|
House of Representatives Standing Committee on Health and Ageing
Navigation: Previous Page | Contents | Next Page
Chapter 3 Screening, surveillance and control of infectious disease
… you can get anywhere in the world in 24 hours. Trying to
prevent infectious disease crossing international borders or any borders is a
nonstarter in this day and age. It cannot be done. You need another strategy.[1]
3.1
As international travel to and from Australia increases, Australia has a
number of screening, surveillance and control measures in place to manage the risk
of infectious diseases being imported into the country.
3.2
Ms Rona Mellor, of the Department of Agriculture, Fisheries and Forestry
(DAFF), told the Committee that government agencies must prioritise the risks
that require management at the border:
The community demand for keeping everything out of the
country is quite high. When you are processing 15 million passengers and you
are processing several million containers and different arrivals in different
ways, you really need to be able to narrow down to the things that matter most.
So, there needs to be a continuation of priority setting in the things that
matter most both in the broad biosecurity imports side and in the human health
side, because we are a trading nation and we need to facilitate it as well as
manage it.[2]
3.3
Dr Paul Douglas, of the Department of Immigration and Citizenship (DIAC),
advised:
In terms of determining who has what tests, we have four to
five million visitors from overseas every year come through the borders. We
cannot screen all of them, otherwise we would not have a visitor or business
program going on.[3]
3.4
This chapter examines the policies and procedures in place to prevent
the importation of infectious disease into Australia.
Screening
3.5
The Department of Health and Ageing (DoHA), DAFF and DIAC, in
partnership with other Commonwealth agencies, play significant roles in developing
and implementing health screening measures at Australia’s borders. These roles
are outlined in more detail in Chapter 2 of this report.
3.6
Dr Gary Lum, of DoHA, told the Committee that DoHA worked closely with
other Commonwealth ‘border’ agencies such as the Australian Customs and Border
Protection Service (Customs) and DAFF (through the Australian Quarantine and
Inspection Service (AQIS)) to screen people for potential public health risks
at the border:
Those border agencies are really important for the work that
we do at the border, particularly at airports and seaports. We work very
closely with them so that they ask relevant questions of any passenger who
volunteers information that they are unwell.[4]
3.7
There are a number of measures implemented by these Commonwealth
agencies, in conjunction with state and territory agencies, to protect
Australians. These measures include:
- entry requirements
for visitors or Australians arriving in Australia from overseas, including:
- the
completion of an incoming passenger card and arrival screening measures; and
- further
questioning and checks if required, based on a health matrix.[5]
- entry requirements
for people entering Australia as migrants, refugees and asylum seekers,
including:
- health
requirements such as pre-migration and pre-departure checks; and
- health
screening for irregular maritime arrivals.[6]
3.8
In addition to health screening, there are a number of biosecurity processes
operating at the border which may also lead to the identification of potential
health risks. Biosecurity measures are overseen by DAFF and AQIS and include managing
all passenger, vessel[7] and cargo movements in
and out of Australia, overseeing the Imported Food Inspection Scheme and
screening imports and exports.[8]
3.9
In this report, the Committee has focussed on the health screening
measures undertaken for travellers, migrants, refugees and asylum seekers in
Australia.
3.10
From a health perspective, there are stark differences between the entry
requirements in place for the travelling public, and those for migrants,
refugees and asylum seekers. These are discussed further below.
Entry
requirements for travellers
3.11
Health screening measures in place for travellers entering or
re-entering Australia consists predominantly of the requirement to complete a
passenger card upon entry into and departure from Australia.
3.12
Travellers to and from Australia are required to identify themselves and
provide certain information to the Commonwealth by completing an incoming or
outgoing passenger card.[9] Samples of the incoming
and outgoing passenger cards are shown at Figures 3.1 and 3.2.
Figure 3.1: Incoming passenger card
Source: Provided
by the Department of Immigration and Citizenship
Figure 3.2: Outgoing passenger card
Source: Provided
by the Department of Immigration and Citizenship
3.13
Passenger cards are used to assist in a range of issues at the border,
relating to immigration, customs and quarantine matters.[10]
3.14
Mr Tim Chapman, of DAFF, outlined how the Commonwealth used the
information obtained through passenger cards:
As far as the card is concerned, there are essentially two
purposes with it. The range of questions on there for immigration, customs and
biosecurity purposes, and also for human health purposes, really assists the
border agencies in assessing the risk and taking the necessary action. One of
the things that occurred as a result—I think it started with SARS and then
there were the various influenza concerns—was the additional detail on the
back, which is the contact details so that, for example, if somebody arrives
and they are quite fine and do not report being sick but they get sick later,
we or the department of health can identify what flight they came in on, who
they should contact and so forth.[11]
3.15
Ms Mellor advised that DAFF worked with DoHA to determine how the
passenger cards could be useful from a health perspective:
In the screening through the passenger process, the card is
used to determine how much intervention a passenger will get—for example,
further questioning or inspection et cetera. Some of the countries that we are
interested in clearly are ones where there are very infectious diseases that
will mostly infect the animal population. But certainly, if we are guided by our
colleagues at the Department of Health and Ageing to look for other things, we
will do that as a matter of priority.[12]
3.16
Dr Rodney Givney, of the University of Newcastle, told the Committee
that the ability to trace a person post arrival through the passenger card was vital,
because a person may not feel unwell until after arriving in Australia:
The important thing about those cards is that we get people's
contact addresses. The interest arises when one of them gets ill … … Border
protection for infectious diseases does not work. We have actually known that
since the 1890s. You have to be able to find cases when they appear in your
community and then you have to be able to trace back their contacts. So the
cards will work in that way.[13]
3.17
DIAC advised that passenger cards are currently processed in the
following way:
- The cards are batched
into flights at the airport and sent to Canberra for scanning by an outsourced
provider;
- The contents of the
cards are scanned and the images are made available for DIAC and other
authorised agencies;
- Cards are stored for
a maximum of 8 weeks depending on receipt date, and destroyed once the ABS
publishes their monthly data on overseas arrivals and departures;
- Typically, the data
from the passenger cards is available for retrieval within 24 hours of receipt
of the cards. However, the time taken to process cards depends on a number of
factors, including the location of the airport where the cards were produced;
and
- Sea arrivals are
dealt with in a different manner and there can be a longer delay in processing
given the time taken to batch and send the cards through. Once the cards are
received, scanning usually takes place within 24 hours.[14]
3.18
The Committee was told that while there were issues in the past
regarding the timely processing of passenger cards, this process had improved
over time, and the information from the cards was now available very quickly
and urgently if required.[15]
3.19
During the 2009 influenza pandemic, people entering Australia were
required to complete a health declaration card if they were feeling unwell, in
addition to completing an incoming passenger card:
In 2009 we put in place a process of health declaration cards
so that, when any aeroplane was descending into Australia or any ship was
coming into Australia, the master of that particular vessel would have to ask
all of the passengers, through a public address system, whether any of them
were declaring themselves unwell. The health declaration card needed to be
distributed and handed to all of the passengers that needed to complete them.
