Minister for Health and Aged Care - press conference - 28 August 2024

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks everyone for joining us this morning at this really exciting announcement. I've got a terrific group of people who are going to make a contribution after I've said some words here. First of all, I want to thank Lauren from Lift Cancer Care Services for hosting us today at their terrific exercise oncology service here at the Tennyson Clinic. We're here to talk about breast cancer, and we've got some patients, some oncologists, the drug sponsor, and the Breast Cancer Network of Australia. A terrific patient advocacy organisation that does extraordinary work right across the country to support the many, many thousands of Australian women who are living with breast cancer today and will be tomorrow.
 
About 57 Australians are diagnosed with breast cancer every single day, and although Australia has some of the best survival rates on the planet for breast cancer, still around seven Australian women die every single day, overwhelmingly through metastatic breast cancer. That is an advanced form of breast cancer that has spread beyond the breast into other parts of the body. We think maybe there are 15,000 Australian women living with metastatic breast cancer today, and around 3,000 diagnosed with that form of advanced breast cancer every single year. Treatment for that form of advanced breast cancer has been relatively limited over the years, and as a result, it has, well and away, the highest mortality of any form of breast cancer in Australia. There is a very exciting, cutting-edge treatment called n Enhertu that has been listed on the PBS for a particular form of metastatic breast cancer with HER2 positive proteins. But today, I'm delighted to announce that we're expanding that listing of Enhertu onto the PBS for the type of metastatic breast cancer that is low in HER2 proteins. I'm sure our oncologists and others can talk about that in much more detail than me. The really exciting news is that this new, cutting-edge treatment for this type of advanced breast cancer will give, we think around 1,700 patients new hope and a new treatment every single year. I can't stress enough the importance of a listing of this type of drug on the PBS because although these new, cutting-edge treatments that are that are being developed all the time across the world, are giving new hope to patients right across the disease spectrum, they are very expensive. Without PBS listing, this drug would cost patients as much as $160,000 for a course of treatment, obviously well beyond the means of the vast bulk of Australians. With PBS listing, of course, it will only cost about $31 for a script, and even less if you are on a concession card. This is the wonderful thing about the PBS. For decades, it has been giving Australians access to the world's best cutting-edge treatment at affordable prices. I'm delighted that since we came to government a little more than two years ago, we've made more than 200 new or expanded listings of this type. Ensuring that Australians get access to the best treatment at affordable prices. The listing of Enhertu is one of the most significant expanded listings that we've made over the past couple of years. I'm delighted to be here with such a terrific group of people the sponsor, BCNA, oncologists and patients here at Lift and I'll now hand to Dr Michelle to explain in much better detail than me, the wonderful way in which this treatment works.
 
MEDICAL ONCOLOGIST, DR MICHELLE WHITE: Thank you, Minister. This is truly a very exciting day in the field of breast cancer, because once we have the PBS listing of Enhertu for our patients with HER2-low disease, it is going to completely change the practice of this particular subtype of breast cancer. This treatment is already on the PBS, as the Minister has mentioned, for patients who have what we call HER2 amplified breast cancer, but these comprise a reasonably small proportion of all patients diagnosed with breast cancer, perhaps only 10 to 20 per cent of patients. This HER2-low population will incorporate a much larger group of patients, and is going to provide patients with HER2-low disease, a treatment that both works in terms of how long patients are able to stay on effective treatment, and also critically, in terms of their overall survival, meaning this treatment prolongs their life. We are all very excited in the field of oncology, because we are always looking for new treatments that we will be able to utilise that will both maintain our patients on an active treatment and also obviously ensure that their lives are prolonged as long as possible.
 
JOURNALIST: Do you mind if I ask, could you explain in layman's terms, what the difference is between the HER2 and the HER2-low, and how significant this is now for those in that HER2-low category?
 
