Wednesday, 8 August 2007
National Health Amendment (National HPV Vaccination Program Register) Bill 2007
Debate resumed from 20 June, on motion by Mr Billson for Mr Abbott:
That this bill be now read a second time.
The purpose of the National Health Amendment (National HPV Vaccination Program Register) Bill 2007 is to amend the National Health Act to ensure and to establish that the National Human Papilloma Virus Vaccination Program Register can operate. As many in this House would know, Labor was instrumental in pushing the government to include Gardasil, the first vaccine available to treat some strains of HPV, on the National Immunisation Program. Of course we will support these measures to establish the register as they will enhance the efficiency of the National HPV Vaccination Program.
By way of background, HPV is a sexually transmitted infection mostly affecting women between 20 and 24 years of age. Almost all abnormal pap smear results are caused by HPV. In 98 per cent of cases HPV clears by itself; in rare cases, if the virus persists and is left undetected, it can lead to cervical cancer. We know that, sadly, cervical cancer does kill around 200 women in Australia each year.
Gardasil was developed by former Australian of the Year Professor Ian Frazer, and is the first vaccine available that protects against some of the cancer causing strains of HPV, notably HPV strains 16 and 18, which cause around 70 per cent of all cervical cancers. Members would recall that late last year CSL Ltd, the Australian manufacturer and distributor of Gardasil, applied to the Pharmaceutical Benefits Advisory Committee for Gardasil to be listed on the National Immunisation Program. As the vaccine was originally on the market at a cost of $460 for a course of three shots, CSL was seeking to have this cost met by the government, rather than borne by Australian families.
PBAC knocked back the application of CSL in November 2006 citing a number of reasons including that it was not cost effective for taxpayers to fund Gardasil at the price originally proposed by the manufacturer, but PBAC also at that time raised some other concerns about a lack of information on how long the vaccine remained effective. It was also reported that PBAC was not convinced by CSL’s claims about the protection that the vaccine would provide over a lifetime.
I am proud to say that Labor, including my colleague the former shadow minister for health Julia Gillard, led the outcry from health stakeholders, patient groups and pharmaceutical companies that PBAC’s decision required urgent review. Comments by the Prime Minister about driving a hard bargain with manufacturing companies gave credence to the then shadow minister’s concern that PBAC, in making its original decision, had been overly influenced by the government’s focus on cutting the cost of its subsidised medicines program. It is all well and good for the minister to say that he respected PBAC’s integrity and process and therefore would not overrule the decision, but this response ignored the absolute need for the Australian government to do everything that it could, within our health system, to reduce the incidence of cervical cancer.
Eventually, but only after prime ministerial intervention, the minister saw the sense and requested that PBAC reconsider or consider a new application from CSL in which the main initial concerns raised by PBAC were addressed. As we now know, Gardasil was subsequently approved for inclusion in the NIP at the extraordinary PBAC meeting in late November.
On 29 November 2006, the government announced that it would fund free the HPV vaccine for females between 12 and 26. The establishment of the HPV register was also announced at that time. Obviously, despite the ups and downs of that process, we do welcome this result, and the availability of this vaccine is going to provide very welcome protection for many Australian women.
Let me turn now to the legislation before us, which inserts a new section 9BA into the National Health Act providing for the establishment of a National HPV Vaccination Program Register. Broadly speaking, the establishment of the register will assist in the administration of the vaccination program itself, provide a means to monitor participants in the program and assist in monitoring and evaluating the effectiveness of the HPV vaccine in preventing certain cervical cancers. According to the new subsection 9BA(3), the purposes of the register are to ensure the successful implementation of the program and, in doing so, facilitate the establishment and maintenance of an electronic database of records for monitoring vaccination of participants in the program.
It is intended that the register will collect information about the vaccination program, including personal identifying details, details about the doses given and the immunisation provider. Labor acknowledges that there will be some people in the community who will have privacy concerns around the collection of such data. On this issue I note that the bill provides for women or the parents of girls to have information removed from the register following a request in writing—an ‘opt off’ register reflecting the arrangements that have been in place in Australian state and territory based Pap test registers for between eight and 18 years, depending on which state or territory you live in. No information about sexual history will be sought or recorded, and the bill precludes the release of personal information except to a vaccination provider or prescribed bodies, either through regulation or as prescribed in the Health Insurance Act. Labor is satisfied on this basis that the bill adequately addresses privacy concerns. Of course, the public interest in the maintenance of this register certainly is a significant factor in the balancing that is always required in these matters.
The register will help to monitor the effectiveness of the program in preventing certain cervical cancers by allowing for future cross-referencing of data against Pap smear and other cervical cancer registers maintained by states and territories. The register will also allow for the maintenance of records tracking the HPV vaccination status of eligible persons for the purposes of certifying the completion of the course of vaccination and establishing mechanisms to advise eligible persons, or the parents or guardians of children, if doses of HPV vaccine have been missed or if booster doses are required in the future. The register will allow for the provision of information on new developments associated with the program to vaccination providers, eligible persons, and parents or guardians of children, promoting general health and wellbeing. Finally, the legislation provides for payments to general practitioners who enter information on the register.
According to the explanatory memorandum, there is no financial impact arising from this bill. Funding for the register was approved by the Prime Minister on 20 February 2007 as part of an additional $103.5 million over five years allocated for the implementation of this program. A total cost of $8 million to $11 million has been allocated to build and operate the register over three years.
As I said earlier, Labor supports this bill and the program that is now in place. Of course, we support measures that are aimed at the promotion of the health and wellbeing of Australians. As I said earlier, Labor is proud of the strong support it gave early to Gardasil in its ability to treat HPV and argued for it to be put on the National Immunisation Program, so we are keen for its implementation to be as efficient as possible and for its evaluation to be as thorough as possible.
We would encourage the government to move this legislation through parliament quickly, as I believe is intended. While we understand that the short time frame from the November 2006 announcement to the commencement of the vaccination program in April this year meant that it was difficult to establish the register before immunisations commenced, we believe the register needs to be operational as soon as possible. We understand that state based immunisation programs and individual GPs are currently capturing vaccination data at a jurisdictional or surgery level while they wait for the register to be implemented. Obviously there are some risks around data being mislaid or not making its way onto the register. A uniform national approach to capturing this data is preferable and obviously much needed, particularly given the privacy issues that have been flagged. Even more significantly, until this register is operational, the impact of the program on cervical cancer prevention cannot be effectively assessed. With the funding already allocated, the government should move swiftly to set up this register.
Labor would also appreciate some clarification from the government on some eligibility rules around the National HPV Vaccination Program. As members would be well aware, this program has been very widely advertised in media across the country. Those advertisements have heavily promoted the government’s intention to fund free HPV vaccine to all 12- to 26-year-olds. Public information has stated that the HPV National Immunisation Program would be targeted on an ongoing basis for 12- and 13-year-old girls, to be delivered through schools, in addition to a two-year catch-up program for 13- to 18-year-old girls, also delivered in schools, with vaccines to the 18- to 26-year-old age group to be delivered through general practice and community based programs.