That is distinct from the incoming passenger card, which is a routine process
that the Department of Immigration and Citizenship manage for themselves at the
moment.[16]
3.20
Heat screening was another tool used during the SARS outbreak of 2003 with
the aim of assisting authorities to identify people who had a temperature at
the border. Dr Givney told the Committee of one of the limitations of heat
scanners:
… The final limitation of those heat screens is that people
with flu are infectious before they have a temperature and before they feel
sick at all …[17]
3.21
With regard to the SARS outbreak, Professor Adrian Sleigh, of the
Australian National University, noted that data from Hong Kong airport
indicated that heat scanners had only detected one case:
There were statistics kept at Hong Kong when they did the
thermal imaging. Something like 36 million people were checked, 1,000 people
were detained, 100 people were investigated and maybe one case of SARS was
found.[18]
3.22
Professor Tania Sorrell, of the Sydney Institute of Emerging Infectious
Diseases and Biosecurity, advised the Committee that heat scanners were more
successful in reassuring the public than providing useful information to the
medical profession:
It is true that if someone newly develops a fever it is most
likely to be due to infection, but there are other causes of fever, which might
be due to disease or a drug reaction. The issue with the scanners in airports
is that they are not reliable—they offer more reassurance to the public than
they actually do information to the medical profession.[19]
3.23
Dr Gary Lum, of DoHA, agreed that from a scientific perspective, thermal
scanners were not useful. However, Dr Lum suggested that the scanners played a
useful role in boosting public confidence when they were used at airports:
There were also the issues at the border where AQIS, as well
as state and territory staff, were looking after things such as the thermal
scanners. We all recognise that, from a scientific perspective, they were not
very useful. From a public confidence perspective, we got a lot of letters from
well qualified health professionals telling us that we were wasting money.
However, at the same time we were also getting letters from Australians who
were saying 'This is fantastic, you should buy more,' or 'Why don't we have one
at every gate and in shopping centres?' You can see that, from a public
confidence perspective, they really had a role to play.[20]
3.24
The master of any aircraft or ship entering Australia is legally obliged
to report any illness on board. AQIS must grant permission (known as
‘pratique’) for passengers and crew to disembark in Australia from an overseas
vessel. Permission is only granted if the vessel is free from any quarantinable
disease. The vessel and people on board remain subject to quarantine until such
time as pratique is granted.[21]
3.25
Mr Chapman explained the pratique process:
In the times of the heightened pandemic awareness, there was
a positive obligation on aircraft captains to report for every arrival, but the
standard process is that they advise us only in circumstances where they have
identified an ill passenger on board. When that occurs, there is a 'traveller
with illness' checklist that we go through. We use that to then advise the
department of health of the outcomes, and they provide advice back to us. In
2011 there were only 16 such events at international airports around
Australia—that is with more than 14 million arriving international passengers.[22]
Committee comment
3.26
The Committee has been reminded throughout this inquiry that infectious
diseases do not respect international borders. As international travel becomes
more frequent and more accessible it is clear that the transmission of
infectious diseases across international borders cannot be totally eliminated.
3.27
The Committee is reassured by the continued efforts of a number of
Commonwealth agencies working in collaboration, and with the relevant state and
territory authorities, to implement a range of health screening measures to
identify infectious disease before it spreads to the Australian population.
3.28
The Committee understands that an incoming passenger card will not
necessarily enable detection of an infectious disease at the border. As the
Committee heard, a person may have an infectious disease when travelling into
Australia, however may not feel ill or show any obvious symptoms until later.
3.29
However, based on evidence the Committee considers that the incoming
passenger card is an effective tool for providing the contact information
necessary to track the spread of infectious disease from that person, if they
become ill after entering Australia.
3.30
It is evident that lessons have been learned in recent times as the
Commonwealth, states and territories have responded to the risks associated
with infectious disease outbreaks such as SARS and pandemic influenza. The
Committee has been told that in response to increased risk, more stringent measures
of infectious disease control were put in place. The Committee is reassured
that the relevant Commonwealth, state and territory agencies have the ability
to adapt and respond to increased risk when required.
3.31
While heat scanners and thermal imaging appear to be an attractive
option for mass population screening at ports of entry, the Committee notes the
observations of infectious disease experts and DoHA regarding the limitations
of this technology. Although the technology is clearly able to detect elevated
body temperature, the Committee is aware that a significant limitation is that elevated
temperature is not a symptom of all infectious diseases. Even when fever is a
common symptom, it may not present at all stages of infection. Fever may be absent
during the incubation period where infected individuals are often asymptomatic.
3.32
Despite these limitations and data indicating that heat scanners were of
little value in detecting SARS during the 2003 outbreak, the Committee was told
how the public was reassured by the use of such scanners.
3.33
In the Committee’s view, this highlights the need for the public to be
better informed and educated about the measures in place at the border to mitigate
the risk of infectious disease importation, and what practical measures they
can take to protect themselves and their families against infectious diseases. The
issue of consumer awareness and education is discussed below.
3.34
The limitations of heat scanners also calls into question the
cost-effectiveness of the widespread deployment of heat scanners at border
entry points for mass screening of incoming travellers. While not dismissing outright
the potential for heat scanners to contribute to the suite of measures to
reduce importation of infectious disease, the Committee believes that
cost-effectiveness must be assessed and considered.
|
Recommendation 2 |
| 3.35 |
The Department of Health and Ageing review the existing
evidence base to evaluate the cost-effectiveness of its policy to use heat
scanners at ports of entry as a measure to mitigate the risk of infectious
disease importation. |
Entry requirements for migrants, refugees
and asylum seekers
3.36
Migrants, refugees and asylum seekers undergo stringent health screening
before being allowed to reside in the wider Australian community. This
screening contrasts to the entry requirements for the travelling public.
3.37
Migrants who choose to come and live in Australia for economic or other
reasons will generally have time to prepare for their relocation. In contrast,
refugees and asylum seekers are usually forced to leave their countries of
origin with little or no warning.
