Teresa Gambaro (Brisbane, Liberal Party, Shadow Parliamentary Secretary for Citizenship and Settlement) Share this | Link to this | Hansard source

I move the motion on the notice paper standing in my name and at the outset I want to acknowledge the work of the parliamentary group for HIV blood-borne viruses and STIs which is chaired by Senator Louise Pratt, and I am the deputy of the group. I also note that Senator Pratt has moved a similar motion in the Senate recently, raising awareness of 28 July as World Hepatitis Day. It is one of the four official world disease awareness days endorsed by the World Health Organization.

The group has worked very well in a bipartisan way to raise and increase the awareness amongst members and senators of the work being done in the areas of HIV and other blood-borne viruses such as hepatitis C. Hepatitis C is a highly infectious, blood-borne virus that was first identified in 1988 and is transmitted by blood-to-blood contact. The most common cause of hep C in Australia is sharing contaminated drug injecting equipment, and unlike hepatitis B, there is no vaccine for hepatitis C. Around 304,000 Australians have been exposed to the hep C virus and more than a quarter of a million Australians suffer from chronic hepatitis C. Approximately 22,000 of these Australians are of Aboriginal and Torres Strait Islander descent and 16,000 of those cases are chronic and need treatment. This means that three per cent of the Indigenous population live with this infection and that is nearly three times the rate of the non-Indigenous population. Research has shown that if 100 people are infected with hepatitis C about 25 of those will clear the virus completely within two to six months of infection but will continue to have hepatitis C antibodies in their blood. About 75 of the 100 people who do not clear the virus will develop ongoing or chronic infection. Needle or syringe programs are the main prevention tool in Australia, and they save lives and they save money. However, as I said, to those who have contracted the virus 75 of the 100 will develop chronic hepatitis C. Current medications are available but they mean that most sufferers will have the common strain and they will have less than 40 per cent chance of being cured. Without access to cure, people with hepatitis C are at risk of liver disease, liver failure, liver cancer and ultimately death. Hepatitis C is already the number one reason for liver transplants in this country. As the motion states, it has now eclipsed HIV-AIDS as the number one viral killer in Australia.

The personal stories of people who suffer from chronic hepatitis C are very moving and I want to quote a story from a sufferer that was made available to me. I would have liked to have quoted the whole story but I only have limited time. This woman contracted hepatitis C due to drug use in her youth and over the years has had numerous flare-ups and three rounds of treatment. She says:

It has been five years since I relapsed. Since that time my health has been slowly declining. My liver scarring has progressed and I am exhausted and ache most of the time. I feel that I am living my life trudging through mud. My son is now eight years old. He is such a lovely child. He is energetic and very talkative. He has an acute sense of empathy which is unusual for a child his age. I wonder whether he will look back on his childhood and remember me as being exhausted all the time.

This is an example of the personal side to this terrible disease. However, there is a significant economic cost. The Boston Consulting Group has done analysis and modelling and has found that hepatitis C costs all levels of government $252 million annually and will cost $1.5 billion over the next five years.

In light of recent developments there is new hope for sufferers of chronic hepatitis C. Two drugs, boceprevir and telaprevir, were recommended by the Pharmaceutical Benefits Advisory Council in July of this year to be listed on the Pharmaceutical Benefits Scheme. The addition of these medicines increases the cure rate of hepatitis C up to between 60 and 80 per cent. As I said before, the current cure rate is less than 40 per cent. It is currently under negotiation with the department of ageing and once it has been completed the decision to list on the PBS is now with the minister for health waiting to go to cabinet. I urge the government to seriously consider elevating these drugs to the PBS to provide a hope of cure for the many thousands of sufferers of hepatitis C. I certainly commend the motion to the chamber.