DR WHITE: Of course, the HER2 protein, is a protein that can be found on breast cancer cells, and it drives the growth of the cancer, and we know that for that 10 to 20 per cent of patients, they have what we call HER2 amplified disease where they are, their cancer is very driven by that growth. And in the past, we thought that the HER2 targeted treatments, like in HER2, would only work for that group of patients. But now with this pivotal trial that has shown that patients who even have very low levels of this HER2 protein on their cancer cells derive benefit. It's going to enable a much greater proportion of patients to access this drug, and it certainly will prove to be very beneficial for a very significant proportion of our breast cancer population who are dealing with metastatic disease. So they're the group that are defined as HER2- low, and we think possibly about 50 per cent of patients with metastatic disease would fit into this category.
 
JOURNALIST: There's no cure for metastatic breast cancer, but the benefits in terms of prolonging life, where does this drug sit now in terms of the expanded time frame that patients can potentially look forward to?
 
DR WHITE: In the clinical trial, they compared Enhertu to our standard chemotherapy, and it was vastly superior in terms of the impact on how long patients could stay on this treatment because it remained active, and also in terms of their overall survival. It really is absolutely a very active drug, and I think all oncologists around Australia will be very keen to see if their patients are eligible to receive this treatment.
 
JOURNALIST: So will we be looking at potentially an extra six months? Or is it an extra potentially couple of years or half a decade? Obviously, each case is different, I take that, but is it a short-term sort of get you to the next line, or is it to look forward to the next five years, for example?
 
DR WHITE: So, in the clinical trial, the benefit in terms of overall survival was in the order of six months, which we certainly think is a very significant improvement for our patients, because compared to the other standard treatments, this was vastly superior in terms of the overall survival. So every single step we make for our patients with metastatic disease, every new development like this is enabling our patients to live longer with metastatic disease and to live well with metastatic disease.
 
METASTATIC BREAST CANCER PATIENT, BRONWYN MOLINE: I don't have a prepared speech, so I don't know if you want to ask me any questions. But I do have a couple of things that I would like to say. Firstly, I'm incredibly thrilled that Enhertu is coming onto the PBS, not only for myself, because I will benefit from it being on the PBS, but also for many other women who are HER2-low, or who have HER2-low breast cancer and who have not been able to access the drug. At the moment, it's what's called a high-cost drug, so the patients need to fund it, and sometimes that can be from family members, as in my case, my mum, Trudy, has really helped out, my health care fund has helped out. But I know of other patients who have had to launch things like a Go Fund Me in order to be able to fund their treatment. So the fact that it's coming onto the PBS is going to be a game changer for a lot of women with HER2-low breast cancer.
 
The other thing that is really significant for me is that living in Australia, I'm well aware of the fantastic healthcare that we have here and the fact that so many cancer patients have access to wonderful healthcare, also access to fantastic research. I'm really, really grateful that we live in a country where the Government and drug companies are actively into research, and that our oncologists have access to that research, so that we're able to, you know, they're able to find them know the best drugs and the most effective drugs. And what I have noticed since I was first diagnosed with cancer in 2014 which is 10 years ago, I've really noticed a change in targeted care. It's much more about looking at the profile of the cancer and determining which drug is going to be most effective for that particular type of cancer. And I fall into that category of not for HER2- low, amplified cancer, but that other, that other group, so I will, you know, be benefiting. I'm already benefiting from the drug, and I am hoping to continue to do so for many, many years.
 
JOURNALIST: What is it like as a patient or a consumer to receive that news, ‘this is how much it's going to cost’?
 
MOLINE: I was thrilled. I was absolutely thrilled when my oncologist, Michelle White, and when she told what was coming on to the PBS. That's great, but I'm thrilled for me, but I'm also thrilled that many more patients will now have access.
 
JOURNALIST: But prior to that, when you found out the cost without it being on the PBS, just how high it is?
 
MOLINE: Yes, yes, it was quite high. It is quite high. I am very fortunate that I was able to access funds to pay for it, but I understand that not everybody else, but I was willing to do that. But I understand that not everybody else you know has access to those funds. I was very fortunate that I did.
 
JOURNALIST: How has the diagnosis changed your outlook towards life now and now, knowing that the access to this drug is available to sort of give you that little bit of extra boost?
 
