Thank you for the invitation to speak in this plenary session this morning. As a member of the Australian Medical Association for the past 38 years, I am honoured to be invited to speak today.
I am speaking to you today from Canberra which is in Ngunawal country.
I acknowledge the traditional owners of the land from which I am speaking, the Ngunnawal people, and pay my respects to their Elders, past and present.
And I extend my respects to all other Aboriginal and Torres Strait Islander people with us today.
The past year has been hugely challenging for us all. Our personal and professional lives have been disrupted as we have each experienced the demands of living under national biosecurity emergency arrangements. Our mental health and emotional wellbeing have been impacted, especially through forced separation from family and other loved ones. And many of us have been working on the front line of the nation’s response to COVID-19.
At the same time, I have never been so proud to be a member of the Australian Medical Association. I have had the pleasure and privilege of working closely first with past president Tony Bartone, and then over the past year with President Omar Khorshid and vice president Chris Moy.
Since my return to Australia in March last year, just ahead of our border closing, I have been chairing meetings – by video call – at least once a week with the leaders of our nation’s medical peak organisations, and similar weekly meetings with the leaders of more than 50 healthcare peak organisations.
The AMA leadership and staff have been involved in all of these meetings and have provided extremely valuable insight and expertise to support Australia’s continuing and evolving response to the pandemic.
In my 30 years of involvement in medical politics in Australia, I have never seen our peak organisations working together so well – our leaders listening to each other, sharing experiences, challenges and solutions, providing advice to government, working together to support the health and wellbeing of the people of Australia, and saving lives as we battle this coronavirus.
So thank you. Thank you to the AMA. Thank you to the leadership team of the AMA, and thank you to the staff of the AMA, led by Martin Laverty. You have served, and continue to serve, our country magnificently in this time of great need.
As Australia’s Acting Chief Medical Officer, while our colleague Professor Paul Kelly takes a well-earned break, I would also like to pay tribute to the work that all of you, the doctors of Australia – along with our colleagues in the nursing and allied health professions – have being doing throughout this pandemic.
Our nation’s success in responding to COVID-19 has only been possible because of the very significant contributions made by doctors and other healthcare workers – and our country owes you all a debt of gratitude for your support, your dedication, and your care for your patients and your communities.
It also hasn’t gone unnoticed that Australian healthcare workers have often had to provide vital clinical services in places and at times when there has been significantly community transmission of the coronavirus – putting your own health and wellbeing, and the health and wellbeing of your own loved ones, at potential risk. On behalf of our nation, thank you.
Five principles of pandemic preparedness
From the outset, Australia’s response to COVID-19 has been based on the best available medical and scientific evidence and advice.
Well before the World Health Organization declared a pandemic in March last year, Australian public health officials were alive to the very real threat posed by COVID-19.
In February last year, the Australian Health Sector Emergency Response Plan for Novel Coronavirus (COVID-19) was activated to guide our health sector’s response.
This plan didn’t seek to reinvent the wheel. Instead, it leveraged existing systems and governance mechanisms – and in particular those relating to human biosecurity and to other respiratory diseases such as influenza.
The plan stressed the importance of evidence-based decision-making and took a flexible approach that could be scaled up and varied as required. It also made use of the strong emergency response arrangements that were already in place.
In March, our national COVID-19 primary care response to the pandemic was developed, informed by the AMA and other key stakeholders. The primary care response has been based on five key principles:
First, the recognition of the need to protect the people must vulnerable to serious disease from COVID-19 infection, especially the elderly and those with chronic health conditions, and recognising that these people are cared for by the nation’s general practitioners and other primary care providers.
Second, the need to provide treatment and support services to people with risk of exposure or possible symptoms of COVID-19, and the need to carry out medical assessment and testing separate from the sites where other health care services were being delivered.
Third, the importance of ensuring the continuity of regular healthcare services for the whole population, recognising that during an epidemic or pandemic more people can be at risk of serious morbidity and mortality from the failure to continue essential preventive care activities and from the failure to manage other acute medical problems, chronic health conditions and mental health conditions, than may die from the actual infectious agent.
Fourth, the recognition that during a pandemic healthcare workers in the community need and deserve access to personal protective equipment just as much as those working in hospitals, and that our healthcare services need to be supported to ensure they are able to continue functioning.
And fifth, the recognition that our response to the pandemic has to acknowledge that the mental health of almost all Australians was going to be impacted by COVID-19 to some degree, and measures were needed to support and address this in parallel to the physical health response. This has come to be true. The toll on people’s mental health during the COVID-19 pandemic has been very significant – and will sadly continue for many people for many years to come. The pandemic, and the restrictions on our way of life imposed to respond to it, have increased depression and anxiety levels, as well as self-harm presentations to hospital emergency departments, particularly among young girls, and increased the complexity of mental health challenges being responded to.
