Opinion: systematically capturing what the pandemic can teach us will support long-term health system change

By and

Thursday September 3, 2020

Adobe

These are difficult times to be in government, faced with managing a pandemic guaranteed to cause extraordinary disruption to the social and economic fabric of Australia.

Governments have had to act with incomplete information and rapidly evolving science. There is no certainty about the right way to proceed; the community has been anxious and opinion divided about all potential options.

Yet, and in contrast to some other countries, Australian governments have sought and relied on the advice of scientific advisers in an unprecedented way. Somewhat against usual practice, Australian governments have been frank with the community about what is known and where gaps and uncertainties exist. This is welcome, and opens up real opportunities for our future approach to policymaking. We must not waste them.

Why has government listened to expert advice on this occasion? In part, because a rapid response was needed and Australia already had in place strong disease surveillance systems. We have a network of highly skilled public health experts within government and the capacity to provide a sophisticated appraisal of evidence to identify the most important practical actions.

Our response to COVID-19 has also challenged the caricature of failed relationships between the scientific community and government, who have worked closely together to solve the problems thrown up by COVID-19, from genes and vaccines to mental health impacts.

The prime minister has said that Australia will experience challenging times for years to come. We will need to use limited health resources effectively and as never before, our decision-making in health must be guided by the best available evidence, understood within the Australian context.

Four keys to evidence-driven health policy

How can we use this moment to make systemic changes that will strengthen our capacity to use evidence to guide health policy into the future? We suggest four early wins:

First, our success in managing the crisis has shown the value of investing in centres of expertise that can work closely with both policy and service delivery agencies. A prime example is governments’ long-term funding of the National Centre for Immunisation Research and Surveillance; this centre has outstanding research capacity coupled with strong partnerships with government. This investment enabled a rapid investigation of COVID infection in school children to inform decisions about returning to school. While short-term project funding is important, COVID has demonstrated the critical importance of partnerships between scientists and government.

Second, effective decision-making requires the synthesis of rapidly changing, complex and sometimes apparently contradictory information. Too often, policy makers are presented with the outcomes of a single study, when what they really need is an integrated picture of what is known, presented in a way that can immediately inform policy.

Over the past few months, sophisticated modelling has been used to provide rapid syntheses of evidence not just about the epidemiology of the virus but also its likely impact on, for example, ICU capacity or the potential contribution of preventive measures such as the tracking app. In the area of mental health, a team from the University of Sydney led by Professor Ian Hickie has modelled the effects of the economic fallout of the pandemic on suicide rates, finding that deaths could spike by up to 1500 per year if we don’t act to flatten the “mental health curve”. Investment in methods to enable rapid synthesis would enable Australia to better use evidence in health decisions over the coming years.

Third, the pandemic has driven rapid change in the health care system, fast-tracking some reforms that otherwise may have taken many years. One example is the widespread uptake of telemedicine: telehealth items introduced for the pandemic have been provided to more than three million Australians over the past few months. It will be vitally important to understand the impact of these rapid changes, such as the cost-benefits, unintentional downsides and who it worked for and why. The earlier we begin to assess these rapid innovations the better the information we will produce.

Fourth, the pandemic will exacerbate the difficulties faced by the most vulnerable in Australian society. We know that there will be significant mental health issues emerging from social isolation and economic downturn. These will compound the disadvantages of vulnerable Australians, particularly those who are poor at looking after their own health. We need to direct some of our research effort to improve understanding of how crises like the pandemic affect vulnerable Australians and, more importantly, identify what works to offset the disadvantage.

Supporting long-term change

Australia has a unique opportunity to build on what we have learned about using evidence during the pandemic. The past two decades have seen growing expertise in how governments can find the scientific evidence they need for good decision-making. We need to nurture this expertise and properly resource it, to ensure that governments are presented with the best available information at the time it is needed, and in a form that can be easily translated into action. Our plea is that we don’t waste this opportunity to capture systematically what can be learned to support long-term health system change.

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