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The Health Wrap: malaria, mental health workforce, science matters – and enjoy the birdsong

In her latest column, Adjunct Associate Professor Lesley Russell delves into why malaria is making the news, and sounds a caution about new, heavily promoted weight loss drugs.

The new National Mental Health Workforce Strategy 2022-2032 is said to provide a vision and roadmap for building a sustainable workforce, but Russell finds it “a disappointing” document that does not deliver on its promise.

The column brings exciting news about women in science, but also sounds the alarm about declining public trust in science in America, and the implications for policy and practice.

The quotable?

COVID vaccines have been the foot in the door for the more general anti-vaccine movement. And unfortunately, that door is open pretty wide now.”


Lesley Russell writes:

After a short break for a fall road trip through Colorado, Utah, Arizona and New Mexico (really splendid with some great hiking), The Health Wrap is back with lots of health news.


Malaria developments

For decades scientists have worked to find a vaccine against malaria. More than 100 clinical trials have been run in the last two decades; nearly all have failed. Now all that hard work has delivered success, with not one but two vaccines approved for use.

According to the latest World Health Organization World malaria report, there were 247 million cases of malaria  and an estimate 619,000 deaths in 2021. Africa has the highest malaria burden with about 95 percent of all cases and 96 percent of deaths. Children under five years of age account for about 80 percent of all malaria deaths in Africa.

In 2021, the WHO approved the first malaria vaccine, RTS,S/AS01 vaccine (Mosquirix), for widespread use. This vaccine was recommended for the immunisation of children in regions with moderate-to-high transmission of P. falciparum malaria (mainly sub-Saharan Africa).

This month the WHO approved a second vaccine, R21/Matrix-M, for the prevention of malaria in children. This vaccine is more effective and perhaps cheaper than the RTS,S vaccine.

“As a malaria researcher, I used to dream of the day we would have a safe and effective vaccine against malaria. Now we have two,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.

“Demand for the RTS,S vaccine far exceeds supply, so this second vaccine is a vital additional tool to protect more children faster, and to bring us closer to our vision of a malaria-free future.”

Experts heralded the announcement, but warned the vaccines were “no magic bullet” in the fight against malaria and that vaccination should be used in tandem with other measures, such as insecticide-treated nets and indoor spraying to prevent the disease.

Meanwhile, the climate crisis is widening the range of the mosquitos that spread it, while the parasite that causes malaria is increasingly developing resistance to drug-treatments.

Malaria was historically endemic in Australia but was declared eradicated from the country in 1981.

Although it is no longer endemic, approximately 700-800 cases occur each year in Australia in travellers who have been infected elsewhere. Due to climate change, northern parts of Australia such as the Torres Strait islands are at future risk.

In the United States, recent cases of malaria in southern states have raised concerns about future outbreaks there.

Other mosquito-borne diseases are also on the rise. In September, ABC News reported that last January’s record-breaking floods in the Kimberley region of Western Australia triggered an increase in mosquito-borne diseases such as Ross River, Barmah Forest and Murray Valley encephalitis.

The New York Times recently published a series on the international “war” against mosquitoes.

See the Twitter thread by NYT global health reporter Stephanie Nolen

Mosquitoes are a growing public health threat, reversing years of progress. Climate change and the rapid evolution of mosquitoes have helped drive up malaria deaths and brought dengue and other mosquito- borne diseases the places that never had to worry about them.

An invasive mosquito threatens catastrophe in Africa.  A malaria-carrying species that thrives in urban areas and resists all insecticides is causing outbreaks in places that have rarely faced the disease.

One village, two houses – and a new tactic to win the war on mosquitoes. Why does one family get malaria all the time and another almost never? A few fixes to homes can protect people from malaria and other dangerous diseases.

Insecticides can’t stop these mosquitoes. Now what?  Bed nets and insecticides don’t work well any more: mosquitoes have evolved to resist and evade them.

Unleashing a new weapon on the mosquito – a mosquito. You can’t kill all the mosquitoes, but what if you could disarm them? Even if you couldn’t keep them from biting people, what if you could block them from passing on disease? What if, in fact, you could use one infectious microbe to stop another?

See the article at The Conversation

Mental health workforce strategy

This month saw publication of the National Mental Health Workforce Strategy 2022-2032. It is described by the Department of Health and Aged Care website as providing “a vision and roadmap for building a sustainable workforce that is skilled, distributed and supported to deliver mental health treatment, care and support that meets current and future population needs”.

