Addressing the threat of pandemics

Over the last year our world has been torn apart by the coronavirus outbreak. If nothing else coronavirus brings to the fore how poorly we are adapted to dealing with epidemic and pandemic outbreaks of infectious disease and raises a wide range of issues that we need to address.

There is without any doubt an urgent need to enhance global capacity for surveillance of, and response to, epidemic and pandemic outbreaks. Relying on the WHO to identify and publicise a new pandemic has its problems as the Ebola outbreak some years ago in Africa identified.

What we need is a better international and national surveillance system involving global watch and response to animal and human infections. As far as Australia is concerned we most definitely need a better national public health system with the ability and capacity to respond quickly and efficiently to infectious disease crises whether natural or deliberate.

This involves state and federal cooperation at all levels, something that has been lacking for most of Australia's history. An important part of this is to develop an inter-disciplinary holistic approach to confronting infectious disease particularly providing a full understanding not only as to how infections spread and infect people but also how people respond and evaluate risk in their lives.

A critical part of this is to develop a much better national disease reporting system characterised by surveillance and timely reporting as well as with better prevention and control measures.

Currently States like NSW rely on a handful of rural GPs to report such things. We desperately need a national disease surveillance and reporting system that monitors disease in animals as well as in humans something akin to a "Neighbourhood Watch" involving a network of GPS, Vets, Laboratories and Hospitals.

It remains critical for us to fully appreciate the linkages between animal and human diseases and the ability of the microbial world to adopt animal hosts and settle in with their lifestyle and environment. We also need to understand how people react and respond when faced by such crises.

In addition, we need a system that educates and produces trained public health practitioners specifically for the identification of microbial threats and the understanding of human behaviour.

An important part of all this is also the ability to develop vaccines and organise efficient and timely delivery to those at risk. There is little doubt that over the last 20 years we have been hindered by a widespread complacency towards infectious disease marked by over confidence in existing antibiotics and a belief that major outbreaks of infectious disease was something attached to our past.

Raising public consciousness and awareness to the resilience and importance of the natural environment and the microbial world is also critical. An important part of this is developing and maintaining concord between the public and public health practitioners and to raise the public's knowledge of how infections are permanently maintained in animal reservoirs and can occasionally spread to involve humans.

We need to develop a system where full details of any infectious disease threat are communicated and made clear to the public as well as engage the public and work effectively with them recognising that all people are entitled to make decisions about issues that directly affect their own lives. Importantly we also need to address denials and apathy where people take refuge in a "don't know", "don't want to know", "not on our worry agenda" or refuse to consider vaccination strategies.

A part of this is a widespread belief "that the Government will protect me" and that I need to do nothing. It is important for the Government to recognise that people react emotionally to epidemic and pandemic outbreaks and that managing fear is very important. Simply telling people not to be frightened over something that seems to be threating life is as good as encouraging disinterest and denial.

Confronting scepticism is also very important. It is part of human nature when presented with a new threatening risk to mistrust the source or the messenger. The belief that "the Government will protect us" is a good example. We also need to fully understand that many of the control measures advanced by governments during infectious disease crises can contribute to fear and public reaction leading to depression, isolation, avoidance and social distancing as well as the search for scapegoats or someone to blame.

In some ways Governments believe that a certain amount of fear might be useful in encouraging people to adopt personal avoidance and take precautions. But unfortunately, Governments and public health practitioners seem to understand little about how fear is transmitted and nurtured and how it plays an important role in ordinary people's lives. Fear is related to personal concepts of risk and is greatly influenced by the people around us – family, neighbours and other members of the local community.

As coronavirus and Australian history demonstrates there is a critical need to ensure cooperation at all levels of Government. Australian history is simply littered with example of States breaking off from the Commonwealth and going their own way during epidemic and pandemic outbreaks. Are we any closer to developing such cooperation or for that matter achieving some of the issues raised above? I am beginning to doubt it.