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10 Sep 2014

Transcript: AMA President, A/Prof Brian Owler, Parliament House Doorstop, 10 September 2014

Subject: Ebola response


BRIAN OWLER: What I wanted to talk about this afternoon was an evolving humanitarian crisis that we're seeing in West Africa. We've all been familiar with the Ebola outbreak that West Africa is currently experiencing.

What our focus has been to date has been the risk of an infection or a case of infection actually coming into Australia and the risk for the Australian population. The risk of someone coming to Australia with Ebola remains, actually, very low. And the authorities have taken measures to make sure that they try and minimise that risk.

But the real concern that we have now is about how we assist in West Africa. Because what we've seen is the number of cases continuing to increase. And the people on the ground are telling us that one of the things that they are really struggling with is to actually be able to provide the supportive care that people with Ebola need to actually survive.

The number of people that have died now has reached over 2000. The number of cases is almost 4000. And, clearly, the outbreak is out of control in that region. What we need to do is make sure that Australia and the international community actually steps up its support to make sure that we send the help that those areas need.

Now, the request has not yet come from West Africa or the WHO to Australia, formally, for that help, but it is expected that it will be coming in the next few days. And Australia needs to be ready to look towards how it approaches its humanitarian assistance and how it delivers help to these people.

We know that the death rate or mortality rate from Ebola can be up to 90 per cent, but if you can provide simple care - supportive measures such as IV fluids, treating their fevers and providing support over the three weeks that the infection generally runs for; you can actually reduce the mortality rate to 30 per cent.

We need the expertise on the ground as well as the health care workers that can provide support, that can actually organise systems, and organise people to help provide that support.

What we've seen is a willingness of the Australian Government and the international community to confront the challenges that ISIS has posed in Iraq. And while we can see that there's clearly a need to take on those challenges what we need to see is the same sort of commitment from the international community, including Australia, to actually make sure that we provide humanitarian assistance, not just to people in Iraq, but to, actually, people in West Africa as well.

Their lives are just as important. So, while it might be okay to send arms to Iraq, we need to make sure that we send arms and legs to actually provide treatment for the people of West Africa. Now, this is not without risk, and clearly people that go to West Africa will have to be on a purely volunteer basis. And doctors and nurses and other health care workers have always taken on that role. If people are willing to go, then we need to be able to be in a position to provide them the resources and support to allow them to do the job and provide that humanitarian assistance. I'm happy to take questions.

QUESTION: Would you be looking to have not just funding but medical professionals, volunteers, people on the ground as well as medical supplies from the Australian Government?

BRIAN OWLER: Well, that's right. So, to date, Australia has given $1 million to the efforts in West Africa. And that's really a drop in the ocean compared to what is needed.

What we would be looking for is either the expertise that Australia has and the health care workers that would - I know would volunteer to actually go and provide help in West Africa – provide that humanitarian assistance and do the work that we know that some people are already there doing.

I think we need to also use the NGOs that are currently on the ground in West Africa. We know that MSF and Red Cross are doing good work, but they actually need the support. So we need things like mobile hospitals and the sort of beds that patients can be treated in in those centres, and we know that other countries are actually looking to provide this as well. So yes, we need medical supplies. We need resources. We need mobile hospitals and beds and we need support and organisation for our health care workers that I know will be willing to volunteer and go.

QUESTION: There's an experimental treatment available for this. Why aren't we paying for that to go there? Wouldn't that be a better solution or developing a vaccine to prevent the disease spreading?

BRIAN OWLER: Well, there's an international focus already on developing a vaccine and developing treatments. I know that that's in process. But there's still - we're still unclear as to the effectiveness of the treatment - the experimental treatment - that some people have described. It's certainly not 100 per cent effective.

And what they're really struggling with at the moment is just being able to provide basic support; having people there that can actually control the infection, that actually can take the public health measures, that when people actually present to a hospital can actually be looked after, be put in a simple bed so that they can be given IV fluids, can actually be given things like paracetamol to control their fevers. And those very simple measures can actually reduce the mortality rate down to about 30 per cent.

QUESTION: Four thousand people, as you said, are already infected. Is it too late to try and contain this?

