Medicines Amendment Bill (No 2)

I present a legislative statement on the Medicines Amendment Bill (No 2).

💬 SPEAKER: That legislative statement is published under the authority of the House and can be found on the Parliament website.

Thank you, Mr Speaker. This is a very simple bill. It does a very simple thing. It gives the Director-General of Health the power to—

💬 SPEAKER: Order! I think the member needs to move the bill.

Oh! I’m obliged, Mr Speaker. I move, That the Medicines Amendment Bill (No 2) be now read a second time.

This amendment bill does a very simple thing. It gives the Director-General of Health the power to make an appropriate order to make a vaccine otherwise not available, available for widespread use. The background to this is, of course, COVID 19, and we have a recognised vaccine, the Comirnaty vaccine produced by Pfizer. Pfizer applied for and obtained from Pharmac approval for the use of that vaccine in accordance with the terms applied for by Pfizer, and that allowed the vaccine to be administered within New Zealand to a number of New Zealanders over a certain age, and a certain number of doses certain periods apart. It is clear from information available that this vaccine, like most vaccines, has a waning efficacy and, as many other countries have found, we wanted to make sure that particularly vulnerable parts of our population continued to get access to the vaccine while COVID remains a real risk.

Pfizer has indicated they don’t intend to make any further application for use of the vaccine beyond the two doses and a booster dose, although for some people they, effectively, receive four doses, although a growing body of international evidence suggests that it would be a useful thing for a further dose to be available to some parts of the population. The vaccine is available to anybody whose GP is prepared to prescribe it on an off-label basis, and so what is being sought here is not something that is out of the realms of possibility otherwise, but it would be an enormous exercise, of course, if everybody who wanted to get it as a further reassurance because of waning efficacy had to go to the GP, had to seek a prescription off-label, and had to go through that process. This simply allows the director-general who would be required in terms of the amendment bill to obtain appropriate advice, which the director-general would do, to allow the vaccine to be available on a broader basis.

That is, effectively, what the bill does. I’m very thankful to the Health Committee, who met in short order, including during the recess week to obtain information and to hear from some stakeholders, who have indicated their support for the bill. On that basis, I commend the bill to the House.

The question is that the motion be agreed to.

Thank you, Madam Speaker. It’s a pleasure to speak to this bill. I want to thank the select committee and officials, who met in a truncated process, and I also want to thank our team and shadow Leader of the House, who made persuasive arguments for us to have a truncated process, so at least we could have some feedback on this bill.

The select committee met with oral submitters and received written submissions. To each oral submitter, we asked several questions: are they comfortable proceeding without waiting for the Pfizer data, which we were told would be available in a month or so, or in the coming months, quote, unquote, is what Pfizer says. Every oral submitter said to us, “Yes”. We then asked: do they believe progressing without the Pfizer data on the basis of the international evidence provides more benefits than waiting for that data? Again, every submitter said yes.

Of the written submissions, I want to just recall for a moment the very valuable submission from Te Rōpū Whakakaupapa Urutā, whose data through the COVID pandemic has been very useful. Their response to the committee was “At our meeting last night we discussed the purpose of the amendment and agreed that the proposed amendment is sensible. It is pleasing to note this determination to improve access to COVID-19 vaccines for Māori and other New Zealanders. We are supportive of the amendment and are of the view that it will ease access to further COVID-19 vaccinations when and if required.” Te Rōpū Whakakaupapa Urutā—that is their submission.

We asked several questions of officials. We asked them: “Is this bill in any way mandating the fourth dose?” The answer we got was “No”. “Is this bill only related to the current assay?”—that is, if the Pfizer vaccine changes in any way, is that being permissioned by this bill? We were told that this bill is specific to the current Pfizer assay; any changes would need new legislation.

The Royal New Zealand College of GPs presented and raised a really interesting question, because conceptually this is an off-label - type process under section 23, and they raised the question that with most off-label medicines there’s a much more involved and engaged, informed consent process that is required. They had concerns that for the number of vaccines that might be being looked at, that informed consent process for off-label could be cumbersome. Officials replied that the consenting process for the COVID vaccine is now mature, and the college should be reassured that the burden of any new consent will not fall on them—that is, the standing consenting mechanisms should suffice for what is required for this slight variation of off-label.

