The Indo-Pacific Centre for Health Security has begun a series of roundtables across the country on Future Funding Priorities.
At the recent roundtable in Melbourne Robin Davies, First Assistant Secretary of the Global Health Division at the Department of Foreign Affairs and Trade and Head of the Indo-Pacific Centre for Health Security, spoke to Professor Jodie McVernon, the Director of Epidemiology at the The Peter Doherty Institute for Infection and Immunity.
Professor McVernon has become a leading voice on disease spread and control during the COVID-19 pandemic. The conversation follows her work at The Doherty Institute and the Institute’s ongoing partnerships with DFAT.
Professor McVernon talks about how DFAT and the Doherty Institute worked together to help governments in the Indo-Pacific track and respond to COVID.
Professor McVernon explains how DFAT and the Doherty Institute’s data for decision making partnership helped strengthen systems and inform clinical decision making, such as where in PNG the government needed to deploy its limited supply of oxygen.
Professor Jodie McVernon 00:00
There are so many impacts of COVID on systems themselves. There's this periods of reduced mixing, leading to increased susceptibility. There are the ongoing changes in social behaviour. But you know, my my kind of analogy is we're moving from COVID, as centre stage to backdrop.
Mr Robin Davies, DFAT 00:18
Hello, and welcome to Contain This. My name is Robin Davies, and I’m First Assistant Secretary of the Global Health Division at the Department of Foreign Affairs and Trade and Head of the Indo-Pacific Centre for Health Security.
The current phase of Australia's Health Security Initiative for the Indo Pacific is coming to a close in the middle of 2022. I recently visited Melbourne to chair a roundtable on future funding priorities with a group of experts there. One of those experts was Professor Jodie McVernon.
Jodie is Head of Epidemiology at the Peter Doherty Institute for Infection and Immunity. She is a physician with subspecialty qualifications in public health and vaccinology. She has extensive expertise in clinical vaccine trials, epidemiologic studies and mathematical modelling of infectious diseases, gained at the University of Oxford, Health Protection Agency London and The University of Melbourne.
Jodie and I talked about how DFAT and the Doherty Institute worked together to help governments in the Indo-Pacific track and respond to COVID-19.
Jodie explained how DFAT and the Doherty Institute’s data for decision making partnership helped strengthen systems and inform clinical decision making.
Our conversation reminds us of the importance of data for effective epidemic preparedness. We hope you enjoy the conversation.
So Jodie, maybe if you could just introduce yourself first.
Professor Jodie McVernon 01:43
Hi, I'm Jodie McVernan. I'm Director of Epidemiology at the Peter Doherty Institute for Infection and Immunity.
Mr Robin Davies, DFAT 01:50
And I thought I'd start by just looking back on some of the activities that DFAT has funded the Doherty to support under the Health Security Initiative over the last five years. Be interested to get your quick description of what those were and, and how they went. And in particular, how they pivoted when when the pandemic hit.
Professor Jodie McVernon 02:16
Sure. So I think the activities that have been funded here really reflect that strength of the Doherty, which is its span of clinical, laboratory and public health capacity. So the activities have ranged from, you know, laboratory strengthening and capacity building, through the Combat AMR Project, which is really thinking about infection prevention and control and bringing on that clinical expertise as well as a one health focus. And SPARK Consortium that I lead is focused on efficient and effective use of health information to support decision making about infectious diseases, strategy and policy using epidemiologic and modelling approaches. So you know, together all of those projects sort of encompass the core elements of preparedness, surveillance, response, and strategic thinking really too about how those parts of the system fit together.
Mr Robin Davies, DFAT 03:09
If we go to a particular case, Papua New Guinea, where, obviously, obtaining good data on disease outbreaks in general, COVID in particular, is pretty difficult, what sort of support were you able to provide to the PNG government.
