Chapter 1Introduction and context
Introduction
1.1On 19 October 2023, the Senate referred the following matter to the Legal and Constitutional Affairs References Committee (the committee) for inquiry and report by 31 March 2024:
The appropriate terms of reference for a COVID-19 Royal Commission that would allow all affected stakeholders to be heard.
1.2On 26 March 2024, the Senate extended the reporting date to 19 April 2024.
1.3There was widespread support for the establishment of a COVID-19 royal commission. Of the 559 submissions received by the committee, only three did not support the establishment of a COVID-19 royal commission.
1.4There was significant interest in the committee’s inquiry, which is indicative of the need for a royal commission into the Australian COVID-19 pandemic experience. The people of Australia deserve an opportunity to learn from the experiences of the COVID-19 pandemic and the response to it. A royal commission would have the powers and resources to properly allow the voices of those affected to be heard, and make recommendations to government in the interests of the Australian people.
Conduct of the inquiry and acknowledgement
1.5In accordance with its usual practice, the committee advertised the inquiry on its website and wrote to numerous individuals and organisations, inviting submissions by 12 January 2024.
1.6The committee received 559 submissions, which are listed at Appendix 1. The committee held public hearings in Canberra on 1 February 2024 and 13March2024. A list of witnesses who appeared before the committee at the hearings is at Appendix2.
1.7The committee thanks all those who made submissions and gave evidence at the public hearings.
Structure of the report
1.8There are three chapters in this report:
Chapter 1 provides background information and context to the inquiry;
Chapter 2 details the perspectives of stakeholders who engaged in the inquiry; and
Chapter 3 articulates the suggested terms of reference for a COVID-19 royal commission and puts forward the committee’s views.
Background and context
The Commonwealth government response to the COVID-19 pandemic
1.9In December 2019, health authorities began investigating a viral pneumonia outbreak in Wuhan, China.
1.10On 9 January 2020, Chinese authorities reported that a novel coronavirus (2019‑nCoV) was the cause of that outbreak. The World Health Organization (WHO) advised that international travellers should be provided with public health information to reduce their risk of contracting acute respiratory infections. It advised 'against the application of any travel or trade restrictions on China based on the information currently available on this event'.
1.11On 19 January 2020, the then Australian Government Chief Medical Officer (CMO), Professor Brendan Murphy, reported that the Department of Health and Aged Care was aware of 2019-nCoV cases in Wuhan and was 'watching developments very closely'. As part of the monitoring regime, Australian legislation required airlines to 'report passengers on board showing signs of an infectious disease, including fever, sweats or chills'. Biosecurity officers would assess ill travellers and 'take necessary actions, such as isolation and referral to hospital where required'.
1.12The CMO advised that the WHO did not 'recommend any travel advisory for China, or additional measures at airports beyond our established mechanisms'.
1.13On 21 January 2020, the CMO declared 2019-nCoV a disease of 'pandemic potential'. That declaration listed 2019-nCoV as a Listed Human Disease under the Biosecurity Act 2015 (Biosecurity Act)and led to:
…the standing up of the national incident centre, the standing up of the National Medical Stockpile, the readiness and activation of the national trauma centre, daily meetings of the Australian Health Protection Principal Committee and meetings of state, territory and Commonwealth health ministers to discuss pandemic readiness.
1.14The CMO reported that following consultation with other Commonwealth agencies and the states and territories, additional border measures would be introduced, 'particularly in relation to the three weekly direct flights from Wuhan to Sydney'.
1.15The then Prime Minister, the Hon Scott Morrison MP, stated that the government was 'taking advice from the [WHO]' in relation to its response to 2019-nCoV. The Prime Minister outlined the enhanced biosecurity measures that were implemented for the direct flights from Wuhan to Sydney and explained:
The Department of Health does not currently recommend mass screening of passengers at airports, including thermal scanning, due to the limited evidence of effectiveness of those measures…There are over 10 million protective masks in the national medicine stockpile and there have been no confirmed cases, I'm advised, of the virus in Australia. So the Government has moved quickly. The Department of Health, the [CMO] working [sic] closely with states and territories to ensure the necessary precautions are being put in place.
1.16The CMO advised Australia was 'extremely well prepared' to respond to cases of 2019-nCoV. There were isolation facilities available in every state and territory and ‘clearly established protocols to get people to those facilities’. The CMO reiterated health officers were meeting frequently and sharing information on how to respond to the health situation. He emphasised health authorities ‘are well-prepared and are keeping a very close eye on this’.
1.17On 22 and 23 January 2023, the Director-General of the WHO, Dr Tedros Adhanom Ghebreyesus, convened the Emergency Committee (the EC) regarding the outbreak of 2019‑nCoV. The primary role of the EC was to provide advice to the Director‑General, who decides when a situation becomes a Public Health Emergency of International Concern (PHEIC).
1.18The EC considered three criteria in deciding whether to recommend that the Director-General declare a PHEIC. Those criteria related to whether 2019-nCoV constituted:
(1)an extraordinary event;
(2)a public health risk to other States through the international spread; and
(3)potentially requires a coordinated international response.
1.19At its first meeting, the EC advised that the outbreak of 2019‑nCoV ‘did not constitute a PHEIC’. The committee decided to reconvene ‘in a matter of days to examine the situation further’.
1.20At a further meeting on 23 January 2023, the EC received evidence that human‑to‑human transmission of 2019-nCoV was occurring. The EC determined that as 2019-nCoV was expected to spread to other countries:
…all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.