MOLINE: There are two questions there, so I'll answer the first one. I was first diagnosed with metastatic disease in 2020. I live in Melbourne, my diagnosis came almost at the time that Melbourne went into its first lockdown, and receiving the diagnosis, of course, was a shock, but it really but because I went into lockdown, I actually made the decision to stop working at that time, which my oncologist supported, and because we were in lockdown, I couldn't do a lot. So it really gave me the opportunity to focus on diet, to focus on exercise, and to focus on my mental health and wellbeing. That has continued, I mean, I always had that focus, taking work out of the equation  really helped me. But I understand not everybody is able to do that. I'm slightly older, so I was close to retirement age anyway, so I just sped it up by a couple of years.
 
In terms of the second part of your question about this particular drug, one of the ways that I look at it, and something that my breast surgeon said to me not long ago was, the longer you can stay alive, the more opportunities and chances that there'll be new drugs. HER2 didn't exist when I you know, it was first diagnosed with cancer, so who knows what other new treatments or drugs will exist in a year, two years, three years, four years. And I've always believed that the best therapy or the best treatment for me whilst I'm going through cancer, treatment is to put my body in the best place to fight the disease. So that means looking after my diet, looking after exercise, looking after my mental health, so that I can give the drug the best chance to do the work and hopefully there will, it's already prolonging my life, and hopefully there will be, something new in the not-too-distant future.
 
DIRECTOR POLICY, ADVOCACY AND SUPPORT SERVICES, BREAST CANCER NETWORK AUSTRALIA, VICKI DURSTON: Thanks so much. Today is a significant milestone, certainly from Breast Cancer Network Australia and the 200,000 strong in our network today is a significant milestone, as we see the announcement of Enhertu for HER2-low made available on the PBS as of the 1st of September. Certainly we know, and what you've heard today is nine people today and each and every day will die of metastatic breast cancer. Breast cancer is not solved. Today is really an important day, and we do acknowledge and thank the Minister and the Government for ensuring that there is a commitment to timely, accessible and affordable medicines. This has been an incredible number of years as not only Breast Cancer Network Australia, but with the likes of Dr Michelle White, you just heard from Bronwyn, and also you'll hear from Sarah Lee, who have been strong advocates and had to fund this drug spending hundreds of thousands of dollars. Today is a key milestone for many people affected by breast cancer, and we know there to be, like the Minister had mentioned, close to 15,000 living with metastatic in this country, but this drug is an innovative new treatment that is really going to benefit many, many people. So today is an important day, and we will continue to strive for advocacy, so the next people coming after Sarah and Bronwyn will be able to access these very drugs. You'll hear from Sarah later about the importance of what she's done through her advocacy, but she's been able to live 22 months on this treatment, and just recently, over the weekend, ran a marathon here in Adelaide. So an incredible feat from Sarah, and you'll hear from her later. But acknowledgement today to the Minister and the Government and we'll continue to advocate for timely access and affordable access to medicines like Enhertu. Thank you.
 
JOURNALIST: Just quickly Vicki, can you take us through the timeline of this drug becoming available and then to it getting on the PBS? Is this a quick turnaround for you?
 
DURSTON: We know that there are significant periods of time that that it takes for drugs to be listed on the PBS. We know that the Government has been working with us, alongside advocates, to see that this that this particular drug be accessible. Because we know that people like Sarah and Bronwyn and people with metastatic disease don't have time. It's important to see that these drugs for rarer types of cancers, those with metastatic breast cancer, actually get access to them in a timely manner. It does take a period of time. We know that there's been with the HTA review and recommendations, and the Government has been invested into looking into how we can make the time less to have these drugs listed. But certainly today, we've seen it, the commitment, and we're pleased to see that today.
 
JOURNALIST: And in terms of developments in drugs, how exciting is it to have this one on the market? We were sort of just hearing that there are new developments often. But how exciting is this one?
 
DURSTON: This particular drug is really exciting because it's new, it's targeted. We're starting to see that real personalised treatment and medicine come into the fore. We're really excited about it, and it is something that we want to see in the future. We know that Australia is at the forefront of clinical trials. The likes of Michelle and their other ecologists in the room that are part of clinical trials within Australia, and we know that they lead the way in this space. Working with industry as well as Government as well as our clinical researchers, is so pivotal to see these drugs accessible.
 
