Associate Professor Lesley Russell has a longstanding interest in infectious diseases – dating back to her post-doctoral studies – and below takes a deep dive into related topics, from outbreaks of diphtheria to Ebola and Hantavirus.
She also investigates global preparedness for such outbreaks, reports on the latest from the Trump Administration, and reviews recent developments in tackling tobacco and vaping.
The quotable?
…it is important to remember that health security affects national security and economic security.”
Lesley Russell writes:
I’m back on board at The Health Wrap after a marvellous hiking trip in the Dordogne Valley and a few days in Paris.
We had perfect spring weather, there were masses of meadow flowers, fields of scarlet poppies, and old-fashioned, sweet-smelling roses tumbling over old stone walls everywhere. We feasted on wonderful breads and pastries, foie gras, duck and guinea fowl, local freshwater fish and seasonal white asparagus and strawberries.
And we were constantly surrounded by history in an area where people have lived since Upper Paleolithic times (for some 35,000 years).
Infectious disease concerns
The Global Preparedness Monitoring Board of the World Health Organization, which was created eight years ago to “help ensure the world would never again experience a devastating crisis like the West African Ebola epidemic,” has just produced a report, A World on the Edge: Priorities for a pandemic-resilient future.
This finds that the risk of a major new pandemic has skyrocketed, but investment and measures to address a threat of this magnitude have stagnated or diminished.
In a recent interview, epidemiologist Richard Hatchett, the executive director of the Coalition for Epidemic Preparedness Innovations (CEPI), said this: “Cuts to emergency health preparedness and the progressive and systemic underfunding of public health, and especially infectious disease surveillance worldwide, are eroding our capacity to prepare for a potential pandemic.
“I understand that we are in a period of many simultaneous crises and that the fiscal space governments have to allocate funds to this type of work is becoming more constrained. But it is important to remember that health security affects national security and economic security.”
It’s interesting that Trump Administration health officials (many of whom were vocal opponents of COVID-19 public health restrictions), now confronted by overlapping outbreaks of Ebola and Hantavirus, are taking quite an aggressive approach to locking down potentially exposed people.
See also Hantavirus and Ebola outbreaks need a One Health research approach in Croakey Health Media.
Ebola outbreak
At the time of writing (24 May), the outbreak of Ebola in the Democratic Republic of the Congo (DRC) is one of the largest on record, with 958 suspected cases and 177 suspected deaths. New cases have also been reported in Uganda.
The World Health Organization has declared the outbreak a “public health emergency of international concern”.
The outbreak involves the rare Bundibugyo strain of Ebola, for which there is no approved vaccine or treatment although there are now galvanised efforts to develop an effective vaccine. The Oxford Vaccine Group has announced it is working to rapidly produce and scale doses of a monovalent Bundibugyo Ebola virus candidate vaccine.
Genome sequencing work shows that the current outbreaks in both the DRC and Uganda are different from previous outbreaks of the Bundibugyo strain in Uganda in 2007.
The outbreak began in the mining province of Ituri in the DRC and infected people later travelled out of the area seeking treatment, thus spreading the disease which has now reached the capital, Kinshasa.
The Africa CDC warns that population movements, weak healthcare infrastructure and violence by armed groups in Ituri could complicate containment efforts.
There are significant public health international concerns because this outbreak was not quickly recognised and acted upon. Containing Ebola outbreaks traditionally relies on tracing cases and isolating those who are infected.
The United States used to fund robust disease surveillance networks across this region and maintained emergency teams to take charge in public health crises like this one.
But most of this work ended with the shutdown of the US Agency for International Development and cutbacks at the Centers for Disease Control and Prevention.
A National Institutes of Health laboratory specifically designed for Ebola work was closed last year and expert staff were laid off.
President Trump says he is “concerned” about Ebola (whatever that means). The White House allegedly resisted the return home of an American doctor with Ebola who was ultimately flown to Germany for treatment.
With an appropriate vaccine months, if not years away, American health officials are working with a small biotech company to provide an experimental treatment (a monoclonal antibody) that may be used in patients exposed to Ebola.
