Minimising harm
Guiding recommendation
Ensure decision-making processes in a pandemic fully account for the broader health, economic and social impacts of decisions, and the changing level and nature of risk to inform escalation and de-escalation of the response to minimise harm.
Immediate actions – Do in the next 12-18 months
1. Address critical gaps in health recovery from the COVID-19 pandemic, including prioritising greater investment in mental health support for children and young people and a COVID catch-up strategy in response to a decline in the delivery of key health prevention measures.
2. Review the COVID-19 Vaccine Claims Scheme, with a view to informing the future use of similar indemnity schemes in a national health emergency for a wider profile of vaccines and treatments.
3. Conduct post-action reviews of outstanding key COVID-19 response measures to ensure lessons are captured, including a review of the Biosecurity Act 2015 (Cth) and key economic measures.
4. Establish structures to ensure young people and their advocates are genuinely engaged, and impacts on children are considered in pandemic preparedness activities and responses to future emergencies. This should include establishing the role of Chief Paediatrician and including the Chief Paediatrician and National Children’s Commissioner on the Australian Health Protection Committee.
Medium-term actions – Do prior to the next national health emergency
20. The Australian Government work with the states and territories to improve capability to shift to remote learning if required in a national health emergency. This should include: • incorporating competency in developing and delivering remote learning into initial teacher training and the Australian Professional Standards for Teachers • investing in the development of a suite of remote learning modules consistent with the Australian Curriculum, made available to all schools, teachers and students to improve preparedness for future emergencies that may require school closures.
Planning and preparedness
Guiding recommendation
Develop and regularly stress-test preparedness and a national response to a pandemic that covers the broader health, economic and social response and fully harnesses capability and resources across governments, academia, industry and the community sector.
Immediate actions – Do in the next 12-18 months
5. Develop updated health emergency planning and response arrangements in conjunction with states and territories, and key partners, including consideration of escalation and de-escalation points, real-time review and a focus on post-emergency recovery. This should include: • An enhanced National Health Emergency Plan (updated National Health Emergency Response Arrangements) and updated National Communicable Disease Plan. These updated plans should align with the Australian Government Crisis Management Framework. • Management plans under the National Communicable Disease Plan for priority populations. • Modular operational plans for specific sectors, including high-risk settings, which can be deployed in response to a variety of hazards.
6. Develop legislative and policy frameworks to support responses in a public health emergency, including for: • international border management • identifying essential services and essential workers • quarantine • the National Medical Stockpile • an Economic Toolkit.
7. Finalise establishment of the Australian Centre for Disease Control (CDC) and give priority to the following functions for systemic preparedness to become trusted and authoritative on risk assessment and communication, and a national repository of communicable disease data, evidence and advice: • Build foundations for a national communicable disease data integration system, enabled for equity and high-priority population identification and data interrogation, with pre-agreements on data sharing. • Commence upgrade to a next-generation world-leading public health surveillance system, incorporating wastewater surveillance and early warning capability. • Work with the Department of Health and Aged Care and jurisdictions on updated communicable disease plans. • Conduct biennial reviews of Australia’s overall pandemic preparedness in partnership with the National Emergency Management Agency. • Establish an evidence synthesis and national public communications function. • Build foundations of in-house behavioural insights capability. • Establish structures including technical advisory committees to engage with academic experts and community partners.
Medium-term actions – Do prior to the next national health emergency
21. Build emergency management and response capability including through: • regular health emergency exercises with all levels of government, interfacing with community representatives, key sectors and a broad range of departments • regular economic scenario testing, to determine what measures would be best suited in different forms of economic shocks and keep an Economic Toolkit up to date • training for a pandemic response.
22. Develop a whole-of-government plan to improve domestic and international supply chain resilience.
23. Progress development of the Australian Centre for Disease Control in line with its initial progress review and to include additional functions to map and enhance national pandemic detection and response capability.
Leadership
Guiding recommendation Ensure the rapid mobilisation of a national governance structure for leaders to collaborate and support a national response that reflects health, social, economic and equity priorities.
Immediate actions – Do in the next 12-18 months
8. Establish mechanisms for National Cabinet to receive additional integrated expert advice for a whole-of-society emergency, including advice on social, human rights, economic and broader health impacts (including mental health considerations), as well as specific impacts on priority populations.
9. Agree and document the responsibilities of the Commonwealth Government, state and territory governments and key partners in a national health emergency. This should include escalation (and de-escalation) triggers for National Cabinet’s activation and operating principles to enhance national coordination and maintain public confidence and trust.
10. Agree and test a national Australian Government governance structure to support future health crisis responses, including an appropriate emergency Cabinet Committee and a ‘Secretaries Response Group’ chaired by the Department of the Prime Minister and Cabinet that brings together the lead Secretaries and heads of relevant operational agencies, to coordinate the Australian Government response.
Medium-term actions – Do prior to the next national health emergency
24. Maintain regularly tested and reviewed agreements between relevant national and state agencies on shared responsibilities for human health under the Biosecurity Act 2015 (Cth) with a focus on facilitating a ‘One Health’ approach that considers the intersection between plant, animal and human biosecurity.
Evidence and evaluation
Guiding recommendation
Ensure systems are in place for rapid and transparent evidence collection, synthesis and evaluation.
Immediate actions – Do in the next 12-18 months
11. Improve data collection, sharing, linkage, and analytic capability to enable an effective, targeted and proportionate response in a national health emergency, including: • improvements to timeliness and consistency of data collection and pre-established data linkage platforms across jurisdictions, including for priority populations • expanded capability in Australian Government departments to gather, analyse and synthesise integrated economic, health and social data to inform decisions • finalising work underway to establish clear guardrails for managing data security and privacy and enabling routine access to linked and granular health data, and establishing pre-agreements and processes for the sharing of health, economic, social and other critical data for a public health emergency.
Medium-term actions – Do prior to the next national health emergency
25. Continue to invest in monitoring and evaluating the long-term impacts of COVID-19, including for long COVID and vaccination adverse events, mental health, particularly in children and young people, and educational outcomes.