1.21On 25 January 2020, Australia declared its first case of COVID-19. On that day, the then Minister for Health, the Hon Greg Hunt MP, convened a meeting with his state and territory counterparts 'to coordinate the ongoing national action and response'.
1.22On 29 January 2020, the Australian Government announced that it would assist Australian citizens in Wuhan and Hubei Province depart China. A condition of that assisted departure included quarantining on Christmas Island for 14 days in accordance with medical advice.
1.23Minister Hunt stated that the quarantine requirement:
…makes Australia one of the most forward leading and one of the most cautious countries in the world. We make no apology for that.
Our job is to save lives and protect lives. Our job is to make sure that above all else we are protecting the lives of Australian citizens.
And with these decisions we have become one of the world's most cautious and conservative countries with the decisions we've taken but it's been done on the basis of the medical advice.
1.24The Prime Minister stated that his:
…first priority right now is the safety of Australians, the safety of Australians here in Australia to ensure that we are doing everything consistent with the advice and acting with an abundance of caution to protect their wellbeing, but also for those Australians who have found themselves isolated and vulnerable as a result of this crisis that we’re also extending some support to them.
1.25On 30 January 2020, the EC 'agreed that the [2019-nCoV] outbreak now meets the criteria for a [PHEIC]'. On the same day, the Director-General of the WHO declared the outbreak of 2019-nCoV constituted a PHEIC.
1.26The WHO declared 2019-nCoV a PHEIC due to concerns for 'the potential for the virus to spread to countries with weaker health systems, and which are ill‑prepared to deal with it'.
1.27The Director-General of the WHO summarised the recommendations of the EC:
First, there is no reason for measures that unnecessarily interfere with international travel and trade. WHO doesn't recommend limiting trade and movement.
We call on all countries to implement decisions that are evidence-based and consistent. WHO stands ready to provide advice to any country that is considering which measures to take.
Second, we must support countries with weaker health systems.
Third, accelerate the development of vaccines, therapeutics and diagnostics.
Fourth, combat the spread of rumours and misinformation.
Fifth, review preparedness plans, identify gaps and evaluate the resources needed to identify, isolate and care for cases, and prevent transmission.
Sixth, share data, knowledge and experience with WHO and the world.
And seventh, the only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation. We are all in this together, and we can only stop it together.
1.28On 31 January 2020, Minister Hunt provided an update on the situation and explained that Australia was taking action to address the health emergency:
Australia is very well prepared and has already implemented measures recommended by the WHO to help stop the spread of the virus and protect Australians.
We continue to take a highly precautionary approach based on the latest and best medical advice.
1.29On 18 February 2020, the Commonwealth government released the Australian Health Sector Emergency Response Plan for Novel Coronavirus. That plan was ‘considered a living document that will be periodically updated’ as more became known about the virus. The government planned to undertake ‘activities to’:
monitor and investigate outbreaks as they occur;
identify and characterise the nature of the virus and the clinical severity of the disease;
research respiratory disease-specific management strategies;
respond promptly and effectively to minimise the novel coronavirus outbreak impact;
undertake strategies to minimise the risk of further disease transmission; and
contribute to the rapid and confident recovery of individuals, communities and services.
1.30On 27 February 2020, the Prime Minister announced the implementation of the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID‑19).
1.31In announcing the implementation of that plan, Mr Morrison explained that the government was acting with 'an abundance of caution' to ensure Australia got ahead of a potential emerging pandemic. While the WHO had not declared the coronavirus a pandemic, there was a strong likelihood of it doing so and Australia needed to be prepared. The Prime Minister indicated:
…the risk of a global pandemic is very much upon us and as a result, as a government, we need to take the steps necessary to prepare for such a pandemic.
1.32He argued Australia was in a better position than other countries and that it needed to take action to remain ahead of the situation:
…because Australia has acted quickly, Australia has got ahead of this at this point in time. But to stay ahead of it, we need to now elevate our response to this next phase. I said the other day, this is a health crisis, not a financial crisis. But it is a health crisis with very significant economic implications.
1.33On 2 March 2020, the Health Minister announced the first case of community transmission of COVID-19 in Australia.
1.34On 5 March 2020, the National Coordination Mechanism (NCM) was activated. The NCM was designed to:
…coordinate activities across the Commonwealth, state and territory governments as well as industry to ensure a consistent national approach is taken to provide essential services across a range of critical sectors and supply chains.
1.35On 11 March 2020, the WHO declared COVID-19 a pandemic.
1.36On 13 March 2020, the Council of Australian Governments (COAG) discussed the Commonwealth, state and territory responses to COVID-19. The communiqué from that meeting reported:
Australia is experiencing the impacts of coronavirus, but we are one of the best-prepared countries in the world, thanks to the early actions of all levels of government. Since January 2020, Australian governments have been working together to develop, implement and coordinate strategies to slow the spread of the virus, including through strengthening our world leading health system and implementing border measures. Today, leaders committed to leveraging their combined resources to slow the spread of the virus and ensure Australia stays ahead of the curve in minimising the impact of coronavirus on the Australian community and economy.
1.37At that meeting, COAG agreed to the National Partnership on COVID-19 Response. That agreement sought to ensure that the Commonwealth, state, and territory governments cooperated to ensure the health system could ‘respond effectively to the outbreak of [COVID-19]’.
1.38COAG also agreed to the establishment of a new National Cabinet comprising the Prime Minister, Premiers and Chief Ministers. The ‘National Cabinet is underpinned by a commitment to genuine partnership between the Commonwealth and States and Territories on issues of national significance’.
