Topics

Opportunities for children to benefit from novel therapies have increased substantially over the past decade. Change is needed to maximise these opportunities, particularly in the paediatric trial environment. Investment and a coordinated national approach are needed to prevent Australian children falling behind their international peers. There is international recognition that collaborative approaches and strategic investment in paediatric clinical trials reap benefits in terms of access to clinical trials and new therapies. This article exemplifies a multi‐state collaboration and presents a united call to action to prioritise paediatric clinical trials, by strategically investing in effective governance and infrastructure, and a shift in culture that embeds clinical trials in the core business of paediatric health care and academic institutions.

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1 Kids Research, Sydney Children's Hospitals Network, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Monash Children's Clinical Trial Centre, Monash Children's Hospital, Melbourne, VIC
4 Monash University, Melbourne, VIC
5 Child Health Research Centre, University of Queensland, Brisbane, QLD
6 Queensland Children's Hospital, Brisbane, QLD
7 University of New South Wales, Sydney, NSW
8 Sydney Children's Hospitals Network, Sydney, NSW
9 Royal Children's Hospital, Melbourne, VIC
10 Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Melbourne, VIC

Correspondence: michelle.lorentzos@health.nsw.gov.au

Open access:

Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians.

Competing interests:

The Murdoch Children's Research Institute and Sydney Children's Hospitals Network have received funding from Roche to aid in building capacity for gene therapy in Australia. All authors’ hospitals and/or institutions are active sites for pharmaceutical company‐sponsored clinical trials and receive enrolment‐based reimbursement on a trial‐by‐trial basis, but do not receive direct funding for clinical trials capacity or capability building unless stated above.

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Perspectives

Online first

Rationale and plan for a focus on First Nations urban health research in Australia

Janet Stajic, Adrian Carson and James Ward

Med J Aust || doi: 10.5694/mja2.52181
Published online: 15 January 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

Social determinants of health

Environment and public health

Indigenous health

Urbanisation is a global phenomenon. The World Health Organization reported in 2015 that 55% of the global population lived in cities and is predicting this to increase to 68% by 2050.1 First Nations peoples globally are disproportionately affected by urbanisation, with major drivers being climate change, deforestation and increased pressures created by globalisation. Despite this, there is limited research to address urbanisation and its impact on human health and wellbeing. Similarly, there is an urgent need for a focus on improving health and wellbeing outcomes for urban First Nations peoples in Australia given the rapid urbanisation of First Nations people.

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1 UQ Poche Centre for Indigenous Health, University of Queensland, Brisbane, QLD
2 Institute for Urban Indigenous Health, Brisbane, QLD

Correspondence: j.stajic@uq.edu.au

Open access:

Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.

Acknowledgements:

The UQ Poche Centre for Indigenous Health is generously supported by philanthropists Greg Poche AO and Kay Van Norton Poche. We acknowledge Dr Anton Clifford‐Motopi of the UQ Poche Centre for undertaking yarning sessions with members of the Research Alliance for Urban Community‐Controlled Health Services and analysis to inform and develop its research priorities.

Competing interests:

No relevant disclosures.

1. World Health Organization. Setting global research priorities for urban health. Geneva: WHO, 2022. https://www.who.int/publications/i/item/9789240041820 (viewed Mar 2023).
2. Australian Bureau of Statistics. Estimates of Aboriginal and Torres Strait Islander Australians [website]. Canberra: ABS, 2022. www.abs.gov.au/statistics/people/aboriginal‐and‐torres‐strait‐islander‐peoples/estimates‐aboriginal‐and‐torres‐strait‐islander‐australians/latest‐release (viewed Oct 2022).
3. Brand E, Bond C, Shannon C. Indigenous in the city: urban Indigenous populations in local and global contexts. Brisbane: UQ Poche Centre, 2016. www.poche.centre.uq.edu.au/files/609/Indigenous‐in‐the‐city%281%29.pdf 30/03/2023 (viewed Nov 2023).
4. National Indigenous Australians Agency, Australian Institute of Health and Welfare. Life expectancy at birth [website]. Canberra: Commonwealth of Australia, 2021. www.indigenoushpf.gov.au/measures/1‐19‐life‐expectancy‐birth (viewed Nov 2023).
5. National Indigenous Australians Agency, Australian Institute of Health and Welfare. Social and emotional wellbeing [website]. Canberra: Commonwealth of Australia, 2021. www.indigenoushpf.gov.au/measures/1‐18‐social‐emotional‐wellbeing (viewed Nov 2023).
6. National Indigenous Australians Agency, Australian Institute of Health and Welfare. Perceived health status. Canberra: Commonwealth of Australia, 2021. www.indigenoushpf.gov.au/measures/1‐17‐perceived‐health‐status (viewed Nov 2023).
7. National Indigenous Australians Agency, Australian Institute of Health and Welfare. Antenatal care. Canberra: Commonwealth of Australia, 2021. www.indigenoushpf.gov.au/measures/3‐01‐antenatal‐care (viewed Nov 2023).
8. Public Health Information Development Unit (PHIDU). Indigenous potentially preventable hospitalisations; identifying hotspots of inequalities. Adelaide: Torrens University Australia, 2020 https://phidu.torrens.edu.au/social‐health‐atlases/topic‐atlas/indigenous‐pph#pph‐rates‐by‐remoteness‐category (viewed Nov 2023).
9. Kildea S, Hickey S, Nelson C, et al. Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best‐practice Indigenous maternity service in an urban setting. Aust Health Rev 2018; 42: 230‐238.
10. Kennedy M, Bennett J, Maidment S, et al. Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap. Med J Aust 2022; 217: 50‐57. https://www.mja.com.au/journal/2022/217/1/interrogating‐intentions‐aboriginal‐and‐torres‐strait‐islander‐health‐narrative
11. Eades SJ, Taylor B, Bailey S, et al. The health of urban Aboriginal people: Insufficient data to close the gap. Med J Aust 2010; 193: 521‐524. https://www.mja.com.au/journal/2010/193/9/health‐urban‐aboriginal‐people‐insufficient‐data‐close‐gap
12. Jennings W, Spurling G, Shannon B, et al. Rapid review of five years of Aboriginal and Torres Strait Islander health research in Australia — persisting under‐representation of urban populations. Aust N Z J Public Health 2021; 45: 53‐58.
13. Thomas J, Barraket J, Parkinson S, et al. Australian Digital Inclusion Index: 2021. Melbourne: RMIT, Swinburne University of Technology, and Telstra; 2021. https://researchbank.swinburne.edu.au/file/ab6218ee‐55f3‐4d84‐9174‐76ca9ec877be/1/2021‐thomas‐measuring_australias_digital.pdf (viewed July 2023).
14. UQ Poche Centre for Indigenous Health. Terms of reference: the National Research Alliance for Urban Community‐Controlled Health Services. Brisbane: University of Queensland, 2023.
15. National Health and Medical Research Council. Ethical conduct in research with Aboriginal and Torres Strait Islander Peoples and communities: guidelines for researchers and stakeholders. Canberra: Commonwealth of Australia, 2018. www.nhmrc.gov.au/about‐us/resources/ethical‐conduct‐research‐aboriginal‐and‐torres‐strait‐islander‐peoples‐and‐communities (viewed Mar 2023).

