AGPN sets new course

AGPN sets new course for membership

Byron Kaye   9th Nov 2012

from MEDICAL OBSERVER www.medicalobserver.com.au

Dr Pearce said he was staying on the AGPN board to ensure general practice remained strong during the ML reforms.

THE AGPN will charge membership fees to discourage Medicare Locals from being members and will make a claim to remain part of United General Practice Australia, the GP who plans to resurrect the shelved divisions body said yesterday.

Victorian GP Dr Nick Demediuk was the only person to nominate for the board of AGPN at a small annual general meeting held on the sidelines of AML Alliance’s conference in Adelaide yesterday – he was instantly elected.

He said he hoped to turn AGPN into a national body for liaison and representation of general practice issues.

“We will bring in a membership fee of sorts,” he told MO. “Part of bringing in a membership fee will be to sort out the membership.

“If we bring in some sort of membership fee, some MLs will say ‘this is not our core business’ and they might actually drop out and leave a cleaner membership base for us to work with.”

He said that would include the ML of which he is chair. He is also on a division board but will step down.

Dr Demediuk said he envisaged returning AGPN to a major representative body which would sit alongside the AMA, the RACGP and AML Alliance “at the table of United General Practice”.

Dr Demediuk joins South Australian GP Dr Rod Pearce, already a director, on the AGPN board while two more directors who planned to leave, Dr Karen Stringer and Dr Tony Lembke, will stay to help the company get its board closer to its minimum of five. Dr Demediuk indicated he would try to change the organisation’s constitution to have the minimum reduced.

Dr Pearce said he was staying on the AGPN board to ensure general practice remained strong during the ML reforms.

AGPN has been a corporate shell since June when its general practice-centric business and funding streams moved to the broader primary health focused AML Alliance and its board failed in an attempt to get member backing to wind up.

Yesterday's meeting was the last for AGPN chair Dr Emil Djakic, whose term expired.

Nothing to hide!

When a Western Australian politician called a halt to the children’s influenza vaccination program in 2010 there were lots of questions needing answers.

• Why was it a politician not a scientist calling a halt to the program? 
• Why were children getting fevers from the vaccine? 
• Was it the Australian vaccine or all vaccines? 
• Why was the government vaccinating children in Western Australia and not elsewhere?

There was the inevitable backlash and chance for some crazy people to declare “all vaccines are evil” but the real issues was that vaccines for influenza and particularly children and influenza had been introduced into Western Australia (WA) because of three deaths from the influenza A in 2007. 

There was a push for ALL of Australia to get free influenza vaccines for children to the age of 5, partly because of the West’s experience but also international evidence that children are more prone to dying from ‘flu as well as the elderly, sick and pregnant. However the government decided it was not a “cost effective” program.

WA went ahead with the State Government and donated vaccines, in the urban area. It proved highly successful and with the help of the GP’s the coverage rate was more than 30% in the first year. Then the 2009 pandemic arrived, so it seemed like a really good idea BUT suddenly the kids were getting fevers and febrile convulsions. The scientists were talking about the reported cases; the Therapeutic Goods Administration (TGA) were aware of the issue and the politicians pulled the pin. Soon it was advised nationally to stop vaccinating kids under 5.

From the point of view of someone who supports vaccines, I think there is a case to make that an occasional side effect is worth putting up with if you are saving lives - BUT I want to know why these kids are getting fevers more than other years and why the Australian vaccine (made by CSL in Australia) seemed to be the problem. It has taken a couple of years to find out why and even in 2012 the “working hypothesis” was “due in part to heat labile, viral-derived components from the new strains used in the 2010 southern hemisphere season” (Scientific Investigations into Febrile Reactions Observed in the Paediatric population Following Vaccination with a 2010 Southern Hemisphere Trivalent Influenza Vaccine. Eugene Maraskovsky)

I am pleased the cause seems to be now evident and discussed. When things go wrong with vaccines we need to be able to talk about it. There should be nothing to hide.

In the 1970's, a Swine Flu vaccine was blamed for causing more problems than the disease. It did cause problems. The vaccine was associated with a condition called Guillain-Barre syndrome (GBS), a paralyzing neuromuscular disorder.

