Radio interview with Minister Butler and Sonya Feldhoff and David Bevan, ABC Adelaide - 5 July 2022

Read the transcript of the radio interview with Minister Butler and Sonya Feldhoff and David Bevan, ABC Adelaide on the Meeting of Health Ministers, COVID antiviral treatments, primary care and hospital pressures.

The Hon Mark Butler MP
Minister for Health and Aged Care

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SONYA FELDHOFF: 

So earlier today I spoke with the state Health Minister Chris Picton, about the changes he's asking for in terms of antivirals and letting you have greater access to them. With COVID numbers due to increase soon, he says he's been talking with the Federal Health Minister Mark Butler, who joins us now. Minister, good morning. 
 
MARK BUTLER, MINISTER FOR HEALTH AND AGED CARE: 

Good morning.
 
DAVID BEVAN:

Mark Butler, what do you think the problem is?
 
BUTLER:

We had a really good discussion at the Health Ministers’ Meeting on Friday, which obviously Minister Picton was at, about a whole range of issues. But particularly the worry that our chief health officers have about a third Omicron wave that appears already to be brewing in the eastern states and will be moving its way westwards over the coming few weeks. We have these extraordinary new treatments now that people are able to take orally, so in tablet form. Up until pretty recently, if you had antiviral treatments, you were getting them in hospital intravenously, which is obviously pretty complex and you have to have got to hospital in the first place.
 
These new tablets though allow you to get in very early, very quickly after having been told you're COVID-positive, and are very effective in preventing severe disease, hospitalisation, or even death. So, the former government, to their credit, ordered many hundreds of thousands of these. They’re on the PBS. The problem is we're not getting them out the door, and we had a really good discussion on Friday about that. There are a few reasons for it. The first is I think the eligibility criteria on the PBS are too restrictive. So I have applied, or the Commonwealth Government has applied, to the committee that oversees that, to broaden the eligibility so more people will be able to access the tablets. But beyond that, there's also not enough information out there. People are still overwhelmingly unaware that there are these new treatments that could potentially save their lives. So I've also asked my Department to look at an information campaign to GPs, who are critically important in this area, but also to patients, particularly older patients, who could access them as soon as they get a positive test. 
 
BEVAN:

How quickly can you free up access to these antivirals?
 
BUTLER:

That advisory committee, called the Pharmaceutical Benefits Advisory Committee, is meeting this week. I’m meeting with their Chair later today. We're doing everything - that's obviously up to them, they've got a statutory charter, I can't interfere with that. But we've made our position clear. Health ministers like Chris Picton who are at the coalface in state hospital systems have done likewise. So I'm really hopeful that we'll get a decision to broaden eligibility and we can get that into force, or into practice very, very soon.
 
FELDHOFF:

We’re told these antivirals are pretty expensive. Is this going to be a factor in who will be eligible under the rule changes?
 
BUTLER:

They are expensive but if they're on the PBS as a concessional payment, you'll be paying about $6 for a course, and as a general patient maybe $40. Without that subsidy from the Government, they’re about $1000. So some people are buying them in that way because they see they’re that effective, but we want to get as many people covered by the PBS so you're paying the same cost you would for any other medicine.
 
The other thing I'll say about them though, particularly Paxlovid, which is the Pfizer product very effective at preventing severe disease, is it does have complex interactions with other medicines. So if you are on other medicines for other conditions like diabetes or blood pressure or something like that, it's really important you talk to your GP about whether or not that medicine is going to interact badly and cause you other troubles if you take the antivirals as well. So it's not something you should be going to the chemist and trying to buy over the counter. You can't do that anyway. It really is something you have to have a conversation with your doctor about, and you should do it before you get COVID.
 
FELDHOFF:

We're talking with the Federal Health Minister Mark Butler here on ABC Radio Adelaide. Minister, you mentioned that this is a life-saving treatment, obviously, but in terms of eligibility is this also about your experience of COVID? I mean, is it about helping you experience COVID less severely, than maybe it ending in your life, that your life is ending?