This is work that was long overdue: levels of unmet need for mental health services, especially among young Australians, have never been higher and workforce shortages are exacerbating the number of people who cannot access care.

The commitment to undertake this strategy was made in 2019, and work began in early 2020 under the previous Coalition Government, which appointed a National Mental Health Workforce Strategy Taskforce to work with the Department of Health and Aged Care and the National Mental Health Commission (NMHC) to jointly develop a 10-year National Mental Health Workforce Strategy. This is to operate in concordance with strategies developed by state and territory governments.

Examination of the timeframes, interim reports and the acknowledgement section of the final Strategy reveals (1) that there were considerable delays in developing the Strategy, and (2) that the final Strategy was apparently written within the Department and/or by ACIL Allen Consultancy.

It’s not clear what, if any, sign-off the Taskforce and the NHMC had on the final document (although there is an upfront message from the Taskforce co-chairs).

Chasing down the documents and research papers that were developed as part of the process has been an interesting exercise and I was unable to find some of them.

For the consideration of the taskforce, several research papers were developed:

Mental Health Workforce – Labour Market Analysis. This was produced in December 2020 by ACIL Allen Consulting but was not made publicly available until January 2023.

Mental Health Workforce – Educational Institutes Review. This was also produced in December 2020 by ACIL Allen Consulting and made publicly available in January 2023.

Literature review of existing workforce strategies. This was produced by the Institute for Social Science Research at the University of Queensland in July 2020 and was made publicly available in July 2021.

In 2020 the ISSR at the University of Queensland undertook an analysis of mental health workforce demand and supply measured against the National Mental Health Service Planning Framework (NMHSPF). I have not been able to find this document. There is some limited information about the analysis here.

A number of working groups were established to examine the following priority areas in greater detail:

  • Rural and remote workforce and service delivery
  • Aboriginal and Torres Strait Islander communities
  • Workforce training and education
  • Peer and lived experience
  • Inter-jurisdictional and inter-governmental workforce policies and strategies.

The working groups reported back to the taskforce in late 2020.

It’s worth noting that during 2021 a Parliamentary Select Committee on Mental Health and Suicide Prevention examined many of the issues around the mental health workforce. The Committee’s final report was issued in November 2021.

All of this work was done before the full impact of the coronavirus pandemic on mental health needs and services was felt.

On 24 December 2020, the taskforce provided the Australian Government with its initial recommendations, including priority actions. This document does not appear to be publicly available.

The Department of Health and Aged Care website indicates that “the National Mental Health Workforce Strategy – Consultation Draft and the associated Background Paper, were available for public consultation between 12 August 2021 and 30 September 2021. Feedback from public submissions informed the taskforce’s final advice and finalisation of the strategy”.

I have been able to locate a version of the Consultation Draft (dated August 2021) on the ACIL Allen Consulting website, and the Background Paper (also written by the consulting firm and also dated August 2021) is here. I have not been able to find any of the public submissions on the Department’s website although some of the organisations have made their submissions publicly available.

The Post-Consultation Draft Strategy was again produced by ACIL Allen Consulting and is dated December 2021. The Strategy timeline indicates that the final advice of the Taskforce was provided to the Government on 18 February 2022.  It was presumably this document.

In May 2022 the Labor Government was elected and there is no further information about how and where the Strategy was developed and who was consulted.

Of course, the most important thing is that the Strategy is truly strategic, recognises the current and future mental health needs of the nation, and then that it is fully and sustainably implemented and evaluated.

The important parts of the Strategy – the Implementation Roadmap and the Evaluation Plan – are yet to see the light of day. How long will this take?

I find the Strategy to be a disappointing document. It is very predictable in its findings and messaging and lacks specific details. The promised vision is simply not there. It reads like what it probably is – a document written by a consulting company for a bureaucracy that is simply not up to the task of health workforce planning. We can only hope that the Implementation Roadmap is better.

The Strategy rightly recognises that the mental health workforce is a poorly defined mix of those who work exclusively in the sector; those who frequently treat, care for or interact with mental health patients; those with lived experience; and those likely to have regular contact with people with mental health problems.

This makes issues of workforce planning and distribution, coordination, communication and funding very complicated. The Strategy has some fancy diagrams and a “conceptual framework” but does not effectively address how to turn these into reality.

For example, there is nothing new offered on how to expand and retain the workforce in rural and remote areas; how to improve the competitiveness and attractiveness of the public health sector for mental health professionals; and what evidence-based strategies are available for addressing workers’ stress and burnout.

