5 Years on from COVID-19: lessons from past health crises and the future of global health

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Amanda Wells (00:10):
Hello everyone.
I'm Amanda Wells from theHistory Council of New South
Wales.
Welcome to everyone in the roomon Zoom and listening to the
podcast afterwards, I'm veryexcited about this panel.
So I'd like to begin byacknowledging the traditional
owners of the land we meet ontoday, the Gadigal people of the
Eora Nation, and pay myrespects to elders past and

(00:30):
present, and I extend thatrespect to any Indigenous people
who may be with us today orlistening to us in the future.
I'm very honoured to be here onGadigal land here at the Sydney
Mechanics School of Arts forthis panel about pandemics past,
present and future.
When I suggested this idea as apanel as we approach the
five-year mark of the discoveryof COVID-19, I couldn't have

(00:53):
imagined inviting such a broadrange of experts as we have here
today.
So who do we have?
We've got Edward Holmes,professor of Virology at the
University of Sydney and NHRMCLeadership Fellow.
Claire Hooker, associateProfessor in Health and Medical
Humanities at the University ofSydney and President of the Arts

(01:13):
Health Network New South Walesand ACT.
Julie Leask, professor ofPublic Health at the University
of Sydney and VisitingProfessorial Fellow at the
National Centre for ImmunisationResearch and Surveillance.
Brent Mackie, director ofPolicy Strategy and Research at
ACON.
Bernadette Saunders, associateProfessor in Life Sciences,

(01:33):
cellular Immunology and GroupHead for Tuberculosis and
Respiratory Diseases at theUniversity of Technology Sydney.
Susana Vaz Nery, professor atKirby Institute University of
New South Wales and theNeglected Tropical Diseases
Research Group Lead.
And Jane Williams, researchFellow in Public Health Ethics

(01:53):
at the University of Wollongong.
And finally, I'll introduce ourfacilitator for this evening and
the brilliant mind who broughtthis impressive panel together,
Philippa Nicole Barr, who's aninterdisciplinary scholar of
medical history and anthropology.
She's the author of Uncertaintyand Emotion in the 1900 Sydney
Plague, published by CambridgeUniversity Press this year in

(02:14):
April 2024, and which won theHistory Council of New South
Wales' Addison RoadMulticultural History Award this
year as well.
Philippa works at both ANU andWestern Sydney University.
Thank you, Philippa.

Philippa Nicole Barr (02:30):
So when studying history, we kind of
often overlook infectiousdiseases.
Yet in 2021, around 20% of alldeaths were from an infectious
disease.
Diseases shape history infundamental ways, just as
history shapes the way diseasesare understood and managed.
As we mark five years since theonset of COVID-19, this panel

(02:52):
will explore the lastinglegacies of significant health
crises like HIV, tuberculosisand COVID-19 to discuss what we
can learn from each other tosolve these present and future
challenges.
This is a veryinterdisciplinary panel for a
reason An interdisciplinaryapproach can transfer knowledge
from one field onto another togain a better understanding of

(03:15):
complex phenomena.
It allows for thecross-pollination of ideas and
methods between differentdisciplines, leading to new
insights and a broaderunderstanding between different
disciplines, leading to newinsights and a broader
understanding.
Yet interdisciplinary researchis not just about borrowing
tools and methods from one fieldto another, but also about
critical analysis of theassumptions, methods and
frameworks within a particulardiscipline, which can also lead

(03:38):
to new ideas and potentiallytransformative changes.
So thank you for joining ustonight to be part of this
exchange of diverse perspectivesand knowledge and to think
about the enduring and emergingchallenges faced in global
health.
Okay, so I'm actually going tostart us off in the present.
This year in Australia we haveseen around 400 cases of mpox

(04:03):
reported, and many of them havebeen coming from New South Wales
.
In 2022, there were also somecases of MPOCs in New South
Wales, and Kyle Sandilandssuggested that his way of trying
to avoid contracting MPOCs wasand thank you for Jane for this
idea, by the way was you know hestated on words on the radio,

(04:23):
words to the effect we havedecided to keep our baby away
from gay people because we thinkmonkeypox is affecting the gay
community.
We're worried about thesymptoms, such as scabs.
And I do want to make it clearthat Sandil ands was found in
breach of decency rules by ACMAfor these comments, so I have
not repeated them verbatim.
So I'm going to start off thisdiscussion by asking the panel

(04:46):
in an era where misinformationcan spread rapidly and
stigmatise people, what kind ofcommunication strategies best
balance the need to informwithout inciting unnecessary
fear or stigma?
How can the explicitcommunication of values like
empathy and transparency enhanceboth public trust and better

(05:06):
understanding of new healthconcerns?
And I want to start by askingBrent Mackie, here from ACON and
has decades of experience inthis area.
Thank you, thank you very much.

Brent Mackie (05:16):
Thank you for that and for the question it's an
excellent question, but I justwant to comment on that comment
by Kyle, which was an incrediblystigmatizing comment and really
was.
It was a sensational comment inorder to get attention, in
order to get an audience, butreally thoughtless, and it is
one that I suppose thecommunities that I come from,

(05:39):
the LGBTQ communities, haveexperienced for a very long time
, especially in the face ofepidemics like HIV, but also
monkeypox.
So it's something we've faced alot from the media, and it's one
that we've had to deal with asa community on an ongoing basis.

(06:03):
And I think the experience thatwe had from that especially in
public health, you know, thatkind of disinformation or
misinformation that iscommunicated has made it
incredibly difficult to respondto these epidemics.
And my experience I wasactually involved with the AIDS

(06:26):
Council, with ACON, back in thelate 80s, early 90s, so I was
there.
There was an incrediblydifficult time in terms of the
stigmatisation of people livingwith HIV.
People were often rejected bytheir families, their loved ones
ones, even their partners inthose early days because we
didn't have a lot of informationabout what HIV was and people

(06:51):
developed a whole lot ofmisinformation about
particularly what it was.
And it's an experience that weget today with monkeypox.
It's an experience we get today.
We've had with COVID as well.
You know, know, and it comes inlots of different ways, like
claims that the virus doesn'tcause the disease.
That happened with COVID, thathappened with HIV as well.

(07:13):
People in positions of power,like Kyle saying those things.
I know with HIV, many people,politicians included, really
transmitted that kind ofdisinformation.
I know in South Africa, thePrime Minister, the President at
the time, Thabo Mbeki, someyears ago now, really was a
denialist, an AIDS denialist,and said it was caused by the

(07:35):
antiretroviral treatments and itwas an incredible, incredibly
bad situation in South Africawhere people't take their
treatments but they could havetaken these life-saving
treatments.
I think countering it isincredibly difficult and
challenging.
I think the reasons why peoplelook at disinformation and

(07:58):
misinformation are varied andthey're not always about
ignorance.
It's not always about that.
They don't know, sometimesbecause those views agree with
their worldviews.
Sometimes it might be culturalor religious, sometimes it may
be just emotionally safe to toinvest in those, those, those,
those, those views.

(08:18):
I think coming from a trustedsource, coming from a source
like a community-based source ora source that they know is
going to communicate informationthat is factual, that is clear,
that is logical, is animportant way and, as you
pointed out, values like empathyand respect are incredibly

(08:43):
important in shaping those sortsof messages and getting them
out to the communities andreally getting that factual,
consistent messaging, warningpeople in advance, getting it
out as quickly as possible,perhaps as fast as you possibly
can managing it over a period oftime is the way to go, and

(09:05):
shaping those sorts of messagesand getting them out to the
communities and really gettingthat factual, consistent
messaging, warning people inadvance.
getting it out as quickly aspossible, perhaps as fast as you
possibly can, and managing itover a period of time is the way
to go.

Thank you for that.
You've mentioned things likereally important words or
concepts like trust, and youknow I was wondering, Julie, if
you have any comment on, youknow, the importance of trust or
using values to build trust inthese sorts of, with these sorts
of communication strategies, orif you wanted to comment on
stigma and stigmatisingcommunication more generally.

Julie Leask (09:46):
There's a lot there and thank you also for all your
preparation for this evening,philippa.
So trust is the bedrock of howwe manage infectious disease
events, crises, pandemics,because if you have the public's
trust, you have cooperationwith what needs to be done.

(10:09):
And because infectious diseasesare social, you do need that
solidarity and collaboration.
But because they're social,there is that huge risk of
stigmatisation.
I think we have all theseborderlines in life, boundaries,
ideas of what's us and what'sother, and they can come into

(10:32):
discussions about infectiousdiseases.
So we can manifest biases,prejudice, racism, xenophobia
through infectious diseasesthreats and we've seen examples
of that and politicians whoactively use those to ferment
public anxiety about othergroups to forward political

(10:55):
agendas.
So I think that a lot ofresponsibility for managing
these issues lies with leaders,with the mass media, with
journalists as well, becausemedia are often curating
information and often veryconscious of these issues as

(11:16):
well in the way they put newstogether, and we often don't see
that because we don't see whatends up in the cutting room
floor and we often don't seethat because we don't see what
ends up in the cutting roomfloor.
So trust is foundational andClaire and I have done some work
and she will talk more aboutthis, I think, on how public
values are so important in howwe communicate.

(11:39):
So, for example, with COVID-19,there were a lot of public
values that influenced policies,but they were often not made
clear and transparent, and weargue that it's important to do
that so that you are transparentwith people about where you're
coming from as a leader.
So our politicians had tosynthesize information from

(12:02):
public health, from all sorts ofdifferent you know forms of
departments, and put the economy, society, workforces and put
all that together into policies.
And they would often say I'mfollowing the science.

