Outcome 14 - Biosecurity and Emergency Response

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Preparedness to respond to national health emergencies and risks, including through surveillance, regulation, prevention, detection and leadership in national health coordination

Major Achievements

• Developing modern legislation to replace the Quarantine Act 1908, in cooperation with the Department of Agriculture, Fisheries and Forestry.
• Designation of Australia’s major international airports and seaports as First Points of Entry under International Health Regulations, recognising their capacity to manage public health events of international significance.
• Publishing the Review of Australia’s Health Sector Response to Pandemic (H1N1) 2009: Lessons Identified.
• Working with CSL to ensure the continuation of the production and distribution of antivenom products to state and territory health departments.

Challenges

• Working with Queensland Health, AusAID and tuberculosis physicians towards the safe and ethical transfer of Papua New Guinea tuberculosis patients, previously treated at clinics in the Torres Strait, to the Papua New Guinea health system.
• Maintaining the Department’s regulatory capacity to process the increase in applications for licences and permits to import, export and manufacture controlled drugs.

Outcome Strategy

Outcome 14 aims to strengthen the nation’s capacity to identify, monitor and implement effective and sustained responses to health threats or emergencies, thereby protecting public health. These health threats and emergencies include mass casualty events, communicable disease outbreaks, terrorism, natural disasters and environmental hazards. The Department worked to achieve this Outcome by managing initiatives under the program outlined below.

Program 14.1: Health Emergency Planning and Response

Program 14.1 aims to undertake activities through the Health Protection Fund to prepare for and respond to changing health protection priorities. Program 14.1 also aims to ensure that Australia’s health system has integrated and coordinated arrangements in place to respond to national health emergencies and protect the health of the community; manage the human health risks posed by people, biological material, vessels (aircraft and ships) and vectors (organisms that act as carriers or transporters of infectious disease) entering Australia; and minimise the risks posed by communicable disease threats, and reduce their effect on society and the economy.

Health Protection Fund

The Health Protection Fund (the Fund)¹³⁹ was established on 1 July 2011 consolidating activities from eleven existing programs¹⁴⁰ to provide a flexible funding pool for activities to prepare for and respond to changing health protection priorities such as national health emergencies, communicable disease outbreaks, natural disasters and terrorist attacks.

The objectives of the Fund are to prevent, eliminate or reduce the occurrence or severity of communicable disease outbreaks, environmental and chemical threats, and acts of terrorism, and/or reduce the severity of unavoidable natural disasters and other emergencies; to continue to build and strengthen Australia’s preparedness to prevent and minimise the impact from events such as communicable disease outbreaks, natural disasters, environmental and chemical threats and acts of terrorism; and to put in place systems to ensure an effective, coordinated and timely response to health emergencies.

In 2011-12, the Department consulted with Health Protection Fund holders to develop the Fund guidelines and developed systems and processes to support the new Fund.

The Department commenced consultations on the new flexible Fund arrangements with Health Protection Fund holders in May 2011. Consultations in September and October 2011 included the discussion paper on the development of the funding guidelines.

The Department released operational guidelines for the Fund in June 2012. The guidelines are available on the Department’s website.

Review of Australia’s Response to Pandemic (H1N1) 2009

In November 2011, the Department published the Review of Australia’s Health Sector Response to Pandemic (H1N1) 2009: Lessons Identified¹⁴¹ (the Review). This followed extensive consultation with domestic stakeholders, including health advisory and decision-making committees, Australian and jurisdictional government agencies, and clinical stakeholder groups. The Review highlighted that successful responses depend on multi-stakeholder cooperation with effective communications, strong science-based decision making and a flexible public health response system able to respond rapidly to a crisis.

The Review made 25 recommendations for a national health sector response to an influenza pandemic which focused on identifying ways to strengthen the planning, management and operational aspects of pandemic health response arrangements in Australia.

