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Episode 2: “You can’t over-invest in public health”: A conversation with Professor Brett Sutton, Chief Health Officer of Victoria

February 15, 2022 Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade Season 2 Episode 15
Episode 2: “You can’t over-invest in public health”: A conversation with Professor Brett Sutton, Chief Health Officer of Victoria
Contain This: The Latest in Global Health Security
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Contain This: The Latest in Global Health Security
Episode 2: “You can’t over-invest in public health”: A conversation with Professor Brett Sutton, Chief Health Officer of Victoria
Feb 15, 2022 Season 2 Episode 15
Indo-Pacific Centre for Health Security: Department of Foreign Affairs and Trade

Prior to the COVID-19 pandemic, not many Australians could tell you who the state’s Chief Health Officer was. In this episode we talk to Professor Brett Sutton, the Chief Health Officer of Victoria, who in the last two years has become one of the most recognisable figures in Australian public health. 

We ask Professor Sutton about how the Victorian government has worked with marginalised populations and diverse subgroups during the pandemic, and what they have learnt along the way. 

Professor Sutton describes how the Department’s community engagement team scaled from 1 person to over 100 people during the pandemic, as they recognised the importance of a diverse team with the ability to connect and engage with individual communities. 

While he recognises that starting this process in the middle of a pandemic was not ideal, Professor Sutton talks about what he and his team have taken from the experience, and how it has fed into the vaccine rollout and broader public health policy in the state.

It’s a fascinating discussion and we hope you join the conversation @CentreHealthSec

Show Notes Transcript

Prior to the COVID-19 pandemic, not many Australians could tell you who the state’s Chief Health Officer was. In this episode we talk to Professor Brett Sutton, the Chief Health Officer of Victoria, who in the last two years has become one of the most recognisable figures in Australian public health. 

We ask Professor Sutton about how the Victorian government has worked with marginalised populations and diverse subgroups during the pandemic, and what they have learnt along the way. 

Professor Sutton describes how the Department’s community engagement team scaled from 1 person to over 100 people during the pandemic, as they recognised the importance of a diverse team with the ability to connect and engage with individual communities. 

While he recognises that starting this process in the middle of a pandemic was not ideal, Professor Sutton talks about what he and his team have taken from the experience, and how it has fed into the vaccine rollout and broader public health policy in the state.

It’s a fascinating discussion and we hope you join the conversation @CentreHealthSec

Dr Stephanie Williams  0:02  

Hello and welcome to Contain This. 

Today, I'm joined by Professor Brett Sutton, the Chief Health Officer of Victoria. Prior to the COVID 19 pandemic, not many Australians could tell you who the Chief Health Officers were. In the last two years that has changed. Brett Sutton became one of the most recognisable figures in Australian public health. Not least because as Victoria was the first state in Australia to manage a significant COVID wave in 2020, we saw him daily, front up to the media, to the public, to explain the public health actions of government and the rationale for them. 

Professor Sutton is responsible for advising the Victorian government on the public health response to the pandemic, including how to adapt and align to reach marginalised populations and diverse groups within Victoria. 

In today's episode, we speak to Professor Sutton about what he has learnt over the last few years and what governments can do better, not just to prepare for a future pandemic, but to take as lessons for broader public health policies. 

Brett, can you describe some of the lessons since about March 2020, that you have learnt or Victorian Government has learnt about working with marginalised populations and diverse subgroups in the Victorian community?

Professor Brett Sutton  1:24  

I could speak for hours on this, but there's been there's been a lot learned. Look, I think the first, the first thing to note is that our most at risk populations require some significant efforts and significant understanding. One, that you can't do that overnight. So you need to do the the planning, the preparation, build the relationships, embed the networks, if you like, and embed those ongoing relationships that build trust and understanding over years. And it's really useful to have that in place. We didn't have that to the extent that we wanted it in March 2020, that that's for sure. We worked really, really hard to try and establish that through various channels. 

And the other lesson in particular is that there are a thousand channels, and there are a thousand different communities within a community and that you shouldn't make any assumptions about the usual suspects, if you like, in terms of trusted figures, or in terms of those points of liaison with those communities. Government tends to have a rather conservative default, you go to the elders in the community, or those who've been put forward as representatives. They are a very, very useful resource, they are very well connected, they also understand government and they have the connections to government. They are not always the individuals who will reach into those most at risk populations or the populations that you think are the real priority populations that you want to reach. So you have to be open minded, flexible, iterative and agile in understanding who those people need to be. And reach into those communities with a thousand different messages and a thousand different channels that work. 

