Discussion Paper: Towards a National Communicable Disease Control Framework
ISBN: 978-1-74186-145-7
Online ISBN: 978-1-74186-146-4
Publications approval number: 10728
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Contents
1. Preface
- Process for development of a Communicable Disease Control Framework
2. Introduction
- Why Now?
3. Strategic context
- Challenges for communicable disease control
4. Communicable Disease Control in Australia
- Historical Roles and Responsibilities
- Current Roles and Responsibilities – in brief
- Assessment of existing system
5. Essential Elements
6. Priority areas
6.1: Leadership and Governance
- 6.1.1 Why is leadership and governance important?
- 6.1.2 What issues are affecting leadership and governance?
- 6.1.3 How can we address the issues?
6.2: Surveillance
- 6.2.1 Why is surveillance important?
- 6.2.2 What issues are affecting surveillance?
- 6.2.3 How can we address the issues?
6.3: Laboratory services for surveillance, prevention and control
- 6.3.1 Why are laboratory services important?
- 6.3.2 What issues are affecting delivery of public health laboratory services?
- 6.3.3 How can we address the issues?
6.4. Evidence-based national policy
- 6.4.1 Why is evidence-based policy important?
- 6.4.2 What issues are affecting national communicable disease policy?
- 6.4.3 How can we address the issues?
6.5. Best-practice prevention programs
- 6.5.1 Why are prevention programs important?
- 6.5.2 What issues are affecting disease prevention programs?
- 6.5.3 How can we address the issues?
6.6: Preparedness, assessment and response to biothreats and emergencies
- 6.6.1 Why is preparedness and response important?
- 6.6.2 What issues are affecting preparedness and response?
- 6.6.3 How can we address the issues?
6.7. Workforce and training
- 6.7.1 Why is workforce and training important?
- 6.7.2 What issues are affecting workforce and training in communicable disease control?
- 6.7.3 How can we address the issues?
7. References
8. Communicable Disease Network Australia Working Group
9. Consultation Participants
1. Preface
Process for development of a Communicable Disease Control Framework
In 2011, the Australian Health Protection Principal Committee (AHPPC) asked the Communicable Disease Network Australia (CDNA) to propose a draft Communicable Disease Control Framework Australia (the proposed Framework), for consideration by Australian Health Ministers. AHPPC requested that a system-focused rather than diseases-focused national framework include a comprehensive overview of current communicable disease management in Australia, identification of the essential elements and any capability gaps, and recommendations for priority actions to enhance communicable disease prevention and control to allow Australia to meet current and future threats.
As a Federation, the delivery of health services including communicable disease control is a shared responsibility of the Australian Government and state and territory governments. Developing the Framework will require consideration of a range of issues associated with current governance and delivery of core communicable disease control functions, many of which are split across legislated Australian, state and territory responsibilities.
The CDNA working group formed to support the development of the proposed Framework has membership based on expertise in communicable disease control through state and territory health departments, professional associations and academia. The membership and terms of reference are available in Section 8 of this paper.
Communication with stakeholders about the proposed Framework and consultation on possible areas for action are critical to its success. Initial input on this Discussion Paper is sought from people and organisations within communicable disease control to ensure technical aspects of the paper are sound. Broader consultation with state and territory governments, professional and consumer groups, and interested people or organisations will form part of the proposed Framework development process.
This Discussion Paper, developed by the CDNA Working Group, provides information on key issues impacting our current system of communicable disease control. It defines the essential elements underpinning the Australian system as core functions, special national functions and enablers. Within these elements, the paper proposes seven priority areas to strengthen Australia’s future communicable disease control system.
For each priority action area, the paper provides a snapshot of:
• Why is it important?
• What issues are affecting this action area?
• How can we address the issues?
The purpose of the Discussion Paper is to seek input on whether the possible areas for action address the challenges facing national communicable disease control in Australia. The paper poses questions as the basis for consultation.
Feedback from consultation will enable drafting of a proposed National Framework for Communicable Disease Control to be considered and agreed by AHPPC in the second half of 2013. Subject to AHPPC’s agreement, it is planned that a proposed Framework be considered and agreed by AHMAC by late 2013 and be ready for consideration by the Standing Council on Health (SCoH) in early 2014.
How to provide input or comment
You are invited to provide written input or comment on this Discussion Paper. Submissions can be sent by email.
Content of submissions
Your submission should include:
• Name and full contact details including email address, company name and designation
of submitter.
