Chief Health Officers back calls for a more sustainable public health workforce
Before the arrival of COVID-19, Australia’s Chief Health Officers (CHOs were relatively unknown, going about their business quietly, efficiently, and effectively to keep our communities healthy and safe. Each state and territory has a CHO, and the Commonwealth has the national Chief Medical Officer. They administer small teams of staff and have substantial authorities and powers under health protection legislation, and the chief advisers to government on health crises.
Wind the clock forward 15 months and our CHOs have become household names. Think back to this time last year – CHOs standing side-by-side with Premiers and Chief Ministers at those daily media briefings. The community hanging on to their every word, and particularly those all important daily COVID numbers – tests completed, new cases, and lives lost.
Our CHOs provided the sound evidence-based advice on which to base those difficult decisions about new community restrictions and border closures. They gave the process the credibility, honesty, and transparency to enable the politicians to take the community on the long and bumpy pandemic journey; and one of them, Dr Brendan Murphy, was a finalist in the Australian of the Year Awards.
At last week’s Preventive Health Conference in Perth, three of Australia’s Chief Health Officers presented at a forum, hosted by former WA CHO Tarun Weeramanthri, to look back at the COVID response to date, and to consider the challenges which still lie ahead. The CHOs were united in their support of PHAA’s call for a stronger public health workforce supported by a bigger slice of the health budget pie… but more on that later.
The panellists were Dr Jeannette Young, CHO of Queensland, Dr Andrew Robertson, CHO of Western Australia, and Dr Kerryn Coleman, CHO of Australian Capital Territory.
COVID-19 early response
While the term ‘unprecedented’ has been thrown around all too frequently in recent times, all three panellists regard the events since the start of last year as their biggest challenge to date.
Having been appointed in December 2019, Dr Coleman was new in her role in the ACT. As she put it, “all I’ve ever known as CHO has been COVID and the bushfires.” The ACT region was heavily impacted by choking bushfire smoke and the threat of fire over the summer immediately before the pandemic hit.
“We’d already been in a State of Emergency for about a month dealing with the bushfires and the smoke, and the ACT’s emergency services were fatigued when the Health Emergency Act was enacted,” Dr Coleman said. The ACT had only six people in its Health Emergency Centre at the time, and this limited depth of resources and skills in a small jurisdiction was one of their biggest challenges, particularly for those first three or four months.
Dr Robertson in WA has a strong background in emergency management and he had experience dealing with the 2009 H1N1 pandemic. The COVID-19 pandemic, however, was a complete leap in scale from anything Australia had dealt with over the past 100 years. WA’s State Health Coordination Centre could accommodate about 20 people and it was felt this would be sufficient to deal with almost any disaster – but no one had factored in the scale and impact of COVID-19.
“I can assure you it’s a heck of a lot bigger than that now,” Dr Roberson said. “It was about dealing with the evolving crisis and also about how we operated our business as usual for all the other important areas, to ensure they weren’t too adversely impacted.”
Dr Young in Queensland – the longest-serving current CHO with 15 years in the role- had dealt with flood and cyclone health emergencies in the past but hadn’t encountered anything of the scale of the pandemic. At the Perth forum, Dr Young spoke of the irony around when needles were found in strawberries in 2019, creating a major public health crisis – this proved to be something of a rehearsal for the much more serious events to come. Dr Young was made State Disaster Manager for the first time in responding to the strawberry crisis, and this allowed her to build relationships and understand the level of support and cooperation she would receive from other agencies, including the police, when the big one hit.
“Having to manage this was quite terrifying but also very reassuring because everyone did what they always do. So, when the pandemic hit, Queensland was able to rapidly scale up and we just treated it as we treat everything else – only scaled up.”
The biggest challenges
Dr Young said the 2020 High Court challenge over state border closures was disturbing and “put so much doubt in my mind”. Dr Young praised her government lawyers for allowing her to focus on the main game, keeping Queenslanders safe.
Dr Robertson also described the legal challenge as a particularly stressful period “because of the amount of preparation required in the middle of still trying to deal with the operational aspects of the pandemic.” He said the early days of the pandemic and the speed with which decisions had to be made was also stressful. “To be honest, the first couple of months were a blur. We were making decisions all the time, and the one thing I do remember from that period was the amazing support received through the Australian Health Protection Principal Committee (AHPPC).” The AHPPC is the key decision-making and advisory group for health emergencies, comprised of all Chief Health Officers and chaired by the Australian Chief Medical Officer. For many months during 2020 they met daily, including on weekends.