While it has been widely noted that not all schools will be vaccinated in this first year—rather, there will be a systematic rollout—no similar qualification has been placed on the community based vaccination of women between 18 and 26. As local members, we are concerned that we are increasingly receiving reports from constituents who have examples of women attending community clinics and their GPs being told that only women in certain age brackets are being immunised in this particular year. We are still trying to get to the bottom of these reports. Obviously there may be people who are not within the specifications, but it seems that at this stage a number are. We are not sure whether this is an issue of the shortage of the requisite volume of vaccine or a practical problem of GPs finding the time and resources in their busy schedules to have these consultations within the correct time frames for young women seeking immunisations. Because there are a range of different ways these vaccines can be provided, we do not know whether it is a problem with the rules the government has set or whether it is a distributional or access problem, particularly with regard to the differences that may exist within some of the community health sectors in different states and territories.
When you consider that some medical services, such as university medical clinics, may have a large number of women on their books who fall within the 18- to 26-year-old age group and that each of these women will need three shots prior to June 2009, when the cut-off for free vaccinations comes into effect, you would understand why some services might seek to streamline their immunisation programs. I know that some people from the department are here, and I would be appreciative of an answer and some clarification on that. Obviously some constituents are very concerned that, if they cannot access it now, by the time they are able to access it they will fall outside the right age categories or the cut-off times. It would be helpful if the government could look into these issues with some urgency and provide us with that information so we can assure or explain to constituents the process to make sure that they get the coverage they are entitled to.
As I have said, given that the vaccination process involves three injections over seven months at a total cost of over $400, if it is not accessed through the HPV Vaccination Program it is a serious cost issue for many families. It is an affordability issue where some families will be forced to make a decision between concern for the health of their daughters and other financial pressures that they have. Obviously the government’s decision has been made. This is a program that is available, and we need to make sure that the rollout is accessible to as many people as possible. After such an extensive advertising campaign has been run we do not want to unnecessarily worry young women, particularly, who want some assurance of knowing that they have been immunised against HPV and who do not want to feel that they have missed out because their local service might not have been able to access the program at the right time.
For the benefit of the staff who are here, I can tell you that these reports have come from many different states. They have come from Queensland, Victoria, South Australia—they are the ones that I can remember off the top of my head—but we have had queries from many constituents. My colleague who is speaking next will know whether this has been an issue in Western Australia. It would be helpful if some proper information could be provided so that we can assist our constituents in making sure that they get the coverage they deserve. As I have said, Labor supports this bill.
The purpose of the National Health Amendment (National HPV Vaccination Program Register) Bill 2007 is to amend the National Health Act 1953 in order to establish and maintain a National Human Papilloma Virus Vaccination Program Register. It also allows for payments to be made to general practitioners for the provision of vaccination information on the register.
Vaccines have had a dramatic effect on the incidence of disease in our populations. According to the World Health Organisation, vaccines are thought to prevent around two million deaths every year. The discovery of vaccines is quite an interesting story, although not always an ethical one. Long before the causes of disease were known and long before the processes of recovery were understood, an interesting thing was observed. If people recovered from a disease, rather than succumbed to it, they appeared to be immune from a second bout of the same illness. It was these types of observations that led the Chinese to try to prevent deadly smallpox by exposing uninfected individuals to material from smallpox lesions. This process, known as variolation, took a variety of forms, from injecting the pus and fluid of lesions under the skin to grinding up dried scabs and inhaling or injecting the ground-up powder. Lady Montagu, wife of the British ambassador, observed this method in the early 1700s and brought it back to England. Although the effects of variolation varied, ranging from causing a mild illness in most individuals to causing death in a few, the mortality and morbidity rates due to smallpox were certainly lower in the populations that used variolation compared with those that did not.
One person who experienced variolation as a child in the late 1700s was Edward Jenner, a young boy who survived the process and grew up to become a country doctor in England. As a country doctor, Jenner noticed that many people who milked cows did not get smallpox, even though they were exposed repeatedly. With this in mind, in 1796 Jenner undertook a daring experiment and infected a young boy with the bovine disease, cowpox, in the hope of preventing subsequent smallpox infection. After allowing the boy to recover fully from cowpox, Jenner unethically infected the boy with smallpox by injecting pus from a smallpox lesion directly into his skin. As Jenner had predicted, the boy did not contract smallpox.
Jenner’s experiment was initially rejected by those in the medical establishment. However, over the ensuing months, he went on to collect case studies and publish a book detailing his observations. As a result, within a few years thousands of people protected themselves from the deadly smallpox disease by intentionally infecting themselves with cowpox. Jenner’s process came to be called ‘vaccination’ after vacca, the Latin word for cow, and the substance used to vaccinate was called a ‘vaccine’.
So how do vaccines work? Disease-causing organisms, such as viruses and bacteria, have at least two distinct effects on the body. The first effect is very obvious—we feel sick and exhibit a range of symptoms. The second effect is less obvious, although it generally leads to eventual recovery from infection—the disease-causing organism induces an immune response in our body. As the response increases in strength over time, the infectious agents are slowly reduced in number until symptoms disappear and recovery is complete.
How does this immune response occur? The disease-causing organisms, such as viruses and bacteria, have proteins called ‘antigens’ which stimulate the immune response. The resulting immune response is multifold and includes a synthesis of proteins called ‘antibodies’. These proteins bind to the disease-causing organisms and lead to their eventual destruction. In addition, memory cells are produced in an immune response. These are cells that remain in the bloodstream, sometimes for life, ready to mount a quick, protected immune response against subsequent infections. If such an infection were to occur, the memory cells would respond so quickly that the resulting immune response can activate the organism, and symptoms would be prevented. This response is often so rapid that infection does not develop.
Obviously a live or virulent organism cannot be used as a vaccine because it would induce the very disease it should prevent. Therefore, the first step in making a vaccine is to separate the two effects of disease-causing organisms. In practice, this means isolating or creating an organism, or part of one, that is unable to cause full-blown disease but that will still retain the antigens responsible for inducing the host’s immune response. This can be done in many ways. One way is to kill the organism using formalin. Vaccines produced this way are called ‘inactivated’ or ‘killed’ vaccines. Examples of killed vaccines in common use today are the typhoid vaccine and the Salk poliomyelitis vaccine. Another way to produce a vaccine is to use only the antigenic part of the disease-causing organism: for example, the capsule, the flagella or part of the protein cell wall. These types of vaccines are called ‘acellular’ vaccines. An example of an acellular vaccine is the Haemophilus influenza B or Hib vaccine. Acellular vaccines exhibit some similarities to killed vaccines. Neither killed nor acellular vaccines generally induce strong immune responses and may therefore require a booster every few years to ensure their continued effectiveness.
A third way of making a vaccine is to attenuate or weaken a live micro-organism by ageing it or altering its growth conditions. Vaccines made in this way are often the most successful vaccines, probably because they multiply in the body, thereby causing a large immune response. Examples of attenuated vaccines are those that protect us against measles, mumps and rubella. Immunity is often lifelong and booster shots are not required.
Some vaccines are made from toxins. In these cases, the toxin is often treated with aluminium or adsorbed onto aluminium salts to decrease its harmful effects. After such treatment the toxin is called a toxoid. Examples of toxoids are the diphtheria and tetanus vaccines. Vaccines made from toxoids often induce low-level immune responses and are, therefore, sometimes administered with an adjuvant—an agent which increases the immune response. For example, the diphtheria and tetanus vaccines are often combined with the pertussis vaccine and administered together. Toxoid vaccines often require a booster every 10 years.
