New vaccines for improved coverage against flu in Australia

Two new ground-breaking flu vaccines will be given to more than three million Australians.

The Federal Government recently said it will provide the new vaccines to those Australians aged 65 years and over who want them.

In making the announcement, Health Minister Greg Hunt said: “This is a direct response to last year’s horrific flu season, which had a devastating impact around the world, and aimed squarely at saving lives.”

More than 90 per cent of the 1,100 flu related deaths in 2017 were of people aged over 65 years of age. While less than one to two per cent of people who get influenza will end up with a complication from it, it is the elderly who seem hardest hit.

“The medical advice, both from the vaccine producers, the World Health Organisation and the Chief Medical Officer is that the mutation which occurred last year in many countries will be specifically addressed by these new vaccines,” Mr Hunt said.

The new vaccines – Fluad® and Fluzone High Dose® – were registered in Australia to specifically provide increased protection for people aged 65 years and older.

From April 2018, both vaccines will be available through the National Immunisation Program following a recommendation from the Pharmaceutical Benefits Advisory Committee.

“Annual vaccination is the most important measure for preventing influenza and its complications and we encourage all Australians to get vaccinated. We encourage all Australians aged over six months old to get a flu vaccination this year before the peak season starts in June” Mr Hunt said.

The Chief Medical Officer, Professor Brendan Murphy, believes the new ‘enhanced’ vaccines will be more effective.

However, Professor Murphy said: “No flu vaccine is complete protection, the standard vaccine seems to protect well in younger people, but we are confident this will give better protection for the elderly.”

The Department of Health believes the new trivalent (three strain) vaccines work in over 65s by generating a strong immune response and are more effective for this age group in protecting against influenza.

There is now a mandated requirement for residential aged care providers to provide a seasonal influenza vaccination program to all staff as well as the Aged Care Quality Agency continuing a review of the infection control practices of aged care services across the country.

Under the National Immunisation Program, those eligible for a free flu shot include people aged 65 years and over, pregnant women, most Aboriginal and Torres Strait Islander people, and those who suffer from chronic conditions.

The following four strains will be contained within this year’s Southern Hemisphere vaccines:

A(H1N1): an A/Michigan/45/2015(H1N1) pdm09 like virus;
A(H3N2): an A/Singapore/INFIMH-16-0019/2016(H3N2) like virus;
B: a B/Phuket/3073/2013 like virus; and
B: a B/Brisbane/60/2008 like virus.

Allen Cheng, Professor in Infectious Diseases Epidemiology at Monash University, has warned: “Despite the common perception that the flu is mild illness, it causes a significant number of deaths worldwide. To make an impact on this, we need better vaccines, better access to vaccines worldwide and new strategies, such as increasing the rate of vaccination in childhood.”

AMA President Dr Michael Gannon welcomed the Government’s announcement because it was targeting vaccine coverage for “a particularly vulnerable group”.

MEREDITH HORNE

Taiwan wants back in as a WHA observer

Taiwan has put out a call for international support for it to be allowed to participate in this year’s World Health Assembly, the decision-making body of the World Health Organisation.

Between 2009 and 2016, Taiwan had been invited to attend the WHA as an observer. No invitation was sent last year.

In 2017, pressure from Beijing resulted in the WHA refusing to invite Taiwan to attend the forum, which was the 70^th World Health Assembly.

Taiwan’s application to observe most of the WHO’s technical meetings was also declined.

When asked during a media conference at the time why Taiwan was not invited to 70^th WHA, the head of WHO Governing Bodies Timothy Armstrong said it was due to an “absence” of a cross-strait understanding.

“Negotiations are still ongoing,” he said. “Anything is possible.”

So Taiwan is seeking an invitation to this year’s WHA.

“Taiwan was not invited to attend the 70^th World Health Assembly as an observer in 2017. For many years, however, it has participated in the WHA and WHO technical meetings, mechanisms and activities; steadily contributed to enhancing regional and global disease prevention networks; and dedicated its utmost to assisting other countries in overcoming healthcare challenges in order to jointly realise WHO’s vision that health is a fundamental right,” it says in a statement.

“Therefore, there is widespread support that Taiwan should be invited to attend the WHA.

“Located at a key position in East Asia, Taiwan shares environmental similarities for communicable disease outbreaks with neighbouring countries and is frequently visited by international travellers.

