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April 14, 2020
State Health Policy Leadership COVID-19
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If there was ever a time for governments around the world to learn from one another, this is it. But which countries should the United States look to for guidance on “flattening the curve” of the COVID-19 pandemic?
The United States doesn’t often compare itself to Australia, but they are alike in some ways. Both countries are about the same size geographically, although Australia’s total population is only about 25 million, a fraction of the United States’ 327 million. They are also both federations, in which the powers of government are divided between the federal, or national government, and smaller, sub-national governments such as state, territory, or county governments. In both the United States and Australia, responsibilities for health are also shared across governments, making cooperation between them necessary to achieve many health goals.
To stop the spread of COVID-19, federal, state, and local governments must work together to facilitate access to treatment and minimize the social and economic impact. That means that leaders have to make life-and-death decisions in collaboration with other elected officials. These decision-makers are often from opposing parties, have different political, social and economic priorities, have constituents with different health needs, and health systems with different capacities. Decision-making in a pandemic is tough, but in federations like the US and Australia, it is even tougher because of these differences. Yet, success will only come through coordinated, whole-government, whole-nation action.
In light of this, there is good reason for the United States to look closely at one aspect of Australia’s COVID-19 response: Australia has recently established a national cabinet to coordinate and deliver a consistent response to COVID-19. The Australian Prime Minister and all state and territory leaders (the equivalent of governors) agreed that the “wartime” cabinet would meet regularly (sometimes daily) via secure video-conferencing to make decisions about health, education, public safety, social services, and infrastructure. Its members are all elected officials responsible to their own parliaments and constituents (the nation’s Chief Medical Officer also participates in meetings). Members come from both major parties but have agreed to work together as a united team to protect the lives of Australians.
The national cabinet shares data and information about the spread of COIVD-19 and agrees on policy, such as testing criteria, limits on indoor and outdoor gatherings, visitor restrictions to aged care facilities, suspension of elective surgeries, mandatory quarantine for international travelers and self-quarantine obligations for people with COVID-19, and the conditions under which any state can adopt additional measures. To date, most decisions of this kind in the US are being made at the state, or even worse, the local level. There is little point having strict social isolation and travel restrictions in force in one county or state when people from a neighboring one are free to move about, spreading the disease.
Australia’s national cabinet has created a forum for governments to discuss critical issues and resolve them quickly, collaboratively and, for the most part, consistently. There is still some scope for local level variation—closing state borders or schools, for example—but the onus is on leaders to demonstrate to the increasingly nervous public why exceptions might need to be made in one part of the country.
As of April 3, 2020, 23 Australians had died from COVID-19 and 5,224 people had tested positive. The vast majority of these people were travelers returning from overseas—from the Americas, Europe or from cruise ships. More than 270,000 people had been tested for COVD-19, giving Australia one of the highest per-capita test rates in the world. Australia’s high test rate is helping reduce community transmission as people who test positive are required to self-isolate.
While it is too soon to declare victory, there is evidence that the growth rate in new infections has been slowing in recent days. This is partly because travel restrictions have reduced the influx of infected people, but also because rates of community transmission are slowing.
Some Americans might be tempted to dismiss the idea of a national decision-making body as infeasible in the US. They will, correctly, point out that Australia has only eight states and territories, whereas the US has 50 states and 14 territories. Other skeptics may point out that states’ rights and individual freedoms are highly prized and deeply entrenched in American culture.
These types of responses are commonly used to explain why the US cannot introduce reforms that clearly benefit the entire nation: universal health care, for example. But if there is one lesson so far from the world’s response to COVID-19, it’s that the impossible has suddenly become possible. Long-standing regulatory and bureaucratic barriers to expanding telehealth, for example, have suddenly fallen away. New hospitals and clinics are rising from seemingly nowhere in record time. Gin distillers have suddenly discovered their capability for producing hand sanitizer. And the US Senate agreed, 96–0, on a $2 trillion stimulus package to help the country through the COVID-19 crisis. None of these events would have been considered possible just a few short weeks ago.
The United States, like all nations, faces extraordinary challenges in the coming weeks and months. Nobody knows how hard it will be hit or when it will recover. We do know that its best chance for recovery is by reviving the spirit of cooperation: within and across its own federal, state, and local governments.
Dr. Anne-marie Boxall is an adjunct associate professor at The University of Sydney and a 2019–20 Australian Harkness Fellow
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