BCNA CONSUMER, SARAH LEE: Sorry, I did come prepared with notes, because I'm not very good at public speaking, so apologies for that. My name is Sarah Lee, and I'd like to share my story with you. I've been on Enhertu since the 20th of October 2022 which I funded, self-funded at a total cost of $208,000 until I was granted free access under the patient access scheme. I am HER2-low, and the drug is working to keep my cancer stable. I was diagnosed with de novo metastatic breast cancer on the 11th of April 2017 at the age of 41 and at this time, my breast cancer had spread to my spine, and undertook six months of chemotherapy followed by a mastectomy and 25 sessions of radiotherapy. Luckily, my Oncologist, who is in the room today, encouraged me to at least walk around the block every day while having treatment, and I decided that this wasn't enough, and I started to hike up Mount Lofty, which is a 10k round trip here in Adelaide, and I did this every week for 38 weeks that I was on treatment. Four weeks into chemotherapy, I also decided that I would run to chemotherapy. So it's 5k from my house to where I have treatment, and I decided to run. And with working with my Oncologist, we gradually built up that distance. And so the week before my final chemotherapy treatment, and a week after having influenza A I ran the city today here in Adelaide, which was 12k. I still continue to run four days a week, and last Sunday, I did run the Adelaide Marathon, which was my 10th marathon after running my first marathon in April 2019. Of the four marathons that I have run since starting on Enhertu, this was my fastest. So whilst having cancer has been my worst nightmare, it's also created an unbreakable bond between myself, my husband and my two children, Jack and Ella. As a family, we have loved hard, we appreciate the days, the memories, the tears and the laughs, while never taking for granted our most valuable commodity, which is time.
 
During a routine scan in December 21 I received the news that my cancer had re-emerged in my spine and was also in my liver. During 2022 my oncologist prescribed a variety of treatments, most of which were ineffective. And in August 22 I was told that I would probably make Christmas but beyond that, there was no guarantee. So this brought home the gravity of the situation that I now faced, and I began my process, and I am preparing, and I milk every day, every hour, for all it offers. At the same time, my Oncologist indicated that there was a new drug in Enhertu, which was showing good results but was not on the PBS. So would come at a huge cost for as long as it worked. So being a stay at home mum for 15 years, my superannuation was small, but between my super and the life insurance, we decided that we would have enough money to give it a go. I have been on Enhertu for 22 months and 32 treatments, and the financial burden of inherited has seen my life savings diminished, while adding an extra burden of me having to continue to work to assist with the payment. Every dollar spent on fun with my family has left me feeling guilty that it could be spent on treatment, and we always felt as if we were judged by people about the decision that I made on how we spent our money.
 
People like me who are living with metastatic breast cancer, live with the highs and lows of the cancer journey, which include periods of stability and progression regular scans, good news and bad news from our Oncologist, and that uncontrollable fear of sitting in the waiting room, waiting for your Oncologist to call you in for scan results, knowing that it will break your heart if it is bad news. What I also discovered when it was suggested Enhertu was my best chance was the financial burden of the disease as well. When hit with the question of whether you use your life savings to pay for the next big drug that has not been approved for PBS or not, it makes us question how much my life is worth. Then there is the sheer terror of what happens when the money runs out. Imagine having to make the decision to stop a drug that's working in keeping me alive. For many people living with metastatic breast cancer, there is no question they simply can't afford it. I couldn't even imagine the heartbreaker family who cannot afford this drug would experience. And this weighed very heavily on my mind over the last 22 months.
 
