Australia is a step closer to having its own national agency to inform and co-ordinate public health responses – a permanent Australian Centre for Disease Control (CDC).

Long-awaited draft legislation was tabled in parliament^[1] last week to create this permanent CDC, which is set to start from January 1 2026.

It’s a milestone for public health in Australia.

This national agency will help protect us against immediate issues including avian influenza (bird flu), falling immunisation coverage and health misinformation. Down the track it’s expected to address other areas of public health, such as cancer, diabetes and heart disease.

But there’s much we don’t know about how the agency will run. We also need to ensure safeguards are in place against political interference^[2] in public health, which we’re seeing play out^[3] in the United States.

Almost 40 years in the making

Public health experts have been calling for^[4] an Australian CDC since at least 1987.

At that time, the Australasian Epidemiological Association noted the fragmentation of disease control efforts across the country. It was particularly concerned about the lack of timely data to inform the public health response to HIV/AIDS.

More than three decades later, the COVID-19 pandemic also exposed weaknesses in Australia’s public health system.

The COVID-19 Response Inquiry found^[5] an Australian CDC could have helped. It could have been a trusted voice for governments and the public; it could have clearly summarised evidence and data as it became available to inform policy and the public; and it could better prepare and co-ordinate responses to future pandemics.

How will the Australian CDC help?

The federal government has committed more than A$250 million over four years^[6] to fund the CDC’s overall activities.

But how will a new national agency help tackle public health challenges? Let’s take vaccination as an example, which is already coordinated nationally.

Under the National Immunisation Program^[7], all levels of government have roles to play. The federal government assesses and buys vaccines; state and territory governments distribute vaccines; and all levels of government fund the providers who administer vaccines. Independent experts, such as the Australian Technical Advisory Group on Immunisation^[8] (of which I’m a past member), develop advice on immunisation, supported by the National Centre for Immunisation Research and Surveillance^[9].

However, the lack of a CDC highlights some of the current system’s weaknesses.

States and territories collect data about vaccine-preventable diseases, but not all data is shared nationally. So we don’t always have a complete^[10] national picture.

Funding for vaccines can also vary across the country. For example, all people aged six months and older in Queensland^[11] and Western Australia^[12] could get a free flu vaccine in 2025. But eligibility in most other jurisdictions is limited to high-risk groups.

An Australian CDC could help with providing evidence on what the best strategy would be to best reduce illnesses due to influenza (including vaccination but also other potential measures), develop national communications to increase vaccination uptake, and evaluate outcomes to inform ongoing control efforts.

How can we protect against political interference?

As recent experience^[13] in the US reminds us, government agencies can be subject to political interference.

Allegations or evidence of political interference have affected or threaten to affect US policies on topics as diverse as mRNA vaccines^[14], scientific research^[15], foreign aid for HIV/AIDS^[16] and alcohol labelling^[17].

But political interference in the US isn’t just a recent phenomenon. In the 1990s, political opposition led to the US CDC having to stop examining gun violence, clearly a major public health issue^[18].

Closer to home, many in the public health community remember the short-lived Australian National Preventive Health Agency. This was established in 2011 but de-funded^[19] a few years later.

Ultimately, the CDC will need to have a close relationship with government. It will need appropriate funding, to provide input into government policies, and to be accountable for its work.

Yet it needs to be independent and transparent. Safeguards in the draft legislation^[20] mean, for example, the CDC director-general must, under most circumstances, publish advice to government and the associated rationale and evidence^[21].

So if any governments make decisions against the advice of the CDC, this would be clear. This is similar to the Victorian pandemic legislation^[22] – the health minister makes decisions but is required to consider and release advice from the chief health officer.

So early signs for the Australian CDC are positive.

What don’t we know yet?

Many questions remain. The draft legislation^[23] is understandably vague in defining the scope of public health so as not to limit its activities.

For example, would hospital-acquired infections be regarded as a public health issue (and would come under the remit of the CDC), or a health-care quality issue (and be addressed by another agency)?

The relationship of the Australian CDC to existing agencies, such as the Australian Commission on Safety and Quality in Health Care^[24] and the Australian Institute for Health and Welfare^[25], will need to be clarified.

We don’t yet have timelines of what the CDC plans to achieve, nor a strategic and implementation plan of how to get there. While infectious diseases are understandably a priority area, how soon will the CDC get into other important areas such as cancer, diabetes and heart disease?

We don’t know the CDC’s role in setting priority areas for research funding, how resources will be allocated within the CDC, and there is no mention of its role in training the future public health workforce.

But answers to these and other questions will come with time.

References

1. ^{^} tabled in parliament (www.cdc.gov.au)
2. ^{^} political interference (theconversation.com)
3. ^{^} play out (theconversation.com)
4. ^{^} calling for (doi.org)
5. ^{^} found (www.pmc.gov.au)
6. ^{^} A$250 million over four years (www.cdc.gov.au)
7. ^{^} National Immunisation Program (www.health.gov.au)
8. ^{^} Australian Technical Advisory Group on Immunisation (www.health.gov.au)
9. ^{^} National Centre for Immunisation Research and Surveillance (ncirs.org.au)
10. ^{^} don’t always have a complete (www.aihw.gov.au)
11. ^{^} Queensland (www.health.qld.gov.au)
12. ^{^} Western Australia (www.health.wa.gov.au)
13. ^{^} experience (theconversation.com)
14. ^{^} mRNA vaccines (theconversation.com)
15. ^{^} scientific research (theconversation.com)
16. ^{^} foreign aid for HIV/AIDS (theconversation.com)
17. ^{^} alcohol labelling (www.vox.com)
18. ^{^} public health issue (publichealth.jhu.edu)
19. ^{^} de-funded (insidestory.org.au)
20. ^{^} Safeguards in the draft legislation (parlinfo.aph.gov.au)
21. ^{^} publish advice to government and the associated rationale and evidence (www.cdc.gov.au)
22. ^{^} pandemic legislation (www.health.vic.gov.au)
23. ^{^} draft legislation (parlinfo.aph.gov.au)
24. ^{^} Australian Commission on Safety and Quality in Health Care (www.safetyandquality.gov.au)
25. ^{^} Australian Institute for Health and Welfare (www.aihw.gov.au)