The science of systems: an interview with Stephen Lucas, Canada’s health chief

By on 22/09/2020
Stephen Lucas

The pandemic has given scientists a key role in shaping policies; but scientific methods, says Health Canada deputy minister Stephen Lucas, are just as helpful in managing systems. The former geologist tells Matt Ross how Canada’s federal and provincial officials worked together in the face of the pandemic, minimising the virus’s impact

When senior civil servants talk of the need to bring more specialist professionals into leadership roles, they often mention the value of topical expertise. And certainly, Stephen Lucas’s background as a Geological Survey of Canada research scientist has often proved invaluable during his civil service career. Over the last 20 years, many of his roles have covered relevant fields such as earth sciences, natural resources and energy generation; until September, he ran Canada’s environment and climate change department.

In his current role as deputy minister of Health Canada – which manages health issues at the federal level – there are fewer opportunities to apply his training in tectonics and the creation of mountain ranges. But even in this job, he says, the scientific method gives him “a rigour and an analytical approach to solving problems” that’s immensely helpful. “The application of science and human creativity to solve public policy problems” is a powerful tool, he says, adding that scientists tend to have “an interest in understanding the bigger picture: in understanding the interaction between human systems, ecosystems, health systems and global political systems”.

Still, Lucas cannot have expected that, just four months after he took the Health Canada job, he’d be facing quite such a big-picture, multi-system problem. On arriving, he recalls, he began getting to grips with the department’s long-standing goals: working with the provinces and territories to strengthen health and care services, and addressing public health challenges such as smoking, vaping and opioid addiction. But by early January, his top priority was “this threat from distant shores, which we knew would come to Canada”: the COVID-19 pandemic was on its way.

Dodging a bullet

Nine months on, Canada’s performance during the pandemic looks stronger than those of many other Western democracies. By mid-September, the country had suffered 3,700 confirmed cases and 243 deaths per million people: both metrics are lower than the EU average, and form a stark contrast with the 20,500 cases and 600 deaths per million across the border in the USA.

As in many countries, says Lucas, existing moves to create a “more agile, responsive, innovative public service” paid off when the virus hit – strengthening work to manage the outbreak. Health Canada had, for example, long championed the introduction of digital technologies and remote consultations in primary care. As the country went into lockdown, he recalls, “we saw a rapid and remarkable transition to delivering those services virtually,” with civil servants “moving very, very quickly to help support that rapid ramp-up.”

At the national level, “the further entrenchment of collaboration – a critical, cross-departmental competency that we’ve been stressing and trying to entrench in recent years – and an openness to taking more informed and smart risks were critical attributes of the response,” says Lucas. “They’ve shown the civil service at its best; and I’d like to think that’s something we can make irreversible, building it into how we work.”

Federal and provincial officials worked together to receive and quarantine Canadians returning to airports such as Vancouver, says Lucas. (Photo courtesy GoToVan via Wikimedia Commons).

This focus on collaboration and agility was crucial to aspects of Canada’s response to coronavirus. The government was, for example, quick to ramp up testing: “We’ve had to innovate to support Canadian businesses to produce reagents and swabs, and other necessary parts of testing,” says Lucas. It closed its borders early, and put the systems in place to resettle and quarantine returning citizens. And it quickly began working with industry to “develop ‘made in Canada’ capability for producing at scale everything from ventilators to surgical gowns.”

Vertical connections

But in federal states such as Canada, ultimately success in tackling COVID rests on effective collaboration between national and regional administrations. In the USA, for example, fractious and competitive relationships between the White House and state governors have exacerbated the country’s COVID outbreak. And Canada’s 2003 outbreak of SARS – which infected 251 people, killing 44 – was worsened by poor partnership working between federal and provincial officials: “coordination was less effective” in those days, notes Lucas, who was working at Health Canada at the time. 

So for Lucas, building strong connections with sub-national health leaders was an early priority. “One of the first things I did on arriving here was to call all my provincial counterparts and open the door to all those relationships,” he says. “Without knowing what was coming, I knew they’d be important.” And as the virus took hold, he focused on “transparency, openness, being clear on where we were going, and sharing information as it came to us.” This approach, he adds, was crucial to building “trust, and the ability to work together – both bilaterally and multilaterally.”

Similarly, “there were a variety of decisions we needed to take collectively – or at least have collective support for”: these included producing public health guidance, managing internal borders, and repatriating and quarantining Canadians overseas. “Adaptive learning and management, together with our jurisdictional partners, was such a critical element of our response, and I think has built linkages which will serve us well as we look to broader, non-COVID challenges on healthcare delivery in Canada,” says Lucas. Should a new COVID wave arrive in the winter, he adds, “the machine will be ready to go.”

Protective action

Canada’s approach to vertical collaboration is well illustrated by the country’s response to PPE shortages. The federal government – which had entered the pandemic with low PPE reserves – decided “in the winter to procure collaboratively the needed PPE,” recalls Lucas. “That became a more and more acutely important undertaking as the global supply chains just stopped functioning and there was some protectionist behaviour by some jurisdictions, in terms of restricting normal, commercially-based supply chains.”

