Law Reform (Epidemic Preparedness) Bill

I am speaking today in favour of the Law Reform (Epidemic Preparedness) Bill, which the National Party will be supporting, although I have to say we are doing so with some reservation. As was outlined earlier in the debate last week, the bill will address some of the gaps in the Crown’s statutory powers under the Health Act 1956. It will ensure that the Government has adequate powers to respond in a quick and effective manner to an epidemic, and it will update quarantine processes.

It is high time that we had this bill, because I can tell members that bird flu is not just a threat; it is imminent. It is almost upon us, and this bill is sorely needed. We cannot ignore the threat of bird flu any longer. The H5N1 strain of the virus is endemic in many countries in Asia, notably Viet Nam, and we know that with international air travel, it is just a matter of a short flight away. What is more, the strain has already caused numerous illnesses and deaths amongst humans in Asia, and the World Health Organization notes “that never before in the history of avian influenza have so many countries been simultaneously affected than in the past 5 or 6 years.”

But the real question is that with years and years to prepare for this eventuality—going right back to the severe acute respiratory syndrome (Sars) epidemic in 2001—why has it got to this point before the Government has actually done anything. The fact is that the Government has been on the back foot right throughout every stage of pandemic planning—right from that first day in November, in question time, when Tony Ryall asked the “4 out of 10” Minister of the “5½ out of 10” health portfolio if there was a list of people who would be receiving a special supply of the drug Tamiflu. The problem was that the Minister did not have a clue, he did not know, and that was pretty much indicative of where the Government’s planning was on this issue.

One has to ask how much it has progressed since then. We have this bill, but what we really need is a plan, and it has to be an actionable plan. We have seen draft after draft of plans—version 14 is the last one, and it was released back in November—but we still have not seen the final plan for how the Government will deal with an outbreak of bird flu in New Zealand. Then we had the debacle from the Government over the supply of emergency drugs during a pandemic. It was not until the National Party brought it to the Government’s attention during the select committee process that the Minister finally woke up and realised that if we have a pandemic we will be quarantined in this country, and asthmatics, diabetics, and many people with chronic and serious illnesses will need a whole lot of drugs and they will not be able to get them. What did we find? We found that the Government had not even thought about that. So it is pretty clear that the Government, from go to whoa, has not had a clue on how to prepare for this epidemic, and it has had 5 long years—going right back to Sars in 2001.

I have to ask members how the people of New Zealand can have confidence that the Government will get it right with this bill.

💬 Lindsay Tisch: No confidence at all.

There is no confidence. I have no confidence. I am frankly very, very worried about the prospect of an outbreak of bird flu, and I know that that fear is shared by the vast majority of the general public. When one looks at the way the “4 out of 10” Minister of the “5½ out of 10” health portfolio has been managing the elective surgery system, one asks why anyone could have any faith in his ability to prepare our citizens and protect them from the threat of this pandemic.

💬 Lindsay Tisch: You wouldn’t have.

One absolutely would not. We have seen a lot of statistics around elective surgery, which the Government has been trying to bury recently. But the fact is—and it is the National Party that revealed this—10,000 people in this country have been removed from the waiting list for first specialist appointments in the past year, and 24,000 people are waiting more than 6 months just to see a specialist. And more than 8,000 people—whom we know about—who had been told they would get an operation have now been kicked off the waiting list. What is more, we are seeing less elective surgery being carried out than when this Government came to power.

So, in the light of elective surgery being the touchstone for how well a Minister is managing the health portfolio, we have to ask ourselves how on earth if he cannot get elective surgery right, and if so many secrets are being swept under the carpet, we can expect this Minister to be able to lead our preparation for an epidemic and be able to supervise our overall planning. The answer is that we absolutely cannot. Because of this, National Party members believe there has to be a multiparty, whole-of-Government approach to this issue. I can say that we are very disappointed that we have not been consulted on the preparation of this bill. I am sure there are members from other parties here who will also be very disappointed, because I think in a matter of this seriousness for the nation we have to have wide consultation to make sure that we have the best possible approach. If we leave it in the hands of one party, and a party that has shown that its ability to manage health is clearly inadequate, we are headed for disaster. That is the actual fact of the matter.

Although, as I have said, the bill gives wide-sweeping powers to the Government and the police, there are some very real gaps in this legislation. The biggest issue, if we are faced with a pandemic, will be a total breakdown in law and order. Suddenly, we will be thrown into a scenario that none of us has ever experienced before. The medical facilities will be overwhelmed and people will be rushing to get into them. We in the National Party say that we have to look at some of the basics that have been missed in this bill. Treasury has stated that if we have a bird flu epidemic in this country, in the first year we will have an economic experience that will be exactly like the Great Depression of 1929. This country will have a drop in its GDP of between 5 and 10 percent in the first year of an epidemic. People will not have money in their bank accounts to pay their mortgages. Money will not be available to pay volunteers. When we consider this bill we need to highlight the fact that there are some simple gaps in it. What will happen to all the people who cannot go to work to earn the money to pay their mortgages? Will the banks foreclose on them? We need to have legislation to address some of those financial basics.

