DR SHELLEY DOLAN:
Good morning everybody. My name is Dr Shelley Dolan, and I am very, very privileged to be the Chief Executive here at the Peter MacCallum Cancer Centre and I’d like to extend a very warm welcome to everybody this morning.
I would particularly like to welcome the Honourable Greg Hunt. I’ve only been here eight months and this is the second time he’s been here which is fantastic. He’s the Federal Minister for Health. I’d also like to acknowledge Professor Mark Hargreaves who is the Pro Vice Chancellor for the University of Melbourne.
A very close partnership and a very close colleague. I’d also like to welcome one of our board directors, Professor Leslie Reti and other esteemed colleagues from Peter Mac and particularly I’d like to welcome Dale and also Professor Linda Mileshkin, who is one of our fantastic leads in medical oncology.
So as I think you all know, Peter Mac is a world-leading hospital, dedicated to the science, education and care for people with cancer and we think of it really as looking, ensuring that we can care for people now but also for the future. And that’s why the science of translation is so important. So I’m very excited now to come away and welcome Greg Hunt. Thank you very much.
Thanks very much to Dr Shelley Dolan, to Professor Linda Mileshkin, to our amazing patient Dale, who is just courageous, positive and a wonderful example of somebody who is dealing with the most difficult of conditions.
Professor Les Reti, Professors Mark Hargreaves and Ricky Johnstone and to everybody here at Peter Mac. Peter Mac is exactly as said, one of the world’s great cancer research, treatment and therapy centres.
We were really privileged to be able to support the uptake of CAR-T therapy here – a breakthrough cellular immunotherapy treatment on two fronts. One, by providing capital for Peter Mac to be a world centre for production of cellular immunotherapy and in particular, CAR-T therapy and secondly, by being able to list on Medicare the CAR-T availability for different blood cancers, for leukaemia’s and lymphoma’s.
I just had the news this morning that 43 patients treated here. Extraordinary results so far. Some where we don’t know the results, but overwhelmingly remission and people returning to their lives.
So lives are literally being saved with breakthrough new treatment. Part of the challenge, as well as that, is that in addition to the more well-known cancers, we also have rare cancers and rare diseases in Australia. Two million Australians live with some form of rare cancer or rare disease.
There are 10,000 different rare diseases of different types that have been identified in Australia and no doubt, there will be more over the coming years. And in any one year, 40,000 Australians will be diagnosed with some form of rare cancer and that can be a terrifying diagnosis and until recently, until we established the Medical Research Future Fund Rare Cancers, Rare Diseases program, historically there hadn’t been a significant focus on diagnosis, treatment and research for rare cancers.
It’s a clinical trials program that has already been providing support across a range of different types of cancers and diseases, from Motor Neurone Disease to childhood glioblastoma’s and medulloblastoma’s – just immensely important research that can save lives and protect lives and give people profound hope. And at this time in our history, the combination of research and hope for Australia is more important than ever before.
So today I am absolutely delighted to be able to announce $35 million for 17 very specific clinical trials programs for rare cancers and rare diseases. These include rare conditions such as ataxia for children.
There’s a beautiful little girl called Goldie. She has her third birthday coming up and she will be one of the potential beneficiaries under this clinical trial program, which will be run by the University of Queensland. Programs for women with particular rare and unmet needs with regards to osteoporosis.
We have other projects that are focusing on the rare cancers, pancreatic disease, which has such a low survival rate, but where there are real prospects of breakthroughs. Similarly, with rarer forms of leukaemia and the project which Linda is leading is about cancers with unknown primaries.
What that means is where we don’t know the origin of the cancer and if we do know the origin, then we have a better chance of treating it and improving the outcomes for the patient, giving them real improvements in the quality of their lives.
And so I am delighted, Linda, that we will be contributing almost $2.4 million to Professor Linda Mileshkin and Professor Rod Hicks, who will be leading the cancer of unknown primary clinical trials program. This is about finding the source of the cancer and then treating it with radiotherapy. These two things – diagnosing and treating.
