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GEELONG CENTRE FOR EMERGING

INFECTIOUS DISEASES
(GCEID)
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Summary of Presentation

1. The problem
2. GCEID framework
3. GCEID activities
4. The future

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1986!
the risks to man from infectious disease
have all but disappeared and we need to
focus on those diseases such as cancer that
are a consequence of our environment,
what we do and what we eat
Attributed to
Chief Medical Officer, USA
DO INFECTIOUS DISEASES
MATTER?
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MAD
cow
disease
Foot and Mouth Diseases
West Nile
Avian Influenza
Human Influenza
H1N1
(Swine Influenza)
MM
MERS
ch
Chikungunya virus
E
Ebola
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Estimated
costs
Figures are estimates and presented as relative size
1990 1995 2000 2005 2010 2015
$50 bn
$10 bn
$20 bn
$30 bn
$40 bn
Cholera,
Peru
$775M
BSE, UK
$7.5 bn
FMD, Taiwan
$5 bn
Lymes disease,
US $2.5 bn
Nipah, Malaysia
$350 m
West Nile, US
$400 m
BSE,
US $3.4 bn
Foot and Mouth,
UK $35 bn
SARS
China, Singapore,
Canada,
$60 bn
Avian Influenza
Global
$30 bn
Bluetongue, Europe
$2 bn
Equine Influenza
Australia $ 1 bn
Economic impacts of selected emerging and re-emerging infectious diseases
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AND SO
the incidence of infectious disease continues to
grow globally and in Australia
Known infectious diseases continue to emerge
and re-occur e.g. rabies, tuberculosis, salmonella,
rift valley fever, West Nile, FMD!
New infectious diseases keep arising e.g. HIV,
BSE, Hendra, Nipah virus, SARS, Ebola Reston
virus, chikungunya
75% of new diseases in man come from animals
and most of this involves the interaction between
wildlife, domestic animals and man

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infectious
disease
AND SO THE CONCEPT OF ONE HEALTH
Animals
Environment
Man
(production levels,
animal welfare,
trade)
(direct disease,
food safety,
food security)
(wildlife,
eco-system,
tourism)
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PATHOGEN INFLUENCES
Quasispecies variation
Genetic recombination
Host/ vector adaptation
Tissue tropism
Virulence determinants
Latency/persistence
HOST INFLUENCES
Reservoir host spillover
Intermediary hosts
Vector competence
Susceptible host range
Pathogenesis
Immune response
GEOPHYSICAL INFLUENCES
Climate change
Climate variability
Extreme weather events
ANTHROPOGENIC INFLUENCES
Globalisation
Urbanisation
Land use change
Behavioral/cultural change
Regional/global conflict
HOST PATHOGEN
ENVIRONMENT
DISEASE
The complex of
disciplines
needed
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Amplification in a
secondary host
Transmission
to humans and dogs
Direct transmission
to humans?
Human to human?
Hendra an example in Australia
Bats
Horses
(not so far!)
(not so far!)
Man
Man
Dog
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Ross River virus
Enzootic (Maintenance/Amplification)
Amplifying
hosts
Incidental hosts
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A One Health research approach is clearly the
most rational, cost effective and appealing
approach to manage the risks facing
environmental, animal and human health BUT
how should we best organise ourselves to really
deliver!




GCEID
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GCEID AS IS!
The Geelong Centre for Emerging Infectious Disease (GCEID) is an
innovative research collaboration between CSIROs Australian Animal
Health Laboratory (AAHL), Barwon Health and Deakin University and
the City of Geelong.
GCEID aims to identify, monitor, understand and develop treatments
and mitigation strategies for new infectious diseases as they
transition between wildlife, domestic animals and human
populations.
This unified 'One Health' approach integrates the knowledge and
expertise of the partner institutions to address disease threats to
humans and animals before they reach crisis point.

A collaborative research partnership between Deakin University Medical School, Barwon Health and CSIRO Australian Animal
Health Laboratory (AAHL)
GCEID
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GCEID AIMS AND OUTCOMES
Early warning/rapid response capabilities
Improved diagnostics
New therapeutics
Innovative vaccines
Public health initiatives
Informing policy

GCEID through these collaborations will reduce the impact of Emerging
Infectious Diseases (EIDs) on human health, livestock productivity and
economic prosperity in Australia and its neighbors through:
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A REGIONAL DEVELOPMENT COMPONENT
GCEID brings together the strengths and values of CSIRO/AAHL,
Deakin University Medical Faculty and Barwon Health
GCEID offers a strong way forward for Bio-Geelong
GCEID provides an innovation pathway of products for local
biotechnology companies to exploit and take to market
The concept has a proven track record e.g. CDC Atlanta
Georgia, USA
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GCEID CAPABILITIES
globally unique high containment facilities at AAHL (PC2/PC3/PC4) and including state of
the art animal containment rooms, immunological laboratory and insectary within
containment
globally leading expertise at AAHL in isolating and identifying animal disease pathogens
and vectors; developing validating and standardizing diagnostic tests; undertaking
pathogenic and vector studies, host switching and pathogen emergence, development of
disease recent animals
Deakin University and Barwon Health researchers have strong expertise in molecular
biology, epidemiology and clinical expression of infection
The Deakins Centre for Integrative Ecology have a proven record in research into disease
prevalence and evolution in wildlife.
Deakin University and Barwon Health have established laboratory and clinical research
teams in infectious diseases, immunology, epidemiology, population health and health
economics.
Deakin and Barwon Health have extensive connections throughout regional western
Victoria, through close links with regional health services and primary care providers

