Under the spotlight: understanding the role of the Chief Medical Officer in a pandemic

Abstract

As the COVID-19 pandemic took hold in 2020, Chief Medical Officers (CMOs) entered the public spotlight like never before. Amidst this increased visibility, the role is deeply contested. Much of the disagreement concerns whether CMOs should act independently of the government: while some argue CMOs should act as independent voices who work to shape government policy to protect public health, others stress that CMOs are civil servants whose job is to support the government. The scope and diversity of debates about the CMO role can be explained by its inherently contradictory nature, which requires incumbents to balance their commitments as physicians with their mandates as civil servants who advise and speak on the government’s behalf. The long-haul COVID-19 pandemic has further tested the CMO role and has shone light on its varying remits and expectations across different jurisdictions, institutions and contexts. It is perhaps unsurprising, then, that calls to amend the CMO role have emerged in some jurisdictions during the pandemic. However, any discussions about changing the CMO role need a stronger understanding of how different institutional and individual approaches impact what incumbents feel able to do, say and achieve. Based on an ongoing comparative analysis of the position across five countries with Westminster-style political systems, we provide an overview of the CMO role, explain its prominence in a pandemic, examine some debates surrounding the role and discuss a few unanswered empirical questions before describing our ongoing study in greater detail.

Tensions and opportunities in the roles of senior public health officials in Canada: A qualitative study

“…Second, the focus on CMOHs in one country limits the transferability of our findings. However, considering the similarity of the public health system and the CMOH role in other countries with Westminster systems of government, we are confident that this case holds lessons beyond Canada [8] . The tensions in the CMOH role described here are like the challenges facing senior public health leaders in the United Kingdom [ 3 , 8 ], as well as in countries with different political systems, such as the United States [4] .…”

“…In addition, this study describes the role of the CMOH in non-pandemic times. Our ongoing research indicates that in Canada and several other countries, the government response to the pandemic has not only dramatically raised the profile of the CMOH role but has also revealed some of the inherent tensions in asking one person to simultaneously act as a senior advisor, public health manager, and government spokesperson [8] .…”

“…The present analysis is part of an ongoing study of the CMOH role in Canada, Australia, Ireland, New Zealand, and the United Kingdom [8] . The central research question of this study is: what are the benefits, costs, risks, and trade-offs of different options for structuring the position of CMOH?…”

“…Public health emergencies like the COVID-19 pandemic thrust senior public health officials into the spotlight. Despite extensive commentary about these officials during such crises, their roles are often misunderstood in public discourse and remain under-examined by researchers outside a very small number of earlier studies [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] . Assessing the impact of senior public health officials on health policy and outcomes requires an in-depth understanding of their statutory responsibilities, their structural authority and situational autonomy, and their relationships with policymakers and the public.…”

Crisis, justice, and managing the appetite for risk

“…In Victoria, the CHO also appeared at press conferences on a regular basis raising issues of the appropriate separation of powers. The role of the CHO during the pandemic has been subject to scrutiny in a number of jurisdictions: 146 the CHO in Victoria is a public servant, and as part of the executive should be independent of the legislature. Public servants placed in this situation are at risk of undermining the public perception of their independence from government.…”