3.38
The vast majority of migrants, refugees and asylum seekers travel to
Australia by air with valid visas. With regard to asylum seekers specifically, recent
data indicates that although the numbers arriving by boat have increased over
recent years, in 2011-12 boat arrivals were about half of Australia’s onshore
asylum seekers.[23]
3.39
Noting the differences in pre-travel planning, means of arrival and varying
levels of contact with the wider community, a number of policies and practices have
been implemented (both pre and/or post entry) to protect the Australian public
from risks of infectious disease entering the country via these population
groups.
3.40
The health requirements for people wishing to migrate to Australia, or
who are seeking asylum in Australia as refugees, are set out in Chapter 2. These
requirements aim to ensure that those people do not pose a public health risk
to the Australian community. Currently, the health requirements focus on
ensuring that people with tuberculosis (TB) are identified and treated before
entering into Australia or into the wider community.[24]
3.41
A waiver of the health requirement is available for certain visa
applicants, however this is not available to people considered to be a ‘public
health risk’.[25]
3.42
As noted earlier, a relatively small population of asylum seekers arrive
without valid visas, usually by boat. The Committee visited Christmas Island in
November 2012 to learn more about the health screening practices undertaken for
so called Irregular Maritime Arrivals (IMAs)[26] in immigration detention on the island.
3.43
During the visit the Committee inspected the facilities used for health
screening at the various detention centres on the island. Following these
inspections, the Committee held a roundtable discussion, hearing from
representatives of DIAC, International Health and Medical Services (IHMS –
DIAC’s contracted health services provider), Indian Ocean Territories Health
Service (Christmas Island Hospital) and the Shire of Christmas Island.
3.44
Health screening on Christmas Island falls under the jurisdiction of the
Indian Ocean Territories Health Service and its public health policy is
determined by the Western Australian government.[27]
3.45
Depending on how a person arrives on Christmas Island[28],
initial health screening for IMAs proceeds as follows:
- a
public-health-screening assessment for communicable diseases is conducted by a
Customs medical officer or health professional from IHMS, before or upon a
person’s arrival on Christmas Island;
- a full health
induction assessment is conducted within 72 hours of a person entering into immigration
detention;
- new arrivals are
separated from the rest of the immigration detention population until the
health induction assessment process is complete; and
- health-screening relating
to infectious disease issues for irregular maritime arrivals includes:
- a
medical examination by a GP;
- documentation
of the client's full medical history;
- medical
observations;
- urinalysis;
- pathology
tests including testing for HIV, hepatitis B and syphilis; and
- a public
health screen including a TB-screening questionnaire and a chest X-ray, which
is reviewed by a radiologist and a GP.[29]
3.46
Mr Paul Windsor, of DIAC, advised the Committee that most communicable diseases
identified in immigration detention were pre-existing conditions identified
during the health induction assessment.[30]
3.47
Mrs Julie McCaughan, of IHMS, explained the health screening process
once people arrived on Christmas Island:
When the clients arrive on the jetty we attend for
observation and clinical assessment of the clients. We are generally looking
for clinical signs that the client has a diagnosis or an issue that we need to
address acutely and quickly. Following that, they are transported up to the
induction centre where we conduct a public health consent. We have a set
questionnaire that we ask the clients through interpretation and then we get
their consent to be able to deliver their healthcare needs. That is the whole
gamut from induction right through the system while they are in detention.[31]
3.48
If a person showed symptoms during the initial assessment that required
further investigation, that person may be isolated or have to undergo further
tests. Mrs McCaughan said that necessary precautions were taken to ensure
people were quarantined until testing was complete:
Should the client through our public health assessment
require any additional treatment such as isolation or should we determine that
they may have symptoms that we want to investigate further, we may isolate them
or start additional investigations of them. Should a client also present
clinically, we can also fast-track them to have a chest X-ray, as an example,
and take additional specimens there so that we can send them off and get the
results as quickly as possible. Until we get a diagnosis, it is quite difficult
for us to determine whether a client needs hospitalisation or full isolation,
but we do take the necessary steps to ensure that they are quarantined if need
be.[32]
3.49
Dr Parbodh Gogna, of IHMS, told the Committee that on Christmas Island,
IHMS and DIAC worked with the Western Australian Department of Health and the
Christmas Island Hospital when infectious disease was identified:
Where we identify infectious diseases we work very closely
with the Communicable Disease Control Directorate of Western Australia, as well
as the Christmas Island hospital. To manage the care of these patients, we do
contact tracing and additional screening when required. These arrangements
depend on the cooperation of all parties, which has worked well to date.[33]
3.50
Mr Windsor explained the process of treating a patient for an infectious
disease while in immigration detention more broadly:
In accordance with guidelines established by the relevant
centre for disease control, if a client is suspected to be affected by a
communicable disease, they are placed into isolation until that condition is
confirmed and a treatment plan is established. In these cases IHMS liaises with
local public health authorities to ensure that appropriate measures are in
place, such as quarantining and treatment to prevent other people from being
affected, including in the broader Australian community.[34]
3.51
Where a person is to be transferred from Christmas Island to another
detention facility, such as a regional processing centre, that person must have
undergone a public health assessment and have been deemed as ‘fit to travel’.[35]
3.52
Dr Gogna outlined the health screening process undertaken before a
person was transferred to a regional processing centre on Manus Island or
Nauru:
For the Manus and Nauru transfers, obviously the authorities
in Manus and Nauru do not want to have any communicable diseases sent to them,
so we have to carefully screen them with dipstick urine you saw at the
induction shed this morning, and we will not send carriers of hepatitis B or
people infected with hepatitis C. They need specialist intervention and they
are given first-world care on the mainland. Patients with HIV we are unable to
send. We will not send people with active tuberculosis.[36]
3.53
Mr Windsor told the Committee that there was a minimal risk of
infectious disease being transferred into the general Australian population
from people living in immigration detention:
There is minimal risk posed to the community by these
diseases, as the department ensures that clients adhere strictly to the
treatment procedures advised by the relevant state or territory communicable
diseases control authority.[37]
3.54
Dr Gogna and Dr Graham confirmed to the Committee that there had been no
known instances of transmission of infectious disease from people living in
immigration detention to the wider population of Christmas Island.[38]
3.55
DIAC provided the Committee with a table of selected communicable and/or
notifiable diseases identified in immigration detention for the period July
2010 until August 2012 (Table 3.1).
