Frequently Asked Questions These FAQs are designed to provide additional information for biobanking participants. They should be read together with the Participant Information Sheet. Taking part and background to the Australian Health Biobank Why am I being invited to take part? You are being invited to participate in the Australian Health Biobank because you are aged 18 years or older and taking part in the National Health Measures Study (NHMS) being conducted by the Australian Bureau of Statistics (ABS). As part of that study, you have been asked to voluntarily supply a blood sample and a urine sample. We are now asking if you would also agree to voluntarily donate an extra blood and urine sample to the Australian Health Biobank. What is a biobank? A biobank is a collection of human biological samples or ‘biospecimens’ (e.g. blood and urine) and/or their products (e.g. DNA). Like a bank, samples donated for health and medical research are kept under tight security and in carefully controlled conditions. Samples are stored securely, together with samples from many other people like yourself, for use in ethically approved health and medical research projects, now and into the future. This bank of samples will be made available to researchers from across Australia to conduct new research to help support the health and wellbeing of Australians. Research is an important part of our health care system. Across Australia, our researchers contribute to discoveries that help us lead longer, and healthier lives. The biobank will support research by providing researchers with access to a national collection of biological samples from the Australian population – making health and medical research easier and quicker. What are the benefits of participating? Your choice to donate a sample and allow access to your health and personal information will support research that could result in discoveries that could change, improve and save lives in the future. It is not likely you will benefit directly. Donating a sample How and when is my sample taken? If you choose to participate in the Australian Health Biobank, you will be asked to attend a second appointment at a Sonic Pathology Australia collection centre (after the appointment when your get your samples collected for the NHMS). At this appointment, you will be asked to donate blood (approximately 20 ml or 1 tablespoon) and urine (approximately 10 ml or 2 teaspoons) to the Biobank. If you agree, some of the blood sample will be used to isolate a sample of your DNA. What happens to my sample after it is taken? Your samples will be sent from the pathology collection centre to a central processing laboratory, where they will be transferred into tubes that are specially designed for long-term storage. Your samples will be labelled with a unique code and won’t have any information on them that could identify you (like your name or address). From the central processing centre, your samples will be sent to a high security, well‑established storage facility for long-term storage. This facility is set up to ensure the samples remain safe and in the highest quality condition. This facility meets international security and safety standards for managing biological samples. This facility will store your samples on behalf of the Australian Health Biobank. They will only be able to access your samples when they are authorised to do so, and the samples will only be used in a way that the Australian Health Biobank approves. Your samples will be made available to researchers for research projects, now and into the future (see FAQ section below on Research Projects). You can choose to withdraw your consent and donation at any time. If you decide to stop taking part, your sample would be removed from the Biobank and destroyed (see FAQ section below on Withdrawal of Consent). How long will my samples and information be kept? Your samples and information could be held indefinitely (or until you choose to stop taking part). Will I be paid for my samples and their use in research projects? No. Your decision to take part in health and medical research is voluntary and you will not receive any payment for your donation to the Australian Health Biobank. It is possible that research from your samples could be used by researchers or a company to develop a test or product that they make money from. If this happens, neither you nor the Australian Health Biobank will benefit financially (See answer to FAQ below: Will commercial researchers be able to access my samples and data?) Do I get a say in what happens to my samples e.g. if I withdraw or if the biobank closes down? You are donating your samples to the biobank, and the Australian Health Biobank is responsible for looking after these samples while they are in the biobank, and disposing of them in accordance with any religious, cultural or other requirements that you may have when they are no longer needed or if you decide to withdraw consent. We will ask you about any such requirements at the time you withdraw or if the biobank closes down for any reason. Withdrawal of consent I’ve changed my mind. How do I withdraw my consent? Your participation is voluntary. If you choose to take part now, you can change your mind later and withdraw your consent at any time. You can stop participating at any time and for any reason. You can withdraw by contacting the Biobank custodian (CSIRO) on 1300 363 400 or email biobank@csiro.au. These contact details will also be available in a regular participant newsletter and on the Australian Health Biobank website. As an Australian Health Biobank participant, you will also be given a unique code for a page only you can access where you can easily • manage your consent status (including withdrawal), • update your contact details or any other information and • see if your samples have been used for any research projects. In addition, a withdrawal of consent form will be available on the website that will be set up specifically for the Australian Health Biobank and regularly updated. The form can be completed by you either online or by printing out the form. You can choose to withdraw from all or different parts of