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Under the spotlight: understanding the role of the Chief Medical Officer in a pandemic
  1. Margaret MacAulay1,2,
  2. Anna K Macintyre3,
  3. Aryati Yashadhana4,5,6,
  4. Adèle Cassola1,
  5. Patrick Harris4,5,6,
  6. Caroline Woodward1,2,
  7. Katherine Smith3,
  8. Evelyne de Leeuw4,5,6,
  9. Michèle Palkovits1,
  10. Steven J Hoffman1,7,8,
  11. Patrick Fafard1,2
  1. 1 Global Strategy Lab, University of Ottawa/York University, Ottawa, Ontario, Canada
  2. 2 Graduate School of Public and International Affairs, University of Ottawa, Ottawa, Ontario, Canada
  3. 3 School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
  4. 4 Centre for Health Equity Training, Research and Evaluation (CHETRE), University of New South Wales, Sydney, New South Wales, Australia
  5. 5 Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
  6. 6 Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
  7. 7 Dahdaleh Institute for Global Health Research, School of Global Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
  8. 8 Department of Health Research Methods, Evidence, and Impact and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Professor Patrick Fafard, Global Strategy Lab, University of Ottawa, Ottawa, Canada; Patrick.Fafard{at}


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.

  • COVID-19
  • public health policy
  • social sciences
  • communicable diseases
  • public health

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  • Contributors MM drafted the manuscript with input from all coauthors. AKM, AY, AC, PH, CW, KS, EdL, MP, SJH and PF provided critical feedback and assisted with the revision process. PF in the principal investigator for the overall project.

  • Funding This work was supported by the Government of Canada’s New Frontiers in Research Fund (grant number: NFRFR-2019-00003). The funding body was not involved in the study design, data collection, analysis or interpretation or the decision to submit the article for publication.

  • Competing interests SJH is the scientific director of the Institute of Population and Public Health at the Canadian Institutes of Health Research (CIHR). The views expressed in this article are those of the authors and do not necessarily reflect those of CIHR or the government of Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.