Introduction by Croakey: Last week’s decision by National Cabinet to end mandatory COVID-19 isolation and pandemic payments has sparked strong criticism from community and health groups concerned about the risk to some people.
Many health leaders, community organisations and members of the public are concerned the decision will place additional strain on the healthcare system, aged care and Aboriginal and Torres Strait Islander communities.
Aboriginal Medical Services Alliance NT CEO John Paterson told the ABC that it’s “too early” to let people with COVID “freely move about” and that it was important that the most at-risk people were kept safe and the virus was kept out of Aboriginal and Torres Strait Islander communities.
While a support scheme based on the pandemic leave payment will continue for workers in aged care, disability care, Aboriginal healthcare and hospital care sectors, people who work in other casual or tenuous employment will be penalised, according to Australian Council of Social Services.
Management of COVID-19 and decreasing the health threats from climate change are the most urgent reasons for a national centre for disease control in Australia, according to Dr Elizabeth Haworth, former director of the Communicable Disease Surveillance Centre/Health Protection Agency (now the UK Health Security Agency).
Below, Haworth outlines recommendations for functions of an “effective CDC” including independence from governments and high-level responsibility for pandemic preparedness plans.
Elizabeth Haworth writes:
After increasing calls for an Australian Centre for Disease Control from many health bodies, including the Public Health Association of Australia (PHAA) and the Australian Medical Association (AMA), the Federal Government has announced that it will establish one and is consulting on it.
While there are many reasons for a national Centre for Disease Control, with arguments for and against, management of COVID-19 and reducing the health threats from climate change are the most pressing.
Clear, evidence-based information and advice to the population from national and international experts is urgently needed if we are to rely on personal responsibility rather than public and population-based measures and mandates for disease prevention and control.
COVID-19 is still with us, and despite government’s wishes that the pandemic is over, this is not so, with Australia experiencing 5,408 new cases and 42 deaths each day in the last week of September.
While the Australian Government seems to have limited the role of a national CDC to improving Australia’s ongoing response to current and emerging public health emergencies, the functions of an effective CDC, whether concentrating on infection or wide-ranging disease threats to improve their prevention and control, should include:
- an independent expert advisory mechanism to government, health workers, organisations and thence the population on emerging and serious diseases
- from a population health perspective, focus on the prevention and control of infectious and environmental threats and the coordination of programs to prevent and control risks to health and health care
- be a one-stop trusted source of evidence, surveillance data, its ongoing analysis and evidence-based advice for appropriate action to government, health workers, institutions, and the public
- lead, manage and coordinate clear advice to and working with the media
- create, maintain, and coordinate a network of infection and environment experts across Australia and internationally, to be called upon at short notice
- introduce new and rapid surveillance methods
- take high level responsibility for preparedness plans for pandemics, outbreaks and incidents and their simulation for implementation at national and local levels rather than current ‘ad hoc’ planning and arrangements being put in place ‘just in time’
- organise and provide surge capacity to local healthcare and public health units
- manage, acquiring if necessary, the stocking and distribution of vaccines, pharmaceuticals and protective equipment and other essential supplies for local health action
- plan and coordinate education, training and workforce development for pandemics/outbreaks and other public health emergencies
- identify gaps in knowledge and establishing a research and development program
- evaluate policy and program impact
- contribute to global surveillance.
An adequately resourced CDC could thus provide the means for vaccine and treatment purchasing and procurement, discussed for COVID-19, by Jane Halton in her recent report to Government.
From its experience with the control of COVID-19, the Federal Government seems to have acknowledged that the existing Australian Health Protection Principal Committee is inadequate. The AHPPC was made up of the country’s Chief Health/Medical Officers, but without the independence and authority necessary for this role.
It would now appear that these members of the Australian Health Protection Principal Committee would understand best the shortfall in previous arrangements.
The basis of a more effective health protection for the population could be established by setting up a time-limited Committee for Disease Control, made up of the Chief Health/Medical Officers, made independent of government, for this purpose.
For infectious disease they would call on leading virologists, microbiologists, epidemiologists, statisticians, sociologists and public health and health promotion specialists for their expertise.
For environmental threats, including climate change, they would call on specialist scientists, climatologists and public health and health promotion experts as well.
For other serious disease threats, such as cancers, oncologists and screening experts would be necessary. Informed members of the public would also be consulted.
This new Committee for Disease Control would review how Centres for Disease Control around the world function and form and test the components of an Australian CDC. It would then specify the expertise and staffing needed for a permanent disease control function.
As our country still grapples with COVID-19, other new infections such as dengue fever, the growing threats from climate change and a range of environmental challenges, an effective national mechanism for the prevention and control of many diseases is urgent.
This is a contribution to the debate.
About the author
Dr Elizabeth Haworth is a medical graduate of Sydney University with qualifications in general medicine/paediatrics/infectious diseases and public health. She specialised in Disease Control, working as a regional epidemiologist and director with the Communicable Disease Surveillance Centre/Health Protection Agency (now the UK Health Security Agency) for London and the South East, based in Oxford.
When she returned to Australia in 2010 she maintained an academic appointment as Honorary Senior Clinical Lecturer in Public Health at the University of Oxford and has an honorary research position at the Menzies Research Institute, University of Tasmania.
Her research interests have included the control of infectious and environmental diseases and most recently the control of infection at the Hajj and other mass gatherings, the epidemiology and control of health care associated infections and vaccine preventable diseases and the health effects of climate change and environmental sustainability.
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