Indo-Pacific Health Leaders Series: Dr Brendan Murphy, Secretary of Australia's Department of Health.

Welcome to the second insightful episode of our special Indo-Pacific Health Leaders series, where Ambassador for Regional Health Security, Dr Stephanie Williams, talks to the new Secretary for Australia's Department of Health, Dr. Brendan Murphy. They discuss his leadership and the challenges during the early outbreak of COVID-19 in Australia during his time as Australia’s Chief Medical Officer.

Transcript

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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.

Dr Brendan Murphy  0:05  

The most important thing for me was to try and be ethical and honest. And had to try in the public profile, which was unwelcome but necessary, to try and be reassuring, as well as honest.

Dr Stephanie Williams  0:21  

Welcome to Episode 14 of Contain This, brought to you by the Indo-Pacific Centre for Health Security. I'm Stephanie Williams, Australia's Ambassador for Regional Health Security. Today we continue a special series of podcasts with Indo-Pacific health leaders. I will bring you frank conversations with leaders in the Pacific and Southeast Asia about how they are facing current challenges, making decisions amid uncertainty, brokering consensus to provide scientific advice to governments and how these individuals adapt and adjust their leadership style during a crisis such as COVID-19. 

Today I have the great pleasure of speaking with Australia's Secretary for the Department of Health, Dr. Brendan Murphy. Now prior to his appointment as secretary in July of this year, Dr. Murphy was Australia's Chief Medical Officer (CMO). And it is his experience in this role that we'll focus on during the interview. Dr. Murphy trained as a nephrologist, a specialist in diseases and conditions that affect the kidneys. He was formerly the chief executive officer of Austin Health, and the chief medical officer and director of nephrology at St Vincent's Health, both institutions in his hometown of Melbourne, Victoria. 

Brendan, welcome to Contain This. So I want to go back to the beginning, Brendan, in the early days of 2020 as we learned about the then called Wuhan coronavirus now SARS-CoV-2 that causes COVID-19. It's fair to say we knew a little about the virus and the disease but needed to take action. During that early period, especially as our understanding was scant, you brought together Chief Health Officers from states and territories to the Australian Health Protection Principle Committee to make recommendations to government. During that time, how did you approach the role of Chair of a committee to reach consensus decisions, amid so much uncertainty?

Dr Brendan Murphy  2:17  

So that I think probably the most important part of my role was that chair because I'm unashamedly not a public health expert. My background was in nephrology, immunology and hospital management. But we, I had a group of wonderful experts, the state and territory Chief Health Officers, and a lot of other experts. People have brought some extra people on, some modellers like Jodie McVernon and Allen Cheng. And it was, at times, quite a robust discussion to reach consensus because there were sometimes different views but on every single policy position we talk to our respective governments and then later to the National Cabinet, I think there was any one occasion when there was one dissenting voice and we really used an evidence based approach and discuss things and came to a conclusion. 

We met, pretty much every day for two hours for nearly six months. And that was a challenge but the collegiality was fantastic. And, you know, there are some positives coming out of this terrible time but the Federation, at a health level has worked, generally pretty well and that Chief Health Officer group are a wonderful group of leaders.

Dr Stephanie Williams  3:42  

And just like your household name, as now is AHPPC, often people don't fully understand that this is a group of people who have actually worked together during crises for some time, to what extent did that support there and your chairing and that ease with which they came together - I'm not saying it was easy - but...

Dr Brendan Murphy  4:03  

No, I think the relationships were fantastic and we're a group that over the previous three years before... I do remember when Minister Hunt suggested that I'm talking about me becoming Secretary of the Department in January I said you know I've done the CMO job for three years, that was late December, and I hadn't had a public health crisis! And he blamed me for that. But we had that group, we've worked together for three years and we've met, used to meet regularly, generally face to face in the old days but often emergency teleconferences when issues arose, and I would probably take a phone call from one of them every other day. You know there's an issue that came up and we've always had a good basis of openness. Hey, I've got an issue with meningococcal disease or I've got an issue with flu or something so it was a very good relationship. And I do remember, Chris Begley, my predecessor telling me the most important thing for the CMO to do is to maintain good relationships with the state and territory Chief Health Officers and I always sought to do that.

Dr Stephanie Williams  5:13  

Sometimes people expect in a crisis that, those decisions have to be taken sort of definitively and that leadership by committee doesn't always work. To a certain extent, your experience of AHPPC, kind of, contradicts that.

