How did I catch a cold in lockdown?

Originally published on theconversation.com

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More than half of Australia is in lockdown in an effort to stem the current Delta strain COVID outbreak, with vast numbers of us steering clear of workplaces, school, retail shops, public transport and other busy places.

If, despite all that, you or your children have developed a sniffle, tested negative for COVID and been forced to conclude it’s just a common cold, don’t worry — you’re not alone.

It’s still reasonably easy to catch a cold even during lockdown. The good news is there’s plenty you can do to greatly reduce the risk.

We cannot avoid germs altogether

The air is much more contaminated than many of us would like to believe. So even if we are isolating from humans, we are still breathing in germs all the time.

Most of them don’t make us sick, thanks to our incredible immune system, but sometimes viruses do sneak past our defences. There have even been outbreaks of the common cold on Antarctic bases after 17 weeks of complete isolation.

Pathogens are part of life, and indeed part of us. We carry around pathogens all the time, including on our skin and up our noses. Most of the time we live in harmony with them.

However, even though our skin and noses are well designed to stop serious pathogens from entering our body, if there’s a breakdown in a barrier — for example, from picking our nose — that can give them a way to get in. In fact, the commonest ways viruses enter our bodies are through our mouth, nose and eyes, which is why we are always being reminded not to touch our faces.

You are still out and about

It’s worth remembering that even during lockdown, many of us still have to go out — for exercise, essential shopping, to seek medical care or for work or compassionate care reasons. So even if you feel locked away and like you’ve not seen friends or family in eons, you have still been out and about.

You can pick up one of the 200 or more viruses that cause what we call the common cold by simply touching a shop counter when you pick up essential groceries, then rubbing the germ into your eye.

Perhaps you pushed a child on the swings and then touched your nose or mouth. A child might have picked up a cold at the playground and brought it home.

Rubbing your eye is a one way to transfer a germ from your hand to your body.
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Viruses that cause the common cold include rhinovirus (which can be airborne and can survive for hours on surfaces under certain conditions). Another virus that causes colds is adenovirus, which can be airborne and has been detected on surfaces.

Once you have actually picked up a cold virus, it may take days before you actually get sick — this is what we call the incubation period, meaning the time between infection with the pathogen, and the onset of symptoms.

Cold viruses can incubate for many days, so it’s possible that even though you or your household members are getting a sniffle now, it was a germ picked up some time ago that has just been biding its time.

And remember: not all “coughs and colds” are actually caused by a virus. For example, whooping cough seems very much like “just a cold” when you first get sick with it. Whooping cough is actually caused by a bacterium, and can survive up to 42 days before it declares itself. For example, my son managed to “catch” whooping cough more than two weeks into lockdown last year. It’s highly likely he picked it up from another child at school before lockdown began, but only developed the cough a fortnight later. Incidentally, he was fully vaccinated as a baby.

Washing hands and wearing masks

What all this shows is that many of us are not as great at washing our hands as we would like to think. Even surgeons, who know how to scrub exceptionally well, still sometimes pass on infections to patients. Viruses are just excellent at surviving and getting past our defences.

So if you’d like to reduce your chances of getting a cold during lockdown — and goodness knows it’s the last thing you need when you’ve got so much else on your plate — remember the basics.

Wash hands often, don’t share utensils, avoid touching your nose, mouth and eyes, wear a mask when you leave the house, and try not to get too close to any other household members who may be coughing and sneezing.

Natasha Yates is a member of RACGP.

We’re paying companies millions to roll out COVID vaccines. But we’re not getting enough bang for our buck

Originally published on theconversation.com

from www.shutterstock.com

How we roll out vaccines is recognised as more important to the success of vaccination programs than how well a vaccine works. And the “last mile” of distribution to get vaccine into people’s arms is the most difficult.

The Morrison government, confronted with a public service ill-prepared for big challenges and with no expertise in rolling out vaccines nationally, has contracted out many aspects of the COVID vaccine rollout to a range of for-profit companies. These include strategies and planning, vaccine distribution, delivery of vaccination programs in aged care, and systems meant to monitor these activities.

To date, vaccine rollout efforts have been clearly inadequate. Government planning has not involved all the possible players and there was no attempt to involve the states and territories in a concerted national effort. Companies have been contracted to give overlapping advice and to provide services where that expertise already exists.

The lack of transparency about how some of these contracts were awarded is also an issue, along with whether the expenditure of taxpayers’ dollars is delivering value and the needed outcomes.

Calling in the consultants

From late 2020, the federal government engaged a raft of consultancies to provide advice on the vaccine rollout. Companies PwC and Accenture were contracted as lead consultants.

PwC was described as a “program delivery partner”. It was engaged to oversee “the operation, and coordinate activities of several actors working on specific functional areas, including — for instance — logistics partners DHL and Linfox”. In other words, PwC was contracted to oversee other contractors.

Accenture was engaged as the primary digital and data contractor to develop a software solution to track and monitor vaccine doses. This included receipt of vaccines by health services, vaccination of patients and monitoring adverse reactions. It received at least A$7.8 million for this work. It is not known if any of these products were delivered or are in use.



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McKinsey received a two-month contract worth A$3 million to work with the health department on vaccine issues; EY was contracted for A$557,000 last November to deliver a “2020 Influenza Evaluation and Covid Vaccine System Readiness Review”. Later there was a A$1 million contract to assess vaccine system readiness and provide advice on on-shore manufacturing.

Despite all this “expert” — and expensive — advice, the vaccination rollout has become a shambles and is far behind schedule. So the military (Lieutenant General John Frewen) has been called in to take “operational control of the rollout and the messaging around the rollout”.

Let’s look at distribution and logistics

Last December health minister Greg Hunt announced the government had signed contracts with DHL and Linfox for vaccine distribution and logistics.

