Lack of medicine access contributing to health workforce shortage

Despite the hedging of various Ministers of Health, it’s hard to avoid the conclusion that our healthcare workforce is in crisis.

People are waiting weeks to see a GP. Between 2019 and 2022, 28% of general practices had fully closed their books. This was due to factors such as staff shortages, workload and burnout. According to a report released 9 August 2023, just to maintain the status quo of GPs (the current ratio of GP per head of our ageing population), we would need 317 more GPs every year for the next decade. The Nursing Council of NZ has estimated that if nothing changes, e.g. that the number of nursing graduates does not increase or more overseas nurses aren’t recruited to work in NZ, the nursing shortage will balloon to 15,000 by 2035.

But there’s another crisis adding fuel to the workforce shortage. This is the medicines access crisis. New Zealand is one of the slowest countries in the OECD to get access to and fund new medications, ranking last out of 20 countries for market access to modern medicines, well behind countries we like to compare ourselves to, such as Australia, Canada and the UK.

These modern medicines include calcitonin gene-related peptide (CGRP) monoclonal antibodies, which were developed specifically for prevention of migraine attacks. Migraine disease affects around 16% of people in NZ and the chronic form of migraine, where headaches occur at least 15 days a month affects 1-2%. The disability associated with very frequent migraine attacks makes it difficult for people to work, maintain relationships and participate in society.

Healthcare workers are also affected by this common condition. There’s even some evidence to suggest that migraine is more prevalent in healthcare workers, perhaps triggered by job strain such as shift work, long hours and emotional stress. The famous neurologist Oliver Sacks wrote about how he was “attracted to neurology” because of his experiences of migraine with aura as a child.

But healthcare workers need access to medicines to manage their health conditions, like everybody else. And migraine, when it becomes severe and chronic, can be difficult to manage. Existing migraine prevention drugs often have such bad side effects that people can’t take them or they don’t work or stop working.

The new CGRP monoclonal antibodies are not only safer and more effective than existing drugs but they have minimal side effects. But only two of them are available in NZ, Aimovig and Emgality, they aren’t funded and are expensive. The cost puts these drugs out of reach of many people who could benefit. This includes healthcare workers.

Kirilee Beil and her husband are registered nurses living in Canada. Kirilee considers herself to be a “medical refugee” because although she is from New Zealand, she stays in Canada where she has access to Aimovig, which is fully covered by her employer’s health insurance. With Aimovig, Kirilee’s migraine attacks reduced from around 15 days a month to less than two a month and she was able to resume work as a chronic pain pediatric nurse.

“My husband and I would love to move our family back to NZ,” Kirilee says, “but not having guaranteed and funded access to Aimovig is an insurmountable barrier to our returning to work in the New Zealand healthcare system. I simply can’t compromise my health and wellbeing and risk returning to a life ruined by chronic daily migraine.”

Another medical refugee (who doesn’t want to be named) worked as a nurse and midwife in New Zealand for 48 years before moving to Australia, where CGRP medicines are available and funded. Affected by severe migraine from age six, in her sixties she started on Ajovy, a CGRP monoclonal antibody not available in New Zealand.

“It’s amazing,” she says. “I just accepted a midwife position purely to access this drug. Otherwise I would return to New Zealand. Migraine attacks have gone from 15 a month to three, which are easily treated. I would like to retire to New Zealand but don’t know how I’ll cope without Ajovy.”

New Zealand’s health system relies heavily on immigrant labour – without health professionals from overseas, our workforce shortages would be even more extreme than they are. But New Zealand’s poor availability of modern medicines can be a deterrent to prospective workers.

Brian and Jen Dressel are family physicians from Massachusetts in the US. They’ve been considering working as GPs in New Zealand for some time but Jen has disabling chronic vertiginous migraine. She’s only able to work with a combination of Botox™ and CGRP medication. No other drugs have been effective and without these treatments, Jen is confined to lying down most of the day due to vertigo.

“Having access to a treatment plan that allows Jen to be functional would be a prerequisite to our moving,” Brian says.

That these treatment options aren’t readily available or funded in NZ may be the factor that turns them away.

Pharmac is in the process of considering whether or not it will fund two of the CGRP monoclonal antibodies for migraine, but that decision will not come quickly. And there are already over a hundred medications Pharmac has approved for funding but can’t make available because of an inadequate budget.

There are many reasons to increase NZ’s pharmaceutical budget. Increased spending on safe and effective medicines not only improves the health and wellbeing of individuals but can have economic benefits and decrease the burden on the health system, by avoiding ED, GP and hospital visits and reducing the need for other treatments.

Improved access to new medicines can also improve the wellbeing of healthcare workers, who are less likely to burn out and bow out when they are working in a well-resourced system and able to provide the best care, including treatments freely available in other countries. And improved access to new medicines may enable some healthcare workers that we desperately need, who personally rely on these medicines to be able to work, to come into or back to New Zealand.

We need to ask our politicians why they’re not committing to better funding and access to modern medicines at this election. Equitable access to safe and effective migraine treatments is one of the election priorities of Migraine Foundation Aotearoa New Zealand. It’s a win for all, and might just woo a few overseas doctors and nurses back to our shores.