As the government sets new ‘horizons’ for the vaccine rollout, questions are being asked about how decisions regarding supply were initially made. By Rick Morton.
The end of AstraZeneca
From September, the federal government will hand out more doses of Pfizer’s Covid-19 vaccine than the AstraZeneca shot. By October, the AZ product will have been phased out entirely. There will be no more of it, unless by “request”.
It is not clear that the Coalition wanted people to know these details. The new targets for the administration of coronavirus vaccines were given to state and territory premiers during national cabinet on Monday, but were not for wider release.
Aged Care Services Minister Richard Colbeck promised the document to the senate chamber, but then stalled on delivering it.
“I am happy to provide that information to the chamber,” he said on Monday. “I will come back to the chamber as soon as possible with that information, because that information hasn’t been given to me off the back of the national cabinet meeting this morning.”
What ensued was almost three days of inertia and confusion.
On Monday evening, the new Covid-19 taskforce commander, Lieutenant-General John Frewen, told a senate select committee hearing he had not been asked to table those documents.
“It’s just a procedural matter at the moment,” the career infantry officer said. “Having prepared the document for national cabinet today, the next step would be for me to consult to release that.”
When the details were released on Wednesday afternoon, the bureaucracy was careful not to call them targets. They were instead “national vaccination allocation horizons”. A horizon, by definition, can never be reached.
Still, this is what the documents reveal across the three time-frame horizons: between July and August, the Commonwealth will deliver 2.2 million to 2.6 million doses of AstraZeneca to states and territories, primary care providers and the aged- and disability-care staff and residents cohort. In the same window, up to 750,000 Pfizer doses will be sent out nationally.
In September, a second mRNA vaccine, from Moderna, will become available to Australians, in small numbers at first. Between 87,000 and 125,000 shots of Moderna will be available each week. Clinical and real-world data shows the efficacy of both Pfizer and Moderna is almost identical, in the 90 per cent or higher range.
“Given the size of the Australian population over 60, it is assumed that demand for AstraZeneca doses will reduce in Horizon 2 and be met by Horizon 3,” the Department of Health vaccine supply documents state.
“However, AZ doses will be available if demand continues through Horizon 2 and 3.”
The switch begins in September, when between 880,000 and 1.2 million AZ doses are to be delivered each week, compared with between 930,000 and 1.3 million Pfizer doses. By October, AZ will be gone for good.
Given the rolling updates on health advice since the early April press conference in which Health Minister Greg Hunt said the AstraZeneca vaccine should be given only to people aged over 50, this is not surprising. On June 17, the Australian Technical Advisory Group on Immunisation (ATAGI) updated this advice to further restrict AZ to over 60s.
“The risks of severe outcomes with Covid-19 increase with age and are particularly high in older unvaccinated individuals,” ATAGI said.
“The benefit of vaccination in preventing Covid-19 with Covid-19 Vaccine AstraZeneca outweighs the risk of [thrombosis formation, or blood clots, and thrombocytopenia syndrome, which involves low platelet levels] in this age group and underpins its ongoing use in this age group.”
Implicit in this statement was that the health advice necessarily considered supply levels. With Covid-19 outbreaks still occurring, older Australians were better off being vaccinated than not. In any case, the risk of severe injury or death from the AZ vaccine is low. Out of four million doses, two people have died in Australia following the shot.
“We’ve had 60 individuals across the program [with longer-term health problems resulting from the AZ dose],” the advisory group’s co-chair, Associate Professor Christopher Blyth, told the senate hearing on Monday evening.
“I think advice has to be context specific and clearly we are in a lucky position with limited transmission at the moment, but I think it is clear in our advice if that situation changes, clearly the risks and benefits change and we will need to evolve over time.
“If we have a significant outbreak in Australia, our recommendations will need to be modified.”
