Minister for Health and Aged Care – press conference – 30 March 2023

Read the transcript of Minister Butler's press conference in Canberra on expanded access to subsidised paxlovid; COVID-19 2023 booster dose ad campaign; COVID-19 leave grants for aged care workers; Chief Medical Officer’s fourth wave report.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks for coming in. We thought it would be useful to provide a bit of an update about where various trends are in in the fight against COVID, and also a couple of developments and new measures that will come into effect over coming days that I want to provide a report on.  

Just to remind people, the advice from the Chief Medical Officer and AHPPC was that the fourth Omicron wave, which we saw really through the most of summer this year, probably came to an end in around early to mid-February, as we saw case numbers, hospitalisations, aged care outbreaks all bottom out in that period of a couple of weeks in the middle of February. We have seen some growth in really all measures over the last few weeks, which you will have seen if you've been looking through the weekly reports. Case numbers are not entirely reliable to track, anymore, given that no jurisdiction has mandatory reporting in place of case numbers. So looking at raw case numbers in and of itself is not a particularly reliable guide, although case numbers have been increasing over the last five weeks or so. But in some more reliable indicators, we are seeing an increase – albeit off a pretty low base – so case numbers in aged care facilities where there is much more robust reporting have increased over the last several weeks – probably by about 65 per cent – off a very low base.

Now, it's important to say that is still about 80 per cent below the peak we saw in the summer wave, so still substantially lower than it was only a couple of months ago. Prescriptions for the oral antiviral treatments have also been increasing slowly but steadily over the last several weeks by about 40 per cent in total over the last five weeks or so. Hospitalisations have largely stayed relatively low, substantially below the peak we saw in the summer wave, which was about 3,500 hospitalisations for COVID across the country. Again, that was substantially below the peak we saw in the winter wave last year – about 5,500 hospitalisations – but we've seen a very slow, small uptick in hospitalisations over the last several weeks as well, all of which goes to reinforce the message that this is not over. As the Chief Medical Officer and state Chief Health Officers have advised, there will be future waves of COVID across the course of this year and it is important to continue to reinforce those standard messages about remaining COVID-safe, and I'll throw to the Chief Medical Officer Professor Kelly in a short while to provide some advice about the report he’s given me about lessons learned from the fourth wave. 

Can I just report on a couple of new measures that take effect over coming days. On the 1st of April, there will be an expansion of eligibility for the oral antiviral Paxlovid, so the Pfizer antiviral treatment, and that has been recommended to government, and that advice has been accepted by government from the Independent Pharmaceutical Benefits Advisory Committee. So from the 1st of April, Australians aged 60 to 69, who have only one risk factor, currently they had to have two health risk factors, but now with one risk factor will be eligible for Paxlovid.

We're advised that that means about an additional 160,000 Australians in that age group will be able to access Paxlovid over the course of this year in the event of additional waves. We know how effective Paxlovid and Molnupiravir – two oral antivirals – are in preventing severe disease and hospitalisation and death, we've seen that through the last few waves over the course of 2022. This will make a real difference to the experience of many tens of thousands of people aged in their 60s and take real pressure off the hospital system as well. It's important just to reinforce that all Australians who are eligible for the oral antivirals, including this new group, make a plan with your doctor, for the event that you contract COVID over the course of coming months, so that when you receive a positive test, there is a plan of action in place to be able to access the oral antivirals very quickly because we know they need to be taken within the first few days to have that very beneficial effect that we've seen.  

I also want to report that on Sunday, the 2nd of April, the Government will begin rolling out the new COVID ad campaign to reinforce the importance and the value of vaccination. This comes off the back of the advice that we actioned from the Technical Advisory Group on Immunisation for an additional COVID booster dose for 2023. If it's been more than six months since you were infected, or six months since you had your last dose of COVID vaccine, you are now able to go out and get an additional dose whether it's your third, fourth or fifth dose to top up your protection. And from Sunday a new, well-resourced, ad campaign will roll out across all media: TV, social media, outside billboards and other media as well, which will be quite a refreshed concept, with a new ad agency the Government has commissioned. It's good to be able to report that, and that has been a recommendation from a couple of different reviews, including the Halton Review to government.  

