Jane Prentice (Ryan, Liberal Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) recognises that shingles and postherpetic neuralgia (PHN) can cause significant and debilitating pain for hundreds of thousands of Australians;

(2) acknowledges that senior Australians unfortunately bear the brunt of the disease burden, as the frequency and severity of complications increase with age;

(3) notes that approximately 1 in 3 adults will develop shingles in their lifetime and that the risk of shingles increases with age, particularly after the age of 60;

(4) recognises there is no cure for shingles and PHN;

(5) understands that prevention through vaccination represents the most effective opportunity to help reduce the number of Australians suffering from shingles and PHN; and

(6) acknowledges that preventative health measures such as vaccination will help protect the health of older Australians and safeguard their ability to work, care and volunteer.

I rise to speak on a well-known but little-talked-about illness that affects hundreds of thousands of mostly older Australians every year. Many of us will have had the childhood virus known as chickenpox. Chickenpox is caused by the varicella-zoster virus. This virus is also responsible for the painful and common condition known as shingles.

Shingles is a painful, blistering rash that can occur on any part of the body after reactivation of the varicella-zoster virus. While the bands of blisters usually occur on the torso, they can also appear on the face and eyes.

Once someone has had chickenpox, the virus lies dormant in the tissue near the spinal cord and brain. It spreads by travelling up and down the nerves. Shingles is a very painful condition.

Anyone who has ever had chickenpox can develop shingles, and there are a number of risk factors to consider. However, the single biggest indicator of elevated risk of developing shingles is age. People over 50 years of age are far more likely to experience shingles. People living to 85 years of age have a one in two chance of experiencing shingles.

And for some people the pain of shingles does not disappear with the blisters. Postherpetic neuralgia, or long-term nerve pain, is a serious, debilitating condition which can last for years as a result of damaged nerve fibres. Those who have shingles on their face or eyes are more likely to suffer this ongoing complication. According to the Mayo Clinic, if blisters are experienced on or around the eye there is a strong risk of vision impairment. Depending on the extent of the nerve damage, shingles can also cause encephalitis, facial paralysis and hearing problems. This is a condition that can and does lead to very serious after-effects that can have a major impact on the quality of life of a sufferer.

There is no cure for shingles, so treatments include painkillers like codeine, tricyclic antidepressants, local anaesthetic and numbing agents. However, there is a vaccine available to help prevent shingles and PHN. While it may not prevent all cases of shingles from developing, it can help to reduce a case's duration and sensitivity.

However, the cost of the vaccination can be prohibitively expensive for older people. According to my local pharmacy, the cost is approximately $200 per treatment. Prior to the budget I had spoken to the health minister about the need for a shingles vaccine to be subsidised through the National Immunisation Program. After all, when we consider the value of our older Australians, through their volunteering, their work and their care for other family members, on top of what they have already contributed to our country, it seems only reasonable that we ease the costly burden of treating shingles by adding the vaccine to the program. That is why I was delighted when the Minister for Health announced, on 9 May, that Zostavax, a vaccine for the prevention of shingles and PHN, will be subsidised through the National Immunisation Program. This means that, from 1 November 2016, the vaccine will be provided free to older Australians aged 70 to 79.

This is the first adult vaccine to be made available in a decade. At an estimated cost to government of $100 million over four years, the new listing will help vaccinate up to 240,000 older Australians each year and 1.4 million through a five-year catch-up program.

In addition to the clear benefits to the quality of life, economic modelling predicts that the vaccine has the potential to reduce the cost of shingles to the Australian healthcare system by up to $31 million over the first five years of vaccinating Australians aged 70 to 79. This includes up to 3,800 hospitalisations, 32,000 prescriptions for antivirals and 131,000 GP visits.

While it is disappointing that the vaccine has not been provided sooner than November next year, I do applaud the health minister for listening and for then acting to ease the suffering of older Australians afflicted by this painful, debilitating but preventable disease. I commend this motion to the House.

