Professor Brendan Murphy was a man with an appetite for health reform who got served a lot more than he bargained for after signing the dotted line and accepting the role as head of Australia’s health department.
There are countless quips and analogies you could choose to tell the story of Murphy’s time in the hot seat.
A reliable turn of phrase to capture the pressure and uncertainty of navigating the global pandemic is ‘building a plane while flying it’.
Those who prefer the dynamism of a maritime-themed story might relate the COVID-19 experience as one of the rougher parts of a voyage, when the sea was our enemy, and public servants had the task of keeping the ship afloat on an even keel while traversing a boundless sea.
Others might reach for the scorching drama of a blazing epic and characterise the pandemic period of the secretary’s responsibilities as a nearly two-year firestorm.
From the time Murphy commenced as secretary in what was then known as the Department of Health (later the Department of Health and Aged Care) — the first medical doctor to do so in more than 30 years – he surely anticipated some degree of crisis.
But he could have no sense of the intense and multifaceted challenges, both health-related and beyond — throttling his way once he stepped up as Australia’s Chief Medical Officer (CMO) to lead the department in February 2020.
“We were just living on this sort of pressure. I remember doing national cabinet papers at 2am for an 8am national cabinet meeting — it was an extraordinary sort of period,” Murphy told an audience in Canberra.
Government interventions made on the basis of public health advice fuelled much of the emotional and political intensity at the height of the pandemic in Australia.
Around the world, scenes of the toll of little-understood virus overwhelming systems and health workforces in places like New York, where 2% of the city’s population taken out in the first outbreak seemed to justify forceful decisions like restrictions on movement, border closures and quarantining.
The set up of makeshift morgues in one of the world’s most iconic cities was a scenario just as possible of playing out in somewhere like Sydney or Melbourne, Murphy said.
“We do need to remember that [our] measures really did save lives.
“There’s been a bit of narrative recently that we should have done what Sweden did, and not introduce public health and social restrictions in the early phases of the pandemic.
“But would the Australian community really have tolerated 30,000 COVID deaths in 2020, rather than 2000, which is what we would have had with a population adjustment for Sweden’s death rate?,” he asked.
And then there was the issue of access to vaccines and requirements to vaccinate.
“I think that most (but clearly, not all people) would say that on balance, Australia did pretty well compared to other similar high-income countries,” Murphy said.
“We are coming out of the pandemic, with a relatively low COVID death rate, and a reasonable economy.
“There will always be debate, and various interpretations of excess mortality and overall mortality data. But the mortality we had in Australia prior to the arrival of vaccines was exceptionally low.”
Whether he was at the controls of a metaphorical plane, steamship or fire truck, it can be said that for this steward, the weather has been torrential and turbulent.
However you want to describe it, leading the health response to Australia’s second pandemic in recorded history (the 1921 Spanish flu pandemic was the catalyst for the creation of the department), was no mean feat.
Murphy called time on his captaincy in April and has a handful of days left before retirement. He made his remarks in a valedictory speech for an IPAA ACT on Friday.
Fellow department heads joined the group to hear the retiring Health boss including PM&C secretary Glyn Davis, APS commissioner Gordon de Brouwer, Andrew Metcalfe, David Fredericks, Meghan Quinn, Alison Frame, Tony Cook and Katherine Jones.
Some retrospective views on Australia’s public health response during COVID
Given a commitment to conduct a “deep review” into Australia’s response to the COVID-19 pandemic made by the one-year-old federal Labor government, Murphy said he wanted to avoid preempting that work with his own detailed critique.
But there were some useful points about Australia’s experience worth noting, he said. This included the proportionality of the response taken by each state and territory, and reflections about what the new approaches the health department needed to adopt in the rapidly changing environment.
“There are people who believe we went too hard with public health and social measures. There’s also people who, even today, say we should be doing much more walking around with personal HEPA filters and wearing masks. The truth is, as always, is somewhere in the middle,” Murphy said.
“The inquiry will identify things we could have done better and things that we must do in the future to better prepare ourselves for the next pandemic. These insights will be particularly valuable as we established a new Centre for Disease Control to prepare us for the next pandemic,” he said.
Among the areas to improve, the secretary said the COVID inquiry was likely to consider how properly the national health systems and Australian Health Protection Principal Committee (AHPPC) coordination were prepared for the pandemic.
The secretary also noted national cohesion was not so strong in the latter stages of the national pandemic response, and this should be something the new Centre for Disease Control considers in its work.
“The commonwealth AHPPC worked very well and collaboratively, particularly in the early days, but data systems could have been better, and some states are clearly better prepared than others,” he said.
Murphy commended the government’s use of international border restrictions and support for supervised quarantine for returning travellers, which he said were crucial to limit major outbreaks in 2020 but existing purpose-built facilities.
