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  • OPEN ACCESS
    The not so over-the-counter status of emergency contraception in Ontario: A mixed methods study with pharmacists
    FACETS • Vol. 2 • pp. 429 - 439
    Introduction: In Canada, the progestin-only dedicated pill is the most widely used method of emergency contraception (EC). This method gained over-the-counter status in Ontario in 2008. Our mixed methods study explored the progestin-only EC knowledge, attitudes, and provision practices of Ontario pharmacists. Methods: From June 2015 to October 2015, we collected 198 mailed surveys from Ontarian pharmacy representatives and conducted 17 in-depth interviews with a subset of respondents. We analyzed these data using descriptive statistics and for content and themes. Results: Results from our English/French bilingual survey indicate that respondents’ knowledge is generally accurate, but confusion persists about the mechanism of action and the number of times the drug can be used in one menstrual cycle. Nearly half (49%) of our survey respondents indicated that progestin-only EC pills are only available behind the counter. Interviewees strongly supported the introduction and promotion of more effective methods of EC in Ontario. Conclusion: Continuing education focusing on both the regulatory status of progestin-only EC and information about the medication appears warranted. Health Canada’s recent approval of ulipristal acetate for use as a post-coital contraceptive may provide a window of opportunity for engaging with health service providers, including pharmacists, about all available modalities of EC in Canada.
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    How did the introduction of mifepristone impact the availability of abortion care in Ottawa? A qualitative study with abortion patients
    FACETS • Vol. 5 • No. 1 • pp. 559 - 570
    In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction (n = 20) and after mifepristone–misoprostol became available (n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.
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    Restoring trust: COVID-19 and the future of long-term care in Canada
    FACETS • Vol. 5 • No. 1 • pp. 651 - 691
    The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.
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    Reconciling civil liberties and public health in the response to COVID-19
    FACETS • Vol. 5 • No. 1 • pp. 887 - 898
    The COVID-19 pandemic has highlighted the challenges governments face in balancing civil liberties against the exigencies of public health amid the chaos of a public health emergency. Current and emerging pandemic response strategies may engage diverse rights grounded in civil liberties, including mobility rights, freedom of assembly, freedom of religion, and the right to liberty and security of the person. As traditionally conceived, the discourses of civil rights and public health rest on opposite assumptions about the burden of proof. In the discourse of civil and political rights of the sort guaranteed under the Canadian Charter of Rights and Freedoms, the onus rests on government to show that any limitation on rights is justified. By contrast, public health discourse centers on the precautionary principle, which holds that intrusive measures may be taken—lockdowns, for example—even in the absence of complete evidence of the benefits of the intervention or of the nature of the risk. In this article, we argue that the two principles are not so oppositional in practice. In testing for proportionality, courts recognize the need to defer to governments on complex policy matters, especially where the interests of vulnerable populations are at stake. For their part, public health experts have incorporated ideas of proportionality in their evolving understanding of the precautionary principle. Synthesizing these perspectives, we emphasize the importance of policy agility in the COVID-19 response, ensuring that measures taken are continually supported by the best evidence and continually recalibrated to avoid unnecessary interference with civil liberties.
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    Open drug discovery of anti-virals critical for Canada’s pandemic strategy
    FACETS • Vol. 5 • No. 1 • pp. 1019 - 1036
    In the event of the current COVID-19 pandemic and in preparation for future pandemics, open science can support mission-oriented research and development, as well as commercialization. Open science shares skills and resources across sectors; avoids duplication and provides the basis for rapid and effective validation due to full transparency. It is a strategy that can adjust quickly to reflect changing incentives and priorities, because it does not rely on any one actor or sector. While eschewing patents, it can ensure high-quality drugs, low pricing, and access through existing regulatory mechanisms. Open science practices and partnerships decrease transaction costs, increase diversity of actors, reduce overall costs, open new, higher-risk/higher-impact approaches to research, and provide entrepreneurs freedom to operate and freedom to innovate. We argue that it is time to re-open science, not only in its now restricted arena of fundamental research, but throughout clinical translation. Our model and attendant recommendations map onto a strategy to accelerate discovery of novel broad-spectrum anti-viral drugs and clinical trials of those drugs, from first-in-human safety-focused trials to late stage trials for efficacy. The goal is to ensure low-cost and rapid access, globally, and to ensure that Canadians do not pay a premium for drugs developed from Canadian science.
