Thursday, 14 May 2020
Therapeutic Goods Amendment (2020 Measures No. 1) Bill 2020; Second Reading
That all words after "That" be omitted with a view to substituting the following words:
"whilst not declining to give the bill a second reading, the House:
(1) notes Australia's substantial reliance on global supply chains for medicines and medical devices;
(2) further notes the supply issues that Australians have experienced during the COVID-19 pandemic, particularly for common medicines; and
(3) calls on the Government to consider stronger domestic supply capabilities as part of Australia's post-COVID-19 response".
In the first two weeks of March, as we faced COVID-19, demand for medicines rose sharply, resulting in pharmacies and wholesalers reporting that numerous common medicines were out of stock. This led to an intervention by the TGA requiring pharmacists to limit dispensing of certain prescription medicines to one month's supply at the prescribed dose and to limit sales of certain over-the-counter medicines to a maximum purchase of one unit. Additionally, pharmacies were also required to place children's paracetamol liquid formulation behind the counter to assist in allocating those products equitably.
One of my constituents, Caleb, lives with asthma. After a check-up with his GP in March, he couldn't fill scripts for either Seretide, his preventer, or Ventolin. Although he was eventually able to fill his Seretide prescription, he was left with a short supply of Ventolin for several days, putting him at some risk. Checking the TGA website, which listed no shortage of Ventolin, was also of little comfort to Rhonda of Kangy Angy when she couldn't fill her prescription. This ultimately led to her calling the New South Wales Department of Health, the Medicines Line and, finally, the New South Wales Health Care Complaints Commission. There was a distressing and possibly risky delay due to the widespread lack of Ventolin, which was out of stock locally. Priceline pharmacy at Woy Woy sought guidance on the compounding of liquid ibuprofen because children's Nurofen was out of stock. The advice they received from the professional body was that it could be compounded for an individual patient when the TGA registered product wasn't available.
It hasn't just been common medicines that have been out of stock but vaccines too. When parliament last sat, I asked the health minister in question time if he was confident that there would be sufficient flu vaccine available so everyone aged over six months could be vaccinated. While he was confident this was the case, there are still people contacting my office and electorate offices around Australia because they can't get a flu shot. I'm told the vaccine is not available due to being out of stock locally. This is causing delays, leaving people at risk and, in some situations, sadly, preventing them from visiting their elderly relatives and parents. I spoke to Ruth yesterday, who can't get a flu shot and is concerned about visiting her mum, who is almost 100 and lives in a retirement villa.
While there has been a lot of media focus, as there should be, on supplies of ventilators and PPE, the availability of key medicines is essential. There are concerns Australian hospitals will face shortages of crucial medicines in the event of a surge of COVID-19 cases. Surveys conducted by the Society of Hospital Pharmacists of Australia show hospital pharmacists continue to be concerned at the lack of supply of key medicines needed to care for patients with acute COVID-19 symptoms and ventilators in case of sudden high demand. For example, almost one in five hospitals—18 per cent—who responded have insufficient propofol to manage their full required ventilator bed capacity for even a single day. The SHPA states:
The critical need to safeguard medicines supply … is appropriately reflected in its listing as one of 15 key triggers for the progressive shift toward a 'COVID-safe economy' …
The SHPA wants to see a national plan for managing the demand for medicines based on the most up-to-date COVID-19 modelling on patient numbers.
As part of Australia's COVID-19 response, hospitals are still on stand-by for a patient surge, and remain concerned at the number of part orders and backorders delayed or not supplied. Not receiving orders can trigger new orders, which feeds into misconceptions around stockpiling. If Australia does have sufficient supply, hospitals have no visibility of this, driving concerns we would not be ready for a caseload surge. Transparency is key to a responsive system in a pandemic. Hospitals need greater surety that medicines will be available in a timely manner when they're needed. The current manufacturer led system does not provide this, and pharmacists and doctors are left without the critical information they need to do their jobs. They can't plan treatments, set up new ICUs or supply satellite healthcare sites if they don't know what is and what will be available.
I'd like to turn now to Australian manufacturing. Medical supply shortages may occur more frequently in a global economy, with consolidation of manufacturing and less products made here in Australia. If more production occurs at fewer sites, especially overseas, there may be less redundancy or spare capacity and more risk of disruption. A single manufacturing plant may produce multiple brands of a particular medicine. If a disruption occurs, the original brand and all the generics may be affected at the same time. The use of a just-in-time approach to inventories can exacerbate these problems. While the issue of shortages of medicines and medical supplies is not new, the COVID-19 pandemic has brought this into sharp relief. When there is a sudden spike in global demand for a particular medical supply, combined with a disruption to normal supply chains, Australia is suddenly even more exposed to shortages—shortages which can cost lives.
That is why Labor believes that, as part of the post-COVID-19 response, Australia should adopt policies to promote stronger domestic capabilities for the manufacturing and delivery of critical medical supplies. As the Labor leader, Anthony Albanese, said this week:
This pandemic reminds us that national resilience also requires Australian capability to secure critical supply chains in the face of global shocks.
We must revitalise high-value Australian manufacturing. The government's lack of support for manufacturing industries has seen the withdrawal of private capital from research and development and the depletion of critical skills. To once again become a country that produces high-tech manufacturing, we need to embrace science. Instead, the government has slashed funding to the CSIRO, the very organisation now testing vaccines for the coronavirus.
In closing, I would like to recognise the many frontline health workers facing COVID-19—those treating patients, those now self-isolating after being exposed and those living away from family so they're not at risk. While there are many, in the context of this bill, I would like to acknowledge my fellow pharmacists. Pharmacists have made a considerable contribution on the frontlines—staying open and offering critical services when many other primary care providers were closed. Sadly, they've also borne the brunt of stressed and frightened people, and that has led to stories of violence against pharmacists and pharmacy staff. Pharmacists have worked together with the TGA to implement supply restrictions on medicines. Hospital pharmacists are managing supplies so that patients in ICU have access to the essential medicines needed—medicines critical for induction on ventilators and preserving life. Aged-care pharmacists provide telehealth consultations to deliver much-needed residential medication management. Consultant pharmacists provide home medication reviews via telehealth, to support the safe use of medication in the home.
For many of our most vulnerable Australians who have been forced into isolation, pharmacists are often the only health-professional contact that those patients have had—be that through the delivery of medication to the home, via telehealth consultations or over the counter in a pharmacy. It has been the pharmacist not only providing these services during COVID-19 but encouraging the most vulnerable in the community to reconnect with their local GP or allied health provider when, at times, their own health can take a back seat.
I would like to finish by thanking all of the health workers and all of the frontline workers who have gone to work so that we can be safely at home.