With the Australian Centre for Disease Control (CDC) permanently in place, in future we would have:

• a centre of expertise and an authoritative voice on disease prevention and control for Australia, and evidence support for decision‑makers in the Australian Government and jurisdictions
• the technical expertise (in-house and through partnership with research and academic organisations) to support a nationally coordinated approach to the collection, analysis and synthesis of real‑time evidence
• rapid risk assessment (pandemic threat, disease hotspots and at-risk segments of the community) and the evidence to support decisions on the introduction, escalation and de‑escalation of public health measures through the oversight and coordination of:
  • multi‑way data sharing across jurisdictions and with Australian Government and other organisations as appropriate
  • rapid linkage of datasets
• evidence on population and health system level impacts of the disease (acute and longer-term sequelae), and of the performance of public health interventions, to inform decisions on the extent and duration of interventions, and the transition out of the pandemic response
• an expanded One Health approach that considers the intersection between plant, animal and human biosecurity, linking departments, agencies and expertise to combat complex disease threats, including avian influenza
• a key contact point for international public health authorities for efficient intelligence sharing on emerging threats in health crises
• increased trust in public health interventions through the timely sharing and translation of evidence on effectiveness as part of a broader public health communication strategy on risk, and the balancing of risks in a public health emergency
• coordinated investment in pandemic and public health leadership training
• advice to government on urgent research priority areas to provide the real‑time evidence required in public health operational responses across jurisdictions, and the health risk assessments and scenario projections that support policy decisions
• living pandemic‑specific guidelines adapted for the various health professions, workplaces and high‑risk settings, including aged care and disability service providers, and other high‑risk or otherwise impacted settings.

Establishing a fully operational CDC expeditiously provides Australia a lasting legacy of the lessons learned about the central role evidence plays in supporting a nationally cohesive and proportionate response, and population trust and engagement in pandemic responses. Most importantly, it will ensure oversight of national preparedness that will put us in a safer and more resilient place ahead of the next pandemic.

The interim CDC, which commenced on 1 January 2024, is progressing work to embed and enhance Australia's national public health capability. The CDC, the National Emergency Management Agency (NEMA) and the Department of Agriculture, Fisheries and Forestry have worked together on preparing for and responding to the avian influenza threat. This is a good start, and highlights the merits of and urgent need for a standalone CDC which is integrated into our national emergency preparedness and response capability and infrastructure. To achieve this, it must be adequately resourced and have a laser‑like focus on translating the lessons from COVID‑19 and improving Australia's national resilience and our ability to respond to future pandemics.

Founding principles

We recommend that Australia's CDC be underpinned by the founding principles of:

• multi‑way cooperative relationships with the states and territories and non‑government organisations
• complementing and enhancing existing health and emergency governance architecture
• transparency, trust and independence
• certainty of funding for investment in world‑leading data‑sharing and surveillance systems
• building on the foundation established by the Interim CDC.

Multi‑way cooperative relationships with the states and territories and non‑government organisations

Responsibility for health is shared between the Australian and state and territory governments and key non‑government organisations. The CDC should develop and maintain trusted relationships and systematic multi‑way sharing of information, data and expertise that serves local responses as well as national‑level surveillance and evidence synthesis.

Within the CDC there must be an expert understanding of the operational intelligence needs of the jurisdictions, and of the interaction of public health measures with the operation of the broader health system and work within state and territory agencies. This requires ongoing, close engagement with counterparts across governments and the broader health ecosystem, including reciprocal training and shadowing programs to ensure the CDC's enduring relevance, expertise and strong relationships.

The Statement of intent: working together to support the Australian Centre for Disease Control⁴³ provides that the development of the Australian CDC be designed to increase independence and transparency, improve national coordination, enhance international connections and allow for efficient utilisation of resources between the jurisdictions.⁴⁴ We support these objectives.

The statement of intent recognises the importance of governments working in partnership with First Nations people. This is strongly supported by the panel. As evidenced in Part E: Equity of this report, the panel also recommends that other priority settings and populations be closely engaged in the development of the CDC.

Complementing and enhancing Australia's existing emergency and health governance architecture

Organisational interfaces at national and state level need to be agreed to clarify roles and responsibilities and avoid duplication, delays or gaps. The states and territories have clear statutory and operational obligations and responsibilities under their respective health, public health and other emergency legislation. The CDC will not cut across these requirements.

Going forward, Ministers for Health should have a key role in directly advising National Cabinet. This will enable decision‑makers to consider broader health perspectives to minimise the risk of harm, maximise achievement of health objectives and enhance coordination in a protracted national pandemic response.

