Doctor writes open letter to Scott Morrison on asylum seekers

Infectious Diseases Physician Trent Yarwood released the open letter below to Coalition immigration spokesperson Scott Morrison on February 28.

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Dear Mr Morrison,

I am writing to you regarding your press release dated February 27, 2012, entitled “Typhoid cases on latest boats highlight the risk of Labor’s border failures”.

I believe it was a crass piece of political opportunism and was not only using the plight of asylum seekers for point-scoring, but plumbed new depths by making the health conditions suffered by these unfortunate people a further reason for the Australian population to fear them. Even worse than this, however is the gross misrepresentation you committed through your obviously limited understanding of communicable disease and the methods for describing its frequency.

The number of cases of communicable disease are of little utility in interpreting health statistics unless a comparison figure is given — for example, the rates/100,000 population or the number of cases in a given area. Reviewing the numbers of cases of diseases in the Christmas Island asylum seekers compared to the total number of cases reported in Australia for 2011 is instructive:

Even without any medical knowledge, it can be seen from these figures that the number of cases suffered by asylum seekers make up a tiny fraction of the total number of cases in Australia each year, and the tone of your press release vastly over-emphasises the risk to the Australian population from the extremely small number of cases introduced by asylum seekers each year.

Secondly, the risk of transmission of these diseases is extremely small. Tetanus is not transmissible from person to person. Shingles only poses a risk to other people if there is close contact with open lesions.

Chlamydia and gonorrhoea require s-xual contact. Most cases of syphilis reported will not be infectious syphilis, and those that are require s-xual contact. Hepatitis C requires blood-blood contact and s-xual transmission is rare. The main mode of transmission of Hepatitis B in asylum-seeker source countries is mother-to-child transmission; transmission to others requires blood (or less likely s-xual) contact and most Australians are vaccinated.

Dengue and malaria both require the presence of appropriate mosquito vectors which would need to bite the infected asylum seekers at the time which the organism is circulating in their blood. Therefore, it can be said that these diseases pose very little threat to the health of any Australians — due to the small number of cases and their poor infectivity.

Finally, your singling out of asylum seekers to Christmas Island as a source of these diseases is unfair. Most of the diseases are endemic in Australia, so the disease could not, by definition be introduced to Australia.

Typhoid is a frequent infection in returned travellers, but the risk of becoming endemic in a country like Australia with good sanitation and a robust public health system is negligible. The notification data presented above shows there is a large number of cases of these notifiable diseases that occur each year in Australia. The vast majority of these are in Australia citizens; in some cases in returned travellers and in some cases in people who have not left Australia. It is certain that the number of cases of chlamydia and gonorrhoea in visa-overstayers who come by plane far exceeds the number seen in these boat people.

Certain groups of overseas tourists on holiday visas almost certainly have higher rates of some of these infections than these asylum seekers. I expect that tourism organisations would have been outspoken in criticism if you had made a similar statement about backpackers — who are far more likely to fraternise with Australian citizens.
It is a marker of the lack of compassion the Coalition and the Labor party hold for asylum seekers that in addition to the hardship of their journey and the documented harms of mandatory detention that you now feel it appropriate to further vilify these poor unfortunates on the basis of medical illnesses that pose almost no threat to the health of Australians.

In short, your media release is ill-informed, not supported by publicly accessible health data, discriminatory and seems to have been intended to prey on fears of the foreigner and fear of pestilence. It has no merit either political or scientific and should be withdrawn.

I will be openly publishing this letter to ensure as many people as possible can be informed of the reality of the situation as opposed to your propaganda. I thank you in advance with not replying with a form letter from your staff informing me that your figures are correct and the straw man defence that the blame lies with the Labor party for not introducing the Coalition’s policy of detention on Nauru.

Yours faithfully,
Trent Yarwood
Infectious Diseases Physician and
Public Health Registrar