One-on-one with Dr. Bonnie Henry: Where she thinks Canada stands in the fight against COVID-19
TORONTO -- A year into the COVID-19 pandemic, Health Canada has approved four vaccines to be administered to Canadians. However, continued public health measures, new emerging coronavirus variants and record case numbers in the second wave have some health experts warning that life won’t return to normal anytime soon.
But Provincial Health Officer Dr. Bonnie Henry is hopeful that people in British Columbia could be living in a "post-pandemic world" by the summer.
The province's top doctor says she is "optimistic" that the recent approval of the AstraZeneca vaccine and the first one-shot immunization from Johnson & Johnson will allow the government to revise its vaccination timeline and have every eligible B.C. resident vaccinated sooner than previously thought.
Henry spoke to CTV's Chief News Anchor and Senior Editor Lisa LaFlamme from Victoria on Friday to discuss where Canada stands now in the fight against COVID-19, as well as her upcoming book, "Be Kind, Be Calm, Be Safe: Four Weeks that Shaped a Pandemic," detailing the first four weeks of the pandemic in B.C.
Below is a transcript of the interview, edited for length and clarity:
Lisa LaFlamme: I don't know how you managed to write a book with your nonstop schedule, but it's a very interesting read. Why now though, before the pandemic is over, before there is a conclusion?
Dr. Bonnie Henry: Oh, that's a very good question. This book was actually written during the one week, the five days I had off in early August, and my sister was back out here with us and with me and she had put all this structure together and had this idea and she says she talked to me about it, but I don't remember.
So she came out and basically sat me down and said, ‘OK these are the bits you need to write’, and it really was, in many ways, for me it was cathartic. It was putting some of the thoughts and feelings that we were going through that very challenging time a year ago now.
So we finished it in early August and it's being released on the anniversary, but I don't think any of us really knew that we'd be in the place that we are right now so it was one of those -- it was just really about that really strange and challenging and difficult period of time that we all went through a year ago now.
LaFlamme: You've suggested we could still save the summer. Is it risky to raise people's hopes after so many setbacks on the vaccine front?
Henry: I think we need hope. We need to know that there's an end in sight and one of the things that we've been saying is this is like a triathlon and we're in the marathon, but we don't know where the finish line is or whether it's an ultra-marathon or a regular 42.2 and those last miles are the hardest, so it is when we need that. We need to know that there's an end in sight and there's things that we can do that are going to get us there and I actually believe, from what we have learned about this virus and this year, we’ve seen that there's a seasonality to it, we've seen that the vaccines -- and this is the incredible thing that within a year we have now four safe and effective vaccines in Canada -- and the thing that really has made it in my mind a possibility that we're going to get there is the data that has shown how effective the vaccine is at protecting older people.
For those people who haven't been in the vaccine world for a long time, that is something that is almost miraculous and I don't use that word lightly. To be able to protect the individuals who are older, is something that makes our ability to get to that place where we can have those important connections together again a very real reality after just one dose of this vaccine.
LaFlamme: And I think everybody is encouraged by that. At the same time this big question -- is a third wave inevitable?
Henry: Here in B.C. we've been seeing a steady increase in the last two weeks and we're back to, in some ways, very much where we were at this point last year; relying on the important contact case management and contact tracing that public health does to try and stop those transmissions before they take off widely.
LaFlamme: When you reflect back it's a little disconcerting to hear you say we're right back where we were a year ago when you're seeing numbers rise, when you think of the first wave and those earliest days, given the vast experience you've had with SARS and Ebola. Were you out there waving a red flag that there was danger ahead and people were reluctant to believe you or were you also blindsided at just how severe this coronavirus would actually become?
Henry: I was very, very concerned and worried and anxious, much more so than many of my colleagues in public health and in the health system because many of them had not been through this sort of thing, and our last pandemic of influenza, we managed fairly well. So there wasn't the thought that quarantine was something that we would actually do, closing borders was something we would actually do, closing schools, closing workplaces -- these measures that we had talked about in some sense and I have spent a lot of time looking into… There was a sense of disbelief that we would actually have to use them.
