COVID-19 Federalism: Disparate Government Responses in Canada

The decentralized government response to COVID-19 in Canada has led to considerable discrepancies in caseload and preparedness across the country. By 1 June, the country had experienced 91,705 cases and 7,326 deaths. Despite a strong economy and healthcare system, the Canadian response has been marked by a series of failures including a slow initial response, a struggling Central Canada, and a crisis in long-term-care facilities (LTCFs). While the nation has faced the shared burden of decision-making related to international travel and healthcare strategy, disparate approaches have highlighted systemic shortcomings in Canada’s provinces and territories.

Canada lost crucial time as the federal government idly watched the country’s first confirmed case in January and other countries’ struggles with the disease. This hesitancy placed the onus on provinces to interpret global events. The day after the World Health Organization (WHO) officially declared COVID-19 a pandemic, Premier Doug Ford told Ontario families they were safe to travel on March Break, having received no federal guidelines to indicate otherwise. Meanwhile, British Columbia advised against non-essential travel during March Break. Only on 16 March did Prime Minister Justin Trudeau announce that the country would be shutting its borders to foreign nationals and declare to Canadians, “it is time for you to come home.” As vacationers returned home, many of them carried COVID-19 with them. Travellers were not subject to a mandatory quarantine until a 25 March Emergency Order—too late to prevent community transmission from March Breakers.

The growing threat of the disease triggered states of emergency across the country. To address the economic repercussions of lockdown, the federal government provided funding to provinces and territories, businesses, individuals, vulnerable groups, and organizations. This included the Canada Emergency Wage Subsidy (CEWS), which subsidized wages for employers experiencing reduced revenues, and the Canada Emergency Response Benefit (CERB), which provided CAD 500 a week for up to twenty-four weeks for workers who had lost income due to the pandemic. According to the federal government’s fiscal snapshot released 8 July, these economic stimulus measures are now estimated to cost more than CAD 230 billion, in addition to CAD 85 billion in tax and customs duty payment deferrals.

Discrepancies in communication, testing capacity, contact tracing, and PPE acquisition demonstrate how, in the absence of national strategy and coordination, the country’s healthcare system has supported the success of some provinces, while others struggle. Canada’s healthcare system is publicly funded and had been strengthened to respond to public health emergencies following the 2003 SARS outbreak. This included the creation of the Public Health Agency of Canada, the Quarantine Act, and the enhancement of diagnostic capacity in the National Microbiology Laboratory. Despite this, Ontario has wrestled with 28,263 cases and Quebec with 51,354 cases as of 1 June. In part owing to a fragmented health system, Ontario has fallen short of provincial and national testing goals, lagged in contact tracing, and struggled to acquire personal protective equipment (PPE).

Meanwhile, success has favoured provinces with a strong and centralized public health approach. British Columbia aggressively flattened the curve to 2,596 cases by 1 June owing to a streamlined health system that supported the early and decisive action of their provincial health officer Dr. Bonnie Henry, including a broad testing strategy. Alberta Health Services, who also enjoys an integrated healthcare system, was able to place a bulk order of PPE in January, whereas provinces who missed the window for stockpiling early on struggled with PPE shortages from March onward. The federal government had to work to catch up to support struggling provinces by purchasing PPE in bulk, ramping up domestic manufacturing capacity, and creating international supply chains of PPE.

COVID-19 has tragically demonstrated the systemic problems with a healthcare system that prioritizes hospitals and doctors while its most vulnerable people remain in LTCFs. These facilities have accounted for up to 85 percent of all COVID-19 deaths in Canada and represent the highest proportion of LTCF deaths among Organisation for Economic Cooperation and Development (OECD) countries. Both Ontario and Quebec suffered extreme crises in these facilities that resulted in system-wide staffing shortages, and thus required intervention from the Canadian Armed Forces (CAF). On 20 May, the CAF released a report that outlined serious deficiencies in LTCFs in Ontario, including inappropriate PPE practices, untrained staff, and unhygienic practices. The CAF report highlighted how staff travelling from facility to facility had the unintentional consequence of rapid transmission across several LTCFs.

While neither an abject failure nor a model for success, the pandemic has painfully exposed deficiencies in the degree of provinces’ and territories’ preparedness for public health emergencies. However, the unintended consequence of Canada’s decentralized system was that the country has been able to test a variety of approaches to COVID-19. As the country reopens its economy and prepares for the possibility of a second wave, Canada’s governments must learn from its failure in policy transfer—both from abroad and across Canada—and work to implement best practices that have already weathered success.