For nearly thirty years now successive governments have been referring to Pharmac as the “government’s specialist drug buying agency”. Whenever Pharmac has been criticised for either not funding a particular medicine, or taking too long to reach a decision on a new one, governments have been quick to defend its autonomy. They have regularly affirmed its independence, stating that funding decisions on the nation’s medicine needs should be made on sound grounds of clinical efficacy, and not by politicians.
For its part, Pharmac has responded to the challenge. While it has infuriated some from to time because of particular funding decisions it has made or the time it has taken to fund a new medicine, it has generally won credit for the way in which it has managed the level of pharmaceutical expenditure over the years. Other countries’ governments have frequently expressed admiration for Pharmac’s negotiating skills with pharmaceutical companies and its ability to put together multi-faceted deals.
Because of the successful way it has managed pharmaceutical and medicines expenditure, Pharmac’s role has been expanded by successive governments to include other areas. Helen Clark’s Labour-led government broadened its role to include medical devices. And the last National-led government gave Pharmac responsibility for acquiring the vaccines New Zealand would need in an international emergency like the current pandemic.
Both those previous Labour- and National-led governments clearly felt that Pharmac’s autonomy and expertise were just what was needed to deal with first the increasingly complex area of medical devices, and second, the better organisation of mass vaccination programmes as and when they were required.
During last year’s election campaign there was criticism of Pharmac over access to new cancer medicines and whether it was taking too long to approve funding for these potentially life-saving drugs. That led the leaders of both the Labour and National parties to make spur of the moment commitments during a television debate to review Pharmac. By the cold light of the following day both were making it clear their commitment extended to merely reviewing some of Pharmac’s processes, not the basic model itself.
So when Covid-19 came along it was widely assumed that, with its independence, responsibility for vaccines, and negotiating expertise, Pharmac would be at the forefront of acquiring the vaccines New Zealand was going to need.
The Government would of course have to make extra funding available to Pharmac for this purpose, but there was no reason to believe that Pharmac would not take on the responsibility of securing the vaccines New Zealand would need to fight the pandemic, in line with its traditional practice and experience. But it does not appear to have happened that way.
From the outset, Minister for Research, Science and Technology Megan Woods has been the driving force on the vaccines front. It was she who announced last October that the Government had signed an agreement to purchase vaccines from Pfizer and BioNtech, and who reported in November that the Covid-19 Vaccine Strategy Taskforce, which is led by the Ministry of Business, Innovation and Employment (which reports to her) was negotiating with other pharmaceutical companies regarding vaccine availability for New Zealand.
The taskforce is chaired by the Chief Science Advisor at the Ministry of Health and draws its membership from a range of disciplines. According to the Ministry for Business, Innovation and Employment, the taskforce’s mission is to “ensure that New Zealand has access to safe and effective vaccines as early as possible.”
Pharmac is listed as one of the agencies (along with the Ministries of Foreign Affairs and Trade, and Health, Medsafe, the Treasury and the Department of Prime Minister and Cabinet). However there is no-one on the taskforce who seems to have any direct link to Pharmac or its work.
All of which looks very strange, given Pharmac’s long-standing responsibility for vaccines and experience in negotiating with pharmaceutical manufacturers. Even stranger is Minister Woods’ comment that it is the Ministry of Business, Innovation and Employment that is leading the negotiations to secure vaccines for New Zealand, not the Government’s “specialist drug buying agency” Pharmac.
What is going on here, and why has Pharmac been apparently sidelined at the very time when, given the unprecedented seriousness of the Covid-19 pandemic, its skills and experience are likely to be of premium value to the Government?
perhaps the Government has a more deep-seated mistrust of Pharmac’s autonomy and has a long-term strategy to clip its wings in that regard to make it more responsive to the Government’s wishes …
Surely in a crisis of the current magnitude, an agency like Pharmac should be playing the leading role in the negotiating and acquisition process, rather than being reduced to playing second-fiddle to a generalist government department that has not exactly covered itself with glory so far in managing other aspects of the Covid19 response, like managed isolation and quarantine, or the return of terminally ill New Zealanders to their families.
A possible explanation may be that at the time the original decisions were being made last year Minister Woods was also the Covid-19 Response Minister and it was therefore logical to bring everything together under the Ministry of Business, Innovation and Employment which was already reporting to her on other Covid-19 matters. If it was just a case of purely administrative convenience to have everything under that Ministry’s wing, it was a very short-sighted move that should have been reviewed a long time ago.
Or perhaps the Government has a more deep-seated mistrust of Pharmac’s autonomy and has a long-term strategy to clip its wings in that regard to make it more responsive to the Government’s wishes, while maintaining a thin veneer of autonomy. Appointing one of its own (former Minister Steve Maharey) a couple of years ago as Pharmac chair could be seen as a first step in that direction. Now, making it subservient to the Ministry of Business, Innovation and Employment in securing Covid-19 vaccines could be seen as the second.
Since Minister Woods’ premature and now clearly foolish comments last year that New Zealand would be at the front of the queue when it came to getting access to vaccines, the Government has been struggling to give a clear indication of when this might actually happen and public vaccinations begin.
Every time current Covid-19 Response Minister Chris Hipkins speaks on this issue, the date slips back further, now towards the middle of the year at the absolute earliest. Increasingly, it looks as though New Zealand is more and more at the mercy of international suppliers and the demands of other governments to deal with the needs of northern hemisphere countries first.
Faced with the fresh-faced enthusiastic naivete of MBIE rather than the hard-nosed approach of Pharmac they have been used to dealing with, the international pharmaceutical companies must have been rubbing their hands with glee.
As the vaccines timetable becomes more uncertain and drawn out, the Ministry of Business, Innovation and Employment, as lead negotiator, is looking more and more impotent and out of its depth. And the general public is slowly becoming more uneasy. Therefore, both the political management of public expectations and ensuring the availability of vaccines is becoming a more pressing challenge for Ministers than it was a couple of months ago. Far better in such circumstances, therefore, to have a compliant Ministry in charge, than an independent agency that might not always play the game the way the Government wants.
Whatever the reason why Pharmac is not leading the access to vaccines response, it is not acceptable. It is an appalling lack of judgment in the extreme to not be utilising in full the skills honed over a long period of time by the “government’s specialist drug buying agency”.
Faced with the fresh-faced enthusiastic naivete of the Ministry of Business, Innovation and Employment rather than the hard-nosed approach of Pharmac they have been used to dealing with, the international pharmaceutical companies must have been rubbing their hands with glee. At last they will be able to push New Zealand around as it suits them without the experienced pushback from the long-vaunted “government’s specialist drug-buying agency.”
The one certainty to emerge from all this is that, unfortunately, whatever the reasons for this bizarre approach, New Zealanders will be the losers.