(00:21) Dr Singleton greets Dr Stoupas and then muses about the impacts of the coronavirus pandemic.
She reflects on previous conversations from the series and how GPs have pivoted into new ways of working. This time the focus is on science and our progress in the development of a vaccine, along with advancements in serology technology. Recognising that the intersection of health and economics is critical in navigating COVID-19, the conversation also includes valuable financial insights from Commsec Chief Economist, Craig James. Dr Singleton kicks off the discussion with Dr Rob Grenfell.
(03:29) Dr Singleton asks about vaccine development and how likely it is that we're going to have a COVID-19 vaccine in the near future.
Dr Grenfell outlines the benefits of the work that was done on SARS and MERS in the early 2000s. So, research groups in Australia already had an understanding at some of those similar structures and he was able to pivot his team to start working on international pre-clinical work on the COVID-19 vaccine development rapidly. The virus was able to be isolated and grown at the Doherty Institute and then replicated in the CSIRO laboratory to understand its structure. With the animal model created to do the pre-clinical studies, they are on their way. There are now 200 potential vaccine candidates globally, but there are really only about nine in an advanced sort of development and two of those are being worked on in CSIRO pre-clinical studies. One is the Oxford candidate and the others is the Inovio candidate. These are both in phase-one human trials and showing encouraging results. Dr Grenfell is optimistic that by the end of the year, there should be a successful vaccine. He feels that the big problem then is, who gets it and when do they get it?
(06:01) Dr Singleton acknowledges that there could be an issue around equity in distribution.
Dr Grenfell relays his experience with the HEP-B vaccine when he was a resident GP in a hospital. And it was the resident doctors in the emergency department who were first to receive it. Why? Because they were at such high risk. He had no hesitation in it being administered to him as he already had colleagues who had died from chronic hepatitis B caught at work. So, Dr Grenfell suggests that the most vulnerable members of our communities should be first in line for the vaccine.
(06:46) Dr Singleton reflects on the speed of the development of this vaccine and suggests that many of her colleagues might have been skeptical that one could be delivered within a 12-month timeframe.
Dr Grenfell agrees and tells us that it normally would take about 10–15 years to get a vaccine to market and that there are only about 100 vaccines that are actually licensed for human use by the FDA. So, a 12-month turnaround is a very tall order and 80–90% of vaccines fail at the human trial stage. He is however maintaining his optimism.
(07:31) Dr Singleton enquires about serology testing next.
Dr Grenfell explains that a PCR, or polymerase chain reaction, test tells us that the genetic material of the virus is present but it doesn’t confirm whether it is viable or not, – meaning that it can be infectious. For various reasons, time being a major one, this sort of testing is really at the experimental level at the moment. Getting more detail on viral load, antibody response and antigen testing from the PCR will take a lot more work.
(09:38) Dr Singleton asks for Dr Grenfell’s prediction on that timing
Sadly, Dr Grenfell doesn’t have the answers on timing but restates the importance and value of getting point-of-care testing for PCR in place particularly for a number of industries who will rely on these results. The aviation sector will need rapid testing to get to a viable volume of traffic. How will we be able to confirm in an accurate and believable way that there is no evidence of the virus on a plane without it? Similarly, healthcare workers’ fitness for duty or their fitness to return to duty will require timely point-of-care testing. And these are only a couple of instances.
(10:30) Dr Singleton details a personal experience she had with a recent PCR test where she was informed that she wasn’t classified as an essential worker and would have to wait three days for results. That made her reflect on the importance of GPs on the frontline and she asks for Dr Grenfell’s thoughts on the importance of GPs.
Dr Grenfell feels that general practice has been very important during the pandemic. The maintenance of primary care and primary care systems is critical. And he was happy to see the creation of telemedicine item numbers to support GPs in that care. He recalls a time when telemedicine was done for no Medicare fees, and figures that it was definitely time that GPs were paid for the variable work done to uphold communities.
GPs will be there on the frontline when a vaccine comes available and also in managing community outbreaks if they were to happen. They are a trusted source of information in these times. One of the unexpected repercussions of the pandemic has been the reduction in visits to GPs and as a result, he feels we are going to see a flare-up in cardiovascular disease, diabetes complications, and a delay in cancer diagnoses. The other issue with the reduction in GP visits is that clinic incomes have plummeted. This has actually pushed many practices to the wall financially and is something that cannot be taken lightly.
(12:54) Dr Singleton mentions that many of their colleagues are experiencing significant financial stress at the moment and sees this as a segue to pick up the discussion with Craig James.
Introduction of Craig James
(13:02) Dr Stoupa thanks Craig for joining the chat and asks for his broad thoughts on how the pandemic has impacted the economy.