Table 3.1: Selected communicable and/or notifiable diseases
new cases identified in Immigration Detention Facilities
|
|
Jul 2010 - Jun 2011
|
Jul 2011 - Jun 2012
|
Jul - Aug 2012
|
|
Disease
|
All Detention Types
|
IMAs
|
All Detention Types
|
IMAs
|
All Detention Types
|
IMAs
|
|
Chickenpox
|
1
|
1
|
2
|
2
|
1
|
1
|
|
Chlamydia
|
13
|
12
|
29
|
27
|
7
|
7
|
|
Gonorrhoea
|
5
|
2
|
16
|
15
|
2
|
2
|
|
Hepatitis A
|
2
|
2
|
3
|
3
|
1
|
1
|
|
Hepatitis B (incl
active and carrier states)
|
111
|
30
|
171
|
159
|
45
|
43
|
|
Hepatitis C
|
13
|
9
|
15
|
12
|
11
|
10
|
|
HIV/AIDS*
|
0
|
0
|
1
|
1
|
3
|
1
|
|
Leprosy
|
1
|
1
|
0
|
0
|
0
|
0
|
|
Malaria
|
1
|
1
|
1
|
1
|
2
|
2
|
|
Mumps
|
0
|
0
|
1
|
1
|
0
|
0
|
|
Pertussis (Whooping
Cough)
|
18
|
3
|
1
|
1
|
0
|
0
|
|
Syphilis
|
63
|
31
|
40
|
37
|
15
|
13
|
|
Tuberculosis -
Active
|
2
|
2
|
31
|
27
|
10
|
9
|
|
Typhoid
|
0
|
0
|
3
|
3
|
0
|
0
|
|
Total
|
230
|
94
|
314
|
289
|
97
|
89
|
|
* 2 clients
(non-IMA) were known to be HIV+ on arrival in detention (July-Aug 2012).
|
Source: Provided
by the Department of Immigration and Citizenship
3.56
Mr Windsor commented on the number of infectious diseases identified in
immigration detention:
I think the numbers that we are seeing are small in light of
the overall numbers arriving. My understanding is that, with conditions like
TB, we believe that the levels we are seeing are broadly comparable with the
source countries from which the people have originated. So, if they are clients
who have made the journey ex-Indonesia, then they are broadly comparable with
levels in Indonesia. Similarly, if they are coming directly from Sri Lanka,
then they are comparable with the levels found there.[39]
Committee comment
3.57
Visiting Christmas Island gave the Committee a valuable opportunity to
hear from a number of medical practitioners working on the island, both within
the immigration detention network, and in the wider community.
3.58
The Committee witnessed firsthand the challenges that DIAC staff, IHMS
staff and health workers from the Indian Ocean Territories Health Service face
on a daily basis in providing health care services in a remote and largely
isolated community.
3.59
Adding to this challenge, health service-providers on the island are
required to meet the often complex medical needs of IMAs, while protecting the
community within immigration detention and the wider community from the risk of
spread of infectious disease.
3.60
The Committee considers the evidence obtained at Christmas Island within
the context of evidence received from a range of infectious disease experts and
public health officers throughout the Committee’s wider roundtable program.
3.61
It is the Committee’s view that there are robust screening processes in
place to protect Australians from the importation of infectious disease from
migrants, refugees and asylum seekers.
3.62
On the evidence before the Committee, there are clear protocols in place
for pre-arrival health screening of migrants and refugees before they leave for
Australia. When deemed necessary by the assessing Medical Officer, people are
required to enter into a Health Undertaking, to ensure they adhere to specific
treatment or actions regarding their health, while in Australia. There is also
a stringent health screening protocol that applies to IMAs once they arrive in
Australia and enter the immigration detention network (noting the usual entry
point is Christmas Island).
3.63
It is evident that the risk of infectious disease spreading to the
Australian community from migrants, refugees and IMAs who undergo pre-arrival
and/or post-arrival health screening is small.
3.64
In stark contrast, an Australian resident or visitor entering Australia
via an international airport does not have to undergo this same stringent
health screening.
3.65
Accordingly, it seems more likely that an infectious disease would be
imported into Australia by returning residents or through travellers who are
visiting Australia, and who enter the country through one of the international
airports or seaports.
Surveillance
3.66
How the Commonwealth, state and territory governments identify
infectious diseases once they have entered Australia is an important element in
protecting Australians from the risk of imported infectious disease.
3.67
Surveillance activities are undertaken primarily at a state and
territory level, whereby specific diseases are reported by GPs or treating
physicians, to the relevant state and territory authority. The Commonwealth is
tasked with coordinating surveillance at a national level. These surveillance
activities are discussed below.
National Notifiable Diseases
Surveillance System
3.68
The Commonwealth Government identifies risks of infectious disease
outbreak at a national level through the National Notifiable Diseases
Surveillance System (NNDSS). The NNDSS is detailed further in Chapter 2.
3.69
There are also enhanced surveillance systems in place for particular
diseases. For example, comprehensive data is collected on influenza by
recording symptoms and other information when a person presents to a GP or
hospital. [40]
3.70
Dr Firman advised that the surveillance data obtained through the NNDSS
and other surveillance processes was reported in annual reports and in a
medical journal called Communicable Disease Intelligence, which was
published quarterly. [41]
3.71
Professor John McBride, of the James Cook University, said the Communicable
Diseases Intelligence (CDI) journal was an important source of information
regarding communicable disease issues, however it had at one stage been
defunded:
It should not have to be about scrimping and begging for
resources to maintain what everyone thought was a fantastic idea: to have a
journal of the communicable diseases in Australia. It is great that that is
continuing, but it is clearly under threat.[42]
3.72
Dr Paul Armstrong, of the Western Australia Department of Health agreed
that the CDI should not have been downgraded, as it is a way of canvassing
infectious disease issues of national concern:
There is a journal called Communicable diseases
intelligence—CDI, it is called. It is run by the Commonwealth. In recent times
it was markedly downgraded in its importance by having its peer reviewed status
taken away. This was not done in consultation with the states and territories.
It has been reversed now and they are starting to build it up again, but it is
really important to have a mouthpiece where communicable disease issues can be
voiced. Countries around the world that have very strong communicable disease
control systems do have a strong mouthpiece. The classic example is the journal
called the [Morbidity and Mortality Weekly Report], which is produced by the
CDC in America. That is an internationally renowned journal for communicable
disease issues. We need to have a good journal like that here.[43]
3.73
Regarding the surveillance data collected, Dr Firman said that the CDNA
met fortnightly to discuss the data:
They look at all the data nationally that is reported for a
fortnight and they look at what states have reported. They notify of
interesting cases or particular cases from these states. That is discussed
further and that is all reported back. Once that data is agreed as valid and
correct, that is then posted on a website for public consumption.[44]
3.74
Dr Richard Gair, of Queensland Health, told the Committee that effective
surveillance allowed authorities to detect and control a disease outbreak
before it became widespread:
We need to be able to become aware early of cases coming in.
