Minister for Health and Aged Care - press conference - 8 February 2023

Read the transcript of Minister Butler's press conference on COVID-19, ATAGI advice and vaccine doses; aged care and health workforce, and hospital discharge.

The Hon Mark Butler MP
Minister for Health and Aged Care

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MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: This morning I have published the latest advice from the Australian Technical Advisory Group on Immunisation, which I think the community has come to know as ATAGI, about the next phase of Australia's vaccine programme. And I've decided in consultation with the Commonwealth Chief Medical Officer Professor Kelly to accept that advice. Now, if you haven't either had COVID, or a vaccine dose in the last six months, adults can now get their next dose of COVID vaccine to top up your protection from February 20 this year. 

ATAGI has been particularly clear about their advice for those Australians most at risk of severe disease, which they identify as Australians 65 years and older, and Australians under that age who have various health conditions or are immunocompromised that makes them vulnerable to severe disease. For those Australians, the very strong recommendation from ATAGI is that it's now time for your next dose of COVID vaccine, provided you haven't had a dose in the last six months or been infected with COVID in the past six months. The Vaccine Advisory Group have said that otherwise healthy children or teenagers do not need an additional dose. And so, the additional vaccine dose is not being provided to children and teenagers under the age of 18, except where they have health conditions that have been identified as placing them at risk of severe illness. 

Now our best advice is that there are about 14 million Australian adults who have gone more than six months since their last dose of vaccine. So, the pool of Australians now eligible for their next dose of vaccine is at most 14 million. But we know that many of them will have been infected by COVID in the past six months, so they are expected to wait for at least six months since they had COVID to access that additional dose, if that is their decision to do. I want to assure Australians and the hard-working vaccine providers: general practices, community pharmacies, community health centres that Australia has more than enough vaccine doses – Omicron-specific vaccine doses to supply this latest round of vaccines in the Australian COVID vaccine programme. 

Currently, we have millions of doses of Omicron-specific COVID vaccine available in Australia, many of them already distributed to providers, either general practices or community pharmacies. And I can announce that over the next couple of weeks 10 million additional Omicron-specific Pfizer vaccines will land in Australia and will be available to those providers in very early March. So, this will be the largest supply, the largest delivery, of COVID vaccines since late 2021.  

Just to remind Australians, you will be able to access this additional dose from your local general practice, from community pharmacies and from community health centres from February 20. It is not available immediately. It will be available from the week after next and it will be completely free of charge. So, I encourage you to consider making an appointment with your usual provider to access that additional dose, you're able to do that. 

I also just want to make a couple of remarks about aged care, because obviously aged care residents - a couple of hundreds of thousands of Australians in residential aged care in particular - are among our most vulnerable members of the community. Over the coming couple of weeks, the Minister for Aged Care, Anika Wells and I will be writing to aged care providers to advise them of the new arrangements for additional doses of COVID vaccine which, for the overwhelming bulk of aged care residents, will be their fifth dose. Our Department, the Department of Health and Aged Care will follow up that written advice through telephone calls to providers to remind them of, first of all, this latest advice and the arrangements that they should be following to ensure that their residents have full access to the additional dose. Aged care operators will be encouraged to bring in local pharmacists and local general practitioners and practice nurses to provide these additional doses of COVID vaccines in the usual way that they make arrangements for other vaccination programmes.  

I want to announce that there will be a new incentive payment for general practices and community pharmacies to visit local aged care facilities and residential disability facilities as well to provide this latest phase of the COVID vaccine programme. This new incentive payment will be much simpler, and it will be about double the amount of the payment that has previously been available to those providers for visiting the aged care and residential disability centres. 

The last thing I want to say before I hand over to Professor Kelly is to reflect on the latest COVID wave that has been present in Australia now since about late October 2022. There's no doubt that this wave has endured for longer than was expected at its beginning, longer than the advice that was received by governments, particularly based on more recent waves then that had happened in parts of Southeast Asia. It was not short or sharp, it lingered for longer. And it had a very significant impact on the community, our health system, and many individuals tragically resulting in the loss of many lives.  