“This makes Taiwan vulnerable to cross-border transmission and cross-transmission of communicable disease pathogens, which could lead to their genetic recombination or mutation, and give rise to new infectious agents.

“However, because Taiwan is unable to attend the WHA and is excluded from full participation in related WHO technical meetings, mechanisms, and activities, it is only after much delay that Taiwan can acquire diseases and medical information, which is mostly incomplete. This creates serious gaps in the global health security system and threatens people’s right to health.”

Taiwan has also been keen of late to highlight its international successes in both medical breakthroughs and global assistance.

In recent years it has transformed from aid recipient to assistance provider. It has established many disease prevention systems. Taiwan insists it needs the WHO to protect the health of its own people, but that it can also contribute greatly to global health protection.

“With an interest in making professional health contributions and protecting the right to health, Taiwan seeks participation in the 71^st WHA this year in a professional and pragmatic way, in order to become a part of global efforts to realise WHO’s vision for a seamless global disease prevention network,” its statement says.

Interestingly, the WHO’s own constitution states:

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.”

CHRIS JOHNSON

[Correspondence] Timely sensory stimulation and early childhood development

The Review by Wilson and colleagues (Dec 2, 2017)1 provides useful insights on the plight of people with or at risk of hearing loss globally, and outlines a comprehensive blueprint for intervention, especially in low-income and middle-income countries. The timing is auspicious because, in May, the World Health Assembly renewed the 1995 resolution on the prevention of hearing impairment, urging member states and the director-general of WHO to take specific steps to curtail the disease burden.2 However, we wish to draw attention to the implications of this Review for the prevailing disability-inclusive Sustainable Development Goals (SDGs).

Government launches online resource to fight antimicrobial resistance

The Federal Government has used Antibiotic Awareness Week in November to launch a new online resource for industry and the community, as part of Australia’s ongoing work to tackle the rise of antimicrobial resistance.

Antimicrobial resistance (AMR) occurs when microorganisms, like bacteria, that cause infections resist the effects of the medicines used to treat them, such as antibiotics.

As a result of antibiotic resistance, standard medical and veterinary treatments may become ineffective and infections may persist and spread to others.

The Government’s funding commitment to help tackle the rise of AMR is $27 million – including $5.9 million from the landmark Medical Research Future Fund.

The planned AMR website, is one of the first priority areas of the Implementation Plan. It will aim to provide information for the community, health professionals, animal health professionals, farmers, animal owners and the broader agriculture industry.

Australia is one of the developed world’s highest users of antibiotics – one of the main causes of AMR. In 2015, Australian doctors prescribed more than 30 million antibiotic scripts through the Pharmaceutical Benefits Scheme.

Many patients are not aware that antibiotics only work against infections caused by bacteria and should not be used to treat viruses like colds, flu, bronchitis and most sore throats.

AMA President Dr Michael Gannon said in a recent ABC interview that AMR is a concern and there needed to be: “Better stewardship in hospitals, better education for GPs, but perhaps most importantly better education for people in the community for them to understand when antibiotics are not only not required, but they’re potentially dangerous or risky.”

AMR has both a health and economic impact with infections requiring more complex and expensive treatments, longer hospital stays, and it can lead to more deaths.

The World Health Organisation (WHO) believes global urgent change is needed in the way antibiotics are prescribed and used because antibiotic resistance is one of the biggest threats to global health, food security, and development today. Antibiotic resistance can affect anyone, of any age, in any country, including Australia.

WHO also believes that even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.

“A lack of effective antibiotics is as serious a security threat as a sudden and deadly disease outbreak,” said Dr Tedros Adhanom Ghebreyesus, Director-General of WHO.

“Strong, sustained action across all sectors is vital if we are to turn back the tide of antimicrobial resistance and keep the world safe.”

A recent study published in the Medical Journal of Australia shows that antibiotic resistance is on the rise and is present in our communities in Australia.

Lead researcher Dr Jason Agostino from the ANU Medical School said about 60 per cent of drug-resistant staph infections were picked up in the community, so infection control needed to shift from hospitals to the community.

“The problem of infections resistant to antibiotics in our community is not just a theoretical problem that will happen some time in the future – it’s happening right now,” Dr Agostino said.