1.39The Australian Constitution does not grant the Commonwealth government ‘a broad emergency power’. Instead, the Commonwealth government relies ‘upon specific powers under specific laws that could be invoked in response to specific emergency situations’. The Biosecurity Act contains powers to declare a ‘human biosecurity emergency’.
1.40On 15 March 2020, after the first meeting of National Cabinet, the Prime Minister stated:
…while many people will contract this virus…just as people get the flu each year, it is a more severe condition than the flu, but for the vast majority…around 8 in 10 is our advice, it will be a mild illness and it will pass. However, for older Australians and those that are more vulnerable, particularly those in remote communities and those with pre-existing health conditions, it is a far more serious virus, and that is our concern. Our aim in all of this is to protect the most vulnerable. The most at risk.
1.41On 18 March 2020, following the advice of the Federal Executive Council, the Governor-General declared that COVID-19 was a human biosecurity emergency. That declaration stated COVID-19:
…is an infectious disease:
(a)that has entered Australian territory;
(b)that is fatal in some cases;
(c)that there was no vaccine against, or antiviral treatment for, immediately before the commencement of this instrument; and
(d)that is posing a severe and immediate threat to human health on a nationally significant scale.
1.42Throughout March 2020, all Australian state and territory governments except New South Wales declared states of emergency in response to the COVID-19 pandemic. During that month, National Cabinet agreed to:
impose quarantine restrictions on all international arrivals;
introduce social distancing measures;
put restrictions on social gatherings;
close the border to all non-citizens and non-residents;
ban Australians from travelling overseas; and
suspend non-urgent elective surgery.
1.43On 19 August 2020, the Commonwealth government announced it had entered an agreement with AstraZeneca for the procurement of COVID-19 vaccines. The agreement ensured Australians would ‘be among the first in the world to receive a COVID-19 vaccine’ provided the vaccine passed clinical trials.
1.44On 5 November 2020, the Commonwealth government secured another 50million doses of COVID-19 vaccines from Novavax and Pfizer/BioNTech. The Prime Minister explained ‘[b]y securing multiple COVID-19 vaccines we are giving Australians the best shot at early access to a vaccine, should trials prove successful’.
1.45On 13 November 2020, the Commonwealth government published the Australian COVID‑19 Vaccination Policy. That policy contained the following ‘key principles and assumptions for the vaccination program’:
Free of charge for all Australian citizens, permanent residents, and most visa-holders;
Not mandatory, but strongly encouraged;
To be rolled out on the basis of identified priority populations, linked to delivery schedules, with scope for redirections to outbreak response;
Centralised Commonwealth oversight, with defined responsibilities for the Australian and State and Territory governments.
1.46On 25 January 2021, the Pfizer/BioNTech COVID-19 vaccine was provisionally approved for use in Australia by the Therapeutic Goods Administration (TGA). On 15 February 2021, the first doses of that vaccine arrived in Australia. A day later, the AstraZeneca COVID-19 was provisionally approved for use in Australia by the TGA.
1.47On 21 February 2021, the COVID-19 vaccination program was launched with the first vaccines being administered in NSW.
1.48On 8 April 2021, the Australian Technical Advisory Group on Immunisation (ATAGI) advised there was a ‘rare but serious side effect’ related to the AstraZeneca vaccine. ATAGI maintained ‘that the AstraZeneca COVID-19 vaccine is highly effective in preventing severe disease caused by COVID-19’. ATAGI advised ‘that the risk of blood clotting side effects from the Astra Zeneca vaccine is four to six in one million people, in the first four to 20 days post the vaccine’. Based on that advice, the Commonwealth government recommended that AstraZeneca be administered to people over the age of 50 and those under 50 should be given the Pfizer/BioNTech vaccine.
1.49On 28 June 2021, National Cabinet agreed ‘to mandate that at least the first dose of COVID-19 vaccine be administered by mid-September 2021 for all residential aged care workforce’. That decision was ‘consistent with the approach taken for mandating influenza vaccinations for aged care workers’.
1.50On 6 August 2021, National Cabinet received advice from the Solicitor-General in relation to mandatory workplace vaccinations. National Cabinet agreed employers ‘have a legal obligation to keep their workplaces safe and to eliminate or minimise so far as ‘reasonably practicable’ the risk of exposure to COVID‑19’. That means:
In general, in the absence of a State or Territory public health order or a requirement in an employment contract or industrial instrument, an employer can only mandate that an employee be vaccinated through a lawful and reasonable direction.
Decisions to require COVID-19 vaccinations for employees will be a matter for individual business, taking into account their particular circumstances and their obligations under safety, anti-discrimination and privacy laws.
1.51On 9 August 2021, the Moderna COVID-19 vaccine was provisionally approved for use in Australia by the TGA.
1.52On 17 April 2022, the emergency measures made under the Biosecurity Act ended.
1.53On 4 May 2023, the WHO EC met for the fifteenth time. At that meeting it ' highlighted the decreasing trend in COVID-19 deaths, the decline in COVID-19 related hospitalizations and intensive care unit admissions, and the high levels of population immunity to SARS-CoV-2'.
1.54Members of the EC acknowledged that while there continued to be 'uncertainties…[about the] potential evolution of SARS-CoV-2, they advised that it is time to transition to long-term management of the COVID-19 pandemic'.
1.55On 5 May 2023, the Director-General of the WHO ‘determine[d] that COVID-19 is now an established and ongoing health issue which no longer constitutes a [PHEIC]’.
