Introduction by Croakey: The importance of the national COVID-19 inquiry announced last week has been underscored by Australian Bureau of Statistics data showing that COVID-19 was the third leading cause of death in 2022, accounting for more than one in 20 deaths (9,859 of 190,939 deaths).
This marks the first time an infectious disease has appeared in the top five leading causes since 1970, the ABS said today.
Below Alison Barrett reports on some of the key questions, challenges and controversies facing the inquiry.
Alison Barrett writes:
The national inquiry into Australia’s COVID-19 response will be told that improved data collection and consistent public health messaging should be prioritised going forward.
Other submissions are expected to highlight the disproportionate impact of the pandemic upon Aboriginal and Torres Strait Islander people, and the concerns of people with disability about their needs not being met.
Many experts have also stressed the importance of the inquiry for informing the establishment and work of the new Australian Centre for Disease Control – for which plans and a timeline were outlined at the Australian Public Health Conference this week. An objective for the Centre will be to “increase independence to improve evidence-based decision making and to improve community trust”, according to these related tweets and slides from a presentation by a Department of Health and Aged Care representative.
The 12-month inquiry, led by an independent panel, including former senior public servant Robyn Kruk, epidemiologist Professor Catherine Bennett and health economist Dr Angela Jackson, is to review Australia’s response to the COVID-19 pandemic, including key health response measures, governance and the role of Federal Government as well as responsibilities of state and territory governments.
The Inquiry “will give advice on what worked, what didn’t, and what we can do in the future to best protect Australians from the worst of any future events”, Prime Minister Anthony Albanese said.
The need to be prepared for other pandemics was one of the key messages to come out of the UN High-Level Meeting on Pandemic Prevention, Preparedness and Response in New York last week.
UN General Assembly President Dennis Francis said the COVID-19 pandemic is “one of the most pressing global challenges of our time…The reality is that we simply lacked preparation and responsiveness”.
At the meeting, Member States adopted a political declaration calling for stronger international collaboration and coordination as well as the need to address global vaccine inequalities and misinformation.
Associate Professor Suman Majumdar, Chief Health Officer – COVID and Health Emergencies at the Burnet Institute, told Croakey that, noting the COVID inquiry is focused on the Australian Government response, it will be hard for us to “prevent or address the next pandemic, particularly an airborne one, without a step change from the status quo and if we only work in a country-by-country approach.”
Majumdar said system changes are required for a “coordinated global approach, grounded in political leadership and commitment, where Australia could also put its efforts”.
The political declaration on pandemic preparedness endorsed last week will be followed by negotiations, through the World Health Organization, on a pandemic treaty and reform to the international health regulations (the Department of Health and Aged Care’s related updates are here).
Concerns
Mixed responses have met the Inquiry announcement – one of the key sticking points is that “actions taken unilaterally by state and territory governments” are not in scope for the Inquiry.
Additionally, some have also questioned why a Royal Commission has not been called.
The release of Australian Bureau of Statistics data showing that COVID-19 was the third leading cause of death in 2022 underscores the importance of broadening the terms of reference and calling a Royal Commission, according to independent MP Zali Steggall.
Steggall said that a Royal Commission would have greater powers than an inquiry to compel evidence, witnesses, and the production of documents.
“From an integrity point of view, the independence of judge in a Royal Commission ensures that there is no perceived conflict of interest, which will go some way to restore trust of governments and advisers,” she said in a statement.
“COVID-19 and the response by state and territory governments impacted every Australian. Lives were lost, families separated, businesses ruined, and children and adults impacted physically – both from the virus itself and vaccine injuries, mentally and emotionally, socially, and financially.
“People were impacted differently depending on their postcode, people stranded overseas or dying without their family, while others were permitted to travel and come in to the country.
“The Australian economy is now in record debt as a result of the pandemic economic support and lock down decisions. We need to learn what we did well, and what we did badly. We need to improve our systems and responses and ensure future measures, including the implementation of the Centre for Disease Control are managed optimally to reduce the negative consequences that were experienced by Australians, our economy and society.
“It is important that issues that have may not be covered adequately are fully investigated, including vaccine injuries, human rights considerations, the ongoing impacts from COVID-19 such as long covid and impacts on mental health and domestic violence.”
Steggall said she had asked for a meeting with Minister Butler to advocate for a Royal Commission and the expansion of terms of reference.
Journalist Jack Waterford AM wrote, the “Australian public is accustomed to seeing royal commissions as the thing we want after a major disruption, such as floods, fires, or failures by significant institutions of society” and may see the inquiry as lesser and some sort of cover-up.