The value of the contracts remains undisclosed. However, the 2021-22 federal budget provides almost A$234 million for vaccine distribution, cold storage and purchase of consumables.



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The decision for these companies to be involved in vaccine distribution shocked many in the pharmaceutical supply industry. The government already has a well-established mechanism to supply pharmaceutical products to the most remote areas. It already does this via pharmacies and other outlets as part of the community service obligation funded under the Community Pharmacy Agreement.

This supply network, for which the government pays A$200 million per year, involves a small number of pharmaceutical wholesalers with decades of experience in delivering to pharmacies. In remote areas, the network also delivers to medical services and doctors’ offices. It’s the same network used every year to deliver flu vaccines.

Pharmaceutical wholesalers offered their expertise. But the government did not approach them to undertake this work. The federal government also ignored the capabilities of state hospital systems, which routinely deliver time-sensitive items such as radioisotopes and blood products.



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More contracts, this time for vaccination programs

The federal government took on responsibility for vaccinating people in aged and disability care, and GP respiratory clinics. It has contracts totalling A$155.9 million with Aspen Medical, Healthcare Australia, Sonic Healthcare and International SOS to deliver these services.

Despite the fact these companies were selected in January, planning has been abysmal.

Only now have most residents in aged care facilities been fully vaccinated. Meanwhile many workers in these facilities and people receiving and delivering care in the community are yet to receive a jab.

The health department has not made these contracts public, citing “commercial-in-confidence” issues. There has been confusion about what the contracts covered and concern the firms involved are significant Liberal Party donors.

There have been widespread logistical problems with juggling vaccine deliveries, having the workforce available to do vaccinations, and demand. Poor planning has led to cancelled vaccinations in aged care and thousands of doses thrown away in one clinic after problems with temperature-controlled storage.



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Where to next?

The key task now is to get all Australians vaccinated.

This will require a competent, reliable and integrated system operating at full efficiency. Those aspects of the system that are the responsibility of the federal government (or its contractors) must be better coordinated with the efforts of the states and territories, GPs and others involved in the vaccination rollout. That should be a key responsibility of Lieutenant General Frewen.

The effort to get more Australians vaccinated requires the public having trust in the system that will get us there and the communications that accompany that.

We have no way of knowing what advice the government has received and indeed, whether that advice was implemented. For-profit companies have been contracted to perform vital services, but we do not know at what cost to taxpayers and whether key performance indicators are being met — or even if they exist.

Openness and transparency are the pillars on which trust in government is built. Currently they are sadly lacking.

Lesley Russell does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

The Lambda variant: is it more infectious, and can it escape vaccines? A virologist explains

Originally published on theconversation.com
The Lambda variant accounts for almost all new cases in Peru, which has the world’s highest COVID death toll per capita. Rodrigo Abd/AP/AAP

The Lambda coronavirus variant was first reported in Peru in December 2020, according to the World Health Organization (WHO).

It then spread to multiple countries in South America, where it currently accounts for over 20% of detected variants.

One case of Lambda was recorded in hotel quarantine in New South Wales in April.

Lambda has now been detected in more than 20 countries around the globe.

The European Centre for Disease Prevention and Control has designated Lambda a “variant under monitoring”, and Public Health England regards it as a “variant under investigation”.

In June this year, the WHO designated it a “variant of interest”. This is due to mutations thought to affect the virus’ characteristics, such as how easily it’s transmitted. Though it’s not yet concerning enough for the WHO to deem it a “variant of concern”, such as Alpha or Delta.

Epidemiological evidence is still mounting as to the exact threat Lamda poses. So, at this stage more research is required to say for certain how its mutations impact transmission, its ability to evade protection from vaccines, and the severity of disease.

Preliminary evidence suggests Lambda has an easier time infecting our cells and is a bit better at dodging our immune systems. But vaccines should still do a good job against it.

Is Lambda more infectious? And can it escape vaccines?

Mutations affecting the spike protein of the SARS-CoV-2 virus can increase infectivity, which is the ability of the virus to infect cells.

What’s more, as many of the coronavirus vaccines currently available or in development are based on the spike protein, changes to the spike protein in new variants can impact vaccine effectiveness

Lambda contains multiple mutations to the spike protein.

One mutation (F490S) has already been associated with reduced susceptibility to antibodies generated in patients who had recovered from COVID. This means antibodies generated from being infected with the original Wuhan strain of COVID aren’t quite as effective at neutralising Lambda.

Another Lambda mutation (L452Q) is at the same position in the spike protein as a previously studied mutation found in the Delta variant (L452R). This mutation in Delta not only increases the ability of the virus to infect cells, but also promotes immune escape meaning the antibodies vaccines generate are less likely to recognise it.

Both mutations F490S and L452Q are in the “receptor binding domain”, which is the part of the spike protein that attaches to our cells.



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Preliminary data on the Lambda spike protein suggests it has increased infectivity, meaning it’s more easily able to infect cells than the original Wuhan virus and the Alpha and Gamma variants. These early studies also suggest antibodies generated in people receiving the CoronaVac vaccine (developed by Chinese biotech Sinovac) were less potent at neutralising the spike protein of Lambda than they were the Wuhan, Alpha or Gamma variants.

It’s worth noting infectivity is not the same as being more infectious between people. There’s not enough evidence yet that Lambda is definitely more infectious, but the mutations it has suggest it’s possible.

A separate small study, also yet to be reviewed by the scientific community, suggests the L452Q mutation in the Lambda spike protein is responsible for its increased ability to infect cells. Like the L452R mutation in the Delta variant, this study suggests the L452Q mutation means Lambda may bind more easily to the “ACE2 receptor”, which is the gateway for SARS-CoV-2 to enter our cells.