As someone living with metastatic breast cancer, I know that we live our lives on one drug, just hoping to stay on it long enough for the next big breakthrough to be made, for the next big drug to come on the market, to give us more hope and more time. To know that someone tomorrow will get the worst news that of cancer progression, but will also be told that they have access to an affordable drug in Enhertu that could be their game changer makes my heart sing. It is one less stress for a person living with metastatic breast cancer, and allows them more time for them to completely emerge in the dream of more memories in the time that they are given as a result. For me Enhertu is working. It continues to give me time, time to spend loving hard. My children, Jack and Ella, will have a mum who loves them unconditionally for longer. My husband, Pat will have a wife, the love of his life for longer, time to spend with family, sharing Christmas’ and birthdays, fun times and making memories. Time to give me hope, hope further medical advancements for when in her two eventually stops working for me, time to live life to the fullest, to appreciate the little things that make life special. But also time to be an advocate for myself and others who find themselves in the same situation. Time to dream the next big marathon, the next big milestone and the adventures that I can have. In the last 22 months, I have become a very good advocate for both myself and for others living with metastatic breast cancer. In the beginning, I didn't even realise that that was what I was doing. It was just I was just a desperate mother with a finite amount of money that needed someone to listen to my story and help me. I started writing to anyone we could think of that could possibly help us, the Federal Health Minister, our federal and state Members of Parliament, pharmaceutical company and the media. I called out the injustice of a treatment being free of charge for one group of people with breast cancer and not for others, but I was just one voice, and it felt like I was hitting a brick wall. My call to BCNA for help was a game changer. The support they gave me made me feel like my voice was not just one, but had a choir behind it. BCNA were able to use my lived experience to drive its advocacy to both the pharmaceutical company and the Pharmaceutical Benefits Advisory Committee. BCNA were able to help me navigate the complexities of the system and add my voice to their advocacy work. This led to the pharmaceutical company making Enhertu available for me free through a patient access scheme. None of this would have happened without their help. I was just one person trying to get my voice out, and they gave my voice power.
 
LEE: My story exemplifies the inequity of access that people are faced with. No one living with metastatic breast cancer has time to wait. It becomes a choice of life or death. We gave up everything we had saved to give me more time. But time with loved ones shouldn't come at a cost, and it caused me great mental anguish to think about how much my life was worth. To know that Enhertu is now on the PBS, and that no one else will have to go through what I have gone through, gives me great satisfaction.
 
AUSTRALIA AND NEW ZEALAND, ASTRAZENECA COUNTRY PRESIDENT, BEN MCDONALD: Thank you Sarah, thank you Bronwyn. I'm Ben McDonald, I'm Country President for AstraZeneca in Australia and in New Zealand. We welcome today's announcement for its power to change the lives of people with metastatic breast cancer. I'd like to thank Minister Butler and the Australian Government for expanding the listing, the PBS listing of Enhertu, for patients with HER2-low metastatic breast cancer. I'd also like to acknowledge and thank the Australian clinical experts and patients who've been involved in the clinical trials for Enhertu. We welcome this news, but we also acknowledge and know the challenges facing metastatic breast cancer patients, and that's why this listing is so important, because it expands the number of people who are able to receive this medicine in an equitable and fair way. We've been bringing innovative medicines to Australia and New Zealand for over 40 years for breast cancer patients and cancer patients in general, and will continue to push for earlier diagnosis and faster access, faster reimbursed access to medicines in Australia. Thank you.
 
JOURNALIST: Minister, on equitable access to medicine, how do you work to ensure that?
 
