Ramping up the vaccine rollout
State and territory leaders are demanding the federal government boost their funding in return for stepping in to rescue the floundering national rollout of the Covid-19 vaccine.
New South Wales Premier Gladys Berejiklian is set to lead a united bloc of premiers and chief ministers at Monday’s national cabinet meeting, insisting the Commonwealth do more to support the states financially as they move to establish mass vaccination hubs.
Last Friday, Berejiklian led the premiers in privately criticising the federal government’s handling of the announcement about new medical advice relating to the side effects of the AstraZeneca vaccine.
The Saturday Paper has learnt that the NSW Liberal premier told Prime Minister Scott Morrison during the most recent national cabinet meeting, “with the greatest of respect”, that the announcement had been badly handled and had added to public anxiety.
The states and territories are welcoming the federal government’s change of heart about their involvement in the rollout strategy, despite differing views on how the reconfigured system should work.
The demands for increased funding from the states and territories come amid a chorus of “we told you so”, after the prime minister conceded on Wednesday that mass vaccination centres would be needed.
“You could see this coming from space,” one official observed this week.
Morrison said 20 million extra doses of the Pfizer vaccine would not arrive until October at the earliest, likewise for the doses previously ordered from Novavax.
“So that will mean we’ll need to change our rollout to go to mass vaccination options, and that will have to be done in partnership with the states and territories,” Morrison told The West Australian on Wednesday.
The extra doses of the Pfizer vaccine were ordered following new medical advice received last week about a rare but now-confirmed clotting side effect of the AstraZeneca vaccine.
The prime minister’s immunisation advisory taskforce has recommended that the Pfizer vaccine is now preferred for those under 50. The AstraZeneca vaccine had been slated for most Australians.
The move to establish more mass vaccination centres reverses the federal government’s insistence the Commonwealth should run the rollout using mostly general practitioners and pharmacists.
Premiers have been urging the Morrison government to make greater use of existing state infrastructure and expertise, given they – and not the Commonwealth – usually deliver health services and are better equipped to do so.
Because of an agreement to share the burden, 50-50, of any state-based health facilities and staff used in the rollout, relying more on these services would cost the states financially.
But it’s understood the states believe that using their services would be the best way to avoid future snap lockdowns and to accelerate progress towards a fully restored economy and reopened international borders.
Until now, the federal government has favoured using GPs to roll out the vaccine, paying them twice as much as they offered the states.
According to official figures obtained by The Saturday Paper, the Commonwealth payment to GPs in metropolitan areas is $55, that is, $31 for the first jab and $24 for the second. The delivery cost for rural and regional areas is higher.
Under the National Partnership Agreement on Covid-19 Response, the federal government would pay the states half of that estimated delivery metro cost – $27.50 per double dose.
The federal government opted to use GP practices for several reasons. It argues that older Australians in particular may be reluctant to attend mass vaccination centres and that GPs are able to provide a more personal, customised and individually reassuring service.
But the Morrison government has also been keen to retain responsibility for the national rollout, chasing the political credit for the vaccination program, which is the vehicle for getting Australian life to Covid-normal. That means using GPs to deliver the vaccine is costing the federal taxpayer about double what it would cost to have state health services operate the system.
One state is proposing a reformed rollout strategy that would split recipients by age group – with the states handling those aged 50 to 70 using both available vaccines. Prime Minister Scott Morrison acknowledged that idea this week.
“Our goal right here, right now, is to ensure that we continue to progress forward with vaccinating that most vulnerable population,” he said.
“We have the vaccines to do that through AstraZeneca, they are being produced and we are getting on with that job. The second challenge is to deal with those under 50 and those in the next phase who are between the ages of 50 and 70. I will be talking and working with the states to look at the options for mass vaccination, firstly in the instance of those aged between 50 and 70.”
Others are proposing one vaccine is given to the states, while the other remains with GPs. Australian Medical Association president Dr Omar Khorshid favours this strategy. He says the proposed state and territory hubs should be in addition to what GPs are offering, not in place of them.