Minister for Health and Aged Care Mark Butler responded to the criticisms in an interview with ABC’s Matthew Doran, saying that as different states experienced the pandemic differently, different decisions were made in each state at different stages of the pandemic.
The terms of reference are focused on reviewing the role and responsibilities of the state and national governments.
“The Inquiry will look at the effectiveness of those national coordinating bodies and also look at the effectiveness of the health response measures that set out expressly in the terms of reference,” Butler said.
“What we haven’t decided to do is set up a quasi-judicial Royal Commission that will go through every one of the literally thousands and thousands of decisions taken by different levels of government at the height of the pandemic to deal with their response that we don’t think is going to take us forward.
“What we are going to do is have an expert led inquiry into the way in which our system operated.”
Butler also said that an inquiry will enable people to participate more freely than a Royal Commission. He said that state Premiers had indicated their willingness to participate.
“We’re not going to have to summons people to this Inquiry because people want to build the best possible response into the future. That’s why you’ve seen the response from Premiers and former Premiers who frankly were in the hot seat at the time. “
The resignation this week of former Victorian Premier Daniel Andrews has also provided a timely reminder of the power and the importance of the states in the COVID response.
Andrews became a leader of “national prominence” during the first two years of the pandemic, and journalist Quentin Dempster urged him to give evidence to the inquiry.
Surveillance
The Australian Healthcare and Hospitals Association plans to include in their submission to the inquiry many of the lessons highlighted in their Issues Brief on long COVID released Tuesday, particularly around the need for improved surveillance and consistency in public health guidance.
“Improved surveillance and consistent public health guidance will be essential to accurately identifying the burden of Long COVID on Australia’s healthcare system and resourcing it to respond accordingly,” said CEO Kylie Woolcock in a statement. (Croakey will report in more detail on the brief in coming days).
Similarly, Nicole Lee, President of People with Disability Australia, told Croakey their COVID-19 Inquiry submission would likely be informed by their recently published position statement on COVID-19.
Based on a member survey and forum, the position statement highlights that many people living with disability feel segregated from society as a result of reduced COVID-19 protection measures.
They feel forgotten, ignored and undervalued by governments and the public, in addition to feeling unsafe in the community.
Nearly 40 percent of people who responded to the survey restrict themselves to the house and only leave when necessary.
“People are really anxious around the lifting of restrictions,” Lee said.
PWDA recommendations include:
- mandate up-to-date vaccinations for all workers in high-risk settings
- development of national indoor air quality standards
- people who have tested positive for COVID-19 should not be allowed to visit disability group homes or aged care facilities until they are no longer infectious
- masks to be work in all health and hospital settings
- equitable access to healthcare via bulk-billed telehealth appointments, regardless of whether they have attended the medical practice in person in the past 12 months
- equitable access to tertiary education to ensure people who are immunocompromised can choose to attend their course online or by a combination of online and in-person.
Lee told Croakey that the disability sector and support workforce – many of whom are casual – also need to be better supported financially so they can take leave if they have COVID or other infectious diseases.
National collaboration
Majumdar told Croakey that the Burnet Institute welcomes the independent inquiry into Australia’s COVID-19 response, saying that “we had a world class response, particularly in the first two years, however we could have done better”, adding the pandemic and its impacts are still ongoing. “We’re not out of it.”
“It has been one of our greatest human challenges – to health, society and the economy,” he said, in particular how it shone a light on and exacerbated inequalities.
“There is a need to take a look at what worked, what didn’t and ultimately, a change in approach is required to prevent pandemics emerging and optimise our preparedness and response,” Majumdar said.
Majumdar said the Inquiry could also help inform the design and development of Australia’s proposed Centre for Disease Control, including with lessons on how “we effectively coordinate emergency management systems and governance across all levels of Australian government (or state and federal)” and also in how independent public health advice and transparent data to inform actions is provided to the community.
“One of the specific lessons is recognition of interventions to respond to airborne infections,” Majumdar said, adding that Australia’s pandemic response plan prior to the COVID-19 pandemic was tailored towards pandemic influenza, which was not fit for purpose for COVID, a novel pathogen, transmitted through the air and not contact with droplets.
Member engagement
The Queensland Aboriginal and Islander Health Council (QAIHC) plans to undertake a broad consultation with members to help develop their final, official submission to the COVID Inquiry.
QAIHC’s Public Health Registrar Dr Shamila Ginige said “it is difficult to outline a key issue in relation to the COVID Inquiry, as the inquiry has excluded unilateral actions taken by states and territory governments including lockdowns, school and border closures and mask mandates”.
However, “the consequences of the COVID response can be seen and will continue to be seen for many years.