With small levels of production and substantial costs, this approach is clearly designed to help only those from wealthy countries.
Hantavirus observations
It’s fair to say that the behaviours of a significant number of countries, in the wake of the disembarkation of passengers from the cruise ship that experienced a fatal outbreak of the Andes strain of Hantavirus, serve to highlight how little has been learned about international pandemic controls.
The virus’ transmission dynamics means that this outbreak is not going to become the next pandemic, but nevertheless its long incubation period (up to 42 days) means that appropriate precautions must be taken.
In a number of cases related to this outbreak, people who might have been infected were allowed to travel without any precautionary measures to reduce airborne transmission.
An article in El Pais outlines the measures taken by Spain, France and several other European countries.
An article in MedPage Today highlights the lack of coordination between the CDC and the WHO.
In the United States, the news about the Hanta infections soon meant that social media was spreading rumours, speculation, and falsehoods. Of course these included claims about ivermectin as a treatment for the infection.
On 23 May, Secretary of Health and Human Services, Robert F Kennedy Jr, announced that he had signed a targeted declaration to support the development and deployment of medical countermeasures related to the Andes Hantavirus, noting specifically that this did not include the development of a new mRNA vaccine.
The report of the Andes Virus Outbreak Working Group, published in The New England Journal of Medicine, is here.
See also World Health Organization calls for global solidarity on Hantavirus in Croakey Health Media.
Australia’s growing outbreak of diphtheria
Australia is facing the worst diphtheria outbreak in decades. As of 19 May, there have been 223 diphtheria notifications: these include 133 cases in the Northern Territory, 79 cases in Western Australia, six cases in South Australia and five cases in Queensland (data from the Australian Centre for Disease Control report).
The majority have been cases of cutaneous diphtheria, but around 30 percent have been more serious respiratory infections. The vast majority (94 percent) have been Indigenous Australians.
Factors contributing to this outbreak include low immunisation rates, the prevalence of skin infections in affected communities, overcrowding in housing and limited access to healthcare services.
As pointed out in an article in The Australian, this outbreak of a disease assumed to be almost eradicated is an indictment of our ability to provide healthcare and safe living conditions for Indigenous Australians, especially those living in remote areas.
This same article points out that the issue of vaccination is more complicated than the growing vaccine hesitancy seen nationally: Aboriginal and Torres Strait Islander children actually have a slightly higher rate of five-year-old vaccination than children in the nation as a whole. But Indigenous adults have low midlife immunity and low booster vaccination rates.
This is an issue of importance and fascination for me that goes well beyond my concerns about the failures in efforts to Close the Gap that have led to this outbreak. My post-doctoral research, conducted in the laboratories of the US Uniformed Services University of the Health Sciences in Bethesda, Maryland, was on the regulation of toxigenicity in Corynebacterium diphtheriae.
C. diphtheriae produces the diphtheria toxin only after it is infected by a virus-like corynebacteriophage that carries the tox gene. This gene is regulated by iron.
A search of the literature reveals that in Australia non-toxigenic C. diphtheriae (often found as commensals on the skin) typically do not become toxigenic strains by the introduction of the phage but rather, the emergence of toxigenic C. diphtheriae is due to the introduction and spread of distinct, highly related bacterial strains that already carry the toxin gene (see, for example, this paper: Characterization of Corynebacterium diphtheriae Isolates from Infected Skin Lesions in the Northern Territory of Australia).
It can be assumed that these toxigenic strains were imported by migrants or travellers from areas in South Asia, Southeast Asia, Africa, and parts of South America where the strains are endemic.
The Albanese Government has now announced a $7.2 million package to support the Northern Territory Government, and the Aboriginal Community Controlled Health Sector response to the diphtheria outbreak.
Further information:
- Donna Ah Chee in The Guardian: Diphtheria is a disease of poverty that has no place in modern Australia. When we talk about Closing the Gap, this is the gap
- The National Indigenous Times: Diphtheria cases linked to West Kimberley prison as outbreak continues to affect regional WA
- The Conversation: Australia is battling its worst diphtheria outbreak in decades but vaccines could curb it.