Professor Jodie McVernon 03:30
So in PNG, we've played a number of roles. Part of that has been about advising on different forms of information gathering. So in particular, thinking about zero surveillance and how information from zero surveillance can best be captured, you know, what the sort of best survey designs are, that might be efficient and effective, and provide insights into changes and trends over time to help inform estimates of population exposure, and also ongoing vulnerability to infection. We've worked on models that have looked at mobility around the country and thinking about, you know, given points of entry, based on, you know, key international movements, how that might affect dissemination around the country, particularly around peak periods of mixing and, and just even a heads up on how long it might take to detect importation and dissemination, that this wouldn't necessarily be something within weeks, but maybe several months in some areas, to try to preempt surveillance needs for response. And we've also looked at scenario modelling so you know, early in the pandemic, and then revised as we understood more about the impact of COVID in the region, to try to anticipate health services needs and likely clinical impacts, as we've moved through different waves of the pandemic to try and inform preparedness for response.
Mr Robin Davies, DFAT 04:47
So the partnership that that we the DFAT has with Doherty on modelling is it's about data for decision making. It's not about data for its own sake. Have you seen good examples where the sort of advice that's been provided by the Doherty has been incorporated into decision making, you know, on the allocation of health resources?
Professor Jodie McVernon 05:12
Yes. So, you know, I think some of that work around preparedness and response has I understand been very useful in helping to inform system strengthening and thinking about likely clinical capacity and need and it's helpful hearing feedback on that to think about, for example, in mobility in PNG, you know how might that help to anticipate where oxygen requirements might be needed over time as an epidemic evolves. You know that there's some nice sort of practical examples where I think we can can build and do better. Working in French Polynesia, I think that was probably the data richest country. And that was a mediated through through WHO in the Western Pacific Regional Office, but it's been a really helpful partnership. And certainly anticipating likely exceedance of capacity, and helping to make the case for support from overseas partners to anticipate that, but then also moving forward thinking about when peak epidemics are achieved, and whether that capacity might actually not be exceeded. So in different waves, we saw sort of different scenarios unfold, informed by our understanding of what happened before. So I think this sort of iterative approach to learning and doing and going back and giving advice again, I think we were able to get better advice by the process of doing that. And then in other situations, in Fiji, we were involved. And a lot of the time, modellers get involved in sort of strategic discussions about thinking about this testing strategies, during incursions and in determining whether community transmission was being established. Also discussions about reactive vaccine strategy during outbreaks and really helping to think through the situational assessment. And from that, based on what was happening with epidemics, you know, provide advice and provide some input into strategic thinking about about what policies might be most effective, and where to distribute resources around things like vaccination, as opposed to public health response. You know, I think these are ongoing challenges that need to be addressed.
Mr Robin Davies, DFAT 07:07
And the Doherty is sort of providing advice, but also undertaking capacity building for people within health ministries or public health institutes. Over the past two years or so, where we haven't been able to have face to face interactions, has it been possible to continue some of that capacity building?
Professor Jodie McVernon 07:28
Look, we've tried the clearly it's been limited by our inability to travel by our partners, similar inability to travel and all of our... overwhelmed with the requirements of addressing needs in our local environments as well. So our partners have been swamped with having to address their COVID response. We have been able to continue to engage in regional training activities through TEPHINET and Safety Net, and some of the fields have been networks. And we've been able to identify and appoint students and postdoctoral researchers in country, particularly in recent years. But the most exciting thing this year is actually being able to travel and you know, we had visitors from Vietnam last week and postdoc researchers from Vietnam, Thailand, and Indonesia are attending a workshop for our early mid career researchers in Townsville, just this week. So it was great to see that happen to see people finally meet face to face and develop the relationships that are so important for trust and confidence in asking questions and learning to understand each other. And we're really excited to be rolling out additional in person trainings this year, in Thailand in mid year and being able to start attending regional conferences and getting people over for learning exchanges. So that's incredibly exciting to be realising that because, you know, given the urgency as well of questions over the last couple of years, where we have partnered with countries, it's largely been in a consultative capacity, you know, addressing urgent decision needs. But really now we want to build on those relationships and the people we've identified, to develop the capacity in-country to to develop those questions and respond to them effectively.
