Tue Jun 14

How should an Australian 'centre for disease control' prepare us for the next pandemic?

Written by: Ben Marais, Associate Professor in Paediatrics and Child Health, University of Sydney

Over the past two years, Australians have become familiar with the threat of infectious disease outbreaks. COVID won’t be the last pandemic to affect our lives.

Early, aggressive restrictions were generally seen as necessary. But they also caused hardship, exacerbated inequality and undermined trust in government.

The pandemic exposed differences between states and territories. We saw inadequate national coordination of disease tracking, data analysis, lab capacity to process PCR tests, vaccination uptake ^[1] and communication ^[2]. This prompted renewed calls for the establishment of an Australian centre for disease control (CDC).

Before the election, Labor leader Anthony Albanese expressed the view that Australia’s COVID response had been undermined by a breakdown in our federated system and noted Australia was the only OECD country without a CDC. He committed to establishing one ^[4] if elected.

So what should an Australian CDC look like? And how can it improve our response to future infectious disease outbreaks?

What is a CDC?

There is no single definition of a CDC. Broadly, it’s a national agency that promotes public health through the control and prevention of disease and disability.

The US Centers for Disease Control and Prevention (US-CDC)^[5] employs more than 10,000 staff. It focuses on infectious diseases, food-borne diseases, environmental health, injury prevention, health promotion, and non-communicable diseases such as obesity and diabetes.

But the US-CDC has been criticised ^[6] for being overly bureaucratic, lacking innovation and being “missing in action” during the COVID pandemic, when the Trump administration completely sidelined scientific guidance. This demonstrates the importance of such an entity being free from political interference.

Other examples include the European Centre for Disease Prevention and Control ^[7] (ECDC), a networked European Union agency with a restricted focus on infectious diseases. It delivers disease surveillance and epidemic intelligence to guide regional and national responses in member states.

The US-CDC was criticised as being ‘missing in action’ during the pandemic. Markus Spiske/Unsplash ^[8]

In the United Kingdom, the UK Health Security Agency ^[9] (UKHSA) recently replaced Public Health England. It has a slightly broader focus on protecting people and communities from the impact of infectious diseases and chemical, biological and nuclear incidents.

The Public Health Agency of Canada ^[10] has the broadest remit of all. It includes preventing disease and injury, responses to public health threats, promotion of physical and mental health, and providing information to support informed decision making.

What does Australia need?

In Australia, states and territories are legally responsible for public health protection and providing the infrastructure for disease surveillance and response. A national CDC would need to work within our unique federated system.

The COVID pandemic showed Australia lacks a rapidly responsive national mechanism to:

collate, analyse and monitor disease surveillance data
coordinate outbreak control responses
evaluate the effectiveness of these responses
undertake rapid research to inform policy and guide decision-making.

Comprehensive infectious disease surveillance and near real-time data analysis is critical for coordinating national disease control responses, such as restricting population movement or contact tracing.

This surveillance and analysis requires an experienced workforce with expertise in epidemiology, microbiology and infection prevention and control.

Experts need real-time data to determine when to use restrictions or other public health measures. Viki Mohamed/Unsplash ^[12]

A new national system will need to improve on the current model, which has served us well in many respects, despite its limitations. The risk is that something hastily implemented can worsen the situation, by establishing less effective mechanisms, duplicating efforts and wasting resources.

Specifically, a new system will require more effective mechanisms for data collation and sharing between states and territories, as well as workforce upskilling and building of core capacities, such as genomic testing of bugs, in all states and territories.

A national CDC will need sufficient funding and a governance structure that allows effective engagement with academic experts and policy makers, with protection from government interference.

Most importantly, it will need a transparent process that provides independent evidence-based advice to government. Australians need assurance that public health responses are based on evidence not politics.

Recent outbreaks of Japanese encephalitis and monkeypox also highlight the need for coordination between human and animal disease surveillance.

The way forward

Following Labor’s election victory, there is risk that the establishment of an Australian CDC may be rushed through for a “quick win”. However, careful consideration and consultation is needed on how best to position such an entity.

It will need to engage with government and policymakers, while ensuring its decisions are independent, evidence-based and without political bias. It will also need to prioritise effective public communication and community engagement.

The best starting point is to define key principles that will guide its establishment and to commit to an open process that works closely with states and territories.

Important questions will need to be answered, such as whether an Australian CDC will encompass both infectious and non-communicable diseases, such as heart disease and diabetes. And where such a centre should be located to ensure it’s seen as a national asset without jurisdictional bias.

The ongoing impacts of COVID and multiple new threats make the need for concrete action to improve our national surveillance and response capacity increasingly urgent.