Good afternoon, and thank you for the opportunity to join you again at the Australian Medical Association national conference.
I acknowledge the Wurundjeri Woi-wurrung and Bunurong peoples of the Kulin Nation, the Traditional Custodians of the lands on which we meet here in Melbourne. I pay my respects to Elders past and present, and I extend that respect to all Aboriginal and Torres Strait Islander people joining us today.
Behind me is the reconciliation action artwork painted for the Australian Government Department of Health, Disability and Ageing by the Indigenous artist, Chernee Sutton, a Kalkadoon woman from north-west Queensland. If you look closely you can see some of the plants and animals and bush medicine used in traditional Aboriginal healing, as well as symbols from Western medicine.
I also acknowledge the AMA's President, Danielle McMullen, the AMA Board and staff members, and the doctors, medical students, health leaders and partners gathered here. As an AMA member for 43 years, I continue to value the strong, independent voice the AMA provides for the medical profession, for our patients and for the communities that we serve.
Danielle, thank you for all your work over the past six years, as AMA NSW President during the early part of the COVID-19 pandemic, as Federal Vice President, and as our National President. You have been a respected voice and a passionate advocate for improving the health and well-being of the people of our nation. As a GP, and the first GP to have been appointed as the Chief Medical Officer for Australia, I have been proud to have you, as a fellow GP, as our national president.
I am also delighted that we have three remarkable talented GPs running for national president this weekend. Thank you all for having the courage and commitment to put yourselves forward for consideration by the electors. From my own experience running for the presidency of the Royal Australian College of General Practitioners twice in the past, and serving a total of four years in that role, I know that medical politics can be challenging and exhausting, as well as hugely rewarding through the impact you can have on our nation's health care system through supporting our colleagues in their critical daily work.
As some of you may recall from my presentation at this conference last year, my first encounter with an AMA president happened nearly 67 years ago, in 1959, when I was a premature neonate, traumatized following my breech entry into the world, and my attending paediatrician was Dr Cecil Colville, who was later elected as the first president of the Australian Medical Association in 1962, and was knighted as Sir Cecil later that year. I am kind of sad Danielle, that that particular tradition of knighting AMA presidents has ended, and that we won't be referring to you as Dame Danielle in the future!
I have been invited to share some insights into what the role of the Chief Medical Officer for Australia, or CMO, involves behind the scenes. When I addressed this conference last year, I had only recently commenced as CMO and I spoke about safeguarding Australia's health care, and about the importance of partnership between governments, the medical profession and the wider community. Twelve months on, that message is even more important.
This year's theme-Leading Change in a Connected World-captures both the challenge and the opportunity before us. Health threats in our connected world do not respect borders. Our patients move between primary care, hospitals, disability supports and aged care. Data, technology, research and public debate connect us more quickly than ever but can also create new barriers and inequities.
The past year has reinforced several lessons for me. In leading change, preparedness is essential before a crisis erupts. Good decision making depends on sound evidence and wise advice. National leadership is strongest when it connects, rather than replaces, local expertise. And meaningful reforms in health care can succeed when clinicians, communities and people with lived experience are involved respectfully right from the beginning.
I want to reflect on how those lessons are shaping my work as CMO in response to both recent and current health emergencies and the longer-term reform of Australia's health system.
Let me begin with some of the health emergencies that have tested our national systems over the past year.
One of my roles as CMO is chairing the Australian Health Protection Committee, the AHPC, which brings together the Chief Health Officers of each of our States and Territories, the Director-General of the Australian Centre for Disease Control, the Surgeon General of the Australian Defence Force, the Commonwealth Chief Nursing and Midwifery Officer, and others.
In 2025, the AHPC met three times. So far this year, the AHPC has met 28 times, as a result of a succession of health emergency risks facing our nation, several requiring the activation of our National Incident Centre within the Department of Health, Disability and Ageing. At times it has seemed like there has been a new disease threat emerging every week. Each threat has been different, but has required the mobilization of people, evidence and resources quickly, and sustaining that effort for as long as the affected members of our communities need it.
Fortunately, on 1 January this year, the Australian Centre for Disease Control, affectionately called our ACDC, was established. The establishment of this independent national public health agency has been one of the most significant national reforms arising from the review of the COVID-19 pandemic.
The Australian CDC strengthens Australia's prevention and preparedness through surveillance, public health intelligence, expert analysis and trusted advice.
