Priorities of Pacific Island countries

Submission to inquiry into Australia’s response to the priorities of Pacific Island countries and the Pacific region

The George Institute for Global Health is pleased to provide a submission in response to the Joint Standing Committee on Foreign Affairs, Defence and Trade, through the Foreign Affairs and Aid Subcommittee (the Committee) inquiry into Australia’s response to the priorities of Pacific Island countries and the Pacific region.

With input based on our current work with partners in the region, our response highlights key health priorities for Pacific Island countries and communities.

Our submission focuses on achievable approaches to lowering preventable illness. 

People in the Pacific Island region are over represented in the global tally of deaths by preventable illness, non-communicable diseases (NCDs). The WHO Western Pacific Region, which includes 27 nations including the Pacific Island nations, recorded one quarter of total global deaths from NCDs. The four major NCDs–cardiovascular disease (CVD), cancers, chronic respiratory diseases, and diabetes–accounted for 12 million deaths in this region in 2019. Almost two thirds of deaths are linked to tobacco use, harmful use of alcohol, unhealthy diets, physical inactivity and air pollution.

High rates of NCDs have flow-on social and economic impacts. By lowering rates of NCDs, people will live more secure, more productive lives.

The summary of our recommendations is below. For full details please refer to the attachment.

Key recommendations

1. Leadership 

We urge Australia to: 

  • Continue to advocate for the expansion of Universal Health Care, particularly in low- and middle-income countries, and the integration of the prevention and treatment of NCDs into primary care systems. 
  • Advocate for and build partnerships to increase the funding available for NCDs in low- and middle-income countries to accelerate progress on the Sustainable Development Goals. 
  • Continue to encourage capacity building of people and communities with lived experience in designing and implementing aid programs. 
  • Prioritise programs that reduce out-of-pocket expenses for people with NCDs, to maximise the social and economic co-benefits. Promote the expertise, knowledge and leadership of Aboriginal and Torres Strait
  • Islander peoples and communities in connecting with Indigenous peoples and communities of the Pacific. 
  • Promote and support an integrated, life-course approach to addressing women’s health, embedding the prevention and management of NCDs into maternal and reproductive health programs to identify women at risk and reduce premature deaths. 
  • Prioritise programs that address commercial determinants of health, including the reducing tobacco use, alcohol consumption, unhealthy food consumption and inadequate physical activity. 

2. Increased investment 

Australia’s overseas development assistance is a vital tool to support countries in our region to achieve their development goals and contribute to the achievement of the global Sustainable Development Goals. We urge the Australian Government to: 

  • Increase its investment in health in Pacific Countries to prioritise programs that address NCDs and have social and economic co-benefits. 
  • Leverage ODA to drive greater private and philanthropic investment in NCDs in the region. 

3. Share knowledge and expertise 

Building knowledge and expertise within Pacific Island nations is essential to building a sustainable health workforce and developing local solutions to health and development challenges. We urge the Australian Government to: 

  • Expand its knowledge exchange and education programs.
  • Participate in knowledge exchange between First Nations Australians and Indigenous peoples of the Pacific. 
  • Partner with Pacific nations to boost the number of trained health workers and strengthen local training institutions.

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Policy Papers - 01/07/2024

Meet Associate Professor Cheryl Carcel, Head of the Brain Health Program in Australia

Cheryl Carcel began her career by studying medicine in the Philippines just over a decade ago. She joined The George Institute’s Sydney office as a study coordinator for the ENCHANTED stroke trial after being introduce to stroke specialist, Professor Craig Anderson. A practising neurologist, Cheryl now heads up the Institute’s brain research program in Australia, leading a team she calls ‘super researchers’.

Meet Dr Sonali Gnanenthiran, Research Fellow in the Cardiovascular Program

Sonali’s journey to cardiology was inspired by a very personal experience; when she was young, her father’s experience after a heart attack drove a desire to improve how cardiac patients and their families are treated in hospitals. Now a practising cardiologist at Concord Hospital in Sydney, Sonali is an award-winning researcher for her work in heart blockages. A combination of perfect timing and ideal opportunity in clinical trial research led her to The George Institute.