This preliminary study suggests Lambda’s spike protein mutations reduce the ability of antibodies generated by both Pfizer and Moderna’s vaccines to neutralise the virus. Also, one mutation was shown to resist neutralisation by antibodies from antibody therapy to some extent.



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However, these reductions were moderate. Also, neutralising antibodies are only one part of a protective immune response elicited by vaccination. Therefore, these studies conclude currently approved vaccines and antibody therapies can still protect against disease caused by Lambda.

Is it more severe?

A risk assessment released by Public Health England in July concedes there’s not yet enough information on Lambda to know whether infection increases the risk of severe disease.

The risk assessment also recommends ongoing surveillance in countries where both Lambda and Delta are present be implemented as a priority. The aim would be to find out whether Lambda is capable of out-competing Delta.

With ongoing high levels of transmission of the coronavirus, there’s a continued risk of new variants emerging. The Lambda variant again highlights the risk of these mutations increasing the ability of SARS-CoV-2 to infect cells or disrupt existing vaccines and antibody drugs.

The WHO will continue to study Lambda to determine whether it has the potential to become an emerging risk to global public health and a variant of concern.

Adam Taylor receives funding from the Australian National Health and Medical Research Council.

‘Die of cold or die of stress?’: Social housing is frequently colder than global health guidelines

Originally published on theconversation.com

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As you huddle inside this winter – possibly as part of a pandemic lockdown – you might be noticing the “thermal performance” of your home. In other words, does your home maintain a comfortable temperature inside, despite cold conditions outside?

If you’re a social housing tenant in New South Wales, the answer may well be no. Our new research examined the relationship between energy consumption and thermal performance in 42 social housing dwellings. We found many homes operated outside the healthy temperature recommendations of the World Health Organisation (WHO) for substantial periods, particularly during winter.

Our research also found many social housing tenants were effectively being forced to choose between keeping their home at a healthy temperature through cooling and heating, and keeping their energy bills manageable. As one tenant told us:

I put the heater on the other night for 20 minutes — it didn’t do much. But the whole time it was on I was freaking about the cost. No good — die of cold or die of stress, take your pick.

Social housing in NSW is often colder than WHO standards.
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The dangers of energy inefficiency

Social housing often brings together low-income households and poor quality building stock.

In Australia, more than one million people live in housing in poor condition – 100,000 of them in very poor or derelict housing.

Yet, little is known about the internal temperatures in social housing, or how tenants experience seasonal temperature change. Our research represents one step to address this knowledge gap.

Exposure to temperatures that are too high or too low has been linked to an increased risk of cardiovascular and respiratory illnesses and other conditions, which can lead to death.

Energy inefficient homes are blamed in part for higher winter death rates in Australia than other much colder nations, such as Sweden. Conversely, research has shown the health benefits of retrofitting housing to improve winter warmth.

Measures to make an existing home more energy efficient include:

insulating the ceiling, and potentially the walls and underfloor
sealing gaps and draught-proofing
installing ceiling fans
improving the efficiency of heating and cooling systems
installing efficient hot water systems
improving windows with shading, heavy curtains or double glazing.



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Insulation helps make a home more energy efficient.
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Our findings

Social housing is provided by government, not-for-profit or private organisations, to tenants who are often vulnerable and marginalised.

We examined the thermal performance of 42 social housing properties in NSW between March 2017 and September 2019. Our study included energy audits monitoring of electrical energy and indoor conditions, and interviews with tenants.

We found substantial under-heating in many of the properties. According to the WHO, the minimum temperature for healthy homes is 18℃. But one-quarter of properties recorded winter temperatures below this for more than 80% of winter. More than half were below 18℃ for more than half of winter.

The problem of overheating in summer was less widespread, but still a significant issue in some homes.

Some households consumed higher-than-average levels of energy despite their low incomes (even after correcting for family size and location) while others used far less than average.

High household energy use was predominately associated with air conditioning use in hot summer climates. In most of these cases, tenants had installed window air-conditioning units with extremely low energy efficiency.

Tenants regularly reported having to forgo thermal comfort to manage their energy bills. To keep power bills down, they also spoke of relinquishing essentials such as daily showers, cooked dinners, night lighting and watching television.



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Social housing tenants often forgo life’s essentials to save on electricity bills.
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What can be done?

The homes in our study subsequently received energy efficiency upgrades, funded by the housing provider and the NSW government. The social housing sector, while operating on tight budgets, is an innovator when it comes to retrofitting existing buildings.

In Australia, social housing upgrade programs typically focus on improving heating, cooling and hot water systems, and in some cases adding solar. This is largely because such upgrades are simple and rooftop solar costs are falling.

However, energy efficiency experts generally say improvements to the building fabric, such as installing insulation and sealing draughts, should be carried out before services to the home are upgraded.

This approach generally requires on-ground assessment of each property and can be difficult and costly to roll out on a large scale. This is a major challenge for housing providers with constrained budgets, and who are often under pressure to deliver new housing.

But building fabric upgrades are long-lasting, don’t increase maintenance costs and deliver benefits regardless of a tenant’s heating and cooling practices.

One social housing tenant told us of the benefits of such upgrades:

[Before the upgrade] I’d have my heater on, say, from half past four of an afternoon ‘til half past eleven, you just would not turn it off. [Since the upgrade] I turn it on at half past four, it’s coming off at about seven o’clock and I don’t need to turn it back on.

While our study involved a small sample size, it provided new empirical evidence of the need for substantial new investment to continue to upgrade the energy performance of our social housing stock. Such upgrades will help reduce energy costs for tenants and enhance their health and well-being.

It would also reduce greenhouse gas emissions, increase resilience to climate change and provide jobs and economic stimulus during the pandemic and beyond.

This story is part of a series The Conversation is running on the nexus between disaster, disadvantage and resilience. It is supported by a philanthropic grant from the Paul Ramsay Foundation. Read the rest of the stories here.