Another way of making a vaccine is to use an organism that is similar to the virulent organism but that does not cause serious disease, such as Jenner did. A more recent example of this type of vaccine is the BCG vaccine used to protect against mycobacterium tuberculosis. The BCG vaccine currently in use is an attenuated strain of mycobacterium bovis and requires boosters every three to four years.
In addition, biotechnology and genetic engineering techniques have been used to produce subunit vaccines—vaccines which use only the parts of an organism which stimulate a strong immune response. To create a subunit vaccine, scientists isolate the gene or genes which code for appropriate subunits from the genome of the infectious agent. This genetic material is placed into bacteria or yeast host cells, which then produce large quantities of subunit molecules by transcribing and translating the inserted foreign DNA. These ‘foreign’ molecules can be isolated, purified and used as a vaccine. The hepatitis B vaccine and the human papilloma virus vaccine Gardasil are examples of this type of vaccine. Gardasil contains the major capsid protein of human papilloma virus types 6, 11, 16 and 18. The proteins are produced separately by the transgenic yeast Saccharomyces cerevisiae. These proteins self-assemble into a virus like particle that is purified and placed into a sterile liquid for injection.
Australia was an early supporter of vaccines. Smallpox vaccination began here in 1804, just five years after Jenner described the protective effect of cowpox, and the vaccine was produced locally from 1847. A vaccine against the plague, Yersinia pestis, developed in 1895, was imported into Australia soon after to control an outbreak in Sydney. The effectiveness of the year-old typhoid vaccine during the Boer War in 1899 led to its production in Australia shortly afterwards.
Since World War II vaccination has had an enormous impact on the lives of Australians. At that time, poliomyelitis and diphtheria struck fear in the heart of every parent, and most families had experienced or knew of a tragedy related to one of these diseases. Also, many children died, were significantly incapacitated by whooping cough or measles, or were born with disabilities as a result of intrauterine infection with rubella. In contrast, in 1998 there were no cases of polio, diphtheria or congenital rubella syndrome reported in Australia and no deaths from measles or whooping cough.
The Commonwealth first provided free vaccines in 1953 with the diphtheria-tetanus-pertussis vaccine. This was followed by the oral polio vaccine in 1966, the rubella vaccine in 1971 and the combined measles-mumps-rubella vaccine in 1989. These have been followed by a range of other vaccines as they have become available. Another major initiative enacted by the Australian government in the area of vaccination was the establishment of the National Immunisation Program in 1997. Under this program the Australian government provides funding to state and territory governments for the purchase of the 25 vaccines listed on the National Vaccine Schedule and funding to Medicare Australia for the Australian Childhood Immunisation Register, the General Practice Immunisation Incentives Scheme and subsidising individual private consultations involving immunisation through the Medicare Benefits Schedule. In 1996 Australian government expenditure on vaccines was $13 million; this grew to $283 million in 2006-07.
In late November 2006 the Australian government added Gardasil to the National Immunisation Program. The reasons for adding this new vaccine to the program were clear. Cervical cancer is the world’s second most common gender-specific cancer amongst women and is currently responsible for the deaths of around 200 women in Australia each year.
Before the introduction of the National Cervical Cancer Screening Program in 1991, the mortality rate was around four in 100,000. It is estimated that the screening program prevents around 70 per cent of squamous cervical cancers and the rate of mortality in 2004 dropped to 1.8 per 100,000 women. The introduction of Gardasil, used in conjunction with the screening program, should reduce this mortality incidence further.
It is essential however that vaccinated girls and women continue to participate in the national screening program. The prophylactic Gardasil vaccine resulted from research by distinguished medical scientist and 2006 Australian of Year, Professor Ian Frazer, and fellow Australian citizen Dr Jian Zhou. Sadly, Dr Zhou’s life was tragically cut short at the age of 42 in 1999, before he could share in the joy of seeing the vaccine brought to market. Not one to rest on his laurels, Professor Frazer is currently working on a therapeutic vaccine for HPV—in other words, to cure the disease. The vaccine could be one of the first products to come out of the new biopharmaceutical production centre. This centre, incidentally, received $100 million in this year’s federal budget.
Gardasil, as mentioned earlier, vaccinates against the human papilloma virus types 16, 18, 6 and 11. Types 16 and 18 are responsible for 70 to 80 per cent of the cervical cancers in Australia and types 6 and 11 cause 90 per cent of genital warts. The human papilloma virus is a common and usually asymptomatic infection. It is highly contagious and many people will acquire an HPV infection within a few weeks of becoming sexually active. In most people the infection clears within 12 to 24 months. However, in three to 10 per cent of women infected with types 16 and 18 the infection does not clear up and can result in cervical abnormalities which in some cases progress to cervical cancer.
Through the National Immunisation Program, the vaccine is being administered to girls aged between 12 and 13 years in three injections over a period of six months through schools which wish to participate. It is the most successful school based program yet, with an uptake of greater than 80 per cent as at the end of June. From this month the vaccine is also available free to girls and women aged up to 26 years through GPs and community providers.
The establishment of a register for the HPV vaccination program is integral to the success of the program. The register will enable: the recording of the details of individuals who participate in the HPV program, allowing statistics on participation rates to be compiled; the recording of vaccination information which can be compared with information recorded in Pap smear, cervical cytology and cervical cancer registers so as to assess the effectiveness of the HPV program over time; the notification of participants of the HPV program, if booster doses are required, to determine vaccination status or to certify completion of the vaccination course; the collection of statistics to inform health authorities, healthcare providers and the public about the HPV program; participants to be informed, or parents of participants, of developments with the HPV program; and the details of vaccination providers to be recorded.
Participants or their parents in the HPV program can opt to have personal details removed from this register at any time. This bill, by enabling such a register, will support the Australian government’s commitment to our progressive, world class immunisation system. I commend the bill to the House.
The National Health Amendment (National HPV Vaccination Program Register) Bill 2007 inserts a new section 9BA into the National Health Act 1953 providing for the establishment of the National Human Papilloma Virus Vaccination Program Register. The need for this bill arose from the government’s 2006 announcement to fund free HPV vaccine for females in the 12- to 26-year-old age group through the National Immunisation Program with the aim of reducing the incidence of cervical cancer. The government made this announcement after the Pharmaceutical Benefits Advisory Council decided that it was not cost effective for taxpayers to fund Gardasil—a decision which, at the time, was not without controversy. The establishment of the HPV register was also announced at that time.
Labor is supporting this bill so that the register can be implemented as soon as possible, because the National Immunisation Program has already begun. We are also supporting this bill with the aim that the register will enhance the efficiency of the program. This is especially important after some schoolgirls were hospitalised following injections. It is important to know if there are any side effects from the injection. While the Department of Health and Ageing officials have labelled the effects as psychological, it is still important to have a mechanism to monitor participants in the program. Of course, it is also important that we monitor the effectiveness of the HPV vaccine in preventing certain cervical cancers.
