As Dr. Theresa Tam steps down, she urges Canada to stand strong on public health
32:47 Share

The ocean is vast, beautiful, and lawless. I'm Ian Urbina, back with an all-new season of The Outlaw Ocean. The stories we bring you this season are literally life or death. We look into the shocking prevalence of forced labor, mind-boggling overfishing, migrants hunted and captured. The Outlaw Ocean takes you where others won't. Available on CBC Listen or wherever you get your podcasts.

This is a CBC Podcast. I'm Dr. Brian Goldman. This is White Coat Blackheart. For our season finale, we have a conversation that I've been looking forward to for months. This week, Dr. Theresa Tam steps down as Canada's Chief Public Health Officer. And if the name isn't familiar, then for better or worse, this may jog your memory. We don't just need to flatten the curve. We need to plank it. Practice social distancing. Practice physical distancing and good hygiene.

Wearing a well-fitted and well-constructed mask. Everybody should still wear their mask. Keep up to date, including booster doses. Go get the booster now. Together, we can do hard things. When Dr. Theresa Tam became Canada's top doctor and head of the Public Health Agency of Canada in 2017, she was on a mission to address health inequities. Little did she know she'd spend much of her tenure steering Canadians through COVID-19, but

the worst pandemic in a century.

Her keep calm and carry on demeanor had many admirers. When she publicly changed her mind on critical aspects of the virus, some saw that as open-mindedness. Her detractors saw that as flip-flopping. Hello, can you hear me? Yes, I can. What's the weather like in Ottawa today? It's hot. Yeah. Hot and kind of windy and yeah. I guess the Ottawa Valley has its charms. As we did our soundcheck, I was feeling nervous thinking of all the weighty questions I wanted to ask.

Then she surprised me with this. I've always been meaning to ask you how you got into this line of work on top of your clinical work. Good question. Like me, you're probably getting the sense that curiosity has been fundamental to Dr. Theresa Tam's successful career. Here's the first part of our conversation. Dr. Theresa Tam, welcome to White Coat Blackheart. It's great to be here.

It's great to be speaking with you too. I'm going to ask you about the unfortunate comeback of measles in this country in just a moment, a disease that was eliminated in Canada back in 1998. But there's this other disease I want to ask you about first, polio. I hear that you were in the trenches as a public health doctor when polio was eradicated in Bangladesh. What was that experience like?

So that was before polio was eliminated in that country. And so it was, I was part of the stop polio team. And I was there really to help set up monitoring or surveillance systems in hospitals and clinics and provide some capacity building to medical officers there. And I

It was really the local medical officers who were the key to the polio eradication or polio elimination in Bangladesh. But it allowed me to get right down on the ground to small communities. So I think that's it. It's a very small part, but it really helped me solidify, I think, at that time, my desire to do public health.

And here we are in 2025 with measles making a comeback in Canada. How do you feel about that? Well, I think it's concerning, obviously, in terms of vaccine-preventable diseases returning and measles being one of the most infectious. It's not surprising to see that being the illness that's made a comeback. It is increasing all over the world and

And through international travel, the virus introduced into an under-vaccinated population or group of people and then spread to other under-vaccinated communities. So yes, I think this is a concern, but we can do something about it because we have a vaccine that is very effective and has been used for many, many years. So we know that the benefits outweigh the risks.

Recently, we heard from Dr. Kieran Moore, Ontario's Chief Medical Officer of Health, about six infants who've been born with congenital measles during the current outbreak. How dangerous is it for those infants?

I think measles, I think everyone should remember, is not a trivial illness and it can lead to complications. And so we see that fairly frequently. It can go from, you know, air infections to pneumonia to inflammation of the brain and some neurological sequelae. People who are pregnant are at higher risk of complications themselves, but it can lead to

complications with a pregnancy like premature birth or indeed sometimes stillbirth. They are rare, but I think it's not that surprising to see this when we have now close to 3,000 cases. So we are going to see severe outcomes. We had about 7% hospitalization rate. Some people in the ICU are

And so with that number, we will see infants being born with congenital infection. Now, that doesn't mean that they all have severe outcomes, but it is a concern because there's not just a short-term impact.