Gai Brodtmann (Canberra, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to support Australia's efforts to address hepatitis C and I commend the member for Brisbane for bringing this issue to our attention. Hepatitis C is one of the most misunderstood health conditions in Australia. It is a virus that causes liver inflammation and liver disease. It is called a slow-acting virus because for most people afflicted by this condition it does not necessarily lead to death, although for a small number of those affected it does. But this condition does lead to a range of health problems that, left untreated, severely impact on the health of someone who has contracted the virus. Living with hepatitis C can restrict your ability to work, to parent and to engage in normal physical activities. Those affected can experience chronic pain. Earlier this year I met with John Didlick from the ACT Hepatitis Resource Centre and a constituent of mine and heard firsthand from him about what it is like living with hepatitis C. There are many challenges.

In Australia it is estimated that over 300,000 people have been exposed to hepatitis C, many living with the virus in its chronic rather than active stage, and 225,000 are living with it. Hepatitis C is passed by blood-to-blood contact. The tragedy of hepatitis C is that there are people who in their youth experimented with drugs, and they may have only tried them once or twice, and the result was them getting a virus that has devastating effects on their long-term health and wellbeing. While it is commonly associated with intravenous drug users, there are many who contracted hepatitis C from blood transfusions, from tattoos, from unsterilized surgical equipment or through accidental blood contact with someone who was HCV positive. While, unfortunately, there is no vaccination for hepatitis C, modern medicine has developed a treatment known as pegylated interferon and ribavirin, which is most effective for most viral genotypes.

I am very proud to place on record that here in Canberra we have one of the most expert and recognised regimes for treating hepatitis C in Australia, if not the world. The Canberra Hospital, in my electorate, is one of Australia's leading treatment centres, and its clearance rate is as good as any other hospital in the world. From all accounts, the nursing staff and specialists at Canberra Hospital provide not only first-class medical treatments but also the psychological and personal support needed by those undergoing treatment programs.

While the success for clearing hepatitis C is very high for most of the genotypes, there are strains that are hard to treat—where more research and investment is needed—and this is why there are people who need to go through a treatment program more than once. What the general public is not necessarily aware of is that those going through the treatment process experience a real rollercoaster ride of side effects. For the fortunate few, however, the side effects are manageable. The various treatment programs, which can range from a few months to almost a year, can have extremely debilitating and stressful impacts.

No matter how a person contracted hepatitis C, it is important to acknowledge that the treatment regime can be extremely arduous and difficult to endure. What is significant about the member for Brisbane's motion is that it addresses some of the main reasons why we must put in place measures that reduce and hopefully eliminate hepatitis C in Australia. Research commissioned in 2012 points out that, for every dollar spent to treat hepatitis C, $4 is spent to combat the consequence of not treating hepatitis C. So it is not just a health issue; it is also an economic issue.

I note that in Spain and Portugal, two European countries that have in place preventative measures, like needle and syringe programs, they take the view that these are health prevention measures designed to stop the spread of a virus. I welcome any measures that stop hepatitis C from spreading and also measures that lead to improved health outcomes for those affected by hepatitis C. I encourage all Australians to learn more about hepatitis C and to support research and services to eliminate this virus from Australia. Once again, I congratulate and commend the member for Brisbane for this motion.

Andrew Laming (Bowman, Liberal Party, Shadow Parliamentary Secretary for Regional Health Services and Indigenous Health) Share this | Link to this | Hansard source

If we are going to make any progress in this place, we do not need a debate between two sides of the chamber where, on the government side of the debate, they are reading notes about standard therapy that is now old news. I would hope that they would realise that there is now triple therapy that involves protease inhibitors, which has more than doubled the treatment rates. What we heard from the previous speaker is just old-generation treatment propositions—for the simple reason that her very own government has not funded the triple therapy that is freely available and funded in a number of other economies.

This is a government that has completely traduced the role of the Pharmaceutical Benefits Advisory Committee. While they may invoke the advice of experts, they also have to follow that advice. This is a government that has finally unhitched and uncoupled expert advice from the PBAC from their own decisions in cabinet. We have here a government that are more worried about their own fiscal outlook and delivering a surplus in 30 June next than they are about the viral threats that people living with hep C face.

