Minister for Health and Aged Care – interview on ABC RN Breakfast – 13 September 2023

Read the transcript of Minister Butler's interview with Patricia Karvelas about tobacco control legislation being introduced into Parliament, and mental health.

The Hon Mark Butler MP
Minister for Health and Aged Care

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HOST, PATRICIA KARVELAS: For decades now, Australia has been a world leader on tobacco control. But in recent years, there's been an explosion in the availability of black market tobacco and unregulated vaping products. Now the Government is cracking down further on cigarettes, with a Bill to increase warnings on packets and outlawing certain additives, in a bid to get the national smoking rate down to 5 per cent by 2030. That's the target. But the other nicotine habit Australia is failing to kick is vaping, with the Government's tough talk, so far, failing to translate into action to clamp down on imports and to close the stores selling them. Mark Butler is the Minister for Health and Aged Care and he's my guest this morning. Mark Butler, welcome.


KARVELAS: So let's talk about the legislation. What will these changes actually do?

BUTLER: I want to just remind people that today 50 families or more will lose a loved one to tobacco and the same number tomorrow and the day after, just reminding us that the fight against Big Tobacco is far from over.

Today I'm introducing the first suite of major reforms in more than 12 years since Australia led the world with the plain packaging reforms that dozens of countries have since followed. And the fact that we haven't continued that reform process means that we're not on track to meet the targets you talked about, to get smoking rates down to 5 per cent by 2030. And the reason we haven't is that Big Tobacco has adapted and innovated and been quite cunning about ways in which they get around the plain packaging intent and make their deadly product appeal to particularly younger Australians where smoking rates are actually climbing. So today's reforms are really directed at updating our efforts and making sure we can stamp out those new marketing tactics from Big Tobacco.

KARVELAS: One of your predecessors, Nicola Roxon, stared down threats from tobacco companies to fight the introduction of plain packaging laws using those clauses in the trade agreements. Are you expecting them to fight these changes?

BUTLER: And she was right to do that. We won three different pieces of litigation initiated by Big Tobacco against our plain packaging reforms. Nicola was absolutely right to do that. And if Big Tobacco tries to do that again, we'll defend our reforms very strongly. I think that's less likely, because Nicola was leading the world in doing that 12 years ago. The fact that there's really been no additional reforms over the past decade means that Australia is now lagging the world leaders, who are countries like Canada and New Zealand, who've introduced a range of the reforms that I'm introducing into the Parliament today.

We need to catch up. We need to reflect what is international best practice here, to stamp out these new marketing tactics. We've got new brand names, we've got new additives and flavours being put into cigarettes like menthol capsules that give you a burst of minty freshness partway through your cigarette, you know, with a label of 'fresh burst'. We've got different shapes and sizes, the so-called 'Vogue' cigarettes that are long and slim and bright white, deliberately designed to look good on an Instagram photo and deliberately designed to appeal to younger smokers. These are things we need to stamp out.

KARVELAS: Yeah, because the bill is going to restrict the advertising of vapes. But is vape advertising really the issue or is the issue the availability of vapes?

BUTLER: The major issue is undoubtedly the availability, which is why I've been working so hard with state and territory colleagues, but also my colleagues here in the Commonwealth, like the Minister for Home Affairs who controls Australia's borders, to put in place that suite of regulatory reforms I announced a few weeks ago. And I'm committed to making sure that an import control is put in place by the end of this year to stop the extraordinary flow of these things coming in from overseas.

And what we're seeing around the world is other countries looking to the measures we've announced. Last week, France announced that they were explicitly following Australia's lead. There's speculation in the last 12 to 24 hours that the UK again explicitly is following Australia's lead. Because this really is the new frontier. We can't forget the fight against traditional cigarettes or what young people call 'analogues' now. But the so-called 'digital durries' – the vapes – are the new frontier to stop a new generation of nicotine addicts being recruited by this industry.

KARVELAS: South Australian police have seized nearly 5,000 vapes over a two-month enforcement blitz, but there are many more in the state and around the country. What are other states doing to enforce the tougher regulations that you've put in place? Because without enforcement you can't get anywhere, can you?

BUTLER: That's right, which is why I've had to work so hard and closely with state and territory colleagues. There's complete consensus across all jurisdictions of the need to stamp out this public health menace, really targeting our younger Australians. So that means us being tougher on the borders. At the moment, they're completely open.

As I think I've said to you before, to his credit Patricia, Greg Hunt tried to put an import prohibition in place but was rolled by his own Coalition party room who had been lobbied by the industry. So we will put one of those import controls in place to start to stem the flow of these things coming in from overseas. But we also need on-the-ground policing. You know, some real enforcement about this in the convenience stores, in these vape stores that shouldn't be open at all, but are increasingly opening in a very deliberate way just down the road from schools – because they realise that is their target audience, their target market.