We were reassured by the submissions that we heard. If we just remind ourselves what we’re doing here, treatments provided under section 23 go through a Medsafe approval process. Due to the timing and the urgency, this particular booster—the second booster, the fourth dose—is unable to go through that same process. There’s currently six preparations approved under section 23, provisional consent: two types of contraceptives, two pandemic flu vaccines, the Pfizer COVID-19 vaccine, and an electrolyte solution used in hospitals. So there is some use of provisional consent, section 23—a little bit of section 20 as well—already out in the environment.

Of the submissions that we heard that addressed the bill, we were reassured that some of the issues that we have grappled with they were comfortable with, and many of them are much greater experts than we are in this domain. More particularly, we were reassured by their assay of the international evidence—which, in the absence of the Pfizer application to Medsafe, which they wrote to us saying it would be in the coming months—that suggests that there are more benefits to proceeding now rather than waiting for that application to Medsafe. So here in the second reading, it has an assessment of what the select committee did. National will be continuing to support this bill in the committee of the whole House. There will be a few points that we’ll just raise for discussion, but here in the second reading we are supporting this bill. Thank you, Madam Speaker.

Thank you, Madam Speaker, and I’m happy to rise in support of the second reading of this bill. As chair of the Health Committee that dealt with the consideration of this bill, can I just acknowledge colleagues from all around the House for their collegiality as part of that process, but also the select committee staff, the Ministry of Health advisers, and also the Parliamentary Counsel Office, because this was a bill that went through a shorter time frame that was determined by the House.

I acknowledge Dr Reti’s contributions as part of that process around the submissions that were received by the select committee. Five of the six submissions that were received were in support. The outstanding one was that of Pfizer, who didn’t explicitly comment in favour or against the bill. The committee, in its report, notes that that’s appropriate given the commercial relationship that Pfizer has with the Government. We also heard from the Minister for COVID-19 Response and was reassured with the responses that he was able to provide to the select committee.

This bill delivers a rather discrete change to the Medicines Act. It inserts new section 34A, and that will allow the director-general to issue a notice that would allow for the fourth dose of the COVID vaccine and only the COVID vaccine, which was a point that was traversed by the Health Committee at the time, to be administered by ways in which we are all familiar with, out in community clinics, community providers, and the like.

There were a couple of issues that were raised during the select committee process. The first is the suitability of this opportunity or whether the IMO, the immediate modification order that exists under the Epidemic Preparedness Act, was more appropriate. What we heard was that that is an emergency power component and therefore it was not appropriate to be utilised for the purpose of what this particular bill or amendment was seeking.

The second was around transparency. Some of the submitters asked questions around whether the information that would be made available to the director-general, in the process of them making a determination to issue the notice or not, would be publicly available. And we heard that that would be no different than what was currently the approach by the COVID-19 Vaccine Technical Advisory Group, which is published on the Ministry of Health’s website.

So I’m delighted that the select committee has returned a report to the House which seeks no amendments to the bill, that it suggests or recommends that the bill be passed, and that it is the unanimous position of the select committee. I commend this bill to the House.

Thank you very much, Madam Speaker. I want to start by saying that the process this bill went through was a very good one—a very shortened process—and I will say that we in the National Party, in the Opposition, were a little bit uncomfortable about the process that was originally envisaged by the Government for the process of this bill, which was, essentially, to put the bill through without any time at the select committee. Our view was that that ran uncomfortably up against our traditions of spending time at a select committee, running through the bill properly and just getting to grips with the precise nature of what we were dealing with. That’s not to say bills can’t skip the select committee process. Clearly, bills can, and bills will continue to have that happen to them in the future. But for something important like this—Parliament, essentially, legislating the authorisation for a fourth dose, or at least the authorisation for the director-general to allow a fourth dose—we’re a bit uncomfortable around doing that holus-bolus without any select committee scrutiny. So I want to credit the Government for acknowledging that and stepping back a bit and saying, “Yeah, we’ll send it to a select committee for a short amount of time.”

