Preparing Australia's Health System for the effect of climate change

How can we ensure the health sector is ready for the effects of climate change?

Sri Devarajan, The University of Melbourne

Executive Summary

The healthcare sector in Australia presently contributes 7% of the nation's carbon emissions. Meanwhile, with the escalating impacts of climate change worldwide, healthcare systems, including Australia's, face mounting pressure from increased infectious diseases (Mora et al, 2022). This is exacerbated by the expansion of tropical weather farther south in Australia, widening the geographical range where hazards like mosquito-borne diseases can proliferate. It is expected that 58% of all human infections will increase exponentially due to climate change (Morea et al., 2022). As an example, treating the individual disease of the Ross River virus currently costs Australia an estimated $8.6 million a year (Yuen & Bielefeldt-Ohmann, 2021), and the CSIRO (2022) expects the cost of treating this virus and other mosquito-borne illnesses to rise. 

This proposal recommends establishing a robust surveillance system for early detection of infectious disease outbreaks in Australia. Such a system enables prompt identification and containment of diseases, curtailing their spread and mitigating community harm. This proactive stance not only saves lives but also conserves resources.

The estimated cost of implementing the recommendation is $15 million. The Department of Health will oversee the development and work in conjunction with states and territories for seamless implementation. The software MedISys will be used as it is seen to be effective in the European context and will only need to be retrofitted in the Australian context.  

The main risks associated with the implementation of this program relate to data privacy issues and false alarms. 

By implementing this strategy, the Australian healthcare system can better brace for the impacts of climate change This ensures the health of the Australian population in a global environment with greater infectious diseases.

Problem Identification

As the effects of climate change become more pronounced, research has shown health systems, both globally and within Australia will come under stress (Blashki, 2011). In particular, climate change will exacerbate the rates of infectious diseases, such as the Ross River Virus, with elderly people, young people, low socio-economic communities, and Indigenous people most frequently affected (Mora et al, 2022). Due to increasing temperatures extending the inhabitable range of infectious disease vectors, it is predicted humans in areas where these diseases previously did not occur will now become susceptible (Van de Vuurst & Escobar, 2023).

The cost of treating one specific virus, the Ross River virus, currently costs an estimated $8.6 million a year (Yuen & Bielefeldt-Ohmann, 2021). Additionally, the Commonwealth Scientific and Industrial Research Organisation (CSIRO, 2022) projects that the financial burden of addressing this virus, along with other mosquito-borne illnesses, is expected to rise significantly in the coming years. This increase is mainly attributed to the increased warming effects of climate change, which can expand the habitats of mosquitoes, leading to a higher incidence of these diseases, and the rising costs of medical treatments and public health interventions necessary to manage outbreaks (CSIRO, 2022).

Gibney et al, outlines how Australia’s current infectious diseases alert system is not ready to detect and combat the influx of new infectious diseases that could arise in Australia because of climate change (2017).The increase in humans contracting infectious diseases will put significant pressure on the same healthcare system which buckled under the serious, yet fleeting COVID-19. Without adequate preparation, the Australian healthcare system is likely to again fail under the pressure caused by a sustained increase in climate-driven infectious diseases (Naughtin et al., 2022).

Context

Infectious diseases are illnesses caused by a pathogen or other organisms such as bacteria, viruses, fungi and parasites (van Seventer & Hochberg, 2017). These diseases can arise when a person comes into contact with an infected person, infected animal or contaminated object which passes the illness on to the individual (van Seventer & Hochberg, 2017). 

According to the Lancet Institute (2023), 15% of deaths globally are caused by infectious diseases. However, what is more striking, is the years of healthy life lost due to infectious disease. Defined as ‘the years of life adversely impacted by illness or disability’ (World Health Organisation, 2011), the Lancet estimates 30 million years of healthy life were lost due to infectious diseases in 2019 alone (Azzopardi et al, 2023).

