Briefings to the Incoming Government: Why we need an Aotearoa Centre for Disease Control (CDC)

The Covid-19 pandemic has had an enormous impact on health and the economy in Aotearoa NZ (NZ) and globally. Future pandemics are inevitable with multiple drivers of pathogen spillover from animals to humans—which is recognised as having been the main cause of emerging infectious diseases with pandemic potential. We also live with the threat of future pandemics that could be far worse than Covid-19.4 And these risks seem likely to increase with bioweapon development from advances in biotechnology and artificial intelligence, and further deterioration of the global geopolitical environment.

NZ and the world in general are still far from adequately prepared to face such threats. The organisation of national infectious disease science capacity will no doubt be considered by the NZ Covid-19 Royal Commission which is due to report later in 2024. But at present NZ is an outlier in not having a dedicated national Centre for Disease Control (CDC). This omission contributed to NZ’s relatively low pandemic preparedness rankings prior to 2020 and presented additional challenges when NZ needed to coordinate an effective and complex emergency response at the onset of the Covid-19 pandemic. Although NZ’s response was broadly effective, it was not perfect. There were infrastructure and workforce issues, inequitable outcomes, and some costly failures.

In this Briefing, we make the case for NZ to establish a national CDC with an initial focus on infectious diseases. ‘CDC’ is a working title only.

In the decades leading up to the Covid-19 pandemic, many territories were strengthening their national infectious disease science capacity. A notable example was Taiwan which formed its CDC in 1990. This capacity proved valuable in their subsequent management of SARS and later Covid-19. Taiwan arguably had the most proactive Covid-19 response of any jurisdiction and launched the earliest pandemic response outside mainland China.

Many countries have also been strengthening their public health workforce training for decades, but NZ is notably absent from the list of those with field epidemiology training programmes. These programmes ensure a capable workforce of epidemiologists ready to spring into action to track and limit the spread of emerging infectious diseases.

In the wake of the Covid-19 pandemic, most countries are reviewing their core public health science infrastructure. Australia is working to establish a national CDC to improve its response to public health emergencies. It is also merging major communicable disease research centres in Melbourne (including the Doherty Institute for Infection and Immunity and the Burnet Institute) to form the Australian Institute for Infectious Diseases.

There are several NZ initiatives and proposals that could contribute to the proposed Centre. MBIE is leading Te Ara Paerangi – Future Pathways – a multi-year programme to build a future-focused research, science, and innovation system. A new infectious disease platform Te Niwha (hosted by ESR and the University of Otago) is now operating to support greater research capacity in this area. And in the 2023 budget, Government proposed establishing a Pandemic Response Centre (as part of the proposed Wellington Science City) to build better linkages between Crown Research Institutes and Universities.

The essential feature of an Aotearoa CDC is that it would have responsibility for an integrated set of critical public health goals and functions.

With this Centre, the whole is very much greater than the sum of the parts. It will integrate and coordinate multi-disciplinary functions such as surveillance, laboratory services, outbreak investigation, and the expertise to guide responses to improve control and prevention.

This Centre can also be seen as an infrastructure project. Achieving the necessary capacity will require consistent, long-term investment in core systems, services, and workforce. This capacity building goes well beyond simply funding short- and medium-term projects and research.

We have added the description ‘distributed’ to emphasise the benefits of building into this model an explicit focus on supporting defined nodes across the country which would be responsible for specific functions, best managed in certain settings. Obvious examples would be clinically focussed areas such as infection control, and developing prevention and control guidelines for particular categories of infections. This model also recognises that some areas of infectious disease research have well established organisational support already, such as the Food Safety Science and Research Centre and Immunisation Advisory Centre.

The Centre would have a regional and global perspective, which is critical given the worldwide distribution of pandemics and other major threats. It would be well-positioned to support regional health and development goals in the Pacific. There would be mutual value in the Centre working closely with the Australian CDC and other international organisations.

There are multiple societal benefits of having an Aotearoa CDC including:

• Better preparedness and response to pandemic threats
• Improved prevention and management of ongoing (endemic) infections
• Improved health equity
• Improved efficiencies from more coordinated services and disease prevention
• Greater progress in science and innovation
• Improved long-term reliability of response capacity and trusted science advice

An Aotearoa CDC will ensure NZ is better prepared for and able to respond to pandemic threats. It would also improve prevention and management of ongoing (endemic) infectious diseases. The potential benefits are large, long-term gains in population health, equity, and economic efficiency.