Australia’s Covid-19 quarantining – an abrogation of federal responsibilities! There is no national plan20/01/2021
Perhaps the most contentious issue of our Covid year is who is in charge of quarantining? With continuing outbreaks of Covid-19 linked to incoming travellers, Australians have reacted with astonishment that quarantining issues were not foreseen and planned for years ago. How did we end up where we are and what should be done about it?
It seems the handballing of quarantine to the states and territories by the federal government has some legitimacy about it. On that, we note that the eight jurisdictions agreed, with little complaint and with no legal challenge.
At the federal level, there has been no coordination of a national approach. Instead of helping the eight jurisdictions, the federal government has hindered. Worse, it shows no sign of long-term planning.
Overriding everything, however, is that the federal government is responsible for quarantine under the Constitution and while it may have effectively delegated those responsibilities to the states and territories, it should be held to account for all outcomes, including the costs of continuing lockdowns and deaths.
The meaning of quarantine for Australia in the Covid age
Let’s define quarantine as a state, period, or place of isolation in which people, animals or plants are placed due to concerns about exposure to transmittable diseases or invasive pests.
With Covid-19 we do not need to deal with animals or plants. However, that hardly helps simplify the discussion of the quarantine of humans in Australia.
John Hewson in the Sydney Morning Herald (14 January) wrote: “Quarantine is a clear national responsibility explicitly designated as such by S51 of the constitution.”
Peter Van Onselen in The Australian (25 July) wrote: “Simply put, the Australian Border Force is in charge of incoming arrivals, with the commonwealth given constitutionally articulated responsibility for quarantining. The Constitution, in section 51 (IX), lays out in black and white that the commonwealth, not the states, has oversight for quarantine. It is the basis for the Quarantine Act, which has not been legally challenged since 1908, including during the 1919 pandemic. We also now have the Biosecurity Act (2015), which provides extremely broad powers, and it mandates that commonwealth powers supersede those of the states.”
Despite the emphatic nature of these statements, it is clear the federal government has abrogated responsibility for Covid-19 quarantine in Australia. The Coate Inquiry (into the Victorian coronavirus outbreak) has pointed to the need to clarify the roles of the federal and state and territory governments.
The federal government is in charge of all international arrivals – who, how many and where from. It is this power that has, in particular, been wielded carelessly and unfairly in regard to Covid-19.
The federal government is also in control of the many immigration detention centres around the country. These facilities have not been incorporated into the quarantine system.
Historical perspective of quarantine
Useful and extensive historical summaries are available from the ABS Year Book archives and from the Victorian Parliament. Both examine quarantining in Australia from the arrival of the First Fleet in Sydney.
Settlers, convicts and soldiers were carriers of infectious diseases common at the time, including smallpox, cholera and typhoid. It is estimated that smallpox wiped out about 50% of the indigenous population.
Over time, the various colonies would handle quarantine independently. Quarantine centres such as at North Head and Point Nepean were established. By the time of Federation in 1901 it was well accepted that quarantine should be a federal responsibility. Thus, the Australian Constitution lists quarantine in the commonwealth’s legislative powers. Quarantine powers were conferred from the states to the commonwealth through the Quarantine Act (1908) and establishment of the Federal Quarantine Service in 1909.
However, conflicts between the commonwealth and the states about responsibilities for quarantine and health soon developed.
Australia’s control of the Spanish Flu epidemic (1918-19) involved a form of mass quarantining, with large numbers of returning troops being sent into isolation. Arrangements broke down, with each state following its own course of action, resulting in inconsistent policies on border closures. Spanish Flu ultimately infected about 40% of the population, killed about 15,000 and possibly 50% of some Indigenous communities.
At the end of the crisis, the commonwealth established a new department of health that was intended to be the focal point for pandemics and quarantine measures. However, over the next 100 years complacency led to lack of national planning.
Quarantine stations around the country were gradually decommissioned, and some specialty centres, such as Melbourne’s Fairfield Infectious Diseases Hospital, were closed or roles redefined. In the 1980s, the federal responsibilities for animal and plant quarantine were removed from the health department to the department responsible for agriculture and primary industry.
In the 20th century, after the Spanish flu, the major worldwide epidemics affecting Australia included polio, Asian flu and HIV/Aids.
In the early 21st century – that is, the past 20 years – the threats of SARS-Cov-1, MERS, Ebola, Zika and Swine flu (H1N1) were negligible or contained. With Swine flu, which did reach our shores, it seems nationwide cooperation for containing outbreaks worked effectively.
Despite unclear government responsibilities, Australia has a history of dealing with epidemics and pandemics with general success.
However, the loose arrangements between the commonwealth and state governments over quarantine in regard to health would be sorely tested with Covid-19 when the country would require mass quarantine for the first time since the Spanish flu.
How prepared were we for another health crisis?
The Victorian Parliament document says: “History also reminds us that pandemic outbreaks are often forgotten, despite the impacts they inflict on societies.”