💬 Lindsay Tisch: Some certainty.

Yep—we need certainty. People’s economic well-being will be detrimentally affected. People’s assets will be wiped out unless we have legislation addressing some of these real basic concerns.

So those are some of the shortfalls, but there is another real shortfall in this bill. In 1918 we did not get on top of the flu epidemic until we appointed one person in charge overall, and the problem at the moment is that the response is totally fragmented. We have 21 district health boards doing what they like on bird flu. We do not know what they will do. There has not been a whole-of-Government rehearsal yet, which is absolutely crucial. We heard of some plan for a rehearsal of a whole-of-Government approach in November 2007, but I suggest to members that if we leave it as long as that, there may well not be anyone left—assuming we have had bird flu by that stage—to participate in the rehearsal. It will be too late. I call upon this Government to appoint someone in overall charge of the operation now. We have to have someone who is answerable for putting a plan in place and for guiding the operation. It will have to be someone with some organisational experience—perhaps a military person or someone with some serious business experience who can work across a number of Government agencies and really get things right.

In summary, we in the National Party support this bill, but we certainly have some reservations. We think there are a number of quite basic gaps in it. There is no question that the legislation is long overdue. I think the Government has been very tardy about this issue. I do not have any confidence that the Minister of Health is the right person to be guiding the response. We have to have a whole-of-Parliament response. We have a lot of talent across all the Opposition parties in this Parliament and a lot of people with knowledge to contribute. It is absolutely crucial for the well-being of this country that we have the best possible response. So my final plea is that we consult more widely on matters of this importance and that we absolutely get it right. It is crucial for the well-being of the nation.

Tēnā koutou te Whare. The most serious influenza pandemic on record is the 1918 Spanish flu pandemic. The virus hit Aotearoa in October 1919, probably arriving here with troops returning after World War I. It lasted a brief but violent 3 months, taking the lives of some 8,600 people. Throughout Aotearoa estimates put the number of Māori deaths at 2,160, which was about 42.3 per 1,000 deaths, but that figure could have been much higher because, at that time, not all Māori deaths were recorded. Māori died at seven times the Pākehā rate, and were one in four of the dead. In his book Te Puea Michael King stated that some Māori settlements were virtually annihilated. In respect of my electorate, he stated: “… a Pakeha visitor to the Atiawa settlement at the headwaters of the Waitara River in Taranaki counted 140 people there before the epidemic, and less than fifty afterwards.” Indeed, it was following the enormous toll of that epidemic that in 1920 the Department of Health established the division of Māori hygiene with Te Rangi Hīroa—Sir Peter Buck—as its first director. This history must be known and never forgotten.

I make mention of it firstly in recognition of the fact that the Spanish flu of 1918-19, which killed 20 million to 50 million people, shares genetic characteristics with the avian flu virus H5N1. Both are true avian viruses, not ones adapted to people, as more typical flu viruses are. But I draw on our past in order for us to learn for our present. This context must ensure that we have special provision to protect ourselves from ever again having to bear the cost of such a massive loss of life for Māori people.

Yet how can it be that the pandemic plans publicly available make no special provision for Māori? Public health physician Dr Nick Wilson, who has written about the projected toll from a pandemic, guides us in knowing that one thing we can operate on in confidence is that Māori will again be at risk of dying in greater numbers than non-Māori. Faced with the release today from the Wellington school of medicine, which reminds us of the ongoing systemic ethnic disparities in mortality rates, I say that the news is all bad. I alert this House to the urgent need to be familiar with this report, which delivers another powerful statement about the “historical and social processes that systematically disadvantage Māori (ie, colonisation, discrimination and racism).”

Is this House prepared to tolerate another decade of disparity? Well, the Māori Party certainly is not prepared to. Given that no major political party has a solution, we and our constituency, who are affected by these disparities, have a solution. We will be developing legislative measures to address the impact of racism as a matter of priority, and we would hope that the Māori members across the House will support us.

This latest report, and the report from Dr Nick Wilson, provides sobering data about the context of more chronic illnesses, more respiratory problems, high cigarette smoking statistics, and lower socio-economic status. All these factors create an environment ripe for the bird flu. Dr Wilson concluded: “If we have learned anything in the last hundred years, we would be doing more in these plans to protect Māori.” Members should note that quotation. So how can it be that the word “Māori” does not even rate one mention in this grand, new Law Reform (Epidemic Preparedness) Bill? It reminds me of last year’s Budget. How can this be, when Māori health professionals have been advising the Government of the vital need for Māori participation at all levels of the emergency planning? And how can this be when for months now Māori have challenged the Government that there must be an appropriate authority to speak on behalf of Māori, and the resources must be made available for them to have input?