Agility
Guiding recommendation Build, value and maintain capability, capacity and readiness across people, structures and systems.
Immediate actions – Do in the next 12-18 months
12. Develop a plan to build, value and maintain emergency management capability within the Australian Public Service, including planning and management of a surge workforce.
13. Agree nationally consistent reforms to allow health professionals to work to their full training and experience.
14. Embed flexibility in Australian Government grant and procurement arrangements to support the rapid delivery of funding and services in a national health emergency, including to meet urgent community needs and support populations most at risk.
Medium-term actions – Do prior to the next national health emergency
26. Include a focus as part of ongoing systems upgrades on modernising and improving data, systems and process capabilities to enable more tailored and effective program delivery in a crisis.
Relationships
Guiding recommendation
Maintain formal structures that include a wide range of community and business representatives, and leverage these in a pandemic response alongside the use of temporary structures.
Immediate actions – Do in the next 12-18 months
15. Ensure there are appropriate coordination and communication pathways in place with industry, unions, primary care stakeholders, local government, the community sector, priority populations and community representatives on issues related to public health emergencies. Structures should be maintained outside of an emergency, and be used to provide effective feedback loops on the shaping and delivery of response measures in a national health emergency.
Trust
Guiding recommendation Rebuild and maintain trust between government and the community including by considering impacts on human rights.
Immediate actions – Do in the next 12-18 months
16. Develop and agree transparency principles for the release of advice that informs decision-making in a public health emergency.
17. Develop a national strategy to rebuild community trust in vaccines and improve vaccination rates.
Equity
Guiding recommendation
Ensure pandemic support measures include all residents, regardless of visa status, prioritise cohorts at greater risk, and include them in the design and delivery of targeted supports.
Immediate actions – Do in the next 12-18 months
18. Proactively address populations most at risk and consider existing inequities in access to services (health and non-health) and other social determinants of health in pandemic management plans and responses, identifying where additional support or alternative approaches are required to support an emergency response with consideration for health, social and economic factors.
Communications
Guiding recommendation Build and maintain coordinated national public health emergency communication mechanisms to deliver timely, tailored and effective communications, utilising strong regional, local and community connections.
Immediate actions – Do in the next 12-18 months
19. Develop a communication strategy for use in national health emergencies that ensures Australians, including those in priority populations, families and industries, have the information they need to manage their social, work and family lives.
The report states that
The Inquiry has identified nine guiding recommendations and 26 actions, including 19 immediate actions for implementation in the next 12 to 18 months. These are key foundations for pandemic preparedness and community resilience. Actions should be implemented with Commonwealth and state and territory governments and key partners where relevant. National Cabinet should have broad oversight of these actions, with support from relevant ministerial councils and First Secretaries.
It goes on to identify 'key principles to guide implementation'.
Minimising harm
Ensure decision-making processes in a pandemic fully account for the broader health, economic and social impacts of decisions, and the changing level and nature of risk to inform escalation and de-escalation of the response to minimise harm.
Immediate actions – Do in the next 12-18 months
Action 1: Address critical gaps in health recovery from the COVID-19 pandemic, including prioritising greater investment in mental health support for children and young people and a COVID catch-up strategy in response to a decline in the delivery of key health prevention measures.
Timing: in the next 12–18 months
Lead: relevant department or entity/s with Health Ministers
Prioritise additional mental health funding and investment in services for children and young people, to help manage the ongoing mental health impacts of the pandemic on this cohort. Health Ministers should coordinate a ‘COVID Catch-up’ strategy in response to a decline in the delivery of elective surgery and cancer screenings, including: • a national plan to reduce the elective surgery backlog, in consultation with the private and public hospital sectors • additional funding and an implementation strategy to re-engage regional, rural and remote and other high-risk populations in preventive care to help address undiagnosed cases of cancer, diabetes and other illnesses.
Action 2: Review the COVID-19 Vaccine Claims Scheme, with a view to informing the future use of similar indemnity schemes in a national health emergency for a wider profile of vaccines and treatments.
Timing: in the next 12–18 months
Lead: relevant department or entity/s The COVID-19 Vaccine Claims Scheme review should: • examine barriers to access for the vaccine scheme based on feedback from the public, users and primary care providers, and links between the scheme and vaccine hesitancy • consider international research on vaccines claims schemes and their relation to public health and confidence in vaccination • include findings of how future processes could be improved.
Action 3: Conduct post-action reviews of outstanding key COVID-19 response measures to ensure lessons are captured, including a review of the Biosecurity Act 2015 (Cth) and key economic measures.
Timing: in the next 12–18 months
Lead: relevant department or entity/s Review the human biosecurity provisions of the Biosecurity Act 2015 (Cth), including to: • examine whether further amendments are needed to ensure it can be deployed proportionately to the level of risk in human health emergencies • explore ways to ensure any decisions on extensions of determinations include consideration of broader advice on the health, economic, educational, social, equity and human rights impacts • consider inclusion of provisions for tabling or publishing relevant advice and rationale for the extension of determinations that implement restrictive measures under the Biosecurity Act 2015 (Cth). Review the effectiveness of the remaining key economic support measures deployed during the pandemic, to draw lessons for the development of the Economic Toolkit. • The following significant economic measures that have not been subject to a comprehensive review should be prioritised: Boosting Cash Flow for Employers, the Coronavirus Supplement, HomeBuilder, the Pandemic Leave Disaster Payment, the COVID-19 Disaster Payment, and the Early Release of Super. Review the aged care retention payment program.
Action 4: Establish structures to ensure young people and their advocates are genuinely engaged, and impacts on children are considered in pandemic preparedness activities and responses to future emergencies.
Timing: in the next 12–18 months
Lead: relevant department or entity/s
This should include: • Establishing the role of Chief Paediatrician. • Including the Chief Paediatrician and National Children’s Commissioner on the Australian Health Protection Committee. • Ensuring consultation mechanisms facilitate genuine engagement with children and young people and advocates charged with representing their interests in pandemic preparedness activities and responses to future emergencies.
