At the height of the COVID pandemic, public health officials working at the nexus of politics and policy faced multiple challenges and pressures.
The Australian Government’s former Chief Medical Officer Professor Paul Kelly tells Alison Barrett about some of his reflections on the experience.
This article is published as part of Croakey’s #COVIDfiveyears series; read reflections from other health leaders and organisations in this special report.
Alison Barrett writes:
In early January 2020, Australia was in the midst of a catastrophic bushfire crisis as intense fires burnt across many parts of the country.
Commonwealth health authorities were working in the National Incident Room – activated in 2019 in response to the national bushfire emergency – to ensure primary healthcare was available.
Meetings were being held daily and a large whiteboard was used to monitor activities and responsibilities in response to the bushfires.
It was at one of these meetings in the first week of January that Professor Paul Kelly, then acting Chief Medical Officer while Professor Brendan Murphy was away, saw a notification flash across the bottom corner of the whiteboard.
“I can still remember it – the little right-hand corner, bottom corner of the whiteboard, with a square around it, sort of saying, ‘Wuhan: pneumonia’,” he told Croakey in a recent interview.
“I didn’t know where Wuhan was. There was always stuff coming out of China, but yeah, I thought, ‘I hope that’s nothing’,” Kelly said.
He remained on the bushfire response for one to two weeks more, but once Australia had its first COVID-19 cases and deaths, “things scaled up pretty quickly”, he recalled.
Kelly – who retired from the Department of Health and Aged Care last year – found it a wonderful experience to work in the National Incident Room – “which was only a room then, and became a Centre later on” – with a real sense of purpose.
But it wasn’t too long before they realised the venue was a COVID super spreader waiting to happen, and they began working from home or in separate parts of the building.
Kelly said one of the key lessons, especially from the earlier days of the pandemic, was the speed of adaptation.
Many of the systems implemented during the bushfires to improve access to primary care, including telehealth and electronic scripts – which had been talked about for years prior to the bushfires and pandemic without getting very far – were able to be put immediately into place during COVID lockdowns, Kelly said.
Those emergencies enabled bureaucratic or financial barriers to be broken, and telehealth and e-scripts now are normal, he said.
It was also at this time that the concept of urgent care clinics was explored, he said.
A public health physician and epidemiologist by training, Kelly first joined the Department in March 2019 as the Chief Medical Adviser, Health Products Regulation Group and became the Deputy Chief Medical Officer in February 2020 following the response to the Summer 2019-2020 bushfires.
Previously he had spent eight years as Chief Health Officer for the Australian Capital Territory and Deputy Director-General of Population Health in the ACT Government Health Directorate.
Politics and public health
Reflecting back on Australia’s response to COVID, Kelly said pandemic responses need both a political and a health lens.
Highlighting the gravity of the situation, governments were desperate for ideas to address the pandemic, and wanting to fund and implement them quickly, which “is not normal for governments”, according to Kelly.
Once advice was given by the chief medical and health officers, a decision was made and then implemented – following the usual government processes to sign off. “It went very quickly,” he said.
Advice provided by him and his state and territory counterparts was never developed in a vacuum – they also had to consider the wider consequences for society and proportionality, which is part of being a public health physician.
“In public health, and particularly in relation to an emerging event like this, where you don’t know what you don’t know on a daily basis, everything you do has some harm,” Kelly said.
“If you’re harming people, make sure that they are compensated for that, and only harm them as much as you have to… for the greater good … for the least time possible,” he said.
Trying to get a national consensus on the response – which was the focus of most of the 500 meetings of the Australian Health Protection Committee from January 2020 – was hard, according to Kelly, particularly following the Victorian outbreak in June 2020.
When the Victorian outbreak occurred, “everyone had different views about what they should do because they had very different pandemics,” he said. From a political view, each of the chief health officers had their own political issues they needed to deal with.
Kelly said at the national level, there were a couple of occasions where some ministers disagreed with his advice, but that was very rare.
On proportionality, Kelly said most of the western world probably didn’t do enough, early enough. New Zealand and Australia did more than others, which he said was right at the time.
But, as also reflected in Australia’s COVID Response Inquiry, Kelly said we probably did too much for too long, keeping restrictions on for longer than necessary.
He said some parts of society, particularly young adults and teenagers, lost a lot. “Did we do too much with them? Maybe we did, I don’t know,” he said.
“Vaccine mandates – apart from very specific places like healthcare and aged care – that was…a misstep…that was not proportional. Closing the border to China in January 2023 was not proportional,” he said.
But it was hard to stop the restrictions, he said. While the vaccines are great, herd immunity was not going to be achieved with them, and without building proper quarantine facilities or closing the borders forever, the virus was not going to stay out, he said.
Kelly empathised with the politicians’ position and the difficult decisions they had to make. “They knew that if they took the foot off the brake that…there would be consequences,” he said.
He recalled discussing the decision to open the South Australian state border at the end of 2021 and early 2022 with former Premier Steven Marshall.