The issue of avian flu has provoked huge reaction from tangata whenua. Members will recall the outrage of kaumātua who responded with utter dismay to the plan to ban tangi and to refrigerate bodies for up to 6 months. Other strategies raised were the direction to ban hongi, as they say that any close contact between people could spread the virus. I recall the Te Arawa Māori Trust Board chairman, Ānaru Rangiheuea, speaking out at the time and advising the nation that any delays in farewelling the dead were a breach of our cultural practices and would aggravate the grieving process. He stated: “Being isolated from a loved one would have serious implications for many families and there would be issues for Māori on how their dead were being treated.” Pīhopa Kingi also spoke out, challenging the speculation that a hongi should be feared. So did Te Runanga o Ngāti Pikiao chief exective Dennis Curtis, reminding us that hongi and tangi are as natural to Māori as breathing air, and any ban on such practices would enrage and outrage Māori, like some of the behaviour that has been experienced in the last week.

I mihi today to the leadership of people such as Ngaire Whata of Te Korowai Aroha and of Te Arawa, who I know has spent a great deal of time preparing for such a pandemic. Tangata whenua, as the Treaty partner, must be actively involved at all stages of the process.

Our history reinforces the excessive mortality Māori have suffered from communicable diseases, and without the appropriate Māori leadership, use of Māori infrastructures, and the ability of health personnel to engage with iwi and Māori communities, they are likely to be severely affected by way of mortality, morbidity, and economic, social, and cultural development. The Māori Party has been advising the Government for some time now of the urgent need to establish a Māori body to develop a Māori emergency plan—a body with Māori who have wide expertise and who are able to mobilise resources and develop a strategy that the Government can use to ensure that Māori and Crown interests are enhanced. The Māori Party has been writing to the Minister of Health and to the Minister of Māori Affairs again and again. We must ensure that Māori well-being can be protected and enhanced so that the future of our nation is assured.

Many, many more questions have to be asked about the efficacy of Tamiflu. We have been advised that the efficacy of Tamiflu against the common flu is questioned by the greater part of the scientific community. Last week in the House I sought a response from the Associate Minister of Health, the Hon Jim Anderton, as to the level of confidence the nation can draw from the efficacy of Tamiflu, and the answer left a great deal to be desired. I quote the Minister’s declaration to the nation: “Until there is a pandemic of that kind, there will not be any definitive answer to that question.”

Why is it, then, that there is so much to-do about nothing—or is it about nothing? There are then many wider questions that people have been raising, such as asking whether there really is a pandemic, or even an epidemic. Evidence is that the bird flu, although fatal to birds, is rarely transferred between human beings. The Concise Oxford Dictionary classifies an epidemic as meaning a sudden, widespread occurrence of an infectious disease. As of 27 April, exactly a week ago, the cumulative number of confirmed human cases of avian flu reported to the World Health Organization was 205—I understand that that is over 10 years—with 113 deaths.

We will not vote against this bill because even one death is one death too many. For tangata whenua the advent of avian flu, given our history and our present situation, would be very severe if it did occur.

I stand on behalf of United Future to speak on the first reading of this bill. The World Health Organization tells us that, historically, we can expect about three pandemics every century. The last one to dramatically hit the New Zealand shores was the 1918 Spanish flu that saw a 98 percent exposure rate of the population to the virus and a 40 percent infection rate, and, of that 40 percent, 2 percent died. That was over 8,000 people. It was experienced in three waves, each lasting about 6 weeks.

Every year in New Zealand we are hit by some strain of flu, and most years the death rate for such bouts and related infections is actually a lot more sizable than many New Zealanders realise. We have all had the flu, experienced its unpleasantness, and have recovered. But every year hundreds of New Zealanders do not recover and die from the virus or related infections.

On the global stage, New Zealand is less likely than most to have to implement a pandemic plan, due to our geographical isolation. However, with the large number of New Zealanders holidaying and working overseas, our isolation should never be taken as some sort of automatic protection. The Government’s pandemic plan is rightly based around a worst-case scenario, and it is interesting to note that as we strip away the fat from our public health system to make it cost-effective, we are unwittingly going to end up with a health system that simply will not cope with up to 40 percent of its staff off work seriously ill with the flu.

