Pathogen on the Prairie

As a practising physician, Ryan Meili has served his time in the deep trenches of poverty, social deprivation, and addiction. As the head of the Saskatchewan New Democratic Party from 2018 to 2022, he also served as leader of the opposition during the first two years of the COVID‑19 pandemic.

Soon after he was first elected to the provincial legislature in 2017, Meili issued an updated edition of his 2012 book, A Healthy Society: How a Focus on Health Can Revive Canadian Democracy, in which he laid out his vision for a more progressive society and a new politics. He argued that such perennial concerns as housing, education, food security, employment, and the environment needed to be addressed as social determinants of health — and resolved together by “prescribing money.”

Too often, social policy is reactive: we try to rescue people who are drowning downstream without venturing upstream to see why they’re falling in. Because “physicians, pharmacists, hospitals, and surgeries” account for “at most 25 percent of health outcomes and probably closer to 10 percent,” Meili advocated for more “upstream thinking.” Only by identifying and coming to grips with the underlying causes of ill health — especially poverty and rising inequality — can we help afflicted individuals and communities alike.

Meili’s latest book, A Healthy Future: Lessons from the Frontlines of a Crisis, should be read as a companion volume to A Healthy Society. Effectively a case study of the pandemic in Saskatchewan, it buttresses his previous argument by negative example. As Meili dissects the disastrous performance of Scott Moe and his Saskatchewan Party government, he tells a tragic tale of political failure: short-sightedness to the point of near-terminal myopia, crude knee-jerk responses, an anti-scientific outlook, and indecision and bad decision making.

Extreme poverty and inequality, structural racism, underfunded medical care, a progressively weakened social safety net: these all amplified the tragedy in Saskatchewan to an excruciating degree, as did political inertia and perhaps even bad faith. “There are larger issues at play than the personalities of the day, than the choices of Premier Moe and his health minister, Paul Merriman,” Meili writes. “At the same time, I couldn’t completely ignore their actions or the anger they evoked. Looking at reliable scientific evidence that shows the course you’re on will result in hundreds of deaths, devastate the health care system, and failing to change course is beyond incompetence.”

Meili set out to write A Healthy Future to help “understand what happened,” so that we might “learn and apply the lessons of this age-defining period.” In Saskatchewan, some 2,000 people have died from COVID‑19 (nationally that number sits at 58,000). As Meili argues throughout, the impact of the virus could have been much less catastrophic: “COVID didn’t cause the problems in our emergency rooms, our ICUs, our long-term care homes, our homeless shelters, our schools, our town squares. It revealed those problems, exacerbated them, made them — at least for a time — impossible to ignore.”

On March 12, 2020, the day after the World Health Organization declared a pandemic, Meili proposed an “all-party, all-hands-on-deck table to start our response to COVID off right.” Moe and his cabinet ignored the suggestion — and offered no plan of their own. Only after community transmission of the virus was detected did the government prepare to declare a state of emergency on March 18. But first it scheduled a “feel-good half-budget press conference.” Meili describes the “sense of betrayal” he felt that day as something he’ll never forget.

Reluctant to tell people what they didn’t want to hear, officials doled out information sparingly. This led, in part, to distrust among the public, along with wild speculation and misinformation, in which the premier eventually took part. The government also grudgingly disbursed minimal financial support for those struggling the most. While other provinces committed hundreds of millions of dollars to new housing initiatives, for example, Moe and his team distributed $171,000 among ten existing initiatives — for cleaning supplies — and offered Saskatchewanians on social assistance a “one-time top‑up of $50.” Despite the dangers posed by the first wave of the pandemic, they committed no new money to public health — which had already suffered years of cuts.

On April 23, 2020, in what would become typical precipitate behaviour, Moe claimed his province had “flattened the curve.” Forty days after declaring a state of emergency, he announced his Re‑Open Saskatchewan plan, as though the virus had been defeated. “By mid-April,” Meili concedes, “we were seeing single-digit new cases of COVID‑19 and our case counts and hospitalizations were among the lowest in the country.” But the numbers began to rise, and the second wave, which began in October 2020, would hit the province hard. Modelling by the Saskatchewan Health Authority had predicted an “out-of-control second wave,” but the information was not shared with doctors or the public —“nor did it lead the government to take the action needed to prevent that outcome.”

Up to the provincial election in October 2020, Saskatchewan had experienced twenty-five deaths related to COVID‑19. By January 2021, over ten times that number had died. In November, more than 400 doctors signed a letter to Moe, warning that cases had increased by 700 percent, that ICUs were overwhelmed, and that strong action was needed. Moe responded that the letter didn’t represent the views of all physicians.

Schools were natural breeding grounds for infection, but teachers were left off the priority list for vaccines for far too long. At one point, the government asserted that masks would not be necessary if students simply faced forward at their desks. Eventually, after several outbreaks, school closures became necessary.