There's also a concern that maybe there's actual sequelae like SSPE, subacute sclerosing panencephalitis, which may not be observed for a little while. But so I think the bottom line is serious, which is why getting our vaccination up to date is very important.

You became Canada's chief public health officer in 2017. In 2019, before COVID, in your report on the state of public health in Canada, you referred to the post-social media world as, and I'm quoting here, the age of misinformation and disinformation, which complicates your role of communicating public health decisions to Canadians. What role do you think health misinformation and disinformation has played in bringing back measles?

I think misinformation has been around for as long as vaccines have been around, but definitely accelerated by the new technological advancements, these social media platforms. I think that we can do a much more comprehensive, holistic approach

multi-pronged approach to address misinformation. I think it plays a role, but I think we have to remember vaccine uptake is impacted by a number of factors other than misinformation. So getting access is very important. And sometimes people haven't kept up with their vaccinations during the pandemic. Of course, parents might have never seen measles, even some health workers.

How does the Public Health Agency of Canada and the next chief public health officer put the measles genie back in the bottle, or at least help to do so? One of the really key things that we all have to do is to build trusted relationships with different communities.

That is easier to do when you're at the local level because each community might have different historic experiences with the health system or with governments, and they may have different questions that they need to have answered. So I think we are there to provide some of that information.

What do you think public health at all levels should be doing differently to curb the spread? Based on the current epidemiology, most of the cases are occurring in communities that historically are under-vaccinated. So trying as hard as you can to reach the under-vaccinated, but also do everything we can to increase vaccine uptake in other areas of the country as well. I think one thing we do need is actually monitoring

more real-time data on vaccine coverage because people have done catch-ups. We don't actually know exactly where the situation with vaccine coverage lies because that really helps us focus in on some of the areas on the vaccination in order to concentrate our efforts and support individual communities.

I think answering people's questions and then I think the full suite of measures on addressing misinformation does come into play. From what you said, I'm wondering if you're making the case for a national vaccine record for all Canadians that would be easily accessible and would say who's gotten what when. Would you be in favor of something like that?

Absolutely, I'll be in favor of a nationally interoperable network of vaccine registries. I think that's how we would describe it. Using standardized information and then making the technology speak to each other is doable. I think going back to the COVID-19 pandemic, we're able to each get our electronic records. In Ontario, you would see a QR code.

you have it. You know your COVID vaccine records. So that's a proof of concept. We've done it before. And I think that the COVID advancements should allow us to be able to do that again. There's, in fact, quite a lot of work underway right now to develop those agreements with the provinces, as well as the more technical aspects of this. But it will be so much easier for public health

and for health providers and for the patients and the parents. That's the most important things that you will know whether your kids got the vaccine and that your health provider can have that information as well.

I want to turn to COVID, not surprisingly, given how much time you spent on the COVID file as the Chief Public Health Officer of Canada. But I want to ask you first how much you think COVID set the stage for declining rates of MMR vaccination that we see in Canada today.

I think we did a survey in terms of measurement of COVID vaccine coverage, a national survey. The last results were that 90% at least or 91 point something percent of two-year-olds have at least one dose.

Now there is a, you know, we haven't taken, we don't have another national measurement at this point, but we have had data from provinces that are able to provide it to us in more real time that there has been a drop, probably around like a 10% drop in vaccination. That's a lot when it comes to measles. I think that during COVID-19, yes, there's been a drop in vaccine coverage.

I think a lot of it may be related to access at the time and then the insufficiency of catch up, no matter how hard maybe people are trying. So I think COVID played a part in disrupting a lot of routine services. And this was one of them. At the same time, as we've discussed,

There's other factors at play in terms of maybe reduction in public trust as well as the mis- and disinformation. That's all kind of interlinked. What do you think you and the Public Health Agency of Canada got right in its response?

