Julia Gillard (Lalor, Australian Labor Party, Shadow Minister for Health and Manager of Opposition Business in the House) Share this | Hansard source

Labor will support the National Health Amendment (Immunisation) Bill 2006, but I move a second reading amendment in the following terms:

That all words after “That” be omitted with a view to substituting the following words: “whilst not declining to give the bill a second reading, the House expresses its concern that the Government has:

(1)

consistently ignored the expert advice of the Australian Therapeutic Advisory Group on Immunisation (ATAGI) with respect to the inclusion of pneumococcal, oral polio and chicken pox vaccines on the National Immunisation Program;

(2)

failed to provide the Pharmaceutical Benefits Advisory Committee (PBAC) with the needed expertise in immunisation as required; and

(3)

failed to provide adequate ongoing funding for essential vaccines over the forward estimates of the 2006-07 Budget, leaving the Government’s long-term commitment to the National Immunisation Program in doubt.’’

This legislation is needed because the Howard government did not pay attention to the role of the states and territories in delivering the National Immunisation Program. Last year the parliament passed amendments to the National Health Act 1953 to change the way in which vaccines were listed on the National Immunisation Program, as announced in the 2005-06 federal budget. The National Health Amendment (Immunisation Program) Act 2005 removed responsibility for approval of vaccines for universal access on the National Immunisation Program from the Australian Technical Advisory Group on Immunisation and gave it to the Pharmaceutical Benefits Advisory Committee.

Labor supported this legislation, with some considerable reservation given the Howard government’s incredibly poor record on accepting and acting on expert advice about which vaccines should be made available on the National Immunisation Program. We would all recall that it took a huge community campaign and a huge campaign from Labor to finally get this government, particularly the current Minister for Health and Ageing, to act on listing the pneumococcal vaccine, the oral polio vaccine and the chickenpox vaccine. We need to recall that these vaccines were assessed as both cost-effective and clinically effective by the Australian Technical Advisory Group on Immunisation. But it was not a question of just months going by; it was literally a question of years going by until the Howard government finally made funding available for these vaccines. I think every member of this House would recall with some horror the callous performances of the Minister for Health and Ageing, time after time, when he was asked why these vaccines were not being funded. In what we believe to be a reprisal against the Australian Technical Advisory Group on Immunisation, in 2005 the government moved to give the responsibilities of the Australian Technical Advisory Group on Immunisation to the Pharmaceutical Benefits Advisory Committee.

Now some 12 months later we find out that the legislation which achieved that reprisal had some serious drafting errors and oversights. The amendments made by the National Health Amendment (Immunisation Program) Act 2005 failed to give the minister power under the act to continue the current arrangements with states and territories for assistance in procuring goods and services related to vaccine provision, for example vaccine storage and delivery. The 2005 amendments also failed to provide for continuing government funding for essential pre or post vaccine requirements under current arrangements—for example, the pre-vaccination screening test for Q fever vaccine.

The explanatory memorandum to this bill makes it clear that that was not the intention of the 2005 legislation—that is, the explanatory memorandum to this bill makes it clear that the government made an error when it amended the National Health Amendment (Immunisation Program) Act in 2005. We trust that the government is to be believed on that and that it was a simple error, not an endeavour to get away from funding essential vaccines. Even if the government’s version of events is accepted, it does leave you to wonder how it is possible that a government can be so unbelievably incompetent.

Here we have a government that has decided, we believe by way of reprisal, that it wants to get rid of the Australian Technical Advisory Group on Immunisation and has brought forth legislation to the parliament to achieve that result. We have a minister who is assisted by literally thousands of public servants. With all of the resources of government being brought to bear and all of the considerable resources of Minister Abbott’s office being brought to bear, how can basic errors like this be in the bill presented to the parliament? If it were not about a matter as serious as vaccines, it really would be a joke that a government can be so unbelievably incompetent in the area of health that it brings forward legislation to this parliament that forgets it has cooperative arrangements with the states and territories relating to vaccine provision, including vaccine storage and delivery, and it forgets that it is involved in funding pre or post vaccine requirements for vaccines like Q fever vaccine. You really would want an explanation of what is going on.

The Minister for Health and Ageing is clearly incompetent—it is his legislation. His office is unbelievably incompetent because the error was not picked up. And what is happening in the department that a bill so fundamentally flawed could be presented to this parliament with all of the time and resources then devoted to it that a debate of parliamentary legislation requires? So yet again in this place we are fixing up the Howard government’s incompetence—and it happens time after time—when it comes to health. We think there is a reason that the Howard government is incompetent in the area of vaccines: it has never really had a strong commitment to funding and supplying vaccines to Australians. It has been very focused on paying back ATAGI for making recommendations that embarrassed the government but it has not been focused on vaccine provision. The case that I referred to earlier of the failure to fund the pneumococcal and chickenpox vaccines for so long is evidence for every Australian of the lack of commitment of this government to the vaccination program.

