Tanya Plibersek (Sydney, Australian Labor Party, Shadow Minister for Human Services, Housing, Youth and Women) Share this | Hansard source

The National Health Amendment (National HPV Vaccination Program Register) Bill 2007 inserts a new section 9BA into the National Health Act 1953 providing for the establishment of the National Human Papilloma Virus Vaccination Program Register. The need for this bill arose from the government’s 2006 announcement to fund free HPV vaccine for females in the 12- to 26-year-old age group through the National Immunisation Program with the aim of reducing the incidence of cervical cancer. The government made this announcement after the Pharmaceutical Benefits Advisory Council decided that it was not cost effective for taxpayers to fund Gardasil—a decision which, at the time, was not without controversy. The establishment of the HPV register was also announced at that time.

Labor is supporting this bill so that the register can be implemented as soon as possible, because the National Immunisation Program has already begun. We are also supporting this bill with the aim that the register will enhance the efficiency of the program. This is especially important after some schoolgirls were hospitalised following injections. It is important to know if there are any side effects from the injection. While the Department of Health and Ageing officials have labelled the effects as psychological, it is still important to have a mechanism to monitor participants in the program. Of course, it is also important that we monitor the effectiveness of the HPV vaccine in preventing certain cervical cancers.

This vaccine is a huge breakthrough and will save many thousands of lives. It is an Australian innovation that makes me extraordinarily proud when I think of the health effects and protection that women around the world will eventually receive from this vaccine. I congratulate all of the scientists involved in the extraordinary discovery of this vaccine.

Turning again to the register, I want to clarify that the register will, firstly, facilitate the establishment and maintenance of an electronic database of records for monitoring vaccination of participants in the program. Secondly, it will facilitate the monitoring of the effectiveness of the vaccine in preventing certain cervical cancers by allowing for future cross-referencing of data against Pap smear and other information contained in registers maintained by states and territories. Thirdly, it will facilitate the establishment of mechanisms to advise eligible persons or their parents or guardians if vaccination has been missed or if booster doses are required in the future. It also allows for the maintenance of a record of people who are eligible to complete the course of the vaccination. It also facilitates the promotion of health and wellbeing by providing information on new developments associated with the program to vaccination providers, to women who are eligible and to their parents or guardians. The register also facilitates a payment to GPs for entering information into the register.

It is important to know that there was initial controversy about including Gardasil in the National Immunisation Program. Labor is very pleased that it has been included. The vaccine protects against two strains of sexually transmitted human papilloma virus and those two strains are responsible for about 70 per cent of cervical cancers. Free vaccines have been available from April 2007 in schools and from most doctors from July 2007. The Immunisation Program is targeted on an ongoing basis at 12- and 13-year-old girls and is to be delivered through schools, and there will be a two-year catch-up program for 13- to 18-year-old girls in schools. For 18- to 26-year-old women, the program will be delivered through their GPs and community based programs.

The government has committed a total of $579.3 million between 2006-07 and 2010-11 for the vaccination program. The program involves three injections over seven months. If the vaccination program had not been included in the National Immunisation Program, it would have cost about $430 for three shots. Of course, while it is a very high cost—more than half a billion dollars—the savings from the treatment of women with cervical cancer and the terrible loss of life associated with this disease certainly makes this half a billion dollars well spent.

I am very pleased that the government has decided to provide the vaccine free to all Australian young women. I think we need to acknowledge the work of the then shadow health minister, Julia Gillard, and the current shadow minister, Nicola Roxon, in supporting the government’s introduction of this free vaccine.

I know that it has not been without controversy. As I said, there are some people who have expressed concern that vaccinating young women will encourage increased sexual activity. Indeed, Australian Family Association spokeswoman Gabrielle Walsh was reported in the Daily Telegraph in May this year saying:

Some parents feel it gives the children a sense they are going to be sexually active ...

She further went on to say that, where young girls were going to abstain from sexual activity, it was not necessary to be vaccinated.

I understand why parents would certainly be wishing to discourage early sexual activity in their teenage children, and I support a parent’s right to do that. The key is that this course of vaccination will eventually result in lifelong protection. When young girls are at school, it is the easiest way of making sure that we have access to 100 per cent of the relevant population. I do not believe that it will encourage earlier sexual activity. I think probably the last thing that young people who are engaged in sexual activity that is too early are thinking of is whether they are protected from human papilloma virus. The difference it is going to make there I think is negligible. As I say, the benefit of giving it to young girls in schools is that they will achieve lifelong protection from human papilloma virus.

Incidentally, it is interesting to note that the federal Department of Health and Ageing says that recent overseas research has shown that 14.3 per cent of women who have had only one partner still carry the human papilloma virus. So, for parents who hope that their daughters will not engage in sexual activity before marriage and will have only one sexual partner throughout their lives, even for those women this vaccination is important.

According to a South Australian study of 2,000 people that was published in the Australian and New Zealand Journal of Public Health, only five per cent of parents were concerned that the vaccine would make their daughters likely to engage in earlier or promiscuous sexual behaviour, and 75 per cent of parents said that they wanted their daughters to be vaccinated. The key scientist involved in the discovery of the vaccine and 2006 Australian of the Year, Professor Ian Frazer, recently said:

The opportunity to protect against cervical cancer is as compelling as the opportunity to protect against polio ...