1.56On 20 October 2023, the CMO, Professor Paul Kelly, declared ‘COVID-19 is no longer a Communicable Disease Incident of National Significance’. The Australian Health Protection Principal Committee (AHPPC) supported that declaration and stated:
We can expect continuing waves of infection across the next few years, but at this stage current and emerging variants pose similar risks to other circulating Omicron strains. Continued uptake of protective behaviours such as vaccination and other mitigation strategies are now more appropriate than an emergency response.
1.57Reflecting upon the Commonwealth government’s response to the COVID-19 pandemic, Mr Morrison stated:
Australia would emerge with one of the lowest fatality rates from COVID in the developed world. When compared to the average fatality rates of OECD countries, Australia’s response saved more than 30,000 lives.
1.58The response to the COVID-19 pandemic was designed to protect the health of Australians and support the national economy:
This was achieved with Australia emerging with one of the strongest economies through COVID. Our historic economic response kept 700,000 businesses in business, it kept more than a million Australians in work and, despite these unpredicted outlays, Australia was one of just nine countries to retain a AAA credit rating.
1.59The former Prime Minister argued the economic response was well designed and implemented:
Our response was timely, it was targeted and it was temporary. We responsibly retired measures as soon as it was prudent to do so, leading to a historic reduction in the actual budget deficit, with the budget even moving into structural surplus during COVID.
State and territory government responses to the COVID-19 pandemic
1.60National Cabinet endorsed a range of measures in response to the COVID-19 pandemic. Those measures included:
quarantining all international arrivals for a period of 14 days;
a ban on cruise ships arriving in Australia from foreign ports; and
restrictions on non-essential gatherings of more than 500 people.
1.61It was stated that the restriction on gatherings of more than 500 people ‘do[es] not include schools, universities and workplaces, or prevent the operation of public transport’.
1.62National Cabinet enabled ‘governments to undertake targeted action to the COVID-19 outbreak’. That action ‘include[d] changes to intensive care unit configurations, social isolation, fever clinics and restrictions on mass gatherings’.
1.63State and territory governments introduced their own measures to respond to the COVID‑19 pandemic.
1.64State and territory governments implemented ‘lockdowns and curfews on an almost regular basis over the course of the pandemic’.
1.65Throughout the pandemic, some state and territory governments closed schools, contrary to the health advice provided by the Commonwealth:
The Australian Government’s health advice at the start of the pandemic was that attending school was safe if proper precautions were taken. But state governments took a different view. School closures were commonplace. This is likely to have significant adverse impacts on children’s outcomes in education, social development, and mental and physical health.
1.66For example, during part of 2020 Queensland state schools only remained open for children of ‘essential workers’ with other children learning from home. In South Australia, schools would be forced to close for a period of at least 24 hours following a confirmed case of COVID-19.
1.67Other states and territories took alternative approaches. For example, Tasmanian parents and carers were initially offered support if they chose to have their children learn from home. Some schools were closed at various times due to the imposition of additional restrictions in response to COVID-19 outbreaks.
1.68The Fault Lines report suggested ‘[l]ockdowns were a sensible course of action in the early stages of the pandemic’. As the pandemic progressed, ‘the use of lockdowns appeared to be driven by policy failures in other areas, such as in quarantine, COVID-19 testing, contact tracing and vaccine procurement and distribution’. That review found that Australian governments:
…became too reliant on lockdowns as our dominant public health response. The decision to impose them appeared to be decided on narrow health advice aimed at minimising COVID-19 case numbers. Too rarely did governments consider potential broader health and social impacts, particularly on the disadvantaged. Cost-benefit calculations were largely absent. Trade-offs were rarely discussed. Governments appeared to be overly focused on short-term benefits, with too little discussion of long-term consequences. The imposition of lockdowns regularly showed overreach, and their implementation lacked consistency, compassion and clarity.
Impact of the COVID-19 pandemic
1.69The COVID-19 pandemic had significant impacts on the Australian economy and the health and wellbeing of the Australian population.
Economic impact
1.70The COVID-19 pandemic and the response to it impacted the trajectory of Australian economic growth and government spending.
Australian economic growth
1.71As illustrated in Figure 1.1, the Australian Bureau of Statistics (ABS) estimated that Australian gross domestic product (GDP) ‘suffered a cumulative loss of $158 billion compared to its pre-pandemic trajectory’.
Figure 1.1Australian gross domestic product, actual and pre-COVID-19 trajectory, chain volume measures, seasonally adjusted
Source: Australian Bureau of Statistics, 'Economic gains and losses over the COVID-19 pandemic', 7September2022, www.abs.gov.au/articles/economic-gains-and-losses-over-covid-19-pandemic (accessed 8April2024)
1.72According to the ABS, ‘[r]ecord falls in household consumption were the main driver of the cumulative loss to GDP’. After the pandemic was declared, there was ‘a swift change in demand and consumption behaviour’. Restrictions on business operations and lockdowns resulted in a decline in consumer activity in some parts of the economy and an increase in others. According to ABS estimates in June 2022, ‘since the pandemic began, households have spent $148 billion less than a continuation of their pre-pandemic spending trajectory would have implied’.
1.73Economic growth began ‘to return to longer term patterns’, once the COVID-19 response measures began to ease.
Response by the Reserve Bank of Australia
1.74The Reserve Bank of Australia (RBA) recognised that the COVID-19 pandemic had ‘a major impact on the economy and the financial system’.
1.75To support the Australian economy and the financial system the RBA:
lowered the cash rate to 0.1% and did not begin raising it until May 2022;
purchased more than $200 billion in bonds issued by Commonwealth, state, and territory governments;
provided a term funding facility to support banks in providing credit to households and businesses;
increased liquidity into the financial system through its market operations;
purchased Australian government bonds in the secondary market as required to support the functioning of that market;
established a foreign exchange swap line with the US Federal Reserve to ensure access to up to US$60 billion; and
monitored the supply of banknotes in the Australian financial system.