• Comments on areas/questions in the Discussion Paper that are of interest to you
• Any other relevant technical information supporting your comments or views
• Identification and discussion of perceived omissions on the Discussion Paper or alternative approaches
Confidentiality of submissions
Unless otherwise indicated, all submissions may be published on the Department of Health and Ageing website. If you wish any information to be treated as confidential, please explicitly and clearly identify that information and outline the reasons why you consider it confidential. General disclaimers in covering emails will not be interpreted as a specific request or taken as sufficient reason to submissions to be treated confidentially. Submissions including personal information identifying specific individuals will be de-identified prior to publication.
Email Address for submissions
(email address valid only until submission deadline)
Deadline for submissions
Friday 23 August 2013
**Changes to document since first released for consultation
Minor adjustments have been made to the Discussion Paper based on inaccuracies identified during the consultation period.
2. Introduction
Why Now?
Australia has made considerable progress controlling and preventing communicable diseases over the last century, reducing communicable disease related mortality from 13% of all deaths in 1907 to 1.3% in 2009 (1). Progress can be attributed to improvements in sanitation, the introduction of antibiotics and immunisation programs and ongoing work of health departments responding to outbreaks and monitoring important infections.
However the risk posed from communicable diseases is never static and they remain a prominent public health concern in Australia and many parts of the world. We must constantly look for ways to improve our capacity to coordinate, to respond and control important communicable diseases to protect the health of Australians.
This Discussion Paper sets the strategic context by describing current challenges in communicable disease control and roles and responsibilities in the Australian context. It summarises the key findings of the communicable disease control system overview in 2012 which informed the development of this paper.
The Discussion Paper outlines proposed elements of the Australian communicable disease control system as core functions, special national functions and enablers.
Core functions could include:
• surveillance,
• laboratory services,
• preparedness and acute response,
• policy and programs, and
• public health research.
System enablers underpinning all functions could include:
• governance and leadership,
• workforce and training,
• partnerships,
• communication, and
• funding and infrastructure.
Special national functions could be:
• biosecurity,
• international engagement, and
• priority populations.
Using this system-based approach, the paper identifies capability gaps within the system elements, discusses issues affecting priority areas and poses questions on how to address the issues to enhance communicable disease prevention and control in Australia.
3. Strategic context
Communicable diseases present a major threat to health and society in Australia. Recent changes in the landscape of communicable disease control, including new threats, such as emerging infectious diseases, biosecurity issues and climate change, have provided an impetus for Australia to review its current systems for communicable disease management and prevention. Advances in technology and changes in population behaviours present an opportunity to re-examine the most appropriate ways of responding. The mobility of the world’s population means that communicable diseases are no longer able to be managed just within nation states nor in jurisdictions within a nation. The modern challenge is to build a robust communicable disease control system able to efficiently detect, prevent and control new and re-emerging infectious disease issues, while maintaining Australia’s low levels of more familiar communicable disease issues.
Challenges for communicable disease control
Global epidemics can be devastating to national economies
Epidemics can place intense demands on a nation’s healthcare system, through widespread illness and mortality, and can cause enormous social and economic disruption. Severe Acute Respiratory Syndrome (SARS) was first reported in Asia in February 2003. The illness spread to more than two dozen countries in North America, South America, Europe, and Asia before the global outbreak was contained. It cost the global economy an estimated US $40 billion (2) demonstrating that the true cost of global outbreaks is far in excess of the treatment of cases alone.
Outbreaks can result in unnecessary deaths
Several communicable diseases can kill healthy individuals. For example, the 2011 European outbreak of enterohaemorrhagic Escherichia coli affected 3816 people, causing 54 deaths and 845 cases of haemolytic uraemic syndrome (3). Within a relatively short period of time, epidemiological studies and systematic tracing of food products identified sprouts as the vehicle of infection, but not before considerable cost to society and the food industry. Even with excellent food safety systems, contaminated food events can cause serious outbreaks because infectious agents can spread far and wide through domestic and international food supply chains. In the absence of adequate human capacity to detect and investigate outbreaks to determine the source, spread continues and unnecessary and preventable deaths occur.
‘Old’ diseases persist
Successful public health programs, especially vaccination, mean that today’s population is largely unfamiliar with ‘old’ diseases such as measles, polio and tuberculosis. But these diseases still occur and can spread quickly if programs are unable to keep pace with new disease threats or changes in the environment and human behaviour. Tuberculosis (TB), as an example, remains a significant global health threat, with unrecognised infections and drug-resistant strains complicating control efforts. Effective interventions in Australia during the twentieth century have resulted in a low rate of TB in the Australian-born population. But absolute numbers of TB notifications are increasing with 80%–90% of Australia’s new cases occurring in arrivals from high burden countries, including student and healthcare worker arrivals (4). Supporting local, regional and international TB control programs is critical to maintain low levels of disease in Australia and prevent the spread of drug-resistant TB.
