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Australia’s Ebola response: A worrying insight into our lack of preparedness for other infectious disease threats?

Melissa Sweet writes:

While G20 leaders are under pressure to step up the global response to the Ebola crisis in West Africa, experts warn that Australia’s tardy response raises concerns about our overall preparedness for global health threats.

The Consumers Health Forum of Australia has supported a call from the International Alliance of Patients’ Organizations for governments to ensure good care for those in need and to strengthen health services during and after the Ebola crisis.

The IAPO call comes after it received an impassioned letter from a member, the Liberian United Youth for Community Safety and Development, which described the dire effect the Ebola epidemic was having on health facilities and on communities.

Nursing organisations in Australia are also backing efforts by the Global Nurses United, an 18-country nurse union alliance, to put the spotlight on Ebola to coincide with G20.

The Queensland Nurses Union is campaigning this week on the need for world-wide universal health care and global investment in public health services and hospitals to protect against outbreaks like Ebola.

Meanwhile, Croakey contributors below suggest that Australia’s dismal response to the epidemic to date is a worrying insight into our lack of preparedness for other infectious diseases threats.

***

Dr Joel Negin, Senior Lecturer in International Public Health and Director of Research, Sydney School of Public Health, University of Sydney

Q: What is your assessment of the Australian Government’s response to the Ebola crisis in West Africa? What have been the factors involved/contributing to the response?

Clearly very slow.  What they needed to do has been clear for months and what they ended up doing is what they and everyone else knew they would end up doing for many months.  The sought after guarantee for care for Australian health workers was always something they could have gotten.  Perhaps not “iron-clad” but there is no iron-clad in emergencies.

They could have secured a commitment of care from the EU, UK, US and facilities are being set up for foreign health workers.  The EU made a commitment to provide care for Australian health workers about 2-3 weeks before the government acted.  Speaking to contacts in Canberra, they all insist they have been “working around the clock” on Ebola for the last 2-3 months – but I have to ask – “to what end?”

Lots of busy work without much action and with eventually announcing what we all knew they would announce.

My main concerns are not so much about West Africa but if it takes us 3 months to get our act together, then I fear for the inevitable Ebola or (more likely) more virulent strain on influenza that emerges in our own region (Indonesia, Hong Kong).  Will we take 3 months to get our act together?  We have the emergency team in Darwin but they are standing around doing nothing.  Are we actually ready to deploy?

SARS arrived 11 years ago – and we have spent hundreds of millions on disaster preparedness.  But turns out we aren’t very prepared.  Where has that money gone?  If an outbreak appeared in PNG or Indonesia or Timor, I have grave concerns.

During the announcement last week, Australia committed $4m to strengthening responses in our region which is very welcome.

The slow response is clearly because the government didn’t care to respond quicker but I do worry if it is because the government is not able to respond quicker.  And that scares me.

Q: What are the questions that should be asked about the Government’s awarding of the Ebola contract to Aspen Medical? What are some of the issues that should be explored short and long term around this initiative?

I personally don’t mind this.  What makes us think that the Australian government is well placed to send a military team to West Africa with the capability to act on the ground quickly?  Perhaps the emergency team in Darwin is not actually well prepared for this.

In that case, I would rather have a private company with experience on the ground (in Liberia, in war zones, in emergencies) running this rather than a bunch of bureaucrats who have shown themselves to be slow and ineffective in the face of crisis.  I would rather Aspen do this than DFAT frankly.

But it does make us question the government’s ability to act when something hits closer to home.

Q: What else should Australia be doing on Ebola, beyond this measure?

Ensuring that there is a government/military team ready for the influenza outbreak emanating from our region when we will not have the luxury of waiting around for the US, UK, China, Japan, Uganda, Cuba, France to act first.

  ***

Professor Stephen Leeder, University of Sydney, Editor-in-Chief, Medical Journal of Australia

Q: What is your assessment of the Australian Government’s response to the Ebola crisis in West Africa? What have been the factors involved/contributing to the response?

Limited and conservative but regrettably very similar to the ‘stop the boats’ philosophy and values.  Recruitment by Aspen of non-Australians to do the work is of a piece with all of this.  Disgusting while we send jets to bomb the IS.

Q: What are the questions that should be asked about the Government’s awarding of the Ebola contract to Aspen Medical? What are some of the issues that should be explored short and long term around this initiative?

You can ask questions but it is an essentially self-preserving attitude. Xenophobic fear of a case of Ebola afflicting an Aussie. Pay others to do the risky work.