I was in isolation last week, so I haven’t had a chance to sit on the committee, but I’m aware that the committee has done a good job very quickly getting to grips with the issues behind the legislation. I think a couple of points come out at me. The first is that a fourth dose is going to be useful for some people—probably not everyone, and it will be voluntary—and I’m already getting emails from a few people who are saying they’re really keen to go and get a fourth dose. I’d encourage those who are eligible and who would find it helpful to go and do that at the appropriate time, which is not too far away. I think the science is relatively clear.

The issue that I had in particular when it came to considering the bill at the start was whether or not we had to legislate and whether or not we had to pass an entirely new Act of Parliament, and whether or not there could be an immediate modification order process gone through to authorise this so that the Parliament didn’t have to sit. Look, reasonable people can disagree about this. At the end, the committee has determined that the bill should proceed, and we’re not going to stand in the way of it. I think it was a pretty collegial process, so we will support it.

I’d just note in passing—and perhaps in closing—that we are going to have to come back to the Medicines Act. This is one of these important, architectural pieces of legislation, and by that I mean the framework with which our health system operates. It’s not political, to be honest—it’s not party political. It’s just important that we get the law right and it’s important that the underlying legislative framework that the health system operates in is well-constructed, and, look, the Medicines Act 1981—there’d be a few members of the House who were around then; I certainly wasn’t. So it’s now 40, 41 years on and we’re going to have to come back and do a thoroughgoing review of it. It may be this Government that does it. I suspect it will end up being the next, National-led Government, but that’s OK. We will do the work as and when it is required.

The other point I’d just finally make in closing is that I was struck by the fact that every submitter to the bill was in support of it, so this is not a particularly contentious issue. This is a bill where we quite rightly said, “OK, let’s just hold fire for a week. Let’s send it to a committee just to make sure we’re really doing the right thing here. Let’s just ventilate the arguments. Let’s just ventilate the issues a bit. Let’s kick it around for a week.” We sent it off to the committee—

💬 David Seymour: Love a bit of ventilation.

What was that?

💬 David Seymour: Love a bit of ventilation.

Love a bit of ventilation, yeah. If we’d had a bit more in the managed isolation and quarantine hotels, we might not have had the Delta outbreak. But, anyway, I digress.

We kicked it round at the committee and every submitter was in support of it, and, of course, the hard-working health officials gave their support as well. So we’re very happy to continue to support this bill all the way through the House, and I don’t think the House need spend a huge amount of time on it in the forthcoming couple of hours. Thank you.

Thank you, Madam Speaker. Yes, the bill actually just provides a permanent and futureproof solution to what is going to be ongoing vaccination requirements. As said by the previous speaker, Chris Bishop, whilst we acknowledge the select committee and thank the submitters, all of them were in favour so there’s nothing controversial here.

It, essentially, just allows the Director-General of Health specifically to authorise the ongoing use and to do so in an equitable way, which I think is a point that we should potentially add, in so far as the Ministry of Health data very specifically showed that most people didn’t go to their GP to get their vaccinations. Nearly half visited a local pharmacy or they went to community sites or community group sites. So it’s really important that this bill allows all of the COVID-19 vaccinators to continue to do so, which should improve the equitable community access to the fourth dose should those vulnerable groups, who the director-general deems may need that second booster, to be able to do so in a reasonable manner. So I have no hesitation in commending this bill to the House.

Kia ora. Thank you, Madam Speaker. It’s good to be back here in the House. It’s been a while for me, actually, and I kind of get the urgency around getting this sort of thing over the line. Parents around the House will know that, with the borders being relatively closed over the last couple of years, we’re getting three years or two years, or whatever it is, worth of winter infections coming into our homes via our kids. So I understand the need to have a select committee process despite the urgency, and I was just finding myself, for once or twice in the history of my short time in the House, agreeing with that corner: that it is actually really important to have that select committee process; that it’s really important to have that transparency, even if it is a shortened process as well; just to kick it around a little bit, get stuff written on the record to make sure that when people go back and reflect on the decisions that we’ve made, that there is some clarity around that.

So it’s good to see that and it’s also good to see the relative ascension of Mr Tangi Utikere to the chair of the Health Committee as well. I’m not a frequent visitor to the Health Committee but I am always impressed by the number of doctors and health professionals at this Health Committee as well. I’ve just got a humble law degree, like I think a fair number of us around here in the House as well. So to have that health expertise embedded into this select committee is a good thing. And I was just thinking, what better person to wrangle all those doctors than a teacher, and Mr Utikere—I can speak to him—he is a good teacher. He taught one of my kids and I have nothing but the utmost respect for all of the teachers that have had the fortune to teach my children.

