Under the spotlight : understanding the role of the Chief Medical Officer in a pandemic

MacAulay, Margaret and Macintyre, Anna K and Yashadhana, Aryati and Cassola, Adèle and Harris, Patrick and Woodward, Caroline and Smith, Katherine and de Leeuw, Evelyne and Palkovits, Michèle and Hoffman, Steven J and Fafard, Patrick (2021) Under the spotlight : understanding the role of the Chief Medical Officer in a pandemic. Journal of Epidemiology and Community Health. ISSN 0143-005X (https://doi.org/10.1136/jech-2021-216850)

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As the COVID-19 pandemic took hold in 2020, Chief Medical Officers (CMOs) entered the public spotlight like never before. Amidst this increased visibility, the role is deeply contested. Much of the disagreement concerns whether CMOs should act independently of the government: while some argue CMOs should act as independent voices who work to shape government policy to protect public health, others stress that CMOs are civil servants whose job is to support the government. The scope and diversity of debates about the CMO role can be explained by its inherently contradictory nature, which requires incumbents to balance their commitments as physicians with their mandates as civil servants who advise and speak on the government’s behalf. The long-haul COVID-19 pandemic has further tested the CMO role and has shone light on its varying remits and expectations across different jurisdictions, institutions and contexts. It is perhaps unsurprising, then, that calls to amend the CMO role have emerged in some jurisdictions during the pandemic. However, any discussions about changing the CMO role need a stronger understanding of how different institutional and individual approaches impact what incumbents feel able to do, say and achieve. Based on an ongoing comparative analysis of the position across five countries with Westminster-style political systems, we provide an overview of the CMO role, explain its prominence in a pandemic, examine some debates surrounding the role and discuss a few unanswered empirical questions before describing our ongoing study in greater detail.