I have to stress the importance of surveillance is becoming aware early because
the spread of anything whether it be pertussis or dengue is exponential. One
case causes two, which causes four, and before very long your chances of
controlling it diminish rapidly, so you need early detection.[45]
3.75
The Committee heard, however, that the success of infectious disease
surveillance in Australia was predicated on doctors not only being aware of the
notifiable diseases list, but also having the skills necessary to recognise the
symptoms of these diseases, including diseases that may be rarely seen in their
location.
3.76
Dr Armstrong told the Committee that there was strong communication
between the Western Australian Government and general practitioners, who are
usually a person’s first point of call when they are feeling sick:
From the Western Australian point of view, we have an ability
to communicate quite rapidly with general practitioners—by fax, by media release
and by, in some cases, email. I think we do have a fairly good system for
communicating with GPs.[46]
3.77
Dr Armstrong said that clinicians in Western Australia were required to
inform the WA Communicable Disease Control Directorate if they considered that
a patient had a disease on the notifiable list. However, he noted that the
system wasn’t perfect:
Not every case is notified to us by the clinician. However,
we have quite a good fall-back position, where in this state it is also
mandatory for laboratories to report to us when they have notifiable diseases
if they diagnose them from a laboratory point of view. That fall-back position
works well. We think we would hear about all notifiable diseases that are
tested for and for which there is a laboratory result.[47]
3.78
In immigration detention centres around Australia, IHMS is required to
report notifiable communicable diseases identified within the immigration
detention network to the applicable state or territory health department.[48]
3.79
Dr Mark Parrish, of IHMS, told the Committee that each state and
territory had different protocols for detection and treatment of infectious
disease:
There are differences in how the states screen, diagnose and,
sometimes, treat—less so in the treatment—so we work closely with the relevant
state or territory health authority and communicable disease centre to ensure
we put in the appropriate methods.[49]
3.80
Dr Gogna, of IHMS, argued that as infectious disease could be easily
transported across state borders, there was a need for a nationalised approach
to infectious disease control:
We need to have a single body that is giving consistent
advice. IHMS as an organisation and DIAC as an organisation have 22 plus
immigration detention centres across the whole nation, and we are trying to
have protocols and guidelines for our staff that are consistent. It is very
hard to do that when a CDC [the state or territory based communicable disease
control directorate] in a different state or territory gives you a differing
opinion. For example, with latent TB in the Northern Territory the CDC there
will ask for sputum to be collected, looked at under a microscope and cultured.
That is not what Western Australia is currently advising us to do.[50]
3.81
Dr Gogna considered that the creation of a national centre for communicable
disease control would assist in the consistent treatment of people with a
communicable disease.[51] This concept is
discussed further in Chapter 6.
Committee comment
3.82
The Committee notes that a national surveillance system for infectious
diseases has been created in Australia in an effort to coordinate surveillance
at a national level.
3.83
The Committee commends the Commonwealth Department of Health and Ageing
for supporting national surveillance initiatives such as the publication of a
national peer-reviewed journal, Communicable Disease Intelligence, to raise
the profile of emerging infectious disease issues of national concern. The
Committee notes the importance placed on this publication by infectious disease
experts, and encourages the Commonwealth to continue supporting its ongoing
publication.
3.84
However, the Committee has heard that the creation of a national
surveillance system for infectious diseases has not translated into uniformity
or consistency of surveillance among the states and territories. IHMS, which
delivers health services in all of the immigration detention centres across the
country, demonstrates this clearly, given they must comply with different
reporting requirements in each state and territory.
3.85
The Committee is of the view that a national, consistent approach to
infectious disease surveillance would greatly assist in the timely and
effective detection of relevant infectious diseases across Australia.
3.86
Accordingly, the Committee recommends that DoHA work with the state and
territory governments to implement a uniform notifiable diseases list across
Australia, with consistent reporting requirements across each state and
territory.
3.87
The Committee views this discussion in the context of considering the
national coordination of infectious disease screening, surveillance and control
measures in Australia. The concept of national coordination is discussed in
more detail in Chapter 6.
|
Recommendation 3 |
| 3.88 |
The Australian Department of Health and Ageing work with the
states and territories to provide a uniform notifiable diseases list across
Australia, with consistent reporting requirements across each state and
territory and consistent public health information on infectious diseases
disseminated to the public. This work should be a priority of Australian
Health Ministers’ Advisory Council (AHMAC). |
Health follow-up processes for migrants, refugees and asylum seekers
3.89
The ability to prevent the spread of imported infectious disease
throughout Australia is influenced by the correct and timely reporting of
notifiable diseases to the relevant health authority.
3.90
However, it is also dependent on whether there are adequate health
follow-up processes for migrants, and for refugees and individuals seeking
asylum as they transition through the immigration detention network and move
into the community.[52]
3.91
Further, it is dependent on medical practitioners across Australia being
equipped to identify infectious diseases, particularly those diseases that may
not be endemic in Australia, but may be prevalent in countries of origin for
many refugees and migrants who settle in Australia.
3.92
Dr Peter Markey, of the Northern Territory Department of Health, told
the Committee that health screening for refugees who arrived on the Australian
mainland was conducted by state and territory jurisdictions on an ad hoc basis:
Postarrival checks for refugees are only done by
jurisdictions on an ad hoc basis. The guidelines have been established just by
non-government organisations such as the Australasian Society for Infectious
Diseases[53]. Informal refugee networks
have been involved in screening refugees and there has not been an overall
coordinated policy approach to postarrival refugee screening.[54]
3.93
Dr Markey expanded on this issue further to the Committee:
There is a need for refugees to be checked in the postarrival
phase, simply because they have a high prevalence of a lot of other tropical
diseases which may affect their health in the future, but also there might be
ramifications for the public as well. The other issue is with immunisation;
they are often behind in their immunisation, so they have to catch up … GPs
just do not have the time, the inclination, the knowledge or the skills, in a
way, to be able to do it. I am aware now that things are better, that there is
a Medicare [item] number, which encourages GPs to take on the role of
screening. But they are still reluctant to do it and it is probably not enough
to cover the amount of time that it takes, because it is a time-consuming
thing. Most jurisdictions have used state government money to support clinics,
sometimes also assisted with Medicare money.[55]
3.94
Dr Parrish advised that IHMS, as the contracted health service provider
for DIAC, had a number of processes in place for conducting follow-up health
checks for people as they transitioned through the immigration detention
network:
The process that we have in place is that, once clients have
had that initial health screening, we can then identify those that have
particular conditions which might need following up. I would put those
conditions in three broad categories. They are: the communicable diseases that
we are discussing today; all of the diseases and issues that you and I and the
general population get that anybody gets; and then there are those, say, mental
health issues that we identify in clients. We have a centrally based,
electronic medical record which allows us track those clients as they move
through the detention system and we can flag clients requiring review in that.