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RESEARCH PRIORITIES
address priority EID risk areas
are identified as research priorities by key stakeholders including the
Victorian Government, DOHA, NBC and DAFF
show a measurable pathway to a product or service that will help achieve
GCEID and the Geelong (BioGeelong) development vision
fall within the 'one health approach
build on existing successes, intellectual property and skills within the
partner Organisations
require the use the high containment facilities of AAHL
have significant opportunities to attract external investment
are based on scientific excellence.
Link with or do not overlap with, activities of the CSIRO
Biosecurity Flagship

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GCEID WILL FOCUS ON THREE DISTINCT
PROGRAMS
1. Mitigation of the risks of EID entry and spread through:-

Classical epidemiology including:
- Surveillance and mapping of pathogen reservoirs
- Geographical information systems
- Modelling outbreaks
- Outbreak investigation
- Impact of climate change
- wildlife disease investigations
Molecular epidemiology
- sequence analysis
- phylogenetic tree analysis
Quarantine and related measures
Diagnostics including penside test development
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GCEID WILL FOCUS ON THREE DISTINCT PROGRAMS
2. Enhancement of the capabilities to respond to an EID event, to control or
eradicate and to provide more efficient and effective means to mitigate
established diseases through:-

Enhancing outbreak response capabilities including managing hospital surge capacity
Therapeutics including antibiotic resistance studies
Vaccines
Modelling and scenario evaluation
Community and social impact studies (e.g. managing public information; home
quarantine, medication)
Economic modelling
Understanding of virus change and evolution through an outbreak
Improving and understanding quarantine requirements for hospital in-patients and staff)
Public health emergency ethics
Education and training

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GCEID WILL FOCUS ON THREE DISTINCT PROGRAMS
3. Improved understanding of the EID threat through
studies in pathogenesis and pathobiology

Host pathogen interactions and comparative immunology
Genomics, proteomics and bioinformatics
Underlying pathogen and host factors that influence
emergence and host switching
Factors governing virulence and host specificity

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CURRENT PROGRESS IN RESEARCH
COLLABORATION
made joint appointments
obtained joint funding for research proposals (including
equipment)
exchanged students and training programs
held a number of joint seminars and meetings
Created good links with the other One Health groups and
activities e.g. SCEID, QCEID, Biosecurity Flagship, Melbourne
University
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ACTIVITIES UNDER GCEID
Staff and students

0.2 FTE GCEID Director
12 joint staff appointments
12 joint PhD students
10 joint Honors students

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ACTIVITIES UNDER GCEID
Grants and Awards

NHMRC Strategic Award, 2009-10 $127,250: Identification of determinants associated with pathogenicity of Swine
NHMRC Strategic Award, 2009-10 $64,164: The structure and receptor of the 2009 swine influenza pandemic virus
hemagglutinin
ACH2, 2009 $66,000: Development of recombinant influenza-SIV vaccines
NHMRC Project Grant, 2009-11 $326,584: Dissecting the contribution of malaria translocon components to
pathogenesis.
NHMRC Strategic Award, 2009-10 $127,250: Identification of determinants associated with pathogenicity of Swine
NHMRC Strategic Award, 2009-10 $64,164: The structure and receptor of the 2009 swine influenza pandemic virus
hemagglutinin
ACH2, 2009 $66,000: Development of recombinant influenza-SIV vaccines
NHMRC Project Grant, 2009-11 $326,584: Dissecting the contribution of malaria translocon component
pathogenesis.
ARC Linkage, 2014-2017 $315,138: Co-evolution between avian parasites and a highly variable host
ARC Discovery, 2013-2016 $497,310: Avian migrants as vectors of zoonotic diseases in a changing world
US-NIH, AWHN, 2011-2014 $350,000: Surveillance of influenza A viruses in wild birds



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ACTIVITIES UNDER GCEID
Mycobacteria ulcerans Ecology GIS study $20,000 Dr I Jeanne; Epidemiology Serosurvey $50,000;
collaboration Uni Melb, AAHL, Deakin Transmission, Immunopathology.
Clostridium difficle Epidemiology study, Novel targets for therapy PhD C Roder, M Thomson.
Biofilm device infections Orthopedic for VIIN grant application 2013 in vivo model; Cardiac device registry
in collaboration Monash University $500,000 Commonwealth Grant.
Clinical trials novel therapies, vaccines and antimicrobial resistance ASID CRN projects (RCT septic arthritis
funding DoH $80,000 2013-15; RCT cellulitis funding DoH $60,000 2013-15; RCT MRGN BSI $200,000
ASA, ISC. NHMRC pending, Univ QLD; Cost effectiveness study $50,000 DoH2013-15; Zoster vaccine GSK
$300,000 50 subjects 2012-14; Ross river vaccine Baxter $150,000 20 subjects 2012-14; Refugee Health
Hub $2 million from NBN in collaboration with Uni Melb.
Endocarditis/ Staphylococcus blood stream infections Collaboration Duke University NIH grant 2 million;
ALG $50 million future projects
Hand hygiene initiative across BH $500,000

