Intouch Public Health

Professor Paul M Kelly

Last week saw a largely under reported but important milestone for public health in Australia and beyond. The draft legislation was introduced in Parliament to establish an Australian Centre for Disease Control (CDC) as a statutory agency under the Minister for Health.

The Public Health Association of Australia (PHAA) advocated for an Australian CDC for several decades. Our Chief Executive Officer, Adjunct Professor Terry Slevin; former President, Professor Tarun Weeramanthri AM; and many others before them, should be rightly proud of the role they played.

In May 2022, I was the Commonwealth Chief Medical Officer, contributing to Australia’s COVID-19 pandemic response. I was privileged to announce at the World Health Assembly in Geneva that the newly elected Albanese Government promised to establish an Australian CDC.

I was tasked by Health Minister Mark Butler to head a small team to turn a three dot-point election commitment into a reality. After extensive policy development and consultation with international organisations, the public health community, academia, commonwealth, state and territory governments and the larger community, an interim CDC within the Department of Health and Aged Care was launched on 1 January 2024. I was its inaugural head until retirement in November 2024.

We aimed to build a strengthened national capacity to plan for and respond to public health threats based on science and collaboration, domestically and internationally. This included a strong commitment to transparency and equity. Clear and consistent communication with the community and health practitioners was a central principle.

The independent Australian COVID-19 Response Inquiry Report assisted in getting this right. The three team members – Robyn Kruk AO, Professor Catherine Bennett and Dr Angela Jackson – were mentioned in the Minister’s speech on 3 September which introduced the Bill. Their report called to establish a permanent CDC and build nine pillars to ensure that Australia is better prepared for the next pandemic. The pillars included:

1. Minimise harm whilst acknowledging harm will inevitably be caused by both the pandemic and the response
2. Plan and prepare through robust systems
3. Empower leadership and ensure coordination through clarity and coherence of roles, relationships and networks
4. Facilitate the collection and use of data to inform decision making and advice
5. Build and maintain trust in governments, institutions and experts, and
6. Improve community communication.

Most of those original principles are in either the draft legislation and/or in Minister Butler’s second reading in Parliament.

Minister Butler’s speech demonstrates important elements which the Government has committed to:

1. Research, workforce and a broad definition of public health advice:

“The CDC’s advice will help set the national direction on public health priorities, spanning from research through to workforce capability gaps. It will support agencies in the Australian government and the jurisdictions to plan and prepare for future health threats and emergencies. And, over time, its role will expand to include advice on how to prevent other health threats, including non-communicable diseases.”

2. A functional review in two years and a commitment to a remit beyond pandemic preparedness and communicable diseases:

“To ensure a comprehensive approach to pandemic preparedness and response, progressive expansion into areas such as chronic conditions will be considered following an independent review of the CDC’s funding and operations in 2028.”

3. Equity and proportionality (also in the legislation):

“The Australian CDC’s advice won’t exist in a vacuum. A core responsibility of the CDC will be to consult widely … CDC’s advice is grounded in the knowledge of the impacts on people and their livelihoods, … The social, cultural and economic factors that support health equity will be well understood, to ensure that no Australian is left behind.”

4. The centrality of better, timely, comprehensive and national data (with suitable privacy provisions):

“The Australian CDC will deliver a modern approach to national public health data to enable more accurate and faster detection of risks, more consistent responses across borders, and a stronger foundation for national public health planning.”

Many key components in the draft legislation will assist in forming a successful national agency dedicated to public health:

1. A strong and clear mandate for a CDC Director General (DG) with public health expertise
2. DG’s commitment to transparency of advice, agreements and directions
3. Suitable parliamentary and administrative appeal tribunal oversight
4. An advisory board of experts from wide backgrounds, not organisation or government representatives, and
5. Data collection, analysis and reporting.

On the negative side:

1. An advisory board should not be chaired by the DG – the person constituted to advise. Instead, an independent chair is more appropriate.
2. There is a commitment to enshrining a research guidance role to the DG, especially in a public health emergency. This is not mentioned in the draft legislation.
3. Some data elements remain unclear. In some sections, the DG has discretionary powers to compel others to provide information, and to arrange linkages with other institutions, including international institutions. However, the DG is specifically precluded from compelling any government entity to release data. This is a similar situation during the pandemic, when we had no system to rapidly collect or analyse information for decision making.
4. Widely defined agreements appear to have a mandated 12-month sunset clause.  There should be a provision to prolong some agreements, for example, those relating to bi-directional data sharing with the states and territories.

Some elements of the new legislation impact other Commonwealth laws. Therefore, another Bill was introduced – the Australian Centre for Disease Control (Consequential and Transitional Provisions) Bill 2025. This relates to communicable diseases and biosecurity responsibilities of the Chief Medical Officer transferred to the CDC DG. This supports clarity of roles and responsibilities.

The Australian National Preventative Health Agency Act 2010 will be repealed. It’s sad to see it finally has a stake in the heart, even though it’s been dead and buried for over 10 years now. It was time.

The legislation will be referred to the Senate Standing Committee on Community Affairs, where it is likely that opponents will point to the demise of US CDC as a reason why this is not a great idea. They will likely also prosecute a line of argument including perceived bureaucratic overreach, national sovereignty and privacy concerns, and a lack of parliamentary oversight and rights of appeal. These matters are addressed in the legislation but are nonetheless worthy of scrutiny. It relates to the central principle of proportionality of public health responses.

Submissions for the enquiry close 26 September.

PHAA members should strongly support the legislation, whilst raising issues that require further consideration. We should continue to closely engage with the process and hold the Government accountable. This includes funding for timely and comprehensive data uplift.

Paul Kelly is a PHAA member, runs PK Public Health Advisory, and is a former Commonwealth Chief Medical Officer.