We know that there are 2,400 people that lose their lives to cancers of unknown primary or unknown origin every year. If we can save one life, then that will be enough, but my hope and my belief is that this will give real prospects for potentially thousands of patients over the years ahead.
At the same time, Australia has been battling coronavirus and we have done magnificently. But I think it is very important to emphasise that as we see a world which has soared past 9 million officially diagnosed cases, and no doubt, many millions more, which has now had over 470,000 lives lost, and again, many, many thousands more are likely to have been lost around the world.
Australia’s achievement has been a national achievement. People have come together, people have partnered. Doctors, nurses, the community, federal, state and local government and it’s very important to acknowledge that.
But we are facing a challenge. Here in Melbourne, whilst in seven states and territories we have largely achieved a very stable state, at the moment, there is a spike. Victoria has identified 20 new cases overnight. One from hotel quarantine, seven linked to existing cases, existing clusters and the others are under investigation.
So our message is two-fold. One, we are as well prepared as any nation in the world. The case numbers are low, even by Australia’s historic standing. They are minimal by global standards, but they are of concern. They could spike further.
So please, one, continue to be tested and we know that there are almost 90 testing sites in Victoria, as well as the capacity to call your GP. Two, please look for symptoms. If you have symptoms, stay at home or make sure you get tested. And three, practice the hand hygiene, the physical distancing remains immensely important.
As we emerge from the lockdowns, we need to make sure that we continue that physical distancing and if you haven’t so far, then please download the COVIDSafe app. It can help save lives and protect lives.
I might invite Linda to say a few words, then I’d be happy to take questions from those here and questions from those on the phone.
PROF LINDA MILESHKIN:
Thank you Minister Hunt. My name’s Linda, as you’ve heard and I’m a Medical Oncologist and I’ve had the privilege to work at Peter Mac for a while now. And I’m really excited to have this opportunity to receive this grant from the MRFF which will allow us to do some more research into this difficult group of patients.
So cancer of unknown primary is a type of cancer that not many people have heard of actually. It refers to a situation where people present with metastatic or secondary tumours in their body, but it’s not clear where the cancer came from, or what the primary tumour was.
And it only accounts for a small percentage of patients diagnosed each year in Australia, as Minister Hunt said, but unfortunately this group have quite poor outcomes and poor survival rates and that’s in part because it’s hard for oncologists to treat these patients if we don’t know where the tumour came from.
We can’t recommend a specific targeted treatment and instead we use general chemotherapy drugs that may or may not work. So at Peter Mac, we do have a dedicated clinic for these patients and we also have a dedicated program of research, looking at trying to improve outcomes for this group and we have a range of collaborators that we work with, including a fantastic group from the University of Melbourne, representatives of whom are here today.
So in this new grant, we’re going to study the role of a protein called FAP or Fibroblast Activation Protein, which is a protein we found in our laboratory studies is commonly found in large amounts in cut tumours. And it seems to play a role in providing the matrix or structure which allows the tumour to form into a mass, that we know of as a cancer mass.
So in the grant, we’ll be looking at studying a new type of PET scan which will allow us to detect tumours that express this fat protein and we hope that this will give us more information about exactly where the tumours are and importantly, where the tumour might have come from.
What the primary was, so we can then provide more effective treatments for our patients. And in a second part of the trial, we’ll also try and see if we can turn this into a therapy, whereby we can use the same approach but try and actually label the tracer used in the PET scan with a small amount of radioactive material that will essentially take radiotherapy via the bloodstream straight to the cancer and treat the cancer, to try and improve outcomes for our patients.
Brilliant. Thanks very much to Linda. Now happy to take any questions from those in the room first, then Candice, Dana and Tom.
Sure. Just in regards to coronavirus, more than a month before the spike in coronavirus cases in Victoria, you were warned of a missed opportunity to prevent outbreaks because of the government’s failure to engage with high-risk communities, including migrant groups.
