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The Health Wrap: Pandemic life expectancy, medicines policy and climate bullying in the Pacific

Introduction by Croakey: Deaths from COVID-19 – and resulting rates of life expectancy – vary dramatically across the world and are analysed in the latest edition of The Health Wrap.

Among many other issues, Associate Professor Lesley Russell also asks why we know so little about the review of National Medicines Policy, announced by Health Minister Greg Hunt more than two years ago.


Lesley Russell writes:

How the pandemic is affecting life expectancy is a topic I have looked at several times and I keep coming back to as new data reveals stark differences between countries.

A paper just out in the BMJ looks at the effects of the pandemic on life expectancy and premature mortality in 2020 in 37 countries (it does not include Australia but does include New Zealand).

Reduction in life expectancy in men and women was found in all the countries studied except New Zealand, Taiwan, and Norway, where there was a gain in life expectancy in 2020. There was no change in life expectancy in Denmark, Iceland, and South Korea. The highest reduction in life expectancy was observed in Russia, the United States, Bulgaria, Lithuania, Chile and Spain.

In terms of excess deaths, the highest rates were observed in Russia, Bulgaria, Lithuania, the United States, Poland and Hungary. More than 28 million excess years of life were lost in 2020 in 31 countries, with a higher rate in men than women.

Russia’s soaring death rate

Last week there was a new analysis of Russian data from John Burn-Murdoch and his colleagues at the Financial Times. This comes as Russia is facing a surge in coronavirus infections. On November 4, 2021, there were 40,217 reported new cases and a record 1,195 deaths.

Moscow’s shops, schools and restaurants are closed for two weeks in a bid to stop infections.

The FT analysis shows that, to the end of September, Russia has recorded 753,000 excess deaths during the coronavirus pandemic, one of the highest tolls in the world. Russia ranks second to the United States in terms of absolute number of excess deaths and third behind Peru and Bulgaria on a per capita basis.

This is considerably higher than the number of excess deaths calculated by Reuters, which found that, between April 2020 and September 2021, there were 632,000 more deaths in comparison with the average mortality rate in 2015-2019.

The actual number of COVID-19 deaths in Russia is a matter of conjecture. The Federal Service for State Statistics (Rosstat) estimates that 462,000 people had died of COVID-19 as at the end of September. The country’s interagency coronavirus taskforce, a body including ministers and other officials to coordinate the pandemic response, attributed 203,549 deaths to the disease at the end of September.

The agencies say they use different approaches to collect the data. The taskforce receives daily updates from hospitals on cases where COVID-19 was the primary cause of death; Rosstat gets monthly data from civil registries.

Russia’s soaring death rate is due to sluggish public health and vaccination campaigns. Russia was fast to develop and launch its Sputnik V vaccine which has been available since December 2020, but take-up has been slow due to apathy and distrust. Only about 42 million of Russia’s 146 million inhabitants have been fully vaccinated, a rate well below most European nations.

It’s no surprise then that life expectancy in Russia has plummeted. In 2020 it fell to 71.5 years, compared with 73.3 years in 2019. The Health Minister linked this to both the coronavirus and “negative demographic trends”.

The situation will not be helped by growing rates of HIV/AIDS. In 2018 – the last year for which precise figures are available – AIDS took the lives of 37,000 people across Russia, with the rate of new infections rising by between 10 and 15 percent a year, according to the World Health Organization.

There are more than one million people living with HIV in Russia, according to official figures, although the true figure could be as high as 1.5 million or about 1 per cent of the population. It is estimated there are 200 new infections a day and only a third of those with the virus are receiving antiretroviral therapy.

A recent report in The Australian (note: behind a paywall) highlights that a coalmining region in Siberia is now the centre of Russia’s spiralling HIV/AIDS epidemic with infection rates approaching those in sub-Saharan Africa.

Life expectancy in US falls by 18 months

In July the US Centers for Disease Control and Prevention issued a report that showed life expectancy in the United States fell by a year and a half in 2020 to 77.3 years, the lowest level since 2003, primarily due to the deaths caused by the COVID-19 pandemic.

Deaths from COVID-19 contributed to nearly three-quarters, or 74 percent, of the decline and drug overdoses were also a major contributor. Preliminary estimates are that US drug overdose deaths rose nearly 30 percent in 2020.

Australia so far shows success of control measures

Australia is one of the few countries bucking the global trend of excess deaths and decreasing life expectancy due to the pandemic.

