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The Current Transcript for March 03, 2021

Host: Matt Galloway

STORIES FROM THIS EPISODE

Prologue

SUPRIYA SHARMA: Good morning.

MATT GALLOWAY: How is it possible that in the space of a couple of days, Health Canada approves a vaccine? And then, NACI says that vaccine shouldn't be given to the population that is at the most risk of serious outcomes of COVID?

SUPRIYA SHARMA: Let's begin with, you know, as you said off the top, that we are in a we're in a kind of complicated phase in terms of data around vaccines. But in a way, it's wonderfully complicated. We never expected that a year ago that we would have three vaccines authorized in Canada, two more under review, and then having huge mass-vaccination campaigns working internationally, sharing all of that information and then making decisions as we go along in real-time. So, you know, I'm really glad that you asked in terms of the age range because when we look at it, so from the Health Canada perspective, we looked at the data from AstraZeneca on their vaccines. And in our product monograph, which summarized, you know, all that information that we looked at, we also noted that there was limited information for people that were 65 years and older. But we had information from, you know, the U.K. and other places where they'd been doing vaccinations, that it did show that in that age group from real-world information that the benefits outweigh the risks. Now, that's really looking at the vaccine if you don't have an alternative. So it looks that if somebody gets the vaccine versus if somebody did not get any vaccine, NACI also looks at that information that they're looking at it from a perspective of, OK, if we have multiple vaccines available, which would be the preferred choice for an age group. So, you know, I think that actually it lines up in that we said it's not that if we have a safety issue with AstraZeneca in the older group, it's not even that we think it might not work. It's that we don't have that much information.

MATT GALLOWAY: Right.

SUPRIYA SHARMA: So I think the messaging is instead of this is not recommended for people 65 and older, it's more like, hey, listen, we've got two other vaccines that are authorized that works incredibly well at this age group. So we have more data on that.

MATT GALLOWAY: You said the science was wonderfully complicated. You can understand how it could be wonderfully confusing to people. That this is to a lot of people it doesn't make sense. Do you understand that... that confusion that people might feel?

SUPRIYA SHARMA: You know? Absolutely. And that's why it's really important that whatever decisions we're making, whatever organization we need to be really open with, that we need to be sharing the data. And most importantly, the reasons that we're making those... those decisions. But I think what people need to get accustomed to is that this is going to continue to evolve. We are going to continue to have information from more clinical trials. We're going to have more information coming in as these vaccines roll out. And it's really important that we're able to make decisions based on the best available evidence that we have at that time.

MATT GALLOWAY: So how are provinces meant to balance this kind of competing information? I mean, the most populous province, Ontario, says that seniors won't be getting the AstraZeneca vaccine, those over 65, right now. What are provinces supposed to do about this?

SUPRIYA SHARMA: You know, I think across the board with provinces, they look to the NACI, the National Advisory Committee on immunization, recommendations for how to use the vaccine. Then they take that information and put it into their own context. You know, each province and territory is, in effect, kind of living through a different kind of pandemic. So the data, the epidemiology is different. They also each province and territory has a different demographic. So for this one, with respect to the NACI recommendation to, at this point in time, not use the AstraZeneca vaccine for people 65 and over, from what we understand, all provinces and territories are going to be aligning with that. So there shouldn't be any... any differences, any confusion at this point in time around the use of the dose. So what we're saying is that for people that are 65 and older, the preference would be to use one of the mRNA vaccines, so Pfizer or Moderna.

MATT GALLOWAY: But there is a lot of confusion. And I guess I just wonder whether you're worried about what we've been seeing in Europe, where France didn't initially recommend the AstraZeneca vaccine for over 65s. They've reversed that policy. Germany has indicated that it might approve it for over 65s. But in the meantime, there's been a very low uptake of the AstraZeneca shot. I mean, thousands of doses apparently are going unused. Do you worry that that scenario could repeat itself here in Canada?

SUPRIYA SHARMA: You know, I think, I mean, I'm always worried that people won't have... have the confidence in going ahead and getting vaccinated because it's such a key tool in terms of, you know, getting our arms around this pandemic, getting the case numbers down, preventing hospitalizations, serious illnesses and deaths. So that's always something that, you know, we're concerned about. What we're hearing and what we're seeing so far in Canada is that people are really anxious to get the vaccine. And so what I want to say to people is by the time a vaccine is offered to you, it's gone through the Health Canada Assessment, it's gone through NACI recommendations. We've done a complicated look at how we should distribute those vaccines. Provinces and territories are making decisions about what's right for their population. So by the time a vaccine, whatever the vaccine is offered to you, it really is a good option for you at that time. And I think that's the bottom line. We're going to keep getting information. We're going to keep modifying our decisions. That's exactly what we need to do. But I think overall, people should know that this system, although, you know, there's lots of inputs and we're making lots of decisions, is really designed to make sure that the option that's available to them is the best option.

MATT GALLOWAY: Just finally, on that, speaking of decisions, do you have a sense in terms of the timeline as to when a decision would be made on the Johnson and Johnson vaccine?

SUPRIYA SHARMA: Yes. So that review is progressing really well. There was some sort of major information that we were expecting to get in last weekend, which we did. And so I'm expecting we'll make a decision within the next two weeks on that vaccine.

MATT GALLOWAY: Let's move to another issue, which is second doses. British Columbia is set to draw out the timeline between the first and second doses of Pfizer and Moderna vaccines. The companies that make these vaccines have recommended four and three weeks, respectively. BC is Looking at extending it to four months. Quebec is considering this. Ontario is considering this. And The Globe and Mail is reporting this morning that NACI will endorse that longer timeline. Is this something that Health Canada supports?

SUPRIYA SHARMA: Yeah. So with respect to what we call... what we're calling delayed second dose, NACI is looking at this for some time as well, and actually presented to all the provinces and territories on the weekend, even before BC kind of came out with their decision. So, you know, I think that all the provinces and territories are thinking about this at this point in time. Now, it's the same sort of a similar thing with the dosage interval as it is with the age in that what NACI is doing and what others are doing are saying, OK, this is what the clinical trials were saying. This is what it's approved for, which we base mostly on the clinical trials. But, in the real world, we're starting to see evidence from other countries that have delayed that second dose that show, oh, it looks like they still have really good effectiveness. We have lab studies, what we called immunology studies that show it's unlikely that that immuno, you know, that immune response will drop off. And we're in a situation where we have limited supply. So what everyone is looking at is saying, OK, what's better? Is it better to get one dose of a vaccine into everyone and delay that second dose because we can get broader coverage? Or do we need to stick to the schedule? And what we're starting to see is that we have greater and greater comfort in knowing that that immune response is there long enough that we can wait for that second dose. So, again, it's... it's sort of the real-world decisions that we need to make based on supply and what we're seeing from the vaccines rolling out versus what the sort of the strict interpretation of the clinical trials were. And when the design of clinical trials, they're looking at that shortest interval possible because they're trying to get those trials finished so we can get results, and we could get authorized vaccines.

MATT GALLOWAY: Again, are you concerned at all about mixed messaging on this?