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    Remembering is a form of honouring: preserving the COVID-19 archival record
    FACETS • Vol. 6 • pp. 545 - 568
    COVID-19 presents an opportunity to preserve a rich and diverse historical record—one intended to honour all experiences and voices and in recognition of ongoing systemic inequalities shaping the pandemic. But policy changes are necessary in three key areas: how memory institutions are funded and supported, the gaps in our capacity to preserve the digital records that reflect how we communicate with one another today, and how to preserve and make accessible valuable scholarly research into the societal impact of COVID-19. Our goal is to begin a conversation about priorities for archival preservation, the need for greater equity and justice in our preservation practices, and ways to safeguard the existence of historical records that will allow us in future to bear witness, with fairness and truth and in a spirit of reconciliation, to our society’s response to COVID-19.
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    Supporting Canada’s COVID-19 resilience and recovery through robust immigration policy and programs
    FACETS • Vol. 6 • pp. 686 - 759
    Canada has been seen globally as a leader in immigration and integration policies and programs and as an attractive and welcoming country for immigrants, refugees, temporary foreign workers, and international students. The COVID-19 pandemic has revealed some of the strengths of Canada’s immigration system, as well as some of the fault lines that have been developing over the last few years. In this article we provide an overview of Canada’s immigration system prior to the pandemic, discuss the system’s weaknesses and vulnerabilities revealed by the pandemic, and explore a post-COVID-19 immigration vision. Over the next three years, the Government of Canada intends to bring over 1.2 million new permanent residents to Canada. In addition, Canada will continue to accept many international students, refugee claimants, and temporary foreign workers for temporary residence here. The importance of immigration for Canada will continue to grow and be an integral component of the country’s post-COVID-19 recovery. To succeed, it is essential to take stock, to re-evaluate Canada’s immigration and integration policies and programs, and to expand Canada’s global leadership in this area. The authors offer insights and over 80 recommendations to reinvigorate and optimize Canada’s immigration program over the next decade and beyond.
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    The need for a federal Basic Income feature within any coherent post-COVID-19 economic recovery plan
    FACETS • Vol. 6 • pp. 394 - 402
    COVID-19 has shone a harsh light on the extent of poverty in Canada. When normal economic activity was interrupted by the exigencies of public health driven lockdowns, the shutdown disproportionately affected people who, before the pandemic, were living on incomes beneath the poverty line or dependent upon low-paying hourly remunerated jobs, usually part time and without appropriate benefits. Those living beneath the poverty line in Canada, three million of welfare poor and working poor, include a disproportionately large population of Black and Indigenous people and people of colour. This paper addresses the challenge of inclusive economic recovery. In particular, we propose that the federal government introduce a Basic Income guarantee for all residents of Canada as part of a comprehensive social safety net that includes access to housing, child care, mental and physical health care, disability supports, education, and the many other public services essential to life in a high-income country. Residents with no other income would receive the full benefit that would be sufficient to ensure that no one lives in poverty, while those with low incomes would receive a reduced amount.
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    Time to be counted: COVID-19 and intellectual and developmental disabilities—an RSC Policy Briefing
    FACETS • Vol. 6 • pp. 1337 - 1389
    The COVID-19 pandemic has impacted the lives and well-being of all people globally, with consequences being observed across all domains from physical and mental health, to education and employment outcomes, to access to community supports and services. However, the disproportionate impact of the COVID-19 pandemic and its associated public health restrictions on individuals with intellectual and developmental disabilities (IDD) has largely been overlooked. Not only do people with IDD have a greater risk of severe complications and death from the virus as shown in large-scale studies, but they also face significant short- and long-term consequences of COVID-related public health measures on their mental health and well-being. At a time when this vulnerable population is already feeling undervalued, ignored, and forgotten, it is imperative that the risks facing adults and children with IDD—as well as their families and caregivers—are recognized, valued, and addressed through a disability-inclusive approach to Canada’s pandemic policy response planning. This requires both a mainstreaming of disability inclusion into all COVID-19 response and recovery policies as well as disability-specific policies to address the unique barriers and challenges encountered by people with IDD during the pandemic. The recommendations in this policy briefing aim to achieve a more inclusive, accessible, and sustainable Canada for people with IDD both during and after the pandemic—an approach that will result in benefits for all of society.
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    A centralized rare disease database and whole-genome sequencing as a standard of care: two essential implementations for the future of health
    FACETS • Vol. 6 • pp. 1831 - 1834
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    Strengthening a One Health approach to emerging zoonoses
    FACETS • Vol. 8 • pp. 1 - 64
    Given the enormous global impact of the COVID-19 pandemic, outbreaks of highly pathogenic avian influenza in Canada, and manifold other zoonotic pathogen activity, there is a pressing need for a deeper understanding of the human-animal-environment interface and the intersecting biological, ecological, and societal factors contributing to the emergence, spread, and impact of zoonotic diseases. We aim to apply a One Health approach to pressing issues related to emerging zoonoses, and propose a functional framework of interconnected but distinct groups of recommendations around strategy and governance, technical leadership (operations), equity, education and research for a One Health approach and Action Plan for Canada. Change is desperately needed, beginning by reorienting our approach to health and recalibrating our perspectives to restore balance with the natural world in a rapid and sustainable fashion. In Canada, a major paradigm shift in how we think about health is required. All of society must recognize the intrinsic value of all living species and the importance of the health of humans, other animals, and ecosystems to health for all.
