Carrots for vaccination are great. But we’re likely going to need sticks, too

OPINION: Doug Ford has to decide whether Ontario will let the unvaccinated jeopardize the hospital system we all rely on
By Matt Gurney - Published on Jul 27, 2021
York Region paramedics load an empty gurney onto a transfer bus outside Kingston General Hospital after transporting two COVID-19 patients from the GTA on April 22. (Lars Hagberg/CP)

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Every so often in Canadian media, someone’s article or column closely tracks with what someone else has already said on an issue, and people get annoyed. In some cases, writers are definitely ripping off the work of others without even adding a link to acknowledge the credit owed. Sometimes, though, it really is probably a coincidence — when something is topical, it’s not shocking that more than one person wants to write about it. And it’s also not shocking if what they conclude is awfully damn similar. What may look nefarious can really just be a coincidence.

For the record, this column is going to come alarmingly close to ripping off something John Michael McGrath recently wrote. So much so that it will save us all effort and energy just to admit it at the outset. This is especially true because he wrote his piece right here, at TVO.org, just days ago. But I still can’t resist chiming in and agreeing: Ontario is almost certainly going to get a vaccine certificate of some kind, and the sooner the Doug Ford government acknowledges this, the better off it will be. I say again: action now will be not only to Ontario’s benefit, but also to Ford’s. 

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The challenge facing Ontario is exactly as McGrath laid it out: even with the overwhelming majority of Ontarians either fully vaccinated or on their way, there are millions of us that aren’t, and our hospital system is still a bit of a mess. In a recent interview here with Anthony Dale of the Ontario Hospital Association, I asked point blank whether we just needed a bigger hospital system. He agreed and noted that this isn’t really even a matter of opinion; by international and cross-Canadian averages, Ontario’s hospital system is small. We operate fewer hospital beds per capita than any other province and fewer than any of the advanced countries tracked by the Organisation for Economic Co-operation and Development. Ontario went into the pandemic with an unusually small hospital system, and it’s still an unusually small hospital system.

As McGrath notes, this leaves Ontario vulnerable to unusually small threats. And, as he further notes, this unusually small, unusually vulnerable system is going to have to cope not only with routine care and COVID-19’s future demands, but also with an 18-month backlog of procedures. Let’s not tip-toe around this ugly and unpleasant truth: that backlog is going to kill people who didn’t need to die.

To this day, I don’t think people have truly grasped how much of Ontario’s response to the pandemic has been driven by this reality: our hospital system was a sitting duck for exactly this kind of emergency, because we let it be. Any after-action analysis of Ontario’s COVID-19 experience needs to be rooted in this understanding. A more robust health-care system would have allowed the province to better navigate the crisis itself and eased the burden on our long-term-care system, where so much horrible suffering and death occurred.

But we didn’t have that system, and as I’ve written about here many times, bottlenecks for patient transfers in the system eat up a significant percentage of what capacity we do have. The major problems in Ontario’s health-care system directly contributed to the pain of the pandemic, and that includes the massive pain and damage done by the lockdowns required to save the hospitals.

So we’ll be facing whatever comes next with, essentially, the same system we went into this thing with. There have been improvements on the fly — hard lessons learned in battle with the virus will continue to pay dividends. It’s not all bad news, and vaccines will improve health outcomes even for those who get sick despite having been jabbed. But the exhaustion of personnel and the massive backlog of needed care are challenges we didn’t face at the outset. 

It is ridiculous that the health-care system in a province of more than 14 million can be significantly disrupted by an emergency that adds a burden of as few as 300 patients. But we shouldn’t let the absurdity of the problem lull us into believing it isn’t a problem. Millions of us have done the right thing and gotten vaccinated, but millions haven’t, or can’t. By all means, let’s roll out a vaccine lottery or a reward for vaccination. I’m all for carrots. But we’re likely deluding ourselves if we think we’ll avoid needing to use sticks.

And the Ford government should get this. Ford has already dismissed vaccination passports (under whatever name) on the grounds that he doesn’t want a divided society. No one wants a divided society! But we have one. It’s already divided — between the vaccinated and the unvaccinated.

Ford doesn’t really have to choose between a divided society and an undivided one; he has to decide whether the unvaccinated (for whatever reason) will once again be able to put the overwhelming majority of us back into a situation where the hospital system we all rely on to stay healthy and safe is threatened. Since the government is unlikely to let that happen, and since we won’t be able to dramatically invest in and expand the system in the next month or two, we all know where that leads. Right?

I’ve been writing for years that Ford has a bad habit of staking out a position he won’t be able to sustain in the face of encroaching reality and mounting public pressure. He resists and resists and resists and then panics and overcorrects in the opposite direction. (As I’m sure we all vividly recall, a few months ago, dozens of Ontario police forces publicly repudiated the expanded powers the Ford government dropped on them as the third wave went entirely and predictably out of control.) 

A modest, planned, and thoughtful program of incentives (both good and bad) to get our vaccination rate as high as possible, as soon as possible, would help our hospitals and help the Ford government avoid a political disaster in the fall. It is certainly a better idea than a frantic, half-thought-through effort months from now. 

Alas, that is likely what we’ll get.

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