We have been warned by experts that pandemics will increase in frequency and severity due to the growing global population and international travel, incursion of human settlements into wildlife habitat, live animal trade and modern livestock management practices.
This 2004 CSIRO report writes:
“Infectious diseases previously unknown in humans have been increasing steadily over the last three decades. More than 70 per cent of these emerging diseases are zoonotic in nature – passing from animals to people, for example influenzas from poultry or pigs…”
A 2004 report by the Chief Medical Officer also notes the potential for exotic viruses to spread around the world:
“SARS reminds us that new diseases will continue to arise as infectious agents mutate and adapt to exploit new ecological opportunities. We cannot assume, as was widely trumpeted in the 1960s and 1970s, that we have conquered communicable diseases. No-one can predict the next emergency, although we can all be wise after the event.”
Since 2000, the world’s population has grown from 6.1 billion to 7.8 billion. Between 2000 and 2018 the number of international travellers per year doubled, while for the Asia-Pacific region it tripled. The number of international visitors to Australia was 4.9 million in 2000, reaching 8.6 million in 2019; the number of visitors from China went from 120,000 to more than 1.3 million.
Despite all these pointers to the likelihood of new pandemics and their potentially devastating consequences, Australia would be poorly prepared for Covid-19.
The Coate Inquiry noted that recommendations from a review after the H1N1 pandemic in 2009 to clarify the roles and responsibilities of all governments for the management of people in quarantine, both at home and in other accommodation, during a pandemic was not undertaken.
Important legislation, though, was passed in 2015 when the commonwealth Biosecurity Act 2015 replaced the Quarantine Act of 1908. This summary in Wikipedia explains how it is jointly governed and administered by two federal departments, the Department of Health and the Department of Agriculture, Water and the Environment. The powers are explained in this article in The Conversation. Prior to 2015 many of those powers weren’t available.
The Attorney General on 3 March 2020 stated that “the biosecurity laws allow the government to do a range of things based on the best medical advice from the chief medical officer … there are a range of powers that are available that were designed specifically to handle something as serious as a pandemic. … many of the orders require very close cooperation between the Chief Medical Officer of the commonwealth and medical offices in the states … it’s very much a cooperative set of circumstances. And the states have their own variations of these laws.”
However, it is one thing to have the legislative power but it is another matter to be properly prepared and ready to use it, and use it with the intent of true cooperation.
Further, despite this powerful legislation, a major flaw seems to be that none of the existing commonwealth or state pandemic plans dealt with mandatory, mass quarantine.
The Coate Inquiry again:
“… it would be unfair to judge Victoria’s lack of planning for a mandatory quarantining program given the commonwealth, itself, had neither recommended nor developed such a plan.”
Nor should the other seven jurisdictions be so judged.
A PM with no national quarantine plan
By mid-March 2020, international arrival numbers were slowing down, but still more than 25,000 a day. By late March, Australia was approaching 4,000 infections, overwhelmingly overseas acquired or sourced, with typically two to four new infections arriving each plane load.
It became an increasing problem that some returned travellers who had tested positive were not self-isolating as directed. Something needed to be done to stem the growth of community transmission.
The National Cabinet met on 27 March.
The PM arrived with full control of international arrivals and federal detention centres, with his own extensive experience in border control and with biosecurity legislation with extremely broad commonwealth powers that superseded those of the states.
However, as reported by Paul Bongiorno, the states were shocked when the national leader arrived at the meeting with no quarantine plan.
It seems the state and territory leaders had no choice but to devise their own plan. The meeting would result in two major decisions, apparently resulting from a proposal by the premiers of NSW and Victoria, the two most populous and vulnerable states:
- As of 28 March 2020 all incoming travellers would be required to undertake a 14 day supervised hotel quarantine period.
- The eight states and territories were required to run the hotel quarantine system.
The system was to be operational in 36 hours.
At the time of the meeting there were about 7,000 arrivals per day, though trending downwards. It is estimated that the number in quarantine after the first 14 days would peak at about 20,000.
The Coate Inquiry noted that lack of planning and such short notice was a most unsatisfactory situation from which to develop such a complex and high-risk program.
All (or most) arriving passengers have been quarantined since that time. From the National Review of Hotel Quarantine it seems that by 28 August 2020, some 130,000 had undertaken hotel quarantine with approximately 96,000 international cases and 34,000 (or 26%) domestic cases. Those numbers would be much larger by now.
A PM who controls international arrivals
The commonwealth would control the number of arrivals but would not, it seems, offer access to or establish remote centres for quarantining.
Mid-September the state and territory leaders learned, without consultation with them, that there would be more arrivals from overseas. The ABC reported that the Prime Minister Scott Morrison said that the number of people allowed into Australia each week would increase by 2,000 by the following Friday, even though the Government was yet to get agreement from states that would have to house the extra people in hotel quarantine. He said “… states would effectively be forced into accepting the arrivals into their quarantine systems, as the decision was set in stone… The planes will land with people on them, and they’ll be arriving”.