SUPRIYA SHARMA: I am. I am. And I think it's really, really, really important for all of us to be as coordinated as possible to give consistent messaging. You know, we're in times where we're all living through unprecedented times, probably the most overused word that we've had in the last year. And there's so much that's new and there's so much that's I'm certain that, you know, Canadians need to get the same information represented in the same way. And to know that whoever's making decisions is doing it, you know, we're basing it on science and evidence and what we're living through at this moment and have confidence in those decisions. So, you know, I think as much as we can make sure that we're coordinated, we're, you know, as open and transparent about everything that we're doing and saying, including talking to... to the media about it and a regular basis, which we are doing, I think people will then, you know, hopefully get the message. But we want them to absolutely have confidence in the vaccines because only if they have confidence in vaccines will people roll up their sleeves and get vaccinated.

MATT GALLOWAY: Dr. Sharma, good to speak with you. Thank you very much for your time this morning.

SUPRIYA SHARMA: Well, thank you.

MATT GALLOWAY: Dr. Supriya Sharma, chief medical adviser for Health Canada. We did request an interview with someone from the National Advisory Committee on Immunization. No one was available to speak with us this morning. Dr. Sumon Chakrabarti is an infectious disease physician at Trillium Health Partners in Mississauga, Ontario. He's been listening into our conversation. Doctor, good morning to you.

SUMON CHAKRABARTI: Good morning.

MATT GALLOWAY: What do you make of what you just heard from Dr. Sharma there? She says that in some ways, what we're seeing is wonderfully complicated. It's also, I think, confusing to the average person. What do you make of that?

SUMON CHAKRABARTI: I agree. This is the issue that I've had with the messaging is that it's true that science can be confusing. Science, we have to often pivot because the evidence can change. And we have to do our best to make the best decisions with the information we have at the time. But at the same time, we have to be careful because this confusion can have a different sort of interpretation in the public than it does in individuals who are in science. And I think that one of the big things that I'm worried about is that with AstraZeneca specifically, the well has now been poisoned. We have a perception that it is a inferior vaccine, which it is not. It does the important things that we know that Pfizer and Moderna do, which is prevent death and hospitalization. And, you know, right now, it works, real-world evidence that it works in people 65 and older. So I think that this has, you know, changed the perception of it in the public. And I hope it doesn't cause the same problem like it did in France and Germany.

MATT GALLOWAY: Do you think that real-world data like what we're seeing in the U.K. and Scotland and elsewhere should that be taken at the same value as clinical trials when it comes to determining who should get the shot?

SUMON CHAKRABARTI: I think rather than being taken, you know, as an alternative or at the same face value, we should just put all the evidence together. We do know with clinical trials, the conditions in those trials are not the same as they are, you know, especially in the real world. So when you start to see how things are rolling out in the real world, you can now add that to the massive clinical data that you have. We're seeing out of the U.K. That the vaccine is working great and is having real-world benefit of reducing death and hospitalization. So I think putting those things together, it looks to be safe and effective. And I think we should be having AstraZeneca in our toolbox for everybody.

MATT GALLOWAY: OK, so what do you say then to those who are left, you know, with their head spinning, given the conflicting bits of information about this? If you're over 65, should you expect not to get the AstraZeneca vaccine right now?

SUMON CHAKRABARTI: As of today, time-stamping our conversation, whatever it is, March the third? Yeah, I think that if you're over 65, it's not being recommended. But I'm hoping that this will be updated within the next couple of weeks. And I suspect at some point in the... in the short-term, individuals age 65 and older will be eligible for AstraZeneca. But like Dr. Sharma said, our goal right now is to reduce death, hospitalization and get out of the pandemic. And the vaccines are our ticket to that. We have the vaccines in our hands right now. We just need to get them into our arms.

MATT GALLOWAY: And so if you're 64 or 63, what should you do about this? I mean, that's close to that cut-off age, right?

SUMON CHAKRABARTI: Absolutely. And there's no magical change that happens, at least physically, when you change from 64, 65. And that's why I say that if you have the opportunity of getting AstraZeneca, I would get it. And you can rest assured that is very, very effective at preventing death and hospitalization, just like Pfizer, Moderna and Johnson and Johnson we've seen in the trials. And this is our ticket out of the pandemic if we get it broad enough.

MATT GALLOWAY: If provinces don't use this vaccine on those over 65, and we're hearing that a number of provinces aren't going to do that right now, who should get the AstraZeneca quickly? Half-a-million doses are set to arrive today. There's an expiry date on many of those current doses. They need to be used by the first of April or somewhere around there. So who should get those shots?

SUMON CHAKRABARTI: So I would say that the backup plan, while we're deciding this is go to the other priority group is the people living in hotspots. So, for example, where I am in Peel or Toronto or Windsor-Essex, where we also know that there's been a lot of transmission occurring in other high-risk essential jobs. So that's what I would say. To shuttle it there because it doesn't have that complicated cold chain. It can be brought into those areas much more easily and quickly. And that's what I would say would be the next priority.

MATT GALLOWAY: Dr. Sharma has said this, and we've heard this from others as well, that there's no, I mean, the vaccine is the vaccine is the vaccine. That if they approve it, there's no benefit in waiting or shopping for, you know, one vaccine or a preferred vaccine. But do you worry that people will do that, that they will hold out, as we have seen in other countries, and say, I'm going to wait until that other vaccine comes on-line or I can get that other vaccine?

SUMON CHAKRABARTI: That is exactly what I'm worried about. And the thing that I think in science that we have to remember is that the way that we can sometimes process scientific evidence is not the same where somebody who's not in science processes it. And, you know, like I told you before, I'm worried about the well being poisoned. And now, even if AstraZeneca is updated for 65 and older, people will worry about taking it. But my reassurance to the public is that, yes, we have real-world evidence that AstraZeneca works effectively, we're seeing that coming out of the U.K. And all the vaccines that we have right now that are approved in Canada, they are extremely effective at preventing hospitalization and death. And those two things are the reason why we've been doing these community restrictions, to begin with. So if we have something that reduces that, you know, that's our way out of here.

MATT GALLOWAY: We're also seeing in some ways, you know, the goalposts moving a little bit when it comes to the second doses of Pfizer and Moderna. And NACI is apparently, Globe and Mail reporting this morning, endorsing this idea of delaying the second dose for upwards of four months. British Columbia has moved ahead on that. There are other jurisdictions that are looking at that as well. Is that a wise idea to get as many shots into arms as quickly as possible and delay that second dose?

SUMON CHAKRABARTI: This is something that I do think is a great idea. Because what you want to do is it's better to, say, in a population of 100 people, it's better to have 100 people partially covered with one dose rather than 50 covered with two and then 50 covered with nothing, completely unprotected. Because what we want to do is interrupt transmission. We want to decrease death and hospitalization. And having that after one dose is happening, it's not happening to the full extent, but it's still happening partially. And that still will reduce transmission across the population. I still think that it's important for us to get that second dose. A delay as OK. We have precedent with that, with other vaccines. We just don't want to delay it too much. You want... don't want to be delaying it, you know, six months, eight months, 12 months. But as long as I think that as many people get a first dose as possible, that's the best way to go on the population level.