This vaccine is a huge breakthrough and will save many thousands of lives. It is an Australian innovation that makes me extraordinarily proud when I think of the health effects and protection that women around the world will eventually receive from this vaccine. I congratulate all of the scientists involved in the extraordinary discovery of this vaccine.
Turning again to the register, I want to clarify that the register will, firstly, facilitate the establishment and maintenance of an electronic database of records for monitoring vaccination of participants in the program. Secondly, it will facilitate the monitoring of the effectiveness of the vaccine in preventing certain cervical cancers by allowing for future cross-referencing of data against Pap smear and other information contained in registers maintained by states and territories. Thirdly, it will facilitate the establishment of mechanisms to advise eligible persons or their parents or guardians if vaccination has been missed or if booster doses are required in the future. It also allows for the maintenance of a record of people who are eligible to complete the course of the vaccination. It also facilitates the promotion of health and wellbeing by providing information on new developments associated with the program to vaccination providers, to women who are eligible and to their parents or guardians. The register also facilitates a payment to GPs for entering information into the register.
It is important to know that there was initial controversy about including Gardasil in the National Immunisation Program. Labor is very pleased that it has been included. The vaccine protects against two strains of sexually transmitted human papilloma virus and those two strains are responsible for about 70 per cent of cervical cancers. Free vaccines have been available from April 2007 in schools and from most doctors from July 2007. The Immunisation Program is targeted on an ongoing basis at 12- and 13-year-old girls and is to be delivered through schools, and there will be a two-year catch-up program for 13- to 18-year-old girls in schools. For 18- to 26-year-old women, the program will be delivered through their GPs and community based programs.
The government has committed a total of $579.3 million between 2006-07 and 2010-11 for the vaccination program. The program involves three injections over seven months. If the vaccination program had not been included in the National Immunisation Program, it would have cost about $430 for three shots. Of course, while it is a very high cost—more than half a billion dollars—the savings from the treatment of women with cervical cancer and the terrible loss of life associated with this disease certainly makes this half a billion dollars well spent.
I am very pleased that the government has decided to provide the vaccine free to all Australian young women. I think we need to acknowledge the work of the then shadow health minister, Julia Gillard, and the current shadow minister, Nicola Roxon, in supporting the government’s introduction of this free vaccine.
I know that it has not been without controversy. As I said, there are some people who have expressed concern that vaccinating young women will encourage increased sexual activity. Indeed, Australian Family Association spokeswoman Gabrielle Walsh was reported in the Daily Telegraph in May this year saying:
Some parents feel it gives the children a sense they are going to be sexually active ...
She further went on to say that, where young girls were going to abstain from sexual activity, it was not necessary to be vaccinated.
I understand why parents would certainly be wishing to discourage early sexual activity in their teenage children, and I support a parent’s right to do that. The key is that this course of vaccination will eventually result in lifelong protection. When young girls are at school, it is the easiest way of making sure that we have access to 100 per cent of the relevant population. I do not believe that it will encourage earlier sexual activity. I think probably the last thing that young people who are engaged in sexual activity that is too early are thinking of is whether they are protected from human papilloma virus. The difference it is going to make there I think is negligible. As I say, the benefit of giving it to young girls in schools is that they will achieve lifelong protection from human papilloma virus.
Incidentally, it is interesting to note that the federal Department of Health and Ageing says that recent overseas research has shown that 14.3 per cent of women who have had only one partner still carry the human papilloma virus. So, for parents who hope that their daughters will not engage in sexual activity before marriage and will have only one sexual partner throughout their lives, even for those women this vaccination is important.
According to a South Australian study of 2,000 people that was published in the Australian and New Zealand Journal of Public Health, only five per cent of parents were concerned that the vaccine would make their daughters likely to engage in earlier or promiscuous sexual behaviour, and 75 per cent of parents said that they wanted their daughters to be vaccinated. The key scientist involved in the discovery of the vaccine and 2006 Australian of the Year, Professor Ian Frazer, recently said:
The opportunity to protect against cervical cancer is as compelling as the opportunity to protect against polio ...
It is entirely the parents’ right to decide if they would like their child to be vaccinated. Hopefully they will be able to consider eventually that the vaccine is designed to protect against disease and the reality is that it has to be given early in life. If they wait too long, they could lose the benefit.
We know that when women contract cervical cancer they are faced with the potential of a much shorter life expectancy than they otherwise would have had or, secondly, if cervical cancer is not caught and treated early enough, a hysterectomy is the other potential. It is a very serious potential. In 2004—which is the most recent data that we have—212 women died from cervical cancer and many others were forced to undertake either the option of hysterectomy or other very invasive surgical and medical procedures. The idea that we can save hundreds of lives and tens of thousands of treatments I think shows what an important breakthrough this is and what an important thing it is for us as a society to support maximum vaccination.
The uncomfortable truth for many people is that a high proportion of teenagers are actually sexually active, the majority of young people in years 10 and 12 are sexually active in some way and a quarter of students in year 10 and half of students in year 12 have engaged in sexual intercourse. My personal view is that those figures are too high, but the reality for many Australian teenagers is that they have become sexually active, and that is another good reason to say it is very important to vaccinate against human papilloma virus from a very early age.
I think these figures, which show a large proportion of teenagers become sexually active quite early, suggest that we need to do a lot better with our sex education in schools. We do not have a very good national approach to educating teenagers about not just the physical consequences of sexual activity but also the emotional and psychological aspects of engaging in early sexual activity. I was interested to see that in the recent federal budget the government announced that it had spent half a million dollars on educational research for high school students to talk about the financial aspects of teenage pregnancy and the responsibilities that arise from becoming a teenage parent. Again, if people know teenagers, they know that thinking about the financial aspects of potentially raising a child is probably not going to be the thing that stops them from engaging in sexual activity if that is at the top of their minds at an early age. I think that, as I say, we can do much better in our sexual and reproductive health education.
I want to conclude by making a few more general comments about women’s health. Women use Medicare services about twice as much as men. An enormous range of medical problems are faced by women, of which cervical cancer is one of the more serious. We know that one in 11 women will be diagnosed with breast cancer before the age of 75. The most common age for that diagnosis is between 50 and 69. Rates of lung cancer, melanoma and non-Hodgkin’s lymphoma are all increasing. The really interesting thing about lung cancer is that Australia has done fantastically well in reducing smoking rates. We have done brilliantly. We now have the lowest smoking rates in the world because of decades of concerted education campaigns, advertising campaigns and because we tax cigarettes quite highly, as we rightly should; but young women are increasingly smoking. Young women are the only group who are taking up smoking in larger numbers. I think that begs the question about why young women are engaging in more risk-taking activities than in previous generations. We are also seeing more young women booked for violent crime, speeding offences and dangerous driving offences. I think there is a very interesting underlying question there about the changes in society that are prompting young women to engage in activities that older men and women see as very dangerous.
We know that we have very good screening technologies available for many of these diseases, including cervical cancer and breast cancer, but many groups in the community do not avail themselves of that testing regime as much as they should or in a way that would significantly reduce their development of these diseases. Breast screening participation rates for Indigenous women and women from non-English speaking backgrounds in the target population of 50 to 69 are just 34.8 per cent and 47.4 per cent respectively and are significantly lower than the general rate of 57.1 per cent of the target community.
