Hunt says Covid outcomes show CDC not necessary

The Federal Minister for Health, Greg Hunt, has ruled out setting up an Australian Centre for Disease Control, despite widespread support for it among medical professionals and scientists.

The Federal Opposition is also in favour.

Health organisations supporting a CDC include: the Australian Medical Association; Australian Nursing and Midwifery Federation, and the Public Health Association. It is also supported by the Australian Strategic Policy Institute.

KEY POINTS: Govt rejects CDC; reasons for doing so; ALP medical professions support it; case for CDC; how politics is getting in the way of a CDC.

However, Hunt argued that Australia is better off without one.

He told Parliament (29 October 2020), “The disease [Covid] is progressing at a faster rate than ever before, with eight consecutive days of over 400,000 cases and, in the last 24 hours, over 500,000 cases. That means that the challenge the world is facing is growing.

“Against that background, Australia has had seven cases within the community in the last 24 hours – 500,000 as opposed to seven. What that means is that Australia’s unique approach has been deeply, fundamentally important in protecting lives and saving lives here. 

“As the Medical Journal of Australia indicated, Australia’s approach – our approach –– has helped save over 16,000 lives compared with the United Kingdom. But, more than that, what we did was over a long period of time.

“In 2014 we worked with the COAG Health Council to establish a communicable diseases framework for Australia. That played itself out in over 50 exercises since 2017 for emergency response preparation involving the National Incident Room and also led the World Health Organization to identify Australia in 2017 as one of the most prepared nations in the world. 

“All of that saw the Australian approach of working together through the AHPPC and the containment and capacity measures lead to the outcomes that we’ve had in Australia. 

“I know there are alternative approaches. There are some who want a CDC, or a centre for disease control. That is the American model and the European model. It’s the model that has seen . . . in Italy 24,000 cases in the last 24 hours, in the UK 24,000 cases, France 36,000, US 81,000.” 

His statement comes after federal government in August 2018 dismissed a recommendation from a 2013 parliamentary review, Disease without Borders, calling for an independent review to assess the case for a national centre for communicable disease control. Hunt was Health Minister at the time.

Labor Leader Anthony Albanese committed a Labor Government to setting up a CDC.

He said (6 October 2020), “An Albanese Labor Government will strengthen Australia’s response to future pandemics by establishing an Australian Centre for Disease Control (CDC).

“Australia is the only OECD country without a CDC equivalent and the Federal Government has not led a national pandemic drill for 12 years.

“Our nation went into the coronavirus pandemic with less than one mask for every Australian in the National Medical Stockpile, an overreliance on global supply chains, and badly stretched aged and health care systems.

“These failures have contributed to the tragic deaths of almost 900 Australians – 673 of whom were aged care residents and 28 linked to the Ruby Princess debacle – and more than 27,000 infections.

“To strengthen Australia’s preparedness and lead the national response to future pandemics, the CDC would:

      0 House surveillance experts and systems to monitor current and emerging threats;

      0 Work with state and territory governments and service providers to improve preparedness in the health and aged care sectors;

      0 Manage the National Medical Stockpile, including analysing needs, procuring and managing stock and distributing supplies as needed;

      0 Run regular preparedness drills on the scale of Exercise Sustain in 2008;

      0 Work with other countries on regional and global preparedness.

“As in other countries, Australia’s CDC would play a role in preventing health threats posed by chronic disease, as well as infectious diseases.”

The Shadow Minister for Health, Chris Bowen, said ““Health experts have been calling for an Australian CDC for more than three decades. It’s time to get on with it.

“We know that almost 90 per cent of Australian deaths are associated with chronic disease – but 38 per cent of the chronic disease burden is preventable. An Australian CDC would save lives and ease the pain of chronic illness.”

The AMA issued its position paper supporting a Centre for Disease Control in 2017, well before the current pandemic. It renewed the call in June, 2020.

AMA President Dr Tony Bartone told the ABC in June that Australia’s response this time illustrated “the importance of having medical leadership entrenched in the decision-making activity, and that has been the core of it”. 

“But it has happened all because of good will, you might say,” he said. “The ad hoc way that AHPCC is set-up, there is no real long-term resourcing, indeed, supported regulations around it. It needs that sort of permanency to guide it through the non-pandemic periods.

