Download Control of communicable diseases in Australia - reflections

Infectious Diseases, 1967-72 Australia
• Many major epidemic diseases
– Vaccine preventable (or potentially preventable)
• diphtheria, pertussis, polio (measles, mumps, rubella,
hepatitis)
– Or treatable with antibiotics
• TB, bacterial meningitis, scarlet fever, pneumonia
Sir Macfarlane Burnet
David O White, 1972
p 263
“On the basis of what has happened in the last thirty years…….the
most likely forecast about the future of infectious disease is
that it will be very dull.
There may be some wholly unexpected emergence of a new
and dangerous infectious disease, but nothing of the sort has
marked the last fifty years”
1980s: HIV/AIDS in Australia:
an exemplary response?
•
•
•
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1981 – 1st cases USA
1982 – 1st case Australia
1984 - HIV identified; diagnostic tests
1984-5 Australia’s response:
• Community/activist organisations: support, education
• Collaboration with government, medical profession, media
• 1985 –National AIDS Strategy
– blood donor screening
– needle-exchange program
Neal Blewett
• 1986 – National Centre for HIV Epidemiology & Clinical
Research (NCHECR) established
Grim Reaper 1987
Condoman, 1987
People with AIDS
look like you - 1989
Communicable disease (CD) surveillance –
“the eyes of public health”
• 1989 – Communicable Disease Network Australia
• 1991 – National notifiable disease surveillance system
• 1996 – National CD surveillance strategy
– 1997 – Public Health Laboratory Network
• Laboratory notification and surveillance
– National Centres & Networks
• 1997 National Centre for Immunisation Research & Surveillance
(NCIRS) – incl. national seroepidemiology
• 2000 - OzFoodNet
Immunisation & VPD research in Australia
- basic, epidemiology, vaccine development
B
Burnet:
Marmion
u
Q fever, influenza
Q fever
r
1930s-60s
Bishop, Holmes et al
Rotavirus 1970s
Fenner
Smallpox
Burgess (Menser) Burrell
Congenital rubella Hepatitis B
1970s
Gust
Hepatitis A, 1980s
Frazer
Garland
HPV/cervical cancer, 1990s
Immunisation policy & practice, Australia
• 1993-7: National Immunisation Strategy
– “Immunise Australia” (Michael Woolridge)
– Aus Childhood Immunisation Register (ACIR)
– Aus Technical Advisory Group (ATAGI)
• 2000s: National Immunisation Program
– Funding agreements
Strategy + policy + surveillance/research + political will +
funding/infrastructure + coordination
= effective implementation + high uptake + low VPDs rates
Australia’s response to antimicrobial resistance
(AMR)
• 1999: Joint Expert Technical Advisory
Committee on Antibiotic Resistance (JETACAR)
– Chair: John Turnidge
Recommendations included:
• regulatory controls
• monitoring and surveillance
• infection prevention
• education
• research
Australia’s response to AMR
• 2000 – Government accepts 9/22 JETACAR recommendations
• 2000-12 - implementation groups, advisory committees
– Little progress
• 2011 – AMR Summit (ASID/ASA): urgent call for action
• 2012-3 Senate enquiry into JETACAR implementation
– ..report was too far ahead of its time..(so)..did not result in
policy change” (Lindsay Grayson)
– “….apparent lack of commitment to a response to AMR…..of
concern..”
Australian Commission on Safety & Quality in
Healthcare (ACSQHC; 2006)
• 2008-10
• Mandatory reporting of S.aureus BSI
• National Hand Hygiene Initiative
Chris Baggoley
2012: National Safety &
Quality in Healthcare
Standard 3
National Framework for CD Control 2014
1st National AMR Strategy 2015-19
• Problems:
– Fragmented responsibility – 7 States, Territories,
7 Commonwealth agencies; ACSQHC
– Uncoordinated – 60 joint committees, networks,
surveillance systems, national centres;
duplication
– 9 communicable disease-related NHMRC-CREs
– Deficiencies:
• skilled workforce; critical infrastructure; performance
measures & accountability
• Solutions:
– Better surveillance
– Infrastructure – information systems
– Leadership & governance
Past/current CD surveillance
• Laboratory notification
– cottage industry microbiology
– slow, insensitive, limited specificity, local
• Epidemiological
– slow, labour-intensive, retrospective
• Privacy protected by “information friction”
Future surveillance – new technology
• Outbreak detection/investigation based on:
– ED syndromic surveillance
– rapid “real-time” laboratory diagnosis & strain typing
• POCT; whole genome sequencing
– linked/integrated data sets
• laboratory, epidemiology, clinical (?EMR)
• pathogen-specific – local, national, international
– intelligent data data mining/analysis
• information for action – decision support
Implications of new surveillance technology
• Rapid detection, communication, response
– strain identification – sources, transmission, infection control
– antimicrobial susceptibility - targeted treatment,
– reduced morbidity, mortality, cost
BUT
• Intrusive (government) surveillance
– Private information – contacts, movements
– To be effective must be routine, universal
• Ethical implications – privacy; anxiety; workforce priorities
– Data sharing, deidentification; ownership, access, security
CD & AMR Control in Australia: Conclusions
• Still important & urgent….fragmented & unco-ordinated
• Plethora of recommendations; implementation?
• Disconnect:
– Jurisdictions; agencies
– community (public health)/hospital (quality & safety)/aged care
• High quality research
– emphasis on translation & sustainability
– infrastructure/funding deficiencies
– confusion between research (NHMRC) & policy (DoHA, DAFF)
• Q: Can technology provide solutions?
• A: Only with:
(1) sound ethical framework
(2) Public, media, politician education