tag:theconversation.com,2011:/us/topics/centre-for-disease-control-24650/articlesCentre for Disease Control – The Conversation2023-02-12T19:11:26Ztag:theconversation.com,2011:article/1993872023-02-12T19:11:26Z2023-02-12T19:11:26ZFair health outcomes start with prevention. The new Centre for Disease Control can make it happen<figure><img src="https://images.theconversation.com/files/509310/original/file-20230209-18-w2n1zt.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5844%2C3893&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/s/photos/hospital">marcelo leal/unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>For the land of <a href="https://www.jstor.org/stable/20638163">the fair go</a>, Australia has work to do on our health. Although the average Australian’s <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/life-expectancy">life expectancy</a> is very high, that’s not true for everyone.</p>
<p>Indigenous Australians, and Australians with little formal education, can expect to die about <a href="https://ctgreport.niaa.gov.au/life-expectancy">eight years younger</a> than their fellow citizens. People who live in rural areas will die about <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">two to three years earlier</a>, on average, than people who live in cities. </p>
<p>And because chronic diseases create most of these gaps, these disadvantaged people will spend more years living in ill health than other Australians.</p>
<p>These statistics don’t begin to capture the immense suffering behind the numbers, or the deep injustice of gaping health gaps in a wealthy nation like ours. </p>
<p>The government has <a href="https://parlinfo.aph.gov.au/parlInfo/download/media/pressrel/7586055/upload_binary/7586055.pdf;fileType=application%2Fpdf">promised</a> to set up a Centre for Disease Control (CDC), which will tackle both infectious and chronic disease. A new <a href="https://grattan.edu.au/report/acdc-highway-to-health/">Grattan Institute report</a> shows how it can be set up to drive down rates of chronic disease. This will help reduce health disparities, especially if the CDC builds equity into its DNA. </p>
<h2>Chronic disease lies at the heart of health inequities</h2>
<p>Much of the life-expectancy gap between the most and least disadvantaged Australians is explained by skewed rates of chronic disease. </p>
<p>The most disadvantaged fifth of Australians are about 20% more likely to be living with one chronic disease, and about twice as likely to be living with two or more, compared with the most advantaged fifth of Australians. </p>
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<img alt="" src="https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508768/original/file-20230208-21-zvpqn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Rates of chronic disease by disadvantage. Grattan analysis of ABS data (2022).</span></span>
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<p>It’s estimated that about <a href="https://www.aihw.gov.au/reports/indigenous-australians/contribution-of-chronic-disease-to-the-gap-in-mort/summary">80% of the gap</a> in life expectancy between Indigenous and non-Indigenous Australians is caused by chronic diseases. </p>
<h2>Gaps in health start before sickness</h2>
<p>Some chronic diseases are difficult to prevent. There is little we can currently do to stop the onset of <a href="https://www.health.gov.au/topics/chronic-conditions/managing-chronic-conditions">type one diabetes or cystic fibrosis</a>, for example. </p>
<p>But other chronic diseases are the result of risk factors such as smoking, alcohol abuse, or being overweight or obese, which we can change. </p>
<p>These so-called modifiable risk factors are the cause of <a href="https://www.aihw.gov.au/news-media/media-releases/2021-1/august/one-third-of-disease-burden-caused-by-modifiable-r">about 40%</a> of the chronic disease burden in Australia. And, like chronic diseases, rates are significantly higher among disadvantaged Australians.</p>
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<img alt="" src="https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509372/original/file-20230210-27-hbs53b.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Risk factors for most disadvantaged fifth of the population compared to most advantaged. High alcohol consumption refers to lifetime risk guidelines of no more than two standard drinks per day. Grattan analysis of ABS (2018) and PHIDU (2022).</span>
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<p>Compared with the most advantaged fifth of Australians, the most disadvantaged fifth are about 60% more likely to be obese, more than twice as likely to have high psychological distress, almost three times as likely to do no physical activity, and over three times as likely to smoke daily. </p>