BUTLER: These have been really powerful stories. As I said, we've  listed more than 200 or expanded existing listings for more than 200 medicines in just two years. I think that gives you a sense of the scale of discovery happening right now. We’re blessed to be living in a turbocharged period of discovery with new treatments, new medicines coming onto the global market almost on a weekly basis, and some of them, as Dr Scott said, are increasingly targeted and personalised. This therapy is quite a new therapy in that it targets the cancer cells with these particular proteins and delivers a tumour killing medicine into the actual cell itself. It's really quite a remarkable thing. We also now know that cell and gene medicines or therapies are coming at us really as something of a tsunami. I mean, there are about seven on the register of therapeutic goods here in Australia right now, only seven. But there are almost 4,000 in development around the world. We know that our system of assessment, approval and then reimbursement on the PBS so that we can get them available to Australian patients at PBS prices is going to need to deal with a much larger group of more expensive but more effective treatments into the future. And that's why, as the Breast Cancer Network said, there view that I've just received into health technology assessment, or the HTA review, is a generationally important review for Government. As I think, has been said by patients, by the network and by the sponsor company ,we all want to get medicines listed onto the PBS as quickly as possible. That does require us to have an independent process that determines whether the medicine is clinically effective as Dr Scott said, this medicine was initially found to be clinically effective for HER2-positive or HER2-amplified breast cancer, but clinical trials then demonstrated they were also effective for HER2-low breast cancer as well. A new process had to take place for the independent experts on the Pharmaceutical Benefits Advisory Committee to determine this was clinically effective. And there then is a process to determine that the price that taxpayers pay for this is cost effective as well. As I think the community, whether it's patient groups or company sponsors, bringing these medicines to market, have said the time taken between the medicine coming to Australia, being approved by the TGA and the time of listing is too long. That really at the heart of the HTA review. The challenge for us in considering that review and seeking to build a system for the next many years that is able to cope with this turbocharged period of discovery that we're going through right now. The experts on the PBAC, our Department, the companies do, work together with the support and the advocacy, frankly, the very firm advocacy of patient groups like the BCNA, to get these medicines onto the PBS as quickly as possible. But I think there is an argument at the heart of this review that we can do better, and we can get them onto the PBS more quickly.
 
JOURNALIST: So Minister, then, when will the Government give its response to the review, if it's so important?
 
BUTLER: As I've said, we've only just received the review. It's a very significant document. I want to see it out into the community as quickly as possible. I've said, in the next very, very little while, I'd like that review to be out there, and for us as a result, to have a pretty full-throated debate as a country about how to manage these challenges. At the end of the day, taxpayers do have to get value for money for this. There needs to be an independent process that, as I said, assesses the clinical effectiveness and the cost effectiveness of these medicines and achieves a price that is right for taxpayers as well as for company sponsors. That that rolls off the tongue very easily, but is often quite a difficult process, particularly given the scale of new treatments and the price of those new treatments that are coming onto the market right now. I don't pretend this is going to be an overnight thing, really, this generational review to build a system of assessment, approval, and reimbursement of these very different types of therapies that are coming onto the market.  We set this review up with very real intention behind it, and I want to get the review out to the public very, very shortly so we can start this process.
 
JOURNALIST: And then any indication of when we might hear from Government its actual response?
 
BUTLER: No, I don't have a time frame right now.
 
JOURNALIST: What does the Federal Government make as a threat of the CFMEU to bring the Labor government down?
 
BUTLER: We've done the right thing in the national interest, but also in the interests of construction workers and the construction industry. I'm a big supporter of unions as a core part of our society and our democracy. I worked for unions for 15 years before I went into Parliament, including 11 as a Union Secretary. A strong, effective union movement is a core part of what we understand our community and our society to be, but those unions have to be clean, and the evidence of the infiltration of criminal elements into the CFMEU, frankly, is irrefutable. It was absolutely incumbent on our Government to act to clean up that union, as I said, for the benefit, ultimately, of construction workers and the construction industry. Yes, some of the leaders are obviously angry about that. They're disappointed that their leadership, their power, has been taken away, but frankly, they only have themselves to blame because they let their union become infiltrated by organised crime, and the Government had a responsibility to act to clean it up.
 
JOURNALIST: Should Green's MP Max Chandler-Mather be sacked for speaking at the CFMEU rally, considering the allegations?
 
BUTLER: That's a matter for Adam Bandt ultimately to determine whether or not members of his party room are dealing with this very serious issue in a manner that's befitting a member of Parliament. These are very serious issues for a core part of our economy, a really important part of our economy, and cleaning up that union for the benefit of construction workers, the construction industry and all Australians who depend upon a clean, effective industry need this process of administration to run smoothly. I don't think any of us in the Parliament are surprised by what the Member for Griffith did. He is a grandstander. He loves getting on a stage. But it was very unwise, it was very irresponsible. Ultimately, whether there are any sanctions for him doing that or a matter for Adam Bandt.
 
