Introduction by Croakey: A report will soon be released that summarises feedback about the Federal Government’s plans to establish an Australian Centre for Disease Control (ACDC).
In a statement to Croakey today, the Federal Department of Health and Aged Care said the report would compile feedback to a discussion paper released last November outlining the roles and functions of an ACDC and suggesting 28 questions for consideration.
The Department said it had been undertaking targeted consultation to inform the scope, powers and structure of the Australian CDC since November, “to ensure a fit-for-purpose design that avoids duplication and maximises public health outcomes”.
“The Department continues to work closely across the Commonwealth and with states and territories on the design of the Australian CDC,” the statement said.
Meanwhile, all eyes will be on the Federal Budget in May, as allocations to the Centre over the next few years will be critical for determining its scope and ambitions.
“The budget for the ACDC needs to be in the hundreds, not tens of millions of dollars, and the legislation that creates it needs to ensure it can function effectively long into the future including through periods when Executive Government does not prioritise public health,” the CEO of the Public Health Association of Australia, Adjunct Professor Terry Slevin, said recently.
Writing for the PHAA’s InTouch publication, Slevin said he expected the ACDC to incorporate the roles of the Communicable Diseases Network Australia and Public Health Laboratory Network, to tackle “the tsunami of chronic disease” (as covered in a recent Grattan Institute report, ‘Highway to Health’), and to lead enactment of the National Preventive Health Strategy, to tackle issues like alcohol, tobacco, and obesity.
“This year will be pivotal, with ramifications for public health infrastructure for decades,” Slevin said. “This is genuinely a once-in-a-lifetime chance to get this right.”
Meanwhile, senior public health experts, drawing upon their experiences of previously working with the Centers for Disease Control and Prevention in the United States, share some suggestions for a National Centre for Disease Prevention and Control (NCDPC) below.
Mike Toole, Hammad Ali, Craig Dalton, Michael Dibley, Marion Kainer and George Rubin write:
The authors have all worked at the US Centers for Disease Control and Prevention (CDC). We wish to share the lessons we learned while working there and our ongoing observations of the agency.
We endorse the OzSage position paper, which proposes a broad mandate and an emphasis on prevention for what they refer to as a National Centre for Disease Prevention and Control (NCDPC), a term we will use in this article.
While the pandemic has highlighted the need for an NCDPC, we should not establish it in haste. In establishing an NCDPC, it will be essential to win the confidence of all jurisdictions and giving it too much regulatory authority may dissuade them.
It will need the capacity to address Australia’s most pressing health problems and be supported by expert networks. These include communicable and chronic diseases, reproductive health, environmental and occupational health, injuries, and mental health.
It should be independent of political influence. To avoid such interference, we believe that the best arrangement for an NCDPC would be a statutory body established by legislation with an independent Board of Management, which would appoint the director.
Its role in capacity building should be in close collaboration with universities and other specialist agencies and not in competition.
While the US CDC is based in Atlanta for historical reasons, to have credibility across the country, the Australian NCDPC headquarters should be in the capital Canberra, although it could have specialty nodes in other cities.
The movement for a national CDC
During the COVID-19 pandemic, there have been frequent calls for a national centre for disease control. Back in October 2020, Prime Minister Anthony Albanese pledged that a Labor Government would establish such a body.
Prior to the pandemic, the Australian Medical Association called for the establishment of a National CDC in 2017. An article in MJA Insight in April 2022 also proposed a similar body, while focusing on its role in preventing and responding to future pandemics.
This indeed would be a critical role. In a future pandemic an NCDPC could enhance a number of core pandemic response tasks, such as:
- Standardising surveillance and reporting
- Quickly commissioning relevant research and modelling and sharing the findings with the public
- Providing up-to-date information to the states and territories on the evidence for mitigating interventions
- Developing a nationally consistent communications strategy on all aspects of the pandemic
- Promoting a traffic light system by states and territories at the public health unit level to guide the introduction of mitigating interventions rather than doing so at the state and territory level. This system has been used in a number of EU countries, including Germany.
However, to best serve the nation’s health priorities, the mandate of an NCDPC should span communicable and chronic diseases, reproductive health, environmental and occupational health, injuries and mental health.
One of the most active bodies promoting an NCDPC has been the Public Health Association of Australia, which has published 11 papers on their website covering many elements of the future agency.
One paper that we wholly endorse is that the Centre should take a One Health approach that incorporates human public health, veterinary medicine, and agricultural and environmental science. This is already national policy in Australia at the Health and Agriculture departmental levels.
Short history of the US CDC
The agency is the successor to the Public Health Service’s Malaria Control in War Areas (MCWA), established in 1942 to protect soldiers during basic training in the US Southeast, where malaria was endemic. Opening in 1946, the Communicable Disease Center, based in Atlanta, built upon the work of MCWA.
