The Health Wrap: Australia bans vaginal mesh implants; Meningococcal vaccine; Action plan for endometriosis

Megan Howe
Sax Institute Communications team
Friday, December 15, 2017

The Health Wrap, Women's health, Infectious diseases, TGA, Public health

In May 2013, the first edition of The Health Wrap was published at Croakey as a pro bono service to our readers from Kellie Bisset, who was then communications director at the Sax Institute.

Since then, others from the Sax’s communications team have also contributed to the fortnightly column, providing a round-up of local, national and global health news.

Due to recent staff changes at the Sax, the column below is the final edition of The Health Wrap for the foreseeable future. Our warm thanks to all who have contributed to this service over the past four-and-a-half years.

In the edition below, the Sax Institute communications team takes a look at the media coverage of three of the top public health stories making headlines over the past fortnight.

Australia bans vaginal mesh implants

As reported right across the media, the Australian Therapeutic Goods Administration (TGA) announced that it will ban controversial vaginal mesh implants used to treat pelvic organ prolapse from the beginning of 2018. The ban comes in the wake of a review of the latest published international studies and an examination of the clinical evidence here in Australia.

Vaginal mesh implants have been used to treat common problems after pregnancy, birth and hysterectomies for several years. But many women who were fitted with the implants have been left in terrible pain and with chronic infections. In a press release accompanying the decision, the TGA stated that it “is of the belief that the benefits of using transvaginal mesh products in the treatment of pelvic organ prolapse do not outweigh the risks these products pose to patients”.

While the clinical evidence and international studies may have tipped the balance for the TGA, it was thanks to the determined and vocal campaigning by many women seriously impacted by these vaginal mesh implants that a review was conducted in the first place. Many courageous women shared their personal and very painful stories through the media, including Jan Maessen, who told the ABC that her life has been destroyed by what she was told was “a simple operation”:

I’m angry at the medical profession for not explaining to me how this would impact my life… I can’t lift my two-year-old grandson or sit and play with him the way I would like to… The doctors were telling me it was due to age or previous surgeries or scar tissue, but now I know it’s not…This device, this mesh impacts your life so much that it needs more thought into before anyone has it.”

Campaigner Gai Thompson told the Sydney Morning Herald her life had become a “living nightmare” after surgery in February 2008. The same article reported that “More than 40 mesh devices were cleared for use by Australia’s peak health regulator, the TGA, without clinical evidence of safety and efficacy, and despite strong warnings from three Australian specialists as early as 2003”.

The issue is far from finished, however. Some devices will still be available under a special access scheme, and this has been labelled “disappointing” by Health Issues Centre CEO Danny Vadasz. The Guardian also reported that more than 700 Australian women have launched a Federal Court class action against medical giant Johnson & Johnson over the implants, with a decision expected to be handed down in 2018.

Of course, the problems surrounding transvaginal mesh implants aren’t limited to Australia. The Guardian reports that the UK health watchdog NICE is expected to recommend that vaginal mesh operations should be banned from treating organ prolapse in England and this article in Newsweek questions whether the US might be the next to ban the products. However, not everyone agrees, with the BBC reporting a warning from the Royal College of Obstetricians and Gynaecologists that “banning vaginal mesh implants would remove an important treatment for some women suffering from a prolapse” and it would be “retrograde step”.

And in breaking news, across the ditch the New Zealand Government have announced what amounts to a total ban on transvaginal mesh implants for all procedures, and not only for organ prolapse. The Guardian reports NZ Ministry of Health spokeperson Stewart Jessamine telling a New Zealand radio station that, “We’re always cautious about the use of the word ‘ban’, but effectively the companies are agreeing no longer to sell these products … in New Zealand from the 4th of January.” While the ban is being welcomed by campaigners, some medical professionals are highlighting potential consequences. Christchurch urologist and spokesman for the Urological Society of Australia and New Zealand Giovanni Losco commented:

This makes New Zealand the only country in the world to have banned all of these procedures and will leave women without effective surgical options for these debilitating conditions.”

Meningococcal vaccine rollouts

Meningococcal disease has wreaked havoc across Australia this year, leaving a tragic trail of death and injury from Western Australia through the Northern Territory to the East Coast. As this explainer in the Conversation sets out, meningococcal disease is a “rare but very serious infection that can lead to blood poisoning (septicaemia) and/or brain infection (meningitis)”.