We estimate that as many as maybe 3 to 4 million Australians were infected during this latest wave. There are about 1 million official cases that have been reported. But we know given that mandatory reporting has been discontinued by all states that the true number of COVID infections will be a multiple of the official number. So, our best advice is as many as 3 to 4 million Australians. Tragically our best advice is that around 2,600 Australians lost their lives, including more than 800 residents of aged care facilities over the period since October. We are coming, I'm advised by the CMO, we are coming towards the end of this wave: case numbers are down dramatically, well over 80%, since the peak sometime in December. We're also seeing hospitalisations reduced substantially. ICU admissions, intensive care unit admissions, reduced substantially, and antiviral prescriptions - which have generally tracked case numbers - reduced in line with the official case numbers, as well.  

But this has had a very profound impact on the community, on the hospital system, on the aged care system, and on the thousands of families who are grieving the loss of their loved ones. It is important that right through this pandemic, we continue to learn the lessons of the impact of the pandemic on the community. And it is my intention to make sure that we learn the lessons of the past few months, and constantly make sure that the response that all governments, including the Commonwealth, put in place to deal with what inevitably will be the next wave of COVID sometime over the course of 2023 is aligned with the best understanding and the best evidence about the way in which we can protect Australians from the impact of this virus. And to that end, I've asked Professor Kelly to provide me with advice which I imagine will be conveyed to the broader Health Ministers group, in Professor Kelly's regular epidemiological report to all Health Ministers. We’re meeting in a couple of weeks’ time on some of the advice about lessons we've learned over the last few months to ensure that we have the maximum protections in place during the next wave of COVID. 

I might hand to Professor Kelly and then take your questions.  

CHIEF MEDICAL OFFICER, PROFESSOR PAUL KELLY: Thanks, Minister. So just to reinforce the main message for today is the revised ATAGI advice. It's quite different to the previous advice that we've had from them in terms of moving to a “time since last boost” whether that's due to the last vaccine or the last episode of COVID-19. And it is based as always, though, from ATAGI advice on the best evidence comparison with international experience. And that's what we have right now. 

It's much simpler than previously: all adults now are advised to consider getting a booster on the basis of not having had a previous vaccine in the last six months or a dose of COVID in the last six months. We're particularly focusing, though, on those higher risk groups and Minister has talked to that about our experience, not only in the last wave, but in previous waves, of who develops severe disease - remembering that is our primary purpose of our policy right now, is to protect those who are most vulnerable and vaccination remains a key plank of that. 

UK modelling, for example, shows that for anyone over the age of 70, you need to vaccinate 800 people to stop one hospitalisation. That might sound like a lot, but that's actually a very important number. That shows that that is the most important group that should be getting vaccinated. In comparison, age 40 to 49, you need to vaccinate 92,000 people. And if you look at younger people, every year younger than that, you need to vaccinate more to get that effect. It really demonstrates that the people that are at most risk of severe disease and death are older people and those other risk groups the Minister has talked about. And that's why we're concentrating specifically our recommendation based on the ATAGI advice on those groups. But everyone is eligible, you should consider your own risk, and then talk to your normal provider.  

In terms of the summer wave, this ended up being the lowest number of cases, and all of the other indicators that the Minister mentioned, of all of the Omicron waves so far, recognising that - as the Minister also mentioned, we don't know the full extent of the number of cases. But we do know the number of ICU admissions: that was lowest of all the Omicron waves. And hospitalisation, similarly lower. That flattened curve that we had of this wave demonstrates to me that there is a large amount of protection right now in the community, in terms of hybrid immunity. We've talked about that before: the combination of the boost you get from having a dose of vaccine as well as the boost you get from having an episode of COVID. And so, without any public health and social measures, essentially, this was a low and slow wave, which was lower and slower than we thought would be the case. But there were deaths, as the Minister said, and that's always a tragedy. We need to consider that. And I certainly welcome the task the Minister has given me to talk to that to the Health Ministers conference in the next weeks. It also demonstrates the importance of data, I think the more data that we have, and the surveillance systems that we have in place are important. The analysis, interpretation and reporting of that, learning from the lessons of previous waves to guide us into the future - and there will be more waves in 2023 and beyond - is really important. And I welcome that opportunity to do that. Thanks, Minister. 