For instance, in the case of clients with a communicable disease, we can put
flags in our record to say that the individual needs a check-up and a repeat
X-ray. Then when patients move from the detention centre into the community, we
pass that information on in conjunction with the local GP and the communicable
disease centre to make sure that those contacts are continually followed up.[56]
3.95
Dr Gogna advised that IHMS undertook a health discharge assessment for
people who moved from an immigration detention centre to live in the community.
He noted however, that this follow-up system could fail:
We are contracted to provide a level of health discharge
assessment information for the community, but there is a richness there that
cannot be transposed in a small document and it is more important to provide
that richness …
… If we have them on a recall register, by law we have to
make two phone calls and then send a letter to be able to say that we have
discharged our medical legal responsibility. There are lots of reasons why that
could fail: addresses change, people move, they get lost to follow-up. Your
melanoma that you had excised that you should have regular checks on gets
missed over a period of time. It requires robust systems in place for recall
and, obviously, resources to maintain those registers.[57]
3.96
Ms Joanna Fagan, of the Western Australian Department of Health, told
the Committee that Western Australia had a centralised refugee health-screening
health service:
Anyone released from detention into WA is linked into our
services. We have a relatively good, but not perfect, turnout. We do try to
increase the numbers coming to use our services, but it is difficult because
they are young men who are very mobile and move from state to state. So it is
not perfect. We have also improved our linkages with the health providers within
the detention centres to try and identify individuals at risk. We maintain that
people cannot be released from detention centres until they have completed
their tuberculosis treatment. They remain in detention until completion of
therapy or until offshore screening occurs. [58]
3.97
Ms Fagan told the Committee that the service would not see about 25 per
cent of people in immigration detention in WA who move into the community, as
the majority of those people moved interstate. Ms Fagan commented:
WA is one of the only states which have a centralised
service. Most refugee screening is done in primary care within the rest of
Australia. We have a dedicated service to try and capture these people…
… We provide a holistic service in that we are not only
looking for infectious diseases but also doing mental health. We do very
thorough health checks—HIV, all the different forms of hepatitis, latent
tuberculosis as well as active tuberculosis, chlamydia, gonorrhoea, syphilis
and all sorts of general health checks as well.[59]
3.98
Dr Graham told the Committee that educating GPs about lesser-known
infectious disease issues facing refugees and migrants was an important part of
managing the spread of disease, once people moved into the community:
… These are diseases that are not common in Australia, and so
symptom recognition by a GP in urban Melbourne may be a prolonged process. By
that stage this person may have been sick for quite a while and may have been
through several health facilities. Those with lowered immunity are at risk, and
so the chance of spread there is an option.[60]
3.99
Professor Scott Ritchie, of James Cook University, argued that ongoing
training of doctors was necessary to ensure they were equipped to recognise and
test for certain infectious diseases:
… quite often we will have a locum doctor from overseas who
has never seen dengue before—they have not been trained for dengue. If it comes
in, even though it is a notifiable disease, they will not test for it, despite
the person maybe even having a travel history. So I would hope in the future
that, with computers and stuff, there may be a way, once these symptoms go in,
and if someone has a travel history or something, there could be a reminder
brought up—'Query dengue'.[61]
3.100
Dr Gogna argued that specialist refugee training would assist in
ensuring that effective diagnosis and treatment of disease took place:
My advice would be to work with the professional colleges.
There are elements of the Royal Australian College of GPs which are devising
specific refugee training programs: being able to engage, cultural awareness
and culture specific issues. We have had to put a doctors' handbook together to
make sure people understand what languages people speak. How does Farsi relate
to Hazaragi? How does it relate to Urdu? People's knowledge of these areas
needs to be built up. We do not want to be immersed completely in one culture
but be able to do enough to ensure that how we approach a situation is
construed clearly…[62]
Committee comment
3.101
The Committee considers that for the most part, there are rigorous
processes in place to ensure that people being transferred from immigration
detention do not pose a public health risk before they are moved into the
Australian community.
3.102
However, the Committee is concerned to have heard that despite the stringent
processes in place to screen and treat people in immigration detention for
infectious disease, the system could fail once individuals were moved into the
community, due to a lack of follow-up health services.
3.103
Further, the Committee was told that some infectious diseases may not be
identified by a medical practitioner in the general community, for instance
where someone has contracted an infectious disease overseas that is not prevalent
in Australia, and therefore the medical practitioner is not aware of the
relevant symptoms of the disease.
3.104
The Committee believes there is a need to facilitate a more uniform,
national approach to the health screening, follow-up and treatment of migrants
and refugees, including individuals moving from immigration detention centres
around Australia (and from regional processing centres) into the wider
community.
3.105
The Committee heard evidence of a successful centralised refugee health
program in Western Australia, where people were linked in with the service upon
moving into the community from a WA immigration detention centre. However, it
does not appear that this is a uniform approach across all states and
territories.
3.106
In addition, the Committee is of the view that medical practitioners,
who are on the front line of identifying infectious disease, should be better
educated on the complex health needs of migrants and refugees, and the symptoms
of notifiable diseases and diseases of concern that are not endemic in
Australia.
|
Recommendation 4 |
| 3.107 |
The Australian Government work with the state and territory
governments to assess the viability of providing a centralised refugee and
migrant health service in each state and territory, which would automatically
refer people who move from immigration detention into the wider Australian
community. |
|
Recommendation 5 |
| 3.108 |
The Royal Australian College of General Practitioners
provide resources and training to general practitioners on the complex health
needs of migrants and refugees, with a focus on identifying infectious
diseases which are notifiable in Australia, or diseases which are of specific
concern to refugee and migrant communities. |
Control
3.109
There are two primary approaches used to control the spread of
infectious disease within Australia. One is prophylactic or preventive, which aims
to reduce the spread of disease by preventing infection in the first place, for
example by immunisation. Where immunisation is not compulsory, national levels
of immunisation are influenced by factors including public awareness of
infectious disease risks and protective factors (including behavioural risk
avoidance), accessibility and cost of undertaking measures to prevent
infection. This is particularly the case for international travellers.