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Research

The burden of occupational injury attributable to high temperatures in Australia, 2014–19: a retrospective observational study

Blesson M Varghese, Alana Hansen, Nick Mann, Jingwen Liu, Ying Zhang, Tim R Driscoll, Geoffrey G Morgan, Keith Dear, Anthony Capon, Michelle Gourley, Vanessa Prescott, Vergil Dolar and Peng Bi

Med J Aust 2023; 219 (11): . || doi: 10.5694/mja2.52171
Published online: 11 December 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Occupational diseases

Abstract

Objectives: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat‐attributable occupational injury in Australia.

Study design, setting: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014–19, based on Safe Work Australia (work‐related traumatic injury fatalities and workers’ compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta‐analysis of climate zone‐specific risk data.

Main outcome measure: Burden of heat‐attributable occupational injuries as disability‐adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen–Geiger climate zone, and by state and territory.

Results: During 2014–19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury‐related DALYs were attributable to heat (2.3% of occupational injury‐related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat‐attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat‐attributable occupational injury‐related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%).

Conclusion: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry‐based policies are needed to safeguard workplace health and safety, particularly in heat‐exposed industries, such as agriculture, transport, and construction.

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1 The University of Adelaide, Adelaide, SA
2 Australian Institute of Health and Welfare, Canberra, ACT
3 The University of Sydney, Sydney, NSW
4 Centre for Rural Health, the University of Sydney, Lismore, NSW
5 Monash Sustainable Development Institute, Monash University, Melbourne, VIC

Correspondence: peng.bi@adelaide.edu.au

Open access:

Open access publishing facilitated by The University of Adelaide, as part of the Wiley ‐ The University of Adelaide agreement via the Council of Australian University Librarians.

Acknowledgements:

This investigation was funded by the Australian Research Council with a Discovery Project grant (DP200102571) to Peng Bi. We gratefully acknowledge the Australian Institute of Health and Welfare for providing YLD estimates and supplying the disability weights and life tables produced by the Global Burden of Disease study, for providing methodological input, and for their assistance and guidance throughout the project. We acknowledge Safe Work Australia for providing deaths data for calculating YLLs and workers’ compensation claims data for calculating YLDs. We thank Syeda Hira Fatima and Matthew Borg (University of Adelaide) for their assistance with data analysis.

Competing interests:

No relevant disclosures.

1. Varghese BM, Barnett AG, Hansen AL, et al. The effects of ambient temperatures on the risk of work‐related injuries and illnesses: evidence from Adelaide, Australia 2003–2013. Environ Res 2018; 170: 101‐109.
2. Varghese BM, Barnett AG, Hansen AL, et al. Geographical variation in risk of work‐related injuries and illnesses associated with ambient temperatures: a multi‐city case‐crossover study in Australia, 2005–2016. Sci Total Environ 2019; 687: 898‐906.
3. Varghese BM, Barnett AG, Hansen AL, et al. Characterising the impact of heatwaves on work‐related injuries and illnesses in three Australian cities using a standard heatwave definition: Excess Heat Factor (EHF). J Expo Sci Environ Epidemiol 2019; 29: 821‐830.
4. Xiang J, Hansen A, Pisaniello D, Bi P. Extreme heat and occupational heat illnesses in South Australia, 2001–2010. Occup Environ Med 2015; 72: 580‐586.
5. Varghese B, Hansen A, Bi P, Pisaniello D. Are workers at risk of occupational injuries due to heat exposure? A comprehensive literature review. Saf Sci 2018; 110: 380‐392.
6. Romanello M, McGushin A, Di Napoli C, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet 2021; 398: 1619‐1662.
7. Martínez‐Solanas È, López‐Ruiz M, Wellenius GA, et al. Evaluation of the impact of ambient temperatures on occupational injuries in Spain. Environ Health Perspect 2018; 126: 067002.
8. Concha‐Barrientos M, Nelson DI, Fingerhut M, et al. The global burden due to occupational injury. Am J Ind Med 2005; 48: 470‐481.
9. Australian Institute of Health and Welfare. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2018 (cat. no. BOD 29). 24 Nov 2021. https://www.aihw.gov.au/reports/burden‐of‐disease/abds‐impact‐and‐causes‐of‐illness‐and‐death‐in‐aus/summary (viewed Jan 2023).
10. Beck HE, Zimmermann NE, McVicar TR, et al. Present and future Koppen–Geiger climate classification maps at 1‐km resolution. Sci Data 2018; 5: 180214.
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13. Australian Institute of Health and Welfare. National Hospitals Data Collection. Updated 3 June 2022. https://www.aihw.gov.au/about‐our‐data/our‐data‐collections/national‐hospitals‐data‐collection (viewed Jan 2023).
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21. Fatima SH, Rothmore P, Giles LC, et al. Extreme heat and occupational injuries in different climate zones: a systematic review and meta‐analysis of epidemiological evidence. Environ Int 2021; 148: 106384.
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26. Shaffer RM, Sellers SP, Baker MG, et al. Improving and expanding estimates of the global burden of disease due to environmental health risk factors. Environ Health Perspect 2019; 127: 105001.

