Prevention, we learnt from the 2017-18 Federal Budget, will be part of a ‘third wave’ of reform being planned by Health Minister Greg Hunt – possibly to be outlined in the next budget.
There’s been big disappointment catalogued in a series of articles at Croakey over the past week or so at the lack of preventative health measures in this year’s Budget, including to address climate change that will see, among other risks and effects, a greater range and prevalence of food, water and vector-borne diseases.
In the latest issue of JournalWatch, Dr Melissa Stoneham looks at research warning that Australia is grossly unprepared for its next pandemic — whether it comes through the emergence of new human pathogens or a bioengineered terror weapon.
Dr Melissa Stoneham writes:
As far back as 1950, directors were making movies about global epidemics. Set in New Orleans, Panic in the Streets tells the story of an Officer of the US Public Health Service and a police captain who have only a day or two in which to prevent an epidemic of pneumonic plague after it is determined that a waterfront homicide victim was an index case.
More recently, we have seen the release of movies such as Carriers, an apocalyptic tale of a viral pandemic that sweeps across the US and Contagion starring Gwyneth Paltrow, which features a worldwide epidemic as the Centres for Disease Control and Prevention (CDC) works to find a cure. All of these movies evoked some level of fear and panic – for me at least!
Movies aside, the experts say it’s not a matter of if, but when a global scale pandemic will wipe out millions of people. We have already seen signs with the Ebola outbreak in West Africa which was first reported in March 2014. When, on 13 January 2016, WHO finally declared all countries to be Ebola free, 11,315 deaths had been recorded. Closer to home, the swine flu outbreak in 2009 taught Australia a lot about managing outbreaks of infectious disease. By the end of that year, H1N1 had caused 191 deaths in Australia, with 681 people admitted to intensive care and a total of 37,642 cases.
So the question needs to be asked – is Australia prepared for the next pandemic?
An article in the recent Medical Journal of Australia investigates this question. Led by Professor Jodie McVernon from the University of Melbourne, the article discusses Australia’s preparedness for a pandemic in the light of the emergence of new human pathogens – including SARS, MERS, Ebola and most recently, the Zika virus.
Of course, there is also the grim potential for someone to bioengineer a deadly pathogen in the lab. The Gates Foundation have stated that advances in gene sequencing and gene-editing technologies are making such nightmare scenarios increasingly plausible. In the MJA article, McVernon further suggests that previously “controlled” diseases have re-emerged or expanded their range. Climate change, population growth and poor hygiene are some of the factors associated with this re-emergence.
McVernon and her colleagues state that Australia’s handling of the 2009 flu pandemic highlighted the need for more research and better coordination, and suggest that Australia is grossly unprepared for the next major outbreak.
Managing an outbreak is a complicated process involving many stakeholders. This is clearly articulated in the article and supported by documents such as the Australian Health Management Plan for pandemic influenza, which was re-released in 2014 and is a nationally agreed plan for flexible and scalable responses in the health sector.
Extensive engagement between public health experts, clinicians, diagnostic laboratory staff, general and at-risk communities and jurisdictional and federal agencies is needed, along with adequate and timely data, rapid communication and strong leadership. The case is made by McVernon that Australia needs to build its national epidemic capacities and should focus on the trilateral engagement between researchers, public health practitioners and policy makers in defining the research agenda.
The WHO has a research and development blueprint which draws on lessons learned from past responses to improve preparedness and reduce the time needed to make diagnostics, therapeutics and vaccines available, and is suggested as a key guideline for future research.
Other areas of focus suggested by McVernon include the identification of priority needs that are linked to training programs and ensuring that research activities and skills feed into ongoing policy and practice.
The development of ethical frameworks to support implementation of an emergency response, with clear emphasis on planning and engaging with key at risk populations, including Aboriginal and Torres Strait Islander peoples, is another recommendation.
Of course, given I work in the field of prevention, it would be remiss of me not to suggest that instead of allocating huge resources that ‘react’ to pandemics, funds must be earmarked to ‘prevent’ pandemics. This is well illustrated by remembering that it typically takes years, if not decades, to develop a vaccine or drug that will have public health impact. We only have to look at the countless billions that have been spent on trying to develop a vaccine for HIV, without success. Yet, some of the recommendations in this article will go some way towards achieving this prevention focus.
Given that infectious diseases are a continuing threat to global health, that we are unable to predict when the next pandemic will occur, and taking into account the well-known phrase that ‘if one fails to plan then one should plan to fail’, it seems imminently sensible that Australia seriously considers our preparedness for the next devastating pandemic — whether it be triggered by a mutated strain of an existing virus or a bioengineered terror weapon.
Article – McVernon, J., Sorrell, T.C., Firman, J., Murphy, B. & Lewin, R (2017). Is Australia prepared for the next pandemic? Medical Journal of Australia 206 (7): 284-6
The Public Health Advocacy Institute WA (PHAIWA) JournalWatch service reviews 10 key public health journals on a monthly basis, providing a précis of articles that highlight key public health and advocacy related findings, with an emphasis on findings that can be readily translated into policy or practice.
The Journals reviewed include:
Australian & New Zealand Journal of Public Health (ANZJPH)
Journal of Public Health Policy (JPHP)
Health Promotion Journal of Australia (HPJA)
Medical Journal of Australia (MJA)
Journal for Water Sanitation and Hygiene Development
Tobacco Control (TC)
American Journal of Public Health (AMJPH)
Health Promotion International (HPI)
American Journal of Preventive Medicine (AJPM)
These reviews are then emailed to all JournalWatch subscribers and are placed on the PHAIWA website. To subscribe click to Journal Watch click here.
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