MATT GALLOWAY: Could that prevent or create issues in terms of people coming back for that second dose? I mean, if you come back for the second dose in two weeks, that's fine. You remember that appointment. Maybe four months down the road, life picks up, particularly if you know the nature of the pandemic changes. Are you worried that getting that second dose may prove difficult?

SUMON CHAKRABARTI: Absolutely. And we know that's even difficult when you're doing it three weeks from now. You know, everyone's life three weeks from now can change. But... but that's... I think that is a price... I don't even want to say a price. That's a complication I think is worth meeting. Just because we know the benefit, the large benefit of having so many people covered with one dose greatly outweighs the the risk of missing an appointment here and there. But I think that we'd still be able to work that out.

MATT GALLOWAY: Science evolves. And I mean, that's one of the things about science, is that it changes. It's not static. New information comes on-line and you show that you are bringing that new information on by changing your opinion or evolving or, you know, growing in light of the new information that you have. But do you worry about that change leading to greater vaccine hesitancy? And it's not people who say that they're never going to take a vaccine. It's people who perhaps are confused by the information. And I just wonder how we go about tackling that hesitancy? This is something that Dr. Sharma says is a real concern. What about for you?

SUMON CHAKRABARTI: Yeah, I completely agree. And this is something that I routinely make an effort to speak to my friends and colleagues who are not in the medical field to get an idea of, you know, what they're thinking, hearing the news, hearing all this information and try to help with that. And also, another thing that I've noticed is that, you know, sometimes vaccine hesitancy can be met with some hostility. And, you know, for me, lots of people, including myself before, have questions about the vaccine. I think it's important to ask those, answer them compassionately. And I think for most people that are on the fence, it really helps.

MATT GALLOWAY: And so in the face of this, again, conflicting information or competing information, different bits of information coming out day-by-day, what do governments need to do now to present clear messaging to the public?

SUMON CHAKRABARTI: I think the idea is to realize that the way the public will process scientific information is not the same as we will. I think it's very good to be transparent and know that the data can change. But, at the same time, you still should be making some kind of recommendation that seems like a consensus across the people who are involved in messaging. And I think that at least right now, with AstraZeneca, this has not been the case. And I think it's important for us to have a unified message. Yes, it can change. Yes, you have to be transparent about that. But you don't want to be conflicting right at the point of messaging. And like I said, the AstraZeneca is a vaccine that is going to be a great tool to help us get out of the pandemic. And I don't want people to think that it's inferior in any way to Pfizer and Moderna.

MATT GALLOWAY: Dr. Chakrabarti, good to speak with you. Thank you very much.

SUMON CHAKRABARTI: You're welcome. Take care.

MATT GALLOWAY: Dr. Sumon chakrabarti is an infectious diseases physician at Trillium Health Partners in Mississauga, Ontario. Your CBC News is next. And then, a bit of a different take on health care from somebody who has been on the front lines and is going to be helping to lead many doctors in this country. He is a self-described medical ninja, [chuckling] soon to be president of the Canadian Medical Association, the first Indigenous doctor to lead that association, Dr. Alika Lafountaine, coming up in six minutes. I'm Matt Galloway. You're listening to "The Current" on CBC Radio One. Stay with us.

Dr. Alika Lafontaine becomes first Indigenous president of the Canadian Medical Association

Guest: Alika Lafontaine

MATT GALLOWAY: Good morning. I'm Matt Galloway. And you're listening to "The Current".

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MATT GALLOWAY: Still to come, 18 and on your own, why many say that change is needed to Canada's child welfare system. But first, one of Canada's next top doctors.

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MATT GALLOWAY: For years, Dr. Alika LaFountaine has been seen as someone with an important voice in Canadian medicine. He's listed on the medical posts, Doctors With Sway, a list of the top 30 most influential physicians in the country. Now that influence will come to be felt in a new position. Dr. LaFountaine has been chosen as the next president of the Canadian Medical Association, which represents doctors across this country. He is an anesthesiologist in Grand Prairie, Alberta, and will be the first Indigenous doctor to head that organization. Dr. LaFountaine, good morning.

ALIKA LAFOUNTAINE: Good morning.

MATT GALLOWAY: Why did you want this position?

ALIKA LAFOUNTAINE: I didn't really map out my leadership journey to arrive here, but I think in the past year with the pandemic, it's been pretty clear that the weight of a lot of the pressures within the system have falling on top of the shoulders of physicians. And looking around to my colleagues and my own experience, I really felt like I wanted to do something to make a difference. And that's one of the reasons why I became involved in the... in the election campaign.

MATT GALLOWAY: I mentioned in the introduction that you are also the first Indigenous doctor to lead the CMA. What does that mean to you?

ALIKA LAFOUNTAINE: I think that it's... it's a moment where people get to reframe expectations for what the Canadian Medical Association is. Any time that you get a person who has a different type of lived experience and for those who are Indigenous, can see their own people within these leadership positions, I think you trigger an opportunity for people to hope for something different. And I think that's the real promise of, you know, diverse and inclusive leadership positions, is we can imagine, a different future.

MATT GALLOWAY: Let's talk about your lived experience. You come from Treaty Four territory in southern Saskatchewan. What was it that made you want to become a doctor?

ALIKA LAFOUNTAINE: So when I was young, my mom used to talk to me lots about her experiences within the health care system, and as I got older, things became more specific. I have a memory of my mom actually coming on the very first day I officially became a doctor. She had come by to see me walking around in the hospital with, you know, my white coat and my stethoscope, seeing patients and other things. And she shared with me just how scary it is sometimes to come into the health system and how relieved she was that if she got sick, she'd have someone that she could trust to help her navigate a system that's often very complex and at times unfriendly to patients. And I think for me, becoming a doctor was really a way to circle back and make sure that my family felt safe and was safe when they navigated the system. Now, that's obviously scaled to including patients who experience racialization and other types of disempowerment. So not just Indigenous, but other people who experience isms like sexism and ableism, et cetera. And I think that that's one of the focuses that I really want to have in my role as president-elect and moving on to the other roles in the CMA.

MATT GALLOWAY: What did she tell you about what she'd faced in the health care system?

ALIKA LAFOUNTAINE: She shared some specific experiences where she felt like trust and communication wasn't at the levels that she would have expected. She talked about feeling like she didn't have the same sort of choice as other patients. And, you know, as a provider, I have a perspective to kind of layer on top of that experience where I know that in the ways that we talk, in the ways that we present information and in the ways that we accept truth that comes from patients, often we can frame the relationship in a way where patients do feel these ways. You know, I never say to any of my colleagues that any of us ever come to work wanting to harm patients. But because of the things that we've inherited through this culture of colonialization that, you know, has been a part of Canadian history, and because of the way that medical culture is just starting to tap into understanding this disempowerment, I think it's a real risk for patients and something we need to address.

MATT GALLOWAY: I think of what happened to Joyce Echaquan, who was a young woman in Quebec who recorded and posted on Facebook the last moments of her life in a hospital where she was in great distress and screaming in pain. And you heard health care providers in the background making degrading comments, calling her stupid and what have you. Obviously, it's not... what happened with your mother is not as extreme as that. But did that sound familiar to you when you learned of the... the story of Joyce Echaquan?