BRIAN OWLER: Well, it's not too late to try and contain it because what we know is that Ebola is not as contagious as what a lot of other viral infections can be; so, for instance, influenza, which is spread via coughing and sneezing. That's not the case with Ebola. It's spread by body fluids, spread by touching. And we know that there are some very simple measures that can be taken to actually reduce the chance of people actually contracting the disease.

Now, 4000 cases is the number of reported cases at the moment. But the word on the ground in West Africa is that it's very likely that the number of cases is actually going to be much higher than 4000. I think we've got to remember that we're dealing with areas and countries that actually have very simple health care systems. They don't have the resources to actually do the monitoring that first world countries have, and so it's very likely that the number of cases is going to continue to rise and, as we've heard today in the media, reports of, for instance, 20,000 cases are not out of the realms of possibility.

The more that the international community does now to try and control this outbreak, the greater our chances of reducing its spread in West Africa and further across Africa, but also reduces the chances of infections arriving in other countries and continents around the world as well.

QUESTION: You mentioned volunteers. Does this not require or deserve a military response, perhaps, from Australia?

BRIAN OWLER: I think that's one thing that could be considered, but I think we know that we have good people that are well-trained. We have the AUSMAT teams that are actually trained to go and work in difficult situations; people that have that public health knowledge and experience; nurses and doctors that are willing to go and work in these sorts of regions. There is clearly a risk to health care workers. Unfortunately, we've seen a number of health care workers, including doctors, die of Ebola in West Africa and so we are - you know, we would be asking people to undertake personal risk.

But that has been something that health care workers, whether it be doctors, nurses or other health care workers, have always done - is put themselves at personal risk to treat other people, their fellow man, and that's one of the principles of the profession of medicine and the profession of nursing.

QUESTION: You've said they’ve put $1 million on how much we've spent so far. How much would you like to see Australia spend? Five million? 10 million?

BRIAN OWLER: Well, it's not up to me to put a figure on it, but clearly, the WHO are going to be looking for resources from countries right around the world, Australia included, and I think we need to certainly be upping the amount that we're actually going to spend, and be able to provide for actually delivering this humanitarian work in West Africa.

One of the other factors that's important is we've got to make sure that there are contingency plans if the worst case scenario does develop where a health care worker from Australia actually did contract Ebola. It's a long way to repatriate them back to Australia, and so there are a number of logistics that have to be worked out before this, of course, would be possible. We want to, as the AMA, make sure that doctors and nurses are going to be provided with the reassurance that, if they did undertake and volunteer to undertake this work, then they would be properly looked after and have all of the assistance that we would expect our government to provide to them.

QUESTION: Dr Owler, the Government has commenced negotiations on the Sixth Pharmacy Agreement. This is an agreement that could be worth up to $20 billion worth of taxpayers' money. In the past it's been negotiated strictly between the Government and the Pharmacy Guild. Do you think other health groups should have a say in this; particularly as the Guild is now trying to take on some of the roles of doctors?

BRIAN OWLER: Well, I think it's interesting that the pharmacists look for protection in the form of up to $20 billion, as you say, in terms of the Community Pharmacy Agreement but, of course, are very willing to take on and increase their scope of practice into other areas such as providing primary care; roles that they're actually not suited to do.

We actually have the potential for other providers such as Woolworths and Coles, clearly, which have always been the groups that have been looked at as potential alternatives to community pharmacies. I think community pharmacies have a role for an important part of our society.

Having the pharmacist, I think, is the most important thing, though, and having them be able to advise patients and provide them with advice about their medication. It should be the thing that pharmacists are focused on, not increasing the scope of practice to areas that they have no training in. It should be focused on being a pharmacist first and foremost.

And so I think we need to ask ourselves - the question is: why are we giving up to $20 billion to pharmacies, essentially chemist shop owners, to actually distribute medicines when we have a lot of other alternative ways of distributing it? And I know that - I think the last Community Pharmacy Agreement was $13.7 billion. So I think we need to consider the Community Pharmacy Agreement in context with all of the other savings measures that are currently going on in health.

QUESTION: So you think Coles and Woolworths should be allowed to sell prescription medicines?

BRIAN OWLER: Look, I think the case should be looked at in terms of what the best thing is for the patient. And if the best thing is for the patient being able to access medicines at a cheaper rate, but still have access to a pharmacist that has the sort of training and expertise to provide the information to the person that's collecting their script and looking for advice on certain medications’, then that's something that I think needs to be considered.