BUTLER:

Spot on. I mean, what it is, is for people who are particularly vulnerable – we know COVID hits some older people much harder than others and hits people who have compromised immunity at whatever age, but also particularly older people who have a range of other conditions, particularly respiratory conditions, so in their lungs, and things like that.
 
So there are a range of risk factors currently that determine whether or not you're eligible. So if you're over 75 and you've got a risk factor like a particular medical condition, you’ll qualify. If you're over 65 you have to have two risk factors, which I think is too restrictive, and I’ve made that submission to the committee, so you have to have two different conditions and be, say, 74 years old before you qualify. I think we need to broaden that eligibility, that’s certainly the argument that Chris Picton, the South Australian Minister, has made strongly as well, and the committee will consider that over the course of this week. 
 
FELDHOFF:

So what is likely to be the broadened eligibility criteria? I mean, is a 45-year-old healthy person who's got a bad dose of COVID likely to get them?

BUTLER:

I'm not sure it would be that, that broad, because there's not a lot of evidence that really has much of an impact on, you know, a fit 45-year-old, who doesn't have other health conditions. I mean overwhelmingly, that person, if they get COVID, particularly the Omicron variety, then they're likely just to have to have a pretty bad cold. What we're worried about is people who are vulnerable to severe illness. So it is older people, it's people with compromised immunity, because they've got health conditions that they might be congenital or they might have had cancer, and particularly older people with other health conditions as well, so quite what the change criteria might be if the committee decides that, we’ll have to wait and see.
 
FELDHOFF:

Cause aren’t they already eligible? All those people you've just mentioned?
 
BUTLER:

Well, no, as I’ve said, if you're 74 years old, you have to show you've got two risk factors. Now the view we've taken and put to the committee is, is that we know from tragic experience, frankly, experience we’re still having right now, that older people, even if they can't show they've got two particular risk factors, are vulnerable to severe disease. And this, this medicine, I mean it is $1000 a pop, but compared to people going into hospital, the possibility of very severe disease, let alone the possibility of death, that is a great investment by the Australian taxpayer. So we should be making the most of it. And we have 500,000 doses already of the Pfizer drug, Paxlovid, in our warehouses. We’ve only been able to get about 20,000 of them out of the warehouse into people's bodies, making them well. So we’ve got to do better than that.
 
BEVAN:

Does it have a use-by date?
 
BUTLER:

They do have a use-by date and I’ve asked for some advice about that. I mean, the idea that these would go to waste would just be a travesty. So this is also part of the motivation, why would we have spent money, as taxpayers, on buying these things, putting them into a warehouse and have them sitting there while we still have well over 3000 people in hospital across the country? We have more than 300 people dying every week and those numbers are climbing because of this third wave that I've said is building, this third Omicron wave, just a third wave this year.
 
FELDHOFF:

Minister, you've said that you will need to go to the GP, to get these antivirals prescribed. Sadly, we have a GP shortage and that seems to be escalating, certainly here in South Australia. We're seeing GPs close. We've got one at Yankalilla, we've got difficulties in regional areas. A lot of people say they can't even get into their GP. So how will they get access to the antivirals?
 
BUTLER:

The first immediate challenge, I’d say, is shouldn’t be going to your GP physically about this. You should be ringing them and having a telehealth appointment or video appointment over the phone, and they will be able to provide an e-script, an electronic script to your pharmacy. Then you'll need to have someone go and pick them up, but you need to do it really quickly. For these drugs to be effective they need to be in your system in the first day or two you have symptoms, otherwise they just don't really have the positive effect. More broadly though, Sonya, you know I was talking right up until the campaign for some months about, probably leaving aside the pandemic, the big structural challenge we have in health. It's never been harder to see a doctor, never more expensive to see a GP.
 
