Extensive public opposition to masks, vaccines, contact tracing, and travel restrictions arose partly because of inconsistencies in the developing science and the way that the science was communicated to the Australian public. Gaps in knowledge about the virus manifested in inconsistent and at times confusing messaging from the government, which generated significant suspicion of public health policy. In some cases, this suspicion manifested in non-compliance and undermined the government’s efforts to stop the spread of COVID-19

The inquiry is overdue but very welcome. It is led by three women with relevant expertise. It is not a royal commission which could be more adversarial which in this case isn’t appropriate. It will no doubt look back critically but also recognise Australia’s strengths – what we did well.

The inquiry will not scrutinise the measures that states and territory led. This is a major limitation because these are the elements that most affected peoples’ everyday lives, like lockdowns, policing, testing, hospitals and community engagement. That is a missed opportunity and begs the question, have the states and territories made their pandemic reviews publicly available?

Some observations that an inquiry would ideally cover:

We need a more unified response, consistency, collection of data, and coordinated communication. We need to keep our pandemic plans updated with regular exercises that rehears scenarios.

The federal government’s health emergency communication plan needs to be reviewed because particularly in the early phases of 2020, we were not hearing early enough from government about what could occur and how we should prepare. At that time, Australians needed better access to information and more frank and open communication. This got better but it was wanting at a crucial time, which increased public anxiety and escalated unhelpful stockpiling.

Vaccine rollout – there were early problems in vaccinating people in a smooth and timely way in aged care, disability care, including workers. This led to problems with uptake of vaccines early on. This improved when states and territories took on more of the vaccine rollout. They should’ve been running it from the beginning.

There were markedly higher COVID death rates for people born overseas. The government should be asking how it can do better and reducing these inequities. Where you are born should not determine how likely you are to die from COVID-19.

We did not enable health professionals like nurses to work within their scope of practice and independently vaccinate people. The under-use of some of our key expertise was a failure that should be corrected.

Key questions:

• How can our governance function in a way that is fit for purpose and coordinate better between federal and state/territory governments? How can the planned Centre for Disease Control contribute to this?
• How can we consult with communities in real time so we aren’t continually second guessing how a policy will affect them and how to mitigate some of its harms?
• How can communities, population health, primary care, and hospitals be better prepared next time?
• How should our risk communication improve for next time?
• How can we better rollout the vaccine so it’s done more equitably?
• How can government and industry better prepare together? Eg, The food industry had a pandemic preparedness working group that had been disbanded by the time the COVID-19 pandemic began.
• How can we better use the expertise we had without relying so much on consultancy firms?

The pandemic response required a rapid mobilization of healthcare providers. Optimizing our ability to utilize everyone available to their full potential was essential, however also put under the spotlight in some areas barriers to scope of practice and care provision. 

The COVID crisis showed us that we can overcome these to improve patient care, however we have quickly reverted to status quo in replacing divisions and barriers to scope of practice. Now is a great time to look at the lessons we can learn from workforce utilization during the pandemic.

Given the urgency of the situation, our response to the pandemic involved immediate actions that were not thoroughly evaluated for effectiveness, costs, and value for money. The Australian Government has invested a total of over $18 billion in Australia's vaccine and COVID-19 treatment supply as part of the COVID-19 Health response. As COVID-19 transitions into an endemic phase, the role of health economics in decision making will be increasingly required to evaluate the cost-effectiveness of various prevention, testing and management modalities of COVID-19, which will inform a more effective and efficient response to future pandemics. Importantly, long COVID (defined as >12 weeks) affects around 10% of COVID-19 cases in Australia. Long COVID has significant health and economic impacts on Australia and we need to find cost-effective ways to detect, treat, and control long COVID, infections and their long-haul consequences.

The announcement of a nationwide inquiry into Australia’s management of the COVID-19 pandemic response is promising, particularly if it considers the wide-ranging medical, social and economic impacts on the community in a fair and objective way. 

COVID-19 is an ongoing concern, and there are major lessons for governments and decision-makers about how protective measures were enacted and communicated to the public over the emergency period and subsequently. Examining the response means we can learn from past mistakes so that when the need arises a more transparent, coordinated and effective response can be mounted to future disease outbreaks.