(12:22):
But they were doing that.
They were following the medicaladvice, but there were
definitely times when theyeither weren't following the
medical advice and werefollowing values and anxieties
of society, or they werefollowing the medical advice
plus a set of values that theyweren't clear about.
So you know, being transparentabout values sounds waffly and

(12:46):
sort of namby-pamby, but it'sactually fundamental to how
policies were made during COVID,including about vaccine
prioritisation, but they wereoften not made clear and
transparent with the public.
And the reason that you want todo that is that you, as Brett

(13:06):
says, transparency with thepublic about where we're coming
from.
Timely, honest, frank and opencommunication is particularly
needed in a crisis and whenpeople are worried, when they're
scared, when there's fear, whenthere's a risk of people using
their fast thinking and oftenthat's where our biases lie.

(13:29):
It's so important to have thatneed for self-determination
respected by politicians andleaders, being upfront about
what could be ahead, what thescenarios are, how we're
planning, and being very honest,frank and open with people, and
that's foundational toself-determination.

Fantastic.
Well, there's a really goodpoint that you've just made and
I just want to ask, you know,this is sort of we've been
thinking a little bit aboutMPOCs, you know, and COVID as
well, so these really kind offast moving situations.
Susanna, I wanted to ask if youhave any comment on how stigma
white work with diseases thatare more sort of borrowed in,

(14:13):
shall we say.
You know, some of the neglectedtropical diseases that you work
have a long history ofstigmatizing individuals leprosy
, for example, I think that youTyphus is another one.
Do you want to make a commenton?
You know how?

Brent Mackie (14:31):
In shaping those sorts of messages and getting
them out to the communities andand and really getting that
factual, consistent messaging,warning people in advance.
Getting it out as quickly aspossible, perhaps as fast as you
possibly can, and managing thatover a period of time, is the
way to go.

Thank you for that.
You've mentioned things likereally important words or
concepts like trust, and youknow I was wondering, Julie, if
you have any comment on, youknow, the importance of trust or
using values to build trust inthese sorts of, with these sorts
of communication strategies, orif you wanted to comment on
stigma and stigmatizingcommunication more generally?

There's a lot there and and thank you also for all
your preparation for thisevening, Philippa.
So trust is the bedrock of howwe manage infectious disease
events, crises, pandemics,because if you have the public's
trust, you have cooperationwith what needs to be done.

(15:34):
And because infectious diseasesare social, you do need that
solidarity and collaboration.
But because they're social,there is that huge risk of
stigmatisation.
I think we have all theseborderlines in life, boundaries,
ideas of what's us and what'sother, and they can come into

(15:58):
discussions about infectiousdiseases.
So we can manifest biases,prejudice, racism.
So we can manifest biases,prejudice, racism, xenophobia
through infectious diseases,threats and we've seen examples
of that and politicians whoactively use those to ferment
public anxiety about othergroups to forward political

(16:20):
agendas.
So I think that a lot ofresponsibility for managing
these issues lies with leaders,with the mass media, with
journalists as well, becausemedia are often curating
information and often veryconscious of these issues as

(16:42):
well in the way they put newstogether, and we often don't see
that because we don't see whatends up in the cutting room
floor.
So trust is foundational andClaire and I have done some work
and she will talk more aboutthis, I think on how public
values are so important in howwe communicate, how public

(17:04):
values are so important in howwe communicate.
So, for example, with COVID-19,there were a lot of public
values that influenced policies,but they were often not made
clear and transparent, and weargue that it's important to do
that so that you are transparentwith people about where you're
coming from as a leader.
So our politicians had tosynthesise information from

(17:28):
public health, from all sorts ofdifferent you know, forms of
departments, and put the economy, society, workforces and put
all that together into policies.
And they would often say I'mfollowing the science.

(17:48):
But they were doing that.
They were following the medicaladvice, but there were
definitely times when theyeither weren't following the
medical advice and werefollowing values and anxieties
of society, or they werefollowing the medical advice
plus a set of values that theyweren't clear about.
So you know, being transparentabout values sounds waffly and

(18:11):
sort of namby-pamby, but it'sactually fundamental to how
policies were made during COVID,including about vaccine
prioritisation, but they wereoften not made clear and
transparent with the public.
And the reason that you want todo that is that you, as Brett

(18:32):
says, transparency with thepublic about where we're coming
from.
Timely, honest, frank and opencommunication is particularly
needed in a crisis and whenpeople are worried, when they're
scared, when there's fear, whenthere's a risk of people using
their fast thinking and oftenthat's where our biases lie.

(19:00):
It's so important to have thatneed for self-determination
respected by politicians andleaders, being upfront about
what could be ahead, what thescenarios are, how we're
planning, and being very honest,frank and open with people, and
that's foundational toself-determination.

Fantastic.
Well, there's a really goodpoint that you've just made and
I just want to ask you know,this is sort of we've been
thinking a little bit about Mpox, you know, and COVID as well,
so these really kind of fastmoving situations.
Susanna, I wanted to ask if youhave any comment on how stigma
might work with diseases thatare more sort of borrowed in,

(19:37):
shall we say.
You know, some of the neglectedtropical diseases that you work
have a long history ofstigmatizing individuals.
Tropical diseases that you workhave a long history of
stigmatizing individuals leprosy, for example, I think that
hepatitis is another one.
Do you want to make a commenton?
You know how sort of how you'veseen stigma work in those cases

(20:01):
and you know to what extentwhat can be done to combat it?
I suppose?

Susana Vaz Nery (20:05):
Thanks, yes, so I guess I'm here to bring
attention to sort of anothergroup of diseases, the
neglectotropic diseases, where Iguess I think a lot of these
concepts that have beenmentioned before apply as well.
I mean, I think stigmatizationin the case of HIV comes from
many times from a place ofprejudice, so, um, you know,

(20:28):
kind of in relation to behaviors, or to sort of um, exploit the
me versus them, sort of uh, youknow, guilt shaming, or just to,
yes, uh, kind of uh,reinforcing these differences
across groups, or either by raceor gender orientation or like
whatever cause.

(20:49):
But also because ofmisinformation or exploitation
of misinformation right, andtaking advantage of of a power
situation to disseminate wronginformation.
And in the case of leprosy, Iguess, as you mentioned, a lot
of stigma comes from poorinformation.

(21:12):
Leprosy because of, I guess, thestigma associated with the
really sort of bad lesions anddeformities that both leprosy or
infantilis is causing peoplethat have the disease.
And these are infections thatare chronic infections and are
easily treatable, though thechronic manifestations of
diseases do cause, like in thecase of elephantiasis, enlarged

(21:37):
limbs and genitals that are veryobvious to everybody else in
the community.
And the same with leprosy thatI'm sure you probably have seen
photographs and for instance,with leprosy it led for people
patients with leprosy beingisolated and not removed from
society, when in fact casualcontact with people with leprosy

(22:00):
doesn't actually lead toinfection.
And so I guess with these sortof diseases you know it comes
from sometimes from a place ofjust poor information, and what
is needed, I guess, is, as youhave also mentioned, like you
know, interventions at communitylevel to sort of you know kind

(22:24):
of fight against that badinformation.
But also, I think we use a lotof you know the terminology of
champions, so people who havehad the infection and disease
and have been treated and havebeen able, you know, to overcome
those stigmas and are alsovaluable contributions for the
rest of those communities atrisk to live and those needs.

Yes, I think Anthony Brown, who's in
the audience somewhere, did alsohave a question about
engagement, of sorry engagementsorry, now I'm the one not
talking into the microphone sortof engagement of the community
during COVID.
Did you want to make a comment,or?

Anthony Brown (23:07):
Thanks so much, Pip.
I'm Anthony from HealthConsumers New South Wales and
one of the things we saw duringCOVID was a lot of the good work
that's happened about involvingpatients and community in
designing health services andthen designing health.
Messages really fell away andwe know that there's a lot of

(23:28):
strength and HIV is a greatexample of where you bring
people in to help say, well,this is what we need and these
are the messages that areimportant to us.
They just seem to fall away alot, particularly in New South
Wales, and took a long time thatto get back to where it was
pre-COVID.
So you're just interested inthe panel's thoughts about the

(23:52):
importance of involving thecommunity and patients, not just
you know, as people to treatand people to give messages to,
but actually involving us indesigning what those messages
are, because I think that'swhere the real cut through comes
from

Jane Williams (24:09):
Yeah, thanks, Anthony.
Um, so I think it's interesting.
I think a lot of things fellaway, and falling away is a um
is a kind of very euphemisticway of putting it right.
So what happened was thatpeople were like it's an
emergency, we don't know what todo, and I think a lot of the

(24:31):
principles of good research andgood design and so on were which
involved transparency, whichinvolved communicating well with
a real variety of people in thecommunity, in the population,
communicating well with a realvariety of people in the
community, in the populationthose sorts of things, I think,
were stripped away in the.
We don't have time for thiskind of, I would say.

(24:56):
That was the excuse used.
I think that that timeliness wascertainly a real issue.
However, I also think and Idon't want to downplay how
difficult it was, you know thework that people were doing
under immense pressure, to tryand make decisions really
quickly when they didn't haveany information.
But I think, as the pandemicprogressed and as everybody

(25:21):
became much more really, I guessattenuated to the idea that it
wasn't just what the virus wasdoing to us, but it was how we
were interacting with the virusand how we were interacting with
each other and so on.
That lack of kind of I suppose,tested social messaging and
messaging that really spoke to alot of different people was

(25:43):
really lost.
I would agree with you on that.

Thank you.
While we're on this topic oftransparency, I'm kind of
interested in addressing thismore explicitly.
I know that sort of inemergencies like the COVID-19
pandemic, we may have a bit orhave to make a compromise
between you know, sharing datarapidly to sort of facilitate

(26:09):
vaccine development or publichealth measures, but then
there's also certain standards,critical processes, peer reviews
, government regulations, thingsthat we really need to observe
and that are very fundamentallyimportant for maintaining, you
know, trust and also for notcompromising or putting
individual people at risk.