Q: What else should Australia be doing on Ebola, beyond this measure?

More and thorough humanitarian response needed from this indecently wealthy and increasingly self-centred nation.

**

Dr Claire Hooker, Senior Lecturer, Medical Humanities, Centre for Values, Ethics and the Law in Medicine, University of Sydney

Q: What is your assessment of the Australian Government’s response to the Ebola crisis in West Africa? What have been the factors involved/contributing to the response?

The Australian government has shown no appreciation for the singular importance of swiftly controlling a disease at its source, both for the sake of preventing cases from arising locally, and as a moral responsibility. While other countries showed leadership in confronting the many logistical challenges and real risks associated with sending practical health care support, and followed the models developed by practice fieldworkers such as medicin sans frontiers, Australia’s response has been narrow minded, short sighted and cowardly.  It stands in poor contrast to the exposure of military personnel to risk in much more unproductive exercises such as Iraq.

I am not privy to government discussion but I perceive the response as primarily ideological, a failure to grasp the economic and social utilities of communal preventive action as a result of attending too much to the (real) concerns about exposing health workers to risk without being able to provide suitably secure treatment and care facilities.

Q: What else should Australia be doing on Ebola, beyond this measure?

I’d like to see Australia establish and secure long term funding for a network of scientists to study emerging zoonotic diseases with a view to developing treatments and vaccines, which can’t be left to companies since the profit motive is insufficient in these infrequent outbreak illnesses.

I’d like this to be multidisciplinary and to include an appreciation of the ecological and social conditions that enable viruses to flourish.  I’d like to see Australia more swiftly invest in a clear risk communication strategy that included disadvantaged social groups as a way of preventing too great a drain on local resources preparing for a disease with only a small chance of arriving here.

***

Alison Verhoeven, CEO, AHHA

Q: What is your assessment of the Australian Government’s response to the Ebola crisis in West Africa? What have been the factors involved/contributing to the response?

The AHHA welcomes the announcement by the Prime Minister and Health Minister of the expansion of Australia’s contribution to international efforts to address the Ebola crisis in West Africa. The decision to commit increased funds, technical capacity and staffing to the development and management of a 100-bed treatment centre is applauded.

The AHHA is also pleased that Australia will be contributing to the development of World Health Organisation regional response plan.

While the Government was regrettably slow to act, the announcements this week are a welcome change and commensurate with Australia’s international standing. The further injection of expertise into on-the-ground assistance will be a positive contribution to addressing this major humanitarian crisis.

Q: What are the questions that should be asked about the Government’s awarding of the Ebola contract to Aspen Medical? What are some of the issues that should be explored short and long term around this initiative?

While Aspen Medical may be well-placed to contribute to the response and we welcome their initiative and engagement, it is unfortunate that the Government has not deployed Ausmat teams and is continuing to avoid more direct assistance. It would be an unfortunate precedent for the Australian government to continue to outsource its leadership role to private partners – this could lead to a diminution of strategic engagement which would do Australia no credit internationally.

Q: What else should Australia be doing on Ebola, beyond this measure?

Australia should review its decision regarding restrictions for people travelling from Liberia and Sierra Leone, taking into account the advice from the WHO and other international expertise regarding the level of risk.

****

Dr Christine Walker, Chronic Illness Alliance

I think the Government’s response highlights the lack of preparedness of Australia to face any viral threats. As we know viruses are on the rise in terms of the different types and their levels of infectiousness.

The attitude is that they all happen ‘somewhere else’ and that Australia can shut down its borders to prevent them entering. It’s a hangover from the days when the cabins of planes were sprayed on arrival at an Australian airport.

We no longer have an infectious diseases hospital (which so far has been OK) but it also means we no longer have teams of qualified infectious diseases specialists. I’m aware we have people like Frank Bowden but I think we might have lost the critical mass. Sending people to work with Ebola would be an advantage to the education of Australian medical staff as well as of course being a social justice issue.

***

Dr Tim Senior, GP and Wonky Health columnist

I actually don’t mind contracting out to a corporate in principle, but it does seem odd if they don’t have the training or expertise, when there are Australian government teams that do.

I suppose the only other observation would be a general one that you exhibit your priorities in your choices, and the contrast in the eagerness to commit troops against ISIL for hostilities against the reluctance to commit anyone for humanitarian reasons speaks volumes. I wonder if the reduction in foreign aid from both governments has an impact on the ability of health systems to cope with Ebola, on top of all the other health problems experienced in those regions.

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