Fahad Razak on why he is excited about the Ontario Science Advisory Table

Fahad Razak became scientific director of the Ontario COVID-19 Science Advisory Table earlier this year and is already at the center of questions about the mandate of masks, wastewater signaling, and the shift of desks from the University of Toronto to Public Health Ontario.

An assistant professor in the department of medicine at the Temerty School of Medicine and at the Dalla Lana School’s Institute for Health Policy, Management and Evaluation, Razak is an expert in internal medicine and epidemiology at St. Michael, Unity Health Toronto.

He spoke with author Jim Oldfield about his decision to take up the job as scientific director of table science and the potential challenges ahead.

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How did you find time for this role?

Before I took on this role, I decided to step away from clinical work for a year. As an internal medicine doctor at St. Michael, on the front lines of the pandemic, these two and a half years have been very busy. My specialty has seen large numbers of COVID-19 patients, many with complex conditions that carry great responsibility. I realized there was no way to continue that work and am still doing research, teaching, and advising at Ontario Health. I also have two children under the age of five. So my colleagues at the hospital generously withdrew from my clinical and administrative duties, and made sure we had enough staff and support to cover my leave. And of course, I spoke at length with my wife and family about the new role and what it meant.

What motivated you to take on this new responsibility?

It is critical that the science table be sustainable, and this position offers an opportunity to help ensure that is the case. The pandemic has come in several waves. We hope this will be over in a few months, but there is nothing about this virus to suggest that it is. With each wave, we have a new set of questions to answer, many of them critical and urgent. And each time, the table has been there – with new models, or guidelines on vaccine launches or lessons learned in long-term care. But it takes a lot of effort to coordinate and produce the work. The table has approximately 30 core scientists and dozens of additional members and staff – many of whom support and communicate findings. There isn’t much precedent for running an operation of that size from a university, so now we have the opportunity to build a new home and permanent infrastructure to support the work.

Was there any tension around the shift?

One of the critical strengths of the table is that, among many community members and decision makers, it is considered an independent body. that one. The researchers at the table are unpaid volunteers – internationally recognized scientists at the peak of their careers. They receive no material benefit from being on the table. They come to questions and problems with a purely scientific lens and do their best to produce what [Harvard University Professor] Sheila Jasanoff calls it “useful truth.” That means, based on the facts, they are as close as possible to the truth that decision makers and the public can use, acknowledging that we live in a world of incomplete data. When a group like this moves or undergoes change, the question on many people’s minds is whether the change will jeopardize their independence. Many in the media and on the table are asking this question.

My firm belief is that the underlying reason why this group is independent and effective remains unchanged. These are scientists who are still recognized as doing unpaid work as a public service. And, they can leave at any time – that ability underpins credibility and ultimately the value of desk work.

What other changes will occur?

I think we will see membership and leadership renewals over the coming months. Two and a half years is a long time to put effort into this off-the-table work. We all have other jobs, so it can’t be an uncertain commitment. Beyond that, there is a need for a desk to provide scientific advice unrelated to the pandemic.

When you think about SARS-1 or the Walkerton water crisis, if a group like ours were there, I believe the province could have made a more agile and strong response. So, we need to establish a frame of reference for this group, so that we can respond better in the next crisis as well as the current one. A lot of things we’ve been doing during this pandemic like building planes while flying them, which isn’t really a good approach. Now that we have the infrastructure, we can stay centered on COVID-19 but also retool so we can shift focus in the future.

Who chooses the scientific director for the table?

It happened through discussion between table and chair members [Adalsteinn Brown and Brian Schwartz]. Part of the idea is that people in these roles can help communicate scientific work and desk consensus building to governments, policy makers, the media and the public. I have been a member of the scientific core of the table since its inception, and became associate director in the fall of 2021, so I am familiar with the work our scientists have produced and I am excited about its value.

How are you prepared to handle inquiries from the media?

I’ve done interviews and learned from a few missteps – and of course during the pandemic I and many colleagues have been called upon by the media for comment. I’m just trying to convey what we know and don’t know as truthfully as possible, avoiding extrapolation from the data, and identifying major risks. Sometimes the risks are known, or may be known, but I don’t think they’ve been considered enough. But I want to be a transparent voice for the desk and whatever consensus we come to. And I realized that sometimes it’s not popular.

But regardless, I think it’s important to show empathy. Both the virus control measures and the pandemic have caused a lot of loss and suffering. The idea of ​​evil problems really applies here – we are often faced with trying to choose the best of several bad options. The choice is a trade-off that touches on values ​​and morality and governance, so it’s not just about science. Look, I grew up in Windsor, which is a blue collar town. My father worked in the construction industry, our family relied on the larger economy to survive and, like many families, we needed public schools to keep our education open. That education really influenced my perspective on the pandemic.

What do you see in Ontario’s future in light of COVID-19?

We are at a risky point in a pandemic. There is a high level of burnout among the public and decision makers, and attention to pandemic issues has been greatly reduced. The general feeling out there is, ‘Let’s get through this.’ But in reality we are not dealing with human enemies. In the last six months, we have seen a rapid resurgence of mortality in long-term care. And we’ve never had an infection rate like we saw at the last peak, which was 150,000 new cases a day. Many people have only mild illness, but we still don’t know the long-term risks. The old COVID is going to be a huge burden on people and the healthcare system, and I don’t think we’ve recognized the risks enough.

I’m also very worried about whether we can put up an effective response in the next wave. As much as we would like, the wastewater signal across the province is clearly increasing. And, as we’ve seen in the abundant media coverage, the health system is clearly in crisis, not just from the acceptance of COVID-19, but general exhaustion, staff shortages, patient backlogs, and other effects that are a cumulative legacy of two and a half years. pandemic year. We continue to see the spread of new variants that could coincide with higher risk scenarios in the fall, when people enter, schools reopen, and other public spaces become more crowded. That time could collide with the pandemic exhaustion and widespread illness of Long COVID to make matters worse. Will we have the energy to come together as a society? I don’t know. I hope we all have a great summer, but we need to refocus.

This interview was originally published by the Temerty School of Medicine on 21 June 2022.

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