Philip Ruddock (Berowra, Liberal Party) Share this | Link to this | Hansard source

I second the motion.

Shayne Neumann (Blair, Australian Labor Party, Shadow Minister for Indigenous Affairs) Share this | Link to this | Hansard source

I thank the member for Ryan for putting forward this motion on the impact of shingles and postherpetic neuralgia, commonly known as PHN, and I am pleased to speak on the motion. Shingles is a common viral disease that affects about one in three Australians during their lifetime. As the shadow minister for ageing I have met many people who have talked to me about issues such as this. Everyone who develops shingles will have experienced an episode of chickenpox, often some decades earlier, perhaps in childhood. If you have not had shingles, it is likely that you will have a family member or friend who has had it. Symptoms include localised pain, described as burning, numbness or tingling; a sensitivity to touch; the emergence of a red rash a few days after the pain commences; fluid-filled blisters that break open and crust over; and itching. So you can imagine the challenge for older Australians, particularly those who are not as mobile as they once were.

This is a particular challenge for those in residential aged-care facilities and for those carers who are looking after older Australians with these problems at home. The rash can appear on a person's face or neck but classically takes the shape of a belt or a band.

A 2014 survey, conducted by National Seniors, found that of those respondents who had shingles, 51 per cent said that it affected their social activities, 45 per cent said it affected their daily household chores and 32 per cent said it affected their work.

PHN is a persistent chronic pain syndrome. Shingles is certainly unpleasant but PHN can be an absolute misery for those people who are suffering from it. The National Centre for Immunisation, Research and Surveillance reports that 150,000 new cases of shingles appear in Australia each year and 70 per cent of those are of patients over 50 years of age. Beyond the age of 70, the rate of shingles is about 14 per cent for every 1,000 of population. About half of those people who live to age 85 will develop the disease. About 15 per cent of patients with shingles over 50 years of age will develop PHN.

About 80 to 85 per cent of PHN sufferers are over 80 years of age. While there is yet no cure for shingles or PHN I commend the government for their decision on the recent vaccine Zostavax. It has been developed to reduce incidences of both these diseases. Encouragingly, the study that was done by the NCIRS reported that the vaccine Zostavax was found to reduce the functional impact of shingles by 59 per cent on those people over 80 years of age who developed the disease.

We on this side of politics note that the government have listed this vaccine on the National Immunisation Program in the 2015 budget. We thank them for that. It will be subsidised for those Australians aged from 70 to 79.

While this news is welcome for many Australians, I do note the last part of the member for Ryan's motion:

… acknowledges that preventative health measures such as vaccination will help protect the health of older Australians and safeguard their ability to work, care and volunteer.

About six million Australians volunteer. It is estimated that this contributes about $15 billion to the national economy every year. So it is an absolute shame that, across two budgets, the government have cut funding for preventative health programs. We note that, after cutting about $57 billion in their first budget and through their subsequent decisions, they have cut another $2 billion in their latest budget. If you look at page 110 of Budget Paper No. 2, there is a cut of almost a billion dollars to an undisclosed number of health programs.

Another of my roles is that of shadow minister for Indigenous affairs. This government has cut $534 million in funding across the forward estimates—including nearly $146 million this year—from Indigenous programs. That includes cuts of $165 million to funding for Indigenous health, in particular funding for community controlled health clinics that make a big contribution not only to Indigenous employment but to health, wellness and welfare. I urge the government to reconsider those cuts. While they have made a good decision in relation to vaccination, I urge them to look at the cuts they have made in the last two budgets to preventative health programs—and to reverse those decisions.

