Vaccine rollout: how it all went so terribly wrong
Shortly after 10am on Monday, the Victorian government department of health issued a media statement warning of “two likely” Covid-19 cases in Melbourne’s northern suburbs.
Within hours, the number of cases in the community had doubled to four. Two days later there were 16. The number of vaccinations administered in a single day also jumped from 8200 to almost 16,000. But this was still well below the state’s capacity.
By Thursday, there were 26 confirmed cases of community transmission. At a mid-morning press conference, the acting premier, James Merlino, announced a seven-day “circuit breaker” lockdown across the entire state of Victoria.
Sick of waiting for the Commonwealth, the state government also pulled the trigger on a scheme it had been hatching for several days: making vaccination available for every adult over 40. Getting vaccinated would be the fifth and final reason people could leave their houses during the lockdown.
“If more people were vaccinated, we might be facing a very different set of circumstances than we are today, but sadly we are not,” Merlino told reporters on Thursday.
The question of why the vaccine wasn’t already being delivered to queues of Australians, in Victoria or anywhere else in the country, has gained an urgency that only an outbreak can bring.
Parts of the strategy, which Scott Morrison on January 7 declared “a federal vaccination policy”, have since been labelled an “abject failure” by the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability.
It was at that January press conference in Canberra that the prime minister announced his government would bring forward the immunisation of priority groups including aged-care residents and workers, those with disabilities in residential settings and their support workers, front-line health staff and Border Force or quarantine employees. By the end of March, he proclaimed, some four million doses of Covid-19 vaccines would be administered.
Instead, at the end of May, only about 3.9 million doses had been injected into the arms of Australians. Of these, just 500,000 people have been fully vaccinated.
Australia had gone from a November 2020 claim by Morrison that it was “front of the queue” to an April 2021 update by Health secretary Brendan Murphy that this is “not a race”.
From day one, there were supply issues – both within and outside the control of the federal government. Then came a series of communication and campaign missteps, ranging from the unfortunate to the dire.
Rare blood clots linked to the AstraZeneca vaccine at a rate of four to six in every million doses led to agonising decisions behind the scenes in the government’s technical advisory committee. The outcome of that was beamed to the nation at an evening press conference by Health Minister Greg Hunt. Since then, a hungry media has latched on to every case of clotting, some of them later proved unrelated to the AstraZeneca shot.
Morrison and his leadership team issued often contradictory statements on when Australia’s international borders might reopen before the apparent resolution in the May budget: not until mid-2022.
Judging by the polls, it’s a political winner, and a handy backstop for a government that once promised every Australian who wants a vaccine will have been given one by October.
In the vacuum of information about where and when and how, twinned with the pseudo-calm of “Fortress Australia” and media saturation about vaccine concerns that has been poorly countered by the government, hesitancy has crept in. There are now people who, while not traditionally opposed to vaccination, are declaring they will wait before getting their dose. Others have said no altogether, while many have developed a preference for Pfizer, which hasn’t been linked to any clotting side effect.
Where Morrison has communicated with the public about the vaccine, it has largely been in the form of “announceables”.
In the past eight months, he’s been involved in at least 12 different photo opportunities regarding the rollout, not including key press conferences. He was photographed receiving both doses of Pfizer, three weeks apart. Then he was at the offices of the Therapeutic Goods Administration; separately at domestic AstraZeneca manufacturer CSL; at a vaccine hub in New South Wales, run by the state government; and pumping out milestone announcements to social media. There were glossy photos posted to his Instagram on February 15, the day the first Pfizer doses arrived in the country.
If you looked at only these, it all seemed to be going so well.
Public health experts have delivered varying degrees of criticism, mostly aimed at the Coalition, but all agree on one central question: Why did the Commonwealth upend decades of convention by hoarding more control over the Covid-19 rollout than it does with, say, the yearly influenza vaccine?
“This is not the usual vaccination arrangement that we’d have, given its significance,” Morrison made clear on January 7.
“And on this occasion, the federal element of this vaccination policy has been driven very much by the Health secretary [Brendan Murphy], who joins us today.”
University of Sydney adjunct associate professor in medical sciences Darren Saunders tells The Saturday Paper there have been “multiple failures at multiple levels” of the vaccine strategy.
“Even without being too cynical, it is hard to separate some sort of political decision-making going on in the whole process,” he says.
“I think it is pretty clear that the federal government had placed a pretty big stake in using the vaccine and the success of a vaccine rollout as a platform for re-election, and they kind of realised that wasn’t going to work for them so well.
“And that’s when the states stepped in and kind of started taking over.”
On May 18, the federal Department of Health quietly extended a tender for the “provision of Covid-19 vaccine administration for residential aged-care providers”. This approach to nursing home operators, specifically to inoculate aged-care staff against the deadly virus, was due to be completed on Monday but has instead been pushed back to the end of June.