Why didn’t the government act immediately on that advice?
I saw that story and that story was wrong. Since the outset, we have set out to work with communities of different languages or communities of diverse language, ethnic origin. I believe the figures are that we have invested in broadcasts in 20 different languages prior to, and subsequent to the report.
We have invested in fact sheets in 63 languages, which has been prior to and subsequent to. So we value the report. Thirdly, we have had 4,300 engagements directly, through the government, led by the Department of Home Affairs, the Minister for Immigration and the Parliamentary Secretary for Immigration, both Victorians.
4,300 engagements with different ethnic communities and leaders and almost 900 of those have been in Victoria. In addition to that, 850,000 unique page views. So, saw the story, the story was wrong.
So the expert committee, the National COVID-19 Health and Research Advisory Committee was actually set up to provide health advice to the government –
Yes, I set it up.
And the people on that are saying the migrant consultants on that were saying they were consulted rarely or on an ad-hoc basis. What do you say to that?
Well in fact there have been 4,300 consultations with migrant leaders or communities in different ways, shapes or forms. Secondly, we not only had the migrant representatives specifically at my request on that committee, which was set up specifically at my request.
We also had migrant consultation to that community and not only have we taken that up prior to it, as I said, beginning in February, we began the process of setting out different language broadcasts, different language fact sheets, 20 broadcasts in different languages, 63 languages in fact sheets, 4,300 engagements with migrant communities, including those who have done a fantastic job and then 850,000 different other language, unique page views in terms of foreign language fact sheets.
They’re saying that the translated material isn’t an effective way of passing the message on. You mentioned of course, the broadcasts as well –
That’s why there were multiple engagements, meeting with community groups –
Ok, well we’ve clearly seen a spike and we’ve clearly seen a fall gap situation here in Victoria, so how can you ensure that these diverse communities are getting your message about COVID?
I think the very important thing here is to understand that you have a small number of outbreaks, particularly in a couple of families, and so where there are a couple of families, you have to do three things. First, to focus on those families and to test and to trace.
The Victorian Government is doing that and we have offered all support to the Victorian Government. The Prime Minister has offered the Premier of Victoria all of the support if they need military support, if they need AUSMAT support, if they need contact tracing support.
Already the contact tracing support public health official units from other states have been accepted by Victoria and I welcome that. Secondly, there is the specific engagement with communities and so, with respect, the error in the report is a complete failure to recognise that there’s been direct community engagement, as well as national level engagement and so within those specific communities, in northern Victoria there’s been engagement led by the Department of Home Affairs and migration, but also the state authorities and so it’s been done in parallel.
And the third thing is, as I say, the national program which started before and continued on. So, I spoke to the head of the body this morning, Professor Michael Kidd, who did the report who said it had been completely misrepresented on the ABC and was very upset and very disappointed as of course, as the person who was the author of the report that such a statement could have been made.
We realise it must’ve been made in good faith, but inadvertent and was an error and he was seeking a correction from the ABC.
And would you say then that your engagement with these diverse communities is more than adequate? Is there any room for improvement at all?
Every day, every day on every front we’re working harder. We’re encouraging the Victorian Government to do more on the ground. We’re offering our support, but 4,300 engagements and 850,000 page views, we have been a world leading.
I think one of the things here is when you look around the world and you see what’s occurred overseas, roaring past 9 million cases, the rate of growth is actually accelerating around the world, and yet in Australia, the achievement we have had is precisely because we have engaged with these communities.
If there’s an individual family where they have not observed the distancing behaviours, then there’s a mixture always of extra information, but personal responsibility and one of the things we know has happened and this was set out in research that was published today, is over recent weeks, particularly since the protests, many Victorians and many Australians have said, gosh if it’s ok for 10,000 people to congregate and huddle together, surely it would be ok for 10 in my family.
