The US has bought most of the world’s remdesivir. Here’s what it means for the rest of us



Dimitri Karastelev/Unsplash, CC BY

Barbara Mintzes, University of Sydney and Ellen ‘t Hoen, University of Groningen

To beat the coronavirus pandemic, countries need to collaborate. We need the best possible science to develop vaccines and drugs, and to test, track and contain the virus. If we’ve learned anything from the rapid global spread of this virus, it’s that we’re all in this together.

It was therefore shocking to hear, on June 29, that the US government has bought more than 500,000 treatment courses of the antiviral drug remdesivir, representing manufacturer Gilead’s entire production capacity for the next three months and effectively excluding other countries from accessing this drug.




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The purchase raises concerns, not only about access to remdesivir in other countries, but more broadly about how to prevent profiteering from the COVID-19 pandemic.

Gilead announced its global price for remdesivir on June 29 as US$390 per vial. The Guardian has reported the cost to the US government will be US$3,200 for a six-day treatment. In contrast, production costs for remdesivir are estimated at 93 US cents for one day’s treatment, or less than US$6 for an entire course.

The profit motive

It was hardly a secret that Gilead was seeking to profit from its product. Earlier this year, it applied for seven years of “orphan drug exclusivity” for remdesivir – a status that extends a drug’s period of patent protection, and is meant to act as a regulatory incentive to develop drugs for rare diseases. If only COVID-19 were rare!

The US Food and Drug Administration granted the exclusivity 12 days after the World Health Organisation declared COVID-19 a pandemic. The move was met with strong criticism and Gilead has since rescinded the orphan drug status.

US consumer group Public Citizen estimates taxpayers in the US, Europe and Asia have contributed US$70.5 million in development costs for remdesivir. The list of US government grants is impressive and begs the question of whether remdesivir should be in the public domain. Instead, Gilead maintains a monopoly on sales, holding patents in many countries, the latest of which lasts until 2036.

Remdesivir’s revenue this year could be US$2.3 billion, which would make the drug a blockbuster.

We might criticise Gilead, but this is how commercial drug companies function – in non-pandemic times, at least. But it does call into question pharma’s lofty promises of ensuring “equitable global access” to COVID-19 treatments.




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Gilead and the billion-dollar odyssey


Is remdesivir worthwhile anyway?

If remdesivir doesn’t work, the US purchase would be a waste of money. The first report of benefit was a small follow-up study of 53 patients with no comparison group. This was followed by a more rigorous randomised controlled trial from China, published in the Lancet, in which remdesivir did not outperform placebo. However, fewer patients were recruited than anticipated.

A third, mainly publicly funded trial by the US National Institute of Allergy and Infectious Diseases found patients given remdesivir recovered four days earlier, on average, than those not treated with the drug. But it also found no statistically significant difference in death rate between the two groups.

That study was also stopped early, which can lead to exaggerated estimates of treatment benefits. A British Medical Journal editorial highlighted the study’s financial links to Gilead as another source of bias.




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More trials are ongoing, but until more evidence becomes available we really don’t know whether remdesivir significantly helps COVID-19 patients. If it does, it would be needed not only in the US but globally. Now Gilead’s supply is confined to the US, what can other countries do?

As a stopgap measure, Gilead has donated a stockpile of remdesivir to Australia, but it’s unclear whether this is a one-time-only act of generosity, or indeed why Gilead would donate its products to a wealthy country like Australia.

Bypass Gilead’s patents?

Gilead has voluntary licence agreements with manufacturers in Egypt, India and Pakistan to supply remdesivir to 127 lower-income countries. Under these agreements, Gilead allows generic manufacturers to produce remdesivir with specified conditions, such as limits on where it can be sold. A company in Bangladesh, where Gilead holds no patents, also produces generic remdesivir.

Where Gilead holds patents, countries could nevertheless gain access to generic remdesivir by issuing a compulsory licence. This is a recognised measure under both international trade law and the patent laws of many countries, including Australia. A compulsory licence grants the right to produce and sell a patented drug without the permission of the patent holder, both domestically and to other countries that have also issued a compulsory licence.

Boost international solidarity

The remdesivir saga highlights the need for greater international solidarity and a more public health-oriented approach to the development of new treatments. On June 1, 2020, the World Health Organisation addressed this by launching the COVID-19 Technology Access Pool (C-TAP), which offers a way to share knowledge and intellectual property in response to COVID-19.

Countries and charities spending billions of dollars on developing new vaccines and drugs should require that technologies developed with public funds are shared with C-TAP.

Unfortunately, Australia has not yet pledged its support to C-TAP. Perhaps the recent experience with remdesivir will help the government realise that an open and collaborative approach is a much-needed alternative to one country hoarding the world’s supply of an overpriced and largely unproven drug.The Conversation

Barbara Mintzes, Senior Lecturer, Faculty of Pharmacy, University of Sydney and Ellen ‘t Hoen, Global Health Law Fellow, University Medical Centre Groningen, University of Groningen

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Alert but not alarmed: what to make of new H1N1 swine flu with ‘pandemic potential’ found in China



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Ian M. Mackay, The University of Queensland

Researchers have found a new strain of flu virus with “pandemic potential” in China that can jump from pigs to humans, triggering a suite of worrying headlines.

It’s excellent this virus has been found early, and raising the alarm quickly allows virologists to swing into action developing new specific tests for this particular flu virus.

