How independent is Australia’s health advice? 

Australia has been receiving coronavirus advice straight from the horse’s mouth. Public information and updates have often been coming from doctors, researchers and infectious disease experts instead of politicians. 

Refreshing as this may be, the process is politicised. Unlike the Centre for Disease Control in the US, the Australian Health Protection Principal Committee (AHPPC) is not independent, but rather a part of the government.

Teams advising chief medical officer (CMO) Brendan Murphy and his deputies are made up of political appointments and public servants accountable to ministers. Is this a problem?

On Friday, Inq took a look at Murphy’s advisory committee. Today, we analyse how independent this process is. 

Is everyone beholden to ministers?

The AHPPC is comprised of chief health officers (CHO) from each state and territory, as well as other federal departments; four deputy chief medical officers; and five invited disease experts. Murphy chairs the committee.

Stephen Duckett, the Grattan Institute’s health program director, told Inq that ministerial accountability limits the independence of the process. “Committees are made up of public servants who are accountable to a minister, either directly or indirectly,” he said.

Bill Bowtell, former Labor adviser and adjunct professor at the Kirby Institute for Infection and Immunity, said while the role of CMO seemed sensible for normal times, a different approach was needed for COVID-19. 

“The CMO is not a position which is independent of the government, which employs and funds that position,” he told Inq. 

Murphy is also set to become the federal Health Department secretary — a political position not held by a doctor in over 30 years. This makes things even muddier.

“The AHPPC and their subcommittees are formed by people who are either directly employed by the government and responsible to ministers, and then a circle of academics who are nominated by the CMOs and the governments to be on that committee,” Bowtell said.

“It is not a transparent, open and independent committee.”

Within opposition ranks there are concerns the process is less than bipartisan — and that, despite regular meetings with the government, its advice and suggestions to the committee are often ignored by the government ministers.

Greens senator Richard Di Natale, a doctor and a public health specialist, told Inq that when it came to the COVID-19 response, more representation was needed. 

“The AHPPC exists as an instrument to provide advice to the government,” he said. “The opposition and crossbenchers need to be involved in the response.” He suggested multi-party representation on the national cabinet could be a solution. 

“In an environment where the government is taking extraordinary action, people need to know what advice is being provided and what factors are playing into deliberations.”

The initial refusal to release the COVID-19 modelling showed this isn’t happening, he said.

Who makes the laws?

After meeting, the AHPPC produces a report presented to the national cabinet which is then made public. With 25 people involved, everyone’s opinion is not always represented as strongly as they would like. But the committee strives for consensus in the report.

Allen Cheng, an infectious disease physician and invited committee expert, told Inq the draft report is often circulated multiple times before they settle on a final version.

James McCaw, another invited expert who is also a professor in mathematical biology and an infectious diseases epidemiologist, told Inq there were often different perspectives and opinions.

“At times we agree completely, and at times we don’t,” he said. While members can speak to the media, they cannot say who disagreed with what during committee meetings.

At the top of the decision-making process lies the national cabinet, made up of Morrison and all state and territory premiers and chief ministers. 

Advice can be ignored by the national cabinet. For example, the committee reportedly recommended against the use of anti-malarial drug hydroxychloroquine to treat coronavirus, while the federal Health Department told doctors they could prescribe it for patients.

The committee’s advice for all returning travellers to quarantine was also not enforced for Ruby Princess passengers. The AHPPC was equally confused about the government’s messaging around “essential services”. It had recommended a strong general statement be made by governments on the need to limit all unnecessary personal interactions. 

States can further muddy this consensus and advice, interpreting government policy differently when state premiers or CHOs write laws into the respective public health acts.

This led to a huge difference in fines and rules across the country. When it came to schools, states broke rank and went against advice from both the federal government and AHPPC for schools to continue operating normally.

Duckett told Crikey the amount of power states now had was concerning: “They come to a decision and implement it themselves…”.

What about the invited experts? 

Five invited experts sit on the AHPPC: Cheng, McCaw, Jodie McVernon, Lyn Gilbert and Martyn Kirk. 

Andrea Carson, an associate professor in media and politics at La Trobe University told Inq that COVID-19 presents a range of issues for Australia’s liberal democracy. This includes streamlining political processes, limiting parliamentary sittings, and not having adequate representation of the opposition. “Getting advice from experts is not one of those challenges,” she said. 

In fact, she said, the new process increases the public’s trust in government.

“If there’s one positive thing coming out of this, it’s that politicians are prioritising expert opinion and taking their cues from them,” she said. 

Invited experts on the AHPPC aren’t there representing their universities, though their institutions do receive government grants to research COVID-19.

The Doherty Institute, for example, is commissioned to conduct reports by the government. McVernon and McCaw work on a range of projects through the institute.

Gilbert is working on a project analysing COVID-19 infection prevention and control, while Cheng is examining expanding ICU surveillance for COVID-19. Both projects are funded by organisations which received funding from the government’s National Health and Medical Research Council (NHMRC). 

McCaw said he had been invited to the AHPPC as an independent expert and academic member. “As an external member, I am providing one form of advice to the committee, and that committee provides advice to the national cabinet which is public.”

He stressed it was the national cabinet — not the experts of AHPPC — who “make the final decisions”.  

Morrison has suggested the national cabinet become a permanent fixture of Australia’s democracy. It’s a strange suggestion given a similar board, Council of Australian Governments (COAG), already exists.

Next: Inq takes a look at the national cabinet’s strict rules and why making it a permanent addition is a bad idea.