The Strategy does state: “There is a need to introduce incentives, including enhanced payment structures to facilitate increased communication between professions and across disciplines” but is silent on how this might be done.

At the heart of this Strategy there is a ticking time bomb: the substantial shortfall in the mental health workforce and the inadequacy of current data to enable better future planning.

There is currently a 32 percent shortfall in mental health workers compared to the 2019 NMHSPF target (so presumably considerably more now). This is expected to grow to 42 percent by 2030 if current shortages are not addressed.

The largest gaps are for consumer and carer peer workers, psychologists and Indigenous Mental Health Workers. There are significant shortfalls in psychiatrists and psychologists in the primary care sector across all regions, especially in rural areas.

On releasing the Strategy, Health Minister Mark Butler re-announced mental health funding from the 2023-2024 Budget, including $91.3 million to address acute bottlenecks in the psychology training pipeline, and $17.8 million to upskill the broader health workforce in mental health.

Other funding commitments from previous Budgets:

2021-2022 Budget – $58.8 million over four years for growing and upskilling the mental health workforce and increase the number of Indigenous Mental Health Workers.

2022-2023 Budget (March) – $64.7 million over five years to implement the first stages of the 10-year mental health workforce strategy, including $28.6 million over three years from 2023-24 to increase the size of the psychiatry workforce through training posts, funding for supervisors, specific rural and remote initiatives and recruitment.

It’s not clear if and how these funds have been spent.


Women in science

The last few weeks have seen some great news for women in science.

First there was the news that the 2023 Nobel Prize in Physiology or Medicine – widely considered to be the highest accolade in modern healthcare – was shared by Adjunct Professor Katalin Kariko and Professor Drew Weissman for their discoveries concerning nucleoside base modifications that enabled the development of effective mRNA vaccines against COVID-19.

And then the announcement that Professor Michelle Simmons was awarded the Prime Minister’s Prize for Science.

And probably I should also note here that the Nobel Prize for Economic Sciences went to Professor Claudia Goldin for her work in providing the first comprehensive account of women’s earnings and labour market participation through the centuries. Her research reveals the causes of change, as well as the main sources of the remaining gender gap.

Professor Michelle Simmons works in an area where physics, engineering and communication technology intersect – topics not typically seen as “female” (although that is such a specious statement). In this field only five percent of researchers are women.

As Australian of the Year in 2018, Simmons worked to raise the profile of Australia’s push to be at the centre of the quantum computing world and she frequently spoke about the need for girls to pursue careers in science and technology.

She has stated that she is proud she has excelled in things that girls weren’t supposed to do when she was growing up, and attributes a lot of her drive to succeed down to the influence of her parents.

Simmons’ advice to young men and women reflects the many insights she has gained on her journey to the top: “Keep your sights high, defy others’ expectations, and be the creators, rather than just the users, of new technology.”

Watch her video talking about challenging expectations here. And tune in as Simmons delivers the 2023 ABC Boyer lectures, starting Sunday, October 22.

It’s interesting to compare and contrast the career paths of Simmons and Nobel Prize winner Katalin Kariko.

Kariko grew up and received her education in Hungary. In 1985, her lab lost its funding and she left Hungary for the United States and took up a post-doctoral position at Temple University in Pennsylvania.

The head of this lab reported her (inaccurately) as an illegal alien when she announced she had accepted another position.

In 1989 she was hired by the University of Pennsylvania as a non-tenured assistant professor. Here she eventually teamed up with Weissman, but they struggled to get interest in and funding for their work on mRNA. She was bounced from lab to lab and was eventually forced to leave.

So, in 2013, she left for Mainz, Germany, where she joined BioNTech, a little-known biotech firm specializing in RNA pharmaceuticals that has now made headlines around the world with a series of COVID-19 vaccines, developed in partnership with the drug company Pfizer.

Kariko’s career seems like an exercise in rejection. She says what kept her going was constant scientific progress, even if it wasn’t noticed or celebrated.

“I felt successful when others considered me unsuccessful because I was in full control of what I was doing,” she says.

For many women in science in Australia, Kariko’s story of struggling to survive in the research world will ring true. We need to hear more stories about their work and their successes  – even where that success is something less than a Nobel Prize or the Prime Minister’s Prize.

A study published in August in the Australian Journal of Education analysed the curriculum of the four year 11 and year 12 STEM subjects taught in Australian schools – biology, chemistry, physics and environmental science.

It found only one female scientist, British chemist Rosalind Franklin, was named in high school curriculums in Queensland, South Australia and the Northern Territory. All remaining states and territories failed to mention a single contribution of a woman in STEM.