The bill that is before the parliament today is a small technical amendment with no financial impact; but the fact that we are even here doing this this morning speaks volumes about the Howard government’s attitude to ensuring effective immunisation programs. They just do not care, and they are not competent to deliver on vaccines. The Howard government stand condemned for a shameful record of inaction on the funding of vaccines for Australian children.

We should remember that in September 2002 the Howard government’s own ATAGI recommended the funding of pneumococcal vaccine, chickenpox vaccine and injectable polio vaccines. What happened then? Absolutely nothing, even though the experts were saying that these vaccines were very important for children and that they were both cost-effective and clinically effective. The government received those recommendations and did nothing. In September 2003, the National Health and Medical Research Council made the same recommendation. What did the Howard government do then, having received the recommendation from a second expert group? You guessed it: absolutely nothing. So we saw Australian children going without vaccines that the experts recommended they should have, and the attitude of the Howard government was to do absolutely nothing.

In May 2004, the record changed from sins of omission to sins of commission. We know that in the process of putting together the May 2004 budget, the Howard government’s Expenditure Review Committee specifically debated whether or not to fund these vaccines and decided not to. There was no oversight or incompetence in that. There was direct consideration by Howard government ministers of funding these vaccines. They sat around a cabinet table and, faced with evidence that these vaccines would save the lives of Australian children, they said, ‘No, we won’t fund them. We just don’t care enough about them to put the dollars behind them.’

The only reason these vaccines were funded is that in the Labor budget reply speech in May 2004, Labor committed to funding these vaccines. On the same day that Labor committed to funding the vaccines, the Minister for Health and Ageing went out to a hurried and unseemly press conference and said that he would fund them as well. So the only thing that made the government fund these vaccines was its fear of political exposure. A fear about the health, safety and welfare of Australians—and Australian children in particular—did not motivate them to move at all.

Even at that stage, the minister for health refused to fund the chickenpox and injectable polio vaccines. We continued to campaign for the funding of those vaccines, and the minister for health ducked and weaved and basically did nothing. It was only in March 2005 that the minister for health finally—after an original recommendation in 2002—agreed to fund these vaccines. We need to remember that the minister for health had conceded that chickenpox killed at least 19 Australians each year and hospitalised some 3,300 people in a two-year period. So we were not surprised when the minister for health moved to gag ATAGI, the independent group on immunisation, because it had been vocal in its recommendations. It made recommendations fearlessly about the funding of these vaccines; and, when asked whether or not those recommendations stood, it always stood behind them. Of course, history has shown that, if you stand up to the Howard government, you pay a price. ATAGI paid that price in 2005 with its abolition and the movement of the assessment of vaccines to the Pharmaceutical Benefits Advisory Committee.

We have been watching since that move in 2005, and we remain concerned about the new vaccine approval system. We want to know: where are the immunisation experts on the PBAC? The 2005 legislation required the appointment to the PBAC of two additional experts in immunisation. If you were actually at a stage where you said, ‘We’re going to get rid of the Australian Technical Advisory Group on Immunisation and move its functions to the Pharmaceutical Benefits Advisory Committee,’ it would make sense that you would want to have within the Pharmaceutical Benefits Advisory Committee people who were experts in immunisation. We were told that there would be two of them. To date, only one appointment has been made. One needs to ask: why is that?

This legislation was brought in in 2005 and here we are in 2006. Vaccines are pretty important to people’s health. I do not think there would be anybody in this parliament who would contest that very basic proposition. This is a country that runs to a lot of experts in vaccines. It is not that we do not have people who can advise on these questions. We have in this country some of the world’s leaders on the question of vaccines. But the Howard government cannot, or will not, fill two expert positions on the PBAC. What could explain that degree of incompetence, that degree of neglect, and that degree of shameful inaction? Maybe we will have an explanation from the minister for health when he sums up the debate on this bill. But it is a mystery to me why there is still an appointment that is unfilled.

It is a tragedy that there is still an appointment unfilled, because we know that, at the present time, the PBAC is making some very important decisions about vaccines. Australians would have read, I think with great delight, about the pioneering work of the Australian of the Year, Professor Ian Fraser, and about what to many Australians would seem like a miracle—that is, the fact that we now have an effective vaccine against cervical cancer. Of course, it is the PBAC that is going to have to assess the clinical data and the cost-effectiveness data for the cervical cancer vaccine and make some decisions and recommendations about the way in which this vaccine should be funded and how it should be delivered to Australian women and girls.

