Questions of scope and governance: A northern Queensland perspective on the proposed Centre for Disease Control

Stephanie Topp¹, Alexandra Edelman¹, Sue Devine¹, Tammy Allen¹, Paul Horwood¹, Julie Mudd², Emma McBryde³, Jeff Warner¹

1. College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville and Cairns, Queensland.
2. College of Medicine and Dentistry, James Cook University, Townsville and Cairns, Queensland.
3. Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland.

 

The COVID-19 pandemic has reignited calls to establish an Australian Centre for Disease Control (CDC). But the scope of responsibilities for such a body remains open. Should it have a narrow remit focussing on communicable disease surveillance and response? Or a broader focus including non-communicable disease,* environmental health, injury prevention, and more? While some have warned that a broad remit risks an overly bureaucratic organisation, efforts to clearly define the scope of responsibility and establish effective governance will ensure that a CDC addresses gaps and reduces complexity. As public health researchers and practitioners in northern Queensland (NQ), we describe key aspects of the public health context in NQ and reflect on their scope and governance implications.

 

 

 

 

 

 

 

 

 

 

 

 

The imperative for multi-disciplinary expertise

Australia’s public health system (as distinct from publicly-funded healthcare services) comprises institutions and processes that protect and promote health and prevent injury, illness, and disability across a range of demographic, epidemiologic, and geographic contexts. One of these contexts is NQ, a rural and remote region larger than most other countries  (750,000km²) and home to approximately 730,000 people. Health outcome disparities between those living in NQ and similarly rural, regional, and remote areas of Australia compared to those in urban settings are well documented, and include higher rates of both communicable and non-communicable diseases.

Surely the time has passed for establishing institutions that deal with pathogenic infectious diseases in isolation? Successful responses to highly visible infectious disease outbreaks have time-and-again depended on addressing the interconnected nature of biological, social, and environmental determinants of disease. In NQ and beyond, higher rates of non-communicable diseases including diabetes increase susceptibility to severe morbidity from infectious diseases such as tuberculosis (TB) and COVID-19. Environmental characteristics including the warmer climate also increase the risk of heat related injury, and water and vector-borne disease.

The disciplinary make-up of an Australian CDC thus requires the capabilities to respond to the interlinkages between a range of emerging public health threats – climatic, vector-borne, commercial, and pathogenic – and inform ethical and strategic policy responses. International and domestic experience with Ebola, Zika and Dengue outbreaks, for example, have demonstrated that alongside entomology, microbiology, virology and clinical expertise, meaningful community engagement is critical to support infection identification and control.  Without the inclusion of multi-disciplinary expertise, including in social sciences and public policy, an Australian CDC will remain significantly underpowered.

Improving Australia’s capacity for cross-border health diplomacy

Another feature of NQ and northern Australia relevant to the consideration of the scope and governance of a national CDC is our proximity to the Indo-Papuan conduit. Significant mobility between NQ (and other northern jurisdictions) and Papua New Guinea, Timor-Leste and elsewhere create bi-directional pathways for the emergence and outbreak of infectious diseases.  While TB, Japanese Encephalitis, and disease vectors such as mosquitoes, have entered northern Australia via cross-border movement of people, livestock, and wildlife, so too have diseases travelled from Australia to northern neighbours. In the early 2000s, a highly virulent strain of community associated methicillin resistant Staphylococcus aureus (CA-MRSA) known as ST93 (or the Queensland clone) was introduced from eastern Australia into the highlands of Papua New Guinea. It’s a leading cause of a debilitating and sometimes fatal bone infection (osteomyelitis) in young children.

In conjunction with the Department of Foreign Affairs and Trade’s Indo-Pacific Centre for Health Security, an Australian CDC should therefore look to invest in strategic, technical, and ‘diplomatic’ relationships essential for improving our understanding of, and surveillance and capacity for, cooperative cross-border handling of disease threats and outbreaks. Establishing data and intelligence sharing agreements and protocols, and joint research and planning initiatives, could be the basis for improved trust – known to be essential for agility and effectiveness during public health emergencies.

Improving the visibility of public health and providing a technical clearing house

Within Australia’s federal system, where state and territory authorities play a central role in disease control, a CDC itself is unlikely to implement disease control activities. But it can and should serve as:

• a hub for the collation and analysis of data,
• a coordinator of surveillance and response activities,
• a catalyst for research, and
• a clearing house for evidence to inform public policy and action.

This is needed in a health funding and political landscape oriented towards hospital investment over health equity, primary and secondary prevention, and population health. Improved national visibility of public health (built off improved awareness generated by COVID-19 and a renewed prevention and intersectoral focus in the new National Preventive Health Strategy) is critical to draw political attention to funding and coordination gaps. An Australian CDC could both improve this visibility, and provide independent, expert advice to the Australian public, policy makers, and public health professionals.

Effective governance is essential and will take time

Finally, we emphasise that discussions about how a CDC would function are as important as deciding what it should focus on. Delivering essential public health services is a core government responsibility. Notwithstanding Australia’s many public health successes, our system is highly fragmented, comprising multiple federal, state and territory legislation, organisations, laboratories (public and private), health information systems, and varied health workforce roles. The National Framework for Communicable Disease Control reports that over 60 joint committees, networks, surveillance systems, and national centres are involved in communicable disease control. A key appeal of an independent Australian CDC is to deliver greater transparency, clarity, and coordination, including by supporting cross-organisational relationships. For example, effective collaboration between government-run health services and Aboriginal and Torres Strait Islander Community Controlled Health Organisations is fundamental. To do this, however, we agree that a CDC should not be hastily implemented: sufficient time is needed to develop clear goals and governance mechanisms independent of, but in conjunction with, federal, state, and territory entities. If effectively governed, an Australian CDC promises to improve coordination, reduce duplication, and strengthen disease control and public health capacity.

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*Editor’s note a) The Australian Labor Party’s 2022 election campaign included establishing an Australian Centre for Disease Control that would encompass non-communicable disease prevention.

Editor’s note b) The Australian Labor Party’s 2022 election campaign abbreviated an Australian Centre for Disease Control to ‘CDC’, with a scope including non-communicable disease prevention. The terms ‘Australian Centre for Disease Control and Prevention’ and ‘Centre for Disease Control’, and abbreviations ‘ACDCP’ or ‘CDC’ are used interchangeably by authors throughout the CDC Corner series.