And that is, that needs to start as a listing project. It doesn't sit very easily when you're in the middle of a crisis. And you're trying to move things really rapidly and you have to move things really rapidly. But you need the mechanisms to understand what the gaps are, what the failures have been, what the historical concerns are and what the potential enablers are in that engagement process.  

And you know, a lot of a lot of the lessons are not new lessons, they've probably been prosecuted by those communities, many, many times over over over decades. Which is, you know, understand us, understand our diversity understand our individual histories of mistrusting government of how we've been treated in our country of origin, on our arrival in Australia, as first/second/third generation groups. 

So I think those are pretty tough lessons. And there's a lot of complexity there. But really, really useful to then establish those networks to build trust and to really understand what those major concerns are that helps you to say, well, what do we need to do here in terms of having people come forward for testing or to engage with government services where we're trying to offer support, to isolate appropriately, to quarantine, to get vaccinated. And they'll they'll each have their own barriers and enablers and complexities to them. And you've got to sit with that because there's there's tough lessons there and some that you can address in some of it, you know, it's probably a decade's long project, but they're also lessons for the next pandemic. And they're also lessons for all of those other crises that tend to affect very similar populations disproportionately, whether it be environmental health challenges, or other communicable diseases that aren't pandemics or all of those other social determinants of health really at play in in many of those communities.

Dr Stephanie Williams  4:56  

It did feel like I've said this before on this podcast, that for the first few months, everywhere around the world, we were talking about a pathogen and not people. And we have learnt that the hard way and so many settings.  

In terms of just practical differences in what the Victorian government did in learning these lessons, did you say, for example, have a community engagement team that was one person to begin with that became a hundred? When you say we, how did that actually look practically, inside the response?

Professor Brett Sutton  5:29  

Yeah, there were lots of mini evolutions and big scale ups. You know, we were, we were very limited in the resources that we had for something of that scale and complexity to begin with. And so we knew we needed, we need to beef up the team really substantially. But it was it was absolutely the case of it's not just comms out, it's not just the information out, and it's certainly not just a push. And again, the you know, the usual modes of government tend to be a little bit overly pamphlet driven English language, statewide campaign level elements, where it's all of the languages, pictographs, face to face engagement, talking it through. 

And so we developed a number of bicultural workers. And the other issue is you need to give up some of that control. Of course, there's a need for a statewide campaign level comms because you've got to reach 7 million people. But if you're really going to impact where you need to put the most effort in, you can't just be a passive display or a one way communication channel, you've got to go back and forth and you've got to have those iterative engagements over days and weeks and months. And so the decentralisation and devolution of some of that engagement was a really important thing as well. 

So we did stand up local public health units, which you know, have really been a sea change in the Victorian Public Health kind of infrastructure. It's gone through different iterations over the years, but to have local public health units with, you know, dozens of staff, public health, medical expertise, but broader expertise in contact tracing and in community engagement were really critical. So bi-cultural workers, there are an embedded workforce element in those local public health units and they have done their real hard yards in speaking to those communities. 

And again, it's not something you stand up overnight. And it's not something that you can easily do with, you know, every culture and language under the sun represented in a city like Melbourne. But it's gone a long way to make a difference in terms of the way that we work with those communities. And I think there is trust building over time, and we've seen the response change in terms of, you know, seeing better engagement and seeing the outcomes of that better engagement, which, which is, you know, the pillars of the public health response in terms of good isolation and good quarantine and huge responses to vaccine uptake, but with an understanding of what we needed to address in that space. 

Because, you know, I live in a world where my sources of information are pretty mainstream and English language. Many, many people have social media as their primary information flow or their extended family. And many of those individuals have their country of origin, mainstream news, and then fringe news, as, as their, you know, preferred sources of information that are either completely wrong, or actual disinformation. And there are many people who are trying to also reach into these communities with misinformation in order to affect behaviour. So we've got to play in that space and be pretty robust about it. 