ALIKA LAFOUNTAINE: I think one of the things for Canadians to understand about racialization within the health care system is the first time you see it, it's never the first time. The fact that Joyce went out of her way to start that Facebook Live as a way to document and validate her lived experience, I mean, she must have gone through that many, many times. And I think that's what you heard when you talked to her family and her friends who knew her and went through some similar experiences in the area that they received care. When you look at the continuum of discomfort and pain for people who experienced this disempowerment, and I think it... it speaks more broadly to is the Canadian experience within the health care system. The question isn't really whether or not it was worse, I think. I think it's whether or not it's cross that threshold of whether or not it should be a part of the health care system? You know, patients should be able to come to see physicians and other providers and just go through their experience in the health care system in a way where they feel empowered and trusted and can have faith in their providers to make decisions that really co-create this pathway through, you know, disease, complexity. And I think that we struggle sometimes when it comes to certain patient demographics. And that's a cultural thing. But I also think it's a systemic problem where we haven't made the proper investments in resources. And because of that, we increase and magnify these experiences.

MATT GALLOWAY: And if you don't have that trust, again, in conversations that I've had with Joyce's family, they talked about how they wouldn't trust the system, that they wouldn't go... if they were in in distress, they wouldn't feel comfortable in going to the hospital or seeing the doctor. What's the cost of that absence of trust?

ALIKA LAFOUNTAINE: Well, there's a there's a different definition of health and wellness that I came across where it talks about it being the ability for someone to manage their own disease processes without the assistance of the system. You know, and depending on the social context that you live in, that may come earlier or later in your disease process. Now, for persons who lack trust and expect negative experiences when they come into health care systems, that... that threshold is often a lot higher. You know, you may wait quite a bit longer with a chronic disease process before presenting, and you'll be sicker and more complex and have less of an opportunity for the system to intervene in a positive way. And that burden of health and sickness is borne on the shoulders of people who are disempowered. And not only is that morally not right, it's also just bad medical practice. It's always more cost-effective for the system when we intervene as early as possible. And I think that it's just better medical practice to make sure that we create these environments that are free of hostility so persons can feel safe coming to health care.

MATT GALLOWAY: So how do you go about addressing that? You have said that you reject incremental change in some ways. Is it... is it just about who is in the room or what else has to happen so that that systemic racism that you've talked about, that the health minister has talked about, that the minister of Indigenous services has talked about that that is addressed in a meaningful way. How do you go about doing that?

ALIKA LAFOUNTAINE: So the solutions are multilayered, but in reality, they're not very complex. You know, anyone who's lived an experience where they feel disempowered, they can imagine themselves and what they'd want in order to create a system that actually eliminates a lot of the hostility that's present. One of the things that the Canadian Medical Association has been working on, and part of the work that I want to carry on is, you know, changing the culture of medicine. You know, what we feel is reasonable, what we believe is normal. One of the things that came loud and clear out of the experience of Joyce was that there was a normalisation of this behaviour. You know, within... within systems, people do things that they feel are reasonable, and they feel that they don't have to be afraid of repercussion, you know? So when we're mean to patients, or when we're hostile to patients or their families, it's because we feel that it's OK for us to do that. And part of the cultural change that needs to happen is to reset, you know, those expectations. And I think more broadly, it's important to really communicate and translate to the general Canadian population that if one patient is disempowered, that means everyone can be disempowered. You know, having those abnormal expectations eventually bleeds into everybody's experience. And that's something that we need to make sure that we protect our system against.

MATT GALLOWAY: You are taking this role as we come out of hopefully, he said with his fingers crossed, this pandemic that we've been in for the last year. And I just wonder what you have learned about the state of... of health care in Canada through COVID.

ALIKA LAFOUNTAINE: I think the pandemic has accelerated the inevitable end of a lot of decisions that we've made over the last 10 or 20 years. You know, one... one that's been weighing heavily on my mind is this idea that austerity would eventually lead to sustainability, that somehow, if we cut and cut costs and, you know, shrunk the system, we'd be able to reach that... that point where we'd have a better functioning system. And the pandemic is really shown that that wasn't true. You know, it was... it was an idea that I think at the time was worth exploring. But we've cut too much and decreased our resiliency too much that our health care system actually can't provide the promise of what it's supposed to provide. And so we have a couple of options here. We can either reinvest within the system, or we can change what the system is and what people expect from the system. And that's a social choice that we're going to have to make. And that word choice is really important because health care systems produce the outcomes that we design them to produce. It's not a mistake or, you know, luck of whether or not you get good care or bad care, great access or poor access. It's because of the investment choices and the rules that we've created that enable these environments, I think, moving forward into the future and the system that we want post-pandemic. It's really important for us to focus on what those choices are and make sure that we look back to history to make better choices.

MATT GALLOWAY: So when you talk about, I mean, investing in the system, that's one thing. And the idea of austerity. And I mean, you're in Alberta. The government in Alberta has had a pretty testy relationship, I think it's fair to say, with many doctors in that province, something that seems to be on the road to being patched up. But the idea of what the system is is really intriguing. What do you mean by that? I mean, what could... what are the opportunities that this moment that we're in present in terms of rethinking what the health care system is in Canada.

ALIKA LAFOUNTAINE: With the Canada Health Act, it's really a financial agreement between the federal government and the provinces on, you know, the structure of how the money is supposed to be shifted and then spent. I think we could have a lot more prescribed shape to that. You know, there's different countries in the world that have things like patient bill of R=rights, you know, where you actually create a floor for what a health care system is and must be. You know, helping to frame out the role of primary care as a central part of health care systems that needs to be supported even if, you know, austerity needs to be implemented because of the realities of fiscal income and other things. Those types of conversations, I think, are important to have. You know, we take this program approach sometimes with health care, where we implement small pilots and then we see whether or not they end up having impact, when we could take a different approach where we can look at outcomes and you know what we actually want the system to do versus immediately operationalizing what we think it should do.

MATT GALLOWAY: Give me an example of that. I mean, boil that down for... for... for people who who may not, you know, be in... in your world. But they... you know, the system is... is... is what keeps them healthy and alive. What would that look like?

ALIKA LAFOUNTAINE: Yeah. Yeah. So you take something very straightforward, like patient safety, right? So patients are on a surgical floor. They want to make sure that not only their providers can operate in a safe way, but they also feel safe. So when we go through cost-cutting mechanisms where we decrease the ratios of nurses to patients, that eventually comes a threshold where you have too few nurses for the patients that you have and the acuity that they carry. And so we don't do a great job within the system of actually using that metric to push things forward. We instead have the priority of cost-saving, kind of overwhelming that. And so the discussion ends up being a lot more simple when you talk about the different priorities that you're trying to achieve. And I think that that's a conversation that patients can really plug into in order to understand how decision-making works within the system. You know, one of the beautiful things of the pandemic, because we've all kind of become armchair epidemiologists, right? [Matt chuckles] And we've had the opportunity to sit back and absorb information and critically think about things. I think that it's the time for Canadians to really start to critically think about the choices that we're making and the conflicting priorities that we need to achieve. You know, I don't think that there's there's such a thing as trade-offs within the health care system. I think there's things that you do and things that you don't, you know? And moving towards decisions and critical thinking and making sure Canadians can plug into what are we actually balancing when we're going through these changes within the health care systems is going to be a positive thing to help people understand what we're actually building post-pandemic.