This male-centric narrative is surely one contributor to the under-representation of girls and women in STEM.

The good news is – there is one female academic who is working hard to ensure recognition for unsung scientists.

Since 2017, when Dr Jess Wade, who works in the Department of Engineering at Imperial College in London, was in her late 20s, she has been campaigning tirelessly to raise the profile of female scientists and scientists of colour.

After realising that many notable women and men from minority backgrounds working in STEM did not have Wikipedia pages, though they were deserving of them, she decided to start them herself, one every day.

To date, she has contributed more than 2,000 entries. Follow her on X/Twitter – @jesswade.


Declining trust in science

A recent guest essay in The New York Times looked at why so many Americans are losing trust in science (although perhaps it should be why so many Americans have lost trust in science – so much damage has been done).

The essay starts with looking at the task Dr Mandy Cohen, the new Director of the Centers for Disease Control and Prevention, has ahead of her in terms of regaining the trust and respect of the organisation she leads. It’s an issue I’ve been following closely: Dr Cohen and I worked together in the Department of Health and Human Services during the Obama Administration.

For some time now public discourse has been rife with concerns about the status of expertise in political life. This is a particularly acute problem in the United States, intensifying since the rise of Donald Trump in 2016, but there is an echo chamber here in Australia.

I wrote about this in a chapter on Health and the Pandemic in my husband Bruce Wolpe’s recent book “Trump’s Australia”.

My chapter is part of a profusion of articles and books that bemoan what is variously described as an “attack on science,” the “death of expertise,” the “war on science,” or the “crisis of expertise”.

Many blame the ignorance or irrationality of Americans (and Australians) who ignore or actively oppose the recommendations of scientific, medical, and other technical experts and are increasingly susceptible to conspiracy theories.

But others argue this is not a general crisis, but a problem localised to certain demographics linked to political polarisation, anti-government sentiment, and manipulation by digital disinformation and demagogues.

A recent survey throws some light on these issues from the American perspective.

It found that trust in scientists has dropped precipitously over the past several years. In April 2020, 87 percent of Americans said they had a great deal or a fair amount of confidence in scientists, and 89 percent were confident in medical scientists. In 2023, only 69 percent of Americans have a great deal or some confidence in scientists, 75 percent have confidence in medical scientists but 29 percent of Americans have little to no confidence in scientists.

The survey found that public perspectives on science are strongly influenced by education, religious beliefs, and political orientation.

Americans with higher levels of formal education tend to express more confidence in scientists and have fewer doubts about mainstream scientific theories.

But this educational background is mediated by political and religious beliefs; college-educated Republicans express far greater doubts about climate science than similarly educated independents and Democrats.

How to get people to believe in science again. A discussion with the President of the US National Academy of Sciences and the Executive Director of the Nobel Foundation.

While Trump and his associates get a lot of the blame for this decline in trust, I can’t help wondering if it is a result of fear and helplessness in the face of what might seem impossible odds around international crisis issues like the pandemic and climate change.

I’ve never seen fear discussed as a factor, but it is used by public health experts as one way to drive behaviour change: perhaps less dramatic approaches would work better?

Back in 2018, Professor Simon Chapman wrote an interesting paper on the ethics of using fear in public health campaigns. And older readers will recall the huge discussions that the “Grim Reaper” ad provoked during the early days of the HIV/AIDS campaign. See “The Two Faces of Fear: A History of Hard-Hitting Public Health Campaigns Against Tobacco and AIDS.”

The US online political journal Politico recent ran a five-part series on the rise of the anti-vaccine movement in the United States and how the Biden Administration is struggling to address this. You can access the series here.

The anti-vax momentum has consequences well beyond COVID-19.

“COVID vaccines have been the foot in the door for the more general anti-vaccine movement. And unfortunately, that door is open pretty wide now,” said Dr Dave Gorski, a Michigan-based oncologist who has been tracking anti-vaccine efforts for two decades.

In the United States efforts to address misinformation and disinformation are stalling.

There is an escalating campaign — led by Representative Jim Jordan (the Republican from Ohio who is currently trying to be elected as Speaker of the House) and other Republicans in Congress and state government — that has  cast a pall over academic programs that study also the quality of medical information online. The politicians and associated activists are accusing them of colluding with tech companies to censor right-wing views.

The National Institutes of Health have frozen a US$150 million program intended to advance the communication of medical information, citing regulatory and legal threats.