Dr Stephanie Williams  8:48  

So you mentioned vaccine uptake. And I wonder how you are - Victoria is doing well in the vaccine coverage as it today, we're talking in October. How, whether the groundwork with some of these communities has made it easier for vaccine uptake, and really, as well, how Victoria tracks that coverage by subgroup. How do you know that you're doing well in some of these populations, in terms of the COVID vaccine?

Professor Brett Sutton  9:15  

Yeah, certainly uptake's going great guns now. So 87% first dose coverage statewide, and, and some, you know, highly multicultural local government areas with with higher first dose coverage and with bookings that tell us that they're going to get to 95% first dose coverage and very likely above 90%, fully vaccinated. So I think the engagement that's occurred has has made a difference because it's addressed the misinformation. 

You know vaccine hesitancy is a term that's bandied around a lot. But often, it really is just about finding a trusted source to talk through your issues, and then going through a rather systematic but relatively simple process of debunking the myths, addressing the legitimate questions that everyone should have about something that's going into their body, especially as an injection, and especially with the, with the misinformation that's probably sat with them for some months before they've had an opportunity to talk that through. 

So I think that addresses the vast majority of people who who waited, I think, rather than opposed vaccination, and it's gotten them over the line. In terms of that really real time and local level information we've, we've just done analysis that's come from really embedding the data sharing with the Australian Immunisation Register. That's a little bit delayed. But we've also got our CVMS system as we call it, which captures the real time vaccination information for people who are stepping up for their first and second doses. And that gives us information on occupation and postcode. So, you know, it's down to statistical area one levels, which can really tell us, you know, almost block by block, how we're doing. It's not always, it's not always accurate, because we've had significant population shifts with international students no longer arriving, people moving about by virtue of the pandemic, that's changed the demographics of some small suburban populations. But it's been pretty insightful in lots of other ways. And we just respond to that, in terms of where we need to focus our attention and get down to that granular level. 

So we've gone from that state, again, statewide campaign, enabling a vaccine provision to the pop up sites, and now the the "mini pops" as we're calling them. So the the pop up sites that are almost at the end of the street, in the local cafe, in the in the school in the shopping centre, in the gyms, where you might only capture 50, 100 people for the day. But those are people who would otherwise not meet vaccines through any other mechanism. So it makes a big difference. 

Dr Stephanie Williams  12:01  

In terms of the next, you know, I want to say just one year, but if we're being practical one to two to three to four years, Victoria has come a long way - you've now high first dose vaxx coverage. From a system perspective, what are your priorities for living in a, I'm going to call it a COVID era, for the next two to three, four years?

Professor Brett Sutton  12:23  

I mean, I want us to embed and sustain the public health capacity and capability into the longer term. You know, that's a foundational lesson, I think, for all of us that you can't over invest in public health. As bang for buck goes, as return on investment goes. Doesn't matter if it's a pandemic or addressing sedentary behaviour, or overweight and obesity, or smoking or gambling or drinking, you always get a better return on investment for the health and well being outcomes. So let's embed that for all of the reasons in responding to the pandemic. But for everything else that public health does. 

But I think the the core elements that are in those local public health units and us in public health centrally, are that we can use that engagement as a platform for everything else that we want to achieve. That's the ongoing response, which means sustained behaviour change for those public health interventions that we think are going to be needed in the longer term, which, you know, maybe mask wearing, maybe social distancing of whatever kind, but also the ongoing vaccine uptake for groups that haven't yet received it or where booster doses are required, or, indeed, if another kind of primary dose is required with a really different variant of concern. So just to just to move to an embedded sustainable response that is obviously going to be a lower scale and a bit less hectic, but needs to be there engaging those those communities through the longer term. 

And then have the recovery ran in parallel, because there are so many harms that have occurred through this. Loss of educational opportunities, the the mental health and psychological well being issues of isolation and the huge economic damage that's run through in terms of economic loss, and all the corollaries of of increased poverty in in families and communities and how that needs to be addressed. You know, that'll be a hole of Victorian government response, but I would hope that public health plays a role in understanding where those issues are playing out and how the well being and health piece can help to support some of those challenges going forward.

Dr Stephanie Williams  14:31  

What do you think of the public health workforce in Australia and Victoria? So you've got decentralised public health units, that one can't necessarily staff them overnight with the volume of the people with the right skills. Have you got a high demand for those jobs and positions? Are you struggling to find them? What are your some views about how we embed that in the future in terms of an adequate pipeline of trained professionals?