I think we really ramped up our operational stance pretty quickly from where we were at the start of the pandemic. I think the thing that was most astounding and most positive was actually getting a vaccine in under a year. And the moment I remember the most from a sort of positive stance is actually the first individuals

They tend to be older adults in long-term care facilities getting their vaccine in the middle of December. That was a tremendous lift. Were there other positives? There's actually increased collaboration. Just as an example, long-term care is a sector that before the pandemic wasn't as well linked to other parts, right, with hospitals, for example. And then there was more linkages during the pandemic, right,

including infection prevention control, linking with public health. I think the science was, you know, really quite incredible. Genomics is now standard of what we do in a lab.

wastewater surveillance wasn't there before. The vaccine records and digital health, I think, increased. On the healthcare side, I mean, just the telemedicine hybrids. The community partnership is another one. So during the pandemic, we had a lot of different programs. One was called the Immunization Partnership Fund, and we were to support community-based organizations that

black physicians, indigenous networks. So those kind of models, once escalated, are now becoming part of what we do. You and the agency also faced a fair amount of criticism. Some of it had to do with public health messaging. Masking, for instance, was criticized because of how quickly the guidance changed, and that undermined public trust. Is that how you see it?

managing a rapidly evolving situation in times of uncertainty is actually very difficult. When you have actual data and shifts, for example, shifts in the virus itself, it's important to change gears

and provide new information. And masking was one of them. The other thing is, I think we need to do a better job in explaining to people how the scientific informations are coming through, how we analyze it, and how we turn them into guidance. But also,

Getting national level consensus takes a bit of time. So all of this is going on. I'm meeting with my colleagues, the other chief medical officers, three times a week, just trying to reach consensus on how we do something.

So I think a lot of the public-facing understanding doesn't quite unpack the iceberg of all the work that goes on underneath. I also think it is hard when science is playing out in front of people's eyes in the media and how we manage that. As public health professionals, we need to tell the public, maybe warn them ahead of time that things can shift.

You faced a lot of criticism for how long it took to acknowledge airborne transmission of COVID-19. Do you think that was fair? So I would say the pandemic and all the sort of discussions about modes of transmission has actually moved the, I would say, scientific domain, but public health as well, in how we view the transmission of viruses through the air.

Where we were at the beginning of the pandemic is not where we are now. And I think I try to get messages across, I have to say, without getting into those details because the public needs some messages that they can understand. So what I was trying to convey was

were layers of protection but also the three C's. Like if you go in an enclosed, crowded, poorly ventilated kind of enclosed environment that's the highest risk. I think we were not out of steps with other international bodies but I was trying to even get ahead of that curve by providing some of those messages. So I would say yeah I mean we can always improve. It was hard

As the face of public health in Canada during COVID, you faced some deep personal attacks. Those must have been very lonely and difficult times for you. Yes. So personal attacks. Yeah. And again, speaking of a pandemic in a social media age, that's the vehicle through which a lot of the more personal comments came through and some of the

racist or misogynistic and you know so that was that came with the job of trying to communicate in different channels. Yes, it can be personally impactful but what I try to do certainly at the time and even now is just to just to focus on the job that I'm trying to deliver. So I think

In some way, my ability to be very focused on the task at hand really helped.

Also having support systems, and I quite soon recognized that while those types of attacks or messages can be upsetting to me, it was actually more upsetting to my office team and others who have to look through the social media or the correspondences. So I think the other thing that all of this taught me was, of course,

to look after our team and have the support systems. You have people who are there for you when things are tough, is really important. So your family supports, people are going to bring you food and actually help you get through. And one of my staff used to also read me the incredibly lovely cards and messages that

The public sent to encourage me to carry on was like the antidote to the other messages as well. So that really helped. During her lowest times in the pandemic, Dr. Tam has said that she leaned on family and friends for emotional support. We'll be right back.

Hi, everybody. I'm Jamie Poisson, and I host FrontBurner. It's Canada's most listened to daily news podcast. Just the other day, we were in a story meeting talking about how we can barely keep up with what's going on in Canada and the world right now. And, like, it's our job to do that. So if you are looking for a one-stop shop for the most important and interesting news stories of the day, we've got you. Stop doom-scrolling. Follow FrontBurner instead.