“The already disproportionate health burden faced by Aboriginal and Torres Strait Islander people has worsened due to periods of isolation (from lockdowns and border closures) with higher rates of psychological distress and reduction in wellbeing, particularly in those with financial instabilities and mental health comorbidities,” Ginige told Croakey in a statement.
Ginige said the historical lack of trust in government and health facilities has deepened after intensive government mandates, and can be seen nationally in a reduction in attendances for preventative breast screen services and the lowest childhood immunisation rates in one-year-olds since 2015.
Lessons to learn
Professor Stephen Duckett from the University of Melbourne’s School of Population and Global Health told Croakey his submission would be based on a paper he wrote in 2022 on the Morrison Government’s management of COVID.
Key points include that while Australia’s response to the pandemic was relatively strong with overall good outcomes, the Morrison Government demonstrated poor pandemic management.
The Government undermined many of the state public health measures and critical crisis leadership competencies – task, adaptive and people competencies – were absent, according to Duckett.
“Lessons must be learnt, and new systems developed to ensure that the weaknesses exposed during the pandemic provide a basis for better planning and better pandemic responses in the future,” Duckett said in the paper’s conclusion.
More expert commentary
The comments below are edited extracts from quotes provided by Scimex. The full versions are here.
Dr Melissa-Ellen Dowling, Senior Lecturer in Government at the Jeff Bleich Centre from Flinders University
“Extensive public opposition to masks, vaccines, contact tracing, and travel restrictions arose partly because of inconsistencies in the developing science and the way that the science was communicated to the Australian public. Gaps in knowledge about the virus manifested in inconsistent and at times confusing messaging from the government, which generated significant suspicion of public health policy. In some cases, this suspicion manifested in non-compliance and undermined the government’s efforts to stop the spread of COVID-19.”
Dr Rebecca Ryan, Head of the Centre for Health Communication and Participation, Cochrane Consumers and Communication Group and Department of Public Health, La Trobe University
“We know that there were positives in the Australian public health response – but also many shortcomings. Communication from government was, for example, often opaque, inconsistent across jurisdictions, and lacking tailored information to help people act to protect themselves. We also know that there has been a failure to continue communicating with the public in recent years, despite mounting deaths from COVID-19, the risks of long-COVID and the implications for people who are at higher risk of severe disease or death due to COVID-19, who have been left behind. There is good evidence to show how this can be done better but to do so in future requires an honest appraisal of what worked well and what did not.”
Professor Julie Leask, a social scientist specialising in immunisation in the School of Public Health, University of Sydney and Sydney Institute for Infectious Diseases.
“The inquiry is overdue but very welcome. The inquiry will not scrutinise the measures that states and territory led. This is a major limitation because these are the elements that most affected peoples’ everyday lives, like lockdowns, policing, testing, hospitals and community engagement. That is a missed opportunity and begs the question, have the states and territories made their pandemic reviews publicly available?”
Professor Lisa Nissen, Director of health workforce optimisation, Centre for the Business and Economics of Health at The University of Queensland
“Now is a great time to look at the lessons we can learn from workforce utilisation during the pandemic.”
Associate Professor Haitham Tuffaha, Interim Director, Centre for the Business and Economics of Health at The University of Queensland
“Given the urgency of the situation, our response to the pandemic involved immediate actions that were not thoroughly evaluated for effectiveness, costs, and value for money. The Australian Government has invested a total of over $18 billion in Australia’s vaccine and COVID-19 treatment supply as part of the COVID-19 Health response. As COVID-19 transitions into an endemic phase, the role of health economics in decision making will be increasingly required to evaluate the cost-effectiveness of various prevention, testing and management modalities of COVID-19, which will inform a more effective and efficient response to future pandemics. Importantly, long COVID (defined as >12 weeks) affects around 10% of COVID-19 cases in Australia. Long COVID has significant health and economic impacts on Australia and we need to find cost-effective ways to detect, treat, and control long COVID, infections and their long-haul consequences.”
Dr Christopher Rudge, a Lecturer for Sydney Health Law at the School of Law at The University of Sydney
“… the inquiry should pay particular attention to: the exercise of powers under public health legislation in each state, and what conditions are placed on that exercise; the process by which vaccines and other therapeutic goods (such as donations of hydroxychloroquine entered into the National stockpile) are selected for government investment; the use of private consultancy firms to architect public health policy during emergencies and the problems associated with ‘business case’ analysis for vaccine investment.”
Professor Chennupati Jagadish, President of the Australian Academy of Science
“The Academy has argued that an inquiry should be future-focused, and about preparing for the next pandemic and led by experts. The approach adopted by Government is consistent with this approach: learn from the past, and prepare for the future. It is critical that it does. The world faces challenges of a type and at a scale not seen before. Climate change and deforestation, for example, will increase the risks of pandemics. We need to work out how to prepare our nation, and our world, for what’s to come.”