the biobank, for example genomic research. What happens to my samples and information if I withdraw my consent? If you choose to stop taking part, the samples you donated will be removed from the Australian Health Biobank and destroyed using standard clinical procedures. Participants will be asked at the time of withdrawal whether there are any cultural or other requirements in relation to their sample. If there are, we will do our best to ensure your sample is destroyed in accordance with these requirements and will discuss this with you if there are any problems meeting them. If you choose to stop taking part, we will ask that any results from research that has already been done on your samples is retained in the Australian Health Biobank data repository, but you can request that all such information is removed if you wish. At the time you let us know you would like to withdraw your consent your sample might have already been given to a researcher and used for a project. They will be asked to destroy this sample if it has not already been used for their research. It is important to note that you cannot withdraw your information from research that has already been published. Information already sent out of the Biobank for research also may not be able to be recovered. When you withdraw your consent, the code that enables us to re-link your samples and personal information will be deleted so that no further information about you will be collected. Only your signed consent form and a copy of the letter confirming your withdrawal will be kept as a record of your wishes. Such a withdrawal will prevent information about you from contributing to further research and analyses. Research projects What can my samples and information from my samples be used for? Your sample and results from analyses done on your samples can be used for many different types of health and medical research. For example, it could be used to help develop better treatments for people living with heart disease and help improve our understanding of risk factors. Some examples of research that could be conducted using your samples or information from your samples could include: • Measuring the levels of a particular micronutrient or environmental toxin in the population • Working out whether there are particular characteristics that make people more likely to get particular diseases • Determining if particular genes can affect how people respond to a specific drug or treatment • Determining the link between alcohol intake and risk of diseases at a population level • Looking at whether there are particular blood or genetic markers that make people more at risk of infectious diseases, including COVID‑19 Will I be told what research projects my sample and information are used for? You will not be told directly what research projects are using your samples or results of analyses done on your samples. However, as an Australian Health Biobank participant, you will be given a unique access code for a website page only you can access. From this website you can easily manage your consent status (including withdrawal), update your contact details or any other information and see if your samples have been used for any research projects. A list of research projects accessing samples in Australian Health Biobank and publications from this research will also be made available at csiro.au/biobank. Do I get a say in what research projects my samples and information are used in? Generally no. By making a decision to donate your sample, you are consenting for your samples to be used for a range of health and medical research projects that have been approved by the Australian Health Biobank and a registered ethics committee. However, in the future researchers may ask the Australian Health Biobank to contact you on their behalf so they can ask if you want to participate in a research project that may require additional samples or health information to be collected. You can choose at the time you are contacted whether you want to participate in these projects. You can also decide that you don’t want to be contacted about these types of projects in the future. Do I get to hear about the research results? Reports or papers that describe general research results, meaning combined results generated from the analysis of biobank samples and/or information from these samples, will be made available to participants, researchers, and any other people who might be interested through the Australian Health Biobank website. You generally won’t be given your individual results (results from the analysis of your own samples). DNA, genomic testing and research What is DNA and genomic testing? Genes are the basic “instruction book” for the cells that make up our bodies. All genes are made of DNA. The complete set of DNA in your body, including all its genes, is called your genome. Although our DNA is very similar to each other, your DNA is entirely unique. Until recently, doctors and scientists were only able to test one gene at a time. Genomic technology allows researchers to test many genes at once (genomic testing). What is genomic information? This is a specific type of research data generated by researchers based on analysing your blood samples for information on your DNA, or genomic testing. Will I be given my genomic information? You will not receive a copy of your individual genomic information by making a donation to the biobank. But we may contact you if researchers find something from your genomic analyses that could have serious implications for you or your family (see FAQ section below on Serious Findings). How will my DNA and genomic information be used in research? By linking the genomic information to health data, researchers may be able to look at whether there are particular genetic markers (collections of genes) or mutations that are linked to health measures (such as body weight or height) or risk of certain diseases. This type of research can help understand why some individuals are more at risk of particular diseases and help to develop better screening programs and more personalised treatments. The Australian Health Biobank will work with the ABS to enable