Opinion

Rachel Smalley: My friends with cancer 'would be dead' if they relied on public health system

Opinion: Pharmac has issued an RFP to supply a drug to treat a form of lung cancer. 

So what does that mean, you say, in non-Government speak? 

Very good question. 

It means Pharmac has asked drug companies to show how their drug can treat lung cancer - what sort of results it gets - and how much that's going to cost the taxpayer. I would turn it around and consider how many lives it saves, but Pharmac's objectives were set in the 1990s, and they've never changed. Get cheap drugs. That's its key objective. 

You'll remember, ladies and gentlemen, the Budget was in May when the Government allocated a bit more money for drugs. About $71m this year, which is roughly a fifth of what they need. Pharmac said they might start to look at funding a drug for lung cancer, our deadliest cancer. That was in May. It's July now. Pharmac has said we'll start to look at a drug for lung cancer. 

The first cab off the rank for lung cancer is a drug called Keytruda. It's a highly effective immunotherapy and it treats several cancers. 

Keytruda was funded in the States 8 years ago. Same for the UK. As soon as it became available, it was funded. In Canada, a year later, it was funded, so 7 years ago. It was the same in Australia. Keytruda was funded in 2015. It's often considered the greatest breakthrough in the treatment of cancer since they developed chemotherapy. And it's not just funded for lung cancer in those countries. It's funded for many cancers. 

I don't know why we need a long bureaucratic process to fund Keytruda. All the information is there. It works. Ask the Aussies. The Swiss, the Brits, the Americans, the Slovakians. The world funds this drug. New Zealand doesn't. 

Pharmac says the process will take around 10 months. That means, in Wellington, it will take a year. Why does it take a year to reach an agreement to fund a proven drug? What is it with the Wellington bureaucracy? 

Here's what you do, Pharmac. You book out the boardroom for two days. You get everyone around the table. You get your respiratory boffins into that meeting and your oncologists, you get your key negotiators, Medsafe's already approved the drug, people are already self-funding it here, you know it works, we know it works, you just need to agree to the deal. You order in lunch, and you have your breakout rooms so you can go away, reconsider pricing, come back to the table... and you agree on a deal that will mean New Zealanders get access to this drug. All going well, we'll have Keytruda in our public health system by August. 

Don't tell me it's not that easy, because it is. 

And Keytruda is but one of the many, many immunotherapies on our waiting list. We haven't funded a bowel cancer drug for 20 years. That's our second biggest killer. We don't treat it. And to understand how far behind we are, you've got to understand how the modern world treats cancer these days, and what we're doing here. 

In the likes of Australia and Canada and many countries far poorer than ours, they don’t treat the cancer, they treat the patient. In New Zealand, we still treat the cancer. But our peer nations fund targeted, personalised drugs that treat the disease as it manifests in you. For example, if you and I get lung cancer or kidney cancer or breast cancer, our cancers can be very different. We may have different gene mutations in our tumours. I know two women at the moment with Triple Negative Breast Cancer. One is being treated with Tecentriq, another is being treated with Keytruda. Same cancer, but their tumours are responding to different immunotherapies. Both of those women are self-funding their drugs, by the way. If they were relying on the drugs in our public health system, both would be dead. 

That is not me sensationalising this issue or being alarmist. That's a fact. Both would be dead in the public health system. This is why Pharmac is failing you and me. It's why the Government which, as we know, isn't averse to throwing a bit of cash around, has fallen well short in its funding of Pharmac too. There is a staggeringly long list of immunotherapies we don't fund in the public health system. 

It comes at a human cost. Pharmac said it wanted to issue this RFP for lung cancer in 2020 but didn't. COVID probably stopped it. Not sure why they had to delay it. We know Pharmac wasn't working on getting the vaccine, MBIE had to do that. But in that time when they just stopped negotiating, the Lung Foundation says around 2,700 New Zealanders prematurely died from this treatable disease. 

Lung cancer is very treatable. It responds well if it's caught early and you get the right drugs. 

Every week, 26 people are diagnosed with lung cancer in New Zealand. 26 people this week. And Pharmac says, look, we'll probably take the best part of a year to get the agreement together to fund this drug. Conservatively, that means over 1,000 people will be diagnosed with this disease while Pharmac's negotiating, and won't get access to Keytruda. 

Maybe you understand why these processes take so long in Wellington. Why can't we move faster? Why, when lives depend on it, do we always move at such a glacial pace in Government? 

We all have hot buttons. Mine is apathy in leadership. Apathy and lethargy, particularly when it comes to our health sector. Bureaucrats and politicians are costing lives in this country, and there is never any transparency and never any accountability. 

Pharmac - you need to up your game. This deal should not take 10 months to agree to.