And the message is it was never ok for that protest to have gone ahead, not because of the subject matter – noble, powerful, important – but because of the fact that two and a half weeks later, we have had an outbreak in Victoria, in part, we know that there are four cases directly linked with that protest, but we also believe that there has been a significant relaxation in parts of the public as a consequence of the double standard.
So the message is, please keep your distance, it’s vitally important, it can save your life and protect your life.
Should Victoria go back to Stage 3 restrictions and should the other states be locking Victorian travellers out?
I think everybody needs to recognise that Australia has done well and continues to do incredibly well. We always warned, back in February and March and April, that no matter how well we did, there was always the potential or risk of spikes or outbreaks. And that’s what we’re seeing.
And in order to deal with that, that was why we established rapid testing, rapid tracing and rapid local responses. That’s what we did in North West Tasmania and we were able to control that outbreak.
That’s what we did in Western Sydney, we were able to control those outbreaks and that’s what’s being done here in Melbourne. I want to thank the public for seeking the tests and their patience in that. That testing is arguable the best testing program in the world and it’s what’s helping to protect Australians and keep them safe.
You’ve got people waiting four, five hours for a test though. Is that (inaudible)?
I think one of the things here is, people have responded and there are multiple places where testing can occur.
So it’s very important to go to health.gov.au or dhhs.vic.gov.au and they set out the almost 90 testing sites that are available in Victoria, as well as going through your GP because many general practices are linked directly to pathology collection centres and that may not be known to the public.
Not every general practice will necessarily want to see somebody or be in a position to because of their physical circumstances, to do it, but call your GP or look at the health.gov.au or dhhs.vic.gov.au, and so there are multiple avenues for testing, not just a couple. Ok, I’ll go to those that are on line. Candice?
Good morning Minister. As you say, Victoria has recorded another 20 coronavirus cases today, as well as another death, sadly, the first in as many weeks now.
My question is two-fold – how have our rates of community transmission (inaudible) both as the Federal Health Minister and as a Victorian and, do you think Victoria (inaudible)?
Look, firstly I think it’s important to acknowledge a 103rd death in Australia, the first in some weeks, so that’s a source of deep sadness for the family and also for the nation. Secondly, this reminds us it is a global pandemic and there were some that may have believed that we were going to be completely out of the woods. That has never been the case.
That was why the protests were not a safe thing to do. That was why we’ve maintained throughout all of this, and I said in Parliament and the Prime Minister said in Parliament and we’ve spoken widely, that we must keep focussing on our 1.5 metres, on the physical distancing which is so unnatural, but so vital to our future.
So we’ve remained concerned about the level of cases. They remain at a low level, in discussions with the Chief Medical Officer only this morning. However, this is a critical juncture and I do believe that is the case. We can continue to work to bring these cases down, supress the case numbers in Victoria.
As a country we’ve done extraordinarily well, but we don’t want to judge any individual state or territory where there is an outbreak, because that is what can happen. It can literally take one person who doesn’t do the right thing.
One person who doesn’t even realise that they have symptoms because it is a disease that can transmit at the late stages of being asymptomatic. And so it is not a case to judge one state for the circumstances they’re in.
It’s our duty to help that state at that moment, which is why we’ve been coordinating national action and the Prime Minister has offered AUSMAT, the army, contact tracing support, whatever is needed by Victoria to assist. Dana?
Thank you Minister. Can I ask (inaudible) between Federal and Victorian Government on a (inaudible) hotel quarantine breach? Is the Victorian Government too proud to ask for (inaudible) help?
Do we need to start diverting flights away from Melbourne? And are you confident that the security companies that are contracted by the Victorian Government to run the hotel quarantine are actually (inaudible)?
Sure. So the Chief Medical Officer took to the medical expert panel the question of standards in hotel quarantine. All of the states and territories work together. This will become increasingly important part of our defence mechanisms.
We know there was a breach within the Victorian context, again no blame, it’s a fact, and so what we have to do is ensure that those standards in hotel quarantine are absolutely at the highest level.