Working with the provinces, national officials secured supplies and “agreed an allocation formula based on provinces’ populations, but including an emergency stockpile so we could respond to emergency requests”. Reviving a collapsed supply chain, says Lucas, required “an extraordinary level of agile response”: civil servants had to both import supplies, “arranging everything from the order to transport; and work with Canadian manufacturers to retool and produce PPE”. But their work paid off: “The provinces, recognising their own interest in supporting the greater good, have come together in that collaborative spirit,” says Lucas.

Lucas never mentions the USA, but it’s worth outlining what happens when national leaders take a different approach. President Trump left the PPE problem to state administrations: by springtime, governors were engaging in fierce bidding wars for scarce supplies, while the federal government frequently confiscated shipments in transit – prompting state leaders to hide their stocks under armed guard.

And where it went wrong

Lucas does not, however, pretend that the government got everything right. The country suffered a “tragedy around vulnerable people, particularly seniors in long-term care,” he says – with the latter accounting for 80% of all deaths. Many care homes suffered outbreaks: as a result, while the country’s total number of cases per million people is 65% of the European average, its death rate is 85% of Europe’s.

Asked why care homes were so badly hit, Lucas acknowledges that the quality of their facilities, training, accommodation and PPE was highly variable across the country. And in a sector dominated by part-time, low-paid staff, many “worked in multiple facilities – often living in lower-income communities, with crowded housing and a higher risk of being infected”; so a single, asymptomatic carer could unwittingly bring the virus into several homes.

“There’s a recognition, in some [worst-affected] parts of the country, of the need to look at some of these structural issues,” says Lucas, citing “infection prevention and control; restricting the flow of people in and out of these facilities; having an adequate supply of PPE; and providing a subsidy or top-up to wages, to enable people to work at just one long-term care facility.”

Another weakness, says Lucas, lies within Canada’s national public health data systems. “It’s unfortunately an area where the steps weren’t taken after the SARS outbreak,” he comments. “We don’t have a strong public health information system in this country.” The lack of timely, granular, local demographic and medical data, he adds, “has impeded our response, and is an area where we’ve engaged and invested with the provinces to better understand the differentiated impact of the epidemic on different groups across the country.”

As Lucas’s predecessor Simon Kennedy told GGF in 2017, Canada also lacks a single common standard for digital health records. The agenda has moved forward since then, says Lucas, with agreement on “some critical indicators to measure progress” in fields such as mental health, seniors care and home care. But he acknowledges that development of the “necessary standardisation, and the flexible, open systems that can enable that sharing” between health providers “remains a work in progress.” 

Looking ahead

One important new component of Canada’s response is its COVID-19 exposure notification app. This uses the Google-Apple protocols – which log Bluetooth contacts between individual phones, rather than tracking phone users’ locations – and include strong privacy protections, Lucas explains. Location-tracking apps could in theory provide valuable data on the disease’s prevalence across the country, but “the view was that there are other tools we can use to track the occurrence and spread of the data in Canada” – and any perception that the government was watching users would undermine takeup, weakening the tool’s value. “To be effective, these apps need to have 60% or so of the population using them. And the only way we’ll get to that is if Canadians can trust it,” he says.

From mountains to hospitals: a scientific approach adds value in many fields of policy, Lucas believes. (Photo courtesy: Koppertone via Wikimedia Commons).

In developing their app, Canadian officials were careful to learn from other countries’ experiences; and Lucas stresses the value of strong international relationships in the face of the virus. The World Health Organization has had a difficult pandemic – Trump, accusing it of covering up for the Chinese, has announced that the USA will be quitting – but in Lucas’s view, it’s a “critical organisation that’s played a key role” in tackling COVID. “The global good is going to be better served by building on and strengthening existing organisations than by setting them aside and starting from scratch,” he adds.

Equally, other countries have much to learn from Canada’s approach to managing the pandemic – particularly the federal government’s commitment to sharing data, developing systems and agreeing policies in partnership with the provinces and territories. South of the border, the White House and states competed for supplies and operated conflicting lockdown policies. And across the Atlantic, a centralising UK government has largely excluded local authorities from its datasets, its policymaking work and its contact-tracing operations. It is notable that the USA and UK have experienced far worse outbreaks, with the number of deaths attributed to COVID per million people about 150% higher than Canada’s.

Follow the science

Canada too has learned a lot during the pandemic. As well as the lessons around care homes and public health information, says Lucas, there’s now a “far stronger recognition of the importance of health care, health security; and a better understanding of the links between that and the economy.” If countries focus narrowly on pandemic response, he says, “we’ll miss one of the learnings”: namely the importance of long-term, preventive work to improve public health, making populations more resilient in the face of emerging health threats. Reducing the prevalence of chronic, long-term conditions “not only makes for a healthier population and lower healthcare costs, but also lesser impacts at times of infectious diseases such as COVID,” he points out.