Sharman Stone (Murray, Liberal Party) Share this | Link to this | Hansard source

I am so pleased that the Abbott government will invest $1.3 billion in listing new medicines and vaccines that are going to save lives and help thousands of Australians manage debilitating conditions like shingles—and the aftermath of shingles, which can include the most debilitating and painful of conditions. I commend the member for Ryan for this motion. I think it is very important that we recognise that shingles and postherpetic neuralgia can cause terrible, debilitating pain for hundreds of thousands of Australians. We are now going to make prevention of shingles possible through vaccination. This is the most effective way to reduce the number of Australians suffering either from shingles or from what we call PHN—one of the neuralgic conditions that can affect older people in particular.

You can get the vaccine now, but it costs over $200. A lot of older Australians simply cannot afford a vaccine that costs $200—in addition, perhaps, to the cost of going to the medical practitioner. This measure will enable older Australians, those over 70, to access this vaccine. It is a shame that it is going to take a fair while—I understand it will perhaps be over a year—to have the vaccine available for the National Immunisation Program. But we are told by the Department of Health that they need to procure the vaccine, develop a communications strategy, plan safety surveillance and undertake negotiations with the states and territories. That is unfortunate. It is a problem.

I know that one of the issues with shingles is that you should get attention urgently, as soon as you recognise the symptoms—the rash, the pain or the itching. If you do not get assistance very quickly, within the first 24 hours, the shingles condition can become much worse and much more prolonged. It can potentially lead to the terrible consequences of the PHN condition. For elderly people, who often are not able to get to a doctor quickly or who might not be aware of the symptoms, this vaccine will be critical. It means the elderly will not have to have someone who communicates with them rushing them to a doctor; they will have been vaccinated against this condition.

I am particularly aware of how serious this condition can be, because one of my father's dearest friends—who was the only other survivor of his Bomber Command crew shot down over Germany—contracted shingles when he was in his nineties and then, unfortunately, developed the most terrible complication of shingles: persistent, chronic neuropathic pain, known as postherpetic neuralgia, or PHN. This affected his face in particular. While he had had other health issues, including renal issues and of course the consequences of his horrific experience during the Second World War, he said to my father that he could bear all of that but that what he found almost impossible to bear was the pain of the herpetic neuralgia on his face. It made his life unbearable. I think if he had been able to access that vaccine, which we will now have available to 71- to 79-year-olds, he might have lived his last few years without that incredible pain. The condition affected his face and his eyes in particular, so he felt less able to go out and socialise with other people. This vaccine would have been an enormous advantage to a man like him, and of course there are so many other older sufferers of this condition.

Of course, the whole business of shingles relates to getting chicken pox in your younger years; it has to have been in your system. In Australia you can be immunised against chicken pox, so I strongly recommend that all Australian parents also look at the good effect of having your children immunised against the very common childhood disease of chicken pox. The disease of chicken pox leads to the virus; it can be activated as shingles in later life.

So, there are a lot of things we can do about this condition, and I am so pleased to be part of a government that recognised this and that the shingles vaccine Zostavax will now be on the Pharmaceutical Benefits Scheme. I am pleased that the Pharmaceutical Benefits Advisory Committee recommended back in November 2014 that it be put on this scheme. We can and will do something about this. We know where our priorities lie. I commend this motion to the House.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I congratulate the member for Ryan for bringing this important motion on shingles and postherpetic neuralgia to the House. Parliamentary Friends of Seniors, which is co-chaired by the member of Swan, Steve Irons, and me, has hosted two events around this. It became very obvious to us that the one thing that was needed was for this vaccine to be listed. Everyone who has had chicken pox is at risk of developing shingles. Older Australians bear the brunt of this disease, and by 85 years of age one in two Australians will have had shingles. So, it is one in three for all Australians, and one in two once you reach the age of 85.