JOURNALIST: You pointed to the millions of Australians who have not had another booster for the past six months or so - does that point to a need to ramp up education campaigns in this space? Is there a reason why there isn't a broader education campaign there? And if I may be so bold to ask a second question, Professor Kelly, you pointed to some of the research coming out of the UK there, in maybe not even an ideal world, but in a realistic world, what is the vaccination rate across the community that you would be happy with to see in the next coming months? 

BUTLER: I might deal with the first question. There are substantial funds in the in the Budget from October for a communications campaign around the next phase of the vaccine programme in the first half of this year. And that is in the late stage of development. And we're very conscious of the need to provide the best possible information to the community about the benefits of the implementation of the latest advice that we've received from the experts. So, you'll see that in the coming period. 

KELLY: So, to the second question: so as high as possible in the over-65 group and the high risk. I'm not going to give you an actual number, but we have had actually good success, very strong success in third doses for that for those high-risk groups, and in fourth doses also. And so we’d be looking to move to that for those high-risk groups, remembering that we're preventing severe disease. They're the ones we need to really target now. 

BUTLER: Before I come to you Clare, just to add to that, because there has been some reporting of the population-wide take up of the fourth dose. I just want to reinforce the fact that in the over 65, population, there has been a very high take up of the fourth dose. So, between the ages of 65 and 80, more than 70% of Australians in that group have now had four doses of the vaccine. And around 80% of over 80-year-olds have had their fourth dose of the vaccine, as well. The numbers in the 50 to 64 year old age group, which were also recommended for a fourth dose by ATAGI late last year, is substantially lower: down to about one in three. But among that group, which the experts have identified in their latest advice, because we know more about the relative risk to people aged between 50 and 64 on the one hand, and the people aged 65 and over on the other. Among the group identified at most risk of severe disease, there has been a very high take up of the fourth dose, and we hope there will be a similarly high take up of this additional fifth dose. 

JOURNALIST: Just for Professor, obviously, you're focused on getting more people having a booster now but can I ask you about more into the future? Are we now in a position where every six months, if an Australian hasn't had COVID, you would prefer that they went and got a maintenance booster? Are we now shifting toward more of the flu vaccine style of vaccine rollout than the sort of emergency that we've had in the last two to three years? 

KELLY: I think it's fair to say we're moving to a different stance now, based on the advice that we have at the moment. And the ATAGI advice is very different from previous, in terms of that six-month period. What the future will hold, and this actually - when you read the full advice, which is now released publicly - you'll see that we're not going to predict the future. But it's true to say that internationally that is what the discussion is about: looking at a time period. But that time period - optimum time period - is not yet settled. For now, it is six months. 

BUTLER: And from my perspective, can I just say we've had a talk about this, we've been watching this debate around the world. Because I'm sure that the community is eager to get some sense of rhythm, a sense of rhythm to this. And although there have been debates in the northern hemisphere about this, I think experts around the world aren't yet ready to settle on a particular rhythm. And the advice that we've received from ATAGI, when you read it Clare, indicates this is something very much that ATAGI and their equivalents around the world are continuing to monitor.  

JOURNALIST: You’ve used words like tragic and profound to describe the impact of this latest wave. Given that, do you think it was a mistake to unwind the COVID restrictions so quickly last year? And just to the Professor as well, research has shown that successive vaccines have got less and less impact. Basically, they provide less protection for a shorter period of time, is there much sense in continuing a program where we keep giving regular vaccinations, when the effect keeps getting lessened? 

