State leaders seize control of Covid-19 vaccine rollout
The people in the line snaking out across the footpath in Sydney’s Homebush were there to get their Covid-19 vaccine, but they also received something else: an object lesson in efficient service delivery by government. And the chatter suggested they were impressed.
One woman offered a long, scathing assessment of the incompetence of the Morrison federal government compared with the Berejiklian government in New South Wales. Nearby heads nodded agreement.
In just a few weeks, NSW had fitted out the mass vaccination hub and staffed it with 300-odd people including 200 medical personnel, capable of vaccinating 5000 people a day. And it moved like clockwork.
Marshals outside arranged the crowd by appointment time, handed out masks to those who didn’t have them and helped scan QR codes from phone screens into the computer system. People were then directed to “pods” where scores of chairs were arranged in safely distanced order, where they waited – not for long – for their number to come up on the eight giant screens.
And in case the number was missed on the big screen, a text was also sent to its holder when it was their turn. “Dear Michael Seccombe,” mine read, “please proceed to Station 39. Your ticket number is M 059. Thank you”.
At Station 39, a few questions were asked about potential health issues before the needle went in, almost painlessly, followed by a brief wait in a separate area in the cavernous building, just in case of complications.
I’ve been through this process twice now. And, as of Friday last week, am one of a tiny minority of Australians who are fully vaccinated – with the Pfizer/BioNTech Covid-19 vaccine.
When I tell this to Dr Chris Moy, vice-president of the Australian Medical Association, his response is part incredulous, part censorious. “How did you do that? They shouldn’t have done that. You should be looking into that.”
He’s right: I’m an over-50 with no other vulnerabilities that would necessitate Pfizer. The same is true for my wife and several other people I know, and a growing cohort of Australians – many of them in the line at Homebush – who shouldn’t have fallen in to phase 1a or 1b.
Most are accidental queue jumpers. My wife and I registered our interest in getting vaccinated as soon as NSW invited us to last month, fully expecting a wait for our appointments to get AstraZeneca shots. Instead, we were booked in during the first week after the hub opened on May 10. Even at Homebush, we half-expected to be sent away, but as staff there explained, they had ample supplies of Pfizer and not so much demand in the first days after opening, so they were simply giving it to all comers.
This was a “clear-cut” contravention of the advice from the Australian Technical Advisory Group on Immunisation (ATAGI), Dr Moy says. “If you’re 50 or above, you should get AstraZeneca. If you’re below you get Pfizer.”
The fact that NSW vaccinated over-50s with Pfizer should be a big story, Moy says.
But actually, it is just part of a bigger story. Australia no longer has a national vaccine rollout plan, in any meaningful sense of the word. It has become a free-for-all.
While national cabinet, presided over by Scott Morrison, still theoretically sets nationally uniform rules, says Bill Bowtell, adjunct professor with UNSW Sydney and architect of Australia’s response to the HIV/AIDS pandemic, “The goodwill to run it has basically evaporated, along with the priority system.”
He continues: “In effect, what’s happening … is that the states and territories are taking over distribution. They are making their own assessments based on what they have on hand – which I suspect is clearly more than we have been led to believe.”
The recent evidence bears this out. The Northern Territory this week announced it would offer vaccinations to anyone over 16. In Western Australia, the rollout was extended to include anyone over 30. In NSW, the age limit is officially 40, but that is not what’s happening on the ground, as evidenced by revelations that hundreds of local government staff have been quietly vaccinated, irrespective of age.
Last Friday’s announcement by Morrison that agreement had been reached by national cabinet to extend vaccinations to “people aged 40-49 years not otherwise eligible” from Monday this week, was little more than a recognition of what was already happening.
“We opened up registration to 40- to 49-year-olds two weeks ago,” a senior Queensland Health Department source says. “We vaccinated 17,000 [people under 50] over the weekend. They were technically not eligible yet, so that was stepping way outside the agreement we had with the Commonwealth.”