It is entirely the parents’ right to decide if they would like their child to be vaccinated. Hopefully they will be able to consider eventually that the vaccine is designed to protect against disease and the reality is that it has to be given early in life. If they wait too long, they could lose the benefit.

We know that when women contract cervical cancer they are faced with the potential of a much shorter life expectancy than they otherwise would have had or, secondly, if cervical cancer is not caught and treated early enough, a hysterectomy is the other potential. It is a very serious potential. In 2004—which is the most recent data that we have—212 women died from cervical cancer and many others were forced to undertake either the option of hysterectomy or other very invasive surgical and medical procedures. The idea that we can save hundreds of lives and tens of thousands of treatments I think shows what an important breakthrough this is and what an important thing it is for us as a society to support maximum vaccination.

The uncomfortable truth for many people is that a high proportion of teenagers are actually sexually active, the majority of young people in years 10 and 12 are sexually active in some way and a quarter of students in year 10 and half of students in year 12 have engaged in sexual intercourse. My personal view is that those figures are too high, but the reality for many Australian teenagers is that they have become sexually active, and that is another good reason to say it is very important to vaccinate against human papilloma virus from a very early age.

I think these figures, which show a large proportion of teenagers become sexually active quite early, suggest that we need to do a lot better with our sex education in schools. We do not have a very good national approach to educating teenagers about not just the physical consequences of sexual activity but also the emotional and psychological aspects of engaging in early sexual activity. I was interested to see that in the recent federal budget the government announced that it had spent half a million dollars on educational research for high school students to talk about the financial aspects of teenage pregnancy and the responsibilities that arise from becoming a teenage parent. Again, if people know teenagers, they know that thinking about the financial aspects of potentially raising a child is probably not going to be the thing that stops them from engaging in sexual activity if that is at the top of their minds at an early age. I think that, as I say, we can do much better in our sexual and reproductive health education.

I want to conclude by making a few more general comments about women’s health. Women use Medicare services about twice as much as men. An enormous range of medical problems are faced by women, of which cervical cancer is one of the more serious. We know that one in 11 women will be diagnosed with breast cancer before the age of 75. The most common age for that diagnosis is between 50 and 69. Rates of lung cancer, melanoma and non-Hodgkin’s lymphoma are all increasing. The really interesting thing about lung cancer is that Australia has done fantastically well in reducing smoking rates. We have done brilliantly. We now have the lowest smoking rates in the world because of decades of concerted education campaigns, advertising campaigns and because we tax cigarettes quite highly, as we rightly should; but young women are increasingly smoking. Young women are the only group who are taking up smoking in larger numbers. I think that begs the question about why young women are engaging in more risk-taking activities than in previous generations. We are also seeing more young women booked for violent crime, speeding offences and dangerous driving offences. I think there is a very interesting underlying question there about the changes in society that are prompting young women to engage in activities that older men and women see as very dangerous.

We know that we have very good screening technologies available for many of these diseases, including cervical cancer and breast cancer, but many groups in the community do not avail themselves of that testing regime as much as they should or in a way that would significantly reduce their development of these diseases. Breast screening participation rates for Indigenous women and women from non-English speaking backgrounds in the target population of 50 to 69 are just 34.8 per cent and 47.4 per cent respectively and are significantly lower than the general rate of 57.1 per cent of the target community.

We have increasing problems not just in the population of young women but also in an emerging population of young men when it comes to eating disorders and body image disorders. At the same time, we have increasing levels of obesity in the young Australian population and in the general Australian population. We need to do better in some of these areas when it comes to preventative measures in health care. As I said, we have done very well with smoking, but we have new and emerging challenges all the time which are increasingly related to diet and lifestyle challenges like obesity, leading to diabetes, for example. At the same time as we are seeing these emerging trends in poor health, most Australians are paying more to see a doctor, more for many medicines and more for private health insurance. There was very little in the most recent budget to genuinely tackle some of these health problems that are linked to the increasing expense of accessing normal medical services.

In the last few days we have had an incredible intervention from the federal government, saying that they are happy to take over the running of the Mersey hospital in Tasmania. It is no coincidence that the Mersey hospital is in an extremely marginal seat. Setting aside all the cynicism of taking over one hospital in one marginal seat, it really does beg the question of the federal government’s broader vision for health care in this country. The one-off taking over of one hospital, leaving many services in many rural and regional areas facing exactly the same problems of shortages of specialists and shortages of equipment and so on, suggests that the government is prepared to pick and choose the health issues it is involved in in a way that is, I think, detrimental to the running of the broader health system.

I will not conclude on a negative note. I want to conclude on a positive note of welcoming the initiative to provide Gardasil to women in the target age group and to other young women to provide them with a lifetime of protection from at least 70 per cent of the cervical cancers that are related to the two particular strains of human papilloma virus associated with this immunisation. It is a terrific step forward. Ian Frazer and his team must be congratulated for what is really a world-class breakthrough in women’s health. It makes me enormously grateful to think that my own daughter and grandchildren, if ever I have them, will be protected against the bulk of human papilloma viruses that may lead to cervical cancer. I want to express my gratitude to the scientific team who have come up with this breakthrough and offer my support not just for the national register but also for the free and ready availability of this vaccination program to young women who will benefit from it.

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