Until the early 2000s in Australia, staph infections resistant to antibiotics mostly occurred in hospitals. The researchers found hospital infection rates are improving, with decreased infections in two of the region’s largest hospitals.

The study found that patients most at risk of the drug-resistant staph infection in the community are young people, Indigenous Australians and residents of aged-care facilities.

“We also need to improve the way we share data on antibiotic resistance to staph infections and link this to hospitalisation across health systems,” Dr Agostino said.

You can find out more about the progress of the Implementation Plan actions in the National Antimicrobial Resistance Strategy Progress Report at www.amr.gov.au.

MEREDITH HORNE

Terminator says health is collateral damage of fossil fuels

Hollywood actor and former Governor of California, Arnold Schwarzenegger, has used a United Nations gathering in Germany to describe fossil fuels as a public health hazard.

At a sideline event of the 12-day UN climate talks in Bonn in November, Mr Schwarzenegger delivered a well-received speech that issued a challenge to world leaders.

A long-time outspoken environmental activist, the star of such blockbusters as The Terminator, Total Recall, Collateral Damage and Predator, urged governments everywhere to start labeling fossil fuels with a public health warning.

That health warning should state, he said, that their use could cause illness and death.

He praised the World Health Organization (WHO) for delivering on a 164-nation tobacco control deal in 2003 that resulted in health warnings on tobacco products.

But he added that a similar deal could be reached with regards to oil and coal products.

“Wouldn’t it be great now if they could make the same pact with the rest of the world to go and say, ‘let’s label another thing that is killing you – which is fossil fuels’,” he said.

“If you went to a gas station, it says that thing you’re pumping into your car is killing you.

“Pollution kills more than nine million people a year. Over 300,000 people will die over the course of this conference. That’s the population of Bonn.

“This is a massive tragedy. And as depressing and terrifying as it is, we are not talking about it enough,” he said.

WHO Director-General Tedros Adhanom Ghebreyesus called on conference delegates talk about building climate resilient health facilities in their home nations by 2013, which is a stipulation of the Paris Agreement.

He added that more investment was needed in the health sector.

“Climate change strikes at the heart of what it means to be human,” Dr Ghebreyesus said.

“Climate change is not a political argument in Fiji and other island nations. It’s everyday reality – whether that’s in the form of destructive storms, rising sea levels or increased risk of infectious disease.

“These communities need assistance to cope with a world that is changing in front of them.”

The Paris Agreement global climate treaty aims to limit rising temperatures to below 2˚C by reducing greenhouse gas emissions.

Fiji presided over the Bonn conference and was also the beneficiary of an initiative launched by WHO and the UN climate secretariat aiming to triple international financial support for action on climate-related health issues in the developing small island nations.

CHRIS JOHNSON

Close the clean drinking water gap

BY AMA PRESIDENT DR MICHAEL GANNON

Safe drinking water is an indispensable human right. The leading national and international health bodies, such as the World Health Organization and the United Nations, all agree that safe drinking water is essential to sustain life, and a prequisite for the realisation of other human rights. The UN General Assembly explicitly recognises the human right to clean drinking water.

Having access to sufficient, safe, accessible and affordable drinking water is an important public health issue.

In developed nations such as Australia, it is often assumed that safe drinking water is accessible to all. However, this is not the case, particularly in many remote or very remote communities where artesian (bore) water is often the primary source of drinking and household water.

According to the Bureau of Statistics (2007), for discrete Indigenous communities the majority accessed bore water (58 per cent), while other sources of water included: town supply (19 per cent), river or reservoir (5 per cent), rain water tank (3 per cent), well or spring water (3 per cent), and other sources of water (2 per cent).

While the supply of potable water (defined as waterthat is safe to drink or to use for food preparation, without risk of health problems) impacts on all people living in remote areas of Australia, Aboriginal and Torres Strait Islander people are disproportionately affected.

Many Aboriginal and Torres Strait Islander people living remotely find it challenging to obtain water that is of sufficient quantity (and quality) to meet their needs.

In 2012, the Australian Bureau of Statistics estimated that there were more than 400 discrete Aboriginal communities across Australia, with the largest number in Western Australia. Data collected on over 270 remote WA communities indicated that the quality of drinking water did not meet the Australian standards, as outlined in the Australian Drinking Water Guidelines (ADWG), approximately 30 per cent of the time.

