Experts: Vaccine rollout deadline impossible at current rates
After a succession of false starts and missed dates, Prime Minister Scott Morrison and Health Minister Greg Hunt declared on February 21 that Australia’s Covid-19 vaccination rollout was off and running.
The pair talked in big, bold numbers.
“Over the course of this week, we hope to see over 60,000 vaccinations, 240 different aged-care centres, 190 towns, and suburbs around the country from Alice Springs to Albany, to Altona Meadows and so many others,” Hunt told reporters.
Morrison said the government would see the “whole population” vaccinated in eight months.
“We said we’d get there by October,” he said. “We’re on track.”
And then things started to go wrong.
Two days later, two residents of a Brisbane aged-care home, aged 88 and 94, were given four times the approved dose of the Pfizer vaccine by a doctor who had not been properly trained. The doctor was stood down and subsequently so was the chief executive of Healthcare Australia, the company that failed to ensure he was trained, after the government was initially misled about his training.
Days after that, another private company contracted to help with the rollout, Aspen Medical, advised the government that 25 vials of Pfizer vaccine – enough for about 120 doses – had to be thrown away on the suspicion they’d not been correctly refrigerated.
Such incidents may be dismissed as simple human error, but there are indications, too, of broader systemic problems.
On Monday this week, the New South Wales premier, Gladys Berejiklian, publicly complained that the federal government had failed to inform her government how many doses of the AstraZeneca vaccine – 300,000 had arrived in the country the previous day – the state would receive.
On Wednesday, she again complained about a lack of information about which aged-care facilities had received the vaccine from the Commonwealth. The state was also concerned that private contractors to the federal government were vaccinating only aged-care residents, not staff, as the state understood was the plan. Moreover, the use of the Defence Force in the rollout was discovered only when it appeared in the media that day.
If all governments were to play as one team in the rollout, Berejiklian said, “we need to make sure we’re sharing information when it’s available, with each other”.
The NSW premier said she would raise the issue at national cabinet.
Certainly there are major teething problems to be addressed. Barely half of Hunt’s predicted 60,000 jabs in the first week were actually delivered.
And what of the prime minister’s confident assertion that the vaccination rollout would be complete by October?
“That’s very, very, very ambitious, given we’ve only been able to achieve 30,000 last week,” says Professor Marylouise McLaws, an epidemiologist with the University of NSW and adviser to the World Health Organization on infection control for Covid-19.
By McLaws’ calculation, if Australia were to achieve an 80 per cent vaccination rate – what’s needed to ensure so-called herd immunity – according to Morrison’s timetable, we’d have to do about 170,000 injections a day.
She doubts we’ll get there with the government’s current strategy.
So does Dr Karen Price, president of the Royal Australian College of General Practitioners (RACGP), and her belief is based on what the government’s own top health advisers told her this week.
When Price specifically asked about the feasibility of Morrison’s publicly announced target, she says she was told it amounted to a “ministerial declaration” rather than a realistic goal.
“The public health [officials] do believe that we are on track to get the first dose in for most people round about October,” she says.
But because the currently available vaccines require two doses, administered three weeks apart in the case of the Pfizer one and 12 weeks apart for the AstraZeneca, the process will take about three months longer.
To achieve full vaccination by October, she says “would mean we’d have to get everyone done … with a first dose by July, which is not possible.”
And clearly, if the rollout proceeds more slowly, it could have consequences for the relaxation of other public health measures, such as the reopening of international borders, for example, now planned for mid-June.
Vaccine supply is the least of our problems, despite a move by the European Commission, apparently driven by Italy late last week, to block a shipment of 250,000 doses of the AstraZeneca vaccine bound for Australia. The government says this will not slow the rollout. We have plenty of reserve capacity, having contracted enough supply to vaccinate the entire population three times over.
Australia has contracted for 20 million shots from Pfizer, as well as 53.8 million doses of the AstraZeneca vaccine, of which 3.8 million will be imported and another 50 million doses manufactured in Australia by CSL. The first two million doses of the Australian-made vaccine is expected by the end of this month.
The accumulating scientific evidence on the efficacy of the vaccines is “incredibly reassuring”, says Professor Jodie McVernon, director of epidemiology at Melbourne’s Peter Doherty Institute for Infection and Immunity.
“I think that’s very important, because we’ve had a very divisive discussion emerging in Australia about waiting for the best vaccine and who deserves it and all of that sort of thing … which is incredibly unhelpful in a situation where time is of the essence.”
The big issue, says Karen Price, is the “mathematical logistics of matching vaccine supply, distribution and clinical capabilities”.