“What we need to do is use the states’ capacity for service delivery to augment our GP rollout, rather than replace it,” he said.
Khorshid warns that despite the revised advice about temperatures for storing the Pfizer vaccine – which previously needed to be stored at minus 70 degrees Celsius – it still requires special freezers, which GPs, for the most part, don’t have.
“There’s going to be a huge need for some sort of delivery mechanism for the Pfizer vaccine, particularly in the second half of the year,” Khorshid said.
He proposes that a reconfigured rollout system should feature state and territory facilities, which have or can obtain the appropriate refrigeration concentrating on distributing the Pfizer vaccine, while GPs deal mostly with AstraZeneca.
“We feel that the GP rollout has gone very well and is limited only by the supply of vaccines,” Khorshid said. “But there’s no doubt that in the past week there’s been a significant drop in public confidence which needs to be reversed. That is the No. 1 priority for our prime minister and state premiers – to design a system people can have confidence in.”
Governments and medical experts are concerned news of the rare blood clots in younger recipients now associated with the AstraZeneca vaccine has prompted more vaccine hesitancy. They emphasise side effects occur with many routine medications and Australians are being urged to discuss any concerns with their doctor.
Khorshid wants to reassure the public that the clotting side effect is very rare, and the AstraZeneca vaccine remains safe for the overwhelming majority of recipients.
A second incidence of clotting has been identified in an Australian patient – a woman in her 40s.
“It’s not normal clotting,” Khorshid said. “This is an immune reaction, a very rare immune reaction … People who have had a history, or a family history, of thrombosis are not [automatically] at increased risk of this reaction.”
On Thursday, Denmark became the first European country to abandon the use of the AstraZeneca vaccine for all ages until further notice.
For Australia, access to the in-demand Pfizer vaccine has been problematic. The Morrison government has argued that supply issues are the primary reason for a slower-than-promised vaccine rollout.
It is now publishing daily national and state-by-state figures on how many vaccinations have been undertaken. But it is not providing breakdowns according to vaccine.
Other figures obtained by The Saturday Paper show that at the end of March, Australia had taken delivery of 872,820 doses of Pfizer vaccine – all of which are imported because there is not the capability to produce mRNA-type vaccines onshore. Another 2.04 million doses of AstraZeneca had been received, including 1.3 million produced onshore in a newly upgraded CSL facility in Melbourne.
Of that total of 2.9 million doses, about one million had not been made available for administration at that stage.
This week, Morrison acknowledged the rollout was not moving as fast as initially expected.
He said his decision to ramp up the frequency of national cabinet meetings from monthly to twice a week was effectively putting governments back on a “war footing” against Covid-19.
Federal Opposition Leader Anthony Albanese ridiculed the approach.
“What’s his response? A couple of meetings a week,” Albanese said. “Under Scott Morrison, we will meet them on the beaches, we will meet them on the phone hook-ups. That’s his idea of war footing. The fact is that he is responsible, and the federal government is responsible for the deals on vaccines, and the problem that you have is you can’t have a rollout of the vaccines if the vaccines aren’t available. And the federal government hasn’t made the vaccines available.”
Trade Minister Dan Tehan headed to Europe on Wednesday to lobby for faster access to the Pfizer vaccine doses the government has ordered.
Qantas chief executive Alan Joyce said on Thursday that his airline was still planning for an October opening of international borders, based on the vaccination rollout.
Joyce backed the idea of so-called vaccine passports that passengers would present as proof of vaccination in order to undertake safe, quarantine-free travel.
“I am hoping once we get to herd immunity for the adult population in Australia, there should be no reason why you do not open up the international borders,” Joyce said.
“We know other countries are going to go ahead of us – other countries have already started opening up.”
But he warned of the economic risks in not being ready.
“I think there is a real danger to our economy, to our tourism, to our business traffic, that we are laggards here and fall behind the rest of the world.”
Prime Minister Morrison will do everything he can to avoid that sentiment taking hold.
This article was first published in the print edition of The Saturday Paper on Apr 17, 2021 as "Supply and demands".
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