Shingles pain can really impact quality of life to a degree comparable to a heart attack, type 2 diabetes and depression. And shingles, as has been mentioned by previous speakers, is accompanied by postherpetic neuralgia, or PHN, which causes the significant and debilitating pain that has been talked about in this House today—pain that can affect all parts of the body and pain that can also impact the optic nerve, which is one of the worst forms of shingles. There are 150,000 cases of shingles in Australia each year. Among Australians aged 60 and over it accounts for 3,609 hospitalisations, costing $16.7 million each year, and 105,000 GP consultations, costing $3.3 million a year. So, any effort to reduce these hospitalisations, any effort to reduce the pain, is well and truly welcome by those of us on this side of the House.

There have been a number of studies that support the vaccine. Since 2005 there have been several large studies. One study involving 38,546 patients aged 60 and over showed an overall 50 per cent reduction in shingles. Another study, of 75,760 people who received the vaccine, found a 55 per cent reduction in shingles. The most recent study, conducted in the US and involving 766,330 randomly chosen people, showed a reduction of 59 per cent in the PHN and 48 per cent in shingles. It is a very debilitating illness. It is an illness that has its greatest impact on people who are older, and it starts with a rash. Antiviral therapy can reduce the severity and duration of shingles but does not prevent the PHN. To actually get an impact you must get that antiviral treatment within the first 24 hours.

So, this vaccine will make a difference in the lives of tens of thousands of Australians—our older Australians, who are particularly adversely affected by shingles. I really welcome the listing of the vaccine, but I am very disappointed that it will not be listed on the PBS until 1 November 2016. That is after the election. It is a long time from now, and in that period of time there will be another 150,000 people who suffer from shingles in the next year, and if you halve that and add another 75,000 onto it, it is a significant number of people who are going to be debilitated by shingles. I call on the government to reconsider bringing that date forward, and I congratulate the member for Ryan on her fantastic motion. (Time expired)

Andrew Laming (Bowman, Liberal Party) Share this | Link to this | Hansard source

Deputy Speaker, thank you for the opportunity to talk about this very, very important topic. Particularly for older Australians over the age of 50, the herpes zoster virus is a significant cause of morbidity. All of us will have had personal experience with chickenpox in children. The herpes zoster virus is simply a manifestation of that disease later in life. It has significant chronic impacts. I am very familiar with those impacts having been an eye surgeon treating herpes zoster ophthalmicus, which is an occurrence from this infection that occurs in about 20 per cent of cases, mostly in older Australians.

Vaccines that are effective in the herpes family have been a long time coming. The herpes zoster virus is probably the most significant cause of morbidity in older Australians in that family of over five different herpes varieties. The herpes zoster virus is responsible for significant pain and suffering for older Australians. Understanding the economics of the benefits of a vaccine requires that we look at the age of the person, because not only is age going to affect the incidence and the severity of the condition but also the vaccine itself is less effective as one becomes older. The economics of life expectancy at every age point in time start to also mean that you have different cost benefits from the vaccination.

Evidence also is not complete for use of this vaccine in younger patients. It is registered for use by those over the age of 50. There was a very important budget announcement that made it available to 70-year-olds, which I commend, and in addition to that there is a catch-up program for those who were recently 70 years of age. If you are between 70 and 80 now you can be reasonably confident that over the catch-up period you will have access to this vaccine. Of course, there is nothing to stop you going out and getting that on the free market, but it is now added to the national immunisation program. It is an important benefit. We are always going to be looking as well at those under the age of 70. There is quite a lot of evidence around those aged 60 to 70. The vaccine's efficacy becomes weaker in those aged 50 to 60.

What we are talking about is familiar to everyone. Most of us can recall having chickenpox in our youth. We cannot always be sure it was, in fact, chickenpox, but that really does not matter. In our lifetime we will see about a quarter of Australians having an episode of the herpes zoster virus, making immunisation something worth considering. Those painful vesicular rashes are very much restricted to what we call the dermatomes, the areas of the body that are covered by a nerve—in this case, a cranial nerve. They demarcate the area where you can get those rashes. Rashes very much conform to those dermatomes.