We know that there were positives in the Australian public health response – but also many shortcomings. Communication from government was, for example, often opaque, inconsistent across jurisdictions, and lacking tailored information to help people act to protect themselves. We also know that there has been a failure to continue communicating with the public in recent years, despite mounting deaths from COVID-19, the risks of long-COVID and the implications for people who are at higher risk of severe disease or death due to COVID-19, who have been left behind. There is good evidence to show how this can be done better but to do so in future requires an honest appraisal of what worked well and what did not.

Those critical of technology responses to COVID-19 based on smartphones have noted that the technology alone does not act to prevent the coronavirus, and that the spread of the virus can only be potentially contained if there is a significant level of participation by members of society. It is also ineffective for those individuals who are asymptomatic and continue to roam without realizing they are carriers and are possibly transmitting the virus to others.

But some of the gravest challenges for these contact tracing apps remains the law, in particular, privacy protections, metadata laws, and laws pertaining to cloud servers with respect to intelligence gathering. While many privacy and security practitioners remained hopeful at the very beginning of the contact tracing journey, as time has passed, it is becoming apparent that the proposed solutions do not work without the relevant regulatory and sociotechnical structures in place.

A subset of these structures includes conducting field data testing for a variety of operational scenarios, which has not been completed to date; providing technical and design specifications that are accessible to a wide range of stakeholders; and offering open source code to the technical community in a timely fashion.

While several important legal and human rights arguments for and against the imposition of coercive and conditional mandates must be considered by the Inquiry, I believe that, on balance, and from a legal and bioethical perspective, the general orders of coercion were legally and morally justified as a late and last resort.

Having said that, the right to refuse medical treatment, freedom of thought, conscience, and opinion, and the right to bodily integrity are important precepts that deserve serious consideration in any inquiry into COVID-19 governance. And in many cases, alternatives to coercion are preferable.

In light of these considerations, the inquiry should pay particular attention to:

• the exercise of powers under public health legislation in each state, and what conditions are placed on that exercise.
• the process by which vaccines and other therapeutic goods (such as donations of hydroxychloroquine entered into the National stockpile) are selected for government investment.

the use of private consultancy firms to architect public health policy during emergencies and the problems associated with ‘business case’ analysis for vaccine investment.

The Australia Academy of Science welcomes the independent Inquiry into Australia’s response to the COVID-19 pandemic. 

The Academy has argued that an inquiry should be future-focused, and about preparing for the next pandemic and led by experts. The approach adopted by Government is consistent with this approach: learn from the past, and prepare for the future.

It is critical that it does. The world faces challenges of a type and at a scale not seen before. Climate change and deforestation, for example, will increase the risks of pandemics.

We need to work out how to prepare our nation, and our world, for what’s to come.

The Academy stands ready to play its part in that process, just as it did through the COVID-19 pandemic, via the Rapid Research Information Forum.

This innovative model provided the latest evidence to the Government to help drive the country’s response to the pandemic. 

Its strengths were its multi-disciplinary focus, independence, and ability to rapidly draw on Australia’s best and most relevant experts on any given policy matter.

This model must continue to be used in the long term to ensure that decision-makers are drawing on the best available evidence base at the time. That is the way we confront, and meet challenges.

And we can’t continue to deprioritise national funding in R&D, which is on a 14-year decline, and just expect to have the capability to do what we will need to do as the challenges to our health, prosperity and security grow.

I certainly welcome the announcement of the inquiry into Australia’s COVID-19 pandemic response. While I am of the opinion that overall Australia performed relatively well in terms of how the pandemic was handled, there were clearly elements of our response that were not ideal and this gives an opportunity for those to be reviewed in detail.

The findings can then hopefully inform how we not only continue to manage COVID-19 (appreciating that this is an ongoing issue) but also be better prepared for future infectious diseases threats, including from known pathogens such as influenza but also new and emerging pathogens that we will inevitably be faced with in the future. One of the issues I would particularly like to see explored relates to the inconsistency of advice between states and territories however I am concerned that this may be seen as out of scope.

