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The Health Wrap: pandemic accountability, youth health, reform lessons – and our favourite trees and mammals

Addressing the mental health and wellbeing of Australian youth must be high on the agenda for the Albanese Government, including through the Strengthening Medicare Taskforce, writes Adjunct Associate Professor Lesley Russell in her latest column.

The Health Wrap also looks at what can be learnt from health reform in Aotearoa/New Zealand, the COVID vaccine rollout in Australia, and the risks that climate change presents for the spread of the Zika virus. Also, competitions about our favourite trees and mammals are about so much more than the winners and losers.


Lesley Russell writes:

We have had days of endlessly shocking news about how former Prime Minister Scott Morrison undermined the principles of responsible and ethical government and still the news keeps coming.

Morrison took on joint responsibility for Health quite early in the pandemic, in March 2020, so now we must wonder what his role was in the sad litany of Australia’s early vaccine roll-out.

Yet to be analysed and understood are the impacts that Morrison’s hidden role as Minister for Health had on Australia’s response to the pandemic and specifically on the vaccine rollout. But an article by Samantha Maiden for News.com.au has kicked this off – she details how Operation COVID Shield co-ordinator Lieutenant General John Frewen struggled to report to both Morrison and Health Minister Greg Hunt.

As Professor Kathy Eagar sagely tweeted:

We had 3 Ministers, a Taskforce, a Secretary & a CMO plus all of their divisions, sections, branches etc of public servants & defence personnel all with the job of vaccinating vulnerable people as an urgent priority. What could possibly go wrong? And who is accountable now?”

Earlier this month the Australian National Audit Office (ANAO) released its audit of the distribution and delivery of COVID-19 vaccines by the Department of Health and Aged Care (DoH).

It also illustrated, amongst other things, the complexity of Frewen’s reporting lines.

The report concludes that the planning and implementation of the COVID-19 vaccine rollout was partly effective, becoming more effective over time, but there were some damning criticisms behind this conclusion.

These included:

  • The planning and implementation of the vaccine roll-out to priority groups (for example, people aged care and Aboriginal and Torres Strait Islander people) was not effective.
  • Initial planning efforts were not timely; detailed planning with the States and Territories was not completed before the rollout commenced.
  • DoH under-estimated the complexity of administering services to the aged care and disability sectors.
  • Targets for the rollout (both dates and numbers of people vaccinated) were not incorporated into planning until a later stage and early targets were missed.

ANAO recommended that DoH conduct a “comprehensive review” of the rollout by the end of this year, including recommendations to the Federal Government “about opportunities for improvement in the event of a future vaccination rollout”.

In its response to the audit, the DoH indicated that this review would likely be a part of the Albanese government’s planned inquiry into the pandemic response, the timing of which is “still to be agreed by government”.

You can read more in this article in the Sydney Morning Herald and this article in The Mandarin.

In an article for Pearls and Irritations, my Croakey colleague Charles Maskell-Knight sees the ANAO report as giving DoH a C-minus grade on the vaccine roll-out. He argues that the examination of the vaccine roll-out, in particular that for aged care, should go beyond the ANAO focus on policy implementation to a review of policy selection.
Back in January, before he was elected, Albanese was asked about an inquiry into the management of the pandemic at a speech at the National Press Club. He said then it was “beyond doubt that you will need an assessment” and indicated that Labor had considered a Royal Commission.

A recent opinion piece in the Sydney Morning Herald goes some way to outlining what an inquiry might encompass and what form it might take.

Professor Stephen Duckett has just published a very useful and comprehensive (and peer reviewed)  analysis of Australia’s public health management of the COVID-19 pandemic that will surely help drive the Government’s planned inquiry.

Duckett’s analysis looks at four health-related responsibilities of the Commonwealth Government during the pandemic (to provide national leadership; to manage external borders; to protect residents of residential aged care facilities; and to approve, procure and roll-out tests and vaccines) and the State Governments’ responsibilities (determining what public health measures are appropriate and implementing them; managing the hospital response).