Professor Brett Sutton  15:02  

It's a huge challenge. We're deeply under done from a public health medicine point of view, says says me, the public health physician talking to another public health physician, but you know, there there are something like 300 full time equivalent public health physician positions in Australia, that is under done. Deeply under done. 

So two lessons there. One, we need a, we need a fuller pipeline to be able to meet those requirements. And as I say, it's not just for this pandemic, or for the next pandemic, it's for all the things that public health can do. But the other reflection is, we have to, we have to be more open and imaginative and accepting of the broader public health workforce in all of the skills that they bring. And I think we have been in we can be all too narrow in the public health medical view, there are there are particular skills there for sure and they're in high demand and, you know, we're doing pretty well in Victoria at the moment in terms of how we've retained individuals and recruited. But we need a broader life experience and skills experience to come through in public health as well. 

So social anthropological insights, you know, behavioural insights are not necessarily my key skill or other public health physicians' key skill, and there'll be lots of people who work having done an MPH or a health promotion course, or just worked in behavioural sciences for a long time, that would be so incredibly helpful to a public health response in the planning, preparation, response and recovery phases. So, you know, we need we need to go to those MPH graduates, to the epidemiologists, and lots and lots of other skill sets in this space, because there's so many facets to the response and recovery that require more than that kind of curious public health medical skill set.

Dr Stephanie Williams  16:51  

Yeah, I mean, the value and strength of public health, as you say, is the diversity of perspective, which needs to be reflected in the leadership. 

Can we switch now to thinking about Australia in our region and Australia in the world. Australia has delivered a lot of COVID assistance and social and economic recovery assistance to the Pacific and countries in Southeast Asia, as well as making multilateral contributions over the last now almost two years. Some of those visible contributions are the AUSMAT teams, Australian Medical Assistance Teams, that fly into countries in our region, PNG, Fiji, Timor-Leste have all had AUSMAT teams deployed. 

Now you're sitting in a state of Victoria, and you join these meetings where we talk about Australian contributions to the region. I'm just interested in your perspective about what else or what are the priorities or opportunities that you see for Australia to be providing or in partnership for COVID response or health security in general in the region?

Professor Brett Sutton  17:53  

Yeah, look, we have done a lot and we continue to do a lot. I think there's a really, really big job ahead for us, because there's a big job ahead for those Southeast Asian/ Western Pacific countries. Some of them, you know, have a vaccine rollout schedule that stretches out for three or four years. Some of them have a primary income, which is seasonal workers or tourism, both of which have been hit very heavily. And so they need support to be able to get high vaccine coverage so that they can be part of the world economy, part of the international travel and tourism that will sustain them as it has in the past. And so I think there's a particular need for support both in a vaccine provision at scale for some of those countries. And some of them don't have large populations and so Australia does have domestic manufacturing capability, which personally I think they should continue with, I think it's been turned off for AstraZeneca vaccine, but it could also be a really significant contributor to supply for WHO Western Pacific and Southeast Asia, and to be able to deliver it. So all of the logistics and financial support. And again, the social and anthropological elements that go to ensuring that uptake is as high as it can be. 

There's, you know, been provision of vaccine to Indonesia and PNG, but PNG is sitting at around 1% coverage. Deep vaccine scepticism, including in the medical community, including across their own Parliament. So there's a lot of work to be done in terms of a deeper understanding of what vaccines are needed for and to make sure that there's a real enthusiasm to take them up. I think the AUSMAT responses have been great, and I've been AUSMATeer in the past, so I I'm a believer in AUSMAT, but again, is a public health physician, I'd say they are overdone on clinical responses and under done on public health responses. So it's one thing to go in and help a busy ICU or a ward full of COVID patients but unless you're addressing the vaccination coverage, that's going to be a three or four year task for an AUSMAT team and AUSMAT doesn't work that way. So make sure that you try and build some system strength, and some embedded advice over the longer term as well.  

And that may not be AUSMAT that might be sending an anthropologist, sending a vaccine behaviourist to a country for a six or 12 month position embedded in their ministry, to say this is what you need to do to make sure that your vaccine campaign works through the next few years. So I'd love to see some more bilateral agreements that embed some genuine expertise for the things that are most needed for their recovery.

