The Public Health Agency of Canada has a trust deficit, and it could be deadly.

The leaders at PHAC are seemingly oblivious to this threat to Canadian public health, which entirely is of their own making.

Earlier this week, ahead of the start of the annual respiratory illness season, Dr. Theresa Tam, Canada's Chief Public Health officer, held a national press conference. She and colleagues from the Public Health Agency of Canada (PHAC) were all wearing N95-style respirator masks and seated far apart from each other to announce new public health advice.

In an era where the medium can often be the message, they were clearly oblivious to the impact of the visual they had created. Dr. Theresa Tam on stage in a respirator mask seated six feet apart from her colleagues, is a trigger for Canadians who are still living with and processing the fallout of the COVID-19 pandemic - no matter what their views on COVID measures were or are today.

Like it or not, Tam, garbed and seated as such, is an image indelibly associated with COVID policy flip-flops and the prolonged maintenance of measures that had profound consequences for every Canadian. It is an image that evokes grief over things like feuds with family members and close friends over COVID mandates, isolation during lockdown measures, and more. 

Because of this fact, and the lack of action over the past year to mitigate it, Tam probably could have presented evidence of rampant Ebola spreading through Toronto, and millions of Canadians would have paid her no heed. That neither she nor her Liberal Minister nor anyone on her team seems to have a plan to address this trust deficit, let alone acknowledge that it exists, is a problem with potentially deadly consequences.

For starters, PHAC should not deny that, this is a problem at least partially of their own making. They made serious communication errors that created skepticism in the general public about the veracity of the information they presented. Case in point: for months in early 2020, Tam vociferously opposed and discouraged asymptomatic people from wearing masks. Then, she changed her tune and supported prolonged mandatory mask wearing mandates.

Some experts, including Tam, blamed this about-face on "evolving science”. This argument would have held water if Tam and her team had acted in a way that acknowledged that evolving science and communicating said evolving science in a way that engenders trust within the public are two different matters entirely. 

Tam's communication approach, throughout the COVID-19 pandemic, was to speak first with dogmatic authority without using qualifying language or taking the context of day-to-day reality in stride. For example, scant days before she reversed course on her masking advice, she leaned into the "no mask" position by incontrovertibly stating, "[wearing a mask] gives you a false sense of confidence, but also, it increases the touching of your face. If you think about it, if you've got a mask around your face, sometimes you can't help it because you're just touching parts of your face." 

That isn't the language of someone who wants the public to know that "the science is evolving." There is no way for a lay observer to reasonably deduce that statement is anything other than definitive medical advice from Canada’s top doctor, with that advice being, don't wear a mask.

That approach came despite the fact that PHAC’s leadership were always aware that the medical community’s knowledge about COVID-19 was evolving. They were also keenly aware of the political realities of a government confronted with a pandemic without sufficient stockpiles of personal protective equipment and a healthcare system already teetering on the brink of collapse. But rather than communicate with the public in a way that transparently acknowledged these points, PHAC officials, most notably Tam, chose to ignore them in their primary communications and then rely on the "science is evolving" talking point when pressured to clarify her position after the fact.

In the early days of the pandemic, PHAC had the option of starting each of Tam’s pressers with a qualifier, but chose not to. Honesty about all the details of the government’s situation, and believing in the Canadian public’s capacity to process this information, could have engendered much more trust and latitude. At the very least, it would have prevented public perception that PHAC was infantilizing Canadians at best, and at worst, withholding information from them. This problem was amplified as PHAC only acknowledged widely known facts after the media, politicians, and the public put pressure on them to do so. Obvious facts like the government not having enough personal protective equipment to supply the public with medical grade masks, or that the department was relying on World Health Organization data that was slow to arrive and be analyzed, should have been given to the public and to Parliament upfront as reasons why advice might change and why it was so important for the public to stay tuned for regular updates.