While the National Health and Medical Research Council (NHMRC) has responsibility for the ADWG, this is not a mandatory standard, with State and Territory Governments and local councils responsible for the implementation and monitoring of water quality and safety. Yet during the two year period 2012-2014, 80 per cent of remote Aboriginal communities in Western Australia failed to meet quality standard testing at least once.

There are obvious health consequences from drinking poor quality water. Some Aboriginal communities are known to have unsafe levels of chemical contaminants such as nitrates and uranium in the water. Nitrates and uranium occur naturally, and are common in the Goldfields and Pilbara regions.

‘Blue Baby Syndrome’ – where an infant’s skin shows a bluish colour and they can have trouble breathing – can be caused by excessive nitrates in the diet, which reduce the blood’s ability to carry oxygen. It can occur where prepared baby formula is made with well water. Water tested in over 270 remote communities in WA showed nitrate levels 10 times the recommended levels.

It is concerning that Aboriginal and Torres Strait Islander people living remotely often have no choice but to pay for safe drinking water. While the majority of us enjoy free, safe drinking water from the tap, those who can least afford it often have to pay just to ensure they are not drinking water sourced from rivers, streams, rivers, cisterns, poorly constructed wells, or water from an unsafe catchment.

The AMA is a member of the Close the Gap steering committee and the Public Health team has raised potable water as a Close the Gap target.

The solution may not just be in more bottled water. In communities without adequate recycling and waste disposal services, thousands of extra plastic water bottles create additional environmental problems.

Governments must invest in infrastructure, such as proper treatment facilities, water storage facilities and distribution systems to meet the changing demands of communities.

All Australians must have permanent and free access to safe water. It is a basic human right and it is difficult to understand how this hasn’t already been implemented and addressed.

WHO discusses health strategies for our region

Low breastfeeding rates and “aggressive” baby formula marketing have been raised as an urgent issue by delegates at the World Health Organisation’s Western Pacific Regional Committee in Brisbane last month.

The annual meeting brings together ministers of health and senior officials from 37 countries and areas to decide on issues that affect the health and well-being of the Region’s nearly 1.9 billion people.

A new WHO regional action plan has been developed to strengthen protections for children from the harmful impact of food marketing.

WHO remains concerned that the baby food industry manipulates policies and practices by creating a positive public image as well as denying wrong-doing. WHO also believes evidence suggests that infant formula industry advertisements, gifts and sponsorships promote misconceptions and myths and ultimately have a negative impact on feeding practices.

Marketing of breast-milk substitutes, including infant formula, follow-up formula and growing-up milk, to caregivers continues to undermine breastfeeding in the first six months and continued breastfeeding beyond that age.

“The baby formula business is booming,” WHO’s regional director Dr Shin Young-soo said.

“And that is undermining breastfeeding.”

WHO believes that globally, 13 per cent of child deaths can be prevented with exclusive and continued breastfeeding.

Protecting children from the harmful impact of food marketing is critical in a region where more than 6.3 million children are overweight or obese. Countries were at the forum to develop a regional action plan to provide greater protection for children and support better health and nutrition, from birth onwards.

“When children are exposed to food marketing, their diets change,” Dr Shin said.

WHO and the Australian Government have also launched their first ever country cooperation strategy, on the sidelines of the 68th session of the WHO Regional Committee for the Western Pacific.

Issues discussed at the forum included: eliminating major communicable diseases, including measles and rubella, as well as mother-to-child transmission of HIV, hepatitis B and syphilis; financing of priority public health services; strengthening regulation of medicines and the health workforce; improving food safety; and health promotion for sustainable development.

Dr Shin Young-soo said the forum was important to the region because: “Our strength in solidarity is our best defence against whatever the future holds.”

It also provided a vision for WHO’s joint work with Australia over the next five years to improve the health of Australians and contribute to better health outcomes in the broader region.

Dr Shin said the strategy with Australia is the first of its kind, but it builds on a history of strong cooperation while also looking towards the future. Traditionally, country cooperation strategies are established between WHO and developing countries, where the Organisation has offices and provides direct support.

“I sincerely thank Minister Hunt and the Department of Health for their commitment to this strategy – and for paving the way for other high-income countries in this Region, with a new form of engagement that goes beyond the traditional donor country relationship,” he said.

