Until COVID-19, little was known about Australia’s chief medical officer or chief health officers of states and territories. Now they are front and center of the news cycle.
But the media coverage misses the specifics of the role. We look at people with special skills and personalities. Nevertheless, each office and official is embedded in a particular institutional and historical context that governs their role.
We are involved in an international study to look at their role during pandemics in Australia, New Zealand, the United Kingdom and Canada. Here’s what we’ve found so far from the Australian data.
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Remind me, who are they?
In Australia, the Chief Medical Officer, Paul Kelly, is the Federal Minister of Health and the Chief Medical Adviser to the Department of Health. He therefore has an overwhelming bureaucratic responsibility for Australia’s federal health response to the pandemic.
For states and territories, chief health officers have that immense responsibility.
COVID-19 has seen everyone taking regular slots in press conferences. They are constantly under the microscope of millions of epidemiologists.
COVID-19 has shown how challenging their roles are. Are they public servants who work on behalf of the government? Or should they be independent of the politics that shape policy to protect public health? Or should he balance the contradictions that come with being both a health professional and a public servant?
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their legal powers may help or hinder
Legislation in each jurisdiction gives the chief health officer varying degrees of institutional power. This affects not only their role, but how outbreaks are defined and managed.
In some jurisdictions (New South Wales, Queensland, Tasmania, Western Australia) the chief health officer becomes the public health emergency “controller” for epidemic management.
Qld gives most of the power to its Chief Health Officer (possibly the most, even internationally). This is partly due to also serving as Deputy Director General (a senior position in the bureaucracy). Qld’s chief health officer is also the final decision-maker with the premier “in consultation” on public health restrictions (most notably borders). NSW also holds the post of Director General but the Premier is the final decision maker.
In comparison, Victoria’s chief health officer has neither the role of a deputy director general nor “controller” oversight of emergency procedures.
An investigation into the Victorian hotel quarantine concluded that it prevented the chief health officer from fulfilling the position of “controller”. As a result, some infection control details were overlooked, resulting in the state’s second wave of outbreaks.
The chief medical officer at the federal level has arguably the least legislative power of all, given the autonomy of the states’ jurisdiction. The power of this role during the pandemic has mainly come through the chairmanship of the National Committee of Chief Health Officers of the State and Regions.
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They work with politics, policy and evidence
Chief medical and health officers work at the interface of politics, policy and health evidence. They are unelected, yet answerable to ministers, the prime minister, and parliament. They work with the respective secretaries and ministerial offices.
Whatever their dispatch is, eventually the buck stays with them. They have the power to “stop the nation” as we have seen under COVID-19.
However, our analysis provides practical insight into how health evidence intersects with political realities during pandemics.
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They should be strategic and media savvy
These officials work within formal avenues such as the Australian Technical Advisory Group on Immunization to collect and interpret the best available evidence.
But communicating evidence is an entirely different matter. More than acting as “honest brokers” of policy evidence, their use of evidence must be strategic if they are to have an impact. And this requires political acumen.
Elected politicians need to be seen in control. When presenting evidence, not all of which will be popular, chief health and medical officials are required to anticipate political responses.
They should also be media savvy. The much-anticipated daily COVID-19 press conferences (recently disbanded in NSW) are well orchestrated. Clarity of message is important as evidence in times of crisis. Image is also there. Despite the strong behind-the-scenes dialogue, collegiality across the government is the essential visual message to display.
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They must be bureaucrats, networkers
As public servants, chief health officers must be excellent networkers and departmental managers. They delegate authority, taking the ultimate responsibility for their legislative role.
Each has set up management systems in their agencies to deal with the complexities of the pandemic. Their networks extend to other regions and agencies. For example, one chief health officer we interviewed spoke of unexpectedly cooperating with police enforcement of public health restrictions.
Quarantine is a federal government responsibility under the Constitution, but it was agreed to be managed at the state level. This source of the outbreak challenged the effectiveness of chief health officials as a mix of public and private partnerships compromised effective quarantine management.
Relationships with other chief health officers matter. The virus does not respect state boundaries, although many political leaders claim the opposite.
Collective decisions, often with massive impact, must be made. Confidence in the skills and decision-making of fellow Chief Health Officers in various jurisdictions is fundamental.
Experience helps, demonstrated by those in NSW and QLD who have served the longest. But being relatively new brings mobility. The initial goal of zero transmission was championed by a chief health officer with little experience.
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what happens next?
An unprecedented pandemic has pushed previously faceless bureaucrats and their representatives onto our screens and devices in ways unimaginable even two years ago.
Ultimately, chief health officers have shown that they need to balance a mix of public servant and health professional with a nuanced approach to politics.
But individuals are never the whole story. For example, investment in public health (hospitals set aside) is inadequate. The new version of COVID-19 is also testing a coordinated public health response like never before, the chief health officer was involved.