'It felt like building a plane while in flight': The Consideration of Social Inequities in Health in the Design of a Contact-Tracing Program for COVID-19 in Montréal

Abstract

Background: In Canada and globally, the COVID-19 pandemic has increased social inequities in health (SIH), furthering the vulnerability of certain groups and communities. Contact tracing is a cornerstone intervention with COVID-19 prevention and control programs. The aim of this study was to describe if and how SIH were considered during the design of the COVID-19 contact tracing program in Montréal.Methods: A qualitative case study was carried out in Montréal, based on a “bricolage” conceptual framework describing the consideration for SIH in intervention and policy design. Qualitative data were collected using semi-structured interviews with 16 public health practitioners, recruited using both purposive and snowball sampling. Data was analyzed using thematic analysis, both inductively and deductively.Results: Results showed that SIH were not considered during the design of contract tracing in Montréal, which the respondents thought was due to the crisis nature of the situation. Public health practitioners deplored the Québec government’s lack of will to integrate SIH into the public health response, as well as the lack of preparedness to pandemics.Conclusions: Considering these findings, prior to designing public health interventions, decision-makers need to have a common vision of SIH, allowing to conceptualize and consider SIH better in the future.