Professor Zoe Wainer, who will speak here tomorrow, took up her appointment as the inaugural director-general of the CDC on 1 March. The Director-General and the CMO work closely together, with the Director-General sitting on the AHPC, and the CMO serving as a member of the CDC Advisory Board. In fact, prior to Zoe commencing on 1 March, I was the only member of the CDC Advisory Board and I am glad to say that we reached total consensus on nearly everything during that time.
Over recent months, Zoe and I have worked closely to address emerging health security and protection priorities, bringing together the CDC's expertise with the national coordination role of the AHPC and the emergency response capabilities and responsibilities that rest with the Department of Health, Disability and Ageing.
One of the responsibilities of Australia's Chief Medical Officer is to formally declare a Communicable Disease Incident of National Significance (called a CDINS) when a disease outbreak requires a strongly coordinated, nationwide public health response.
Australia's CMO has declared a Communicable Disease Incident of National Significance, or CDINS, five times since 2020. Can you recall what they have been for? Previous declarations were for COVID-19 in February 2020, for Japanese encephalitis in March 2022, and for mpox, formerly called monkey pox, in July 2022.
Then, on 7 August 2025, just 5 days after last year's AMA conference, I declared syphilis as a CDINS. This followed a sustained, decade-long rise in infectious syphilis cases across our country, but the primary driver for my emergency declaration was that infectious syphilis cases were resulting in an increasing number of tragic cases of congenital syphilis and totally preventable infant deaths. It is hard to accept that syphilis is such a serious problem in a wealthy country like Australia. Aboriginal and Torres Strait Islander people are disproportionately affected, especially those living in remote communities, with infectious syphilis notification rates 7 times higher than those of non-Indigenous Australians in 2024.
The CMO declaring a CDINS enables enhanced coordination of national efforts from the Australian Government and state and territory governments, in this case, to stop the spread of infectious syphilis and dire health outcomes of congenital syphilis. We have since enhanced antenatal testing for syphilis with the recommendation that all women be tested three times during pregnancy, as well as opportunistic testing when pregnant women attend any health service for any reason. The response has involved the engagement of many health professionals who are not normally involved in the diagnosis and management of sexually transmissible infections, as well as strong involvement of Aboriginal Health Professionals and our nation's network of community-controlled health services. I thank those of you directly involved in our nation's syphilis response and for your work in starting to turn around this tragic tide of preventable cases of congenital syphilis.
On 22 May this year, I declared my second CDINS as CMO in response to the diphtheria outbreak that emerged in northern Australia.
As I hope you all know by now, Australia is experiencing its largest recorded diphtheria outbreak since national record keeping began in 1991, and most likely the most significant outbreak in more than 80 years since the time when widespread protection through immunization first became available.
The CDINS declaration on diphtheria has formalised and strengthened work already under way. The declaration followed national risk assessment and advice that the continuing rise in cases required clear, coordinated leadership across governments and services, especially again involving our nation's Aboriginal Community Controlled Health Services. Those at greatest risk are those who have never been vaccinated against diphtheria, or who may have missed booster doses, a sobering reminder for us all about the continuing importance of vaccination.
The Australian Government is delivering a $13 million response package, including vaccines, antibiotics and support from both the National Critical Care and Trauma Response Centre, based out of Darwin, and from AUSMAT, the Australian Medical Assistance Teams.
Nearly 120,000 diphtheria vaccine doses have been administered to Aboriginal and Torres Strait Islander people in remote communities so far this year, and more than 30 AUSMAT deployments have supported communities across the Northern Territory, South Australia and Western Australia.
To date 538 cases of diphtheria had been notified nationally this year with most in the Northern Territory and Western Australia, and a small number of cases detected in South Australia and Queensland. We expect a long tail of infections, and enhanced efforts will need to continue for months. The response must remain sustained, culturally safe and locally responsive, with First Nations communities and community-controlled services central to its design and delivery.
At the same time, we are closely monitoring the outbreak of Ebola disease, caused by Bundibugyo virus, in the Democratic Republic of the Congo. The risk to Australia remains low, consistent with assessments by international partners, and we review that risk regularly. Low risk, however, does not mean no preparation.
Australia has maintained routine pre-arrival screening at every international airport and introduced targeted measures to identify recent travel to the DRC or neighbouring countries. We have also managed the safe return of humanitarian workers in close partnership with receiving jurisdictions.
This work has required close consultation between the Department of Health, Disability and Ageing, the Australian CDC, border agencies, the Department of Foreign Affairs and Trade, the Australian Health Protection Committee, and our national network of Human Biosecurity Officers. Every jurisdiction has reviewed and refreshed its protocols for managing a possible case, including arrangements for patient transfer, infection prevention and control, and laboratory testing.