I also want to advise that from the 1st of April aged care workers who contract COVID but do not have leave entitlements, particularly if they're casuals, but also if they’re permanent aged care workers without access to leave entitlements, will be able to access a support payment indirectly through their employer funded by the Commonwealth Government. People might recall that there was a cooperative arrangement reached between the Commonwealth, states and territories, through National Cabinet to provide what was then a High-Risk Settings Pandemic Payment paid through the disaster payment system through Services Australia for those workers. That scheme comes to an end on the 31st of March – so tomorrow – and immediately from Saturday, a new Commonwealth scheme funded and operated by my Department, the Department of Health and Aged Care at a Commonwealth level will provide exactly that same entitlement: up to $750 per week for aged care workers who contract COVID without leave entitlements. Obviously, that is about providing support to those workers, but importantly, it's also about making sure that if they can track COVID, there is no disincentive from them isolating and not going to work and potentially exposing residents of their aged care facility to a virus that is very dangerous for the most vulnerable members of our community in aged care.  

And finally, can I say that when I last stood up here a few weeks ago, I think, as we were reporting that the fourth wave really seemed to have come to an end, I indicated that I'd asked the Chief Medical Officer after four pretty quick succession waves through Omicron, and a soup of variants of Omicron, it was important that we reflect on lessons we'd learned from that, particularly around ways in which we could support the most vulnerable members of our community in settings like aged care. And today, I have published the report that the Chief Medical Officer, Professor Kelly, has given to me, and that's out there transparently for people to look at. And I might now throw to Professor Kelly to say a few words about that report and anything else the CMO wants to talk about. 

CHIEF MEDICAL OFFICER, PROFESSOR PAUL KELLY: Thank you, Minister. So indeed, that report is public, and I commend people to have a look at it. The key points from that report has been partially summarised by the Minister about what we have learnt from that most recent COVID wave, and I should say, we are continuously learning from the pandemic. We have done that since the beginning, and we will continue to do that, we must do that, and we should adjust our settings accordingly. The fourth wave was longer than previous waves and what was originally predicted, it lasted for 19 weeks or so which was more than previous waves, it was much flatter than previous waves in terms of case numbers. As the Minister mentioned, we need to be cautious about looking at case numbers now because of the change in the way people are getting their tests and reporting those tests. But it was also flatter in terms of severe illness indicators, and so that's an important thing to look at over the course of the Omicron wave, so we've seen that within the fourth wave, since late 2021 there has been a progression to less severe illness and less number of people with severe illness, so whether you measure that by hospitalisations, by ICU, by death rates, it has been dropping. 

The other key that the Minister has mentioned already is this was the first wave that we've had more than one circulating virus, and that so called soup of viruses was new, and it makes it actually more difficult to predict what is going to happen in the next wave or in the timing of the next wave. We will see more waves, as the Minister mentioned, we have seen a very slight increase over the last few weeks, but certainly much less than what we were seeing during summer, what we saw during winter last year, what we saw around about this time last year, and certainly much less than what we saw in summer of 2021–22.

Other things we learnt from that wave is certainly the effects of hybrid immunity are really showing now, so that link between immunisation and previous infection is showing a difference, and we're seeing that even in most of the groups that we have been concerned about throughout the pandemic.

So there's been a normalisation now of death rates, in particular in relation to First Nation people, CALD groups, and also in – to a certain extent – disability. People living with disability are at higher risk, that is certainly still true, but it is much closer to the general population now than it was previously, based on infection and immunity from infection, but particularly vaccination. Similarly, with culturally and linguistically diverse groups, early in the pandemic we found that they were they were more likely to die or to have severe illness, that is less of a case now, they're basically the same risk as the as the wider community. So these are positive things. 

Very clearly, my advice to the Minister was that the settings that were put in place last year – the Community Framework for Protection Against COVID-19 – are still relevant. And the COVID Transition Plan that was put in place by the Federal Government towards the end of last year and endorsed in National Cabinet is also fit for purpose. There is still a need to protect our most vulnerable people and that's very clearly the policy that we're pursuing now. Our most vulnerable people are our elderly, particularly those who are residents of aged care facilities.

On that basis, the evidence that we've seen from the Australian experience is the same, as led to ATAGI’s advice in relation to a dose of vaccine: if you have not had a vaccine or an infection in the last six months – that time since the last immunising event is really crucial. So, very strong message particularly to people over the age of 65 and others with risk factors, is to get that vaccine now, don't wait. And I thought you were going to announce the number there, Minister. But I'll leave that to the Minister because there is good news in terms of how many people have come forward for their booster dose. But there's more to be done in that in that case with this new advice in relation to Paxlovid, there is probably another 160,000 or so people that are now eligible if they were to become infected – that's the 60 to 69 age group, only one risk factor available to have that subsidised medicine on the PBS. 