George institute team

George Institute team celebrates major achievement at global conference

The George Institute’s Critical Care Program team are celebrating an unprecedented achievement as authors, presenters and sponsors of two major global trials and three systematic reviews and meta-analysis - one using individual patient data - answering important treatment questions.

The Critical Care Reviews Meeting held in Belfast, Ireland from June 12-14 is one of the key events in the critical care calendar, highlighting major trial results and reviewing the best trials of the previous 12 months, regularly attracting attendees from 25 countries around the world.

Featuring throughout the program, the team’s research will help inform critical care treatment practice around the world, with the potential to save thousands of lives.

What is the best way to give antibiotics?

Changing the way antibiotics are given to adult patients with sepsis could save thousands of lives a year globally, according to new research sponsored by The George Institute. BLING (Beta-Lactam Infusion Group) III - one of the largest ever antibiotic randomised clinical trials - included more than 7000 patients in 104 hospitals across seven countries. 

Director, Professoriate, and critical care physician Professor John Myburgh said, “Giving antibiotics in this way maintains the levels in a patient’s blood and tissue, killing bacteria at a greater rate.” 

While the 2% lower rate of death was not statistically significant, it was clinically important, with one death prevented for every 50 patients treated. When the results were included in a systematic review and meta-analysis combining 18 studies and more than 9000 patients, continuous infusion showed a very significant benefit. 

Program Head, Critical Care, Associate Professor Naomi Hammond, co-first author of the combined analysis said, “The much larger additional analysis we conducted saw this benefit double, saving one life for every 26 patients treated, suggesting the practice should be widely adopted.” 

The BLING III trial and the systematic review and meta-analysis have been simultaneously presented and published in JAMA to coincide with the Critical Care Reviews meeting.

Does preventing ulcers with medication improve outcomes?

Critically ill patients are at greater risk of developing stress ulcers in the upper part of the gut, but why this happens is not fully understood. The development of these ulcers has been linked to an increased risk of death and longer stays in the intensive care unit (ICU) so today, most patients receive a type of medication called a proton pump inhibitor to prevent this. But this carries its own risk, with reports of a link to pneumonia and other types of infection, raising questions about the best treatment approach.

The Re-Evaluating the Inhibition of Stress Erosions (REVISE) trial was an international randomised blinded trial involving 4,821 critically ill patients on ventilators in 68 ICUs across eight countries.

Conducted by The George Institute for Global Health in collaboration with Canada’s McMaster University, the trial was designed to see if giving the proton pump inhibitor pantoprazole reduced rates of gastrointestinal bleeding and death from all causes after 90 days.

Researchers found that pantoprazole compared with placebo lowered the risk of clinically important upper gastrointestinal bleeding but did not influence mortality.

”While there was no change in mortality, reducing clinically important bleeding is an important patient centred finding supporting the use of proton pump inhibitors in this population,” said senior author Professor Simon Finfer, Professorial Fellow at The George Institute.

When these results were included in a systematic review and meta-analysis combining 12 trials and 9533 patients, the reduction in clinically important bleeding was confirmed with high certainty in the evidence.

The REVISE trial and the systematic review and meta-analysis have been simultaneously presented and published in NEJM and NEJM Evidence respectively. 

Is tightly managing blood glucose better for patients?

Reduced sensitivity to insulin and stress-related high blood glucose levels are common in acute and critical illness and can lead to worse outcomes. But previous research into whether tighter control of blood glucose is better for critically ill patients has shown mixed results. 

One possible explanation is that particular subgroups of patients may respond differently, but this hasn’t been studied in a randomised controlled trial.

The George Institute’s Critical Care team combined 20 trials and analysed individual patient data from over 14,000 critically ill adults that were randomly treated to achieve a lower or higher blood glucose target.

The research, simultaneously published in NEJM Evidence, showed that intensive glucose control was not associated with a lower risk of death, and in fact it increased the risk of dangerously low blood glucose levels. 

Professor Simon Finfer, who led the study said, “We didn’t find any subgroup of patients that benefitted from intensive glucose control.”

“These results support current guideline recommendations to accept a certain level of elevated blood glucose in critically ill patients,” he added.   
 

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