Government spending
1.76As illustrated in Figure 1.2, general government consumption increased above the pre-COVID-19 trajectory during the pandemic. The increase in general government consumption was mainly driven by increased public health spending in response to the COVID-19 pandemic.
Figure 1.2General government consumption, actual and pre-COVID-19 trajectory, chain volume measures, seasonally adjusted
Source: Australian Bureau of Statistics, 'Economic gains and losses over the COVID-19 pandemic', 7September2022, www.abs.gov.au/articles/economic-gains-and-losses-over-covid-19-pandemic (accessed 8April2024)
1.77Compared to the pre-pandemic trajectory, the Commonwealth, state, and territory governments spent an additional $42 billion in 2019–20, 2020–21, and 2021–22.
1.78The 2021–22 Budget stated that the Commonwealth government had spent $311billion on ‘direct economic and health support since the onset of the pandemic’.
1.79Most of that $311 billion was spent on economic support, including:
The JobKeeper Payment, which at $89 billion is the largest economic support program in Australia’s history, having supported over 3.8 million individuals;
Boosting Cash Flow for Employers which provided more than $35 billion in cash flow support to more than 800,000 employers; and
The Government’s temporary Coronavirus Supplement which provided over $20 billion in additional financial assistance to over 3 million Australians affected by the economic impacts of COVID-19.
1.80According to estimates by the Australian Institute of Health and Welfare, during 2019–20 and 2020–21, the Commonwealth spent $35.1 billion on the health response to the COVID-19 pandemic. State and territory governments spent a further $11.9billion on their health response to the pandemic.
1.81According to the Audit Office of NSW, that state alone spent $7.5 billion on health and economic stimulus from the start of the COVID-19 pandemic to 30June 2021.
1.82An analysis by EY found that, as a result of lockdowns and increased government spending, state and territory expenses between financial year 2019 and financial year 2022 increased by an average of 29 per cent. The increase in expenses was most notable in NSW and Victoria which recorded ‘an expense growth rate of 50 per cent and 43 per cent respectively’. That has led to an expectation that those two states will ‘see much larger net operating deficits than previously expected’.
Health impact of the COVID-19 pandemic
1.83The COVID-19 pandemic had a significant impact on the health of Australians as indicated by infection and hospitalisation rates, and deaths caused by the disease.
Infection and hospitalisation rates
1.84According to the Australian COVID-19 Serosurveillance Network, ‘by December 2022, more than two-thirds of the Australian adult population had been infected with SARS CoV-2’. It is likely that a further 15-20 per cent of that population has had the virus, as some infections ‘may be missed by these seroprevalence estimates’, which are drawn from tests on blood donated by donors.
1.85Over the 18 months from January 2020 to June 2021, ‘there were over 270,700 hospitalisations involving a COVID-19 diagnosis’. According to the AIHW, ‘[i]n 2021–22, there were 263,400 hospitalisations involving a COVID-19 diagnosis’.
1.86In 2021–22, 30.5% of hospitalisations involving a COVID-19 diagnosis were for people over the age of 65 and 26 per cent were for people under the age of 24. In that year, three per cent of hospitalisations involving a COVID-19 diagnosis involved a stay in an intensive care unit.
Deaths caused by COVID-19
1.87According to the ABS, COVID-19 was the third-leading cause of death in Australia in 2022.
1.88The ABS maintains a provisional register of ‘deaths where people died with or from COVID‑19’. The ABS received 687 639 death registrations between the start of the pandemic in March 2020 and January 2024. Of those registrations, 21 827 recorded a death from or with COVID-19.
1.89Of the registered deaths from or with COVID-19, there were 17 276 deaths where the disease was the underlying cause. The remaining 4 551 registered deaths had a different underlying cause with COVID-19 being a contributory factor.
1.90The proportion of registered deaths where COVID-19 is the only cause of death has declined since the start of the pandemic, as the ABS reported:
The proportion of deaths where COVID-19 was the only condition recorded on the medical certificate has declined since the pandemic began to 3.3% of deaths in 2023, from 11.3% in 2020.
Excess deaths
1.91The ABS reported that an ‘increase in the number and rate of deaths in 2022 led to Australia recording excess mortality (higher than expected mortality)’. In 2022, Australia recorded almost 20,000 more deaths than in the prior year.
1.92In April 2023, the Actuaries Institute reported that ‘there were over 20,000 more deaths in 2022 than would have been expected if the pandemic had not happened’.
1.93Of those deaths, the Actuaries Institute estimated that:
10,300 deaths (51%) were from COVID-19;
2,900 deaths (15%) were COVID-19 related, meaning that COVID-19 contributed to the death; and
7,000 deaths (34%) had no mention of COVID-19 on the death certificate.
1.94On 26 March 2024, the Senate referred an inquiry into the excess mortality recorded by the ABS in 2021, 2022, and 2023. That inquiry will examine the factors that contributed to excess mortality in those years and recommend ways to address those drivers.
Inquiries into the Australian response to the COVID-19 pandemic
1.95According to the Hon Anthony Albanese MP, Prime Minister of Australia, there have been 20 inquiries into the Australian response to the COVID-19 pandemic. Most of the Australian states and territories have conducted inquiries into their responses to the COVID-19 pandemic. Some states have ongoing inquiries into their responses to COVID-19.