It shouldn’t be a surprise that the PM announced a nationwide enquiry into Australia’s response to the COVID-19 pandemic. Perhaps the only surprising thing is that it has taken this long. The pandemic has been the biggest health challenge that we have faced both globally and in Australia. It is important that we learn every single lesson that we can to ensure that we are both prepared for the next pandemic and better equipped for dealing with future emerging infectious disease threats. Whilst many of the lessons appear to be clear, we need a national inquiry to identify all of the areas where we need to improve.

With the Australian Centres for Disease Control (ACDC) being established and finding its feet in the next few years, the findings from this review will be an important resource to help inform the priorities of this new body. It has already been flagged that one of the main initial priorities of the ACDC will ensure Australia is prepared for new pandemics, and one of the major challenges we faced in Australia during the pandemic was the coordination of our response between all of the stakeholders. This inquiry will be able to probe deeply into how we can improve this coordination and thereby guide the ACDC in this aspect of its role and so it is welcomed.

An inquiry into Australia’s response to the COVID-19 pandemic is welcome news. The challenges we witnessed during the pandemic went far beyond the medical and the economic; they included challenges related to the various values – and clashes of values – that were expressed through policy decisions and the public’s reactions to these decisions, e.g., the use of mandates and whether they breached people’s freedoms; the stigma faced by culturally and linguistically diverse populations; a sense of abandonment with the closing of borders to Australian citizens and residents; etc. As such, in addition to medical and economic experts, the inquiry should include experts in ethics, sociology, and law.

An inquiry examining the response to the COVID-19 pandemic during the period when restrictions were applied needs to be undertaken, but will be of mostly historical interest, at least until we are faced with a new pandemic disease.

The really important question is the failure of our system to deal in any way with COVID-19 as an endemic disease, currently killing around 10,000 Australians every year, and with largely unknown and unmeasured effects from 'long COVID'. Masks and vaccination requirements have been abandoned, even in high-risk environments such as hospitals. Furthermore, while we know that ventilation is crucial in reducing transmission, efforts in this direction have been virtually non-existent. Smaller risks such as potentially flammable cladding have seen a much more concerted and effective response.

As the pandemic continued into a second year, there was a lack of a data-centric and data sharing approach to informing and managing the direct impact of the pandemic and the subsequent social and economic fallout in individual states and across the country. There was limited transparency on data relating to infection trends, transmission pattern, virus associations, as well as the data and impact of decisions, evaluation of such decisions related to policies implemented at the state and federal level. Data-driven approaches could have informed operational and strategic decision making, for instance how much transmission could be suppressed through lockdowns, optimised vaccination strategies, and communities of care for high transmission areas.

Also, more effective data sharing would have enabled comparison of state strategies and federal strategies with strategies adopted in other OECD countries. An example here is the extreme but seemingly effective approaches adopted by the state of Florida. The design of a data-driven strategy for potential future pandemics or such natural disasters will ensure the policy responses are effective, robust and consistent across the country. Retrospectively, this can be applied to understand the contributing factors to anomalies such as the 11.3 million cases that were contracted during the Omicron wave in December 2021.

COVID-19 was a huge learning experience for the world in terms of pandemic preparedness and response. It is appropriate to now look back and see what we did well and where we could improve to equip us for future threats.

Any enquiry into the COVID-19 pandemic should consider some hard facts. Scientists had long warned of the possibility of a pandemic arising from zoonotic spillover, but no practical risk mitigation measures were prepared for that. The likelihood that an airborne pathogen would drive a pandemic has long been understood by scientists. These pathogens, usually viruses, are what transmit most rapidly. They are what mutate and evolve most effectively. And they are entirely too poorly characterised in the animals we live alongside and whose habitats we encroach upon. Investment in the science to better understand this is lacking.

Experts called to this enquiry must include those with a hands-on understanding of bioaerosols. It should investigate carefully why the message that SARS-CoV-2, the cause of COVID-19, was an airborne pathogen was never properly communicated. That failing undoubtedly resulted in harm to Australians. And this harm continues today because infection continues. Long COVID continues. Excess deaths continue. All because of a failure to communicate the need for high-quality, well-fitting N95-like respirators instead of baggy surgical masks. Where this failure originates from requires analysis. Was it because of terrible advice driven by some who utterly failed to understand the science behind aerosol transmission, preferring an old and incorrect mythology of droplets driving respiratory virus transmission? Whatever the reason, high-quality masks have never been modelled by the nation's leaders. There was never a public understanding that masks can reduce the dose of the virus we are each exposed to. Learning opportunities abounded during the pandemic, but they were not seized upon by those who could use them to keep Australians safe.