LaFlamme: What about accountability in this country for all the preparedness manuals that were clearly sitting on shelves somewhere? It felt for a lot of Canadians we were woefully unprepared -- mixed messages, B.C. doing one thing, Alberta doing another, this patchwork across the country and I know that is the reality of a provincial-based health-care system, but for the collective good would you have preferred a more centralized response from the beginning?
Henry: I've been thinking a lot of about it for many years and I chair our Canadian Pandemic Influenza Preparedness Planning Task Force that actually had the plan that we used as a basis for this response. And yes, I do wish that we had had a much stronger co-ordinated federal, provincial response. Some of the things that we need to really move and change are having a national information system that allows us to rapidly share information on these critical communicable diseases with us across the country and with the federal government. We don't have that. We needed that after SARS, we knew that, we spent years building something and then some provinces backed out, the federal government decided they weren't going to use it and once again we're here with a patchwork system.
There are so many things that could have been easier had we followed the advice that we'd had, and it is very challenging in times of non pandemics to spend the critical money that's needed to develop information systems to have a stockpile. One of the things that I've been advocating for, as have many of my public health colleagues for many, many years is an onshore vaccination production capacity in Canada, but those things are hard to put forward when you have such urgent issues in our health system on a day-to-day basis. And of course, the tragedy of the reality of how we have neglected our long-term care homes across the country, that is something that we need to change.
LaFlamme: That is the true tragic legacy of this pandemic so far. Do you see that as a public health failure or where's that responsibility?
Henry: I see it as a failure of multiple different levels. We have commoditized in some ways, we've got for-profit, we've got not-for-profit, we've got religious, but we have to look back on the history of long-term care. It really started as religious orders supporting older members as they aged and so it has been -- it has grown up piecemeal. And then the way we've treated it as sort of partly in the health-care system and partly not has created a lot of barriers.
We had to take some drastic action very early on because normally, we wouldn't be providing personal protective equipment and support to private care homes, but early on here in B.C. we said we have to do that because if those people get sick, it's going to transmit into the community. So we needed to do things like that and overcoming that inertia to get those things done, but it was not easy.
Primary carers who work in our long-term care homes have been mistreated just to be frank for many, many years -- underpaid, undervalued, many of them are people who are from racialized communities and that is something that we need to collectively address and change.
LaFlamme: And you were one of the first people in this country to actually be able to put a name and a face to the first Canadian victim of COVID-19. We still don't know who patient zero is, but how did that experience shape your message so early on and in communicating hard information to Canadians on a daily basis?
Henry: It is really hard, and the backstory of it from the SARS outbreak in Toronto where …I got to know every single one of the families who had people who died in that outbreak. It really became an integral part of my approach to the many different outbreaks that we've been involved in; the importance of protecting people's personal information and making sure that they can't be linked and found by people who are trying to… It’s challenging, because everybody wants the story and wants to know all the details for families often need privacy, they need time to grieve, to understand what's happening, and sadly with this virus as we have seen with many other communicable diseases, people can be mistreated, and treated badly.
Even now, we see instances of racism against community members who are COVID positive through no fault of their own, and it started very early on with anti-Asian sentiment that we're still see. But the importance of getting people the information they needed to take the actions that we knew would protect each other without violating the intense personal privacy that people needed -- very difficult balance and I know everybody wants more and more information, but it's what you need to know as opposed to what people want to know. Finding that balance can be a very difficult challenge sometimes.
LaFlamme: I'm sure personally it was a great challenge too I mean, here you are presenting this message, but you're also the target. There was a lot of love in the beginning for you, but we all saw that turn. What was that experience like for you and how do you sort of compartmentalize the trolls and the cruelty that is landing on your doorstep?
Henry: I was kind of prepared for that and I said it from the very beginning, I am the face and the voice unwittingly of a really strong, important team and they support me, I support them. That's one of the things that gets you through the good times and the bad times my fellow chief medical officers of health from across the country, but also my team here in B.C. So that is really important for me.
