'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

Objectives: 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 Montreal. Methods: This study is part of the multi-country research program HoSPiCOVID, looking at the resilience of public health systems during the COVID-19 pandemic. A qualitative case study was carried out in Montreal, 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 analysed thematically, both inductively and deductively. Results: Results showed that SIH were not considered during the design of the contract tracing program in Montreal, which could have been due to the crisis nature of the situation. Public health practitioners deplored the Quebec government’s lack of will to integrate SIH into the public health response, as well as the lack of preparedness to pandemics or health emergencies. Conclusion: There is a need for a clear and common vision of SIH at the political, institutional, and local levels in public health, allowing to better conceptualize them. Decision-makers need to actively consider SIH prior to designing public health interventions for them to not further increase SIH in the future.