The Pandemic Review Implementation Advisory Committee (the Committee) was established in November 2011 to provide expert advice and to oversee implementation of the Review’s recommendations. The Committee is chaired by the Chief Medical Officer and has representations from the Australian Government, jurisdictions and expert groups. It reports to the Australian Health Protection Principal Committee.

The update of the Australian Health Management Plan for Pandemic Influenza commenced in November 2011 and is now expected to be completed in late 2013. The delay is to ensure recommendations of the Review of Australia’s Health Sector Response to Pandemic (H1N1) 2009: Lessons Identified, published in November 2011, are fully considered as part of the update. It is expected that the update will be available in 2013-14.

National Medical Stockpile

In 2011-12, there was no cause to deploy items from the National Medical Stockpile to support a response to a health emergency. There were also no opportunities in 2011-12 to exercise National Medical Stockpile deployment capabilities.

The Department established a Taskforce in August 2011 to implement a series of recommendations arising from the Strategic Review of the National Medical Stockpile, conducted in 2010. Once implemented, the recommendations will provide costing savings and minimise waste and for the National Medical Stockpile, while maintaining capacity to respond to a national health emergency.

The time frames for implementation of the recommendations for inventory management have been extended to allow for a more comprehensive and detailed review of possible inventory management solutions.

The recommendations for stock disposals were implemented and completed by 30 June 2012.

Environmental Health

In 2011-12, the Department implemented the fifth and final year of the National Environmental Health Strategy 2007-2012. The Department worked with the Environmental Health Subcommittee of the Australian Health Protection Principal Committee to finalise and publish Asbestos: a guide for householders and the general public, the revised Environmental Health Risk Assessment: Guidelines for assessing human health risks from environmental hazards and its companion Australian exposure factor guidance. The web based publications, The Role of Toxicity Testing in Identifying Toxic Substances in Water and Arthropod pests of public health significance in Australia were also produced.

The Department also supported the 7th National Aboriginal and Torres Strait Islander Environmental Health Conference held in Darwin on 26-29 September 2011. In March 2012, the Department, with state and territory representatives on the Environmental Health Subcommittee, agreed to the new National Environmental Health Strategy 2012-2015. The 2012-2015 Strategy recognises the evolution of environmental health governance structures since the Environmental Health Subcommittee’s establishment in 1999, with all levels of government and other key stakeholders now making decisions that impact on environmental health policy, regulation, research and practice.

National Health Emergency Planning and Response

The Department coordinates health responses to national emergencies from the National Incident Room. The current National Incident Room has been functional since September 2006. Since then, there have been many emergencies with human health implications including: Pandemic H1N1 2009, Victorian bushfires, flooding in Queensland and Victoria, Tropical Cyclone Yasi, the Japanese earthquake tsunami/nuclear reactor crisis and the Christchurch earthquake. Many lessons have been identified following the Department’s responses to these emergencies to enable the Department to more efficiently coordinate national health emergencies.

The Department refurbished the National Incident Room between December 2011 and June 2012, in line with recommendations arising out of lessons learned from responses to those emergencies. The refurbishment improved functionality and increased the number of workstations. The National Incident Room can now accommodate larger response teams and is better placed to coordinate multiple emergencies. The National Incident Room’s operational readiness was maintained at all times during the refurbishment.

In 2011-12, the Department continued to fund and collaborate with the National Critical Care and Trauma Response Centre to maintain and improve a state of preparedness for response to major onshore and offshore incidents both in Australia and South East Asia. The Centre enhanced preparedness nationally through a variety of activities such as trauma and disaster training for local and interstate clinicians.

As part of the ongoing work on national planning and response, the Department worked closely with states and territories under the Australian Health Protection Principal Committee to develop and trial a range of processes relating to national Australian Medical Assistance Team capability in the 2011-12 reporting period.