Funding for this work was provided by the Cooperative Research Centre for Low Carbon Living and the New South Wales Office of Environment and Heritage

Paul Cooper receives funding from the Australian Research Councili.

Federico Tartarini, Gordon Waitt, Michael Tibbs, and Theresa Harada do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

7 tips for making masks work in the classroom

Originally published on theconversation.com

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With more infectious variants of the COVID-19 virus emerging, teachers and students have been required to wear masks in high school classrooms. It was mandatory in Greater Sydney and all of Victoria before the recent switch to remote learning under lockdowns. Mask wearing has also been compulsory in schools overseas, including parts of the US, Canada and Malaysia.

The new variants appear to have increased infection risks for younger people, and most Australians are not yet fully vaccinated. Until that time, masks may well be one of our best tools to allow a return to face-to-face schooling.



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However, having to wear masks in the classroom may create challenges for teachers and students. Mask-wearing can have negative impacts on all students, although the issues can be greater for students from minority cultures and those with chronic health or disability barriers.

Education is primarily a communication and relational activity. Masks not only hinder the visual communication tools we rely on but can also muffle speech, create discomfort and be psychologically unsettling for some. The word mask is thought to come from the Medieval Latin masca, meaning spectre or nightmare.

Most of the barriers to wearing masks can be overcome. By harnessing the benefits of embracing the mask, classrooms can adapt and thrive during the pandemic. Adopting recommended practices for using masks in the classroom will benefit all students.



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Use masks properly

Openly and regularly discuss mask use with all students. Teach and practise mask etiquette so students understand the need to avoid touching the mask and to touch only the edges if they need to adjust their mask. They may need to do this to maximise comfort and to ensure the mouth and nose are properly covered, protecting the wearer and those around them.

Encourage students to use hand sanitiser, especially after touching the mask.

Remind students to clean reusable masks every day and to dispose of single-use masks.

Encouraging students to use hand sanitiser adds to the protection masks provide.
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Exaggerate body language and facial expressions

Young people take many visual cues from the mouth of the speaker, while adults take more visual cues from the eyes. When wearing masks covering the lower half of the face, teachers and students will naturally become more aware of upper face expressions.

Exaggeration is helpful to communicate clearly while wearing a mask. Teachers should continue to use natural facial expressions like smiling, such as the “Duchenne smile”, but exaggerate eye gestures and eyebrow movements to aid communication. The face has 42 individual muscles. We should use them all.

Play with facial expressions when using masks and have students read social cues from the eye movements they can see. Make the development of social and emotional intelligence a game of exploration to promote an understanding of psychology and how we react to others. This is merging science and the arts.

Teachers can and should use their whole body to communicate. For example, the teacher can shrug their shoulders when asking a question, or shake or nod their head to communicate a point of view. Exaggerated hand gestures and being near to the students are other helpful strategies.

Wearing a mask means we have to express more with our eyes and body language.
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Use your voice

Although the mask covers the mouth, teachers can generally still be heard through the cloth. The key here is again a form of exaggeration as well as proximity to the student. Teachers can stay close to their listeners, speak more slowly, articulate all sounds clearly and increase volume.

However, teachers must balance vocal volume with projecting the voice. Teachers can practise diaphragmatic breathing to help avoid vocal straining.

Where possible, try to rely less on talking for teaching. Use PowerPoint and written communication. Keep language simple and straightforward.

In addition, check with students that they can hear and understand. Pay particular attention to children who are deaf or hard of hearing. Speak with them about the situation and take their advice.

Embrace technology

Where possible, use technology such as iPads or IT devices. Choose or make a video clip with subtitles instead of having to speak while wearing a mask. This is particularly important for students who are deaf or hard of hearing.

Use a microphone, carefully placing it near the mouth but not against the mask material.

Don’t panic

Masks do allow enough airflow to breathe comfortably. However, remain vigilant to children who do panic or feel claustrophobic when required to wear a mask. These psychological challenges can be made worse when a child has breathing difficulties such as asthma.

Schedule regular quiet breaks throughout the day – even every hour.

Create a safe space

Staff should try to include a photograph of themselves on their school ID badge, if wearing one. This can help reassure those who feel isolated and uncomfortable when people are wearing masks.

Children with neurological disabilities, such as autism or dyspraxia, will not always have the issues some might expect with wearing a mask. Like all children, they just need to know who we are and why we are all wearing masks.

The most important thing is to communicate. Talk with and listen to students, as the best teachers always do. Let them talk about their masks and take ownership of the situation, and then we can move forward with learning.

Taking the time to talk with individual students and hear what they have to say is most important.
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Following Maslow’s Hierarchy of Needs, children will learn when they know they are safe.

See it as a opportunity to learn

The challenges of mask-wearing can be opportunities. Rather than seeing the mask as a burden, see it as an opportunity to teach and have fun.

Incorporate lessons that look at masks in history, from the earliest Greek plays through to Asian theatre and more recent times. Look at superhero movies, look at politics and public protests. Understand medicine and the use of masks throughout history – why we wear them to keep both ourselves and others healthy.

Explore the inclusive nature of masks and how they can create acceptance and equity. Research has found masks allow children to disassociate from identities and see themselves and others from a more empathetic and accepting perspective.

Many societies where people commonly wore masks prior to COVID, in parts of Asia for example, have thrived. Schools are microcosms of society. The mask is not a barrier to learning. A mask should only be a barrier to the spread of the virus, so mask up and enjoy the masquerade.

Jill Duncan is affiliated with Aussie Deaf Kids, Disability Council NSW, Deafness & Education International.