<p>This means inequity is already baked in well before people get ill. </p>
<h2>Isn’t being healthy a choice?</h2>
<p>Modifiable risk factors are sometimes branded as “lifestyle choices”. But this glosses over the fact our choices are heavily influenced by environmental and social factors. </p>
<p>For example, more disadvantaged Australians are <a href="https://aifs.gov.au/resources/practice-guides/food-insecurity-australia-what-it-who-experiences-it-and-how-can-child">more likely to</a> find it hard to get or afford sufficient healthy food, which increases the risk of obesity. The increased and often chronic stress that disadvantage brings is associated with <a href="https://www.nature.com/articles/s41598-017-07579-w">smoking more</a>, and may have links with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5958156/">obesity</a>. </p>
<p>Disadvantage is also <a href="https://www.vu.edu.au/mitchell-institute/educational-opportunity/socio-economic-disadvantage-educational-opportunity-persistently-linked">intertwined with fewer educational opportunities</a>, and education is <a href="https://www.rand.org/content/dam/rand/pubs/working_papers/WR1000/WR1096/RAND_WR1096.pdf">strongly linked to health</a> because it provides people with better knowledge of health and healthy behaviours. It shapes employment opportunities and can provide a stronger sense of personal control, which helps people make healthier choices. </p>
<p>Many modifiable risk factors may seem like choices, but the causes are often structural. There’s little Australians living in disadvantage can do about these influences, but they all increase the chance of modifiable risk factors, and sickness. </p>
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<a href="https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man smoking" src="https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509311/original/file-20230209-18-3ycvxz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Environmental and social factors heavily influence modifiable risk factors for health, like smoking.</span>
<span class="attribution"><span class="source">reza mehrad/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>A CDC has a chance to reduce health gaps</h2>
<p>The proposed <a href="https://www.health.gov.au/our-work/Australian-CDC">Australian Centre for Disease Control</a>, promised by the Albanese government, is an opportunity to tackle these structural barriers. </p>
<p>The centre has a big job to do. Australia has fallen behind our peers when it comes to prevention. As <a href="https://grattan.edu.au/report/acdc-highway-to-health/">our report</a> shows, <a href="https://stats.oecd.org/">we spend about 2% of the health budget</a> on public health, which is less than one-third of what Canada spends, less than half of what the United Kingdom spends, and far below the OECD average.</p>
<p>While many other countries have introduced <a href="https://www.who.int/news/item/13-12-2022-who-calls-on-countries-to-tax-sugar-sweetened-beverages-to-save-lives">sugar taxes</a> or taken action to reduce people’s intake of <a href="https://academic.oup.com/advances/article/12/5/1768/6159028?login=true">salt</a> and <a href="https://www.who.int/publications/i/item/9789240067233">trans fats</a>, Australia’s prevention progress has largely stalled.</p>
<p><a href="https://grattan.edu.au/report/acdc-highway-to-health/">Our report</a> shows that to have an impact, the CDC must be set up for success, with independence and the right role and resources. And the federal and state governments must make a new funding deal to make the investments the centre recommends.</p>
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Read more:
<a href="https://theconversation.com/how-should-an-australian-centre-for-disease-control-prepare-us-for-the-next-pandemic-184149">How should an Australian 'centre for disease control' prepare us for the next pandemic?</a>
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<h2>A focus on fairness</h2>
<p>Reducing risk factors across the population would have a big impact on health inequity. But to make the biggest gains, the communities at highest risk should be the focus. The CDC should understand who those communities are, and what will work for them.</p>
<p>One of its central roles should be providing technical advice to Australian governments. This advice must take equity into account. </p>
<p>When the centre looks at what works in prevention, it should consider who will benefit. Initiatives that disproportionately benefit disadvantaged groups should be valued more highly. </p>
<p>When the centre advises government on progress and targets, it should reflect not just how the average Australian is going, but also the status of groups that have traditionally been left behind. </p>