MATT GALLOWAY: Do you think that that demands greater responsibility in role for the federal government? I mean, it's a bit of a third rail because the federal government funds health care, but it's the provinces that have the jurisdiction over it. But I just wonder whether patients, to your point, whether patients care about jurisdiction or whether they care about care?

ALIKA LAFOUNTAINE: I think at the end of the day, patients care about care. You know, it matters less who's in charge and more about the systems that they create. But even the discussion about jurisdictions of federal versus provincial, you know, we look at medical assisted dying. And just from a structural point of view, it's a medical intervention that the federal government has actually created an environment where all provinces have to provide this service. You know, there's not a lot of things within health care that are structured that way. And I think things like creating that threshold or that floor, whether it's a patient's bill of rights or whether it's rewriting the Canadian Health Act in a way that's maybe a little bit more prescriptive, is one of the ways that we enable that systemic change. The federal government having leadership in health care is probably one of the most important things that we need in order to create a better post-pandemic world.

MATT GALLOWAY: And is that going to be one of the focuses of your time leading the CMA is pushing that federal government to take that leadership role?

ALIKA LAFOUNTAINE: I think when it comes to access to care, that definitely will be within that umbrella. There's a lot of different roles for people to play. And within health care with all the different stakeholders that participate it's important for us all to kind of lift where we stand. One of the big themes of my campaign was amplify your voice. And I personally believe that if we amplify physicians voices, that then empowers physicians on the front lines to amplify the voices of their patients and the priorities and focuses that governments, whether they're provincial or federal, need to focus on. So it's really coming down to those end states that we want. You know, the quality of access to everyone, ensuring that people are able to have interactions in a way that's free of hostility and, you know, full of trust. And if the federal government taking a leadership role falls under those umbrellas, absolutely, it's going to be a focus.

MATT GALLOWAY: Just before I let you go. This has been a hard year for so many people and a lot of people have had the opportunity or been forced to reassess, rethink who they are, where they are, what they do, what is coming down the road. We've been asking people about hope, and this is across, you know, different walks of life. From inside the medical system, the system that you know so well, what is giving you hope right now?

ALIKA LAFOUNTAINE: I think what gives me hope is seeing my colleagues in the midst of an extremely challenging year and a whirlwind of transformation, really still providing good care for patients. And I think that post-pandemic, when people get the chance to slow down, providers across the system are going to realize just how much they sacrificed of their own lives in order to make sure that patients, when they came to the system, didn't fall into those cracks that we know are there, you know? And so it gives me hope that I work and live in an environment where persons are willing to sacrifice themselves for others. You know, it gives me hope that patients are starting to understand the complexity of health care. And it gives me a lot of hope that people care. You know, people are speaking up and talking about issues that really matter to them. And engagement is a by-product of hope. And so I'm very, very hopeful going into this post-pandemic phase.

MATT GALLOWAY: I hope we have the chance to talk again. In the meantime, congratulations and thank you for speaking with us this morning.

ALIKA LAFOUNTAINE: All right. I really appreciate it. Have a good day.

MATT GALLOWAY: Dr. Alika LaFountaine will be the new president of the Canadian Medical Association once he's confirmed at their annual general meeting in August. He was in Grand Prairie, Alberta. You're listening to "The Current" on CBC Radio One. My name is Matt Galloway. Tomorrow we will roll into a community, a couple of provinces east of Alberta and Steinbach, Manitoba. It's our next stop on "Canada's Road Ahead". And in this series, we are visiting, virtually, communities across the country to find out how covid-19 has affected people. Last November, Steinbach had the highest covid test positivity rate in the entire country at 40 per cent. One of those positive cases was health care worker Lester Quives. He spent eight days in a coma and hospital, and when he made it out the other side, his co-workers and friends decided to do a drive-by parade outside of the home he shares with his wife, Christie Mae, and their two daughters. Here's a little taste of how that surprise sounded.

WOMAN: Hi!

MAN: Hello. Just put this there. Over there. I'm going to grab it! [laughing]

WOMAN#2: Merry Christmas!

A MAN AND WOMAN TOGETHER: Thank you very much.

[horns honking]

WOMAN: Just careful, love!

MATT GALLOWAY: Christie Mae, what's going on there?

CHRISTIE MAE QUIVES: Yeah, so, yeah, day before, they told me, they asked me if they can come over by, you know, they're going to honk their horns. And then I said, oh, how could I? I could tell Lester, Hey, you have to go out and show yourself to your friends. So in the video, he's wearing shorts because he doesn't have any clue, actually. So when I told him your friends, your friends were coming and they're going to honk their horns, and then he said, why didn't you tell me! [both laughing]

CHRISTIE MAE QUIVES: [in the distance] Oh, my goodness! Lester for mayor! [laughing]

CHRISTIE MAE QUIVES: So he managed to show... to show himself in, you know, outside and wave to his friends. And I know he's very happy, and I'm very happy to, so.

MATT GALLOWAY: Lester, what did that mean to you that people would do something like this?

LESTER QUIVES: I thought it was very unexpected. Most of them are my closest friends, and they're not just co-workers. I consider them as my family. And doing that to me, I feel very special. [laughing] Of course, it was cold. But then you know what? I don't feel the coldness because the warmth of welcoming me, the warmth of telling me that, hey, good job you did it! You did it. It's just very overwhelming.

MATT GALLOWAY: Tomorrow, more of my conversation with Lester and Christie Mae Quives in Steinbach, Manitoba, for "Canada's Road Ahead". We've been talking about vaccines and the changing science around vaccines. You want a bit of good news? Yesterday, Dolly Parton shared the news that she got the Moderna vaccine, which she actually helped fund. She got the shot in Nashville, Tennessee.

DOLLY PARTON: Hey, it's me. I'm finally going to get my vaccine. I'm so excited. I've been waiting a while. I'm old enough to get it. And I'm smart enough to get it. So I'm very happy that I'm going to get my Moderna shot today. And I wanted to tell everybody that you should get out there and do it, too. I even changed one of my songs to fit occasion, it goes [singing] vaccine, vaccine, vaccine, vaccine. I'm begging of you, please don't hesitate. Vaccine vaccine vaccine vaccine. Because once you're dead, then that's a bit too late. [laughing] I know I'm trying to be funny now. I think we all want to get back to normal, whatever that is. And that would be a great shot in the arm wouldn't it? OK Dr. Nobles, you get in here and give me a shot. How are you?

DOCTOR: Hey, how are you?

DOLLY PARTON: I'm good.

DOCTOR: It's so good to see you!

DOLLY PARTON: Have you been practicing?

DOCTOR: And thank you very much for coming.

DOLLY PARTON: Think you got it?

DOCTOR: I got it.

DOLLY PARTON: OK, that didn't hurt! Just stung a little bit. Band-aid?! No!!! Mess up my beauty mark.