Newly released figures from the Australian Bureau of Statistics show that a boy born in Australia between 2018 and 2020 can expect to live to 81.2 years – up from 80.9 years in 2017 to 2019 – and a girl to 85.3 years, up from 85 years.

Analysts say this reflects Australia’s comparative success in controlling COVID-19 and its strong healthcare system.

In 2020, just 0.6 percent of all deaths in Australia – 898 – were due to COVID-19, compared with 73,766 in the United Kingdom (12 percent, making it the leading cause of death) and 345,323 in the United States (10 percent, the third leading cause after heart disease and cancer).

There are several key issues that emerge from these analyses:

  • Most of this work was done in 2020, ahead of the emergence of the Delta SARS-CoV-2 strain so the results for 2021 will arguably be worse, certainly in those areas where vaccination rates are lagging.

Just last week the WHO warned that Europe is once again at the epicentre of the pandemic as cases soar across the continent. There are fears there could be half a million more deaths by February 2022 as winter approaches, the rate of vaccination slows and public health measures are relaxed.

  • The worst outcomes in terms of both life expectancy and excess deaths are mostly in countries in Eastern Europe and South America – and, of course, the United States. As yet there is no good data from Africa and the Middle East. But it does seem that what links all these countries is the failure to promulgate effective public health measures such as social distancing and mask wearing.

I wrote about this issue for Inside Story in 2020. You can read my article here.


Australia is a climate change bully

No-one I know is feeling very proud of the way Australia is emerging from COP26 and it seems the Federal Government cannot and will not be shamed, cajoled or goaded into meaningful action on climate change.

Now there’s an emerging story of how Australia has attempted to bully small Pacific Island nations, tried to dilute regional climate declarations, and “greenwashed” aid to these countries, claiming projects were addressing global warming when there was little or no link to climate change.

These claims are made in a Greenpeace report, Te Mana o te Moana: Pacific Climate Report 2021, released in August. The report finds that national emissions reduction pledges like Australia’s would lock in between 2 and 3 degrees of global heating, a level incompatible with life in the Pacific.

Pacific leaders quoted in the report said Australia had acted to dilute regional climate declarations, most notably at meetings of the Pacific Islands Forum (PIF). PIF members apparently discussed expelling Australia in 2015 because it was obstructing a consensus on limiting warming to 1.5 degrees Celsius.

Australia’s climate change diplomacy is described as “highly un-human”.

The report includes an analysis of projects that Australia told the OECD were either “significantly focused” or “principally focused” on helping the Pacific adapt to climate change. It found that “hundreds of millions of dollars in Australia’s aid budget have been counted as ‘climate adaptation’ aid despite those funds being allocated to projects with no link, or at best a tangential link, to climate change”.

In 2018 Prime Minister Scott Morrison pulled Australia out of the Green Climate Fund, set up by the United Nations to help developing nations adapt to climate change and cut emissions.

At COP26 last week, Morrison promised an extra $500 million over five years to help Pacific and south-east Asian countries “enhance climate resilience for future infrastructure investments, including roads, schools and bridges”.

But he rejected calls for Australia to rejoin the Green Climate Fund, saying: “We want to make sure that the climate finance investments that Australians are making are invested in our back yard, among our Pacific Island family and among our south-east Asian partners and friends.”

Clearly this is an issue to be monitored.


Integrated care – lessons from the NHS

As we head into the federal election, a number of groups I’m involved with are thinking about what should be on the agenda.

Croakey Health Media is busy planning and working with a range of partners for #AusVotesHealth. See this comprehensive Twitter thread on a recent webinar from public health student Sienna Crabbmor.

One of the things on my list is better integration across healthcare services. And, of course, one of the problems is that while everyone agrees on the concept, there’s confusion about what that means.

So I’ll go for this, from a 2016 paper: “… integrated care cannot be narrowly defined, but should be seen as an overarching term for a broad and multi-component set of ideas and principles that seek to better coordinate care around people’s needs.”

Three major national pilot programs for integrated care have been initiated within the UK National Health Service (NHS) since 2008: Integrated Care Pilots (ICPs), Integrated Care and Support Pioneers (Pioneers), and New Care Model Vanguards (Vanguards).

All three pilot programs shared similar high-level aims, such as breaking down perceived barriers between service providers, better coordination between hospital and community-based health services and between health and social care, improving the ‘user-centredness’ of care, and providing more services in a community setting.

