“Acting decisively despite imperfect information… is at the heart of crisis leadership”: MPP alumnus interviews Canada’s Chief Public Health Officer

Dr. Emily Stowe and Dr. Jennie Trout paved the way for women to practice medicine in Canada. Your appointment as Canada’s Chief Public Health Officer was historic – you became the first woman to hold this office. What insights have you gained about leadership, resilience, and the evolution of public health? And what advice would you offer to young women in science who aspire to follow in your footsteps? 

When I entered medical school, it was still relatively rare to see gender parity in the field. Today, we see many more women pursuing medicine, but at that time, it was a different landscape. My interest in science and a deep desire to work directly with people led me to pursue medicine, becoming the first in my family to do so. Looking back, I realise I was often the first—or one of the few—in various academic and professional milestones, though at the time, I didn’t perceive it as breaking a glass ceiling. I simply moved forward, unaware of the precedent I was setting. 

In many ways, I stood on the shoulders of the trailblazing women in Canadian medicine—women like Dr. Emily Stowe and Dr. Jennie Trout. I see myself as part of a continuing legacy, helping to expand opportunities for women in healthcare and leadership. 

I immigrated to Canada, and my journey into public health was not linear. I initially trained in paediatrics and later specialised in infectious diseases—not just because I was fascinated by pathogens and their impact on individuals and communities, but also because of the field’s global dimension. At the time, there was a sense in medicine that infectious diseases were on the decline—antibiotics and hospital protocols were thought to have them under control. I disagreed. I believed infectious diseases would remain a significant global challenge, and I was drawn to that complexity. 

I pursued field epidemiology training to become, essentially, a disease detective—investigating outbreaks both in Canada and abroad. That led to work in polio eradication and deepened my understanding of global health. I didn’t plan to work in public health, nor did I aim for this leadership role. I simply remained open to possibilities. Sometimes the door you thought you’d walk through isn’t the one that opens—but walk through it anyway. Make the most of what’s in front of you. Resilience has been central to my career. Medicine tests you—in training, in practice, and in leadership. 

Resilience, to me, is about building strong support networks—professionally and personally—and cultivating self-awareness. You have to understand your strengths and recognise when you need others. I often compare life to running a marathon. It requires sustained effort, preparation, and learning how to push through walls. I wasn’t the fastest marathon runner, but I trained enough to finish—and finishing can be more meaningful than speed. 

A colleague once told me, “Bumps are part of the road.” And that’s exactly it. Every setback is part of the journey, and every challenge prepares you for the next. 

To young women entering science or medicine: remain curious. There is enormous purpose in this field—in serving individuals, and in contributing to the health of entire populations. Medicine is a vast landscape; you will find your path, even if it’s not the one you first imagined. 

Leadership, too, evolves. When I transitioned from clinical work to management, it was a profound shift. I had to learn how to lead teams, develop systems, and manage human resources—skills that are essential to strengthening the public health infrastructure. These are investments in people, and people are the foundation of public health. 

So yes, there are moments in any career where you face pivotal choices. See those moments not as endings, but as opportunities—to grow, to lead, and to support others. That mindset has shaped my journey, and it’s one I hope to pass on to those who come next. 

Dr. Tam, you have served as an expert on multiple World Health Organisation committees and have played a pivotal role in leading Canada’s response to some of the most significant public health crisis of our times – SARS, H1N1, Ebola, mpox, and, most notably, COVID-19. What does crisis leadership mean to you and what guiding principles shape your approach? 

My role, fundamentally, is to provide science-based advice. While elected officials ultimately make decisions, my responsibility is to synthesise the science, assess the risks, and present options to inform policy. 

Throughout my career, I have been deeply immersed in emergency management. I see the role much like conducting an orchestra. You have a detailed emergency plan—the score. Each part of the system is like a section of the orchestra such as strings, woodwind or percussion: experts in their field, from epidemiologists to logistics teams. My job is to unify those parts into a coherent response. Conducting requires trust, a sharp ear, and the flexibility to interpret and adapt. The plan is never rigid; it evolves as the crisis unfolds. 

Another principle I hold closely is humility. In a crisis, especially one defined by uncertainty, no one has all the answers. Humility is a capability. It's the ability to admit what you know and, more importantly, what you don’t know—and to communicate both clearly. It’s also about acting decisively despite imperfect information. That balance is at the heart of crisis leadership. 

Communication is another cornerstone. Being transparent and speaking frequently—internally and publicly—builds trust. People don’t expect perfection, but they do expect honesty and consistency. They want to understand the rationale behind decisions. And, in turn, they want to feel heard. 

In turbulent times, I return to my core values. They are the compass in a storm. Whether it’s protecting population health, promoting equity, or upholding science, these values ground me when the path ahead is unclear. 

Crisis leadership is also about sharing power. It’s about building strong teams, delegating authority, and trusting others to lead in their domains. During the COVID-19 pandemic, I worked closely with provincial and territorial Chief Medical Officers. We often said, “We’re all in the same storm, but in different boats.” Recognising those differences, while coming together as a community of practice, was essential. 

And finally, kindness matters. When stress runs high, patience and compassion become leadership tools. You must be generous with your team, even when you yourself are under strain. That grace—that humanity—is what sustains both individuals and institutions in a crisis. 

Throughout the COVID-19 pandemic, your daily briefings were a critical source of information for millions of Canadians. Yet, we have also witnessed an alarming rise of mis- and disinformation, eroding public trust in science and institutions. How can we combat this phenomenon and restore trust? 