But it’s important to understand that, as yet, there is no evidence of human-to-human transmission of this particular virus. And while antibody tests found swine workers in China have had it in the past, there’s no evidence yet that it’s particularly deadly.




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What we know so far

China has a wonderful influenza surveillance system across all its provinces. They keep track of bird, human and swine flus because, as the researchers note in their paper, “systematic surveillance of influenza viruses in pigs is essential for early warning and preparedness for the next potential pandemic.”

In their influenza virus surveillance of pigs from 2011 to 2018, the researchers found what they called “a recently emerged genotype 4 (G4) reassortant Eurasian avian-like (EA) H1N1 virus.” In their paper, they call the virus G4 EA H1N1. It has been ticking over since 2013 and became the majority swine H1N1 virus in China in 2018.

In plain English, they discovered a new flu that’s a mix of our human H1N1 flu and an avian-based flu.

What’s interesting is antibody tests picked up that workers handling swine in these areas have been infected. Among those workers they tested, about 10% (35 people out of 338 tested) showed signs of having had the new G4 EA H1N1 virus in the past. People aged between 18 to 35 years old seemed more likely to have had it.

Of note, though, was that a small percentage of general household blood samples from people who were expected to have had little pig contact were also antibody positive (meaning they had the virus in the past).

Importantly, the researchers found no evidence yet of human-to-human transmission. They did find “efficient infectivity and aerosol transmission in ferrets” – meaning there’s evidence the new virus can spread by aerosol droplets from ferret to ferret (which we often use as surrogates for humans in flu studies). G4-infected ferrets became sick, lost weight and acquired lung damage, just like those infected with one of our seasonal human H1N1 flu strains.

They also found the virus can infect human airway cells. Most humans don’t already have antibodies to the G4 viruses meaning most people’s immune systems don’t have the necessary tools to prevent disease if they get infected by a G4 virus.

In summary, this virus has been around a few years, we know it can jump from pigs to humans and it ticks all the boxes to be what infectious disease scholars call a PPP — a potential pandemic pathogen.

If a human does get this new G4 EA H1N1 virus, how severe is it?

We don’t have much evidence to work with yet but it’s likely people who got these infections in the past didn’t find it too memorable. There’s not a huge amount of detail in the new paper but of the people the researchers sampled, none died from this virus.

There’s no sign this new virus has taken off or spread in the regions of China where it was found. China has excellent virus surveillance systems and right now we don’t need to panic.

The World Health Organisation has said it is keeping a close eye on these developments and “it also highlights that we cannot let down our guard on influenza”.




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What’s next?

People in my field — infectious disease research — are alert but not alarmed. New strains of flu do pop up from time to time and we need to be ready to respond when they do, watching carefully for signs of human-to-human transmission.

As far as I can tell, the specific tests we use for influenza in humans won’t identify this new G4 EA H1N1 virus, so we should design new tests and have them ready. Our general flu A screening test should work though.

In other words, we can tell if someone has what’s called “Influenza A” (one kind of flu virus we usually see in flu season) but that’s a catch-all term, and there are many strains of flu within that category. We don’t yet have a customised test to detect this new particular strain of flu identified in China. But we can make one quickly.

Being prepared at the laboratory level if we see strange upticks in influenza is essential and underscores the importance of pandemic planning, ongoing virus surveillance and comprehensive public health policies.

And as with all flus, our best defences are meticulous hand washing and keeping physical distance from others if you, or they, are at all unwell.The Conversation

Ian M. Mackay, Adjunct assistant professor, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why some people don’t want to take a COVID-19 test


Jane Williams, University of Sydney and Bridget Haire, UNSW

Last week, outgoing chief medical officer Brendan Murphy announced all returned travellers would be tested for COVID-19 before and after quarantine.

Some were surprised testing was not already required. Others were outraged some 30% of returned travellers in hotel quarantine in Victoria had declined to be tested.

This week, Victorian premier Daniel Andrews said more than 900 people in two Melbourne “hotspots” had declined door-to-door testing.

Again, there was outrage. People refusing COVID-19 tests were labelled selfish and rude.

A positive test result, together with contact tracing, gives public health authorities important information about the spread of SARS-CoV-2, the coronavirus that causes COVID-19, in a community.

So why might people at higher risk of a positive result be reluctant testers? And what can we do to improve testing rates?

The many reasons why

Reluctance to be tested for COVID-19 is not unique to returned travellers in hotel quarantine or people living in “hotspot” suburbs.

In the week ending June 28, FluTracking, a voluntary online surveillance system, reported only 46% of people with a fever and cough had gone for a COVID-19 test.

That can be for a variety of reasons.

A medical test result is not a neutral piece of information. People may refuse medical testing (if they have symptoms) or screening (if no symptoms) of any type because they want to avoid the consequences of a positive result.

Alternatively, they might want to avoid the perceived burden of the test procedure itself.

Reasons may relate to potentially losing money or work

Many reasons for avoiding testing are likely to be structural: a casualised workforce means fewer workers with sick leave and a higher burden associated with having to isolate while waiting for test results. After a COVID-19 test in NSW, for instance, this can take 24-72 hours.

Then there’s the issue of precarious work. If people can’t attend work, either waiting at home for test results or recovering from sickness, they may lose their job altogether.




