation.

These ministers and this world view mattered in Liberal governments — within the cabinet, in the caucus and across the civil service — for decades. The business Liberal perspective didn’t always or even mostly prevail in policy-making, nor should it have. But it was represented forcefully and considered seriously in the mix.

As a young ministerial staffer in the mid-1990s, I watched the business Liberal wing of the Chrétien cabinet move to dominate a government that I naively thought was headed in a centre-left direction.

As a young ministerial staffer in the mid-1990s, I watched the business Liberal wing of the Chrétien cabinet move to dominate a government that I naively thought was headed in a centre-left direction. In those days, their point of view carried a lot of weight — and for good reason, as the chief policy challenges were economic and fiscal. Ottawa was staring down the twin evils of a deficit crisis and double-digit unemployment.

A minority in the cabinet, the business Liberal ministers nevertheless occupied key positions, notably Finance (Martin), Industry (Manley), International Trade (MacLaren), Transport (Young) and Natural Resources (McLellan). It was difficult enough for the Prime Minister and the Finance Minister to tackle the deficit aggressively in those days. It would have been harder still without a few forceful business Liberals around the table backing them up. Doug Young, for instance, largely forgotten now but a force of nature in those days, embraced the dismantling of a large part of his portfolio in pursuit of the broader business Liberal agenda of deficit reduction, deregulation and privatization.

This strong business voice in past Liberal governments had three main purposes. First, to focus on economic and fiscal policy, to understand and appreciate business concerns and priorities, and sometimes make a case for those at the cabinet table. Second, to have meaningful and trusting relationships in the business community that could be drawn on to reassure business about the broad direction of the government as well as on specific policy initiatives, and to sometimes road-test government ideas. And third, to listen and speak to business in a language they understood — to empathize, if you will.

The business community knew that within those governments there were ministers with gravitas who were concerned chiefly with the economy’s performance and had the back of business, as well as the voice and power to bring business perspectives to the cabinet table in an influential way. This is what business Liberal ministers did.

If you talk to people who represent business interests in Ottawa today and have regular interaction with the federal government, you will be hard pressed to find anyone, in any sector of the economy, who thinks those kind of ministers exist anymore. The business Liberals of old seem to be extinct, presumably because their perspective is not valued the way it once was.

The business community, as represented by its various associations and spokespersons, has applauded the Trudeau government’s effort to secure a renegotiated NAFTA that does no harm to Canadian business. But beyond that file there isn’t much this government gets credit for from business. At the same time, there is a mountain of policy criticism from the business constituency — and not just from the oil and gas industry, which is well covered in the media, but from virtually all sectors touched by the legislative arm and regulatory hand of the federal government.

A general sense exists within the organized business community that the Trudeau Liberals are at best indifferent to business and its interests, if not ignorant of them, and at worst hostile to the business mind and orientation. The government is often seen by business as being far more inclined to listen to and be influenced by the non-governmental organization or “civil society” perspective — including in policy domains that directly affect business — than by the business view.

There is no senior minister in this government, much less a group of important ministers, who is thought by the business community to be focused on the impact of government policy on business, and who possesses the clout, and the willingness to use that clout, to take the business view forcefully to the cabinet table and the Prime Minister’s Office. In other words, there are no “go-to” ministers for business in this government.

This is a problem, especially as business faces unsettled times in the short term, and a longer term in which Canada moves toward a fundamental transformation to a less carbon-dependent economy, which will affect virtually all business.

The business community, including both its organized advocates and individual companies, does not have the market cornered on good public policy ideas. Far from it. Its proposals are often unworkable or not in the public interest. Some are fatuous.

That said, business knows more about how public policy decisions affect it than any public servant ever will. For that reason alone, business Liberals are needed at the cabinet table. Liberal prime ministers in the past recognized this need and provided for it. The policy process was enriched as a result. Prime Minister Trudeau and his people need to better appreciate this basic feature of Liberal government success and regenerate the business Liberal species.