Medium-term actions – Do prior to the next national health emergency
Action 20: The Australian Government to work with the states and territories to improve capability to shift to remote learning if required in a national health emergency.
Led by the Department of Education, this should include: • incorporating competency in developing and delivering remote learning into initial teacher training and the Australian Professional Standards for Teachers • investing in the development of a suite of remote learning modules consistent with the Australian Curriculum, made available to all schools, teachers and students to improve preparedness for future emergencies that may require school closures.
Planning and preparedness
Develop and regularly stress-test preparedness and a national response to a pandemic that covers the broader health, economic and social response and fully harnesses capability and resources across governments, academia, industry and the community sector.
Immediate actions – Do in the next 12-18 months
Action 5: Develop updated health emergency planning and response arrangements in conjunction with states and territories, and key partners, including consideration of escalation and de-escalation points, real-time review and a focus on post-emergency recovery. As part of this, develop: • An enhanced National Health Emergency Plan (updated National Health Emergency Response Arrangements) and updated National Communicable Disease Plan. These updated plans should align with the Australian Government Crisis Management Framework • Management plans under the National Communicable Disease Plan for priority populations • Modular operational plans for specific sectors, including high-risk settings, which can be deployed in response to a variety of hazards.
Timing: in the next 12–18 months
Leads: • National Health Emergency Plan – Department of Health and Aged Care and the Minister for Health with input from relevant departments and agencies including the National Emergency Management Agency and the Australian Centre for Disease Control (CDC) • National Communicable Disease Plan – Department of Health and Aged Care with input from relevant departments and agencies including the CDC, and agreed at the Health Ministers Meeting • Management plans – Department of Health and Aged Care with input from the CDC, relevant departments and agencies, and state and territory governments • Modular operational plans – relevant lead department or entity/s, with state and territory governments The series of plans should: • have clearly defined scope, ownership and accountability, including a clear legal basis and defined roles for Commonwealth bodies (including the CDC), states and territories, and industry partners such as aged care providers • work in symphony with the Australian Government Crisis Management Framework; interface with emergency management plans at state and regional levels; and reference sub-plans including priority population management plans, workforce plans and the communications strategy • draw on technical expertise and be updated in light of risk assessments, and scientific and technological developments • embed pre-planned review mechanisms to support the real-time, rapid review of consequences as they arise, including quick assessments and corrections to emergency response measures without a protracted inquiry process • incorporate feedback from community, industry and academia into plans and response measure adjustments • be flexible enough to be used in response to a range of communicable disease or pandemic scenarios, while covering more likely events (such as an influenza pandemic) • include mitigations to address impacts of the planned response – for example, compassionate exemptions to public health orders (minimising harm) • consider transition and recovery • include arrangements that support workforce preparedness (such as surge models) • require post-action reviews, including on a whole-of-government basis • include external oversight and complaints handling and embed privacy principles. Develop management plans for priority populations under the National Communicable Disease Plan, including: • Aboriginal and Torres Strait Islander people • people with disability • culturally and linguistically diverse communities • older Australians • children and young people • regional, rural and remote communities. Management plans should: • take into account the unique needs of priority populations and co-design with communities and experts from the relevant sectors including primary care and relevant service providers (such as aged care and disability providers) and Public Health Networks • consider the transition out of pandemic settings and take into account potential risks for priority populations as protective health measures are reduced • establish infrastructure and pre-agreements to support data sharing, and enable rapid research for real-time pandemic detection, risk assessment, and response evaluation • utilise the latest data and evidence and regularly test through health emergency scenario exercises that involve all partners identified in the plan (also see Action 21) • address recommendations arising from scenario testing in a timely way. The Management Plan for Aboriginal and Torres Strait Islander people should include co-designing strategies to mitigate the risk of a virus spreading to remote Aboriginal and Torres Strait Islander communities, limiting the impact of pandemic response measures on cultural practices, and ensuring culturally appropriate delivery of vaccination and healthcare services. This plan should be aligned with the Closing the Gap Priority Reform Areas and make explicit the central role of the community-controlled sector in responding to a pandemic. The Management Plan for people with disability should include co-designing strategies for in-reach vaccination services in residential settings, ensuring continued access to supported decision-making and oversight of closed settings, ensuring support workers and carers can access health settings, and expanding virtual and telehealth services. This plan should consider the interface between the disability and health systems and link to other related agreements and strategies, including the National Health Reform Agreement. The Management Plan for culturally and linguistically diverse communities should include co-designing strategies to ensure culturally appropriate delivery of vaccination and healthcare services that acknowledge the specific language and cultural barriers different communities may face. This plan should consider the role of community organisations, leaders and intermediaries. The Management Plan for older Australians should account for older Australians both in residential aged care facilities and their own homes. This should include co-designed strategies which embed a human rights approach to mitigate isolation and loneliness, prioritisation for vaccination and other treatments, and surge workforce requirements. Compassionate exemptions should be made to ensure people at the end of their lives are not denied visitation by family and friends. The Management Plan for children and young people should consider the differential health and indirect impacts children and young people may face and specific interventions that may be required. The plan should be aligned with the operational plan for early childhood education and care and schools. Develop modular operational plans for specific sectors to be deployed in response to a variety of hazards. Plans should be developed by relevant agencies in conjunction with the states and territories, and relevant service providers: • Early childhood education and care and schools – led by Department of Education • Managing the international border – led by Department of Home Affairs • Repatriation of Australian citizens – led by Department of Foreign Affairs and Trade, with the Department of Home Affairs and National Emergency Management Agency • Quarantine – coordinated by Department of the Prime Minister and Cabinet, with the Department of Home Affairs and Department of Health and Aged Care • Supply chains – led by Department of Industry, Science and Resources • Aged Care – led by Department of Health and Aged Care • Housing – led by Department of Social Services The Early Childhood Education and Care and Schools plan should: • recognise access to education as an essential