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Close the airports or pandemic influenza will fly in.

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Wednesday 29 August 2007

Athol Yates, Executive Director, Australian Homeland Security Research Centre


Close the airports or pandemic influenza will fly in

The recent deaths of six children and a 37-year-old to influenza is just a taste of what is to come this year. Several hundred people are likely to die from the disease and its most common complication - pneumonia.

This year, the influenza impact is far worse than in the recent past - with notifications more than double that of 2006.

The consequences of the seasonal influenza outbreak while tragic, are minuscule when compared with what would happen if there was a worldwide influenza pandemic.

For example, the influenza pandemic in 1918 and 1919 claimed over 20 million lives worldwide including 12,000 in Australia.

With today's population and population density, this outbreak could kill up to 200 million.

For the last few years, health authorities have been concerned that such a deadly pandemic influenza strain would appear.

This virus would most likely come from of a mutation of the prevalent H5N1 bird flu virus.

This virus can be transmitted to humans but only under conditions of very close contact with infected birds.

To date, 60% of the people known to be infected with H5N1 have died.

If a pandemic influenza strain did appear overseas, the most important action Australia could take would be to stop it from entering the country.

This would buy the time needed to mobilise health resources, create influenza clinics, and distribute personal protective equipment. So when mass sickness does occur, deaths will be minimised.

Border control measures will include requiring aircraft captains to declare the health of all people on board, requiring passengers to fill in health declaration cards, scanning passengers with thermal cameras to locate those with temperatures above 38C, deploying border nurses to make assessments of passengers, and transferring suspect cases to hospitals.

If you pass through the screening and return to your home and family but have come into contact with a person later identified as infected, health authorities will instigate contract tracing. This involves rapidly locating you, educating you about the disease, isolating you, and treating you as appropriate.

However the evidence from two recent experiences indicates that this list of border security measures will not be effective in keeping out the disease. This means that Australia's health officials will be faced with only one effective way to keep out the infection. That is, to stop international flights from arriving.

On 2 July, a passenger infected with polio arrived in Melbourne from Bangkok. The majority of the 238 people on the flight were tracked down quickly and given polio shots or placed in home quarantine.

However 15 passengers were never located. If the passenger was carrying the pandemic influenza variant, then these unlocatable people would have already introduced the virus into the Australian population.

A few months ago, Australia's largest ever health simulation exercise was held at Brisbane airport and at several other locations. The exercise included the arrival of a plane carrying 155 passengers from a fictitious country where pandemic influenza outbreaks had occurred. Passengers were screened, and where appropriate, quarantined, hospitalized and treated.

The lessons learnt from contract tracing were sobering. These included that there were difficulties in explaining to non-English speaking contacts, that the effort of tracking down passengers placed significant demands on staff who had to locate the contacts, and there were problems sustaining these efforts over several days.

These two incidents highlight the problems of dealing with just one infected person or one planeload. Imagine the effort required when there are multiple planes arriving from different infected countries simultaneously.

Given that there are about 50,000 inbound and outbound passengers a day in Australia, it is an almost certainty that infected people would slip through border control measures. And locating infected people before they had the time to introduce the virus into our cities, would be near impossible.

Consequently, the Australian Government's expectation that border control would contain the virus at the borders for a reasonable period of time is completely unrealistic. The only practical way of significantly delaying the spread of pandemic influenza is to suspend all air travel to Australia.

To be effective, a decision would have to be made within hours of an outbreak of a highly transmittable human to human infection occurring and where it is believed that the disease is not contained in quarantined areas.

Closing the airports would leave about 1 million Australians stranded overseas but it would save tens of thousands of Australian lives at home.

The decision to close our borders will probably be the toughest decision any Australian government will ever have to make.


Athol Yates  

Executive Director  

Australian Homeland Security Research Centre