Paul Griffin, Director of Infectious Diseases at Mater Health Services, Associate Professor of Medicine at the University of Queensland, and Medical Director and Principal Investigator at Q-Pharm, Nucleus Network
“While I am of the opinion that overall Australia performed relatively well in terms of how the pandemic was handled, there were clearly elements of our response that were not ideal and this gives an opportunity for those to be reviewed in detail…One of the issues I would particularly like to see explored relates to the inconsistency of advice between states and territories; however I am concerned that this may be seen as out of scope.”
Hassan Vally, an Associate Professor in Epidemiology at Deakin University
“It is important that we learn every single lesson that we can to ensure that we are both prepared for the next pandemic and better equipped for dealing with future emerging infectious disease threats.”
Professor John Quiggin, an Australian Laureate Fellow in Economics at the University of Queensland
“The really important question is the failure of our system to deal in any way with COVID-19 as an endemic disease…masks and vaccination requirements have been abandoned, even in high-risk environments such as hospitals. Furthermore, while we know that ventilation is crucial in reducing transmission, efforts in this direction have been virtually non-existent. Smaller risks such as potentially flammable cladding have seen a much more concerted and effective response.”
Dr Daswin De Silva, Deputy Director of the Centre for Data Analytics and Cognition (CDAC) at La Trobe University
“As the pandemic continued into a second year, there was a lack of a data-centric and data sharing approach to informing and managing the direct impact of the pandemic and the subsequent social and economic fallout in individual states and across the country. There was limited transparency on data relating to infection trends, transmission pattern, virus associations, as well as the data and impact of decisions, evaluation of such decisions related to policies implemented at the state and federal level. Data-driven approaches could have informed operational and strategic decision making, for instance how much transmission could be suppressed through lockdowns, optimised vaccination strategies, and communities of care for high transmission areas.”
Associate Professor Ian Mackay, a clinical virologist at the University of Queensland
“Any enquiry into the COVID-19 pandemic should consider some hard facts. Scientists had long warned of the possibility of a pandemic arising from zoonotic spillover, but no practical risk mitigation measures were prepared for that. The likelihood that an airborne pathogen would drive a pandemic has long been understood by scientists. These pathogens, usually viruses, are what transmit most rapidly. They are what mutate and evolve most effectively. And they are entirely too poorly characterised in the animals we live alongside and whose habitats we encroach upon. Investment in the science to better understand this is lacking.
“Experts called to this Inquiry must include those with a hands-on understanding of bioaerosols. It should investigate carefully why the message that SARS-CoV-2, the cause of COVID-19, was an airborne pathogen was never properly communicated. That failing undoubtedly resulted in harm to Australians. And this harm continues today because infection continues. Long COVID continues. Excess deaths continue. All because of a failure to communicate the need for high-quality, well-fitting N95-like respirators instead of baggy surgical masks.
“Where this failure originates from requires analysis. Was it because of terrible advice driven by some who utterly failed to understand the science behind aerosol transmission, preferring an old and incorrect mythology of droplets driving respiratory virus transmission? Whatever the reason, high-quality masks have never been modelled by the nation’s leaders. There was never a public understanding that masks can reduce the dose of the virus we are each exposed to. Learning opportunities abounded during the pandemic, but they were not seized upon by those who could use them to keep Australians safe.
“One of the learnings from this pandemic that we failed to take on board is one of large-scale risk reduction, achievable by the cleaning of air in shared indoor spaces. This approach takes the burden of risk reduction from the individual and it delivers better bang-for-buck, protecting many at once. This will even have added benefits for reducing illness and lost productivity for 200 other respiratory viruses. This should be explained and discussed.
“In a broader sense, Australia failed to prepare for the pandemic through a lack of investment in the kind of education that explains related science to the public. Not just school children in the classroom but the harder-to-reach adult population. From the science behind how we test in the laboratory to the reasons for each of our responses to the pandemic and to help the community understand after the initial surge, why we were seeing more surges, why vaccinated people could be infected and how important viral evolution was to all of this. All around the work, equally scientifically unprepared populations have proven to be a fertile field for the sowing of misinformation and disinformation that has grown into an anti-science movement that has left us with future issues around all vaccines and expert advice.”
