INEQUALITY and structural disadvantage may be the biggest dangers for Australia as we head into the third year of the COVID-19 pandemic, according to a Chief Health Officer and one of the country’s leading health economists.

Dr Brett Sutton, Victoria’s CHO, and Emeritus Professor Stephen Duckett, Head of the Health and Aged Care Program at the Grattan Institute, warned that Australia’s relative success in keeping COVID-19 at manageable levels with “relatively mild” effects on the economy may encumber how we “live with” the virus going forward.

Writing in the MJA, Duckett and Sutton said that 2022 and beyond “could be the start of the inter-pandemic period: if all goes well, community vaccination levels will be high enough that the occasional COVID-19 outbreak will not require lockdowns or other strict public health measures”.

But, they warned, that depends on the nature of the virus itself in the future.

“All viruses mutate, new dominant strains emerge. We do not know whether the next SARS-CoV-2 strain will be nastier than its predecessor, or whether a new vaccine will be required and could be developed quickly,” they wrote.

Professor Duckett warned InSight+ that the Australian Government’s National COVID-19 road map, released in July 2021, did not go far enough in planning for the future while living with the SARS-CoV-2 virus.

“It’s as if we could all just heave a sigh of relief and move on,” Professor Duckett said.

“I’m an economist, not a magician, or a seer. But we know that there will be a new dominant virus – there will be a mutation, and there’ll be a new dominant virus sometime in the future.

“And it will be dominant because it spreads more easily than the Delta variant. What we don’t know about that next variant is, is it going to be nasty or not? It might be milder, or it might be much worse and much more infectious. We might not need a new vaccine, or our current vaccines might not protect us against it.

“This is where we are facing an uncertainty, and this is where it is vital that we learn the lessons from the past couple of years.”

Professor Duckett said he supported the idea of a national “debrief”.

“It’s not about a witch-hunt, not about pointing the finger,” he said. “It needs to be about learning from what worked well and what didn’t.”

Duckett and Sutton wrote that COVID-19 had become “a disease of low income workers — those who couldn’t work from home — and their families and communities”.

“It affected Australia very unevenly, with poorer outcomes for those at greatest disadvantage. The recovery phase needs to rebuild community and system resilience and redress disadvantage exacerbated by COVID-19. Planning for workforce responses, especially preparing for burnout and the needs of staff for time out to recover,” they wrote.

Professor Duckett told InSight+ that the uneven nature of the impact of COVID-19 – the “social gradient” – was not a new phenomenon.

“There are multiple causes for that social gradient, and we see it in everything we do in the health care sector.

“It’s the job of policymakers to recognise that and have purposive strategies to address it.”

In their MJA editorial Duckett and Sutton pinpointed several areas where the federal government will need to direct its attention.

“The federal government will need to finalise a policy on permanently incorporating telehealth into primary care and specialist care in the community,” they wrote.

“It also needs to share the increased health care costs caused by the pandemic; and not just the direct costs, which it has already agreed to share with the states on a 50:50 basis, but also the costs of deferred care in 2022 and possibly even 2023. Under current arrangements, these costs will be borne entirely by the states because of the cap on federal funding.

“The real lesson of the pandemic, however, is the huge impact of inequality and structural disadvantage on its course and outcomes,” they wrote.

“It is convenient to imagine that respiratory viruses are randomly transmitted from one person to another. The reality is that they find all the social, demographic, and economic vulnerabilities within and between populations: differential effects related to sex, overcrowding, essential but casualised work, public housing, homelessness, poverty, poor health literacy, cultural marginalisation, and stigmatisation.

“Australia weathered the COVID-19 storm well. But these successes may have hindered our vaccination rollout. We cannot allow complacency to similarly encumber how we live with COVID-19.

“We must ensure that our health system has the capacity to respond to the shadow pandemic of mental health problems caused by the viral pandemic and its management, and that we are well placed to face the challenges of both long COVID and future pandemics.”

Also online first at

Editorial: The implications of living with COVID‐19 for intensive care in Australia
Raper; doi: 10.5694/mja2.51332FREE ACCESS permanently.


The COVID-19 pandemic has made me rethink wanting to continue my career in health care
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