COVID-19 pandemic: challenges of crisis management remain unsolved

“The Federal Government failed to provide for the necessary organizational structures and personnel prerequisites.” This is the conclusion reached by the auditors of the Austrian Court of Audit (ACA) in their report published today on "Pandemic Management of the Health Authorities in the First Year of the COVID-19 Pandemic". As the supreme authority in this sector, the Federal Minister of Health is responsible for pandemic management. However, the allocation of responsibilities between the Federal Government and the provinces remained often unclear. Moreover, uncoordinated action was also taken at the federal level. 

The report lays out which lessons are to be drawn for a more efficient and effective pandemic management. This includes, for example, the preparation of a draft bill for a modernized Epidemics Act (Epidemiegesetz), the provision of staff resources and the development of a new national pandemic plan. The cooperation between all key players needs to be ensured.

In conclusion, the ACA notes that “the challenges of crisis management during the COVID-19 pandemic remained unsolved. The experiences made since the outbreak of the pandemic have not been sufficiently harnessed to further develop the crisis management based on the lessons learned”.

Pandemic preparedness and pandemic management: the minister’s responsibility  

Both pandemic preparedness as well as pandemic management in healthcare are tasks of the Federal Government and are executed, as matters falling within the scope of indirect federal administration, by the provincial authorities. Strategic decisions and the development of adequate measures geared towards the health authorities to address the pandemic are the responsibility of the Federal Minister of Health. As the supreme authority he shall lead, manage and coordinate the pandemic management of the health authorities across the country. The provincial governors are responsible for the execution of the regulations and instructions issued by the Federal Ministry of Health via the district administrative authorities.

Despite that, uncertainties existed between the Federation and the provinces as to who was responsible for what, who had to make which decisions on a practical level and who had to implement them. This resulted in duplications of efforts. The provinces, for example, introduced, in addition to the federal epidemiological reporting system (EMR), their own IT applications for recording infections. Decisions were often delayed. This led to the fact that, on the one hand, tougher contact restriction measures became necessary, and on the other hand, the measures adopted based on such3 late decisions took longer to produce the necessary protective effect.

Diverging figures provided by crisis units

Uncoordinated action was not only taken by the Federal Government and the provinces, but also at the federal level – between the Federal Ministry of Health and the Federal Ministry of the Interior. Although it was exclusively the Federal Minister of Health and his crisis unit who were responsible for the pandemic management, the Federal Ministry of the Interior also collected data on the pandemic situation on a regular basis, namely together with the provinces in the framework of the National Crisis and Disaster Protection Management – an informal coordination tool without procedural rules. The indicators published by the Federal Ministry of the Interior deviated from those of the Federal Ministry of Health. The lacking congruence of data did not only render it difficult for the authorities to take evidence-based action, but was also detrimental to their credibility and therefore negatively impacted public acceptance and the effectiveness of the pandemic management measures.

Safeguarding public health in a uniform manner

The ACA recommends to safeguard public health in a uniform manner across the country. To this end, the Federal Minister of Health should actively exercise his role and lead, manage and coordinate the measures of the provincial health authorities necessary for the pandemic management (such as vaccinations, tests or officially imposed restrictions) more intensively. Should the measures prove to be lacking effectiveness, the Federal Minister of Health should intervene and take countermeasures.

Although the fact that the provincial authorities could issue regional or local measures against COVID-19 in addition to the regulations issued by the Federal Minister of Health enabled a regional approach adapted to the number of infections, it also entailed the risk of an unclear allocation of responsibilities on the federal and provincial level in pandemic management.

National pandemic plan outdated and inadequate

At the time of the outbreak of the COVID-19 pandemic, no updated national pandemic plan was available. The last officially published "Influenza Pandemic Plan – Strategy for Austria" ("Influenza Pandemieplan – Strategie für Österreich") dated back to 2006 and was therefore not adapted to the current WHO phase of pandemic alert. The provinces therefore had no basis for drafting up-to-date pandemic plans. 

The ACA critically notes that both the WHO as well as the Federal Ministry of Health and the Federal Ministry of Defence had identified deficiencies in pandemic preparedness in 2019 – already before the outbreak of the COVID-19 pandemic. They had rated the risk associated with such deficiencies as high. In addition to the failure to update pandemic plans and the lack of regular exercises related to the interaction of all stakeholders, the lack of staff at the federal and provincial level had also been identified as a risk.

Ensuring cooperation between all key players

Based on the experiences gained from the COVID-19 pandemic, a new general national pandemic plan should be developed together with the provinces for the ongoing pandemic management efforts and for future pandemics. In the event of a new pandemic, this should ensure a mutual flow of information as well as cooperation between all key players (health authorities, health insurance providers and hospitals).

Key posts remained unfilled for a longer period of time

In key functions essential for public health, continuity has been lacking after an internal reorganization in 2018. This was due to the fact that the structure of such functions, which had been adequate until then, was changed and certain positions remained unfilled for a longer period of time. The position for the “General Directorate for Public Health”, which had been vacant since 2019, was not filled by the Federal Ministry of Health until the end of 2020 after the outbreak of the COVID-19 pandemic. The three-year term of office for the members of the Supreme Health Board (“Oberster Sanitätsrat”) (31 representatives of the medical profession, science and the Austrian Chamber of Pharmacists) expired at the end of 2019. The new appointment did not take place until March 2021.

Combined with the inadequate staffing in the specialized departments of the Public Health Division, this resulted in a reduced capacity of the Federal Ministry of Health to act.

According to the statement provided by the Federal Ministry of Health, the circumstances identified by the ACA continue to exist in 2022. Since the available human resources were still not in line with the requirements, both special contracts and staff loans remained indispensable. From the viewpoint of the ACA it is not comprehensible why the Federal Government did not use the instruments at its disposal to react to an exceptional situation such as the COVID-19 pandemic with corresponding flexibility as regards the management of posts.

Epidemics Act outdated – a crisis mechanism needs to be established

The basic form of the Epidemics Act, which has applied throughout Austria to fight the spread of communicable diseases, dates back to 1913. When the COVID-19 pandemic broke out, it was no longer relevant for the situation at hand. Although the Federal Ministry of Health drafted several amendments to the Epidemics Act during the course of the COVID-19 pandemic, it failed to carry out the required comprehensive modernization.

It was therefore all the more important to issue clear regulations that clarify the Epidemics Act to ensure a coordinated and effective approach by the health authorities throughout Austria. However, the Federal Minister of Health failed to make sufficient use of the instruments available to him for this purpose, such as decrees, regulations and instructions.

The ACA recommends to the Federal Ministry of Health to prepare a draft for a modernized Epidemics Act and submit it to the National Council through the Council of Ministers. This would, for example, regulate the cooperation between the authorities in much greater detail. As a result, a legal framework for a crisis mechanism should be created with clear procedures and responsibilities both for the necessary measures and for the external communication related thereto.