MARK BUTLER, MINISTER FOR HEALTH AND AGED CARE: I'm delighted to be joined by Professor Jane Halton today - I'll ask Jane to say a few words in due course about the review that she has undertaken for the government. When we were elected, we said we would bring new energy to the fight against COVID, and very quickly, we've put in place a range of measures that were critically important in responding to the building third wave at the time - the building third Omicron wave of 2022.
We needed to put in place secure funding arrangements for the hospital systems by extending the COVID National Partnership Agreement, which was a decision that flowed from the first National Cabinet decision that Prime Minister Albanese had with his Premier and Chief Minister colleagues, a commitment of $760 million to the security of the hospital system.
We've also worked hard to expand eligibility for the fourth dose of the vaccine for particularly older and other vulnerable populations, and expanding eligibility of the antiviral treatments which have been critically important in capping and then reducing that peak of hospitalisation numbers - much earlier, frankly, than any level of government expected. We also said, though, that we needed to review some of the arrangements that the former government had put in place around procurement of vaccines or treatments. Not because we have any particular criticism of the fitness for purpose of those arrangements, particularly as they run through the rest of this year in 2023, but because as a new government, we thought it prudent to conduct a review to make sure that they were fit for purpose and will continue to be fit for purpose, particularly in light of all that we had come to understand about the Omicron variant and the different sub variants that we've been grappling with over the course of 2022 around the world.
Now, I just could not think of any more appropriate person in Australia to conduct that review for the government than Professor Jane Halton, one of Australia's most esteemed public service servants. As people know, Jane has been the Secretary of the Department of Health here in Canberra, and of the Department of Finance, as well as a number of other very senior important public service roles. Just as importantly, perhaps even more importantly, Jane is more plugged in to the global pandemic response than any other Australian I can think of, particularly through her role as Chair of the Coalition for Epidemic Preparedness Innovations - really at the forefront of new vaccine developments. And also the co-chair of COVAX, which is thinking through ways in which we can ensure that everyone in the globe is protected against COVID, not just those in high income countries.
It's important to say this is not a review about the pandemic response across Australia over the last two and a half years. It is not a review about what we did well as a country and what we perhaps could have done better. As the Prime Minister and I and others have said there will come a time for a deep inquiry into the nation's pandemic response. It would be extraordinary not to have that inquiry given the extraordinary level of dislocation, death, distress, and spending, frankly, on this pandemic. But now is not the time to conduct that review. That time will come.
Instead, what we asked Professor Halton to do was to conduct a forensic review of the procurement arrangements that are in place for vaccines and COVID treatments over the course of this year and next year, and analyse their fitness for purpose given all we now understand about the nature and the shape of the pandemic. Also, to examine associated arrangements, distribution arrangements, the operation of the National Medical Stockpile, and suchlike. Professor Halton has delivered to me a comprehensive analysis of all of those things, and I thank her for the work that she has undertaken to do that. I also thank the companies and other parties who have engaged very generously with Professor Halton to ensure that she's able to do the work that we've asked her to do. It goes without saying obviously when you're conducting a review of procurement or contract arrangements, that review will consider a lot of Commercial-in-Confidence material. So I'm not in a position to release the full report which is replete with Commercial-in-Confidence material that companies have shared with Professor Halton to allow her to conduct the review in the fullest way possible. But as early as practicable, I've wanted to release the executive summary, the conclusions and the recommendations that Professor Halton has delivered to the government and I've done that within only a few days of having received her report. I might hand over now to Jane to say a few words about the review she has conducted for the government, then we're happy to take your questions.
PROFESSOR JANE HALTON: Thank you, Minister, and thank you for the opportunity to have a look to see whether we are prepared for the next little period. As I've said to the Minister in this report, we are not yet COVID stable, and that's a situation we would all like to be in. I think many people are calling the end of the pandemic but as the Director General of the World Health Organization said recently, we can see it but we're not quite there yet. That's got implications for the decision that the Minister and the government have to make over the next coming months. We all hope that the life that we'd all like to lead, absent of this kind of infectious disease, is just around the corner. But what we also hope is that governments are prepared in the event that there is another nasty variant or, exactly as the Minister has outlined, another wave of infection and disease.
