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Estimates: Richard asks the Health Department about Antimicrobial Resistance

Estimates & Committees
Richard Di Natale 26 Feb 2014

Dr Richard Di Natale asked the Department of Health for an update on the government's response to antimicrobial resistance.

Senator DI NATALE: Can I have an update on the progress with response to antimicrobial resistance?
Prof. Halton: You have pushed the button!
Prof. Baggoley: There has been considerable progress in quite a number of areas. The Antimicrobial Resistant Prevention and Containment Steering Group, chaired by Professor Halton and Dr Paul Grimes, has continued to meet.
Senator DI NATALE: Can you just remind me of the composition of that group?
Prof. Baggoley: The composition of that group is: Secretary to the Department of Health; Secretary to the Department of Agriculture; the Chief Veterinary Officer, Dr Mark Schipp; and me. A secretariat is provided by the Australian Commission on Safety and Quality in Health Care. We also had Ms Morris attending to assist with secretariat functions and, at our last meeting, Professor John Turnidge attended, who has now been taken on by the Australian Commission on Safety and Quality in Health Care to assist and lead its work in implementing enhanced arrangements for surveillance of human health in Australia.
Professor Turnidge's appointment to the commission is particularly noteworthy and is a significant development. He is both a microbiologist and an infectious diseases specialist. He heads the Australian Group on Antimicrobial Resistance and has been involved in that group for quite some time. He has had a long involvement with matters relating to JETACAR and worked subsequent to that from 1999 up until him going part time in South Australian Health where he was the clinical director for SA Pathology.
Prof. Halton: Professor Baggoley—
Prof. Baggoley: I am filling in the—
Prof. Halton: It is unnecessary; it is very late. You are stretching my patience. I know we pushed the button.
Prof. Baggoley: You did press the button. The steering group is working on a national strategy for antimicrobial resistance and looking at a number of elements under that. There was a colloquium last year—
Senator DI NATALE: Do you have the terms of reference?
Prof. Halton: There are terms of reference, which we have agreed.
Senator DI NATALE: Are they publicly available?
Prof. Halton: We can make them available.
Senator DI NATALE: Do you have a deadline for the development of that strategy?
Prof. Baggoley: That has a number of steps still to be undertaken.
Senator DI NATALE: But do you have a deadline?
Prof. Halton: We have not got a hard deadline. Obviously, with a change of government I actually need to have a conversation with Senator Nash about this. My colleagues in agriculture need to talk to Minister Joyce about this.
This is a priority. You know that I regard this as being incredibly important. We actually had the conversation at the last meeting about making sure both ministers are well briefed on the subject, which will then enable us to progress the strategy. But I cannot put a timetable on it until we have actually had the opportunity to brief the new government on this. We have had other work that has been going on and the government has been busy. But we will get to it very shortly.
Prof. Baggoley: There was a colloquium in July last year under the auspices of the steering group. The paper from the colloquium is published on the websites of Health and Agriculture. There is a webpage devoted to AMR on the Health website and on the Agriculture website and also on the Australian Commission on Safety and Quality in Health Care website. The report entitled National surveillance and reporting of antimicrobial resistance and antibiotic usage for human health in Australia, which was produced by the Antimicrobial Resistance Standing Committee and accepted by the Health Protection Principal Committee and AHMAC, is now on the website, including that of the commission. That is a report you have been keen to see for some time. While it is a different portfolio, Agriculture has commissioned a report on surveillance and reporting on AMR and antibiotic usage in animals in Australia. That is due for completion in the latter part of 2014. The National Lead Clinicians Group, which has developed awards for excellence this year, has included antimicrobial resistance and plans to recognise successful and innovative implementation and best practice in the prevention and containment of AMR in the primary healthcare and aged-care sectors. At the risk of infuriating my secretary, I might just pause there.
Senator DI NATALE: Professor Halton, is there anything that you want to add?
Prof. Halton: We have now discussed this at these estimates on several occasions, but I think it is worth underscoring that this is a global problem. We are taking this very seriously. I have been delighted that successive secretaries of the Agriculture portfolio, when I have talked to them about how important this is as they have come into the role, have been absolutely seized of the issues. The chief vet is a very willing advocate. I can say that, when I was chairing the Executive Board of the WHO in Geneva in January, I had a number of conversations with the secretariat and with other interested parties, including with the UK and other countries, about, firstly, the need to cooperate with OIE and the other international agencies. Secondly, a resolution that goes to these issues was passed by the board, and people were delighted that it was passed. So we have a number of projects, ideas and things we need to pursue, but it is absolutely front of mind, which I am delighted about. This is a really serious issue. It is an issue for medicine and for agriculture. As Professor Baggoley has indicated, we are progressing with this in an orderly fashion. We will be working through this with the ministers in the near future, and next estimates we will be delighted to tell you where that is at. I may then have a deadline for you on the strategy, but we are certainly working that way.