DOCTOR: OK!

DOLLY PARTON: [laughing] Can you do what you got to do?.

[Music: "Jolene" by Dolly Parton/Country]

MATT GALLOWAY: Your day is better already for hearing Dolly Parton. Coming up after your regional update, you turn 18 and you're on your own. That's the reality for most young people in the child welfare system in this country that could change. We'll talk about how and why coming up in about 90 seconds. I'm Matt Galloway. This is "The Current" on CBC Radio One.

And Ontario is changing out of aging out of foster care.

Guests: Savoy, Bryant Doradea, Sandra Vena, Irwin Elman

MATT GALLOWAY Hi, I'm Matt Galloway. You're listening to "The Current". For most of us, turning 18 is an exciting milestone on the road to adulthood. You're finishing high school. You're allowed to vote. In some provinces, you're even old enough to buy a drink to celebrate. But for young adults in the child protection system, it is often a terrifying number. For them, adulthood means you're on your own, with far fewer supports and required to leave your foster or group home. Some provinces have taken steps to protect vulnerable teenagers during the pandemic, but advocates question whether that is enough? Savoy is a young man under child protection, turns 18 in June. We've agreed just to use his first name, Savoy. Good morning.

SAVOY: Good morning! Can you hear me?

MATT GALLOWAY I can. Do you feel like you're ready to become an adult?

SAVOY: Oh, no, definitely not.

MATT GALLOWAY Definitely not.

SAVOY: Yeah.

MATT GALLOWAY: And so the idea of turning 18, and as they say, aging out, when you think about that, what goes through your mind?

SAVOY: It's a little scary. It's definitely a scary thing. The idea of turning into adult, especially where I am right now. Because where I am right now, there are a lot of things that I feel like I don't know. And there's a lot of things that I feel like I'm not ready for. So, yeah.

MATT GALLOWAY: What do you think you're not ready for?

SAVOY: Probably the... first the whole idea of just like figuring out what I want to be. That was difficult because I felt like I had such a little time to do it. So it was kind of just like, oh, maybe I want to do this. Maybe I want to [connection breaking up] into is this going to make me successful? Is this going to give me money, you know, things like that.

MATT GALLOWAY: Yeah.

SAVOY: And there was this thing generally about the way things worked in society that I didn't know. Like, how do I pay my taxes? Like, what am I supposed to eat in order to be healthy?

MATT GALLOWAY: All those adult... all those adult things.

SAVOY: Right, Yes. All of those adult things of which I lack. So it's definitely scary, the idea of adulthood.

MATT GALLOWAY: How long have you been in care?

SAVOY: I've been in care for maybe around four years in total, four or five years.

MATT GALLOWAY: I should probably say, I mean, I know the family that you're living with now.

SAVOY: Right.

MATT GALLOWAY: And you and I have have met before. How many different foster homes have you been placed in?

SAVOY: I've been placed in three different foster homes, and I now live sort of with a family friend that I know personally.

MATT GALLOWAY: And what's foster care have been like for you? I mean, if you take a look at that journey, what has that been like?

SAVOY: It's an interesting journey. And it... it's been a difficult one, and I... it sort of happened really fast. And I was thrown into a house. And it was difficult adapting. But I think I got the hang of it a little bit. But then I got confused in a bunch of different places, and I didn't know who I was. And I don't want to go too much into specifics because I don't know how much time we have?

MATT GALLOWAY: Yeah.

SAVOY: But it's just kind of like it happened really quickly, and there was a lot of identity issues, and there was a lot of school issues. And in my upbringing, there were things that I didn't know because my mom didn't know how to teach them to me. So when I, a strange child with interesting attributes, gets put into a different household, they kind of have a hard time trying to teach me what is correct, especially when I didn't want that connection and I didn't want to listen to what they were saying. So it was, yeah, it was definitely very strange. Yeah, it felt as if I was on my own for a lot of the time.

MATT GALLOWAY: The province of Ontario says it's going to take steps to support young adults under its care during the COVID pandemic and that no young adults will age out of the system until at least September of 2022, regardless of when they turned 18. You'd be 19 by then. Do you think you'd be ready then?

SAVOY: I would be ready to be an adult by then. I... I'm not 100 per cent sure, to be perfectly honest, because, like when I was like 16, I'd be like, oh yeah, I think I'll be fine when I'm 18, right? Because I have this long thing that I've been doing for years. So I'm just kind of slothy. I'm just kind of slow. I don't have the best work ethic. And I like to go with the flow of the world. And I feel like that was sort of like a thing that I had to inhabit so I didn't stress myself out about things.

MATT GALLOWAY: Yeah.

SAVOY: So, yeah, I don't like to worry about it because I feel like there's a lot to worry about. So if I were to be, like, am I ready to be an adult? I could convince myself in the moment that I am, and then I'll wait for it. So it's hard to say because I don't really trust my judgement on that.

MATT GALLOWAY: Fair enough. I mean, it's... it's a tricky thing to suddenly be in that position where, as I said, you age out. Just hang on with us. I want to bring a couple of other guests into our conversation. Bryant Doradea is somebody who aged out of the BC child welfare system at 19. Now works as a youth worker in Vancouver. Sandra Vena aged out of Manitoba's child protection system early. She was just 17 when she was told to fend for herself in Winnipeg. Now works as a teacher in Vancouver. Good morning to you both.

BOTH: Good morning.

MATT GALLOWAY: Bryant, when you listen to Savoy and the concerns that he has about his future, and... and that whole idea of becoming an adult, does that sound familiar to you?

BRYANT DORADEA: Yes, it's very, very familiar across the board, I think, for everyone coming out of care.

MATT GALLOWAY: What was your situation? As you got close to your 19th birthday in Vancouver, what were you going through?

BRYANT DORADEA: Well, my situation's a bit different, but also very similar to many youth in care. I was actually very street-entrenched youth, and very involved with the youth justice system. So I was actually incarcerated when I aged out of care. So when I got out of jail, I was actually got out into literal homelessness. So I didn't even get a chance to to prepare, right? And, you know, some folks might say, well, you made your choices. So, you know, you kind of have to, you know, lie in bed that you made. But the fact is, is that when you're put in group homes that kind of have a lot of systemic apathy, and you're not given the resources that you need, and you're suffering from PTSD and trauma and you don't have that love of caring parents and stuff, often, the streets are being drawn to those more criminal activities is not an uncommon narrative or journey for lots of youth in care, unfortunately.

MATT GALLOWAY: What about for you, Sandra? You weren't even 18 when you aged out. How... how did that happen?

SANDRA VENA: It happened because I was doing pretty well. I was in school. And there is a shortage of beds in the child welfare system. And so they told me that they would give me a bit more support while I was on my own until I turned 18, but that I had what it takes, what they said, to live on my own earlier. So that was very difficult because I was still in high school at the time.

MATT GALLOWAY: What was the most difficult part of that transition?

SANDRA VENA: I had no idea what I was doing. So a lot of the same things I would say echo what Savoy was saying earlier on in the show. I didn't know what I was doing. I didn't know how to pay my rent. I didn't know how to cook. I didn't know how to do laundry. I didn't know what I didn't know. So I'm trying to manage living on my own, affording to live and going to school, juggling all of that was more than I could handle at that age.