QUESTION: Do you see any risks in chemists being able to check patients' blood pressure and cholesterol levels?

BRIAN OWLER: Well, what we're trying to do in primary care is actually have coordinated primary care with the GP at the centre. That is the whole role of the Primary Health Networks that have been established. And what we're not trying to do is fragment care where we have providers all over the community providing little bits of care with no linkage back to the general practitioner.

And I think this is the problem with pharmacists providing health checks when they don't have the training to do it. They don't have the linkage to actually provide people with advice about their health care. It's not looking after the whole patient and I think what we should be doing is investing in general practice and making the GPs the centre of primary health care, which is their role.

QUESTION: Regarding the GP co-payment negotiations, what are your thoughts on the comments from the cross-benchers and Clive Palmer about your alternative proposal?

BRIAN OWLER: Well, we haven't heard anything from Clive Palmer about the AMA's alternative proposal. All that we've heard is that he doesn't want a co-payment, full stop. But it does ignore the fact that we already have 20 per cent of GP services that attract a co-payment or at least private billing, so a co-payment in one form or another. And co-payments are something that the AMA has supported in principle, but we have never supported the Government's co-payment proposal because of its effect on vulnerable patients.

I think what we need to do is to make sure that people do actually have a look at the AMA's alternative proposal because it does provide protection for vulnerable patients. It does, in the government's words, still send a price signal to those people that can afford to contribute. It doesn't cut the Medicare rebate, which is an important part of the Government's proposal, something that the Palmer United people never talk about. The fact that there is this cut to the Medicare rebate; which is the patient's rebate. Not the doctor's rebate. It's the patient's rebate, and I think that's important to note.

But the AMA's proposal is about investing in general practice, making sure that we actually have a sustainable general practice that actually can do prevention and chronic disease management so that we actually can look after the burden of chronic disease, which is going to be the biggest challenge for the Australian health care system in the future.

QUESTION: And how long do you think these negotiations will be going on for?

BRIAN OWLER: Well, it really is going to depend on the approach of the Government. If they're serious about looking at alternatives we put, I think, a very well-thought-out alternative to the Government. We've never said that we will provide them with something that will take another $4 billion out of the pockets of patients and provide them with $3.5 billion of savings. I think the Government needs to consider alternative models, and have a good look at the AMA's proposal, and if it does that, it may have a chance of winning further support.

QUESTION: Has the Health Minister got back to you since you handed in your proposal?

BRIAN OWLER: I've had a discussion with the Health Minister since then. The Health Minister made his position fairly clear, but we're talking with a number of other members of the Government, and having further discussions about what an alternative might look like, and making sure that we do continue to protect vulnerable patients, but actually also value general practice and make sure that we invest in general practice so that we can perform the sort of quality general practice that we need for a sustainable health care system.

QUESTION: So you're talking to Tony Abbott or Joe Hockey?

BRIAN OWLER: I've talked to Minister Cormann recently, and we're seeking a number of other meetings at the present time.

QUESTION: So are you prepared to compromise on your plan?

BRIAN OWLER: There are very little things in our plan that we can see as a compromise. We can't accept a cut to the Medicare rebate. We definitely want to make sure that we protect the vulnerable patients. And so I think there's very little room for actually changing the fundamentals. Now, we will continue to act in good faith and continue to talk to the Government. That's what the AMA does, and what the Government wants to do as well, as we'll see where we can get to in the future. But where - we can't compromise the very principles that we've structured our alternative proposal on.

QUESTION: So have you found Senator Cormann more conducive to your plan?

BRIAN OWLER: Well, I think we had a very good discussion about the details of the plan. I think there was a very quick approach taken by Minister Dutton, in terms of saying, well, it doesn't - you know, it takes away 97 per cent of the savings. But I think when you actually look at the plan and go through the details about protection for vulnerable patients, but actually meeting a number of the Government's other objectives, while still being able to fund the Medical Research Future Fund through other means, you know, it's a proposal that's worth further discussion, and I think that's what other people are starting to realise as well.



 10 September 2014


CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

                            Odette Visser                      02 6270 5464 / 0427 209 753

Published: 10 Sep 2014