BUTLER:  I might deal with the first question. National Cabinet has agreed on a COVID strategy for 2023. And that builds on decisions taken last year to progressively unwind some of the quite significant community-wide public health orders that were in place and move to a system that focuses more forensically on protecting those who are at risk of severe illness. And I think that has been endorsed, again, by National Cabinet in their transition plan late last year and the Commonwealth's COVID plan for 2023. And I think that is the right approach. I think what we'll find as we learn more about the precise detail of what's happened over the past few months, is again: the task for governments not just here in Australia, but around the world, is to put in place protections for those who are most at risk. And so, I don't see any sense that that was the wrong decision. It is about applying that set of principles in the most effective way. And that's what I want to make sure that we do over the course of 2023: learning from the experiences over the last four Omicron waves. 

KELLY: Two quick things I'll say to add to Minister's comments there. One is: there is an effect. There absolutely is an effect of having an extra dose of vaccine. In the context of where we are at the moment in terms of repetitive waves, many of us - probably everyone in the room has had COVID - the incremental increase in immunity from the vaccine is less each time you have it now because you're continually being boosted by episodes of the of the virus. But vaccine does help. It does work. It does protect people, particularly those in that severe, severe end of vulnerability. 

The second thing is: the other key issue we have at the moment now is antivirals. And so, we peaked at over 45,000 antiviral prescriptions in a week during this wave - higher than anytime previously. We are getting we know, into aged care, in particular, very high rates of rapid diagnosis followed by offering of antivirals. Around 90% of people are receiving antivirals within the time period that's recommended. So, we have those tools. They've been very crucial during this wave and will continue to be into the future. 

JOURNALIST: A different one on aged care, the HSU is in Parliament today, they're asking you or the government again, to not phase in that aged care pay rise over two years, they want it in over one year. Is the government still committed to making that phase in over two years rather than the one year, I guess, what would you say to Gerard Hayes whose saying that three quarters of aged care workers might leave the job in the next year, because they can get paid more working at KFC? 

BUTLER: We are committed to the decision that the Government has made and has incorporated into our submission to the Fair Work Commission. What it effectively means is that the decision from the Fair Work Commission is phased in over a 12-month period, so July 1 this year and July 1 next year. And when you add that to the substantial increase for the national wage case last year, in part because of the submission that we made, there are substantial increases effectively flowing to aged care workers over a 24-month period from July 1 2022 to July 1 2024. And we're very conscious that strikes the right balance.  

JOURNALIST: Your office a month ago said that you’re expecting this revised advice. Why, if you knew it was coming, why did you wait a whole month to introduce – sorry this is the advice on new vaccinations - why did you wait a whole month to introduce it, announce this? And if I may, my second question on antivirals that the Professor has just raised, anyone’s eligible to have an antiviral if they pay privately for it and get a prescription for it. But the Health Department is actively telling GPs not to prescribe it to anyone but the vulnerable, so we have enough for the vulnerable. Why are you allowing people access if you’re telling doctors not to prescribe it? Why don’t we have enough to allow everyone to pay if they want to pay? Because isn’t it lowering the viral load and therefore protecting everyone a little bit more? 

BUTLER: I imagine Professor Kelly might want to add on the second question, Karen. I think what I’m sure I said over the last couple of months is that ATAGI had indicated publicly that they expected, because back in late November, I think maybe early December, they declined to provide advice for an additional dose. But they indicated they would be likely to provide advice in the very early part of 2023. And I think my public statements simply reflected that. I had no idea what that advice might be or when I might receive it. I've only received this advice in the last couple of days. I've considered it and sought advice from the Chief Medical Officer as quickly as I could. And I'm publishing it this morning. 

But a month ago, if you're referencing what my office might have said, or what I might have said, I didn't have any advice. I didn't know when ATAGI would provide advice. And I certainly didn't know if they did provide advice, what it would contain. That is why I haven't put any steps in place. It's proper that I receive the advice, consider it and then, if I accept it, put in place the sorts of decisions that I've announced this morning. 