service for children and young people and consider strategies to maintain early childhood education and care (ECEC) attendance and keep schools open during public health emergencies, where consistent with health advice • document triggers and criteria for the closure of ECEC and schools where recommended by health advice, and criteria for reopening • be developed in consultation with states and territories, education providers, peak bodies, education and public health experts, and children and young people • commit governments to shared principles, triggers and criteria, while allowing flexibility to respond to local risks and circumstances • recognise that ECEC and school educators are essential workers if health advice recommends children and young people continue attending ECEC or school, and should receive priority access to vaccination; PPE and infection, prevention and control training • include development of a more responsive ECEC emergency funding model that can be deployed rapidly, respond to different needs, support consistency in children’s access to services, be predictable for parents and sustainable for providers, and account for a transition out of emergency settings. The Managing the International Border plan should: • document and stress-test pre-agreed roles and responsibilities across decision-making powers (Commonwealth) and implementation powers (states and territories), to ensure that the interface between the Australian Government agencies (such as the Department of Foreign Affairs and Trade, the Department of Home Affairs and the Australian Border Force) and state and territory agencies (such as state police, health and hotel quarantine providers) is seamless – operationally and legally • recognise the interdependencies between any quarantine arrangements and international border controls (arrival caps, entry approvals and the movement of goods), the aviation and maritime sectors, and diplomatic relations. The Repatriation plan should: • clearly define how repatriation systems will be scaled up in a future pandemic and pay due consideration to humanitarian and domestic border intersections • include processes to review the exemption decision-making process and its underpinning rules during a future public health emergency to ensure exemptions are timely and equitable, align with the key health objectives they are intended to support, and seek to better balance health risks with personal circumstances and human rights. The Quarantine plan should: • draw on recommendations from the 2021 National Review of Quarantine • establish and regularly update best-practice guidance, informing practical implementation for quarantine facilities (including on infection prevention and control standards and changing technologies), which is informed by CDC advice. The Supply Chains plan should: • be developed in consultation with state and territory governments and industry • consider agreed protocols between Commonwealth and state and territory governments, should state border travel be restricted, to ensure ongoing operation of critical supply chains • include provision for scenario exercises with industry to simulate responses to supply chain disruptions. The Aged Care plan should: • document an agreed escalation response model for a sector-wide crisis • include clearly defined triggers and criteria for escalation and de-escalation • cover the clinical response, surge workforce capacity, infection prevention and control strategies, personal protective equipment, outbreak management strategies (such as compassionate quarantine, self-isolation and cohorting) • identify data required to inform the response • consider the interface between aged care and health services. The Housing plan should: • be aligned with the National Agreement on Social Housing and Homelessness • include development of potential emergency measures in advance of a future pandemic to ensure access to secure and affordable housing is maintained.
Action 6: Develop legislative and policy frameworks to support responses in a public health emergency. This should include frameworks for: • international border management • identifying essential services and essential workers • quarantine • the National Medical Stockpile • an Economic Toolkit.
Timing: in the next 12–18 months
Leads: • Essential services and essential workers – Department of the Prime Minister and Cabinet • International border management – Department of Home Affairs • National Quarantine Strategy – Department of the Prime Minister and Cabinet with the Department of Home Affairs and the Department of Health and Aged Care • National Medical Stockpile – Department of Health and Aged Care • Economic Toolkit – Treasury Essential services and essential workers frameworks should include: • definitions of essential workers and essential services in a national health emergency • mechanisms to support rapid harmonisation between the Australian Government and state and territory governments where practicable • a set of agreed principles to guide decision-making, with respect to the movement of essential workers and the continued operation of essential services in a crisis • a commitment to clear and consistent communication of the definitions and how they will apply • clearly communicated rationale for localised approaches where required • arrangements for priority access to vaccination, PPE, and infection, prevention and control training in a national health emergency. The international border management framework should: • formalise a targeted legislative framework to give clear legal power to ‘close the border’ in an emergency that minimises any legal risks. The National Quarantine Strategy should: • formalise governance arrangements around the activation of quarantine, with a focus on triggers for de-escalation and recovery • clarify the roles and responsibilities of Commonwealth and state and territory governments, as well as industry bodies, formalising principles for cost-arrangements and workforce requirements • identify a full set of quarantine options, including home quarantine, to limit the use of hotel quarantine and ensure that purpose-built quarantine facilities can be quickly re-engaged • be designed closely with the Department of Health and Aged Care, the Department of Home Affairs and the Australian Centre for Disease Control, and states and territory agencies with experience operationalising quarantine arrangements during the pandemic • account for the complex pathways and many different cohorts which the COVID-19 experience has shown us will be processed through the system • establish culturally appropriate options for people in remote Aboriginal and Torres Strait Islander communities to quarantine on country in a national health emergency, and culturally appropriate options for culturally and linguistically diverse communities. The National Medical Stockpile plan should: • address the recommendations from both the 2021 Australian National Audit Office audit and the 2022 Halton Review on National Medical Stockpile preparedness. The Economic Toolkit should: • be developed by Treasury and the Reserve Bank of Australia, in consultation with relevant departments and the states and territories • include measures that can be tailored to respond to different forms of economic crisis, including a public health emergency, with an appropriate gender lens applied. • cover the division of responsibilities of the Australian Government and state and territory governments for the development and implementation of economic response measures • draw on lessons from reviews of significant aspects of Australia’s COVID-19 response, including ensuring all residents, regardless of visa status, are supported during the response • be updated over time to reflect research and reviews of economic settings (see Actions 8 and 22) • consider the mechanisms for the implementation of measures, and whether these could be enhanced to better support delivery – such as upgrades to existing systems or data-sharing arrangements • consider the role of transparency mechanisms in promoting public trust.
Action 7: Finalise establishment of the Australian Centre for Disease Control (CDC) and give priority to the following functions for systemic preparedness to become trusted and authoritative on risk assessment and communication, and a national repository of communicable disease intelligence capability and advice.
