Minister Butler press conference in Canberra - 15 November 2022

Read the transcript of Minister Butler's press conference on COVID; Pfizer Comirnaty Bivalent Original/Omicron BA.1 vaccine; port protests.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MARK BUTLER, MINISTER FOR HEALTH AND AGED CARE: The Chief Medical Officer and I just wanted to provide some updates on the COVID situation generally and particularly some advice that has just been uploaded to the Department’s website from ATAGI which I considered overnight and decided to accept as well. And finally, an update on some supply issues around the Omicron vaccines, or so-called Bivalent vaccines which there was an update on. Obviously, I think it's now well understood that case numbers across the country are increasing, they increased substantially last week by about 47% week on week. Having said that they're still about 85% below the peak in late July. But there's no question that we've now seen two weeks in a row, where on every indicator case numbers are climbing. Hospitalisations have climbed as well by about 11% over the past week, and indicators like staff furloughing in hospitals, and aged care case numbers are also indicating that there is an increase underway, and I'll let the CMO talk a little bit more about that in due course.

I want to particularly to address some advice that I've received and considered overnight by ATAGI: the Technical Advisory Group on Immunisation. There are three points to this advice that I just want to outline before I go to the advice that they've provided.

Generally, in relation to some current increase in cases, as the CMO I'm sure will point out, this increasing cases is a complicated one: it's not been driven by any particular subvariant of the Omicron strain of the virus, it's been something of a soup of subvariants, BA4 and BA5 still present in the country, but other cousins of Omicron subvariants, XBB and BQ1 also now present in Australia - variants that we've seen elsewhere around the world. So I'll talk a bit about that and then hand over to the CMO.

ATAGI though over the last several days has considered the bivalent vaccine now on the market, from Pfizer. This is an Omicron-targeted vaccine that has elements of the original strain of COVID in it as well as the BA1 subvariant of the Omicron strain. You will remember that about five weeks ago, the Moderna equivalent BA1 bivalent vaccine went on to the market and has now been administered quite widely through the Australian market.

The ATAGI has recommended that the Omicron vaccine from Pfizer be added to the booster doses available or recommended here in Australia. And that will be for people aged 18 and over - only for a booster dose not for primary dose - but now available as well as the Moderna bivalent vaccine and some of the original strains of the Pfizer and Moderna vaccines as well as the Novavax vaccine as well. So I'll talk a bit about what that means for supply in a second.

The second recommendation from ATAGI is that the paediatric vaccine from Pfizer which is for very young children aged six months up until five years of age, be added to the existing Moderna paediatric vaccine that is available for very young children under the age of five in limited circumstance: so largely only children who have severe immunocompromised, or another specified health condition which is available to parents. So I've decided to accept that advice as well.

And thirdly, and this will be of interest to a number of Australians: thirdly, ATAGI has considered international evidence as well as the local data around vaccination numbers as well as case numbers in the pandemic and decided not to recommend a fifth dose or a third booster, if you like, at this point in time. They have said that they anticipate new booster recommendations being made in early 2023 in preparation for the southern hemisphere winter.

In making that recommendation, ATAGI first of all reiterated that they're continuing to actively review the role of booster doses and particularly evidence some from around the rest of the world around the performance of booster doses. But they particularly noted that the recent XBB wave, which is one of the subvariants now present in Australia, the recent wave in Singapore over the last several weeks was to use their words “short and small”. And I think the CMO and other health experts have been making that point over the last couple of weeks as well.

They also noted that severe disease and death during that wave in Singapore was very rare for people who had had at least two doses of a vaccine for COVID. And they also noted that, in their view, any reduction in transmission in this current - what appears to be - a building wave, any reduction in transmission by adding a fifth dose to the system would, in their words, likely be minimal.

So I've decided to accept that recommendation as well. So I've accepted all three recommendations from ATAGI, which I received yesterday and considered overnight. ATAGI, in their advice, as the CMO and other Chief Health Officers around the country have done over recent days, strongly reiterated the importance of being up to date with current vaccines. And they made the point that there are 5.5 million Australians still eligible for a third dose who have not yet had it. And in many instances: many, many months overdue for their third dose and reiterated the importance particularly as case numbers start to build again, in getting that third dose. And they also made the point that there are 3.2 million Australians aged over 50 for whom a fourth dose has been recommended for some time now, who have still not had their fourth dose, as well.