CHAIR: Can I ask one question here. It is great to hear that there is that much expertise involved in the area, but in the end isn't it end user behaviour that we have to change?
Senator DI NATALE: You should read the Senate report.
Prof. Halton: Yes.
Senator DI NATALE: There are lots of different things to be done.
Prof. Halton: Yes, it is a very complex space. It would probably take beyond the next 10 minutes to go into it, but I agree completely with the comment: it is very complicated and we need actions and monitoring in a whole series of areas. We need to be really clear that we need to be very good global citizens. As I have said quite frequently, I cannot go around lecturing people globally if we do not have our act together, and there are some serious things we can do, including in the human health area, which looks to antibiotic usage among ourselves. That is not just us; it is also the medical profession. So there are a whole series of things we need to do.
Senator DI NATALE: I have one more question of Professor Baggoley. Have you been involved in any capacity in the response to the fire in the mine in Morwell?
Prof. Baggoley: Not directly at all. I have had discussion about that with the Chief Health Officer in Victoria, Dr Rosemary Lester. For the benefit of other senators, there is a fire in the open-cut mine in Morwell, as you are
aware. It is in its third week, and I think there is not a definite date for when it is anticipated that the fire will be out. It is thought to be at least two weeks. There are concerns about the air quality, therefore, for the people in Morwell—in particular the particulate matter. Apparently carbon monoxide is not a problem, but particulate matter is.
Senator DI NATALE: It was originally, though, but, yes, I think—
Prof. Baggoley: There have been health warnings for those with chronic lung disease and asthma, the elderly, children and pregnant women. The advice for those who are vulnerable is, if it is possible right now, to temporarily move from Morwell. As I understand it, there is even some short-term assistance to help people do that. There is a community respite centre in Moe, a nearby town. Dr Lester has asked the enHealth Standing Committee of the Australian Health Protection Principal Committee for advice on this matter, particularly the implications if the fire is not extinguished over the next few weeks or close to that. That is what I have been advised and I think Dr Lester is taking the appropriate steps. I certainly know she is concerned about the matter.
Senator DI NATALE: Can you explain to me about the enHealth Standing Committee—who they are and the nature of the advice they will provide?
Prof. Baggoley: They are being asked for advice. Dr Lester was approaching them today. The Environmental Health Standing Committee comprises jurisdictional representatives who are experts in environmental health matters. That is basically who they are. It is a standing committee of the Australian Health Protection Principal Committee. What it does is—
Senator DI NATALE: Are they doctors? Are they health professionals?
Prof. Baggoley: There are a range of people. Certainly some are doctors. I do not have the composition of the committee with me. There is a jurisdictional group under them as well. I can get you the—
Senator DI NATALE: Can you take that on notice?
Prof. Baggoley: Yes.
Senator DI NATALE: Can you please also take on notice the nature of the advice that is being provided?
Prof. Baggoley: Yes, we can check that with Dr Lester.
Senator DI NATALE: This is a very serious issue. I want to ask you about the concerns around—
CHAIR: Senator McLucas has questions.
Senator DI NATALE: I will be quick.
Senator DI NATALE: This is a serious issue because there are a number of people in the Latrobe Valley who have been to, firstly, the—
CHAIR: Is this a question?
Senator DI NATALE: Yes. I will be a little sharper. There is great concern about exposure to PM2.5 in particular— the very fine particles. What is your view about the long-term health impacts associated with the sort of PM2.5 exposure that people in Morwell are currently being exposed to?
Prof. Baggoley: I would need to take my own advice on that. I am not an environmental health expert. I think Dr Lester is on the right track in seeking this further and specialised advice.
Senator DI NATALE: Why is that being sought now? Advice has been provided to residents in the town for three weeks reassuring them that the best course of action would be for them to stay in their homes.
Prof. Baggoley: I would think that it relates to duration of exposure. Harm is proportional to duration of exposure, as you well know. The longer the exposure—if there is potential harm—the greater that risk would be. That makes sense.
Senator DI NATALE: At the time the fire began, it was very clear to everybody involved that this would be a fire that would be many weeks, if not months, in duration. Why was that advice not sought at the onset of the fire—rather than waiting until three weeks after the exposure occurred?
Prof. Baggoley: This truly is a matter for the Victorian authorities.
CHAIR: Thank you for that, Professor Baggoley. That is an adequate answer for that and now we will move on.
Senator DI NATALE: I am grateful for the advice that has been provided. I think it has been most helpful.

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