The Communicable Diseases Network of Australia (CDNA) and the Australian Society for Infectious Diseases (ASID) conference in Canberra last week was largely overshadowed by the machinations in nearby parliament house. And what little media attention it did receive failed to highlight a very significant public health advance.
A parliamentary report entitled Diseases Have No Borders was released with a number of recommendations, including border security, systems for migrant health, advice for Australians travelling overseas, pandemic planning, further research and addressing a shortage of skilled public health workers.
Many of these projects would be the role of the body mentioned in the last of the report’s recommendations. This item considers the case for the establishment of a centre for disease control in Australia (CDCA or more popularly, the ACDC - for music fans).
This is not a new idea. The Public Health Association of Australia’s (PHAA) conference in 2011 had a headline debate on the establishment of a CDC, and they and others have been calling for the creation of such a body for a while.
The American CDC has a very high profile, has existed since 1946 and employs 15,000 staff. The European CDC is smaller, having starting out from a single office in 2005 but has grown rapidly. The diversity of member states in Europe has been a challenge for ECDC, but Australia could learn from its experience.
Like many other aspects of health, public health in Australia is state-based. The Communicable Diseases Network of Australia (CDNA) is made of representatives from the state and federal health departments, the Australasian Society for Infectious Diseases and other stakeholders. The network prepares national guidelines that state public health units either use or base their own guidelines on.
The recent outbreak of listeriosis associated with Jindi cheese resulted in 26 people becoming ill and three deaths in three states. Local public health units interviewed the people affected to identify a possible source. This part of the process can be difficult, as the German E. coli outbreak of 2011 showed.
Once the source of the infection is determined, the information is distributed though the CDNA and channels such as OzFoodNet, so that people in all states and territories are aware of possible exposure.
When other cases occur, an outbreak is identified, but right now, the response still occurs state-by-state. A centre for disease control would make streamline this process and make it faster and more efficient. It would not only be the source of surveillance data, but also the responding body. This would improve response times to outbreaks - and this is often critical for containing them.
Bringing experts together would also facilitate workforce training and public health research. These were two of the other recommendations of the report. The touted centre would be a mecca for students in Australia’s epidemiology training course.
A centrally-funded health agency would also federalise funding for disease control and public health. States tend to target preventive health functions for health savings, so federal funding would help maintain services in the face of local cost-saving efforts.
Although a CDC would have a primarily clinical role, the benefits of centralised data collection for research would be enormous and more than offset any concern about a public health “brain drain” to a national body.
Australia has a unique position in the world by virtue of being a a developed country in a region with a high prevalence of communicable disease. We have significant research expertise in public health and an excellent public health workforce.
It is only very early days; the results of the inquiry was to recommend establishing a mapping exercise and review. Although it might seem like yet another bureaucratic hurdle, as with many aspects of public health, it’s the long game that’s most important. Once a review is established, I encourage as many people as possible to make a submission.