We expect informed consent to be upheld in all interactions with medical and health professionals along with other professionals and individuals in our lives including teachers, lawyers, paramedics and others.

Would we allow medical treatments to be given to us and our children without our informed consent?

For informed consent we need open dialog, assuring that the interaction is entirely open and transparent and the provider conducts themselves confidentially and ethically without conflict of interest. Information must not be withheld, delayed or obscured. This is the foundation of trust.

Have our political leaders, Prime Minister Justin Trudeau and BC NDP Premier David Eby, failed to uphold the importance of open dialog and informed consent?

Premier David Eby was too busy last year when I publicly invited him to a kitchen table talk along with Health Minister Adrian Dix and PHO Dr. Bonnie Henry (1).

Why were they avoiding an open dialog?

Only in May of this year, with the election approaching, the BC NDP Government finally lifted the mandate on health workers allowing them to return to work. The science didn’t change overnight. For years, BC was the last jurisdiction in the world with mandates not allowing unvaccinated health workers to earn their livelihood. Also following the announcement, the BC NDP Government has been slow in acknowledging the impact on the lives of those workers.

Eli Sopow suggests in his book that organizations in trouble commonly use “the 3-D defense: Deny, Delay and then Destroy critics” (2).

We don’t need a royal commission, but we do need to take a good look ourselves. Medical history tells us sunlight is the best disinfectant.

The limiting of dialog and stifling of discussions.

There are several examples of efforts made, deliberately or inadvertently, to limit dialog and stifle discussions on health care matters by provincial and federal governments, regional health boards, professional associations and health profession unions, exacerbated by the pandemic response starting in 2020.

During the pandemic in BC, the role of the Provincial Health Officer (PHO) saw mandates become dictates. While public health may focus on population health, with a tendency to view people as graphs, numbers and data, the PHO, Dr. Bonnie Henry, is also a physician and has the ethical responsibility to ensure informed consent rights are respected and upheld.

In fact, all politicians and political officials have a duty to respect and uphold our rights. Failure to uphold our rights including informed consent, even in emergencies, may not be acceptable or necessary and to extend the actions through prolonged mandates may be further violations.

At the very least, suspending individual rights even in an emergency cannot be undertaken without full debate in the legislature and parliament along with requirements for frequent and meaningful review. Imposition by a simple majority along party lines is not sufficient. Emergency measures should require a 2/3^rd majority or 75 per cent support to pass.

Did Dr. Bonnie Henry and the BC NDP Government get the right balance?

Did Dr. Bonnie Henry and the BC NDP Government get the right balance? We may never know. What we do know is, there was an abundance of lawyers paid for by government and on staff in the government drafting the mandates in full legalese. It’s easy to spot when you see pages on end. You might expect, since it’s coming from a doctor, it would be simple and brief, like a prescription.

The typical role for the Public Health Officer is to provide suggested treatments or recommendations and then be available for further discussions. Typically, a local hospital medical staff meeting or grand rounds would invite the PHO and the local public health officer, infectious disease experts and others including the full medical staff for a discussion.

Then, it is still the responsibility of individual physicians and providers, like public health nurses and others, to ensure patients are fully informed when providing consent for treatment.

Even in cases where the treatment presented is a recommendation of the PHO, as always, the physician or provider is still responsible to provide for informed consent from patients.

How well informed are we?

How well informed are we as patients, and by providers? It may have declined in recent years with the introduction and expansion of use of protocols. Now, will the quality of informed consent decline further, when recommendations are from a top official to be followed, encouraged and possibly enforced, especially in times of uncertainty, anxiety and fear?

In October 2021, when mandates were introduced for health care workers to be vaccinated against COVID-19 a number of health professionals and workers applied to Dr. Bonnie Henry for exemptions and provided test results with evidence of natural antibodies against the SARS-CoV-2 virus. Their applications went unanswered and they lost their jobs or retired early.

When questions were raised, they were not answered directly by Dr. Bonnie Henry. They were diverted to rhetorical responses, lawyers or the courts. Even judges presiding on these matters who expressed in court being miffed by the actions, were not willing to include that in their decisions or judgments.

There has been no requirement for the PHO to answer questions directly and taking the matter to court has been futile, resulting in judgments that neither provided answers nor required that answers be provided. This only added prolonged time delays and heavy costs, including increased costs to taxpayers for government lawyers.

Some media pundits showed numbers and graphs as if they were the full picture while ignoring other bodies of research.

From the start, the PHO Dr. Bonnie Henry and governments on all levels were focused on the rapid development and roll out of vaccines with recommendations and mandates for use. Their experts were convinced that mRNA technology was worth investment and expansion even though needing an exemption from normal testing requirements for new experimental treatments in humans that had never before been granted.

Was it easier for health professionals to repeat to patients the recommendations of the PHO Dr. Bonnie Henry than dig through medical publications themselves?

Are doctors more trusting and comfortable repeating recommendations passed to them like protocols? Are they more complacent having received a bonus from government in the form of payments by the Medical Services Plan for virtual visits, assuring their income would continue and possibly increase during the pandemic years and beyond?

How many physicians and other health professionals explored the science any further than the recommendations of the PHO?