1.96On 8 April 2020, the Senate established the Senate Select Committee on COVID‑19 (the COVID-19 committee) to scrutinise 'the Australian Government's response to the COVID-19 pandemic'.
1.97In April 2022, the COVID-19 committee recommended 'that a Royal Commission be established to examine Australia's response to the COVID-19 pandemic to inform preparedness for future COVID-19 waves and future pandemics'.
1.98On 20 October 2022, an independent review funded by several philanthropic organisations reported on Australia's response to the COVID-19 pandemic.
1.99In August 2022, the Prime Minister, the Hon Anthony Albanese MP, indicated the government 'will need to have an examination in some form of what we got right, what we got wrong, how we can do better'. He stated that the government would conduct that examination 'in some form, but we will make that decision at some time in the future'.
1.100Senator the Hon Katy Gallagher indicated that the government had made it:
…clear that there should be an inquiry into the pandemic. We believe it had such massive implications across the economy, across the community that an inquiry would need to be undertaken at the right time.
1.101Senator Gallagher elaborated that as the pandemic was ongoing it would not be appropriate to conduct an inquiry immediately:
People are still becoming unwell and management plans are still in place, so that remains the government's focus to ensure that we are responding to that appropriately, but we also do believe there needs to be an inquiry. There have also been a number of inquiries conducted or that are in the process of being conducted across the states and territories. That should feed into information that we would use at the federal level.
1.102On 21 September 2023, the Prime Minister announced an independent inquiry into Australia's response to the COVID-19 pandemic. The Prime Minister highlighted the importance of the inquiry:
We said before the election and I've said since, given the enormous dislocation, the stress, the, of course, loss of life, the economic impact of the pandemic, it is appropriate that when we reached a certain period, that we would have an inquiry. It's a commitment that I made before the election.
…
But of course, Australians will recall, will never forget, what the country went through in 2020 and 2021 in particular. It was a time when Australians joined together. They made sacrifices to help each other. They sacrificed some of the normal activity that would go on. And it was a very disruptive period in our lives. But we got through it. And we got through it in a way that was positive in most respects. But we need to examine what went right, what could be done better, with a focus on the future. Because the health experts and the science tells us that this pandemic may well be, indeed, is not likely to be the last one that occurs. So that's why better preparedness is very important.
1.103The Prime Minister explained that a Royal Commission may not be the most appropriate mechanism to inquire into the Commonwealth Government's response to the COVID-19 pandemic:
I promised one Royal Commission as Leader of the Labor Party, that was into Robodebt. And that has reported and has been effective. One of the things we've learned about Royal Commissions is that they can roll on, and on, and on, for year, after year, after year…There have been 20 inquiries already. What we want to do is to bring together that information and to consolidate that. What are the findings of the inquiries that have been held? There's been a commission, for example, already in my state of NSW, into the Ruby Princess. There's been a range of inquiries. What we want to do is to get the information consolidated and get those recommendations about how we better prepare in the future.
1.104The Hon Mark Butler MP, the Minister for Health and Aged Care, similarly explained that the COVID-19 inquiry would deliver on the election promise 'that there would be a deep and thorough inquiry into the nation's pandemic response'. He reiterated that the government had been clear that an inquiry 'would take place after the worst period of the pandemic had receded. And we wouldn't start an inquiry while our health systems, our governments, were still focused on pandemic management'.
1.105The Department of the Prime Minister and Cabinet stated: ‘[t]he purpose of the Commonwealth Government COVID-19 Response Inquiry is to identify lessons learned to improve Australia’s preparedness for future pandemics’.
1.106The purpose of the inquiry is similar to the commissions of inquiry established in the United Kingdom (UK) and New Zealand (NZ), as both of those commissions are intended examine the COVID-19 pandemic experience to better prepare for the next health emergency. However, the UK Inquiry is ‘established under the Inquiries Act (2005) [UK]. This means that the Chair will have the power to compel the production of documents and call witnesses to give evidence on oath’. Similarly, the NZ Inquiry has been established as a Royal Commission of Inquiry under the Inquiries Act 2013 of New Zealand with powers to require production of documents and to call witnesses.
1.107The terms of reference for the Commonwealth Government Covid-19 Response Inquiry stated:
The Inquiry will review the Commonwealth Government’s response to the COVID-19 pandemic and make recommendations to improve response measures in the event of future pandemics. It will consider opportunities for systems to more effectively anticipate, adapt and respond to pandemics in areas of Commonwealth Government responsibility.
1.108The inquiry may examine the following, non-exhaustive list of areas of Commonwealth government responsibility:
Governance including the role of the Commonwealth Government, responsibilities of state and territory governments, national governance mechanisms (such as National Cabinet, the National Coordination Mechanism and the Australian Health Protection Principal Committee) and advisory bodies supporting responses to COVID-19.
Key health response measures (for example across COVID-19 vaccinations and treatments, key medical supplies such as personal protective equipment, quarantine facilities, and public health messaging).
Broader health supports for people impacted by COVID-19 and/or lockdowns (for example mental health and suicide prevention supports, and access to screening and other preventive health measures).
International policies to support Australians at home and abroad (including with regard to international border closures, and securing vaccine supply deals with international partners for domestic use in Australia).
Support for industry and businesses (for example responding to supply chain and transport issues, addressing labour shortages, and support for specific industries).
Financial support for individuals (including income support payments).
Community supports (across early childhood education and care, higher education, housing and homelessness measures, family and domestic violence measures in areas of Commonwealth Government responsibility).
Mechanisms to better target future responses to the needs of particular populations (including across genders, age groups, socio-economic status, geographic location, people with disability, First Nations peoples and communities and people from culturally and linguistically diverse communities).
