Adj Prof Terry Slevin, PHAA CEO
It’s obvious that the COVID-19 pandemic has and continues to have an enormous effect on people’s health globally. It remains a dominant theme around discussions on public health issues. It’s far from over, and continues to attract very strong opinions and reactions, including some accusations that public health organisations have misplaced their/our priorities.
Many are keen to find “the solution” to COVID-19, to express frustration at the alleged “lack of government action” or propose specific responses, sometimes depicted as simple and obvious. Understandably, feelings continue to run high among some.
At the time of writing, the Australian Government reported 8,047 cases of COVID-19 across the country over the last week, with a daily average of 1,150. At the same timepoint, they reported between 10 and 20 deaths a day.
Undoubtedly, COVID-19 is now an embedded, additional public health challenge that we must address, on top of the already-existing huge burden from chronic diseases like cancer, mental health issues, and cardiovascular disease.
A senior, experienced, and respected PHAA member recently expressed the concern about “the failure of all governments in Australia to safely manage the ongoing COVID pandemic”. That person went on to suggest
“Simple things like encouraging use of masks as a measure to take care of ourselves and other; air filters in inside places where people are for work and leisure to reduce exposure. A more extensive campaign to encourage vaccination and to promote the narrative that precaution in this circumstance is a good and worthwhile, caring thing to be doing. Outdoor events rather than indoor events.”
All these actions are sensible to consider. So let’s look at the ‘where to from here’ scenario.
How does Public Health tackle big challenges?
The basics of public health skills and training come to the fore. We examine the data, get a sense of a threat’s size and nature, assess the evidence for and efficacy of potential responses, and continue to invest in research to find better answers. Ultimately, we break it down to chewable chunks. What can we do now, what are the highest priorities, what does the evidence say, what resources have we got? Let’s ensure we evaluate what we do to figure what works best, what doesn’t, and continue a virtuous cycle of improvement.
The simple truth is COVID-19 isn’t going away soon, so how do we minimise the threat? Let’s explore some options.
Masks – exactly how effective are they in reducing transmission? While accepting there is a debate about degree of efficacy, let’s assume there’s some benefit. If we are to recommend them, who should wear them, where should they be worn, what kinds of masks, when might they be worn for greatest benefit? What are the barriers to their use? What perceptions exist to either reinforce or discourage their use? How well do mandates work? What are the downsides? What’s the cost and impact of enforcement? What does the evidence say? How does that emergency apply now that the World Health Organization (WHO) has declared the COVID-19 Public Health Emergency of International Concern (PHEIC) over?
“Given the disease was by now well-established and ongoing, it no longer fit the definition of PHEIC. This does not mean the pandemic itself is over, but the global emergency it has caused is, for now.” WHO
Should masks be strongly recommended, or mandated, for use by everyone constantly? By people in schools, offices, outdoors, residential aged care facilities, on public transport? How do we most effectively communicate these messages, and who should do it?
Vaccines Although the COVID-19 virus’ evolution continues, broadly most experts agree that COVID-19 vaccines have been highly efficacious at reducing morbidity and mortality, and also reducing transmission.
Who is eligible? Can people get easy access? Are there effective campaigns to promote vaccines? Yes, including campaigns aimed at Aboriginal and Torres Strait Islander people. How good is each different campaign? How wide reaching, how influential? These are researchable questions, and should be addressed by sound evaluation protocols.
There is monthly data published on vaccine uptake by the Australian Government Department of Health and Aged Care.
The uptake of COVID-19 immunisation boosters is waning. What are the barriers? How can those be addressed?
Air Quality has attracted a lot of attention. Everyone wants high air quality. It’s fundamental for life. But when it comes to reducing risk of viral transmission, what standards should be met? How? What is the technical capacity to reach that standard? At what cost? What are the immediate priorities for places where the investment should be made?
Distancing and social habits
We saw early promotion and adoption of simple transmission reduction measures, like changes to handshaking, increased hand washing, reducing hugging and other physical contact, physical distancing, and avoiding crowding. How effective are these measures, individually or in combination? Again, who and what is most important?