You're listening to White Coat Blackheart. This week, we're speaking with Dr. Theresa Tam, who just ended her time as Canada's chief public health officer. Our conversation turned to the Trump administration and its impact on public health. Just last week, Health and Human Services Secretary RFK Jr. fired all 17 members of a key body that recommends vaccines and began replacing them with people whose views align more closely with those of RFK Jr.,

This after cutbacks and firings at the National Institutes of Health and the Centers for Disease Control. You must have known a lot of the people who've been let go.

Yes, I mean, our colleagues in the United States, we've worked with for a very long time. And so that's, I know it's very impactful on them. But, you know, we continue to try very hard to work with the technical staff. I think we are focusing on, therefore, strengthening

our scientific-based evidence decision-making, even as we speak. You mean in Canada? Yeah, in Canada, absolutely. We're continuing to support NACI and its science-based recommendations. Health Canada continues to be a science-based regulatory authority. We continue to provide our science-based advice and messages.

To me, part of what's going on in the United States looks like the anti-science movement has gained institutional power in that country. Do you see any indications in, say, Alberta that the same thing might be happening here or could happen here? Um...

I think we need to be vigilant to different negative impacts on our programs. But I would also say that we can build on our strengths and that the fact that the majority of

people in this country get vaccinated. So I think you've probably heard of trying to reach the movable middle in terms of people who just want more information in order to get vaccinated. So all of those things have been done. Right now, I have not seen any jurisdiction

where people are not actually trying to increase vaccine coverage and they're all providing science-based information. So I'm sort of pinning my hope and

confidence in our public health system and our general public, but recognizing that other forces at play that might influence what's happening here. But we have been able to mount responses in our own way, focused on our Canadian values.

We've talked a lot about the last pandemic. Let's talk about what might be the next one. There are growing concerns that H5N1 or avian flu might be the next pandemic. How is the Public Health Agency of Canada dealing with that threat?

Yeah, so H5N1 has been devastating in birds in particular and has been transmitted to animals. So we are very vigilant about what is happening in that virus, how it is undergoing any changes, and of course the detection of human cases. And again, in this domain, we have to collaborate with the United States.

I would say one of the key parts that is a bit different is that we have a stronger One Health response now, collaborating with chief veterinarians, wildlife experts.

We've stood up an Avian Influenza H5 expert panel already. We already identified knowledge gaps in the research plan. CIHR is already, you know, they have a new center that is about pandemic response. And so we have domestic vaccine manufacturing.

We already secured H5N1 vaccine that is a non-pandemic vaccine, so a vaccine that could be used if we see more activity here in Canada. And we have antiviral stockpiles. You know, I've been part of the monitoring and response to H5N1 since I started in public health, which was 1997.

And so I think we need to keep monitoring it because there's an unpredictability in the behavior of this virus. So that's avian flu, H5N1. Is there a different pandemic, potential pandemic, that you've got your eye on? Well, for influenza viruses, H7 viruses, others that we're watching, there's a global network of surveillance for unusual influenza strains that are not normally circulating in humans.

Coronavirus surveillance is important. But I think strengthening global capacity to detect different virus families and different types of respiratory, you know, severe respiratory outbreaks, illnesses of unknown etiology is really important. Canada spends more per capita on its annual budget for the Public Health Agency of Canada than the U.S. spends at the Centers for Disease Control. Of course, that might be changing as we speak.

You know, the World Health Organization's annual budget is somewhere around $7 billion U.S. How do Canadians know that they're getting their money's worth? I mean, certainly in terms of public health system work, it is a very good question. People don't understand what is public health as opposed to the rest of publicly funded health care systems.

We've been, and certainly myself included, been championing the measurement of some of the public health system indicators so that it becomes much more transparent on the financial investments, the

the human resource capacity in the public health system and other really important capacities just so that we can explain to people in this country and decision makers, not just about the public health agency, but we're part of a larger public health system. I think the data is not

the greatest. In the end, a lot of our work is somewhat subterranean because we prevent things. So I think doing a better job at explaining that, but also from an economics perspective, as we all know, prevention is actually generally very cost effective.

And managing measles outbreaks is very expensive. Getting prevention in place is actually really not that much of an investment. Maybe you want to get your successor, the next chief public health officer of Canada, to gather data on how much it's costing to manage measles in this country at this time and compare that to what it would have cost, say, 10 years ago.

