John Hewson
Preparing for future crises

Controversial English historian Arnold Toynbee, having reviewed and analysed the rise and fall of more than 20 civilisations, concluded that “civilisations are not murdered, they commit suicide by not meeting their challenges”. 

This raises some very important questions for the governments of our country as they have managed to get through a series of major challenges in recent years, including extreme weather events such as bushfires, floods and droughts, as well as the Covid-19 pandemic. The key question is whether they have learnt anything from these experiences, such that they would be better prepared if they had to face these challenges again in the future.

While the climate debate intensifies over the inevitability of further, even more extreme weather events, and the necessary transitions to a low-carbon Australia, it seems that governments are ignoring or playing down the possibility of further pandemics and the need to be better prepared next time. In addition, it was disturbing to recognise that globally many governments and health authorities had been warned about the possibility of a new and deadly coronavirus and were still alarmingly unprepared.

In light of all this, the question has to be asked as to why our governments have not responded to considerable mounting expert opinion, over many years, urging the establishment of a national centre for disease prevention and control. This expert opinion dates back to at least 1987, when a two-day workshop by 75 epidemiologists concluded with the resolution that “disease control activities are presently seriously inadequate and that some rearrangement of resources and institutions will be needed to ensure that the task of controlling and preventing disease is properly addressed”.

Since then there have been several workshops on the matter that have reiterated these concerns, most recently the OzSAGE   review. Members argued that Australia’s response to Covid-19 “revealed significant gaps” in the way we manage public health problems. “We did not succeed in having a harmonised approach to Covid and this led to a less than optimal degree of control, with outbreaks crossing state and territory borders,” the review said. “The pandemic was worse in communities already disadvantaged by social and economic drivers of poor health. Our immunisation program was not well organised, resulting in important gaps in protection. There was a considerable amount of reinventing the wheel.”

They noted the need for leadership to be informed by science and an understanding of the issues faced: “Our view is that current processes and structures do not provide the best basis for achieving this at a national level and that this is true both for emergent public health threats and for ongoing threats to health. We consider that a national resource, in the form of a National Centre for Disease Prevention and Control, will strengthen Australia’s ability to respond to public health problems.”

It is hoped that, unlike its predecessor, the Albanese government is genuinely willing to listen to the science and to take expert advice on this kind of proposal, or at least be willing to debate it. In political terms it offers a unique opportunity to draw a line in the sand on the issue of the handling of pandemics and to draw a sharp contrast to the Morrison government, which defined itself by the mismanagement of vaccines and rapid testing, after exaggerated claims about how prepared they were. Morrison’s response to his failures was to run a distraction by appointing senior military personnel to make it look as if he were operating on a war footing.

In defence of its proposal, OzSAGE  made a number of other significant points. “Our healthcare system needs to focus on prevention as well as on treatment of established diseases,” the review said. “A national resource is needed to enhance the focus on a long-term view of public health, engaging in the science, understanding and practice of health protection, prevention and promotion.”

A national centre for disease prevention and control would “co-ordinate multidisciplinary workforce training and capacity-building in public health and public health preparedness”. It would provide operational response capacity and “could also be a focal point for international response and collaboration”.

It would have “24/7 operational functions and have responsibility for responses on the ground actions”. These would include support for “immunisation, screening, disease surveillance and anti-tobacco measures, as well as short-term responses to emerging threats including response to cross-border or international emergencies”.

A principal function of the centre would be to detect, instigate and respond to emergent threats to health, working with the Australian Institute of Health and Welfare and the states and territories in monitoring and evaluating the health status of the population. It would need to develop a strategic plan to improve and promote health equity in the population, especially addressing the health of Aboriginal and Torres Strait Islander populations. It would also take a central role in assessing the health risks arising from climate change and be an important focus of contributing to pandemic, emergency and disaster responses.

OzSAGE also places emphasis on the need for tough independent governance of the centre. OzSAGE argues that the centre will need to respond to the social and political concerns of the day, also to be scientifically independent and able to focus on long-term health. “A major issue is the question of public trust,” the review noted. “The centre should be established and operated in a way that builds public trust. Trust is essential for effective public health outcomes.”

The centre would need to recognise the constitutional reality that public health is primarily a state and territory matter and will need “some form of delegation and/or control by states and territories”. To do this it would “recognise and promote the benefits of a national, consistent and cost-effective response to issues” and link with the Commonwealth and national agencies. It would need to be “some form of public sector agency”, either a Commonwealth statutory agency or a Commonwealth business enterprise, with a looser responsibility to a Commonwealth minister. It could require a national law enacted by each state and territory.

Although Scott Morrison was quick to recognise Covid-19 as a pandemic by global standards, this didn’t translate to effective early action. His government clearly wasn’t prepared. With their tendency towards science denial, they were unwilling to take expert advice. Perhaps an over-reliance on the Almighty coloured views from the top.

The establishment of a national centre for disease prevention and control would go a long way to ensuring that our nation was better prepared for future pandemics or epidemics and more able to respond in a timely and effective manner. These are challenges we can’t afford to fail in our response.

Our governments would argue that they have taken steps to be better prepared for future bushfires and droughts, in the case of the latter establishing the Office of the National Soils Advocate. Unfortunately, without harnessing these expert groups, investing in science and research and listening to the advice, we remain exposed to the risk of future pandemics.

This article was first published in the print edition of The Saturday Paper on July 2, 2022 as "The centre is on hold".

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John Hewson is a professor at the ANU Crawford School of Public Policy and former Liberal opposition leader.

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