Preparing government responses to reports from Parliamentary inquiries often involves finding a plausible excuse to reject a perfectly sensible suggestion. The Department of Health and Aged Care failed this task in its response to the House of Representatives Long COVID inquiry.
The inquiry began in September 2022 and received almost 600 submissions. It held four days of hearings, and published its report (Sick and tired: Casting a long shadow) on 24 April 2023.
The government finally got around to releasing its response to the report on 15 February 2024.
Given it took longer to prepare the response to the report than it took to carry out the inquiry leading to the report, one would expect a clear account of the actions the government was taking. One would be disappointed.
The report made nine recommendations, some with several parts, leading to 20 recommendations in all. The government supported eight, supported in principle another six, noted five, and did not support one.
As anybody with experience in deciphering the tea leaves in government responses will tell you, there is not much difference between not supporting, noting, and supporting in principle – they all mean that the government is not going to take action.
For example, the report recommended that the government should establish and fund a multidisciplinary advisory body to assess the impact of poor air quality and ventilation in high-risk environments, and lead the development of national in-door air quality standards.
The government response notes the recommendation, before going to describe a range of unconnected and disjointed activities that are vaguely relevant to the issue.
To actually explicitly say that the government does not support something is thus a very strong statement.
The only recommendation to receive an explicit “the government does not support” is the recommendation “that antiviral treatments for COVID-19 be approached as a pharmacist-initiated medication to participants eligible under the PBS”.
Under current arrangements antivirals must be prescribed by a GP, physician or nurse practitioner. The government guidance for the use of antivirals says that “you must start courses of these antiviral treatments as soon as possible after symptoms from COVID-19 begin”. Given the difficulty in many areas in securing a timely or affordable appointment with a GP, the requirement for a prescription from a GP will potentially be inconsistent with starting treatment “as soon as possible”.
The committee’s recommendation was based on evidence from the Pharmacy Guild that pharmacists are able to initiate COVID-19 antiviral treatments in the US, Canada and NZ. It concluded that similar arrangements in Australia “would ease the pressure on GPs and assist people who are not able to easily access an appointment with a GP within the first five days of their COVID-19 infection. This will also improve patient access to COVID-19 antiviral treatments and extend access and use throughout Australia, including in rural and remote areas, leading to a decreased burden on public hospital emergency facilities and other health services”.
The government response explains that antiviral treatments are classified as Schedule 4 (‘Prescription Only’) under the Poisons Standard, and that under state law, pharmacists are usually prohibited from prescribing Schedule 4 medicines.
It then goes on to state that “the Government must comply with current legislation, which does not support pharmacists dispensing COVID-19 oral antivirals without a prescription or prescribing these medicines as pharmaceutical benefits. The National Health Act 1953 and subordinate legislation do not authorise pharmacists to prescribe pharmaceutical benefits that are eligible for PBS subsidies”.
The statement of the law is true – but the whole point of the committee’s recommendation was that the law should be changed. If pharmacists could prescribe antivirals under current legislation, there would be no need for the recommendation.
And while it is true that the states would need to amend regulations under their Poisons Acts, there is no point in them doing this unless the Commonwealth amends the PBS to make benefits payable for these medicines if prescribed by pharmacists.
There may be other arguments for not allowing pharmacists to prescribe COVID-19 antivirals. It could be argued that only a doctor or nurse practitioner could assess a patient’s eligibility against the clinical criteria for access to the medicines. It could be argued that COVID-19 is such a serious illness that a patients should be under the care of a doctor or nurse practitioner, not just seen by a pharmacist. But the government is not making these arguments.
Rejecting a proposal to change the law to a state inconsistent with the unchanged law simply because it is inconsistent with the unchanged law is sophistry. The government should do better.
• Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media. Follow on X/Twitter at @CharlesAndrewMK.
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