researchers to undertake data linkage (See FAQ section below on Linking Information from your Samples to Health and Other Information). Only Australian researchers will be able to link genomic information to other health information, and this will need to be approved by the Australian Health Biobank Steering Committee and Science and Technical Advisory Committee. Given that the impact of genomic information may change over time as new knowledge is gained, we cannot specify at this stage what type of research will be undertaken. The sorts of genomic research that happens today includes: • Developing screening tests to determine if you are at higher risk of a particular cancer (like the BRACA gene for breast cancer) • Tests to determine which treatment option (for example type of chemotherapy) is most likely to benefit a particular patient • Determining whether you have a risk of developing high blood pressure or high cholesterol, so that diet and lifestyle changes or other treatments can be started earlier and stop serious disease from developing • Screening babies to see if they have any genetic disorders that could be treated from birth to reduce the long term impacts (neonatal screening) DNA, genomic testing and research Can I be identified from my genomic information? Your sample and genome information will not be labelled with any details that could identify you (like your name or address), and instead this will be replaced by a unique code. We will keep the link between this code and information that could identify you separately with only a few people able to access it to ensure only people who are allowed to can tell which sample and what information is yours. Your coded information and sample will only be shared when safeguards are in place to protect your privacy. Personal identifiers will be removed (including your name, contact details and address) and stringent security measures will prevent unauthorised access or misuse. Data sharing will also involve the minimum, necessary information so researchers don’t get more information than they need to do their research. Genomic information alone is not sufficient to identify a person. It needs to be matched with personal information available from other sources for that to happen. However, because your genomic information is unique to you there is a possibility that it could be used to identify you. To minimise the risk of this occurring, we will ask researchers who want to access your genomic information to agree not to attempt to identify who you are and to handle your genomic information carefully so that your privacy is protected. Do I get a say if I want my samples to be included in genomic research? You may choose whether your samples are available for genomic research at the time of signing the Australian Health Biobank consent form. You will also be able to withdraw your consent for genomic analyses at any time. Withdrawing your consent for genomic testing does not affect your participation in other research projects that do not collect genomic information. Serious findings from genomic research What are serious findings? Very rarely when genomic tests are done on donated samples, a potentially serious and important piece of information can be discovered. For example, a change in your DNA could indicate a higher risk of a heart problem. This DNA might be something you share with your genetic relatives, such as your parents, siblings or children. In the consent form, we ask you to agree to be contacted by your doctor or other nominated health professional about a potentially serious finding. You would only be contacted about potentially serious findings if they meet each of the following criteria: • Significant: The finding indicates a potentially life-threatening health condition or affects your reproductive health. • Actionable: There are specific established treatments or other available actions that might help you. • Confirmed: The finding has been checked as accurate and/or valid, as far as reasonably possible within a research context and to current best knowledge. General health information collected during research projects, such as evidence of increased risk of high cholesterol or diabetes, will not be returned. It is important to continue your regular health check-ups with your family doctor. How and when will I be told about serious findings? In the rare event that a potential serious finding is discovered, the matter would be referred to clinical experts. If the clinical experts determine that the potential serious finding is significant, actionable and confirmed, they would inform your doctor or healthcare professional (who we will ask you to nominate when you sign the consent form). The nominated clinician would contact you to tell you that a potential serious finding might exist and you may be referred to a medical expert or genetic counselor. Why am I being contacted about a serious finding? You are being told about a potential serious finding, as this knowledge could give you early access to information that helps you understand or protect your health and wellbeing, or the health and wellbeing of your family. Could taking part impact my ability to take out health or life insurance in the future? In rare cases, taking part in health and medical research might affect health or life insurance cover for you and your blood relatives. For example, if you have a serious and life-threatening genetic condition that you share with your family, it could affect insurance you apply for in the future (for example life insurance or income protection). A fact sheet is available at fsc.org.au/resources/1785-moratorium-key-facts You are encouraged to seek specific advice from your doctor and/or your insurer if you’re concerned about the impacts of taking part in the biobank. What if I don’t want to be told about a serious finding? If you are contacted about a potential serious finding, you may choose not to be told the details. You can change your mind about being contacted at any time after you consent by contacting us or visiting the Australian Health Biobank website (csiro.au/biobank). Even if you don’t agree to be told details about