Mr Robin Davies, DFAT 09:07
Now, I think everyone expects, in fact, we're starting to see it, a resurgence of endemic diseases as we move, we hope beyond the COVID pandemic, whether it's measles, or malaria, or a range of other things. Do you see a role for the Doherty in supporting governments to get a good or a better grip on the dimensions of that resurgence, where and how it might start to hit their health systems.
Professor Jodie McVernon 09:37
Yeah, absolutely. And, you know, there are so many impacts of COVID on systems themselves, there's this periods of reduced mixing, leading to increased susceptibility. There are the ongoing changes in social behaviour. But you know, my my kind of analogy is we're moving from COVID, as centre stage to backdrop. So it will continue to have an impact on systems and services. And we see that you know, in Australia as well. But understanding how some of the strengthening that's happened might be able to be sustained, how some of the systems that have been severely impacted can be sort of revived and renewed. I think we completely understand that this has to be a holistic approach moving forward that encapsulates all health needs. And, you know, there are some interesting challenges, you know, what is the role of COVID vaccination moving forward, if there is a role for vaccines in preventing severe outcomes, it's probably an adult immunisation platform that's needed. And that doesn't exist in most countries. So, you know, what is the value proposition for those things? And how might that impact on other immunisation services and health services? You know, these are the kinds of trade offs that need to be considered systemically, I think moving forward as well.
Mr Robin Davies, DFAT 10:49
So where do you think the Doherty can make the biggest contribution in your field over the next few years in, you know, what is a very different public health environment?
Professor Jodie McVernon 11:01
Look as modellers often what we do is help to think about the big picture system. And we've learned a lot of things about the sources of information that are useful, that are scalable, and we've had to adapt and incorporate different sources of non traditional data. Mobility, for example, has been an absolutely critical thing in understanding transmission and intervention impacts. We have newer technologies, we have more distributed bull and scalable technologies like rapid antigen testing, and so on. So helping to think through what country information needs are to monitor and respond to disease, trying to help think through what the various modes and technologies are to, to gather the necessary information to support early detection, surveillance, response and recovery. Just putting together that big picture and helping to work out in a particular context, what are the critical things? You know, I think that's, that's part of how we can help to think moving forward. And, you know, there was a WHO consultation on resilient surveillance systems last night talking about this mosaic of surveillance approaches, and that within a given country, you know, different tiles in that mosaic are going to be more critical, but in defining what those are to address the needs, and then how those sources of information are brought together, I think that's where we would like to help. While at the same time, obviously, continuing the capacity building focus of translating that, that capability in terms of the technical skills of individuals to effectively, you know, analyse and interpret data, but also on the policy side, helping decision makers to understand how they can make more effective use of information and support that incorporation of evidence into policy. And, you know, the last two years have certainly seen us much more learned, we've learned a lot more as a group of researchers and and academics in our work with government in Australia and in the region, and also a global level with WHO.
Mr Robin Davies, DFAT 13:06
And who were you working with at the regional level on surveillance? Is it is it the very high capacity countries like, you know, Indonesia or Malaysia? Or are you working across across the whole region?
Professor Jodie McVernon 13:22
So in our scenario planning, we were working across all focus countries as requested. But yeah, we've worked with a number of different country partners with Ministries of Health and also with Institute's like PNG IMR. So really just trying to work with and support decision makers as those relationships were enabled through DFAT or WHO in Western Pacific, or others. So primarily, in in PNG, in Fiji, in French Polynesia, as I said, those are the countries where we've worked most closely. And also engaging now with Samoa, to try to support decision making as they reopen, unfortunately, preempted by Omicron.
Mr Robin Davies, DFAT 14:01
I wanted to ask you about the Australian Institute for Infectious Diseases, the Doherty Institute is one of the alliance partners. If you could just say a bit about how you see that the creation of that Institute, potentially adding value for some of our partner countries in the region. I know, it's it'll probably have a largely domestic focus.