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Perspectives

Planetary health: a new standard for medical education

Catherine GA Pendrey, Sonia Chanchlani, Laura J Beaton and Diana L Madden

Med J Aust 2023; 219 (11): . || doi: 10.5694/mja2.52158
Published online: 11 December 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Medical education

Health services administration

Global health

The Australian Medical Council (AMC) recently released updates to the National Framework for Prevocational (PGY1 and PGY2) Medical Training and the Standards for Assessment and Accreditation of Primary Medical Programs (medical school standards). Together, these cover all medical school programs in Australia and Aotearoa New Zealand and all accredited prevocational training programs in Australia.1,2 In a significant development, the standards recognise the health impacts of climate change, the need for environmentally sustainable health practice,3 and planetary health.4 This welcome and necessary development comes as climate and environmental health indicators deteriorate. All medical education institutions should now integrate planetary health into curricula to ensure the profession is equipped to respond to the unfolding planetary health crisis and realise environmentally sustainable health care.

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1 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
2 Climate and Environmental Medicine Specific Interests Group, Royal Australian College of General Practitioners, Melbourne, VIC
3 Melbourne Medical School, University of Melbourne, Melbourne, VIC
4 Doctors for the Environment Australia, Melbourne, VIC
5 University of Notre Dame Australia, Sydney, NSW
6 Australasian Faculty of Public Health Medicine, Royal Australasian College of Physicians, Sydney, NSW

Correspondence: catherine.pendrey@anu.edu.au

Open access:

Open access publishing facilitated by Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australian University Librarians.

Acknowledgements:

We thank all who have contributed to advancing planetary health education and practice in Australia, Aotearoa New Zealand, and globally.

Competing interests:

No relevant disclosures.