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In the case of hotel quarantine, a positive result on day ten will mean a longer stay in isolation. Hotel quarantine is not an easy experience for many, particularly if quarantining alone.

An extension of time at a point where the end is in sight may be a very difficult proposition to stomach, such that avoiding testing is a preferable option.

Another structural issue is whether governments have done enough to reach linguistically diverse communities with public health advice, which Victoria’s chief health officer Brett Sutton recently admitted may be an issue.

Through no fault of their own, may people who don’t speak English as a first language, in Victoria or elsewhere, may not be getting COVID-19 health advice about symptoms, isolation or testing many of us take for granted.




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People might fear the procedure or live with past traumas

Reasons may be personal and include fear of the test procedure itself (or fear it will hurt their children), distrust in government or public health systems, and worry about the extent of public health department scrutiny a positive result will bring.

People may also feel unprepared and cautious in the case of door-knocking testing campaigns.

We can’t dismiss these concerns as paranoid. Fears of invasive procedures are associated with past trauma, such as sexual abuse.

People who have experienced discrimination and marginalisation may also be less likely to trust governments and health systems.

COVID-19 can also lead to social stigma, including blame and ostracism, even after recovery.

As with any health-related decision, people usually consider, consciously or not, whether benefits outweigh harms. If the benefit of a test is assumed to be low, particularly if symptoms are light or absent, the balance may tip to harms related to discomfort, lost income or diminished freedoms.

Should we force people to get tested?

Although federal and state laws can compel certain people to undergo testing under limited circumstances, acting chief medical officer Paul Kelly said it was “a last resort”.

Forcing a person to undergo a test contravenes that person’s right to bodily integrity. This is the right to make decisions about what happens to your own body, without outside coercion.

It also involves medical personnel having to override their professional responsibility to obtain voluntary and informed consent.

Some states have indicated they will introduce punishments for refusing testing. They include an extension of hotel quarantine and the potential for fines for people not willing to participate in community testing.




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Forced testing will backfire

We don’t think forced testing is the way to go. A heavy-handed approach can create an antagonistic and mistrustful relationship with public health institutions.

The current situation is not the only infectious disease emergency we will face. Removing barriers to participating in public health activities, in the immediate and long term, will enable people to comply with and help build trusted institutions. This is likely to create an enduring public good.

Victoria is trying to make testing easier. It is offering a test that takes a saliva sample rather than a nasal swab, which is widely perceived to be unpleasant.




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This may encourage parents to have their children tested. The test is less sensitive, however, so the gains in increased uptake may be lost in a larger number of false negatives (people who have the virus but test negative).

Ultimately, we need to understand why people refuse testing, and to refine public health approaches to testing that support individuals to make decisions in the public interest.The Conversation

Jane Williams, Researcher at the Centre for Values, Ethics and the Law in Medicine (VELiM), University of Sydney and Bridget Haire, Postdoctoral Research Fellow, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Victoria’s coronavirus contact tracers are already under the pump. What happens next?



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Gerard Fitzgerald, Queensland University of Technology

The emergence of significant community transmission of COVID-19 in Melbourne over the past week is greatly concerning to the whole of Australia.

Earlier this week, Victoria’s chief health officer Brett Sutton said the state was struggling to cope with the volume of contact tracing required for more than 2,500 people in self-isolation, who must have all their close contacts traced and contacted:

[…] we’re at the limits of managing that number.

Since then, the number of cases in Victoria has risen further still.

What options are available for increasing the pool of contact tracers in Victoria, or any other state that finds itself handling significant rises in COVID-19 cases?




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Remind me, what are contact tracers?

The key strategy to preventing further community transmission is to identify all cases through extensive testing, isolate people who test positive, and then trace their close contacts.

These contacts require initial testing to see if they are also potential spreaders, but more importantly they need to be isolated and closely monitored. Should they develop symptoms, they also need to be tested.

The process of identification of cases, ensuring isolation and monitoring, identifying contacts and following up each of those requires extensive effort.




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Every patient who tests positive needs to be interviewed to identify where they have been during the potentially infective stage of the disease, and who they may have come into contact with.

In some circumstances, this may be limited to family members, while in others it may involve following up others who may have been in the same locations, such as workplaces, restaurants, shops or public transport.

All these people need to be made aware of the risk and followed up. This is challenging in a free society. It requires cooperation from the community. It also requires understanding that some who may be spreading the disease are not aware they are doing so.




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This task is traditionally the role of public health workers — including doctors, nurses and those with specific public health qualifications — called contact tracers.

They are the real heroes of this effort, doing mundane work below the radar to keep the community protected.

In normal circumstances, these staff monitor diseases that are present in the community and identify and follow up notifiable disease such as measles, HIV, hepatitis or tuberculosis.

These public health workers have been working desperately hard for months and now those in Victoria are being asked to step up to the mark again.




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How can we expand the pool of contact tracers?

The public health workforce needs to be expanded rapidly to handle the increased workload. There are several ways to do this, some of which have already been implemented in Victoria.

We could reallocate people from other public health functions, which could immediately provide a ready and well-trained workforce.

But this will impact other vital public health protections, including surveillance of other disease, health promotion, screening, early diagnosis and intervention. Diverting staff from these efforts may also have long-term health consequences.




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Staff could be deployed from other agencies, including the Australian Defence Force.