So it will take cooperation, it will take additional effort. We're committed to doing our bit at the border. State and territory colleagues are committed to doing their bit on-the-ground. And you mentioned the South Australian blitz. There have been other blitzes by other state governments as well that are also really sending a message that the open market the open flow that has existed over the last few years really exploded over the last few years is something we intend to stamp out.

KARVELAS: I'm just wondering if making vapes prescription only opens the Commonwealth potentially to legal liability if vapers do get sick? I mean, I know it's one of the reasons in the UK that they've been reluctant. Have you considered that?

BUTLER: The Therapeutic Goods Administration – the TGA – oversees the safety and the effectiveness of all of our prescription products. And you know, they've looked at this measure very closely.

KARVELAS: And what advice have they provided on that?

BUTLER: Obviously the advice they're providing to me as the Federal Health Minister is advice that that's clearly been the subject of legal advice and is not going to expose the Commonwealth to legal risk and also, more importantly, not going to expose patients and consumers to actual risk and physical risk

KARVELAS: There isn't a lot of long-term research, is there, in relation to vaping. What does that mean for the process of a new drug or vaccine? Are you going to look at that sort of element as well and funding that more?

BUTLER: You're right, because this is a relatively new product. There's not a lot of longitudinal evidence about the effectiveness of e-cigarettes or vapes as a smoking cessation tool. And remember, that's what these were presented as being, rather than a recreational product for young people. You know, there's not clear evidence about that. And there are different views.

But around the world generally, it's accepted, as an additional tool in the armoury to help harden smokers kick the habit. But we'll continue to look for evidence about that. Where there is increasing evidence is about the harm that is caused by these products. Only over the last couple of days, again, we received additional evidence from some research institutes and universities in New South Wales about the second-hand, third-hand was about to go to that, the chemical residue.

KARVELAS: So what does that mean? What just what are the implications of that and what are you worried about?

BUTLER: These things have – these vapes – have more than 200 chemicals in them, some of which are very, very dangerous poisons that are used in products like weedkiller and nail polish remover. And people, first of all, are ingesting them into their lungs, which every lung specialist will tell you is a very dangerous thing to do. We don't know what the long-term effects of this are because it's such a new product. But really just working on basic principles, all of the thoracic and other lung specialists tell us the long-term damage is going to be very, very profound. But what the evidence this week showed is that the residue from blowing out these chemicals after you've inhaled them is very sticky. It sticks to clothes and other surfaces and is then ingested through people licking their fingers and things like that, particularly that young people do – a little bit more than adults perhaps – and that is already causing substantial harm as well, just because how dangerous these chemicals are.

KARVELAS: Minister, I just want to ask you about another element of your portfolio before we say goodbye. Let's look at that issue in relation to essentially mental health. It's been nine months since you scrapped the extra 10 subsidised psychology sessions, that were 20, you put them to 10. You said that you'd come up with an alternative to improve access. What is that alternative?

BUTLER: I said I'd do that by the end of the year, and I intend to keep to that timeframe. Only on Friday I had a full day meeting with an advisory committee that I've pulled together to help me design that response. I mean, these are complex issues, as you understand, Patricia – developing ways in which we can make the spread of that psychological therapy much more equitable across Australia.

There are real gaps in outer suburbs and in regional Australia in terms of people's access to any psychological therapy and also real gaps for people who have more complex needs. But I remember when we first discussed this, Patricia, I pointed out that the additional sessions that the former government had put in place for a time-limited period during COVID had actually choked off supply of psychological therapy, which meant that far fewer Australians were getting access to any therapy.

Actually, tens and tens of thousands fewer Australians got access to psychological therapy because of that. And indeed that had been predicted a couple of years earlier. I'm really pleased to say that the changes that effectively took place on the 31st of December because of the former government's decision, has meant already that tens of thousands more Australians have got access to psychological therapy this year, compared to last year.

So more people are getting access. There are more sessions, about 250,000 more sessions being delivered overall by psychologists. So this has freed up that bottleneck to a degree. But there's no question there's still a real supply problem. We, in the Budget, funded hundreds more psychology positions because there's a real shortage of psychologists, which is part of the reason why we have this unmet need out in the community. But I'm committed to working with this advisory committee representing the sector. I'm committed to the timeframe I outlined to you earlier in the year to provide that response by the end of the year, because this is such an important issue.

KARVELAS: And are you completely ruling out adding more sessions?

BUTLER: What I've said is that additional sessions for the entire system don't work well right now. I mean, the system is not designed to triage and calibrate people who have more complex needs against people who don't. This was a system designed for people with relatively mild to moderate needs who might need four or five sessions of therapy to get them through a period of anxiety, depression or something like that.

It was not designed for people with more complex needs. So what we're working through with this committee, I'm working directly with them, is a recognition that we do need additional services of a range of types for people with more complex needs. But simply adding additional sessions onto this sort of one-size-fits-all system we have now of Better Access is not going to do the job. And, indeed, the evaluation of the scheme found that 12 months ago.

KARVELAS: Thank you so much for joining us.

BUTLER: Thanks, Patricia.

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