It was not easy to examine the scientific literature

It was not easy to examine the scientific literature as it became available. And conclusions were hard to draw early on in the pandemic, as one might expect.

One of our key hopes was that herd immunity would emerge. Maybe it did, in pockets at first and more widely later.

Opportunities were missed that may have helped develop a better picture of the unfolding patterns of the illness and development of herd immunity, natural and acquired immunity.

The Provincial Health Laboratory, under the authority of the PHO, could have been directed to review and collaborate with UBC Department of Medicine professor of biochemistry Dr. Steven Pelech and Kinexus Bioinformatics labs in Vancouver that had developed simple tests to measure over 40 antibodies for the SARS-CoV-2 virus proteins to determine natural and acquired immunity.

There was nothing to lose. This is science after all. Researchers develop techniques for tests and share their findings to continue improving knowledge, understanding, techniques and treatments.

At some time, a lab in Alberta was chosen to conduct tests on weekly samples collected from physicians and others working in hospital emergency departments and on the wards such as at the Royal Columbian Hospital in the Fraser Health Region.

What were the findings of those tests and when were they reported? Some physicians said that, despite working with patients regularly since the beginning of the pandemic, their test results for natural antibodies were still negative years later. Were the tests from the Alberta lab as accurate or as comprehensive as those available through other labs like Kinexus who found rates of 90% positive antibody results by the middle of 2020, and strong detection in the same people a year later? These are important questions to ask to truly understand herd immunity.

It is not all in the past

It is not all in the past. The need for open dialog with questions and discussions is always with us. Take for instance this year as the cold and flu season is almost upon us. The vaccine recommendations are for people to get the flu shot and also the updated COVID-19 vaccine at the same time (even though it is not known what variant will occur here and it is not really seasonal although there are increases with gatherings, especially indoors).

Vaccines are available from pharmacists and medical offices. However, the government is only providing mRNA vaccines to Canadians for free. The Novavax vaccine, Nuvaxovid, a traditional vaccine consists of a measured dose of viral spike proteins, while it has met regulatory approval from Health Canada, will not be provided to Canadians for free according to reports of the decision by the Federal Government of Canada (3).

What is the difference between the mRNA vaccines and a traditional vaccine like Nuvaxovid?

I will share my understanding and I am open to corrections or additions.

The traditional inactivated vaccines, like the flu-vaccine, consist of a measured amount of inactivated viral particles that our bodies detect and respond to with creation of antibodies and stimulation of T-cells. Particles that drift away from the injection site are still detected by white blood cells in the blood and other tissues and they are dealt with in the same way.

The mRNA vaccines use a different mechanism. What is injected in our bodies are instructions in the form of mRNA. The amount of mRNA contained in different products varies significantly as known for the Pfizer and Moderna vaccines. The vaccine mRNA enters our cells and, like our own mRNA, is used by cell mechanisms to create proteins. In this case spike proteins that are placed on the surface of cells to be seen by our immune system as foreign and consumed to develop antibodies and stimulate T-cells.

The vaccine mRNA can give rise to many, many more viral spike proteins than particles in traditional vaccines and can result in trillions more. In addition, the mRNA freely floats into blood and is distributed to tissue cells away from the injection site, possibly distant sites, and wherever it lands it uses the body cells there to produce spike proteins with other potential consequences. Is this really needed? While our bodies are great at dealing with a lot of junk every day with our lungs, kidneys, liver, intestines and immune systems, do we need this extra load? Repeated high doses with an antigen induces tolerance so that the protective response of the immune system may actually decline against a foreign threat like the SARS-CoV-2 virus.

Individual rights to choose treatment, in this case: whether to receive a mRNA vaccine or a traditional vaccine, may be impacted by a need to pay privately or even a lack of available vaccines or knowledge they exist. Will all providers ensure patients are fully informed of the options before patients consent to receive treatment?

Open dialog should be the expected norm for political officials and leaders of our provincial and federal governments, just as it is for professionals and others. The ethics of leadership.

Many British Columbians want a change in government and a change in how government works.

Web links

(1) 2023 Apr 5 Dr Zafar Essak, Doclounge Three Reasons for a Chat with Dr. Bonnie Henry, BC Health Minister Adrian Dix and BC Premier David Eby.

(2) 2010 Jul 6 Book review Eli Sopow, The 3D defence; Deny, Delay, Destroy.

(3) 2024 Sep 6 https://www.cbc.ca/news/canada/new-brunswick/novavax-covid-19-vaccine-canada-fall-arthritis-immunocompromised-reaction-mrna-1.7312017

(4) 2022 Oct 17 Dr. Zafar Essak, Doclounge We are in grave danger, we have taken people out of the picture. Have we become leaders of entities not leaders of people?

(5) 2022 Mar 28 interview with Sonia Furstenau, disagrees with Dr. Henry’s approach and how public health works best through sharing knowledge and understanding, https://www.thisisvancolour.com/blog/2022/3/28/150-sonia-furstenau-bc-green-party

(6) 2021 May 10 interview with Sonia Furstenau on the withholding of granular health data from the public and health care workers, Mo Amir’s show “This is Vancolour”, https://www.thisisvancolour.com/blog/2021/5/10/123-sonia-furstenau-bc-green-party

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