<p>To help the centre understand health disparities and the perspectives of people who experience them, the staff, leadership and culture of the centre should be diverse and inclusive, representing the broader community. And the centre should also listen to different groups that face the biggest barriers to good health, using a range of consultation and engagement methods. </p>
<p>Narrowing the health gap that divides Australians won’t happen overnight. And not all the structural barriers that create health inequalities can be solved by another government agency. </p>
<p>But for too long, these gaps have received too little attention. A strong, equity-focused CDC can help ensure that, when it comes to their health, all Australians get a fair go.</p><img src="https://counter.theconversation.com/content/199387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Albanese government has promised a centre for disease control. Its main focus has to be health equity for disadvantaged groups.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteLachlan Fox, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1387242020-06-25T03:15:48Z2020-06-25T03:15:48ZCoronavirus pandemic shows it’s time for an Australian Centre for Disease Control – in Darwin<figure><img src="https://images.theconversation.com/files/343892/original/file-20200625-190523-o4mmyn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">James Ross/AAP</span></span></figcaption></figure><p>Australia has weathered the coronavirus pandemic better than many other countries, recording just over <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers">7,500 cases and 100 deaths</a> so far. But various errors, such as the <a href="https://www.abc.net.au/news/2020-05-13/australia-coronavirus-death-toll-rises-ruby-princess-fatality/12239626">Ruby Princess debacle</a>, show we can – and must – do better. </p>
<p>The crisis has reignited a long-running debate about the need for an <a href="https://www.afr.com/policy/health-and-education/medicos-renew-call-for-national-disease-control-agency-20200310-p548j1">Australian Centre for Disease Control and Prevention (AusCDC)</a>. </p>
<p>Opposition leader Anthony Albanese <a href="https://www.heraldsun.com.au/news/victoria/morrison-government-coy-on-labors-energy-policy/news-story/5ef01b8c93ffc126a19441275623a4fb">advocated for one</a> this week, as did Australian Medical Association President <a href="https://www.skynews.com.au/details/_6167003229001">Tony Bartone</a>. It is likely these calls will grow louder as the pandemic progresses, especially if we see a second wave in Australia.</p>
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<h2>Support has been building for decades</h2>
<p>The proposal for an AusCDC has been debated for at least the past <a href="https://onlinelibrary.wiley.com/doi/pdf/10.5694/j.1326-5377.1987.tb133642.x?casa_token=y4Eb76aCTGEAAAAA%3AIve7Dz3vjImQkPwzEqHwgIMgudUWmTb0yAXD2-8bLWD32shyhF3dA53wmqu-Y2HMk97skjCrXqoz">33 years</a>. </p>
<p>In 2012, a parliamentary committee on trans-border health threats received submission after submission supporting the creation of an AusCDC, prompting the committee to <a href="https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=haa/internationalhealthissues/report.htm">recommend commissioning an independent review</a> into the feasibility of its creation. </p>
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Read more:
<a href="https://theconversation.com/proposed-australian-centre-for-disease-control-will-deliver-high-voltage-public-health-12993">Proposed Australian centre for disease control will deliver high-voltage public health</a>
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<p>However, after a limited consultation and six-year delay, the federal government responded by saying a centralised agency to coordinate health emergency responses <a href="https://www.health.gov.au/resources/publications/diseases-have-no-borders-report-on-the-inquiry-into-health-issues-across-international-borders">was not needed</a>. </p>
<p>This finding goes against the consensus of the <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=2ahUKEwjosML9qbfpAhXczzgGHRsHAyoQFjABegQIAhAB&url=https%3A%2F%2Fwww.phaa.net.au%2Fdocuments%2Fitem%2F405&usg=AOvVaw0hFVytKqVb-Nye4M9vMrAs">Australian public health community</a>. It goes against the advice of the <a href="https://ama.com.au/position-statement/australian-national-centre-disease-control-cdc-2017">Australian Medical Association</a>. Worse still, it goes against basic common sense. </p>
<p>The need for a coordinated and improved response to health emergencies across Australia’s multiple jurisdictions has been flagged many times during COVID-19. So what’s stopping us?</p>
<h2>Politics getting in the way</h2>