“We didn’t always go the same way but we felt we had the evidence base and the knowledge base, and we were able to make those decisions in what were very complex and very ambiguous times,” Dr Robertson said. “We were still learning about the disease, and still learning about what worked. We were saying initially there wasn’t much utility in masks, but that all changed.”
Dr Coleman found coming out of restrictions more challenging than ‘going in’ during the crisis. She highlighted the closing of state, territory, and international borders as ‘the standout’ in terms of the significant actions put in place to stop the virus spreading. “It’s those decisions that actually impact on the viability of business.”
Being in the national capital, the ACT also had to manage the comings and goings of diplomats and federal politicians to allow them to continue their important work.
“Proportionately, we had to consider how we treated individuals and how we applied risk… for whatever reason; whether it’s an international agreement or a constitutional expectation,” Dr Coleman said. She also had to advise on the plight of 100 Canberrans who were stranded at the Victorian-NSW border for five days and unable to travel home after a snap border lockdown.
It’s not all bad news
All three CHOs said the COVID-19 crisis had prompted new ways of thinking and innovations which will benefit jurisdictions and the nation in the longer term.
In Queensland, Dr Young paid tribute to Australia’s First Nation’s people for the “absolutely fantastic work” in not allowing COVID to get into those communities. Of the approximately 1,500 COVID cases in Queensland, only 12 were of First Nation’s People, “and I’m so proud of what our leaders did in those communities.” Dr Young said the appointment of a Chief Aboriginal and Torres Strait Islander Health Officer shortly before the pandemic hit had been instrumental in helping coordinate the response “which will stand Queensland in really good stead going forward.” Queensland also supported their homeless community by providing hotel accommodation during lockdowns – as also happened in other states – and offering vaccinations to those who were happy to receive it.
In Western Australia, the government has made a commitment as part of the state’s Sustainable Health Review, to increase funding in prevention “to at least five per cent of total health expenditure by July 2029”. Dr Robertson also highlighted the development of a QR ‘COVID-safe’ check-in app in WA in only three weeks (“not three months, or three years”) was something he’d never witnessed before in terms of speed of delivery of a new programme. He said the insatiable desire for data from the government and departments had seen the rapid development of new public health information systems which have been critical in supporting the contact tracing efforts when positive cases were detected.
In the ACT, there’s been a strong focus on investment in people. Dr Coleman said a Director of Health and Wellbeing was appointed whose principle role is to keep tabs on the health of the workforce. A community development model and methodology was adopted based on lessons learnt from the Victorian outbreak, firstly to get vital COVID information to CALD and other hard to reach communities, and more recently in helping spread the word about the vaccination program rollout.
Public health workforce
While PHAA has led the charge nationally for an increased commitment from governments for a stronger and better resourced public health workforce, it was Queensland’s Dr Young who raised the issue at the CHO’s forum.
“I’ve been looking at National Cabinet decisions about enhancing our public health workforce, and my understanding is that there was to be a program and a strategy put together, so I look forward to that.”
Dr Young described the current program as “ad-hoc”, “a bit of an orphan”, and needing much greater structure. She encouraged PHAA to continue to lobby governments saying “it’s possibly not front of mind at the moment for the government because we’re still in the middle of the pandemic. I suspect they’re not thinking about the next pandemic – but we need to be.”
In response, PHAA CEO, A/ Prof Terry Slevin, said “we’ve pestered everybody to the point I’m starting to feel embarrassed about it.” He said the proposal put to Australia’s CHOs was the creation of a working party within AHPPC to drive the initiative. “We propose a similar model to the public health physicians which has a target in terms of per head of population number of physicians operating in their jurisdictions. I genuinely believe 2021 is fundamentally and vitally important as an opportunity to actually make it happen.”
Whatever challenges the pandemic has thrown up, it’s also seen unprecedented levels of collaboration and cooperation within and across jurisdictions.
While the CHOs were full of praise for the collaborative approach between jurisdictions and the Commonwealth, Dr Young believes there’s still room for improvement, with the priority being an interoperable communicable disease database between all jurisdictions.
“If we could end up with one system for the country, that would be a really good outcome from this pandemic, and I think that’s where we’re heading.”