Reti ShaneDr SHANE RETI (National—Whangarei): Thank you Mr Speaker. It's a pleasure to speak to this Budget and appropriations bill. I want to speak to some of the points that the Minister of Finance the Hon Grant Robertson has raised particularly around the increase in the Vote Health Budget and the appropriation and the pre- and post-coronavirus situation which he also described in some detail particularly the contribution to the coronavirus response. I want to set this first of all in a big-item summary of where we are with health: with burgeoning DHB deficits $2 billion over three years; I think we've got more Crown monitors now as we're concluding this Parliament than before the Parliament started; and we've got areas of contention around the health system such as the Christchurch rebuild which is making very small progress and I believe was in an urgent meeting last night.Now the Minister has talked about the Budget appropriation for health and he's talked about the appropriation for coronavirus. I want to talk to why the figure is so large in the Budget and in the appropriation because it's a consequence of previous decisions or more specifically it's a consequence of us not learning as a country. We had three opportunities three sets of infectious disease that we could have learnt from that would make this Budget and this appropriation significantly different; we squandered that experience. We squandered the learning from those three episodes which I'll describe here now that make this Budget and appropriation what it is—the Government did not learn from those.Let me go through them. First we had a meningitis outbreak a Third World disease. Six children died. Unfortunately it was in Matt's and my electorate—a meningitis outbreak; Third World disease. There were some experiences which we could have learnt from that would have affected this appropriation. It would have been less I would contend if we'd have carried that experience forward and I'll tie it into coronavirus and the coronavirus appropriation as well and I'll tell you what those are. First of all we could have modelled the outbreak better. Again I'll tie that back into how that would have been useful for other outbreaks. Vaccine supply became an issue—we had a single supplier and as you'll recall Pharmac kept 20000 secret. Contact tracing for meningitis: really important. We had a training run with an infectious disease on contact tracing vaccine supply and modelling before coronavirus hit us. We could have learnt from that and done better; this appropriation could be different.Then about six to eight months later we had a measles outbreak. A different sort of disease but getting close to what coronavirus looks like certainly from an airborne situation and again having an impact on this appropriation. There were some things we could have learnt from this second infectious disease that would have affected this and the coronavirus budget that the Minister was talking about that he's put on the Table that we're voting through here today.It's very interestingly the same three things that we could have learnt from meningitis: modelling and predicting the outbreak—again I'll come to coronavirus and tie this in also; vaccine supply we ran out of measles vaccines; and contact tracing—really important parts to our coronavirus response. This was our second testing run. This was our second training run here in New Zealand. We had that information. It was our living laboratory if you like. We had the opportunity to learn from our second infectious disease for this Government and look at those important aspects of modelling vaccine supply and contact tracing.We knew that we needed to do better with contact tracing because we had the backpacker who developed measles in the Bay of Plenty who then hopped on Cathay Pacific after doing Air New Zealand I think it was to Auckland and then Cathay Pacific back to Germany infectious all the way. Did we call Cathay Pacific? No. Did we call Air New Zealand? No. Our contact tracing was appalling. We knew that back then and yet we didn't seem to learn from it. That would have made a substantial difference to this Budget that's being put on the Table here today. We did not learn from it. Did officials even call backpackers around New Zealand saying Look you're in a high-risk environment for this disease."? No we did not.I think the fourth thing that's interesting is: modelling vaccine contact tracing personal protective equipment (PPE). We didn't have the right PPE for measles. We were late with PPE for coronavirus and that had a huge financial impact on this appropriation that we're now signing through.We could have learnt from those two episodes. But do you know what? We actually had a third run as well because the flu vaccine 2019 also ran short of supply. Another infectious disease—our third one in the hands of this Government all in this Government our third opportunity to learn and do better; we didn't know that coronavirus was coming. Our third opportunity to do better and what happened? We ran out of flu vaccines again—the third infectious disease. It also showed us how poor our modelling store was now 18 months later. It also created perverse behaviours and incentives some of which I'm not very happy with which we also saw during coronavirus.For example when the paediatric flu vaccine ran out—this is the one that you can pay for privately as a parent—what did big pharma do? Try and get more vaccines? No they increased the price—they increased the price to manage their inventory. There's something very wrong with that and that's only discoverable through an Official Information Act (OIA) request—with Pharmac actually. There's something very wrong with that—that as the paediatric flu vaccine was running out big pharma the sole supplier increased their price to maintain their inventory. They didn't manage the children; they managed their inventory. Surely our mission is to vaccinate more children. Their greater task was to get more vaccines in not to increase the price—as Pharmac said in the OIA they successfully managed their inventory by increasing the price. That's a perverse behaviour; that's not a good behaviour. I'm very uncomfortable with that and I suspect we've seen parts of that through coronavirus as well.Now let's move to the post-coronavirus situation which the Minister talked about and said he had allocated a significant amount as part of this recovery. Again no more than four or five months ago we were running out of flu vaccines. What is it with flu vaccines and this Government? Why can't they model? Why can't we get this right? Why can't we figure this out so that we have a logistics chain that meets the needs so that we've modelled what the needs are? I accept that we used more vaccines because by intention we asked people to come in earlier and so we gave more of them. That was the correct thing to do. But we must have had some robustness of the logistics chain behind that so that we didn't run out like we did.The solution? Well the solution has been—and this is what part of the Budget will pay for—to get 400000 flu vaccines from the Northern Hemisphere. That might seem reasonable except here's the problem: New Zealand experts at the beginning of the year—in fact last year—said there are four strains that we're going to need in New Zealand this winter: four strains in winter 2020. We run out of flu vaccines what does Pharmac do? They buy the rejects from the Northern Hemisphere—400000 of them; the problem is that they only cover two of the strains. The four strains that we were told we need—that if you had your flu vaccine probably up to about June you got—you do not get today. You get two of the four; you are 50 percent covered. Oh by the way I'm wondering if you're consented for that and if when you're getting the flu vac they say "Hey look I need to tell you we're actually only vaccinating you for half of the effectiveness that you should have. Oh and by the way I'm actually consenting to give you two strains that will give you no benefit." Oh that's going to raise interesting ACC and adverse reaction sort of questions. Knowingly injecting people with vaccines that won't work—that's going to be an interesting dilemma coming down the pipeline if we get problems.But what it talks to is that we haven't learnt from three instances of infectious diseases that brings us here today that brings this appropriation to the size figure and type that it is. We squandered the learning we could have had that would have changed this. I'm not saying that it might have changed our overall coronavirus uptake if you like—I'm not saying that at all but our response could have been better. This Budget and this appropriation could have been better as well.I think what I want to summarise then is to say that I think it's been a challenging time for this Government in Government. I think if we look at their infrastructure I do quite like the inventory that they've done and I acknowledge there's work to be done there. It's not clear to me in this appropriation where infrastructure—the purported $14 billion that needs to be applied into Vote Health to pick up infrastructure—I'm not seeing too much here in this appropriation that's talking to that. So yep identified the problem maybe but then what's your solution? We know that it was $598 million I think in the last Budget for capital improvements; I'm not seeing anything of late as a top up or any sort of notices. Maybe it will come down the trail somewhere in the next few weeks but I just wanted to point that out: fine to identify the problem but come with solutions as well. That's what you'll see from our health manifesto somewhere in the next couple of weeks. You'll see the problem well identified well discovered well authenticated with solutions that make sense that New Zealanders will get and we'll proudly stand behind that manifesto and we'll do a more efficient job than this Budget. Thank you Madam Speaker."