Terry Slevin, PHAA CEO
On 25 January 2020, Minister for Health, Greg Hunt, made a public announcement that Australia had recorded our first case of COVID-19. Six months on, what have we learned and where are we headed?
Anxiety is understandably high with the outbreak in Victoria continuing, and concerns that NSW may be following suit. However, on the global scale, the Australian response is seen as a very successful one. Especially when we compare our results, so far at least, with places like the USA and the UK. Failures there, given their expertise and resources, have been a breathtaking tragedy.
Australia has undoubtedly done well in dealing with the first stages of this pandemic. But it has revealed a major weakness in our armour, and that is the paucity of investment in public health. In the expert workforce, in programs and in institutions.
Public and preventive health attracts less than 2% of the national health investment – which tops $185 billion pa. We are the only OECD country that does not have a centralised Communicable Disease and Public Health agency (frequently called Centres for Disease Control); and only 27 out of 1057 Specialist Doctor Training positions in Australia are held by Public Health Doctors.
I am very proud of the success and dedication of my Australian public health colleagues, but the gossamer-thin line of public health workers and experts is stretched to breaking. And many critical public health functions (immunisation, cancer screening, public health nutrition and more) have been suspended or diminished while all hands have been sent to the COVID-19 pump. These will have impacts down the line.
It is accepted that COVID-19 is a long way from over, and the prospect of similar future viral outbreaks is very real, even likely. So we now need to urgently consider how we boost our capacity to deal with the future of this virus, and plan for the next.
Just as the perceived threats to our national security have recently attracted a $270 billion investment in defence over ten years, so too should the existing, and future threats to public health attract a major rethink of our investment in the public health infrastructure.
We have without doubt some outstanding international leaders in public health. But facing this battle, they need reinforcements, and they should not be taking on this fight on the smell of an oily rag.
And right now in Victoria in particular the contact tracing capacity is a genuine concern.
The battle is also not just about communicable diseases. Chronic diseases like cancer, heart disease and diabetes remain out biggest preventable killers and they also require an injection of resources to boost our preventive efforts.
So far we’ve done well, but how do we really compare with other countries? There are many metrics. Perhaps the most important one is the number of COVID-19 deaths. Taking into account population size we use deaths from COVID-19 per 100,000 population. Australia is at 0.5 per 100,000 people. Belgium (probably because they are among the few countries ensuring all related cases are recorded) are at 124 per 100,000, the UK is at 62, USA at 43 (likely an underestimate). Our figure of 0.5 looks pretty good by comparison, as is that of the Kiwis at 0.45.
Australia is served well in this crisis being an island nation, and by its early closing of borders and quarantining of overseas arrivals. Finding cases, tracking contacts of the people involved and quarantining them, changing our ways to stay at a safe distance, improving our hygiene and restricting travel have all been essential tools in the ‘COVID wars’.
Driving those changes has been our expert public health leadership, centred around our governments’ Chief Health and Medical Officers and the Australian Health Protection Principal Committee. Credit must also go to our senior politicians who have learnt from and been guided by these experts – sadly we’ve seen too many other countries demonstrate that expert advice can fall on deaf ears and be rendered useless.
Of course there have been mistakes, challenges and debates along the way. We have been far from perfect. With the threat of a new and poorly understood disease, decisions that affect millions of people have had to be made with sometimes very limited evidence. That has meant reliance on judgement and application of caution. We must accept accountability for those decisions.
And legitimate expert debate about the best way forward in times of uncertainty, while sometimes difficult, is ultimately a healthy thing. And it seems to have served us well. The closing of schools, borders, workplaces and sports events have all been contentious. Some suggesting “we’ve gone too far”, while others take the “go hard, go early” approach. Most recently we’ve heard the ’elimination’ vs ‘suppression’ debate. Rational scientific debate, while sometimes causing confusion, has been necessary to drive us to the best decisions.
But all this must be seen through the prism of the unfolding science around the behaviour of this virus. The understanding of COVID-19 has unfolded at a pace rarely seen in science before. But we still have so much more to understand. Keeping abreast of that evidence takes resources and expertise.
This must be coupled by efforts to maintain the faith and trust of the Australian people in expert advice. If Australians had not adhered to recommendations for safe behaviours early on, many more of us would have fallen ill and many more would have died.
One suggestion has been to create an Australian Centres for Disease Control (ACDC). The US entity of the same title has attracted criticism, but the name is not important, the issue is how best to structure and deploy the nation’s public health expertise. The even greater issue is, how much larger a workforce do we need, across all governments, to be confident that we can keep Australians safe?
As we enter the next and challenging stage of the COVID wars, it seems a good time for all Australian governments to review the resources we are taking into this battle and into the next, as yet unknown battlegrounds.
Last year, Western Australia’s Sustainable Health Review recommended that at “least 5% of the health expenditure” should go into prevention by 2029.
2020 has already proved that our health system cannot rely entirely on ‘cure’ services, but must become much more focused on ‘prevention’ services, if we are to build back better as a healthy Australia.
Terry Slevin is the CEO of the Public Health Association of Australia, and is also Adjunct Professor in the School of Psychology at Curtin University and Adjunct Professor in the College of Health and Medicine at the Australian National University.
Image credit: David Crosling/AAP