Pleasingly on the positive side, can I say that around 80% of Australians over the age of 75 have had their fourth dose. So older Australians, in particular, have heeded the call from the experts to get up to up to date with their vaccinations. But there are still some millions of Australians who are eligible to receive a booster dose that will help protect them and those around them who have not yet done so. And so ATAGI reiterated those calls that the CMO and other CHOs have made to get up to date.

I'll let the CMO talk about the other advice that health experts have been providing, but very broadly in addition to being up to date, with vaccines, the advice as case numbers climb again is to wear masks in crowded indoor spaces if you are not able to socially distance. If you are unwell: stay home, do not mix with others. Stay home if you are unwell, particularly if you test positive to COVID. But more broadly, if you have symptoms, stay home. And lastly, and very importantly, if you are over the age of 70, or if you are over the age of 50 with two risk factors, then make sure that you have a plan with your doctor to get antivirals very quickly in the event that you contract COVID. Because we know even from recent evidence from Victoria, just again, how important antivirals can be in protecting vulnerable Australians from severe disease, hospitalisation, or even worse. So I'll let the CMO add to that advice.

Finally, can I just update on supply of these next generation Omicron vaccines or so-called bivalent vaccines. You'll recall that the Moderna Omicron vaccine came onto the market about five weeks ago. Since then we've administered about 94,000 doses of that Omicron vaccine. There is plenty of that in the system. There is already about 440,000 of those doses have been delivered to pharmacies and other vaccine administration outlets. And over the coming fortnight another 320,000 doses of that Moderna Omicron vaccine will be delivered as well. Currently there's about 75,000 vaccines being administered every week. That's up 50% in the last fortnight, which is good. But there's more than enough Moderna Omicron vaccine in the system for people who want to access that. You can go to the Vaccine Finder website: find a pharmacy or other outlet in your area that delivers bivalent vaccine, and if that's what you want, there's plenty in the system for you to be able to access that.

I'm also pleased to announce that we have reached an agreement with Pfizer for them to provide the Omicron variant vaccine that's just been approved by ATAGI to the Australian market. 4.7 million doses of this Pfizer bivalent vaccine will arrive in two shipments over the course of the next fortnight. So in addition to the hundreds of thousands of Moderna Omicron vaccines that are already on the market, over the coming couple of weeks, we will receive, then batch test and then distribute 4.7 million doses of the Pfizer Omicron variant vaccine that has just been approved by ATAGI or recommended by ATAGI. And that will start to be or be available to be administered to Australians, from about the 12th of December. I might leave it there and hand over to the Chief Medical Officer.

CHIEF MEDICAL OFFICER, PROFESSOR PAUL KELLY: Thank you, Minister. And the Minister has summarised the situation at the moment. It's as I put in my CMO statement on the 7th of November, that said last week that we were in a wave and that the wave would probably continue for some weeks, and we'll probably get higher case numbers. And so everything that I said in that statement has proven to be correct over the last week: 47% increase in the number of cases, very pleasingly a 43% increase in the use of oral antiviral treatments. They're the ones on the Pharmaceutical Benefits Scheme, they're available by a script from GPs, from nurse practitioners, as of the first of November.

It is now possible and lawful for nurse practitioners or doctors to carry some of those treatments with them in their doctor's bag or their nurse practitioner bag. And so they should be immediately available.

There's been some discussion I've seen in the media at the last few days that there was some challenges finding those antivirals in some pharmacies, so I can absolutely assure everyone that we do have plenty of supply of both of those antivirals. And as the Minister mentioned, they are extremely effective for those that are eligible for those treatments. So for example, a person over 70, even those that have had three or four doses of vaccine can halve their rate of death by taking those tablets, halve the rate of death. Incredibly important to get those treatments as quickly as possible: within a day of being diagnosed is best, but up to five days it would also make a difference in both your chance of severe illness, leading to hospitalisation, or indeed, of dying from COVID.

For those 50 years and over with two risk factors, for Aboriginal and Torres Strait Islanders over 30 with two risk factors, and people with immunosuppression, now's the time to consider that you have a plan to access those very effective treatments, as soon as possible. Once you get a positive test, I would reiterate again, and we say this at every press conference, now's the time to get vaccinated if you are due for a vaccination.

If you're one of those millions of people in Australia, who have not had the third dose and you are eligible, or the fourth dose and you are eligible, now's the time to go and get it again. Pleasingly over the last couple of weeks since there's been, I think, discussion around this current wave, there has been an increase in third and fourth doses. But it's been very small compared with what we've seen in the past. So now's the time to get on and do that.