The Department of Health says that “no tenders have yet been awarded … [and] the evaluation process is under way”.
An even broader tender, for outsourced “vaccine administration providers to deliver the safe, targeted and timely administration of Covid-19 vaccines for the populations within the Phase 1a cohort of Australia’s Covid-19 Vaccine National Rollout Strategy, published on 7 January 2021” was made public on March 16. Submissions were due by April 30, but this was extended again to May 7 with the expectation that these providers would complete the “Phase 1a cohort across Australia by late May 2021”.
Extraordinarily, the Department of Health says no tenders have yet been awarded under this process, either. “The evaluation process is under way,” the department said in a statement.
Some large contracts have, however, already been awarded: first to Aspen Medical and Healthcare Australia and, later, Sonic Healthcare.
With so much basic work still under way, almost five months after the January 7 announcement, accusations of mismanagement have begun to accumulate.
“Look, our approach has been very clear. The principle of underpromise and overdeliver,” Greg Hunt told reporters in January.
“Which means that whilst we have allowed for cautious time frames, it’s because we’re relying on data from others, shipping from others, testing from others or distribution from others, we’ve allowed for any gap in that chain.”
It is now a matter of record that significant gaps emerged in that supply chain. Just two months after those grand announcements, the Commonwealth quietly moved the goalposts on its own targets for phase 1a “to the extent that people in aged care had been prioritised over people in disability residential care”.
The disability sector only found out during a senate estimates hearing on April 20.
The depth of the betrayal, however, was not apparent until a May 17 special hearing of the disability royal commission, where federal government officials conceded they didn’t even know how many people there were to vaccinate.
“There’s a document the Department [of Health] has provided to us that says that of the 190,000 aged and disability care residents, 183,989 are aged-care residents,” senior counsel assisting the royal commission Kate Eastman told departmental associate secretary Caroline Edwards.
“That would leave 6011 residents in disability care. That’s a document that the department has provided to us. Do you accept that there may have been a significant error in identifying the number of people who live in disability residential settings?”
In reality, there are at least 26,000 disabled residents living in group homes or congregate care settings – more than four times what the government planned for.
“There was an underestimate, yes,” Edwards told the commission. “I accept the maths works like that.”
At the beginning of the rollout, no one within the federal government knew precisely how many aged-care and residential disability-care staff there actually were. It was a guess, one that proved to be wrong by a significant margin.
When both priority rollouts faltered, the Coalition abandoned disabled people to marshal resources in the aged-care sector. It had been spooked by a catastrophic failure last year to protect elderly residents from a virus that was spreading like wildfire.
Kate Eastman asked the Department of Health associate secretary if there was a “decision to prioritise aged over disability care residents?”
Edwards, who confirmed she made the decision, disputed this wording.
“No, there was a decision to focus the resources of the Commonwealth in-reach providers to aged-care residents first,” she said.
“The real reason is that 685 people died in residential aged care in Australia and that it was clearly the greatest risk group and it was one that I felt obliged to make sure we safeguarded in the first instance we could, with the resources we had available, at the same time acknowledging that that would have an impact on other people and continuing to work on how we would do the vaccination program for others.”
Edwards was firm, however, in response to a suggestion that the Commonwealth ought to have finished vaccinating everyone in phase 1a before moving on to the rest of the population.
“That was never the intention,” she said on May 17.
At the time of that hearing, fewer than 1000 disability-accommodation residents had been vaccinated. It was an “appalling” number, researcher Professor Anne Kavanagh said.
Since then, 8440 vaccines have been administered to 5855 people with a disability living in a care facility. More than 2090 vaccines have been administered to 1813 disability workers.
On Wednesday this week, Greg Hunt announced an additional 130,000 Covid-19 vaccinations would be released to Victoria over the next six weeks to support an “acceleration” of injections.
In that statement, he conceded there were still 29 nursing homes in Victoria that had yet to receive a single vaccination dose. A further 208 facilities were awaiting a second dose. Nationally, about 100 aged-care homes have yet to receive a vaccine visit.
Hunt said these “facilities will be prioritised”.
Julie Leask, a professor at the University of Sydney school of nursing and midwifery, is an expert on immunisation and vaccine behaviour. While cautious in her criticism of the government, she becomes exasperated when talking about federal contracts to private providers.
“Why don’t they just get the states to do it? I can’t see why they couldn’t use the same system they use for influenza vaccination each year, where the federal government purchases and distributes the vaccine and the states and territories manage the rollout,” she says.
“It’s been very difficult for states and territories not having insight into who in their own populations in aged care, in disability, including staff, are actually being vaccinated.”