In the case of her members at the RACGP, some 4700 general practitioners have submitted expressions of interest to administer the vaccine and are awaiting notification of their role.
“The way we do it is muddle through,” Price says. There will be “iterative adjustments” along the way to “post-pandemic life”.
That applies even where people are willing to be vaccinated, but surveys suggest that a significant proportion – maybe up to a quarter of the population – is reluctant or hostile. Particular attention has focused on anti-vaxxers and conspiracy theorists.
But these people, says Professor Julie-Anne Leask of the nursing school at the University of Sydney and senior fellow of the National Centre for Immunisation Research and Surveillance, may not be as much of a problem as portrayed.
She points to a detailed survey from the Australian National University, which analysed a variety of factors that might influence vaccine acceptance and found only 7.7 per cent of people were definitely opposed.
“They basically found that around 80 per cent [of people responded] yes, or probably yes, and 20 per cent no, probably no,” Leask says.
“Most of the reasons people have hesitancy … are not conspiracy theories.
“They’re kind of logical, intuitive, reasonable concerns like ‘this has been developed quickly, can I trust it?’ or ‘is it safe for me if I’m planning to have a baby, or pregnant or breastfeeding?’ or ‘is it needed because we don’t see a lot of Covid-19 in Australia?’ ”
For such people, who are still shaping their beliefs, facts are important, says Leask. They are persuadable but they need to be made confident, which is why the early missteps were damaging. If people get the impression that things are “chaotic”, she says, it undermines the rollout.
“But the biggest enemy of vaccination uptake is often the logistical and practical barriers,” says Leask.
Whether it is easy to get to the service, when and how they should make the appointment, and where it fits into their busy or complicated lives will all affect whether people get vaccinated.
The banal subject of logistics, she says “tends to get ignored because everyone gets enlivened by the bright shiny sort of narratives of conspiracy theorists and what is going on in people’s heads”.
So, how to encourage people to get vaccinated? There are two basic ways: the carrot and the stick – mandates and penalties applied to people who resist.
Dr Katie Attwell, a senior lecturer with the School of Social Sciences at the University of Western Australia, specialises in behavioural research relating to vaccine uptake.
She says that Australia already is quite coercive in its approach to childhood immunisation, and more so since Scott Morrison toughened the government’s approach in 2016, cutting welfare benefits and childcare from vaccine refusers.
The government has not adopted the same approach to Covid-19, though, and Attwell says that is a good thing.
Before you go to a mandate, she says, “you would want there to be an epidemiological justification as to why we need to do it”.
And, as yet, there is not one for Covid-19. Compare it with measles; we know how extremely transmissible that virus is, and how effective vaccination is in preventing its spread. We know, says Attwell, “who we want to protect and the number [the proportion of fully vaccinated people] we need to achieve that protection”.
When it comes to Covid-19, while it’s known how effective the vaccines are at preventing serious illness, we still are leaning how good they are at stopping transmission. We also don’t know the duration of protection the vaccines offer.
“We don’t know enough about the whole spread situation in a fully vaccinated population. And we don’t know what percentage of the population is going to need to be fully vaccinated,” Attwell says.
Unless there is a clear need for it – for example in a prison a prison, hospital, an aged-care home or other frontline, high-risk area – Attwell says it’s best the vaccine remain voluntary and “supported by strong and targeted recommendations and public communications”.
Experts agree that the carrot is the better option, particularly if governments are making it as easy as possible for people to get the jab.
McLaws says she sees little sign of moves from the Australian government to make it as easy as possible for the general population to get vaccinated. She suggests Medicare could send SMS messages to people “and give you some ideas about where you could go because of your address”.
“We need to be clever [if we are to engage] lower socio-economic and underemployed people, people who are disaffected, who working multiple shifts to make ends meet,” she says. “… Go to workplaces, go to Centrelink and have it set up there. Take it to the churches to the mosques to the synagogues. Be innovative.”
It’s still early days in the vaccine rollout, and way too early to pass judgement about its effectiveness. But one thing all the experts agree on is the need to be adaptable.
Australia, says Jodie McVernon of the Doherty Institute, is in a uniquely privileged position. There is an element of luck. But more importantly: “We had political will. And we had population cohesion, to co-operate with recommendations and measures.”
To maintain our good fortune, we will need what has been somewhat lacking in the initial rollout: clear communication.
“I think this is really the year of communication around vaccines … to be sure that we fulfil the promise of our first year.”
This article was first published in the print edition of The Saturday Paper on Mar 6, 2021 as "Experts: Vaccine rollout deadline impossible at current rates".
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