Patrick Fafard (GSPIA, University of Ottawa)
The conventional public health governance model for many countries, developed in the 20th century, grants public health experts employed by governments significant autonomy to make key decisions on how best to respond to public threats, whether large or small. The COVID-19 pandemic, the decline in public trust in expert authority, and the rise of populist politics have fundamentally challenged this model. The autonomy of public health authorities has been diminished to varying degrees, most notably in the United States, but also in Canada and in Europe. Is this nothing more than a rebalancing of authority away from unelected and unaccountable experts in favour of politicians? In short, no, because public health has more in common with central banking, an area generally understood to be best kept at a distance from those we elect. Drawing on work in political theory, philosophy of science, and public administration, this paper argues in favour of an autonomous public health function. The first section provides an overview of the conventional model and the rationale for autonomous public health institutions. The second section provides a rationale for granting public health officials independent authority to advise and make decisions regarding the management of health threats. The final section addresses the challenging question of who has the authority to make binding regulatory decisions in a public health emergency, such as a pandemic.