There is excellent triple therapy available. We now understand very well their implications, even in the most complex of patients—with, for example, serious sclerosis or post-liver transplant. Work has been done in France with early access to these drugs. That is years old. Around 6½ thousand people went to Barcelona—which the previous speaker referred to—and talked about the role of triple therapy, and there was a statement made about a commitment to making sure that it is available. There was a very, very good reason for that. There are 300,000 Australians who live with hep C, with 226,000 of them having more than just the antibody response—having a genuine clinical disease. Half of them may be lucky enough not to have symptoms. But let me make one fact very clear: every year that this government delays and dithers on world standard care that has been ticked off and approved by our expert committee represents hundreds of people in this country dying of liver cirrhosis—and a handful will die from hepatocellular carcinoma. So let us not have any more speeches from that side of the House, reading off talking points, talking about standard therapy that is 10 years old. The work has been done; it has been extensively evaluated. We know now there is even more in the pipeline coming through—new drugs that have even fewer side effects, lower levels of anaemia, less need to treat with thrombocytopenic treatments like eltrombopag, which is the treatment to basically push up production of platelets and reduce the need to lower levels of protease inhibitors, which then obviously reduces your risk of successful treatment and getting control of your viral load. But, no, we have a government that is going in circles.

I put a call out to the next two speakers: acknowledge that there actually is new treatment available in your speeches. It has been through your very own PBAC. Acknowledge that and give us the dates and not talk about where the excuses lie for not moving ahead and helping these Australians have the world-class care that can be accessed if you are a citizen of another country but not here.

What we are seeing in this uncoupling is a breaking up of the PBAC as we know it, from authorised treatments that get ticked off to a new world where they get ticked off by the PBAC but do not get funded by this government. I can appreciate that there have been times when vaccines worth hundreds of millions of dollars were subject to a ATAGI delays, but this is the PBAC and this is not a large amount of money for the uncertainty, the risk of chronic disease and ultimately of death that are faced by people with hep-C. I acknowledge the previous speaker for pointing out that almost a fifth of them have not been involved in injecting drug use, despite the stigma that is attached to that activity; and many of these people only did that once. Let us stop treating them like they are second-class citizens. Let us acknowledge that the treatments are now available and extensively evaluated. It is called triple-therapy, and they have done an enormous amount of work on that around the world. So patients in Australia—there are 226,000 of them—would simply say to this government: 'What do we have to do? Do we have to have another World Hep-C Day on 28 July next year, where this treatment is not available?'

We have massive privacy issues already, reaching out to these patients. They are hard enough to find, in many cases, because five years ago they were told the treatment is too toxic and unpleasant—'So, don't worry about it; you don't need to be treated, you'll probably be okay.' But every month and every year matters. I say to the next two speakers—because I know their hearts are in the right place here—go back and talk to your very own Treasurer. I have said it once and I will say it again: the fiscal problems are self-induced. The fiscal pain that this government is facing next year, where it is effectively snookered on its promise to have a budget surplus, should never trump the people sitting behind me and the people around Australia who just look to Australia, with our world-class PBAC, to make the drugs available through a simple tick of this government's cabinet and at this time, it has not occurred.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

If I could commence my contribution to this debate by saying hepatitis C is a disease, an illness, that should not be politicised in the way that it was by the previous speaker. People on both sides of this parliament are committed to ensuring the best and timely treatment for people with hepatitis C. In a previous life I actually worked with people who suffered from hepatitis C. One case is particularly memorable for me—a young guy who died at the age of 17. He was having the standard treatment, that is still available. As the previous speaker mentioned, there are new treatments, treatments that should be embraced and will be embraced by the government, I am quite sure.

But the previous speaker took the opportunity to just play politics around such an important issue. I think he stands condemned for that, because it is not in the interests of the people who have hep-C to just make political statements and lower this debate to that base political level; rather, we should all be working to try and have the new-generation drugs listed. I know that on this side of the parliament we are committed to working to get cures and treatments that are going to help people with hepatitis C. I look at this from the perspective that with hepatitis C, what we need to do is look at education within the community, prevention, research and cure. It is all those things that go together to develop the right kind of outcome for people who are suffering from hepatitis C and those that are potential suffers from hepatitis C. It is through taking a strategy such as that that we can actually deliver real hope for the future to people in our community.