Dr Brendan Murphy  5:32  

In a sense, but in the practical reality of Federation where the Commonwealth has a coordinating role, but the public health effector arm is in the states and territories who are sovereign entities in their own right. It has to be thus, so it might have been easier sometimes for me to make a unilateral decision but it would not be enforceable unless I had that collective ownership of it because that's the challenges of the Federation and some of the benefits because you get that collective wisdom as well.

Dr Stephanie Williams  6:06  

So, in the early part of this year, we were needing you and the committee to not only respond to the crisis at hand, but plan and anticipate a range of uncertain scenarios. How did you manage to do those two things concurrently?

Dr Brendan Murphy  6:25  

Yeah, I think what we were very aware of it. So we had to plan for the worst, for what we did never want to happen so we, in the early days, we sat down and planned for what would happen if we had a situation where we had widespread community transmission in something like the UK or northern Italy where you know hospitals could have been overwhelmed. We would have had tens of thousands of deaths, hundreds of thousands of deaths. And so we did a lot of work on getting PPE supplies, one of my biggest challenges. We did a lot of work on ICU capacity, what was realistic and practical, we bought several thousand ventilators. We looked at all of those capability issues of the health system we then looked at how our testing capability could be expanded. And so we prepared ourselves and that took quite a few months but at the same time we had to say, "Well, we've only got a small amount of transmission of this virus it's pretty much all imported, how are we going to stop it?" So we were taking and took some immediate actions to stop it.

Dr Stephanie Williams  7:45  

I'm going to change tack a bit and think about how leaders reflect on their own leadership during a crisis. Now it's clear and much said by many not just me, that you did a terrific job as CMO guiding us through the first phase of Australia's response to COVID. How did you know you were doing a good job? Did you seek feedback? Were you offered feedback? Did you change things along the way?

Dr Brendan Murphy  8:09  

Yeah, it's a good question. I did get feedback from political masters you know they would often after the weekly and sometimes twice weekly press conference with the PM, he would often say "that went well". And my ministers, Minister Hunt is very, very strong on positive feedback, will often send you a message and will often say when, you know, I perhaps wouldn't have done that... But I'm lucky in a way, is that I'm not a very insecure person. I'm probably my own worst judge. Often we'll finish a press conference or a meeting or cabinet meeting or something, say perhaps I shouldn't have said that but often then when I seek feedback people haven't felt that it was as negative as I thought it so. 

So look, you know, I think the most important thing for me was to try and be ethical and honest, and enter try in the public profile which was unwelcome but necessary to try and be reassuring, as well as honest. That was quite hard because a lot of very frightened people including in our health professions and a lot of, you know, diverse and conflicting opinions flying out there from terrified people sitting at home on Zoom. And it was to try and get an evidence-based middle ground and try and reassure the public was a challenge.

Dr Stephanie Williams  9:53  

You certainly have a very calm and authentic manner. It was commented on, by many, as a very trusted top doc. When you think about that culture of leadership and reflection, how did you translate that to the people that you're working with in the department in trying to keep that focus on ethical and honest? And keeping on going when actually individually we were all responding in different ways to the crisis?

Dr Brendan Murphy  10:22  

Really important is a couple of things. One is recognition, you know people, people will go huge distances if you are empowered by recognition and acknowledgement. So, you know, I remember one of my senior managers who'd worked, she got a little four year old kid and she worked, I think probably, like I had, done 30 hours, 30 days straight without seeing her kid. And so I remember buying, sending someone out, my EA, to buy some toys for her kid. Sort of little things that I do and just telling people how well they're doing and forcing people to take some time off. You know, just like everyone thought they're indispensable in the big crisis and just saying, "well, you're not that indispensable we'll fall over so, go away for a couple of days." So, and again you know just if there was a difficult political discussion to have with another department or another government I would try and do that myself and have the difficult conversations and sort of try and free people up to do their constructive work. So... I don't have a leadership philosophy. Other than that, that to value the people in your team get good people around you and recognize and acknowledge them. And also, trust them to make mistakes, and iron out their mistakes for them, rather than blame. I hate blame cultures, it's the worst thing.

Dr Stephanie Williams  10:56  

Australia is part of the region, and I know you've had in the last few months, a number of discussions with some of your counterparts in the Indo-Pacific region, what elements of Australia's response, do you think are relevant and transferable to the developing countries of our region?