Timing: in the next 12–18 months
Lead: Australian Centre for Disease Control • Work to finalise the Australian Centre for Disease Control in cooperation with the Department of Health and Aged Care, state and territory governments and key non-government organisations. It needs to complement and enhance existing emergency and health governance architecture. Build foundations for a national communicable disease data integration system, enabled for equity and high-priority population identification and data interrogation, with pre-agreements on data sharing, including: • Finalising an evidence strategy and key priorities to drive optimal collection, synthesis and use of data and evidence, address data gaps and develop linkages to public health workforce capability data. This would include: o identifying inconsistencies and gaps in shared data with the states and territories to prioritise for national surveillance data linkage, and upgrading existing datasets by improving data consistency and enabling data linkage readiness (see Action 11) o establishing technical advisory groups that bring together technical expertise as required to contribute to preparation of pandemic guidelines and rapid research-gap advice; advise on developments in their fields that should be incorporated in future pandemic detection and response strategies; assist in designing and reviewing pandemic exercises; and advise on national technical capacity and training needs. This can rapidly contribute additional expertise in a crisis o finalising work underway to establish clear guardrails for managing privacy and enabling routine real-time access to linked, granular data. • Publishing a report on progress against key priorities identified in this data strategy. Commence upgrade to a next-generation world-leading public health surveillance system, including: • commencing establishment of new comprehensive surveillance infrastructure that incorporates wastewater surveillance to facilitate disease detection and monitoring, risk assessment, national data sharing, and operating with state and territory systems to provide national updates on notifiable diseases • developing a plan to improve at-risk cohort data collection and linkages to ensure cohorts are visible in an emergency and responses can be appropriately tailored • ensuring captured surveillance data meet the analytical needs of public health responders and support rapid research and real-time evaluation • drafting enhanced surveillance protocols for potential use in pandemic settings, including for proactive community screening and for the cohort of first cases to monitor for persistent symptoms resulting from infection • enhancing early warning surveillance capability and related modelling to inform procurement planning for the National Medical Stockpile (to be undertaken by the Department of Health and Aged Care) • confirming linkages with New Zealand health authorities and other regional partners, and agreeing to near real-time data and intelligence sharing with them and other regional partners. Work jointly on updated communicable disease plans, including: • working with the Department of Health and Aged Care on finalising the: o National Health Emergency Plan, aligned to the Australian Government Crisis Management Framework (see Action 1) o National Communicable Disease Plan, which would be agreed by the Health Ministers Meeting (see Action 1) • jointly holding a major pandemic drill with NEMA to assess national, whole-of-government preparedness, involving the Prime Minister, First Ministers and senior officials from the Commonwealth, state and territory governments and the Australian Local Government Association • determining responsibility and accountability for implementing actions arising from these scenarios, enabling continual updating and quality improvement, with support from the Department of the Prime Minister and Cabinet and NEMA. These should also be reported to the Secretaries Board. Conduct biennial reviews of Australia’s overall pandemic preparedness in partnership with NEMA, including: • summaries of new pandemic exercises held to date • detailed reporting on local and national incidents with advice on system strengths and weaknesses • recommendations for system improvement • a preliminary view of how many public and private health workers might need to be deployed in response to different pandemic scenarios, as informed by an assessment of national capacity • mapping of national technical public health pandemic response and research capability to identify skills gaps and coordinate and resource training programs in partnership with the Department of Health and Aged Care and states and territories • reporting to the Health Minister and National Cabinet prior to tabling in the Australian Parliament. Establish an evidence synthesis and public communications function, including: • support for both business-as-usual communication activity and crisis communications in a public health emergency • working with the Department of Health and Aged Care, NEMA and the Department of the Prime Minister and Cabinet to develop a national communication strategy for use in national health emergencies (see Action 19) • making communication a focus for technical advisory group input, drawing from public and private channels to provide risk communication data synthesis and behavioural and social science expertise • in-house expertise in evidence synthesis and communication. Build foundations of in-house behavioural insights capability, including: • mapping existing behavioural insights functions across the Australian Government with the Behavioural Economics Team of the Australia Government • working with experts to develop a fully scoped and costed business case for an in-house behavioural insights capability. Establish structures including technical advisory committees to engage with academic experts and community partners, including: • public reporting on work to support research and intelligence exchange with research institutes in Australia and abroad, including behavioural research, private scientists, and peak health industry bodies.
Medium-term actions – Do prior to the next national health emergency
Action 21: Build emergency management and response capability. This should include: • Regular health emergency exercises with all levels of government, interfacing with community representatives, key sectors and a broad range of departments (led by the Department of Health and Aged Care), including: o large-scale exercises that bring in all levels of government, a broad range of departments/agencies, including the Australian Centre for Disease Control (CDC), as well as broader Australian academia, industry and civil society groups o exercises and stress tests for testing and contact tracing, including the utilisation of genomic surveillance across jurisdictions and analytic epidemiology capability o a primary coordination role for the National Emergency Management Agency (NEMA) and the Department of the Prime Minister and Cabinet to test the cooperation between the health system and broader emergency management arrangements, and apply relevant learnings to other crises o timing balanced against resourcing for other capability-building activities, including staff training and readiness reviews. • Regular economic scenario testing to determine what measures would be best suited in different forms of economic shocks and keep an Economic Toolkit up to date (led by Treasury), including: o a primary coordination role for Treasury and inclusion of state and territory treasuries o testing a system-wide response, including Treasury, the Reserve Bank of Australia and key economic and financial regulators at the Australian Government level o drawing on the Economic Toolkit to test the suitability of those measures to respond to different types of economic shocks o reflecting any learnings from scenario testing exercises in updates to the Economic Toolkit. • Training for a pandemic response (led by NEMA), including: o arrangements to train agency staff in emergency management to better equip them to surge to contribute to whole-of-government crisis responses o establishment of training programs to address technical expertise gaps identified through emergency exercises and add to response capacity at jurisdictional level when a crisis occurs during an active training period o a primary coordination role for the CDC/NEMA with input from technical advisory committees and states and territories, and embedded within jurisdictions.