In designing governance arrangements, we recommend that the head of the CDC:

• report to the Minister for Health to inform the Minister's use of the human biosecurity powers under the Biosecurity Act
• provide advice directly to National Cabinet at the invitation of First Ministers to enhance clear, coordinated and timely decision‑making and communications at the national level
• provide advice to meetings of Health Ministers and the Health Chief Executives Forum to share world‑leading evidence synthesis and advice to support national, state and territory decision‑making
• be an ex‑officio member of the Australian Health Protection Committee
• be informed by an advisory council. Members would be appointed by the Minister for Health and be representative of a broad skills base, with knowledge and experience relevant to the CDC functions, including expertise in pandemic responses, communicable disease epidemiology, behavioural insights and priority cohorts. This advisory group should have international representation and be adaptable to changing risk environments and be aware of the views of broader industry stakeholders.

The roles of the CDC and the Health portfolio under the Australian Government Crisis Management Framework must be articulated and understood by staff and external stakeholders.

Transparent, trusted and independent

The CDC's role and functions should be codified in legislation to ensure it is independent and skill based. To be influential, the CDC must remain proximate and relevant to key decision‑making structures. CDC advice needs to routinely be made public, and published in parallel with policy that has drawn on its advice.

The CDC should also develop and issue consensus statements on issues within its remit, especially where there is not yet a settled view. Drawing on available research and experts, a consensus statement identifies areas of agreement and disagreement to provide recommendations based on collective opinion. Leveraging its trusted and authoritative reputation, the CDC can help address uncertainty and confusion in the public debate.

Investment in data sharing and surveillance systems

The CDC needs ongoing funding certainty to establish its most critical pieces on data consistency and sharing, surveillance infrastructure and evidence synthesis. Expert roundtables and interviews clearly expressed that the CDC should establish these functions as a priority. Doing so will be complex and take time, requiring funding certainty to build necessary supporting systems, attract the expertise required and establish key relationships across governments and the broader sector, and with priority populations.

Building on the foundation established by the Interim CDC

The Interim CDC is the first step in operationalising the government's election commitment to establish a standalone agency. While it is not widely known, good progress has been made within available resources to support future pandemic preparedness.

Including:

• driving work to reform Australia's overarching national health emergency response plan which sets out obligations, roles, responsibilities, functions and governance arrangements
• undertaking multifaceted health emergency exercise scenarios across multiple states
• enhancing surveillance activity, particularly around respiratory infections in aged care settings over the winter months
• increasing engagement with international partners – Australia increasingly has a 'seat at the table' because of the Interim CDC.

There are significant concerns about the current level of preparedness of the health system, and whether it has diminished due to impacts of post‑pandemic backlogs, health budgets and loss of key capabilities. Continued uncertainty regarding the future scope and funding of a permanent CDC is counterproductive and delays the necessary decisive action to enhance Australia's level of preparedness.

Scope

We support a phased approach to establishing the CDC, with the necessary upfront funding to address agreed priorities and commence the building of supporting interoperable systems. The Interim CDC is building the necessary technical and system capability to embed core functions. A phased approach also provides time for the CDC to build trust and credibility with key stakeholders and the Australian community.

An initial progress review of the CDC should be undertaken 12 to 18 months after the establishment and funding of the permanent entity, and after the first biennial report to National Cabinet and Parliament on Australia's pandemic preparedness. This would assess its effectiveness in delivering on its core functions, and the biennial report will shape the work plan for its next phase. Based on performance outcomes, the CDC's remit should be expanded in a staged way, including non‑communicable diseases so that the CDC has a complete health remit.

Core functions

Nationally interoperable data systems

Laying the foundations for a national communicable disease data integration system across Australia's health system is the CDC's highest priority. Because of our early and successful interventions against COVID‑19, the Australian population had a unique immunity profile. Yet we were relying on evidence from countries that had levels of immunity from past infections that exceeded ours. When you take your own road, you need to pave it with your own data.

The CDC should coordinate the collection, storage and management of national public health data. It should have the authority to agree standardised case definitions and reporting requirements across jurisdictions, and the convening authority to coordinate access to relevant data from other custodians for the purpose of preventing, detecting, preparing for and responding to a health emergency. It should provide for secure, two‑way data systems across the Commonwealth and the jurisdictions and, importantly, there must be capacity within the CDC to undertake meaningful analysis and synthesis of data for sharing with the states and territories, and tailored advice for other health stakeholders, including the health professions, health facilities and key industry and community stakeholders.

We recommend that the CDC prioritise coordinating and linking data for notifiable diseases, immunisation rates, hospitalisations, health system usage and workforce impacts, and excess mortality.

