Medical Journal of Australia最新文献

To the Editor: Recently, more than 400 Australian doctors (including both authors) signed an open letter published in The Australian,¹ calling on our federal government to protect the health of Australians by banning any new fossil fuel projects.

From the perspective of clinicians treating cancer, there are many reasons that this is an urgent request. Aside from their contribution to greenhouse gas emissions, fossil fuel projects increase air pollution and particulate matter less than or equal to 2.5 μm in diameter (PM_2.5), which are both risk factors for lung cancer.² This includes EGFR-mutated lung cancer, which is classically associated with never smoking or light smoking.³ Disturbingly, air pollution is linked to increased mortality in paediatric and young adults with cancer.⁴ Air and wastewater pollution generated by fossil fuel projects contains multiple carcinogens. This includes benzene, which is associated with haematological malignancies; additional studies demonstrate a positive association between residential proximity to petrochemical facilities and leukaemia.^5-8

While new projects have been recently approved across the nation, the Beetaloo Basin and Middle Arm project are the most notable, with echoes of the distressing Louisiana petrochemical corridor (United States), which is also referred to as “cancer alley” due to residents’ disproportionate exposure to toxic industrial by-products.^{8, 9} Australia risks creating its own “sacrifice zone”, harming the health of its people and contributing irrevocably to the climate crisis.

Natural disasters and extreme weather events amplified by climate change also disrupt access to care, which is critical for patients undergoing cancer treatment and translates to poorer outcomes.

Aside from cancer, there are various other risks, including asthma, cardiovascular disease and pre-term birth. These are avoidable and unacceptable illnesses, which can lead to deaths.

When the evidence that smoking harmed health was overwhelming, doctors championed this message and took action. In 2024, we — as physicians — need to convey the message that banning new fossil fuel projects is not a political ask, rather is essential to protect the health of our nation.

Both authors are active members of Doctors for the Environment Australia, and signed the open letter, which is referenced in this manuscript.

In reply: On behalf of our co-authors, we thank Islam and Seale for their interest in our article.¹ We largely support the general sentiments of Islam and Seale.² The seroprevalence survey that was the focus of our article was undertaken to support and guide the rapid public health response to the emergence of Japanese encephalitis virus (JEV) in New South Wales. The nature of a rapid public health response, which is focused on understanding enough to contain the risk in a short space of time, inherently limits the comprehensiveness of the epidemiological design.

Although Islam and Seale indicated that outbreaks of JEV have been reported in Australia since 1995,³ the few reported cases were sporadic and the single cluster limited to the islands off the north coast of Australia.⁴ The outbreak in 2022 represented the first detections of JEV in south-eastern Australia, and was close to 3000 km from the nearest previous case. The emergence of JEV in a largely naïve population in a temperate climate was significant in the course of the disease and presented challenges in understanding JEV transmission dynamics in the Australian context.

We acknowledge that social science approaches would certainly expand our understanding of risk behaviours contributing to infection, in response to an emerging disease. The One Health approach,⁵ referred to by Islam and Seale, has been well practised in NSW, with strong collaboration, communication and coordination across animal, human and environmental sectors.⁶ This intersect is particularly important to emphasise and acknowledge when responding to zoonotic and vector-borne disease outbreaks, which tend to impact regional and agricultural communities away from metropolitan centres.

No relevant disclosures.

To the Editor: The findings from Baldwin and colleagues,¹ regarding the seroprevalence of Japanese encephalitis virus (JEV)-specific antibodies in community members (in settings not traditionally considered as risky), underscore the critical need to characterise transmission pathways and identify probable hosts of infection within New South Wales.

While critical to understand the scope of infection, what we are currently missing is a deep dive into the factors contributing to the risk of JEV. This is not a criticism of their work but rather a call to action as traditional epidemiological studies do not necessarily capture these points (due to the approaches taken) and there is a need to build stronger partnerships within One Health to ensure that the broader social–ecological risk factors at the individual, family, community, and national levels are captured.²

Given the increasing cases of arboviruses and the shift in epidemiology, it is critical that we start ensuring our epidemiology studies are coupled with opportunities to capture data on exposure history, behaviour and practices that facilitate prevention or transmission. To support public health measures, it is also critical to understand the risk perceptions of community members, what protective measures they are using to avoid mosquito bites and if they are willing to receive vaccines against JEV.

Regarding risk history, we do not have a good sense of how much time the infected individuals spent outside the home, what kinds of activities they did, and where. Vaccination is the best method to prevent JEV, but did we prepare this community for JEV vaccines? Lessons learnt during the coronavirus disease 2019 pandemic showed that the likelihood of getting the disease and risk perceptions towards the vaccine affected vaccine acceptance.³

Social science intelligence that uses open-ended unstructured interviews, participant observation and group discussion is in the best position to answer these questions.⁴ Outbreaks of JEV have been reported in Australia since 1995;⁵ however, it is likely that we will see increased JEV incidence. Now is the time to break down siloes and ensure that we are producing outbreak investigations and epidemiological studies that capture these critical social and behavioural factors to inform future approaches.

No relevant disclosures.