As to antivirals, you will recall that the Commonwealth, our Government, took the, I think, then-unprecedented step to make a submission or an application to the Pharmaceutical Benefits Advisory Committee to ask them to expand eligibility to these two antivirals: molnupiravir and Paxlovid. Antivirals that are still highly effective against Omicron, unlike some other treatments, like the monoclonal antibodies, which have been shown to be quite less effective, so we made that submission, quite unprecedented that the Commonwealth would do that, not the companies. And I was very pleased to receive the decision of that Advisory Committee that everyone over the age of 70 would thenceforth be eligible for that treatment at a PBS price. So, from January 1, just $30 for general patients, much less for concessional patients, and for people under the age of 70 if they had various health conditions. 

Now, I have said publicly, but let me step back. That is how the law operates in this country. You only are able to access medicines at PBS prices if the Pharmaceutical Benefits Advisory Committee has provided that advice. And in doing that, they balance clinical effectiveness and cost effectiveness. I have said that I am sure, and I want to be sure that PBAC - the Advisory Committee - is constantly monitoring the emerging evidence about the effectiveness of these antivirals. And that if evidence emerges, to suggest that eligibility, or those eligibility criteria should be revisited that they would do that. And I'm confident they would. I might ask Professor... 

JOURNALIST: Why has the Health Department released the fact sheet for GPs telling them not to prescribe it to anyone other than the most vulnerable?  

BUTLER: I might throw to Professor Kelly about that. But the impact of the decision or the reasoning behind the decision of the Pharmaceutical Benefits Advisory Committee, is that the effectiveness of that medicine - that antiviral medicine - is for people over the age of 70, and people under the age of 70, who have particular health conditions.  

KELLY: And that's where the evidence points. It's quite clear that that's the case, as the Minister said, I've had multiple discussions with PBAC. He's asked me on several occasions at look at this issue. But that's the evidence. All medicines, all vaccines have a risk and benefit profile. And it's where the benefit outweighs the risk that these things are used. And realistically, there was a paper in The Lancet just before Christmas, which very clearly demonstrated that in a high-risk group, molnupiravir particularly is of use - there was a paper by myself and Professor Michael Kidd - clearly is useful to stop severe disease and those at highest risk. But actually another paper in the same edition of The Lancet demonstrated for those that are at lower risk, it actually doesn't make any difference. So that's the basis of the of the advice through from PBAC. Just to really reiterate this: it is not because of any shortage in supply. We have plenty of supplies, I said we've had over 45,000 prescriptions, mostly to people over the age of 70 and the rest to people at higher risk, in the peak of this particular wave. And I'm absolutely certain that that protected those 45,000 people that received that dose.  

JOURNALIST: Just on aged care, there are growing calls to overhaul the financial model of the sector, making wealthier Australians pay more. Is the Government considering this? Or is it open to looking at the model that they put forward? And secondly, I think you said 800 residents of aged care died in the past wave out of 2600. So that's almost a third. Can the government confidently say that it's doing enough to protect vulnerable Australians? 

BUTLER: I'll deal with a couple of your questions. I might get Professor Kelly to add some remarks to the second question. As you know, we're in the process of rolling out very significant additional reforms in aged care responding to a number of the recommendations from the Royal Commission. A new funding model only commenced a couple of months ago in October, that provides a substantial funding boost, which much better reflects, I think, the needs and the profile of aged care residents today compared to when the previous funding system was put in place more than a decade ago. That will provide a substantial funding boost to aged care providers. 

We're also putting in place our staffing reforms to increase the staffing ratios of carers to residents and to ensure that there is a registered nurse on shift at all times in residential facilities. I know providers are still under financial pressure, that financial pressure has been aggravated substantially by COVID, which among other things, has driven the occupancy rate down to levels that I don't think we've seen in the 30 years I've been involved in the sector. So, we'll continue to talk with providers about ways in which we maintain their sustainability, but we're pretty busy right now putting in reforms that bring several billion dollars of additional funding into the sector.  