your serious finding, in rare cases your doctor may contact your family members if there is a serious and imminent threat to their health. Linking information from your samples to health and other information What is data linkage? ‘Data linkage’ is a method of bringing together information from different sources about the same person. For the Australian Health Biobank, this would involve linking the results of analyses done on your samples to data about your health or other information that describes who you are (in general terms, like your age or the broad area you live in, but without identifying you). This health and other information would come from the surveys run by the Australian Bureau of Statistics (ABS) and information from other government agencies (e.g. on education) and is held by the ABS. For more information on the ABS’ data integration program, including how the ABS keeps your information safe and secure, and protects your privacy, please see abs.gov.au/about/data-services/data-integration. As part of agreeing to be involved in the Australian Health Biobank, you provide consent for the results obtained from your samples to be linked to this other health information. Why is data linkage important for health and medical research? Data linkage helps researchers to better understand health and healthcare over the life course. When combined across numbers of people, this linked data can provide researchers with a valuable resource that helps them to investigate and improve the way disease is detected, diagnosed and treated. Linked data can help us to understand how lifestyle, medications, treatments, genes or other factors might affect the future health in the population. It can also help to improve the delivery of healthcare, develop future treatments and provide insights into why some people are more susceptible to disease than others. Linking information from your samples to health and other information What type of health‑related data will be linked to my sample? Your health is influenced by many factors – including your own behaviours, your biology and genes, your lifestyle and environment and your engagement with the health system. This type of information is referred to as health-related data in this document. Researchers will be able to apply to link the results of analyses on your samples to a range of health and administrative information that is held by the ABS: 1. Information from ABS surveys, such as the National Nutrition and Physical Activity Survey: This could include information like: – Core Health Information – Dietary recall – Physical and sedentary activity (objective and self-report) – Sleep – Breastfeeding 2. General National Health Measures Study Information: The results of analyses of samples collected in the National Health Measures survey 3. Other health Information: This includes data that comes to the ABS from a range of health-related national databases, including: – Pharmaceuticals Benefits Scheme – Medicare Benefits Schedule claims – Centralised Register of Medical Practitioners Information here could include things such as the number of visits times to your family doctor (based on) or the prescription medicines you get from a pharmacy (based on Pharmaceutical Benefits Scheme claims) 4. Information that describes who you are (without identifying you individually): This includes things like your gender, age or age group, metro vs rural, education, state your live in etc. This could include information held in national databases including: – Total Vocational Education and Training activity – Apprentice and Trainee, Higher Education – Australian Early Development Census – Migration, Data Exchange – Australian Tax Information – Medicare Consumer Directory – Centrelink Administrative Data – Census Data – Death Registrations Data linkage will only be used for research that will contribute to the health and wellbeing of Australians. Data will not be used for compliance or monitoring purposes. It is important to know that the ABS operates under extremely strict privacy and security guidelines around protecting these data so that it can’t be used to identify you. Part of this protection is that all personal information that could be used to identify use (like your name and address) is removed from the data held in the ABS and replaced with a unique code. Linking information from your samples to health and other information How does data linkage work? For all data that is held by the ABS (wherever it comes from) the identifying information (your name) is deleted and replaced with a code that is unique to you. The means that the ABS knows that information from different databases and different sources came from the same person but have no way of knowing which person that was. In other words, researchers will not be able to identify you as a result of undertaking data linkage. The results of analyses done on your samples that are held by the Australian Health Biobank are also identified by a unique code. The Australian Health Biobank (CSIRO) holds the ‘key’ to link these two codes together. When you link data, the code from the biobank is replaced with matching ABS code, so that in the final spreadsheet all data (whether its from the ABS or the Biobank) that comes from the same person is labelled with the same code. It is now linked, and researchers can examine relationships between different pieces of information from the same person without ever knowing any identifying information. Researcher access to samples and health data Who can access/use my sample and information and to undertake data linkage? Access to samples and information held in the biobank, and permission to link any of this information to health or other information (data linkage) is only provided to researchers to undertake projects that are approved by the Australian Health Biobank Steering Committee following strict scientific and ethical scrutiny. All researchers requesting access to samples/data must apply and be approved by the Australian Health Biobank Steering Committee and the Australian Health Biobank Science/Technical Advisory and Access Committee. These committees will review whether the proposed