Priority should also be given to data linkage with residential aged care, the National Disability Insurance Scheme, the Australian Bureau of Statistics, the Australian Taxation Office and the Department of Social Services. Capability to match Medicare Benefits Schedule usage with hospitalisation rates and vaccination status, for example, would have allowed a far more efficient prioritisation of resources and targeted responses for vulnerable cohorts. Further, rapid linkage may be required in an emergency depending on the nature of the infectious agent, and in‑house capability to oversee this will be essential.

In the first 12 to 18 months after its commencement, the CDC should:

• finalise 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:
  • 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
  • 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
  • finalise work underway to establish clear guardrails for managing privacy and enabling routine real‑time access to linked, granular data
• publish a report on progress against key priorities identified in this data strategy.

Surveillance systems

The CDC should provide a world‑leading public health surveillance system to inform horizon scanning and early warning advice on global emerging diseases and their transmission potential, disease pathways and trajectories, and population outcomes at a national level, before isolated cases turn into outbreaks. Surveillance should be scalable in an emergency to accommodate increased testing and case numbers. Surveillance should be complemented with early detection tools, including proactive population sample screening regardless of symptoms and wastewater surveillance (including on incoming planes), in collaboration with the states and territories, so the prevalence and virulence of variants in the community, and any changes to this, can be quickly assessed.

The CDC should be the primary contact point for communicable disease agencies in partner nations to share research, modelling, and horizon scanning and improve global preparedness.

An agreed implementation pathway will set out the appropriate sequencing of these priorities, given inter‑dependencies.

In its first 12 to 18 months the CDC should:

• commence establishment of new comprehensive surveillance infrastructure that incorporates wastewater surveillance, to facilitate disease detection and monitoring, risk assessment, and national data‑sharing, operating with state and territory systems to provide national updates on notifiable diseases
• develop 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
• ensure captured surveillance data meet the analytical needs of public health responders and support rapid research and real‑time evaluation
• draft 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
• enhance early warning surveillance capability and related modelling to inform procurement planning for the National Medical Stockpile (undertaken by the Department of Health and Aged Care)
• confirm linkages with New Zealand health authorities and other regional partners, and agree to near real‑time data and intelligence sharing with them and other regional partners.

Preparedness and scenario testing

The CDC, working with the Department of Health and Aged Care and NEMA, should update communicable disease plans. These plans should be informed by the latest data and evidence and be regularly tested through health emergency scenario exercises. These scenarios should involve all partners identified in the plan, including key industries, priority populations, Primary Health Networks, unions and the states and territories. Broader scenario testing with a focus on concurrent plant, animal and human biosecurity incidents and involving the Department of Agriculture, Fisheries and Forestry and other relevant stakeholders should also be conducted. Discoveries and recommendations arising from scenario testing must be acted on in a timely way.

Pandemic preparedness relies on accessing the full breadth of our public health expertise to support surge workforce models. The CDC must have visibility of national health workforce trends, including in the public health workforce, through work done by the Department of Health and Aged Care and the Medical Workforce Advisory Collaboration. This would include oversight of surge workforce capabilities and gaps to be mapped, and advice to be provided to governments ready to be operationalised in a future emergency response.

Mapping of gaps for the public health workforce should be guided by and align with the World Health Organization's Global competency and outcomes framework for the essential public health functions.⁴⁵ It is also an important opportunity to map and monitor the availability of high-level expertise needed in pandemics (genomics, modelling, quantitative and qualitative epidemiology, behavioural science, mental health, social science and so on). The CDC needs to draw on these trend data to inform its advice on the pandemic readiness of the health system, and identify training needs.

In its first 12 to 18 months the CDC should:

• work with the Department of Health and Aged Care to:
  • finalise the National Health Emergency Plan, aligned to the Australian Government Crisis Management Framework
  • finalise the National Communicable Disease Plan, which would be agreed by the Health Ministers Meeting
• jointly hold a major pandemic drill with NEMA to assess national, whole‑of‑government preparedness, involving the Prime Minister, First Ministers and senior officials from Commonwealth, state and territory governments and the Australian Local Government Association
• determine 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.

Biennial pandemic readiness reporting

The CDC should conduct biennial reviews of Australia's overall pandemic preparedness. These reviews should be considered initially by the Commonwealth Minister for Health, then by National Cabinet prior to tabling in the Commonwealth Parliament.

This review would provide:

• summaries of new pandemic exercises held to date
• detailed reporting on local and national incidents in the past year to advise on how systems managed the response, to highlight strengths and weaknesses
• recommendations for system improvement.

These reports should build on mandated post‑incident reviews that the CDC facilitates across the Commonwealth after a health emergency.

In its first 12 to 18 months the CDC should:

• jointly finalise with NEMA its first biennial pandemic preparedness report to the Commonwealth Minister for Health and National Cabinet prior to tabling in the Commonwealth Parliament
• report 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
• map 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.