So the purpose of this bill is to allow for another COVID-19 booster. We are doing it through the legislative process as well. We are in the midst of a pandemic as well, so it is important that we have some way to actually move this stuff forward. The bill would insert new section 34A into Part 2 of the Medicines Act, which relates to medicines and medical devices. New section 34A would enable “the Director-General of Health, by notice, to authorise the administration of a COVID-19 vaccine other than in accordance with the data sheet”. The proposed amendment would enable the director-general to specify by notice one or more of the following: “(a) who the vaccine may be administered to: (b) the recommended number and frequency of doses: (c) the recommended manner of administration: (d) [and] any other circumstances” as well.

As previous speakers have said before, we got support, both from oral submissions and written submissions, and there were questions put to those submitters just to get that clarity from them that they saw that this was the process that we were going through, because there is that Medsafe process there as well. But because of the situation that we’re in, let’s ask the experts, let’s ask those submitters whether they thought this was the right process moving forward, and they all said yes.

I guess, for me, the bit on transparency is really important. What I have learnt and maybe what we all have learnt—hopefully we all have—is that we should trust the experts. We should trust the health experts, those with the very specific expertise in those areas: epidemiologists, microbiologists, etc. I was just thinking, you know, if you get a plumber that comes into your house, you trust them to fix the plumbing in the sink, you don’t then go and double question them and go on to YouTube and double check to see if they really know what they’re talking about; you trust the expertise that they have. Starting off with that basis of trust is a really, really important thing. So having this select committee process, even though it was short, was also quite important as well.

I guess the other theme that keeps popping up for me, when we talk about the COVID-19 response, is the key element of communication. I was just reflecting on the report that came out last week about the Government’s response to Delta, and the lesson in there was around making sure that we allow those leaders in Māori and Pasifika communities and making sure that we centre the voices of our immunocompromised and disabled whānau as well.

It would be good to have a line of sight from the sorts of things that we are deciding to do today, but also moving forward as well. Things like a school plan, because when I meet with teachers they are wondering, “Well, what’s happening here?” We’ve got things that are impacting upon teachers and impacting on relief teachers, disregarded sick leave and so on and so forth. So having that plan in place would be really important for them, but also really important for their parents, of which a number of us around the House are those parents.

We’ve got a nice, sharp, short, written submission from Te Rōpu Whakakaupapa Urutā. They said, “Thank you for the opportunity to make a submission on the Medicines Amendment Bill (No 2). At our meeting last night we discussed the purpose of the amendment and agreed that the proposed amendment is sensible. It is pleasing to note this determination to improve access to COVID–19 vaccines for Māori and other New Zealanders. We are supportive of the amendment and are of the view that it will ease access to further COVID-9 vaccinations when and if required.” And so, if it’s good enough for the good doctors, then it’s good enough for the Greens. Thank you, Madam Speaker.

Madam Speaker, thank you. I rise on behalf of ACT in support of this Medicines Amendment Bill (No 2) at the second reading of it. I couldn’t help but think about what the member Teanau Tuiono, who just sat down, was saying. He said something very interesting: “We should trust the experts.”, and I thought that’s very interesting. That was the way for thousands of years, and one of the greatest advances in the last few centuries was the idea that ordinary people could read the Scriptures for themselves and didn’t have to be told what to think by the experts. They called that the Reformation.

Then there was the Enlightenment and the scientific revolution—the idea that people actually could think for themselves and challenge. He said that we should trust the experts because you wouldn’t second-guess your plumber. Well, actually, if you’ve never been ripped off by a cowboy tradie, I guess that’s probably a reasonable way to be. Well, I think it’s important for this particular debate that, actually, we have a balance between trusting and respecting expertise and merit, but also being prepared to question and actually challenge authority, because I think we’ve got that balance wrong through a lot of our COVID response.