As to your second question, the mortality rate of aged care residents has come down dramatically over the course of this pandemic, as we've learned new ways to keep people safe. There's no doubt though still the frailest, the most vulnerable members of our community are still very vulnerable to severe disease, and death. My advice is that of the confirmed cases in aged care, around one in 40 of those residents have died over the past wave. In the early part of the pandemic, around one in three aged care residents who contracted COVID died. Over the course of last year, it was closer to one in 30. So, we are getting better at protecting aged care residents: the most frail, the most vulnerable from the worst impacts of COVID. Professor Kelly talked about the deployment of antivirals. But there's no question that more than 800 deaths in a few months in aged care is a devastating tragedy. And I want to make sure that we learn the lessons of that. And if there are ways in which we can improve protections in aged care, we will do that. 

Now, Minister Wells has already been seeking advice from the Chief Medical Officer about that - has already asked for advice from the Aged Care Advisory Group about options for improved protections beyond all of the things that we're currently doing. You know, my sense about that is that probably the only additional things we could do would be to lock down aged care facilities again, during the next wave. And we learned about the physical health and most importantly, the mental health impacts that those lockdowns had on aged care residents and their families in what is often their final months of life anyway. But we're going to learn those lessons. I know Minister Wells is very focused on this, taking advice from Professor Kelly, and making sure she engages with the sector to ensure that over the course of the next period, we're providing the best possible protection to our most vulnerable citizens. 

KELLY: Just to add to that, at the moment, the reflection in aged care is the same as in the community. And I think that's the key piece of this. As long as we're having cases in the community, it will get into aged care. When we were very closely monitoring this in 2020 and 2021, on average we found if there was more than 10 cases in the community, there was a case in an aged care worker and it was in aged care. We're getting substantially more than 10 cases every day now. So that is a reality we need to live with. All of the work that's been done in the last two years under the auspices of the of the Aged Care Minister, but also, on the advice of the Aged Care Advisory Group - real on the ground experts in relation to aged care - has been implemented and reinforced and reinforced again. And the outbreaks have been - during this wave - shorter and smaller than previous waves. And that that's very encouraging, and has rapidly decreased as all of the other indicators have over the last couple of weeks to the point we have less outbreaks in aged care now than at any time since December 2021 - less number of people with COVID and the same in aged care staff. But it will never get back to zero, unless that sort of drastic action that has been suggested. And there are there are real consequences for that. 

JOURNALIST: Minister, can I just ask you about critical doctor shortages? I've spoken to the Head of ED in one of the busiest hospitals in Adelaide, who says ‘well, you know, the Medicare reforms are welcomed, the real issue is the critical shortage of GPs’. And he, and the Group of Eight universities has called on the government to increase funding for Commonwealth Supported Places for doctors by 1000. Can we expect to see that in the Budget? 

BUTLER: Well, I'm not going to pre-empt what might or might not be in the Budget. I think there is a live debate about the supply of medical graduates in this country. And we've got some additional Commonwealth Supported Places for medical schools that are in the process of rolling out now. We're seeking expressions of interest. They’re particularly for rural and regional universities. I think there is a live debate about the distribution of medical graduates between specialties, I've said publicly. I want us to have a conversation as a group of Health Ministers, all of my state and territory Health Minister colleagues agree with this. We want to have a collective conversation with all of the Colleges to ensure we're getting the distribution right. This is a matter identified in the National Medical Workforce Strategy that was approved under the former government. I mean, are we getting the number right that go into general practice - into psychiatry, there's a very substantial shortage of psychiatrists? 

JOURNALIST: Would you consider increasing funding on the proviso that those people went into general practice or went into psychiatry?  