One of the learnings from this pandemic that we failed to take on board is one of large-scale risk reduction, achievable by the cleaning of air in shared indoor spaces. This approach takes the burden of risk reduction from the individual and it delivers better bang-for-buck, protecting many at once. This will even have added benefits for reducing illness and lost productivity for 200 other respiratory viruses. This should be explained and discussed.

In a broader sense, Australia failed to prepare for the pandemic through a lack of investment in the kind of education that explains related science to the public. Not just school children in the classroom but the harder-to-reach adult population. From the science behind how we test in the laboratory to the reasons for each of our responses to the pandemic and to help the community understand after the initial surge, why we were seeing more surges, why vaccinated people could be infected and how important viral evolution was to all of this. All around the work, equally scientifically unprepared populations have proven to be a fertile field for the sowing of misinformation and disinformation that has grown into an anti-science movement that has left us with future issues around all vaccines and expert advice.

The federal government’s announcement of a 12-month inquiry into how the pandemic was handled is timely. There are many things that the federal government did well, like the quick closure of international borders, the establishment of a national cabinet, and a joint committee of Chief Medical Officers.

However, there are also many things that the federal government did poorly – one of the worst being leaving most of the responsibility for responding to the pandemic to the states and territories. Poor choices by our governments included the use of hotels as quarantine accommodation, a questionable choice of vaccines, very poor messaging (that still continues), inconsistent border closures, and inconsistent data collection and definitions (that also still continues). There must be a hard look at lockdowns – were they necessary? How long should they have continued? Should we have shut schools down? Was the use of mandates for vaccination and mask-wearing necessary? And finally, how good was the government’s economic response to the pandemic?

It would be nice (but don’t get your hopes up) if this didn’t turn into a political bun fight. Certainly, there should be many lessons learned – one of which would be the need for Australia to become much more independent in the manufacture of vaccines, PPE etc. The role of the new Australian CDC also needs to be discussed. The best outcome will be an Australia better prepared for the future.

I am pleased to see that a nationwide inquiry into Australia's COVID-19 pandemic response has been announced. There will be a lot to learn that can help inform our response to future pandemics, and related health threats. 

While it is important that the inquiry will be led by health and medical experts, I am slightly disappointed that behavioural scientists were not mentioned. Human behaviour and behaviour change are key components of any pandemic response and we saw this firsthand during the COVID-19 pandemic. We had to change people’s behaviours to get them to test, isolate, wear a mask, physically distance, wash their hands, and get vaccinated. 

While some elements of the Australian pandemic response were good, such as closing the borders early and achieving high vaccination rates, there will be important lessons to learn regarding problems with the quarantine system, dealing with infections on cruise ships, better engagement with CALD communities, and improving how we promote health safe behaviours. 

I would strongly encourage the Australian Government to include experts from across the behavioural sciences such as social marketing, social psychology, behavioural economics, and human anthropology in the forthcoming inquiry. 

This will help us to make sure we develop a strong strategy for future health threats. 

From a healthcare perspective better planning will be needed - in the absence of vaccines, treatments were postponed. With vaccines, delays in screening still occurred as the backlog of treatments were provided. The inquiry will hopefully look at systems internationally and benchmark responses. More importantly, a focus on State-Federal integration may be necessary, and not just as separate entities. An assessment of fear of COVID-19 hysteria on mental health of the populations is warranted. Particularly for vulnerable groups who isolated and had impacts on them financially and socially.

The Inquiry should therefore go beyond the health-economy trade-off debate and ensure equity is a focus in future responses. The longer-term effects of COVID-19 are not just in physical health outcomes, but also the mental health effects, including long-term border closures, on the population. A complete benchmarking with other comparable economies can now be used to assess the best options for future pandemics. A complete evaluation of how government funds were distributed and their outcomes would be necessary, in terms of workforce impacted, to help inform efficient future planning.

