The federal government was warned of the need for a centralised pandemic response agency more than two years before Covid-19 reached Australia.
Prime Minister Scott Morrison formed national cabinet in March 2020, a month after Australia recorded its first Covid-19 case, to coordinate Commonwealth and state responses to the virus.
But the Australian Medical Association in 2017 highlighted the "urgent" need for a National Centre for Disease Control, warning "diseases and health threats do not respect borders".
Its statement warned Australia's pandemic response systems relied on "disjointed state and Commonwealth" structures, along with "informal networks" based on goodwill between public health officials and experts.
AMA Vice President Chris Moy said national cabinet, and Health Department Secretary Brendan Murphy, had "stood us in really good stead" throughout the pandemic.
"[But] it's a patch up job ... They work well as a team, but other times they haven't worked so well," he told The Canberra Times.
"A CDC would put us at a far more of a war footing for the next time, because we're going to get another pandemic.
"It's going to happen. We haven't even got out of this one, and we're going to be up for another one at some stage. You can guarantee it."
Labor has pledged to deliver a CDC if it wins the next election. The new agency would be tasked with turning "rapid risk assessments" of outbreaks into policy advice, managing the national vaccine stockpile, and coordinating public communication.
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Dr Moy said a respiratory-borne virus like COVID-19 was "predictable" but Australian authorities were left scrambling in early 2020.
That included some states telling patients experiencing symptoms to visit their GP, or "speak to the receptionist" during the Wuhan outbreak, he said.
"We didn't have even simple posters about what to do ... If we had a CDC, they would have been essentially on the shelf," he said.
And with COVID-19 likely transferred from animals to humans, the AMA has also touted linking the CDC to veterinary and agriculture bodies.
The Australian Technical Advisory Group on Immunisation has come under the microscope after it advised the AstraZeneca vaccine, set to make up the bulk of Australia's rollout, was no longer preferable for people under 60.
Prime Minister Scott Morrison has attempted to walk back the damage, stressing AstraZeneca remained available to any Australian aged over 18 provided they consulted their GP.
Dr Moy argued ATAGI's remit was too narrowly focused, and a CDC would provide more "holisitic" advice considering the broader impact on society.
"[It would] look at overall the risk-benefit of not only the person next to you ... but the risk of the lockdown as well," he said.
Crucially, it would also wield authority across borders to neuter state disputes.
States have taken markedly different stances on border closures and lockdowns throughout the pandemic.
Federal Finance Minister Simon Birmingham accused Queensland authorities of spreading "extremist" views on AstraZeneca, after the state's chief health officer Jeanette Young warned the jab could kill young people who "probably wouldn't die" from COVID-19.
"The problem at the moment is everything's looked at in a politicised, parochial [way]. We'd just take that out of play, because it would be the CDC making the call," Dr Moy said.
State squabbles have continued this month as NSW, grappling with the Delta variant, pleaded for doses to be redirected.
"The problem has been that the decision-making process has been opaque, not that there's not an authority to distribute the vaccine," he said.
The Australian Health Protection Principal Committee had coordinated across borders, it was not resourced and had no permanent staff.
Professor Duckett said while there were some coordination mechanisms, including the Australian Health Protection Principal Committee, they were not permanently staffed.
He accepted the need for a "beefed-up centralised resource" but was "equivocal" on a CDC.
"I don't think it is going to be a panacea unless we can really get the governance right, and I'm skeptical about that," he said.
"The governance really needs to be thought through, because it could very easily slip into being the Commonwealth making the decision, which would be the wrong thing."
Professor Duckett warned the experience in the US, where more than 610,000 people have died from Covid-19, showed centralising power exacerbated the threat of incompetent leadership.
Diluting the process had reined-in the federal government's worst instincts at the beginning of the pandemic, he said.
"It's not clear to me, if there was a national CDC, what advice it would have given. Would it have followed the Commonwealth position, which was to let the virus rip, or would it have followed the all-state position that we should go into lockdowns?" he asked.
"The diversity, the fact that the states were able to take those decisions autonomously led to, I think, the right outcomes."
With health the purview of the states, he said the formation of national cabinet was an attempt by the Commonwealth to gain a foothold in decision making.
"It was set up as a political exercise to deal the Commonwealth back into the equation, because they were excluded from state decisions and they wanted to have some sort of say," he said.
"It has not worked at all as an effective decision-making body. It has worked to serve the Commonwealth's political interest."
But the Health Department insisted Australia had "world-class" public health systems which were "well-prepared" to respond to the pandemic.
National cabinet had worked with the AHPPC and the states to "ensure we could protect all Australians", it said.
"We have a highly effective and well-practiced national governance and collaborative arrangements in place for health crises," it said.
"Our emergency directions ... have been successful in slowing the growth of cases to ensure our health system has the capability to manage the epidemic."
Labor Health spokesman Mark Butler said Australia was the only OECD country still lacking a CDC, which would have made its Covid-19 response "so much more robust".
"Our nation went into the coronavirus pandemic with less than one mask for every Australian in the National Medical Stockpile, an overreliance on global supply chains, and badly stretched aged and health care systems," he said.
"The CDC will lead the federal, not just Commonwealth, response to future infectious disease outbreaks by coordinating advice to governments, improving the quality and consistency of advice from the current fragmented system; and ensuring consistent and effective public communications."
The AMA first started pushing for a CDC in 2017 over a decade-long syphilis outbreak, primarily afflicting young Indigenous Australians, which Dr Moy described as a "national disgrace which most people are not aware of".
The outbreak originated in Queensland in 2011 but jumped the Northern Territory border in 2013, before eventually spreading across South Australia and WA.
There had been 4,151 cases linked to the outbreak between January 2011 and March this year, the Health Department revealed.
NT AMA President Robert Parker said the state response to the disease, which was nowhere as fast-moving as Covid-19, was found wanting.
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