As the week unfolded, the situation in New South Wales became more unnerving for its residents. In just three days, local cases attached to the Bondi cluster went from 12 to 22 to 31. The speed of growth was still much lower than the Avalon outbreak over the Christmas holiday period – there community transmission jumped almost 40 cases in a single day – but there is a question of what the Delta strain is able to do in the real world. On Thursday, Queensland recorded three new cases of community transmission.
The escalation followed what would have been explosive revelations first aired by the ABC’s Norman Swan, that Australia had met with Pfizer representatives in July last year and turned down an offer of more than 40 million doses to vaccinate the entire nation.
This simply was not true, according to both government officials and Pfizer itself.
Lisa Schofield, first assistant secretary with the Department of Health’s Covid-19 vaccine strategy taskforce, told the senate hearing on Monday that there was a July 10 meeting between the department and Pfizer last year.
“Pfizer wrote formally, at the end of June, to government and there were a couple of emails to and fro and then the meeting was on the 10th of July,” Schofield said.
“So, at that discussion, Pfizer presented where it was up to in high-level terms. They talked through the work they were doing on their clinical trial for the vaccine, they talked broadly about their manufacturing strategy and supply chain activities.”
Labor’s Senator Katy Gallagher pressed for more information: “So you can say Pfizer didn’t make an offer to the government about the supply of vaccine at that meeting?”
Schofield was clear: “We said we were interested to talk to them about potentially purchasing that vaccine but that was it, there were no numbers or details that were put on the table at that discussion.”
Between July and November, when an initial agreement for 10 million doses was struck with Pfizer, there was a flurry of activity between the two parties. There were emails, phone calls, briefings and discussions about what an agreement would eventually look like.
“I would reiterate that Pfizer has indicated publicly that it put the 10 million doses on the table as the offer that was available to Australia,” Schofield said.
All vaccines were secured on the advice of another panel, set up by the Australian government. That panel, the Science and Industry Technical Advisory Group, is chaired by Department of Health secretary Brendan Murphy, who told the senate hearing on Monday that on “every occasion” the panel has made a recommendation, “government has procured the vaccine that it has recommended and in the doses and amounts that [the panel] has recommended”.
The key concern early on, Murphy said, was that the group stick with the most proven vaccine technologies – subunit protein platforms – that could be manufactured locally.
“It has been a true surprise and delight to the world that the mRNA vaccines have been so successful, which is why, in our initial contract with Pfizer, we had clear provision for making additional purchases which have been enacted on two occasions,” he said.
“Both the University of Queensland and the AstraZeneca vaccines were recommended to government as the important backbone of locally manufactured vaccines, because they were the two most proven technologies.”
At Monday’s Covid-19 select senate committee hearing, independent senator Jacqui Lambie asked health officials how the public could be sure the federal government hadn’t just gone for the cheaper options and turned down the greater number of Pfizer doses.
“Well, the government has made it very clear that purchase decisions were made on the recommendations of [the Science and Industry Technical Advisory Group],” Murphy said.
“In fact, AstraZeneca is a significantly cheaper vaccine than the mRNA vaccines.”
Murphy was cut off by senators Lambie and Gallagher: “That’s exactly the point.”
The health secretary became aggravated. “Senator, cost was not a consideration in these purchases. I have made it very clear that our purchases were made on the basis of the medical advice from [the advisory group], on getting local manufacturing of a diverse portfolio of vaccines. We have spent, I think, $7 billion on vaccine purchases and distribution.
“Price has not been a factor in any of these decisions. Government has paid the price that these companies have offered.”
Lambie retorted: “Oof, that’s hit a nerve.”
On Thursday morning, as NSW recorded another 11 community cases of coronavirus, including one with no known link to the existing cluster, the prime minister did the rounds of morning television, excluding the ABC.
Today co-host Karl Stefanovic asked the key political question: “If the public believes this rollout has been too slow, too mistake-ridden, will it cost you the next election?”
Scott Morrison didn’t flinch: “That’s the last thing on my mind, Karl.”
This article was first published in the print edition of The Saturday Paper on June 26, 2021 as "Bring me that horizon".
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