Photo: At a January 1995 press conference in Ottawa, Finance Minister Paul Martin talked about how his federal budget for that year would be available on the Internet. The Canadian Press/Tom Hanson


 

Authored by Eugene Lang,  Adjunct Professor, School of Policy Studies, Queen’s University and Fellow, Canadian Global Affairs Institute

(Originally published by IRPP Policy Options  – March 18, 2020)

Caring for the Elderly: A Health Human Resource Problem

 

Authored by Rosalie Wyonch, Policy Analyst, C.D. Howe Institute, and Don Drummond, Stauffer-Dunning Fellow in Global Public Policy and Adjunct Professor, School of Policy Studies, Queen’s University

(Originally published as an Intelligence Memo from C.D. Howe Institute  –March 10, 2020)


 

From: Rosalie Wynoch and Don Drummond
To: Healthcare policy planners

Re:  Caring for the Elderly: A Health Human Resource Problem

 

Canada’s population is aging and there is a shortage of specialists trained to provide healthcare to elderly patients. One in six Canadians are over 65 years of age and these older individuals have higher need and utilization of healthcare services.

While most physicians gain some experience with the complex and interrelated healthcare needs of seniors, there are only 304 geriatric specialists to provide care for Canada’s more than 6.1 million seniors. To ensure that seniors can access the care they need as they age, and their needs become more frequent and/or complex, the shortage of professionals with the needed skills and knowledge to deliver it needs to be addressed.

Provincial and territorial governments spend an average of about $17,000 per person on healthcare for individuals 75 years of age or older – more than triple the individual costs for those aged 50 to 74. As the population ages, the need for healthcare services will grow and the increasing demand will continue to put upward pressure on healthcare spending.

The elderly have higher and more complex healthcare needs, and are more likely to suffer from multiple chronic conditions, comorbidity, as well as more severe complications and side effects from treatment.

Geriatrics is a medical specialty that deals with the prevention, diagnosis, treatment, remedial and social aspects of illness in older people, mainly those 75 and older. There are 11.7 licensed geriatricians per 100,000 Canadians over 75. For comparison, there are 2,887 pediatricians in Canada, or 48.8 per 100,000 Canadians under 15.

To ensure seniors have access to high-quality healthcare when they need it, more professionals will be needed to manage and provide such care. The imbalance and general lack of elderly medicine specialists will not be solved quickly or without intervention.

In 2019, there were only 10 applicants to “family medicine and integrated care of the elderly” in the entire country.  It takes 10 years of training to become a medical specialist (four years of medical school, four years to become qualified in general internal medicine and two years to specialize). Canada’s senior population is projected to grow by about 50 percent in the time is would take to train new geriatrics specialists. Given the lack of popularity of geriatrics among medical students, and the time it takes to train specialists, more geriatricians is not the solution to the current and growing shortage of healthcare professionals able to provide care for elderly patients.

More than two-thirds of Canada’s geriatricians work in academic health sciences centres, which makes them well-placed to educate medical students and other physicians about elderly care clinical practices.

If the scope of primary care could be broadened to embrace at least the first phase of geriatric care, it would reduce the number of elderly patients that need referral to geriatric and other specialists. It would also free some geriatricians’ time to focus on the patients with the highest need.

Expanding the scope of primary care to early geriatrics is no small task and will require enhanced competency requirements for family physicians and nurse practitioners. It will also require easy access to clinical guidelines and the ability to consult with the relevant experts and specialists when necessary for primary care providers.

Elderly care specialists will continue to have an important role in treating the most complex-needs patients.

The current need for more elderly care providers, however, will not be solved by more specialists alone. Most physicians gain experience with elderly care during their training. Enhancing that training and broadening the scope of primary care is one way to ensure continuing access to high quality care for Canadians as they age.


Authored by Rosalie Wyonch, Policy Analyst, C.D. Howe Institute, and Don Drummond, Stauffer-Dunning Fellow in Global Public Policy and Adjunct Professor, School of Policy Studies, Queen’s University

(Originally published as an Intelligence Memo from C.D. Howe Institute  –March 10, 2020)

The views expressed here are those of the authors.