He says that “all the states have now moved outside the realm of the agreement with the Commonwealth”.
“And they’re not criticising us for it, because they know they’d get hammered. They understand people just want us to get on with the job.”
In Queensland, and elsewhere, he says this has meant not only offering doses to younger people but also “picking up some of the slack that the Commonwealth had with the vaccination of aged-care and disability workers. Although we haven’t gone as far as NSW and Victoria have – yet.”
The states now have taken on the primary role in administering vaccinations. From June 4, when Morrison announced the broadening of vaccine eligibility, to June 9, some 560,000 injections were given across Australia. Well over half of them – more than 290,000 – were done by the states.
This, the Queensland health official says, amounts to a significant deviation from the original rollout plan, which envisaged the states and territories vaccinating about 30 per cent of people, while the Commonwealth would do about 70 per cent, mostly through GPs. And the bulk of doses would be AstraZeneca.
But in early April, the ATAGI advice changed, as a result of concerns about rare blood clots among younger recipients of AstraZeneca.
“Before that change,” the Queensland official says, “we were vaccinating about 55 per cent of the people we were doing on a daily basis with AstraZeneca and about 45 per cent with Pfizer. And straight after that, the bottom fell out of AstraZeneca.
“Last Sunday we did 7570 vaccinations, total. We did 7534 Pfizer, and 36 AstraZeneca.”
That was an exceptional day, he concedes, “but even on a normal day, we’re still doing seven or eight doses of Pfizer for every one of AstraZeneca”.
As a consequence, Queensland was left with an AstraZeneca surplus.
“So, we started giving some of our AstraZeneca to GPs because they wanted it and they could use it … because they can’t get enough from the Commonwealth.”
The decision to offer vaccines to younger Australians has sparked some strong criticism.
Speaking at the National Press Club on Wednesday, Australian Medical Association president Omar Khorshid amplified Moy’s comments to The Saturday Paper, saying that deviating from the original phased rollout plan raised worrying issues of equity.
The priority should be vaccinating the most vulnerable, Khorshid said.
“We still have a significant number of elderly Australians in residential aged care who are not vaccinated. We have enormous numbers of aged-care workers who are not vaccinated and a lot of Australians over 70 who are not yet vaccinated,” he said.
“Those between the ages of 30 and 39 are not a high-risk group. If we did get an outbreak in Australia, the chance of someone in that group ending up in hospital on a ventilator with Covid is actually very low.”
As Professor Peter Collignon, an infectious diseases expert at the Australian National University, told The Sydney Morning Herald: “Many GPs and clinics still have long waits, we should only open up when bookings are not overwhelmed. By opening it up to others we are making the priority groups wait longer.”
But the picture is complicated. While it is true that opening up vaccination to more people potentially pushes some further back in the vaccine queue, it’s also true that the states and territories – by greatly increasing their efforts – are making the whole queue move faster.
At the end of March, by which time the federal government had promised to have four million vaccinations done, only 670,000 people had received their first dose.
Then, on April 1, NSW Premier Gladys Berejiklian went on television with an offer to speed things up.
“We can do tens of thousands of doses a week,” she said. “We’re saying to the Commonwealth, ‘Let us help you’, which they haven’t agreed to. We’ve got 100 hubs set up ready to go around NSW – they haven’t agreed to that.”
But she was adamant: “If we don’t help the Commonwealth, they will not be able to meet their own deadlines rolling out the vaccine.”
By saying aloud what the rest of the country had whispered for months, Berejiklian cleared space for the states and territories to push ahead. And ever since, they have largely ceased to take notice of what the federal government agrees to and have thrown themselves into vaccinating as many people as possible.
Just in time, Bowtell says, for the reality is that the Morrison government failed those its health experts identified as priority groups.
“They issued press releases, talking about priority distribution for aged care, which they have control over, and for disability. They created a system that they didn’t take responsibility for. They handed it out to subcontractors.”