David Roy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Gender-specific health programmes address important issues, but risk creating new biases

Originally published on theconversation.com

Shutterstock/elenavolf

Gone are the days when health programmes were designed to simply punish or reward people to encourage behaviour change. We now know lasting behaviour change is more complex and nuanced, and this has prompted a proliferation of programmes that attend to factors like motivation, confidence, social support and social determinants of health.

Among such programmes, we’ve observed a trend towards gender-targeted interventions. Examples include programmes for men focusing on rugby fandom as a route to getting them to look after their health, and those for women that concentrate on small, holistic health changes to limit the impact of damaging body ideals.

Health programmes are often tailored for either men or women.
Shutterstock/Nataliia Martseniuk

While biological sex is based on our anatomy and physiology, gender is a socialised identity. Our gendered identities accompany societal expectations of how we should or should not act.

There is no doubt gender shapes how we “do” health — the way we eat, sleep, exercise, connect with others and manage stress. While gender-specific needs are important, a gendered approach may ignore people who identify as neither and it runs the risk of creating new biases.

A case for women-focused health programmes

Women-focused health programmes were arguably developed as an antidote to an overwhelmingly patriarchal society.

The most obvious bias in health research is that much of the data on women’s health has been collected by and from men.

Gendered disadvantages or inequities for women also result from poor representation in leadership positions and unfair norms that place greater expectations on them.

For example, women spend more time than men doing unpaid household work and taking on caring responsibilities. These imbalances trickle down to shape how women spend their time and care for their health.

In response, women-specific research centres have been established in New Zealand and internationally to help close the gap in knowledge regarding women’s health.



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Similarly, organisations like YWCA and Women’s Health Victoria position gendered inequities at the centre of their work and help create a better understanding of how health programmes can effectively support women’s long-term outcomes for behaviour change.

In New Zealand, Shift supports young women to be physically active through a focus on collaboration, fun, building community and leadership. Next Level Health empowers women by using a holistic and weight-neutral approach to behaviour change. This moves the focus away from body weight and defines health more broadly, emphasising well-being, connection to people and place and other behaviours.

As a result, sleep, self-care and stress management become as important as physical activity and nutrition. Such programmes create a more inclusive and relevant vision of health and counteract the body image concerns women often experience due to socialised pressures to attain an “ideal” body.

Men are less likely to seek medical help.
Shutterstock/Chinnapong

‘Tough’ approach to men’s health

Despite a male-dominated health system, men continue to have a higher risk of various health conditions, including coronary heart disease and being overweight.

When it comes to health behaviour programmes, men are notoriously difficult to recruit. This may be due to the fact men are less likely to seek help.

There have been urgent calls for male-specific healthy lifestyle programmes that often use “masculine” male-dominated sports (rugby, football) to entice men to join.

Some, such as Tough Talk, play with stereotypical male traits to encourage men to discuss their health. In parallel with women’s health research, male health research centres are fast becoming commonplace.



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Considering these gender differences, a gendered approach can be justified. Gender equality and health equity are global priorities and such programmes have potential to address them. Playing to peoples’ gendered identities may work for recruitment and effectiveness, too.

Slipping through the cracks

While gendered interventions aim to fill certain gaps, they may actually create new ones, particularly when we consider that many health programmes are funded by nationally competitive grants that often favour projects with potential for greater impact (the biggest slice of the population).

People who identify with the wider group of LGBTQI+ are vulnerable in terms of mental health. This disparity exists because of the greater inequities this community faces.

Some solutions may come from gender-diverse marketing that emphasise gender responsiveness, rather than placing a specific gender at the centre of campaigns.



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Perhaps non-gendered health programmes could create open discussion about how people identify their gender, rather than repeating an inherited gendered story. Admittedly, that might be idealistic for a lifestyle programme.

We’re not arguing against gender-specific programmes. Gender bias in health research is an ongoing issue, among others, that requires targeted action to eliminate harmful inequities.

But we suggest gender responsiveness as a compatible approach for lifestyle programmes, in which gender is embraced but does not drive the programme. A choose-your-own-path approach that allows for diverse identities and autonomy, regardless of gender. Otherwise, the gaps we aim to fill might become gaping holes elsewhere.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

Is the COVID vaccine rollout the greatest public policy failure in recent Australian history?

Originally published on theconversation.com

Is the Morrison government’s COVID vaccination rollout program one of Australia’s biggest ever public policy failures?

As COVID-19 infection numbers in locked-down Sydney show little sign of abating and Victoria extends its fifth lockdown, the prospect of life resuming some level of normality appears distant.

In recent weeks, we have learned more about the flaws in the federal Coalition government’s vaccination program. There’s the failure to procure sufficient vaccine and an accompanying over-reliance on the AstraZeneca vaccine.
The complications with rolling out the latter have exposed the shortage of supply of the Pfizer vaccine.

While other international leaders personally lobbied Pfizer executives for supplies, Prime Minister Scott Morrison and Health Minister Greg Hunt were inexplicably passive.

Then there is the sluggish pace of the “it’s not a race” vaccine rollout, particularly among vulnerable people, such as aged and disability care residents, and frontline health workers. Only 13% of Australia’s eligible population (those aged 16 and above) are fully vaccinated, while 35.3% are partially vaccinated. That’s a long way short of the goal of a fully inoculated adult population by October 2021, as initially promised.

Exacerbating these problems has been the lack of an effective public education campaign about the vaccine. This has left a vacuum, which anti-vaxxers and the vaccine-hesitant have filled.



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View from The Hill: Morrison and Coalition sink in Newspoll on the back of rollout shambles

Fallout from a shambolic vaccine rollout

Public confidence in the government’s handling of the vaccine rollout has sharply diminished. The latest Newspoll shows disapproval of the rollout jumping 11 points to 57%.

The policy missteps, which have Australia languishing at the bottom of the OECD for the proportion of its population that is fully vaccinated, have elicited a rising chorus of condemnation.

