Next steps to the design principles for an Australian Centre for Disease Prevention and Control

PHAA CEO, Adj Prof Terry Slevin

The establishment of the Australian Centre for Disease Prevention and Control (ACDPC) is the most important change in public health architecture in Australia for a generation. Our CDPC Corner has so far primarily focused on what the agency should include and prioritise.

Here we’ll focus on the process by which it is established, and how all those competing demands and raised expectations will be juggled and ultimately determined. It is important to recognise that the expectations of what the ACDPC can encompass will likely be far higher than the resources available to support their delivery.

Stakeholder engagement

With many strong voices looking to influence the Centre’s establishment and design, PHAA has recommended to decision makers that, from the outset, a clear and transparent process is needed to give all stakeholders the chance to comment on how to create the strongest possible entity.

To serve the interests of current and future generations of people in Australia, the ACDPC must build strong relationships, and trust. Giving a voice to all stakeholders from the outset is the best way to start building that trust.

A respected Australian public health leader should be appointed to Chair an Australian Centre for Disease Prevention and Control Taskforce, supported by a secretariat with robust knowledge of governmental processes and public health. The Taskforce should comprise experts from diverse backgrounds.

This group would make recommendations on the establishment of the ACDPC’s governance structure, scope, and resourcing, and ideally produce this report within six months of the Taskforce’s formation.

To do this, they should consult widely, with professional bodies, organisations, and individuals in fields including: public health, infectious disease prevention and control, chronic disease prevention, data capture, analysis, and dissemination, Aboriginal and Torres Strait Islander health, clinical medicine, one health, and risk communication.

Cross-jurisdictional engagement

Early, and transparent, engagement with state and territory jurisdictions (who deliver public health services) is an essential, even non-negotiable, element for the ACDPC’s success.

There are many organisations that are obvious partners, fellow travelers, and interest groups. These include relevant Australian Government entities such as the Therapeutic Goods Administration, National Health and Medical Research Council (NHMRC), Australian Institute of Health and Welfare (AIHW), Department of Foreign Affairs and Trade (DFAT), Australian Pesticides and Veterinary Medicines Authority, and more.

The Taskforce should identify strengths and weaknesses of Centres for Disease Control and similar organisations internationally, learning lessons to benefit the ACDPC. It should also consider learnings from reviews and reports conducted within Australia that have considered design principles of relevance to the ACDPC, and lessons from the COVID-19 pandemic.

There should also be a public consultation process to ensure anyone in Australia can give feedback.

The Taskforce should investigate and recommend optimal governance models, and be empowered to provide independent and publicly available recommendations based on technical advice suitable for cross-jurisdictional enactment.

There may have to be negotiation between the Commonwealth and jurisdictions regarding the legislative framework needed to form an ACDPC, and the governance models of relevant existing national (and international organisations like the European Centre of Disease Prevention and Control) organisations should be considered.

The Taskforce should carefully consider and provide recommendations on the ACDPC’s:

1. Legislative framework;
2. Board composition and committee structure, and other advisory representation on decision-making processes;
3. Agreements and arrangements with Australian states and territories;
4. Agreements and arrangements with other key entities such as the Australian Government Department of Health and Aged Care, DFAT, AIHW, NHMRC, and others including the Australian Health Protection Principal Committee, and Communicable Diseases Network Australia.

Scope

The Taskforce should make recommendations about the initial scope of the ACDPC. At a minimum, the scope should be consistent with the Australian Labor Party’s pre-election commitment to ensure ongoing pandemic preparedness, a nationally-led response to future infectious disease outbreaks, and work to prevent both non-communicable and communicable diseases. The scope may also be expanded to include workforce planning, training, and related programs. Additional functions could include:

1. Public health workforce development and monitoring;
2. Overseeing the development and operation of the Australian Strategy on Antimicrobial Resistance;
3. Coordinating with jurisdiction surveillance initiatives;
4. Tracking global infections, diseases, and other threats and linking into relevant international initiatives;
5. Overseeing initiation of the National Preventive Health Strategy implementation;
6. Environmental health concerns;
7. Injury prevention.

Resources

To adequately prosecute the ACDPC’s scope, the Taskforce should make recommendations about resourcing the Centre.  Consideration should be given to:

1. The initial and ongoing funding models (including the extent of state and territory government contributions) required
2. Including existing programs, resources, and entities in the ACDPC’s structure, such as the Public Health Laboratory Network, the Australian Government Department of Health and Aged Care’s Population Health Division, and others.

The funding mechanism and quantum should be recommended with a minimum five-year initial establishment phase.  It is expected that the budget will be in the hundreds, rather than tens of millions of dollars.

The Taskforce could consider a phased approach to establishing the ACDPC, and could recommend how to appropriately expand the agency’s scope beyond the initial five years. It might also recommend the timeline for a progress review process.

Formal partnerships

This Taskforce could also recommend what partnerships and connections the ACDPC should develop to optimize its efficacy. At a minimum, these should include formal partnerships with the Australian Bureau of Statistics, NHMRC, and Medical Research Future Fund,, among other national and international organisations. Other connections and partnerships should be explored, including but not limited to:

1. Key research organisations, e.g., National Centre for Immunisation Research and Surveillance (NCIRS), Australian Infectious Diseases Network (AIDN), and others;
2. Agreements and arrangements relating to relevant disease data capture, sharing, analysis, reporting, and stewardship;
3. Primary and tertiary care sectors, pharmacy, and community health sectors;
4. The Aboriginal Community Controlled Health Organisation sector, and other Aboriginal and Torres Strait Islander health organisations and systems;
5. Other relevant government agencies at national, state, and local level.

The ACDPC’s underpinning philosophy and values should be articulated, with due consideration for the value of a One Health approach and a focus on social, commercial, and other key determinants of health, among other major drivers of health outcomes.

Timeframe

The Taskforce’s report should be available within its first six months, and within a further six months, the Government should have in place the Centre’s legislative framework and relevant joint agreements with states and territories.

The selection of an ACDPC board and nomination of a chair should be completed. The recruitment of the Executive leadership team should also have commenced, with key leadership posts filled.

In the first instance, resources of around $20 million might be made available in FY 2022/23 to undertake the Taskforce’s work and establish the ACDPC. Additionally, a budget bid to secure adequate funding for the initial stage of the ACDPC should be made available to Treasury for inclusion in the May 2023 Budget.

Creating the Australian Centre for Disease Prevention and Control is a vital reform for advancing Australia’s capacity to prepare for, manage, and prevent infectious diseases, and to tackle the increasing burden of non-communicable diseases.

Health Minister Mark Butler has committed to open Population Health Congress 2022 in Adelaide in September.  If not already announced, the Congress provides him the ideal opportunity to articulate how the ACDPC might progress.