We are now seeing many, many different costs to our COVID response that are the result of failing to challenge authorities that turned out to be wrong in hindsight. I’ll just give you one example. We were told unquestioningly that we needed to have a COVID-19 managed isolation and quarantine (MIQ) system to keep us safe from the virus. Well, actually, as it turns out, behind closed doors in as early as October, there was conflicting advice and debate about whether that indeed was true. But that debate was kept from us for a further four months, during which time we spent $220 million on MIQ and we kept people out of the country, at enormous human cost—and we’ve only just had an acceptance, but not an apology, that that was wrong—all because we believed the mantra that you should accept what the experts are saying, even to the point that debates are concealed from us and we don’t participate in them.

So I’d just say to the member that trusting the experts—that was the mantra of humanity for many millennia. But, actually, critical thinking, the Enlightenment, and the ability to challenge, debate, and think for ourselves are equally important and would have improved our situation in material ways as we have responded to the COVID-19 pandemic. I digress.

This Medicines Amendment Bill (No 2) is not a particularly complex thing, although I differ slightly in my reading of it from Shane Reti, which I hesitate to do because his expertise and sincerity in all matters medical is beyond reproach. But he said this would only be for the Comirnaty vaccine. It says if there’s been provisional consent to “a” COVID-19 vaccine, then the director-general can change the way that it is administered, how often it’s administered, in what doses, frequency, administration, the way that it’s administered—those things can be varied. So, for example, without a data sheet, we can have a fourth dose where, previously, consent was given only for a third dose. But I would imagine that that applies not only to Comirnaty but to any other vaccine that has been consented through the normal process. Those ones could also have their conditions varied under this.

Where that gets interesting is a question that we’ll have at the committee stage, and one that I know that many people have, which is will this law allow the director-general to approve Comirnaty in much smaller doses—I think it’s three—for six-month-old to five-year-old children, because there are a great many parents out there who would like to be able to immunise their little ones. I accept there are others who don’t want to, and that’s just fine. But we’re here for freedom and choice and accepting other people’s choices—we need a lot more of that sort of sentiment in our world today—and there’s a lot of parents of young ones who would like that choice.

In theory, reading this legislation, it will allow the Director-General of Health to vary the administration of the Pfizer Comirnaty vaccine—it’s a problem when you say things you’ve only ever read—and allow it to be administered not just as a fourth dose but also to younger New Zealanders. I know there’s a lot of parents who are fearful and they believe that if their kid is going to get COVID at some point in their life, then giving them some baseline immunity now is a worthwhile preparation. I think they should be allowed to do that and I think the director-general should use the law that way. We’re looking forward to asking the Minister if the Minister believes that they will.

With that thought in mind, I think this bill also points to wider issues in the way that we regulate, and other members have referred to this, saying that perhaps our Medicines Act 1981—it’s older than me—should be kept as it is, or it needs a serious do-over. Actually, I would argue that New Zealand’s duplication of regulatory systems, where we have our own system in parallel to Australia and the US and the EU and UK and Japan, is completely nuts. I mean, this is a supposedly First World, industrialised, developed country that is having conniptions where the leading article in the news most nights is about the shortage of a sandwich of cardboard and plaster of Paris—you can’t make this up. But the fact is that because we’ve duplicated our regulatory systems—we’ve said we’ve got Australia standard, New Zealand standard—AS/NZS—for building products, we’ve got brands, and we’ve got the councils and architects having their 10 cents, there’s only one particular type of plasterboard that’s managed to run the gauntlet and get 96 percent market share. Now, they can’t supply the market and we’re in crisis, but, as it turns out, plasterboard is on the critical path for most building.

I’ve raised this because, actually, we have a similar problem right across our regulatory regimes, and it’s been very true during COVID in our response to it. It’s been true across medicines. The fact that we need this bespoke legislation so we can approve something that other countries have been doing for months—that is, giving a fourth dose—tells us that our regulatory system is duplicative and broken, and we need to fix that. But, actually, we need to fix our regulatory systems and duplication thereof right across the board when it comes to product markets.

We particularly needed to do it, and this has been ACT’s policy for about two years now—that if a COVID treatment or technology or test is available in those other jurisdictions of Europe, the US, Japan, Australia, and the UK and if it’s good enough for them, it should be good enough for us. If we’d done that, for example, with rapid antigen tests, we would have had a much more advanced response and we’d be a lot further down the track back to normalcy. Instead, we are accepting and absorbing all of those costs of our COVID response that may not have been obvious at the time, but are becoming obvious now in so many ways. You know, kids that weren’t intensively worked on by youth aide police officers are now doing ram raids. Actually, it’s happening around the Western world as a response to COVID response.