This year we have also seen how geopolitical disruption can place pressure on the less visible foundations of our health care system.
During the fuel crisis, resulting from the conflict in the Middle East, we have been focused on planning for the risk of disruptions to the delivery of health care services, as well as supplies of medicines, medical devices, consumables and vaccines. To date we have not seen conflict-related shortages impacting patient care directly. But increased costs, changes in delivery schedules and tighter allocation controls for some products have showed, once again, how quickly international disruptions can impact supply chains.
Another national emergency response followed the hantavirus outbreak detected aboard the MV Hondius. The initial case involved a bird watcher who came in contact with the virus while visiting a rubbish dump in the Andes, frequented by local birdlife, but also by hantavirus carrying rodents. The outbreak resulted in several deaths and passengers being offboarded in the Canary Islands, and six passengers being repatriated by a chartered aircraft to the Centre for National Resilience, north of Perth, where they were held in quarantine for 42 days under Commonwealth public health orders. The National Critical Care and Trauma Response Centre provided staff and clinical care, while the AHPC and its subcommittees, along with Australian CDC staff, developed the evidence-based policy and infection prevention and control advice for the repatriation flight, the transfers, and the operations of the quarantine facility, as well as support for local health services on stand by, and provisions to protect the wider community.
Following completion of the period of quarantine, and supported by expert advice from the Australian Health Protection Committee, I determined that no further isolation, quarantine or public health follow-up was required and the passengers headed home.
On 28 April this year, I activated the Poliovirus Infection Outbreak Response Plan for Australia.
Australia's emergency polio response protocol was last activated in July 2007, when an overseas-born student in Melbourne fell ill with a wild poliovirus infection acquired during a trip abroad, with local transmission successfully prevented. This time the emergency response protocol was activated following the detection of poliovirus as part of routine wastewater surveillance from the Subiaco wastewater treatment plant in Western Australia.
Our surveillance system monitors wastewater for poliovirus and serves to provide an early warning on the possible presence of the poliovirus in Australia.
I activated our national response plan in collaboration with the Chief Health Officer of Western Australia, following advice from the members of Australia's Polio Expert Panel, Australia's National Certification Committee for the Eradication of Poliomyelitis, the Chair of the Communicable Disease Network Australia, and the Director-General of the CDC. The Australian Health Protection Committee was convened to ensure the Chief Health Officers of all states and territories were aware of the notification and clinicians, especially paediatricians and GPs in WA were alerted to the risk. Australia notified this detection to the World Health Organization as required under International Health Regulations.
Fortunately this surveillance report was not linked to any active cases of poliomyelitis disease in Australia, but the incident again reinforced the importance of vaccination to protect Australians against the risk of infection with serious infectious diseases.
And now we have H5 avian influenza in Australia. Although the risk to human health is assessed as low, the risk to the mental health of the people of Australia is significant, especially if we start to see widespread deaths of native birds and animals, including risks to many iconic species, and potential spread into our agriculture sector, including poultry farms, which will impact rural communities, and spread into areas cared for by Aboriginal communities.
Across all these emergency responses, the hazards were different: a prolonged domestic outbreak of a forgotten disease; an overseas haemorrhagic viral disease requiring border and laboratory readiness; geopolitical pressures on essential supply chains; the repatriation and quarantine of Australians after an exposure to a rare but deadly virus; wastewater alert of a disease that has almost been eradicated from the planet; and the arrival on our shores of a virus which could impact many native birds and animals. Yet the foundations of our responses have been consistent-early detection, evidence-based advice, clear governance, capable people, trusted communication, and genuine partnerships across governments, health services, health professionals, and communities. I thank the AMA team for your continued role in ensuring that the doctors of Australia are kept informed of these risks and know what they can be doing to support affected communities.
In the background we are continuing preparedness for future pandemics and other emergencies, including the risks of chemical, biological, radiological and nuclear threats. In our brave new world, artificial intelligence is starting to add to the biosecurity risks in some frightening ways, but also provides novel ways to further mitigate and track risks. Natural disasters also continue, as we have seen this week with the devastating flash flood in Nepal, involving some of our fellow Australians.
Immunisation, of course, remains one of the most effective public health interventions we have, and trusted advice from doctors remains one of its most important foundations. You will have seen the reports from the World Health Organization showing that vaccines have saved an estimated 154 million lives over the past 50 years, most in children under five years of age.
In February, I wrote to all GPs in Australia reminding my colleagues that your recommendation to your patients is one of the most influential drivers of vaccination acceptance, and that a strong, confident endorsement from a trusted health professional can make a significant impact on patient decision-making, especially among young parents and older at risk people.
