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Objectives The aim of this survey was to investigate parental vaccination attitudes and responses to vaccine-related media messages from political and medical leaders. Design This was a cross-sectional study using a semiquantitative questionnaire. Data were analysed using descriptive statistics, X 2 tests and logistic regression. Setting Data were collected from a web-based questionnaire distributed in Australia by a market research company in May of 2017. Participants 411 participants with at least one child under 5 were included in this study. The sample was designed to be representative of Australia in terms of gender and state of residence. Primary and secondary outcome measures The primary outcome measures were parental attitudes towards childhood immunisation before and after viewing vaccine-related messages from political and medical leaders, including Donald Trump (USA), Pauline Hanson (Australia) and Michael Gannon (Australia). Parents were classified as having susceptible' (not fixed) or fixed' (positive or negative) views towards vaccination based on a series of questions. Results Parents with fixed vaccination views constituted 23.8% (n=98) of the total sample; 21.7% (n=89) were pro-vaccination and 2.2% (n=9) were anti-vaccination. The remaining 76.2% of participants were classified as having susceptible views towards vaccination. Susceptible parents were more likely to report a change in their willingness to vaccinate after watching vaccine-related messages compared with fixed-view parents, regardless of whether the messaging was positive or negative (Trump OR 2.54, 95% CI (1.29 to 5.00); Hanson OR 2.64, 95% CI (1.26 to 5.52); Gannon OR 2.64, 95% CI (1.26 to 5.52)). Susceptible parents were more likely than fixed-view parents to report increased vaccine hesitancy after viewing negative vaccine messages (Trump OR 2.14, 95% CI (1.11 to 4.14), Hanson OR 2.34, 95% CI (1.21 to 4.50)). Conclusions The findings suggest that most parents including the vaccinating majorty are susceptible to vaccine messaging from political and medical leaders. Categorising parents as fixed-view' or susceptible' can be a useful strategy for designing and implementing future vaccine promotion interventions.

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through "herd immunity", which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian Government has determined that rates should be higher, and has recently introduced policy that includes involved removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination ("No Jab No Pay"). In addition, it has raised the possibility of banning unvaccinated children from childcare centres ("No Jab No Play"). This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices.

Over the last decade infant pneumococcal vaccination has been adopted as part of routine immunisation schedules in many developed countries. Although highly successful in many settings such as Australia and the United States, rapid serotype replacement has occurred in some European countries. Recently two pneumococcal conjugate vaccines (PCVs) with extended serotype coverage have been licensed for use, a 10-valent (PHiD-CV) and a 13-valent (PCV-13) vaccine, and offer potential replacements for the existing vaccine (PCV-7) in Australia. To evaluate the cost-effectiveness of PCV programs we developed a static, deterministic state-transition model. The perspective for costs included those to the government and healthcare system. When compared to current practice (PCV-7) both vaccines offered potential benefits, with those estimated for PHiD-CV due primarily to prevention of otitis media and PCV-13 due to a further reduction in invasive disease in Australia. At equivalent total cost to vaccinate an infant, compared to no PCV the base-case cost per QALY saved were estimated at A$64,900 (current practice, PCV-7; 3 + 0), A$50,200 (PHiD-CV; 3 + 1) and A$55,300 (PCV-13; 3 + 0), respectively. However, assumptions regarding herd protection, serotype protection, otitis media efficacy, and vaccination cost changed the relative cost-effectiveness of alternative PCV programs. The high proportion of current invasive disease caused by serotype 19A (as included in PCV-13) may be a decisive factor in determining vaccine policy in Australia.