Dr Brendan Murphy  12:31  

Yeah, I mean, that's really interesting question because, I mean, there are some countries in our region that have done better than we have. Look at Vietnam, you know. Now, it's probable that the Australian public may not have tolerated the measures that Vietnam took but you'd have to say, I mean they've got a little outbreak right now, everyone's got got their second waves. But they really had only a few hundred cases and clamped down really well by a very draconian isolation and contact tracing and they put every primary contact in government operated quarantine for two weeks. I can't see the Australian public living with that so that was interesting.

I think it's really worrying for those countries that don't have... in middle income countries, lower income countries. I'm anxious about Indonesia, I'm anxious about those countries that don't have widespread testing and public health capability, or advanced healthcare systems with... I mean our survival rate in ICT is very good in Australia, and with people we've often talked about sending ventilators to countries and I wonder, you know it's not much point to any ventilator unless there are people who can use them and their hospitals to put them in. So, I think, you know, there's no question that the physical distancing measures work in any country but again it's very hard when you've got people in overcrowded accommodation.

It's really hard to translate a high income country response to a low income country response, in some ways, and it's sort of tragic that a low income country might come out of this more quickly than a high income country because though they are used to tolerating death rates and things that we wouldn't be prepared to tolerate.  And the younger population, as in every country, will sail through this.

But I think that the most important lesson we've learned in our second wave, which is primarily in Victoria is that this virus is rapidly spreading in fit young healthy people who will [spread it] and that if you don't get into culturally and linguistically diverse communities with communications packages and different strategies. I think a lot of the second waves - Singapore had the same experience - the first wave in most countries, a lot of countries was returned travellers and they're often higher income people, more compliance and more easy to get out. And once it gets into different communities, it's a very different, different challenge to deal with.

Dr Stephanie Williams  15:33  

I think we can see that in our region where the Pacific following Australia's lead and also seeing the threat for themselves had swift border closure with big consequences for their economies and livelihoods, but still a protection from COVID, and almost an inevitability once we reach a border opening if the hands are forced. Knowing that we've had potentially a bit more time to prepare but on the back of systems that are fundamentally weaker and I know, certainly in the region the health leaders in the Pacific have valued opportunities to connect with you and with officials in the department if nothing else, but to continue to share experience and be in partnership. My last question is a personal one, which is really, when the demands are endless on you, but your personal resources are finite, either in a 24 hour period or a 30 day period with no break, I'm interested in how you kept going.

Dr Brendan Murphy  16:35  

It was quite tough because most of my sort of relaxation things I couldn't do. The gyms were closed. Because I've been having singing lessons for the last few years until till COVID hit, that was in Melbourne. Seeing my two granddaughters is one of my biggest delights. I've hardly seen them for four or five months so I've been on the screens. I used to go back to Melbourne every weekend and my wife has been up here in Canberra the last few months, which has been great. 

So, I just kept going because you know you feel this enormous sense of purpose that was this is a crisis or a problem that's unsolved. I've seen it just in the last few weeks with aged care in Victoria. I mean I've been essentially, you know, even though I've been secretary, the Department of Health for a while I was doing bed management in aged care facilities in Victoria at 11 o'clock on Sunday night because there is a crisis and if there's no pathway to resolution and the buck stops with you, you've just got to find a pathway. 

So it's been hard. I've been pretty tired at times. There was a period, most of like May and June when things pretty quiet where I was getting my weekends back and being able to sort of go for some walks and even watch a bit of Netflix and read a novel but the last few weeks again it's been really back to full pressure. I'm very confident that you know we'll get on top of Victorian measures that have been recently announced. We'll bring that under control and we'll get back under control but it's been a rollercoaster ride, and I just... the most important thing is to do everything we can to protect those people who are vulnerable to severe disease.

Dr Stephanie Williams  18:38  

Well, I knew we were in safe hands with you as CMO and we are in safe hands with you as secretary. And if I had I known about the singing I would have said we get a better audio setup. We could have had an impromptu performance.

Dr Brendan Murphy  18:50  

I'm not a very good singer yet!

Dr Stephanie Williams  18:52  

Thanks, Brendan. 

Dr Brendan Murphy  18:54  

Thank you. 

Dr Stephanie Williams  18:55  

You've been listening to Dr Brendan Murphy, the Secretary of Australia's Department of Health, formerly Australia's Chief Medical Officer. I'm Stephanie Williams, Australia's Ambassador for Regional Health Security. Thank you for joining me on the Contain This podcast for this week's launch of the Indo-Pacific Health Leaders series. Over the coming months, I look forward to talking to a range of people in different countries in our region to explore how public health leaders are facing the challenges of responding to COVID-19.