(26:29):
I'll go to Edward Holmes.
Your decision to share theSARS-CoV-2 genome online in
January 2022 kind of enabledresearchers worldwide to
initiate the kind of process ofdeveloping mRNA vaccines and
different diagnostics, but thisactually exposed you and your
colleagues to really significantpersonal risk and I was just

(26:51):
wondering if you could commenton that and maybe what the
pandemic might have looked likeif we didn't have that
information.

Edward Holmes (26:58):
Yeah, nice to be here.
So I think, alas, I think itwould look pretty similar to how
it was, and that's because itwas going to be a pandemic long
before I released the sequence.
We're talking about arespiratory virus that's pretty
infectious.
By the time the authoritiesrealised what was going on, it

(27:18):
was probably too late.
It was in the community and itwould have Wuhan's an extremely
well-connected city, so it wouldhave got out.
I don't think there's any doubtabout that.
So I don't think I think thepandemic was going to happen.
There was a narrow window, maybein November, december, for a
couple of weeks, but that wasthat In terms of personal risk.
It wasn't me, it was mycolleague, zhang Zhengzhang in
China, who really was under andhas suffered because of this.

(27:41):
What has suffered because ofthis?
Um, what I, what I did wasshare the sequence and I was
thinking at that point about pcrtesting, because you need to
have the genetic code of thesequence make a pcr test.
So that's what I was thinking.
What I did not expect was thespeed at which vaccines were
designed was actuallybreathtaking.
So I released a sequence on afriday evening us east coast, us

(28:01):
time by monday morning theydesigned the vaccine, that was
the moderna vaccine, that wasthe one and everyone used the
same technology basically.
And so two researchers in theus they saw my, my sequence
downloaded it over the weekendthey worked out how to stabilize
it and turn it into a vaccineextraordinary.
But then it takes months to dothe trialing again.
So so you know, overall, if Ihadn't released it, that release

(28:24):
would have been delayed maybe afew weeks at most.
In the great scheme of tryingand how it's done, it wouldn't
have made a huge difference.
Bigger consequences were madeby governments, probably in
China, and lots of governmentsfailed right.
So China took overly long toaccept those human-to-human
transmission.
It was blindingly obvious.

(28:46):
It was because the number ofhealthcare workers being
infected was huge.
That wasn't getting reported InEurope.
The UK, particularly BorisJohnson, and Italy just didn't
take it seriously at all.
The US were very slow in theirresponse.
So I think initially peoplewere in denial actually of what
was going on.
So you know, I think it wouldhave panned out pretty quickly.

(29:09):
But on the plus side, we, youknow there have been definite
improvements since on thebiomedical side.
If improvement since it startedand one is in is in vaccination
.
I think our countries realisewe need to have vaccine capacity
, production capacity indifferent locations.
Mrna vaccines will betransformative.
The next thing you'll see willbe multiple mRNA vaccines in

(29:33):
single doses.
So you'll get a single shot forflu, covid, rsv in one day.
That will happen soon and inthe bank they are already
designing vaccines to recognisewhat they think might be
pandemic threats coming forward.
So that is definitely apositive thing.

(29:53):
Scientifically, whethergovernments have got any better,
I was much more sceptical aboutthat.
You know, politics isunfortunate.
As someone very famously said,when you mix politics and
science, you get politics right.
So, sadly, the politics isawkward.
Awkward, but the scientificallyit would've definitely improved

um on the politics or the um, the issue of
sort of whether there wassufficient transparent, early
communication, um, Claire, doyou have any comment on on that
topic?
You know whether sort ofofficial, how official
communication impacted publictrust?
We had a question from RowenaRyan online who sort of asked if

(30:31):
public health communicationcould have been better from day
one.
So what would be your take onthat?

Claire Hooker (30:37):
I don't think anyone was really happy with
communication in a pandemic andI don't think anybody ever is.
And, to Jane's point, weunderstand why.
We understand that everybodywas under immense pressure and
things were not always managedin the most ideal form.

(30:59):
Having said that, I kind of wastrying to keep the thread of
all of these different ideasaround the panel.
I thought I would circle backto where you started with
stigmatisation, because it's avery concrete element that can

(31:19):
be addressed throughcommunication and it made me
think about how stigmatisationof particular groups has been an
absolute feature of pandemicexperiences historically, back
into the mists of time, as longas we've had historical written

(31:40):
records of pandemics, includingbubonic plague and various the
English sweat, and in factpandemics often have the names
of countries, just so that youknow who to blame.
But one thing that we that'strue and at the same time, the

(32:01):
other flip side of that is truethat pandemics, as somebody has
written in an entire book, havealso been stories of, like any
crisis, of incredible generosity, enormous amounts of solidarity
, a lot of mutual support, a lotof people who are understanding
and coming together.
So both stories are actuallyvery true and have been

(32:23):
historically sustained.
The media that although in thevery, very early stages there
were some use of a lot ofreferences to China, for example

(32:52):
, or talking about the Chinavirus or those sorts of things,
it was not very long beforethere was a lot of conscious
intention to correct that.
And I say that because Ithought that was also a feature
of a lot of communication duringCOVID-19 in Australia.

(33:12):
There were many ways in which Icould look back and talk about
how I would like it to beimproved.
Ideally, for example, thepeople who are going to be
affected by a decision will havethe earliest and first notice
of it, and that is alwayssomething that people are
concerned about if they hear onthe news first a policy that's

(33:33):
going to have a direct impact onwhat it is that they do.
You can't always manage it, butit always feels more like an
imposition if you're not beinggiven some kind of additional
communicative support aroundthat set of responsibilities.
And I certainly would be veryhappy to talk at length about

(33:54):
the inestimable, in my view,public value of being as
maximally open about the basison which you're formulating a
decision, including theevidentiary basis on which
you're formulating a decision,including the evidentiary basis
on which you're formulating adecision as possible, and it
goes to what Julie said.
She alluded to the work that wehave both done in identifying.

(34:17):
Well, we didn't identify.
We had taken note of extensiveamounts of cognitive science
research that shows thatpeople's responses to
communications are very stronglydetermined by whether or not
they trust the speaker.
I mean, it's actually.
That sounds almost like atruism, it doesn't sound like an
insight, but of course, it'ssomething that people need to be

(34:39):
taking into account.
Well, what makes you trustsomebody?
One of the first things thatmakes you trust somebody is that
you know they're beingtransparent with you and that
works on a population basis.
In a country like Australiathat is, despite the fact that
we might want to critique it,that is, on the whole, fairly
civic minded in both its publichealth decision making and its

(35:02):
communication around that.
This space in which that kindof transparency can be your best
guide, and what it does is.
It allows people to do a coupleof things.
It allows people to understandwhat's uncertain, even if that
makes them feel uncomfortable.
It allows people to understandthat there is no single right

(35:23):
answer.
People to understand that thereis no single right answer and,
even if you don't like theanswer that the authorities pick
, you can at least also, at thesame time, accept that you're
still within the zone ofpossible reasonable responses.
So you might not like that one,but at least they're all
potentially reasonable and youcan understand the parameters of
that.
It allows people to feel likethey are being trusted, and that

(35:48):
is so critical and key tobringing them with you as
partners in your decisions in apandemic.
A pandemic is an uncertainsituation, so I'm just going to
tell you right now.
So I'm just going to tell youright now we will all get it
wrong.
My favourite article in thenews in the entire pandemic was

(36:09):
when a journalist asked maybeeven you, eddie, somebody, at
least a number of people whatwere things they'd gotten wrong
so far.
I loved hearing that they wereabsolutely the most expert
people.
So we're all going to getsomething wrong.
So the other thing that beingreally transparent in a pandemic
lets you do is make a mistakeand still have the public with

(36:31):
you, and you will be making amistake.
So you need the public to bewith you and in the literature,
this is referred to assustainable public trust.
That is public trust thatyou're not going to lose simply
because it turns out that thedecision that you made was not,
in retrospect, the correct one.

(36:52):
And people will do that againwhere the conditions of civic,
democratic discourse are met andwe are, despite our complaining
.
We have those here, and I thinkall of us need only look to
highly polarised countries toappreciate the privilege of

(37:12):
maintaining and sustaining thatkind of civic space.
Things shift where you have anincredibly polarised set of
circumstances, because there youdon't have the same affordances
.
You still have the correctresponse of being reasonable and
factually oriented, but you dothat knowing that it will not

(37:35):
have the kind of reach thatunder those circumstances.
In my view, some of your mosteffective tactics are to align
more explicitly with socialidentity and social values,
because they are often strongdrivers for how people appraise

(37:56):
information.
So all of us appraiseinformation in ways that is
framed by some of our priorvalues and commitments.
We've got lots of studies thatshow that.
So all of us are open toappraising information in a way
that's we will never appraiseinformation from a position to

(38:16):
which we are opposed.
With an unbiased brain, I guess, is what I'm trying to say.
So in those circumstances, then, communication is about looking
for common ground, andsometimes it's about social
identity, and sometimes it'sabout values where transparency
can no longer hold you.