I knew that over time the longer things go on the more challenging it becomes, the more likely people are to lash out and we know from human behaviour that in a time of crises and anxiety and particularly uncertainty and, I've come to learn, nuance creates this feeling of uncertainty that makes some people take it out with acting out and becoming angry. It's hard, it's really hard, but I try and balance that, and I can say that I am buoyed every day by positive messages that I get from people all the time from my neighbours, my mother of course…
LaFlamme: There's so much confusion for Canadians on the role of [vaccine] manufacturers, laid out guidelines, 21 to 28 days between doses. Canadians are suddenly told no, the two doses will have a four month gap because an advisory committee has decided it's safe. I know you're a member of that, but do you understand or do you follow the fact that this is what is so confusing and perhaps leading to mistrust in public health in this country?
Henry: Yeah, I understand absolutely that people hear the different messages, but I think what we all need to recognize is that we are learning as we go. We learn more about the virus, we learn how it was transmitted, we learned that in certain conditions indoors, with poor ventilation with lots of people it spread more easily and maybe by aerosols, we learned the importance of masks in certain situations, these are all things that we learn. We get data, it's a scientific way. You get data, you get more data, you get real-world data, you understand more, and you make changes depending on what you're learning as you go. Same with these vaccines.
We have to remember that last summer, there was about 150 candidates for vaccines that were in the initial phases of trials. We didn't know which ones of those were going to work or not. These amazing ones that we have, the Pfizer-BioNTech and the Moderna vaccines, messenger RNA vaccines, brand new vaccine platform, nobody in the world has ever made a vaccine with these before, though there have been little bits of research that have gone back for decades saying that these might be a good idea and people are trying to find a new rabies vaccine, for example. So yeah, the companies wanted and needed to minimize the interval between doses, they needed to figure out if you needed one or two or more, and they needed to minimize the interval between doses so that they could get see if the vaccines worked and we're safe as rapidly as possible. And that happened, and it happened even before we expected it because we had that surge of cases so the irony is you need more people to get sick to understand that the vaccines are actually protecting people. That is part of how the vaccines were developed and that's what the manufacturer puts their information into the regulators like Health Canada, and the decision that Health Canada has to make is, does this vaccine work and is it safe? And with the protocols that were used in these clinical trials -- so those are very rigid protocols, people are swabbed on a specific date, they're get blood tests at a specific date, they get vaccines within a specific very narrow timeframe -- those are the clinical protocols that help us understand does it work and is it safe.
Once we start using them in the real world, we get what we call effectiveness data. So that's efficacy, that's the rigid trials. And then once we get them in the real world we start to understand, well who do they work better for, and there wasn't so many people who were over 65 in this study so we better watch people who are getting it who are over 65 and see if it is what the studies show. And we've learned in real life that -- and these are studies too, this is scientific method, it's just a different type of study … So we're getting great information about how these work in the real world and that's what drives our decisions now. So the clinical trials are the basis to figure out if they worked, and then we use the real world data to develop where do they work best and how do we make the best use of the vaccines we have and that's why we made the decision that not only is it good to extend, it is safe to extend the dose interval to four months, but it's maybe better for people in the long run and that is from vaccine science, from immunology. We know it takes time for our immune system to build up, and for some of these vaccines it may turn out that a single dose is all we need. We don't know that yet because we haven't done those, we haven't followed long enough, but it is likely that we're going to change again as we get more information. We may need maybe six months, that's the optimal time to get a second dose, that's going to help us get through the next two years of COVID circulation with protecting people so those are things that we're going to learn as we go. So that's the way science works in the real world, that we take the studies and then we see how it works in reality.
LaFlamme: Well we are all experiencing a harsh dose of the real world over this past year and Dr. Bonnie Henry we thank you so much for your time and valued insight over this year and, again, congratulations on the book.
Henry: Thank you so much.