Dr Stephanie Williams  20:38  

Yeah, I mean, the model of short term public health deployments is almost an oxymoron. Public health is built on relationships and long term commitment. And to just to address one of your points. Australia is committed and will supply vaccines to achieve comprehensive coverage in the Pacific and Timor. And from balance of vaccines, over the medium term as well. 

Switching to sustaining yourself and your team. Just, I always finished with this, because part of the Public Health Leader series is not just understanding, from your perspective, what's important, but to hear a bit more from you as a person, about how you sustain yourself and your team in this sprint turned marathon.

Professor Brett Sutton  21:28  

Yeah, I think that's a particular challenge. Clearly, we sprinted from the start, and we've been sprinting ever since. And to be 20 months in and actually now to be facing some of the most substantial challenges ahead of us in the next few months is is rather dispiriting and pretty hard to pick yourself up to address. So it's a it's a rather tough juncture right now. 

But for me, personally, it was last year through our second wave in Victoria, again, just super long days and nights workwise. And the urgency and volume makes it particularly challenging. So I think I sustained myself better now, having learned the hard lessons of not doing it so well last year, and recognising what those foundational elements of self care are. And we can be a bit trite about them. But I, I really like to emphasise them. Because if you again, make them part of your daily schedule or weekly schedule and and make a commitment to them, then you end up sustaining yourself a bit better.  

So sleeping properly, which means trying to get the phone away from you, as you're going off to sleep exactly, and putting it on silent and trying to set it aside for a period of time that you're not forever ruminating on work, and the next email and the next meeting and the next decision that you have to make. Eating properly. So you know more home cooked meals, better proper set aside times to eat. Exercise, so trying to do that, again, as a kind of embedded routine, if not every day, you know, every couple of days. And then for me meditation, but you know, for anyone time to not be thinking about work, again, hand your phone over, go for a walk, have a bath, progressive muscle relaxation, whatever it is, but that kind of self care element in the day and embed it. So those were key elements for me.

I also spoke to a psychologist, great for venting, great for reinforcing that kind of mental health hygiene stuff, but also really useful kind of tactical lessons on how to manage the beast that is work. You know, there are people in the department who genuinely care about your welfare and are trying to support it. But the machine that work is just churns the demands through continuously. And so you you need, you need to be really clear and really committed to putting boundaries up in that regard, because it'll eat away, every last minute you've got with your family. And, you know, the real struggles that I had last year, were not seeing my three kids for days on end. And even when I was putting them to bed, not being with them mentally, that that really destroyed me in lots of ways. So I'm different in that regard now.  

And then for my team, I reinforced these things. I hope I lead by example in terms of revealing some of that vulnerability and the struggles because the struggles that people have had through lockdown and COVID are universal, even if the work demands and responsibilities haven't been the same. So there's a real common ground we have here to say, gee, we've all we've all done it tough in one way or another through the last couple of years. Let's recognise how tough it is for ourselves. Be a bit easier on ourselves in that regard. Take those lessons and embed them and then be there for other people, because the best support that I've had has been my family and my dearest colleagues. And, you know, they're not people I've been able to hug as I've worked from home for months on end. But the love and kindness and offers of support that we can give each other are the real strength that we'll have in being able to manage in the longer term. So sounds a bit sounds a bit Oprah Winfrey, but it really is what we end up saying that we need as individuals when when we're struggling in whatever way that there is someone we can go to. And it might be to swear and scream, but it's also to get the support and empathy and compassion and care that can help us through.

Dr Stephanie Williams  25:45  

Brett, thanks for sharing those perspectives from vaccine uptake right down to self care with us. It's a terrific example of what has been talked about in many settings in this pandemic about enlightened public sector leadership. I think we've just had a great example of that today. 

You've been listening to Professor Brett Sutton, the Chief Health Officer of Victoria. I'm Stephanie Williams, Australia's Ambassador for Regional Health Security and I spoke to Brett late last year for a Contain This episode, just after Victoria began its COVID-19 vaccine rollout. 

As at the 30th of January this year in 2022, almost 80% - 79.86% to be precise - of Victoria's total population, including children, have had two vaccine doses, making it one of the most vaccinated places in the world. 

Thanks for listening. We invite you to tune in next fortnight for the next episode of Contain This.