Grants and awards (contd.)
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FURTHER RESOURCING
A full time Director
An administrative assistant
A business manager
Seed funding for priority research areas
Cross-Institutional PhD scholarships (812)
Interdisciplinary Post doctoral positions (46)

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AS THE GLOBAL RISKS FROM NEW AND
EMERGING INFECTIOUS DISEASE
INCREASES DOES
AUSTRALIA/AUSTRALASIA NEED A CDC
LIKE STRUCTURE?
but is this enough??
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THE REVIEWS TO DATE
1990 Australia needs communicable diseases centers (Rubin et al.)
2002 Academy of Science establish ACDC
2008 Review of threat from emerging diseases by Rudd
Government establish a CDC like entity (ACEID)
2013 House of Representatives Standing Committee on Health
and Ageing - Diseases have no borders (DOHA April 2013)
2013 McKeon Review Integrated Health Centers establish one
for infectious diseases
2013 The time has come for an Australian Centre for Disease
Control (B. McCall, M. Young, S. Cameron,R. Givney, R. Hall, J. Kaldor,
A. Koehler, V. Krause, C. Selvey: Australian Health Review, May 2013)


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the House of Representative report on the need for an
Australian CDC felt that such an entity was strongly
warranted BUT recommended a review (2013).
From a policy perspective GCEID meets the
requirements of
these Government reports
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SOME CDC MODELS
USA CDC - budget of billions, established 60 years ago, contributes
towards basic health knowledge, health policy, health
program enactment and workforce development
HPA, UK - independent statutory authority, provides technical
leadership in disease control, strengthens surveillance
and response, improves health protection, and supports
local public health officials
ECDPC - strengthen Europes defenses against infectious diseases,
independent center of scientific excellence in disease
control
CAPH, Canada independent, evidence based advice on
public health



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KEY ELEMENTS OF THESE MODELS
Focus on public health (human health!)
Independent technical advice (no political agendas or
pressures)
Based largely on epidemiological and surveillance data
Elements of preparedness, response, control and workforce
management
Mainly formed in response to global growth of infectious
diseases affecting humans (SARS and Influenza)
Relatively small budgets (except CDC)
Not really about research much more operational
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CURRENT SITUATION IN AUSTRALIA
Australian Health Protection Principal Committee (chaired and
supported by the Department of Health and Ageing with
representatives form all States) - manages the national
communicable disease agenda
CDNA technical subcommittee of the above (wide range of
competing priorities, primarily in program management)
Very limited national scope for ongoing analysis and
interpretation of data, development of new surveillance
methods, routine review of international findings, evaluation of
policy and program impact, and the training and
mentoring of the public health workforce as a response
capability


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THE ISSUES FOR AUSTRALIA
We need to better understand the risk from new and
infectious, particularly those of a zoonotic nature
We need to develop a process for providing advice
Governments on policy and process for managing these
risks
We need to create new partnerships between the medical
profession, animal health experts, wildlife ecologist and
social scientists
We need a focussed one health research program
We need to resource the above
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TO PROGRESS IN THIS AREA WE NEED TO:
Agree that the threat from new and emerging infectious diseases is
real
Agree that a one health research approach is valuable and the best
way forward
Recognize and agree that GCEID provides a CDC like entity for
Australia
Allocate additional resources to GCEID to allow for further
development of national priority based research program
Provide a positive framework for SME biotechnology companies to
relocate to Geelong and market the outcomes of the GCEID research
program (vaccines, therapeutics, diagnostics)
Develop a governance structure for GCEID that recognizes and
provides inputs for the key partners and stakeholders in GCEID


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BUT IS GCEID THE SAME AS A CDC?
Most Centers for Disease Control (CDCs) are about
communicable diseases not just a focus on infectious disease
and certainly not those of a zoonotic nature
Most provide independent advice to Government on a wide
range of health issues
Most CDC focus on epidemiology, surveillance and control (not
just research)
None to date have a significant One Health perspective and
are largely managed by the medical profession
All have a public health focus (humans not animals)
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AND SO GCEID WOULD ADDITIONALLY:
Monitor national surveillance data and provide advice on
trends and issues
Develop new surveillance methods
Review and provide advice in international situation and trends
Independently evaluate policies and programs
Provide a response capability to augment what already exists
In an emergency provide independent advice
Not replace the CDNA but support it!


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AND THE ADVANTAGES
No real new structure needed
Would provide arms length advice
Cost effective through use of on-going research
Provide a national central resource in line with other countries
Can be fully mobilized when needed
Augments what we already have and does not replace

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CONCLUSIONS
Yes we need a CDC like entity to strengthen our capacity to
analyze and respond!
Yes we need GCEID to strengthen our research and
understanding!
Yes we need additional resources!
Yes we need these now!