While readily available and well-disciplined for the task, only some of these people have the necessary expertise to identify cases and trace contacts. Others may need to serve in support roles.

Options include calling in the Australian Defence Force to add to the pool of contact tracers (Department of Defence Australia).

Other states and territories could provide support. However, this may require people to relocate to Victoria with the personal disruption implied, as well as the enhanced risk to them and to their families and communities when they return.

This sharing of public health resources across state borders requires significant national cooperation, which has been evident in other parts of Australia’s COVID-19 response.

Finally, people may be recruited from the pool of partly trained people (public health students). While they may lack the practical skills, they will at least bring theoretical knowledge to perform some targeted tasks with specific training. For instance, they could work with experienced personnel to help maintain records or identify contacts.

We have a lot at stake

This new outbreak in Victoria threatens to overwhelm the system’s public health capacity. If that occurs, we can expect large numbers of deaths to follow. We are not there yet, but this outbreak in Victoria is placing the whole country at risk.

So public health workers need all the help and support the Australian community can provide.The Conversation

Gerard Fitzgerald, Emeritus Professor, School of Public Health, Queensland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Explainer: what’s the new coronavirus saliva test, and how does it work?


Deborah Williamson, The Peter Doherty Institute for Infection and Immunity; Allen Cheng, Monash University, and Sharon Lewin, The Peter Doherty Institute for Infection and Immunity

A cornerstone of containing the COVID-19 pandemic is widespread testing to identify cases and prevent new outbreaks emerging. This strategy is known as “test, trace and isolate”.

The standard test so far has been the swab test, in which a swab goes up your nose and to the back of your throat.

But an alternative method of specimen collection, using saliva, is being evaluated in Victoria and other parts of the world. It may have some benefits, even though it’s not as accurate.




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Saliva testing can reduce risks for health workers

The gold standard for detecting SARS-CoV-2 (the coronavirus that causes COVID-19) is a polymerase chain reaction (PCR). This tests for the genetic material of the virus, and is performed most commonly on a swab taken from the nose and throat, or from sputum (mucus from the lungs) in unwell patients.

In Australia, more than 2.5 million of these tests have been carried out since the start of the pandemic, contributing significantly to the control of the virus.

Although a nasal and throat swab is the preferred specimen for detecting the virus, PCR testing on saliva has recently been suggested as an alternative method. Several studies demonstrate the feasibility of this approach, including one conducted at the Doherty Institute (where the lead author of this article works). It used the existing PCR test, but examined saliva instead of nasal samples.




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The use of saliva has several advantages:

  • it is easier and less uncomfortable to take saliva than a swab

  • it may reduce the risk to health-care workers if they do not need to collect the sample

  • it reduces the consumption of personal protective equipment (PPE) and swabs. This is particularly important in settings where these might be in short supply.

But it’s not as sensitive

However, a recent meta-analysis (not yet peer-reviewed) has shown detection from saliva is less sensitive than a nasal swab, with a lower concentration of virus in saliva compared to swabs. It’s important to remember, though, this data is preliminary and must be treated with caution.

Nonetheless, this means saliva testing is likely to miss some cases of COVID-19. This was also shown in our recent study, which compared saliva and nasal swabs in more than 600 adults presenting to a COVID-19 screening clinic.

Of 39 people who tested positive via nasal swab, 87% were positive on saliva. The amount of virus was less in saliva than in the nasal swab. This most likely explains why testing saliva missed the virus in the other 13% of cases.

The laboratory test itself is the same as the PCR tests conducted on nasal swabs, just using saliva as an alternative specimen type. However, Australian laboratories operate under strict quality frameworks. To use saliva as a diagnostic specimen, each laboratory must verify saliva specimens are acceptably accurate when compared to swabs. This is done by testing a bank of known positive and negative saliva specimens and comparing the results with swabs taken from the same patients.

When could saliva testing be used?

In theory, there are several settings where saliva testing could play a role in the diagnosis of COVID-19. These may include:

  • places with limited staff to collect swabs or where high numbers of tests are required

  • settings where swabs and PPE may be in critically short supply

  • some children and other people for whom a nasal swab is difficult.

The use of saliva testing at a population level has not been done anywhere in the world. However, a pilot study is under way in the United Kingdom to test 14,000 health workers. The US Food and Drug Administration recently issued an emergency approval for a diagnostic test that involves home-collected saliva samples.

In Australia, the Victorian government is also piloting the collection of saliva in limited circumstances, alongside traditional swabbing approaches. This is to evaluate whether saliva collection is a useful approach to further expanding the considerable swab-based community testing occurring in response to the current outbreaks in Melbourne.




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A saliva test may be better than no test at all

Undoubtedly, saliva testing is less sensitive than a nasal swab for COVID-19 detection. But in the midst of a public health crisis, there is a strong argument that, in some instances, a test with moderately reduced sensitivity is better than no test at all.

The use of laboratory testing in these huge volumes as a public health strategy has not been tried for previous infectious diseases outbreaks. This has required a scaling up of laboratory capacity far beyond its usual purpose of diagnosing infection for clinical care. In the current absence of a vaccine, widespread testing for COVID-19 is likely to occur for the foreseeable future, with periods of intense testing required to respond to local outbreaks that will inevitably arise.

