Introductory speech at the H5N1: Are We Prepared? Forum

Transcript of a speech given at the H5N1: Are We Prepared? Forum, Canberra, 1 November 2012.

I acknowledge the traditional custodians of the land, the Ngunnawal people and pay my respects to their Elders past and present.

I’m honoured to be jointly hosting this forum on H5N1 today with the Bill & Melinda Gates Foundation.

Thank you to Dr Niteen Wairagkar, Professor Yoshihiro Kawaoka and Professor Derek Smith for making a special effort to be here.

I’d also like to thank Professor Anne Kelso and Professor Mark von Itzstein for being on the forum’s Scientific Advisory Committee.

Ms Jane Halton, Secretary of the Department of Health and Ageing

NHMRC Council and Principal Committee members

Purpose of today

We meet today to:

Develop a greater awareness of the knowledge gaps that exist in H5N1 research, and discuss possible ways forward for addressing these.

Lay foundation blocks for establishing global collaborations in H5N1 research.

The Gates Foundation – overview

The Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives.

The Foundation’s maxim is: “Every person deserves the chance to live a healthy productive life.”

The Foundation is led by CEO Jeff Raikes and Co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett.

The main way in which the Foundation goes about achieving its goals is through its grantmaking activities.

The Foundation’s three primary grantmaking programs are:

  • Global Development;
  • Global Health; and
  • United States.

Since it was founded in 1994, the Foundation has allocated over $26.2 billion in grant funding.

This includes over $3.6 billion through its Global Development program and $15.3 billion through its Global Health program.

The Foundation’s Global Health program has a number of priority areas, including:

  • Pneumonia;
  • Maternal, neonatal and child health; and
  • Neglected diseases and vaccines.

Through its efforts on vaccine discovery, development and delivery, the Foundation aims to immunize 90 per cent of children against diseases like measles, pneumococcal pneumonia, and rotavirus by 2025.

How this forum came about

Before I provide an overview of Australia and NHMRC’s efforts in the area of virology and influenza research, I’d like to talk about how this forum came about.

On a trip to London earlier this year I was approached by Dr Doug Holtzman, then Senior Program Officer in Infectious Diseases Development with the Bill & Melinda Gates Foundation.

Doug spoke passionately about the incredible research the Gates Foundation had funded on H5N1, and we will hear some of the outcomes of that research today.

Doug also spoke about how so much more could be done in the Asia-Pacific region to manage this ever-present threat.

Doug has since left the Gates Foundation, but I am pleased to welcome Dr Niteen Wairagkar who is here today to represent the Gates Foundation.


Australia boasts some outstanding achievements in virology and influenza research.

These achievements were accomplished by some remarkable Australian scientists, some of whom are here today.

I’d like to make special mention of Professor Mark von Itzstein, who will be speaking today, developed the anti-influenza drug, Relenza.

Professor Itzstein and his colleagues Doctors Laver and Colman won the Australia Prize in 1996 for their research into the surface proteins of the influenza virus that led to better flu vaccines.

This work continues with Professor Itzstein and his team from Griffith University successful in the 19 October grant announcement with a project grant.

  • Title: Exploring the haemagglutinin-neuraminidase of human parainfluenza virus
  • Amount: $706,029

Another Australian scientist who made a significant contribution to this field is Professor Peter Doherty.

Professor Doherty is unfortunately overseas and could not attend today’s forum.

Professor Doherty won a Nobel Prize in 1996 jointly with Professor Rolf Zinkernagel for their discoveries of how the immune system recognises virus-infected cells.

NHMRC is proud to have supported their work over the years.

Overview of H5N1

About four decades back, virologists and epidemiologists began to understand that the influenza A viruses, that can be so dangerous to humans, are maintained primarily in waterfowl.

This finding has profound implications for human and animal disease.

The massive increase in both the human and domestic chicken population since the mid-20th century influences the interaction between birds and humans.

H5N1 avian influenza is an infectious disease of birds that can be spread to people, but is difficult to transmit from person to person.

Tens of millions of birds have died of H5N1 influenza and hundreds of millions of birds have been slaughtered and disposed of, to limit the spread of H5N1.

Although highly pathogenic, avian influenza virus infection of humans is rare, with only sporadic cases of human infection being reported.

Almost all people with H5N1 infection have had close contact with infected birds or H5N1-contaminated environments.

The first known human infection of H5N1 was detected in a three year old boy from Hong Kong in 1997.

Current situation

Between November 2003 and August 2012, 608 human highly pathogenic avian influenza virus of type A of subtype H5N1 and H5N1 cases have been reported to the World Health Organisation (WHO) from 15 countries in Asia, Africa, the Pacific, Europe and the Near East.

  • 359 of those infected have died; a 60% death rate.
  • Indonesia, Vietnam and Egypt have reported the highest number of human HPAI H5N1 cases to date.

Potential impact of a H5N1 pandemic

If a H5N1 pandemic were to occur, the economic impact on the Asia-Pacific region would be significant:

  • For example, the 2002-03 SARS pandemic cost approximately US$40 billion and crippled tourism in the Asia-Pacific region.
  • GDP also fell by 2% in Asia over a three month period in 2003, that was attributed to SARS.