  • OPEN ACCESS
    Investing in Canada’s nursing workforce post-pandemic: A call to action
    FACETS • Vol. 7 • pp. 1051 - 1120
    Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the review to arrive at recommendations and actions that are presented in this policy brief. The findings and recommendations from this policy brief are meant to inform a national and sustained focus on retention and recruitment efforts in Canada.
  • OPEN ACCESS
    COVID-19 pandemic: the impact on Canada’s intensive care units
    FACETS • Vol. 7 • pp. 1411 - 1472
    The COVID-19 pandemic has exposed the precarious demand-capacity balance in Canadian hospitals, including critical care where there is an urgent need for trained health care professionals to dramatically increase ICU capacity.The impact of the pandemic on ICUs varied significantly across the country with provinces that implemented public health measures later and relaxed them sooner being impacted more severely. Pediatric ICUs routinely admitted adult patients. Non-ICU areas were converted to ICUs and staff were redeployed from other essential service areas. Faced with a lack of critical care capacity, triage plans for ICU admission were developed and nearly implemented in some provinces.Twenty eight percent of patients in Canadian ICUs who required mechanical ventilation died. Surviving patients have required prolonged ICU admission, hospitalization and extensive ongoing rehabilitation. Family members of patients were not permitted to visit, resulting in additional psychological stresses to patients, families, and healthcare teams. ICU professionals also experienced extreme psychological stresses from caring for such large numbers of critically ill patients, often in sub-standard conditions. This resulted in large numbers of health workers leaving their professions.This pandemic is not yet over, and it is likely that new pandemics will follow. A review and recommendations for the future are provided.
  • OPEN ACCESS
    An analysis of Canada's declared live wildlife imports and implications for zoonotic disease risk
    FACETS • Vol. 8 • pp. 1 - 18
    In Canada, there have been calls for increased research into and surveillance of wildlife trade and associated zoonotic disease risks. We provide the first comprehensive analysis of Canadian live wildlife imports over a 7-year period (2014–2020), based on data from federal government databases obtained via Access to Information requests. A total of 1 820 313 individual animals (including wild-caught and captive-bred animals but excluding fish, invertebrates, Columbiformes (pigeons), and Galliformes (game birds)), from 1028 documented import records, were imported into Canada during 2014–2020. Birds were the most imported taxonomic class (51%), followed by reptiles (28%), amphibians (19%), and mammals (2%). In total, 22 taxonomic orders from 79 countries were recorded as imported. Approximately half of the animals (49%) were imported for the exotic pet market. Based on existing literature and a review of the Canadian regulatory apparatus, we gesture to these importations' potential implications for zoonotic disease risk and discuss potential biosecurity challenges at the Canadian border. Finally, we identify data gaps that prevent an extensive assessment of the zoonotic disease risk of live wildlife imports. We recommend data collection for all wildlife importation and improved coordination between agencies to accurately assess zoonotic disease risk.
  • OPEN ACCESS
    Urgent and long overdue: legal reform and drug decriminalization in Canada
    FACETS • Vol. 9 • pp. 1 - 28
    The International Guidelines on Human Rights and Drug Policy recommend that states commit to adopting a balanced, integrated, and human rights-based approach to drug policy through a set of foundational human rights principles, obligations arising from human rights standards, and obligations arising from the human rights of particular groups. In respect of the Guidelines and standing obligations under UN Treaties, Canada must adopt stronger and more specific commitments for a human rights-based, people-centered, and public health approach. This approach must commit to the decriminalization of people who use drugs and include the decriminalization of possession, purchase, and cultivation for personal consumption. In this report, we will first turn to the legal background of Canada's drug laws. Next, we will provide an overview of ongoing law reform proposals from civil society groups, various levels of government, the House of Commons, and the Senate. We end with a three-staged approach to reform and a series of targeted recommendationscr.
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    Comments regarding “A Canadian model for providing high-quality, timely and relevant evidence to meet health system decision-maker needs: the SPOR Evidence Alliance.”