There is a recommendation going to cabinet very shortly. I know that the minister will look at it very seriously. I know that there has been a lot of work done that indicates just how important it is that a number of these drugs are listed. I know that there are many of us on this side of the House that will be working to see that people can get the best possible treatment that is needed. I think it is very important that we are debating this motion today in the parliament, because it is also about raising awareness of hepatitis C. The young guy that I talked about that lost his life at 17 years of age and whose real achievement in life, the thing that gave him the most happiness, was actually to pass the test and obtain his driver's licence, obtained his hepatitis C from a blood transfusion. It is very pleasing to note that since 1990, blood is being screened; prior to 1990, it was not. That is all part of the research and putting in place the right protocols to address this disease.

As time goes along, the strategies, the treatment, the prevention and the research change. We need to embrace change. We need to look at it from the perspective of those people that already have hepatitis C and those people that could potentially end up with hepatitis C at some time in their life. That is why the needle exchange program is so important. That is why I would like to encourage all members of this parliament to get behind and support the needle exchange program, as well as new treatments. I have not gone into the statistics and the number of people that suffer from hepatitis C, but needless to say it is 1.4 per cent of our population, and 1.4 per cent of our population deserve to have some hope for the future. Those that do not have hepatitis C need to be certain that they will not end up with hepatitis C. If they do, they need to know that there is a treatment that can help them.

John Alexander (Bennelong, Liberal Party) Share this | Link to this | Hansard source

I thank the member for Brisbane for presenting this important motion following World Hepatitis Day earlier this year. Chronic hepatitis B is a leading cause of death around the world. In Australia, we have a disproportionate level of chronic hepatitis B infection in Indigenous and migrant populations. Without a change to our approach to treatment, it is predicted that incidents of liver cancer—which is often terminal—will increase exponentially over the coming years, placing huge burdens on patients, families and our national health budget. Hepatitis C is a large and growing health problem, with more than 220,000 people in Australia living with this disease and thousands of new infections identified each year. Hepatitis C has overtaken HIV related deaths in Australia.

Unfortunately, hepatitis C is not often identified, with only two per cent of the population living with hepatitis C treated each year. Untreated hepatitis C can lead to progressive liver damage, liver cancer and death. Hepatitis C is the leading reason for liver transplants in Australia. These figures show us that the time is now to embrace a more holistic approach to hepatitis C prevention, treatment and management. According to the Boston Consulting Group, for every dollar spent to treat chronic hepatitis C infection, four more dollars are spent on the consequences of failing to prevent and treat the disease.

As the member for Bennelong, with the majority of the nation's pharmaceutical companies based in my electorate, and also as the chair of the Parliamentary Friends of Medicines, I am well aware of the amazing amount of work and investment that goes into the progressive improvement of drug treatments, prevention and care for chronic diseases like hepatitis C. Investment by the government into these treatments will be an investment into our nation's health and into our nation's long-term health budget. Recent medical breakthroughs now present us with an opportunity to make a difference to those suffering from this disease and to further reduce the transmission of the disease in our society. Last year two Bennelong-based companies presented new treatments to the Pharmaceutical Benefits Advisory Committee to obtain approval for listings on the highly specialised drugs program and the Pharmaceutical Benefits Scheme.Merck Sharp and Dohme submitted Victrelis and Janssen-Cilag submitted Incivo. Both of these received approval from the Therapeutic Goods Administration earlier this year, and PBAC approval in July.

This medicines represent significant clinical advantage in the treatment of hepatitis C, predicting an increase in cure rates from 30 to 40 per cent, using the current standard of care, up to 80 per cent with the new medicines. I understand there are budgetary constraints as this government chops every project it can in a mad scramble to achieve its promised budget surplus. It is therefore very heartening to observe a company like MSD enter a risk-sharing agreement with the Department of Health and Ageing, which will see the total cost of the Pharmaceutical Benefits Scheme capped at $50 million per year for all new hepatitis C medications, with a 100 per cent rebate of any cost to the PBS over $50 million. This means that any cost in making this medicine available to the community of over $50 million will be covered by the pharmaceutical company. This results in an absolute cost to the PBS of $200 million over four years to facilitate great steps in the treatment and prevention of this chronic disease for just over $4 per week for each hepatitis C sufferer.