1. Australian Medical Council. New National Framework for Prevocational (PGY1 and PGY2) Medical Training (2024+). https://www.amc.org.au/accredited‐organisations/prevocational‐training/new‐national‐framework‐for‐prevocational‐pgy1‐and‐pgy2‐medical‐training‐2024/ (viewed Oct 2023).
2. Australian Medical Council. Standards for Assessment and Accreditation of Primary Medical Programs. Date of effect – 1 Jan 2024. https://www.amc.org.au/wp‐content/uploads/2023/08/AMC‐Medical_School_Standards‐FINAL.pdf (viewed Aug 2023).
3. United Nations. Report of the World Commission on Environment and Development: our common future (Brundtland Commission report). 1987. http://www.un‐documents.net/wced‐ocf.htm (viewed June 2023).
4. Whitmee S, Haines A, Beyrer C, et al. Safeguarding human health in the Anthropocene epoch: report of the Rockefeller Foundation–Lancet Commission on planetary health. Lancet 2015; 386: 1973‐2028.
5. Beggs PJ, Zhang Y, McGushin A, et al. The 2022 report of the MJA–Lancet Countdown on health and climate change: Australia unprepared and paying the price. Med J Aust 2022; 217: 439‐458. https://www.mja.com.au/journal/2022/217/9/2022‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐australia‐unprepared
6. Intergovernmental Panel on Climate Change. Synthesis report of the IPCC Sixth Assessment Report (AR6): summary for policymakers. 2023. https://report.ipcc.ch/ar6syr/pdf/IPCC_AR6_SYR_SPM.pdf (viewed May 2023).
7. United Nations Environment Programme. Making peace with nature: a scientific blueprint to tackle the climate, biodiversity and pollution emergencies. 2021. https://wedocs.unep.org/xmlui/bitstream/handle/20.500.11822/34948/MPN.pdf (viewed July 2023).
8. Climate Council. Survey results: summary of results from national study of the impact of climate‐fuelled disasters on the mental health of Australians. 2023. https://www.climatecouncil.org.au/wp‐content/uploads/2023/01/Mental‐health‐survey‐results_IL_230112_V13.pdf (viewed May 2023).
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10. Vardoulakis S, Matthews V, Bailie RS, et al. Building resilience to Australian flood disasters in the face of climate change. Med J Aust 2022; 217: 342‐345. https://www.mja.com.au/journal/2022/217/7/building‐resilience‐australian‐flood‐disasters‐face‐climate‐change
11. Coates L, Haynes K, O'Brien J, et al. Exploring 167 years of vulnerability: an examination of extreme heat events in Australia 1844–2010. Environ Sci Policy 2014; 42: 33‐44.
12. Standen JC, Spencer J, Lee GW, et al. Aboriginal population and climate change in Australia: implications for health and adaptation planning. Int J Environ Res Public Health 2022; 19: 7502.
13. King D, Penny G, Severne C. The climate change matrix facing Māori society. In: Nottage RAC, Wratt DS, Bornman JF, Jones K, editors. Climate change adaptation in New Zealand: future scenarios and some sectoral perspectives. Wellington: New Zealand Climate Change Centre, 2010. https://ndhadeliver.natlib.govt.nz/delivery/DeliveryManagerServlet?dps_pid=IE2009364 (viewed July 2023).
14. Burch H, Beaton LJ, Simpson G, et al. A planetary health–organ system map to integrate climate change and health content into medical curricula. Med J Aust 2022; 217: 469‐473. https://www.mja.com.au/journal/2022/217/9/planetary‐health‐organ‐system‐map‐integrate‐climate‐change‐and‐health‐content
15. McLean M, Behrens G, Chase H, et al. The medical education planetary health journey: advancing the agenda in the health professions requires eco‐ethical leadership and inclusive collaboration. Challenges 2022; 13: 62.
16. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27‐e35.
17. Barratt AL, Bell KJ, Charlesworth K, McGain F. High value health care is low carbon health care. Med J Aust 2022; 216: 67‐68. https://www.mja.com.au/journal/2022/216/2/high‐value‐health‐care‐low‐carbon‐health‐care
18. Brand G, Wise S, Bedi G, Kickett R. Embedding Indigenous knowledges and voices in planetary health education. Lancet Planet Health 2023; 7: e97‐e102.
19. Armstrong F, Wyns A, Colagiuri P, et al. Healthy, regenerative and just: guiding the development of a national strategy on climate, health and well‐being for Australia. J Clim Chang Health 2023; 10: 100205.
20. Bragge P, Lennox A, Pattuwage L, et al. Climate change and Australia's healthcare systems: a review of literature, policy and practice. Royal Australian College of Physicians, 2021. https://www.racp.edu.au/docs/default‐source/advocacy‐library/climate‐change‐and‐australias‐healthcare‐systems‐a‐review‐of‐literature‐policy‐and‐practice.pdf?sfvrsn=efe8c61a_6 (viewed June 2023).
21. Heenan M, Rychetnik L, Howse E, et al. Australia's political engagement on health and climate change: the MJA–Lancet Countdown indicator and implications for the future. Med J Aust 2023; 218: 196‐202. https://www.mja.com.au/journal/2023/218/5/australias‐political‐engagement‐health‐and‐climate‐change‐mja‐lancet‐countdown
22. Lal A, Walsh EI, Wetherell A, Slimings C. Climate change in public health and medical curricula in Australia and New Zealand: a mixed methods study of educator perceptions of barriers and areas for further action. Environ Educ Res 2022; 28: 1070‐1087.
23. Australian Medical Association. AMA submission to the AMC Review of the Accreditation Standards for Primary Medical Programs. 7 Dec 2022. https://www.ama.com.au/articles/ama‐submission‐amc‐review‐accreditation‐standards‐primary‐medical‐programs (viewed May 2023).
24. Madden DL, Horton GL, McLean M. Preparing Australasian medical students for environmentally sustainable health care. Med J Aust 2022; 216: 225‐229. https://www.mja.com.au/journal/2022/216/5/preparing‐australasian‐medical‐students‐environmentally‐sustainable‐health‐care
25. Australian Medical Council. Standards for the Assessment and Accreditation of Specialist Medical Programs and Professional Development Programs by the Australian Medical Council 2015. https://www.amc.org.au/wp‐content/uploads/accreditation_recognition/specialist_edu_and_training/assessment/standards_for_assessment.pdf (viewed Aug 2023)
26. Australian Medical Council. Criteria for AMC accreditation of CPD homes. July 2022. https://www.amc.org.au/wp‐content/uploads/2022/08/Criteria‐for‐AMC‐Accreditation‐of‐CPD‐Homes‐August‐2022.pdf (viewed July 2023).
27. Australian Medical Council. Good medical practice: a code of conduct for doctors in Australia. July 2009. https://www.amc.org.au/wp‐content/uploads/about/good_medical_practice/2009‐07_Final_Code.pdf (viewed May 2023).
28. Shaw E, Walpole S, McLean M, et al. AMEE consensus statement: Planetary health and education for sustainable healthcare. Med Teach 2021; 43: 272‐286.
29. Navarrete‐Welton A, Chen JJ, Byg B, et al. A grassroots approach for greener education: an example of a medical student‐driven planetary health curriculum. Front Public Health 2022; 10: 1013880.
30. Mailman School of Public Health, Columbia University. Global Consortium on Climate and Health Education. https://www.publichealth.columbia.edu/research/centers/global‐consortium‐climate‐health‐education (viewed Aug 2023).
31. Doctors for the Environment Australia. Health professional education resources. https://dea.org.au/publications/healthprofessionaleducationresources/ (viewed May 2023).

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Research

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Disruption of gender‐affirming health care, and COVID‐19 illness, testing, and vaccination among trans Australians during the pandemic: a cross‐sectional survey

Sav Zwickl, Tomi Ruggles, Alex FQ Wong, Ariel Ginger, Lachlan M Angus, Kalen Eshin, Teddy Cook and Ada S Cheung

Med J Aust || doi: 10.5694/mja2.52169
Published online: 11 December 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Infectious diseases

Social determinants of health

Abstract

Objectives: To assess rates of disruption of gender‐affirming health care, of coronavirus disease 2019 (COVID‐19) illness, testing, and vaccination, and of discrimination in health care among Australian trans people during the COVID‐19 pandemic.

Design, setting: Online cross‐sectional survey (1–31 May 2022); respondents were participants recruited by snowball sampling for TRANSform, an Australian longitudinal survey‐based trans health study, 1 May – 30 June 2020.

Participants: People aged 16 years or older, currently living in Australia, and with a gender different to their sex recorded at birth.