I’ll finish by making one comment that I know will be on the minds of people with anything to do with the regulation, permitting, or consenting of vaccination, particularly around COVID-19. Some people believe that this will somehow be a precursor to mandating and making it compulsory—you will have to be vaccinated—and I can understand the distrust, because the Prime Minister of New Zealand stood up and said, “You’ll never be penalised for not being vaccinated.”, and then it actually turned out that you would be. That has eroded our social capital and our trust in institutions, as we saw in our conflagration outside Parliament, which was the irrational, extreme end of that eroded trust.

I think we need to be clear as a Parliament that nothing in this legislation will lead to it being mandatory, and there is something the Government could do, which is to actually remove the remaining mandates for medical workers, because here’s a situation: we are currently, depending on who you ask—the Minister had to correct himself today—2,500 to 4,000 nurses short. Nurses are vaccinated at a rate of about 40 percent for the flu, but are mandated to be boosted for COVID, and yet there’s now more flu in the hospitals than COVID in the hospitals, and there are 518 nurses currently mandated out by the requirement for boosters. So can we afford to have 500 nurses missing because they’re not vaccinated for COVID? Meanwhile, the hospitals are filled with nurses who haven’t had their flu shot and the hospitals are full of flu. Where’s the logic here?

A gesture that the new Minister for COVID-19 Response, Ayesha Verrall, could make is to stop the mandates for nurses and get the nurses back into the hospitals, and if she’s not prepared to do that, why doesn’t she mandate them for the flu shot? If she ain’t going to do that, there’s no logic in requiring the COVID one, because there’s more flu than COVID in the hospitals.

That would be a gesture that would help reassure people around this legislation. But it’s absolutely the right thing to do, and ACT absolutely supports it. Thank you.

Mālō e leilei, Madam Speaker. It’s great to back in the House after taking time out with my now eight-week-old baby girl. So it’s good to be back. It’s just, I guess, a good reminder that our families do sacrifice for us to be here doing the work here, as well.

It’s good to rise to support the second reading of this bill. It’s good to ease back into work as well, sitting on the select committee last week and hearing our submitters come in. I acknowledge my colleagues from the Royal New Zealand College of GPs and hearing what they had to say, but it’s good all round to get reassurance that all our submitters supported the bill, bar Pfizer because of their interests in it.

I do want to mention in terms of this bill making it easier that it is all about equity, it’s about access, and it’s about protection of our whānau. I think about my nanna with mobility issues. If she had to go get a prescription, the timeliness of getting that, and then also getting the vaccination done—this bill will help improve that process and make it better not only for the patient but for the provider as well.

So I’ll be brief: I support this bill. Thank you.

The next call is a split call.

Thank you very much, Madam Speaker. I rise on behalf of the National Party and as the member of Parliament for North Shore to talk on the Medicines Amendment Bill second reading.

I want to recognise Dr Leavasa—welcome back to the House, and also a good and consistent member of the Health Committee, of which previously he was a part of, but I do acknowledge our members on this side of the House Matt Doocey and Dr Shane Reti for their contribution in regards to that Health Committee, which has reviewed the bill that is in front of us. I think the review by that committee was an important aspect in terms of being able to put thought and get feedback from the six submitters that did provide feedback, including the Ministry of Health, in terms of some of the practical implications and challenges in regards to this bill.

I pick up from David Seymour’s comments before around that regulatory complexity. I think I would agree with that in regards to the fact that throughout COVID—and having been a member of the Health Committee throughout that period—I think one of my memories will be around the fact of the challenges around our system in terms of being able to balance the need for the regulatory impact, which is articulated, highlighted, and amplified, in a bill such as this, but also the need to be agile to the rapidly changing environment. I think our regulatory complexity that we do have is an area that does need to be reviewed and simplified. The reality is, as has been canvassed, regulatory complexity and burden does bring a cost, not only a fiscal cost but also a cost in terms of decision making and delay, which can and does have implications more broadly.