I find that very interesting and I'm
particularly interested in thisnotion of values and sort of
civic identity and to whatextent we are able to cooperate
But oftentimes, obviously, thesepandemics, sort of civic
identity, and to what extent weare able to cooperate when we
feel like we share an identity,but oftentimes, obviously, these
pandemics sort of you know,they're global experiences we
have to depend on decisionsbeing made in countries where we

(38:56):
have no control over what'sgoing on, where we can't really,
you know, contribute and yetsomehow we're still going to be
affected by how other countriesmanage diseases and by how, you
know, by how these things sortof play out on a global level.
And I want to address that andalso then maybe think about, you
know, some of the diseases thatare, you know, more prevalent

(39:20):
outside Australia and why weshould potentially think about
that.
Jane, I saw you nodding when Iwas saying that.
Did you have any comment onthis kind of you know, how we
can think about this ethics ofthe global health?
I suppose you would say.

by closing the borders and trying very, very
hard not to be part of theglobal health story, and I think
that was a not unusual forAustralia response but one that
obviously worked well for mostpeople most of the time.

(40:02):
But it's not the way that weusually manage global health
issues.

Yeah, I wanted to kind of think about I
suppose you know what'shappening.
We do sort of often forget thatthere is a world outside of
Australia where a lot of thingsare quite different, and you
know, I guess I just wanted tomaybe reflect on the way that
diseases can kind of the waythat we might need to have some

(40:34):
or share some responsibility forwhat's going on beyond our own
borders In terms of zoonoticdiseases.
You know there's a lot ofthings going on that are
changing the world and changingthe way diseases spread and
changing the way that you know,people are engaging with their
own environments.
Susanna Vazneri, did you haveany kind of comment on why we

(40:58):
should be thinking aboutzoonotic diseases, how the
relationships are with you know,why they're increasing or would
appear to be increasing infrequency, and what the global
community can potentially doabout it?

zoonotic diseases have always existed and
, um, and they will continue todo so at the moment.
Yes, you're right, it isbelieved that maybe six out of
ten emerging diseases will bezoonotic diseases, but it is, I
think.
I guess they are becoming morecommon because of of human

(41:32):
activity.
Um, you know urbanization andlike including this
deforestation sort of you knowurbanization and like including
deforestation, sort of like youknow anything that?
Well, zoonotic diseases sort ofimply that people are
infectious agents that's used toonly infect other animals will
be able to also then jump andinfect humans, and sometimes

(41:52):
they evolve in such a way, likein HIV, that food originated in
an animal but then strainsbecame just human only.
But so this process hasoccurred over and occurs over
time.
But the more we sort of destroyand affect our natural
environment and make, you know,deprive animals from their

(42:13):
original habitats and exposehumans to those sort of wildlife
that wouldn't share the samehabitat as us, we will be
increasing the odds of thishappening.
And then there's also climatechange, obviously.
You know, particularly forvector-borne diseases, so

(42:35):
diseases transmitted bymosquitoes, for instance, that
with the temperature increaseglobally, mosquitoes will be
able, or some species ofmosquitoes that are, I guess
more concentrated in tropicalareas, will be able to then also
kind of expand and transmitthose diseases to other areas

(42:57):
where they usually didn't existand also, you know, kind of
increased flooding and increasedlevels of precipitation, again
sort of increased breeding sitesfor mosquitoes.
So yes, human activity isleading to an increase in the
arisal of zoonotic diseases,including, you know, I guess

(43:20):
maybe not the only theory aboutthe emergence of COVID, but I
guess the more accepted one isthat it is a zoonotic disease
and jumped from you know animalsto humans, as others did.

Edward Holmes (43:35):
Can I say that these jumps happen every single
day.
If you go into Southeast Asianot just Southeast Asia you look
at people who interact withwildlife, who work in animal
markets, and you test them.
They've been exposed to animalviruses and coronavirus.
It happens every single day,and so every time is a roll of

(43:56):
the dice and eventually yournumber will come up.
Okay, and we need to.
We need to understand that,that that process just goes on
continually and with climatechange, it's just going to
magnify it thousands of fold.
Okay, so covid could be a walkin the park compared to what
comes next.
Unless we kind of take itseriously, then then it could be

(44:17):
, you know, much, much worse.

And this is a good reason to think about
what's going on beyond ourborders, absolutely so, on that
point, I want to talk to or askyou know, bernadette, you about
your research, because you knowyou focus on a disease that you
know has existed for millennia.
Is, you know, still the 10thbiggest killer of people or 10th

(44:41):
biggest cause of deathworldwide I think in 2021 or
2022, and, you know, has beenpresent since homo sapiens
evolved.
So obviously you like achallenge.
I'm getting lunch.
I'm getting um, you know, um,can I ask you why, what, why or

(45:02):
how has TB managed to persistand adapt for millions of years?
And, um, yeah, you know, how,does the rise of sort of
treatment resistant TB reflect akind of broader problem of
antimicrobial resistance as well?
Um, I'd be very interested inin the global.

Bernadette Saunders (45:14):
So we've as you mentioned, we've had
tuberculosis for a long time andone of the reasons it survives
so well is it has adapted withus um, it has lots of
characteristics that allow it tosurvive.
So a disease that is sovirulent that it kills its host
really quickly.
That's not a good survivalstrategy for the disease because

(45:34):
it doesn't have enough chanceto infect the next person and
then and survive, so that theorganism and tuberculosis is a
bacteria it wants to survive.
So one of the things that'squite amazing about tuberculosis
is we estimate that about aquarter of the world's
population is infected and TB isone of those really interesting

(45:56):
diseases where infection anddisease are very separate things
.
So most people who gettuberculosis, their immune
system does what we want.
It protects them.
They never get disease, theynever get sick.
A small portion of people willat some stage go on, maybe very
quickly.
Sometimes it can be years ordecades after they were first

(46:17):
infected.
They will go on to developactive disease and spread that
disease to the community.
So for tuberculosis, it canlive in the community for a long
time and move quite gradually.
It's a very slow growingorganism and move from person to
person and so it creates hugeproblems.
One of the problems about beinga very slow growing organism.

(46:38):
So it takes about 24 hours forthe bacteria to double, whereas
normal bacteria double in about20 minutes, most of them.
So if you normally get sick andyou need some antibiotics, five
days is probably about averagefor a course tuberculosis.
It's four antibiotics for aboutsix months, or at least two
months to start and then acouple to keep, continue on.

(47:00):
And that's because it's veryslow growing.
It's hard to kill.
It manages to sort of burrowits way into our cells.
It's very well adapted.
The strains areulent, butthey're not so virulent that
they normally kill peoplequickly.
One of the problems aboutantibiotic resistance is that we

(47:21):
have antibiotic resistancestrains everywhere.
It can be magnified by the factthat you know how many people
in this room could be honestlyadmit that you had a five-day
course of antibiotics and youforgot to take one of your
antibiotics one day.
You know we're not very good.
Imagine being told right here'syour big chunk of pills.
I want you to take them everyday for the next six months.

(47:43):
Your pee will go red.
Sometimes they have liverdisease.
They can cause toxicity of theliver.
It's hard to get people to taketheir antibiotics for that long
, so that increases the risk ofthem developing antibiotic
resistance.
Antibiotic resistance is muchharder to treat.
The drugs we have to treat itare terrible.

(48:05):
They cause deafness, they cancause people to get psychosis.
They cause terrible sideeffects.
So it just compounds theproblem.

You've done.
I mean, I find this veryinteresting because obviously
it's a huge problem but it sortof seems very invisible in
Australia and history has kindof almost forgotten this disease
, which is amazing because it'spersisted for so long.
But you've actually done someresearch on a similar-ish
infection and a non-tuberculosismycobacteria infection I hope
I'm getting that right thatappears in Queensland and other

(48:38):
parts of Australia, and so I'minterested in this because it
seems like a little bit of ajump into Australian territory
and a reason for us to kind ofanother reason.
Obviously there are goodreasons, but another reason to
think about this Can you explainthis research?

Bernadette Saunders (48:52):
So mycobacteria is the name of the
species that cause tuberculosis.
Mycobacterium leprae causeleprosy.
All the other bacteria in thatspecies we call non-tuberculous
mycobacteria, and there's acouple of hundred of them.
A couple that we might youmight've heard of are the ones
that cause ulcerans, those nastyulcers that you see in people,

(49:13):
and there's a couple of otherstrains that who are part of the
non-tuberculous mycobacterium,mycobacterium avium.
That got a lot of prominence inAustralia because early on in
the days of the HIV it caused alot of death in people to what
we would call an opportunisticinfection.
So people who areimmunocompromised are more at

(49:34):
risk.
The non-tuberculous mycobacteriaare big risks in cystic
fibrosis patients, people withchronic lung disease, because
they're mainly lung infections.
In Australia you're more likelyto catch a non-tuberculous
mycobacteria than you are TB.
All around us, particularly inour Pacific neighbours,
tuberculosis is a major problem.

(49:56):
Tuberculosis has still killedmore people globally than any
other disease and it still lastyear killed about 1.3, 1.5
million people.
So it is something that we cantreat with antibiotics.
So it is something that we needto improve treatment.
It remains a risk.

(50:18):
The non-tuberculous mycobacteriaare actually even harder to
kill and the reason why we weoften talk about them in
Queensland is because Queenslandcollects better data than any
other state about thenon-tuberculous mycobacteria.
It's a a reportable diseasethere, whereas it's not in New
South Wales, so that makes itmuch harder for us to know

(50:38):
actually how many people areinfected.
But again, antibioticresistance and a lot of these
organisms have intrinsicresistance so that they're hard
to kill.
They have quite differentstructures to other bacteria,
which impacts their slow-growingnature and, being slow-growing,
it's harder for the antibioticsto get there and to kill them.