Main outcome measures: Proportions of respondents who reported disruptions to gender‐affirming health care, COVID‐19 illness, testing, and vaccination, and positive and negative experiences during health care.

Results: Of 875 people invited, 516 provided valid survey responses (59%). Their median age was 33 years (interquartile range, 26–45 years); 193 identified as women or trans women (37%), 185 as men or trans men (36%), and 138 as non‐binary (27%). Of 448 respondents receiving gender‐affirming hormone therapy, 230 (49%) reported disruptions to treatment during the pandemic; booked gender‐affirming surgery had been cancelled or postponed for 37 of 85 respondents (44%). Trans‐related discrimination during health care was reported by a larger proportion of participants than in a pre‐pandemic survey (56% v 26%). COVID‐19 was reported by 132 respondents (26%), of whom 49 reported health consequences three months or more after the acute illness (37%; estimated Australian rate: 5–10%). Three or more COVID‐19 vaccine doses were reported by 448 participants (87%; Australian adult rate: 70%).

Conclusions: High rates of COVID‐19 vaccination among the trans people we surveyed may reflect the effectiveness of LGBTIQA+ community‐controlled organisation vaccination programs and targeted health promotion. Training health care professionals in inclusive services for trans people could improve access to appropriate health care and reduce discrimination.

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1 The University of Melbourne, Melbourne, VIC
2 Austin Health, Melbourne, VIC
3 La Trobe University, Melbourne, VIC
4 ACON, Sydney, NSW

Correspondence: adac@unimelb.edu.au

Open access:

Open access publishing facilitated by The University of Melbourne, as part of the Wiley ‐ The University of Melbourne agreement via the Council of Australian University Librarians.

Data sharing statement

De‐identified participant data are available upon reasonable request to the corresponding author (adac@unimelb.edu.au), provided that the aim of the request is deemed to be of benefit to the trans and gender‐diverse community and has received Austin Health Human Research Ethics Committee approval (as an amendment).

Acknowledgements:

We thank the Melbourne Clinical and Translational Sciences (MCATS) research platform staff for the administrative and technical support that facilitated this investigation. Ada Cheung is supported by a National Health and Medical Research Council Investigator Grant (2008956).

Competing interests:

No relevant disclosures.

1. Zwickl S, Wong AFQ, Bretherton I, et al. Health needs of trans and gender diverse adults in Australia: a qualitative analysis of a national community survey. Int J Environ Res Public Health 2019; 16: 5088.
2. Bretherton I, Thrower E, Zwickl S, et al. The health and well‐being of transgender Australians: a national community survey. LGBT Health 2021; 8: 42‐49.
3. Zwickl S, Wong AFQ, Dowers E, et al. Factors associated with suicide attempts among Australian transgender adults. BMC Psychiatry 2021; 21: 81.
4. Boyer TL, Youk AO, Blosnich JR, et al. Suicide, homicide, and all‐cause mortality among transgender and cisgender patients in the veterans health administration. LGBT Health 2021; 8: 173‐180.
5. Hughes LD, King WM, Gamarel KE, et al. Differences in all‐cause mortality among transgender and non‐transgender people enrolled in private insurance. Demography 2022; 59: 1023‐1043.
6. Zwickl S, Angus LM, Wong AFQ, et al. The impact of the first three months of the COVID‐19 pandemic on the Australian trans community. Int J Transgend Health 2021; 24: 281‐291.
7. World Health Organization. Coronavirus disease (COVID‐19) situation report 162. 30 June 2020. https://www.who.int/docs/default‐source/coronaviruse/20200630‐covid‐19‐sitrep‐162.pdf?sfvrsn=e00a5466_2 (viewed June 2021).
8. Zwickl S, Wong AFQ, Ginger A, et al. Trans in the pandemic: stories of struggle and resilience in the Australian trans community. Melbourne: Trans Health Research Group, University of Melbourne (Austin Health), 2022. https://www.transresearch.org.au/_files/ugd/53102e_556c291b919944f282cbd05fe5b60a4b.pdf (viewed Nov 2023).
9. Balaji JN, Prakash S, Joshi A, Surapaneni KM. A scoping review on COVID‐19 vaccine hesitancy among the lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) community and factors fostering its refusal. Healthcare (Basel) 2023; 11: 245.
10. Rich AJ, Scheim AI, Koehoorn M, Poteat T. Non‐HIV chronic disease burden among transgender populations globally: a systematic review and narrative synthesis. Prev Med Rep 2020; 20: 101259.
11. Australian Institute of Health and Welfare. Long COVID in Australia: a review of the literature (Cat. no. PHE 318). Canberra: AIHW, 2022. https://www.aihw.gov.au/getmedia/9592f439‐9b96‐4589‐a55d‐6b04e262e5e1/aihw‐phe‐318.pdf.aspx?inline=true (viewed Mar 2023).
12. Wang Q, Xu R, Volkow ND. Increased risk of COVID‐19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry 2021; 20: 124‐130.
13. Australian Bureau of Statistics. Patient experiences. Reference period 2021–22 financial year. 18 Nov 2022. https://www.abs.gov.au/statistics/health/health‐services/patient‐experiences/latest‐release (viewed Mar 2023).
14. Operation COVID Shield (Australian Government). COVID‐19 vaccine roll‐out. 31 May 2022. https://www.health.gov.au/sites/default/files/documents/2022/05/covid‐19‐vaccine‐rollout‐update‐31‐may‐2022.pdf (viewed Mar 2023).
15. Australian COVID‐19 Serosurveillance Network. Seroprevalence of SARS‐CoV‐2‐specific antibodies among Australian blood donors: round 2 update. 26 July 2022. https://www.kirby.unsw.edu.au/sites/default/files/documents/COVID19‐Blood‐Donor‐Report‐Round2‐May‐Jun‐2022%5B1%5D.pdf (viewed Mar 2023).
16. Hembree WC, Cohen‐Kettenis PT, Gooren L, et al. Endocrine treatment of gender‐dysphoric/gender‐incongruent persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2017; 102: 3869‐3903.
17. Olson‐Kennedy J, Warus J. The impact of male chest reconstruction on chest dysphoria in transmasculine adolescents and young men: a preliminary study. J Adolesc Health 2017; 60 (Suppl 1): S88.
18. Foster Skewis L, Bretherton I, Leemaqz SY, et al. Short‐term effects of gender‐affirming hormone therapy on dysphoria and quality of life in transgender individuals: a prospective controlled study. Front Endocrinol (Lausanne) 2021; 12: 717766.
19. White Hughto JM, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health 2016; 1: 21‐31.
20. Snoswell CL, Arnautovska U, Haydon HM, et al. Increase in telemental health services on the Medicare Benefits Schedule after the start of the coronavirus pandemic: data from 2019 to 2021. Aust Health Rev 2022; 46: 544‐549.
21. Isautier JM, Copp T, Ayre J, et al. People's experiences and satisfaction with telehealth during the COVID‐19 pandemic in Australia: cross‐sectional survey study. J Med Internet Res 2020; 22: e24531.
22. Bouman WP, Schwend AS, Motmans J, et al. Language and trans health. Int J Transgend 2017; 18: 1‐6.
23. Philip BV. Impact of Covid‐19 on transgender persons: the need for an inclusive approach. Int J Sex Health 2021; 33: 248‐267.
24. Gil RM, Freeman TL, Mathew T, et al. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities and the coronavirus disease 2019 pandemic: a call to break the cycle of structural barriers. J Infect Dis 2021; 224: 1810‐1820.
25. Thomas S. Fab jab: LGBT community steps up to get vaccinated at Pride Centre. Star Observer (Sydney), 21 Oct 2021. https://www.starobserver.com.au/news/fab‐jab‐lgbt‐community‐steps‐up‐to‐get‐vaccinated‐at‐pride‐centre/206495 (viewed Apr 2023).
26. TransHub (ACON). Vaccinations. Updated 7 Mar 2023. (https://www.transhub.org.au/covid/vaccination) (viewed Apr 2023).