Public communication

The CDC should become a trusted, authoritative and accessible source of information on communicable diseases, both during a pandemic and as part of its business‑as‑usual activities.

During a pandemic, the CDC is to provide timely, transparent and reliable communication that effectively explains risk and promotes action to inform and support public health measures. It must have the capability and authority to take a lead role and support the Prime Minister and the Minister for Health to directly and effectively communicate with the community in a time of crisis and work in partnership with national, state and territory emergency communications to enhance coherence.

It should also be the public health emergency communications hub, providing a single place where the Australian public can find integrated information about the pandemic and emergency response. Communications products should reflect genuine engagement and co‑design with Aboriginal and Torres Strait Islander people, culturally and linguistically diverse groups, and aged and disability care communities so they can be readily adapted for specific community and occupational settings. These products should be updated to incorporate lessons learnt either through to scenario testing or through public health incidents.

Working with the Department of Health and Aged Care, states and territories and the advice of relevant professional bodies, the CDC would be responsible for the development of best‑practice guidelines on infection prevention and control across a wide range of settings, including testing for and tracing of emerging diseases.

This 'living guidance' needs to be developed and constantly updated with the states and territories to ensure messages can be tailored and delivered through local networks. It should build on existing material such as the Series of National Guidelines provided by the Communicable Diseases Network Australia.

In its first 12 to 18 months the CDC should:

• establish and embed a public communications function within the CDC that can support both business‑as‑usual communication activity and crisis communications in a public health emergency
• work with the Department of Health and Aged Care, NEMA and the Department of the Prime Minister and Cabinet to develop – including through co‑design with those in priority populations, families and industries – a national communication framework for use in health emergencies to ensure that Australians have the information they need to manage their social, work and family lives. The framework should:
  • be informed by behavioural science and risk communication expertise
  • meet the diverse needs of communities across Australia
  • include mechanisms to coordinate and consolidate communications, including considering the timing and frequency of announcements
  • include a strategy for addressing the harms arising from misinformation and disinformation
• include communication as 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
• develop in‑house expertise in evidence synthesis and communication.

Behavioural insights to support public health responses

An effective pandemic response relies on the community changing its behaviour to slow the spread of the virus. Behavioural science was used by government agencies to help develop and target public health messages to assist people to comply with public health measures.

In the medium to long term, the CDC should develop and embed behavioural insights capability to assess, refine and enhance the effectiveness of pandemic responses. This capability is required both during crisis periods and to support business‑as‑usual activities of the CDC, including providing public health evidence to Australians in effective ways that encourage healthier choices.

In its first 12 to 18 months the CDC should:

• map existing behavioural insights functions across the Australian Government with the Behavioural Economics Team of the Australian Government
• work with experts to develop a fully scoped and costed business case for an in‑house behavioural insights capability.

Engagement with key academic and community partners

The CDC will not be a research organisation. However, it should have a role in supporting and leveraging the work of the research community to the benefit of the nation to support health emergencies. It should also have a role in advising government on pandemic‑related research priorities to support government decisions on research funding calls, and moving to pandemic settings for enactment of pre‑agreements on enhanced data sharing and expedited research support processes.

The CDC should have an ongoing relationship with research communities to identify research gaps and advise government on how these could be addressed. Inclusion of leading technical and research experts on the CDC technical advisory group will help to build the authority of the CDC and guide its development.

In its first 12 to 18 months the CDC should:

• draw on technical advisory structures to publicly report on work to support research and intelligence exchange with research institutions in Australia and abroad, including behavioural researchers, private scientists, and peak health industry bodies.

Phased functions for the CDC

By 31 December 2026 the CDC must be reviewed to identify progress towards meeting its core objectives. Establishing and developing a new organisation with a workforce capable of delivering on initial priorities will take time. Once established, there needs to be consideration of widening the CDC's remit to potentially include the following functions.

Non‑communicable diseases

There is a strong link between pandemic preparedness and a healthy population with managed levels of non‑communicable disease. Pandemics also have a direct impact on the prevalence and management of chronic diseases. Given the clear synergies, the CDC's pandemic response remit would benefit from a progressive expansion to include non‑communicable diseases, using the data infrastructure and data linkage established by the CDC in its initial phase. However, the argument for inclusion of non‑communicable diseases goes beyond this if we are to realise the CDC as a transformative national health asset: non‑communicable diseases impact more Australians, for more of their lives; contribute to more deaths; and drive greater health disparities. In order to deliver trusted advice on risk assessment, and provide a comprehensive approach to pandemic preparedness and response, the CDC should be expanded to encompass chronic and communicable diseases when it has progressed preparedness priorities, and support existing advice pathways to government and the Department of Health and Aged Care on policy priorities for non‑communicable diseases and the wider determinants of health.