Introduction: There are no publicly available national data on healthcare worker infections in Australia. It has been documented in many countries that healthcare workers (HCW) are at increased occupational risk of COVID-19. We aimed to estimate the burden of COVID-19 on Australia HCW and the health system by obtaining and organizing data on HCW infections, analyzing national HCW cases in regards to occupational risk and analyzing healthcare outbreak. Methods: We searched government reports and websites and media reports to create a comprehensive line listing of Australian HCW infections and nosocomial outbreaks between January 25th and July 8th, 2020. A line list of HCW related COVID-19 reported cases was created and enhanced by matching data extracted from media reports of healthcare related COVID-19 relevant outbreaks and reports, using matching criteria. Rates of infections and odds ratios (ORs) for HCW were calculated per state, by comparing overall cases to HCW cases. To investigate the sources of infection amongst HCW, transmission data were collated and graphed to show distribution of sources. Results: We identified 36 hospital outbreaks or HCW infection reports between January 25th and July 8th, 2020. According to our estimates, at least 536 HCW in Australia had been infected with COVID-19, comprising 6.03% of all reported infections. The rate of HCW infection was 90/100000 and of community infection 34/100,000. HCW were 2.69 times more likely to contract COVID-19 (95% CI 2.48 to 2.93; P < 0.001). The timing of hospital outbreaks did not always correspond to community peaks. Where data were available, a total of 131 HCW across 21 outbreaks led to 1656 HCW being furloughed for quarantine. In one outbreak, one hospital was closed and 1200 HCW quarantined. Conclusion: The study shows that HCW were at nearly 3 times the risk of infection. Of concern, this nearly tripling of risk occurred during a period of low community prevalence suggesting failures at multiple hazard levels including PPE policies within the work environment. Even in a country with relatively good control of COVID-19, HCW are at greater risk of infection than the general community and nosocomial outbreaks can have substantial effects on workforce capacity by the quarantine of numerous HCW during an outbreak. The occurrence of hospital outbreaks even when community incidence was low highlights the high risk setting that hospitals present. Australia faced a resurgence of COVID-19 after the study period, with multiple hospital outbreaks. We recommend formal reporting of HCW infections, testing protocols for nosocomial outbreaks, cohorting of workforce to minimize the impact, and improved PPE guidelines to provide precautionary and optimal protection for HCW.

Infectious disease dynamic modeling can support outbreak emergency responses. We conducted a workshop to canvas the needs of stakeholders in Australia for practical, real-time modeling tools for infectious disease emergencies. The workshop was attended by 29 participants who represented government, defense, general practice, and academia stakeholders. We found that modeling is underused in Australia and its potential is poorly understood by practitioners involved in epidemic responses. The development of better modeling tools is desired. Ideal modeling tools for operational use would be easy to use, clearly indicate underlying parameterization and assumptions, and assist with policy and decision making.

Objective: To understand the global outbreak surveillance needs of stakeholders involved in epidemic response in selected countries and areas in the Asia-Pacific region to inform development of an epidemic observatory, Epi-watch. Methods: We designed an online, semi-structured stakeholder questionnaire to collect information on global outbreak surveillance sources and limitations from participants who use epidemic intelligence and outbreak alert services in their work in government and nongovernment organizations in the Asia-Pacific region. Results: All respondents agreed that it was important to remain up to date with global outbreaks. The main reason cited for following global outbreak news was as an early warning for serious epidemics. Mainstream media and specialist Internet sources such as the World Health Organization (n = 54/91; 59%), the Program for Monitoring Emerging Diseases (ProMED)-mail (n = 45/91; 49%) and the United States Centers for Disease Control and Prevention (n = 31/91; 34%) were the most common sources for global outbreak news; rapid intelligence services such as HealthMap were less common (n = 9/91; 10%). Only 51% (n = 46/91) of respondents thought that their sources of outbreak news were timely and sufficient for their needs. Conclusion: For those who work in epidemic response, epidemic intelligence is important and widely used. Stakeholders are less aware of and less frequently use rapid sources such as HealthMap and rely more on validated but less timely traditional sources of disease surveillance. Users identified a need for more timely and reliable epidemic intelligence.

Background: Migrant travellers who return to their country of origin to visit family and friends (VFR) are less likely to seek travel-related medical care and are less likely to adhere to recommended medications and travel precautions. Through this study, we aimed to get an understanding of the views of stakeholders from community migrant centres and primary care providers on barriers for migrants, particularly from non-English speaking backgrounds, in accessing travel health advice and the strategies that could be used to engage them. Methods: A qualitative study involving 20 semi-structured interviews was undertaken in Sydney, Australia between January 2013 and September 2014. Thematic analysis was undertaken. Results: Language barriers, a lower perceived risk of travel-related infections and the financial costs of seeking pre-travel health care were nominated as being the key barriers impacting on the uptake of pre-travel health advice and precautions. To overcome pre-existing language barriers, participants advocated for the use of bilingual community educators, community radio, ethnic newspapers and posters in the dissemination of pre-travel health information. Conclusions: Travel is a major vector of importation of infectious diseases into Australia, and VFR travellers are at high risk of infection. Collaboration between the Government, primary care physicians, migrant community groups and migrants themselves is crucial if we are to be successful in reducing travel-related risks among this subgroup of travellers.