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Perspective

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Invisible wounds of the Israel–Gaza war in Australia

Susan J Rees and Batool Moussa

Med J Aust || doi: 10.5694/mja2.52168
Published online: 20 November 2023

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REFERENCES

Topics

Mental disorders

Global health

Among the many dire consequences of the Israel–Gaza war that began in October 2023, the impact on the mental health of populations living in multicultural Western countries is significant and should not be overlooked1. The psychosocial reverberations of the conflict are felt in societies throughout the world, embodying unique characteristics of trauma and adding to the complexity of the mental health risk for people living in Western countries. The threat to mental health status is higher for those who have had family members killed, harmed or gone missing, and for those with previous exposure to war, including in Lebanon, Iraq and Syria. The level of stress has been exacerbated by its enduring nature, including systematic oppression, economic hardship, violence, human rights violations and national struggle.2,3

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Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, NSW

Correspondence: s.j.rees@unsw.edu.au

Open access:

Open access publishing facilitated by University of New South Wales, as part of the Wiley ‐ University of New South Wales agreement via the Council of Australian University Librarians.

Competing interests:

No relevant disclosures.

1. Murthy RS, Lakshminarayana R. Mental health consequences of war: a brief review of research findings. World Psychiatry 2006; 5: 25‐30.
2. Helbich M, Jabr S. A call for social justice and for a human rights approach with regard to mental health in the occupied Palestinian territories. Health Human Rights J 2022; 24: 305‐318.
3. Lavi I, Canetti D, Sharvit K, et al. Protected by ethos in a protracted conflict? A comparative study among Israelis and Palestinians in the West Bank, Gaza, and East Jerusalem. J Conflict Resolution 2012; 58: 68‐92.
4. Diab M, Veronese G, Abu Jamei Y, et al. Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers’ perceptions. Transcult Psychiatry 2023; 60: 577‐590.
5. Silove D, Ventevogel P, Rees S. The contemporary refugee crisis: an overview of mental health challenges. World Psychiatry 2017; 16: 130‐139.
6. Rees S, Mohsin M, Moussa B, et al. Cohort profile: intimate partner violence and mental health among women from refugee background and a comparison group of Australian‐born – the WATCH cohort study. BMJ Open 2022; 12: e051887.
7. Rees SJ, Fisher JR, Steel Z, et al. Prevalence and risk factors of major depressive disorder among women at public antenatal clinics from refugee, conflict‐affected, and Australian‐born backgrounds. JAMA Netw Open 2019; 2: e193442.
8. Horowitz M. Treatments of psychiatric disorders: a task force report of the American Psychiatric Association. Washington, DC: American Psychiatric Association, 1989.
9. Thabet AM, Thabet SS, Vostanis P. The relationship between war trauma, PTSD, depression, and anxiety among Palestinian children in the Gaza Strip. Health Sci J 2016; 10: 1‐8.
10. Mollica RF. Waging a new kind of war. Invisible wounds. Sci Am 2000; 282: 54‐57.
11. Silove D, Liddell B, Rees S, et al. Effects of recurrent violence on post‐traumatic stress disorder and severe distress in conflict‐affected Timor‐Leste: a 6‐year longitudinal study. Lancet Glob Health 2014; 2: e293‐e300.
12. Lev‐Wiesel R, Amir M. Secondary traumatic stress, psychological distress, sharing of traumatic reminiscences, and marital quality among spouses of Holocaust child survivors. J Marital Fam Ther 2001; 27: 433‐444.
13. Lehrner A, Yehuda R. Trauma across generations and paths to adaptation and resilience. Psychol Trauma 2018; 10: 22‐29.
14. Hensel JM, Ruiz C, Finney C, Dewa CS. Meta‐analysis of risk factors for secondary traumatic stress in therapeutic work with trauma victims. J Trauma Stress 2015; 28: 83‐91.
15. Yehuda R. Post‐traumatic stress disorder. N Engl J Med 2002; 346: 108‐114.
16. Silove D, Tay AK, Kareth M, Rees S. The relationship of complex post‐traumatic stress disorder and post‐traumatic stress disorder in a culturally distinct, conflict‐affected population: a study among West Papuan refugees displaced to Papua New Guinea. Front Psychiatry 2017; 8: 73.
17. Schauer M, Schauer E. Trauma‐focused public mental‐health interventions: a paradigm shift in humanitarian assistance and aid work. In: Martz E, editor. Trauma rehabilitation after war and conflict. Springer, 2010; pp. 389‐428.