In 1970, the name was changed to the Center for Disease Control, reflecting the expansion of its mandate beyond communicable diseases, and in 1992 it became the Centers for Disease Control and Prevention, retaining the CDC abbreviation.
Lesson for a federated Australia
While federal wartime powers established the MCWA, the continued effectiveness of the US CDC has relied on ongoing support by the states and territories. This support derives from the US CDC providing a technical service.
US CDC can only send staff to help investigate a disease outbreak if the relevant jurisdiction issues an invitation and articles about local investigations in the US CDC flagship weekly publication MMWR are always co-authored by state and county health officials.
The US CDC has very limited regulatory authority, including regulating cruise ships sailing from US ports and incoming migrants and refugees. Dr Neal Blewett, the Minister of Health in the Hawke Government, visited the US CDC in 1992 (and met co-author MT), then attempted to set up a national CDC in Australia but failed due to lack of support by the states and territories.
In establishing an NCDPC, it will be essential to win the confidence of those jurisdictions and giving it too much regulatory authority may dissuade them.
Scope of a CDC mandate
The US CDC has nine centres whose responsibilities range from specific diseases (for example, HIV, hepatitis, and TB) to environmental and occupational health, chronic diseases, reproductive health, injuries and global health. An NCDPC should have the capacity to address all conditions that have a major impact on the burden of disease in Australia, including mental health.
The US CDC has long been a key partner in global health and has made major contributions to smallpox eradication, HIV/AIDS, malaria control, and the response to the Ebola epidemic in West Africa.
In addition to epidemics, CDC has a long history of technical assistance in conflict and refugee associated health emergencies since the Nigerian Civil War in the 1960s. Many senior World Health Organization staff have a history of leadership roles at the CDC.
An Australian NCDPC should facilitate expert technical advice through the Department of Foreign Affairs and Trade on health development programs and emergency responses while focusing on the Indo-Pacific region. This should be done in partnership with the Indo-Pacific Centre for Health Security, which employs a One Health approach to development assistance in the region.
Governance and financing
The US CDC is a component of the Department of Health and Human Services and reports to its Secretary. The President directly appoints the CDC director. This arrangement may encourage political influence which can potentially lead to guidance and/or action contradictory to scientific evidence.
While the best arrangement for an NCDPC would be a statutory body established by legislation with an independent Board of Management, the NCDPC would require significant financial support by the Federal Government, preferably supplemented by the state and territory governments. This should be a priority consideration in preparing the upcoming May budget.
This is a significant undertaking which will take years of recruitment and significant investment. Based on a simple comparison of percent of budget apportioned to the US CDC (0.12% of the federal budget), the budget for an Australian NCDPC would need to run to several hundred million dollars.
The US CDC has several independent advisory committees, including the Advisory Committee on Immunization Practices. An NCDPC should follow this practice and could include certain existing groups, such as the Australian Technical Advisory Group on Immunisation. That would require an excellent working relationship with the Australian Health Protection Principal Committee, with its representation by federal, state and territory chief health officers.
Role in capacity building
The US CDC established its signature field epidemiology fellowship, known as the Epidemic Intelligence Service (EIS), in 1951. It has also played a major role in training laboratory scientists and establishing standards for the country’s public health laboratories. Another example of capacity building is the innovative sentinel surveillance for emerging infectious diseases.
The Field Epidemiology Training Program (FETP), an adaptation of the EIS training model, had its first iteration in Thailand in 1980 but has since been implemented in 80 countries. FETP trainees spend 75 percent of the program in field positions. The FETP has led to the creation of numerous national and regional disease centres, including the China CDC , the European CDC and the Africa CDC.
In 1991, the US CDC helped to establish the Master of Applied Epidemiology at the Australian National University, a program that has trained hundreds of Australian and Pacific Islander field epidemiologists. Furthermore, in 1991 NSW Health set up its epidemiology branch and public health officer training program modelled on CDC structures and the EIS program.
Given that context and the fact that many Australian universities now have Schools of Public Health and post-graduate epidemiology and public health courses, the role of an NCDPC in capacity building should be in close collaboration with universities and not in competition.
While the pandemic has highlighted the need for an NCDPC, we should not establish it in haste.
It requires extensive consultation with states, territories, universities, and institutes with the relevant expertise. It will need the capacity to address Australia’s most pressing health problems and be supported by expert networks. It should be independent of political influence.
To have credibility across the country, the headquarters should be in Canberra, although it could have specialty nodes in other cities.
Professor Mike Toole, Burnet Institute and Monash University
Adjunct Associate Professor Hammad Ali, University of Queensland and University of New South Wales
Conjoint Associate Professor Craig Dalton, University of Newcastle
Professor Michael Dibley, University of Sydney
Adjunct Assistant Professor Marion Kainer, Western Health (Victoria) and Vanderbilt University
Adjunct Professor George Rubin, University of Sydney
Read more about the US CDC in the latest edition of The Health Wrap