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House of Representatives Standing Committee on Health and Ageing
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Chapter 1 Background to the inquiry
Many issues are realised when dealing with complex infection
challenges across borders. We need to remember that with infectious diseases we
are dealing with something a little bit different to other areas in the health
sector. We are dealing with the intersection of the environments and the
lifelines of at least two different organisms. This creates complexity.[1]
A globalised society
1.1
In an increasingly globalised society, protecting Australians from the
spread of infectious disease across international borders is a complex task for
the Commonwealth Government, state governments, non-government entities, and
individual consumers.
1.2
The Department of Health and Ageing (DoHA) told the Committee that
international travel is on the rise:
International movement of people is becoming easier, quicker
and increasingly desired by the people of the rapidly growing economies of
Asia. The volume of arrivals into Australia through air travel is forecast to
increase by 22.7 per cent over the next five years.[2]
1.3
Due to its proximity to neighbouring countries and the nature of the
border between the Torres Strait Islands and Papua New Guinea, Australia faces
a unique challenge in preventing exposure to imported infectious diseases and
epidemic or pandemic disease outbreaks.
1.4
Professor Tania Sorrell, of the Sydney Institute for Emerging Infectious
Diseases and Biosecurity, told the Committee:
When we think about emerging infectious diseases within
Australia, we are thinking about what we can do within our own borders—to
detect them, to control them et cetera. But we need to recognise that the
Asia-Pacific region is quite an important incubator for emerging infectious
diseases and for increasing antimicrobial resistance.[3]
What is infectious disease?
1.5
‘Infectious’ means ‘capable of spreading disease or a disease that is
capable of spreading (also known as communicable)’.[4]
1.6
In this inquiry, the terms ‘infectious disease’ and ‘communicable
disease’ are used interchangeably.
1.7
According to the World Health Organization (WHO):
Infectious diseases are caused by pathogenic microorganisms,
such as bacteria, viruses, parasites or fungi; the diseases can be spread,
directly or indirectly, from one person to another.[5]
1.8
An outbreak of an infectious disease could be triggered by a range of
factors, including poor population health, poor hospital and medical
procedures, contamination of water and food supplies, international travel and
trade, and changing climatic conditions.[6]
1.9
An epidemic is ‘an outbreak or unusually high occurrence of a disease or
illness in a population or area’.[7] A pandemic is an
‘epidemic on a global scale’.[8]
1.10
Professor Adrian Sleigh, of the Australian National University, told the
Committee that infectious disease outbreaks are complex:
The situation may be quite unstable and expansive, creating
an explosive epidemic such as when we were confronted with SARS and avian influenza,
or it may be stable and constrained and be a habitually present problem like
tuberculosis in Papua New Guinea. It often has an ecological dimension and
often involves predilection for people in poor situations, so that the poor are
particularly afflicted. [9]
1.11
Infectious disease outbreaks of recent or current global concern include:
- Avian Influenza
(referred to as H5N1 or bird flu) – first infected humans in 1997 and continues
to pose a threat to public health[10]
- Severe Acute
Respiratory Syndrome (SARS) outbreak – 2003[11]
- Pandemic influenza (referred
to as H1N1 or swine flu) – 2009[12]
Adoption of inquiry
1.12
One of DoHA’s primary objectives in 2010-2011 was:
… [to] strengthen the nation’s capacity to identify, monitor
and implement effective and sustained responses to health threats or
emergencies, thereby protecting public health. This includes mass casualty
events, communicable disease outbreaks, terrorism, natural disasters and
environmental hazards.[13]
1.13
After reviewing DoHA’s 2010-2011 annual report, the Committee resolved,
pursuant to Standing Order 215(c), to inquire into and report on Health
issues across international borders.
1.14
To support its inquiry, the Committee convened a series of roundtable
discussions to learn about the challenges for population health in Australia.
1.15
The Committee reviewed Australia’s screening, surveillance and control
practices for infectious diseases, having regard to the roles and
responsibilities of Commonwealth, state and territory governments and
non-government entities, and coordination of their activities in Australia and
across regional borders.
1.16
Terms of Reference for the inquiry (p. x) were developed to encourage
wide-ranging discussion and to allow full exploration of all relevant issues.
Related inquiries
Delegation to Papua New Guinea and
the Solomon Islands
1.17
On Thursday 18 March 2010, the Australian Parliamentary Committee
Delegation to Papua New Guinea and the Solomon Islands tabled its report on the
roundtable forum on regional health issues entitled Regional health issues
jointly affecting Australia and the South Pacific.[14]
1.18
The report detailed a visit by a delegation of members from the House of
Representatives Standing Committee on Health and Ageing, to Papua New Guinea (PNG)
and the Solomon Islands, where discussions canvassed a range of regional health
issues jointly affecting Australia and the South Pacific.
1.19
Chair of the delegation, Mr Steve Georganas MP, observed:
The delegation afforded a unique and valuable opportunity for
parliamentarians to learn more about the health system and health services
delivery in neighbouring countries and to strengthen the bilateral relationship
with two countries with which we have longstanding and important ties.[15]
1.20
A number of infectious disease issues facing the Torres Strait Islands,
PNG and the Solomon Islands were identified during the visit. The Committee
considered Australia’s role in preventing the spread of infectious disease
within these countries and across regional borders, noting the frequent
cross-border movements between PNG and the Torres Strait Islands, and
Australia’s proximity to PNG and the Solomon Islands.