As climate change escalates, so will infectious diseases, and the associated effects will soon be felt in Australia (Mora et al., 2022). Not only will the number of cases increase, but a greater variety of infectious diseases are also expected to develop on the Australian coastline with tropical diseases expected to reach further south into New South Wales and even Victoria (Climate Council, 2022). It is understood that 58% of all diseases that affect humans will be exacerbated due to the effects of climate change, and this figure does not account for novel viruses that will emerge (Mora et al., 2022)

For example, the Ross River virus is a mosquito-borne illness that has largely affected Northern Queensland, the Northern Territory, Papua New Guinea and Indonesia. However, the incidence of the Ross River virus being detected in more southern regions and urban centres of Australia has increased from 2014-2017 (Murphy et al, 2020). Due to climate change, the broad range of areas where vectors and reservoirs can thrive heightens the risk of sporadic infectious diseases.

Currently in Australia, the National Notifiable Diseases Surveillance System (NNDSS) tracks 70 infectious diseases in Australia through laboratory and in-hospital testing and is then manually entered into the NNDSS (Miller et al., 2004). To activate this system, a public health practitioner at the state level has to input information about the infection at their set timeframes and abide by different state laws and regulations (Gibney et al., 2017).  However, this data is not accessible to members of the public and all health personnel, it also uses a rigid list of 71 infectious diseases, so diseases not listed can not be reported. Additionally, it does not communicate well with health professionals due to its limited accessibility (Gibney et al., 2017). 

It is purported that Australia’s current surveillance system will be ineffective when infectious diseases are increasing, as the current time delay of 3-5 days will reduce the ability to contain the spread of an outbreak. More recently, fragmentation of data collection, with states and territories collecting and storing information differently, has been identified as a barrier to effective national infectious diseases surveillance  (Dyda et al., 2021). This is highlighted in the First interim report into COVID-19 by the Select Committee on COVID-19 (Commonwealth of Australia, 2022) which outlined that the development of a centralised disease control network may resolve the issues faced by states in cross-jurisdiction spread of COVID-19 in the early stages. 

This system is in contrast to countries like Germany, Ireland and the Netherlands which have the European Commission’s Medical Information System (MedISys), an electronic real-time communicable disease surveillance system (Elliot, 2013)(Gibney et al., 2017). 

MedISys is a Europe-wide system designed to monitor health-related information from diverse sources, official medical reports, news & social media, to provide early warnings about potential health threats (Elliot, 2013). It uses advanced data mining and analysis techniques to detect trends and anomalies. Data is stored in a centralised, secure repository managed by the European Commission, ensuring standardisation and accessibility across member states (European Commission, 2022).

MedISys is operated by the European Commission, ensuring a broad oversight and coordination across different countries. It has been successful in providing timely alerts about cross-border health threats, such as Dengue fever on the island of Madeira, facilitating a coordinated response among EU member states (European Comission, 2022). The system's wide reach and integration capabilities have been praised for enhancing the EU's public health preparedness (European Medicines Agency, 2021).

The uniform upload of records electronically to a national database as is done in the Netherlands ensures that information regarding infectious diseases is disseminated effectively to the parties that require the information. By law in the Netherlands, diseases of concern must be reported within one working day (Swaan et al., 2019).

The cost of setting up such a system for the entirety of Europe was €810 million (Genovese et al., 2022). Compared to moderated ones, as currently used in Australia, automated systems exhibit higher effectiveness in controlling outbreaks, quicker data processing, adaptability to new diseases and are more cost-effective to operate (Rees et al., 2019).

Options

In order to prepare for Australia’s exposure to an increased variety and number of pathogenic diseases,the health sector’s response mechanisms need to be addressed. There are several policy options available to effectively prepare Australian healthcare systems for the climate change induced increase in pathogenic diseases.

Option 1: For the Department of Health to implement an effective and uniform National Surveillance System for Early Detection of Infectious Disease Outbreaks: 

Establish a robust surveillance system that enables timely identification and containment of infectious diseases. This aims to prevent their spread and minimise the harm caused in the community. This proactive approach can save lives and resources. However, implementing and maintaining an effective surveillance system requires substantial financial and technological investments. Privacy concerns about collected data may also arise. This will be addressed by using strict cybersecurity protocols and data encryption. 

