KERRY BREEN and KERRY GOULSTON.-An improved response to COVID-19 will not be achieved with the current approach.

One of the puzzling and troubling aspects of the Australian response to the Covid 19 public health crisis is that the actions taken or advised by government have often lagged behind what many in the community, including people with expert knowledge, are agitating for.

When actions are taken, they frequently appear to be a week or two late. We consider here why this might be so and whether any contributing factors might be corrected. Meanwhile, others more expert than us have urged a different approach to the handling of the crisis.

There are several interlinked possible explanations:

  1. The crisis may be being viewed through the lens of an economic and employment issue and not a public health issue. This possibility is consistent with the Prime Minister’s focus on economic stimulus packages and not on short-term financial help for those people who soon will have no income, or an inadequate income should they apply for the Newstart Allowance. An alternate view is that some Western governments, including Australia’s, are ill-prepared for a crisis that demands strong government leadership and intervention.
  1. Political leaders may be wary of being proactive too early for fear of later being criticised for taking actions that some may claim in hindsight were never required. This possibility is consistent with statements from government which emphasise the need to take a balanced approach to the timing of any actions and that any actions must be proportionate to the situation. This language suggests that government may have the next election in mind and not the immediate well-being of the people.
  1. There may exist subconscious bias on the part of the members of the key government advisory body for the Covid 19 crisis, the Australian Health Protection Principal Committee. These people are all employees of government and although ‘public servants’, that concept has been weakened by the politicisation of the appointment process. If there is subconscious bias, it will be in the direction of giving advice more acceptable to government. In the case of the Federal Chief Health Officer it is relevant here to note that shortly he will step down to take up the position of Secretary of the Federal Health Department.
  1. The nine chief health officers who make up the membership of the Australian Health Protection Principal Committee may collectively not have the relevant expertise to handle a once in 100 year viral pandemic. Although most have public health training, none to our knowledge have expertise in virology nor experience in pandemics. Without being taken into the thinking of the Committee or having access to the evidence that the Committee has before it, community trust may be weakened.
  1. Even if there are members of the Committee with relevant backgrounds, there is likely to be difficulty having alternate views heard should the member come from a small jurisdiction, especially if the jurisdiction is currently governed by a political party of a different colour. That actions taken so far have varied between jurisdictions suggests this is a reality.

Having considered all of the above possibilities, we feel that it is likely that a combination of all five factors is in play. In the face of such complexity, this is unlikely to be a matter than can be helped by seeking to direct the Committee in any manner or by adding new members.

We find ourselves in agreement with those well-informed people who have argued that the response to the Covid 19 health crisis must be more urgent and more drastic. We believe that an improved response will not be achieved with the current approach. As others have suggested, what is needed is a new task force that is non-political and expert based (and, we suggest, with community input).

The Prime Minister, the Premiers and the Health Ministers should urgently convene such a group led by a person with credibility and the inherent trust of the community. Not only could this ensure that the Australian response from here on is more timely and appropriate but it would protect the current government from any electoral backlash.

 

Dr Kerry Breen AM is a retired physician who is interested in the regulation of the medical profession, medical ethics, medical professionalism and the health of doctors and medical students. He has published over 120 peer reviewed academic papers as well as several opinion pieces for the print media and internet publications. He is the lead author of Good Medical Practice: Professionalism Ethics and Law (4th ed) and the author of So You Want to be a Doctor: A Guide for Prospective Medical Students in Australia. He has also written a memoir and two medical biographies.

 

Dr Kerry Goulston AO is a retired physician and gastroenterologist. Past positions have included Associate Dean, Northern Clinical School of University of Sydney, Royal North Shore Hospital and Inaugural Chair of the Postgraduate Medical Council of Australia and New Zealand.

print

This entry was posted in Health, Politics. Bookmark the permalink.

13 Responses to KERRY BREEN and KERRY GOULSTON.-An improved response to COVID-19 will not be achieved with the current approach.

  1. Kevin Bain says:

    Re the metaphor of our current plight as a War, what’s different is that secrecy towards “the enemy” is unnecessary, and all combatants are on the same side, since restoration of the ex ante situation is the common objective. Yet in our real world success is compromised by inadequate professional debate to protect the medical hierarchy, and political exclusion to advantage the federal government’s interests. In a shooting war this would be called sabotage.

