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Growing drug resistance a national concern, new Chief Medical Officer says

Croakey readers may be interested in this interview with Chief Medical Officer Chris Baggoley, which appeared in The Conversation today………  

Emergency medicine specialist Chris Baggoley has been appointed Australia’s new Chief Medical Officer, after acting in the role since April.

The Chief Medical Officer works out of the Department of Health and Ageing and is responsible for health and medical research, public health, medical workforce, quality of care and evidence based medicine.

In this edited Q+A, Professor Baggoley, former chief executive of the Australian Commission on Safety and Quality in Health Care and Director of Emergency Medicine at the University of Adelaide, explains his policy priorities.


What do you see as the role of the Chief Medical Officer?

It is quite a varied role.

In relation to hospitals, primary care, to prevention, there’s a lot happening. As Chief Medical Officer, I want to keep the focus on what these changes mean for practicing clinicians and their patients and consumers generally.

I am referring to the changes with local hospital networks or local hospital districts. There has been, for some areas, a devolution of responsibility to these networks which provides opportunity for those delivering care to be more involved with the policy at their local level.

Lip service is often paid to patient-focused care but when you look at health delivery through the eyes of the patient or the consumer, it really opens things up.

The time is right to look at health delivery in a different way than maybe it has in the past and act on it. It still needs everyone embracing this.

The other roles of the Chief Medical Officer, of course, relate to preparedness for emergencies, be they infectious disease emergencies or natural disasters, whether they be they in Australia or internationally.

For me, what will be particularly important is to focus on the quality of health care. It needs every effort to be made to translate good policy into good practice and continually put that into the mainstream of thinking.

There are work force issues constantly and Health Workforce Australia has a major role leading that but I can have input. It relates not just not the numbers of doctors, nurses and allied health people but to their training.

Then there is the emerging area with the clinical issues of aged care, the impact of dementia. There’s an opportunity everywhere you look.

It’s your job to get the ear of government and ministers. How will you do that?

I see this role as being not only being a policy advisor but to be a translator.

Let me give an example. Firmly on the agenda now is the issue of health care associated infections. This is hardly new but what I have found in my many years working in health and emergency services is that I understood the messages and particularly those being sponsored by infectious diseases experts but the messages weren’t understood at a health policy level, at a political level.

That’s partly because if you sit down and listen to lectures given on such topics, after five minutes, many of us are lost.

I was Chief Medical Officer in South Australia between 2005 and 2007. What I found there is that (ministers and senior departmental executives) are bombarded with issues of importance and the message needs to be conveyed in a clear way and a quick way, in a way that has a health minister or a director general of a department say ‘That is important and you have given me a way forward.’

I see the role of a Chief Medical Officer as not only conveying issues of concern on a day-to-day basis but in a method and language that is instantly grasped. That’s the art of this role.

How good is your access to federal government ministers?

I have good access and (Health Minister Nicola Roxon), in particular, has regular meetings with the executive of the Department of Health and Ageing.

Where there are particular issues, I meet with her and her chief of staff and there’s a ready and free dialogue. If I have an issue I need to take to them, I have ready access.

I am getting better at walking the halls of parliament and not getting lost.

What’s your take on the state of medical research funding in Australia right now — is it in a healthy state or will you push for more secure funding?

I think in health, the question is: could we do more? I think we could do more in every aspect of health care.

Australia is committing around three quarters of a billion dollars a year for medical research, which is a significant amount of money. It’s based on a competitive approach and I think that provides the best outcome.

Those questions will be firmly addressed by the review of medical research which (Minister for Mental Health and Ageing, Mark Butler) has announced.

We know there are more applicants than research dollars available, so that’s always going to be a tension. As I understand it, the forward estimates for the (funding agency) National Health and Medical Research Council haven’t changed.

I think the opportunities that will arise out of this review will be most helpful.

What are your views on how we regulate chiropractors and alternative medicines?

I can’t profess to be an authority on chiropractic medicine but I know it’s a registered profession and that’s important. It’s important that anybody providing care to consumers has an evidentiary basis for what they are providing. The issue of alternative medicines and homeopathy is coming under increasing scrutiny, as it should, as any aspect of health care should.

What is the government doing to counter public perception of vaccines being unsafe for children?

The important thing is to make sure the vaccines are safe for children. It was the case last year in relation to Fluvax that the level of adverse events in children was higher than for other vaccines in children and than had been in previous years.

You have to pick up the signals and monitor them. You can’t assume that a vaccine is forever safe, you have to monitor what is happening.

John Horvath, the previous Chief Medical Officer, undertook a review of the whole system of monitoring adverse events and how we deal with them. I am chairing a steering committee which is implementing the recommendations for the review.

What we’d be looking at is to ensure the system of assessing for adverse events is robust and reliable and where there are adverse events, they can be acted upon.

The exact nature of that issue with Fluvax is still yet to be defined but it is accepted there is a problem. Hence, Fluvax is not recommended for children under five but there are other products which have not had a problem.

The downside is that vulnerable children may not be immunised because there are concerns that any vaccine in a child could be of concern or cause harm. So they don’t get vaccinated and then they get exposed.

This whole issue of immunisation is an increasingly difficult one. We are now moving to a generation who have not seen the effects of diseases that are vaccine preventable.

My mother had polio and was paralysed in her right arm all her life. Her great regret was that she became unwell in the 1951 epidemic, just before there was a polio vaccine. For her and my generation, vaccines were seen as marvellous advances able to remove disease that had been commonplace.

We are now in a different world and a different era. There are messages now being promulgated that can really be regarded as scaremongering and cause concern for people, particularly if they have not ever seen someone who does have measles or whooping cough or who has seen the devastating effects of influenza.

I am a strong believer that healthcare workers should be immunised against influenza and other diseases for patient safety. That’s something I’ll continue to pursue as an important patient safety initiative.

A drug-resistant strain of swine flu has been found in Newcastle. What measures have been taken to deal with this?

Yes, there is a cluster of patients that have been infected with the H1N1 strain in the Hunter New England region, detected between June and August this year. It’s 14% (of those cases) that tested resistant. It does seem to be just related to this area.

We are still talking to the patients and getting their exposure history and medications provided, so at this stage it’s a process of examining what this means.

None of the patients who have been involved have died and none have been admitted to intensive care.

The point about pandemic strains and drug resistance is just to highlight that antiviral medication is not the only weapon we have against H1N1. We do have a vaccine. Well, the best way to respond is not to get the flu in the first place, which is through a vaccine.

Antimicrobial resistance more generally is one of the issues I am very to keen to pursue in my role here. We need to use our antimicrobial surge judiciously. This is an issue of national concern.

The concern is that 2030 could be like 1930 in relation to antibiotics. There are very few antibiotics being produced at the moment because resistance emerges so quickly.

How concerned are you about Hendra virus?

It’s something I am paying close attention to. I keep in touch with my colleague the Chief Veterinary Officer. It’s a fascinating and worrying virus in many ways. We have been blessed by the fact we have not had a human case this year. I think this is attributed to better understanding by farmers of the infectivity of the virus. I understand it’s a stable virus, it hasn’t undergone any change.

We are keeping a close eye on this.

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