In a paper just published in the International Journal of Integrated Care, the independent evaluators of these programs collaborated to compare and synthesise findings from their studies. It makes fascinating reading.

Here’s a brief summary of their findings, focusing on issues I think are key for Australian efforts in this area:

  • There was no obvious evidence that each program built on the experiences of its predecessor in terms of refining models of care. This may reflect the modern tendency within government to deliver policy change through disconnected projects rather than as an ongoing process of policy evolution.
  • There was a general expectation that integrated care would result in a reduction in the level of unplanned hospital admissions and the relative importance of other objectives, such as improving patient experience or clinical quality, was less prominent.
  • Sites in all the programs also found it easier to make progress when implementing relatively discrete interventions rather than complex, multi-factorial system changes.
  • Similar reported barriers to progress were identified in each of the three programs. For example, difficulties with sharing data between organisations was a common and significant problem, notwithstanding the fact that information technology was seen as a potential catalyst for integration. There was little evidence that the NHS did much to address such consistent and common barriers.
  • Securing and maintaining sufficient engagement of team members was commonly a problem, particularly in relation to GPs, whose activities were generally central to many integration efforts.
  • Well organised health services have greater ability to successfully access multiple pilot programs, thus benefiting from more financial support.

The paper has a long and very interesting discussion that says in summary:

  • All three national programs made some headway against their objectives but were limited in their impact on unplanned hospital admissions.
  • A lack of shared understanding of what “integrated care” means resulted in different practices and priorities and a mismatch in expectations between local and national actors.

National Medicines Policy shrouded in secrecy

Australia’s current National Medicines Policy (NMP), described as “a cooperative endeavour to bring about better health outcomes for all Australians, focusing especially on people’s access to, and wise use of, medicines”, was launched in 1999.

It’s finally about to be updated – or perhaps just “refreshed”. The need for an update was flagged by Professor Andrew Wilson, head of the Pharmaceutical Benefits Advisory Committee, back in 2017.

As usual with the Morrison Government, it is not a race and the timetable for the NMP review seems to be rather distorted.

The review was announced by Health Minister Greg Hunt in October 2019. The Terms of Reference for the review were released in August 2021.

A NMP Review workshop was held in January 2020 although the “themes” from this workshop were not released until August 2021, along with a discussion paper (I missed its release – did you?)

The period for submissions in response to the discussion paper closed on 8 October. Apparently, the consultation process is continuing through November into December.

It seems the Department of Health has said that submissions made to the review will not be made public. No explanation is provided for this lack of transparency. An organisation called Better Access Australia is collating some of the submissions on its website.

The discussion paper states that the review will also draw on the so-called Zimmerman inquiry. This is an inquiry by the House of Representatives Standing Committee on Health, Aged Care and Sport (chaired by Liberal MP Trent Zimmerman) into approval processes for new drugs and novel medical technologies in Australia that was established in August 2020. (So it’s also linked to the current Health Technology Assessment Policy and Methods review that’s part of the strategic agreement the Government recently signed with Medicines Australia. I wrote about this in The Health Wrap, September 28.)

The committee website states that it has completed its round of public hearings and is intending to report in the latter part of the year, but no date has been set for reporting.

All in all, this is a pretty unsatisfactory state of affairs for a review that is supposedly about delivering the best health outcomes for Australians.


HPV vaccination helping to eliminate cervical cancer

A UK study published last week in The Lancet shows how vaccination against human papillomavirus (HPV), which can cause cervical cancer, has led to plummeting rates of cervical cancer.

The study found that cervical cancer rates in women offered the vaccine between the ages of 12 and 13 (who are now in their 20s) were 87 percent lower than in an unvaccinated population. You can read more here.

In the future the impact of vaccination against HPV is likely to be even more pronounced. This study followed the outcome of the Cervarix vaccine, which became available in Britain in 2008 and covers two main cancer-causing HPV strains. A newer HPV vaccine, called Gardasil, protects against more strains of the cancer-causing virus, and the UK switched to that version in 2012.

Australia has been one of the leading countries in implementing public health programs for the prevention of HPV. It was among the first to introduce a National HPV Vaccination Program for girls and young women and subsequently the first to expand eligibility for government-funded universal vaccination to boys.

Since 2007 Australia has seen a 92 percent decline in the prevalence of infections of vaccine-targeted HPV types in females aged 18 to 35 years.