BUTLER: There are a range of matters that we're considering like the distribution of existing medical graduates between specialties. There's also a question about the way in which general practitioners are currently working. Are there tasks that GPs are currently doing that could quite properly be performed by practice nurses, if the right systems were in place? And those sorts of things were really the central part of the Strengthening Medicare Taskforce report. So rather than jumping just to add additional money or add additional places to the existing system, I think the clear recommendations and clear advice to me has been: we need to think about the way in which the existing system is structured first. 

Can I just say that there are arrangements in place to try to move graduates into particularly rural and regional Australia. Minister Clare announced some of them only in the last couple of months in terms of the HECS relief or HELP debt relief, I think they call it now. So there are programmes in place to do that. But we want to make sure we get the supply of the right workforce right, of course. I don't think we're ready to jump to a particular number of additional graduates added to the existing system. 

JOURNALIST: One for you Professor Kelly, previous booster advice said eligible Australians should receive the booster three months after COVID infection. Could you provide some insight or clarification as to why ATAGI has upped that to six months? 

KELLY: It's the simplicity of message as much as anything. But it also is - as is all ATAGI advice - based on the best evidence. And as we all know, the evidence is rapidly-moving in this pandemic and that includes that particular issue. So for simplicity of message, if you have not had a dose or an infection in the last six months, you can go and get one now. 

JOURNALIST: Just on aged care workforce again, clearly workforce is an issue. The AMA has released a report today saying that some patients are stuck in the public hospital system waiting up to a month, because there's nowhere for them to go. How can something like what your government is doing to try and get 24/7 aged care nurses help these facilities when the workforce isn't actually there to facilitate it? And then when that is supposed to come into effect at the start of July, I believe, how will it be policed and what will happen to these facilities that can’t actually achieve it? 

BUTLER: We’re very confident it’ll be achieved. Survey work over years has shown that the vast bulk of registered nurses are employed on a part time basis and would be willing to work additional hours, many of them would be willing to work additional hours if that work was available. And if they had confidence that the broader staffing arrangements in place where appropriate. So, we're very confident that with the additional funds, we'll be able to achieve the commitment for a registered nurse on shift at all times in all aged care facilities. Now we have put in place some arrangements to consider the circumstances particularly of quite remote aged care facilities in labour markets where there are real challenges. We'll work through all of that.  

I think one of the real challenges in the aged care sector that leads residents to be admitted to hospital rather than cared for in-situ, and one of the challenges in having them re-admitted or admitted in the first place to aged care facilities if they have, you know, reasonably substantial needs is the inadequate staffing arrangements in aged care. It's not the only issue, but it is a substantial challenge. And we're confident our staffing arrangements will help that situation.  

As to the broader report from the AMA this morning, there clearly is a challenge in in older Australians who are clinically able to be discharged from hospital not being able to move in a timely fashion to an aged care facility. And National Cabinet, so the First Ministers, have tasked us as Health Ministers and Aged Care Ministers with finding solutions to that challenge. They're not easy, they're not quick, but I can assure the community that Health Ministers are looking at that with our Aged Care Minister colleagues. In disabilities, which is also a challenge that has been identified, this is perhaps a little easier to deal with because there's a single agency, the National Disability Insurance Agency responsible for the several hundred NDIS participants who have been in hospital beyond the clinically advised time. Bill Shorten and his colleagues have been working really hard and they're already achieving really substantial inroads in making sure that as many of those participants as possible are able to move out of hospital into appropriate disability accommodation.  

JOURNALIST: Can you provide some light on some of those discussions you are having with the state Health Ministers about doing that?  

BUTLER: I think I've tried to be honest with you to say that we recognise this is not easy. It's not going to be quick. We're talking about 3,000 aged care facilities run in the most part, particularly outside Victoria, by private providers. We have to engage with them. We don't have a single agency responsible for all those participants and their placements in the way the NDIS does. 

