A Chinese father has stopped taking the medication that controls his hepatitis B in a last-ditch bid to keep him and his family in Australia.
Paul*, who wishes to remain anonymous, has lived in Sydney since 2012 when he moved with his wife and young children on a student visa.
His children have received most of their education in Australia and speak English as their primary language.
Paul later began teaching and applied for an employer-sponsored visa (subclass 186) that would allow him and his family to remain in the country permanently.
But last year he found out he had because he has hepatitis B - a virus likely inherited from his mother at birth - and it was deemed his healthcare would cost the taxpayer too much.
“I feel very depressed with this outcome … my medication costs less than a dollar a day,” he told SBS News.
Paul* and his family are facing a possible return to China after seven years in Australia. Source: Supplied
“My biggest concern is my children because I have been here for seven years and they receive their education here and I know it's really hard for me to take them back to my country.”
The government’s immigration health criteria dictates that an applicant for Australian residency must be free from a disease or condition which “would be likely to require health care or community services” that would “result in a significant cost to the Australian community”.
Currently the “significant cost threshold” sits at $40,000.
“A hypothetical person in Australia with the same condition as the applicant, at the same severity, would be likely to require long term specialist health care services, including but not limited to antiviral pharmaceuticals,” Paul’s decision from the medical officer of the commonwealth read.
Professor Benjamin Cowie, a physician and expert in hepatitis B at the University of Melbourne, said the cost of antiviral medication had plummeted in recent years and not only when it is imported from overseas. Paul previously bought his from China but Dr Cowie said it costs about the same in Australia.
“If you are seeking to buy them [the medication] on a private script, with no government rebate whatsoever, it could be as cheap as $30 a month. Where the government, for the same drug, is paying five times that on the PBS [Pharmaceutical Benefits Scheme],” he told SBS News.
The PBS refers to a system where the government subsidies selected medicines so the public can access them at a cheaper price.
Professor Benjamin Cowie, an expert in hepatitis B, said the cost of antiviral medication has plummeted. Source: SBS News
If the antiviral medication is likely to cost about $30 a month, as claimed by Dr Cowie, even if Paul lived for another 50 years, the total cost for the medication would only reach $18,000.
“There needs to be a recalculation of those costs, and I would suggest a reexamination of how much the PBS are paying for these drugs that can be bought privately for a fifth of the cost,” Dr Cowie said, questioning whether the difference in cost is factoring into the government’s cost calculations for visa applications.
When calculating costs under the requirement, a Department of Home Affairs spokesperson told SBS News it uses the cost of medication as paid by the government.
'There's only one way'
After being told he failed the requirement, Paul told his doctor in February he was stopping taking the antiviral medication he had been taking since 2006, believing its cost is what stopped him passing the health requirement.
He is now waiting for the results of medical tests, which hopefully will show his liver is functioning normally without medication, in the hope it will lead to the medical officer overturning their original decision.
“There's only one way, if I can prove them if I stop medication and then my liver still functions well and the viral load is low and it's OK, then maybe they’ll still consider my application,” he said.
But despite his hopes, Paul said he is worried about what stopping the medication will do to his health.
According to Dr Cowie, the antiviral medication can cut the risk of liver cancer for people with hepatitis B by 50 to 70 per cent in only a few years.
“To stop my medication is quite risky,” Paul said.
“I have been under this process for almost two months but I can feel I'm really tired now.”
Dr Cowie said three-quarters of people with hepatitis B will never need any form of treatment during their lives, but for those that do, the widely available antiviral medication is an “amazing opportunity”.
“A person going off their treatment purely to try and get residency here is a real tragedy, that someone is not engaging with something that could save their life in a desperate attempt … to be able to contribute to Australian society,” he said.
At the time Paul stopped taking his medication, his specialist wrote in a letter he was “well” with “no physical stigmata of chronic liver disease”, a possible result of a hepatitis B infection.
Hepatitis B is the most common liver infection globally and is caused by the hepatitis B virus which infects the liver. In some cases it can lead to scarring of the liver, liver cancer or liver failure if not monitored.
In Australia, an estimated 230,000 people live with the disease, more than Hepatitis C and HIV combined. Hepatitis B can be transmitted via blood and sexual contact, but it does not spread through contaminated food or water, casual contact or sneezing and coughing.
Increasing visa rejections due to hepatitis B
According to Dr Cowie, it is only in the last five years that people with hepatitis B have faced having their visa applications in Australia rejected due to their condition.
Previously, he said, people would be tested for the infection or report their condition and it would not affect their residency.
“But then over the last few years, and particularly in the last two to three years, it’s been the case that many people when they report to the commonwealth as part of obtaining permanent residency or they are tested and found to have hepatitis B, increasing numbers of people are having their residency rejected on that basis,” he said.
It’s unclear why this has happened, but Dr Cowie said it might come down to a greater awareness of available treatment options for people living with the disease. The Department of Home Affairs spokesperson said there had been no changes to the health requirement that would increase the number of visa applicants failing the test.
Chronic viral infections, such as hepatitis B, are considered a disability under both Australian law and international conventions.
In Australia, laws dealing with migration are exempt from anti-discrimination law, which prohibits discrimination against people on the basis of their disability.
Last month disability advocacy groups told SBS News from Australia every year due to one family member's disability or illness not meeting the migration health requirement.
“We have laws which forbid the discrimination against people living with disabilities unless they happen to be trying to migrate to Australia - which in that case, discrimination is allowed,” Dr Cowie said.
“People living with hepatitis or other chronic viral infections are often stigmatised and discriminated against in many areas of life - including in health care situations, tragically - let alone in the migration process.”
According to the Department of Home Affairs, a specific medical condition alone does not mean someone will fail to meet the health requirement.
“The current policy does not discriminate against applicants who have a disability or illness, or a combination of both. All applicants are treated in an equal and fair manner,” the spokesperson said.
In Paul’s situation, there is a possibility that his test results will show he is able to function without antiviral medication. If it is determined he does not need treatment and he is likely to remain in that phase indefinitely, it is possible his costs will be calculated to come in under $40,000 and the decision preventing his visa may be overturned.
But beyond this case, Dr Cowie said the system needs to change.
“The idea that this comes down to an accident of whatever is going on with their hepatitis B at that point in time or, even worse, an accident of who is actually aware that they have rights in this regard and can seek a second opinion, that doesn’t seem like the equitable society that we are trying to build,” he said.
“These decisions need to be brought up to date with the current economic environment, the current therapeutic environment and what we see happening with hepatitis B, so we don’t continue to deny people the opportunity of contributing to Australian society just because they have a health condition they’ve had since they were born.”
The Department of Home Affairs spokesperson said they do not comment on individual cases but do not support individuals ceasing medication without consulting a health professional.
*Name has been changed
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