Pandemics increase the risk of ill health and death, and responses involve fundamental changes to the way we live and the operation of our economy. In this context, it is uncontroversial that governments should aim to minimise harm through taking proportionate responses at the various stages of a pandemic that fully account for the broader health, economic and social impacts of decisions. This objective is supported by the other eight pillars of a pandemic response and should factor into every decision made throughout a successful pandemic response.

Controlling the spread of COVID-19

During the initial alert phase of the COVID‑19 pandemic, the Australian Government and state and territory governments acted swiftly to introduce precautionary measures to suppress transmission, ‘buying time’ to better understand the health threat, and to prepare the public health response and increase the health system’s resilience. We heard from former Prime Minister Scott Morrison that leaders were motivated by the idea that a ‘good decision made late was deadly’. The Biosecurity Act supported this focus on controlling the virus by giving extraordinary powers to the Commonwealth Minister for Health to act unilaterally.

Measures enacted under the Biosecurity Act were restrictive, and their broader economic, social and mental health and human rights impacts were not always understood or considered. In future, additional checks, such as publishing the reasons and supporting advice that underpinned extensions, would have improved the Australian Government’s transparency, accountability and discipline, and helped maintain public confidence and trust.

The strategy to ‘buy time’ was successful in suppressing the initial wave, which in turn saved lives, protected the health system and minimised the negative economic and social impacts of the pandemic.

Once more was understood about the virus threat and our healthcare system’s resilience had increased, the pandemic response should have shifted from a reliance on the ‘better safe than sorry’ precautionary principle, where fast actions not necessarily informed by evidence are required, to a risk‑based approach grounded in evidence. However, aspects of the response continued to rely on the precautionary principle, maintaining a low risk tolerance for COVID‑19 case numbers, with inadequate consideration of the broader health, economic and societal impacts.

A real‑time evidence‑based approach gives decision‑makers more confidence about introducing and modifying measures, and when it is safe to target the response rather than relying on broad restrictive health orders, reducing the severity and duration of restrictions. Such an approach also reduces fear and distrust in the community, by providing the evidence that public health measures are the right and proportionate thing to do.

While the Inquiry heard of real‑time evidence‑based approaches being employed during the pandemic, there was variation across jurisdictions over the course of the response. National Cabinet announced a coordinated approach across jurisdictions to gathering evidence to inform changes to isolation and quarantine ahead of Australia’s opening up, but this did not eventuate, undermining public confidence and trust at this critical time.

Loss of lives in aged care

For many Australians, their acceptance of public health orders was driven by the understanding that measures were needed to protect the lives of older Australians during the pandemic. Older Australians were more vulnerable to severe disease regardless of whether they were living in aged care or the community. Many experienced extreme social isolation, due to the choice of older Australians and their family and friends to avoid interactions to reduce the risk of exposure to infection or because of visitation bans enforced in aged care facilities where older Australians lived.

Notwithstanding the early success in containing the spread of the virus, the majority of the approximately 900 COVID‑19 associated deaths in 2020 were among older Australians,⁹ primarily living in Victoria, the state with the most significant community spread during this period. While outbreaks impacted only a small number of residential aged care facilities, they accounted for 75 per cent of all COVID‑19 deaths.¹⁰ Pre‑existing vulnerability in the aged care system, including insecure employment arrangements and workers operating across multiple facilities, a lack of planning and preparation, cases of weak leadership at the provider level, inadequate infection prevention and control and a lack of mechanisms to share learnings and experiences were all contributing factors.

Vaccines

Australia had a phased vaccine rollout that sought to prioritise those most at risk. After a slow start dogged by a lack of supply and logistical issues, Australia’s eventual success in immunising more than 90 per cent of the country by the end of 2021 involved a number of policies designed to encourage uptake, including vaccine mandates linked to occupation. Historically Australia has high rates of vaccination, providing broad public health benefits, and this was relied on during COVID‑19 to allow Australia to safely transition from pandemic to endemic.