As leaders in the health system, restoring and strengthening public trust is a top priority. One of the first steps is understanding the current landscape—gathering data on public sentiment and trust. Surveys by the Canadian Medical Association (CMA) and the Government of Canada consistently show that, while trust in government may waver, health professionals—doctors, nurses, pharmacists—continue to be highly trusted. That’s a critical asset. As health professionals, we have both the responsibility and the opportunity to build on that trust. 

In this digital era, misinformation spreads rapidly and takes root. We need to approach this with the same mindset we apply to public health and emergency management. First, we must detect and respond to misinformation in real time. Tools such as AI and open-source social listening now allow us to track misinformation as it spreads. But reaction alone is not enough—it’s also about prevention. 

Public health teaches us the value of upstream intervention. The equivalent of “vaccinating” against misinformation is pre-bunking—engaging communities before disinformation takes hold. For example, with new vaccine technologies like mRNA, we need to involve the public early—during development and clinical trials—not just at the moment of rollout. That includes educating people on how clinical trials work, what regulatory bodies like Health Canada do, and how safety is monitored. Transparency throughout the process fosters confidence. 

Science and health literacy must begin early, embedded throughout education systems, continuing into adulthood. But even that is not enough. We need to address structural factors—particularly the roles and responsibilities of social media platforms. Right now, we expect parents to safeguard children navigating digital environments without any real regulatory “seatbelts,” unlike in other areas of public safety. That must change. 

The future also depends on how we govern AI. It’s not just about concern—it’s about active engagement. We need to ensure AI is harnessed for good and for equity, especially in its role in shaping public discourse. 

Ultimately, tackling misinformation requires a whole-of-society response. Right now, different players—whether it’s the CMA, MediaSmarts, Science Up First or government initiatives—are operating in silos. We need to map that landscape, connect these efforts, and amplify their collective impact through coordination and collaboration.

Rebuilding trust also means delivering on promises. Institutions must be competent, reliable, and transparent. People trust those who listen, who centre their work on community needs, and who act on shared values. Concepts like operational transparency and participatory governance are essential. Canadians don’t just want to hear the final recommendation—they want to understand how it was reached. They want openness in science, accountability in regulation, and the ability to participate, particularly youth, people with lived experience, and community leaders. 

As we move toward modernising health promotion, how do you envision creating a public health system that meaningfully supports Indigenous communities and ensures culturally competent care? 

Building on Canada’s leadership in health promotion means expanding our foundational frameworks—like the Ottawa Charter—into the broader space of well-being. Today, we also have the Geneva Charter, which allows us to think more holistically about what drives well-being and how public health must evolve to support it. My final report will focus on well-being and public health, reflecting this evolution. 

Health is created where we live, work, learn, and play. Over the years, I have worked to ensure our frameworks are rights-based and aligned with our responsibilities toward Indigenous rights and reconciliation. This means embedding Indigenous self-determination in all aspects of public health—including in data governance and sovereignty. Collaborations with Indigenous organizations like the First Nations Health Authority and our national Indigenous partners are essential. At every level of public health, we must co-develop and co-create solutions with Indigenous communities—rural, urban, and remote alike. 

Crucially, we must recognise that Indigenous communities offer vital knowledge. Their holistic approach to health and well-being aligns closely with how we are reframing health promotion in Canada. In fact, we are not merely supporting Indigenous communities; we are learning from them. Indigenous worldviews often take a multigenerational perspective—such as the “Seven Generations” principle—which is profoundly relevant to the long-term vision of public health, especially in contrast to the short-termism of political cycles. 

Structurally, we are beginning to shift our governance frameworks. As co-chair of the Public Health Network Council, I work with federal, provincial, and territorial colleagues to support policy development across Canada. We are learning to build what we call an FPTI approach: federal, provincial, territorial, and Indigenous. 

We now have an Indigenous Rights and Reconciliation Working Group under the auspices of the pan-Canadian “Unlearning Club”—a space for public health leaders to deepen their understanding of the United Nations Declaration on the Rights of Indigenous Peoples, the Truth and Reconciliation Commission's Calls to Action, the National Inquiry into Missing and Murdered Indigenous Women and Girls’ Calls for Justice and how to respectfully collaborate with Indigenous experts and communities. It’s a model of what learning, humility, and shared leadership can look like in public health. 

In your 2024 “Realizing the Future of Vaccination for Public Health” report, you advocated the critical issue of access, particularly for underserved populations. What specific measures are you implementing to close the gaps and ensure equitable access to essential vaccinations for all Canadians? 

Equity is central to how we approach vaccination—just as it is to public health more broadly. We are working to ensure that everyone in Canada, regardless of where they live, their education, or socioeconomic status, has equal access not only to vaccines themselves but also to trusted, culturally relevant information. 

A major barrier is inequitable access to information. That’s why we are investing in community-led, culturally competent communication through the Immunization Partnership Fund. This initiative supports grassroots organisations—such as Black physicians and community leaders—to develop and share vaccine messaging in ways that resonate with their communities. People may distrust institutions, but they often trust community leaders. By funding these leaders, we build vaccine confidence from the ground up. 

Take the HPV vaccine, for example. It’s a remarkable tool in cancer prevention—not just cervical cancer, but a range of cancers across all genders. And the promise of eliminating cervical cancer in Canada is within reach. But those most at risk—people experiencing systemic inequities—are often the least likely to access it. Ensuring equitable access to the HPV vaccine could significantly reduce cancer disparities. 

Ultimately, vaccines are not only a powerful tool to protect against infectious diseases—they are also a pathway to reducing broader health inequities. We must treat access to vaccination as a public health imperative grounded in social justice.