1.21
The Committee determined to explore these themes further as part of the current
inquiry into health issues across international borders, with a focus on
the infectious disease issues faced by PNG and the Torres Strait Islands, and
the impact of free movement of people between these regions.
Senate inquiry into antimicrobial
resistance
1.22
On 29 November 2012, the Senate referred the following matter to the
Senate Finance and Public Administration Committees for inquiry and report: Inquiry
into the progress in the implementation of the recommendations of the 1999
Joint Expert Technical Advisory Committee on Antibiotic Resistance.
1.23
Terms of Reference to the inquiry are:
- Progress in the
implementation of the recommendations of the 1999 Joint Expert Technical
Advisory Committee on Antibiotic Resistance, including:
- examination
of steps taken, their timeliness and effectiveness;
- where and
why failures have occurred;
- implications
of antimicrobial resistance on public health and the environment;
- implications
for ensuring transparency, accountability and effectiveness in future
management of antimicrobial resistance; and
- any other
related matter.
1.24
The Committee notes that the subject of antibiotic resistance and its
implications for the public health of Australians has been canvassed during the
course of this inquiry, in the broader context of learning about the challenges
for population health in Australia.
1.25
Although the Committee has considered antibiotic resistance during this
inquiry (particularly in relation to tuberculosis), it does not propose to separately
discuss this in detail.
1.26
The Committee notes that the Senate Committees on Finance and Public
Administration is due to report on 10 May 2013.[16]
Conduct of inquiry
1.27
On 20 March 2012, the DoHA provided the Committee with a private
briefing on international cross border health initiatives. The Committee
subsequently authorised the publication of the transcript of this briefing, so
that the evidence could be utilised in this inquiry.
1.28
The Committee conducted a series of public roundtable discussions for
this inquiry:
- Friday, 25 May 2012,
Canberra;
- Thursday, 2 August
2012, Cairns;
- Wednesday, 8 August
2012, Perth;
- Friday, 24 August
2012, Canberra; and
- Wednesday, 21 November
2012, Christmas Island.
1.29
On 21 November 2012, the Committee also undertook inspections of the
health facilities at the Christmas Island Hospital and the immigration detention
centres on Christmas Island.
1.30
The Committee did not call for written submissions, but instead relied
upon the evidence provided during the roundtable discussions. Participants
included infectious disease physicians and nurses, medical practitioners, epidemiologists,
microbiologists and academics from various related fields, Commonwealth public
servants and representatives of relevant peak bodies.
1.31
A full list of roundtable discussions and participants is outlined at Appendix
A.
1.32
During the roundtables, some participants provided the Committee with additional
documents, including discussion papers, research material and other relevant reports.
1.33
A full list of these documents is outlined at Appendix B.
Committee comment
1.34
The Committee chose to receive evidence to this inquiry via a series of
roundtables held in various locations around Australia, rather than calling for
written submissions.
1.35
Participation in the roundtable discussions was by invitation from the
Committee.
1.36
The Committee thanks all of the individuals and agencies who participated
in the roundtable discussions for their valuable contribution.
1.37
The Committee heard from a range of infectious disease experts during
the roundtable discussions. The format was designed to encourage interactive
discussion between participants on a wide range of pertinent issues.
1.38
Given the breadth of this inquiry, the Committee did not intend that the
evidence gleaned from these roundtables would cover the field. The Committee
appreciates that there are many other government agencies, non-government
organisations and individuals around Australia who could have made a valuable
contribution to the roundtable discussions.
1.39
The Committee did not seek to identify all infectious disease issues of relevance
to Australians in this report. References to infectious diseases were intended
to illustrate some of the issues, rather than forming an exhaustive list of
diseases to be managed in Australia and across international borders.
1.40
Due to time and resource constraints, the Committee was not able to
conduct roundtable discussions in all Australian states and territories.
Accordingly, this report is not illustrative of all infectious disease issues
faced in each jurisdiction across Australia.
Structure of the report
1.41
This report comprises six chapters.
1.42
Chapter 2 sets out the policy framework upon which this inquiry is based,
including an outline of the role of relevant Commonwealth agencies in developing
and administering public health policies related to infectious disease issues.
1.43
Chapter 3 discusses the screening, surveillance and control of
infectious disease in Australia and across international borders, including a
review of border control measures and health screening of travellers, migrants,
refugees and asylum seekers arriving in Australia.
1.44
Chapter 4 identifies international cross-border issues, including the
challenges posed by the Torres Strait-Papua New Guinea border, and Australia’s
role in assisting neighbouring countries respond to emerging infectious disease
threats.
1.45
Chapter 5 discusses Australia’s preparedness to respond to a national or
global health crisis involving an infectious disease outbreak on an epidemic or
pandemic scale.
1.46
Chapter 6 considers how Australia manages infectious disease issues at a
Commonwealth, state and territory level, and how these issues are coordinated
across portfolios and between the tiers of government. The Committee considers whether
a national centre for communicable disease control is needed.