18. Rees S, Silove D. Sakit hati: a state of chronic mental distress related to resentment and anger amongst West Papuan refugees exposed to persecution. Soc Sci Med 2011; 73: 103‐110.
19. Benjamin R, Haliburn J, King S, editors. Humanising mental health care in Australia: a guide to trauma‐informed approaches. Oxfordshire, UK: Routledge, 2019.
20. Wiederhold BK. A legacy of trauma: how local conflicts can have global implications for mental health. Cyberpsychol Behav Soc Netw 2023; https://doi.org/10.1089/cyber.2023.29296.editorial [Epub ahead of print].
21. Menyhért A. Digital trauma processing in social media groups: transgenerational Holocaust trauma on Facebook. Hungarian Historical Rev 2017; 6: 355‐376.
22. Mollica R. Healing invisible wounds: paths to hope and recovery in a violent world. Nashville, TN: Vanderbilt University Press, 2008.
23. Selod S. Citizenship denied: the racialization of Muslim American men and women post‐9/11. Critical Sociol 2014; 41: 77‐95.
24. Staszewska E. As the Hamas‐Israel war rages, Islamophobia and antisemitism are rising in Australia. SBS News, 28 Oct 2023. https://www.sbs.com.au/news/article/as‐the‐hamas‐israel‐war‐rages‐islamophobia‐and‐antisemitism‐are‐rising‐in‐australia/385jt872y (viewed Nov 2023).

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Editorials

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The Lancet Countdown on health and climate change: Australia a world leader in neglecting its responsibilities

Paul J Beggs and Ying Zhang

Med J Aust || doi: 10.5694/mja2.52152
Published online: 20 November 2023

ARTICLE
AUTHORS
REFERENCES

Topics

Environment and public health

Health services administration

Statistics, epidemiology and research design

Climate is integral to good health and wellbeing, but it can also be a forceful driver of death and disease. Many diseases both here in Australia and globally are climate sensitive — the global magnitude of such diseases was estimated to be 39 503 684 deaths (69.9% of total annual deaths) and 1 530 630 442 disability‐adjusted life years in 2019.1,2 Climate change is the biggest health threat facing humanity.3,4

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1 Macquarie University, Sydney, NSW
2 University of Sydney, Sydney, NSW

Correspondence: paul.beggs@mq.edu.au

Competing interests:

No relevant disclosures.

1. Cissé G, McLeman R, Adams H, et al. Chapter 7: Health, wellbeing and the changing structure of communities. In: Pörtner H‐O, Roberts DC, Tignor MMB, et al, editors. Climate change 2022: impacts, adaptation and vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge: Cambridge University Press, 2022; pp. 1041‐1170.
2. Vos T, Lim SS, Abbafati C, et al., GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204‐1222.
3. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009; 373: 1693‐1733.
4. Health Organization; Regional Office for the Americas of the World Health Organization. Climate change and health. https://www.paho.org/en/topics/climate‐change‐and‐health (viewed October 2023).
5. Beggs PJ, Zhang Y, McGushin A, et al. The 2022 report of the MJA–Lancet Countdown on health and climate change: Australia unprepared and paying the price. Med J Aust 2022; 217: 439‐458. https://www.mja.com.au/journal/2022/217/9/2022‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐australia‐unprepared
6. Romanello M, Di Napoli C, Green C, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health‐centred response in a world facing irreversible harms. Lancet 2023; https://doi.org/10.1016/S0140‐6736(23)01859‐7.
7. Zhang Y, Beggs PJ, McGushin A, et al. The 2020 special report of the MJA–Lancet Countdown on health and climate change: lessons learnt from Australia's “Black Summer”. Med J Aust 2020; 213: 492.e2‐492.e10. https://www.mja.com.au/journal/2020/213/11/2020‐special‐report‐mja‐lancet‐countdown‐health‐and‐climate‐change‐lessons
8. Vicedo‐Cabrera AM, Scovronick N, Sera F, et al. The burden of heat‐related mortality attributable to recent human‐induced climate change. Nat Clim Chang 2021; 11: 492‐500.
9. Australian Government Department of Health and Aged Care. National Health and Climate Strategy. 15 June 2023. https://www.health.gov.au/our‐work/national‐health‐and‐climate‐strategy (viewed July 2023).
10. Heenan M, Rychetnik L, Howse E, et al. Australia's political engagement on health and climate change: the MJA–Lancet Countdown indicator and implications for the future. Med J Aust 2023; 218: 196‐202. https://www.mja.com.au/journal/2023/218/5/australias‐political‐engagement‐health‐and‐climate‐change‐mja‐lancet‐countdown