<p>The short answer is politics. While the public health community has long supported the creation of an AusCDC, it has repeatedly fallen foul of state and federal politics. </p>
<p>NSW and Victoria have consistently held any CDC should be based in their respective states, while others have argued for Canberra. </p>
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Read more:
<a href="https://theconversation.com/7-lessons-for-australias-health-system-from-the-coronavirus-upheaval-141122">7 lessons for Australia's health system from the coronavirus upheaval</a>
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<p>State governments have also resisted calls for a national CDC on the basis it might “steal” their top public health experts. </p>
<p>The federal Department of Health, meanwhile, has reportedly flagged its discomfort with an <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=14&ved=2ahUKEwjukvnorbfpAhXczDgGHccxA4M4ChAWMAN6BAgEEAE&url=https%3A%2F%2Faea.asn.au%2Fdocuments%2Fae%2F17-13-2-aea-history%2Ffile&usg=AOvVaw3Y6WyF12FxuAtnndUafqv5">independent, arm’s length entity</a>. </p>
<h2>The case for an AusCDC</h2>
<p>Australia’s pandemic preparedness efforts throughout the early 2000s established a solid foundation for the national COVID-19 response, but successive governments dropped the ball. </p>
<p>Multiple recommendations to continue strengthening our preparedness efforts were ignored. Our national influenza vaccine manufacturing capacity that once guaranteed Australians priority access <a href="https://www.smh.com.au/business/companies/there-will-be-enough-csl-to-hit-record-flu-vaccine-production-20200419-p54l49.html">has been privatised</a>. </p>
<p>And our national medical stockpile of personal protective equipment appears to have been subjected to budget cuts and efficiency savings to the point where there was insufficient stock when the pandemic struck. </p>
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Read more:
<a href="https://theconversation.com/4-ways-australias-coronavirus-response-was-a-triumph-and-4-ways-it-fell-short-139845">4 ways Australia's coronavirus response was a triumph, and 4 ways it fell short</a>
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<p>While our politicians will no doubt point to the National Cabinet as evidence Australia managed the crisis well, its creation was a stop-gap measure <a href="https://www.theguardian.com/australia-news/2020/apr/04/the-two-meetings-that-changed-the-trajectory-of-australias-coronavirus-response">invented in the middle of a crisis</a> that ignored Australia’s existing pandemic governance arrangements.</p>
<p>Admittedly, an AusCDC would not fix all of these problems. But there is a reason why countries like <a href="http://www.chinacdc.cn/en/">China</a> and <a href="https://ncdc.gov.ng/">Nigeria</a>, as well as entities like the <a href="https://www.ecdc.europa.eu/en">European Union</a>, have followed the US lead in creating one.</p>
<p>In fact, Australia is the <a href="https://ama.com.au/position-statement/australian-national-centre-disease-control-cdc-2017">only OECD country</a> without such a centralised disease control agency.</p>
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<h2>Basing a new AusCDC in the north</h2>
<p>Building an AusCDC is only one small part of the equation. Our region is one of the most disaster-prone areas of the world. Added to that, it comprises nearly two-thirds of the world’s population, many of whom live in high-density urban environments <a href="https://www.tandfonline.com/doi/full/10.1080/10357718.2018.1534942">where diseases can spread easily</a>. </p>
<p>When the next crisis emerges – and it will – Australia will have an important role to play. </p>
<p>For these reasons, it makes little sense to locate the new AusCDC in Canberra or Sydney. It needs to be as close to Asia as possible – in Darwin. </p>
<p><a href="https://www.dfat.gov.au/aid/topics/investment-priorities/building-resilience/humanitarian-policy-and-partnerships/Pages/australian-medical-assistance-teams-ausmat">Australia’s civil-military medical assistance teams (AusMAT)</a> are already based there to respond rapidly to regional disasters. </p>
<p>Locating a new AusCDC in Darwin would address one of the <a href="https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id%3A%22library%2Fpartypol%2F2550511%22;src1=sm1">Coalition’s long-standing priorities</a> of developing Australia’s north, guaranteeing the creation of new jobs and infrastructure. </p>
<p>If built on the AusMAT foundations, it would complement the Australian Defence Force’s efforts to <a href="https://www.defence.gov.au/WhitePaper/Docs/2016-Defence-White-Paper.pdf">help regional neighbours to meet common threats</a>, such as malaria, dengue, even Zika. </p>