Action 22: Develop a whole-of-government plan to improve domestic and international supply chain resilience. This should include: • consideration for how resilience can be built across all critical supply chains • arrangements to collect supply chain data to support decision-making • engagement structures that encourage ongoing and regular communication between government and industry on the development and implementation of the whole-of-government plan and emerging supply chain issues.
Action 23: Progress development of the Australian Centre for Disease Control in line with its initial progress review and to include additional functions to map and enhance national pandemic detection and response capability. This should include: • agreeing standardised case definitions and reporting requirements across jurisdictions • linking datasets prioritising residential aged care, the National Disability Insurance Scheme (NDIS), the Australian Bureau of Statistics, the Australian Taxation Office and the Department of Social Services • undertaking pandemic response capability mapping and coordinating national training programs with jurisdictions to address capacity gaps • acting on recommendations arising from scenario testing and post-incident reviews it has facilitated following health emergencies and through this Inquiry • establishing a library of living guidelines for high-risk clinical, residential and occupational settings and health professions that can be readily adapted for a new health emergency. This should include nationally agreed testing and tracing principles. These guidelines should be developed in partnership with: o the Department of Health and Aged Care, states and territories and relevant professional bodies o the NDIS Quality and Safeguards Commission in relation to disability settings • embedding behavioural insights capability to assess, refine and enhance the effectiveness of pandemic responses • drawing on national health workforce trend data to inform advice on pandemic readiness of the health system. This would include oversight of national surge workforce capabilities and gaps to be mapped and ready to be operationalised in a future emergency response • developing dedicated ethical guidelines and processes for national health emergencies to enable rapid review in a changed risk context and enable real-time crisis-related research, overseen by the National Health and Medical Research Council.
Leadership
Ensure the rapid mobilisation of a national governance structure for leaders to collaborate and support a national response that reflects health, social, economic and equity priorities.
Immediate actions – Do in the next 12-18 months
Action 8: Establish mechanisms for National Cabinet to receive additional integrated expert advice for a whole-of-society emergency, including advice on social, human rights, economic and broader health impacts (including mental health considerations), as well as specific impacts on priority populations.
Timing: in the next 12–18 months
Lead: Department of the Prime Minister and Cabinet • In parallel with making decisions based on key public health advice, National Cabinet should consider the differential impacts of a pandemic across the population and economy. This must include considering and mitigating unintended consequences, and seek to minimise negative impacts on broader health, mental health, educational, equity, economic and social outcomes. • Human rights considerations should be embedded into National Cabinet’s decision-making processes, particularly where measures are intended to significantly restrict rights and freedoms. • This might include mechanisms for a national health emergency that allow: o Health Ministers’ expertise to be utilised as a key source for whole-of-system health advice for National Cabinet o Heads of Treasuries to be expanded in a crisis to include the Reserve Bank of Australia Governor (and other key economic regulators as required) to bring together national economic expertise to support National Cabinet o expert advice to be sought from the Australian Human Rights Commissioner and other commissioners (e.g. National Children’s Commissioner) to support better understanding of the broader impacts of their decisions on human rights and priority populations.
Action 9: Agree and document the responsibilities of the Commonwealth Government, state and territory government and key partners in a national health emergency. This should include escalation (and de-escalation) triggers for National Cabinet’s activation and operating principles to enhance national coordination and maintain public confidence and trust.
Timing: in the next 12–18 months
Lead: Department of the Prime Minister and Cabinet This should include: • National Cabinet providing opportunities for more structured engagement and active consultation with local government to enhance the coordination and communication of a national response • agreeing escalation (and de-escalation) triggers for activation and operating principles to enhance national coordination and maintain public confidence and trust, including in relation to state border closures • greater clarification of roles and responsibilities, including around key areas of shared or intersecting responsibility such as vaccine distribution, health and social care of people with disability, older Australians and the provision of economic support in a national health emergency.
Action 10: Agree and test a national Australian Government governance structure to support future health crisis responses, including an appropriate emergency Cabinet Committee and a ‘Secretaries Response Group’ chaired by the Department of the Prime Minister and Cabinet that brings together the lead Secretaries and heads of relevant operational agencies, to coordinate the Australian Government response.
Timing: in the next 12–18 months
Lead: Department of the Prime Minister and Cabinet A purpose-specific governance structure, aligned with the revised Australian Government Crisis Management Framework, should be rapidly mobilised and tested in future pandemic incidents requiring a multi-sectoral response. Plans should be tested to ensure they are ready to be mobilised ahead of a crisis. The governance structure should include: • an Emergency Management Cabinet Committee to manage the Australian Government’s response, with appropriate membership and operating principles to reflect the nature of the risk, the role of statutory decision-makers and the importance of having the right people, with the right knowledge, at the right table, at the right time • a ‘Secretaries Response Group’ with a similar role to the Secretaries Committee on National Security, to support the Prime Minister and Cabinet to lead the coordination, development and implementation of the Australian Government response. o The Secretaries Response Group should be chaired by the Department of the Prime Minister and Cabinet and include lead Secretaries and heads of operational agencies that reflect the specific circumstances of the emergency and response. o There should be formal reporting lines between the Secretaries Response Group and other senior officials’ bodies, including supporting clusters of officials across relevant departments to progress work and enhance coordination with the states and territories.
Medium-term actions – Do prior to the next national health emergency
Action 24: Maintain regularly tested and reviewed agreements between relevant national and state agencies on shared responsibilities for human health under the Biosecurity Act 2015 (Cth) with a focus on facilitating a ‘One Health’ approach that considers the intersection between plant, animal and human biosecurity. • Agreements should ensure clarity and agreement on roles and responsibilities between governments and government agencies under the Biosecurity Act 2015 prior to the next crisis.
Evidence and evaluation
Ensure systems are in place for rapid and transparent evidence collection, synthesis and evaluation.
Immediate actions – Do in the next 12-18 months
Action 11: Improve data collection, sharing, linkage, and analytic capability to enable an effective, targeted and proportionate response in a national health emergency.