Surely you would want that decision—a groundbreaking decision; a decision about a medical miracle—to be made by a PBAC with a complete range of advice about immunisation available to it. Why would you leave unfilled one of the spots for an immunisation expert at the time that the PBAC is considering such a groundbreaking vaccine? And it is not the only vaccine. There is also the rotavirus vaccine. The rotavirus vaccine can prevent children getting a disease which causes diarrhoea. In some children, of course, that can be a minor issue, but I am sure the minister at the table, Dr Nelson, with his medical qualifications, would know that diarrhoea in very young children can in fact be a major medical problem because of dehydration. It is a particular problem in Indigenous communities, where children, because their health status already tends to be poor, when they get rotavirus, tend to suffer with the illness more acutely than Australian children generally. But I do not mean to say that it is not a problem amongst Australian children generally; it is.

Once again, the PBAC is there, considering a new vaccine which prevents this virus and, consequently, the diarrhoea it causes and the hospitalisation that can result from that because of dehydration. The PBAC is considering that vaccine now—once again not fully advised on immunisation questions because the government has not bothered to fill the second spot. What would explain that unbelievable act of negligence? We are in a situation where doctors know how important these vaccines are. They want them funded. They are there and dealing with the agony of seeing children in families they know would benefit from the vaccines but are unable to afford them. They are therefore waiting anxiously for the PBAC to make decisions on these vaccines, and the PBAC does not have available to it the full range of expertise.

Our second question is: where is the ongoing funding for essential vaccines? The 2006-07 budget papers show a drop in PBS funding for essential vaccines from $184 million in 2007-08 to $120 million in 2008-09 and $122 million in 2009-10. We would like an explanation of what is going on here. I am sure that the minister for health will have one of his usual dodgy explanations, but the fact is that the money should be allocated for vaccine supplies into the future and it is simply not there in the budget papers. If we had a government with a better record of delivery on vaccines, we might be less concerned, but with this government we are highly concerned that that money is missing from the budget papers.

Then we would like an answer to the question: what is going to happen with the 12½ per cent price cut policy when it comes to the application of vaccines? This is a policy where a mandatory price cut comes into play for pharmaceuticals if a generic product is listed. In the pharmaceutical manufacturing business, generic products that are chemically identical to the branded product come on the market routinely, and consequently price issues arise. But, in the world of vaccine supply, there is a difference. There tends to be one supplier of any vaccine listed on the national immunisation program—indeed, one would say that there should only be one supplier of a vaccine to the immunisation program because, with vaccines, supply issues are often difficult. Every batch of vaccine must be approved separately, and it is not uncommon for individual batches to fail because the titre—the levels of active ingredient or antibody—is not adequate. Also, if there is an outbreak of disease elsewhere in the world, supplies can be diverted. Vaccine manufacturers have written to the minister for health, asking him about this issue, but they have not had any response—and they deserve one.

The fact that the 2005 amendments also omitted to provide for continuing government funding for essential pre-vaccination screening tests for Q fever highlights the Howard government’s failures around Q fever. CSL is the only manufacturer in the world of a vaccine to protect meatworkers and veterinarians against Q fever. This vaccine was made in a small-scale, rather old-fashioned operation and the vaccine needed to be subsidised by the government to ensure that the target population received it. However, the TGA last year required that CSL upgrade their Q fever vaccine manufacturing operations to meet good manufacturing processes. That meant substantial costs and consequently, in the absence of continuing government subsidies, the vaccine would now cost around $500 a dose. CSL announced it would stop making the vaccine. Not surprisingly, the meatworkers and veterinarians who are exposed to this disease were upset, and protested.

It is not at all clear what the Howard government is doing to address this. The simplest answer would seem to be to subsidise a new production facility at CSL, and perhaps to offset this by selling additional Q fever vaccine overseas. But instead the Howard government has put out an international tender for the supply of Q fever vaccine when the only manufacturer in the world is here in Melbourne. That seems a pretty roundabout way to get to a situation where we have a continuous and affordable supply of Q fever vaccine for workers at risk of this disease.

Once again, in addressing a health bill in this House, I am in the unfortunate situation where the health bill itself raises the continuing failures of the Howard government with respect to vaccines. We will support this legislation, but the issues dealt with in my second reading amendment are substantive and need to be answered by the Howard government.

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