Recently appointed chair of the Generic and Biosimilar Medicines Association, Jane Halton AO PSM, spoke with BioPharmaDispatch about COVID-19 vaccines, active ingredient prescribing, the patience required to achieve system-level change and the importance of a mature dialogue on policy.
Ms Halton led the Department of Health for over a decade during a period that delivered significant structural change to the health system, including the PBS. She retired from the public service in 2016 having led the Department of Finance since 2014.
The GBMA chair is a member of the prime minister’s COVID-19 Coordination Commission advisory committee and has played a key role in the development of COVID-19 vaccines as chair of the Coalition for Epidemic Preparedness Innovations.
On the vaccine rollout that is progressing at different speeds in over 60 countries, Ms Halton said, “The thing to remember is that almost everyone is doing something they have never done before.”
She said Israel has been so effective, having fully vaccinated over 20 per cent of its population in just over one month, because “it practices”.
“They are worried about biological and radiological events. They practice vaccinating the whole population.
“Yet nobody should think countries are going to roll-out a program of this size and scale and not experience some glitches. In fact, and I have already said this several times, we should expect it and not be too perturbed about it.”
Ms Halton said Australia’s plan to vaccinate the entire approved population group in 2021, which could be approximately 20 million people, will require the administration of around one million doses per week.
“The good news for Australia is that our health system does work and we know it will deliver,” she said, adding the experience in other countries shows the prioritised population groups are relatively easy to find because they are more likely to regularly engage with the health system or even reside in aged-care facilities.
“Over 60 per cent of people who have died from COVID-19 have been in residential aged care. If our objective is to prevent ill-health and death, which by definition it must be, we know where to find those people to administer a vaccine.”
Ms Halton said the UK and Israel have been very effective at quickly immunising these groups and that we could expect to see a significant decline in pandemic-related deaths in these countries over the next four to six weeks.
The GBMA chair also described the adoption of active ingredient prescribing for the PBS from 1 February as “really sensible”.
“It has taken longer than many people would have liked but I am pleased it has now been implemented.
“It actually underscores just how much work and time is required to make significant changes. In the case of active ingredient prescribing, there is years and years of practice that has to be adjusted, so all credit to the people who have done all that work.”
On the issue of biosimilars and the potential for further mechanisms to promote their use, Ms Halton said, “I think we are only at the beginning of that journey. The number of people involved in making this work is significant. It does not mean there is ill-will but it takes time to change the familiar, even if we know it is for the best. We all have a role in creating a level of comfort and giving them the required knowledge and incentive. We are at the beginning of that process.
“You will remember when we were doing this in the small molecule space just how long it took us to get past the natural concern and reserve. We got there in the end. I see this as being the same journey.
“Change is incremental and inevitable. It is important we take everyone on the journey and not pander too much to the people who, for their own reasons, just want to slow it down.”
Ms Halton continued, “It works at two levels. There is the system-wide view but also the micro-detail. You want to understand the kinds of considerations people have and what they need to enable them to confidently make a change.
“This is important for the PBS. The focus on deficits has gone away for a while but it will be back. What we do not want, what none of us want, is for the PBS to yet again be under pressure to make serious budget cuts in ways that none of us would think are good.
“If we know there are structural changes that can be made, and biosimilars is the obvious next ‘cab-off-the-rank’, then that can help contribute to what continues to make the PBS sustainable.
“Frankly, that is in the interests of the entire sector, including the innovators because it will enable new listings.
“With all of these changes it is a journey and I think the capacity to have a respectful conversation is absolutely part of that journey. What is important is that we have a group of people who have a collective interest in protecting the institution of the PBS.
“Industry can participate in and, indeed, lead on these issues around innovation and change. It is the industry’s part in the collective stewardship of the institution. This is very important and something we have seen with the change on prescribing. Everyone has been involved. All of the associations are involved. This has enabled the delivery of something that is a good thing to do for the institution.
“Ultimately, it is in the interests of the government, industry and patients if there is a mature dialogue about how to best manage this system. That is the best and frankly only way to do it.”