Timing: in the next 12–18 months
Lead: relevant department or entity/s Improvements to data collection and pre-established data linkage platforms, including: • Delivering actionable insights regarding optimal emergency response design to ensure emergency responses can be appropriately designed, tailored and adjusted through real-time evaluation of both intended outcomes and broader impacts. • For priority populations, this should include: o Aboriginal and Torres Strait Islander people – enhanced data collection in line with Indigenous Data Sovereignty and Indigenous Data Governance principles o Children and young people – investment in improved longitudinal data to monitor educational outcomes and wellbeing o Culturally and linguistically diverse communities – prioritising collection of key metrics in primary and acute healthcare settings, including country of birth, language spoken, interpreter requirements, ethnic/cultural background and year of arrival o People with disability – ongoing investment in and stewardship of the National Disability Data Asset, including enhanced data transparency such as facilitating access and analysis by researchers and relevant non-government organisations o People experiencing homelessness and housing insecurity – enhanced data collection on different types of homelessness and on ages, cultural backgrounds, hospitalisation and mortality rates of people experiencing homelessness. Expanded capability in Australian Government departments to collate and synthesise economic and health data to inform decision-making, including: • bolstering health departments at all levels of government with public health data analytic expertise to better inform policy decisions • translating health statistics and information for the wider health community and general public, helping to build health data literacy particularly in pandemic settings • leveraging research across academia and research institutions through the Australian Centre for Disease Control (CDC) technical advisory groups in key methods areas • coordinating and resourcing training programs in partnership with states and territories and research institutions to address gaps in applied public health analytic and evidence synthesis expertise identified within and across jurisdictions • planning for how Treasury and the CDC will work together to integrate health and economic data and analysis. Finalising work underway to establish clear guardrails for managing data security and privacy and enabling routine access to linked and granular health data, and establishing pre-agreements and processes for the sharing of health, economic, social and other critical data for a public health emergency, including: • ensuring rapid mobilisation of real-time evidence gathering and evaluation • sharing within the Australian Government, between the Commonwealth and states and territories and with relevant sectors • finalising agreements by the CDC on the sharing of health data between the Commonwealth and the states and territories (also see Action 7) • prioritising key health data on Aboriginal and Torres Strait Islander people, culturally and linguistically diverse communities and people with disability • prioritising key health and education data on children and young people • establishing appropriate arrangements for the sharing of data related to the delivery of economic support measures, as described in the Economic Toolkit. This could encompass data sharing within the Australian Government, and with the state and territories.
Medium-term actions – Do prior to the next national health emergency
Action 25: Continue to invest in monitoring and evaluating the long-term impacts of COVID-19, including long COVID and vaccination adverse events, mental health, particularly in children and young people, and educational outcomes. • Where evidence from ongoing monitoring and evaluation shows long-term impacts of the COVID-19 pandemic continue to be seen, governments must ensure policies and programs in place are tailored to actively address the impacts. • Evidence collected from ongoing monitoring and evaluation should inform plans and responses to future public health emergencies in order to mitigate similar long-term impacts.
Agility
Build, value and maintain capability, capacity and readiness across people, structures and systems.
Immediate actions – Do in the next 12-18 months
Action 12: Develop a plan to build, value and maintain emergency management capability within the Australian Public Service, including planning and management of a surge workforce.
Timing: in the next 12–18 months
Lead: relevant department or entity/s This should: • prioritise investment in emergency management capability uplift across the public sector, especially within the Department of Health and the Department of the Prime Minister and Cabinet, to ensure there is a sufficiently large pool of people who have knowledge and understanding of crisis management and delivery principles and approaches • establish arrangements to ensure agencies are able to appropriately fulfil their emergency management obligations and agreed roles and responsibilities under the Australian Government Crisis Management Framework. • establish arrangements to train agency staff to better equip them to surge to contribute to whole-of-government crisis responses • ensure the Secretaries Board maintains a role in stewarding these priority emergency management capabilities • be aligned with the work done under Action 21 to improve capability and readiness, including through exercises and readiness reviews.
Action 13: Agree nationally consistent reforms to allow health professionals to work to their full training and experience.
Timing: in the next 12–18 months
Lead: relevant department or entity/s Options outlined in the independent Scope of Practice Review should be prioritised, including harmonising existing legislation and regulation which govern what services pharmacists can provide. In addition, these reforms should include: • simplifying and streamlining the legal basis under which Aboriginal and Torres Strait Islander Health Practitioners are able to administer medications • supporting nurse-led clinics to work independently and be remunerated equitably for services provided that are commensurate with those of a GP, such as for vaccination • streamlining legislative changes made during the pandemic to engage the broadest possible range of health professionals in ongoing immunisation efforts. Action 14: Embed flexibility in Australian Government grant and procurement arrangements to support the rapid delivery of funding and services in a national health emergency, for instance to meet urgent community needs and support populations most at risk.
Timing: in the next 12–18 months
Lead: relevant department or entity/s This should include: • funding arrangements for community organisations and industry, and procurement processes • funding mechanisms that allow organisations to rapidly develop and deliver solutions tailored to their communities • funding to Aboriginal and Torres Strait Islander community service providers and the community-controlled health sector, culturally and linguistically diverse community organisations and Disability Representative Organisations during a national health emergency • flexible funding to Primary Health Networks to support innovations in primary care delivery • guidance and random audits embedded in program delivery.
Medium-term actions – Do prior to the next national health emergency
Action 26: Include a focus as part of ongoing systems upgrades on modernising and improving data, systems and process capabilities to enable more tailored and effective program delivery in a crisis. Consider preparedness for future crisis as part of ongoing investment in key data, system and process capabilities, including: • Prioritising the modernisation of Department of Foreign Affairs and Trade repatriation systems, which must be: o ready to make better use of existing data capture processes and to assist in mobilising the core consular structures to be scaled up in a global crisis o scalable in a future crisis to ensure those who want to come home can be regularly communicated with and supported. • Building on the successful use of the Australian Taxation Office’s Single Touch Payroll to deliver the JobKeeper payment, future IT system upgrades should consider potential ‘emergency capability’ that could support greater flexibility in program delivery in a crisis. • Working to address known data gaps, which could enhance the effectiveness of policy measures, while being cognisant of the burden on the business and community sector.