We've got a really serious problem in general practice, which is why almost all of our health policies were focused on rebuilding general practice and that's not just the Commonwealth that think that. I mean, we are responsible for general practice through Medicare. When I met with the health ministers last week, Chris Picton, the other state health ministers, they were saying the difficulty people have getting into a GP. That the fact that we don't staff our aged care facilities sufficiently to look after people in those facilities, all ends up at the local emergency department. A whole lot of people end up at the local ED who frankly should be cared for in the local community, and that's causing enormous pressure on our hospitals right across the country.
 
BEVAN:

One of the other problems that you brought up at this meeting of health ministers is the NDIS.  We’re getting calls, just the last few days, but we know there's a long-running issue that is people who are with the National Disability Insurance Scheme. Some acute problem gets them into a hospital and they can't get out, they end up staying there for months. Some of them have been in there for longer than that. Mark Butler, do you have a plan to get people out of hospitals, out of acute care and back into the community? 
 
BUTLER:

I've heard of NDIS participants, not many of them obviously, but some are NDIS participants being in hospital for years, obviously very distressing for them, extraordinarily expensive for taxpayers, and blocking up hospitals that are under real pressure. Bill Shorten, who your listeners probably know is the Minister for the NDIS in the new government federally, has already met with his local disability ministers. He's instructed the agency that that looks after the NDIS, the NDIA, to look at the we think, 1000 people across the country who are in hospitals and have been there as long-stay patients, as you say David, many cases for months—well beyond the time where they are clinically able to be discharged. To see why they haven't been and, really, the challenge is to find them suitable accommodation, and that's the task that Bill and the state disability ministers have set themselves over the last week or two and they are working very hard on it. But it's not just NDIS participants, it's also people who should be in aged care facilities. Now, after they were at the point of being clinically able to be discharged, we have to ask why they're not able to go back into the aged care facility, and that’s a task that we identified on Friday at the meeting of health ministers. That particularly, as the Commonwealth that regulates aged care, that needs to taken seriously.
 
BEVAN:

And did you have an answer to that? Do you know why the nursing homes aren't taking them back?
 
BUTLER:

I think there's probably a range of reasons, but right the centre of it is that aged care facilities don't have the staff they need. You know, probably the big policy that we talked about over the last few months, it was the centrepiece of Anthony Albanese’s Budget reply, was to put nurses back into nursing homes. The idea that nursing homes don't have registered nurses on duty all of the time is often stunning to people when I tell them that. So, our policy of requiring nursing homes to have registered nurses on duty 24/7, and to lift the number of carers, will make it aged care facilities much more able to deal with those conditions that older, vulnerable people, frail people inevitably get day to day.
 
BEVAN:

Because you can understand where the nursing home's coming from – they’re saying listen, we could take this person back into our care, but they've got complicated problems, they've just come out of hospital, they need acute care, they need special care. They need to be in hospital. That's a resident with a lot of challenges as opposed to, you know, somebody's grandmother who's quite okay, well she can go in that room and we haven't even got a nurse to look after them. So how about you just keep them in the hospital? Is that effectively what's going on?
 
BUTLER:

That's right, you know, I think what we find is that our local public hospital, the QEH in my community in western Adelaide, ends up as the lightning rod for every failure elsewhere in the system. If you're not able to provide proper care in an aged care facility or you don't have NDIS accommodation or you can't get into a GP, it all ends up at the local emergency department and ultimately in the hospital, providing real pressure on our hospital system. What I've said, the best thing the Commonwealth can do right now to free up pressure on our hospitals, because right across the country we're seeing pressure, is to is to really make it easier to see a doctor. To staff up our aged care facilities better. To have Bill Shorten and the state disability ministers explore alternative accommodation for these 1000 people right now who are stuck in hospital for months after months.
 
FELDHOFF:

Mark Butler, thank you for your time.
 
BUTLER:

Thanks very much.
 
FELDHOFF:

The Federal Minister for Health and Aged Care, Mark Butler.

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