Some of the criticism comes from usually supportive sources, such as right-wing commentators Janet Albrechtsen and Miranda Divine.

Former Coalition prime minister Malcolm Turnbull claimed recently he couldn’t recall “a more black and white failure of public administration” than the vaccine program. Historian Frank Bongiorno declared the rollout “the worst national public policy failure in modern Australian history”.

Public confidence in the Coalition government and the prime minister has dropped due to the vaccine rollout.
Lukas Coch/AAP

How do we measure public policy failure?

There’s no doubt the Commonwealth government, measured by its inability to reach professed objectives, which are then repeatedly revised, has performed poorly.

Disingenuous attempts by the prime minister and senior ministers to dissimulate, or deflect responsibility to others, have been well canvassed.

But are we ready to conclude that what we are seeing is a near-unprecedented instance of policy failure, especially when there are other pressing public policy issues on which the government has also been found wanting, most noticeably climate change?

There are three principal factors for measuring public policy success or failure.

The first is an assessment of how successfully the policy action ameliorates the problem it seeks to solve. This appraisal must take into account the consequences of that action. Consequences are often unintended and unanticipated. They might not become apparent for some time and can be difficult to quantify and link unequivocally to the policy in question. For example, the Coalition’s inclination to cease support for manufacturing in Australia has led, as is now evident, to our incapacity to meet the demand even for COVID vaccine production.

Second, an assessment of policy success or failure must consider the significance of the policy. That is, the failure of a minor government program has less negative impact than the failure of an economic, social, environmental or public health policy that affects the entire community.

Third, we must take account of the reputational enhancement or damage ensuing from a particular course of action. This may have decisive effects on a government’s electoral prospects.

Applying these measures, we can say that, to date, the Morrison government’s approach to the COVID vaccination rollout fares badly on all three criteria.

On all three measures of policy effectiveness, the vaccine rollout fails.
Mick Tsikas/AAP

The vaccine rollout has failed the tests of public policy success

The problem is not that the proposal – a level of vaccination that will enable the community to “live with” endemic COVID – is misconceived. It is that incompetent planning, logistics and implementation have so far prevented it from sufficiently ameliorating the threat we face.

We can see, from international comparisons, the dimensions of risk while COVID remains insufficiently checked and potentially able to generate more dangerous mutations.

Second, the significance of success or failure in this domain – brought home by recurrent lockdowns – is manifest. There are negative flow-on effects for the entire community, not only in containing the virus, but also with clear impact on the economy, mental health, domestic violence and trust in government.

We are also confronted with counter examples: Seattle, for instance, in dire circumstances not so long ago, is now more or less back to normal because of the swift uptake of vaccination.

Third, the reputational damage to the federal government is evident in a string of public opinion polls that have found a substantial decline in confidence in the Coalition and the prime minister.

… but there is one that is worse

Some other examples help us flesh out the picture. One is a public policy from recent decades that did not achieve its intended purpose: the Rudd government’s Resource Super Profits Tax and its successor negotiated by the Gillard government, the Minerals Resource Rent Tax.

These policies failed on at least two levels. First, they did not reap anything like the revenue that was forecast. Second, the taxes were electorally damaging for the Labor governments, engendering a fierce backlash from the mining industry.

A more significant public policy failure, with consequences that took much longer to become apparent, was the Howard government’s Aged Care Act of 1997. This legislation established the framework for the funding and regulation of the aged care system. Partially privatising the aged care sector, that policy regime is widely recognised as being responsible for the underfunding of the system and associated chronic shortcomings, which the recent royal commission thoroughly documented.

Perhaps the biggest public policy failure of recent times relates to climate action where, as with COVID vaccination, Australia ranks last among developed economies.

This has been a product of the failure of the parties, but in particular of internecine battles within the Coalition and a brutal politics that, as Martin Parkinson argues, brought about “a fracture of the political centre”, rendering it incapable of the negotiation and consensus necessary for resolution.

While the vaccine rollout has been a failure, inaction on climate change represents the biggest policy failure in recent times.
AAP/Department of Defence handout

Indeed, the intractability of climate change as a policy problem suggests that it, rather than the handling of vaccine rollout, is the biggest failure of modern times.

Despite the chaos that has been well documented, the required levels of vaccination can still be achieved, even if belatedly. The situation is potentially capable of resolution, and possibly in time for Seattle-like “normality” to be re-established. Adequate climate action, on the other hand, still appears to be incapable of resolution under this government.



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But will the Morrison government’s mishandling of the vaccine rollout be politically fatal? Certainly, falling confidence in the rollout is translating into a decline in support for the Coalition. Yet we should be wary of jumping to conclusions.

The prime minister has until next May to hold an election. The government has ample time to play catch-up with the rollout. If further outbreaks are contained and the elusive herd immunity is achieved by then, lockdowns will have become a thing of the past. The relief at being able to move on may obliterate current disquiet.

Further, in normal circumstances, policy virtue is not necessarily synonymous with political success. The last federal election was an indicator of this. The Coalition triumphed despite a threadbare policy program. In other words, policy prowess is only ever one measure of a government’s success.

Carolyn Holbrook receives funding from the Australian Research Council.

James Walter and Paul Strangio do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

Podcast with Michelle Grattan: three states in lockdown

Originally published on theconversation.com

As well as her interviews with politicians and experts, Politics with Michelle Grattan now includes “Word from The Hill”, where she discusses the news with members of The Conversations’s politics team.

In this episode, politics + society editor Amanda Dunn and Michelle talk about where we never expected to be in mid 2021 – 13 million people locked down in three states.

They also canvass the “car park rorts” in which marginal electorates were brazenly targeted in a $389 million car park construction program for the 2019 election, and if such misconduct will ever be stemmed.