These five principles have formed a robust framework for responding to the COVID-19 pandemic – and I hope will also form the basis of responses to future national and international health emergencies.
Adhering to these principles has put us in the strong position we are in today.
So with these five principles I have mentioned in mind, what specifically did the Australian Government do in the initial stages of our response to the COVID-19 pandemic? And how are these five principles continuing to guide our response?
Expansion of telehealth services and sourcing of PPE
One of the initiatives the medical profession has emphatically embraced is telehealth, and this has, and continues, to play a vital role in supporting Australian patients and their healthcare providers to remain safe during the COVID-19 pandemic.
Telehealth has been a lifechanging initiative – and a great example of how we can adapt to new circumstances and tap in to new technology for the benefit of our practices and our patients.
The global shortages of personal protective equipment caused huge distress and many avoidable infections among health care workers around the world. The Australian Government has greatly increased our national supply of personal protective equipment – including securing hundreds of millions of masks, as well as hand sanitiser, goggles, gloves and gowns.
The PPE was rolled out to doctors and other health professionals working in the community, as well as in hospitals.
One hundred and fifty general practitioner led respiratory clinics were established in urban and rural areas across the country to provide care for those with respiratory symptoms, ensuring access to face-to-face care for this group, as well as boosting the nation’s testing capacity.
This important work was enhanced through other initiatives, including the National Pandemic Response Plan for Mental Health and Wellbeing, developed by the National Mental Health Commission. This plan is proving to be extremely important as additional lockdowns continue to affect the emotional, psychological and social wellbeing of many members of the Australian population.
The five key primary care principles continue to guide the current phase of our response, with general practice as the backbone of the nation’s rollout of COVID-19 vaccines. The GP-led respiratory clinics have also taken on a role as commonwealth vaccination centres.
Ensuring general practice remains at the centre of our nation’s vaccine rollout is vital because, as we all know, our nation’s GPs look after the health of the people in our country most vulnerable to COVID-19 – including the elderly and those with chronic diseases.
A clinician’s perspective of the COVID-19 vaccine rollout
The organisers have asked that I include a clinician’s perspective of where Australia’s COVID-19 vaccine rollout is up to.
This, of course, is different to the logistical side of the rollout program that is being led by Lieutenant General John Frewen – but the two perspectives can’t be entirely separated from each other.
So as a clinician, what’s my view of where our vaccine rollout is at?
People following some media reports might have the impression Australia’s vaccine rollout has been an abject failure. As I expect all of you know, that’s simply not the case.
Yes … there were early constraints on the supply of vaccine doses from overseas.
And yes, the necessary actions taken in response to the early reported cases of the thrombosis with thrombocytopenia syndrome, or TTS, have impacted the anticipated speed of the rollout by initially limiting most of the administration of our “workhorse” domestically-produced AstraZeneca vaccine to people over 60.
But we have now surpassed 12 million vaccine doses administered across the country. And this has included the most recent million doses delivered in the past five days.
General practice has consistently administered more than half of these doses, showing the importance of relationships between patients and their chosen, trusted health professionals.
General practices and other primary care sites are now administering more than 100,000 COVID-19 vaccine doses every weekday – and this number is constantly increasing.
Our vaccination rates among Australia’s most vulnerable population groups are also far higher than is the case for the overall population, which now sits at about 40 percent in terms of a first dose.
More than three-quarters of Australia’s population aged 70 or over have had at least one dose of a COVID-19 vaccine. Approximately 70 percent of the population aged 50 or over have had at least one dose.
And every residential aged care facility – nationwide – has had both first and second dose vaccination visits.
Why is this important? Because as every one of you knows, our older Australians are more at risk of dying or suffering severe illness if they contract COVID-19.
This remains the case with the much more transmissible Delta strain. It is a tragedy to see elderly people becoming seriously unwell and dying from COVID-19 in Sydney over the past weeks, when they could have been protected four months ago.
There is still considerable work to be done to meet the Government’s goal of providing every Australian with access to vaccination, as well as ensuring our priority groups are vaccinated – including all of the healthcare workers who are playing such a pivotal role in Australia’s COVID response.
General practice is well placed to continue to support this goal, and the rollout will continue to expand as more vaccine becomes available.
As ATAGI’s advice regarding the AstraZeneca vaccine has changed to reflect the new evidence and changing circumstances, particularly in Sydney, this has meant our messaging has had to pivot.
The Australian Government’s advice for people living in Sydney is very clear.
Based on ATAGI’s recommendations, any unvaccinated adult in the greater Sydney region should strongly consider getting vaccinated with any available vaccine – including the AstraZeneca vaccine. This is based on the increasing risk of COVID-19 in Sydney and ongoing constraints regarding Pfizer supplies.
In addition, people in areas where outbreaks are occurring can receive the second dose of the AstraZeneca vaccine four to eight weeks after the first dose, rather than the usual 12 weeks, to bring forward optimal protection.