- The Conversation: Deep‑rooted inequalities are driving the latest diphtheria outbreak. But we can fix them.
- Croakey Health Media: Diphtheria outbreak underscores need for better investment in community-controlled health.
As a concluding aside: this infection does threaten the unvaccinated, non-Indigenous population – along with growing rates of measles and pertussis.
“Dangerous neglect”
An obvious reflection after reading the sections above is that the whole world is affected by the withdrawal of the United States as an international leader in the science, public health control and funding of infectious diseases.
Former CDC Director Tom Frieden, who led the agency during the 2014–2016 Ebola outbreak in Africa, said that the dismantlement of USAID, the withdrawal from the WHO and deep cuts to CDC staff have delivered a “1-2-3 punch to global health architecture.”
Democratic Congresswoman Rosa DeLauro, who is the ranking member on the House Appropriations Committee said: “This is the perfect storm President Trump created. He recklessly dismantled the US Agency for International Development, withheld and slashed other United States assistance to the region, fired critical staff, and created global health chaos.
“This is not efficiency. It is dangerous neglect. The United States spent years building the relationships, supply chains, laboratories, and community health networks that help stop deadly diseases at their source. The Trump Administration tore into that capacity and now wants to pretend the consequences were unforeseeable.”
Many US health agencies that could be involved in these international efforts lack key political leadership and senior staff. That – combined with the withdrawal from the WHO – meant there were no American personnel listed as co-authors on the report on Hantavirus from the WHO working group.
As I write this, it was announced on 21 May that Dr Jeffery Taubenberger, named last year as acting director of the National Institute of Allergy and Infectious Diseases (NIAID), has “stepped down from his position” and three of the institute’s senior leaders have been reassigned.
The Trump Administration fails to see that cooperative international efforts serve American interests and protect the United States from pandemic threats as well as helping developing nations.
Rising healthcare costs
As predicted, enrolment in the Affordable Care Act (Obamacare) health insurance exchanges is dropping as Americans (mostly those who are less well-off) face dramatically higher premium costs as a consequence of the failure of the Republican Congress and the Trump Administration to continue the enhanced subsidies.
A new report from KFF estimates that in 2026 some five million fewer people will be without affordable health insurance and that some two million more people will purchase “bronze” level plans with high deductibles.
This year premium payments for exchange enrollees have increased by an average of 58 percent, from US$113 to US $178 per month. Average deductibles have increased by 37 percent to a record high of US$3,786.
The Trump Administration has downplayed the widespread loss of health insurance, saying this is mostly the result of a drop in fraudulent or improper enrolments.
The Trump Administration’s attacks on Obamacare ignore the very positive benefits it has delivered both in terms of providing some 24 million more Americans with health insurance (a number that is now declining) and in slowing the growth of national healthcare spending.
A report from the Brookings Institute finds that “Since … 1960, no 14-year period has seen as slow growth of medical spending relative to GDP as was realised over the 2010-2024 time period.” [Obamacare began to be implemented in 2010.]
Meanwhile, more Trump Administration cuts to healthcare are planned, in the name of reforms.
A new HHS health advisory committee (called, innovatively, the Healthcare Advisory Committee) has been announced and has held its first meeting.
Its stated purpose is to “advise HHS Secretary Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator [Dr Mehmet Oz] on ways to improve how care is financed and delivered across Medicare, Medicaid, the Children’s Health Insurance Program [CHIP], and the [Affordable Care Act] Health Insurance Marketplace. The committee will provide non-binding recommendations to inform federal healthcare policy and program administration.”
Six working groups will address the following issues:
- Reducing administrative burden, including evaluating friction and challenges across traditional Medicare, Medicare Advantage, Medicare Accountable Care Organizations, Medicaid and CHIP
- Make America Healthy Again (MAHA) by improving wellness and preventing chronic disease
- Deploying real-time data, including efforts to combat fraud, waste, and abuse
- Improving care for vulnerable populations
- Strengthening Medicare Advantage (the privatised version of Medicare)
- Crushing fraud, waste, and abuse.
