Pandemic planning and preparedness can reduce the negative impacts of a pandemic by improving the processes for establishing, evaluating and refining pandemic responses that slow disease outbreaks and protect at‑risk populations whilst minimising collateral negative impacts.

Preparedness

Preparedness involves building the strength and resilience of systems to efficiently respond to and manage an emergency as well as effectively move from response to recovery phases. Specific actions governments can take include strengthening the healthcare system, establishing early warning systems, building data collection, sharing and synthesis platforms, establishing trusted relationships and reducing inequality.

Preparedness also requires consideration of the national security of key supply chains, including our sovereign ability to produce personal protective equipment, medicines and vaccines during pandemic times, as well as maintaining the supply of other essential medical, food, fuel and basic items.

In 2017, a World Health Organization-led team of experts assessed Australia’s health system as having a high level of emergency preparedness.¹⁵ However, the last comprehensive test of communicable disease arrangements involving multiple levels of government occurred in 2008, over a decade before the COVID‑19 pandemic. A 2018 Australian Government stress test to explore how the Department of Home Affairs and other departments would support the Department of Health in a national health crisis found that while systems and arrangements could sufficiently respond to an ordinary crisis, a ‘very significant or near‑existential crisis would push current arrangements beyond their limits’.¹⁶

Of concern, the responsible minister was not informed of this finding until after the COVID‑19 pandemic had started.¹⁷

During the pandemic, the limited readiness of some key systems became evident. These issues related to the management of the National Medical Stockpile, the strength of the public health system both nationally and across several states, and building design in high‑risk settings that had not accounted for disease spread risk. Australia’s pandemic response also suffered from not having a national technical advisory body, such as the European Centre for Disease Prevention and Control, with the capacity to conduct risk assessments and evidence evaluation to support the national response.

As a critical piece of social and economic infrastructure, Australia’s social safety net was found to be unable to adequately support households that suffered large falls in income due to the impacts of the pandemic and public health restrictions on activity. A particular gap was temporary visa holders, who accounted for one in 12 people living in Australia^18,19 but were generally not eligible for any social security support, or for many of the initial pandemic‑specific measures.

Planning

Planning is a component of preparedness and involves establishing arrangements in advance to enable timely, effective, and appropriate responses to a hazardous event or disaster. While pandemics had been identified in risk assessments, the Australian Government had not planned for the length, complexity and severity of COVID‑19 and its recovery period. Plans had largely focused on an influenza‑based pandemic, and few government agencies had an active pandemic plan.

Where plans did exist, they did not interact well with each other or across levels of government. There were no plans for potentially high‑risk settings, such as aged care or schools, or for priority populations, including Aboriginal and Torres Strait Islander people, children and young people, culturally and linguistically diverse communities, remote communities, people with disability and older Australians. There had also been little consideration of the economic impacts of a pandemic, including on critical supply chains, nor had policies to support households and businesses through such a shock been developed. There were also no strategies that considered workforce issues.

The Australian Government rapidly responded by adapting existing plans.²⁰ The national Australian Health Sector Emergency Response Plan was activated for novel coronavirus on 27 February 2020, just nine days after COVID‑19 was declared a Communicable Disease Incident of National Significance in Australia. Subsequently, plans were developed to address the specific needs of some priority populations, including Aboriginal and Torres Strait Islander people, older Australians and people with disability. However, the panel heard consistently that there was a sense that throughout the pandemic, ‘the plane was being built while it was flying’, and this meant there was little ability to think ahead and anticipate the next challenges as the crisis unfolded.

There was early recognition by the Australian Government of the need to consider the transition out of the pandemic response, but National Cabinet struggled to agree a plan in the face of repeated waves of infection overseas and delays in reaching vaccine targets. In July 2021, National Cabinet developed a clear roadmap for reopening based on joint health and economic modelling. The focus on transition to post‑pandemic settings was important; however, we heard that the plan lacked detail and sector‑specific planning that would have provided greater certainty.

Pre‑existing pandemic plans ruled out the use of a number of measures that were considered unlikely to be tolerated or ever implemented, such as school closures, border closures and supervised quarantine. However, these measures were deployed early in the COVID‑19 pandemic. Because arrangements for implementation had not been developed, their delivery was not as well considered or, in some cases, as effective as it could have been. An additional challenge was that these measures were often governed by complex policy or legislative arrangements and required new decision‑making systems which made national cohesion difficult, even where broad agreement on their use had been reached at National Cabinet.

The lesson for the future is that, in a pandemic, the unimaginable can quickly become necessary and planning should cover the full suite of possible responses – however hard their implementation may be to conceive outside a pandemic setting. No issue demonstrates this more than the decision to close Australia’s international borders, which we heard repeatedly was the most important decision in our pandemic response, but one not factored into any pre‑existing pandemic plans.

The Australian Government’s closure of Australia’s international borders had consequences for Australians overseas wishing to return home and for those with relatives overseas. Affected individuals experienced significant personal costs, including being stranded overseas in countries with higher COVID‑19 risk, extended separation from children, parents and partners, and the financial costs of travelling home.

There were no plans in place to manage an efficient exemption process, and despite a system being set up from the outset, the lack of timeliness in response and low proportion of exemptions granted meant that the system did little to alleviate the anger or distress for those impacted. We heard from people that they considered the government had failed in its duty of care towards them. There was also an inadequate focus on communications and supports and, at times, a lack of compassion, fairness and timeliness in the process.