In addition to swab-free specimens like saliva, testing innovations include self-collected swabs (which has also been tested in Australia), and the use of batch testing of specimens. These approaches could complement established testing methods and may provide additional back-up for population-level screening to ensure testing is readily available to all who need it.


This article is supported by the Judith Neilson Institute for Journalism and Ideas.The Conversation

Deborah Williamson, Professor of Microbiology, The Peter Doherty Institute for Infection and Immunity; Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University, and Sharon Lewin, Director, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne and Royal Melbourne Hospital and Consultant Physician, Department of Infectious Diseases, Alfred Hospital and Monash University, The Peter Doherty Institute for Infection and Immunity

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Lockdown returns: how far can coronavirus measures go before they infringe on human rights?



DANIEL POCKETT/AAP

Stan Winford, RMIT University

As of this morning, ten “hot spot” postcodes in Melbourne’s suburbs have gone back into Stage 3 coronavirus lockdown.

In these suburbs, stay-at-home restrictions will be enforced by police patrols, “booze bus”-style barriers and random checks in transport corridors. In what Premier Daniel Andrews described as “extraordinary steps”, people moving in and out of these suburbs will be asked by police to identify themselves and provide one of four valid reasons for being out. Otherwise, they could face fines.

It seems likely that ever-more restrictive public health measures will be adopted should the coronavirus outbreak continue to worsen. With measures to protect public health competing with individual rights in what appears to be a zero-sum game, there are legitimate questions about how far the government can go before it reaches the outer limits of the law.




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Compulsory testing

In two suburbs of Melbourne, over 900 people have refused to be tested for coronavirus. The reasons vary, but include people being concerned about having to self-isolate and not understanding the dangers of the virus, as well as privacy reasons.

These refusals aren’t explicitly linked to increased transmission rates, but some disgruntled residents in locked-down suburbs and others have called for compulsory testing.

Existing laws already enable compulsory testing, but they have not yet been used. The March declaration of a human biosecurity emergency under the Biosecurity Act empowers the health minister to issue directions considered necessary to prevent or control the spread of coronavirus.

Under the act, these powers must not be used in a manner that is more restrictive and intrusive than necessary. However, there are few other obvious limits on these powers.

Door-to-door testing is now under way in parts of suburban Melbourne.
James Ross/AAP

The Victoria Public Health and Wellbeing Act 2008 gives the chief health officer the power to compel a person to take a test. To use this power, the officer must believe the person either

is infected with the infectious disease or has been exposed to the infectious disease in circumstances where a person is likely to contract the infectious disease.

Unlike the Commonwealth Biosecurity Act, this power seems constrained to being used as a measure of last resort. The Victorian act refers to the consideration of alternatives and a preference for the

measure which is the least restrictive of the rights of the person.

Such orders could be reviewed or challenged in the courts, but more practical challenges, including the need to have police present when conducting compulsory testing, may explain why this measure has not yet been used.

Quarantine restrictions

In the state of emergency currently in force in Victoria, the chief health officer also has the power to detain or restrict the movement of any person for as long as necessary to eliminate or reduce a serious risk to public health.

The hotel quarantine program relies on this power. While the chief health officer must review the need for the continued detention of people at least once every 24 hours, there are no other obvious limits on this power.

In practice, international travellers entering Victoria receive notices imposing a 14-day quarantine with permission to leave their hotel rooms only for medical care, where it is reasonably necessary for physical or mental health, on compassionate grounds, or if there is an emergency.




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The quarantine program in Victoria has been a clear failure, due to the alleged breaches of public health protocols.

An independent inquiry into the program is being conducted by retired judge Jennifer Coate, and Corrections Victoria will take over supervision of the program from the private security contractors who had been running it.

It is possible the newly appointed authorities – with prior experience managing prisoners – may adopt a more restrictive approach.

People detained under the new regime may find it more difficult, for example, to get permission to leave their rooms for supervised outdoor exercise. If this approach is disproportionate to the health risk, and causes or contributes to a person’s ill health, court action may ensue.

Possible infringements on human rights

Public authorities responsible for the management of people in quarantine must balance their role mitigating public health risks with their duty to protect the human rights of those in their care and custody.

In a civil society, fundamental freedoms and individual liberties are highly valued, and intrusive powers should be used only where necessary. In a state of emergency, some limitations of rights may be necessary, but any such limitation must be necessary, justifiable, proportionate and time-bound.

Unless it is overridden by parliament, the Victorian Charter of Human Rights and Responsibilities Act 2006 continues to apply during a state of emergency. Although no charter rights are absolute, this act has been used successfully by people challenging the conditions of their detention.

Governments across Australia have extraordinary emergency powers at their disposal, and have been prepared to use many of them in response to the pandemic. Although the courts have considered the impact of coronavirus on existing laws and procedures – such as the right to protest in the face of social-distancing measures and increased risks to the health of prisoners – they have yet to scrutinise some of the key public health measures adopted.

Despite the deference of courts to public health measures in the face of a deadly infectious disease, there are limits, and it seems inevitable that some limits will eventually be reached.

Returning overseas travellers have been forced to quarantine in hotels since early in the pandemic.
Scott Barbour/AAP

Questions over legitimacy

There are also limits to the effectiveness of these measures when people perceive them as unfair.

People obey laws and comply with rules when they see them as legitimate, not because they fear punishment. If the rules are unclear, or the process of developing them poorly explained, they may feel like postcode lottery to residents. This, in turn, could bring more dissatisfaction with lockdown measures and fail to effect behaviour change.

