Lum on H1N1 and PROTECT

Ky Luu:  The executive committee that you just described is an extremely interesting concept of operations.  Can you provide a little more detail in terms of how it functions, given the fact that it works across various offices and agencies, each with their own leadership.  Who runs it, who calls the meetings, and more importantly, how do you implement the recommendations that come out of this executive committee?

Gary Lum:  Definitely.  The group or the committee is chaired by a Deputy Secretary within the Department of Health and Aging, and she will call a meeting when an event occurs for an emergency meeting, and at the same time, or usually, will take a recommendation from myself to activate the National Incident Room.  The committee itself is made up of very senior decision makers from the states, and territories.  So we’re talking about chief health officers from each state and territory, as well as senior executives from Defense Health, Emergency Management Australia, as well as some subject matter experts in disaster health response.  And as I said, for an acute event, for an emergency event, our Deputy Secretary of the Department of Health and Aging will call an AHPC teleconference, usually give members a couple of hours lead-in time, but during that lead-in time, myself and other colleagues from within the National Incident Room will get ourselves busy and start communicating with everybody, just to give them a heads up on what is happening, and then go into the meeting where we will always be looking at situational awareness, a situation report if it is available from the agency that has the lead, depending on the nature of the emergency, and then we will develop a plan of action, if such a plan of action is necessary.  If it’s for information only, because something has happened that we just are concerned about—so for example, a tsunami watch that may be more emergent than the normal ones we come across—then there may be no actions that come out of the meeting if the tsunami watch is cancelled during the meeting, but sometimes we will be alerted and we will need to take action in the sense that we would develop medical assistance teams, and we would be providing advice to governments.

Ky Luu:  Australia has been closely monitored by many of the countries in the northern hemisphere as a potential gauge for the upcoming influenza season.  What strategies did the Australian Department of Health and Aging, and in particular, the National Incident Room, employ in order to lead an effective response?

Gary Lum:  We went through a number of internal phases.  I think it’s important to understand like most developed countries, we had a very strong plan for pandemic influenza, and in preparation for any major global outbreaks of an infectious disease, so we had the Australian Health Management Plan for Pandemic Influenza.  Now when the outbreak of international significance occurred the WHO declared on the 24th of April, based on the information we were seeing from Mexico, the US, as well as Canada, we quickly understood, like most other countries understood, that this particular strain of influenza virus A was not causing the severe disease we were expecting or had planned for, so as a result of that we went very quickly into examining our plan, working out what we needed to keep, and what we needed to change, and within a very short period of time, we had a forward planning team within the NIR who had written a new annex or a new phase for our Australian Health Management Plan for Pandemic Influenza, and we called that “PROTECT”.  Because the infection rate was waning after we went into PROTECT, we did a number of things within the Room.  So during that early stage we were at very high intensity.  The Room was activated full-time, so twenty-four hours a day, seven days a week we were putting out three situation reports a day, we were providing situational updates to our Minister’s office very regularly.  When we went into PROTECT we knew that the disease was mild in most, severe in some, and moderate overall, and we were regrouping.  We took a lower stage level of activation where we still worked extended hours, we still worked weekends, but the reporting schedule changed slowly to one report a day, and we didn’t have to be here all night, and over the entire weekend.  But then when we started preparing for the vaccine rollout, and I think that Australia was in a very good position because as part of our plan we have established contracts with major vaccine manufacturers, and with the announcement of the pandemic those deeds came into place, and so we were in a position where I think we were the second country to announce and deliver on our pandemic vaccine.  We were in a position to roll-out, and as a result of that we stepped up the activation of the National Incident Room by putting in a new rapid response team, and by reforming some of our teams, and by developing a vaccine team.  That was largely so that we could respond to our colleagues, health professionals, and as well as our ministerial offices who undoubtedly would be asking a number of questions about the vaccine.  And also because there needed to be an understanding about adverse reactions, adverse events, and also questions from the public, so that rapid response team and that vaccine team were able to respond quickly to questions that came from state and territory colleagues and from minister’s offices, and we were able to update our internet site relatively quickly so that we could respond to members of the pubic as well.  The feedback that we’ve received from our colleagues, health professionals, doctors, nurses, and others who are delivering and administering the vaccine has been very favorable in the sense that we’ve responded as quickly and as effectively as we could.

Ky Luu:  So PROTECT is a real-time response to what you were seeing with regard to the H1N1.  It was something that did not exist prior to this, correct?

Gary Lum:  Correct.  Up until May of this year, we had not even considered a phase called “PROTECT”. Our phases had been put in place in our management plan, and we were fully expecting to go with those phases.  But when we saw the change or the difference in what we had planned for in this particular disease, and given the difference in geographical spread throughout the country, that it was concentrated in a couple of jurisdictions but more sparsely occurring in others, we quickly used the Australian Health Protection Committee to look at what was happening around the country, to do some things very quickly so one jurisdiction modified one of the phases so that it could develop its own small plan to cope over a number of weeks. While we were planning the PROTECT phase, very quickly over a few days to a week, and then we were able to announce that, establish that, and in very quick time the whole country went into the PROTECT Phase, and we were able to do things like deploy from the national medical stockpile more easily, we were able to provide consistent messages, consistent advice to the public, to health professionals, and to those in government.