We have increasing problems not just in the population of young women but also in an emerging population of young men when it comes to eating disorders and body image disorders. At the same time, we have increasing levels of obesity in the young Australian population and in the general Australian population. We need to do better in some of these areas when it comes to preventative measures in health care. As I said, we have done very well with smoking, but we have new and emerging challenges all the time which are increasingly related to diet and lifestyle challenges like obesity, leading to diabetes, for example. At the same time as we are seeing these emerging trends in poor health, most Australians are paying more to see a doctor, more for many medicines and more for private health insurance. There was very little in the most recent budget to genuinely tackle some of these health problems that are linked to the increasing expense of accessing normal medical services.
In the last few days we have had an incredible intervention from the federal government, saying that they are happy to take over the running of the Mersey hospital in Tasmania. It is no coincidence that the Mersey hospital is in an extremely marginal seat. Setting aside all the cynicism of taking over one hospital in one marginal seat, it really does beg the question of the federal government’s broader vision for health care in this country. The one-off taking over of one hospital, leaving many services in many rural and regional areas facing exactly the same problems of shortages of specialists and shortages of equipment and so on, suggests that the government is prepared to pick and choose the health issues it is involved in in a way that is, I think, detrimental to the running of the broader health system.
I will not conclude on a negative note. I want to conclude on a positive note of welcoming the initiative to provide Gardasil to women in the target age group and to other young women to provide them with a lifetime of protection from at least 70 per cent of the cervical cancers that are related to the two particular strains of human papilloma virus associated with this immunisation. It is a terrific step forward. Ian Frazer and his team must be congratulated for what is really a world-class breakthrough in women’s health. It makes me enormously grateful to think that my own daughter and grandchildren, if ever I have them, will be protected against the bulk of human papilloma viruses that may lead to cervical cancer. I want to express my gratitude to the scientific team who have come up with this breakthrough and offer my support not just for the national register but also for the free and ready availability of this vaccination program to young women who will benefit from it.
As always, it is my pleasure to speak in the Australian parliament as the federal member for Ryan in the western suburbs of Brisbane, an electorate that I grew up in and that I represent very proudly here in the national parliament. I am delighted to speak on the National Health Amendment (National HPV Vaccination Program Register) Bill 2007 because it is something that is of great interest to all my constituents, particularly to the parents of young women in my electorate. They will be very pleased and very proud, I think, that their government has acted very strongly to protect their daughters. I am very proud to be an advocate of this bill and to continue, as a local member, in working to promote this very significant piece of legislation and policy content therein.
Australia has a long history of using immunisation in targeted and mass vaccination programs in order to control communicable diseases, although it should be said that in 1996 our immunisation rates were at a disturbingly low level with some 53 per cent of children aged zero to six years fully immunised for their age—so much so that Professor John Horvath, the current Chief Medical Officer in the Department of Health and Ageing, described those levels as ‘on a lower rate than in some developing countries’. I am pleased to say that today those rates are very different. In 1996, interestingly, only $13 million was spent on vaccines by the then Labor government. Again, I am pleased that this is a very different figure today. In the past 10 years the Howard government has been able to turn around this sort of figure. We have been able to increase our immunisation programs to the point where we are the envy of many developed countries around the world.
I think that the turning point might be the Howard government’s introduction in February 1997 of the Immunise Australia strategy, which consisted of a seven-point plan and a comprehensive range of initiatives to increase Australia’s immunisation rate as quickly as possible to international levels. Overall, the government increased expenditure on immunisation some 22-fold to a figure of $283 million in 2006. We have been able to do that in the last few years only because of our very prosperous economy. A very strong economic performance allows the government to be able to inject this kind of money into very worthwhile and significant programs. The flip side of that is that, if an economy is going backwards or stuttering along, there is no way in the world that a government will be able to invest heavily in social services and in the communities around the country. It is a very indicative and a very salient point to make that it is only when an economy is performing robustly that governments can invest in their people, and in their young people in particular.
The Gardasil vaccination program alone represents an expenditure of $107.4 million a year—eight times the yearly expenditure on all vaccines by the previous Labor government—which brings the predicted expenditure on vaccinations in 2007-08 to $443 million, or a 34-fold increase on 1996 levels. These are not insignificant figures. I am sure that the constituents of Ryan will appreciate this massive 34-fold increase on 1996 levels. Again, it points to the capacity of the government to be able to do this because we are generating revenues from the business community as a result of business doing well in Australia thanks to the policies of the Howard government in the economic area.
Immunisation coverage rates have also increased dramatically, despite being at levels as low as 52 per cent in 1995 for children aged zero to six years of age. Since the introduction of the Immunise Australia program, childhood immunisation coverage rates have increased to all-time highs, with over 90 per cent of children aged 12 to 15 months now fully immunised. The Howard government has of course conducted a number of very successful vaccination campaigns during its time in office: firstly, the measles control campaign in 1998, where 1.9 million primary school children were vaccinated with MMR, and, secondly, the current immunisation program against meningococcal disease, which commenced in 2003 and targeted all one- to 19-year-olds over a four-year period. At the time of its commencement the meningococcal vaccination program was the largest of its kind ever undertaken in Australia, at a cost of $298 million over four years. Just think about it: almost $300 million over four years of taxpayers’ money invested in the people of Australia by the government, which is a very significant investment in the people of Australia. Again, I just make the point that the government had the capacity to be able to do this because it has been able to manage the economy very well over the last decade.
The benefits of such a large-scale vaccination program are already evident with the reported cases of meningococcal disease dropping from 213 cases in 2002 to just 40 cases in 2005—a decrease of 81 per cent. In 2006, the numbers were better still, with just 24 cases of meningococcal disease reported and one death. The success of this vaccination program is indicative of the benefits of these large-scale immunisation programs and reflects very well on the Howard government’s ability to effectively manage them. The Gardasil vaccination program, of which I will speak in a moment, will be the biggest of these programs yet.
Approximately half a million women worldwide develop cervical cancer every year, and 230,000 of these women will die of the disease—many of them from the developing world. In Australia, about 800 women get cervical cancer each year, and about 270 women die from it. Thanks to the success of the Pap smear program in Australia, cervical cancer has dropped from the eighth to the 18th most common cause of cancer death amongst Australian women. Indeed, Australia has the second-lowest incidence of cervical cancer and the lowest mortality rate in the world. However, we all know that one death is still one too many, so whatever our government and our brilliant medical scientists, researchers and doctors can do to minimise cancer—or should the good Lord allow them to rid our society of cancer—would, of course, be a wonderful blessing upon us all.
The Cancer Council of Victoria estimates that the Gardasil vaccine has the potential to prevent up to 500 cases of cervical cancer each year in Australia and to save in the order of 200,000 lives every year worldwide. Looking at this figure, one finds it enormously disturbing. However, when one goes beyond it, one must stop and think that this is not just a number on a piece of paper; it is someone’s loved one, someone’s relative, someone’s daughter, someone’s mother or someone’s sister. Whatever we can do, we must do. We must do all we can within the powers of humanity to rid our earth of such cancers and all the other ills and evils of our world.
