Intouch Public Health

Melanie Parker – PHAA

 

With a 50/50 chance of an Australian Centre for Disease Control (CDC) being formed after the federal election on 21 May, discussing the scope and structure of this centre was key to PHAA’s webinar on 11 April 2022.

Presenters are leading figures at their respective organisations:

• Professor Sharon Lewin, Doherty Institute
• Professor Allen Cheng, Monash University
• Dr Craig Dalton, Hunter New England Population Health
• Dr Leanne Coombe, University of Queensland

Engagement was strong among the audience of more than 260, including paediatrician, Labor’s Dr Mike Freelander MP.

Watch the recording and read the summary below.

50/50 chance of an Australian CDC

PHAA President, Adjunct Professor Tarun Weeramanthri, introduced the webinar, stressing the importance of having discussions on how an Australian CDC should be formed prior to election day. He noted three key ingredients for a CDC’s success:

• Sustainability: having it built to last.
• Strengths-based: building upon already-existing health system strengths
• Solidarity: consensus among public health professionals on an Australian CDC’s design, to ensure strength in advocating to governments.

Chronic disease prevention as part of an Australian CDC

PHAA CEO, Adjunct Professor Terry Slevin stressed the importance of chronic disease prevention’s inclusion in an Australian CDC. Adj Prof Slevin also noted the policy positions of the ALP and the Liberal National Coalition.

The ALP has publicly stated:

“An Albanese Labor Government would improve pandemic preparedness and response by establishing an Australian CDC. The CDC will:

• ensure ongoing pandemic preparedness;
• lead the federal response to future infectious disease outbreaks; and
• work to prevent non-communicable (chronic) as well as communicable (infectious) diseases.”

Adjunct Prof Slevin later said he “greatly welcomed the inclusion of chronic disease prevention in the scope of the proposed CDC.”

The Coalition’s outgoing Health Minister, Greg Hunt MP, stated in a 2022 letter to the PHAA that,

“A National CDC would not add to Australia’s proven expertise and capacity to effectively respond to national communicable disease outbreaks. Additional structures could risk overlap and duplication with existing communicable disease control functions.”

Adj Prof Slevin later commented, “So Labor is already committed to creating a CDC. The Coalition have so far said no – but we will be working to persuade them to match Labor’s stand as the current election campaign unfolds.”

Adj Prof Slevin’s key design principles included:

• Independence, particularly board member and chair appointments
• A funding model of 50% funded by Commonwealth and 50% by states and territories on a per capita basis
• A clear scope, including chronic disease prevention, and infectious disease prevention, preparedness and management
• Well-resourced communications systems
• Transdisciplinary One Health approach
• Connection to and engagement with the Pacific region and internationally.

Timeframe for a CDC post-election

Adj Prof Slevin urged an Australian CDC’s establishment by June 2023, using a taskforce and ensuring stakeholder engagement. A Parliamentary inquiry may be of benefit to bring all parties “on board” but this should not slow the process.

The Doherty’s Professor Sharon Lewin, however, urged a more careful review of the strengths and weaknesses of networks already established in Australia prior to a CDC’s implementation.

Monash’s Professor Allen Cheng noted that government often moves at either ‘lightning’ or ‘glacial’ speed. There’s a long wait, then suddenly swiftly-implemented government action, like pushing a large, heavy rock off the edge of a cliff. He noted the public health community must gain consensus on an Australian CDC’s design to ensure strong guiderails, so that when/if it does get pushed off the proverbial cliff, it will “roll in the right direction” and be implemented in the right way.

Research and Pandemic Preparedness

The Doherty Institute’s Professor Lewin spoke on how research could partner with an Australian CDC. Prof Lewin discussed pandemic preparedness, and how the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE), a network of experts, was established and funded.

Prof Lewin discussed gaps in coordinating research into public health responses, and how addressing these gaps can boost national coordination of pandemic preparedness. These challenges included:

• Governance issues
• Data sharing barriers
• Lack of strategic frameworks for public health research
• Coordination between researchers and the public health response

Prof Lewin noted that creating an Australian Infectious Diseases Network may lift this coordination, without replacing useful existing network structures.

Clinicians and an Australian CDC

Monash University’s Professor Allen Cheng used the example of antimicrobial resistance (AMR) to highlight strengths and weaknesses currently present in coordination of surveillance and management of cross-disciplinary issues.

Prof Cheng noted the potential benefits associated with an AMR national coordination centre (like a CDC), and the standardisation of surveillance and guidelines, with better cross-jurisdictional coordination. He also noted the following as the potential scope of an Australian CDC, including:

• Communicable disease
• Non-communicable disease
• One Health
• Injury prevention
• Occupational health

Prof Cheng highlighted the need for the Australian CDC to have a clearly defined budget, scope and model, and the benefits of using already-existing networks.

Surveillance in an Australian CDC

Hunter New England Population Health’s Dr Craig Dalton discussed an Australian CDC’s potential functions and role in surveillance, and his past experience of the United States Centers for Disease Control and Prevention and lessons learned. Aspects included comprehensive development and support for individuals, a practical, surge-able workforce, and its transdisciplinary nature.

Dr Dalton also stressed the importance of developing an appropriate culture in an Australian CDC and connecting researchers with the public health response.

Dr Dalton referenced the Emerging Infections Program (EIP), which enacted local sentinel county/state surveillance, between the CDC and motivated local academic organisation and health department. He recommended this article for further reading. Dr Dalton suggested that this type of system could be used for an Australian CDC for both infectious and non-communicable diseases.

CDC role in public health workforce development

Dr Leanne Coombe, a highly experienced public health workforce focussed professional from the University of Queensland, discussed the varying degrees of workforce development currently done by national public health agencies across the world. This included the UK Health Security Agency, Public Health Agency of Canada, Africa Centres for Disease Control and Prevention, US CDC, and European Centre for Disease Prevention and Control.

Dr Coombe compared strengths and weaknesses between the latter two centres, and the importance of an Australian CDC being independent, having strong leadership, and clear public health workforce standards including monitored credentialling and accreditation. Dr Coombe noted that CAPHIA (Council of Academic Public Health Institutions Australasia) could potentially partner with a CDC to coordinate ongoing professional development.

What’s next?

If there is a change of government in May, a focused project needs to be established with a short but achievable timeline to design the scope, governance, structure, and connections to give the Australian Centre for Disease Control (and Prevention) the best possible chance for success.  Wide consultation and the capture of the relevant existing resources will be essential. So too will be the need for a clear timeline and meaningful constructive co-operation across the public health community. Only then can the genuine opportunity created by the COVID-19 pandemic put in place an institution that sustainably serves the health of all people living in Australia.