project has received prior scientific and ethical approval, and that the research fits within the purpose of the biobank and meets other general requirements. How will I know that the researchers accessing my samples and data are legitimate? Before they can access samples and linked health data, researchers must apply to the Biobank. They must provide detailed information about their research project and credentials. Research projects must demonstrate scientific credit, must be approved by a Human Research Ethics Committee and must have the potential to improve the health and wellbeing of Australians. The Australian Health Biobank custodian (the CSIRO) will ensure researchers meet the above requirements before approving any access to the biobank samples and data. How long can a researcher hold results of research done on my sample? Researchers can hold your sample and research information in accordance with the registered Human Research Ethics Committee approval and the Australian Health Biobank Custodian’s approval for their research project. They can only use your sample or results from your sample for the project for which it’s approved. The length of time a researcher can hold results can vary between projects. Researcher access to samples and health data Will commercial researchers be able to access my samples and data? Commercial organisations will be able to apply to access samples in the biobank. This is because commercial organisations are good at turning research findings into new and improved diagnostic tests, treatments and medicines that can be made widely available to benefit human health. Commercial research will have to meet the same strict access criteria that all applicants must meet and the Australian Health Biobank custodian will decide whether to grant access. Researchers also may commercialise their research findings. This means that it’s possible that research done on your samples could lead to discoveries that lead to the development of a new test or product. It’s also possible that the researchers or company that makes this discovery could make money from it. If this happens, this money will be paid to the company or researchers who made the discovery and will enable them to continue to do more research. Neither you nor the biobank will receive any financial benefit if this happens. You or your family will not derive any personal financial advantage from this commercialisation. The Australian Health Biobank will also not benefit financially from this commercialisation. Protecting your privacy Where are the results of research done on my sample stored? The data from research done on your sample will be held securely by CSIRO who will: • assign unique codes to your samples and results of research so these are not labelled with any information that could identify you • keep your identifying information details separate from your data and samples • use stringent security measures to prevent unauthorised use, including strict access controls, computer security and data encryption techniques, confidentiality agreements, and staff training • hold information in secure databases, which can be accessed only by the authorised staff members and by approved researchers • have a decoding step that will allow us to re-link your identifying details with your samples and information, should you want to withdraw from the project or to make sure that the database records are correct. Researchers may keep a copy of the results of analyses that they do on your samples, but this will not include any details that could identify you. Protecting your privacy How is my privacy protected? The Australian Health Biobank is committed to making sure that information about you is kept safe and in strict confidence. This project will be carried out according to the National Statement on Ethical Conduct in Research involving humans (March 2007), produced by the National Health and Medical Research Council of Australia, The NHMRC Biobanks Information Paper (2010), the CSIRO privacy policy and compliance with Section 95B of the Privacy Act. These statements have been developed to protect the interests of people who agree to participate in human research projects. The information about you stored electronically by the Australian Health Biobank Custodian will include information such as your name, sex and date of birth, the coded samples you have provided and where in the Biobank facility they are stored. All information collected about you will remain confidential and will be managed with a specific code allocated to you. Information that can identify you and the information about your samples is stored in separate databases. The Australian Health Biobank, and Australian and international researchers accessing the Biobank must adhere to these laws, their ethics approval and policy. Only authorised staff members will have access to your information. Researchers approved to receive samples/data will not be given any information that would allow them to identify you. The utmost care will be taken to ensure the confidentiality of all data. Your identifying information and research data will not be released to Third parties, such as employers or insurance companies or family members, unless required by law or a court order. Could I be identified from my sample or results of analyses on my sample being held by the biobank? Your name and address have been removed from both your samples and any results from research on your sample and replaced with a unique code. This helps to protect your privacy. Researchers must sign agreements that control their access to samples and information. They are not permitted to disclose or transfer samples or information to anyone else or to use them for purposes other than those agreed to. Researchers must also agree that they will not try to re-identify you from your data and samples. When researchers have used the samples for the approved research, they must return them to the biobank or destroy them according to strict protocols. Researchers must also return their research results to the biobank, so that those results are available for other researchers to use in the future. This facilitates