Victoria’s frontline defence against the spread of infectious disease is at risk of being dismantled after Health Minister Mary-Anne Thomas refused to guarantee funding for the state’s local public health units beyond the end of this financial year.
Uncertainly over the future of the nine suburban and regional public health units, which opened at the height of the COVID crisis to address a critical weakness in Victoria’s pandemic response, comes as the government is yet to appoint a new chief health officer after a six-month search.
Vaccine queues in Melbourne during the pandemic when public health units were first installed.Credit: Getty Images
Public health and infectious-disease experts, including current and former departmental officials, believe a downgrading of the chief health officer’s operational authority since the pandemic, when Brett Sutton wielded broad emergency powers and emerged as one of the state’s best-known public figures, has deterred qualified candidates from applying.
Dr Tarun Weeramanthri, a former chief health officer for Western Australia and the Northern Territory, is currently acting in the role for Victoria after Sutton’s successors, Dr Clare Looker and Professor Ben Cowie, quit at the end of last year. Weeramanthri is due to end his fill-in role in two weeks’ time.
Thomas on Thursday denied the state was finding it difficult to attract a permanent replacement but did not say when an appointment would be made.
“A chief health officer is a very important, significant appointment,” she said. “It is important that we take the time to make sure that we are appointing the right person, and I’m confident that we have the processes in place that will ensure that.”
When asked whether her government would extend funding for its local public health units, Thomas said she would not pre-empt budget decisions. “There are programs with lapsing funding and that gets assessed at budget time, but I am not going to comment on any of the budget outcomes,” she said.
The minister’s responses will do little to alleviate concerns that a government desperate to find budget savings is planning further cuts to already stretched public health resources.
The local public health units were formed in 2020 after Victoria’s small and highly centralised public health team was overrun by the second-wave COVID epidemic which killed 800 people and plunged the state into lockdown.
The health minister at the time, Martin Foley, predicted the public health units would be a permanent feature of the state’s health system.
“We are talking about whether they will exist in three months’ time,” said one expert who spoke on condition of anonymity. “We have apparently learnt nothing from COVID, all of that reform has been wiped out.”
Professor Tarun Weeramanthri who reviewed WA’s hotel quarantine system and is now Victoria’s CHO.Credit: Peter de Kruijff
Victoria’s chief health officer is the state’s most senior public health official and adviser to government. However, under a departmental restructure which came into effect last February, the role was stripped of much of its operational clout, with communicable disease and other operational teams no longer reporting directly to the chief health officer.
The effect is that, during an outbreak or public health emergency, the chief health officer does not have direct control over frontline staff. Three sources unauthorised to discuss internal, departmental matters said this was the primary reason Dr Looker and Professor Cowie gave notice last October, prompting the search for a replacement.
“You have no ability to change things but still have to take responsibility when the shit hits the fan,” a public health expert explained. Another said: “It is all responsibility, no care. It is not an appealing job for anyone who knows it well.”
The downgrading of Victoria’s chief health officer has coincided with other, unreported cuts to public health resources. The department recently axed a role dedicated to helping pregnant women access treatment for congenital syphilis, a sexually transmitted disease which has killed 10 babies in Victoria.
Public Health Association of Australia chief executive Terry Slevin said he was aware of potentially strong candidates for the chief health officer who decided against applying for the job because of the state of public health in Victoria.
“I’m keen to see an outstanding candidate apply for what is a very important public health job … but the truth is any candidate should be aware that it is an uphill battle fighting for public health in Victoria,” he said.
One senior health source, who did not want to be identified because it could jeopardise their employment, said the poor reputation of Victoria’s Health Department had deterred highly qualified people from applying.
“People are concerned when they find out how much is being stripped in terms of staffing and resources, and the amount of chaos in decision making,” they said. “It really is leading to a perception that Victoria is doing the worst job in public health. It’s seen as a pariah.”
Then chief health officer Brett Sutton oversaw much of Victoria’s COVID-19 response.Credit: Chris Hopkins
Opposition health spokeswoman Georgie Crozier described uncertainty surrounding the chief health officer role as extraordinary. “Under Labor, the Department of Health is in complete disarray,” she said. “The level of chaos and dysfunction is hampering their core responsibilities.”
A Department of Health spokesperson said recruitment for a new chief health officer was well progressed. “We will announce the outcome very soon,” they said.
Victoria’s local public health units were modelled on the decentralised approach to public health taken for decades in NSW and Queensland. The nine units are located in public hospitals in Melbourne’s north, west and south-east and the regional centres of Geelong, Bendigo, Ballarat, Shepparton, Traralgon and Albury.
The units receive combined, recurrent funding of $12 million for health promotion and prevention. Additional funding for health protection – surveillance, testing and containment of infectious diseases – is allocated on a yearly basis. Last year’s figure shared between the units was about $40 million.
A leading infectious-disease expert said if Victoria reverted to its previous approach to public health, when contact-tracers and protective health officers worked from the department’s Lonsdale Street headquarters and lacked the local knowledge and community connections needed to effectively respond to outbreaks, the consequences would be fatal.
“Our public health responses were undercooked prior to the pandemic,” they said. “The government recognised that, which is why they set the units up during the crisis.
“The idea that we throw that away now purely on budgetary preservation grounds, is an affront to public health. If they get rid of the public health units people are going to die.”
Another public health expert predicted that a return to a more centralised approach would be a disaster.
Slevin said Victoria had for more than a decade lacked the infrastructure needed to run effective public health and preventative programs.
“It desperately needs to be addressed,” he said. “The next pandemic is only around the corner. Victorians have a right to expect a proper level of resourcing for infrastructure that people rely upon when the shit hits the fan.”
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