1.109The terms of reference specifically stated that:
The following areas are not in scope for the Inquiry:
Actions taken unilaterally by state and territory governments.
International programs and activities assisting foreign countries.
1.110By not examining the actions of state and territory governments, the Commonwealth Government COVID-19 Response Inquiry differs from the UK inquiry. The terms of reference for the UK Covid-19 Inquiry allow the inquiry to:
…consider reserved and devolved matters across the United Kingdom, as necessary, but will seek to minimise duplication of investigation, evidence gathering and reporting with any other public inquiry established by the devolved governments.
1.111The Commonwealth Government COVID-19 Response Inquiry is being conducted by ‘an Independent Panel of three eminent people’ appointed by the Prime Minister. During the course of the inquiry, ‘[t]he Independent Panel will consult with relevant experts and people with a diverse range of backgrounds and lived experience’. The inquiry is scheduled to deliver its final report by 30 September 2024.
1.112It is further noted that the Commonwealth Government COVID-19 Response Inquiry does not have the powers a Royal Commission would have under the Royal Commissions Act 1902 (Royal Commissions Act) to summon witnesses and require the production of documents. This is discussed further below. In addition, the inquiry cannot be viewed as independent from government because it actually sits within the Department of the Prime Minister and Cabinet and is being supported by a taskforce within that department. That is not to make a reflection on any of the members of that panel or those providing support. However, it is important that such an inquiry should not just be independent but also be seen to be independent.
1.113As stated in paragraph 1.3, an overwhelming proportion of submissions were in favour of a royal commission. In relation to the opposing view, Catholic Health Australia suggested the Commonwealth Government COVID‑19 Response Inquiry ‘is the appropriate mechanism to review Australia’s pandemic response’. In its view, a royal commission is unnecessary as the inquiry ‘will hold sufficient power and be more timely as well as less burdensome on the strained health and aged care sector’.
1.114The Tasmanian government similarly argued a royal commission is not necessary ‘as each state and territory has already undertaken numerous reviews or inquiries into their response to the pandemic’. It recognised there is ‘value in identifying lessons learned from the COVID-19 response to improve Australia’s preparedness for future pandemics’.
1.115In contrast, the Australian Human Right Commission (AHRC) indicated that while it supported the inquiries into the Australian response to the COVID-19 pandemic, ‘and engaged with many of them, they are not sufficient substitutes for a properly constituted Royal Commission’.
Royal commissions
1.116Dr Scott Prasser described royal commissions as ‘a particular form of public inquiry’ that investigate specific matters and provide advice on their findings. They ‘are seen as the apex of public inquiries…[and] attract extensive media and public attention and more resources than other permanent advisory‑investigatory bodies’.
1.117According to the Attorney-General’s Department, ‘royal commissions are the highest form of inquiry on matters of public importance. They are only established in rare and exceptional circumstances’.
1.118Federal royal commissions are established under the Royal Commissions Act. Under that Act, royal commissions have the power to:
summon witnesses to give evidence, produce documents, or both;
take evidence under oath;
penalise witnesses who fail to attend a hearing, produce documents, or give information; and
issue search warrants to assist in their investigation.
1.119Royal commissions ‘are ad hoc, temporary bodies appointed by executive government with members from outside of government or parliament’. Each royal commission is ‘individually tailored to meet the issue being reviewed as well as executive government’s requirements’.
1.120Commonwealth royal commissions are established by the Governor-General issuing Letters Patent. The Letters Patent list the terms of reference for the royal commission and appoint a commissioner or commissioners to conduct it.
1.121Dr Prasser suggested the establishment of a royal commission can carry risks for the appointing government:
Some have interpreted their terms of reference broadly, probed into unexpected areas and produced reports fatal to the appointing government. They can also have flaws like produce poor quality reports, take too long, cost too much and can be seen as being appointed for politically expedient purposes. Royal commissions into disasters and calamities like floods or bushfires have at different times been criticised for being too narrowly focussed on their specific event, and too bent on allocating blame. Consequently, they fail to develop recommendations that tackle the broader policy issues for the future.
1.122In Australia, there are no ‘constitutional or legislative requirements’ that automatically trigger a requirement for the executive government to establish a royal commission. Similarly, the Parliament does not have the power to establish a royal commission and it is not required to approve the establishment of a royal commission. Parliament’s role is to provide ‘the legislative base for their powers of investigation’.
1.123According to Dr Prasser, royal commissions may be appointed by the executive government for a range of reasons:
Generally, royal commissions are appointed when the existing array of permanent advisory and investigatory agencies of government are not seen as being independent enough, or they are asked to review highly controversial issues, ones of widespread concern, and high political salience. Often executive government, or parts of it, needs to be reviewed because of some nefarious activity. Often royal commissions are appointed where there are contrary views that need to be resolved, including contestable data of a scientific kind. Lastly, royal commissions are appointed where there are blurred lines of accountability and responsibility and confusion about who is accountable for certain actions that need to be clarified.
1.124In Dr Prasser’s view:
These are situations when facts need to be clarified and verified, contrary views aired and resolved, responsibility identified and allocated and reforms for the future developed. In such situations royal commissions are the ‘institution of last resort’ to be deployed when nothing else in a government’s advisory or investigatory tool-box will do.
1.125Royal commissions may collect information and evidence through open public processes. Witnesses that provide evidence to royal commissions are provided with legal protection.
1.126Dr Prasser explained some of the main differences between royal commissions and other, non-statutory, public inquiries that have been appointed by federal governments. He pointed out there have been more than 500 other non-statutory public inquiries appointed by federal governments since the Second World War. Those inquires did not have the power ‘to call witnesses or to procure information…[or] provide any legal protection to witnesses’.
