Intended for healthcare professionals

Editorials Accountability for Canada’s Covid-19 Response

Canada’s pandemic response and future preparedness

BMJ 2023; 382 doi: (Published 24 July 2023) Cite this as: BMJ 2023;382:p1622

Read the full collection: Accountability for Canada’s covid-19 response

  1. Kelley Lee, Canada research chair in global health governance
  1. Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
  1. kelley_lee{at}

Domestic health security requires more than talk about global equity

The Canadian government’s actions fell far short of its advocacy for global vaccine equity during the covid-19 pandemic.12 This discord is documented by Houston and colleagues as part of The BMJ’s series on accountability for Canada’s covid-19 response ( The government waxed lyrical about the importance of accelerating vaccine access worldwide to end the pandemic and described itself among the leading countries contributing to this goal, but it failed to follow through on actual vaccine doses committed to Covax, engaged in excessive advance purchasing, and did not support an intellectual property (TRIPS) waiver that would expand global production.

Was this glaring contradiction a result of tensions between domestic and global health priorities? Did the unfolding nature of the pandemic make it impossible for the government to fulfil its good intentions? Or was it simply business as usual for a trade dependent country inextricably tied to a world economy dominated by powerful transnational corporations? The reasons behind the disparity between Canada’s talk and actions may never be fully explained given the diminishing prospects for a public inquiry on the country’s pandemic response.

Yet identifying why vaccine equity was largely reduced to a soundbite is essential for being better prepared for the next pandemic event. More broadly, many forms of inequity shaped how this pandemic played out across this vast and diverse country, and globally. The World Inequality Report 2022 shows that SARS-CoV-2 arrived at a time when the world was divided by historic levels of wealth and income inequality—as wide as when much of the world was colonised at the peak of western imperialism.4 The report also comments on persistent gender inequality, with women’s share of total income from work only slightly improving over the past 30 years, from 30% to 35%.4 These longstanding and structurally embedded forms of disadvantage, in turn, determined why some people became ill and died during the covid-19 pandemic or faced much greater precarity.5 Inequitable access to life saving vaccines and treatments among those who needed them most was a direct consequence of an already unfair world.

Yet despite irrefutable evidence of how inequities hindered the pandemic response,678 meaningful commitment to equity as a core principle remains a key sticking point for many governments in current negotiations for a global pandemic treaty.9 This includes what can be gleaned so far about Canada’s proposed amendments to make it voluntary to provide access to medical technologies and waive intellectual property rights during a pandemic,10 which would entrench the inequitable status quo. This goes against Torreele and colleagues’ conclusion that “market-based systems cannot deliver essential epidemic countermeasures in a timely, fair, equitable, and sustainable manner.”11

Misunderstandings about equity

Why this continued discord between the Canadian government’s talk and action on global equity? At least three beliefs may be hindering progress. The first is that equity is harmful to national self-interest when there is global scarcity of an essential good like vaccines. However, pandemics are mass events from which few can escape. When pathogens can readily spread across national borders, the distinction between national and global interests becomes moot. Like putting a fire out in a neighbour’s yard, delivering vaccines wherever they can most effectively reduce transmission is the best use of scarce resources.

Second is that equity is charity and, when times are tough, charity begins at home. In a globally interconnected world, however, mitigating the conditions in which outbreaks are more likely to occur, or preventing them from becoming epidemics and pandemics, is a collective action problem requiring shared investment not charity.

The third belief is that domestic political success means not championing global equity too loudly for fear of alienating voters with conservative values. But in an unequal world, it is inequity that breeds disillusion, detachment, and division. The 2022 report on the global state of democracy found half of the world’s democracies in decline by the end of 2021, fuelled by public distrust in political processes, rising corruption, and powerful elites.12 During covid-19, more fractured societies led to a weakened pandemic response, which allowed SARS-CoV-2 to spread and establish itself permanently. The same lessons are identified in an Organisation for Economic Cooperation and Development review of 67 evaluations by 18 governments of the initial pandemic response. The main takeaways from this review are the importance of policies targeting the most disadvantaged groups in society and strengthening social safety nets to protect the fabric of societies before, during, and after a pandemic.13

Thus, to effectively mitigate the domestic threat of future pandemics, Canada must finally confront the false distinction between domestic and global equity, and align its talk with action.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare I am co-chair of the joint Royal Society of Canada-Canadian Academy of Health Sciences Expert Panel on Canada’s Role in Global Health; and a Commissioner on the NUS-Lancet Pandemic Readiness, Implementation, Monitoring and Evaluation (PRIME) Commission.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • This article is part of a series commissioned by The BMJ ( The lead editor was Jocalyn Clark.