Listening to science helps put community at centre of pandemic response

By: Professor Brendan Crabb AC   |   Director and CEO of the Burnet Institute   |   https://www.burnet.edu.au/

Almost one year on since the first cases of SARS-CoV2 were identified in China, much of the world is still gripped in the throes of a viral pandemic causing untold misery and human suffering. Many countries are experiencing record case surges, ICU beds in some hospitals in the US and parts of Europe are close to capacity, and millions of people are sick. The health, social and economic impact has been felt by each of us, and in every corner of the globe. But there is hope.

The devastating impact of the global pandemic has raised awareness that the answer to any of these big health problems is science.

The best information to date indicates that fatality rates are significantly higher than that of seasonal flu/influenza, and it is having a disproportionate impact on older people, and those with pre-existing medical conditions, such as cardiovascular disease, chronic respiratory disease or diabetes. COVID-19 is caused by a new virus, meaning there is no immunity in the population, and so even though most younger people will experience only mild symptoms, everyone is susceptible to being infected, and infecting other people in turn.

But science and researchers can’t achieve that alone.

In the blog I wrote in March, I stated what we all intuitively knew, and that is that collaboration is essential if we are to successfully tackle COVID-19. And what the intervening months has shown us is that with the collective effort of research, government, health, business, community, and philanthropy we can start to turn the corner in the fight against SARS-CoV-2.

From a medical and health services perspective we have seen an unprecedented response, from the surge in our medical systems capacity to cope with the first wave, to the public health response (our behavioural vaccine) of quarantine, isolation, physical distancing and masks to contain multiple waves of infection in Australia and overseas.

The investment and speed of vaccine and antiviral development has been unprecedented in human history. With a focus of talent and capacity, the UK regulatory approval of the first vaccine on 2 December has meant the medical research community has achieved in 11 months what usually takes a decade. 

Burnet Institute’s mission is to achieve better health for vulnerable communities. We know these communities are disproportionately affected by health issues, and that improvement in health of the most vulnerable people drives greater equity and leads to a more sustainable, secure and prosperous world.

The SARS-CoV-2 virus by all accounts has been an equaliser on many fronts, infection has not discriminated between race, age, gender, wealth, or geography.

Yet, in its pathological pursuit of survival, the virus highlighted many of our societal weaknesses, especially among the most vulnerable people and communities.

The aged, and especially those in aged-care, across the world have died in higher proportions as the virus swept through un-prepared and ill-equipped aged-care homes.

While the wealthy and well-travelled unwittingly spread the virus across borders, we have seen many outbreaks start and spread from people in casual, low-paid work where missing a few days’ of paid work to get tested and self-isolate was extremely difficult. This was further compounded by high density living which helped the virus jump quickly from household to household. 

Unintended consequences have been the increase in domestic violence and young people struggling with multiple issues including mental health, social isolation, difficult living situations, and financial security.

As the pandemic has led to people to shun treatment for serious medical issues in Australia, there is also fear that decades of progress in tackling endemic diseases such as malaria, tuberculosis (TB) and HIV in the south Pacific, south-east Asia and Africa could be undone. For example, malaria poses the most acute, short-term risk. It can double, triple or do worse in a single wet season if the wheels come off control measures.  With children under 5 accounting for 67% of the 409,000 annual deaths from malaria, we cannot go backward.

At Burnet we took a decision early on in the pandemic that we would play to our strengths in research, the crucial translation of evidence into practice, working with vulnerable communities, and adapting our existing infectious disease networks here and overseas. The duration of the pandemic and response would be longer than many were hoping. Over half our staff pivoted their focus into collaborations around vaccines, treatments, diagnostics, public health and advocacy here and overseas.

One of our biggest challenges has been that funding has been weighted towards the more tangible responses to the pandemic ­­– medical equipment for the coming surge and into antivirals and vaccine development, the ‘silver-bullets’. All vital and critically important pillars in pandemic preparedness and response.

Yet, one thing decades of infectious disease research and community engagement has taught us is that public health response is the ‘behavioural vaccine’ and the final critical pillar in any effective response. We have all now seen and experienced how it helps suppress transmission and infection, which in turn dampens pressure on the medical system, and importantly buys times while new drugs, treatments and vaccines are developed. 

The investment needed in public health research, community engagement, data and modelling is not as tangible or engaging, which meant funding flowed to equipment, drugs and vaccine development. It was a struggle to gain traction, and I am extremely grateful to The Macquarie Group Foundation for their faith and vision in backing our public health and modelling teams.

The work of these scientists was significant in helping inform Victoria’s policy and public health measures (including mandatory use of masks and Victoria’s COVID-19 roadmap) at a crucial time when the state faced rapidly rising case loads and two lockdowns of Melbourne. We maintained a seat at the table to advocate for community-centred engagement, especially our more vulnerable members of society.

As a nation, our collective response has been difficult, but commendable. Countries such as Ireland have already looked to Melbourne and Australia’s success in crushing two damaging waves of the virus. Many more may follow as Australia enjoys the first days of summer with zero to low community transmission. But we still have to be very vigilant as thousands of Australians prepare to return home from countries with high prevalence of COVID-19, and the risk of the virus escaping quarantine systems is always a threat. We must err on the side of caution if we are to keep our hard earned ‘freedoms’. 

Until most of the world’s population is vaccinated, we still have a long road to travel. Where the public health response has been slow and disjointed, the virus is breaking new records for infection and death. Efficacious vaccines are already moving through regulatory approval. It’s a remarkable scientific achievement in less than a year and unprecedented. But the reality is they will need manufacturing at scale, complicated logistics (especially cold-chain storage and reaching remote communities), a skilled workforce to deliver the vaccine, and trust from the community to vaccinate at-scale to reach widespread immunity. Each presents a major hurdle. 

We are to all intents only at the start of the beginning of the end of winning the fight against this disease and must not to lose focus or our resolve as the next 12-24 months will be critical.

But as the world focuses on solving this pandemic, we must not lose sight that many millions of people and vulnerable communities are still losing their lives and livelihoods to existing infectious diseases – malaria, TB, hepatitis and HIV. That battle is not over.

In the ongoing spirit and embodiment of collaboration between research, government, health, business, community, and philanthropy, Burnet Institute is joining forces with the Doherty Institute and University of Melbourne to build our capacity to continue the fight against existing infectious diseases (COVID-19, malaria, TB, hepatitis, HIV, etc), global health issues, and be prepared for the next pandemic. The Australian Institutes of Infectious Diseases and Global Health (AIID&GH) will bring together some of Australia’s and the world’s brightest minds to take up this challenge. 

We welcome the investment by the Victorian Government in this world-class infectious diseases hub, and are seeking Federal Government, business and philanthropic collaboration. 

The global pandemic has caused much devastation and loss, but human spirit is prevailing, and together we are stronger.

Dec. 17, 2020

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