During times of emergency, it is critical powers with the potential to limit human rights and deprive people of liberty are properly communicated to the community and used with restraint.

This is not only important for the protection of individual rights, but also to prevent lasting damage to the rule of law. Ensuring that respect for human rights remains a central concern of government responses to the pandemic will build confidence and resilience in our communities and our institutions as we emerge from the crisis.




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The Conversation


Stan Winford, Associate Director, Centre for Innovative Justice, RMIT University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Eden-Monaro focus groups: Voters want government to cushion pandemic recovery path


Michelle Grattan, University of Canberra

Eden-Monaro voters are calling for a compassionate and empathetic recovery process as Australia emerges from the pandemic.

In focus group research conducted this week, ahead of Saturday’s byelection, the vast majority of participants favoured increasing the JobSeeker payment above the pre-COVID level, extending the JobKeeper wage subsidy scheme, and providing targeted help for areas hit hard by the summer fires and the impact of the coronavirus.

More surprising, almost all participants were willing to pay more tax to assist the economic and social recovery effort. Many were concerned about leaving debt for future generations.

This was the second round of online research by the University of Canberra’s Mark Evans and Max Halupka. Two groups, with 10 and nine participants respectively, were held on Monday and Tuesday. All but three participants had taken part in the research’s first round. Drawn widely from the diverse electorate, participants included aligned and swinging voters.

Focus group research taps into voters’ attitudes rather than being predictive of the outcome.

Both Scott Morrison and Anthony Albanese have been very active in the seat as voting day nears, although over the campaign as a whole Albanese has been on the ground much more than the PM. But the Liberals have invested heavily in an effort to wrest the seat – which is on a margin of under 1% – from Labor and increase the government’s parliamentary majority.

There was only marginal change in participants’ views on the key issues.

Top issues are: action on climate change, the federal government’s response to the bushfire crisis, job creation, better access to public health care, and addressing the high cost of living.

Climate change action continued to receive the greatest support when people were asked to nominate the one most important issue to them. Most participants saw a link between the bushfire crisis and the need for climate action.

People continued to be aggrieved at the Morrison government’s handling of the fire crisis, which they thought suffered from poor federal leadership, inadequate preparation and insufficient collaboration between federal and state government.

In the second round discussion, there was greater concern over economic recovery issues. “The economy looks weak so we will need good economic management and that tends to come from the Coalition,” a retired Coalition voter noted.

But there was some cynicism over the extra support the government has promised.

People saw Morrison’s announcement in Bega of a $86 million package for the forestry industry, wine producers and apple growers hit by the bushfires as “guilt money”. “It’s an obvious bribe – which might well work,” said a middle-aged hard Coalition supporter, while a female Greens voter described it as “a shameful example of logrolling”.

Most participants thought there would still be a bushfire backlash against the Coalition, despite Morrison’s announcement.

The government is hoping Morrison’s performance on the pandemic negates criticism of his handling of the fires.

Since their first discussion, people have cooled in their views of leaders’ management of the virus crisis. Morrison is now seen as the best performer, followed by NSW premier Gladys Berejiklian, a reversal from the first round.

Berejiklian’s poorer performance is attributed to general annoyance with the states and the perception they are acting “selfishly”. The vast majority of participants think Morrison “is handling the coronavirus outbreak competently and efficiently.” But people are worried by a second wave and cautious about re-opening too quickly.

Albanese is a distant third (the question about him was whether he was doing a good job holding the PM to account); his performance was rated more poorly in the second discussion compared with the first. He wasn’t impacting on the core political agenda: “he hasn’t got a plan,” said one participant.

The vast majority of participants, however, did not believe any party was offering a clear COVID-19 recovery plan and were surprised there hadn’t been a national conversation on the issue.

COVID-19 has constrained the usual forms of campaigning, and has led to a very high demand for postal votes. Participants perceived the Coalition had run a very traditional campaign using “old media”, while they thought Labor had run a “new media” campaign with more emphasis on social media platforms.

Both the major candidates are seen positively. Fiona Kotvojs (Liberal) was considered an “excellent” candidate even by Labor supporters. But several people suggested the intervention of senior Coalition figures in the campaign (Morrison and Payne) may have “reduced her community standing”. Labor’s Kristy McBain was considered a “really hard working” and a “very well liked” candidate by Coalition supporters.

But McBain was regarded as having run the better campaign.

When people were asked who they would vote for, the responses suggested a Labor victory and strong support for McBain. However there had been some attitudinal changes over the campaign.

There appeared to be a marginal increase in support for Cathy Griff (Greens) as the campaign neared its end and two independent candidates emerged from the woodwork – Narelle Storey (Christian Democratic Party) and Matthew Stadtmiller (Shooters, Fishers and Farmers) – during the discussion. That suggested the possibility certain soft Coalition voters might be exercising a protest vote against the government.

Some soft Coalition and Green voters might have moved to Labor and some soft Coalition voters to the Greens, but hard Coalition, Green and Labor voters looked to be remaining loyal.

Kotvojs’s well-resourced campaign appeared to be losing some momentum. But the participants continued to think the election – a straight Labor-Liberal battle despite a field of 14 candidates – would be very close.