“I remember saying to him, ‘Premier, you’re in a really hard place, because as soon as you open the border, you will get cases and people will die, and you haven’t had that really, and you’ll always be the Premier that opened the border and let people die and everything else will be forgotten’,” he said.
The great silence
Highlighting the change of public engagement and political interest, the reopening of borders and lifting of restrictions coincided with the lead up to the 2022 federal election and what Kelly referred to as the “great silence”.
Even though 2022 was really Australia’s “pandemic year”, no one wanted to talk about COVID, he said.
Daily teleconferences and press conferences stopped, and little came from the chief health officers – who were the real experts on the pandemic response as they knew how to balance everything, including the science and local political context.
Kelly said this had detrimental effects as the health officers were not able to counter misinformation and disinformation.
“As soon as we went into the election period in April 2022, neither side of government wanted to talk about it, and so we didn’t,” Kelly said. When you work in government, you have to go through a process – “you can’t just go on Twitter…and say what you like”.
He said he and the state and territory chief health officers are blamed unreasonably for all sorts of things, including falling NAPLAN scores, inflation and cost-of-living. While the pandemic and related responses were factors in those things, it was the role of CHOs to offer advice on “what we should do so that people don’t die tomorrow”.
Kelly told Croakey that while there is a lot of critique of the pandemic response in the COVID Response Inquiry report, the executive summary and recommendations are very reasonable.
Kelly’s use of the term “reaping” to refer to deaths in vulnerable populations in 2022 drew widespread criticism, and the Department of Health later told Croakey that he used the term in the context of reflecting on the experience of past pandemics and plagues, particularly those of the Middle Ages, where the plague was depicted as a ‘Grim Reaper’.
Trust
While the Australian public responded to the pandemic and enforced measures very well, Kelly said he was not sure that would be the case in the event of another pandemic: “I’m just not sure that they would, that would happen again. I don’t think we’d be able to close the border…I don’t think we’d get that support.”
Events like the disproportionate lockdown of nine public housing towers in Melbourne and police on horseback disrupting crowds of young people [at Bondi and Coogee Beaches] who were having “a normal picnic…when there was no COVID cases” interfere with people’s trust, Kelly said.
“At the time, it was kind of, ‘is this really necessary?’ And, with hindsight, it’s clearly not,” he said.
“The trust thing is crucial, really. And I think that’s the important thing…having people that are in positions like the one I had, who can tell truth to power and…relate to the general public. I think that’s sort of as a trusted source…of information. That’s really important, and that’s…under threat, I think, globally at the moment.”
Looking to the future
The Australian Centre for Disease Control is tasked with improving national data systems, which are critical for better pandemic responses, but it does not have the funding that is required, according to Kelly.
There is a commitment from the current government to keep working towards that, but “I’m going to keep reminding people” there is a gap in the funding needed, he said.
The Australian CDC will also play a critical role in rebuilding trust and becoming a trusted source of information, he added.
“I think building our sovereign capacity in vaccine development, and probably in medical devices and so forth is supported, but it also should be seen as part of a global capacity…not just for us, and that’s always been on the cards,” he said.
With the Moderna mRNA vaccine plant opening soon in Melbourne, he said we are in a far better situation in that respect than we were at the beginning of the pandemic.
The speed with which vaccines, diagnostics and treatments were developed was “extraordinary science”, Kelly said. As there had never been a vaccine against a coronavirus before, at the beginning of the pandemic he was sceptical we would ever see one.
“They saved tens of millions of lives probably, and are still saving lives,” he said.
Some of the misinformation and disinformation to rise out of “the great silence” is about the vaccines, which also played out in the US election with incoming US health secretary – Robert F Kennedy Jnr – being clearly anti-vax.
“Everyone, any sensible person, is sceptical of vaccines and medicines,” Kelly said. “That’s the way the science works. That’s the way that regulation works. You have to say, well, yeah, that might be a good idea, but show us that it actually works, and that it’s safe, and you can make it in high quality at the at the volumes that are required.
“So that is, that’s what I call scepticism, but that’s not what he [Kennedy] is peddling and others in that ilk. And we’ve got people with the very same playbook here in Australia.”
Kelly said the same people have fronted the Senate 60 or more times, asking questions about free markets, no regulation, small government. “It’s actually got very little to do with vaccines…It’s about an ideological vent which is not able to be shifted by anything,” he said.
On his own future, Kelly – who has previously worked in academic and research roles in Australia, as well as in Malawi, Indonesia, East Timor and the UK – said he was not on permanent retirement, just having a break and will “think of doing something else”.
He said his time in the Health Department had come to a natural conclusion, but “it was quite a ride”.
Declaration: AI app, Otter, was used to record and transcribe interview with Professor Paul Kelly. Quotes were verified with audio.
Acknowledgement: This article was produced with funding support from a Local and Independent News Association micro-grant.
Read Croakey’s articles in the #COVIDFiveYears series.