Data capture, reporting
Various people still raise concerns about data quality and frequency of reporting. What is the availability, how strong are the systems? How can they make responses better? If valuable, how can these be improved?
Communications, campaigns and messaging
Let’s assume there are clear agreed answers to the various questions set out above. Has enough work been done to ensure the right messages are amplified? Have the campaigns been effective? Have they been through the best channels? Targeted to priority populations? Who might be best to deliver those messages, and how? How do we deal with people feeling vulnerable, people who’ve had loved ones die, or been severely disabled by COVID? What about those with immunocompromised circumstances?
What about people who don’t perceive themselves at risk? Those who feel their lives have been unnecessarily restricted, freedoms curtailed for no good reason? How do we tailor communications to this key group?
Research and evaluation will give us answers to many of these questions. Many have probably been well answered. But what are the new questions? What else do we need to know? Never has the old trope, “more research is needed” been truer.
Acknowledging the need for more data, and keeping across the data updated weekly, is an enormous task demanding substantial expertise and resource.
Lots of questions, some answers, and some challenges.
There are many more questions. And some may say “I have the evidence on that” to some of these questions. It’s important to remind ourselves that this virus has been around for less than four years, yet in that time an extraordinary amount of research has been conducted and published. I suspect very few could confidently answer all – or even most – of these questions with confidence of being across the latest evidence. But the point is, it is not simple.
One analysis suggests “It seems governments have been cowed by commercial determinants and the fringe ‘freedom’ groups.” I see no evidence of that. Already the Commonwealth Government has proven willing to push back on commercial interests like tobacco and vaping, and I’m optimistic they will do so on gambling. We need to accept that governments also have finite capacity and cannot fix all things for all people all at once. But we should still push for ambitious reforms.
What has PHAA been doing?
Our focus has been on that core question of capacity and resources. We have actively urged governments maintain and grow public health funding – most recently in Victoria and WA. We’ve consistently sought to constructively contribute to the debate about the need for an Australian Centre for Disease Control (ACDC). Now that the forthcoming centre’s been committed to, we’ve sought to encourage debate on and influence its establishment, governance, scope, and resourcing.
We need to build our workforce capacity, in some jurisdictions, from a rudimentary base. Establish systems to recruit and train the next leaders and experts in public health. New and longstanding Public Health Units need to be, firstly, defended from savage cuts, and then built to respond locally to various challenges.
We need to retain our existing research capacity and expertise, and create opportunities for the next generation by attracting a reasonable proportion of health and medical research funding sources. The review of the NHMRC and the MRFF is pivotal to the future of public health research resourcing.
We also look to weigh in, mostly with partners with greater resources and specifically focused expertise, on big issues like gambling, alcohol, obesity, tobacco and vaping, environmental health, assaults, gun control and much more. We continue to bring public health people together through our conferences and events.
We can focus on good structures (crucially, creating the ACDC), good processes (transparency of expert committees, accountability for decision makers), and offer our communication channels to those members who wish to weigh in, via our blog, journal, and the PHAA policy process.
Should PHAA be “putting out our own publicity to create a social environment that would be receptive to COVID-protective government action”? Maybe. But our reach doesn’t expand into the wider community; we’ve no capacity to run sustained wide reach or sub group targeted COVID-19 community awareness and education campaigns. Our focus is instead to exercise our influence on governments, policy makers, professional groups.
PHAA has arguably had some modest success in influencing government policy. We will stick to our knitting. That is, to continue to seek to do so, with the assistance and advice of our expert, enthusiastic and committed members.
We will make the case for the long-term improvement of public health capacity, the boosting Australia’s public health workforce, arguing for greater investment in public and preventive health, improving policy that advances public health and equity, and the creation of a strong, well resourced, and properly governed ACDC. We will continue to support campaigns lie the Yes vote for the Voice referendum and the Raise the Rate campaign. I argue that should continue to be our focus.