So we’ve offered support and it’s entirely a matter for each state and territory to determine their particular needs at that particular time. In North West Tasmania, we had an AUSMAT team, so the medical assistance team – think of it as the, they’ve been described as the SAS of infection control – come in with military support underneath simply for logistics.
So Victoria is a great state, but they have done an extraordinary job so far, overwhelmingly extraordinary job and I think it’s very important as a Commonwealth Minister to put that on the record, as have all the states and territories.
Our resources are available, Victoria has already accepted support with contact tracing from New South Wales and South Australia and we work as one single country. And when somebody needs the help, we’re here to help and they will accept and ask for what it is that they need and I’ll leave it them to determine that.
In terms of flights, which work very constructively - we have a mixture of commercial and specific repatriation flights. The commercial flights obviously have their destinations. The advice I have this morning is there’s no plans at this stage to change the destination for any of those flight arrivals. If either the Commonwealth or any state had concerns then that would be easily resolved.
Thanks Minister. Just a couple of questions, firstly, following on from that, is there a point where you see (inaudible) to hotel quarantine in Victoria (inaudible) where you could see flights diverted so you can ensure that arrivals are going to a safe place and secondly, just on the pattern of effective reproduction rate of the virus, today Victorian authorities were saying this morning that that’s now up to 2.5 and obviously you wanted it one or below, (inaudible) does that sort of change the National Cabinet view on easing restrictions?
Does Victoria potentially have to pull back further if they’re unable to get that number under control?
Sure. So, firstly in terms of hotel quarantine and flights. Our job is to ensure that each of the states is maintaining the standards. That’s why the Chief Medical Officer, Professor Murphy, took the question of hotel quarantine specifically to the medical expert panel in recent days.
The purpose of that was to ensure that all states were at the highest level and I think the different state chief health officers have taken on board the suggestions and standards of each other. But we’ve offered assistance in terms of AUSMAT or infection control specialists to be available, but Victoria does have extraordinary people.
I think the key thing here is to make sure that the particular security companies are up to standard and if they’re not up to standard then to ensure that somebody else is in place. And, you know, if at any stage any state is struggling, then we’re very open to them talking to us. We haven’t had that notion yet, but if any state is struggling.
There’s been an outbreak. Somebody has either not known or not done the right thing, so we need to be honest about that, but we need to keep in perspective that Australia, by global standards, is doing extraordinarily well and we will continue to do well.
But locally, and this goes to the second part of your question. If you had a continued and prolonged case of what’s known as the effective transmission rate, being higher than one, sustained and significant – so you’ve got to have sustained and significant, because if it’s very low numbers as the Deputy Chief Medical Officer, Dr Nick Coatsworth said to me today, then that can literally be between one or two families.
But if it’s sustained and significant, then you have a case for a local lockdown because the model we’ve designed is rapid testing, rapid tracing and the capacity for local responses. So a local lockdown has been specifically identified by Victoria. That’s the structure that the National Cabinet and the medical expert panel have put together. And I think there’s one more here.
Just, how concerned are you about that reproduction rate of 2.5, given that we wanted to stay at about the one level?
Yep, it’s obviously amongst a very, very small community, including a series of families. So those families, where there’s physical proximity and physical contact are the most likely for transmission.
Having said that, our approach here is that we want to see that there is active suppression of these cases, that all of these families are fully contact traced, and then what’s occurring literally in the suburbs around us at the moment, the testing and the tracing and the active focus on those communities is continued.
So, it would need to be something which was sustained and significant. At the moment, it’s early days and the numbers, according to the Deputy Chief Medical Officer, are low. Ultimately, we have a task and that is to keep each other safe through our practices. As we said at the outset – there would be spikes and there would be difficult days.
This is one of those spikes, it is one of those difficult days, but more generally, my view and our advice is Australia is as well-placed as any country in the world. As we saw from the international economic advice overnight and as we see from the repeated views from around the world of Australia compared to what’s occurring.
So there’s more work to be done, but as one single country we will continue to do that. Thank you very much.