Vaccine mandates were introduced in critical care settings when only 10 per cent of staff were fully vaccinated. This was justified due to the increased health risks associated with COVID‑19 for those receiving care. The mandates also contributed to containing the spread of the virus during waves where recent vaccination reduced the likelihood of infection, reducing the risk of severe illness in the wider community and the health system being overwhelmed.

However, research indicates that the use of mandates has reduced the motivation of some people to be vaccinated for COVID‑19 and has led to ongoing reluctance to receive vaccines. Of particular concern is the fall in critical routine vaccination uptake amongst children, and a rise in vaccine‑preventable illnesses such as measles and whooping cough.

The Inquiry also heard profoundly tragic personal stories of vaccine injury. They highlight the need to always weigh up the risk of an adverse reaction to a vaccine against the risks of the disease itself, including the impacts on broader health outcomes if the spread of the virus is uncontrolled and the health system is overwhelmed.

This is particularly difficult when the people at greatest risk from infection are a different group to those at greatest risk of having an adverse reaction to the vaccine.

The COVID‑19 Vaccine Claims Scheme provided those impacted by adverse events with compensation; however, the scheme is yet to be reviewed to assess its effectiveness and determine its appropriateness for a future pandemic.

Broader health impacts

The focus on controlling the spread of COVID‑19 meant broader health issues were often given a lower priority. These issues included increased poor mental health due to the negative impacts of social isolation, pandemic disruptions and increased anxiety, and reduced access to usual health care, such as cancer and other disease screening, non‑emergency surgery and chronic disease management.

Studies have also concluded that the increases in the rate of unemployment benefit and the implementation of a wage subsidy scheme were an important strategy in mitigating the negative mental health impacts of the pandemic. At the start of the pandemic, the Australian Government moved quickly to mitigate some of the impacts by expanding access to mental health services under Medicare, including through allowing online sessions, and increasing funding for helplines. These initiatives helped many Australians, but the benefits were not universal.

Decisions to pause cancer screening services and reduced attendance at scheduled screenings during the pandemic response are likely to have long‑term implications. Independent modelling from Australian researchers anticipates an additional 1,186 deaths from colorectal cancer through to 2030 due to COVID-era disruptions to screening services.¹¹

Almost five years after the pandemic commenced, large backlogs in elective surgery remain due to its suspension during the pandemic. The health system, while protected from being overwhelmed during the pandemic, has enduring issues. Workforce shortages across the system, burnout, ongoing sickness and the furloughing of staff have impeded health services in their recovery to business as usual, let alone enabling them to find the additional capacity needed to address substantial backlogs. These system‑wide issues are having an ongoing impact on Australians in need of health care.

Social impacts

The negative social impacts of the pandemic included extended social isolation, increases in the incidence of family violence, and reductions in access to education, disability supports and secure housing.

Risk factors associated with family, domestic and sexual violence increased through the pandemic. Some women were forced into lockdowns with their abusers, unable to leave, to be checked on by family and friends, or access domestic violence support services. In addition, there was an increase in alcohol consumption, which is linked to higher rates of family violence. One important risk factor, financial stress, was reduced due to the increases in income support payments.

While some of the evidence is mixed, overall it indicates that a significant number of women and children experienced violence for the first time, and that there was also an increase in the severity of violence during the pandemic.

Children faced lower health risks from COVID‑19; however, broader impacts on the social and emotional development of children are ongoing. These include impacts on mental health, school attendance and academic outcomes for some groups of children. The panel notes that while the Australian Health Protection Principal Committee never recommended widespread school closures, a lack of early and clear communication on the risks undermined public confidence, particularly for parents with school‑aged children, teachers and unions. This created the environment for subsequent state‑based decisions to transition to remote learning that impacted the quality and accessibility of education throughout the pandemic.

