Australia’s Centre for Disease Control: Signposts from foreign lands

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Dr Babatunde Balogun, PhD candidate at the Australian Institute of Health Service Management, University of Tasmania

Here we are. The end of a journey that started 35 years ago is now within sight. The seed sown in a 1987 meeting of Australia’s epidemiology experts about a federal coordinating body for disease prevention and control is expected to sprout soonest.

In commitment to its pre-election campaign promise in 2020 and 2021, the present government is set to establish a national Centre for Disease Control (CDC). It’s apparent that there’s still a lot of ground to cover. The fine details of the modalities to run the organisation as an enduring agency are still being worked out. The steps taken so far, however, cannot be faulted.

The federal government initially earmarked $3.2 million dollars to kickstart initial consultations with various stakeholders, including the Public Health Association of Australia (PHAA). The government also indicated in its recent discussion paper that the CDC may become operational by 2024.

There is no basis to think that this project could go the way of Australian National Preventive Health Agency (ANPHA) that became extinct in 2014. ANPHA was bedevilled by political interferences, which meant its operations – and existence – were subject to the whims of the incumbent government. It appears the new CDC is being packaged differently, and conceivably will be free from such encumbrances.

Health experts across various fields, including the Australian Medical Association, the Australian Nursing and Midwifery Federation, and PHAA, have welcomed the proposed establishment of Australia’s CDC and hailed the federal government’s efforts hitherto.

It’s apparent that the CDC is seen by many as the magic wand to comprehensively deal with Australia’s myriad health challenges. And why not? After all, the COVID-19 outbreak in 2020 exposed inadequate preparedness and coordination weaknesses in Australia’s health infrastructure. And according to the 2020 arguments of then Opposition Leader Anthony Albanese, “Ask any Australian and they’ll tell you our response to the coronavirus pandemic was too slow, too reactive and too uncoordinated.”.

The existence of a CDC may have meant more proactive and effective management of the COVID-19 outbreak. Less morbidity and mortality, and next to zero cataclysm for the healthcare system. Or perhaps it may not have had any effect at all.

Australia belongs to the Organisation for Economic Co-operation and Development (OECD), a 38 member organisation of wealthy countries committed to promoting and implementing policies aimed at bettering lives. The question is, ‘how did Australia fare during COVID-19 compared to other OECD member nations with a CDC?’

An October 2020 document tabled in the 2020-2021 Budget estimates may be helpful. The report ranked 35 OECD countries according to the death rate per 100,000 population as of 9 October 2020. New Zealand, without a CDC, had the lowest death rate. Australia had the seventh lowest. The top 10 was dominated by countries with CDCs in full operation. Five of them, Belgium, Spain, Italy, Sweden, and France, subscribe to a continental body, the European CDC (ECDC). Along with the United States of America (US), these countries make for a curious case. If we query the existence or relevance of a CDC in these countries, are we asking the $64,000 question? If the ‘sloppiness’ of health authorities in Australia in tackling the COVID-19 menace in 2020 is attributed to the absence of a coordinating body as a CDC, how do we explain the document’s rankings?

As these are early days, it is imperative that stakeholders look at the operations and functioning of CDCs in other countries. Of course, we know that no two countries are the same, and many of a country’s unique characteristics and circumstances can affect mortality rates. Yet, evaluating what has worked (and what has not) in other regions may provide substantial insights.

Stakeholders need to ask pertinent questions. What went wrong with COVID-19 management by the US CDC, despite having seventy-five years’ experience dealing with public health emergencies? Why did the ECDC not live up to its ambitions even though it could leverage vast human and financial resources from multiple wealthy countries? Comparatively, how did New Zealand succeed in curtailing COVID-19 without an almighty CDC?

The US and Australia each declared their first case of COVID-19 on 21 January and 25 January 2020 respectively. It took both countries about six weeks to announce their 100th case. One would have expected the US, with its CDC, to take much longer. Japan, South Korea, and Singapore reached their 100th case in fewer days, 31, 29 and 37 respectively, despite having functional CDCs. Netherlands, Switzerland, and Austria, despite their ECDC, presented startling scenarios. Each of their first cases of COVID-19 were in late February. Yet it took no more than 12 days after the first for each to reach their 100th case. They had a head start of monitoring the trend in other countries for a month during which the ECDC had the opportunity to take appropriate preventive measures. Notwithstanding, the rate of spread after their first cases exceeded that of Australia.

It’s important to acknowledge that Australia did certain things right during the early days of COVID-19. The federal government needs to critically chronicle all the steps taken and catalogue both the positives and negatives. What would an Australian CDC have done differently? A non-partisan and multidisciplinary team should interrogate the archives and publish its findings.

This measure will provide a solid footing on which further steps can be taken to define and design what Australia deserves. While it’s conceivable that a CDC would be helpful to handle future pandemics and other responsibilities, we cannot take it for granted that it is that straightforward. It is convenient to attribute poor coordination of Australia’s COVID-19 response on the absence of a CDC, but simply creating one does not provide solution.

Being one of the last OECD countries to introduce a national CDC is a blessing in disguise, as we can identify and avoid the pitfalls of other CDCs. This is a call for an inclusive approach, an in-depth evaluation, and a wide consultation in planning and setting up Australia’s CDC.


Follow Dr Balogun on Twitter at @tundeomobalogun.

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