As part of a $137 million plan to immunize every man, woman and child in the US to prevent a pandemic like the Spanish Flu (that killed half a million people in the U.S. and as many as 50 million worldwide), more than 500 people developed GBS and at least 25 people died from this side effect of the vaccine. It triggered a public backlash against flu vaccinations.

This is perfectly understandable if authorities try to keep this information quiet.

Even today there are lots of stories about the terrible effects of vaccinations.  Vaccines save lives but can cause side effects. Vaccines used in Australia now are safer than ones we used 20 years ago, and they are 1000’s of times safer than getting the diseases like polio, measles, diphtheria.

As a measure of the concern about safety in Australia and the vaccine we use, we changed from the oral polio vaccine that cause vaccine-associated paralytic poliomyelitis (VAPP) in about 1 in a million vaccines. The new vaccine will cause problems in about 1 in 14 million vaccinations, and the risk of catching polio is low in Australia.

We also changed our triple antigen from the old “whole cell” vaccine in the whooping cough (pertussis) component to the less painful “acellular” vaccine. This is also an interesting story because we have had recent outbreaks of whooping cough and we now wonder if the safer, less painful vaccine might not be as effective as the old painful one

Either way, my thought are that there is nothing to hide, or should be nothing to hide. As we talk about the risks of catching diseases like the ‘flu, whooping cough, measles we should be talking about the benefits of our vaccines, how safe they are and if there is a problem we should disclose what we know straight away.  It has been hard for us here in Australia to find out that one of our vaccines (made in Australia by an Australian company) causes fever in children, but we know it is still good in adults and it can still save lives (like vaccinating pregnant women).

It is also important to lean from anything like this that happens. In Australia we have a better working relationship now between the scientists and the politicians about our vaccination programs; we have had a review of some of the regulators (e.g. TGA) and most people think it will be working better now. We know what causes the fever in children with the Australian vaccine and we may be able to use that knowledge to develop tests that could check future strains of influenza vaccines to make sure they have fewer side effects.

Let’s keep it that we have nothing to hide from the people who will be getting vaccinations, who will be paying for them through their taxes and who need to be confident they are being kept informed about what is going on.

Welcome to my first BLOG!

I have just travelled to Germany for the first time to attend "Incidence, severity, and Impact: An international conference on seasonal and Pandemic Influenza"

I had heard lots about how the swine flu was not as bad as predicted but at the same time just about every developed country described how it had presented and as one person at the meeting stated 'Try telling the intensive care staff that it was a mild pandemic.'

The last pitch of medical treatment in the most advanced countries in the world is to do the breathing for the patient via a machine. Not just oxygen in and out of the lungs but taking the blood out of the body, bubbling oxygen through the blood until the red cells have enough oxygen to keep the patient alive. Wow!  Australia used every machine available, and used ALL its capacity at once.

I now understand how complicated the question is from someone asking 'is this year going to be a bad 'flu' season'.In 2009 the first estimates of the death rates were 4%. The Case Fatality Rate (CFR) was then reviewed again as more information became available and the CFR was closer to 0.4%. A review of all cases in NZ came up with specific details of around 0.04%. Most of us remember  the first scary news from Mexico (1 in 25 people will die), less bad news from USA (1 in 250 who get influenza will die) then the realization that is was closer to 1 in 2,500 people were dying. Having been through the whole thing, most of us have pandemic fatigue!

My own view is that we could improve on what happened and perhaps we did 'dodge a bullet'. However I look on the WHO messages and original 'scary figures' like a weather forecast. My Mum would always want to know what the weather would be for Christmas. Ask 6 months out and get an answer with a number that is barely useful. These days, a week out, you can get a good guess. So as weather forecasting has got better, the forecasting of pandemics has got better because of what happened in 2009. The conference was good because it showed there is lots of science, good people and good thinking behind the scenes with influenza forecasting.

I have enjoyed my time in Germany, and perhaps knowing they have trains that run late, don't crop their lawns to perfection, make good food and great beer and are lovely people - reminds me 'we are all human' and we will all benefit from getting pandemic predictions better.