Additional audio

Gaena, Blue Dot Sessions, from Free Music Archive.

Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Teens should have a say in whether they get a COVID vaccine

Originally published on theconversation.com

Shutterstock

The Delta variant has taken hold in NSW and Victoria, which are both in lockdown, and now in South Australia too, which will enter a lockdown tonight.

The World Health Organization has predicted Delta will become the dominant variant globally.

A concerning feature of Delta is the number of children and adolescents becoming infected. Earlier in the pandemic, Australians were able to feel reassured that transmission in schools was negligible. But Delta is already proving different, with some evidence of transmission among school children, teachers and their households emerging in Australia.



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Those who’ve been vaccinated against COVID-19 have been less likely to be infected with the Delta strain. If infected, they’re less likely to require hospitalisation.

There’s now a sense of urgency surrounding Australia’s COVID vaccine rollout, which ranks last among OECD countries.

Some experts are calling for vaccination of children and adolescents to be a high priority as well.

Australia’s drug regulator, the Therapeutic Goods Administration (TGA), may soon approve the Pfizer and Moderna COVID vaccines for adolescents aged 12-15.

If the vaccines are approved for this age group, how might we undertake mass vaccination of adolescents in Australia? And who will be involved in decisions about consent?

How can we vaccinate teens?

Adolescent vaccinations have been effectively delivered in Australian states and territories for many decades, via immunisation programs at schools.

The National Immunisation Program is funded by the federal government, which means vaccines listed in the schedule are provided for free.

Vaccines are given in high schools by nurse immunisers. If a dose is missed at school, adolescents are eligible to “catch-up” via their GP (meaning the vaccine is still free).

The current schedule for adolescents includes vaccines against HPV (human papillomavirus), the “dTpa” (diphtheria, tetanus, pertussis) booster and meningococcal ACWY disease.

It makes good sense to include COVID vaccines as part of the tried and trusted school-based immunisation program.

Who gives consent?

Because these immunisations are given through schools, adolescent vaccination in Australia is a partnership between health and education departments.

Written parental or guardian consent is required prior to the administration of vaccines.

This differs to what’s done through health settings, such as general practice, where adolescent “competency to consent” is an important consideration.

“Competency to consent” refers to the capacity of someone under 18 to consent to or refuse medical treatment. It signifies the minor has reached sufficient intelligence and understanding to fully understand the proposed treatment. The seriousness of the treatment is taken into consideration and capacity is assessed by individual health professionals. If deemed competent, then there’s no legal requirement for parental or guardian consent. Although, parental consent in addition to adolescent consent is encouraged as best practice.

Currently, adolescents need written parental or guardian consent to get vaccinated through high school immunisation programs.
Shutterstock

2 approaches to adolescent COVID vaccination

First, we must improve adolescents’ understanding of vaccination to support their involvement in decision-making. In our own research about HPV vaccination, we found information designed specifically for adolescents is important. Adolescents otherwise have limited understanding of the vaccines they receive, or the diseases they prevent.

Even if consent from a parent or guardian is required as it is in the school-based program, promoting vaccine literacy among adolescents is appropriate and ethical. Understanding the purpose and process of vaccination increases vaccine confidence and reduces fear and anxiety.



Read more:
Young people are anxious about coronavirus. Political leaders need to talk with them, not at them

Second, we need to acknowledge adolescents’ legal right to consent where they are competent to do so. This is pertinent where parental consent isn’t obtained, often due to a simple failure to return a consent form in time.

Where this happens, a GP can obtain informed consent in the usual way for medical treatment.

However, the requirement to access a GP practice presents other barriers for mature minors (those under 18 years who are competent to consent), which may impede vaccine uptake.

The national imperative is to achieve as high coverage of COVID vaccination as possible across the population. To achieve this and reduce the impact of the pandemic on young people’s health, we must work with young people.

What do young people think?

The National Health and Medical Research Council (NHMRC) has established a network of researchers who champion adolescent health, called the Wellbeing Health & Youth Centre.

This network has created the WH&Y Commission, which includes the voices of young people. Its goal is to ensure adolescent health research and policymaking are guided by young people themselves.

We asked three young WH&Y Commissioners what they thought about the issue of COVID vaccines and adolescents.

Here’s what they had to say

Young people should be given unbiased, accurate information about the benefits and risks associated with COVID vaccines.

Young people understand that because it’s a new vaccine, there will inevitably be scepticism. They’re aware family members may be hesitant or hold opposing views, which could deny young people their right to be fully informed. They want transparent instruction and information to be a huge priority for governments.

Young people deemed competent should be afforded their legal right to consent to a COVID vaccine. This would acknowledge the autonomy of, and trust placed in, young people to make their own medical decisions. There should be appropriate structures in place to protect young people’s privacy in their decision-making process. This is important to avoid stigmatisation based on their choice.

Australian Common Law reflects the understanding that over the second decade of life, young people gain autonomy over their lives and are capable of making decisions about their own health care. For the majority, this will involve conversations with, and support from, parents and guardians.

From early adolescence, scientific information about COVID vaccine benefits and risks should be provided in a way young people understand.

Ideally, adolescents should also be granted the legal and ethical right to make their own decisions, as would ordinarily happen for medical interventions of low risk. — WH&Y Commissioners Anhaar Kareem, Jenon Castro and Aish Naidu.

This article was co-authored with WH&Y Commissioners Anhaar Kareem, Jenon Castro and Aish Naidu.

Melissa Kang is an Associate Investigator on the Wellbeing Health & Youth (WH&Y) NHMRC Centre for Research Excellence. She has previously provided paid consultant advice on GP education for engaging adolescents to Pfizer.

Cristyn Davies is a researcher on the Wellbeing Health & Youth (WH&Y) NHMRC Centre of Research Excellence.
She holds current research funding from IMCRC (Innovation Manufacturing Collaborative Research Centre).