According to the ABC, at least 10 people have died from meningococcal disease in 2017, with the potent “W” strain being particularly dangerous. There has been increased incidence of this strain since 2013 and it accounted for almost half of all cases of the disease last year, according to statistics from the NCIRS.

To help combat this deadly disease, campaigners and public health officials are calling for an expanded vaccination program covering more strains of the disease. The West Australian reports that former WA health minister John Day is backing a campaign to convince the Federal Government to fund a vaccine that will protect children and teenagers against the A, C, W and Y strains of meningococcal disease:

We really need to have national action on this, especially as the incidence is continuing to increase and we’re seeing some catastrophic consequences, including five deaths in WA which are really tragic outcomes.”

There is welcome news in the Northern Territory, however, with all 12 month-old babies across the NT being offered the vaccine that covers four strains of meningococcal free of charge, according to a report from News.com.au.

This Australian-first campaign comes in the wake of a deadly outbreak of meningococcal disease across central Australia and will see the Territory Labor Government replace the existing C-strain vaccine with the ACWY-vaccine. News.com reports that all those who contracted meningococcal W this year have been Aboriginal, with the majority children aged 10 or younger. NT Health Minister Natasha Fyles said it was important to not only have the vaccination on hand, but to also recognise the symptoms of the disease:

Meningococcal disease can be very severe. People infected with it can become extremely unwell within hours of the first symptoms appearing… meningococcal W disease can present more broadly than just as meningitis or blood poisoning with symptoms including pneumonia or septic joint presentations.”

And in further welcome vaccination news, homosexual men in Victoria are to be offered free meningococcal vaccinations after an outbreak of the C-strain in that state. According to SBS, eight cases have been identified across Melbourne since May, almost all in gay and bisexual men, prompting the targeted vaccination campaign.

National endometriosis action plan

The Federal Government has announced the first national endometriosis action plan, with an announcement by Minister for Health Greg Hunt coming after years of campaigning by women to have the medical condition taken seriously.

Endometriosis is a condition in which tissue similar to that which normally lines the uterus, grows outside the uterus causing inflammation and debilitating pain. The Guardian has a helpful explainer here.

One in 10 Australian women are believed to have endometriosis, but a lack of awareness has meant doctors often struggle to identify it, research is scarce, and thousands of women are suffering in silence with their complaints too often dismissed as “bad period pain”.

For many women, the pain can be unbearable. Tara Smith suffers so badly that she can require hospitalisations and morphine to deal with an attack. She told the Sydney Morning Herald that:

Some days it’s like an intense period pain, but when it’s bad, it’s like someone’s wrapped up all my abdominal organs in barbed wire and are pulling on it tightly…It’s a very stabbing, horrible pain.”

The Guardian reports that at the announcement of the action plan, Minister Hunt took the remarkable step of apologising to women who have suffered for so long, without support or recognition from the health services.

A targeted call for endometriosis research will be issued under the Medical Research Future Fund and the government will provide $160,000 in immediate funding to Prof Grant Montgomery to continue his work using genomics to investigate better treatments for women with endometriosis.

For Sylvia Freedman, the founder of EndoActive Australia & NZ, Minster Hunt’s announcement was a “pinch-yourself moment”. Writing in the Guardian (in a piece that is well worth reading in full) she speaks about the long struggle for recognition by women with endometriosis:

In my shift from patient to activist, I’ve struggled to comprehend why endometriosis – a chronic disease which is such a burden to women, and the Australian economy, is so poorly understood. Endo affects at least one in 10 women.

The prevalence is incredibly high and the cost is enormous.

Why then is there no mention of endometriosis, or even menstruation, in the Australian high school syllabus, no clinical guidelines, no public awareness campaigns, a seven to 12 year diagnostic delay, a woeful lack of funding and hardly a mention of endometriosis on the health department own website?…

To spend years living in chronic pain with no diagnosis, being labelled drug seekers, losing jobs, enduring repeated surgeries and not being believed, suddenly here we are in Parliament House. Our voices are finally being heard.”