All the advice available is that at the moment, we cannot predict what this virus will do. We are hopeful that the virus is now trending down in terms of the implications we see for health and welfare and therefore for our economy, for education, for the operation of our health system. But we can't call that just yet. What we do know is that we need to be prepared and I've made some recommendations to the Minister about the ability to scale up quickly if that's needed, but also to make sure that we have sufficient vaccines for the next couple of years.
I'd remind people that one of the things that we all accept as being part of life is the notion of going to have an Influenza vaccine, so one of the things I've said to the Minister is that as an absolute minimum, he should be in a position to ensure that the Australian public can be vaccinated for COVID much as they might like to be for Influenza, and remembering that probably 50 per cent of the people who are vaccinated for Influenza do that of their own volition. There's some distance to travel in terms of becoming COVID stable, things are looking positive but we still need to be ready. And that does mean some decisions in relation to access, to treatments, and vaccines going forward. Minister, thank you.
BUTLER: Thank you Jane. Happy to take your questions.
JOURNALIST: I have a question for both of you. Professor, the recommendation about advisory structures being streamlined - is that a subtle dig at ATAGI? What does a streamlined advisory structure look like? And Minister, the report found pre-pandemic settings weren't fit for purpose and ad hoc arrangements were put in place. In what ways would you be looking to update the arrangements?
BUTLER: I might say a few words in response to the second question and hand it over to Jane, who I'm sure will do a much better job of explaining those things. I think it goes without saying that the pre-pandemic structures, for example around assessing a new vaccine, are not going to work when you're in the middle of a pandemic. The usual sort of process to consider the cost effectiveness and clinical effectiveness of a new vaccine that will usually run for some considerable time through the Pharmaceutical Benefits Advisory Committee is not going to serve the community in a pandemic. And so, as Jane outlines in her report, particular bespoke structures were put in place by the former government appropriately, to be able to fast track the consideration of vaccines through the TGA and then through ATAGI - the Technical Advisory Group on Immunisation. And those decisions at the time were supported by the Labor Opposition and I think in hindsight, were the right decisions. It goes without saying that when you're facing the worst pandemic in 100 years, you have to be in a position to act quickly.
HALTON: Thank you. The Minister is exactly correct. All of our existing settings which are business as usual settings, they're not designed for speed and agility. I think the thing we all knew was that this was a race and we actually had to have as responsive a regulatory context as we were seeing in the vaccine development world. In the vaccine development world the fastest vaccine previously developed was four years. We were actually rolling vaccines out in under a year this time round, with no corners cut on safety. But that meant that we needed our regulatory systems, our funding and our procurement systems to move at great speed as well. As the Minister has indicated, we also had a series of advisory structures, well known. Most of those people, and I've made this comment in the full report, the people who do this work, they do a fantastic job. Many of these people turned into public figures, not what they expected when they signed on. And what they have done is a really outstanding job. But we're at a different point now. So let's think about what preparedness looks like going forward. We're in the middle of another problem with Monkeypox right now, so one thing I've said to the Minister is he ought to think about how those advice structures can be more flexible, particularly when it comes to emergencies and crises.
BUTLER: Can I just add, we will be doing that. That's a recommendation that we're keen to work through, obviously to consult with those structures and with other members of government as well.
JOURNALIST: Can I just ask about Novavax? Obviously, we've ordered 51 million but I gather from recent reports only 13 million are in the country - but only 200,000 have been dispensed. Can you advise what will happen to the surplus stock? What is the shelf life of the product you already have in the country, and can that not be redirected for example to the COVAX program rather than just being wasted?