The pandemic has also boosted the profile of science in government. Among policymakers there has, says Lucas, been a widespread “recognition of the critical importance of having science and evidence drive our response.” And in the government’s public communications, scientists have taken a leading role: “Some of the most popular people in Canada now are the chief public health officers, from Dr Theresa Tam at the federal level to, for example, Dr Bonnie Henry in the province of British Columbia,” he comments.

For when a scientist lends their authority to messages around infection control and social distancing, people listen. Senior civil servants and political leaders may be waking up to the contribution that scientists can make in government. But the public has long respected and valued – as Lucas puts it – “the application of science and human creativity to solve public policy problems.”

Global Government Forum: five thoughts for better government

Stephen Lucas on learning from overseas

To help our readers get the best out of Global Government Forum, we ask interviewees five standard questions – four seeking practical advice and opinions, and one to reveal something a little more personal. This is an edited version of Stephen Lucas’s answers.

Can you name one lesson or idea from abroad that’s helped you or your colleagues?

“One area of lessons is around antimicrobial resistance. I was particularly influenced by a discussion I had with the United Kingdom’s Dr Sally Davies – who was the chief medical officer – in terms of the need to create greater public awareness about the risks of our antibiotics not working [due to] overuse. She encouraged the UK government to have a study undertaken about the importance for the economy and society of focusing on this challenge, and then pushed it globally. And I think that leadership and has inspired and informed Canada’s approach on anti-microbial resistance.”

Are there any projects or innovations from Canada that might be valuable to your peers overseas?

I’ll mention two. In recent years we’ve put in place a framework for more agile regulations for pharmaceuticals and other health products, effectively creating what we call a regulatory sandbox: an area where we define the rules to ensure the safety and quality and effectiveness of new innovations based on their characters, rather than pigeonholing them in traditional pharmaceutical or medical device frameworks. [This recognises] the intersection of different artificial intelligence, digital and drug delivery technologies, for example.

“Another area’s on nature conservation, where we created a challenge to double the amount of protected areas in this country. We worked to involve indigenous people in helping to develop and effectively own new protected areas, supported by the charitable sector and and private sector through a matching fund request. This innovation in who’s involved in helping to protect nature, involving Canada’s indigenous people as the original and ongoing stewards of the land, was really interesting and, we think, could be of interest and application in other parts of the world.”

How can we improve the ways that senior public officials work with and learn from their peers overseas?

“One of my you know reflections coming through COVID has been the importance both of structured dialogue but also informal interaction with peers in other countries. So we have regular engagement with G7 and other partners. But we also follow up routinely with colleagues in the UK, United States, Australia and other jurisdictions; [and that] has created great insights in pure learning, if you will.

“And fora that had been established in sunnier days – such as the international coalition of medical regulators – [are] now coming into [their] own in these stormy days of COVID.  So it’s that combination of some structured dialogues in different bilateral and multilateral fora, including on a thematic basis; and also the more informal relationships, where you can pick up the phone and learn from a colleague as we go through this unprecedented territory.”

What are the biggest global challenges in your field in the next few years?

“I’ll note a couple. One is we’re going to be living with COVID: understanding its impacts; understanding – as they emerge, hopefully – the effectiveness and safety profile of different vaccines. And the pandemic, I think, will drive broader reflection on global public health; on pandemic preparedness and response; on vaccine development and distribution, equitably and on a global basis; and on the health of our populations, and the critical interlink with the economies and social fabrics of our countries. [But] some of the issues that have taken a less prominent role but are equally challenging – such as antimicrobial resistance – remain. And I think there is a risk of a sustained focus only on pandemics and COVID [relative to] some of these other challenges.

“Another one… is around mental health and wellbeing. There will be impacts – as we’re already noticing – associated with COVID on the mental wellness of Canadians and vulnerable populations. I think it’ll be an area where we need to double down on efforts, both nationally and internationally, in the coming years.”

And finally, what is your favourite book?

“I’m one of those Tolstoy fans. So Anna Karenina is probably my favourite all-time book. But recently I read a book called The Invention of Nature: a great telling of the story of Alexander von Humboldt, by Andrea Wulf. And given my interest in nature, in ecosystems and in geology, this was a fascinating tale that took us across multiple continents and really told the story of the birth of a systems approach to understanding nature. A tale well worth reading!”

About Matt Ross

Matt is a journalist and editor specialising in public sector management, policymaking and service delivery. He was the editor of Civil Service World 2008-14, serving an audience of senior UK officials; and the features editor of Regeneration & Renewal 2002-08, covering urban regeneration, economic growth and community development. He has also been a motoring and travel journalist, and now combines his role as editorial director of Global Government Forum with communications consultancy, marketing and journalism work for publishers, public sector unions and private sector suppliers to government.

Leave a Reply

Your email address will not be published. Required fields are marked *