  2. roma guerin says:

    Dr Julie Hall was medical adviser on pandemic prevention to the Australian government for two years, after three and a half years leading the WHO team in China immediately after the SARS outbreak. Before leaving Australia to take up a similar role for WHO in Manila, covering 30 countries including Australia, she said: “It’s about increasing the ability within the region to detect infectious diseases, respond to them very quickly and stop large outbreaks occurring, as well as strengthening all of those systems so we have a much stronger health system”. It is simply not credible that Dr Hall left nothing behind, advice, recommendations, planning guidelines? Bill Bowtell and Norman Swann seem to be the only knowledgeable people I can find in the media, maybe they would know.

  3. Greg Briggs says:

    In this time of a public health crisis, it is not wise to be undermining the Federal Chief Medical Officer and the well – informed AHPP committee.

  4. J.Donegan says:

    Re: forward planning etc., was anyone representing Australia last year at Event 201 ?

  5. Rosemary Lynch says:

    1. I notice the US’s community spread does not seem to have impacted the testing protocols, despite well-known consequences.
    2. I am astounded that the presumption that disease spread is by importation persists, when a) there appears to be variability in valid test results b) the experiences in both the UK and US has been that while the local population is not tested en masse, as in Taiwan, Sth. Korea, Singapore, that domestic spread continues with devastating effect, unknown until the testing is widespread.
    3. I am gob-smacked that widespread public health information about containing coughs and sneezes has not been shared, everywhere. Not everyone walks around with tissues, or a convenient bin to throw them in. If they’d use them.
    4. I wish that Infectious Disease, Public Health, and Epidemiologists be the only voices we hear.
    Politicians and their credibility are up for grabs at the moment, the magic money they promise has still not arrived in any meaningful way, except from the RBA, even from the bushfires, let alone Covid-19. We need credible spokepersons with simple messages, and proportionate staging of pandemic process.

  6. Dr Katrina Watson, OAM says:

    Professors Breen and Goulston conclude there is a political dimension hampering Australia’s response to the coronavirus pandemic. Political brakes or not, Australia has missed the coronavirus boat. We had an opportunity to put the highest level interventions in place and make a difference, but it may be too late.

    I cannot help wondering whether there was a crisis management plan in place before this epidemic? Organisations should have crisis plans for high likelihood and/or high impact events.

    This pandemic is both high likelihood and high impact. We’ve known for years that something like this would happen one day. By mid-January 2020 the data from China showed that we were on the trajectory for an overwhelming crisis and therefore the most stringent measures were needed immediately. Then we might have had some hope.

    What we have had instead is the dribble approach. Try this and if it doesn’t work in 5 days add that. Try hand-washing then add in a touch of social isolation, and if that doesn’t work, dribble something else over the top.

    Not good enough. Researchers from Imperial College London have modelled responses to the epidemic and found that the dribble approach does not work. We should have had The Lot from the beginning. Multiple interventions aimed at preventing transmission – all at once.

    It’s probably too late to avoid thousands of deaths but at least it is worth trying. We need the most stringent measures possible – now.

    In order to achieve this the team has to have the best advice and best leadership, plus common sense and courage. Best advice – actual experts on emerging diseases and epidemics.

    Best leadership – we need charismatic leadership which can bring the community along, and is not hidebound by any political agenda (as so well described by Breen and Goulston). I have no doubt that our current leaders have worked incredibly long hours, and taken on enormous responsibilities – done everything they possibly can. But we are losing.

    We need common sense. Look at the nursing home situation. What is the point of rushing a 95-year-old with pneumonia off to hospital to infect another four people? None at all. They should be allowed to die in peace, with family there, family all wearing PPE of course.

    We need courage. Take the AFL match. Why wasn’t this just nipped in the bud? I don’t know why our leaders came down with a figure of 100 people in the first place. But surely the intent was clear- get rid of large gatherings. Reduce physical contact. The AFL has ignored the spirit of the 100 person rule. It’s not the health of the footballers I am worried about – it’s their parents and grandparents.

    The latest dribble is the 4 square metre rule. Where did this idea come from? Guaranteed it will last only a few days and be replaced with something else.

    Information also seems to be in the dribble category. It is hard to get the stats on the Australian situation, especially the denominators. Perhaps there is a database I have missed. The only data I have seen has been collected by the ABC.

    I would vote for putting in a senior military person at the top. This is a war and we are losing.

    • Lorraine Osborn says:

      “Crisis of management” identifies the systemic problem in too many of our critical institutions. The cruise ship being allowed to dock and disembark thousands of potentially infected people into the middle of Australia’s largest city yesterday is an exemplar. We need sustained bi partisan support for our institutions. They should have the brightest and best in their ranks and be frank and fearless. Governments are only as good as the public service that supports them.

