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AUSTRALIA remains vulnerable to the threat of infectious diseases unless we follow the lead of other countries and establish an independent authority for communicable disease control.
As pointed out in a recent article which I coauthored and published in Australian Health Review, Australia is now unique in being the only Organisation for Economic Co-operation and Development country without a recognised separate authority for national scientific leadership in communicable disease control.
This has been recognised by a range of health experts and was the subject of a recent inquiry by the House of Representatives Standing Committee on Health and Ageing.
The inquiry recommended a national audit and mapping exercise followed by an independent review to assess the case for establishing a national centre for communicable disease control.
There have been a number of recent public health threats that have prompted these calls for the establishment of an Australian Centre for Disease Control (or similar body), including the pandemic (H1N1) 2009 influenza; the identification in April 2010 of an excess of febrile convulsions in young children following administration of seasonal influenza vaccine; and the 2011 outbreak of Hendra virus in horses across Queensland and NSW which has led to the deaths of four people since 1994.
Each of these events presented unique challenges and all placed a strain on our current level of resources and expertise at both federal and state/territory level.
If there was a body to provide overall leadership and coordination on emerging communicable disease threats, including the efficient allocation of resources, it could provide timely reports to government, health services and the community and prioritise national research efforts.
We have a range of models to choose from, including the extensive and well resourced US Centers for Disease Control and Prevention (CDC) as well as more modest enterprises such as the UK Health Protection Agency and the European Centre for Disease Prevention and Control.
Given the federal governance structure in Australia, perhaps the most pertinent example in terms of comparable legislative frameworks is the Public Health Agency of Canada.
While different nations have different models to deliver this function, all are composed of professionals with a degree of independence from government to ensure that there is a clear separation between politically sensitive decision making and the advice and tools needed to inform best practice from a technical perspective.
Current arrangements in Australia for managing communicable disease issues have very limited scope for ongoing analysis and interpretation of national data, development of new surveillance methods, routine review of international findings, evaluation of policy and program impact, and the training and mentoring of the public health workforce that must be kept in readiness for the communicable disease threats that may emerge in the next decade … or week.
Despite being one of the richest countries in the world, our current communicable disease control arrangements are leaving us surprisingly vulnerable to outbreaks of infection, whether due to recurrent known pathogens or those yet to be identified.
The establishment of an Australian CDC would bring us in line with the situation in other countries of similar resources, and provide much-needed insurance against the disaster that may never happen or may be just around the corner.
The time has come for an Australian CDC.
Dr Brad McCall is the Queensland Public Health Medical Officer.
This article was written with assistance from health policy analyst Jennifer Doggett.
We will have many serious public health challenges facing us in the next decades, with climate change poised to change many aspects, not only of communicable disease transmission, but also of other significant health conditions including mental health and chronic disorders. Preparing and responding to climate change consequences is rather like dealing with an outbreak – where urgent investigation and responses will be needed – and we will need to learn progressively from experience how to deal with extreme weather events, impacts on infrastructure and their aftermaths in a warmer world. Starting now to create a centre where top expertise, support and advice is available, perhaps beyond infectious diseases alone, is likely to be a great foundation and voice not only for today’s challenges, but also for future preparedness.
I totally agree that Australia needs to align globally and have its own CDC to regulate, monitor and advise on infectious diseases
I fully agree with Brad. Our research into the impacts of the Swine Flu pandemic demonstrated the need for a consistent, trusted and independent voice. That is best served by a CDC. No government funded agency is ever truly independent nor should it be in a democracy. However a CDC established as a statutory authority would have the ability to provide independent advice to the public which is at least perceived to be independent of the government of the day; a perception which is in the interests of all sides of politics.
Australia badly needs a CDC that is at arm’s length from government, staffed by appropriately qualified medical and scientific personnel with expertise in public health, and not subject to the personal interests of whoever is the Chief Medical Officer, Secretary or Under Secretary of the Department of Health and Ageing at the time. We need investment in a robust and long-term communicable disease response infrastructure that enables planning beyond the next political election cycle.
There is no doubt that an Australian CDC would be of immense benefit as long as this was modelled on medical professional collaboration and did not result in an expanding politically controlled bureacracy. There is no doubt that the expertise exists in the individual states, but whether the political understanding exists to accept and promote this is uncertain.
I agree with the comments regarding the PHLS in the UK.
Unfortunately, vaccine deniers, woo-woo practitioners and others of the tinfoil hat brigade will all see it as another Government/Monsanto/BigPharma conspiracy and will continue to undermine scientific medicine.
Brad: Yes, we badly need a CDC. In the next few years or at most a decade, we will have a new pandemic.
We could be better prepared. Go for it.
Meanwhile who is responsible for our not having it already ?
John
It is a long time since the issue of an Australian Centre for Disease Control was last raised and my response to the new suggestion is very much the same as before (Forsyth JRL. An Australian centre for disease control? Med J Aust 1988; 148: 484.)
At that stage I argued that the American model has some serious flaws, including political, which we would not like to reproduce here. The model then represented by the Public Health Laboratory Service, in England and Wales, in which staff in the different regional laboratories, and in the central laboratory, were colleagues and in which the organisation was at one remove from government, had much to recommend it. Its success was not enough to protect it from the malice of the ex-, and unlamented, Chancellor of the Exchequer, Gordon Brown, who had long expressed his desire to destroy the PHLS under the guise of ‘rationalisation’.
A federal system of government does raise problems for such an organisation, whether here or in Canada. It didn’t help that the central laboratory of the Canadian system was plonked down in Winnipeg for political reasons, for example. It is also important to take regard of existing personalities. The PHLS had its origin in the exigencies of war, which helped; but we wouldn’t like to have as a prerequisite.
At all times it is essential to remember that public health is totally dependent on genuine cooperation and unselfish collaboration at all levels – from primary care and municipal organisations through to national centres – and even international centres. Earnest and well-meant suggestions are not enough. Australia has already had enough of expensive back-of-the-envelope national initiatives to last a long time. Don’t let us create a disaster.
I am surprised that we do not have something akin to a rudimentatry form of CDC which would at least tie together the activities of various infection monitoring, advisiory and regulatory groups. The argument presented by Brad McColl is convincing and we should put a case forward.