Spotlight on CoVaRR-Net’s Pillar 8 Public Health, Health Systems & Social Policy Impacts Delivering timely, research-driven insights to public health leaders

How did more than 300 Canadian scientists, working on a common problem from different angles, get their research insights on COVID-19 variants of concern (VOCs) put into action rapidly?

CoVaRR-Net’s Pillar 8 team, led by Dr. Nazeem Muhajarine and Dr. Cory Neudorf, embraced and helped successfully meet that challenge since the Network’s inception in March 2021. “The COVID-19 pandemic was a public health emergency unlike any other experience in our lifetime in its scope and scale, and the red-light alarms sounded loudly and consistently,” says Dr. Nazeem Muhajarine, Co-Lead, CoVaRR-Net’s Public Health, Health Systems and Social Policy Impacts Pillar 8 and Professor, and epidemiologist, at the University of Saskatchewan.

“Pillar 8’s mandate from day one was to play a liaison role within the Network and most importantly, to rapidly bring the research information, insights and knowledge about SARS-CoV-2 variants generated by immunologists, virologists, vaccinologists and other basic scientists in CoVaRR-Net to the people working in public health on the front lines and keep them regularly informed,” he says.

Sharing timely, actionable research with local public health leaders across Canada

Dr. Muhajarine and Dr. Neudorf, Co-Lead of Pillar 8, and Professor at the University of Saskatchewan, promptly formed a public health leaders roundtable – comprised of local medical health officers from across the country – to share and discuss the latest VOC-related epidemiological information, insights and recommendations through monthly Zoom meetings, and to directly influence pandemic management.

As an academic researcher and experienced senior medical officer at both the local and provincial levels in Saskatchewan, Dr. Neudorf recognized the value and importance of proactively bridging the gap between frontline public health practitioners and CoVaRR-Net researchers.

“We tapped into the existing Urban Public Health Network to set up the VOC Expert Panel. Local medical health officers and other public health practitioners were looking for high-quality, evidence-based information from sources they could trust to update them on new VOCs and inform surveillance, talk about common concerns, and help them in developing and implementing public health guidelines and protection policies,” explains Dr. Neudorf, who was served as the interim senior medical officer at the Saskatchewan Health Authority during the pandemic and previously served for over two decades as chief medical officer for the former Saskatoon Health Authority.

Those regular monthly meetings were also an opportunity for us to ask frontline practitioners in cities and regions across the country, ‘What are the questions you need answered?’ Pillar 8’s targeted approach helped to ensure that CoVaRR-Net’s research efforts were both timely and strategically aligned with real-world priorities and the most urgent public health needs.

Translating knowledge for decision-makers at pandemic speed

Throughout the pandemic, the Pillar 8 team also provided practical support to public health decision-makers at the federal and provincial levels, including through Situation, Background, Assessment, and Recommendation (SBAR) briefs. These were routinely submitted to Canada’s COVID-19 Leadership Group, chaired by Canada’s Deputy Minister of Health, offering concise and evidence-backed guidance on critical heath policy decisions on timely topics ranging from breakthrough infections, vaccine allocation and distribution, and vaccine hesitancy, to rapid antigen testing and outbreak management, school testing, tracing and isolation, and vaccine hesitancy.

“The SBARs and other information releases we put together were very helpful for decision-makers,” says Dr. Muhajarine. “I remember when news about the spread of omicron in South Africa and Botswana broke at the end of November 2021. CoVaRR-Net Executive Director Dr. Marc-André Langlois called a meeting on a Sunday afternoon. Within the week, we had collected and synthesized the best information about this new COVID-19 variant from many reliable sources for public health practitioners across Canada. Pillar 8’s work demonstrated it was possible to conduct knowledge translation at the speed of a pandemic.

Effective policies and best practices for vaccination campaigns and strategies

The Pillar 8 team also carried out its own public health and social impact research studies on important issues such as managing COVID-19 transmission in schools, effectiveness of provincial and territorial vaccination campaigns, evaluation of vaccine mandate policies in Canada, and the role of public trust in government, health institutions, and social organizations during the COVID-19 pandemic.