There is a high-profile lawsuit, Missouri v. Biden, currently before the US Supreme Court, where the Biden administration seeks to have the court block a ruling from the US Court of Appeals for the 5th Circuit that found the White House, FBI and top federal health officials likely violated the First Amendment by improperly influencing tech companies’ decisions to remove or suppress posts on the coronavirus and the pandemic.

Read more about this case, which has ramifications beyond science communication, here.

One of the brave American scientists willing to speak out (and thus to cop some very nasty flak) is Professor Peter Hotez, who has used his public profile on social media platforms to combat misinformation about the COVID-19 pandemic and vaccines.

This month he was awarded the inaugural Infectious Diseases Society of America (IDSA) Anthony Fauci Courage in Leadership Award. The tweet below shows why this is well deserved.

Hotez’s latest book “The Deadly Rise of Anti-Science” has also just been released (also covered in this recent ICYMI column). See this X/Twitter thread for a series of reviews.

On 6 November at 5-6pm (US east coast time) Hotez will speak at the Walter Cronkite School of Journalism and Mass Communication on the alarming rise of medical misinformation and the anti-science movement. That’s 8am AEDT on 7 November if you are interested in joining.


New weight loss drugs

You can’t miss the endless media about the new weight loss drugs Ozempic, Wegovy and Mounjaro.

An article earlier this year in The New York Times started off this way:

“Every so often a drug comes along that has the potential to change the world. Medical specialists say the latest to offer that possibility are the new drugs that treat obesity – Ozempic, Wegovy, Mounjaro and more that may soon be coming onto the market.

It’s early, but nothing like these drugs has existed before.

“Game changers,” said Jonathan Engel, a historian of medicine and health care policy at Baruch College in New York.”

There’s a good description of the round-about research work that led to these drugs here.

But it’s not all good news.

Much about these drugs and how they work is shrouded in mystery.

Researchers discovered by accident that exposing the brain GLP-1 (a natural hormone that exquisitely regulates blood sugar levels) at levels never seen in nature elicited weight loss. They really don’t know why, or if the drugs may have any long-term side effects. The issue of side effects is particularly relevant because these drugs need to be taken long-term.

However, obesity itself is associated with a long list of grave medical problems, including diabetes, liver disease, heart disease, cancers, sleep apnea and joint pain, and mortality.

There has also been controversy around these drugs because they were originally approved for the treatment of diabetes.

See the Stat News Twitter thread

Now, thanks to promotions on social media and stories of celebrities using these drugs, the demand for weight loss is so great that production cannot keep pace, and many people who need these drugs for diabetes control struggle to get them.

These drugs raise the tantalising potential of helping millions of people lose weight, easing the dual epidemics of diabetes and obesity in countries like the United States and Australia.

See “Treating obesity: will new miracle drugs end the crisis?

While some think these drugs will end the current reliance on bariatric surgery, others see bariatric surgery as the continuing gold standard for the treatment of obesity and yet others see the two approaches working together.

In Australia, Professor John Dixon from Swinburne University says there are serious reasons why these drugs should be considered a “breakthrough” treatment for obesity. He says they offer an avenue for obesity to be treated as a genuine medical condition rather than a problem of patients’ own making.

Wegovy was approved by the TGA for use in the treatment of obesity in Australia in early 2022. However, due to demand in Europe and the United States, the manufacturer, Novo Nordisk, has yet to make the drug available for use here.

There is an ongoing shortage of Ozempic, the version of the drug approved for diabetes use. Likely some of this is due to off-label uses for obesity.

The main issue isn’t about when Wegovy will arrive, but rather when it will be added to the Pharmaceutical Benefits Scheme. To date, a weight loss drug has never been provided on the PBS.


The best of Croakey

In the sad and disheartening aftermath of the Indigenous Voice referendum, I urge you to turn to Croakey’s archives on the Uluru Statement and Indigenous health where you will find a raft of stories about the great things happening to improve health and wellbeing in Aboriginal and Torres Strait Islander communities.

It is important that in the days ahead we focus on the positive examples where community voices and expertise have made a difference, and speak out about how these examples might be further expanded and/or used as exemplars.

Here are some articles I recommend:


The good news story

Last week was Aussie Bird Count Week. As I enjoyed the bird life in my (very urban) back yard – Australian magpies, pied currawongs, rainbow lorikeets, noisy miners, and a kookaburra – I came across an article in The Washington Post about why birds and their songs are good for our mental health.

Research has consistently shown that more contact and interaction with nature is associated with better physical and mental health, and birds appear to be a specific source of these healing benefits.

A pair of Australian magpies in my backyard


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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