Several days ago the department signed an agreement with MSD on those terms, meaning that cabinet approval is the only obstacle left that is stopping this marginalised community group from accessing this innovative new medicine. Hepatitis C sufferers in over 25 countries already receive publicly subsidised access to this medication, including the European Union, the United States, Ireland, Canada and Spain. I urge the minister to fast-track this listing for cabinet approval and to bring Australia into the modern era of hepatitis C treatment and prevention. I thank again the member for Brisbane for introducing this motion and allowing this parliament to recognise the 220,000 Australians silently suffering from this disease and the way in which we as policymakers can provide better treatment and help prevent the further spread of hepatitis C.

Janelle Saffin (Page, Australian Labor Party) Share this | Link to this | Hansard source

I too would like to thank the honourable member for Brisbane for bringing this matter before the House. The private member's motion was to acknowledge World Hepatitis Day, which was 28 July. The motion also lists a number of facts and figures and observations that I wholeheartedly support, including point (2), which says:

… welcomes scientific and treatment advances that greatly increase the chance of curing patients with the most common and hardest to treat strain of hepatitis C.

There are a number of other things that the honourable member pointed out in there. What I would like to put on the public record is some facts and figures to do with the area that I live in. My home is Lismore, my seat is Page, I live in the Northern Rivers on the North Coast, and I have here some observations and statistics which I got from North Coast Medicare Local and also from the local health service. It was on one of the papers of the ASHM New South Wales. It was a paper about chlamydia, STIs, hepatitis B and hepatitis C, and it was issues from Medicare Locals. I quote from that:

Northern NSW has the highest notification rate of HCV—

that is hepatitis c—

in NSW. The rate is highest in the LGAs of Byron and Lismore—

Lismore is my home town.

Northern NSW has the 4th highest rate of—

and then it goes on and talks about chlamydia. It also talks about the rates there and it covers the North Coast of New South Wales, a bigger area. So it is covering the Northern Rivers and the North Coast. The paper has a table which covers the same areas and which has a measurement of the high impact, medium impact and low impact. Again, it has HIV data, but it also talks about hepatitis B and C and chlamydia, but hepatitis C, HCV, is rated at No. 1, which is the highest impact on the scale of one to 15, with 15 being the lowest impact. I thought it was important that I put that on the record.

I also have here a media statement from 25 July. In the statement, the Northern New South Wales Local Health District Manager of HIV and related programs, Jenny Heslop, was talking about data from Medicare Locals which showed the rate of hepatitis C infection. Again, it shows the same figures but they are saying that, even though there are a number of public health strategies in place, there is still a way to go. The media statement talked about illnesses that hepatitis C can cause, such as cirrhosis, liver failure and cancer. But it can be treated. In the media release Jenny Heslop talks about treatment and what the treatment is. She said that it has a really high success rate, which I think is over 70 per cent. She was encouraging people to utilise that treatment.

The same report that I was referring to earlier, I think, talked about people receiving treatment. The figure was quite low. I cannot remember but I think it was 1.6 per cent or something. That has stuck in my mind. I had to read it a few times to believe it because it seemed incredibly low. Somehow we have to get more people getting treatment. I want to quote from the Economic Impact of Hepatitis C in Australia, a report by the Boston Consulting Group. They make a whole lot of observations, including about prisons and the high numbers of people in prisons. We cannot forget about people in prisons and we need to do a lot of work there. The report goes on to talk about two new drugs and says that one has had:

… regulatory approval in the US, Canada, Japan, the UK, the EU, Switzerland and Australia, although it is not yet listed here on the Pharmaceutical Benefits Schedule …

I think they are the drugs that people are talking about. I know people who are utilising them and getting some good results. I have read a report on how they work. (Time expired)

Debate adjourned.

Proceedings suspended from 13:33 to 16 : 00