Very interesting, this kind of idea
of all of the things around usthat we think we've got
solutions or we're keeping themat bay, but they keep kind of
growing and changing and evadingus.
That's how they survive.
Yeah, yeah, yeah.
I want to just touch again onthis issue of sort of the global
nature of this problem.
Julie Lee asks I'm wondering ifyou want to make a comment on

(51:25):
sort of why the health of peoplebeyond our own borders might
matter to the Australiancommunity.
I know that you know justtaking us back to COVID for a
minute but during COVID-19Australia was sort of accused of
vaccine hoarding.
There were calls for moresupport of, you know,
vaccination, covid vaccinationin the Pacific, southeast Asia,

(51:46):
some of these places whereBernadette has drawn attention
to you know a prevalence of TB.
I'm just wondering if youwanted to make a comment on that
.

Remember when the Prime Minister was accused of
the stroll out, the vaccinestroll out and everyone was so
frustrated and annoyed that wehad to wait.
And then we had that problemwhere we'd relied a lot on
locally made vaccines and the UQvaccine didn't quite work out

(52:22):
and then we were relying onAstraZeneca.
That caused this rare butserious clotting disorder, and
so AstraZeneca was recommended,you know, mostly for people over
50, then 60.
And the mRNA vaccines Modernaand Pfizer were going to come to
the country, but we're onlygoing to get most of them by
September 2021.
And so there was a lot ofcommunity anger because we're

(52:45):
all being held hostage to COVIDat home waiting for the vaccine
rollout to happen so we couldget sufficient population
immunity so we could go back tonormal life.
I'm sure all of you are feelinga bit re-traumatized by hearing
about that again.
What was interesting in thatdiscussion was, yeah, we were

(53:09):
understandably frustrated as anation, but rich countries like
ours had the power to getcontracts with the vaccine
manufacturers and get thosevaccines a lot earlier than
countries such as most Africancountries got vaccines in those

(53:30):
countries in sufficient quantityfor a vaccine rollout After
COVID was well and trulyestablished in those countries.
So there was less motivation,less urgency.
It was harder to get thevaccinations out to people and
harder to get the motivation ofpeople and that was the problem
of vaccine inequity.

(53:51):
And in Australia, in all ofthat public discussion, at least
about the rollout, thereweren't many people saying, hey,
if we rush on this and we'recontrolling COVID relatively
well here compared to othercountries, then other countries
will potentially miss out.

(54:12):
Now, we're a small populationso we probably wouldn't have had
that much impact on it.
But what struck me was thatlack of global citizenship in
the public rhetoric, in themedia rhetoric, and you talk to
journalists, and it wouldn'tmake the cut.
You know, it wouldn't end up onthe telly or the newspaper

(54:33):
because we were thinking aboutourselves and that vaccine
nationalism, as it was called,is understandable, it's human,
but it's unfortunate because thehealth of other people in other
countries will affect ours.
But also we should care, youknow we should care about the
health of people in countriesthat are less well resourced as

(54:55):
well.
So what do we do about it?
I think it's really it is verydifficult.
So we had COVAX, which wasdesigned to put a lot of money
together and buy vaccines anddistribute them more equitably,
but that was challenged becauseof this vaccine the purchasing

(55:17):
plans.
Australia did have bilateraldeals where we were donating
vaccines, particularlyAstraZeneca, to other countries
in the region and that was aperfectly good vaccine in many
respects.
It just had this rare clottingdisorder risk.
So what many people are sayingthe answer is now is that we

(55:40):
need local manufacturing.
So African nations need to havetheir own manufacturers of
vaccination so that they can getaccess to those vaccines in a
more timely way than they didwith COVID-19.
To those vaccines in a moretimely way than they did with
COVID-19.
There needs to be thoughts, youknow, with MPOCs.

(56:00):
For example, the DemocraticRepublic of Congo needs vaccine
now because they've got anepidemic of it there.
How are other countriessupporting timely access of that
country to that vaccine?
These are important questionsand we need to think about these
as national citizens in aglobal way.

Can I add something to that?

Audience Member (56:25):
as well.

Because it's if we're going to.
I agree, julie, that localmanufacturing capacity is super
important.
No-transcript, and you know,maybe that was justified, maybe

(56:58):
it wasn't, but it wasn'texplained and it wasn't
justified.
Well, it wasn't justified usingevidence or whatever.
So I I completely agree withwhat you're saying and I think
there needs to be more, you know, there needs to be less racism.

And we need the Pentagon to not use
anti-vaccination campaigns as atool of espionage and propaganda
, because that's what they didin trying to undermine
confidence in the Philippines inthe Sinovac vaccine from China
was that the Pentagon seededanti-vaccine propaganda in that

(57:38):
country to stop people wantingthat.
This is not a conspiracy theory, even though it sounds like it.
It is a well-documented reportfrom a media organisation
recently that the Pentagon hasnot denied.
So you know, let's not allowgovernments to also see

(57:58):
misinformation about vaccines aswell in that process.

It's very interesting.
I mean, I think not only arethese ethical concerns of you
know, to what extent shouldnations think about what's going
on beyond their own borders,but then there's also the
question of to what extentshould we be thinking about how?
You know, these sort of otheryou know, I don't know if I'd
call TB endemic, but you knowthese kind of really persistent,

(58:24):
ongoing diseases are creatingkind of weaknesses that should
be addressed before we get to acrisis moment and particularly
with you know, the kind ofcontinuing emergence of zoonotic
diseases and these sort of youknow, climate change, whether
we're getting a global healthsituation that is sort of so

(58:44):
weak that we won't be able todeal with the next crisis as
well.
I wanted to kind of ask Susanna, you and Bernadette about sort
of resource allocation, again,thinking about what happened
beyond our borders.
What kind of things happenedwith resource allocation for TB
programs or for some of theneglected tropical disease

(59:05):
programs when COVID hit?
Susanna, do you want to?

Yeah, but yes, I mean, I think, sorry, just
kind of a step back as well.
I mean I think, sorry, justkind of a step back as well.
I mean, when COVID hits.
I think we've been talkingabout inequities and sort of.
You know how we dealt with thecontrol measures and how the

(59:30):
decisions were made, and I think, and also like how to
communicate information,including sort of differences in
opinion of information.
I mean, even in Australia, atthe beginning of the pandemic,
there were voices sort ofagainst the sort of shut
everything down and lockdowns,particularly then when it

(59:53):
continued in 2021.
And, you know, one can arguethat a lot of those measures
were actually quite notequitable, because, you know,
it's very different for peoplewho have, you know, jobs or
non-casual jobs to stay at homeand work online, whereas you
know people on casual contractsor manual labours and they don't

(01:00:15):
have an option to do zooming oronline whatever.
So you know, like you're,you're there there, there was
still many other levels ofsociety, even in high-income
countries like australia, beyond, uh, covid and other disease
programs that and and peoplesuffering from other conditions
that were, you know, affected,you know, like cancer, chronic

(01:00:38):
diseases, people needing surgery, chronic pain, all that those
situations, if we look then at,you know, low and middle income
countries, what I've said interms of social inequalities
becomes amplified.
So these neglected tropicaldiseases, particularly in
countries that you know I guesshave population demographics

(01:01:00):
that are quite different fromkind of high-income countries,
but also where infectiousdiseases do cause a lot more
mortality and morbidity thanthey do in high-income countries
.
So you know, there are globaltargets to sort of eliminate a

(01:01:21):
lot of these neglected tropicaldiseases as public health
problems and you know, with thecontrol measures that were
established at the beginning,that derailed those control
programs and and now people kindof look back and it is, it's
estimated that, um, you know,like a stop in these programs.

(01:01:44):
So the, so the for neglectedtropical diseases, and sorry
about the jargon, but thesediseases are very easily, most
of them, or quite a number ofthem, are very easily treatable.
Of them, or quite a number ofthem, are very easily treatable
but they require mass drugadministration campaigns.
So they require people orhealth staff going out to
communities and givingmedications to people and

(01:02:05):
because of these socialdistancing measures they were
interrupted, not for very long.
So the WHO did tell countriesstop all these master
administration programs, butmaybe six months into after that
Still in 2020, they startedsort of going back because they
realized that interrupting allthese efforts would have huge

(01:02:29):
consequences, and they did so.
They set back control programsfor every year that they were
interrupted.
You probably lost five years ofprogress, and I'll let
Bernadette talk about TB.
But in malaria, you know, that'skind of.
You know it still causes600,000 deaths every year, most

(01:02:50):
of them children, and until 2020, in recent years before that,
the world was in a goodtrajectory to decrease malaria
cases and deaths because of, Iguess, renewed global interest.
Sorry again about the numbers,but malaria it is believed that

(01:03:15):
malaria, over the history ofhuman humans, has killed 50
billion humans.
That's half of the entirenumber of people that ever lived
.
I mean, if you think about it,it's like really kind of really
hard to believe how come malariastill exists and still causes
600,000 deaths a year and whythere is okay, now there's two

(01:03:38):
vaccines, but you know COVIDvaccine was developed in a year
and rolled out, and malariavaccine has been in a pipeline
for like 30 years.
It took 30 years to develop avaccine that is now being rolled
out.
So there is a lot of socialinequalities.
That that you know we shouldreflect beyond COVID-19.

(01:04:01):
And, ashley, I don't know ifI've answered your question.

Philippa Nicole Barr (01:04:03):
Yes, fantastic.
I want to go to Bernadette.
Why is there no TB vaccine?
And also, can you comment onsort of what happened during
COVID with you know the TBtreatment programs and what was
going on in terms of resourceallocation?

Bernadette Saunders (01:04:17):
So well, there is a TB vaccine, so it's
called BCG and many people willhave a scar on their arm.
I'm looking at all these peoplehitting their arm.
We don't give it in Australiaanymore as a general rule
because it wouldn't actuallyhelp Like there's, so it
wouldn't save people fromgetting TB in Australia because

(01:04:37):
we have very little TB.
The vaccine is still givenglobally.
Most children get it in thefirst 24 hours of life,
particularly in any part of thedeveloping world, and it's still
very effective at preventingdeaths by children.
Children, when they get TB,unfortunately often get
meningitis TB in their brainsand it has a high fatality rate.