The Department conducted an exercise with Food Standards Australia New Zealand to review response protocols for food-related incidents with potential human health impacts. In addition, the Department participated in, and provided contributions to, a number of multi-agency national emergency exercises.

The principal vehicle for the Department to coordinate and support national health emergency management is through the Australian Health Protection Principal Committee (the Committee). In 2011-12, the Committee considered and agreed to policies on the national disaster management capability audit; Australian Medical Assistance Team arrangements; pandemic influenza preparedness; climate change adaptation; and immunisation.

The Department also provided disaster management training for Committee members.

The Committee held two short notice emergency meetings to consider the public health response to Hendra virus and the contamination of the blood product AlbuminTM.

In 2011-12, the Department also participated in short notice Australian Government emergency management meetings and teleconferences on severe flooding in NSW, Queensland and Victoria; a major landslip in Papua New Guinea; and the sinking of the MV Rabul off the Papua New Guinea coast.

The National Health Security Act 2007 sets the framework for the Department, through its National Incident Room, to communicate with state and territory public health units and other designated responsible bodies in the event of a potential health event of national significance or public health emergency of international concern. These arrangements also implement Australia’s obligations under the World Health Organization’s International Health Regulations (2005).

A common example of such work is tracing people potentially exposed to a communicable disease, either overseas or in Australia, such as passengers on a flight to Australia sitting near to someone subsequently diagnosed with a communicable disease. In 2011-12, the National Incident Room coordinated responses to 82 contact tracing incidents, including for measles, meningococcal disease, tuberculosis, legionnaires’ disease and HIV related incidents.

The Australian Government also recognises the important role the Australian Red Cross Society (ARCS) plays in responding to disasters and continues to support funding to ARCS for a broad range of health related humanitarian work and community activities. These include disaster preparedness, first aid, disaster response and refugee services, both at national level and in the Asia-Pacific Region.

The Australian Government provided additional funding to CSL to ensure that antivenom products of a range, type and quantity suitable and adequate for the treatment of venomous bites/stings peculiar to Australia are available for purchase by state and territory governments and other persons.

In 2011-12, the Department developed and revised plans and guidelines underpinning the National Health Emergency Response Arrangements, including the development of a Health Chemical, Biological, Radiological and Nuclear Incidents of National Consequence Plan. The Plan will provide strategic and operational guidance to effectively consider a national health response to a large scale chemical, biological, radiological or nuclear incident.

Biosecurity, Drug and Chemical Safety

Replacing the Quarantine Act 1908

Together with the Department of Agriculture, Fisheries and Forestry, the Department is developing modern legislation to replace the Quarantine Act 1908. The proposed Biosecurity Bill seeks to better manage biosecurity risks, including human health risks, at Australia’s international borders. This work has included consultation with key stakeholders in relation to provisions relating to human health, including state and territory Chief Human Quarantine Officers, a range of communicable disease experts, civil liberty groups and transport industries. The proposed Biosecurity Bill is expected to be introduced into Parliament in Spring 2012.

A risk assessment framework has been developed to support health protection policy development. This framework addresses the Department’s regulatory requirements under the existing Quarantine Act 1908 and proposed legislative requirements under the new biosecurity legislation.

The Department worked with the Department of Agriculture, Fisheries and Forestry to develop an implementation plan for the delivery of biosecurity reforms. This included the delivery of new legislation to replace the Quarantine Act 1908.

The Department continued to develop policies designed to prevent the entry and spread of communicable diseases into Australia, including for the importation of cats and dogs into Australia.

Security Sensitive Biological Agent Regulatory Scheme

The Department continued to administer the Security Sensitive Biological Agent Regulatory Scheme. In 2011-12, over 165 suspected Security Sensitive Biological Agent reports and over 80 reports from registered entities were received and processed. The Scheme’s comprehensive inspection program continued to ensure a high level of compliance across both registered and non-registered entities. Education and awareness raising activities continued through the Scheme’s online training facility, regular newsletter, stakeholder engagement and face-to-face contact during inspection processes. The Scheme is being continuously enhanced through legislative review and IT infrastructure improvements.

