Public health, and its role in Victoria’s pandemic recovery election

The upcoming Victorian state election offers the opportunity to reflect on, and learn from, the state’s response to the COVID-19 pandemic, to guide public health policy, and improve our resilience to emerging pathogens over the next four years.

Australia’s pandemic response was characterised by a clear recognition of the importance of the states and territories as leaders in the public health response.

States became the key decision-makers in determining the need for lockdowns and a broad range of other public health restrictions.

Overall, Australia had a comparatively successful response in terms of controlling the virus, but also endured extended periods of lockdown in pursuing this aggressive strategy.

Read more Victoria's COVID-19 lockdown: Getting ahead of the spread 

Victoria was at the forefront of this process, as the state government embraced the COVID-zero strategy. This elimination approach required several extended periods of lockdown, but allowed for restrictions to be released once transmission had been driven back down to zero, with extended periods of relative normality between outbreaks as the pandemic raged overseas.

These decisions were made in the context of an emergency response to a generational threat, but as COVID transitions to endemic transmission, and with emerging infections a persisting threat, we can now look to more sustainable policies.

Strengths of our pandemic response

The adaptation of our world-leading academic sector, laboratory resources and personnel to the pandemic response was a key strength; as a state, we’ve contributed substantially to the national response through our innovative genomics, modelling, engineering, evidence synthesis, therapeutic trial expertise, and vaccine development.

This has helped drive the response to the pandemic in real time, and kept us at the forefront of the national and international fight against COVID-19. As data, technology and evidence were developed, they were rapidly incorporated into our local public health response.

... And the weaknesses

Given the lightning-fast time scale of the pandemic, Victoria was initially reliant on its pre-existing public health and healthcare infrastructure. Victoria’s public health system suffered from a lack of consistent resourcing and a system that was overly centralised in Melbourne.

This exposed key weaknesses early in the pandemic, which included an inadequate public health workforce, and outdated systems for disease surveillance and management, such as a paper-based contact tracing system.

The more decentralised systems, such as those of New South Wales and Queensland, provided greater local public health capacity.

Further, Victoria’s centralised systems contributed to delayed or ineffective communication with many Victorian communities, particularly during the early weeks of our second wave in 2020.

Building on the strengths

Continued investment in high-quality research capacity could sustain Victoria as a global leader in infectious disease control.

The recently announced Victorian mRNA Hub, a collaboration between Monash University and the University of Melbourne, was backed by the state government, while the large philanthropic grant provided to the University of Melbourne to establish the Cumming Global Centre for Pandemic Therapeutics was likely facilitated by Victoria’s outstanding medical research track record.

Such major global centres for research will have spinoff benefits for Victoria, as they become hubs for attracting more researchers and PhD students, and drive developments in technology and industry, creating jobs in Victoria.

As the Commonwealth government looks to fulfil its election promise of a national CDC, Victoria can remain at the forefront of this process.

Addressing the weaknesses

Victoria has taken the first important steps towards revitalising its public health and response capacity, notably through the development of Local Public Health Units (LPHUs) in late 2020.

These health units help to decentralise the public health system, embedding the response within local health services and communities, while still maintaining strong connections with the Victorian Department of Health.

LPHUs can have many important local roles, including:

• contact tracing
• disease surveillance
• operationalising intervention programs
• communicating with local communities.

The local knowledge, community links and value LPHUs offer are vital components of future pandemic preparedness.

The next parliament should prioritise consistent funding of LPHUs, and ensure links to primary care and community services continue to be developed. Expanding the public health system also has the spinoff benefit of supporting the career progression for public health professionals.

Social cohesion and investment in public institutions

COVID-19 has clearly demonstrated we need to develop a more robust health and societal system that is the greatest asset for supporting our response.

This should extend beyond investing in newer and bigger hospitals to span the full spectrum of the health system, including community and primary healthcare, aged care, public health, and research.

The social determinants of health, such as living and working conditions, education, and social support have long been recognised as upstream drivers of broader health outcomes.

The COVID-19 pandemic has been no exception, with individuals and groups that were socially vulnerable experiencing the greatest impact and poorest outcomes in Australia.

Equity should be a core principle of our response to future pandemics, but is difficult to achieve overnight as we scramble to grapple with the latest emerging pathogen.

Despite the often-divisive discussions leading up to this state election, the next state parliament should focus on developing community cohesion.

For public health decisions, public trust is critical for ensuring control strategies are optimally effective against infectious threats, and is our most important defence against future pandemics. However, the process of developing such trust extends far beyond heath policies, and requires a whole-of-government approach.