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Position statement summary

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Cough in Children and Adults: Diagnosis, Assessment and Management (CICADA). Summary of an updated position statement on chronic cough in Australia

Julie M Marchant, Anne B Chang, Emma Kennedy, David King, Jennifer L Perret, Andre Schultz, Maree R Toombs, Lesley Versteegh, Shyamali C Dharmage, Rebecca Dingle, Naomi Fitzerlakey, Johnson George, Anne Holland, Debbie Rigby, Jennifer Mann, Stuart Mazzone, Mearon O'Brien, Kerry‐Ann O'Grady, Helen L Petsky, Jonathan Pham, Sheree MS Smith, Danielle F Wurzel, Anne E Vertigan and Peter Wark

Med J Aust || doi: 10.5694/mja2.52157
Published online: 20 November 2023

Correction(s) for this article:

Erratum | Published online: 26 June 2024

ARTICLE
AUTHORS
REFERENCES

Topics

Statistics, epidemiology and research design

Respiratory tract diseases

Health occupations

General medicine

Abstract

Introduction: Cough is the most common symptom leading to medical consultation. Chronic cough results in significant health care costs, impairs quality of life, and may indicate the presence of a serious underlying condition. Here, we present a summary of an updated position statement on cough management in the clinical consultation.

Main recommendations: Assessment of children and adults requires a focused history of chronic cough to identify any red flag cough pointers that may indicate an underlying disease. Further assessment with examination should include a chest x‐ray and spirometry (when age > 6 years). Separate paediatric and adult diagnostic management algorithms should be followed. Management of the underlying condition(s) should follow specific disease guidelines, as well as address adverse environmental exposures and patient/carer concerns. First Nations adults and children should be considered a high risk group. The full statement from the Thoracic Society of Australia and New Zealand and Lung Foundation Australia for managing chronic cough is available at https://lungfoundation.com.au/resources/cicada‐full‐position‐statement.

Changes in management as a result of this statement:

Algorithms for assessment and diagnosis of adult and paediatric chronic cough are recommended.
High quality evidence supports the use of child‐specific chronic cough management algorithms to improve clinical outcomes, but none exist in adults.
Red flags that indicate serious underlying conditions requiring investigation or referral should be identified.
Early and effective treatment of chronic wet/productive cough in children is critical.
Culturally specific strategies for facilitating the management of chronic cough in First Nations populations should be adopted.
If the chronic cough does not resolve or is unexplained, the patient should be referred to a respiratory specialist or cough clinic.

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1 Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD
2 Queensland Children's Hospital, Brisbane, QLD
3 Menzies School of Health Research, Darwin, NT
4 Rural and Remote Health, Flinders University, Darwin, NT
5 University of Queensland, Brisbane, QLD
6 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
7 Wal‐yan Respiratory Research Centre, Perth, WA
8 Perth Children's Hospital, Perth, WA
9 University of Sydney, Sydney, NSW
10 Lung Foundation Australia, Brisbane, QLD
11 Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
12 Alfred Health, Melbourne, VIC
13 Monash University, Melbourne, VIC
14 Institute for Breathing and Sleep, University of Melbourne, Melbourne, VIC
15 Queensland University of Technology, Brisbane, QLD
16 Austin Health, Melbourne, VIC
17 University of Melbourne, Melbourne, VIC
18 Griffith University, Brisbane, QLD
19 Alfred Health, Melbourne, VIC
20 Western Sydney University, Sydney, NSW
21 Royal Children's Hospital, Melbourne, VIC
22 Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW
23 John Hunter Hospital, Newcastle, NSW

Correspondence: jm.marchant@qut.edu.au

Open access:

Open access publishing facilitated by Queensland University of Technology, as part of the Wiley ‐ Queensland University of Technology agreement via the Council of Australian University Librarians.

Acknowledgements:

We thank Lung Foundation Australia and the Thoracic Society of Australia and New Zealand for their support in the preparation of these guidelines.

Competing interests:

The authors received no specific funding for this work. Julie Marchant is supported by the Lung Foundation Australia Hope Research Fund Andrew Harrison Fellowship in Bronchiectasis Research 2021 and receives personal fees from being an author of two UpToDate chapters, outside of the submitted work. Anne Chang reports multiple grants from the National Health and Medical Research Council (NHMRC) during the conduct of this work; is an independent data monitoring committee member for an unlicensed vaccine (GSK) and an unlicensed monoclonal antibody (AstraZeneca); is an advisory member on the study design for an unlicensed molecule for chronic cough (Merck); and has received personal fees from being an author of two UpToDate chapters, outside the submitted work. Andre Schultz receives salary support from a Medical Research Future Fund Investigator Grant (APP1193796). Danielle Wurzel has received research grants from the NHMRC and GSK, and honoraria from Merck and MSD. Stuart Mazzone has received honoraria from Merck, NeRRe Therapeutics, Reckitt Benckiser and Bellus Health for consultancy on their antitussive programs, and antitussive‐related grant support from Merck, Bellus Health and Reckitt Benckiser, as well as multiple grants from the NHMRC and the Australian Research Council. Shyamali Dharmage has received multiple grants from the NHMRC and the Australian Research Council, including the NHMRC Investigator Grant (APP1193993) that currently supports her. Additionally, Shyamali Dharmage and Jennifer Perret have received independent investigator‐initiated grants from AstraZeneca and GSK for unrelated research. Jennifer Perret is supported by an NHMRC Early Career Fellowship (APP1159090). Johnson George has received honoraria through consultations for AstraZeneca, GSK and Pfizer which have been paid to his employer, and has held research grants from Boehringer Ingelheim, GSK and Pfizer through investigator‐initiated research schemes. All other authors have no conflicts of interest to declare in relation to this work.

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