The small percentage chance that you will have more than just the pain of the immediate episode is the great concern. It is not the immediate infection that is necessarily the problem; it is a whole series of what we call sequelae that can follow with time. When there is pain in the affected area lasting more than 120 days after the initial infection, we consider that to be postherpetic neuralgia. That kind of a pain, which can exist for years, is worse in those who are older. It can be associated also with a range of other outcomes. There is local scarring and pigmentation of the skin where the rash has occurred. There is the ocular involvement that can lead to severe ocular problems, which I will talk about in a second. There is even the possibility of meningitis and other systemic infections where large parts of the body are affected. These neurological problems are extremely rare and they are most commonly seen either in people who are living asymptomatically with HIV, for instance, or in someone who has had some other type of treatment that might affect their immune status. In those cases, on a case-by-case basis, you would want to consider the benefits of vaccination.

Right now we have the program that is approved for those who are 70 and above. But I commend the member for Ryan for raising this bigger picture, which is that this is a relatively affordable vaccine. Through more and more detailed cost-effectiveness analysis, I hope it will be considered in the future for younger populations. Anyone who has seen a patient living with postherpetic neuralgia would know that its treatment is limited to only a very few versions of analgesia to reduce pain. This pain can go on for years. It is something that a vaccination can make a complete difference to.

Remember that it is not a complete cover. We are talking about reducing the incidence of the disease by around 50 per cent. We would be trying to reduce the severity and duration of that postherpetic neuralgia with a vaccine. We see reductions of about two-thirds in those over the age of 70 and slightly less than that for those under. It is well worth considering. We will see further cost-effectiveness analysis leading to further approvals, I am sure.

Chris Hayes (Fowler, Australian Labor Party) Share this | Link to this | Hansard source

I, too, would like to commend the member for Ryan for bringing this matter before the House. It is a very important issue, particularly when you consider the consequences for an ageing population. Shingles, as others have referred to, is a virus based on the chickenpox virus. At the moment, as I understand it, it impacts on about 150,000 Australians each year, principally older Australians aged above 60. In terms of those Australians aged above 85, it affects almost one in two. So it is something that is very much an issue to be considered.

One of those Australians affected was my father. He died a couple of years back. He died from the consequences of cancer. He also had very advancing dementia, but if he were alive today I am sure he would say that, of all the suffering he experienced, nothing came close to the suffering he experienced from shingles. The shingles he acquired manifested in his eye socket. He would almost go mad from the symptoms. Dad was a former police officer. I grew up never knowing him to have sick day. He was a very strong and very determined man and one who would rarely cast a shadow over the door of a doctor's surgery. So when he acquired shingles he decided he would ride it out. As most people would be aware, to treat shingles effectively you must treat it in the first 24 hours. So unfortunately for dad in his last six years of life, apart from the radiation for his cancer, it was very much shingles that really debilitated his quality of life.

To think that we now have a vaccine for shingles being brought forward is great. I wish it could be done earlier. I know that it is not planned to be brought onto the PBS until November next year, but for an ageing population, as we have here in this country, this is something that will change the lives of many people. That is something that has to be considered, as we look at the holistic aspects of medication that is being funded. A vaccine of this nature will change the lives of many. It will take away a lot of suffering, and if it can help ease the lives of people who will suffer as greatly as my father did, then that is a great contribution that this parliament could make to our community.

The virus, as has been indicated, really becomes manifest for those who have suffered chickenpox. I know that in the past one of the things about chickenpox—and this happened when I was growing up—was that you would make sure your child came in contact with kids with chickenpox, because in that generation it was thought that once you had it, you did not get it again. That is the way I suppose a generation of us were brought up, but the consequence of that is that once that virus is there, it remains in the body, in the spinal cord. For older Australians, as I said, it becomes less dormant, particularly for those aged above 60, and it mutates into shingles and delivers the effects of PHN in the body. This is something that, as I said earlier, is very debilitating. And the consequence of it is that it affects vast numbers of older Australians. Therefore, I am very happy to speak on the member for Ryan's motion. I am very please that she has brought this forward. It is something I have not really reflected upon for some time, not since my father's passing, but if this could make a difference in people's lives and reduce the degree of suffering that I had to witness, it would be a great thing.