The urgent nature of epidemic infectious diseasesbring specific challenges in disease control. Epidemicscan cause immediate health, social and economicimpacts, and require complex cross-sectoral andglobal response as illustrated by the 2014 Ebolaepidemic. Travel and globalisation mean thatinfections spread rapidly around the world, so thatglobal solutions are required for epidemic control.Recent developments in artificially engineeredpathogens (dual-use research of concern) posean added complexity to global biosecurity. Globalsystems, thinking and capability in biosecurity haslagged behind quantum changes in science, leavingus more vulnerable than ever to infectious diseasesepidemics. This Centre addresses critical systems gaps in epidemic control.The NHMRC Centre for Research Excellence,Integrated Systems for Epidemic Response (ISER)conduct applied systems research, enhancecollaboration and build capacity in health systemsresearch for epidemic control. We bring togetherexperts in field epidemiology and epidemic response,military experts, international law and risk scienceexperts, and government and non-governmentagencies involved in epidemic response. The ARMNetwork for epidemic response is central to theCRE, with the co-founders all being part of theCRE. This Centre is international, with partnersin Australia, New Zealand, USA, China, Malaysiaand Indonesia who work together to solve globalproblems in epidemic response. A pillar of theCRE is ISER Academy, which is a think-tank andconvenor of important dialogue, capacity buildingand generation of ideas, between all stakeholdersand sectors involved in epidemic response.ISER is conducting research in three main areas:1) Epidemic response, control and prevention, 2)Epidemic intelligence and risk analysis and 3) theestablishment of the ISER academy, a think tank ofepidemic experts and stakeholders for the purposeof sharing information, collaboration and developingsolutions. This presentation will outline the workof ISER, the initial results of early research effortsacross the three main research areas, collaborationopportunities for military personnel interested inbioterrorism, biosecurity and epidemic responseresearch careers, and future directions for researchconducted by ISER.

The urgent nature of epidemic infectious diseasesbring specific challenges in disease control. Epidemicscan cause immediate health, social and economicimpacts, and require complex cross-sectoral andglobal response as illustrated by the 2014 Ebolaepidemic. Travel and globalisation mean thatinfections spread rapidly around the world, so thatglobal solutions are required for epidemic control.Recent developments in artificially engineeredpathogens (dual-use research of concern) posean added complexity to global biosecurity. Globalsystems, thinking and capability in biosecurity haslagged behind quantum changes in science, leavingus more vulnerable than ever to infectious diseasesepidemics. This Centre addresses critical systems gaps in epidemic control.The NHMRC Centre for Research Excellence,Integrated Systems for Epidemic Response (ISER)conduct applied systems research, enhancecollaboration and build capacity in health systemsresearch for epidemic control. We bring togetherexperts in field epidemiology and epidemic response,military experts, international law and risk scienceexperts, and government and non-governmentagencies involved in epidemic response. The ARMNetwork for epidemic response is central to theCRE, with the co-founders all being part of theCRE. This Centre is international, with partnersin Australia, New Zealand, USA, China, Malaysiaand Indonesia who work together to solve globalproblems in epidemic response. A pillar of theCRE is ISER Academy, which is a think-tank andconvenor of important dialogue, capacity buildingand generation of ideas, between all stakeholdersand sectors involved in epidemic response.ISER is conducting research in three main areas:1) Epidemic response, control and prevention, 2)Epidemic intelligence and risk analysis and 3) theestablishment of the ISER academy, a think tank ofepidemic experts and stakeholders for the purposeof sharing information, collaboration and developingsolutions. This presentation will outline the workof ISER, the initial results of early research effortsacross the three main research areas, collaborationopportunities for military personnel interested inbioterrorism, biosecurity and epidemic responseresearch careers, and future directions for researchconducted by ISER.