1.127Dr Prasser explained that the powers available to royal commissions make them ‘more effective’ than other bodies when investigating certain matters:
Commissions can collect ‘evidence’ from a wider variety of sources, force witnesses to give evidence even if self-incriminating, and can accept hearsay or ‘scuttlebutt and gossip’. This, combined with their extensive resources which allows them to employ large teams of researchers to develop new data and examine existing information forensically. This is what allows royal commissions to be more effective than many existing permanent bodies including anti-corruption agencies in relation to reporting on certain issues.
1.128The evidence collected by a royal commission informs the findings and recommendations contained in its report. The final report is provided to the Governor-General and is usually tabled in Parliament and published on the royal commission’s website. A government response to the final report explains ‘how it will act on the royal commission’s findings and recommendations. The timing of the response will be determined by the government of the day’.
1.129Dr Prasser pointed out that calls for a COVID-19 royal commission often include demands for an investigation into the role of state and territory governments and that such a commission of inquiry ‘should be a joint Commonwealth-State royal commission’. He suggested that because ‘Commonwealth royal commissions can only be conducted if the subject matter of the inquiry lies within the field of Commonwealth power any such joint commission requires State support’. Dr Prasser indicated that there are examples of joint Commonwealth-state royal commissions, including into the Great Barrier Reef, drugs, hospitals, drug trafficking, Aboriginal deaths in custody, and child sexual abuse.
1.130There are also examples of joint Commonwealth-state royal commissions ‘where not all the states have joined up to them’. Dr Prasser suggested that the federal government can ‘put pressure on the states to join’. In his view, ‘[i]t can be done and it requires effort and persuasion by the federal people putting it together’.
1.131In Dr Prasser’s view, the Commonwealth Government COVID-19 Response Inquiry ‘should be closed down and its evidence so far collected passed on to a new royal commission’. Again, there are several precedents for an inquiry ‘taking over and absorbing the evidence’ of an earlier one.
1.132The AHRC noted that, given the magnitude of the COVID-19 pandemic and the response to it, a royal commission ‘is the appropriate form of inquiry’. Such a royal commission would review the response ‘to improve Australia’s future emergency preparedness’. The powers available to royal commissions ‘are essential to ensure that the pandemic response can be reviewed in a comprehensive way’.
1.133Mr Peter Fam, a human rights lawyer, indicated that a royal commission was necessary to restore trust amongst the Australian populace. He argued that as a result of the response to the COVID-19 pandemic:
…Australian citizens no longer trust the medical system, not longer trust the legal system and no longer trust the political system to protect them when it counts, and this is because those systems did not protect them when it counted. A comprehensive and transparent royal commission is a minimum requirement to earning back that trust.
1.134The People’s Terms of Reference supported a royal commission as Australia has:
…a crippling hangover of devastation, including economic, social and psychological harm from the lockdown policies, border closures and other draconian measures taken, none of which were part of Australia’s documented pandemic plan. A royal commission must be prepared to investigate the uncomfortable truths about Australia’s COVID response, the consequences of the actions taken and the state of democracy in this nation.
1.135Mr John Larter, a former paramedic, argued:
There needs to be a royal commission because this is just too massive to ignore. In my view, we need to learn. The only way we can learn is to investigate what happened: what we did well, what we didn’t do well, and make sure that this doesn’t repeat itself.
1.136Mr Graham Hood, a former Qantas pilot, urged the government to appoint a royal commission to investigate the response to the COVID-19 pandemic:
This country is in dire straits. The spirit of this country has been systematically destroyed. I have witnessed it firsthand. I’ve done what many of you don’t have the time to do. I’ve been face-to-face with people who have lost loved ones where they know their death was from vaccine injury. I don’t know whether these excess deaths have been caused by vaccines long COVID or whatever else it might be. It could be from an additive in food; I don’t know. But nobody else seems to know, either, and that’s why we must stop. We must investigate. We must do a proper debriefing. We must apply proper human factors and we must bring the people that I mentioned that have been locked away with censorship back out of the dark with their data so that we can start healing the people of this country. If we don’t do that, we have neglected an opportunity that will go down in history as one of the greatest human factor failures in the world.
1.137The Australian Medical Network suggested that, with the benefit of hindsight, a royal commission could examine ‘what worked and what didn’t work’. That commission could be informed by the ‘rock-star doctors here in Australia that don’t have big profiles but they have been doing on-the-ground work. They deserve a voice; they deserve that’. That examination could assist in the development of a future pandemic strategy:
…to put some protocols down, some strategies down, so that this is treated differently next time. There will be a next time, whether it is as large as what we went through or smaller. We need different voices and different opinions, expert opinions, coming through—not just experts that have that privilege, that work with government and work in academia. We need on-the-ground people, too, who actually have access to people, who deal with the common man and woman, because they feel that they’re not heard.
1.138There were a range of other stakeholders who similarly supported the need for a royal commission and proposed terms of reference for a royal commission including:
the Royal Australian College of General Practitioners;
the Victorian Aboriginal Community Controlled Health Organisations;
Anglicare Australia;
COVERSE;
the Ai Group; and
People with Disability Australia.
1.139The committee also received submissions from The People’s Terms of Reference and the Winston Smith Institute that called for the establishment of a royal commission. Those submissions were supported by 46 609 and more than 65 000 signatories respectively.
1.140The next section of this report provides reviews evidence received from those organisations and others. The call for a royal commission is overwhelming.