Exactly. So I think that's really important. That kind of information comes from the local level, obviously, because they're doing a vast amount of work. So I think that that would be a very interesting gathering of information for sure. I ask this because as we've seen in the U.S., it's not hard or maybe it's easier than we thought it would ever be to drastically reduce the budget for public health.

In this highly politicized era, how do you convince politicians of all stripes that public health is an absolute necessity for Canadians?

Yeah, so I think particularly in the current discourse about health and it being, you know, generally focused on some important things like getting primary care physicians and shoring up different parts of our health system, I think, you know, being able to convince people that

And by the way, a lot of the analysis shows that it's, you know, in the Providence Territory is probably, you know, it's certainly in the single digits in terms of what is spent on public health versus the whole health spending. And what you get in return in terms of prevention is huge. And also, I think the other messages are that public health reduces the impact on the health care system.

which we saw during the pandemic. In fact, public health was being asked repeatedly to enact actions which reduces the impact on an already strained health system. So that's really important. The other argument I think for public health is that it does impact productivity and therefore economy. If you didn't have a healthy workforce, you'll be less productive.

So I think, you know, certainly looking at health and well-being in the context of is an investment rather than a cost center, basically. So instead of a spending line, you should look at it as an investment. So I think we should all try and do that for our decision makers.

You're reminding me that before COVID, you spent a lot of time, and maybe that's your destiny, to have spent all that time on COVID. But before COVID, you were passionately interested in health disparities, weren't you? Yes, yes. Well, and throughout COVID, actually, as well. Because they were material in who got COVID and who didn't, and who died of COVID and who didn't. That's right. So my whole chief public health officer mandate, the whole eight...

plus years had the central focus on equity and health equity. The bottom line is, you know, where you live, work, play, learn impacts your health. Your health is

created not in the health system, health is created in those other systems. And the structural issues, the past histories of colonization, cultural language, and stigma and discrimination, including the health system itself.

results in health disparities and certainly social economic strata. You can see the differences in health outcomes for people. So I do think that is part of the role of public health is to point out those differences and then collaborating with other sectors

And I think one of the very critical and personally important area of work that I really try to lean into and really learn is our building of trust and supporting the rights and self-determination of First Nations, Inuit and Métis people. So that's been very central in my work. How else do you want Canadians to remember you? How else?

I think I again try very, very hard and you know every ounce of my energy in my work to try and bring that science-based advice. But I hope I've helped in communicating the messages so that people knew how to protect themselves and their loved ones.

And I think that I've been trying to do this in a sustained and calm fashion and that I'm very, very grateful for everybody who, everybody, and not just the health system, but Canadians in coming together and helping to address really hard things. So what's next for you?

What's next for me? I think there are just so many opportunities. And what I decided to do was to just take a little bit of time, not to just rest up, but in order for me to do some deep reflections and then see what's going to be purposeful to do for the next number of years. Are you going to miss the job?

I think so. I think what, and everybody says this, and I think it will borne out to be true in my case as well, which is I'll miss the people that I work with. Well, we will miss the opportunity to speak to you as Chief Public Health Officer of Canada. But I want to thank you for speaking with us on White Coat Black Art. And I wish you all the best as you enter the next chapter of your life and career. Thank you so much. Thanks for the opportunity.

Dr. Theresa Tam hands over the reins as Chief Public Health Officer of Canada. As a polarizing figure, I found her to be thoughtful, reflective and open-minded. Some worthy characteristics for her successor to emulate. Thank you so much and thanks for your work. If you need an assistant, maybe I'll, you know. And that's our show this week. That's it for the season. Beginning next week, White Coat Blackguard in the summer will air some of our favorite recent episodes.

The Dose is also taking a break, but we'll be back again after Labor Day. White Coat Black Art was produced this week by senior producer Colleen Ross with help from Jennifer Warren, Samir Chhabra and Stephanie Dubois. Our digital producer is Ruby Buisa. I'm Brian Goldman, and I'm proud to bring you stories from the Canadian side of the gurney. Have a safe and happy summer. For more CBC Podcasts, go to cbc.ca slash podcasts.