Infections impact on health systems
A considerable proportion of health service use is attributed to infectious disease. In 2010, infections accounted for 1 in 6 problems managed by general practitioners. Furthermore, in 2009–10, there were nearly 128,000 hospitalisations with infectious and parasitic diseases as the principal diagnosis, the majority (84%) of which occurred in public hospitals (1). Infections can also be acquired during a stay in hospital, and these are concerning for both patients and the health-care system. Such infections can prolong a patient’s stay, aggregate existing conditions or, in some cases, lead to death. Examples include infection of a surgical wound, bloodstream infections from an intravenous catheter, or hospital-acquired pneumonia. In recent years, some bacteria have become resistant to standard antibiotics. The most prominent examples are methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE).
Human behaviours still drive disease
Some of the most common and most concerning communicable diseases are driven by seemingly modifiable human behaviours. There are around 200,000 healthcare-associated infections (HAIs) in Australian acute healthcare facilities each year (5). Implementation of infection control programs reduces HAIs. Programs recommend behaviours such as hand hygiene and maintaining a clean environment but time and time again, poor adherence to hand hygiene, in particular, compromises control efforts. Improved healthcare worker hand hygiene is now the highest priority of the Australian Commission on Safety and Quality in Healthcare to combat the rise of HAIs, and the National Health Performance Authority is responsible for the public reporting of the hand hygiene indicator via the MyHospitals website. It is critical that prevention programs for all diseases enable individuals to adopt protective behaviours promoted by system wide and environmental changes.
Traditional treatment losing effect
Antimicrobial agents used to be highly successful in treating infections but their unrestricted use in humans and animals has led to an alarming rise in antimicrobial resistance, especially in the developing world (6). Australia is vulnerable. Antibiotic-resistant bacterial infections occur in hospitals and increasingly in the community rendering first line treatments ineffective. Comprehensive and coordinated government led responses across the world are vital to preserving our ability to treat infectious diseases.
Communicable diseases are linked to chronic diseases
Infectious agents can cause cancer and other long term debilitating illnesses. Chronic viral hepatitis infections cause liver cancer, human papillomavirus infections cause cervical cancer, and Helicobacter pylori bacterial infections are linked to gastric cancer. Some gastrointestinal infections caused by microorganisms such as Salmonella and Campylobacter can cause persistent arthritis. Preventing longer term complications can be difficult. For example, many people with chronic viral hepatitis are unaware they are infected, increasing their risk of chronic liver disease and cancer as well as transmitting the infection. Early identification and treatment of chronic viral hepatitis, and other potentially chronic infections, can prevent long-term complications and costs.
The environment is changing
Climate change could contribute to the mutation and spread of infectious agents, increase availability of vectors and the risk of animal diseases infecting humans (zoonotic infections) because of sensitivities to climatic conditions (7). Recent reports suggest climate change might be affecting some infectious diseases such as malaria, dengue, and cholera (7). The predicted increase in frequency and severity of extreme weather events such as heatwaves and floods could stress local populations beyond their ability to cope and heighten vulnerability to communicable diseases. The regional impact of climate change may tip the ecological balance in our neighbouring countries and precipitate epidemics (7).
New diseases continue to emerge
Since the 1980s, new infectious diseases have emerged with greater frequency and infectious agents thought to be under control have re-emerged (8). Newly identified agents, predominantly viruses, include Hendra virus, West Nile virus, Australian bat lyssavirus, Ebola virus, and Nipah virus (9,10). The emergence of highly transmissible novel influenza viruses and of the novel Middle East respiratory syndrome coronavirus (MERS-CoV) remain global concerns. Most of these new diseases emerge from animals (zoonoses), mainly from wildlife. Drivers of disease emergence include changing land use and agricultural practices, changing demographics in society, poor global health, international travel and trade, reduced biodiversity, limited urban planning and changing climate. Within this complex environment, the infectious agents that cause epidemics constantly evolve so predicting future threats is very difficult. Australia must therefore prioritise preparedness and maintain a resilient, flexible system with sufficient skilled human capital to respond to such threats.
There are new opportunities for control
New technology has led to advances in detection and treatment methods. Rapidly growing trends in utilisation of social media and electronic devices may enhance the ability of health services to update and improve early warning systems and provide more acceptable and successful public education. The evidence-base is expanding with great speed, presenting new opportunities for understanding, preventing and controlling communicable diseases. But being at the cutting edge of knowledge requires the human capacity to regularly synthesise and interpret evidence. Health authorities must prioritise this capacity to ensure their actions maintain best-practice and stay up-to-date.