Leask doesn’t buy the theory that the Morrison government “almost doesn’t mind us being in this state of complacency”.
“There is a lot of political pressure on them to get us vaccinated,” she says. “There is also motivation from the business sector and the economy. I would imagine the government want to see high take-up of vaccination. I don’t know why they are not doing some of the things that would help that to happen or doing some things as well as they could.”
Victoria’s minister for Disability, Luke Donnellan, wrote to the federal government in March with concerns about its vaccination program and received no reply. Earlier this month, Donnellan wrote to the new minister for the National Disability Insurance Scheme and Government Services, Linda Reynolds, and Minister Hunt again. The Commonwealth ministers responded, finally, and confirmed the federal government will persist in delivering vaccinations to disabled people living in specialist accommodation.
Reynolds and Hunt advised that Aspen Medical had only begun this process in April for the ACT and the Northern Territory, with Victoria beginning in the last fortnight and “all other jurisdictions by the end of May 2021”.
“After months of waiting for a vaccine, it is absolutely critical we get the rollout for Victorians living in disability-care homes back on track,” Donnellan tells The Saturday Paper.
“That needs to start with a clear and transparent plan from the federal government.”
In Canberra, Susan Hutchinson went on a mission to see if she could be vaccinated as part of the 1b phase. Her condition, she discovered, was explicitly excluded from the list of qualifying medical complaints that might have seen her vaccinated. This is despite the fact myalgic encephalomyelitis/ chronic fatigue syndrome wreaks havoc on the immune system, forcing it into overdrive or suppressing it.
Hutchinson never managed to get the vaccine, but on Tuesday noticed an update on her vaccination record on myGov.
“It says that I have had one shot of the AstraZeneca vaccine that I received yesterday, May 25,” she tells The Saturday Paper.
“I have not received a shot of any Covid-19 vaccination. There are hundreds of thousands of Australians who should be in 1b who are terrified and trying to protect themselves from this disease. It’s totally heartbreaking.”
Hutchinson has no answer yet as to why her official immunisation record declares she has received one dose of a Covid-19 vaccine she is not allowed to have. Services Australia says it is “concerned”.
“I could not help but think, is someone just trying to make their statistics look better?” Hutchinson says.
There have, of course, been many plans and strategies.
In August last year, global management consultants McKinsey & Company were awarded a $660,000 one-month contract to develop advice on a “Covid-19 vaccine and treatment strategy”. They would do well from the outbreak. In December, the Coalition awarded them a three-month, $2.2 million tender to provide “professional advice on a business case for an onshore Covid-19 vaccine manufacturing capability” for the new generation of mRNA shots, which includes Pfizer’s and Moderna’s candidate. This report, now finished, will not be released by the government.
On February 25 this year, McKinsey also won an open tender to deliver a $1.6 million program of “support services” for the vaccine rollout. This was twice amended, and the contract is now worth $3.8 million.
These time lines have been studded with supply delays – a quarrel with European authorities about a shipment of AstraZeneca bound for Australia key among them – and that now infamous morning press conference on May 20 in which Greg Hunt urged “hesitant” Australians to get the jab, before telling them they could also wait until more Pfizer arrived in the country later this year.
“Right now, we need a campaign,” Leask says. “There is going to be more and more vaccine and the supply is going to exceed demand and you certainly don’t want to stockpile vaccines. There hasn’t been as much of that proactive advertising campaign.”
At least, not one that people have seemed to notice. A $5 million, six-month advertising buy was contracted by the Commonwealth two weeks after Morrison first announced he was bringing forward the vaccine rollout. This contract is now worth $18.6 million. A further $1 million was paid to BMF Advertising for “creative services” relating to a national media campaign and $330,000 was inked for the LOTE Agency for multicultural communities.
There have been some underwhelming television commercials and, last weekend, full-page advertisements in the Murdoch newspapers. The Australian ran the largest version in its broadsheet pages, which tepidly reminded those over 50 that Covid-19 vaccines are “voluntary, free and the best way to protect you and your community”. Late on Wednesday, as Victoria’s leaders prepared emergency measures for another snap lockdown, Scott Morrison told the Australian parliament that his critics were “sleepwalkers”.
“I don’t know Australians who want to go and take up residence and live in the Covid environment whether it be in Europe, the United States, UK or anywhere else,” he said.
“Those opposite, Mr Speaker, may want to retreat into whingeing and complaining and undermining the government as we fight the virus, and they focus on the politics.”
Without vaccinations, however, and with a woefully managed rollout overseen by his government, Victorians have had to retreat indoors. Again.
This article was first published in the print edition of The Saturday Paper on May 29, 2021 as "Vaccine rollout: how it all went so terribly wrong".
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