Again, I thank the AMA for your national social media campaign encouraging Australians to "have the jab chat" with their GP to help cut through vaccine misinformation fuelling the recent decline in rates of immunization.
While we tackle misinformation and deliberate disinformation about vaccines, we also have more vaccines becoming available.
Effective protection against respiratory syncytial virus (RSV) now extends from our very youngest Australians to our very oldest. Recent changes to the pneumococcal vaccine program have extended funded protection for priority groups, including for those of us aged over 65.
From 1 October, COVID-19 vaccination will transition from the emergency-era national program to a more targeted National Immunisation Program approach. Funded COVID-19 vaccination will focus on older people, Aboriginal and Torres Strait Islander people in specified age groups, and adults with severe immunocompromise.
Some patients may interpret this change as meaning COVID-19 vaccination is no longer important. This is where clear communication from trusted clinicians will matter. The transition reflects a more targeted and sustainable approach-not the disappearance of risk.
As new priorities emerge, we must not lose sight of established programs, including influenza, shingles and routine childhood immunisation. In a noisy information environment, your recommendation as a trusted clinician can maintain confidence, identify missed opportunities and support timely protection.
As CMO, closing the gap in health outcomes for Aboriginal and Torres Strait Islander people remains one of my most important national responsibilities. I know this also remains a top priority for the AMA, and I thank you for your leadership.
The latest figures are confronting. Life expectancy is improving, but not fast enough. Progress on healthy birthweight has stalled. Suicide outcomes are worsening. These realities require sustained investment, but also structural change in how decisions are made, how services are designed and who holds authority.
The Australian Government is investing $4.6 billion over the next four years through the Indigenous Australians' Health Programme. The new National Health Reform Agreement between the Commonwealth and states and territories includes an inaugural First Nations Schedule, placing a clearer focus on equitable outcomes and on addressing structural and institutional racism in our health system.
While these investments are significant and important, even more important is the way this work is done, especially through strengthened shared decision-making through the First Nations Health Governance Group, the transition of funding to First Nations-led organisations, and increasing investment in our nation's Aboriginal Community Controlled Health Organisations. Self-determination is not an optional addition to good health policy; it is central to its effectiveness.
There are encouraging examples of what sustained partnership in Aboriginal and Torres Strait Islander health can achieve. In April this year, the World Health Organization validated Australia as having eliminated trachoma as a public health problem-a significant achievement led by First Nations communities and supported by long-term collaboration with many partners, including some of our nation's leading clinicians in ophthalmology, public health, infectious diseases, primary care and more. This is a welcome achievement, but surveillance, prevention and investments in improving the social determinants of health must continue.
I am also keen to work with you all on efforts to eliminate rheumatic heart disease. Acute rheumatic fever and rheumatic heart disease are preventable, yet continue to impose a profound and lifelong burden on many First Nations people, particularly in remote communities. Australia's Rheumatic Fever Strategy is being delivered with NACCHO, the National Aboriginal Community Controlled Health Organisation, along with states and territories, and the Australian Institute of Health and Welfare.
As we all recognize, our health system will not close the gap by doing more of the same. Progress depends on supporting First Nations leadership, culturally safe care, and community control and accountability for outcomes.
Another area requiring careful, evidence-informed leadership is care for transgender, non-binary and gender-diverse people. Transgender people have, of course, always been a part of our communities, sometimes revered and cherished, sometimes stigmatized and discriminated against. As a GP who has worked with many wonderful transgender and intersex people throughout my career, and as a gay man and a member of the LGBTQI+ community, I have been concerned about some of the public discourse and the impact it can have on vulnerable people.
As CMO, I am a member of the Council of the National Health and Medical Research Council, the NHMRC, which is developing national clinical practice guidelines for the care or trans and gender diverse people under 18 with gender dysphoria. Interim advice for public consultation on the use of puberty suppression will be available later this year.
I hope we see robust but also respectful engagement with that consultation. Our shared objectives include supporting clinicians to provide evidence-based care, manage clinical risk, and respond appropriately to the individual needs of each patient, as we always do.
We also need to recognise that periods of heightened public debate can affect the wellbeing of many people, especially young people and their families. As health professionals we are uniquely placed to provide trusted information and compassionate support. Whatever views are expressed in public discussion, dignity, safety and respectful care must remain at the centre.
Chronic conditions remain Australia's leading cause of illness, disability and premature death. Three in five Australians live with at least one chronic condition, and almost two in five live with two or more. The impact is felt not only by individuals, but by families, workplaces and every part of our health system.