HALTON: In terms of Novavax, let me say one thing, which I think is a really important message. Novavax is a good vaccine. It suffered from being a little bit later into our market than other vaccines and now I think people don't know very much detail about it. And I can tell you when I get around to having my fourth dose - I had COVID so I'm just waiting till I hit that date - I'm going to have the Novavax vaccine because it is a good vaccine to have. We have a certain amount of stock in the country and the Minister and the Department are working with Novavax to look at the delivery timetable around that vaccine. There is not a huge opportunity to donate many vaccines into the global context at the moment. COVAX has delivered 1.7 billion doses of vaccine globally. But there is a pretty sufficient supply for most of the countries, particularly low-income countries. I'm thinking it's unlikely that those vaccines will be donated, but they will be scaled over a period, if that makes sense. And I think one of the messages we should be giving people actually is that Novavax is a good vaccine, and it's a good vaccine as a booster.
JOURNALIST: What is the anticipated wastage, I guess, if that's the case?
HALTON: Well, we can't properly predict that yet because we're in the process of rolling out in terms of boosters. So the short answer is we don't yet know.
JOURNALIST: Minister, will you be taking that advice in terms of shifting the approach to Novavax? because it's currently not a preferred booster under your program.
BUTLER: There are a couple of things we need to deal with around Novavax. Firstly, as Professor Halton indicated, there is a question about the delivery schedule of those 51 million doses and my Department is in discussions with Novavax about the degree to which we can shift the delivery date of those to minimise wastage and maximise the use within the population. But as you know, Novavax is currently not recommended as a preferred booster by ATAGI. Novavax was in the country, or the global leadership of Novavax was in the country last week. They met with me, they met with my department, and they've put the view that there is more recent clinical data that should lead ATAGI to reconsider that position or that recommendation in relation to the Novavax vaccine as a booster. I am encouraging them to provide that clinical data to us and for ATAGI to come together and to be able to consider that data and see whether or not that warrants a change to the recommendation.
JOURNALIST: Minister Butler, a report noted that Australia secured a portfolio of effective vaccines that enabled high rates of vaccination and prevented serious illness and death relative to global peers. Does that not undermine Labor's criticism from opposition that the Morrison government bungled the vaccine rollout?
BUTLER: We were firstly very clear in 2020 that the government should order more vaccines, not less, and that they had been slow particularly in signing deals with the mRNA vaccine providers. At a time when countries like the UK or the US, Canada, certainly Israel, were inking deals with Pfizer in the middle of 2020 from June to about August 2020, our former government did not incur a deal on Pfizer until much later in 2020.
They didn't then do a deal with Moderna for an mRNA vaccine until well into 2021. When the issues associated with AstraZeneca became a problem in terms of the speed of the vaccine rollout, we were left without Moderna and a very slow delivery schedule of the Pfizer vaccine. Our criticism was very much about timing. Our criticism was that frankly, the former Government had not acted quickly enough to secure deals with Pfizer and I think a lot of the material that came out through Freedom of Information requests bore out the fact that Pfizer was seeking to engage with the Australian Government as they were with the UK, the American, Israeli, the Canadian governments, and others as well, to secure early deals with the Australian Government to ensure early supply. That was our criticism.
We have always had the position that Australia should take a portfolio and redundancy approach to vaccine procurement, and that is a conclusion that you'll see in the material that we've published from Professor Halton's review, and it's obviously something we now need to bear in mind as we look forward to 2023 because the Moderna vaccine arrangement only runs to the end of this year. Next year, we have contracted supply through Novavax and we've talked about the issues associated with that particular vaccine already, and then Pfizer. Recommendations from Professor Halton's report will need to be considered by the government given Labor's longstanding position to support a portfolio and redundancy approach.
JOURNALIST: The Health Department said yesterday that Australia's total vaccine wastage is just above 17 per cent. That's nearly one in five vaccines that have gone to waste or nearly 30 million - does that concern you? Is Australia going to move towards an on demand ordering or procurement method in the next few years? I know that was noted in the report. Professor Halton, one for you. Why isn't there much capability in the international context to donate vaccines at the moment?