Professor Adrian Esterman, Chair of Biostatistics at the University of South Australia
“There are many things that the Federal Government did well, like the quick closure of international borders, the establishment of a national cabinet, and a joint committee of Chief Medical Officers. However, there are also many things that the federal government did poorly – one of the worst being leaving most of the responsibility for responding to the pandemic to the states and territories. Poor choices by our governments included the use of hotels as quarantine accommodation, a questionable choice of vaccines, very poor messaging (that still continues), inconsistent border closures, and inconsistent data collection and definitions (that also still continues). There must be a hard look at lockdowns – were they necessary? How long should they have continued? Should we have shut schools down? Was the use of mandates for vaccination and mask-wearing necessary? And finally, how good was the government’s economic response to the pandemic?
“It would be nice (but don’t get your hopes up) if this didn’t turn into a political bun fight. Certainly, there should be many lessons learned – one of which would be the need for Australia to become much more independent in the manufacture of vaccines, PPE etc. The role of the new Australian CDC also needs to be discussed. The best outcome will be an Australia better prepared for the future.”
Ross Gordon, an Advertising, Marketing and PR Professor at Queensland University of Technology and Member of the WHO Technical Advisory Group on Behavioural Insights and Sciences for Health
“While it is important that the inquiry will be led by health and medical experts, I am slightly disappointed that behavioural scientists were not mentioned. Human behaviour and behaviour change are key components of any pandemic response and we saw this firsthand during the COVID-19 pandemic. We had to change people’s behaviours to get them to test, isolate, wear a mask, physically distance, wash their hands, and get vaccinated. While some elements of the Australian pandemic response were good, such as closing the borders early and achieving high vaccination rates, there will be important lessons to learn regarding problems with the quarantine system, dealing with infections on cruise ships, better engagement with CALD communities, and improving how we promote health safe behaviours. I would strongly encourage the Australian Government to include experts from across the behavioural sciences such as social marketing, social psychology, behavioural economics, and human anthropology in the forthcoming inquiry. This will help us to make sure we develop a strong strategy for future health threats. ”
Professor Brenda Gannon, from the School of Economics at The University of Queensland
“The Inquiry should therefore go beyond the health-economy trade-off debate and ensure equity is a focus in future responses. The longer-term effects of COVID-19 are not just in physical health outcomes, but also the mental health effects, including long-term border closures, on the population. A complete benchmarking with other comparable economies can now be used to assess the best options for future pandemics. A complete evaluation of how government funds were distributed and their outcomes would be necessary, in terms of workforce impacted, to help inform efficient future planning.”
Scarlett Smout, a PhD Candidate and Research Program Officer at The Matilda Centre, The University of Sydney
“Research from The University of Sydney’s Matilda Centre and Australia’s Mental Health Think Tank found that financial distress was one of the biggest drivers of mental ill-health during the pandemic period.In April 2020 the Australian Government took action to stem the growing economic impacts of the pandemic by introducing the Coronavirus Supplement, which boosted income support payments (including JobSeeker, Youth Allowance, AusStudy and ABStudy) and pulled hundreds of thousands of Australians above the poverty line overnight. Qualitative research led by Dr Marlee Bower and quantitative research led by Dr Ferdi Botha both showed that this made a difference to the mental health of many Australians.
“Unfortunately, the supplement was quickly wound back, and by April 2021, income support payments were again well below the poverty line.
“Australia’s Mental Health Think Tank released a Youth Mental Health Recovery Plan with a suite of recommendations to address the disproportionate impacts of the pandemic on young Australians, including a call to bring income supports back to levels achieved with the coronavirus supplement. The recommendations remain more relevant than ever as we’ve seen compounding crises following the pandemic, including natural disasters and cost-of-living crises.”
Dr Abrar Chughtai, a Senior Lecturer and the Director of the Master of Infectious Diseases Intelligence Program at the School of Population Health, University of New South Wales Australia
“It should not be conducted as an ‘inquiry’, rather it should be a structured ‘review’ of pandemic response, with a more positive and collective learning approach, involving all stakeholders. For such reviews, the World Health Organisation (WHO) uses the term, ‘after action review’. See detail here.
In summary, an after action review is a ‘qualitative review of actions taken in response to an emergency as a means of identifying best practices, gaps and lessons learned’. During this process, we use a structured approach to reflect on our experiences during acute public health events. The aim is to identify what worked and what did not, why, and how to improve.”
Professor Tissa Wijeratne OAM, a researcher at RMIT University and Co-Chair of Public Awareness for the World Federation of Neurology
“The ongoing impact of COVID-19 as a leading cause of death and disability worldwide is a significant concern. In 2020, it became evident that a substantial portion of COVID-19 infections resulted in what was described as Post-COVID-19 Neurological Syndrome, affecting approximately one in four individuals, potentially impacting over 200 million people globally.”
See Croakey’s extensive archive of articles on COVID