future research and enriches the database of the Australian Health Biobank. In rare cases, researchers might be able to identify you from your health-related data. If this happens, researchers are required by law to maintain your privacy. Risks Are there any risks? While we take the greatest possible care to protect you, there are some risks associated with participating in any health and medical research. This could include: • small amount of pain or discomfort from the needle when giving a blood sample and small amount of bruising or discomfort where the needle was inserted. There is also a very small chance of infection at the injection site. It is not expected that these risks will be lasting or will cause much discomfort. • minimal risk of unauthorised access to your samples. There are rigorous physical security measures in place to protect your samples and your identity. The samples will be stored in a high-security facility and will not be labelled with any information that could identify you. Health information is regarded as one of the most sensitive types of personal information. For this reason, there are laws, policies and procedures in place to protect the safety and security of your sample and your health and personal information. However, there is a rare risk of breach of your privacy. This means that researchers might work out who you are from your samples, or that identifying information is released by accident to people who are not authorised to see it. If this were to happen, it would be dealt with in line with strict Commonwealth Government privacy laws and guidelines. Contact How will the Biobank stay in contact with me? The Australian Health Biobank will keep your contact details so we can stay in touch with you. Once you’ve had your samples for the biobank collected, you will be given the option to receive regular newsletters. These newsletters will only be sent to participants in the biobank and will include updates on the progress of the biobank. You can choose to receive newsletters by email or by post and you can opt in or out of receiving them at any time, either via the Australian Health Biobank website (csiro.au/biobank) or by getting in touch with us by phone (1300 363 400), email (biobank@csiro.au) or by post (PO Box 10041, Adelaide BC, SA 5000). It is possible in the future that some researchers will want to do research projects where they need to collect some additional information (for example, extra samples or a new survey). If this happens, a person from the Australian Health Biobank may contact you on behalf of a researcher to ask if you want to participate in a project like this. If you are contacted in the future, you can decide if you want to take part without affecting your participation in the biobank. You can also decide not to be contacted about this type of research if you would prefer not to. We may need to contact you from time to time to let you know about changes to the biobank that may impact on your decision to continue to take part or may change how your samples and information are used. Because of this, it’s important that you keep your contact details with us up to date. How do I update my contact details? As a biobank participant, you will be given a unique code that you can use to access a private page on our website that only you can get to. This page will provide information on your samples and how they have been used. You will also be able to manage your consent status, opt in or out of receiving newsletters or information about additional research, and update your contact information. The forms for changing your consent status, updating your contact details, or changing your nominated contacts will also be available on the Australian Health Biobank website. You can either complete these forms online or download them and send back to us by email or post if you prefer. Contact What happens if the biobank can’t contact me? Your consent form to participate in the Australian Health Biobank provides an option for you to name one or more people (family member or other trusted individual) to be your proxy only for purposes of your continued participation in the Australian Health Biobank. In the event that you should die or become mentally incapacitated during the course of your participation in the Australian Health Biobank, your nominated person will have the authority to decide to either (a) remove your samples and/or data from the project (subject to the limitations on removal described in this consent form); (b) allow the Australian Health Biobank to maintain your samples and/or data for continued research and use in accordance with this consent form; or (c) authorise the Australian Health Biobank to obtain and add additional data to the project on your behalf. They will also be able to help us find you in the event that we are not able to get in contact with you. You will be asked to discuss this situation with family members, or a person nominated by you to make decisions on your behalf and let us know your decision via the consent form. Closure of the Biobank What happens if the biobank needs to be closed down? If for some unforeseen reason the biobank is required to close: • all research results and information will be put into an archive that will be overseen by CSIRO • all the samples and data will be destroyed or • all of the samples and data will be transferred to another biobank You will be contacted prior to closure of the Australian Health Biobank (unless you have not consented to further contact) to discuss your data and samples being archived, destroyed, or transferred to another biobank, including whether there are any cultural or other requirements in relation to their sample. More information Where can I find more information? If you would like more information about the Australian Health Biobank or your participation. Website: csiro.au/biobank Phone: 1300 363 400 Email: biobank@csiro.au Please keep a copy of your Participant Information Sheet with the copy of your signed Consent Form. You can contact us at: Australian Health Biobank PO Box 10041 Adelaide BC SA 5000 CSIRO Enquiries 1300 363 400 biobank@csiro.au csiro.au/biobank