HALTON: Perhaps I can talk about the wastage point first, actually. One of the things that the full report takes the Minister through is what you should expect in a normal vaccine program in relation to wastage. If you look at Influenza, you're expecting a ratio of procured vaccines to delivered vaccines to be something in the two and a half to 1.6. So in fact, the 17 percent wastage point that you quote that's what you would expect at a really acute phase of the pandemic where you're using every dose in every vial. What we're doing now is we're actually taking the opportunity to vaccinate people when we can get them, which means you're going to have higher wastage. So we do normally expect much higher wastage than that 17 per cent.
Indeed, procurement needs to take account of that expected level of wastage. In terms of other countries this is a terrible term - there is an issue with absorptive capacity, which is a fancy way of saying many health systems in low-income countries are at the max in terms of what they can actually deliver to people. And there are other issues they're managing as well. They're managing Cholera, they're managing all sorts of other diseases and challenges. So with my other hat on, I can tell you that in the global context COVAX and others have worked really closely, particularly with low-income countries. We’ve vaccinated 73 per cent of health workers. We've vaccinated 60 something percent of older people, and we’ve vaccinated over 50 per cent of people in those countries on average. So we're doing what we can but there is a limit to how many vaccines they can actually use.
BUTLER: If I can just add to that, so far, I think Australia has donated around 46 or 47 million doses in our own region into the COVAX facility. Certainly, in the time that I've been the Minister. I have been exploring any opportunity for further donations to our region or more broadly into the global market working with the Department of Foreign Affairs.
Our advice very much bears out what Professor Halton has said is that the market is a little saturated right now. In relation to wastage, I think the former government and our government has obviously been very keen to monitor wastage levels. Wastage rates at a time of high vaccinations were obviously much smaller. These vaccines are all delivered in multi dose vials.
So if there are only a few people coming through your door as a pharmacist, or a GP you open a vial of 10 doses and only two or three people come through the door, we want those two or three people to be vaccinated, even though we understand that seven or eight doses might go to waste. I think the approach in a pandemic, you vaccinate whoever comes through the door. Hopefully over time, those dose vials will come down from 10 to maybe a smaller number of doses in each vial and maybe even we get to a position of prefilled syringes, but right now, the whole market around the globe is a market of 10 dose vials. So that does lead inevitably, when vaccination numbers have dropped off a bit, to wastage.
JOURNALIST: In your report if you tend to use the term COVID stable - could you take us through what that means. And I guess I came a little bit later on. I think you were touching this point when I walked in, but in the report you said that policy settings have not been updated and to take account of already widespread COVID infections and hybrid immunity that sort of thing. Could you reflect on what COVID stable means?
HALTON: I'd be happy to do that. So essentially, what we mean by COVID stable - a bit like we all understand how influenza - and it's not influenza - which we've said more times in the last two and a half years and I can count. It's not the same as influenza.
But what it means is we understand, and we expect that we will get waves. We know what's going to happen in terms of the influenza season when it will be, and we can prepare for that. Everyone I think would know they probably get a text message from their local general practice or perhaps from a pharmacy saying we've now got influenza vaccine available, you know, make your appointment come and be vaccinated.
We're not at that point yet with this particular virus. So whilst things are looking good, and most of us are not currently really concerned about the number of cases in the community, but we can't still predict what the virus is going to do.
So while we are hopeful and while - as Dr. Tedros says - we can see the end of the pandemic, we can't yet tell exactly what the next few months or indeed the next six months will take. What we are hopeful is that the northern winter, which is coming, will actually enable us to monitor what happens with the virus.
I've said to the Minister that I would think by the end of the northern winter, we will have a much clearer understanding of what the trajectory of the virus is going to be. That helps with everything - procurement, thinking about delivery arrangements, etcetera.
So, it's not stable because we can't yet predict it, but we're hopeful it will be soon. And the policy setting - so essentially, there was an integrated policy statement put out towards the end of 2020, which I think enabled everyone to understand what our objectives are.