<p>This would provide new opportunities for civil and military cooperation in health, and counter China’s growing influence through its <a href="https://www.eastasiaforum.org/2018/10/13/geopolitical-objectives-fuel-chinas-peace-ark/">military medical diplomacy activities</a> across the region. </p>
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<img alt="" src="https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/343896/original/file-20200625-190531-1agoo95.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An AUSMAT nurse consulting a woman in an Australian health centre in Pakistan.</span>
<span class="attribution"><span class="source">Petty Officer Damian Pawlenko/Australian Defence Force</span></span>
</figcaption>
</figure>
<h2>We could be doing more</h2>
<p>An AusCDC would allow us to add another component – a new Australian Public Health Corps (AHPC), a uniformed service of epidemiologists, nurses, pharmacists, physicians and even engineers that could be deployed at a moment’s notice to respond to disasters or health emergencies. </p>
<p>This workforce would be based on the <a href="https://www.hhs.gov/surgeongeneral/corps/index.html">US Public Health Service Commissioned Corps (USPHSCC)</a>, which has responded to disasters such as Ebola outbreaks in Africa, Hurricane Katrina in Louisiana and the 2010 earthquake in Haiti. It also provides healthcare services to Native Americans living on remote reservations. </p>
<p>The same concept could work with an Australian Public Health Corps, staffed partially by highly skilled Indigenous health care professionals, who could provide health care services to rural and remote communities. </p>
<p>This would not only aid our <a href="https://closingthegap.niaa.gov.au/">Closing the Gap</a> efforts, but also provide Indigenous healthcare workers with new employment opportunities similar to the <a href="https://www.countryneedspeople.org.au/indigenous_rangers">Indigenous Rangers</a> programme that has proven so successful.</p>
<p>We must look to the future and ensure we are better prepared for the next pandemic or regional health emergency. The time for the creation of an Australian Centre for Disease Control is well past due.</p><img src="https://counter.theconversation.com/content/138724/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Kamradt-Scott receives funding from the Australian Research Council to examine the role of militaries in health emergencies, and the Canadian Government on examining compliance with the International Health Regulations (2015) during COVID-19. Adam is a director of the Global Health Security Network, and co-convenor of the Global Health Security conferences.</span></em></p><p class="fine-print"><em><span>Katrina Roper does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The idea of an AusCDC has been debated for at least 30 years. Momentum is now building to finally make this a reality to be better prepared for the next pandemic.Adam Kamradt-Scott, Associate professor, University of SydneyKatrina Roper, Honorary Lecturer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1117712019-02-21T14:17:57Z2019-02-21T14:17:57ZWhy Nigeria is battling to control disease outbreaks like Lassa fever<figure><img src="https://images.theconversation.com/files/259714/original/file-20190219-43264-1ndawwm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigeria was quick to respond and control the 2014 Ebola outbreak.</span> <span class="attribution"><span class="source">EPA</span></span></figcaption></figure><p>The first case of Lassa fever in Nigeria was recorded in 1969. A zoonotic disease endemic to West Africa, the disease was named after the town in Nigeria where the first case occurred. </p>
<p>The past seven years has seen a spike in the number of cases as well as deaths from the disease. In addition, its geographic <a href="https://ncdc.gov.ng/diseases/sitreps">range is spreading</a>. Last year was particularly bad: 3,498 suspected cases and 171 deaths were <a href="https://ncdc.gov.ng/diseases/sitreps">reported</a>. Another outbreak has gripped big parts of the country – and may be even worse than last year. </p>
<p>It’s particularly disheartening that Nigeria has failed to control Lassa fever outbreaks, which happen every year. The country responded <a href="https://theconversation.com/how-nigeria-beat-the-ebola-virus-in-three-months-41372">successfully</a> to the deadly Ebola outbreak of 2014 – yet it seems unable to do the same when it comes to bringing Lassa fever under control. Each year it’s taken by surprise, unprepared to rapidly and adequately respond to new outbreaks.</p>