(01:04:58):
So the vaccine works well atpreventing deaths in children.
The problem with the vaccine isit starts to wane when people
become late teens, into earlyadulthood, and they start to
develop active TB disease thenand of course that's a
population who are havingchildren, who are working, who

(01:05:19):
are supporting the rest of thecommunity, unfortunately
succumbing to TB.
What we found happened duringthe pandemic is that TB is a
respiratory disease, so finiteresources of numbers of doctors
and nurses and respiratoryclinics.
So they put their efforts intoCOVID because it was a more

(01:05:39):
immediate problem.
People were scared to go tohospital because they didn't
want to contract COVID and die.
There was lots of people didn'tunderstand the disease so they
were scared.
So lots of people who hadsymptoms didn't want to go to
hospital or there were noclinics to go to because they
had been turned into lookingafter the COVID clinics.
The hospitals were lookingafter COVID patients, so it was

(01:06:02):
a juggle of resources.
As a result of that, lots ofpeople missed being diagnosed
and so now we've seen increasesin the number of deaths and
cases the number of deaths andcases and, like malaria and some
of the other neglected tropicaldiseases they estimate we've
kind of put our progress towardsdeclining TB back about 15 to

(01:06:23):
20 years.
So it's had a major impact ontuberculosis control globally
that we're still trying to dealwith now very persistent these
diseases.

None of them have kind of none of them
are closed, I suppose you wouldsay.
I think that that's kind of it'sa good.
It's a good point to reflect onthe kind of the way that these
sort of other diseases, if leftkind of without sufficient
resources, kind of create asituation where, you know, the

(01:06:56):
pandemic will really create amajor setback, I suppose.
So it's a kind of like a globalweakness If we were to think
about, you know, healthinternationally rather than
nationally potentially nothaving well, having these other
diseases without sufficientresources, without sufficient
you know, the right, the besttreatments, or having such large
case numbers, is reallycreating a weakness that's going

(01:07:18):
to, you know, cause biggerproblems when a pandemic comes.
And I wonder if that should beone of the lessons that we learn
from COVID-19.
I kind of want to go to sort ofa more general question now and
really kind of think about youknow what lessons from pandemics
prior to 2020 should have beenuseful in the COVID-19 pandemic

(01:07:42):
and what we might take away fromCOVID-19 that we should sort of
bring to the table next time.
Julie Leas, do you haveanything?

Julie Leask (01:07:52):
Well, in fact, some of our pandemic planners had
read the 19 um 19 about the 19181919 uh, what they called it
the spanish speaking of countrynaming there, the was the
original h1n1 um influenza uhpandemic and it came to

(01:08:17):
Australia in 1919.
And there was a report aboutthat from our who was the Chief
Health Officer of New SouthWales at the time, I think, and
some of our very own pandemicplanners who were, you know,
writing pandemic plans 10, 15years ago, had read that and

(01:08:38):
were taking lessons from that.
So we actually had a bit ofthat noticing of history and it
was very useful because the pastteaches us a lot about what
could happen now and what weshould anticipate.
And some of the things thatwere observed in 1919 were that
people were getting terriblysick and they didn't have people

(01:08:59):
to care for them.
People wouldn't go near thehouses, they'd put flags outside
the homes of sick people andvisibly stigmatize them and
people were terrified of them.
So there was not enough care.
That was happening.
But also what they saw happenwas communities rallying, didn't

(01:09:19):
they, claire?
And the importance of community.
And of course we rediscoveredthat with COVID-19 and just how
essential it was to have strongcommunity-based, community-level
responses that involvecommunity engagement, that heard
from communities as well asinformed communities.
So I think we could have takena lot more notice of what had

(01:09:45):
been learned in 1918 and 1919.
Polio epidemics in Australia inthe 50s there were
controversies.
They closed the beaches, theyclosed schools.
Lessons from then that couldhave informed how we managed
COVID-19 more than they did.

Yeah, good point.
Brent, you had a lot ofexperience with the sort of HIV
AIDS pandemic and with workingwith ACON for a very long time
and I just want to ask if therewas anything from that
experience that you were able tobring to your work during
COVID-19 and sort of how ACONresponded and also that element

(01:10:28):
of community that Julie wasreferring to.

Brent Mackie (01:10:30):
Yeah, yeah, of course.
So appreciating that COVID wasa very different epidemic to HIV
in many respects yes, it wasvery quick and it spread quickly
.
It was transmitted in a verydifferent way.
I think there are still somereally valuable lessons that we
can learn from the experience ofHIV in COVID and we talked

(01:10:54):
earlier about communityinvolving community,
community-led organisations,getting them involved in
designing and leading many ofthe responses.
I think some of the issues thatwe faced with COVID could have
been alleviated or lessened ifthat was followed more.
And I do understand that weneed to respond quickly, but you

(01:11:15):
can still involve community inthose decisions and I know some
of the issues communities inSouth, western and Western
Sydney face could have beenresponded very differently to
community involvement andbuilding that trust we talked
about earlier, that trust andresponses.
I think some of the lessons wealso could use with COVID

(01:11:39):
include things like not using afear-based response and at the
beginning with HIV, you know,with campaigns like the Grim
Reaper, which really didalienate a lot of people living
with HIV, that really did, youknow, provide little information
about how to deal with HIV andscared a great deal of the

(01:12:01):
community.
I think taking those lessons interms of how we communicate
around COVID and other epidemicsinto the future, bringing
people along, using trust andalso using, you know, empathy as
you talked about earlier um, isa far more productive way of

(01:12:22):
responding to those, to those um, to emerging new uh epidemics.
I think um and I I think one ofthe last ones I probably would
touch on is with HIV, and Ithink it's kind of important
because there's a lot of talkabout we've talked earlier about

(01:12:44):
stigmatizing people anddiscriminating against people
with these conditions and a lotof that time it's signaling
people or groups of people out,very often vulnerable people as
the spreaders of those diseases.

(01:13:04):
And I think if we really focuson our responses, on the
behaviors, rather than thesegroups or individuals as the
ones that are the problem, youknow, and I think there was a
lot of that in COVID, I rememberwhen that I think it was a taxi
driver or an Uber driver wassignalled out as being a person
who has, you know, destroyedlockdown the limo driver.
The limo driver.
Yes, and there was a lot oftalk about his ethnicity, which

(01:13:26):
was really, I think, verydamaging and would have been
incredibly painful for him as aperson.
But we need to talk about thebehaviours how you spread it,
and we certainly learnt thatover time.
In HIV, you talk aboutprevention activities as using a
condom or using PrEP or PEP.

(01:13:47):
I think that's far better thansaying one particular group.
I think we can transfer tofuture epidemics.

Edward Holmes (01:13:56):
So can I say something that we didn't learn?
Okay, and that was we'd had twoprevious COVID outbreaks in the
previous 10 years of SARS andMERS, and yet there was no
investment in vaccine.
There was short-term vaccinefunding and then it was stopped.
There was no investment inantivirus for those, nor in the
basic biology of thoseinfections.
So they came and they went andwe just forgot about them.

(01:14:18):
And that data was there and ourmodels for how the pandemic
would go were based on flu,which is not a bad model, but
it's not COVID, and COVIDbehaves in a different way than
flu and so they were there andwe just didn't pay attention.

Yeah, I know that.
Well, I'm not sure if this istrue, but I heard that virology
got a bit of a funding boostfrom the HIV pandemic, in a
sense, because there was a sortof renewed attention on it, I
suppose.
Has the same result kind ofemerged from COVID-19?
Is there more investment in it?

Well, unfortunately, yeah, yeah, it's
been offset by the let's justthink about the conspiracies.
It's offset by by, um, theblame that people have now
attached to virologists for thispandemic, and I think that has
been massively detrimental.
What you've seen in the US hasbeen science on trial, and my

(01:15:13):
colleagues, in fact the ussenate, had a, had a place set
for me at their hearings.
You've seen people on trial forwriting a scientific paper, and
so there's been a massiveanti-establishment, anti-science
movement in the us.
But you know why?
Because science counterspopulist rhetoric.
Because in populist rhetoric youcan have alternative facts

(01:15:34):
right, which you can justalternative facts right, which
you can just spew out.
Science, you have one fact andthat's the truth.
So science is kind of, it'santi, that way of thinking, and
so science scientists have been,I've been been vilified and
it's been been absolutelyhorrendous.
Okay, and if and if, if theelection goes the way it might,
you know it could continue uselection.
I should say so, um, you know,so I, I, yes, there has been

(01:15:58):
some money in, in, in, inneurology funding, but I think
an offset by by the damage thatum, it's been, it's been done by
the politics of this that willgo on for a generation yeah, we
stigmatize virologists.

Yeah, um, claire, I just wanted to kind of
go back to some of the pointsthat Brent was making about, you
know, targeting people who arevulnerable.
We've been sort of chattingtoday about how you know
vulnerable people around theworld are possibly going to
suffer, or more likely to suffer, a disease.
Certainly, you know from peoplefrom potentially lower
socioeconomic backgrounds orwhere healthcare standards are

(01:16:39):
different in Australia, and wealso, you know, potentially will
also blame people that extrakind of vulnerability to
infection will then be sort oftranslated into blame for
spreading the disease, even, youknow, without really kind of
taking into account context.
So I just wondered if you hadany comment on that.