In March, the Australian Government released the new National Strategic Framework for Chronic Conditions which runs for the next ten years and which aims to improve outcomes for the more than 15 million Australians living with chronic health conditions, through prevention, early intervention, continuity of care and a stronger focus on equity.
I wanted to share the achievements of our new National Lung Cancer Screening Program which shows what prevention and early detection can achieve. Since commencing in July 2025, more than 111,000 people at high risk have accessed free screening, and more than 340 primary lung cancers have been detected.
Clinicians-especially those working in primary care-are central to this program's success. We identify eligible people, explain the benefits and limitations of screening, and support follow-up. Equity is also fundamental. Mobile screening services are expanding access across rural and remote communities, including in Western Australia and the Northern Territory, with additional mobile services still to come into service.
As CMO I have responsibilities across health, disability and ageing.
Dementia is one of Australia's most significant health challenges. It is the leading cause of death and the second leading cause of disease burden, and the number of Australians living with dementia is projected to increase substantially over coming decades.
International evidence, including from the Lancet Commission on dementia prevention has shown that a significant proportion of dementia may be prevented or delayed by addressing 14 modifiable risk factors across the life course.
Australians turning 50 recently received a letter from the Australian Government encouraging them to take practical steps to support their brain health and reduce their future risk of dementia. The letter points people to evidence-based information and self-assessment tools, and encourages people to consult with their GP or other health professionals where appropriate.
We developed this initiative with the Royal Australian College of General Practitioners because we know that prevention must be grounded in primary care. Many actions that reduce cardiovascular and metabolic risk also support brain health: physical activity, a balanced diet, smoking cessation, managing blood pressure, maintaining hearing and vision, and staying socially connected.
Dementia is not an inevitable consequence of ageing. By giving people practical, credible advice earlier in life, and by supporting our clinicians with current guidance, we can help more Australians protect their health and independence as they age.
People with disability-particularly people with intellectual disability-continue to face major barriers to timely, accessible and comprehensive health care. Addressing those barriers is a national reform priority and a clear test of whether our health system works for everyone.
We need to design health systems to fit people, rather than expecting people to fit our health systems. Bringing health, disability and ageing into the one department creates an important opportunity to improve how these systems connect for individuals and their families, as well as for health, disability and aged care workers and service providers.
Doctors and health services can help turn disability reform into daily practice by making reasonable adjustments, communicating in accessible ways, supporting preventive care, and working in genuine partnership with people with disability, their families, carers and support networks.
It is important to be clear: disability is not a health condition to be fixed or cured. The task of disability reform is to remove barriers that prevent people with disability from participating equally in society, including barriers to high-quality health care.
As CMO, every day is different and brings a new set of really interesting challenges. I am conscious that there are many more topics that have occupied me over the past year that we could have discussed: urgent care clinics, pharmacist prescribing, illegal peptides, asbestos contamination in children's coloured sand, scope of practice, GLP-1 agonists, aged care assessments, medicinal cannabis, bulk billing incentives, endometriosis care, voluntary assisted dying, flumist, NDIS reforms, thriving kids, the list goes on. Perhaps you can invite me back next year and we can talk about some of these. But I want to close by returning to the theme of this conference: Leading Change in a Connected World.
The issues I have discussed today may appear very different-from diphtheria and pandemic preparedness to chronic disease, dementia prevention, and disability reform. But they are connected by a common question: how can we strengthen our health system to act early, use evidence well, earn trust, and be centred on the needs of our patients?
In addressing these issues, national leadership matters, but so do local relationships. Technology matters, but only when it improves the safety and quality of our care. Evidence matters, but it must be communicated with clarity and compassion, and balanced by what we don't know. Reform matters, but it must be respectful of what happens in our clinics, hospitals, homes and communities.
As doctors, we have a distinctive role in all this work. We see where systems connect well, and where they fail to connect. We carry the trust of our patients through times of uncertainty and fear and confusion. We translate policy into care, and we bring practical experience back to further inform policy.
Our AMA has an essential role in bringing our profession together, challenging our governments when necessary, contributing constructively to reforms, and keeping the health of our patients and our communities at the centre of national debate.
We won't always agree on every issue or every solution. But honest, respectful dialogue is a key part of progress. Our shared purpose is stronger than any individual difference, and is driven by our desire for better health and wellbeing for every person in Australia.
Over the coming year, I look forward to continuing to work with you all, with our AMA, and with our new president.
Thank you for the important work you do every day supporting the people who trust you for their medical care and advice.