This decision was not a request but an order.
The Prime Minister, through Border Force, has control of all passengers into Australia, including disembarkation, immigration and finally egress from customs. Effectively the federal government has been dumping arriving passengers into airports for the state health authorities to look after. Flights were allowed to continue from major hotspots such as the USA, the UK and India without special constraints, increasing the chance of infected arrivals.
While state and territory leaders possibly thought they could manage certain numbers, they might not have appreciated that the hotel numbers could be unreasonably raised any time. And perhaps they thought that hotel quarantine would be a temporary measure while the federal government worked on alternative arrangements.
Hewson wrote: “A clear acceptance of its responsibility would have seen the Morrison government establish quarantine centres around Australia for all incoming arrivals.” Despite using Christmas Island early in the pandemic, no similar federal offer seems to have been made. Except for Howard Springs in the NT, the states and territories have been stuck with CBD based systems that they might have to operate for some years to come.
Curiously, in 2015 the federal government opened the Mickleham animal quarantine station near Melbourne airport. A state-of-the-art facility costing $380 million, it is described as “one of the nicest animal quarantine facilities in the world”.
In relation to securing our borders and quarantine, Onselen wrote in July that these “are the responsibilities of the national government, not the states”, that failure occurred ”… once power was abdicated to them”, that the “fingerprints of failure by the commonwealth are nowhere to be seen, leaving state governments to wear the odium for mistakes made”.
Throughout the whole COVID-19 process Morrison has been a follower, not a leader, with the New Zealand PM and our state and territory leaders, scientists and health experts showing him the way, all the way.
The federal government’s most obvious contribution has been to berate, target or praise selected jurisdictions in a highly partisan way.
What needs to be done in the short and long term
Can our ‘cobbled-together’ system of hotel quarantine prevent a serious third wave somewhere in Australia during 2021? Can Australia survive another pandemic without a national coordinated plan?
We should not assume vaccines are the solution
There are too many unanswered questions about the current Covid-19 vaccines: how effective, how long for, can the vaccinated still become infectious and spread the virus, will an annual shot be required, will vaccinated travellers still have to quarantine …?
We have seen that the science, and the virus itself, is constantly evolving and we cannot assume Australia will be able to ‘go back to normal’ by mid-2021. While new highly transmissible variants of the virus are appearing, will more alarming variants appear?
The Age is reporting that Health Department boss and former federal chief medical officer Brendan Murphy predicts Australia will spend most of this year with overseas border restrictions still in place despite a vaccine rollout, and that even if a lot of the population is vaccinated, it is not known whether that will prevent transmission of the virus. He expects quarantine will continue for some time.
Minimise the number of infected individuals arriving in Australia
It defies logic that the state and territories strive to rid their communities and quarantine facilities of coronavirus, with huge impacts on the lives of the citizens, while the federal government lands more on top of them on a daily basis. The federal government needs to find ways to stop infectious people boarding flights. The Australian Tennis Open is currently under a cloud.
We learn that international flight crews have been allowed to follow their own rules, and that the states – rather than Border Force – have had to negotiate with individual airlines. The Department of Home Affairs approach to air crews was simply advisory, not mandatory, with words such as “advised to” rather than “must”.
All our states and territories, even NSW, have shown that they can eliminate community transmission. Most Australians are keen to get back to that position, so are becoming less tolerant of outbreaks linked to international arrivals.
Quarantine sites must be remote from population centres and be used in the long term
The CBD-based system has proven to leak unpredictably, with immense consequences, and should be phased out.
The risks of hotel quarantining outbreaks might be independent of city size, but the cost of lockdown and tracing is greatly accentuated in Melbourne and Sydney due to their bigger areas and populations and higher densities, with greater flow-on costs to their economies and the entire country. Sydney has been accepting about 50% of all arrivals which magnifies risk even more.
The many options include upgrading federal detention centres, mining camps and tourist resorts. These quarantine centres would employ well-paid FIFO/DIDO staff on site. Outside pandemics, these specialised facilities can be used for other purposes.
The costs of setting up remote centres need to be balanced against the extraordinary ongoing disruption and impacts caused by local lockdowns and border closures, including the costs of testing tens of thousands each time there is an outbreak and having to extend support such as JobSeeker.
After 100 years we need a national quarantine plan
The warnings are that there will be more frequent and possibly more dangerous pandemics.
We need to overhaul federal and state planning and coordination for pandemics, in particular mass quarantining.
Had proper planning been in place some years ago we would have experienced a much more cost-effective, humane and cohesive approach.
Given the warning of future diseases and the rapidity with which the world is changing due to human activity, we need to act as if another pandemic is just around the corner. We should begin this process and start to implement it even as we continue to manage and mop up from the current pandemic and begin a vaccination program. This is a task for the commonwealth and will place us in a far better position next time.
We need to learn from our mistakes, anticipate the worst, and work together as a nation.
PS On 18 January, 7.30 included a report about who is responsible for our quarantine system.