Over the last 40 years, the world has witnessed a seemingly endless parade of new infectious diseases. Today, the outlook remains bleak. HIV-AIDS continues to wreak havoc in sub-Saharan Africa. Elsewhere, bioterrorism is emerging as a potential threat, increasing antibiotic resistance among many diseases with little international interest in developing new antibiotic drugs. There is also the emergence of a whole range of new zoonotic infections with implications for human health. There seems little doubt that despite the considerable medical and technological advances of the last half century, infectious disease will continue to play an important role in world events over the next few decades.
Many now argue the influenza pandemic clock is ticking and it is only a matter of time before another pandemic is launched upon an unprepared world. Certainly it would appear the world is long overdue for such an occurrence and currently the bird flu virus seems to have established a permanent niche among tens of millions of wild and domesticated birds throughout Asia. As this virus changes and spreads to infect more hosts, and as resistance grows to existing antiviral drugs, some argue it is only a matter of time before the virus encounters the human flu virus, and transforms into a deadly new infection, capable of transmission from person to person. If this happens, the world may be confronting a new pandemic of human flu with potentially catastrophic implications for human health and wellbeing.
Given all this, how well-prepared are we in Australia to confront such a circumstance? In the case of SARS and influenza, the commonwealth and states have prepared management plans which lay down a basic traditional response to epidemic containment and management. Much of this has been debated in the public arena over the last few months. What I wish to advance here is a set of key pandemic response principles, essential for any Australian government confronting outbreaks of infectious disease in the 21st century.
In the first place, Australia needs to enhance its capacity for the surveillance of animal and human diseases both at home and abroad. We need an efficient, effective and centralised global and national neighbourhood watch system which keeps tabs on potential infections and evaluates their possible impact on the Australian population.
Such a system should provide an early warning and should view animal diseases here and abroad as sentinel outposts for possible human outbreaks. Nationally, there is a pressing need for a single, centralised infectious disease surveillance network built on a substantial network of reporting GPs, laboratories, hospitals and vets, widely distributed across all states and territories. An important part of this would be a fast and secure internet link between health providers and public health authorities.
Only with such a system would we get the sort of neighbourhood disease watch we really require. The present disease surveillance systems in Australia are all state or territory based and are reliant on a very restricted range of reporting doctors, laboratories and hospitals. In addition, animal infections are not included in the human surveillance network. Perhaps we also need to explore new systems of disease surveillance, such as satellite monitoring of bird migrations.
In the second place, we urgently need to expand our national public health capacity and our crisis response systems, not only so we have the ability to react quickly and decisively when confronted by disease outbreaks, whether naturally occurring or deliberate, but also so we have a body of experts who fully understand how disease impacts all aspects of life and society, from biology and medicine to social policy, politics, the economy, education, law and human rights and geography. We require a holistic, interdisciplinary and multidisciplinary approach and we need to ensure our public health specialists are trained to appreciate and benefit from the synergies that would flow from such an arrangement.
Third, we need to look back at and learn from Australia’s experience of past epidemics, the measures that were advanced to contain them, the human reaction they engendered and the problems they raised. This way we can learn from previous mistakes and better comprehend the reasons why such epidemics occurred, the demographic, social and economic impact, the mechanisms of their transmission and the attitudes and behaviour they produced.
Fourth, Australia must have at its disposal a rapid diagnostic service that can quickly identify the disease agent so the appropriate response can be initiated. This would be no problem with common infections like influenza, but does raise some problems with more exotic infections like pneumonic plague that might be used by bioterrorists.
In the fifth place, if our containment and management plans involve stockpiling relevant antiviral drugs and or vaccines, then we need to have a discussion about the relevant mix of drugs and the volume required, and try and ensure adequate supplies are readily available for all Australians. If this proves impossible, as at present with bird flu, and limited supplies are destined only for key health and emergency workers and the severely ill, then there needs to be clear communication with the general public as to who would have access to limited supplies and the reasons why. The government must also have in place adequate delivery systems so drugs can be delivered quickly and efficiently to millions of people.
The sixth point is that we need to fully appreciate the impact of major epidemics and pandemics on our healthcare system and plan accordingly. The sheer volume of people who would demand medical care would quickly overwhelm the healthcare delivery system, with hospital emergency departments flooded with patients and hospitalisation rates soaring. Respiratory equipment such as ventilators would obviously be in short supply, as would antibiotic drugs to treat secondary bacterial infections. All this would place extraordinary demands on our healthcare system. As would the likelihood that many healthcare workers would themselves be sick.
The seventh principle involves the importance of “risk communication”, fully involving the public and raising public consciousness about the epidemic or pandemic and the measures being advanced to contain it. We need to ensure the public are fully aware of the nature and importance of any infectious disease threat and the rationale behind the measures advanced by the government to meet it. Continually reassuring people there is nothing to worry about, when in essence such episodes are very frightening and threatening, is as good as encouraging apathy and denial.