I wanted to recognise the submissions. While there was only a small number that were made in regards to this bill, my understanding from those on the committee is that it was comprehensive and it did provide clarity and context in regards to this area, which gave the committee confidence in terms of continuing to support this bill.

I think the other element in terms of that—it has been already made as well—is in regards to that trust and confidence. You can definitely see that trust and confidence in Government has significantly reduced, particularly over the past five years. I think, post-COVID, that trust and confidence, or lack of, has been amplified, and definitely the way in which elements of the response in regards to COVID, particularly around vaccination, has definitely played a factor in regards to that. That’s a real issue, and something that has and will be canvassed. I’m obviously looking forward to the point at which we actually undertake a review of our COVID-19 response in this country and actually undertake a thorough exercise, which I do note that the UK Government actually started to commission last year, so they’ve already started and are well into it.

The reality of any review of a response is, one, at a primary level, to be able to learn from what did occur and what didn’t occur so that those improvements can be made. I think this bill, or the lack of that review not even being started or commissioned or planned, remains a considerable issue, I think, in terms of New Zealand’s resilience to be able to deal with—

💬 Hon Andrew Little: I thought the member didn’t like working groups.

—future challenges in regards to that. And I can hear members on the other side just commenting around that, and I’m still not clear on why they aren’t supporting those reviews to be undertaken, but I’m sure we will continue to call for that transparency.

I think, lastly, the point around the fact that there is nothing in this bill that would mandate this vaccination I think is important to make. We have moved on in terms of where we are in regards to that conversation and again, reinforcing that point that this bill does not do that, but, of course, those decisions can be taken by Government, and we’ve seen the implications of that in the past.

That’s pretty much all I wanted to cover in regards to the second reading of this bill. Obviously, a comprehensive process undertaken, which I think has added value in regards to where we are. I think, obviously, in terms of the ability now for this to be implemented to ensure that everyone who requires this will have the ability to have access to this medicine—as a result of this, they now will be in that position. So I’d like to commend this bill to the House.

Thank you, Madam Speaker. Very much like the member for the Green Party Mr Tuiono, I also am not an expert in health and am just a humble lawyer. So I wasn’t there to scrutinise this particular bill as part of the select committee. But what I did quickly have a look at were the experts who did submit on the bill—the five that did agree with it.

I just want to basically confirm and affirm my support for the Immunisation Advisory Centre’s submission, which is, very briefly, that they approve the use of the vaccine that already had consent or provisional consent for use as a new medicine. They believe that this bill will help to manage the risks of COVID-19’s spread and provide therapeutic value to those being vaccinated. They also supported this bill because it allowed for our vaccination workforce to administer further doses of the COVID-19 vaccine in the same way they have for the primary courses and the first booster doses. And they paid particular question to the House to just pay heed to targeting Māori and Pasifika. So, on that note, I commend this bill to the House

Thank you, Madam Speaker. This is, as Mr Little said, a very simple bill which allows the 834,000 people who would benefit from a fourth dose to receive it if they wish—if they wish—in a much swifter and more equitable way. The people that we are referring to here are people who are over 65, Māori and Pacific people over 50, and those who are severely immunocompromised.

I just want to follow up very briefly on the conversation that we heard a little earlier about flu. Influenza is indeed an extremely serious illness, but COVID and flu are not directly comparable. To the unvaccinated person becoming infected, COVID has a substantially higher, up to 10 times higher, rate of mortality—that is, it will kill 10 times as many people as the flu does. The moral of the story is please get vaccinated, and vaccinated against flu too. Thank you.

Thank you, Madam Chair. I think the fact that the Health Committee in its deliberations has recommended no change to the bill does not undermine the importance of the process that was followed in the last 10 days. I want to commend submitters and the committee for their work in that regard. I think some of the questions that I had at first reading have been answered. Others have not, and I think we need to explore a little bit of that in the committee of the whole House.