3.110
The second method of control relates to the broader way in which the
Commonwealth, state and territory governments mobilise to respond to disease
outbreaks, and reduce the spread and impact on the population. This second
facet of control is discussed in Chapter 5.
3.111
Immunisation and consumer engagement as methods of controlling the
spread of infectious disease are discussed below.
Immunisation
3.112
Maintaining strong immunisation among the general Australian population
builds on Australia’s capacity and ability to control outbreaks of infectious
disease.
3.113
The Committee was told that Australia maintains good vaccination
coverage compared to other countries in the world, despite some groups or
individuals holding objections to immunisation:
In Australia, we have very good vaccination coverage compared
to many other countries in the world. Compared to when we were children, in
fact it is probably better than it was then. But we do have some pockets where
people, yes, for whatever reasons have some objections to childhood
immunisation, but they are relatively small, they are visible and certainly
there are other activities to try and improve vaccination rates. I suspect that
with the internet we potentially have greater visibility of those pockets of
people who have objections to it. But in Australia, because of some of the
initiatives involving the Childhood Immunisation Register, we actually have
very good coverage.[63]
3.114
Dr Firman explained developing a ‘herd immunity’ was key to ensuring that
a disease doesn’t circulate through the population:
With respect to herd immunity, depending on how infectious
the disease is, that means you have to vaccinate a greater and greater number
of people to achieve a herd immunity, where everybody is vaccinated and the
disease will not circulate. For instance, with something like measles, … but I
think around 95 per cent is what you would require to actually develop that
herd immunity because it is a very infectious disease. With something like the
flu, you can achieve herd immunity with around 30 per cent because it is not as
infectious.[64]
3.115
Professor Peter McIntyre, of the National Centre for Immunisation
Research and Surveillance of Vaccine-Preventable Diseases, explained that
Australia leads the world in its national immunisation program:
The areas where Australia is a world leader include the fact
that we are the only place, still, that has a national immunisation register
that includes all children. This gives us tremendous capacity to track what we
are doing. We have also developed over the last 20 years or so a national
program, which means that, once a vaccine is on the national program, the
delivery of the vaccine right to the point of administration and so on is all
covered, and is not at cost to parents or others who might be receiving the
vaccine, including the elderly—it is not just children anymore. That means that
Australia achieves a very high uptake of vaccines very quickly and that our
regional neighbours—and, more broadly, internationally—often look to Australia
for early evidence of what is happening with vaccines that are introduced.
Recent examples of that include the pneumococcal vaccine and the HPV vaccine.[65]
3.116
Dr Peter Markey, from the Northern Territory Department of Health, told
the Committee that having a national immunisation program has led to low rates
of vaccine preventable diseases. He noted that more could be done regarding
adult immunisation:
We have a very low rate of vaccine preventable diseases, with
the possible exception of pertussis. This was really a result of when the
immunisation program went national in the late nineties. The fact that we had
national data collection systems, a national immunisation register and a
national approach to immunisation is why we really got on top of things.
Where we are short now is in fact in adult
immunisation—because that program concentrated on childhood immunisation. Now
we are short at the adult level because we do not have a national program for
adult immunisation…
… That is an example of something where we have done really
well at when we have approached it nationally but we can do better by having a
national approach to policy and data collection and surveillance.[66]
Committee comment
3.117
Australia is a world leader in the area of immunisation, evidenced by
the high rates of immunisation of children in Australia, and the eradication of
vaccine preventable diseases such as endemic measles and polio in Australia.
3.118
It is clear that Australia has achieved its low rates of vaccine
preventable diseases through its internationally-recognised national system of
immunisation.
3.119
The Committee is of the view that while there may currently be a low
risk of spread of vaccine preventable diseases in Australia, there is a need
for governments, non-government entities and individuals such as medical
practitioners, health service providers, and individual consumers to remain
vigilant about the ongoing success of immunisation in Australia.
3.120
The Committee views the national immunisation program and Australia’s
ability to maintain nationally low levels of vaccine preventable disease in
Australia as an example of strong national coordination between the
Commonwealth and state and territory governments.
3.121
The Committee considers that the national coordination of immunisation
issues should be considered by the Commonwealth as a model for national
coordination on infectious disease issues more broadly. This issue is discussed
in more detail in Chapter 6.
Informing and engaging the general
public
3.122
Informing and engaging the general public, and specifically the
travelling public, about the risks of infectious disease is seen as an
important step in preventing and controlling the importation and spread of
infectious disease across international borders.