This is a byelection where even seasoned watchers are wary of chancing their arm in advance of Saturday night.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

‘We are in a bubble that is set to burst’. Why urgent support must be given to domestic violence workers



http://www.shutterstock.com

Dr Naomi Pfitzner, Monash University; Jacqui True, Monash University; Kate Fitz-Gibbon, Monash University, and Silke Meyer, Monash University

During lockdown, we have seen an increase in demand for domestic violence services in Australia and around the world.

The United Nations recognised this problem in April, declaring a “shadow pandemic” of violence against women and girls.




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How do we keep family violence perpetrators ‘in view’ during the COVID-19 lockdown?


But while we look at specific supports to victims, we cannot forget the people who work to help them.

Our research highlights how we risk losing the essential workers on the frontlines of our domestic violence response, as a result of overwhelming workloads and potential burn out.

Thousands of workers involved

While there is no national data on the Australian domestic violence workforce, in Victoria alone there are around 3,000 specialist practitioners and an additional 30,000 workers who provide core support for, or interventions to address, domestic and family violence.

These include workers from specialist domestic violence services, men’s behaviour change services as well as child and family services.

A 2017 Victorian family violence workforce census revealed that almost one third of specialist practitioners were considering leaving their job due to burn out.

Our new research demonstrates why this is likely to be exacerbated by the pandemic.

Our research

In partnership with the Queensland Domestic Violence Services Network and Monash University’s Melbourne Experiment, we have surveyed Victorian and Queensland practitioners responding to violence against women during the COVID-19 restrictions.

COVID-19 has seen domestic violence support being delivered from people’s homes.
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This included 166 workers in Victoria and 56 and 117 workers over two surveys in Queensland.

As shutdown commenced in March, many services moved to remote delivery, with 73% of specialist practitioners in Queensland reporting they now worked from home.

This change resulted in frontline workers providing crisis counselling and conducting risk assessments and planning with traumatised and abused women from their homes. Often they were doing this incredibly challenging work from their living rooms.

The ‘shadow pandemic’

According to our recent surveys, the incidence and severity of domestic violence has increased in Australia during the COVID-19 restrictions. Over 50% of workers in Victoria reported an increase in the frequency and severity of domestic violence. These findings were mirrored in Queensland, with 70% of practitioners observing an escalation in the violence experienced by women in May.




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Reports of ‘revenge porn’ skyrocketed during lockdown, we must stop blaming victims for it


The pandemic conditions have also made providing support to victims more difficult and more complex. The lack of face-to-face services and the constant presence of perpetrators in victims’ homes limits workers’ ability to respond to violence. As one practitioner explained

You can’t see the hole in the wall, the bruise on her jaw, the fear in the kid’s eyes when dad’s name is mentioned.

Our Victorian and Queensland survey findings also showed during COVID-19, perpetrators have adapted their abusive behaviours, finding new opportunities to control and isolate their victims.

Frontline workers told us in some cases perpetrators are using the pandemic to force women into residing in homes with their abusers where there are children involved.

Perpetrators have also pressured women to wash their hands to the point they are experiencing cracks and bleeding, and have used the threat of COVID-19 infection to isolate women from friends, family and other supports.

Flow on effect to the workforce

Queensland domestic violence workers reported a decline in their mental well-being during April and May. More than 40% of practitioners surveyed in April said working during the pandemic was causing additional pressure and stress.

They tended to attribute this to their challenging work coming into their homes.

Frontline domestic violence workers say it has been difficult working from home during COVID-19.
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Queensland workers also revealed the transition to remote work alongside an increased demand for their services during COVID-19 has been harmful to their mental health.

I have already used a week of personal leave due to potential burn out. The impact on domestic violence workers needs to be considered by government.

Similar reports have emerged from Victorian workers. As one survey respondent explained

We are all working from home, which has been emotionally, extremely difficult. Having this work in my bedroom, my safe space, has been frankly awful and has wreaked havoc on my work/life balance and self-care routines. Most significantly of all, not being around my colleagues for support, guidance and debriefing has really been the worst.

Self-care strategies and well-being supports

Positively, some workers involved in the Queensland surveys talked about new self-care strategies developed during the lockdown. For example, many Queensland workers said their services had implemented regular online catch-ups and debriefing sessions to check in with staff and provide regular contact and support.




Read more:
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Other well-being supports shared in the Queensland surveys included dedicated counsellors to provide individual counselling services to workers and their families during the pandemic.

We need to protect these essential workers

Historically, there has been limited attention paid to the support needs of the domestic and family violence workforce, beyond a general emphasis on self-care in social work training.

Our research shows why this must change moving forward.

As Australia navigates the easing of restrictions in some locations, funding and resources must be increased to ensure the sector can meet the demands of the increasing number of women seeking help from violence.

Victoria and Queensland have already provided multi-million dollar emergency funding packages, to address increased demand on the sector and the scarcity of short-term accommodation for victims fleeing violence.

Equal investments are now needed to ensure the health and well-being of support workers now and into the future.

The specifics of what this entails should be decided in close consultation with the sector, but we note workers said they benefited from counselling for themselves and their families and flexible working conditions, including additional leave days.

Without dedicating the resources needed to support practitioners, we run the risk of seeing an exodus due to burn out in the coming months and years. As one practitioner warned

I feel like we are all in a bubble that is set to burst very soon, in terms of capacity. And when it does burst, I don’t know what it will look like but I know who will pay the ultimate price – victims.


