The state of vaccinations
State and federal health ministers traded blows on Wednesday after it was revealed only a fraction of the four million Covid-19 vaccinations that were supposed to have been delivered by the end of March had actually been administered.
On Tuesday, Australia’s chief medical officer, Professor Paul Kelly, confirmed the government will undershoot its target by more than three million doses.
The four million dose target was initially set by Prime Minister Scott Morrison, who in January said he wanted all Australians vaccinated by the end of October – an outcome that now appears impossible, based on current trajectories.
Labor’s shadow Health minister Mark Butler told The Saturday Paper the delays meant Australians were being left to pay the cost of a “chaotic” vaccine rollout.
“The opening of our economy is dependent on people getting jabs in their arms,” Butler said. “The longer the wait, the more lockdowns we’ll see.
“The government’s next target is six million Australians vaccinated by May 10. To reach that goal, there would need to be over 130,000 vaccinations per day just to deliver a first dose.”
Speaking to 9News this week, the federal Agriculture minister, David Littleproud, pointed the finger at state governments, which are overseeing the rollout.
“The states have been tasked with this responsibility. We all have a responsibility and a role to play, and you just have to do it,” he said, accusing the states of stockpiling doses.
“The fact is they have left these in the rack when they could have put these things in people’s arm. We have plenty coming through, you cannot leave them in the rack, you have to put them in people’s arms and get us out of this whole situation.”
However, in an extraordinary statement to the media on Wednesday, the New South Wales Liberal Health minister, Brad Hazzard, pushed back against criticism of the states for their handling of the rollout, saying the federal government should take responsibility.
“Let’s get this really, really clear: the NSW government was asked to roll out 300,000 vaccinations to the groups in 1a and 1b. Of that we have done 100,000,” Hazzard said. “The federal government was asked and is responsible for 5.5 million people and they have rolled out 50,000.
“I think the figures speak for themselves.”
Hazzard acknowledged his statement marked the end of a Covid-19 truce between all levels of government.
“Up until today, for 15 months, every government in the country – every state and territory government – has maintained a collegiate approach because we want people to feel confident in a collective government decision,” he said. “As Health minister here in NSW, I am extremely angry, and I know there are other health ministers in the country who share similar views.”
Queensland Deputy Premier Steven Miles, while more restrained, was similarly dismissive of the Morrison government’s criticism of the states. “If the Commonwealth can tell us what their supply is, we are more than happy to roll out the rest of that as quickly as possible,” he said.
On Wednesday evening, the federal Health minister, Greg Hunt, announced there had been “an extraordinary acceleration in the rollout”, with a record 72,826 vaccines distributed in the previous 24 hours.
The war of words raises questions about Australia’s performance to date, particularly about how the country’s vaccination program was supposed to work, and where it had gone wrong.
Professor Catherine Bennett, chair of epidemiology at Deakin University, says the problems owe much to the challenge facing the government as the pandemic enters its final phase: how to create a logistical supply chain from scratch in order to vaccinate 26 million people across a vast continent.
“You’re trying to construct a very complex logistical system that interfaces with our health system,” Bennett says. “It requires building large-scale infrastructure and nuanced infrastructure, because it has to look different in every community but also interface with our health system.”
Bennett says this task has been complicated by decades of cuts to the public sector, which had shrunk its organisational capacity.
“We have had planning in place but, as everyone is now aware, the planning has been getting dusty on the shelves for a while,” she says. “When I was training, we knew then we were 20 years overdue for a pandemic.
“Part of what happened over those 40 years has been a shrinkage of our capacity, rather than a growth that would allow us to respond in a similar way to what we might have done in the ’80s and even ’90s.
“Now our population is larger and more complex and we have people with different expectations. So, you have to work harder to make sure the systems we put in place are appropriate to the population.”
Unlike other countries that have been grappling with widespread Covid-19 outbreaks, Australia’s management of the virus had seemingly granted the country the time to plan and prepare. However, much of that seems to have been squandered.
When the plans for the vaccination program were released in January, the broad architecture was contained in a five-page document on the federal government’s website, which outlined a three-stage process.
In phase 1a of the plan 1.4 million doses would be injected into the arms of essential workers in front-line healthcare, border control and quarantine positions, along with aged and disability care staff and workers.
The next phase would expand to deliver 14.8 million doses to the elderly, other healthcare workers, Indigenous people, and those with underlying health conditions.
From phase 2a, the wider population would begin to be vaccinated followed by “the balance of the adult population” during 2b. Under phase 3, those younger than 18 would be vaccinated.
In order to deliver the shots, the government envisioned a network of 1000 GP clinics around the country that would serve as distribution points. When the call went out for GPs to volunteer for the program, about 4000 responded.
There were good reasons to rely on GPs. It allowed patients with pre-existing conditions to ask questions of their doctor and avoided people having to take time off work to queue at a stadium or school hall with no guarantee they would actually receive a shot.
It also enabled existing health systems to build the capacity to run the Covid-19 vaccination program alongside the regular flu and other childhood vaccinations campaigns without diverting resources.
The government’s plan was that when the rollout moved into phase 1b and onwards, 30 to 40 “hospital hubs” – bearing Pfizer’s brand – would be set up to vaccinate the public.
In order to drive the program, ambitious targets were set: 60,000 shots administered in the first week. Four million Australians by the end of March. The entire country vaccinated by October.
In reality, the complications began almost immediately.
The delays are due, in part, to a confusing array of responsibilities divvied up between the state and federal governments that has left different jurisdictions moving at different speeds. This state of affairs came to a head with the Brisbane outbreak, where two nurses who had not been given their first doses treated a Covid-19 patient because no one else could be found, setting off a sequence of events that triggered a lockdown across the city’s metropolitan area.
If the federal government was responsible for supply and distribution, the states and territories have been responsible for working out the logistics – and from the beginning, supply limits constrained what was possible.
GPs who geared their practices to deliver 5000 doses a week reported they had been given just 50. Meanwhile, the federal government failed to register enough GPs in time for its booking system to go live, which meant the system suggested people head across state lines to get their jab.
As the federal government has pointed out, all of this has been compounded by factors beyond anyone’s control – from the floods that have affected vast swaths of NSW to vaccine nationalism that has led to some jurisdictions, including the European Union, blocking the delivery of vaccines to Australia.
Australia’s hopes now largely rest on CSL to rapidly start local production, with a goal of producing one million does of the AstraZeneca vaccine each day. There are plans to share locally produced doses with Papua New Guinea, which has been hard hit by the virus.
At its last update, CSL said it currently had 2.5 million doses in cold storage that were awaiting approval.
There are also lingering questions about the potential for side effects with use of the AstraZeneca vaccine, registered in 70 countries, with women under 55 reportedly more likely to experience blood clots.
Though Canada had recorded no vaccine-related blood clots, the country announced it was stopping the vaccine from being given to people below 55 pending more information – a precautionary measure that is common when trials are going on in real time and datasets are updated week to week.
In terms of the vaccine rollout in Australia, the chair of the Australian Medical Association’s Council of General Practice, Dr Richard Kidd, says the issue is one of communication, with governments needing to prioritise clarity and transparency around stock levels in order to build public trust.
“There needs to be transparency around that so people can develop understanding about how they may get the vaccine,” he says. “There needs to be much better communication jurisdiction by jurisdiction.”
A failure to do so, Kidd says, will only undermine public trust at a critical moment.
“Everyone will get vaccinated. I know it’s kind of self-evident but it would be really helpful if the government actually said it, clearly and often.”
This article was first published in the print edition of The Saturday Paper on Apr 3, 2021 as "Unheard immunity".
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