We’ve seen with Zika virus, with SARS, and now with COVID. these biosecurity risks will always continue to be very, very prevalent and present. There’ll be more in the future. We can’t rely on good will and the people in those positions. We need to have permanency of both funding, of process, of research, of coordination and planning that occurs in between the pandemics to ensure that we have got the right response in the pandemic.”

One of the arguments for a CDC is that it could put out co-ordinated advice to doctors, patients and the general public instead of different messages from different state and territory governments and conflicting advice being given to GPs.

Professor Johnatan Carapetis, who is also president of the Association of Australian Medical Research Institutes, also supports a CDC. He told the Australian Financial Review, “The government response has been admirable, but it relies on an informal network of experts. It is still early days and we are yet to see how this plays out. We need a CDC that brings the science together and ensures science-based responses.”

Another long-time supporter of an Australian CDC, Professor Professor Peter McIntyre.

He said, “A central facility in Canberra funded by and working closely with government to enhance epidemiologic capacity, but independent from government, would be a valuable enhancement to the field epidemiology training already based in Canberra.”

The Parliamentary review, Disease without Borders, said: “The committee shares the concern expressed by several participants that some of the most effective networks in place regarding infectious disease control are informal networks, maintained by the goodwill and enthusiasm of a number of hard-working infectious disease physicians and individuals around the country.

“In the committee’s view, there is a strong case for giving further consideration to the need for an overarching national structure to oversee policy development and co-ordinate responses to infectious disease outbreaks issues at a national level.

“A national centre for communicable disease control could serve as a central co-ordinating agency, overseeing infectious disease policy development and managing any response to a large-scale outbreak of infectious disease.”

The AMA’s position paper said: “The AMA calls for the immediate establishment of an Australian National Centre for Disease Control (CDC), with a national focus on current and emerging communicable disease threats, engaging in global health surveillance, health security, epidemiology and research.

Diseases and health threats do not respect borders.  Australia must play a global role in combating infectious diseases and potential threats by establishing a national CDC. A CDC is urgently needed to provide national leadership and to coordinate rapid and effective public health responses to manage communicable diseases and outbreaks. The current approach to disease threats, and control of infectious diseases, relies on disjointed State and Commonwealth formal structures, informal networks, collaborations, and the goodwill of public health and infectious disease physicians.”

The full position paper is here: https://ama.com.au/position-statement/australian-national-centre-disease-control-cdc-2017

Adam Kamradt-Scott is an Associate Professor at the Centre for International Security Studies, University of Sydney, Katrina Roper, a Research Fellow (adjunct) in the Research School of Population Health at ANU called for a CDC to be set up in the north of Australia.

They wrote in The Conversation: “The need for a coordinated and improved response to health emergencies across Australia’s multiple jurisdictions has been flagged many times during COVID-19. So, what’s stopping us?

“The short answer is politics. While the public health community has long supported the creation of an AusCDC, it has repeatedly fallen foul of state and federal politics. NSW and Victoria have consistently held any CDC should be based in their respective states, while others have argued for Canberra.  State governments have also resisted calls for a national CDC on the basis it might “steal” their top public health experts.

“The federal Department of Health, meanwhile, has reportedly flagged its discomfort with an independent, arm’s length entity

“Australia’s pandemic preparedness efforts throughout the early 2000s established a solid foundation for the national COVID-19 response, but successive governments dropped the ball. Multiple recommendations to continue strengthening our preparedness efforts were ignored. Our national influenza vaccine manufacturing capacity that once guaranteed Australians priority access has been privatised. And our national medical stockpile of personal protective equipment appears to have been subjected to budget cuts and efficiency savings to the point where there was insufficient stock when the pandemic struck. 

“Building an AusCDC is only one small part of the equation. Our region is one of the most disaster-prone areas of the world. Added to that, it comprises nearly two-thirds of the world’s population, many of whom live in high-density urban environments where diseases can spread quickly.

“When the next crisis emerges – and it will – Australia will have an important role to play. For these reasons, it makes little sense to locate the new AusCDC in Canberra or Sydney. It needs to be as close to Asia as possible – in Darwin.”

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