    • Andrew McRae says:

      Thanks for that excellent summation of the approach being taken; the ‘dribble’ approach. Morrison keeps calling it a ‘clear plan’, his favourite expression. I haven’t detected even a speck of dribble in the last couple of days, except the brilliant 4-square-metre rule. What comes often with dribble, is drivel, and we’re getting a lot of that, too.

    • Comments with which most of us would fully agree but PLEASE, this is not the time for a “senior military person”. This is the time for a small team of MEDICAL EXPERTS with excellent communication skills to be informing the public on a daily basis. We are not at war! Or, if we are, then the enemy is less the virus than self-interest and ignorance.
      Let’s speak instead the languages of co-operation and humility. Let’s talk of care, containment and especially wisdom. Let’s accelerate the research; let’s fund richly the scientific groups that are currently starved; let’s call on vestiges of manufacturing capacity to supply what’s needed locally; let’s re-house those in grossly inadequate housing or homeless – we have empty apartments galore that could be requisitioned; let’s “redeploy” our abandoned creatives to provide their ingenuity in the 1000s of ways this will be needed; let’s find our how grandparents (like me) can resource our communities and especially those families in unbearable isolation. Let’s have the social revolution we desperately need.
      (As to who should lead the COVID response?
      Bill Bowtell. Pat Turner. Norman Swan. They’d speak to our hearts, minds, souls. And would keep many more alive.)

  7. Dr Kerry J Breen says:

    The authors agree. To the best of our knowledge, past suggestions that Australia needed the equivalent of the USA Center for Disease Control fell on deaf ears – or was rejected by those whose authority might have been undermined by its existence.

  8. Con Karavas says:

    What a huge difference a citizens jury made up of experts in the field would make. Parliament must be compelled to act on its advice.

    With respect, may I add a 6th point. It is added with Australia‘s declining position on Transparency International Corruption Perception Index in mind. Also the resistance by our Federal Parliament to enact an ICAC or Federal Bill of Rights when they have been called for, for decades.

    6. Politicians have too many conflicting interests to act in the interest of the people.

    To help the people and small to medium businesses, now is the time to introduce a Universal Basic Income (UBI).

    It’s cost would be marginal if, with exception of benefits for the chronically ill, it replaces all benefits, pensions and other welfare payments and departments and companies managing them are closed down.
    To be paid by ATO would have numerous advantages.

    The most common sticking point when I discuss is; the wealthy would get it. As this is only a very small percentage of the total population, it would probably be less expensive to give it to them than have a department setup to say who gets and who doesn’t .

    Trials have shown people don’t just sit at home – they become more involved in the arts, social work and become very innovative in setting up small businesses.
    The old dog-whistle ‘jobs’ becomes meaningless.

    Are we clever enough to adjust our economy for the benefit of society, democracy and small businesses?

  9. Andrew McRae says:

    With regard to point 2 above, the LNP has continually disparaged the successful program undertaken by the Rudd government to ameliorate quickly the worst effects of the GFC. Morrison and his cronies have lambasted the Rudd stimulus program as having gone much too far, much too soon, and been spent on useless, much-lampooned projects; no doubt had they been in power at the time a grim austerity regime would have been instigated, paid for and suffered by the large majority.

    The ‘balanced approach’ is another not-all-that-subtle Labor-bash, even in the midst of crisis. But if ever a crisis warranted throwing everything including the kitchen sink at it right from the start, or before the ‘start’, this is it; the Morrison ‘balanced’ approach is to wait, unlike Rudd, till it’s too late for the kitchen sink, when risks have already become realities.

  10. David B Gillett says:

    I understand that Australia is the only OECD country without an ongoing agency within government dedicated to disease control.

    If that’s the case then perhaps the suggestion within the above can morph into some ongoing highly valued agency which is part of the ongoing machinery of government … providing risk analysis and risk assessment and planning (including initiating integrated thinking within/across all departments) based on that risk management and being alive to the lessons learned over the long term would appear to be an indispensable agency supporting the operation of a government protecting the public health.

    We don’t appear to have this ongoing capability now as your article indicates … this should have been the scope of work for a specific agency for at least the last 2 decades

    The limitations of our current approach are very obvious and who has been served by the adherence to the current approach

    Am I wrong?

Comments are closed.