As a result, he says, “Aged care is very bad. Disability care is a disaster. The fact that we cannot, by June of 2021, have fully vaccinated even 3 per cent of the Australian population is just deeply embarrassing.
“In Equatorial Guinea tonight, it’s about 6 per cent. In the UK and the US, it’s 41. Australia is less than 3 per cent. This is just deeply embarrassing.”
Bowtell says the federal government just “didn’t have the capacity” to vaccinate the majority of Australians. “They should have had the good grace to say to the states, ‘You do it. Here’s the money,’ ” he says.
Dr Stephen Duckett, a health program director at the Grattan Institute, is pleased to see the states stepping up.
“If you want to do mass vaccinations, you have to have mass vaccination centres,” he says. “Sure, it’s okay for GPs to be able to do vaccinations – it’s actually a good thing for GPs to do vaccinations as part of holistic care. But to design a program which said the vast bulk, the only general access vaccination program, was going to be through GPs and subsequently pharmacists was wrong from the start. It just could not have worked.”
Duckett is also a critic of the government’s privatised distribution system. Two days before Christmas last year, a media release from Health Minister Greg Hunt announced the government had contracted with DHL and Linfox to transport vaccines. Accenture would provide tracking of doses, with PwC to monitor the progress of the rollout. It did not go well.
“I mean,” Duckett says, “I’ve ordered books from Amazon, and I’ve ordered beer from Dan Murphy’s. I get regular texts saying, ‘Your book has been dispatched and this is when it’s going to arrive’ or ‘Here’s your beer and it will be delivered tomorrow’ – quite detailed information about the supply chain.
“One of the problems, the GPs are saying, and the states were saying originally, is they have no idea how many doses are going to arrive or when they’re going to arrive.
“Why couldn’t we get just the basics I get from Dan Murphy’s? It’s just crazy.”
Moy, however, defends the distribution system.
“It’s actually been a lot better than people think. It just took a while to get going, because it was so big. The number of points of delivery are just huge,” he says.
He also stresses the role primary care doctors have played in the rollout so far and will continue to play.
“Primary care – mainly GPs and GP-run respiratory clinics – have done close to 2.9 million vaccinations out of 5.2 million, despite only being given AZ,” he says. “State and territory clinics are just reaching two million despite a head start, and despite having a much better funded … and resourced model,” he says.
“You’ve also got to remember that only about half of general practices have been involved so far – about 4600. More are going to slowly get involved as well.”
Upon them will fall much of the task of persuading the vaccine-hesitant to get the jab. The people lining up outside mass vaccination hubs obviously don’t need any persuasion or they wouldn’t be there.
The corollary of that is that as even more of the eager get vaccinated, the proportion of the hesitant will rise, and GPs who have established relationships with their patients become more important.
“With a lot of people, we have to talk them through it. It takes a long time,” says Moy.
And there is a great deal of hesitancy out there. An Essential poll this week found 27 per cent of respondents were willing to get Pfizer but not AstraZeneca, while 6 per cent held the reverse view.
Beyond that, though, there is confusion among people about where they stand in terms of priorities, about when more supply of their preferred vaccine will become available, about whether they should get the shot now, or wait. About whether the Morrison government will limit their freedom of movement by instigating a “vaccine passport” that they can’t get, because they cannot yet get vaccinated.
Moy confesses frustration that the political machinations and mixed messages and fracturing of the national system only work to undermine the rollout.
The Queensland health bureaucrat could not agree more. The problem right now, he says, is getting vaccine to those who want it.
“Now, at some stage, we’re going to run out of those eager people, and we’re going to have to convince the people who don’t necessarily want to get it, for whatever reason.
“And by the time more vaccine becomes more available, they will have spent six months or eight more months watching a shit-show of poor communications, of missed time lines, of the Commonwealth putting the boot into the states unreasonably and unnecessarily et cetera,” he says.
“It doesn’t inspire confidence.”
This article was first published in the print edition of The Saturday Paper on Jun 12, 2021 as "State leaders seize control of Covid-19 vaccine rollout".
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