MATT GALLOWAY: What would have made that transition easier?

SANDRA VENA: I think if there was more education and training to teach you those skills, and as well as being afforded the chance to stay in the system until I was done school would have been a tremendous help.

MATT GALLOWAY: What about for you, Bryant? I mean, you talked about the supports that you needed so that you didn't end up homeless, didn't end up falling into a situation on the streets that was not conducive to growing. What would you have needed that would have been giving you better support?

BRYANT DORADEA: So I'm appreciate you ask that question, Matt. I actually think there's... there's multiple levels to answering this question. You know, I could... I could tell you that aging out of care, you know, most of us are completely unprepared. And many, many professionals and other advocates would call it a service cliff, right? Where you hit 18 or 19, and then everything disappears, right?

MATT GALLOWAY: Yeah.

BRYANT DORADEA: And the you know, the system tries to have the idea of promoting, like, healthy adult connections that are not professionals and relationships that can go on going post-care. But at the same time, the way the system is set up, it completely restricts any ability... any ability to make those connections, right? So it's impossible to even make them before you're 19. But really, I think the real issue is that a lot of folks look at these issues in a reactive way as opposed to a proactive way. And so I feel like, you know, what would have helped me is not having to go into care in the first place, right? Being placed with family members or my parents being given additional supports in the first place, right? Which down the road could save so much money and so many kids. And... and, you know, there's all already so many reports that come out like, you know, Cindy Blackstock's, you know, work with the Human Rights Tribunal in proving that canada has been wilfully and recklessly discriminatory towards on-rserve Indigenous folks and... and many other folks. And it's not just indigenous folks. It's all sorts of kids who have been apprehended into the system due to matters of... of really poverty and, you know, an inability to access services. Whereas if down... if in the beginning of that pipeline, you were able to give those parents services or give those... those relatives or family members of people in the home communities of these young people who are being taken into care, if you're able to give them more support and services, then you could stop the children from being taken into care in the first place. You know, and I think that's really what we need to be looking at.

MATT GALLOWAY: Sandra, is there an arbitrariness to this? I mean, is age the best determinant to figure out when somebody is an adult?

SANDRA VENA: No, absolutely not. Everybody develops at a different rate. And they're prepared... some are prepared more, and some are prepared less. And you have to look at where each individual is in that particular journey, just like with normal adults who live with families. Some move out earlier, and some move out later. We all have our own journey.

MATT GALLOWAY: Do you think the governments are better now at understanding that than they were when you aged out, Sandra?

SANDRA VENA: I was really hoping that they would be. But listening to some of the stories and doing some of the reading as to what's happening with youth now, it really doesn't sound like the narrative has changed much in the last 20 years.

MATT GALLOWAY: What advice... I mean, you're a teacher now.

SANDRA VENA: Yes, I am.

MATT GALLOWAY: And, I mean, you think of the life that you have now compared to where you were when you were ageing out. What advice would you give to Savoy as he's trying to figure out what's going to happen in the next few years?

SANDRA VENA: I think, first of all, I know that it is OK to be scared. It is a scary situation. And definitely reach out for help. I wouldn't be where I am today if it wasn't for asking for and accepting for help everywhere that I possibly could. And knowing that it is OK to fail and to climb back out again. I had failed at it, flunked out of school the first time I tried to go. I dealt with homelessness at one point when I was a young adult as well. So, it's OK, just keep trying. You'll get there eventually.

MATT GALLOWAY: What about for you, Bryant? What would you say as a youth worker in terms of words of advice for where Savoy is right now and where he's going to be going?

BRYANT DORADEA: I would say you're a warrior, and I'm so proud of you, even though I don't know you. I think I feel... I empathize, and I really relate to your journey and where you're at and that fear and anxiety. And just know that that's normal. That all of us feel that. And one thing I wish that people would have shown me more is, unfortunately, when you hear about kids in terror, and you hear about people aging out, you hear about all the adverse outcomes, right? You hear about death or poverty, or homelessness. And what... what's missing from the narrative is how many of us from care are thriving today that are politicians, executive directors, youth workers, entrepreneurs, actors, actresses, business owners. You know, there's people from care all over the place just killing it at life, just doing amazing things. And that's what's missing from the conversation.

MATT GALLOWAY: And that's what's really important to hear. That's really important.

BRYANT DORADEA: We're also warriors. And we overcome. And we overcome. And you'll overcome, too.

MATT GALLOWAY: And that's really important to hear, right? I mean, that... that narrative that people can be successful coming out of that situation.

BRYANT DORADEA: A hundred per cent. A hundred per cent.

MATT GALLOWAY: Savoy, what's it like to be described as a warrior?

SAVOY: Oh, that feels good. It definitely feels pretty good. It tickles the confidence a little bit. I have... I'e been feeling pretty down for lack of a better word, throughout these few years because it's felt as if I have been working up and I have been fighting just to... I've been going on a trek that just bring me down to a negative lifestyle, if that makes sense? I'll find a better way to phrase it.

MATT GALLOWAY: But when you... but when you hear those success stories, I mean, you're hearing from a teacher, from a youth worker.

SAVOY: Right, yeah.

MATT GALLOWAY: And to Bryant's point, I mean, the future is in front of you. Does that give you a bit of wind in your sails?

SAVOY: Oh, absolutely. Yeah, definitely. It makes me feel good. And it definitely helps to hear people who have been in similar situations to me being successful in doing what they want to do with their life and recognizing what they want to do with their life. It definitely helps.

MATT GALLOWAY: Where do you want to be in 10 years? What do you want to do?

SAVOY: In ten years?

MATT GALLOWAY Yeah.

SAVOY: I think I want to do something related to like, you know, childcare work and stuff like that because I've recognized and there's a lot of messed up kids out there, and I have been one of them. And I feel as if since they are the children of the future, I would want to do my best to, you know, help them out and give them my experiences and things like that. I want to do something related to that. And as well, I want to do something within the entertainment industry, maybe acting, maybe comedy, something related to that. But I also just want to do general, just like public speaking. Because I feel as if there are stories that I can tell that could maybe influence and move other people as stories have done the same to me.

MATT GALLOWAY: Aim high. That's that would be my advice is aim high. And it sounds like everything is out there right in front of you. We will wish you the best of luck, Savoy. It's great to talk to you. Thank you very much.

SAVOY: Right. Thank you.

MATT GALLOWAY And Sandra and Bryant, it's really important to hear from you, but also, Bryant, to your point about stories of positivity and... and hope. Thanks for joining us.

BOTH: Thank you.

MATT GALLOWAY: Savoy is 17, living in care in Toronto, Bryant Doradea is a youth worker in Vancouver. Sandra Vena is a teacher in Vancouver. Irwin Elman has spent a long time thinking about what child welfare should look like in Canada, and what young people like Savoy might be going through. Irwin is the former child and youth advocate for Ontario, the only person to hold that post. He's now the global strategic adviser for the charity Until The Last Child, advocating for stable housing and family support for all children. Irwin Elman, good morning to you.