BUTLER: I'm very sorry, but a division has been called in the House. Please continue.  

PROFESSOR KELLY: All right, so I'm flying solo now. So I can make the announcement then, there's been over a million booster doses since the start of the year which is very pleasing. But there are more than that that are eligible, and so that advice to go and get booster doses is still relevant. If you are in any of those groups that are eligible for oral antivirals, they still work, they work against all of the new variants, there's new research just this week demonstrating that from international experience. So if you are in those groups that can get those antivirals, have a plan to get them if you were to become positive over the coming weeks. 

In terms of aged care, we are continuing as we did last year to prepare for winter, and we are currently giving personal protective equipment and rapid antigen tests to our aged care facilities. That's rolling out right now. The Aged Care Commissioner and I are writing to all aged care providers tomorrow, reminding them of the of the issues – as we did last winter – about what might come, and learning from the northern hemisphere winter, it's more than COVID, it’s also flu, it's RSV, and other viruses that we need to prepare for, and luckily, most of the things we do to protect our most vulnerable people will also protect against those other viruses.

So I think we will have more to say on flu vaccine in the future, but I had a text message from my own GP yesterday saying that the flu vaccine is available from next week in terms of the private market, and in the next couple of weeks in terms of the National Immunisation Program, so people are very much encouraged again this year to think about flu vaccine as well as COVID vaccine. So, I'll leave it there but happy to take questions. 

JOURNALIST: Should we expect another wave of COVID over winter? And is there any indication at this stage how severe the flu wave will be? 

PROFESSOR KELLY: So that's a crystal ball question. I don't have a crystal ball. But in terms of future COVID waves, as the Minister mentioned, I think we've got a ripple at the moment whether that will turn into a wave for the reasons I mentioned, and mentioned in my report, it's difficult to predict to the stage. But certainly, there has been an increase in numbers over the last few weeks as mentioned, but off a very low base. In terms of flu, what we've seen from the northern hemisphere winter – and that's usually a good indication for us – is that the flu vaccine was very well matched with the circulating viruses. We saw a range of types of flu. They also saw a lot of respiratory syncytial virus RSV. And, in fact, talking to my colleagues in the UK, the US and Canada recently, they were more concerned about that than they were about COVID. I think they've seen the same hybrid immunity issue coming up, but they saw all three in winter, and we should be prepared for that as well. 

JOURNALIST: With all of the different viruses, it might be a deadly form of a strep virus, or it might be bird flu, or whatever. How important is a Centre for Disease Control going to be? Do you think, given the state we find ourselves in right now it is very urgent? What's your sense of that? 

PROFESSOR KELLY: So a couple of things in that question. So firstly, in terms of avian influenza, there has been a change and it's been well reported around the world in terms of avian influenza, and we're certainly watching that very closely. We've seen more cases in wild and domestic poultry, birds, as well as across over to some mammalian species, but no sense at the moment that there's an increased – a majorly increased – risk to humans, but we're watching that very carefully. In terms of the other diseases, yes, there's many diseases out there that we should be monitoring and dealing with, and the CDC will be definitely well placed to do that. That will be a matter for Government decision and announcement in the Budget context.  

JOURNALIST: Professor Kelly, there's obviously lots of new campaigns being rolled out in terms of picking up booster rates, for instance, and antivirals and COVID. Are you still worried that there's still a lot of COVID fatigue throughout the country? And I guess, how do you counter that, I guess, nonchalance from people about, you know, we've survived the initial waves of COVID, we've got vaccines, some people have got boosters, or people who might think that they’re relatively fine, we are past the peak of COVID. 

PROFESSOR KELLY: You're right, people are over COVID. I'm certainly over COVID. But it's still there. We can't ignore that there is COVID circulating in the community. People that are at most high risk, as we've mentioned before, they should make definite plans now to do what they can. Vaccine is definitely the best way to protect, the antivirals work, taking precautions in places where you're at higher risk with a lot of people or if you're living in aged care facilities, as I mentioned, there's a lot that can still be done there. I think we're rapidly moving to a time where we're actually really targeting those messages for those higher risk individuals rather than the general population. And that matches what people also are making the decisions about. 