The Gardasil vaccine is a breakthrough in the treatment of cervical cancer, and the Howard government is very proud to be able to make it widely available to young Australian women. It is a good example of politics and government at their very best. Previous speakers and colleagues have mentioned Professor Ian Frazer. He can claim much of the credit for discovering the vaccine, in cooperation with his good friend and colleague—a man who has now sadly passed on—Dr Jian Zhou. I never had the opportunity of meeting Dr Jian Zhou, but he did live in my electorate of Ryan. I do know his wife very well, Ms Sun Xiao-Yi, who still lives in the suburb of Mt Ommaney in the Ryan electorate. She is a wonderful lady. She has become a family friend to me and my wife in the last 10 years, through mutual friends of ours. I regret very much that I did not have the opportunity of meeting her husband, who, from all accounts, was an incredibly gifted man and a wonderful human being. He spent some time at my old alma mater at Cambridge University, in the United Kingdom. I wish very much that I had had the pleasure and honour of meeting him.
Ian Frazer, also a Ryan constituent, lives in the suburb of St Lucia and works at the University of Queensland. He is a very distinguished professional, a very smart man and a very kind man. His compassion, humanity and decency and just sheer determination to make an impact on the world through his medical and research skills is an inspiration to all of us and certainly to those in the medical profession. Someone like my brother, who is a young neurosurgeon in this country, looks up to Ian Frazer. My sister is about to graduate from Sydney University as a doctor and aspires, as I think all doctors and medical researchers do, to make a difference in their professional endeavours. I have had the pleasure of meeting Ian Frazer—or as the press like to call him and as media magazines and feature stories like to label him, ‘God’s gift to women’—on many occasions. I am very fortunate that he is a Ryan constituent. His wife has just retired as a teacher at a local primary school in the Ryan electorate, and I want to pay tribute in passing to her for her dedication at that local primary school. She and Ian are wonderful people. Everyone knows Professor Ian Frazer for his Australian of the Year honour in 2006. He relished, of course, this opportunity to promote Australia’s medical research capabilities and to inspire others to pursue a career in this very important field.
The vaccine that he came up with protects girls and young women against four strains of the human papilloma virus, which is sexually transmitted. Two of the four strains are responsible for 70 per cent of all cervical cancer, and the remaining two strains cause over 90 per cent of genital warts. Before the vaccine was cleared for use in Australia, more than 8,000 women across 16 countries received the vaccine as part of the clinical trials designed to test the efficacy and safety of the vaccine. The results, as published in the very prestigious New England Journal of Medicine, are remarkable and demonstrate that Gardasil protects against a range of cancerous and precancerous conditions.
The worldwide take-up of Gardasil has been incredible, with over six million people now being vaccinated in the United States alone. Germany, Italy and France have now also instituted an Australian style widespread immunisation scheme. In November 2006, the Howard government announced a funding outlay of $537 million for the national HPV vaccination program using the Gardasil vaccine. I am pleased that I can stand here and say that I was a very strong advocate of that in the corridors of government here. The $437 million over five years is for the vaccine itself, which retails at approximately $460 over the counter. An additional $100 million over four years is provided to support the implementation of the program with an education campaign and the establishment of a national register, which this bill specifically establishes.
The free vaccine is being provided through school based programs to girls aged between 12 and 13 years on an ongoing basis. As part of the program, the Howard government will also fund a two-year catch-up program at schools for girls aged between 13 and 18 years. As well, there is an additional two-year catch-up program to enable young women, aged up to and including 26 years, who have left school to be vaccinated through their local GPs.
We might recollect the scenes on national television when, in April this year, Professor Ian Frazer himself vaccinated the first Australian schoolgirl. Speaking of Professor Frazer and Australian schoolgirls being vaccinated, I had the pleasure, during the recess, to be part of Professor Ian Frazer’s visit to a very significant college in my electorate—Brigidine College at Indooroopilly. On behalf of the college principal, Ms Madeleine Sayer, I invited Ian Frazer to speak to the young women at the college about medical research in general, about his life and times, about what inspires him and, in particular, about the Gardasil program and vaccination. On the record in the parliament, I want to thank Brigidine College for having me visit the college with Professor Frazer. I want to thank the college captain, Stephanie Byrnes, for her assistance and hospitality in looking after us and showing Professor Frazer around the college and, of course, to thank the college principal, Madeleine Sayer, for her foresight and very strong reception of the visit by Ian Frazer.
For Ms Sayer this was an investment in the young women of her college in a broader sense as well as in the very direct sense, with Professor Frazer speaking of his experience and his skills. The day was a resounding success. This college is at Indooroopilly and has some 500 students. The Brigidine College newsletter published on 27 July and distributed to the parents of the girls states:
Mr Michael Johnson, the Federal Member for Ryan organized this visit to the College last Monday. It was a great privilege for the girls to meet and hear an address by Professor Ian Frazer. He spoke of his work in the development of the vaccine that protects women against cancer. All the Yr 12, 11 & 10 students have already been immunised this year (one more injection to complete the series). It is a great initiative of the Federal government and we were able to express our appreciation through Mr Johnson.
I thank Madeleine Sayer and Brigidine College for their hospitality. I know that the students of the college would have very much appreciated listening to a very distinguished Australian and someone who is in enormous demand by a lot of schools, organisations and companies for his time and his wisdom. Madeleine Sayer’s letter to me, commenting on this Howard government initiative, says:
It is a marvellous program and I would commend all associated with this decision for the investment in the future of our nation.
This bill will amend the National Health Act 1953 to enable the establishment and operation of this national program register. It will ensure the successful implementation of the national HPV program. The national register will enable the government to collect information on girls and women immunised by the cervical cancer vaccine, Gardasil, to gauge the success of the national immunisation program. Through the compilation of data and statistics, the register will enable the government to determine how many people participated in the HPV vaccination program in relation to the eligible population, and also of course enable outcome based analysis as recorded by cervical cytology registers. The register will also provide a way for participants to be contacted if need be and will help women to find out whether they have been vaccinated and whether they require booster doses.
The register will contain personal and vaccination information about women who participate in the program. However, only registered vaccination providers will be given access to the HPV register to allow information to be entered on the register and to check the vaccination status of those to whom they are administering the vaccine. The bill also makes provision for vaccinated persons to make the request in writing at any time to have their details removed from the register.
In conclusion, I want to again thank Professor Frazer and pay tribute to him in the parliament. He is of course a very strong advocate of good health policy and of medical research expansion in this country. I know that when he was named Australian of the Year he was very proud of that—and, like me, he is not an Australian by birth. He is an Australian by migration, coming from Scotland—I do not come from Scotland—and is someone that many in this country admire because he has every decency about him to make a difference in our country.
Of course, we are a country of only 20 million people. I think the amount of money that the federal government invests in health alone is something we can be very proud of. There is always a case for more money to be spent in every aspect of government and public policy, but as a prosperous nation we can be very proud of what we have spent. That is not to say we cannot do more. We can always do more. Every government can always look to revisit its programs to try and invest in areas where it will really make a difference to people on the ground.
This is something that, as a local member, I want to continue to advocate. At the pointy end of life—at the grassroots of our community, in the day-to-day living that takes place across our country—we should always remember what makes a difference, at the end of the day, to people’s lives. It is this sort of thing that people look at very seriously. We can get caught up in theory and academic nonsense about a whole bunch of things but, at the end of the day, we should just remember what actually strikes at people’s hearts and souls. It is this sort of thing that makes a difference in the lives of children and in the lives of their family security. I commend this bill very strongly to the House.