In my first reading speech I talked about the committee asking two questions: is this the right thing to do, and is this the right way to do it? Now, to the degree that we are seeking equity and removing barriers to people actually getting their fourth dose if they are eligible for it, we are achieving that goal, and people have talked in this reading about the evidence of benefit. I’m not convinced it’s as strong as people would suggest. The Minister talked about the plethora of countries that are doing this—the second booster—and by my count there are only seven, which leaves over 190 countries that are not doing it. As recently as last month, the World Health Organization reviewed the evidence for a fourth COVID dose and said that the lack of data exists and it may show some short-term benefit for those over the age of 60, but a very tenuous benefit for anybody else. Pfizer themselves, in their four-paragraph submission to the committee, made a telling comment: “Recommending the use of an additional booster is a decision for the New Zealand Government”. So they were ambivalent, at best, about it.

Like Mr Seymour, I was interested in Teanau Tuiono’s comments about trusting the evidence of the experts. The plumbing analogy: I would have a slightly different take on it. It would be analogous to a qualified plumber coming in and fitting systems that had not been approved by any standards organisation, and everybody going, “Well, they’re the experts. That’s OK”. Now, it is slightly different, but I think we should be healthily cautious about the expertise.

So to the issues that were raised, I think the two really important things are that this isn’t going to be mandated—that was very clear to the select committee—and the application would be required if the assay changes, although I note that assay is only one aspect of dose management. There’s also the frequency and quantum of the dose that’s administered in any pharmaceutical. I doubt that that will be amended, but technically it could be.

The things that I’m worried about still are whether changing the legislation is necessary. I still believe the immediate modification order is a perfectly legitimate way to continue to do the things that the Government has already done with a third dose.

The refusal to consider a sunset clause on the basis that the Medicines Act will at some stage in the future be repealed and replaced—well, we’ve been talking about that for 10 years. The previous Government was talking about it. The next Government will be talking about it. I don’t think that was a case for not having a sunset clause on what’s a pretty broad mandate.

The fact that there’s no benefit-cost analysis: I’ll be raising this in the committee of the whole House with the Minister, but I would encourage the select committee, in taking advice from Pfizer, to actually do it by way of an inquiry and I trust Mr Utikere, with his Labour colleagues, to consider that very carefully. I think two things would be considered in such an inquiry that we could hold in the spring or early summer, and that is: what is the evidence of benefit for the fourth dose, or the second booster, and what was the cost of administering 830,000 doses of that fourth dose, and was that matched by, as the regulatory impact statement (RIS) said, the number of avoidable hospital admissions, harm, and death—because I think the RIS has a much stronger sense of the benefit here than the World Health Organization did in its article last month.

So there’s still quite a bit to be done. While the House is obviously going to support this, there are still some caveats. We can explore them in the committee of the whole House, but I do implore the Health Committee to keep in touch with Pfizer and with Treasury or the Ministry of Health on whether or not the extraordinary further outlay is going to be exceeded by the benefits in reduced harm.

Tēnā koe, Madam Speaker. Tēnā koutou e te Whare. Before I speak on this bill, I just want to wish everyone in the House Mānawatia a Matariki—happy Māori New Year—as well as acknowledge that today is international yoga day, which is being celebrated across the world in over 150 countries. Today, I had the pleasure of hosting it here in New Zealand with the honourable Ginny Andersen, being the first country in the world to host it. I just want to thank all the members who actually came early in the morning to join us for yoga.

Just coming to the bill now, the Medicines Amendment Bill (No 2), the House has been in recess in the last week. I was out in the community meeting people and talking to them and I got asked about six times when the fourth dose of vaccine is on its way. So it was really good to see, out in the community, that people are interested in having another booster shot, which will eventually help our communities keep away from hospitals, keep away from sickness. As my colleague, and former midwife, Sarah Pallett said, it is also a good reminder now to make sure that you get your flu shots at the same time to make sure that we are doing a good service and keeping the waiting lists of the hospitals low.

I also want to acknowledge, as a member of the Health Committee, the submissions we did receive in the tight time lines we had, especially from organisations and people who are involved in looking after our communities, because it does make a huge difference when these people are involved and support the work we are doing through this bill. I also want to quickly acknowledge parties across the House who all agree on this bill, and I would like to recommend the bill to the House. Thank you.

Motion agreed to.

Bill read a second time.

In accordance with a determination of the Business Committee, this bill is set down for committee stage forthwith. I declare the House in committee for consideration of the Medicines Amendment Bill (No 2).

In Committee

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