Michael Hatton (Blaxland, Australian Labor Party) Share this | Hansard source

For the member for O’Connor’s benefit, I might spend 20 minutes doing the same thing with regard to his speech. He made a bald assertion about funding in 1996. If you look at the whole funding year for 1996, you see that part of that year—fully one-third of that financial year—included funding when the coalition came to government in March 1996, so a quarter of the time is allocated to them. But he took a point in the Bills Digest and said that funding for immunisation in that year was $13 million and that funding in 2005-06 has risen to $290 million.

The member for O’Connor argues—I think he argued it three times in his speech—that that is the fundamental pole on which you would sit Labor and the government in determining whether or not they were committed to immunisation. He does not take into account relative costs. He does not take into account that the pneumococcal vaccine was funded as a result of immense pressure from the Labor Party over a period of three years. It was only when Labor committed to that for the 2004 election that the minister, on the same day, announced that the government would do it. But, in the other two areas that we are looking at, an injectable polio vaccine and a chickenpox vaccine, he determined that the government would not go ahead. They chose pneumococcal only. The cost of the pneumococcal vaccine is very great—something in the order of $70 million a year. The cost of some of the other vaccines that will possibly be taken up—we are not sure whether they will or will not be—is also very large.

Anyone at all familiar with the Pharmaceutical Benefits Advisory Committee’s job of trying to restrain costs in the pharmaceutical area will know this. Connected to this, of course, what this government has done is to take the job relating to vaccines away from the technical advisory group, a group of experts who really knew what they were doing and who were specialised with regard to vaccination and immunology, and they have given the job to the cost cutters. As good as the PBAC are, their fundamental focus—what their driving instructions are—is to make sure that there is not only quality but also cost-effectiveness in the provision of service to the Australian public. At this point in time they have not been able to properly take account of what the theoretical and practical arguments are in regard to immunisation and the use of vaccines. Since the chair of the ATAGI cancelled himself out, we have not had a full substitution of qualified people. That continues to sit there. At this point in time, he has argued that it has not yet become a major problem. But it is indicative of this Minister for Health and Ageing and how he has treated the situation.

The fundamental reason for the difference between 1996 or 1997 and 2005-06 of $13 million is the relative cost of the new vaccine and the emphasis given to medical research in Australia and to the development of new vaccines in Australia and those that have been developed overseas. There has been a massive increase in capacity and in our ability to target diseases that research could not target previously. The cost of those, as with the cost of all major pharmaceutical provision, is very great, particularly in the period before they become generics. So it is a false argument.

I will come to the second part of the member for O’Connor’s argument—apart from his not taking into account relative cost. It is not just an inflation factor over that period of time but it is the fact that, when you incorporate high-cost drugs into the system compared to what was there previously, you get a relative disparity. That disparity will grow over time as we introduce new drugs. There are those that were introduced yesterday, as the minister indicated just before this bill came into this House. He indicated that there would be funding for Herceptin—that is a major cost—and there is a series of others that will be of a large cost as well. The government, rightly, has determined to make those funds available.

There is a cost to the Australian people. It is a question of balancing up the cost of those with the benefit that will be provided. There are lots of pharmaceutical companies and other companies with vaccines that have their hands up and are demanding to be part of that program. There is always a balance necessary to what government decisions should be on the basis of the qualified advice that they get, in this case from the PBAC. Previously, it was directly from ATAGI in relation to this. Now they have just a tangential advisory role in regard to it.

The core issue in what the member for O’Connor put was the second part of it—just the most outrageously stupid argument that, in the 13 years of the Hawke-Keating government, immunisation in Australia under that government effectively did not exist. His argument was about the $13 million and that what happened for 13 years was that the Minister for Community Services and Health, Neal Blewett, and other health ministers after him were so little concerned about immunisation that they took direct note of the very small group of people who were waging campaigns against immunisation. I well remember that period. I well remember the campaigns that were waged not within the government or within the government’s backbench or the government’s ministerial frontbench but in the public media in regard to this and the airtime and the prominence that they were given—another case of almost complete irresponsibility on the part of our press and our media. The full story was not told—the other key side of the story: the beneficial effects of vaccination and immunisation.

I can well understand the problem that some people have with the whole idea of vaccination and I can understand that people can in fact be directly affected. I have a cousin who has had autism since she was nine months old. Up until she was nine months old, as far as we know and can determine, she was a perfectly normal baby. She got a triple antigen shot—a series of three different vaccines in one shot—when she was nine months old, when she had a cold. She was speaking—‘mum’, ‘dad’; as much as that—at nine months. She was as advanced as that. She has never uttered a word since—total, complete autism.

It took a long time to determine it. It was in the very early days in relation to experience, in the sixties and seventies. We have much more experience with autism now than we had. But the probability—not the certainty—is that there was a conjunction. It was an immense problem for her parents. It ended up in the break-up of their marriage. It is a 24 hour a day, seven day a week problem.

If you extrapolated from that one experience, no-one would ever be immunised. But you cannot just extrapolate from the individual experience. Immunisation is about getting as many people as possible, if not the whole cohort that you are dealing with, vaccinated and immunised. That is the greatest victory the world has ever seen in Jonas Salk’s development of the polio vaccine—the eradication of polio from the world—and the eradication of smallpox. Those two massive campaigns did so much to transfigure the lives of millions of people, when there had been so much transfiguring for the worse. In the case of smallpox, there had been massive infection throughout history. In the case of polio, people like Alan Marshall had their lives entirely distorted and destroyed because they got juvenile polio. Vaccination programs work; immunisation works.

The Labor government of the Hawke and Keating period was as committed to immunisation as the Menzies government was, as the Chifley and Curtin governments were and as previous governments were, from the point that the great advances in the modern era had taken place, where we had the capacity to save people’s lives. Penicillin is not vaccination, but penicillin is effectively an Australian invention. Fleming may have found the mould, but the person who developed it was an Australian.