In 2011-12, inspections of laboratories registered under the Security Sensitive Biological Agents Regulatory Scheme revealed full compliance with the Scheme. The regulated community maintained a high standard of cooperative compliance in supporting the goals of the scheme in ensuring the secure handling of Security Sensitive Biological Agents and minimising the risk of a bioterrorist event.

Drug and Chemical Safety

The Department continued to provide advice to the Australian Pesticides and Veterinary Medicines Authority on the public health effects of human exposure to chemicals and pesticides regulated by the Authority. The toxicology profile of each product and its method and purpose of use is considered by the Department and used to inform the regulation and approval process for new pesticides and veterinary medicines.

The assessments of agricultural and veterinary chemicals provided to the Australian Pesticides and Veterinary Medicines Authority were accepted as comprehensive, accurate and of good quality. However, assessments were not always completed within the required time frames. The Department, through the Office of Chemical Safety, recommended against granting some applications on human health grounds.

In 2011-12, the Department maintained the quality and continued to improve the on-time delivery of human health risk assessments to the Australian Pesticides and Veterinary Medicines Authority, the Department’s stakeholder for agricultural chemicals and veterinary medicines. The Department continued to develop and maintain the database of health standards arising from these assessments.

The Department’s structural adjustments made in 2010-11 assisted in increasing capacity and flexibility to deliver risk assessments. While the previous backlog of assessments was substantially cleared during 2011-12, the lag effect of the backlog and ongoing difficulty in recruiting appropriate staff meant that the Department did not meet its time frame target. The Department explored accessing external expertise to minimise this risk. However, this was not found to be effective or efficient. Time frame performance significantly increased by 48%, from 41% compliance in 2010-11 to 61% in 2011-12. Time frame compliance is expected to continue to improve in 2012-13.

All scheduling decisions on requested amendments to the Standard for the Uniform Scheduling of Medicines and Poisons made by the Secretary’s delegates were published within acceptable time frames.

In 2011-12, 115 requests for scheduling consideration were processed, for which 11 were rejected by the delegate. A total of 69 decisions were made, 30 being delegate-only decisions and 39 being made following advice from an advisory committee. Thirty-five decisions will be determined in 2012-13. For matters referred to an advisory committee and thus requiring public consultation, 75 public submissions were received and processed.

Management of Controlled Substances

An escalation of emerging drugs and continued rise in import and export activities increased the regulatory effort required by the Department. This has continued to present a challenge to the Department’s capacity to process applications in a timely manner while meeting international reporting obligations. The Department is engaged with relevant government agencies to address this emerging issue.

In 2011-12, the Department maintained controls for the licit use of narcotics, psychotropic substances, precursor substances and other controlled substances under the Customs (Prohibited Imports) Regulations 1956, the Customs (Prohibited Exports) Regulations 1958 and the Narcotic Drugs Act 1967. These controls are in accordance with Australia’s obligations under the international drug conventions. The Department monitors the licit trade of narcotic, psychotropic and precursor substances in and out of Australia and provides regular reports on this information to the United Nation’s International Narcotic Control Board.

The Department actively cooperated with other countries in the control of substances (precursors) that have the potential for diversion into illicit drug manufacture. There were 1,735 pre-export notifications processed by the Department for all precursor substances controlled under the international drug conventions.

Through collaboration with the states and territories, the Department monitored the stock, manufacture and approximately 3.2 million wholesale transactions of all controlled drugs in Australia. The data collected contributed to Australia’s obligations under international drug treaties and assisted states and territories with monitoring potential drug diversions.

Australia is a major global producer of narcotic materials from poppy cultivation. In accordance with international drug conventions, Australia is required to carefully control and supervise all stages of poppy growing and production of narcotic raw materials. The Department issued manufacturing licences and permits under the Narcotic Drugs Act 1967 and reports on the cultivation areas, harvest and narcotic production to the United Nation’s International Narcotic Control Board.