He succinctly describes his analysis as discussing “why [the national government’s response] has attracted a thesaurus of negative adjectives”.

In an interview for The Mandarin, Duckett talked about the enormous pressures facing the healthcare system and the need to rebuild its capacity. I was pleased to see his advocacy for a health workforce planning agency.


COVID neurological risks

Several recent articles (see for example here and here) have outlined how Australia needs to prepare for a “tsunami” of Long COVID.

Now, to heighten the concerns about the long-term impact of infection with the SARS-CoV-2 virus, a study from researchers at the University of Oxford, published in The Lancet, shows the emergence of significant neuropsychiatric sequelae (dementia, epilepsy, psychosis and cognitive deficit or brain fog) in individuals that had COVID-19.

Adults appeared to be at particular risk of lasting brain fog, a common complaint among coronavirus survivors.

Some of the effects seen were fairly small – for example, it found that 4.5 percent of older people developed dementia in the two years after infection, compared with 3.3 percent of the control group – but the authors argue that the size of the study makes this 1.2-point increase in a diagnosis as damaging as dementia “worrisome”.

This research links in with that published earlier this year in Nature Communications from researchers at La Trobe University. They found indications that some of the neurological symptoms in long COVID are caused by amyloid clumps appearing in the brain that are similar to those that cause Alzheimer’s Disease and dementia.

American doctor, Eric Topol is always a good source of information on COVID-19 issues (you can follow him on Twitter @EricTopol). His recent opinion piece in the Los Angeles Times is a great summary of where things stand with Long-COVID research and treatments.

(See also more on these issues in the latest ICYMI column, including discussion about The Lancet article).


Concerns about youth mental health

The National Mental Health Survey revealed the annual prevalence of mental ill health in 16 to 24-year-old Australians had surged from 26 per cent in 2007 to 39 per cent in 2020-21 — an unprecedented increase of 50 percent in 15 years.

These rates of mental illness are double the level of the rest of the Australian adult population.

A survey conducted early in 2022 found one in four young Australians aged 16 to 24 years had thought about suicide over the past two years and 15 percent had attempted self-harm. Eighty-two percent of those surveyed said they had experienced mental health issues during COVID-19.

The prevalence of symptoms across the mental ill health spectrum has risen sharply in the past decade, even before COVID-19, and particularly in young women.

These statistics have provoked much discussion (including at Croakey, see here and here) but – to date – little meaningful action.

While there are programs designed specifically to address youth mental health it’s a case of all the eggs (not very many) in one small basket – just 164 communities will have headspace programs. A serious lack of access to services means too many young people go without proper support of treatment.

Other countries are also experiencing burgeoning youth mental health problems.

In a a nationwide survey in the United States, 44 percent of high school students said they feel “persistently sad or hopeless.” Even before the COVID-19 pandemic, suicide rates jumped 57 percent  among kids and young adults ages 10 to 24, and have only worsened in some states since.

Dr Vivek Murthy, the US Surgeon General, says he is gravely concerned about the “unprecedented” obstacles facing young people – from climate change and racism, to the “culture of comparison” embraced by social media.

Speaking at a seminar on the State of Youth Mental Health held earlier this month, he said that he worried about children who are struggling in silence.

In Australia, the Children’s Commissioner, Anne Hollonds has talked about how addressing  children’s mental health is more complex than blaming social media and requires investment in social housing and supports through schools.

Addressing the mental health and wellbeing of Australian youth must clearly be high on the agenda for the Albanese Government, and a facet of the current work of the Strengthening Medicare Taskforce.

It will require the best efforts of all the healthcare professionals who make up the mental health team.

To quote Hollonds: “You just have to ask how bad does it have to get before we recognise that we need to make children a national policy priority?”


Health reform lessons from Aotearoa/New Zealand

Back in April 2021, it was announced that New Zealand’s district health board system would be replaced with three new entities – Health New Zealand, the Māori Health Authority, and the Public Health Authority. The latter (a directorate of the Health Ministry) would be tasked with centralising the provision of public health services in New Zealand.

Legisla