I would like to make one more point about the AstraZeneca vaccine in the context of ATAGI’s advice – and your patients, whether you are administering the vaccine or not.
People who receive the AstraZeneca vaccine should be aware of the symptoms of the TTS syndrome, and when they should seek medical attention. Early detection of TTS means people can get treatment and this can improve their outcomes.
So a reminder that anyone with an unusual or persistent headache or abdominal pain four or more days following the AstraZeneca vaccine should seek urgent medical assessment. Please be vigilant and proactive. If you see anyone with headache or abdominal pain, please ask about their vaccination history.
Going forward, our nation’s GPs will be invited to continue to play a vital role protecting our senior Australians by ensuring those moving into residential aged care facilities – about 1,000 people every week – are fully vaccinated against COVID-19.
Experience in the UK
It’s interesting to note how the role of GPs in Australia has mirrored the experience in the UK, which is also rolling out a national vaccination program involving Pfizer and Astra Zeneca. I spoke a few weeks ago with the Chair of the Royal College of General Practitioners in the UK, Professor Martin Marshall, himself a former Deputy Chief Medical Officer at NHS England, who told me it was initially thought GPs would only play a small role in the UK vaccine rollout.
It was thought GPs would vaccinate a small number of people most at risk, while mass vaccination centres administered most of the doses to the population.
I cite this story in the context of the criticism from some quarters that Australia has not sufficiently embraced mass vaccination sites – and that maybe this has led to our vaccination rate being lower than it might have otherwise been.
In fact, 75 percent of the vaccine doses delivered in the UK have occurred through the clinics established by general practices, with 12.5% being conducted at hospital vaccination clinics and the final 12.5% through mass vaccination clinics.
Professor Marshall stated that this reflected the trust people in the UK have in their general practices and general practitioners – and I would say that sentiment is shared in Australia.
General practice is the place where most vaccination occurs. Think flu vaccines. Think childhood immunisation vaccines. Think the vaccines Australians take before they travel – back at the time when we were able to travel freely overseas!
Our nation’s GPs and primary care nurses have been our COVID-19 vaccinators-in-chief, having delivered more than half of the doses of vaccine delivered in Australia to date.
The future
I would like to finish my speech by touching on some things that have changed during the pandemic, and make a few predictions about how things may play out in Australia in the months and years ahead.
It is clear the pandemic has had a transformative impact on the way health and medical services will be delivered in Australia, going forward.
For instance, the uptake of telehealth and other digital health initiatives by both practitioners and patients has been extraordinary – and will remain an important part of Australia’s service delivery model.
For the first time, “big data” from all states and territories has been shared and used to inform public health responses, and there has been a greater integration of public health and clinical medicine. These are important developments that I hope are here to stay.
I also note that some of the most respected voices Australians have been listening to throughout the pandemic have been doctors and other health professionals, many of them AMA members, who have been advising our governments about how best to respond to COVID-19.
And there is absolutely no doubt the general public knows a lot more about epidemiology, virology and vaccines than was the case pre-pandemic. And everyone has an opinion.
From early next year we will likely start to open up our international borders – and this will inevitably lead to significant community spread of the coronavirus. What we don’t yet know is what rate of infection – and everything that flows from that – the Australian population will tolerate.
Then there will be the ongoing impact of what is now known as “long COVID” – which may affect up to 10 percent of people who contract COVID. Some of the symptoms of COVID-19 – for instance extreme tiredness, impaired respiratory function, and memory issues – can persist for some time after a person has been cleared of infection.
And sadly, there is also the potential for more people to die from entirely preventable causes in coming years than from COVID-19 itself. As you all know, there is likely to be a long tail of preventable morbidity and mortality, and as medical practitioners, it is essential we continue to remind our patients to keep their appointments for both preventive interventions and chronic disease management.
It is also vital we do all we can to minimise any delays our patients may experience in terms of elective and semi-elective surgery, antenatal care, childhood immunisation, developmental screening, dental care, and mental health care.
Lastly, in terms of looking forward, I would urge you not to get too comfortable.
Given the situation in Sydney, I don’t think there is much risk of that right now, but the point I make is there will be plenty of twists and turns as we continue along the pandemic journey – and as the current Delta variant is tragically demonstrating, future variants are going to pose significant public health challenges.
Conclusion
In conclusion, widespread vaccination may be our ticket out of this pandemic, but the work we do, as medical practitioners, will be fundamental, too.
Tragically, more than 900 people in Australia have now died from COVID-19, and the situation in Sydney remains very serious. But were it not for your efforts, and those of everyone else in Australia’s healthcare system, many tens of thousands of people in Australia could have died from this virus.
That you have prevented this from occurring is a testament to everything that makes me proud to be a medical practitioner in Australia and a member of the Australian Medical Association.
Thank you.
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