Option 2: For the Department of Health to develop community-based education programs:

Implementing community-based adaptation programs that empower local communities to understand and mitigate the health risks associated with climate change. This could include training community health workers to educate residents on disease prevention measures, such as vector control strategies and proper sanitation practices. Public awareness campaigns using advertisements can also raise awareness about the increased risk of infectious diseases, fostering behavioural changes to reduce exposure risks. Engaging communities in adaptation planning ensures that interventions are culturally appropriate, context-specific, and sustainable in the long term.

Option 3: For the Department of Health to legislate the One Health Strategy:

Use a 'One Health' approach to tackle diseases. This means working together across human, animal, and environmental health sectors to address infectious diseases increase as a result of climate change. The Department of Health is to collaborate with experts and agencies to monitor, prevent, and respond to diseases that can pass between animals and humans. This includes keeping an eye on wildlife diseases, managing land responsibly to stop diseases from spreading, and improving communication between different groups.

Policy Recommendation

Option 1, to “develop and implement an effective surveillance system for the early detection of infectious disease outbreaks”, is the most viable option for preparing Australian healthcare systems for the impacts of climate change-driven vector-borne diseases given its ability to trace and track outbreaks that could arise from the changes in weather patterns caused by climate change. 

The system should be developed to align with the model of the European Commission’s Medical Information System (MedISys) (Elliot, 2013).

This system will need to be accessible to the public while also offering specialised access to meet the specific requirements of health agencies, including private discussion forums and enhanced functionality for data processing from commercial sources (Rees et al., 2019). Without requiring the manual inputs of the current system in Australia, an automated system will ensure fast and quick containment of outbreaks.

The building of such a system will require collaboration between the national and state/territory health departments to ensure a homogenous system. Having all state and territory data collected and stored in the same way will allow for effective analysis and control of infectious diseases that arise due to the increase in the vectors such as mosquitos' habitable ranges (Rees et al., 2019). 

MedISys requires the implementation of this system in all states and provinces within each EU country. The cost will likely be lower in Australia given that it will be an internal national system that does not need to communicate with other countries. Funding would need to be allocated to this project by the Department of Health. The total health expenditure of the Department of Health in 2023 was estimated at $105.8 billion (Department of Parliamentary Services, 2022). It is estimated that $15 million will be required to implement a surveillance system for Australia which could proactively save hundreds of millions over time in responding to an increased number of pathogenic disease outbreaks 

The project would be deemed successful if a state or territory, in the presence of a new virus, can report to the central system within a day of diagnosis and all other states and territories receive and can act on the information within that same day. Compared to the current 3-5 day notification time, this lead time in allowing health departments to respond will save money and lives.

Risks:

Data privacy concerns: 

Collecting and analysing large amounts of health data, especially using advanced technologies like artificial intelligence, raises concerns about privacy and data security. There's a risk of misuse or unauthorised access to sensitive information, which could reduce public trust in the healthcare system. To combat this, it is recommended a training program be rolled out to all doctors to be completed as part of their yearly AHPRA registration renewal. This ensures that all health professionals are aware of the legalities and processes of using the surveillance system.

Data should be stored at secured facilities and protected physically. The data itself should be protected from hackers through advanced cybersecurity protocols, encryption during data transmission and collection and regular security audits.

False alarms:

Relying solely on surveillance systems may lead to false alarms or panic due to fluctuations in disease patterns. Without completely understanding the disease patterns, unnecessary panic within the community can disrupt access to healthcare and put a strain on healthcare services. To ensure false alarms are reduced, data patterns will need to be thoroughly studied and the release of information or data needs to be contextualised by the federal Department of Health and Aged Care. 

Limitations:

The limitation of such a surveillance system is once a disease becomes endemic or is widely spread in the population, a system like the one described above will not be effective (Madhav et al., 2018). 

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