'Decade of elimination': $5m project's big goal for NZ health

A major new research programme aims to build on our stunning success against Covid-19 by wiping out other infectious diseases - making the 2020s the "decade of elimination".

"The successful elimination of Covid-19 transmission in Aotearoa New Zealand has shown us the value of aiming high," said the programme's director, prominent Otago University epidemiologist Professor Michael Baker.

"With good science and good leadership, tough challenges that previously were thought to be impossible are now within our reach."

The five-year programme's name - Syndemic Management of the Biology and Treatment of Infections and Chronic, or "Symbiotic" - reflected that infectious diseases and serious long-term conditions like diabetes tended to occur together.

"The programme was written in 2019, but the ideas are very relevant to our current response to Covid-19 where the risks of infection and poor outcomes are strongly influenced by the presence of chronic conditions and poverty," Baker said.

"A major goal of the programme is to better understand the two-way relationship between acute and long-term conditions to improve health and equity in New Zealand."

Symbiotic's deputy director and lead researcher, Otago epidemiologist Dr Amanda Kvalsvig said that many infectious diseases caused complications in later life.

Infection with the bacteria Helicobacter pylori, for example, was the leading cause of stomach cancer.

"So, elimination of H. pylori infection will not only treat the infection, it will also be cancer-preventing."

One goal of the programme was to improve screening and treatment of H.pylori among those groups most at risk - particularly Māori and Pasifika people.

The cycle also worked the other way: having multiple long-term conditions was an important risk factor for infectious conditions like influenza.

There was now a growing list of infections that could be eliminated in our populations, with potentially "enormous" benefits for health, Baker said.

"Tuberculosis and Hepatitis C are two examples of serious infections that can be eliminated from Aotearoa New Zealand in the next few years, with suitable science-informed leadership and adequately-resourced public health programmes," he said.

"Understanding the connections between infectious diseases, long-term conditions, and disadvantage is just the start."

Kvalsvig said the programme would effectively bring together communities, clinicians, university researchers, Māori health providers and policy-makers to tackle long-standing barriers.

"We need a transformational model that can address these complex health issues as a whole, instead of the fragmented approaches that have been used until now."

Kvalsvig said a team from Massey University would be investigating the potential role of antibiotics in childhood in long-term conditions like diabetes, inflammatory bowel disease and attention deficit hyperactivity disorder.

"An important contribution of the programme will be uncovering these life-course effects. This issue may be yet another example of the hidden risks of antibiotic overuse."

A key strength of the programme is that the research draws on Māori models of health and is designed to uphold Te Tiriti o Waitangi principles.

"Grounding the research within Māori experiences will help identify solutions for how infectious diseases and long-term conditions can better be managed by and with Māori communities," senior researcher Andrew Waa said.

"The whakatauki in the framework of the Tākari Mai Whānau Ora Collective is especially relevant to our relationship," added another senior Māori researcher in the group, Cheryl Davies.

"Me mahi tahi tātau, ka ora ai te iwi. Working together as one."

The programme, which has received a $5m Health Research Council grant, will be formally launched today with a hui at Kōkiri Marae in Lower Hutt.