What happens when your acting medical officer of health doesn’t like public-health measures?

ANALYSIS: A newly appointed acting MOH has voiced his opposition to COVID-19 restrictions. Here’s what the rules say about what he can and can’t do — and for how long
By John Michael McGrath - Published on Sep 15, 2021
The Haldimand-Norfolk Board of Health has opted not to reverse the appointment of Matt Strauss as the acting medical officer of health. (Twitter)

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Ontario’s local medical officers of health have been key figures in the management of COVID-19 and the drive to get people vaccinated. The residents of the province’s largest cities might not have known much, if anything, about their MOHs pre-pandemic, but after months of hearing Eileen de Villa, Vera Etches, and Lawrence Loh lay out sometimes grim statistics and announce new public-health measures, those have become familiar names. Now, the name Matt Strauss is also becoming a familiar one — but for very different reasons.

The newly appointed acting MOH for Haldimand-Norfolk, Strauss has been extremely vocal on social media about his opposition to basically all the public-health measures Ontario has adopted since the pandemic began. He’s praised Florida governor Ron DeSantis for rejecting such measures (the state has seen higher numbers of daily deaths in August and September 2021, with vaccines freely available, than in any previous wave of the pandemic). He tweeted, in August of last year, “I would sooner give my children COVID-19 than a McDonald’s happy meal.” (Recent data from Israel suggests that between 2 per cent and 5 per cent of children infected with the disease still suffer from “long COVID” symptoms six months afterwards, a rate of illness not associated with eating a cheeseburger.) The government of Alberta enthusiastically embraced the idea of lifting COVID-19 restrictions earlier this year: that province is now facing a catastrophe in its hospital system; one doctor recently told the Edmonton Journal, “We’re f**ked.”

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Strauss has defended his views in a letter published by the Port Dover Maple Leaf. “As an academic, freelance journalist, and physician-advocate, my conscience has at times compelled me to criticize government policies in the SpectatorToronto StarToronto SunNational Post and on my personal Twitter page,” he writes. “It has sometimes behooved me to use sarcasm or eye-catching analogies. In my new office, it will not.”

At a meeting on Monday night, the Haldimand-Norfolk Board of Health opted not to reverse his appointment, and Strauss is now the acting medical officer of health for the unit. The province’s chief medical officer of health, Kieran Moore, has said that the province will ensure Strauss has the “guidance” he needs and that, if he believed there were a threat to public-health in the PHU, he’d have broad powers to act.

Strauss’s appointment is also notable because, under Ontario law, it would be illegal to appoint him permanently. The requirements for a permanent MOH, set out in Ontario regulation, require that a candidate have completed at least a year-long post-graduate study in epidemiology, disease prevention and health promotion, or other related fields. Strauss has no such qualification. But he doesn’t need to, because he’s only “acting,” and the bar for that is considerably lower: under section 69 of the Health Protection and Promotion Act, an acting MOH need only be a physician in Ontario.

The elected members of Norfolk County who supported his nomination have been clear in their statements to media that they chose Strauss because of his views on public-health measures and not because of his qualifications.

Oddly, there’s no time limit on the appointment of an “acting” MOH, although there used to be. In 2011, the Liberals passed legislation that limited the term of an acting MOH to no longer than six months. As then-MPP Liz Sandals told the legislature in February 2011, “While acting MOHs are required to be physicians, they are not required to hold any other public-health qualifications, and in some cases, acting MOHs, medical officers of health, have served for literally years because they have been appointed and reappointed and reappointed without ever gaining the appropriate qualifications.” 

In 2017, however, the Liberals removed the time limit they themselves had put into law; the change took effect the following year. According to Liberal MPP John Fraser, who was parliamentary assistant to the minister of health and long-term care at the time, the limit had had an unintended consequence: local boards of health were finding it difficult to fill vacancies quickly.

“The reason for that change, to my understanding, was the challenge of recruitment. It became an administrative burden — that’s why it happened,” Fraser told TVO.org Tuesday. “There’s obviously a consequence to that; we’re thinking about that today.” 

Fraser did concede that the 2017 changes might need revisiting. He added, though, that that it was never the Liberal government’s intention for local boards of health simply to ignore the qualifications of their medical officers. Policy directions from the Ministry of Health instruct boards of health to inform the ministry in writing about the appointment of any new acting MOH, and boards were clearly told that the government did not expect any acting MOH to serve for an extended period of time. 

TVO.org asked Minister of Health Christine Elliott’s office whether the Haldimand-Norfolk board of health had informed her office in writing about Strauss’s appointment but had received no response by publication time.

Beyond the finer details of provincial policy, Fraser says that, even if the government hadn’t been aware of Strauss’ appointment in advance, it had ample reason to know there was a problem in the local public-health unit. Strauss followed another acting MOH, Alex Hukowich, who was appointed in May. Hukowich himself succeeded Shanker Nesathurai, whose public-health orders earlier in the pandemic, intended to protect migrant workers, were challenged by local farmers and eventually upheld by an Ontario court. That kind of turnover in less than a year is itself something the ministry should have been concerned about, Fraser argues.

Strauss, like the other 33 medical officers of health in the province, will have little discretion when it comes to implementing any of the province-wide COVID-19 measures, such as mandatory vaccine passports for non-essential businesses. What will bear closer scrutiny is whether he continues the measures exclusive to Haldimand-Norfolk,  including those intended to improve protections for temporary farm workers. If he chooses to undo them, that could trigger a stand-off between the local board of health and the province. But it will be a fight only if the province — either cabinet or Moore — chooses to make it one.

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