Health Minister Greg Hunt, who attended the meeting, said the strategy: “Strengthens our systems to guard against emerging diseases at home and abroad, boosts our public health capacities and improves our already robust regulations to ensure we have safe and effective medicines and treatments.”

Australia’s breastfeeding guidelines are in line with WHO recommendations that infants up to six months should be exclusively breastfed. However, the Department of Health Australian National Breastfeeding Strategy expired in 2015.

The AMA believes that breastfeeding should be promoted as the optimal infant feeding method. AMA has also called for doctors and other health professionals to be appropriately trained on the benefits of breastfeeding, including how to support mothers who experience difficulties with breastfeeding.

AMA’s position statement can be read here: position-statement/infant-feeding-and-parental-health-2017 .

MEREDITH HORNE

Rec leave rewards for non-smokers in Japan

Japan currently comes in last on the World Health Organisation’s ranking of nations’ anti-smoking regulations, rated according to the type of public places entirely smoke-free.

So, it is quite remarkable that Japanese marketing company Piala Inchas announced it is granting its non-smoking staff an additional six days of holiday a year to make up for the time off smokers take for cigarette breaks.

“I hope to encourage employees to quit smoking through incentives rather than penalties or coercion,” Chief Executive Officer Takao Asuka said in regards to his company’s decision.

Hirotaka Matsushima, a spokesman for the company, said the idea came about following a message in the company suggestion box earlier in the year saying that smoking breaks were causing problems.

Other companies are also pushing for change. Convenience store chain Lawson Inchas introduced an all-day ban on smoking at its head office and all regional offices in June with an eye toward lowering the ratio of smokers in its entire workforce by around 10 percentage points in fiscal 2018.

“The company is willing to take an even tougher anti-smoking measure in the future,” a public relations officer for Lawson Incsaid.

A recent government survey in Japan showed that the number of smokers nationwide has fallen below 20 percent of the population for the first time on record, estimating about 18 per cent of Japanese are believed to smoke. Both genders recorded a decrease. The rate of male smokers fell 2.6 points to 31.1 per cent, while smoking among women declined 1.2 points to 9.5 per cent.

The Japanese health ministry is seeking new restrictions on smoking in public places before the 2020 Tokyo Summer Olympics. But the proposal is likely to encounter strong opposition from Japan Tobacco, which is one-third government owned.

MEREDITH HORNE

[Editorial] Eliminating viral hepatitis: time to match visions with action

Viral hepatitis caused an estimated 1·4 million deaths in 2015—similar to tuberculosis and more than either HIV or malaria, yet historically these diseases have received insufficient attention from donors and policy makers. In May, 2016, the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis, 2016–20, which aims to eliminate viral hepatitis as a major public health threat by 2030. The strategy set global targets to reduce new viral hepatitis infections by 90% and to reduce deaths due to viral hepatitis by 65%, focusing mainly on hepatitis B virus (HBV) and hepatitis C virus (HCV), which are responsible for most of the global burden.

The world is running out of antibiotics

The World Health Organization has confirmed in a new report that there is a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

The report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, reveals there is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli).

This is alarming because these pathogens can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

Most of the drugs currently being developed are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections. This includes drug-resistant tuberculosis which kills around 250,000 people each year.

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, believes antimicrobial resistance is a global health emergency.

“There is an urgent need for more investment in research and development for antibiotic-resistant infections including TB, otherwise we will be forced back to a time when people feared common infections and risked their lives from minor surgery,” Dr Tedros cautioned.

WHO has also identified 12 classes of priority pathogens which can cause common infections such as pneumonia or urinary tract infections but are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only eight are classed by WHO as innovative treatments. There are also very few new oral antibiotics being developed, despite these being essential formulations for treating infections outside hospitals or in resource-limited settings.

“Pharmaceutical companies and researchers must urgently focus on new antibiotics against certain types of extremely serious infections that can kill patients in a matter of days because we have no line of defence,” explained Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) have set up the Global Antibiotic Research and Development Partnership (known as GARDP), with Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust recently pledging more than €56 million.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,” Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme said.

WHO believes that new treatments alone will not be sufficient to combat the threat of antimicrobial resistance, and is developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

The AMA believes the over-prescribing of antibiotics is a threat to the wellbeing of Australians as we remain one of the highest consumers of antibiotics in the industrialised world. The AMA also encourages antibiotics to be responsibly prescribed.

MEREDITH HORNE