It gives me great pleasure to support the National Health Amendment (National HPV Vaccination Program Register) Bill 2007, which will record on a register personal and vaccination information for individuals receiving the HPV vaccine under the National HPV Vaccination Program. This register is needed because the existing Australian Childhood Immunisation Register only collects information up to age seven. The aim of this bill is to overcome some technical difficulties with the Department of Health and Ageing being able to collect and use a person’s Medicare card number for purposes other than the purpose for which the Medicare number was generated.
The HPV register will assist in monitoring the number of doses of vaccine received, notifying individuals if doses of vaccine have been missed, recalling individuals in the event that booster doses might be required in the future and providing educational materials. It will also allow vaccination information to be compared in the future to patient outcomes, as recorded in Pap smears, cervical cytology or cervical cancer registers. It is so important to have accurate registers of information so that medical professionals have access to a person’s medical history. This information can be vital in diagnosing future illnesses and determining which medications to prescribe to patients. It can be difficult for a teenager or a young adult, and difficult for the families of these people, to remember and have knowledge of all the vaccinations that they have received, so this register will also mean that medical professionals can use this information rather than relying on information from the actual patient or their family. Many times you may have a separation in a family, whereby parents go separate ways, and then records of children’s vaccination programs are not kept intact. Years down the track, it becomes a vital and difficult issue for some of those young people to reconcile exactly which vaccination programs they have undertaken. A mum or a family member could have a tragic death, and with that death goes all of the information on the way in which the children were vaccinated in their early years. That leads to confusion about many illnesses. Particularly when young couples decide to marry, this becomes a problem. Having a register such as this will mean that professionals and those people will be comforted that they can access this kind of information and that it is not lost to them forever.
The cross-referencing of information will provide information about the effectiveness of the HPV vaccine in reducing cervical cancers and inform the future directions of the HPV program. Australia is one of the first countries in the world to fund a HPV program. It really is a great credit to the Australian government, particularly to the minister, for having acted on this fantastic initiative. This bill will remove the obstacles associated currently with the collection of personal and HPV vaccination details and the disclosure of Commonwealth assigned identifiers, such as the Medicare number, for the purposes of the register. It also establishes the register and provides for the recording of certain personal information about individuals participating in the HPV program. It also details the purposes of the register and provides individuals with an opportunity, on written request, to be able to access these kinds of details in individual circumstances.
It also allows for the cross-referencing of information about the vaccination status of females on the register, with Pap smear, cervical cytology or cervical cancer registers maintained by states and territories. It also recognises that some personal information—such as name, address, date of birth and Medicare card number, which are already in the possession of, or under the control of, the Commonwealth—may need to be disclosed to and used by the Department of Health and Ageing in order to facilitate the operation of the register. It facilitates the payment of a small administrative fee to GPs who provide details on the register relating to individuals in the 12- to 18-year-old group who are vaccinated with HPV vaccine.
Our immunisation system is now world class, with immunisation coverage rates above 90 per cent for 12-month-old children for the last six years. The proof of the success of the program can be measured by the large decline in the rate of preventable diseases. In the case of polio and smallpox, it has led to the eradication of diseases in Australia. Our childhood immunisation rates have increased. When I was on the Wagga Wagga City Council, I was running a program, through ABC radio, trying to encourage young mums and families to vaccinate their children, because at that time only 53 per cent of children were fully immunised by the age of 12 months. We saw the re-emergence of whooping cough and the threat of other diseases being reintroduced simply because our young mums and dads had never seen the devastating consequences of those diseases. Many people were frightened off by claims—whether or not they were valid—of damage caused to children through having vaccinations.
I felt it was almost a national crisis, with almost half the children in Australia not vaccinated against killer diseases and typically terrible diseases. So prior to my coming into this House I encouraged families to vaccinate their children. I am really proud to see that we have now lifted those rates substantially, with over 90 per cent of children now fully immunised. I congratulate the government on this massive effort because it has been committed to ensuring that Australians can access free vaccines to protect the population against vaccine preventable diseases through our National Immunisation Program.
As the previous speaker indicated, the Australian government announced in 2006 that a free human PV vaccination program for all Australian girls and women from 12 to 26 years of age would be implemented. In 1996 the Australian government expenditure on vaccines was $13 million a year; when the Howard and Vaile coalition government came into this place, vaccination expenditure was a mere $13 million a year. In 2006-07, our vaccine expenditure was $283 million a year. I am very proud of the government for this extensive program to ensure the protection of Australian children.
The HPV program has commenced with $475.9 million of funding over five years from 2006-07 until 2010-11. The commitment to the vaccine funding of that is estimated to be over $443 million. We have a very good program for schools and young girls in particular. This program will provide vaccinations for three groups of females: girls aged 12 and 13 years, which will be delivered through schools on an ongoing basis; girls aged 13 to 18 years, which will be delivered primarily through school for a two-year catch-up period; and young women aged 18 to 26 years, which will be delivered through our community programs, including GPs, for a two-year catch-up period. This will be staged in various ways and by various means, but it has commenced in 2007 and will continue through 2008.
I am extremely pleased to see that the government has acted forcefully and decisively, as it does, to ensure that our Australian children, and their families, are supported and protected and to encourage families to move on this issue. I congratulate the minister and the government. I commend this bill to the House.
The Australian government has every reason to be proud of its achievements in the area of health. Unfortunately, the same cannot be said for some of our state Labor governments, especially the Queensland state government, which has a dismal record of failure and mismanagement in this area. The Howard government constantly seeks to be proactive in tackling health problems and costs. We know that we face escalating health costs—firstly, because of the scientific and technological advances in medicine; secondly, because our expectations for treatment have risen with those advances; and, thirdly, because we are an ageing population with all the health problems that that entails.
It therefore makes sense to concentrate resources on building good health and immunity from infancy, and on the prevention of disease or injury, to minimise future health costs. In my role as Chair of the House of Representatives Standing Committee on Health and Ageing, I am involved in an inquiry at the moment into the breastfeeding of babies in Australia and have heard much evidence regarding the long-term health benefits that this gives our children. We are listening to people and gathering data so that we can say to parents, ‘Here is the latest information; here is the data so that you can make informed choices about ensuring the best lifetime health outcomes for your child.’ A healthy nation is also a more productive nation. Building immunity is an important step in keeping our people healthy, which of course is good for our people, for our economy and for our future health costs. We start building that immunity with care, nutrition and immunisation of babies and young children.
Under the Immunise Australia Program, we fund vaccinations in babies and children for a wide range of diseases including hepatitis B, diphtheria, tetanus, whooping cough, polio, pneumococcal, measles, mumps, rubella and meningococcal C.