IRWIN ELMAN: Good morning, Matt.

MATT GALLOWAY: What do you make of what you've just heard from those three young people?

IRWIN ELMAN: Well, it's moving and powerful. You know, you have to acknowledge that the... the guests you had are using their lived experience, which can be painful even to think about it and talk about it, which can be worrisome because they talk about not knowing if people are going to judge them for the fact that they're being in care. And I heard your guests talk about coming out of youth custody. And they're doing that. And we have to remember they're doing that to help and support change a system for others who are coming after them. And that's courage, man. And, you know, they've done that for years. And any changes that might happen and have happened over the years, in the 30 years I've been involved trying to amplify those voices, has come from them and their courage. And it's not... we're not at a place, Ontario, where I know you're going to ask about ending aging out. We're not at that place because the government just decided to. It came from somewhere. And it came from those people that you just had on the phone. Despite barriers in their personal lives, despite barriers that governments throw in front of them. I mean, our present government ended tuition relief for four young people in and from care. They cut school success programs, cut a billion dollars out of the budget of the Ministry of Community and Social Services, and they stood strong. And then in a pandemic, they stood strong. Can you imagine Savoy on his own, pushed out into maelstrom that is the pandemic? Thank God that young people like your guests fought the government to create a moratorium in the first place.

MATT GALLOWAY: I just going to say, I mean, if you take a look at the age issue, is age in any way the best determinant for when somebody is capable to... to be out on their own?

IRWIN ELMAN: Well, I agree with your guest who said, no, it's completely arbitrary. The way that we should think about supporting young people on their own is the way we... we support human beings, we think about human beings, is young people should be on their own when they're ready and when they feel ready. And that's a very personal decision. And parents... and remember, ministers in charge of child welfare are the, in a way, young people in care think of them as their parents. They're responsible. And so how parents bring up their kids, the choices they make for their kids as they're younger, living under their roof, what they teach them, how they prepare them, is how people become ready to live on their own. Even then, it's different among different young people. But you do not start preparing a child to live on their own when they're 17 and you're pushing them out the door and saying goodbye, don't come back. That's not how you treat people. In fact, that's traumatizing.

MATT GALLOWAY: What are the supports that are missing? I mean, if you're taking a look at designing a new system, what are the supports that should be there to provide the architecture for those young people as they step out?

IRWIN ELMAN: Young people and former young people in care have said there should be some readiness markers that the system works towards. And they should be established by young people themselves. So, for instance, you don't ask a young person to leave care without ID, without immigration status, without a place to live or a source of income. Makes sense, practical things. You don't ask young people to live on their own unless they have permanent, stable, positive relationships in their lives that are reliable, not professional ones, but positive, reliable, personal relationships. You don't ask them to live on their own unless you've supported them to learn how to have the confidence to make decisions. And you don't do that when they're living in your home by ensuring that every decision made about them is done without their participation, as young people say, when they're as if they're driving in... in a car, that's their life, but they're in the back seat. And when they're turned 18, nobody taught them how to drive, but they hand them the keys and said, go, and the gas tank is empty. That's what we do to young people. And certainly, if politicians think this is about slapping together some life skills programs and maybe a youth and transition worker when young people are turning 18, that's not it. That's not the fundamental change that young people are calling for, and I think young people will say, how dare you, how dare you? In Ontario, just a few weeks ago, a class-action suit was settled by the provincial government with a number... with young people who were abused, sexually abused and physically abused in care since 2012. And a suit revolved around the government not telling these young people they could apply to criminal injuries, compensation board, not a peep from our government, not an apology that usually goes with a class-action suit, not a recognition that there's been problems. How, if young people are being physically sexually abused in care, not all of them, some placements are good, but some are very bad. We know that if there's no quality of care standards that are implemented, accountability for where we put children in the homes were responsible for, how and heavens do we expect them to be prepared when they leave the system? You stack more traumatized on top of trauma that brought them into care.

MATT GALLOWAY: We just have about a minute or so left.

IRWIN ELMAN: Yeah, I'm sorry.

MATT GALLOWAY No, no, no, don't apologize. It's the passion that you have of this! And it comes right through and it come through in the work that you've done.

IRWIN ELMAN: I know people, your listeners, need to understand these young people and acknowledge them.

MATT GALLOWAY: Well, I just wonder whether, finally, you think that their decision-making will be centred in whatever happens to create the system that's there to support them, whether they... whether they're going to be at the middle of this?

IRWIN ELMAN: Yeah, they should be. That's the law that they fought for in Ontario, the Child and Youth Family Service Act that young people forced, that change. That every service needs to be child-centred. But I'll tell you this. I've already heard the minister, even before she's made her announcement that's supposed to come today, which was leaked yesterday, that the ageing out is going to end. I've heard her start walking it back. I've seen articles where she's saying, well, we'll see. We're not sure. No.

MATT GALLOWAY: That's the minister in Ontario?

IRWIN ELMAN: Yes, that's the minister in Ontario. No, Minister, these are your children. When I've met her, I've told her this is the most significant responsibility she will have in her entire lifetime, the responsibility for 12,000 at any one time, children living under her roof. It's not good enough. You cannot start walking back, hope you cannot. And this government is completely unqualified to undertake this task. They centred themselves on open for business. Every decision is made about money first. They told me this, and that's been their actions. So we need to support a call to action for Ontarian and support these first voices, these young people, being at the table with this government because they brought us here to this moment where fundamental change can happen. And Ontario needs to support them. Look them up on on Twitter and Facebook, wherever social media handle you have, Ontario Children's Advancement Coalition, Youth in Care Canada, Project Outsiders, Child Welfare PAC. Follow them, and tell them you're thinking about them. If our government won't, and our minister won't, daymn well Ontarians can. And so can Canadians in their provinces. Look up Fostering Change. Look up in BC, look up Voices For Care in Manitoba, young youth-led organization. Look them up and follow them, and tell them you've got their back when they're fighting for something better than what the government provides on our behalf now.

MATT GALLOWAY: Irwin, it's always great to talk to you about this. And as I say, you are seized with this issue. It's... it's a pleasure. Thank you very much.

IRWIN ELMAN: Thank you.

MATT GALLOWAY: Irwin Elman, the former child and youth advocate for Ontario, now the global strategic advisor for the charity Until The Last Child. His focus in the work that he has done has been in Ontario. But this spreads right across the country, obviously. Your thoughts on this would be welcome, experiences and being in care and that whole idea of aging out and what that's been like for you or someone you know. And what support would have been required or perhaps encouraged to help in that aging process. You can email us: thecurrent@cbc.ca is where to reach us. That's it for "The Current" for today. "q" is next. One of the great singers of our time, Brittany Howard of Alabama Shakes, will be on the program talking about going solo. Speaking of great singers, the legendary reggae artist Bunny Wailer died yesterday in Jamaica, the last surviving member of The Wailers, the group that he formed with Bob Marley and Peter Tosh, and of course, changed the world of reggae music around the world, will leave you today with Bunny Wailer, a tune called "Dreamland". I'm Matt Galloway. Thanks for listening to The Current. We'll talk to you tomorrow.

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March 3, 2021 Episode Transcript

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