JOURNALIST: Just still on the Greens, will you agree to any, any of the Greens Robin Hood reforms to get their support for key Government legislation through?
 
BUTLER: I think all Australians will be thankful that the Greens do not determine economic and fiscal policy for our country, because the consequences of that, frankly, would be unthinkable. The Finance Minister, Katy Gallagher, has been out this morning indicating the Government's position about this. But again, it's  probably of no surprise to people who watch politics that the Greens have again come out with a completely irresponsible economic and fiscal policy.
JOURNALIST: Given the CFMEU have been talking about they're considering campaigning against Labor in the next election. Do you think that can hurt your prospects at the ballot box?
 
BUTLER: I don't think any of us are deterred by that in Labor, we did the right thing. We didn't do it lightly. But as I said, as Labor MPs, particularly, representing a party that was formed by the trade union movement the century before last, become the political voice of Australian workers. We were absolutely convinced we needed to act firmly to clean up a union that had irrefutably become infiltrated by organised crime.
 
JOURNALIST: Just quickly one on Super, one in four workers has been shortchanged on their superannuation for retirement. When will the Government introduce legislation to crack down on the $5 billion a year problem?
 
BUTLER: I'm not aware of that story, so I'll leave that to the relevant portfolio Minister.
 
JOURNALIST: Minister on IV fluids, are you confident that 22 million bags you've secured will be enough to make demand for all states and territories?
 
BUTLER: These are 22 million additional bags of IV fluid. Australia uses around 80 million bags of IV fluid every single year. Delivering an additional 22 million over six months, I'm advised, will ensure that we have more than enough to meet Australian demand over that period. I visited the Baxter facility in Toongabbie in Western Sydney yesterday, and was able to sit down with their leadership team and talk through with them their assessment of the Australian market for IV fluid. Remember that Baxter produces about 75 per cent of the demand needed for IV fluid here in Australia, so it is the big player. It's a very important part of manufacturing here in Australia, and they're running flat out, they're running their lines at more than 105 per cent at the moment, to trying to do everything they can to supply our hospitals and health systems with the IV fluid that we need. The Response Group that I set up that covers all jurisdictions, private hospitals, representatives from primary care, and the AMA is meeting on a weekly basis. They met again on Monday, to continue to monitor a situation that they advise me is stabilising. But the addition of 22 million additional IV bags to the Australian market, I'm advised, will ensure that we have more than what we need over the coming six months. But clearly, this Response Group needs to continue to do its work. I'm continuing to talk to Baxter about ways in which we can ensure in the medium to long term, Australia has everything it needs.
 
JOURNALIST: Will this additional stock then eradicate the need for fluid rationing? And when will that happen?
 
BUTLER: I'm advised by the Response Group from its meeting this week that the situation is stabilising around the country, and frankly, the situation has been relatively variable between different jurisdictions and between the public and private sector. But I am advised that the additional 22 million bags will ensure that Australia broadly has more bags than we need over the course of the next six months.
 
JOURNALIST: Recently, doctors at a major Sydney hospital were told patients had been kept in recovery for longer with hypertension and dehydration because doctors were rationing fluids. How concerning is that?
 
BUTLER: I'm not advised that there's been any cancelation of surgeries. But the reason I set up the Response Group that is meeting on a weekly basis, representing all jurisdictions and other groups is to monitor this situation system wide. As I said, the advice that they have given me from their meeting this week is that the situation is stabilising. But clearly, we needed to do something to ensure there was an additional injection of supply into the market, and we've done that.
 
JOURNALIST: Can you just define stabilising? Does that mean that there's not going to be fluid rationing?
 
BUTLER: Rationing is your term. Our system has become used to there being very significant stockpiles and what we what we're getting advice from different jurisdictions, because different jurisdictions have different levels of supply right now, is that there certainly is advice to use the product judiciously. But as I'm advised, there has not been an impact on activity to the extent of something like the cancelation of surgeries. But I think there is generally advice going through the system that IV fluids should be used judiciously at this stage. Thanks everyone.
 
JOURNALIST: Thank you.