A report by Public Citizen finds that: “Many of the appointees to the [committee] are politically connected to the Trump world or Republican party or have business relationships with the Trump family or Trump administration officials, indicating little diversity in political philosophy among the panel members.”
Smoking and vaping
Britain is about to raise its first smoke-free generation
The British Parliament has passed landmark legislation, the Tobacco and Vapes Act 2026, which aims to stop anyone born after 1 January 2009 from taking up smoking by making it illegal for shops to sell them tobacco. It also expands current smoke-free laws with bans on vaping in cars carrying children, in playgrounds and outside schools and at hospitals.
You can read more here and here.
Polling shows that these new bands are popular.
Let’s hope the British law is more lasting than similar legislation which was enacted by New Zealand in 2022 but repealed by the National-led coalition government in March 2024 to help fund tax cuts.
Trump gives the tobacco industry a win on vaping
The Food and Drug Administration has issued new guidance that will allow major tobacco and vape companies to begin selling flavoured e-cigarettes, marking yet another step in the paring back of federal tobacco-control efforts under the Trump Administration. The FDA has also said it will institute mechanisms remove illicit e-cigarettes (mostly imported from China) from the market.
This was the result of direct orders from Trump as he was lobbied by the industry. The policy was announced hours after Trump signed off on a plan to fire Dr Marty Makary, the FDA Commissioner, who has resisted allowing sales of flavoured vapes over concerns about their appeal to young people.
As reported by The New York Times, at a lunch at his Florida golf club in early May, Trump heard from a group of tobacco executives and lobbyists unhappy with the way the FDA was regulating their industry.
Trump interrupted the conversation to call Dr Makary, who did not respond. Furious, Trump then called Kennedy to complain. Less than one week later Makary was gone and the new FDA guidance was issued.
It should be noted that a US$5 million donation to MAGA Inc the preceded the FDA decision.
Does vaping cause cancer?
A review, led by researchers from the University of New South Wales, provides what the authors say is “strong evidence” that vapes are likely to cause lung and oral cancer.
The researchers found a range of other diseases could be attributable to vaping, and it could no longer be considered “safer than smoking”.
You can read more here and here.
Tobacco and the Australian Budget
A recent article in the Australian Financial Review (paywalled) highlights the impact of falling tobacco excise revenue on the Federal Budget. It finds that the booming illicit tobacco market has wiped $6 billion from the federal budget bottom line in just five months and revenue from tobacco excise, which brought in $16 billion in 20202, is now forecast to plummet to just over $2 billion a year by 2030.
Health groups are concerned that the tobacco industry is now using the rise of illicit tobacco to reshape public debate and to push for lower taxes.
In an open letter, a coalition of health organisations has called out the industry’s testimony, given in private to the federal parliamentary Inquiry into the illegal tobacco crisis in Australia, stating that: “The industry is now using the rise of illicit tobacco to reshape public debate and to push for lower taxes. But illicit tobacco is primarily an enforcement and health issue, not a tax one.”
“Even if we were to cut the tobacco tax altogether, illicit products would remain cheaper, while legal tobacco would become more affordable, tobacco industry profits would skyrocket and smoking rates would increase, undoing decades of progress.”
You can read more in this article in The Guardian: Big tobacco is exploiting fears of the illicit market to unwind health gains, Australian experts warn.
See also this recent Croakey Health Media article: Open letter calls for more transparency on tobacco industry interference in public policy.
Follow-up to issues previously reported
Report on childhood deaths due to COVID-19 vaccination is finally released
Last November, the former Director of the Center for Biologics Evaluation and Research at the Food and Drug Administration (FDA) Vinay Prasad (since fired), issued a memo claiming that at least ten children had died as a result of their COVID vaccinations.
Surprise – the FDA’s own study, finally released, shows that was incorrect.
The review found that more than 95 million doses of Pfizer’s Comirnaty and more than 42 million doses of Moderna’s Spikevax had been given to kids under age 12 by August 14, 2025, the cut-off date for the review.
It assessed five deaths as “possibly” related to the shots, and two as “probably” related. There were no deaths that were “certain” to be related to the shots.