The fear in the community, and wider impacts on children and young people, could have been mitigated through more proportionate decisions based on a balanced approach that used evidence on the risk of viral spread in school settings and the effectiveness of in‑school measures. Earlier communication and greater transparency around decisions, and improved engagement with experts and advocates to feed into government decision‑making, would also have minimised the long‑term harm caused by the suspension of face‑to‑face learning.

There was a strong sense that people with disability were not a priority, despite many being at a higher risk from COVID‑19 infection and pandemic-associated disruptions to their usual supports. Poor planning, inadequate communications and a lack of transparency around prioritisation decisions in the vaccine rollout exacerbated a sense of being forgotten by government. Additionally, public health restrictions often meant that people with disability faced challenges accessing health and support services and were not able to be supported by carers in accessing medical appointments, COVID‑19 vaccination or testing. Guidelines to support the management of infection risk by disability support providers and in residential settings were lacking at the start of the pandemic.

Recognising the importance of secure housing in a pandemic, state and territory governments, local governments and community organisations moved quickly to implement programs to house in hotels those sleeping rough. These were highly successful programs that reduced risk for this key cohort through the pandemic.

In addition, measures such as increased social security payments and eviction and rent rise moratoriums meant that, rather than increasing, the number of households living in housing stress reduced through the pandemic. However, once supports were withdrawn, many people were in the same position as before the pandemic, if not worse off.

Economic impacts

The health crisis quickly became an economic crisis, and the Australian Government moved swiftly to provide economic supports that were focused on minimising harm by mitigating financial stress, poverty and labour force ‘scarring’. Economic supports announced in March totalling $213.7 billion supported the health response, allowing individuals to isolate and restrict activity.

While Australia recorded its first recession in almost 30 years, with GDP falling by 6.9 per cent between the December quarter 2019 and the June quarter 2020,¹³ it was able to largely mitigate severe economic impacts. The success of the health response in Australia meant it had a corresponding success in its economic outcomes during 2020.

That said, there were a number of ways in which the individual design of supports during this initial period could have been improved to ensure value for money for taxpayers and to support the economic recovery. A lack of planning for the economic impacts of a pandemic meant that the main economic support measure and biggest ever government spending program, JobKeeper, was developed while the Australian Government was responding to the health crisis. While the program was pivotal in Australia’s health and economic response to the pandemic, the lack of planning led to delays that increased job losses and necessary compromises in policy design that reduced value for money for taxpayers. In addition, some policy decisions, such as excluding temporary migrants and foreign companies from JobKeeper, exacerbated skills shortages and inflationary pressures during the economic recovery.

The economic recovery was much stronger than anticipated, reflecting the success of Australia’s public health and economic responses and widespread misjudgement as to the strength of demand following the pandemic. With the benefit of hindsight, there was excessive fiscal and monetary policy stimulus provided throughout 2021 and 2022, especially in the construction sector. Combined with supply side disruptions, this contributed to inflationary pressures coming out of the pandemic.

Australian policymakers were not alone in misjudging the nature and strength of inflationary pressures coming out of the pandemic, which have led to declines in real incomes across much of the developed world. Following a decade of low inflation, and based on prior pandemic experiences, inflation was not viewed as a credible risk by policymakers. The policy focus on getting unemployment down as far as possible also came with real benefits for households, businesses, and government finances. However, a stronger focus on supply side rather than demand side policies in plans for the economic recovery would have mitigated some of the inflationary pressures.

Lessons for a future pandemic

Minimising harms through a pandemic requires a broad consideration of the health, economic and social impacts of decisions and policies to mitigate negative impacts.

The stronger the existing systems and supports, the greater the resilience Australia will have in a future pandemic.

Many of the harms will be felt long after the pandemic is declared officially over, and consideration of recovery should factor in government decision‑making.

Immediate actions

To meet the object of minimising harm, the Inquiry has identified the following immediate actions to be completed over the next 12 to 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

In addition, the Inquiry has identified the following medium‑term action to be completed prior to the next major 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, including:
    • 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.