Australia's profit-based health system causes swine flu fatalities

By Linda Waldron

According to data published by the World Health Organisation (WHO) on August 20, the H1N1 influenza strain, commonly known as swine flu, has killed at least 1799 people and infected 182,166. Since countries are no longer required to provide data on swine flu cases to the WHO, and it has ceased reporting on each country, citing funding constraints, real figures are undoubtedly higher. According to the WHO website, the largest toll from swine flu has been recorded in North and South America, with 1579 deaths, followed by the WHO’s South East Asian region with 106 deaths and 53 in Europe.

Australia, despite its geographical isolation and small population, has recorded 112 swine flu fatalities, with 30,111 confirmed cases, making it the fourth worst affected country. While most fatalities were patients suffering a chronic secondary condition, on August 18, a 37-year-old man with no pre-existing conditions died at the Flinders Medical Centre in South Australia.

Australia is a wealthy developed country and should be able to protect its people from a new flu strain. The Australian government did take immediate action once the outbreak was reported in Mexico, enforcing airport screenings, placing cruise ships under quarantine, establishing a swine flu response task force and an information hotline and easing access to the national stockpile of anti-viral medication. These measures failed to contain the virus or prevent high numbers of fatalities because they did not address the actual risks. Australians are at risk from influenza outbreaks because there is no free access to preventive health care.

Expenses

The H1N1 outbreak took place during the Australian winter, when seasonal flu outbreaks occur. However, immunisations against seasonal influenza are provided free by the government only to people aged 65 and over. As of next January, all pregnant women and Aboriginal and Torres Strait Islanders aged 15 to 50 will also be able to receive free seasonal flu vaccines. If the entire population had been able to receive free seasonal immunisation before the H1N1 outbreak, detection of the swine flu strain amid the various seasonal colds and flus would have been much easier.

To be diagnosed with the virus, patients need to visit a GP. The consultation is partially subsidised by Medicare, but generally surgeries “bulk bill” (so that Medicare covers the full cost of the consultation) only if patients have a healthcare concession welfare card. This means visits to the GP can cost upwards of $25 each. So if an entire family of four are afflicted with mild flu-like symptoms, it will cost at least $100 to have the illness diagnosed. The cost doubles or even triples for after hours consultations. In many areas there is no bulk billing GP or surgery, making visits to a GP even more expensive.

This system discourages families from seeking medical attention at the first sign of illness or making repeat visits if symptoms change or deepen in severity. The prohibitive costs mean that many working-class adults in generally good health will visit a doctor only when severely ill, saving the money for medical expenses for vulnerable family members such as children or aged relatives. Anti-viral medication is most effective if taken within the first 48 hours of the onset of influenza, so if visits to the local GP were free, early diagnosis and effective treatment would be more widespread.

Medication restricted

In May, federal health minister Nicola Roxon said that the national stockpile held 8.7 million courses of anti-viral medication, which, as she pointed out, was one of the highest per capita stockpiles in the world. Even so, access to the national stockpile remains restricted. Once the official response was downgraded from “contain’ to “protect”, governmental policy determined anti-virals from the national stockpile should be offered only to those most vulnerable to complications, or those with moderate and severe infection.

The restrictions go beyond the recommendations made by the Swine Influenza Task Force of the Thoracic Society of Australia and New Zealand (TSANZ) and the Guidelines Committee and Executive Council of the Australasian Society for Infectious Diseases (ASID) in a joint position paper released on June 18 and updated on July 7. These guidelines state that “treatment should be prioritised for patients with risk factors for severe disease, such as older people (>65 years), pregnant women, patients with chronic disease (eg, asthma, cardiorespiratory disease, diabetes and renal failure) or immunosuppression, and young children”.

Current governmental H1N1 policy decrees that, “Vulnerable individuals with mild disease can receive antivirals following clinical assessment”. “Vulnerable” patients are defined as pregnant women, those with chronic respiratory conditions, Indigenous Australians, people with morbid obesity and those suffering a chronic illness. The policy therefore restricts access to the national stockpile to those categories deemed vulnerable, whereas the ASID/TSANZ guidelines simply recommended that these categories be “prioritised”. As well, the governmental policy removes older Australians and young children from the at-risk list. The policy guidelines state that “anti-virals will NOT [emphasis in the original] be routinely provided for: treatment (unless the person is vulnerable or has moderate or severe disease); nor prophylaxis of household members or other school, work or community contacts”.

