The Ontario government offered the Star an interview with its top doctor. At the last minute, it was cancelled. We found out the real reason why

The Ontario government offered the Star an interview with its top doctor. At the last minute, it was cancelled. We...

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It was a rare interview opportunity at a pressing moment.

In mid-December, as patients sick with RSV, COVID-19 and influenza were flooding emergency departments, and pediatric ICUs were overflowing, the Star accepted an offer to interview two of Ontario’s most influential health-care leaders.

Government spokespeople said the interview with Dr. Kieran Moore, Ontario’s chief medical officer of health, and Matthew Anderson, president and CEO of Ontario Health, would speak to the “layers of protection” ahead of the holidays and to the current pressures on the health-care system.

The interview never happened. Nearly 10 minutes after it was supposed to take place on Dec. 15, the Star’s Kenyon Wallace received an email. The call was cancelled. When he asked why, he was told “there was a scheduling conflict.”

That statement, it turns out, was not true.

Government emails obtained by the Star under freedom-of-information legislation reveal it was the director of communications for Health Minister Sylvia Jones who made the call to pull the plug on the interview, apparently unhappy that it would be Wallace asking questions.

The internal emails offer a snapshot of how decisions are made about communications during a health crisis. Several experts in governance, ethics and journalism say they also raise questions about the level of communication control over the office of the chief medical officer and the degree to which the public has access to health leaders at such times.

The email exchanges, they say, point to an ongoing tension between political and bureaucratic interests, and independent, non-partisan health communications. And there is a risk, they caution, that trust in public health messaging will be undermined if it is — or has the appearance to be — influenced by political considerations.

“If the chief medical officer of health has an obligation to protect the public’s health but is in any way constrained in their actions or communications by political forces, the public must be made aware of this so they can interpret such actions or communications accordingly,” says Maxwell Smith, a bioethicist who specializes in infectious diseases and an assistant professor at Western University.

Among other things, the internal correspondence shows:

  • The idea for a media availability had come from the minister’s office;
  • It took 68 emails, in which 17 civil servants were either providing input or copied on the exchanges, to arrange a handful of media interviews for Moore and Anderson on Dec. 15 and respond to media requests;
  • The health minister’s office asked to review the list of media outlets and individual journalists being offered interviews;
  • Moore’s talking points around COVID and flu vaccinations, masking and family gatherings were sent to the minister’s office in advance;
  • At no point in the communications did the office of the chief medical officer object to the involvement of the minister’s office or push back against its instructions.

During the pandemic, the chief medical officer of health became the face of public health communications in Ontario.

At crucial points, Moore — and his predecessor, Dr. David Williams — stepped to a podium to tell Ontarians about lockdowns, vaccine requirements, mandatory masking and other public health measures.

They became, for many, the authorities on how to stay safe.

But whatever the public perception, the independence of the office isn’t so cut and dry given the chief medical officer of health’s many, often competing priorities.

The office of the chief medical officer stressed in an email that Moore is a public servant who has “a reporting relationship to the Deputy Minister of Health” and as such, “endeavours to work collaboratively with the Deputy Minister of Health, Minister of Health and with other officials in the government of Ontario on matters of public health, including communication to the public.”

The chief medical officer of health, appointed by the government under the Health Protection and Promotion Act (HPPA) for a five-year term, “provides leadership and policy direction on public health matters and public health standards” in the province, the statement said.

Under the HPPA, the chief medical officer has a number of statutory powers including the ability to exercise independently “any of the powers of a medical officer of health or board of health,” and to “issue directives to health-care providers or health-care entities on precautions or procedures to be followed,” the statement said.

“The CMOH wears several hats,” says Patrick Fafard, a professor in the faculties of social sciences and medicine at the University of Ottawa. “And the pandemic has revealed that there are tensions — if not outright contradictions — between these hats.

“The way the role is constructed, in general, but especially during a public health crisis, is that it’s meant to be an independent and autonomous person who can both provide advice to ministers, but also speak directly to the public as they deem appropriate,” says Fafard, considered one Canada’s top experts on chief medical officers.

He says that in Ontario, the chief medical officer has many roles: adviser to the government; a senior public servant who oversees and implements the government’s public health priorities; the “explainer-in-chief” for the public; and, increasingly, a government spokesperson.

“The challenge lies in the fact that those different roles don’t align perfectly,” says Fafard, also a senior investigator at the Global Strategy Lab, an interdisciplinary research and policy lab that advises governments on designing laws and policies to promote public health.

He adds that he would not label the communication in the emails as “inappropriate.” The chief medical officer of health, as a top bureaucrat, is “subject to the same communication strategy as every other public servant,” he says.

Rather, the tight co-ordination is “inconsistent with the public perception of the role,” says Fafard.