The Department monitored and authorised the import and export of narcotic drugs, psychotropic drugs and precursor chemicals into Australia that are subject to the International Drug Conventions Data collected from these activities were provided to the INCB on a quarterly and annual basis.

The Department also collected and reported consumption data for narcotics, monitoring legitimate movements of controlled drugs between establishments. The movement data was also matched and reported to state and territory health agencies within agreed time frames.

In 2011-12, the Department issued a total of 7,600 licences and permits authorising the import, export and manufacture of controlled drugs, an increase of 5% from 2010-11. This increase, and related activities, contributed to processing being outside of the target of 98%.

The Department also issued 1,735 Pre-Export Notifications (an increase of 16% from 2010-11) and recorded a 7% increase in formal statements provided to law enforcement agencies.

Departmental Human Quarantine Officers have access to online human quarantine training. Face-to-face training of Australian Quarantine Inspection Service Officers has been suspended while it is reviewed and updated to incorporate new requirements under the proposed Biosecurity Bill.

All airports and seaports designated under the International Health Regulations have an emergency plan in place to address human health emergencies.

Minimise Risks Posed by Communicable Diseases

In 2011-12, the Department commenced development of a national framework for communicable disease control in Australia. This will be a guiding document that aims to critically appraise the Department’s current national communicable disease control capacity, articulate a vision for the future and therefore guide decisions about future priorities and investments. The framework will specify key communicable disease functions, system enablers and opportunities for progress. The year ahead will include further development of the framework, stakeholder consultation and the public release.

Papua New Guinea Tuberculosis Patients

In 2011-12, the Department worked with AusAID, Queensland Health, Papua New Guinea and Australian tuberculosis physicians to safely and ethically transfer Papua New Guinea tuberculosis patients, previously treated at tuberculosis clinics in the Torres Strait, to the Papua New Guinea health system.

World Health Organization best practice guidance for tuberculosis treatment is for long term continuous care which includes patients being observed taking their medication – directly observed treatment short-course (DOTS). This helps patients to take their drugs regularly and complete treatment and, in turn, leads to cure and prevents the development of drug resistance. The Department worked with Queensland Health and Papua New Guinea, through AusAID, to support delivery of this model of care in the Torres Strait and Papua New Guinea.

The Department also worked with stakeholders to put in place longer term protocols and arrangements towards the sustainability of health care in the South Fly District of Papua New Guinea. This approach will improve outcomes for the communities in Daru and South Fly by enabling them to access the health care they need at home. It also better manages risks to Torres Strait communities. The Department will continue to work with stakeholders to consolidate and complete the transfer of those patients.

Progress reports submitted by Queensland show progress towards achieving the agreed control, monitoring and elimination strategies. Funding contributed towards Queensland Health staff making eight trips to the Torres Strait to monitor, control, eliminate and prevent the expansion of Aedes albopictus mosquitoes in the Torres Strait region. The Department accepted Queensland’s progress reports for September 2011 and March 2012.

The Department continued to fund Queensland Health for the Aedes albopictus Prevention and Control in the Torres Strait Program. In 2011-12, the evidence received by the Department from ongoing surveillance indicates that there is currently no established exotic mosquito (Aedes albopictus) population on mainland Australia, thus restricting the spread of dengue fever and other mosquito-borne diseases.

In response to an incursion of Aedes aegypti (dengue-transmitting mosquitoes) in Tennant Creek in late 2011, the Department provided funding assistance to the Northern Territory government towards a mosquito elimination program. This assistance will reduce the possibility of dengue-transmitting mosquitoes establishing across Northern Australia and thus reduce the risk of dengue transmission in the region.