Lockdowns — the most extreme public health and social measure to be wielded during the pandemic — were worthy of scrutiny and deep analysis, he said. For all the commentary already given to the subject he said these steps worked, especially in Victoria during 2020 to stop transmission in a way that many believed not possible.
But subsequent lockdown policies applied in other states were, in Murphy’s view, “a bit reactive” and potentially based on a lack of confidence in the public health response.
“Hotel quarantine was always imperfect, but mostly worked well when combined with high-quality outbreak response,” Murphy said.
“Internal borders restrictions for state borders — most agreed that they were necessary in 2020 in preventing people leaving Victoria during their big outbreak, but many of the other instances of state border closures are worthy of a review of their proportionality, and indeed, effectiveness,” he said.
Other issues that attracted heated debate during the pandemic and were worth reconsidering with the clarity of a retrospective analysis included the ‘aerosol transmission versus droplet spread debate’ which would have impacts on mask mandates and calls to retrofit public buildings to lift air standards.
Murphy said the inquiry would also be well served to consider how high-risk settings like aged care facilities were prepared for outbreaks, as well as the sense of closing schools for long periods based on the proportionate risk, and the material difference ordering vaccines earlier would have made it they were not guaranteed to be delivered sooner.
“I did once say at a press conference, when asked why we were slow in registering vaccines compared to other countries who were using emergency use provisions, that ‘it was not a race’, that we were doing registration properly, not trying to beat other countries to approve and release vaccines,” Murphy said.
“That comment in no way meant that we wouldn’t roll our vaccines as quickly as we safely could. But that was disappointingly taken out of context.”
Vaccination mandates, a controversial subject during a time of heightened fear and concern, and when the politicians were struggling to communicate with an anxious society about what needed to happen, and when, would also likely be the focus of the inquiry.
Murphy said that mandates made sense when early transmission in health and aged care settings could be prevented by a vaccinated workforce. But the later Omicron variant, which saw vaccines become less effective in preventing transmission, meant shots were “mainly for personal protection”.
“The proportionality and the persistence of some vaccine mandates for the general population is worthy of debate,” Murphy said.
“Many other issues for the inquiry to consider: access to the approval of antiviral agents, First Nations outbreak response, the impact and engagement with CALD communities and the disability community.”
Commenting on long COVID, Professor Murphy warned against extrapolating Australia’s epidemiology from that of other countries whose COVID experiences were materially different. The condition was a legitimate concern, he said, but its potential impact should not be catastrophised.
“[The inquiry should also consider] the great unknown – which is long COVID. Clearly, this is a real syndrome and people need to be believed and reassured that they will likely get better with the effluxion of time and potentially some rehabilitation activity,” he said.
The politicians are alright but “I certainly wouldn’t want their job”
Murphy has served to PMs as health secretary — Morrison and Anthony Albanese — and he reflected that his experience with both politicians and many others over a seven-year career in the public service was that most political masters were interested in the public good.
While party political processes and the rough and tumble of the popular views of the day could “derail this purity of purpose”, Murphy said he believed many lawmakers had altruistic motivations.
“There are many other politicians that I’ve worked with and talked to over the last seven years in many settings, including beloved parliamentary processes — some more entertaining than others, some very incisive interrogators,” he quipped with tongue in cheek.
“I do genuinely believe that from whatever part of the political spectrum they come from, the great majority are motivated to make a difference, according to their view of the world.”
Professor Murphy also made a point to defend Scott Morrison’s legacy, arguing that the former PM had received much “unfair post facto public commentary” about his leadership.
“I found him to be an effective and respectful leader at a time when such leadership was required. None of us are perfect — but I genuinely enjoyed working with him,” the secretary said of Morrison.
“I was particularly struck how in the early stages of the pandemic, he achieved a solidarity and national sense of purpose in national cabinet that hopefully will endure.”
Exercise, languages and creative pursuits
Professor Murphy’s tenure as health secretary ends this week, when he hands the baton to Blair Comley.
He was upbeat about his forthcoming retirement from the public service, hinting that his next professional iteration would not be a full-time role and that he looked forward to having more time to spend learning Italian and singing.
Responding to a question about how he maintained his equilibrium during the pandemic, Murphy said he avoided “too many red wines” to calm down and had invested in a bike to ride around Lake Burley Griffin. Exercise was important, but of course, the use of gym facilities was hindered when those facilities were also shut due to public health order.
During the height of the pandemic, the Victorian based himself in Canberra.
“I didn’t do anything specific — I just kept going,” Murphy said.
“I can’t underestimate the sense of purpose that we saw in the health department at that time. You’d go into the national incident centre at 2am and find 20 people there, on the phone and checking things up and chasing things — it really did energise the department,” he said.
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