Although no one wants us to have to ever exercise the powers set out in this bill, we have to understand that this is written with an absolute catastrophe in mind on a national scale. If a worst-case scenario played itself out in this country, it would not just be the death rate that would be tragic. Treasury has predicted that the blow to our economy would be of such magnitude that our lives—those of us who live through it—would never be the same. It would take us a long time to recover.

United Future has, as a party, a natural aversion to excessive rules and regulations, and there are some provisions in this bill that under normal circumstances we would have huge concerns about. I think it will be important for the select committee to check very carefully what the time frames are and what the definitions are around when these pandemic rules apply. When do they begin? Obviously it would be with a declaration that we are in a pandemic, but when do we determine that it is over and normal law can be reinstated?

This will need to be thought through very carefully, and I think we need to listen very carefully to submitters, particularly those who have some expertise in this area. I would also like to think that the select committee considering this bill will lay it alongside these provisions those that are already contained in civil defence legislation, and that it will also look at some of the local government legislation that currently exists, allowing local government officials to isolate their regions should they so chose to do. A national pandemic plan may be thwarted by a local council that determines to put some oil cans across the roads—the exit and entrance into its area—and forbid anybody to come in.

United Future would like to encourage the Government, as it continues to plan and refine its plans and to listen to what is happening overseas, to be a little bit more proactive than merely planning. We believe there is a range of no-regret policies that could be implemented and funded now so that even if a pandemic does not occur we will never regret their implementation. Let me give an example. One of the reasons it is hard to get children in schools to wash their hands—and let us be clear, one of the main ways that we can avoid getting this bug, if it does arrive in New Zealand, is to have very high standards of hygiene around hand-washing, and the way we handle coughing, and sneezing, and things like that—is that very few schools have hot running water in their toilet blocks. In the middle of winter, which is a likely time for this type of pandemic to hit, children are very averse to coming out of the toilet and putting their hands under a tap of freezing cold water to wash their hands. Apparently someone has cited a figure that it would cost $30 million to have every public school in New Zealand with hot running water. But maybe it is an amount of money that could well be spent with very good results for our ongoing health outcomes in this country.

We need to look at our safer community initiatives around building better connectedness in neighbourhoods, because certainly we are not going to be able to rely on the normal hospitals and health professionals in a worst-case scenario. We are going to have to help look after each other, and people are going to have to stay at home and look after themselves. At present lots of people do not even know the names of people who live on either side of them. Some really great initiatives have been put in place in areas such as New Plymouth where the safer community council has a project called “three doors down” that encourages people to get to meet and know the names of people who live three doors down on either side of their property. What a great idea. It would certainly be good for social connectedness, and if we did have a pandemic on our hands that is the kind of initiative that would be very, very useful.

I agree with the Māori Party that it would be a very sensible thing to have a Māori emergency response team funded now so that it can start to plan and work with its people around marae in this country and discuss the types of issues that would need to be considered, particularly some of the ones that were raised by Tariana Turia. I think she raised some very interesting points.

We also need to stay abreast of international thinking. For instance, current thinking with pandemic planning is that one of the first things we would do is close all schools. Apparently, over in Australia people are, for very good reasons, rethinking that. It will be interesting to see the conclusions they come to and their reasons behind that. They are reviewing that because of some of the other problems it might create—workforce problems, children needing to be cared for at home, and children not being properly cared for at home and the kinds of social problems that would create. Some of the current solutions that are part of our New Zealand pandemic plan need constantly to be reviewed against international best practice, as it is being considered by others.

I do feel a sense of confidence. It sounds like the National Party members feel despairing about the current level of preparedness. I do not feel so concerned. I have kept in contact with Ministry of Health officials on this. One of the things I would like to encourage as part of a no-regrets policy is that every caucus in this House right now makes a time to be briefed, as a caucus, by the Ministry of Health on this important area. As local MPs it is really important that we start to make sure that the information we get to hear is disseminated out into our communities, our local government, our non-governmental organisation sector, our schools, and our Government departments, as they exist at a local level.

I managed to host an official from the Ministry of Health in Whakatāne just yesterday. It was a meeting of invited people who reflect key organisations in our communities, and it was called so that those people could hear the briefings I have been privileged to hear, so that they could respond and go back to their organisations and make any adjustments that might be necessary. I am sure that if every caucus in this Parliament took the time to get a full caucus briefing on this matter, they would leave very sobered by the facts as they are presented. It is a very important issue, and I think that members would all go back to their electorates with some really important initiatives that they want to see done.

United Future is supporting this bill. We think it is important and we welcome its introduction. We are mindful that some of its provisions are serious and need to be carefully monitored through the select committee process.

Bill read a first time.

on behalf of the Minister of Health: I move, That the Law Reform (Epidemic Preparedness) Bill be considered by the Government Administration Committee and that the committee report finally to the House on or before 31 July 2006.

Motion agreed to.