Professor Jodie McVernon 14:24
Yeah, so that Institute, you know, is, is an exciting opportunity to really help to consolidate and enable partnerships between institutions and academics who have highly complementary skills and relationships and networks, by co-locating them in a single facility. And, you know, I think COVID made us better at working remotely from each other but we've also learned in reentry, the importance of meeting face to face and just being able to see other people and innovate and work together. And so I think that provides new opportunities to really strengthen and enhance relationships and identify new ways of working with partners that can help to address you know, these complex, multifaceted needs that really need to be addressed at systematic level. And so you know, in thinking about how those relationships come together, you know, really being able to more adequately address partner identified challenges with a broader toolkit, because there are more people co-located who may bring a new approach or a new capability to helping to solve those more complex challenges.
Mr Robin Davies, DFAT 15:33
And just finally, it's it's been an interesting two years for people who, I guess previously had relatively obscure roles, highly technical roles, not not used to appearing in the spotlight, and, and now your name is well known to many people, you've, you've been under a lot of pressure to provide your expert perspective on what's happening in Australia and and in the region. I'm just interested to know how you how have you managed that communication burden alongside your your normal professional activities?
Professor Jodie McVernon 16:08
Yeah, so it was kind of life was a little easier when preparedness wasn't sexy. But suddenly, epidemiologists, while every every other person was an epidemiologist, so I guess that shared the load. But no, I think, you know, very early in the pandemic, back in March 2020 a colleague convinced me I really needed to be at the National Press Club, and talk about this. And, you know, it was clear that this wasn't something that I did alongside my work, this is actually a core part of my work. And public communication and engagement is so critical and and being able to effectively convey information to the public and to decision makers is so important for trust and confidence. And I actually believe the media overall in Australia did a brilliant job of really trying to help convey the truth, and the evidence to the public. And, you know, I learned a huge amount from communicating on a whole range of levels. And I also very purposely grew my friendships with people who are expert in communication, like Julie Leask, from Sydney. You know, and when there was a new message, or a new challenge, really thinking through how to make that message as clear as possible, without introducing complexities or barbs or challenges. But, you know, I think that that was a fabulous learning curve in terms of really focusing my skills, and I got into medicine on public speaking, and debating and English literature. So I was always kind of language focused and communication focus. But yeah, sort of had to dial up my skills to the next level. And I've learned a lot from that process, but it's critical part of public health.
Mr Robin Davies, DFAT 17:41
But it must be a bit like being the Governor of the Reserve Bank commenting on interest rates. So there must be a journalist wanting you to sound dramatic and then public health people wanting you to perhaps downplay risks, is that difficult to do?
Professor Jodie McVernon 17:58
Look, I think in the world, whenever we put a message out there, we can convey one of two key things fear or hope. And I guess I saw my responsibility is trying to be a calm voice of reason, conveying something hopeful to give people that sense of agency at a time when the world was out of control. I also had the advantage of my teenagers, who if I got too technical or complex would tell me. So you know, I also had them keeping me honest and humble, which is probably also helpful when you're at risk of thinking you're a bit too clever. So I have no no danger of doing that.
Mr Robin Davies, DFAT 18:33
I think everyone who who's heard you speaking over the past few years would agree that you've been a calm voice of reason. So thank you very much.
Professor Jodie McVernon 18:41
Thank you so much, Robin, lovely to talk to you.
Mr Robin Davies, DFAT 18:45
Thank you for joining us for today’s episode of Contain This. I’m Robin Davies, Head of the Indo-Pacific Centre for Health Security. You’ve been listening to my conversation with Professor Jodie McVernon, the Director of Epidemiology at The Peter Doherty Institute for Infection and Immunity.
Jodie and I spoke at a Roundtable Discussions on Future Programming Priorities in Health Security for the Indo-Pacific Region in Melbourne. We hope to bring you more important conversations from roundtables across the country over the next month or two. As Jodie said, reconnecting face-to-face after the separation of the pandemic is vital to learning from our regional response to the crisis and future planning.
We hope you have enjoyed this conversation. Contain This is produced by the Indo-Pacific Centre for Health Security. You can follow us on Twitter @CentreHealthSec.