As horse owners in Eastern Australia still reel from the impact of equine influenza and the rapidity and unpredictability of its spread, it must have crossed the minds of many epidemiologists and public health officials that this is an insight into how an avian flu pandemic would look.
Earlier this month the Australian National Audit Office issued an audit that examined Australia's preparedness to respond to a human influenza pandemic. The overall findings were that while Australia has undertaken considerable planning over the past three years to prevent, prepare for and respond to an influenza pandemic, there is no room for complacency and there is considerable room for improvement.
This is reinforced by two recent experiences. The 2007 influenza season was quite severe, with twice as many notifications of disease as in 2006 and some deaths reported. Hospital emergency departments and doctors' surgeries were overwhelmed with patients whose very presence further contributed to the spread of the virus.
And in July a young man infected with polio flew into Melbourne on an international flight. It took several weeks for health authorities to track down the 238 people on the flight. If the virus had been avian flu, such a delay could have been fatal.
The Federal Government held Exercise Cumpston in October 2006 to test health responses for an influenza pandemic. The report from this exercise made 12 recommendations to improve Australia's response capability. These recommendations related mainly to communications, and the need to improve, update and further test plans. The Department of Health and Ageing has developed a plan to address these, but the audit office has criticised the absence of time frames for completion of the plan.
The audit had a particular focus on the National Medical Stockpile which contains vaccines, antidotes, antibiotics, antivirals and equipment for use in a health emergency. In June the stockpile was valued at $231.8million, with $219.7 million being the influenza pandemic component. It is claimed that this will provide sufficient coverage for nearly 44per cent of the population.
The audit highlighted the critical need for the Department of Health and Ageing to have a better long-term management and storage strategy to ensure the stockpile, which has grown considerably since 2004, can be rapidly delivered to those in need, when they need it. This will require consultation with the states and territories and integration with their planning processes, as they also have medical stockpiles.
The audit office identified the lack of a procurement strategy, the failure to use competitive tender processes for storage, the lack of oversight of storage quality, and the need for formal processes for approving subcontracted storage arrangements as risk factors. Effectively what this means is that the Department of Health and Ageing cannot ensure that medicines in the stockpile are within the approved expiry dates, are correctly stored to ensure full potency, and can be readily retrieved for distribution.
One issue that the audit office did not look at is progress in the development of a vaccine against avian flu. In Australia this is being done by CSL which has received $4.9million from the Government to fast-track vaccine research and development.
Australian researchers and clinicians have tested a vaccine made using an H5N1 virus strain from Vietnam and the results are promising. But to meet national demand in a pandemic, and to have any chance of meeting the promise Health Minister Tony Abbott made to APEC health ministers in July to share an Australian-made vaccine with Indonesia and other Asia-Pacific neighbours once it was available, more clinical studies are needed to assess how to make vaccine production go further.
It's a costly exercise, but Australia is fortunate to have a local vaccine developer and a World Health Organisation reference laboratory which can provide the needed viral strains.
It's clear that Australia has done well in preparations for an avian flu pandemic, but further planning and testing efforts, resources for communication and stockpile management, and funding for research and vaccine development are required.
Possible changes in personnel and responsibilities after the election serve as a reminder that arrangements need regular review and updating so they can translate instantly into action whenever, wherever or however the avian flu pandemic arrives on our shores.
Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, the University of Sydney/Australian National University.