Claire Hooker (01:17:01):
I thought when you asked me before what would I
improve about communication inCOVID-19, I had something to say
then that came from theresearch that I share with Jane
and Julie in particular, andthat's what I told you.
But after I finished speaking, Ithought that I actually should
have spoken back to you, anthony, and said what Brent said,

(01:17:22):
which was what was the worstpart of communication during
COVID, and it was the way weabsolutely did not communicate
well with the most affectedpopulations in lower SES,
culturally and linguisticallydiverse communities in Melbourne

(01:17:44):
and Sydney.
That was the major failure.
That question is the answerthat Brent and Anthony and our
colleagues would deliver, whichis that you have to involve
community with you every step ofthe way, in the spirit of Lila

(01:18:06):
Watson and her colleagues to say, not to help them, but because
my health is bound up with yoursand we need to work together.
So, as a basic lesson that canbe understood globally, like any
catastrophe, any catastrophe isdefined first and foremost by

(01:18:28):
the systems that generateinequality, and a pandemic is no
different.
And finding ways to counterthat, that be they at a macro
level um, or with globalpandemic treaties in an ideal
way, or at a meso level and theactions of our own state
agencies and actors or at amicro level in the community, is

(01:18:50):
always going to be first andforemost priority.

So yeah, I agree that you know marginalised
populations are not usuallyfirst on the list for
communication.
So that is the 11am mediaconferences.
Sbs ended up translating thosebut it took quite a while.
So you know there's always thatdelay in even simply language

(01:19:19):
translation.
But to be fair, there was quitea lot done.
That wasn't always completelyobvious as time went on.
So in Victoria and New SouthWales, which I'm familiar with,
the vaccine rollout did involve.
For example, in Victoria theyfunded community groups and

(01:19:41):
migrant community groups to runtheir own community engagement.
In New South Wales there werepeople I remember talking with
people in Western Sydney andwe've got the former Director of
Public Health of Western Sydneyhere, steve Corbett who were
embedded in their communitiesand working for the local health

(01:20:02):
district.
So that provided an embeddedchannel of communication between
health and the communities inWestern Sydney and that would
happen across many LHDs.
In Hunter, new England, forexample, we had some very strong
Aboriginal leaders who wererunning a COVID response for
Aboriginal communities in thatdistrict.

(01:20:24):
So there was good stuffhappening and you know that too,
claire, but it just it tooktime and I think one of the big
lessons for even some of ourpublic health leaders has been.
We need to prioritize thosecommunities much more quickly
and build stronger communitiesyeah.

Stronger health systems and communities,
yeah um.

Audience Member (01:20:49):
So I actually come from a low socioeconomic
area and there was a lot ofconspiracies going around.
A lot of people felt like theywere being deliberately excluded
or that things weren't beingtold to them because people
thought they were stupid orthings like that.
But there was obviously somepeople who still took the health
advice and whatnot.
But how can we in the communityactually tell others who may be

(01:21:12):
angry at the world or angry atwhat they're not being told or
falling down conspiracy rabbitholes?
Actually educate our communityand keep everyone safe.

My first answer is that you can't change
people's mind unless you're in arelationship with them.
So it's about the relationships.
Many things come down to therelationships that you build
prior to a crisis and to thealliances that you can form
within a community in order torespond to it.

(01:21:44):
And then I feel, as Julie'salluded to, that we have people
with lived experience andexpertise who can speak to that
with far more depth andcomplexity, who can speak to
that with far more depth andcomplexity and I think, if I,
it's a terrific question, by theway, thank you.

Jane Williams (01:22:01):
I think, also adding in respect.
You know, if you continuallytreat some populations with the
lack of respect, then you can'tall of a sudden expect sort of
compliant buy-in, because thatjust it's not the way people
work.

I would just also add and we've spoken about it
before it's about building thattrust with those people and with
those communities, and thattakes time.
That's something that takesconsiderable time, and also
providing them with clear andfactual evidence or information.
And I think it is difficultwhen a new epidemic emerges,

(01:22:45):
because you don't always havethat to hand.
But then you've got to behonest about that.
You don't know.
All of the answers that arestill being worked out, and I
think that was some of theissues with COVID is that we
said things that we thought weretrue but they weren't, and we
weren't clear about that as ahealth sector circulating in

(01:23:16):
some communities that weresaying that they were largely
imported from the US, that thevaccine was a conspiracy to
control people and harm people.

And what worked there was for First Nations
community leaders to bepromoting vaccination.
So Uncle Ray Minicon, who wasalso a pastor, got on a video
and said to and this wasparticularly designed for

(01:23:45):
Christian communities,indigenous Christian communities
vaccination is an act of love.
Get yourself vaccinated.
And so working with thosecommunity leaders, uh, was
incredibly important and one ofthe reasons why you know where I
did 50 webinars with differentcommunity groups, for example,

(01:24:06):
because that informing themabout vaccination, guiding them
on how to have conversations,address conspiracy beliefs,
build relationships,relationships, use trusted
sources, that was really thebest way to deal with that
challenge.

Stephen Corbett (01:24:22):
Yes, my name's Stephen Corbett.
I was Director of Public Healthat Western Sydney.
There's two things I'd like tosay.
Trust is a two-way street, andI mean I've been reading a lot
recently about the Swedishexample, which I just am amazed
about, because they had verylittle lockdown, very little
policing of behaviour, and oneof the keys that they've

(01:24:43):
identified is that thegovernment trusted the people to
do the right thing.
And I'm really interested,brent, in the analogies with the
HIV epidemic, because I knowthat happened as well.
Sure, there was education andeverything, but there does seem
to have been an investment inpeople rather than we had police
patrolling the streetsenforcing behaviour.

(01:25:06):
That's not a signal about trust, that's a signal about
authoritarian control, and Ijust wondered whether, if Sweden
can do it, and they had anexcess mortality about the same
as ours at the end of the day.
So to me that's a remainingquestion.
The second thing is, I would say, about Western Sydney and this
is the thing that really shockedme was how some groups are

(01:25:30):
incredibly disconnected fromgovernment.
We had Somali people and PacificIslanders particularly, because
when the threat happened, theyhunkered down into their family
groups and they weren't hearing.
Or it's not just a matter ofthem trusting you.
I mean, we had imams and we hadZoom meetings with lots of

(01:25:56):
Islamic populations of Westernsociety.
We did all that stuff.
But there were some peoplewhose response and that was the
thing that we, I guess, and whenwe were successful it was just
through individual contacts andgiving people your telephone
number and having lots ofcontact with people.
But that was the thing thatshocked me the most was just how
some groups were so livingwithin their communities.

(01:26:19):
They didn't really they weren'tinterested to hear what the
government was telling themabout how to protect themselves,
and in some situations to greatharm.
You know, the Pacific Islanderssuffered particularly badly
from COVID in Western Sydney, soI don't know if any of the
panel would like to comment uponthat.

Thanks, stephen.
Yeah, I mean it is veryinteresting.
In the early days of the AIDSepidemic or HIV epidemic,
governments did show a greatdeal of trust for the LGBT
community to take on themessages.
Part of it was also, I wouldhave to say, is that messages
that we were communicating, hadto communicate, were unpalatable

(01:26:59):
for government organisations todo in the 1980s.
It was a time whenhomosexuality was just being
legalised and coming out withthose messages was really
difficult for public health ingovernment institutions.
But also there was that trustthey did provide the money
reasonably well.
In New South Wales, but noteverywhere like Queensland,

(01:27:20):
there was a very conservativegovernment and they wouldn't
fund the community there.
And I know money came throughthe federal government, through
an order of a Catholic nuns whothen passed it on to the
community.
So it was kind of like we'refunding nuns who then passed it
on to the community.
So it was kind of like we'refunding nuns but we weren't
situation.
But you know those workaroundswere thought through by, you

(01:27:44):
know, governments, bureaucraciesat the time and you would have
to say some of that perhaps wasa result of.
You know there's certainly alevel of privilege that you know
inner-city gay men have thataren't in those marginal

(01:28:05):
communities in southwestern andwest Sydney, especially recent
migrant communities, and perhapsthat had an impact on how they
were perceived in those circlesand governments.

I think we've probably got time for one
more question from the audiencebefore we conclude.

Audience Member (01:28:24):
I wanted to ask .
In 1974 in Australia we had amassive bovine TB eradication
campaign and I don't know howthey managed buffalo up in the
Northern Territory and all therest of it, but anyway, and we
were all as veterinariansinvolved in that, my

(01:28:44):
understanding was that thetuberculosis passed to humans
through milk wasn't that high inAustralia.
But also I know that in NewZealand possums had a high
infected rate of tuberculosisand I just wanted to ask if you,

(01:29:06):
for my interest at least anyway, could and hopefully some of
the audience could make acomment or would you like to
make a comment on that.

And certainly the tuberculosis that
you that passes through animalsis the same strain that infects
humans.
Pasteurization of milk is.
You know.
We see outbreaks occasionallyin places where there is still
bovine tuberculosis in theanimals and milk is not
pasteurized.
Australia worked very hard toreduce our TB levels.

(01:29:37):
You know people went for chestx-rays when antibiotics became
available.
We put people on antibioticsand we worked very hard to
reduce our level of tuberculosisGlobally.
Now you would definitely saytuberculosis is a disease often
associated with poverty.
There's a lot of stigma inhaving tuberculosis so people

(01:29:58):
will sometimes not come fortreatment because they don't
want people to know they're sick.
So you know, in terms of thehealth and ensuring people have
access to good health, we stillhave a long way to go globally.
But yes, we worked very hard inAustralia to reduce our level
of bovine tuberculosis.
But there's still quite a lotin New Zealand and it's often

(01:30:21):
spread by the possums UK, it'sthe badgers.

That's uh, that's controversial.

Brian May, yeah, Brian May, I want to know the
truth of this.