For those that particularly those who are at higher risk of disease, now's the time to reconsider your mask use - whether that's on a plane in other parts or places where you cannot physically distance and you have to be in that situation. Particularly those that are at higher risk of disease, the ones I just mentioned, who are eligible for those doses, should consider wearing a mask again, at this time.

I fully expect that we're nearing the middle of this wave. All of the indicators that we have, whether that be furloughing of staff, ambulance call outs, wastewater testing, aged care staff positivity rate - because they continue to be regularly tested - and all of the other measures and including that antiviral prescribing.

This wave has been going up for the last few weeks. If it ends up being similar to Singapore, and I believe it will, then it should peak soon and drop quickly. Short and sharp is what I would say, in terms of cases. Hospitalisations are rising, but not largely so right across the country. And we will continue to watch those very closely over the coming weeks. Thanks.

JOURNALIST: Minister, is it a failure of government communication, complacency, or both that five and a half million Australians haven't had their third dose. And secondly, to Paul Kelly what can you tell us about the death rate as it stands, compared to say, six months or 12 months ago?

MINISTER BUTLER:  I'll go first. I've said on a number of occasions in the first half of 2022, that then was the time to put out a very strong information campaign about the importance of booster doses.  The evidence from around the world at that time, was very clear that two doses, particularly against the Omicron variant of the virus - that has really swept the whole globe - that two doses of the vaccine was not sufficient, and you needed at that stage three doses to be fully vaccinated.

And I think we lost very important time over a period of a few months leading into and during the election campaign not having that information out. We moved very quickly to provide that sort of public information, we're still doing that, states have been doing that as well.

But I think we all have to accept that it we're not really shifting the dial much at all. So I talked about five and a half million Australians being eligible for a third dose last week, only 7000 of that five and a half million got their third dose, so that that number just is not shifting.

We are taking advice about how to shift that, during the building wave that we've been experiencing over the last couple of weeks, is the obvious opportunity to reiterate the importance of being up to date with vaccinations. And as I said, the fact that vaccine numbers have increased by about 50% over the last fortnight, that's pleasing, but there's still much more to do, and we're considering what we can do to improve that.

PROFESSOR KELLY: So the absolute reason why we're wanting people to be vaccinated is mainly for personal protection. And we particularly want people that are at high risk of severe disease to be vaccinated. Whilst there is that missing number, and it's a large number, that have not had their third or fourth doses, the coverage is actually extremely high in people over the age of 60. And so that's a positive thing. If we think back to your question about January this year, compared with now, certainly the case fatality rate has been less in this wave, and in the previous waves, this is now the fourth wave of Omicron since the end of last year. But because of the large number of cases, we have seen deaths through this year, and that is a terribly sad statistic that we have. It's mainly in older people, the vast majority, almost two thirds are over the age of 80. And that's in no way to discount the tragedy that is for family and friends that lose a loved one from COVID. But that is that high risk group that we've been talking about. There are ways now that we did not have in January of protection, particularly the antiviral medications.

JOURNALIST: What's your level of concern with this wave in particular? And is there anything about the situation we're in now in terms of use of treatments, vaccine coverage that you're concerned about?

PROFESSOR KELLY: Look, I'm very pleased with the treatments, as I said, we've had around about the same percentage increase in both cases and treatment use in recent in recent weeks. We've been seeing antiviral treatments go up over the last month, in fact. So I think that's good. I think our message is out there. People know, they know where to go, they know how to do it, and pleasingly have mostly made a plan before they've become sick. So I think all of those things are good. We have plenty of supply of antivirals. That data that the Minister mentioned, and I also mentioned from Victoria is also very reassuring from that perspective. In terms of vaccination: yes, please go and get your vaccine. We've certainly not seen that uptick that we would normally expect in a wave. So I think that's a key message for today.

JOURNALIST:  The official advice on precaution seems to largely be around masks in crowded indoor spaces where you can't socially distance, do you expect during this wave that you will reconsider - or might reconsider - mask mandates, isolation, mandatory isolation periods, encouraging employees to work from home, etc? Or do you think this will be such a short, sharp wave that it won't be necessary?

MINISTER BUTLER: I don't think there's any evidence yet that there would be the need to move to those sorts of restrictions. And I think that’s been the view put at a state level by relevant ministers, leaders and the Chief Health Officers broadly as well, that I don't see any evidence emerging to lead to a change.