<p>This is true not just of Lassa fever, but of other diseases too, such as Yellow fever, Cerebrospinal meningitis as well as monkey pox. There is currently an active <a href="https://ncdc.gov.ng/diseases/sitreps/?cat=10&name=An%20update%20of%20Yellow%20Fever%20outbreak%20in%20Nigeria%20%22%22">Yellow fever outbreak</a> as well as 311 suspected cases of <a href="https://ncdc.gov.ng/diseases/sitreps/?cat=8&name=An%20Update%20of%20Monkeypox%20Outbreak%20in%20Nigeria">monkey pox</a> in 26 states.</p>
<p>Why is this the case? </p>
<p>There are three main reasons: the first had to do with a weak system of disease control in the country. Related to this, is the fact that Nigeria has become too dependent on foreign aid for its surveillance needs. And the last factor is that the country’s inability to clean up its streets and manage its garbage has led to a spike in the rodent population. Rodents are considered <a href="https://theconversation.com/lassa-fever-will-keep-ravaging-nigeria-unless-better-surveillance-is-put-in-place-83847">possible carriers</a> of the Lassa fever virus. </p>
<h2>The reasons</h2>
<p>All levels of government in Nigeria have, for many years, neglected and <a href="http://yourbudgit.com/wp-content/uploads/2018/04/Nigeria-Health-Budget-Analysis.pdf">underfunded</a> the health sector in general and disease surveillance, in particular. As a result, the country has been unable to detect and rapidly and efficiently control or respond to outbreaks. </p>
<p>As a result, Nigeria now depends too much on foreign aid for disease surveillance. It’s difficult for the country to coordinate assistance programmes that are funded and run by international NGOs and other partners with defined objectives. This has resulted in a haphazard and uneven development of the national disease surveillance system and the failure to establish a national functional laboratory network. The country has failed to sustain the structures and facilities that were used to control Ebola in 2014. </p>
<p>The control of the 2014 Ebola outbreak in Nigeria was a combination of chance and an eventual commendable but rare performance of the country’s national disease control system. Nigeria was able to limit the Ebola epidemic through a combination of factors – the laboratory confirmation of Ebola virus disease outbreaks, the rapid declaration of an emergency by the government, the setting up of an emergency operation centre and the aggressive tracing of contacts.</p>
<p>But soon after Nigeria was declared free of Ebola, the emergency operation centre was closed. </p>
<p>Other contributory factors to the persistence of Lassa fever is the fact that rodent populations aren’t being kept control. This matters because <a href="https://wwwnc.cdc.gov/eid/article/22/4/15-0155_article">rodents</a> currently regarded as the hosts of the <a href="https://www.nature.com/articles/srep25280">Lassa virus</a>. One theory is that <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1804498">increased transmission</a> may have resulted from transmission from local rodent populations, rather than human-to-human transmission. With Nigeria becoming filthier by the day, there is bound to be an increasing contact between the <a href="https://www.environewsnigeria.com/nigeria-ill-prepared-control-lassa-virus-says-virologist/">humans and rodents</a>. </p>
<h2>Effects of military rule</h2>
<p>In three decades immediately after Nigeria’s independence in 1960, the federal government and each of the state governments had effective disease surveillance divisions responsible for disease surveillance, prevention and control. The ability to actively and efficiently respond to disease outbreaks was based on the strength and effectiveness of disease surveillance at each level of governance. </p>
<p>But the entrenchment of military and unitary rule led to a progressive disruption of good governance. Under poor political leadership, the states abandoned their responsibilities and became totally dependent on the federal government – which in turn was dependent on foreign aid – to survey for and control diseases. </p>
<p>An overwhelmed federal government became incapable of sustaining high quality disease surveillance, prevention, control and response. The result is the current national impotence to effectively survey, detect, confirm and respond to any disease outbreak</p>
<h2>What needs to be done</h2>
<p>To remedy the situation, Nigeria must recognise and understand that it makes economic sense to prevent rather than control disease outbreaks. Prevention results in a significant reduction in disabilities and deaths from diseases and can be achieved through reliable and responsive disease surveillance, prevention, control and response. </p>
<p>Therefore, providing adequate funding to maintain and sustain an effective national disease surveillance system backed by a reliable laboratory network service is the first step in ensuring national health security and protection of Nigerians from the ravages and death caused by disease outbreaks. This calls, not for dependency on foreign aid and assistance, but on national ownership of disease surveillance and control systems.</p>