The state Health Ministers and the state Premiers, frankly through National Cabinet, have been wanting a dialogue with the Commonwealth about ways to make that transition or improve those care pathways. And that's a process that's still underway. 

JOURNALIST: On the 10 million vaccine doses on order could you just outline which specific vaccines they are? And over the last few months Pfizer and Moderna overseas have indicated they potentially will be exponentially increasing their COVID vaccine prices, is that something that worries you at all? 

BUTLER: We have existing contracts with both Pfizer and Moderna. We've been, I think I've spoken about this publicly before, we've been working very hard with both of those companies in good faith negotiations to substitute the old vaccines, if you like, the original versions of the vaccine, for the new Omicron specific vaccines as part of our existing contract, which have existing prices attached to them. We've been very successful in being able to do that. I've indicated there are some millions of Omicron specific vaccines already in the country, many of which are already distributed to pharmacies and general practices. And on top of that, over the course of the next couple of weeks, the Pfizer BA.4 and BA.5 Omicron vaccine - 10 million doses of those will arrive in Australia as well and be able to be distributed through that network over the couple of weeks, following batch testing and the like. Those are doses secured under the existing contracts, which the former government concluded at the existing price.  I thank Pfizer and Moderna for the negotiations we've been able to have with them, so that we're not getting the old-style vaccine into country, we're getting the most up to date version of vaccine for Australians. 

Can I just maybe add to that Professor Kelly might want to say something about this, ATAGI has been quite clear in its advice that it prefers the Omicron specific versions of the vaccine, whether that's Moderna, Pfizer, the BA.1 or the BA.4 version. 

JOURNALIST: Just back on the aged care workforce issue. You've got the entire aged care industry and the union movement, calling in unison for this pay rise to be delivered now, not in July, isn't stagnant from July to little too late. And if I can secondly, just ask on a separate issue, to put your ALP President cap on from 2018, you argued in favour of the imposition of bargaining and service fees for non-members, do you still stand by that? 

BUTLER: I don't have any responsibility for workplace relations policy. I'm here as the Minister for Health, not as the Minister for Workplace Relations. As to your first question, as I said in response to Josh's question, I'm very confident we got the balance right here. There will be after the increase of around 5 per cent last year, a 10 per cent increase to aged care worker wages from the 1st of July this year, plus one would presume whatever the national wage case increase comes down with, plus an additional increase within 12 months in 2024. This over the course of a 24-month period is a very substantial increase to wages, underwritten by taxpayers, which was the commitment that our government made.  

Now, of course, I understand the extraordinarily important work that aged care workers do. I've worked with them for three decades now watching the work that they do, watching the degree to which that work has become harder as the profile of aged care residents has changed over the last three decades. And they have been underpaid for a long period of time for that work. This is not a decision we came to lightly; we recognise the value of the work of aged care workers, we recognise the importance from a recruitment and retention perspective of increasing those wages. But we're very confident the decision we made incorporated into our submission to the commission was the right one. 

JOURNALIST: On the Voice to Parliament, and I understand this is also not in your portfolio, but the AFR is reporting that the Government will backflip on the decision to scrap public funding for the official yes/no pamphlet. Not in your portfolio, obviously, but do you have anything for us on that will the government allow that yes/no pamphlet to go ahead after all? 

BUTLER: I'll leave that to relevant ministers or the Prime Minister. 

JOURNALIST: Just for clarity, you said that it wasn't to do with supply of vaccine for the changing advice, but for the lower age sort of 18 to 35 what's changed about the risk profile? Because when the fourth dose was introduced last year, it was suggested that the medical advice was that the risk, you know, the benefit didn't outweigh the risk. So, what's changed for that younger cohort?  

KELLY: Further evidence of waning of immunity and the sort of time period that that occurs and that's particularly a case for people in older age groups, but it's also the same for all adults and so it's again - that very careful weighing of risk and benefit on the basis of the current evidence that ATAGI has given, that current advice - any adults can consider it and for people over the age of 65 it is highly recommended. 



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