    FACETS • Vol. 8 • pp. 1 - 2
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    Wastewater Surveillance for SARS-CoV-2 RNA in Canada
    FACETS • Vol. 7 • pp. 1493 - 1597
    Wastewater surveillance for SARS-CoV-2 RNA is a relatively recent adaptation of long-standing wastewater surveillance for infectious and other harmful agents. Individuals infected with COVID-19 were found to shed SARS-CoV-2 in their faeces. Researchers around the world confirmed that SARS-CoV-2 RNA fragments could be detected and quantified in community wastewater. Canadian academic researchers, largely as volunteer initiatives, reported proof-of-concept by April 2020. National collaboration was initially facilitated by the Canadian Water Network.Many public health officials were initially skeptical about actionable information being provided by wastewater surveillance even though experience has shown that public health surveillance for a pandemic has no single, perfect approach. Rather, different approaches provide different insights, each with its own strengths and limitations. Public health science must triangulate among different forms of evidence to maximize understanding of what is happening or may be expected. Well-conceived, resourced, and implemented wastewater-based platforms can provide a cost-effective approach to support other conventional lines of evidence. Sustaining wastewater monitoring platforms for future surveillance of other disease targets and health states is a challenge. Canada can benefit from taking lessons learned from the COVID-19 pandemic to develop forward-looking interpretive frameworks and capacity to implement, adapt, and expand such public health surveillance capabilities.
  • OPEN ACCESS
    The humanities and health policy
    FACETS • Vol. 9 • pp. 1 - 10
    COVID-19 was a stark reminder that understanding a novel pathogen is essential but insufficient to protect us from disease. Biomedical and technical solutions are necessary, but they do not prevent or resolve misinformation, vaccine hesitancy, or resistance to public health measures, nor are they sufficient to advance the development of more equitable and effective healthcare systems. Responding to crises such as pandemics requires deep collaboration drawing on multiple methodologies and perspectives. Along with the science, it is imperative to understand cultures, values, languages, histories, and other determinants of human behaviour. This policy briefing argues that the humanities—a group of methodologically diverse fields, including interdisciplinary studies that overlap significantly with the social determinants of health—are an underused source of cultural and social insight that is increasingly important and could be better leveraged in such collaboration. Humanities disciplines approach health and illness as part of the human condition. Their historical perspective could be more effectively mobilized to explore the social and cultural context in which science exists and evolves, in turn, helping us understand the forces shaping perceptions, concerns, and assumptions.
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    Did the COVID-19 pandemic disrupt food security in West African rural communities? Survey results from four regions of Senegal and Burkina Faso
    FACETS • Vol. 9 • pp. 1 - 16
    Transboundary rural communities in West Africa play an important role in the exchange of goods, mainly food, among countries. The COVID-19 pandemic restricted these activities due to the closure of the borders. Semi-structured interviews were conducted in two regions of Senegal and Burkina Faso to examine the impacts of these restrictions on the pillars (availability, access, utilization, and stability) of food security in rural areas on men and women. The data set included 230 interviews, and they were analyzed through thematic content analysis. The results showed a decrease in agricultural production in all the communities due to mainly lack of labor force, and limited access to inputs, resulting in increased post-harvest losses. The disruption of trade and border and market closures affected rural families engaged in transboundary trade. Farmers experienced a sharp loss of household income leading to debts and decapitalization. Availability and diversity of and access to food was also heavily affected. Food security greatly varied among the communities and between countries. Perceptions also varied between men and women in terms of production, mobility, and food consumption. The restriction measures have triggered a spiral of effects and responses seriously impacting long-term food security in already highly vulnerable countries.
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    Inventory and characteristics of Canadian interhospital transfer coordination structures
    FACETS • Vol. 10 • pp. 1 - 8
    Several studies have described interhospital transfer coordination structures in the US but there is a lack of data on Canadian coordination systems. We aimed to develop an inventory of existing interhospital coordinating structures across Canada and to detail how they operate in terms of governance, re-sources, tools, and processes. A cross-sectional survey was designed and ten managers/medical officials from seven coordination structures of interhospital transfers across Canada completed the survey. Findings indicate that coordination systems had similar communication modalities and covered similar services including the provision of medical advice. However, they differed in terms of the profile of staff processing transfers and transportation coordination. Mature structures such as Ontario and Alberta, who manage high annual volumes, distinguish themselves with very clear, standardized, and efficient processes, as well as implemented quality and performance improvement methods including key performance indicators. These results suggest that Canada may benefit from having an inter-provincial community of practice for interhospital transfer coordination structures to promote best practices, identify solutions, and harmonize services and processes. Better harmonization in transfer coordination would improve equity in the access to healthcare services. Future research should focus on the elaboration of evidence-and consensus-based guidelines that apply to the Canadian context.