That tension is the reason some are calling on provincial governments to clarify the role of the chief medical officer.

The Dec. 15 interview was set up by Catherine Fraser, senior communications adviser for the chief medical officer of health, who wrote to the Star the previous day, offering a teleconference with Moore and Anderson, to be on the call together.

The Star set up an interview at 9:30 the next morning with reporter Kenyon Wallace.

But the call never came.

At 9:38 a.m. Wallace received an email from Fraser saying the interview was cancelled due to “scheduling conflicts.” Wallace phoned but she said no details could be provided. Wallace inquired if there would be other opportunities to interview Moore and Anderson but did not hear back.

The abrupt cancellation — and the lack of details — was unusual, so the Star made a freedom-of-information request to the ministry for any communications between it, Ontario Health and the office of the chief medical officer regarding the planning and execution of interviews with Moore and Anderson.

The records received show the minister of health’s director of communications, Alexandra Adamo, expressing concern the afternoon before the scheduled interview after being told Wallace was the reporter. She asks if another reporter can be lined up.

In response, Gillian MacDonald, manager of strategic communications and issues management at the ministry, writes: “Kenyon is already on tap for this.”

Adamo replies that in future she would like her office to be alerted earlier if alternative reporters cannot be found.

Then, on the morning of Dec. 15, shortly before the scheduled interview, Adamo writes to MacDonald and Donna Kline, chief communications and engagement officer at Ontario Health: “the Toronto Star interview needs to be cancelled all together.”

After Wallace inquires as to why, MacDonald writes to Adamo and Kline, saying the Star wants a reason.

“I would say nothing at all or a scheduling conflict,” Adamo replies.

Adamo also instructs the Ontario Health communications team to cancel the remainder of Anderson’s media interviews following a segment on CBC’s “Metro Morning.” No explanation was included in the emails.

That day, Moore also spoke to The Canadian Press, Postmedia and the Globe and Mail.

The emails show that Adamo asks to view the names of the media outlets and reporters to be approached. As well, Adamo tells the communications teams for Ontario Health and the chief medical officer that “We’d also like to see key messages for both Matt and Dr. Moore in advance.”

The three-page document outlining Moore’s speaking points includes messages on the importance of getting a flu shot and COVID booster, staying home if sick, good hand hygiene, wearing a mask in indoor public spaces and creating a mask-friendly environment if you are hosting guests.

The health system was stressed at the time — hit hard by a “triple threat” of COVID, RSV and flu cases, with strains on the pediatric care system and in emergency rooms. Calls for a return to masking had resurfaced the month earlier and Moore himself had urged residents to wear masks in indoor public settings.

Western University’s Smith says some degree of communications co-ordination between the offices of the chief medical officer of health and the minister is to be expected to “avoid unnecessary mixed messaging.”

“However, the line between co-ordination and control can become blurred or easily crossed, the result of which being that public health communications are mediated by political considerations and objectives,” he says. “This can in turn undermine the public’s trust in public health interventions and communications insofar as they’re no longer perceived as being independent from political influence, and hence no longer strictly in the interest of the public’s health.”

Lori Stoltz, a lawyer with expertise in public health law, says the emails raise questions about the independence of the chief medical officer.

“And the reason that’s an important question is that the CMOH under the Ontario legislation holds very important operational powers that are there to be engaged in times of public health emergency,” she says.

“In the context of a public health emergency, it is absolutely essential that the population have confidence that the chief MOH is going to advise the public and advise the minister and exercise those powers or choose not to exercise those powers really free from bureaucratic or political pressure of any kind … It’s not just the actual independence but the perception of independence.”

Josh Greenberg, director of Carleton University’s School of Journalism and Communication, says when bureaucrats engage in the kind of message control highlighted by the emails, it risks shifting the focus from public health to politics.

Greenberg notes there was an observable shift in Moore’s approach to public health advocacy and communication after he moved from his role as the chief medical officer for Kingston, Frontenac, Lennox and Addington to Ontario’s chief medical officer of health in 2021.

At the regional job, he was “widely lauded for his openness,” Greenberg says, but as a provincial chief medical officer “his style became very clearly more controlled.”

“This may well reflect the different responsibilities and priorities that these jobs entail.”

Fafard says the chief medical officer’s competing roles can cause confusion, even among public health experts, many of whom believe the chief medical officer’s priority is to advocate for the population’s health.

Recent academic papers by Fafard, including one in which the authors interview former medical officers of health, call on governments to clarify the role.

“Coming out of the pandemic, we need to ask questions about what we learned, and what changes we want to make,” Fafard says. “Because we do want the (CMOH) to be understood by the public as autonomous and independent, but there may be better ways of doing that.”

With files from Kenyon Wallace

Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie or reach her via email: [email protected]

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