Over the last 20 years, child mortality rates in Australia have been reduced by half; however, some years ago many parents stopped vaccinating their children because diseases such as diphtheria, tetanus, polio and whooping cough appeared to have been eliminated. In 1989-90, only 53 per cent of one-year-olds were immunised; since 2000—that is, on this government’s watch—that figure has been over 90 per cent. When we came to government in 1996, Australian government expenditure on vaccines was $13 million a year—I repeat: $13 million a year. In 2006-07, our vaccine expenditure was $283 million, and that was before the introduction this year of the National Human Papillomavirus—HPV—Vaccination Program, and also the rotavirus vaccinations. The addition of rotavirus vaccine to the National Immunisation Program will cost $124.4 million over five years, while the HPV vaccine program commenced with vaccine funding of $475.9 million over five years. The Australian government’s commitment to vaccine funding in this financial year is estimated to be over $443 million. That contrasts again with the $13 million that it was in 1996.
In 2007-08, our expenditure is to be, as I said before, $443 million. That is a very large commitment to proactive health care from the federal government. We would not be responsible managers if we did not try to ensure that that investment is both effective and cost-effective.
The National HPV Vaccination Program, announced by the government in November 2006 and introduced in April this year, funds free HPV vaccine for females in the 12- to 26-year-old age group, with the aim of reducing the incidence of cervical cancer. The vaccine is most effective if given before any exposure to HPV infection and is administered as a series of three injections over a period of seven months.
As part of that program, the National Health Amendment (National HPV Vaccination Program Register) Bill 2007 establishes a register of those vaccinated. There are a number of very good reasons for this register. The first is to ensure that each young woman completes the full course of three injections. The second is that research on this vaccine is ongoing and it is possible that a booster may be necessary in future years. The register enables women to be notified if this is necessary. The third is that it provides data on the efficacy of the vaccine, as well as ascertaining whether the vaccine program causes any drop in the number of women having their regular pap smear test under the National Cervical Cancer Screening Program.
Routine pap smear tests have proved highly effective in detecting cervical cancer in early treatable stages, significantly reducing the mortality rate, but there is concern that the vaccination may give some women a false sense of security leading them to neglect having these routine tests in the future. Another concern is that, although the vaccine protects against two strains of HPV responsible for 70 to 80 per cent of cervical cancers, other strains may also adapt or develop over time. Cross-referencing the vaccines with NCSP data will help monitor such changes and allow us to be proactive in combating them.
I know most of us get a little bit nervous about personal information being gathered on a computer that may be shared with unknown people or organisations. In this instance, we are talking about a record of vaccination, not of an illness. There are in-built safeguards. The first safeguard is that the HPV register will also hold information about general practitioners and registered nurses who are recognised for the purpose of the HPV register as vaccination providers. Only those registered providers would be given access to the register for the purpose of making an entry or checking the vaccination status of their patient. The second safeguard is of course choice. All vaccinations are voluntary. Good sense, yes; highly desirable, yes—but still voluntary. On top of that, this bill makes the provision for a female or her parent or guardian to make a request in writing at any time to have her details removed from the HPV register. That request must be complied with as soon as practicable.
We all need to make choices, preferably informed choices, in our own health care. The government can only do so much to help protect us. We, as individuals, have to make health choices for ourselves and our children regarding diet, lifestyle, exercise, smoking, medical practitioner treatments, vaccinations and the use of this register. I believe it is an important tool in the fight against cervical cancer. Obviously the government also believes that the bottom line is that each individual has a choice. Australia has a world-class immunisation system and we should be proud of it. It is part of this government’s forward-thinking and proactive approach to health. We also have world-class health professionals and clinicians. The problems lie in the administration by state government.
I do not mean to play the blame game, which was the name of the report that I tabled last year on behalf of the House of Representatives Standing Committee on Health and Ageing, but unless you look at where the problem is coming from, look at the cause, not the excuse, you cannot fix the problem. While the federal government, through the GST, funds most state hospitals and health costs, they are administered by the states and the Commonwealth has no say in how those dollars are spent. I find it particularly difficult to see the level to which funding health care in my own state, Queensland, has sunk. This is affecting the morale and retention of health professionals working in the public system, which of course exacerbates the problem.
In the Courier-Mail on 6 August there is an article about a report released this week on Queensland Health by the former head of the University of Queensland School of Medicine, Mr Ken Donald. The article says:
The latest inquiry into the department, once envied by other states as delivering a model of public health care, reveals a system in meltdown … In five years’ time the breakdown in services will be ‘out of control’.
Queenslanders already know about the long waiting lists for public hospitals and the secret waiting lists—the lists that you have to get on to get on the list. That arrangement is used deliberately to mislead people over the length of a waiting list. Last week’s report reveals that in spite of all the press conferences, assurances and hand on heart declarations, the situation is becoming so desperate that some in Queensland Health are marking patients’ files never to be seen by a doctor. Minister Robertson insisted that these people only had minor ailments, but how do you know that they are minor until the person has been examined? Also, the ailments include cancer and stroke—and they are hardly minor conditions.
I mention the sad state of Queensland Health as a contrast. This bill is indicative of the federal government’s attitude that it is far more effective to be proactive and spend money ensuring better health early than to wait and treat the problem when it is serious. Queensland Health’s approach to its own health has been to try to hide and deny the symptoms until it is at a point of collapse even in coping with emergency calls. I commend this bill to the House.
In summing up the National Health Amendment (National HPV Vaccination Program Register) Bill 2007, I firstly thank the members who have spoken on this bill. I would like to thank the member for Gellibrand, the member for Sydney, the member for Moore, the member for Fairfax, who has just finished his speech, the member for Ryan and, most importantly, the member for Riverina—and I say that because the member for Riverina brought up a valid point that I can relate to as a single parent. When my wife passed away, when my children were very young, I found it difficult to locate all the records that my wife had for my son and my daughter for their vaccinations over the years. Like a lot of men, I had left that up to my wife to do, and so of course I had a witch-hunt to try and find the necessary papers. I had to contact my doctors et cetera. One of the things that this bill does is to make sure that it takes that onus away from those situations and assists the family unit, in moments of crisis like that, in having a record of vaccinations that have taken place.
This bill is about vaccination and information. The bill amends the National Health Act 1953 to insert provisions for the establishment and maintenance of the human papilloma virus, or HPV, register to complement the implementation of the National HPV Vaccination Program. The register will collect personal and vaccination information about people who receive HPV vaccine under the HPV program with a view to evaluating in the long term the effectiveness of the vaccine in reducing the incidence of cervical cancer. The HPV register will also facilitate a number of other functions relating to the HPV program and the payment of an administration fee to general practitioners who provide information to the register.
In summary, the legislation will ensure the collection of information which, in addition to evaluating the success of the HPV program in reducing cervical cancer, will also inform the policy direction of the HPV program and government expenditure in the future. It will also benefit individuals participating in the HPV program by providing them with information about their vaccination status, sending notifications when doses of vaccine have been missed and facilitating a recall system for participants in the event that booster doses may be required in the future.
As the father of a 12-year-old girl, I see this bill as being absolutely vital—vitally important not only for my daughter but, indeed, for me and for the rest of my family, my son included, because none of us wants to lose a wife, a daughter or an aunty and none of us wants to lose a close relative when it can be prevented. So this bill shows a vision on behalf of the coalition government—a vision for the future, a vision to monitor the health of young Australians well into the future, well into the years ahead. It is for that reason that I would like to commend this bill to the House.
Question agreed to.
Bill read a second time.
Ordered that the bill be reported to the House without amendment.