<p>Nigeria took the first step towards achieving this vision with the establishment of the <a href="https://ncdc.gov.ng/ncdc%20%22%22">Nigeria Centre for Disease Control</a> in 2011 to enhance the country’s preparedness and response to epidemics through prevention, detection, and control of communicable diseases. </p>
<p>The positive effects of establishing the NCDC are starting to show. There is an improved awareness among health care workers and the public of Lassa fever. And cases are now detected faster and appropriate action can be taken before more states are infected. </p>
<p>Another area of improvement is in the laboratory diagnosis of Lassa fever cases. Before 2014 – when the CDC began getting funding for disease surveillance and the coordination of laboratory back up – diagnosis of Lassa fever was based mainly on clinical diagnosis. But there’s since been an increasing number of <a href="https://ncdc.gov.ng/reports/weekly/">laboratory confirmation</a> of suspected cases.</p>
<p>The <a href="https://ncdc.gov.ng/news/156/president-muhammadu-buhari-signs-bill-for-an-act-to-establish-the-ncdc">establishment</a> of new legislation under the NCDC is a small, yet important step. But it’s one thing to have a law, it’s another to implement it. The Nigerian government must back the political will for improving disease prevention and control with financial commitment to ensure the sustainability of the NCDC.</p><img src="https://counter.theconversation.com/content/111771/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Oyewale Tomori does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nigeria’s health systems are overwhelmed and incapable of sustaining high quality disease surveillance, prevention, control and response.Oyewale Tomori, Fellow, Nigerian Academy of ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/537382016-02-10T04:37:24Z2016-02-10T04:37:24ZWhy Africa can’t afford to have an outbreak of the Zika virus<figure><img src="https://images.theconversation.com/files/110806/original/image-20160209-12577-1ex724o.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Should there be an outbreak of the Zika virus in Africa, the continent will not be able to cope. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If the latest mosquito-borne Zika virus breaks out in Africa the continent would be less prepared than any other to deal with the outbreak. </p>
<p>Zika fever is a mosquito-borne viral disease caused by the Zika virus which is suspected of leading to the birth of <a href="http://www.ncbi.nlm.nih.gov/pubmed/26820244">deformed babies</a>. The virus is transmitted to humans when an infected <a href="http://www.ncbi.nlm.nih.gov/pubmed/26820244">Aedes</a> mosquito stings a person. Direct human to human transmission through <a href="https://www.nlm.nih.gov/medlineplus/news/fullstory_157104.html">sex</a> has also been reported. </p>
<p>The virus has spread to 23 countries in the South American <a href="http://www.reuters.com/article/us-health-zika-who-idUSKCN0V61JB">region</a>. Brazil has been the hardest hit with over 3700. Although the outbreak in Brazil has received the most attention, the virus has also since spread beyond the region to the Cape Verde Islands, which are off the coast of Senegal but are not part of the African mainland, Samoa and Tonga.</p>
<p>There are global attempts underway to stop the spread of the virus. It has been declared an international emergency by the <a href="http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/">World Health Organisation</a> and the US’s Centre for Disease Control has put out six <a href="http://wwwnc.cdc.gov/travel/page/zika-travel-information">travel alerts</a> so far.</p>
<p>There are several reasons Africa is least prepared to deal with an outbreak of the Zika virus. This includes the limited laboratory capacity and a lack of experts and funding.</p>
<h2>Limited lab capacity</h2>
<p>Firstly, the laboratory capacity to test for the virus is limited. Although the clinical features of the Zika virus are known, these are non-specific. This means other known diseases, such as malaria, have some - though of course not all - of the same signs and <a href="http://www.niaid.nih.gov/topics/malaria/understandingmalaria/Pages/symptoms.aspx">symptoms</a>.</p>
<p>That Zika may appear like several other diseases makes laboratory testing for the virus imperative. But there are no widely available tests. This is unlike diseases or infections such as malaria and HIV/AIDS that have clinically tested and approved commercial laboratory tests or reagents. </p>