This type of a tone would have set public expectations to expect changes in advice, and to give latitude to officials who were trying to do the best they could with the tools they had at their disposal on any given day. It would have sent a message to the public that the government trusted them with honesty. Being transparent about gaps in data and supply of tools also would have allowed the political debate to focus on solving those problems, as opposed to tilling a fertile field for divisive rhetoric to emerge.

Every Canadian - regardless of political viewpoint - has an inherent understanding that when shit really hits the fan, not everything is going to be perfect. We have a remarkable capacity for forgiveness in our leaders in these situations - as long as they are upfront with us. But PHAC, and the Liberal government, consistently chose not to lean into this remarkable aspect of Canadian culture, and presented a perfectly perfect world when presenting advice, even when they were wrong. 

So even as months and years of Canadian COVID restrictions wore on and became more political and less grounded in a rational debate of the opportunity cost of each decision, Tam and her team stayed oblivious to the impact their communications approach was having on the amount of trust that Canadians were willing to lend to them. 

And our country is still paying the price for that failure.

For all of the multiple questionable situations that Liberal cabinet ministers have been caught in that involved eyebrow-raising contracts with communications consultants, it's worth noting that an order paper question revealed that throughout the pandemic, PHAC spent nothing on external communications advice. And it showed.

PHAC made announcements like "wear a mask while having sex" at the same time that provincial governments were mandating people not to mix with people beyond their households. PHAC vaccine efficacy and safety communications were approached with the same disastrous confusion, which undoubtedly contributed to Canadian vaccine skepticism. PHAC also publicly stood by the Liberal government extending hotel quarantine measures, even after the government's expert panel advised lifting the measures. PHAC officials also stayed silent on the dangers of politicizing vaccine-hesitant Canadians instead of finding ways to address their concerns. And PHAC’s overlong dogmatic adherence to an unattainable COVID-zero posture, long after expressing that border measures were likely ineffectual, didn’t prevent COVID from becoming endemic in Canada.

In addition to failing on those communications fronts, at the start of the pandemic, PHAC press conferences shied away from communicating the obvious: the primary objective of restrictions were to prevent Canadian emergency rooms that were taxed before COVID from experiencing complete collapse. PHAC shouldn’t have shied away from bluntly voicing the obvious - that politicians are going to have to do things to fix a fundamentally broken system - but that was going to take time the country didn't have when first confronted with COVID, and that the agency was providing advice which considered the burden COVID could have on hospitals.

These critical communication errors and lack of transparency have put the agency into a trust deficit with the public, and they, or their new Liberal Minister (Mark Holland), have done sweet fudge all to address it. PHAC has yet to ameliorate that for millions of Canadians, the image of Dr. Tam on stage in an N95 mask evokes the powerful feelings that are still associated with Canada’s prolonged COVID restrictions - grief, loss, anger, hurt and frustration with the government. Until PHAC and Holland constructively address this problem, PHAC can expect more mainstream news headlines like this one about her most recent announcement, which told Dr. Tam to "go pound sand."

Many PHAC officials legitimately did their best during an intensely stressful time. But that does not absolve their leadership from failing to address issues of their own making that may breed serious future challenges. 

PHAC is entrusted with a critical mandate in helping to protect the health and safety of Canadians. It is crucial that the public be able to trust the officials in this department - particularly at the start of the annual respiratory illness season. But trust is earned or restored, not dictated. The department’s COVID communications failures have left a question mark in the heads of millions of Canadians about the department where one shouldn’t exist. This is why it is so critical for the department to acknowledge this problem and address it head on - people’s lives depend on it.

The buck for the performance of a department stops with its Minister, and PHAC is now on its third Liberal Minister since the start of the pandemic. One presided over the creation of the trust deficit; the other allowed it to continue without consequence. If the third time isn't a charm and concrete measures aren't taken to acknowledge past failures and a transparent plan on how the government plans to restore trust isn't taken, the consequences could have a detrimental impact on the health and safety of Canadians.

PHAC has spent three years asking Canadians to do better to help protect the health and safety of the country when it comes to respiratory illnesses. 

It's far past time the Liberal government did something to ensure they took their own advice.