The images we all saw of COVID-19 patients on respirators in ICU were a devastating illustration of our inability to control the body’s inflammatory response and prevent it going dangerously into overdrive.
Inflammation is the body’s natural response to viruses, bacteria and other invaders, but in its chronic form, it contributes to more than half of all deaths worldwide.

The understanding of inflammation is a massive gap in current medical knowledge and COVID-19 made that devastatingly obvious.

When the next pandemic hits, we need to have cost-effective drugs that can be administered easily, don’t cause severe side effects, and can be broadly used for any virus and on any age group. The only way this can occur is through increased, consistent, long-term investment in medical research – particularly in the field of inflammation.

Research from The University of Sydney’s Matilda Centre and Australia’s Mental Health Think Tank found that financial distress was one of the biggest drivers of mental ill-health during the pandemic period.

In April 2020 the Australian Government took action to stem the growing economic impacts of the pandemic by introducing the Coronavirus Supplement, which boosted income support payments (including JobSeeker, Youth Allowance, AusStudy and ABStudy) and pulled hundreds of thousands of Australians above the poverty line overnight. Qualitative research led by Dr Marlee Bower and quantitative research led by Dr Ferdi Botha both showed that this made a difference to the mental health of many Australians. Unfortunately, the supplement was quickly wound back, and by April 2021, income support payments were again well below the poverty line.

Australia’s Mental Health Think Tank released a Youth Mental Health Recovery Plan with a suite of recommendations to address the disproportionate impacts of the pandemic on young Australians, including a call to bring income supports back to levels achieved with the coronavirus supplement. The recommendations remain more relevant than ever as we’ve seen compounding crises following the pandemic, including natural disasters and cost-of-living crises.

I think it's a great idea and really important to improve preparedness and response capacities for future public health events. However, I think, it should not be conducted as an 'inquiry', rather it should be a structured 'review' of pandemic response, with a more positive and collective learning approach, involving all stakeholders.  For such reviews, the World Health Organisation (WHO) uses the term, 'after action review'. See detail here https://iris.who.int/bitstream/handle/10665/311537/WHO-WHE-CPI-2019.4-eng.pdf. 
 
In summary, an after action review is a 'qualitative review of actions taken in response to an emergency as a means of identifying best practices, gaps and lessons learned'. During this process, we use a structured approach to reflect on our experiences during acute public health events. The aim is to identify what worked and what did not, why, and how to improve. 

So, probably, we are going to do the same here, but we should go with a more positive and structured approach. Instead of 'inquiry' I would say 'to review pandemic response', instead of 'calling witness', I would say 'to arrange informal debriefing sessions with team members', and instead of 'examining the federal and state governments' response', I would say, 'to discuss with all relevant stakeholders involved in the COVID-19 response to find common ground on how to improve preparedness and response capability

The ongoing impact of COVID-19 as a leading cause of death and disability worldwide is a significant concern. In 2020, it became evident that a substantial portion of COVID-19 infections resulted in what was described as Post-COVID-19 Neurological Syndrome, affecting approximately one in four individuals, potentially impacting over 200 million people globally. 

Research into the disease has provided valuable insights into its mechanisms. It has been established that persistent maladapted immune system changes play a critical role in the post-COVID-19 phase. Additionally, there is growing evidence of energy system dysfunction at the cellular level, which contributes to the complexity of the condition.

Furthermore, clinical observations have highlighted the utility of simple bedside tests, such as assessing hand-eye coordination, in detecting and predicting which patients are more likely to develop post-COVID-19 Neurological Syndrome and post-COVID condition, both of which have significant neurological manifestations. These insights underscore the importance of early detection and intervention.

The urgent need for action is clear. Clinical trials are essential to develop effective treatments and interventions for those experiencing post-COVID-19 Neurological Syndrome and related conditions. Equally important is providing peer support and resources to affected individuals and their communities as they navigate the challenges of these conditions.

In conclusion, it is indeed time to take action. The global community must come together to support research, clinical trials, and initiatives aimed at better understanding, preventing, and treating the neurological consequences of COVID-19. By doing so, we can provide much-needed relief and hope to millions of people affected by these conditions.