As for long-term-care facilities, an outbreak at Parkside, one of the five private Extendicare residences in Saskatchewan, resulted in thirty-nine deaths. Problems with the building had been flagged before the pandemic, and when Extendicare requested routine testing for staff, the Ministry of Health refused. “Like many workplaces, Parkside put in place reasonable questionnaires and temperature checks,” Meili writes, “but these were haphazardly enforced.” After disaster struck, the Saskatchewan Health Authority eventually had to take over the homes.

By the spring of 2021, Saskatchewan was actually outpacing the rest of Canada in vaccine uptake, and this indicator led to more triumphant crowing by the government. Plans to “reopen” Saskatchewan were again proclaimed. But the vaccination rate was still well below the 85 percent that modelling suggested would result in a “milder fall ICU surge,” and Moe’s public optimism kept it that way: by June, Saskatchewan was dead last in vaccinations, competing along the way with Alberta.

Although modelling predicted a bad autumn, Moe was oblivious. His government refused to urge its citizens to get the jab until much later, a neglect that undoubtedly cost lives. While Saskatchewan announced a paid three-hour vaccination leave for adults in March 2021, it offered no additional time for parents to take their children for shots. That spring, Meili’s NDP proposed a bill that would give workers ten days of paid sick leave per year, but it was defeated — leaving half of the province’s workforce without coverage. That forced many, including those earning the lowest minimum wage in the country, to go to work while infected.

In July, Moe lifted all public health orders, including mandatory self-isolation for those testing positive for COVID‑19. “We won’t be having a Trudeau summer here. We’re going to have a great Saskatchewan summer,” the premier tweeted. (By the fall, as the bad news poured in, he had to reintroduce many of the measures.) The modelling proved to be spot‑on, and by October, Saskatchewan led the country in infections, deaths, and ICU admissions. Some patients were sent to Ontario for treatment as local facilities were overwhelmed. Doctors and the public were made aware of the modelling only after the fact. “There is no single moment that is more clearly a deadly abdication of responsibility, no more obvious example of political malpractice on a fatal scale,” Meili writes. “The lives of the people you are elected to represent should always be the highest priority and primary consideration.” It is hard to disagree.

Moe and his team continued to blunder along, ignoring all expert medical advice. After at first speaking out against the unvaccinated, the premier ended up endorsing the Freedom Convoy and embracing far-right politics. He resisted assistance from the military until his province experienced the highest death rate in the country during the fourth wave. Meanwhile, his health minister inexplicably ruled that parents had to be physically present in schools when their children were being vaccinated for COVID‑19, though they’re not similarly required to be present for the HPV and meningococcal vaccines. Obtrusive political interference led Scott Livingstone, the chief executive officer of the Saskatchewan Health Authority, to walk away from his job suddenly in December 2021.

Two months later, amid the fifth wave, Moe lifted all remaining public health measures. Not by coincidence, “more people died from COVID per day in February 2022 than in any other month of the pandemic to date.” Later that year, worn out and demoralized, Meili resigned the NDP leadership and his own seat.

Readers of A Healthy Future should likely exercise caution. The author was, after all, Moe’s political antagonist as the official opposition leader. But even if he is looking through a partisan lens, Meili presents a series of facts, well-documented with footnotes, that speak for themselves. He has done us a service in meticulously chronicling a ghastly period.

Yet the story isn’t fully told. Between Meili’s vision for a better society and the hard reality of present-day Saskatchewan — a social safety net in tatters, health care workers leaving the profession in droves, and the highest poverty rate in the country — lie unfathomable gulfs. Meili’s assessment of the current situation is sharp and well-founded, and he makes sensible suggestions for a health-in-all-policies approach to governing. Still, he seems unable to offer a critique of the very economic system that creates inequality and poverty in the first place. “You tell yourself, someday we’ll be in government, someday we’ll fix this,” he writes. As he must know, and as Bob Rae can surely attest from his experience in Ontario, “fixing this” is not simply about winning an election. Requiring the complement of a powerful grassroots movement to achieve meaningful transformation, electoral politics by itself is incapable of changing the system from above.

Meili blames his own leadership for “going along with the tendency of progressive parties to make ourselves boring, to find loopholes to principled arguments in hopes that people will just get tired of our opponents rather than taking a stand and offering a clear alternative.” This is remarkably frank, but he’s being unfair to himself. Those who might imagine the NDP as a vehicle for major social change face an increasingly steep climb, even within the party. As Meili noted in his earlier book, “When applied to wealth, ‘redistribution’ has become a dirty word, even among left-of-centre New Democrats.” Where does one start?

No wonder the Moes (and Larrys and Curlys) of this world keep getting elected by a scarred electorate grown increasingly cynical, distrustful, and unwilling to take risks. Our political culture, which favours mediocrity and business as usual, needs a serious health check. Until it is transformed for the better, inequality, in Meili’s words “the world’s biggest killer,” will remain at large, more dangerous than ever and claiming untold new victims.