Access to mifepristone
The US Supreme Court has determined that access to mifepristone, used for medical abortions, without an in-person consultation with a medical professional, is preserved – for now.
But the issue will continue to be litigated with no guarantees that the final outcome will continue to allow this access. It will likely ultimately return to the Supreme Court for a final decision.
The underlying lawsuit involves Louisiana’s objection to a Food and Drug Administration regulation that allowed mifepristone to be prescribed through telehealth, in pharmacies and through the mail, making it available even in states where abortion is banned.
Pandemic accord update
World Health Organization (WHO) member states have failed to finalise the Pathogen Access and Benefit-Sharing (PABS) annex to the 2025 Pandemic Agreement ahead of the World Health Assembly (held last week).
Because this system is legally required for the Pandemic Agreement to enter into force, the broader treaty remains in limbo until negotiators can bridge stark divides.
How governments are failing Indigenous children
Last week The Guardian published an important article from Professors Fiona Stanley and Marcia Langton. It makes the case that, in the wake of the death of Kumanjayi Little Baby and almost 20 years after the NT intervention, governments are still making the same mistakes and thus failing Aboriginal people, and especially, Aboriginal children.
They outline the clear and consistent evidence that when Aboriginal people are engaged in service provision, those services are trusted and used and say that two patterns explain successive government failures.
“First, most Aboriginal-controlled welfare services – in early childhood, health, child protection, education, diversionary programs and justice – are either chronically under-funded or have had their funding cut entirely. Second, services developed and implemented without Aboriginal input consistently fail to deliver.”
Urgent Care Clinics funded
To keep Urgent Care Clinics operating as permanent, bulk-billed alternatives to hospital emergency departments, the 2026 -2027 Federal Budget provides $1.8 billion over five years from 2025-26, with ongoing funding of more than $525 million annually from 2030-31.
This substantial investment has been greeted with surprise in some quarters (see this article in Health Services Daily), given that a full evaluation of the UCCs’ cost-effectiveness and effect on ED presentations and local GPs is not due until later this year.
Currently 135 clinics are operating nationally.
Finally – movement on medical research funding
There was good news (sort of) in the 2026-2027 Federal Budget: annual disbursements from the Medical Research Future Fund (MRFF) will eventually reach the promised $1 billion – but not until 2030-2031.
I must say, with $5.2 billion in funds accumulated over the $20 billion target just sitting there, why can’t this additional funding – so needed – be rolled out now?
Commitments to be funded from the additional $508.5 million to be provided over the next four years include:
- $210 million to address national research priorities, including establishing the Australian Cancer Research Program and the Precision Health Research Program.
- $128 million to address research administration costs.
- $127.6 million to bridge the gap between promising research and the delivery of new medical treatments and innovations. This will include $30 million for the Australian Epilepsy Project and $14.6 million for the Australian Centre for Accelerating Diabetes Innovations.
The long-awaited National Health and Medical Research Strategy 2026 – 2036 has finally been released.
It has been widely welcomed by researchers and research organisations (see, for example, responses from the Australian Academy of Science and the Association of Australian Medical Research Institutes). Attention will now turn to its implementation.
See more on this in the latest edition of The Zap.
Best of Croakey
This week members of the Croakey team joined many others in the final sections of the National Walk for Truth to Parliament House in Canberra. See: Bearing witness to the National Walk for Truth in Canberra.
Bookmark this link to follow reports, and also see this coverage of the 2025 walk.
The good news story
One of the best books I read last year – amazing and breathtaking in its scope and detail and sensitivity – was Professor Clare Wright’s Näku Dhäruk: The Bark Petitions, which chronicles the history of the 1963 Yirrkala Bark Petitions.
You can read more about this book here. Or better, buy a copy and read it – don’t be put off by the size, it’s very readable and very engaging.
Now comes the deservedly good news that the book (published in 2024) has won the book of the year at the NSW Literary awards, along with the Douglas Stewart prize for nonfiction.
Judges called the book “a work of national significance”, saying the personal accounts included in the narrative felt “vividly alive” with “an extraordinary depth of research and sophisticated scholarship”. “It is a book that should be read by all Australians,” judges said.
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
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