Throughout history, we've seen a consistent pattern of infectious diseases emerge and re-emerge. This underscores the importance of ensuring our health systems are well-prepared and equipped with effective disease surveillance. New research from the Australian Institute of Tropical Health and Medicine (AITHM) seeks to determine how well disease control is being governed in Australia.
Public health surveillance refers to the collection and analysis of health-related data, including disease and health trends within populations. It is essential for detecting disease outbreaks and coordinating responses. Yet, the capacity for such surveillance varies widely between and within countries.
In Australia, public health surveillance — including data collection and emergency response — is primarily the responsibility of state, territory and local governments. But governance arrangements, which determine who has authority to make decisions, are not always clear. As exemplified by the COVID-19 pandemic, this can lead to contradictory messaging and inconsistent strategies to respond.
To better understand the strengths and weaknesses of current surveillance and response systems for communicable diseases in Northern Queensland (NQ), AITHM Professor Stephanie Topp and colleagues in JCU’s College of Public Health, Medical and Veterinary Sciences conducted case study research examining how different disease groups are governed in the region.
“Northern Queensland is an interesting zone for communicable disease control for a couple of reasons,” Professor Topp said. “It’s located within the Tropics, so it experiences higher rates of communicable disease outbreaks. It’s the only region of Australia that has an international border, because of the proximity to Papua New Guinea. And it is a vast geographic area, positioned quite far from the policymaking centres of Brisbane and Canberra.”
During the initial stages of the research, Professor Topp noted how the governance of different diseases varied. Consequently, she and the team chose to analyse the governance systems of four different disease groups: COVID-19, tuberculosis, sexually transmissible infections (STIs) and arboviruses.
“For each group of diseases, we looked at how decisions were being made and enacted in NQ,” she said. “We asked: who is responsible for collecting and analysing communicable disease data? What are the organisational entities and decision chains that enable a response? What formal policies and informal practices guide the way the system functions?”
Over 18 months, Professor Topp and her team collected data by reviewing documents, observing organisational settings, and conducting over 80 interviews with public health staff, Queensland Health policymakers, National Aboriginal Community Controlled Health Organisation (NACCHO) leaders, and Hospital and Health Service (HHS) leaders.
The research found that the NQ surveillance and response systems for all four disease groups face at least three challenges in common.
First, weak coordination within and between sectors (for instance, between teams and organisations responsible for disease screening, data collation, analysis and strategic response). This means surveillance and response systems often rely on ad hoc communication and data-sharing arrangements, with unclear accountabilities when it comes to response. This leaves the systems prone to error or breakdown, especially in times of stress, as has been particularly evident in the case of the ongoing STI outbreak.
Second, a shift toward activity-based funding has reduced the resources available to maintain and adapt surveillance and response systems in the face of new or shifting threats, as was clear in the arbovirus surveillance section of the study and the 2022 outbreak of Japanese encephalitis.
Third, limited funds and a lack of priority during non-crisis times has left public health units short-staffed for all but the most basic functions, hindering their ability to respond to surges without undermining other essential services; this was particularly evident in the study’s examination of the COVID-19 emergency.
Professor Topp hopes that these findings will be used to strengthen health systems for future pandemic preparedness and other public health crises.
“At a local level, I’d like these outcomes to stimulate conversations around the degree of priority and visibility that public health units have within Queensland’s HHSs. I’d like to see more discussions around how to ensure they are better positioned and resourced to conduct routine surveillance and to be capable of rapid response,” she said.
“And at a state level, a conversation is needed around how to support and ensure HHSs better deliver on their public health responsibilities. They do have legal responsibilities for public health functions, but currently the oversight of those responsibilities by the state government is pretty limited. I would like to see an investment in stronger mechanisms of accountability, including a more robust set of public health indicators that help track and support HHS performance in this area.”
In striving for future preparedness, Professor Topp suggests policy makers in all jurisdictions do more to invest in disease prevention and promoting wellness.
“Unfortunately, decision makers in our health systems are often captive to electoral cycles and the curative care metrics associated with those cycles. And so, funding tends to follow instances of care, hospital bed availability and ramping rates; not the harder-to-quantify but more impactful population health strategies that could prevent or mitigate the next pandemic,” Professor Topp said.
“But preventing ill health and promoting good health ought to be a key focus of all health systems. It is vastly more cost efficient and produces better outcomes.”