If you or someone you know is impacted by sexual assault or family violence, call 1800RESPECT on 1800 737 732 or visit http://www.1800RESPECT.org.au. In an emergency, call 000.The Conversation

Dr Naomi Pfitzner, Postdoctoral Research fellow with the Monash Gender and Family Violence Prevention Centre, Monash University; Jacqui True, FASSA, Professor of Politics and International Relations, Director Monash Gender, Peace and Security Centre, Monash University; Kate Fitz-Gibbon, Director, Monash Gender and Family Violence Prevention Centre; Senior Lecturer in Criminology, Faculty of Arts, Monash University, and Silke Meyer, Associate Professor in Crimninology; Deputy Dircetor Monash Gender and Family Violence Prevention Centre, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

By persisting with COVIDSafe, Australia risks missing out on globally trusted contact tracing


Ritesh Chugh, CQUniversity Australia

Australia has ruled out abandoning the government’s COVIDSafe contact tracing app in favour of the rival “Gapple” model developed by Google and Apple, which is gaining widespread support around the world. Deputy Chief Medical Officer Nick Coatsworth told The Project the COVIDSafe app was “a great platform”.

In the two months since its launch, COVIDSafe has been downloaded just over 6.4 million times – well short of the government’s target of 40% of the Australian population.

Its adoption was plagued by privacy, security and backwards compatibility concerns, and further exacerbated by excessive battery consumption. And despite being described as a vital tool in the response to COVID-19, it is reportedly yet to identify a single infection that hadn’t already been tracked down by manual contact tracing.




Read more:
False positives, false negatives: it’s hard to say if the COVIDSafe app can overcome its shortcomings


It seems the app has failed to win the public’s trust. Software downloads are based on the perceptions of risk and anticipated benefits. In this scenario, the risks appear to outweigh the benefits, despite the dangers of a second coronavirus wave taking hold in our second most populous city.

COVID-19 cases in Melbourne continue to surge. But more broadly, the relatively low number of overall cases in Australia and the lack of adequate buy-in among the public make it difficult for COVIDSafe to make a meaningful contribution.

Is there another way?

Some 91% of Australians have a smartphone, whereas a rough calculation based on the 6.4 million downloads suggests only 28% have downloaded COVIDSafe.

For digital contact tracing to be effective, an uptake of around 60% of the population has been suggested – well beyond even the 40% target which COVIDSafe failed to hit.

The logic is straightforward: we need a system that 60% of people are willing and able to use. And such a system already exists.

Tech giants Apple and Google have collaboratively developed their own contact-tracing technology, dubbed the “Gapple” model.

How does Gapple work?

Gapple is not an app itself, but a framework that provides Bluetooth-based functionality by which contact tracing can work. Crucially, it has several features that lend it more privacy than COVIDSafe.

In simple terms, it allows Android and iOS (Apple) devices to communicate with one another using existing apps from health authorities, using a contact-tracing system built into the phones’ operating systems.

The system offers an opt-in exposure notification system that can alert users if they have been in close promixity to someone diagnosed with COVID-19.

Gapple’s exposure notification system.

Gapple’s decentralised exposure notification system offers more privacy and security than many other contact-tracing technologies, because:

  • it does not collect or track device location

  • data is collected on the users’ phones rather than a centralised server

  • it does not share users’ identities with other people, Apple or Google

  • health authorities do not have direct access to the data

  • users can continue to use the public health authority’s app without opting into the Gapple exposure notifications, and can turn the notification system off if they change their mind.

The system meets many of the basic principles of the American Civil Liberties Union’s criteria for technology-assisted contact tracing. And its exposure notification settings appear in recent updates of both Android and iOS devices. But without an app that uses the Gapple framework, the exposure notification system cannot be used.

COVID-19 Exposure Notification System.

Gapple going global

Global support for the Gapple model is growing. The United Kingdom, many parts of the United States, Switzerland, Latvia, Italy, Canada and Germany are abandoning their native contact-tracing technologies in favour of a model that could achieve much more widespread adoption worldwide.

The ease of communication between different devices will also make Gapple a crucial part of international contact tracing once borders are reopened in the future, and people start to travel.

In this light, it is hard to see why Australia resisted the calls to ditch COVIDSafe and adopt the Gapple model.

Can Australians use Gapple anyway?

No, they can’t, because the Gapple model requires users to download a native app from their region’s public health authority which uses the Gapple exposure notification system. Australia’s decision means that won’t be happening here any time soon.

In grappling with the dilemma between citizens’ civil rights and curbing the growth of the fatal COVID-19 virus, the Gapple model is a trade-off to encourage higher uptake of contact-tracing technologies.




Read more:
70% of people surveyed said they’d download a coronavirus app. Only 44% did. Why the gap?


Ultimately, the Gapple model will be a step forward in the world’s fight against COVID-19, because it will encourage significant numbers of people to use it.

The decision to persist with the COVIDSafe app, rather than adopting an emerging global model, could have severe repercussions for Australians. For any digital contact-tracing technology to work effectively, a large number of people must use it, and COVIDSafe has fallen short of that basic requirement.The Conversation

Ritesh Chugh, Senior Lecturer/Discipline Lead – Information Systems and Analysis, CQUniversity Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.