Craig states that it’s been absolutely dramatic. At the start of the year, we were worried about the US China trade war, we worried about Brexit, and then along came COVID-19. Craig says that there’s no playbook for this sort of thing and that it would be good to have one based on what was learned during the Spanish flu pandemic. He thinks that the government’s and central bank’s actions have been quite decisive, particularly here in Australia. And that we should be proud about how our governments have responded to this crisis. Certainly, he says, that we’re seeing the biggest decline in activity since the Depression of the late 1920s and early 1930s. The good news is because we have acted decisively, it is likely that the economy will rebound quite quickly.
(14:39) Dr Stoupas asks for some clarification on the difference between a depression and a recession.
Craig explains that we haven’t had too many depressions over time. In Australia, you’d have to look back to the 1890s to see the first depression. And then subsequently to the late 1920s and early 1930s. A depression is arguably a long and deeper recession. And a recession is defined by economists as two consecutive quarters of negative growth. Unemployment is, of course, a strong characteristic of recessions and depressions. During the depression of the late 1920s and early 1930s we saw an unemployment rate rising to at least 20%. So, the good news is this time around, we’re not going to get anywhere near the heights of that depression in terms of the unemployment rate. The current unemployment rate is sitting at 7.1%.
(17:14) Dr Stoupas asks for clarity around the unemployment rate in light of job seeker and job keeper numbers and the government’s stimulus packages.
Craig outlines that the number may well be inaccurate because of the government’s subsidies and their protection plan for parts of the economy. Effectively some businesses went into hibernation and were pretty much shut down. With the government paying wages until the lockdown period ends and those businesses are reopened, their employees can stay connected. The good news is now we are starting to see businesses reopening. But if it hadn't been for Jobkeeper and Jobseeker, we would have seen unemployment rates sitting at 11%. Craig thinks that Jobkeeper and Jobseeker have done exactly what they were supposed to do.
(19:04) Dr Stoupas follows on with some questions on what Craig thinks will happen in September when Jobkeeper finishes and how we should be managing our finances.
Craig says that we have to have a degree of trust in our governments. We need to believe that they’re going to do the right thing and that they’re going to get the balance right between supporting the economy but not leaving ourselves with too big of a debt to pay back in the future. Around 23 July, halfway through the proposed timeline of the support, the Federal Government will decide on the future plans for subsidy. Craig is hopeful that we’ll get it right.
(21:13) Dr Stoupas is nervous about the potential size of the deficit and asks how Craig thinks we will pay it back and how long it will take.
Craig acknowledges that Australia went into the crisis in very good shape. The budget at the start of the year was effectively balanced and our debt levels were low compared with a number of other major economies around the globe. So, we had plenty of firepower to throw at the crisis and that’s what was done. Australia’s federal debt levels were sitting at around 20% of GDP before the pandemic. After the stimulus investments, the debt might rise to 30 or 40% of GDP. But other countries have much steeper ratios. Japan’s is around 190% of GDP, the United States is approximately 140% of GDP, as is the case with the UK. So Australia is doing relatively ok in this regard.
(23:02) Dr Singleton jumps in and takes the opportunity to ask Craig about the potential double whammy for GPs with the loss of Jobkeeper as well as the telehealth Medicare codes. She asks for his thoughts on the impact to primary care if more isn’t invested in the industry?
Craig is grateful that across Australia, most states and territory governments have got COVID-19 pretty much under control. While we pay close attention to what transpires in Victoria and New South Wales while we reopen the economy with regard to virus spread, it’s feeling pretty good. The government needs to continue to balance the health risks with the economic risks and he’s confident that’s what they’ll do. And it will do so that with a significant amount of advice provided by health professionals. Ideally these things will conspire to provide enough relief to the GP sector.
(24:50) Dr Stoupas asks Craig about the economic response to a successful vaccine.
Craig suggests that the major forecasters around the world are focused on modelling the suppression of the virus through flattening the curve with a view to getting economies slowly but surely back to a degree of normalcy. The outlook featuring the commercialisation of a vaccine is likely further down the track.
(26:45) Dr Stoupas thanks Craig James and then throws to Rob to ask his thoughts around the idea of a pandemic rulebook, particularly after our experience 100 years ago with the Spanish flu.
Dr Grenfell says that based on the conversations that he’s having now and understanding the history of the formation of the CSIRO in the aftermath of the Spanish flu, he feels that there actually is a bit of a rulebook and he’s hopeful that we take heed of its lessons.
(27:39) Dr Stoupas and Dr Singleton each thank the guests.
(27:58) Dr Singleton reflects on the discussion and is inspired by the positive collaboration of experts from both the fields of health and economics.