Woodhouse MichaelHon MICHAEL WOODHOUSE (National): 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 830000 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."