PROFESSOR KELLY: So as part of the decision that was made by National Cabinet at the end of last month and came into end of September rather, and came into force on the 14th of October, the Australian Health Protection Principal Committee, all the Chief Health Officers and myself agreed on what we call the National COVID-19 Community Protection Framework for a COVID Safe Australia - I'll show that there - that's available on the website. That goes into all of the things that will be considered in new waves, I would suggest we're in tier one. Queensland has chosen to call that Amber, but it is very consistent with that. And so this time, it's about increased messaging, not mandates, but by choice around masks and other things, particularly around high-risk settings, like hospitals, aged care and disability care. And we're all very consistent on that and all agree.

JOURNALIST: Clearly, the strong information campaign isn't really doing much to lift booster uptake. What other options is the government considering to get that booster rate higher?

MINISTER BUTLER: This is ultimately a matter of personal choice, particularly at this stage of the pandemic. So the role of government is to provide the best possible information along with health experts and the Chief Health Officers, to people to make that choice. As the CMO said, I think we're all very pleased with the level of uptake among Australians who are most vulnerable in this pandemic, particularly to severe disease. As I said, we have vaccination rates at a fourth dose level of around 80% for Australians over the age of 75. We've got those fourth dose rates up in aged care up considerably from where they were when we came to government. So the point in terms of the group that we are most focused on protecting at this stage of the pandemic, there are very good levels of booster vaccination. But across the general population we need to continue to get that message out that over time, the protection from your second dose of the vaccine will start to wane. I mean, there's still good protection against severe disease and hospitalisation for the broad community, but you need to consider getting up to date.

JOURNALIST: Professor Kelly, can you first of all give us any indication on timing of when you expect the peak to be of this current wave? And when word started circulating about that, another COVID wave in and around November, I think many people were probably worried we were heading for another COVID Christmas. But given you expect that the peak is coming soon, or is imminent, does that mean we're perhaps a little more in the clear for the month of December?

PROFESSOR KELLY: Look, I don't have a crystal ball about those things. I don't have an absolute indicator. And the reason is because of the variant soup that the Minister mentioned. These are new viruses, they're still Omicron COVID-19 viruses, but they have different transmission effects. And it's hard to tell which one will become dominant out of all of them.

But my sense is, as I said, is I think we'll have a similar experience to Singapore. Singapore went up fast, went down fast in about a month, a month to six weeks. So that's kind of what my ballpark figure is. But I'm not going to speculate when this might be over with. I will though say, similar to my previous answer, that we're in a very different situation than we were this time last year. Now, virtually no one had had a third dose by then: leading up to Christmas, had just started that third dose, there were no antiviral treatments. So it's a very different situation.

MINISTER BUTLER: Can I just add to that as well: all of the tools in the armoury that we would want to deal with a wave are well supplied. Unlike last summer, you know, we've got more than enough RATs - or rapid antigen tests - we've got a very good supply of antivirals that frankly didn't exist over the over the last summer. As I've as I've just reported, we've got very good levels of supply of the Omicron specific vaccines as well. So we're in a good position.

JOURNALIST: Minister, or potentially for Professor Kelly, what is the thinking around people who have had a COVID infection and the impact on the immunology with it? I feel like I've spoken to a lot of people who have had COVID once or multiple times, and it seems to be stopping a lot of people from going and getting those booster shots. What's the thinking around COVID infection and the immune response from that?

PROFESSOR KELLY: Thank you for the question. Both help. Having had an infection helps in definitely boosting immunity. There's a lot of good data and good studies around the world now that demonstrates that at least one episode of infection, together with three doses of vaccine, at least three doses of vaccine, are highly protective. As the Minister mentioned earlier, that protection against severe disease is probably quite long lasting. And this is one of the elements I know, from having talked to my colleagues in ATAGI during last week, that they were really looking at in terms of their advice. Three doses or four doses, gives very good protection against a severe disease. If you add also an infection that will give another boost.

JOURNALIST: Would you be encouraging people who might have had two or even three doses but have also had an infection? Would you be encouraging them to then still go and get a fourth booster?

PROFESSOR KELLY: People should go and get whatever they're eligible for now. The infection alone will not protect you for a long time, and it will not protect you against severe disease. That in combination with a number of booster shots, will.

JOURNALIST: Professor Kelly, with National Cabinet not due to meet until December, do you anticipate or do you think that you'll be suggesting to the Prime Minister National Cabinet should be convening a little bit earlier - given the peak is imminent, and Christmas is around the corner - just to be able to speak to all the states and territories as well?

