A breach in the social contract: Limited participation and limited evidence in COVID-19 responses.

Medically trained health professionals have been central to the development of policy responses to the coronavirus 2019 (COVID-19) crisis. In their multiple roles-as clinicians, public health leaders, members of scientific advisory boards, and also as media pundits and health professionals-they have helped shape discourses of science-based policy options during the first 2 years of the pandemic. In particular, health professionals as a collective voice insisted on the necessity of society-wide measures of social control to curb the morbidity and mortality of the virus. These measures, in turn, informed the political and moral imagination of the political class, the media and the larger public. Yet, as emerging evidence suggests, measures of social control posed a serious and long-term risk for health equity. In this discussion piece on the first 2 years of COVID-related public health directives, we interrogate the tensions that advocating for extensive and protracted measures of social control can pose to the social contract between medicine and society, health equity and democracy. To illustrate these tensions, we discuss the public fallout between vocal members of the OSAT, an ad hoc biomedical-led organization, and the Government of Ontario in light of the disagreement on the scope of 'stay home' orders to manage the third wave of the pandemic in the Spring of 2021 and, more recently, the mass protest against mass-scale public health measures in Ottawa, Canada. We argue that while decision making under emergency conditions is a difficult task, the legitimacy of the social contract between medicine and society depends on medical experts' judicious exercise of public health ethics principles. We offer a set of recommendations for building a more collaborative response to future health crises.