The Department participated in the following meetings in 2011-12:

• two meetings of the Torres Strait Cross-Border Health Issues Committee;
• the Department of Foreign Affairs and Trade’s Joint Advisory Council;
• two interdepartmental committee meetings on the Torres Strait Treaty; and
• two meetings with tuberculosis clinicians from Queensland Health and Papua New Guinea and AusAID.

A key role of the Torres Strait Cross-Border Health Issues Committee, which the Department chairs, is to identify health concerns that arise in the Torres Strait Treaty Zone encompassing Torres Strait islands and certain villages along the Papua New Guinea coast. This work includes maintaining links and cooperation between Australian and Papua New Guinea officials to enable continued surveillance and information sharing on communicable diseases and emerging health risks in the Treaty Zone. In 2011-12, the Department supported this function by coordinating the Torres Strait Cross-Border Health Issues Committee’s activities for its biannual meetings and its activities between meetings. The Committee reviewed communicable disease surveillance data, and in 2012-13, the Committee will consider ways to address gaps to achieve international best practice for cross-border health issues in areas such as cross-border patient referrals and communication protocols, in partnership with relevant agencies.

Whole of Program Performance Information

In 2011-12, the Department researched and developed evidence-based policy to prepare for and effectively respond to national public health emergencies and inform targeted health protection policy through a number of activities.

Funding provided to research organisations such as the World Health Organization Centre for Reference and Research on Influenza contributed to Australian national, regional and international influenza surveillance and the Department’s influenza pandemic planning policy.

The Department provided funding to specific research projects to contribute to building the evidence base for future pandemic planning in the revision of the Australian Health Management Plan for Pandemic Influenza.

In 2011-12, the Department, under the auspices of the Australian Health Protection Principal Committee, reviewed the National Capability Audit process to ensure the Audit program produced a useful and meaningful document.

The Department consulted with relevant stakeholders including Australian Government agencies, states and territories, industry, academic and research institutions, and expert bodies on health protection policy and program development.

The Department continued to consult with key health protection stakeholders through the Australian Health Protection Principal Committee and its subcommittees. For example, the National Health Emergency Management Subcommittee of the Australian Health Protection Principal Committee contributed to the ongoing development of the Australian Medical Assistance Team Program.

The Department engaged regularly with the Department of Agriculture, Fisheries and Forestry (DAFF Biosecurity) on human quarantine policies and the delivery of human quarantine services at Australia’s borders.

Together with Food Standards Australia New Zealand, the Department provided advice to DAFF Biosecurity on the human health risks associated with imported goods.

The National Medical Stockpile Taskforce undertook high level consultations with states and territories to inform implementation of the National Medical Stockpile Strategic Review.

Torres Strait Cross-Border Health Issues Committee meetings provided an avenue for Australian Government, Queensland Government and health authorities from Papua New Guinea to provide advice and information on cross-border health issues.

This underspend was due to a lower than anticipated write down and deployment of assets in the National Medical Stockpile.

Outcome 14 – Financial Resources Summary

1. Departmental appropriation combines ‘Ordinary annual services (Appropriation Bill 1)’ and ‘Revenue from independent sources (s31)’.
2. ‘Expenses not requiring appropriation in the current year’ is made up of depreciation expense, amortisation, make good expense and audit fees. This estimate also includes approved operating losses – please refer to the departmental financial statements for further information.

139. In the 2011-12 Budget the Australian Government announced the consolidation of 159 whole or part Health and Ageing programs within 18 flexible Funds. The Health Protection Fund is one of the 18 Funds that came into operation from 1 July 2011. The establishment of flexible Funds will, over time, reduce red-tape for funding recipients in line with the National Compact, provide increased flexibility to government to respond to emerging health and ageing issues, and deliver better value for money and evidence-based funding.
140. A full list of activities consolidated into each flexible Fund is provided at Part 3.6: Activities Consolidated to Establish Flexible Funds.
141. Available at: www.flupandemic.gov.au

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