Keith Pitt (Hinkler, National Party) Share this | Link to this | Hansard source

I rise to speak in support of the motion moved by my hard-working colleague the member for Ryan. But I would also like to mention and to congratulate the member for Lyne, Dr David Gillespie, who has also been out briefing his colleagues about just how devastating the effects of shingles can be, and how important it is to have this vaccine on the list. As a child of the seventies, I suffered chickenpox and I clearly remember asking my mother if I could have a bath in calamine lotion, which happened to be the treatment at the time. You would be covered in all of this pink substance, which hopefully made it all a little bit better. Unfortunately, the chickenpox also manifested as shingles in my early 20s, so I have some personal experience of this. It is a terrible disease, absolutely terrible, and there have been good contributions from both sides of the House on this motion.

Shingles, or herpes zoster, presents as a painful rash on one side of the body that can lead to long-term nerve pain as well as hearing loss and damage to eyesight, as we have heard from many other speakers. Some 21,700 people over the age of 70 call the Hinkler electorate home. The reason this is relevant to this topic today is because senior Australians are particularly susceptible to the shingles virus. One in two Australians—one in two—will experience an episode of shingles by the age of 85. The frequency and severity of complications associated with shingles increases with age, and up to 50 per cent of patients over 50 years of age with shingles may develop a debilitating neuropathic pain that can persist for years, as we have heard in the contributions this morning.

Senior Hinkler residents make a significant contribution to the local economy and the community. Not only do they care for their grandchildren so that their adult children can work but they also make up the overwhelming bulk of volunteers in my electorate. For those who currently still work or want to be working at the age of 70 illness, injury and disability can be major barriers to employment participation. Pain is the most debilitating symptom of shingles. Sixty per cent of patients who were working when they acquired shingles reported an absence from work. More than 50 per cent of patients had to limit walking, and were unable to sleep properly. One-third of patients had difficulty with simple activities such as bathing and getting dressed. Shingles sufferers' risk of stroke increased 63 per cent in the four weeks after shingles.

There is no cure, only prevention. The Pharmaceutical Benefits Advisory Committee has recommended listing the shingles vaccine on the National Immunisation Program. It was estimated the vaccine could prevent up to 47,000 cases of shingles and up to 14,000 cases of postherpetic neuralgia in the first five years following the commencement of the vaccination program. The makers of the vaccine estimate it will reduce the cost of shingles on the Australian healthcare system by about 31 million in five years, including 30,000 fewer prescriptions for antivirals, 130,000 fewer visits to GPs and almost 4,000 fewer hospitalisations.

As part of the 2015-16 federal budget released earlier this month, the coalition announced $1.3 billion for new life-saving drug listings, including the shingles vaccine. Zostavax will be subsidised through the National Immunisation Program to prevent shingles in people aged between 70 and 79 years of age. It is estimated the new listing will cost more than $100 million over four years. This new listing will help vaccinate up to 240,000 older Australians on an ongoing basis each year, and 1.4 million individuals through a five-year catch-up program. Without government subsidy, this vaccine would cost consumers more than $200 per dose of vaccine. There are more than 14,000 Hinkler residents aged between 70 and 79—14,000—who will benefit from this listing. Of course they live in my electorate because they can take advantage of a wonderful climate and a fantastic place to live and all of the other advantages you have of being in Queensland of course.