And certainly, one of the things for the Minister, he needs to have a clear policy statement which enables him to think about procurement and talk to the profession about what it is we are looking to achieve. Are we looking still to achieve high rates of vaccination coverage for those who will benefit? I would argue yes, that is what we should be continuing to try to achieve. Are we attempting to achieve access to those antivirals on the other therapies? Yes, I think that's what we should be trying to achieve. So just bring together the strands so everyone understands what it is we're currently trying to do and that helps inform the Minister's decisions and I think it helps form the government's decisions as well.
BUTLER: Sorry, can I just say that this is a really important recommendation. It's obviously something we've been thinking about over the course of the last several weeks. Our focus over that time obviously has been to get through this third wave, but our decision that we announced last week to extend a whole range of support arrangements that were due to expire this week until the end of the year, will allow us over the course of the coming little while to put in place that sort of policy framework that I think gives guidance to the community and to the rest of the government about what the policy objectives in this new phase of the pandemic are. Because we haven't seen an update really since that emergency phase, which obviously had very different objectives and a very different environment to work within.
JOURNALIST: Professor Halton, you’ve said in the report that there are significant clinical differences between different vaccines, that the government should simplify its approach to encourage public uptake rather than looking at the absolute risk of side effects. Do you think that all the changes in recommendations around the AstraZeneca vaccine have damaged the rollout?
HALTON: I think there is significant confusion. And I think even for people who have websites where they give you advice about what you can do, if you try and book a vaccine, you're not necessarily seeing a really clear set of information for people.
I think one of the things we know particularly about public health communication, keep it simple, so people go - this is what I need to go and do - I know how to go and do that. This is not a criticism of the people who have updated their advice over time, but I do think now is the time to streamline that advice. Make it permissive. Make it easy to understand and so people can then follow that advice. And frankly, go and get on with their lives.
JOURNALIST: Just a follow up in terms of the eligibility settings for Novavax - is ATAGI looking at updating those settings and if not, will you ask them to?
BUTLER: As I said, the global leadership of Novavax visited last week. I met with them, my Department met with them. They indicated to us that there was more recent clinical data around the effectiveness of the Novavax vaccine as a booster that they wanted to put before ATAGI. They were presenting to authorities all around the world. I've indicated that it would be good for them to present that clinical data to the Australian Government and to advisory authorities. I've also indicated to the Department it would be good for ATAGI to come together and to consider that new data. Obviously, it will be a matter for ATAGI to reach their own conclusions about it but at the very least, they should be considering the most recent clinical data.
JOURNALIST: With Novavax, it seems like there have been some confusion that some people incorrectly thought they needed a doctor's letter in order to get it. Do you think that this sort of thing reflects that ATAGI needs to make its advice clearer, or that this sort of translation between what ATAGI is advising and what providers are being informed of needs to be clearer?
HALTON: I think it needs to be clearer. And this is my point. It depends on who you're writing for. You're writing for a narrow audience or a broad audience, I think we need to be really top notch in our health communication, to make it simple for people to understand. Now, the truth is on Novavax, if you read the guidance, it says mRNA is preferred unless it's contraindicated or if the person prefers. That more extended advice is quite hard to find unless you read the original source document. And this is exactly my point. I think we need to make this easy for people, make it easy to access these vaccines for boosting. And I think that will help us with uptake because if you actually look at our uptake of the fourth booster, we are lagging most of the world. We're sitting on 40 per cent, or a bit over 40 per cent at the moment. That is not as good as a number of other countries. I think if we make it easier for people, we will get better uptake
JOURNALIST: Just on hospital funding. Minister, do you expect the federal government to hit the 6 and a half per cent growth cap this financial year? And if so, what would that mean for state government budgets?
BUTLER: This is obviously a moveable feast. So I think advice on that changes from time to time. At the moment we do not expect to reach that. There are obviously constraints on hospital operations, most of them workforce related, and state governments have talked about that quite extensively.