NHMRC funding on H5N1 research

  • NHMRC has been active in funding influenza research.
  • I want to give you a few examples.
  • H5N1 Urgent Call for Research (UCR) in 2006:
  • 33 grants worth $6.5 million were awarded.
  • Research was aimed at preventing detecting or controlling avian influenza.

H5N1 UCR outcome example 1:

CIA: Dr Tuckweng Kok
Institution: University of Adelaide
Funding: $425,400
Title: Rapid Point-of-Care detection of Avian Influenza virus using Ion-Channel Switch Biosensor
Developed a specific monoclonal antibody to H5N1 using inactivated virus.
This monoclonal antibody will next be used in the construction of a H5N1-specific biosensor assay to detect Bird Flu.

H5N1 UCR outcome example 2:

CIA: Professor Michael Parker
Institution: St Vincent’s Institute of Medical Research
Funding: $87,250
Title: Molecular basis of potential resistance of neuraminidase inhibitors
Developed a new method to produce large scale quantities of an essential avian flu protein, Neuraminidase 1 (N1), without the need to use live virus at any stage.
This protein has been made into crystals – the first step to determining the detailed three-dimensional atomic structure of N1.

NHMRC work on H1N1 research

H1N1 Urgent Call for Research in 2009

  • 41 grants worth just under $7 million were awarded.
  • This UCR was for public health and medical research proposals that aimed to rapidly inform and advance Australian strategies to prevent, prepare for and respond to a potential H1N1 Influenza pandemic and inform the development of public policy.

H1N1 UCR outcome example 1:

CIA: Professor Terry Nolan
Institution: University of Melbourne
Funding: $60,712
Title: Immunity to novel H1N1 influenza prior to and after immunization with seasonable TIV in children aged 6 months to 9 years
Tested immunity to H1N1 in children who had not previously received seasonal influenza vaccines following two doses of the 2009 Southern Hemisphere ‘seasonal’ trivalent influenza vaccine (TIV)
Study confirmed that seasonal influenza vaccines did not produce antibodies in children that would protect them against H1N1.

H1N1 UCR outcome example 2:

CIA: Professor Gerard FitzGerald
Institution: Queensland University of Technology
Funding: $108,258
Title: Emergency Department impact and patient profile of H1N1 Influenza 09 outbreak in Australia: a national survey
Surveyed the impact of the H1N1 pandemic on Emergency Departments (ED) around Australia including impact on individuals and their work.
Findings included a low level of awareness of pandemic plans amongst staff; the design of EDs was inadequate for the management of infectious patients; the need to establish fever clinics that reduce burden on EDs.

NHMRC work on other influenza research

  • MOU in 2011 between NHMRC and A*STAR, Singapore, for collaborative research.
  • First grant call was for utilising integrative technologies to combat emerging infectious diseases.
  • Grant call outcome expected to be announced by the end of this year.
  • So far this year, total NHMRC expenditure on influenza research has amounted to nearly $7 million.

I’m very pleased that Professor Lorena Brown is able to join us today to talk about her work, which involves tracking H5N1, having entered an animal model body through different entry points.

Professor Brown and her team were featured in this year’s NHMRC Ten of the Best Research Projects for this work on H5N1.

Purpose of H5N1 forum

We’re here to explore two primary questions:

  • Are we prepared for a possible H5N1 epidemic in the Asia-Pacific region?
  • What would Australia be able to do to help in the event of an epidemic occurring?

Recent findings that have occurred in the field of H5N1 research have created the impetus for greater examination of these questions, including:

  • Professor Yoshihiro Kawaoka’s research, which demonstrated that certain genetic alterations in H5N1 could increase its transmissibility between ferrets.
  • Professor Derek Smith’s research, which showed the potential for H5N1 to mutate and adapt to other hosts.

Today also offers us the opportunity to hear about different work that is happening around the world on H5N1 and share knowledge on this subject.

Discuss recent developments in H5N1 research, their implications for public health and health policy and how this information can be used effectively to prepare the Asia-Pacific region for future pandemics.

Implications of H5N1 research: dual use

While the intention of research into H5N1 is one of benefiting human health, concerns have arisen that knowledge and material produced in the course of research activity might be re-purposed against human interests.

Discussion about this will no doubt lead us to the Australian Code for the Responsible Conduct of Research (The Code), whether a supplement should be added to deal with issues of dual-use and if so, what shape that supplement should take.

As you’re all aware, the Code was developed in 2007 by NHMRC, the Australian Research Council and Universities Australia.

The Code provides guidance to institutions and researchers about responsible research practices.

Currently, research in Australia involving highly infectious agents is regulated under the Security Sensitive Biological Agents Regulatory Scheme.

It is also a requirement that research of this nature is conducted at the world-class biosecurity facility in Geelong, the CSIRO-Australian Animal Health Laboratories.

As a result of these precautions, the risk of knowledge and material produced through H5N1 research being misused or entering the environment is considerably reduced.

Expected outcomes of the H5N1 forum

Develop a greater awareness of the knowledge gaps that exist in H5N1 research, and discuss possible ways forward for addressing these.

Lay foundation blocks for establishing global collaborations in H5N1 research.