Adjunct Professor Terry Slevin – PHAA CEO
Adjunct Professor Tarun Weeramanthri – PHAA President
As a federal election looms, the question of what, if any, new structures, programs or initiatives will be established in Australia to deal with current and future public health crises, remains unanswered.
The Public Health Association of Australia has for more than 10 years supported the establishment of a separate government entity to focus exclusively on public health.
Regardless of whether it is titled a Centre for Disease Control (CDC – or ACDC), Public Health Australia, or similar, the notion is to put in place a specialised, well-resourced agency that exclusively, and only, does public health.
We have written an editorial in the Australian and New Zealand Journal of Public Health (the peer reviewed journal of the PHAA), published blog posts, and this issue is one of our seven priorities we are committed to in our 2022 federal election platform.
We argued back in 2013 that an Australian CDC should be a
“Strong central, expert driven leadership and co-ordination of national communicable disease control”. It promoted a ‘hub and spoke’ model, recommending a legislated ‘hub’ separate from the Commonwealth Department of Health. Its focus would be on key technical functions such as national coordination of disease surveillance, leadership in immunisation and other programs, management of communicable disease outbreaks, and regional and international engagement.”
Flash forward to a pandemic-ridden early 2022, and many people would include the following as a potential significant positive of CDC implementation: Improved consistency and co-operation across states and territories in managing communicable disease outbreaks. This includes creating transparent evidence-based policy, consistent contact tracing systems, robust ‘Check-in’ applications that protect privacy, and more.
We would argue that inclusion or taking leadership in prevention of Chronic Diseases may also be appropriate for an Australian CDC, using the National Preventive Health Strategy to help direct the effort and taking the lead on advancing Public Health Workforce issues.
So far, we know that the Labor party in opposition has committed to the establishment of an ACDC.
As yet the only response from the current federal government is to reject that proposal on the basis that the necessary systems and structures are in place. A pre-pandemic process proposed a commission be established to examine the need for a CDC. In 2018 the government did not agree to set up such a commission.
There are calls from both sides of the political fence to set up a Royal Commission into Australia’s response to the COVID19 pandemic, and while there is debate as to the value of such an exercise, it seems likely that an enquiry of some kind will occur.
But as we approach a Federal Election, it also seems likely that a government aiming for re-election may be keen to make a major announcement to signal their efforts to futureproof Australia for new pandemics. A possible strategy is a major injection of funds, perhaps in the hundreds of millions of dollars, into communicable disease research in the form of a substantial new research initiative.
But what does that mean? What is needed and what can a research group do? More importantly, what can it not do?
There is no doubt that an injection of funds into communicable disease research, infrastructure and capacity would be an important and welcome development. Having better, faster, more reliable data on which to make policy decisions, having more efficient capture of evidence, and improved technical and scientific expertise are undeniably good things. These are things PHAA would support and fight for. But are they sufficient given the experiences of 2020 and 2021?
We would argue that an injection of funds is necessary but not sufficient to respond to our requirements and learnings from the COVID-19 pandemic.
Improving existing structures
Before talking about what a CDC should do, it is vital to think about how it should be structured to complement the strengths and weaknesses of the current system. To be successful, an Australian CDC must:
Have genuine input and investment from States and Territories. As we have learned, the jurisdictions hold many of the “on the ground” public health powers and responsibilities. A standard model for such vital national entities is that the Commonwealth funds 50% with the other 50% funded on a per capita basis by states and territories.
Strengthen public health capacity in the Commonwealth Department of Health. Historically, public health workforce capacity has been strongest in the states and territories and weakest in the Commonwealth. Quarantine is the only constitutional responsibility for public health that the Commonwealth holds, and even that is delegated in practice to state and territory officials.
Be an independent entity at arm’s length from government. It should have a leader or Director who is appointed and can only be removed from office by the Minister for Health, ideally under a statutory act (such as the Biosecurity Act). This is a common arrangement for many regulatory bodies. Its purpose is, to the degree possible, depoliticise the role of an expert entity that must act in the public interest with some immunity from the political process.
Be able to make transparent evidence- and expert-based recommendations, free from political influence. For much of the early stages of the pandemic, many governments made a virtue of “following (or at least listening closely to) the medical expert advice”. But at various times, some were concerned that this commitment was not consistently or transparently applied.
Ensure strong international links, particularly near neighbours in our region, and must have strong international links to the many CDC-like agencies around the world. As a result, it also needs a strong relationship with government departments like the Department of Foreign Affairs and Trade (DFAT), which is the home agency for the Indo-Pacific Centre for Health Security.
Have a governance structure that is inclusive, expert, and has representation from the key stakeholders in addition to the jurisdictions. It should be designed to maximise credibility, expertise, and reach of its work.
What should it do? None of what follows implies these things are not currently being done. But a CDC should be focused on ensuring these are enacted at the highest possible international standards in a planned, coordinated, and coherent manner. Much of it is the back-room machinery ‘nuts and bolts’ of government-type work, and not the prime focus of research institutions or networks.
A CDC must:
Put systems in place to ensure consistent, high quality public health processes (e.g. contact tracing – as per the 2020 Contact tracing review , disease capture and reporting), with contingencies and mechanisms to adapt in crisis circumstances.
Ensure evidence and policy that can be prepared in advance, is prepared in advance. This must be implemented to the highest possible standard, be widely agreed upon, available, and understood. It must also be updated and modified as new evidence becomes available.
Have an advanced intelligence function. This means a specific group with responsibility to take a future view of risks, threats, possibilities, and analyse evidence of new emerging problems or issues.
Constantly develop and improve the workforce and expertise. These assets will continue to be an essential component of the disease and outbreak management process.
Planning and executing “war games” style training and preparation with necessary stakeholders. Run ‘lessons identified’ type debriefing sessions (similar to what happens after a natural disaster) and ensure they become ‘lessons learnt.’
Develop and maintain major and substantive programs addressing Non-Communicable Diseases (NCDs) as well as communicable disease. The important inclusion of NCD programs could include preventive health programs on tobacco control, healthy nutrition, promoting physical activity, reducing alcohol consumption, and align with the National Preventive Health Strategy. Some may choose to argue these responsibilities are better prosecuted elsewhere, but a definitive position should be articulated.
As Australians decide who should form the next national government, a question should be asked:
“Who will best prepare for current and future public health crises?”
Many strongly hold the view that a properly constituted and properly resourced ACDC is an important part of that architecture. Investment in gold-standard research capacity and infrastructure is a valuable piece of the puzzle.
But the independence, machinery and structure of a Public Health Australia, or Australian Centre for Disease Control (ACDC), will need to be much more than that to ensure the future health of Australians.