<p>Although inferior laboratories are not unique to Africa, in high income countries this challenge is mitigated by sending the tests to a national laboratory. For example in the US samples obtained from suspected Zika cases are now being sent to the Centre for Disease Control. In the UK the agency responsible is Public Health England’s Rare and Imported Pathogens Laboratory <a href="http://www.selectscience.net/editorial-articles/laboratory-diagnosis-of-zika-virus-what-you-need-to-know/?artid=40041">RIPL</a>.</p>
<p>Although South Africa has the National <a href="http://www.nicd.ac.za">Institute</a> for Communicable Diseases, which could manage these tests in a standardised manner, several other countries do not have this capacity. Examples of the few comparable laboratories outside of South Africa are the Uganda Virus Research <a href="http://www.uvri.go.ug/">Institute</a> and the Centre of Excellence for Genomics of Infectious Diseases at Redeemers University in <a href="http://cpgs.run.edu.ng/index.php?active=page&pgcat=view&newscid=199&catid=3">Nigeria</a>. But much of the continent does not have the infrastructural and human capacity to diagnose Zika. </p>
<h2>A lack of experts</h2>
<p>Facilities are not the only challenge. There is also a lack of proactive national and regional health experts to guide the response in case of any outbreak. This is a gap that needs urgent attention, not only for the Zika virus but also to deal with emerging and re-emerging infections.</p>
<p>There is much to learn from the Ebola epidemic which swept through several countries in West Africa in 2014 and 2015. </p>
<p>To effectively deal with the Ebola outbreak, international cooperation and collaboration was vital. Affected national governments, neighbouring nations and both local and international funders all came together to stem the spread of disease. For instance, Uganda and South Africa sent several teams of health workers to Liberia and Sierra Leone. There was significant capacity building which would not have taken place had this manpower not been available. </p>
<p>The international collaboration continues in terms of searching for a vaccine as well as the treatment and care of Ebola patients. We have learned that fragile health systems are more susceptible to infectious diseases epidemics.</p>
<p>Another challenge which the Ebola outbreak should teach Africa is that in terms of a disease spreading, no country is an island. While there may not be local transmission of Zika in a particular country, there is no guarantee that a country will not have individuals who travel to or come into it carrying the disease. </p>
<p>Unlike Ebola where direct human to human transmission through droplets was a concern, it is note that easy to transmit the Zika infection. The Aedes mosquito is needed as an intermediary or sexual intercourse must occur between an infected person and a susceptible individual. Therefore the border control needs for Ebola are more stringent than Zika. A Zika infected individual who travels from one country is more at individual risk of not being diagnosed and receiving appropriate care than of transmitting the infection.</p>
<h2>No unified body</h2>
<p>Unlike in the US, there is not a unified body of health experts on the continent. The available regional bodies such as the West African College of Physicians and the soon to be launched College of Physicians of East, Central and Southern Africa have their jobs cut out already to lead in the health sector. </p>
<p>The World Health Organisation’s African Regional Office, unlike its Pan American Health Organisation (PAHO), does not proclaim advisories and guidelines apart from those decided at headquarters in Geneva. </p>
<p>As early as July 2013, the African Union Summit identified the need for an African centre for disease control modelled on the on the in the <a href="http://www.cdc.gov/media/releases/2015/p0413-african-union.html">US</a>. Among its responsibilities would be surveillance and response, which would include an emergency operations centre. Although the centre has been launched, it has yet to handle its first epidemic. Until the African centre for disease control is fully active, there is no comparable entity for Africa.</p>
<p>The re-emergence of diseases such as Zika calls for African states and experts, as well as the international community, to join forces to build the continent’s disease response capacities.</p><img src="https://counter.theconversation.com/content/53738/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adamson S. Muula does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With limited laboratory capacity and a lack of experts and funding, an outbreak of the Zika virus in Africa could be problematic.Adamson S. Muula, Professor of Epidemiology and Public Health, University of MalawiLicensed as Creative Commons – attribution, no derivatives.