Since coming to office, the coalition has doubled the number of drug listings for consumers. That is an investment of almost $3 billion for 652 new and amended drug listings in just over 18 months. In order to continue listing new drugs quickly for patients, government had to find a sustainable way to fund them. With total investment in the PBS currently $10 billion and growing as more and more new drugs come onto the market, taxpayers will invest at least $50 billion in the Pharmaceutical Benefits Scheme in the next five years. We have already got another $3 billion worth of new, innovative medicines in the pipeline for future listing and will need to find sustainable ways to fund them. The sensible place is to look at the price taxpayers and patients pay for existing medicines to ensure we have the capacity to fund new ones, and I welcome the health minister's comments that she will hold constructive discussions with the entire pharmaceutical supply chain about the best ways to make the PBS sustainable for future generations. I look forward to her announcing the full package of proposed measures in due course. I commend this motion to the House. It will be a fantastic outcome for the people of my electorate.

Stephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Link to this | Hansard source

I thank the member for Ryan for bringing this motion before the House and enabling us and the members who have gathered in the gallery today to learn a little bit more about this terrible , debilitating disease. I also want to say by way of introduction that I pay tribute to member for Shortland , who has been a strong advocate on this issue in side our party room and inside the parliament, convening several parliamentary forums over the course of this and the previous parliament on this impo r tant issue.

Postherpetic neuralgia and shingles are d ebilitating diseases. They create pain , they disrupt lives, they affect family relationships, they degrade our mental health and they limit our ability , particularly our ability to participate in the workforce. The d ebilitating pain is a burden that many Australians will face either directly or through somebody that they know and love. Treatment and management of the pain is something that Australia's world - class public and universal health system is uniquely equipped to deal with. As previous speakers have noted about one of every 100 Australians over the age of 50 have had shingles at a point in their lives. When you reach 70, it is 14 out of every 100 Australians that will suffer from the terrible virus.

S hingles is a caused by the same virus that causes c hicken p ox , h erpes z oster , and it manifests itself in a painful rash —luckily in most cases this clears up after a few weeks. However, PHN is a complication that emerges out of s hingles and causes severe and chronic nerve pain , o ften a sensation of burning under the skin. PHN is typically more likely to affect seniors. For most people with PHN the symptoms w ill c lear after about three or four months . However, an unlucky one in three people will have the symptoms for over a year. Progress can be slow and the patient treatment can be very difficult and, in fact, typically the patient remains in pain for the majority of that time. Once you have the virus, treatment is the only option—there is yet no known cure for PHN.

The most effective prevention is of course a vaccination from shingles. Australia has long managed a globally-recognised vaccination program, so we welcome the decision to place this vaccine on the national i mmunisation scheme. Pain management treatments for PHN can range from anti-epileptic medication, opiates, antidepressants, combination therapies, local anaesthetic patches, nerve - blocking creams and antihistamines. Clearly , the better option is an immunisation to ensure individuals do not get the disease in the first place.

We welcome on this side of the House placing this vaccine on the national immunisation scheme—it is an unequivocallygood thing. However, we cannot pretend that this decision occurs in a vacuum and is isolated from a range of other decisions affecting the health system and the health of Australians in this and the previous budget. We have talked about the importance of prevention and we are still suffering from the impacts of the government's decision to defund the Preventive Health Agency and to withdraw significant amounts of funds from preventative health programs throughout the country.

We are still suffering from the impacts of the government tearing apart Medicare—the system that puts in place universal health care in this country and the very system that many people who are suffering from PHN and shingles will rely upon to receive their ongoing treatment. This is the backbone of care for those people who are suffering with PHN today. While I am at it, if you are unlucky enough to have contracted PHN after suffering from shingles, you will require ongoing care and access to drugs and treatments that are listed on the PBS. So the government's decision to increase co-payments and to restrict access to the PBS safety net is again a retrogressive decision which will impact on this particular patient group.

I take the opportunity of this motion, which I welcome, and the decision of the government to list this vaccine, which I welcome, to ask them to revisit their decisions which impact on Australians through the PBS and that Medicare system, because this is the sort of relief that Australians will really need.

Debate adjourned.