JOURNALIST: There's been an inquiry into DFAT’s response into COVID that recommends that the Government delivers a full response to the Review of Hotel Quarantine, do you know where the Government is at? Or where the Department is at in terms of responding to that? 

PROFESSOR KELLY: Look, I think that's one for the Minister who's unfortunately not with us. I think the government is committed to do a review of the COVID response in general, there have been, of course, many reviews for specific components of the response over the last few years, both at the Commonwealth level and in states and territories, and I think a review would be good to build on those. But that's really a decision for Government. And I can't really comment further. 

JOURNALIST: Do you think a response into hotel quarantine is more needed, given that we saw so many waves come out of hotel quarantine? 

PROFESSOR KELLY: Well, there's been a number of reviews, both at the Commonwealth – one at the Commonwealth by Professor Halton – and then also in the states and territories. So I think whatever we do in that area would need to build on those things.  

JOURNALIST: Professor Kelly, just in terms of your report, does the fact that the difference in the fatality rates between Australians with disability, culturally and linguistically diverse Australians, Indigenous Australians and the rest of the population, does the fact that difference in mortality has dropped indicate more should have been done at the beginning of the pandemic to try to boost immunity in those groups? 

PROFESSOR KELLY: I think all of those groups were identified very early on as needing specific and particular protection, and we did what we could at that at the time. So for example, you'll remember back in the early days in the First Nations group, for example, biosecurity controls in remote areas. So we did a lot of very strong protection at that time when vaccine became available, all of those groups that you mentioned were specifically targeted and had early access. So, all of those things have been done. Could more have been done? I think I defer back to the review that will happen in due course to kind of examine some of those things in more detail. 

JOURNALIST: Can I ask you about the changes to Paxlovid. Can you explain why the eligibility criteria has been changed? It is simply a supply and demand issue – we've got more Paxlovid than we’ve had previously? Is this maybe an admission that previous criteria were too restrictive? Is it that you're really worried about this group – this cohort here? And as we approach winter, what's the reasoning behind changing this?  

PROFESSOR KELLY: So this is advice for the Pharmaceutical Benefits Advisory Committee who have – like ATAGI with the vaccines – have a continuous process of looking at evidence and thinking through what that shows, so this is, again, probably the third or fourth time they've changed slightly their recommendations. So it reflects that new evidence, analysis of that evidence, advice given to government on the basis of that evidence. In terms of supply, there's plenty of supply. And Paxlovid has changed, whereas Molnupiravir has not because of the previous advice at the end of last year from PBAC that Paxlovid is the one you should go for in the first instance and Molnupiravir as a backup in case that's not recommended for a particular person.  

JOURNALIST: For the people who aren’t eligible on the PBS for these antivirals, do you have any indication of what that out-of-pocket cost is at this point? Because it's gotten to hundreds of dollars for some people? And then do you think that's reasonable? 

PROFESSOR KELLY: So the price on the private market is what you're referring to, it is the price that is available from the pharmaceutical company that provides that medication, so that’s the same with any private script. I believe it's close to $1,000 for a course. But I think that the message to Australians is the people that really need it, they are now eligible for that highly subsidised PBS rate. And so they're the ones that should be looking for, making those plans, in case they were diagnosed with COVID in coming months. 

JOURNALIST: Do you know what the end date is for the extension of the aged care leave payments?  

PROFESSOR KELLY: There’s no specific end date at this point.  

JOURNALIST: Just on boosters, do you have any update on what we’re doing for Australians who are falling behind with their booster doses? Are you still counting the four doses? Or where are you at with those stats?  

PROFESSOR KELLY: Yes. So the new ATAGI advice has led to a change in the way we will be reporting, I think, from tomorrow, if not next week, we'll be reporting on those that are eligible and due, and what percentage of those. So essentially answering that question, I don't have that data with me at the moment, but we are doing our best to estimate who has had an infection in the last six months. We definitely know who's had a dose in the last six months. But we're agnostic to the number of vaccines that people have had once you've had the initial dose, which is two, we know that's enormously high in Australia. And, frankly, people that haven't had those first two doses now are unlikely to have them. So we're not measuring that. We're measuring the time since the last dose and the proportion that are eligible who have had it. And as I said, over a million people have already had it this year which is just terrific. In the last few weeks since that advice came from ATAGI, there has been a large increase particularly in the over 70 age group, which is exactly where we want that to be happening. 

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