Drugs can save lives and save them in the millions, which is what happened during World War II—we lost 30 million but millions survived. Hundreds of millions of people have survived since because of the direct effect of penicillin. In respect of vaccination, preventing the problem is fundamental to its cure.

Another point the member for O’Connor made was a bit strange. He argued how the vaccine against cervical cancer was not a vaccine against cervical cancer but a vaccine against the virus that causes it. Well, blow me down with a feather! What does he think vaccination is about? It is not about the end condition; it is about the active agents that cause the condition in the first place. To go back to Louis Pasteur and his invention of a cowpox vaccine, the whole prospect was to get to the active causative agent—not its fundamental manifestation. The modern understanding, from Pasteur on, that you can target viruses and bacteria and develop a mechanism to make the population safe from them is fundamental. For the member for O’Connor, on behalf of the government, to traduce the entire history of immunisation through that 13-year period is a vast and gross distortion that takes no account of the relative cost of modern vaccines.

I commend Minister Wooldridge for what he did in 1977 and the vigour with which he pursued a campaign which was initially focused on Aboriginal communities but which then became a broad campaign throughout the community. He was fundamentally responding to the low rates of immunisation that had developed over a period of time, not because of inertia on the part of the previous government but because of the fact that, once people become used to something and it is part of their set environment, then their level of anxiety or their level of concern about it drops off. The trajectory is very steep. In trying to get people to understand the importance of a major immunisation campaign Australia-wide so that the whole cohort was affected, Dr Wooldridge used his medical expertise and understanding to drive that campaign and to make it a signature part of what he did as health minister. I congratulate him for it. He reflected the fact that, in the modern era, since the development of the first major vaccines and during the 1950s, 1960s and 1970s in particular, vaccination became relatively low cost. Major advances such as being able to vaccinate against polio and smallpox were not low cost to start off with but the relative cost decreased dramatically, which is simply an economic function of ramping up production capacity. If you have a big enough group to distribute the product to, you will knock your costs down. If you are producing for only a very small group, all of the costs cannot be amortised.

It is the very success of the great immunisation and health campaigns in the 1950s, 1960s and 1970s that created the conditions for people to be certain that things would just roll through, and so they took their eyes off the ball. Rather than looking at relative cost, you should look at the attitudinal situation. In the public health area, particularly in regard to vaccination and immunisation, you have to focus on public health policy. At times you have to ramp it up, rejig it and have a fundamental focus on it. You have to work against the public campaigns that have been run and put something else in there. I think we had reached that point. Dr Wooldridge recognised that, and I congratulate him for what he did. This bill is minor, it is technical. It seeks to fix a government stuff-up—or a series of them.

When I spoke on the bill in 2005, I mostly concentrated on the fact that ATAGI had been wiped out of the picture and we had moved over to the PBAC. Most of this arose from the discomfiture of the minister for health. Labor launched a three-year campaign in regard to the pneumococcal vaccine, the injectable polio vaccine and the chickenpox vaccine and there was immense resistance to it. It finally crumbled before the 2004 election. We have a problem in putting into process a regime where there is a direct connection.

This is all about funding the states and making sure that the states have the facility to get the vaccine—to buy it in the first place—to distribute it freely and to make sure all the preceding infrastructure is in place. This bill fixes it. I support that; Labor supports that. However, the core question is a question of attitude. There is a difference in attitude between Minister Wooldridge and this minister. It concerns whether you use the media and the facilities that are available to us to advance a campaign to get immunisation to the highest levels we can across a range of fundamental diseases or whether you want to use the media in a journalistic sense simply to push a very narrow agenda. Part of the problem here and the reactive nature of what the minister has done in regard to the pneumococcal vaccine is that I do not have a clue whether in 2006 we are going to get a renewal of that pneumococcal vaccine. We know that in 2004, under Labor pressure, the minister buckled and said he would fund it. We know that it is costly, at $70 million a year. We know that, from the data that I understand has come through, it has been very effective, but when he funded it, he funded it for two years. That is up this year.

What are we going to do? I would like the minister to be able to tell us whether he is going to continue that funding, whether he thinks his advice is appropriate and whether there can be certainty for not only those people faced with the prospect of suffering from this disease but also those who have been assisted during that time. I would also like to know whether he and the government are committed to continuing this immunisation campaign or whether they have decided it has got them through the last election and that is enough. This also relates to other decisions that have been determined.

I do not say that you can give everything that people want in this area. Companies put their arguments but if they are not well founded—if, on balance or from the best advice given, people do not think a vaccination program is going to work at all or well enough or that the cost is so great that other means might have to be sought to try to fix it—then a different set of questions is raised. But the key issue here is commitment.

For the member for O’Connor to argue that the Hawke-Keating government had no commitment to immunisation and that they were imprisoned by a very small but vocal group that did not want any immunisation at all is a complete travesty, an utter falsity and an untruth. That is not uncommon in this place of overblown verbiage, but his argument is a direct attack on the history of immunisation in Australia. Throughout the decades, you could attack any Australian government in the same way because the fundamental problem was not just the availability of the vaccines but the programs and how they were driven. We were dealing with an Australian population that had become relaxed and comfortable with the immunisation program because it had been so successful. When signals to be alert are not there, you can get significant problems. So I congratulate Dr Wooldridge for the campaign that he initiated. I also congratulate the shadow minister for health on what she did on the pneumococcal vaccine.

In response to this very small technical bill, I would like to see the minister give an affirmation that the pneumococcal program will be continued if the advice to him is that it is appropriate to do so—and it should be—and to give a better understanding of how committed the government will be—(Time expired)

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