Brian May of Queen has led a campaign um,
because there was a badgerculling program, because badgers
were thought to be spreadingbovine TB and, bizarrely, Brian
May of Queen has been theresearch trying to show that in
fact badgers were not passingthe.

Do you have a call to make about this, Eddie?
I really want to know it iscertainly not proven.

That's all I can take from that okay um,
well, I think we're kind of atabout time.
I just want to sort of round upby going around the panel and
just sort of asking what lessonyou would like the world to
learn or what problem you wouldlike them to solve, um, in order
to kind of improve globalhealth.
And you might focus on yourparticular disease.
And, yeah, it's a smallquestion with a little answer.

(01:31:21):
So there you go, bernadette.
Do you want to start us off?
What would you like to seehappen to?

Sharing our resources.
I mean, a lot of these diseasesare treatable.
You can see what amazing thingswe did with COVID incredibly
quickly and we could apply thatto a lot of other neglected
diseases, particularly in thedeveloping world.

Eddie Holmes?

there was a lot of talk after
gonna talk about pandemic,future pandemics, that's my
thing.
There's a lot of talk aftercovid of this global pandemic
radar to set up, to have, youknow, a global way of mechanism,
seeing new things andresponding quickly.
Just hasn't happened okay, andit was talked about a bit, very
quickly went off the agenda.
Um, I think we, we could dothat, we could, we could, and

(01:32:09):
it's actually the science behindsurveillance now and um,
tracking outbreaks is reallygood and and as is making
vaccines and antivirals.
We could easily do that and thecost is is minuscule, given how
much covid costs.
Sadly, it's political will okay, and it the political will is
is is undermining the basicscience.

(01:32:31):
So if I get all the worldleaders bang their heads
together and kind of make themtake it seriously, because it's
very, very doable and we should,you know, very doable jane
Jane williams illiams?
I think include socialscientists.
Give me a job.

(01:32:52):
I knew I was like, - oh, I getto go before Claire and Julie!
There was still so much at thebeginning of COVID.
That was all about science andall about the virus and not
about the people.
I'm still seeing that now.
I went to a conference recently.
It was called the PandemicSciences Institute.

(01:33:13):
There was very little socialscience, almost no ethics.
It's like we all say we'velearned, but I don't really know
that.
We have very little socialscience, almost no ethics.
It's like we all say we'velearned, but I don't really know
that we have Positive note toend on.

Learning?
Possibly?

Yeah, I'll go all out on that.
I'll meet your social sciencesand I'll raise you the
humanities.
Yeah, yeah, I got one cheerfrom the audience which is not
to say - I actually really lovethe sciences.
I just want Eddie to know thatbecause I actually really really
do.

(01:33:54):
But I'm sure many of you in thisroom and those of you who are
watching online know theincredibly famous, indeed
symbolic, story of the greatpathologist Rudolf Virchow, who
was sent to Silesia, now Poland,to investigate typhoid
epidemics typhoid or typhus?
I cannot now remember, and whenasked for his recommendations

(01:34:16):
for how to control thosepandemics which were widespread
and devastating in the greatcontrol, those pandemics which
were widespread and devastatingin the great era of pandemics
which is the 19th century, hisanswer was to give everybody the
vote, because voting was notuniversal.
To educate them in their ownlanguage, because they were

(01:34:38):
supposed to be only educated inschool in German and not in
Polish, and essentially, toenfranchise them and give them
freedom.
So I know it's not a directanswer and we love direct
impacts, but all I want forChristmas is a repeal of the
Jobs Ready graduates package andfor everybody to be able to go

(01:34:59):
and do a basic BSc and a basicBA for free, because that
investment, in my view, is howwe have a population that can
come with us to confront anepidemic.
Top that!

Susana Vaz Nery (01:35:14):
Thank you - that's what I was going to say!
That's going to be hard to beat,but I mean, I guess what I wish
for Christmas and Christmasevery day, so maybe today, I
mean, you know, I wish COVID isan infectious disease and I wish
people in countries likeAustralia and other high income

(01:35:36):
countries, you know, wouldreflect a bit more on that
threat, because you know we livein countries where, in fact,
you know, people die more ofnon-communicable diseases but
that's not true for the vastmajority of the population and I
think we forget.

(01:35:57):
I mean I don't because I work ontropical diseases because of
that, because I think we forget.
I mean I don't because I workon tropical diseases because of
that, because I think, you know,I'm very lucky and fortunate to
have been born where I was, butyou know there's lots of people
who don't, who are not born inplaces where they are.
Given those opportunities, andyou know, the opportunity to
live a life free of infectiousdiseases or poverty are, you

(01:36:21):
know, is something that doesn'thappen to a lot of people
worldwide, and so I wish peoplein countries like these would,
including politicians and donors, would not.
I understand the need to fundresearch and policies to protect
us globally from emergentdiseases, but I hope that that

(01:36:44):
is not at the cost of divestingfrom diseases that have been
around for many, many years andstill affect a lot of
marginalized and poor people.

It's hard acts to follow.
It's a hard acts to follow, butI would say I was lucky enough
in July to go to theInternational AIDS Conference in
Munich and one of the bigthemes for that conference was
communities are experts, and Ithink I would think what we can
learn, what we can take forward,would be to value the lived

(01:37:20):
experience of people in thecommunities and the expertise
that is there when designing anddeveloping public health
responses.

And because Jane stole mine, which was support
social sciences and stop puttingall that money into consultant
companies.
I'm going to end on a positivenote because I think tonight,
you know, when we think aboutinfectious diseases, there can
be a bit of doom and gloom.
But what overwhelmed methroughout the pandemic which

(01:37:53):
has officially ended, eventhough COVID is still with us
and still a huge burden is thatwe people did incredible things
and I feel incredibly gratefulfor all of the heavy lifting
that so many people did in somany different ways people
within government departments somy husband, for example.

(01:38:17):
He was seconded into theemergency response and he that's
the guy in the blue shirt there.
He's going to hate this, butpeople like him were working
very hard within governments tohelp answer ministerials really
difficult questions, deal withchallenging policy dilemmas,

(01:38:41):
enact difficult policies, andthey were working extremely hard
getting data together,reporting, communicating.
People in the community,community groups who rallied
people.
All of you you're interested ininfectious diseases, clearly,
because you're here tonight oryou're online, you are all

(01:39:03):
probably doing important things.
So my wish is that weacknowledge each other and all
the things that we did to managethis last pandemic and have
hope that we can do this againif we need to.

Stephen Corbett (01:39:22):
And I'm going to take my right to reply and
say that it was the entirepopulation of New South Wales,
it was the entire population ofNew South Wales which responded
to the advice that was comingfrom the government, with all
its shortcomings, I mean, mysense is we did a poor job in
saying why the decisions thatwere made were made, why the

(01:39:45):
choices, what was behind that.
But, despite that, thecommunity of New South Wales are
the people that brought NewSouth Wales through the pandemic
with a very, very low cost interms of death and infection.
There were all sorts of costsfor school children who couldn't

(01:40:06):
go to school and all thoseother things.
But, in compliance and, Claire,I completely agree, we are an
obedient, you know sign readingcommunity, obedient, you know
sign reading community, and andthat that's what got us through
and we are extremely fortunateto to be part of this, this

(01:40:27):
statewide community that we'repart of.

Thank you, what a note to end on.
Thank you all very much.
I'm just going to say someconcluding remarks because we do
have to wrap up and I I, as wesort of conclude today's
discussion.
I really think it's clear thatthis sort of contested end of a
pandemic doesn't reallyguarantee that diseases won't
persist, won't resurface, won'tevolve and change and won't beat

(01:40:49):
us in the end.
And that tb man, that's a goodon you for tackling that one,
because that one is tough.
Um, and this sort of realityreally underscores the kind of
vital importance of publicengagement and the need to kind
of continuously bridge the gapsbetween scientific advancement
and sort of public knowledge.
Knowledge isn't really staticlike diseases.

(01:41:10):
It's sort of constantlychanging and adapting and you
know, like all of us I suppose,and it is relational.
I think that was a really greatpoint that was made earlier.
You know, the knowledge we haveis the knowledge we share and
the things we learn from otherpeople.
So I think moments like this,between crises, focusing on

(01:41:31):
these issues, is reallyessential to building knowledge,
to building trust, enhancingcommunity involvement in public
health decision making, as Ithink we've all emphasised, is
very important and ourstrategies for addressing health
challenges has to be dynamicand flexible as these pathogens
that we're battling.
What's more, the global natureof diseases, which are

(01:41:52):
infectious diseases which, youknow, really don't respect our
national borders as much as we'dpossibly like them to mean that
we do need to think aboutinternational solutions and we
need to think about what isgoing on beyond our borders, as
Susanna has pointed out.
So the challenges we discussedtoday are shared and we do
really need to come together andthink about them in groups, in

(01:42:15):
a concerted effort, and we needto consider these sort of
diseases that, while currentlymore prevalent in other regions,
still pose potential riskseverywhere.
And you know, consider the ideathat if a disease is prevalent
in one region, then it needs tobe addressed by the whole
community and not just left forthat community to suffer and

(01:42:35):
deal with and be blamed for.
So this global perspective isreally crucial and it highlights
the imperative for continualinternational cooperation and
innovation so to respond to sortof both existing and emergent
health concerns.
So thank you to everyone, thankyou to the audience, thank you
to the panel Today.
You know it was a bit of anexperiment.
I really want to thank Amandaparticularly, and also Catherine

(01:43:00):
from History Council of NewSouth Wales for presenting this
event tonight and for being sotirelessly organising everything
behind the scenes, and SMSA aswell, if they're still in the
room.
So thank you, you, you, you,you.

Amanda Wells (01:44:51):
Yes, thank you

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