Relationships
Maintain formal structures that include a wide range of community and business representatives, and leverage these in a pandemic response alongside the use of temporary structures.
Immediate actions – Do in the next 12-18 months
Action 15: Ensure there are appropriate coordination and communication pathways in place with industry, unions, primary care stakeholders, local government, the community sector, priority populations and community representatives on issues related to public health emergencies. Structures should be maintained outside of an emergency, and be used to provide effective feedback loops on the shaping and delivery of response measures in a national health emergency.
Timing: in the next 12–18 months
Lead: relevant department or entity/s • Build and maintain engagement mechanisms outside of an emergency with the community sector and industry (including businesses and entities across the supply chain). • Maintain and build on effective structures that were established before or during the COVID-19 pandemic, including those with priority populations such as Aboriginal and Torres Strait Islander people, people with disability, culturally and linguistically diverse communities and older Australians. • Consult these groups on the development and updating of pandemic plans, and ensure they participate in stress-testing exercises. • Ensure there are clear mechanisms to feed into decision-making processes in an emergency, and genuinely engage relevant bodies in pandemic preparedness activities and responses to future emergencies. • Utilise these structures in national health emergencies to provide effective feedback loops on the delivery of response measures. As part of this: • make the Culturally and Linguistically Diverse Communities Health Advisory Group, or similar advisory body, a permanent subcommittee of the Australian Health Protection Committee • make the Advisory Committee for the COVID 19 Response for People with Disability, or a similar advisory body, a permanent subcommittee of the Australian Health Protection Committee. The advisory body should also have clear mechanisms to feed into the Disability and Health Sector Consultation Committee • ensure permanent advisory structures for culturally and linguistically diverse communities and people with disability have roles consistent with the National Aboriginal and Torres Strait Islander Health Protection subcommittee and the Aged Care Advisory Group, including reporting to the Australian Health Protection Committee • engage Primary Health Networks in emergency planning and fund them in a flexible way to ensure they can leverage community connections.
Trust
Rebuild and maintain trust between government and the community including by considering impacts on human rights.
Immediate actions – Do in the next 12-18 months
Action 16: Develop and agree principles for the transparent release of advice that informs decision-making in a public health emergency.
Timing: in the next 12–18 months
Lead: relevant department or entity/s • National Cabinet (and other key decision-making bodies) should be more transparent in disclosing the expert advice that underpins their decisions, and the other multi-sectoral factors that must necessarily influence policy decisions. • This should include the rationale for why decisions are being made that result in significant reduction of freedoms. • Principles should be developed in partnership with science communication experts to ensure consideration is given to how evidence and advice can be easily interpreted given the inherent complexities and nuances.
Action 17: Develop a national strategy to rebuild community trust in vaccines and improve vaccination rates.
Timing: in the next 12–18 months
Lead: relevant department or entity/s with Health Ministers As part of this: • Health Ministers should urgently agree a strategy for addressing the broad decline in COVID-19 vaccination, especially among priority cohorts, with a view to formalising policy responsibility to improve these vaccination rates by target dates. • There should be an emphasis on lifting early childhood vaccination rates for other communicable diseases to pre-pandemic levels. Equity Ensure pandemic support measures include all residents, regardless of visa status, prioritise cohorts at greater risk, and include them in the design and delivery of targeted supports.
Immediate actions – Do in the next 12-18 months
Action 18: Proactively address populations most at risk and consider existing inequities in access to services (health and non-health) and other social determinants of health in pandemic management plans and responses, identifying where additional support or alternative approaches are required to support an emergency response with consideration for health, social and economic factors.
Timing: in the next 12–18 months
Lead: relevant department or entity/s • All plans and response measures should have an equity lens applied, including for health, social, human rights and economic factors (see Action 1).
Communications
Build and maintain coordinated national public health emergency communication mechanisms to deliver timely, tailored and effective communications, utilising strong regional, local and community connections.
Immediate actions – Do in the next 12-18 months
Action 19: Develop a communication strategy for use in national health emergencies that ensures Australians, including those in priority populations, families and industries, have the information they need to manage their social, work and family lives.
Timing: in the next 12–18 months
Lead: relevant department or entity/s with the Australian Centre for Disease Control
The strategy should: • create a central public health emergency communications hub that serves as a single source where the Australian public can find integrated information about the emergency response around the country • be informed by behavioural science and risk communication expertise • proactively seek to ensure consistency of messaging between levels of government, providing supporting rationale and evidence for different approaches • leverage existing communication channels through professional bodies, unions, local government and advocacy groups • meet the diverse needs of communities across Australia, including through co-design • include mechanisms to coordinate and consolidate communications, considering the timing and frequency of announcements • include a strategy for addressing the harms arising from misinformation and disinformation, which incorporates: o information environment and ongoing narrative monitoring to combat misinformation o transparent engagement with social media companies o promotion and coordination of policies to increase the resilience of the information environment o partnership between government and trusted organisations, experts, media, and other influencers to pre-bunk and debunk misinformation • build on the principles of crisis and risk communications and have clear communication goals, including: o being timely, transparent, empathetic and consistent, promoting action and effectively communicating risk to foster trust o being inclusive, addressing inequities in accessing information, and supporting two-way communication o reflecting an evidence-based approach relevant for the contemporary information and media environment o embedding ongoing evaluation practices to ensure communication activities are effective, are appropriate, and are meeting the diverse needs of the Australian public • account for the distinct communications preferences and requirements of priority populations – including: o reflecting the key role of community and representative organisations in communicating with priority populations, including Aboriginal and Torres Strait Islander community organisations; peak bodies for children, young people and education providers; culturally and linguistically diverse community organisations; Disability Representative Organisations; peak bodies for older Australians; and community service providers o funding community and representative organisations to tailor and disseminate communications through appropriate channels and trusted voices o providing plain English messaging to community organisations for tailoring in a timely manner.