“Our comparative studies of how different provinces and territories managed their COVID-19 vaccination rollouts showed that reaching out to communities with campaigns tailored to different population subgroups increased vaccine uptake,” says Dr. Neudorf. “Making vaccines available and accessible in workplaces, and through mobile and after-hours clinics, was also important for boosting uptake and health equity.”

Another Pillar 8 study reported that proof-of-vaccination mandates led to an immediate short-term increase in first dose uptake, but the effects differed across age groups. “Our findings suggested that if and when policymakers develop future vaccination mandates, they should consider designing proof-of-vaccination requirements around young and middle-aged adults who are more likely to socialize and work outside their homes, and school-age children who come into close personal contact daily,” explains Dr. Muhajarine.

Managing COVID-19 transmission in schools

Pillar 8’s research on effective policies and best practices for managing COVID-19 transmission in schools was useful in helping educational institutions across Canada safely navigate pandemic challenges, reduce transmission, and minimize disruptions to in-person learning for students. “We saw a lot of variability in how schools in different provinces managed COVID-19 transmission and policies on school closures, and this was a highly contentious issue,” says Dr. Neudorf. “We recommended that school-based COVID-19 mitigation strategies be adjusted according to the level of community transmission.”

“Emerging evidence from Canada has shown that children were probably not a large-scale factor in the spread of the virus in the population. It’s very important to balance transmission mitigation measures in schools with the problems in child development that result from prolonged school closures,” adds Dr. Neudorf.

How public trust changed in the pandemic and how to rebuild that trust

Pillar 8’s Trust Dynamics and Equity in Public Health project, a mixed-methods study on COVID-19, explored the essential role of public trust in provincial/territorial and federal governments, public health authorities, and health scientists, among others. They compared public trust in May 2024 to before the COVID-19 pandemic. In collaboration with CIEDAR/Pillar 7 (CoVaRR-Net’s Indigenous Engagement, Development and Research Pillar 7) and CoVaRR-Net’s EDI&I (Equity, Diversity, Inclusion & Indigeneity) team, this large national study of over 5,600 Canadian adults also investigated how trust disparities took hold during the pandemic. They looked at the differences in trust between Indigenous and non-Indigenous people, various ethno-cultural minority communities, women and men, and newcomers and Canadian-born citizens.

“These national studies on public trust at the tail-end of the pandemic are intended to help reset and rebuild Canadians’ confidence in public institutions, health scientists and medical care providers,” says Dr. Muhajarine. “Some preliminary findings indicate that public trust is complex, yet it can be described. For example, across Canada, trust in provincial and federal governments is lowest in Alberta and Saskatchewan; and, surprisingly, in New Brunswick—in the mid to upper 30 percents. Public trust is highest in health scientists across Canada—in most provinces in the 70 percent range. Trust in public health was in between these two, but depending on the region of the country, it varied from high 40 percents to 60 percents, or in Newfoundland, in the 70 percent range,” he said.     

“We have a ton of data, both quantitative and qualitative, from this study. Our hope is that the findings and insights emerging from this study will lead to broader conversations about trust dynamics and help to generate ideas about what public health officials can do to strengthen and rebuild trust among all Canadians,” says Dr. Neudorf. 

Trust Dynamics in Government, Public Health, and Scientists in Canada: May 2024

The percent trust in government, public health, and health scientists was calculated for the whole sample (n=5607 Canadian adults) of Pillar 8’s Trust Dynamics and Equity in Public Health project. The following questions were asked about each group: How much did you trust the government (federal, provincial) to take care of the popula­tion during the COVID-19 pandemic? How much did you trust public health authorities in their management of the COVID-19 pandemic? Did you trust the work of scientists? Responses were categorized into Trust, Distrust, Neutral, Prefer not to answer. Only percent Trust is shown (unpublished data).