On 1 December 2017, Australia was the second country in the world to transition its successful National Cervical Screening Program from two-yearly Pap smears to five-yearly HPV tests with greater accuracy. As a result, Australia is well on track to eliminate cervical cancer by 2035.

Last November, the World Health Organisation (WHO) launched an effort to eliminate cervical cancer as a public health problem. The program set an ambitious goal for countries to vaccinate 90 percent of girls by 2030 and to have 70 percent of women screened for cervical cancer by age 35.

Every year more than 300,000 women die from cervical cancer, mainly in low- and middle-income countries; nearly all these deaths are preventable by vaccination. But as I pointed out in a recent article on vaccinating the world published in Inside Story, the cost of HPV vaccine is out of reach for many low-income countries.


In case you missed it

There’s always so much interesting new information to share, and never enough time or space, so here are some quick summaries:

A great science story

As he grew up and watched his father gradually decline with an unknown muscle wasting disease, Dr Sharif Tabebordbar vowed to solve the mystery and find a cure. His quest led him to a doctorate in developmental and regenerative biology, the most competitive ranks of academic medical research, and a discovery that could transform gene therapy — for nearly all muscle wasting diseases.

His research was just published in the journal Cell. It is beautifully summarised in an article in The New York Times.

A new way to look at Alzheimer’s disease

London cabbies’ brains are being studied for their navigating skills in the hope that this could help Alzheimer’s research.

Since 1865 London cabbies have been required to pass a difficult test known as “the Knowledge” to prove that they can navigate anywhere in London without a GPS. The series of exams — which take three to four years to complete — have been hailed as possibly the most difficult memorisation test in the world.

A 2000 study showed that learning the Knowledge causes positive changes in a taxi driver’s brain. Now a project called Taxi Brains is underway at University College London to study the brains of London cabbies as they map out taxi routes while undergoing MRI scans.

The hippocampus area of the brain (which plays an important role in learning and memory) may hold some clues. This region appears to grow larger the longer the taxi drivers are on the job, and is known to shrink in people with Alzheimer’s disease.

Mapping vaccine production for future pandemics

An article on the website of the Coalition for Epidemic Preparedness Innovations (CEPI) describes the first studies to map vaccine production efforts internationally. The full survey data is here.

As the pandemic has highlighted, few nations currently have the end-to-end capacity to translate basic research into vaccine products that are tested and manufactured on a large scale (Australia is one of the lucky countries that can do this).

This means many regions are dependent on the willingness of a few nations to sell and ship vaccines – and we are currently seeing what this means for COVID-19 vaccines.

You can read more here about how rich countries have dragged their feet on promises to help less well-off countries with vaccines, and what is being done to address this.

CEPI now has data from more than 95 vaccine manufacturers, global health organisations, research and veterinary institutes, and government agencies from 37 countries across Africa, South-East Asia and the Western Pacific, the Middle East, Latin America and the Caribbean.

Currently only South-East Asia/ Western Pacific has established capabilities to translate vaccines from R&D through to manufacture and supplied products.

The information collected will be used by CEPI to drive efforts to establish, improve, or expand vaccine production efforts in these regions to improve preparedness for future epidemics and/or pandemics.

Turning patient engagement into the new normal

The authors of this paper just published in the BMJ reflect on how COVID-19 has impacted on patient participation in policy and decision-making in The Netherlands and highlight the importance of “nothing about us without us”, especially in times of crisis.

Like integrated care (as discussed above), “patient centred” and “patient engagement” have become almost ubiquitous terms in health policy – but what do they mean?

I found this interview, done for Cochrane UK several years ago, useful and thought-provoking.


Croakey impact

Croakey Conference News Service reports on Aboriginal and Torres Strait Islander communities on the frontline of the climate emergency were an important complement to COP26 coverage.

You can read the story here from a recent virtual roundtable hosted by the Lowitja Institute in partnership with the National Health Leadership Forum and the Climate and Health Alliance, and another on the recommendations to emerge from the roundtable for Lowitja Institute’s discussion paper on Climate Change and Aboriginal and Torres Strait Islander Health:

 Listen to the CroakeyVOICES podcast featuring interviews with participants from the roundtable.


The good news story

It’s hard to believe but this is a good news story about hospital food!

I loved this story about how a donation plan at one Alaskan hospital means First Nations patients are able to eat their traditional foods as they recover.

These foods offer not just nourishment but also many layers of cultural connection.

You can read more about the Traditional Native Food Initiative here.


Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.

Previous editions of The Health Wrap can be read here.

 

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