Rachel Skinner is Deputy Director of Wellbeing, Health & Youth (WH&Y) NHMRC Centre for Research Excellence. She is NSW Ministry of Health’s Senior Clinical Advisor in Youth Health and Wellbeing. She has received competitive grant funding from the following organisations: Australian Research Council, National Health and Medical Research Council, NSW Health Office of Health and Medical Research and IMCRC (Innovation Manufacturing Collaborative Research Centre). She has received honoraria for educational presentations on HPV vaccination from Seqirus and Merck.

When COVID is behind us, Australians are going to have to pay more tax

Originally published on theconversation.com
Australian Tax Office

The biggest unstated message from the intergenerational report released during the lull between lockdowns is that we will need more tax.

Not now. At the moment it’s a matter of throwing everything we’ve got at getting on top of the COVID outbreaks and worrying about how to (and the extent to which we will need to) pay for it later.

But when the economy is healthy again, taxes are going to have to rise, big time.

That the intergenerational report doesn’t say so explicitly might be because the government is sticking with its arbitrary and implausible guarantee that tax collections will never climb above 23.9% of GDP, which is the average between the introduction of the goods and services tax and the global financial crisis.

Or it might be because what’s needed sits oddly with legislated high-end tax cuts likely to cost $17 billion per year from 2024-25.

Among the drivers of increased government spending identified by the report is spending on health, at present 4.6% of gross domestic product, and on the report’s projections set to climb to 6.2% over the next 40 years.

We’ll want better health

To fund that alone the government will need to collect 6% more tax in 2061 than had spending on health stayed where it was as a proportion of GDP.

Perhaps surprisingly, most of the extra spending on health won’t be a direct result of the population ageing. It’ll be because health technologies are getting better and becoming much, much more expensive (à la the COVID vaccines). And because incomes are rising.

Rising incomes, the report explains, are the largest driver of government spending on health internationally.

That’s because for some things, including the provision of hospitals, private spending can’t cut it, no matter how well off you are.

Australia’s richest man needed hospitals as much as anyone.
AP

After billionaire Kerry Packer suffered a massive heart attack while playing polo in 1990, he was rushed to Sydney’s Liverpool Hospital.

When the ANU election survey began in 1990, 54% of Australians surveyed regarded health as “extremely important” in determining their vote. It’s now 70%. In 1990 11% regarded health as “not very important”. It’s now just 2%.

The intergenerational report has spending on aged care climbing from 1.2% to 2.1% of GDP, which by itself means the tax take will have to be 4% higher than otherwise, but it was prepared ahead of the government’s final response to the aged care royal commission.

The interim response had 14 (mostly expensive) recommendations subject to “further consideration”.

The National Disability Insurance Scheme already accounts for one in 20 tax dollars collected and is set to overtake Medicare.

The report says the government’s response to the royal commission into disability care presently underway is likely to place “additional pressure” on costs.

We’ll need to spend more than projected

None of this extra spending is bad if it delivers value for money, and it’s what the public wants. But it is hard to reconcile with official projections in the report showing government spending climbing only 2.5% per year in real terms over the next 40 years, compared to 3.4% per year in the past 40.



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Intergenerational report to show Australia older, smaller, in debt

The report gets there in part by an outrageous sleight of hand. It says JobSeeker and other payments will become tiny as a proportion of GDP because they will only climb with inflation (which is typically low) rather than wage growth or GDP growth (which is typically higher, and lines up with how the pension grows).

A moment’s reflection would show that if that actually happened for 40 years — which is what the treasury’s report assumes — JobSeeker would fall from 70% of the single age pension to a hard-to-justify 40%.

JobSeeker and age pension as projected in intergenerational report

Payment for a single person, dollars per fortnight. JobSeeker indexed to IGR inflation projections, pension indexed to IGR wage projections.

We know it won’t happen because it hasn’t happened.

JobSeeker was boosted this year after only 20 years rather than 40 in order to make sure that sort of thing wouldn’t happen.

And we know there’s nothing to stop an intergenerational report using more realistic assumptions.

The 2015 report, released at a time when the Abbott government planned to adjust the pension in line with the more miserly JobSeeker formula, relaxed the assumption after 13 years because if it left it in place the pension would slide untenably below community expectations.

We’ll easily be able to afford more tax

There’s nothing wrong with paying more tax if it’s for things we want, like better health care, better aged care, better disability care and benefits we can live on.

The intergenerational report has government spending climbing by four percentage points of GDP between now and 2061. But it also has real GDP per person almost doubling, climbing 80%.

Even if that’s an overestimate and GDP per person grows by, say, 50%, and the need for tax grows by more than four points, we’ll easily be able to afford the extra tax, and we’ll want what that tax will buy. Expectations climb with income.

The present government will be long gone by the time the tax to GDP ratio reaches its “cap” of 23.9% of GDP (which the report expects in 2035).

Mathias Cormann has moved to the OECD where average tax rates are high.
Ian Langsdon/EPA

The finance minister who came up with the cap, Mathias Cormann, is now head of the Organisation for Economic Co-operation and Development, in which the average tax take is 34% of GDP.

An obvious place to look for the tax is high-income senior citizens, at present enjoying tax-free super, refundable franking credits and special tax offsets. Grattan Institute calculations suggest an older household earning $100,000 pays less than half the tax of a working-age household on the same amount.

Like less well-off seniors, they are highly likely to use the services tax provides.

To say we’ll need more tax is not to say the government needs to fund all of its spending with tax.

It is projecting budget deficits for the next 40 years. Budgets have been in deficit for all but a few of the past 100 years.

But it will need to cover much of it with tax to keep the economy in check. If we want what tax provides, we’ll be prepared to pay it.

Peter Martin does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.