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This commentary is an abridged version of a June 2020 submission from the Public Health Association of Australia to the Australian Parliamentary Senate Inquiry into Australia's response to COVID‐19. In many ways, Australia's response, especially in the early phase, has been exemplary – led by medical and scientific advice, and prioritising the health of the community as evidenced by our relatively low case numbers and fatality rates. Moving into the COVID‐19 recovery phase, it is essential to keep a broad perspective and recognise the contribution of public health, and the importance of resourcing public health expertise and capacity to learn from this pandemic and prepare for similar future emergencies.
The World Health Organization (WHO) was notified about cases in Wuhan, in the People's Republic of China, of what would become known as COVID‐19, on 31 December 2019. 1 The first case was recorded in Australia on 25 January 2020, less than a month later, 2 and by 30 January 2020, the WHO had declared COVID‐19 to be a global public health emergency. 1
Australia's cases in the first wave peaked at over 400 cases per day in late March 2020, 2 and on 8 April 2020, the Australian Senate established the Select Committee on COVID‐19 to inquire into the Australian Government's response to the pandemic. PHAA's submission (number 448) to that Inquiry was the result of extensive consultation with PHAA's members and public health experts and was made in June 2020. The full submission and appendix are available from the PHAA website (https://www.phaa.net.au/documents/item/4622; https://www.phaa.net.au/documents/item/4623).
The Senate Inquiry will hear evidence from across the Australian community and make findings and policy and legislation recommendations.
Public health practice is about ‘Protecting Health, Saving Lives – Millions at a Time’. 3 Public health is built on prevention activities, rather than health care and treating illness. Optimal health is about more than just not being unwell, it is also about the ways in which whole populations behave and interact and stay healthy. Public health responses during a pandemic are therefore critical to the maintenance of health in whole populations.
The initial response to the pandemic was on reducing the immediate health and economic impact, based on information available at the time. This included a portfolio of action across all 11 public health intervention types – public policy development, legislation and regulation, resource allocation, engineering and technical interventions, incentives, service development and delivery, education, communication, collaboration and partnership building, community and organisational development, and advocacy.
The Australian response and efforts of community members; health, community and service workers; and national advisory group and governments should be recognised and celebrated; they have demonstrated the extraordinary capacity of the community to deal with a significant health threat.
Compared with international rates, Australia has maintained low population and case‐fatality rates and has contributed only a very small number of cases and deaths to the international burden of disease. Whilst in part this may be due to being geographically remote (unlike European countries, for example), the efforts made by Australia's public health advisors and the ministers who operationalised their advice is to be acknowledged. Distancing has clearly worked so far – some of the best evidence being the huge reduction in influenza and other seasonal communicable diseases cases this year. However, we must be mindful that this is far from over. Globally, the virus is spreading faster now than early on in the pandemic, and there are many conditions under which Australia would encounter a second wave.
Prior to this pandemic, we are aware that major outbreak exercises had been conducted and response plans formulated and updated as a result. We know that this had made Australia as prepared for an outbreak as other countries (such as the UK and the USA), the major difference being that when the outbreak happened, the plans were activated. This is very much to Australia's credit. PHAA has recognised this through our special PHAA President's Award for Members of the Australian Health Protection Principal Committee (AHPPC) on 12 May 2020. 4
However, Australia's relative success has come at the expense of other public health activities as every available public health professional was pulled into the pandemic response. This reflects the capacity constraints brought about by years of inadequate investment in public health and disease prevention. Sustained increases in funding are needed to support building capacity and skilled public health workforces at federal and state and territory levels.
PHAA supports the efforts and response of the World Health Organization (WHO) within its limited remit and resources. 5 We note that the WHO has produced a COVID‐19 Strategic Preparedness and Response Plan Monitoring and Evaluation Framework, which we hope was used in the Commonwealth COVID‐19 Senate Inquiry. 6
Economic and social recovery from this world health crisis will depend on securing, protecting and improving population health. The broader public health impacts of the pandemic, and the responses to them, must be considered and given a higher priority than was initially possible or necessary. This submission provides an overview of some of these issues, highlighting examples of existing health issues and inequities being exacerbated and unforeseen consequences of the response, and forecasting longer‐term impacts.
Public health responses during a pandemic are critical to the maintenance of health in large populations. There are a number of tools we have to assist us in this, which are briefly described here.
The World Federation of Public Health Associations (WFPHA) has developed a Charter, endorsed by the World Health Organization. 7 A helpful lens through which to examine public health activities, all Charter elements were relevant to Australia's response to COVID‐19, although some elements were better activated than others. Core prevention–protection–promotion elements were activated quickly using pre‐existing mechanisms including standard public health surveillance notification and contact tracing, public education and more. Our laboratories and notification systems performed well.
Internationally, the World Health Organization (WHO) and Johns Hopkins University provided excellent and timely international information, and Australia utilised these sources at all stages. National and local information was updated in a timely way. Australian public health legislation was activated to good effect; nationally, public health unit capacity was upgraded; and advocacy for many constraining aspects of emergency management was disseminated effectively.