3.123
The Committee was told that across the population, many Australians did
not have an adequate understanding of health issues, including how to prevent
infection:
The latest available data, including the Australian Institute
of Health and Welfare's Australia's health 2012 report, showed that only 41 per
cent of Australians aged 15 to 74 had a level of health literacy that was
adequate or above. That means that almost 60 per cent of Australians do not have
adequate health literacy, and the levels of health literacy are much worse for
people living in the most disadvantaged areas, those outside of major cities
and people with poorer self-assessed health status.[67]
3.124
Consumers Health Forum of Australia (CHF) told the Committee that
engaging with consumers was key to controlling the spread of infectious
disease, observing:
If there is a major threat to health coming across
international borders to Australia, it is people, the health consumers, who
will be affected. You can have all the strategies you like in place for
preventing diseases from entering Australia and preventing diseases from
spreading, but ultimately it is consumers and how they act that will have a
major impact on the severity of the outbreak and how well that outbreak is
controlled.[68]
3.125
Ms Carol Bennett, of CHF, told the Committee:
If we want consumers to be active participants in reducing
the risks of the spread of infection and the outbreak of disease, we need to
inform them about the challenges we face and empower them to be involved and
make the right decisions that protect their health and ultimately the health of
all Australians.[69]
3.126
In correspondence to the Committee CHF commented:
… consumers can be active participants in reducing the risks
of the spread of infection and the outbreak of disease, but only if they are
informed about the challenges Australia faces and empowered to be involved in
making decisions that will protect their health, and the health of all
Australians.[70]
3.127
Dr Armstrong argued that a person’s risk of contracting an infectious
disease while travelling overseas was largely dependent on the steps that
person took to prevent infection. He told the Committee:
People do tend to have an attitude when they go to Bali or
other countries that they are on holidays and they let their guard down. They
have unsafe sex more often. They wear singlets, T-shirts and thongs without
putting mosquito avoidance spray on. Raising the awareness of the public is
something we work hard on in this state because 40 per cent to 50 per cent of
all people going to Bali from Australia come from Perth or leave from Perth. So
we are overrepresented in Bali travellers. One way we can improve things is for
governments at the state and federal level to improve the information that is
imparted to the public.[71]
3.128
Dr Armstrong stated that some people did not recognise that travelling
to overseas destinations such as Bali held different infectious disease risks
than travelling within Australia.[72]
3.129
Ms Bennett argued that people needed to be properly informed about the
implications of risky behaviour, so they could make the right choices.[73]
3.130
Ms Bennett said that a challenge to government was to provide consumers
with good access to information about the risks of infectious disease:
There are websites like Smartraveller, for instance, that
provide some good information, but it is not particularly proactive advice and
it is not necessarily consumer friendly. I do not know if it is even tested
with consumers and on consumers. But it is about making sure that people know
what actually happens, when do people get tested and for what purposes, what
happens to them when that happens, what people should be aware of, what are the
deterrents, when something does happen what are the controls in place? It is
all those sorts of things.[74]
3.131
The Committee heard that there was not enough information about
infectious disease risks for Australians travelling overseas and that people
had to proactively seek out the information that was available:
The feedback we get predominantly is that there is not enough
information at hand and people have to proactively search it out. Unless you
are vaguely aware that there are particular issues in the country you are going
to, you may not even be aware that you need to find the information. So I think
there need to be more proactive strategies that alert people to the point at
which they need to both get the information and then provide quality
information access.[75]
3.132
The cost of immunisations and other health services was also seen as a
potential barrier to people taking preventative steps to reduce the risk of
infectious disease. Ms Anna Greenwood of CHF told the Committee that
precautionary measures and travel immunisations were expensive:
Travel is much cheaper and more accessible for all sorts of
people but they may not be factoring the medical costs into their travel.[76]
3.133
While in some circumstances the lack of public information and
engagement resulted in an underestimation of risk, under others the perception
of risk was elevated.
3.134
For example, Councillor Kelvin Kok Bin Lee, of the Shire of Christmas
Island, told the Committee that some Christmas Island residents were concerned
that boats arriving on Christmas Island could lead to the spread of infectious
diseases to the wider population:
Definitely, when the boatloads of people come in here and
when they have the tuberculosis detected, it does create some situations where
people are fearful. In our community it has been the case for a long time that
we have not come across this sort of disease, so it is a bit frightening for a
majority of them. Also, in the early days, when the boat people went to school
and they mixed with our kids, they were fearful that it might just carry over
to them.[77]
3.135
However, Councillor Lee could only recall one instance where a local
resident was actually diagnosed with TB, and was unaware of how the disease was
contracted. Councillor Lee advised that Dr Graham, on behalf of the Indian
Ocean Territories Health Service, usually circulated information to the
community regarding infectious disease on the island. Councillor Lee said that
it would be helpful if DIAC also communicated more with the community about
infectious disease issues, to lessen the fear of the community:
To me it would help if the communicators from the detention
centre, especially from those people who are in charge on the other end, could
work together with our local doctor in order to provide more information to the
community at large; it would lessen the fear.[78]
3.136
Mr Troy Sokoloff of DIAC responded to Councillor Lee by stating that
DIAC had a very strong program of engagement and inclusion with the Christmas
Island community:
We have a community reference group which meets monthly. We
also have representatives from the council and shire invited to our daily
morning meetings where we discuss issues. We also have regular bulletins that
we put out …
… Certainly on the part of the department we have a very
strong sense of working with the community and we are always open to hearing
any feedback or responding to any concerns people have. We have a dedicated
officer within our team whose primary responsibility is dealing with that. She
does a very capable job.[79]
Committee comment
3.137
The Committee is of the view that the general public, including the travelling
public, could be better informed about infectious disease issues. Such issues
include the purpose of screening processes at the border, preventative steps
that could be taken to minimise the risk of infection while overseas, and general
information about infectious disease issues of concern to the community.
3.138
The Committee acknowledges that some information is already available
for consumers in the public domain. For example, the Commonwealth website
‘Smartraveller’ provides a range of health advice for Australians travelling
overseas.
3.139
The Committee considers that a wider public awareness campaign regarding
infectious disease issues is necessary to better inform the general public. For
travellers, this campaign could link in with the information already provided
on the Smartraveller website. Information should easy to access and
user-friendly.
3.140
The public awareness campaign proposed should be developed in
consultation with the general public, and could include (subject to consumer
consultation and feedback) such features as:
- videos which could be
published via YouTube, Smartraveller, international flights and/or other
relevant access points, providing general advice to consumers about the general
health risks for travellers, including infectious disease issues, and actions
which could be taken to reduce these risks;
- reading material such
as brochures which can be provided at travel agencies, passport offices, on
international flights and other relevant access points, covering issues such as
keeping well overseas and preventive measures to take against infectious
disease; and
- targeted ongoing
engagement with consumers via social media and on travel websites.
3.141
The Committee notes the evidence from the Shire of Christmas Island
suggesting that some Christmas Island residents considered that DIAC did not
provide enough information regarding infectious disease risks stemming from the
immigration detention processes on the island. The Committee also notes DIAC’s
response that they engaged regularly with the residents of Christmas Island on
these issues.
3.142
The Committee encourages DIAC to consult further with the Christmas
Island community to ascertain where gaps in information and awareness exist,
and how these gaps could be filled.
|
Recommendation 6 |
| 3.143 |
The Australian Government, coordinated by the Department of
Health and Ageing and in consultation with the wider Australian community,
develop a national public awareness campaign to better inform and engage the
travelling public about infectious disease issues.
This campaign should cover the risks associated with
travelling overseas, preventative measures that can be undertaken to minimise
these risks, and screening measures used at the border to prevent the
importation of infectious disease.
Subject to consumer input and feedback, this campaign could
include a range of materials and platforms, including:
- videos,
which could be published via YouTube, Smartraveller, international flights
and/or other relevant access points;
- reading
material such as brochures which can be provided at travel agencies, passport
offices, on international flights and other relevant access points; and
- targeted
ongoing engagement with consumers via social media and on travel websites.
|
Navigation: Previous Page | Contents | Next Page
Back to top