Australians not identified as “vulnerable” can access anti-viral medication only by obtaining a prescription from their GP and then purchasing it from a pharmacy. This winter there was the usual high demand for anti-virals to treat seasonal influenza and increased demand related to swine flu. Many pharmacies intermittently ran out of private anti-viral stocks, and only a few designated outlets in each major centre were permitted to dispense national stockpile medications. The pharmacists can distribute national stockpile medication only to “vulnerable” customers with authorisation from their GP, even if all the private stocks have been depleted.

Prices escalate

Even if local pharmacies have regular and plentiful supplies of anti-virals, their cost further restricts access to treatment. Tamiflu, the brand name for the orally ingested oseltamivir agent, has no recommended retail price, so as demand for the drug escalates so does the price. On July 7, the ABC reported that some chemists were selling Tamiflu for between $7 and $8 for a single tablet. Because the medication needs to be taken twice a day for five days, a course of Tamiflu can cost up to $80. In April the Pharmacy Guild stated that the usual price was $50 per course, but guild president Kos Sclavos said he “can’t tell chemists what to charge for Tamiflu”.

While Australian surgeries and pharmacies are enjoying good business from the flu outbreak, the pharmaceutical companies are the real beneficiaries of the crisis. In late April the share price of pharmaceutical giants Roche and GlaxoSmithKline (GSK) rocketed in expectation of super-profits based on the global demand for anti-viral drugs, Tamiflu and Relenza. Second quarter results of GSK’s sales of Relenza were US$100 million, a 20-fold increase from 2008.

Sanofi-Aventis, GSK, Novartis, Baxter, AstraZeneca and the Australian-based Commonwealth Serum Laboratories (CSL) are currently developing swine flu vaccines. CSL is attempting to fill a 21 million-dose order for the federal government, and an order from the US for US$180 million worth of antigen—enough for 20 to 40 million doses. Analysts suggest that CSL may post sales worth A$300 million this year for its swine-flu vaccine.

The WHO has unofficially estimated that even if all the world’s labs were in full operation, only around 900 million doses could be supplied in time for the world’s population of 6.8 billion. In early August, WHO director Margaret Chan said: “The lion’s share of these limited supplies will go to wealthy countries. Again we see the advantage of affluence. Again we see access denied by an inability to pay.” Chan appealed directly to drug companies to donate supplies to poor nations, but so far only GlaxoSmithKline PLC of Britain and Sanofi-Aventis of France have pledged to donate 150 million doses to developing countries. Novartis AG of Switzerland has said it is looking at selling vaccines to those countries at discounted prices.

On July 27, Argentine health minister Juan Manzur said: “We expressed our concern about being able to count on the vaccine when it starts going on sale. We have information that much of the production is already reserved.” Argentine President Cristina Kirchner has called on the WHO to demand that patents be unblocked so that all countries can produce vaccines.

Socialist Cuba, while being a poor Third World country, produces its own generic anti-viral medication and provides the treatment free of charge within Cuba as well as sharing its biomedical research with other nations, thus bypassing the profit-based patents system. The ready access to free anti-viral medication is a key factor in Cuba’s high success rate in controlling such diseases, as well as in limiting their spread.

The August 1 London Telegraph published an account by British medical student Isobel Amsay regarding her treatment for suspected swine flu while holidaying in Cuba. Her article emphasised the scarce material comforts, such as the grim hospital wards and bland breakfast fare, starkly contrasted with the high level of medical care and ready access to free medication that she received. On manifesting flu-like symptoms, Ramsay visited a local clinic where she was seen by a doctor immediately. After being seen by a consultant epidemiologist, she was sent in an ambulance to the local hospital, where she was met by two emergency doctors. Identified as a potential swine flu patient, she was placed in a two-bed quarantine unit where she was attended once a day by a doctor and twice a day by nurses who administered Tamiflu.

After five days, when Ramsay’s swine flu results were confirmed as negative, she was discharged. She concluded her account by saying: “Despite the feeling of being in a story by Kafka, I was impressed with the professionalism of doctors who do their best with meagre resources and chastened by the thought that they earn a mere $30-$40 (£18-£24) per month. I won’t be complaining about junior doctors’ pay for a while.”

Despite its scarce material resources, socialist Cuba offers a free, universal healthcare system with research and training ranked among the best in the world. Capitalist Australia, with its vast material resources, runs a profitable healthcare industry that benefits multinational pharmaceutical companies, private practices and health insurance companies. Perhaps the different systems explain why Cuba has only had 242 confirmed cases of swine flu and no fatalities while capitalist Australia, with twice Cuba’s population, has had 30,000 confirmed infections and suffered more than 100 swine flu fatalities.