PROFESSOR KELLY: Well, that's really a matter for the Prime Minister to decide.

JOURNALIST: Given the rising number of hospitalizations, has the government yet decided whether it will extend that COVID-19 funding for hospitals beyond the end of 2022?

MINISTER BUTLER: Well, there are a range of COVID measures, as I've said publicly before, that expire on the 31st of December. Some of them in aged care, some of them in primary care, some of them in cooperation with the state public health systems. The Premiers, the Chief Ministers and the Prime Minister agreed some time ago that that inpatient hospital arrangements for COVID -particularly bespoke arrangements - would end on the 31st of December. So, hospital admissions for COVID from the first of January will be treated the same way as other admissions. The Commonwealth will pay its share under the hospital funding agreement, the general hospital funding agreement, from the first of January. But there are a range of other COVID arrangements, including in cooperation with state public health systems, as well as aged care and primary care that we’re going through, in a measured way. And we'll have more to say about that in the near future.

JOURNALIST: Professor Kelly, you've talked about Singapore a couple of times. I think Singapore did put on a few more extra rules through the COVID peak. They changed some things around like hospital visitors and mask wearing in health settings and that sort of thing. The Minister said that he didn't see any need, potentially to bring on some more of those rules. But do you anticipate making any of those recommendations or asking states to start looking at those sort of things as we hit the end of this peak?

PROFESSOR KELLY: So actually, they considered doing a whole bunch of things. But what they did is pretty much similar to what we're doing now, which is: giving the information, giving the advice, suggesting that people do the sort of things we've already talked about. So actually, what they actually did is very similar to the community protection framework at this point.

JOURNALIST: Given the relatively low uptick of booster shots, over the past few months, and we have an abundant supply of vaccines, do you have any idea of in terms of wastage, how many of these vaccines have expired, having to chuck out? How much is that costing us?

MINISTER BUTLER: We're going we're going through that process now, particularly a lot of recommendations that were contained in the Halton report. I'll have more to say about that in due course.

JOURNALIST: So just quickly on another issue, do you have anything to say about the port protests at the moment? Firstly, do you think that that's going to be impacting Australians and their Christmas gifts? But also you said that there was some shipments of vaccines coming through as well, do you think that there's going to be any kind of impact on that?

MINISTER BUTLER: Yeah. Firstly, can I say generally in relation to this dispute, the Minister for Workplace Relations, Tony Burke, has commented publicly on the dispute broadly, and I don't have anything to add to that.

But across government, in a dispute like this that has the potential to disrupt port operations. There are a range of portfolio interests, one of which is medicine supply, so we'll be engaging across departments about that. But Tony Burke, more broadly, has made comments in relation to the dispute. I've got no advice about that, at the moment. But that is one of the issues that across government, we'll be looking at.

JOURNALIST: At what point do expect ATAGI would consider expanding vaccines for very young Australians, beyond those particularly vulnerable groups six months and older? And what about antivirals, at what point might they be expanded beyond the groups that that are eligible for them now?

MINISTER BUTLER: Well, I might start and then Paul can fill in the colour on both of those two things. My understanding is that ATAGI continues to monitor the evidence from around the world, about vaccines for younger Australians. That's not just under-fives. But really, from five up until 16, where there is currently restricted access to vaccines. For example, 12 to 15 year olds can only have boosters in certain circumstances. And I know that ATAGI is constantly monitoring the evidence around that to balance the benefits and the risks associated with additional vaccines.

JOURNALIST: And antivirals?

PROFESSOR KELLY: Just to finish with vaccines. With all medicines, including vaccines, we have to consider the risks and benefits. And that's what ATAGI is there for, they’re the experts to advise on those things. 

We know that COVID is not as severe in children, as it is in adults, particularly older adults. So that's an important component. We do know that some of the side effects of vaccines are more common in children with some of the vaccines. So there’s always that trade off and they’re looking at that very closely and examining the data and they will give advice in due course on that.  We also know from our CSIRO surveillance studies that most children, including those under 5, have a very high rate of protection, so they do have some protection, as we talked about before, from their COVID illness.

In terms of treatment, that’s not a matter for ATAGI but one for the Pharmaceutical Benefits Advisory Committee. They continue to meet and met recently to discuss those matters and there will be advice in due course. The only change that’s been made recently is the one I mentioned about availability: that now doctors can have some doses in their bags that they carry with other emergency treatments, if that’s required. 

MINISTER BUTLER: Thanks everyone.  

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