Vaccines, part two: ‘Is this guy serious?’
At the end of last year, Australia aborted the University of Queensland’s Covid-19 vaccine trials. The candidate vaccine was returning false positives for HIV. In a single decision the country lost half the “backbone” of its vaccination strategy – more than 50 million doses. Prime Minister Scott Morrison needed to change tack.
On December 11, as the last national cabinet for the year wrapped up and a day after the UQ results were announced, the prime minister shifted the language from the clear and consistent “front of the queue” to something far more passive.
“We are aware of what is happening in other nations [and] we have a front-row seat as they go through that,” he told reporters after the meeting.
“Overseas, vaccination is the only thing they’ve got, frankly, to address [spread] of the virus in the community. Australia is not in that situation.”
Inside the meeting, which included all state and territory first ministers with a rolling guest list of chief health officers and others giving briefings, some members were stunned by the near-instant switch in tone.
“I think that was the moment he gave up,” one member tells The Saturday Paper. “It was the first meeting we could all attend in person and you could actually see the look on people’s faces in the room sort of saying, ‘Is this guy serious?’ ”
Back then, at least, the federation attempted to abide by the unity code of the pandemic. National cabinet was, and is, treated with strict confidence. There have been few insights into its machinations.
When the cabinet broke for the last time in 2020, Morrison reframed the entire vaccine debate before the rollout had even begun.
Whatever Morrison might have thought privately, his Health minister, Greg Hunt, was still bombastic. Days before the new year began, he offered the view that all Australians who wanted a Covid-19 vaccine would have access to both doses by October. “Fully vaccinated”, in his words. On January 6, Hunt announced that the start of the program was being brought forward and the next day the Coalition released its now infamous vaccine strategy with ostensibly five phases. The highest priority groups in Phase 1A – quarantine and border workers, front-line health workers, aged- and disability-care residents and staff – would be inoculated first. This would take about six weeks.
History records it never happened.
Around this time, in January, the federal government began receiving warnings both internally and from AstraZeneca itself that there would likely be global vaccine shortages as Covid-19 outbreaks raged across the planet.
There was no room for movement, however, because only two candidates had received, or were about to receive, approval from the Australian Therapeutic Goods Administration: AstraZeneca and Pfizer. Australia had secured supply of both, but not enough and not soon enough. Its third major purchase, Novavax, was nowhere near ready for approval or supply.
Scott Morrison, a believer in the old maxim “the show must go on”, received his first dose of Pfizer’s mRNA vaccine on February 21 during an almost perfectly calibrated photo opportunity with an 84-year-old World War II survivor, Jane Malysiak.
Within weeks, in early March, the warnings about supply became reality. The Australian government was embroiled in a spat with the European Union over at least 250,000 doses of the AstraZeneca vaccine, which were blocked from leaving Italy. By April, Morrison was claiming 3.1 million doses bound for Australia had been withheld because of the crisis in Europe.
At least some of his scientific advisers believe this played a major role in missing initial vaccine targets. By March 31, the gap between promise and delivery was 3.4 million doses.
“If you look at the numbers,” one source says, “the failure to meet the four million doses target by April is almost entirely explained by those doses that didn’t turn up.”
Although the government had negotiated an additional 10 million doses of Pfizer in early February, taking the total to 20 million, these were not due to arrive for many months. Hunt said Australia entered into “four separate agreements for the supply of Covid-19 vaccines” and that “combined, these agreements will ensure access to approximately 150 million doses”.
The problem, of course, was that the nation didn’t yet have medical approval for usage of a third of these – the 51 million doses of Novavax. More critically, the other two-thirds of the promised vaccines were not yet physically in the country.
There was another and festering issue that plagued the government: high-profile figures such as the ABC’s Dr Norman Swan had sowed seeds of doubt about the AstraZeneca vaccine. In December, he claimed a “core trial” of AZ in Brazil showed only 62 per cent efficacy – which ignored published results in the Lancet showing, at the time, an average efficacy of 70 per cent when including results from the British trial, which scored 90 per cent.
“If that sticks it’ll be a second-rate vaccine compared to the others,” Swan said of AstraZeneca. “Let’s hope they find that a dose change lifts the effectiveness. We can’t be stuck with an underperforming vaccine.”
Later studies with more than 20,000 participants revealed AZ is 81.3 per cent effective with two doses, 12 weeks apart, but many had already made up their minds: Australia had purchased a dud vaccine.
Swan would later concede: “Fair cop. I probably did cause some vaccine hesitancy.”
In telling this story, it is important to note there are no single events, or even individuals, that can discolour the narrative about a vaccine ready to be injected within a year of the SARS-CoV-2 discovery. The authors of that doubt are many.
The individual factors in this account began to coalesce in the lead-up to Easter this year, when the first case of blood clots associated with the AstraZeneca vaccine was reported to Australian authorities. One million doses had been administered by this stage.
“By Easter, we had some of Australia’s top haematologists and experts in thrombosis involved,” John Skerritt, the head of the Therapeutic Goods Administration, told a senate hearing in June.
“It wasn’t a taskforce. That gives it too much status. But we were talking to them hourly over Easter … We worked together with them extremely early in the piece and, as a result, we’re picking up cases earlier on.”
In the Australian system, Skerritt’s agency acts as an analysis arm for the Australian Technical Advisory Group on Immunisation (ATAGI) and supplies its findings to them. It is then up to ATAGI to provide advice about what to do with the information in a practical sense.
ATAGI met on April 8, six days after the first report of a clotting case. An hour after the meeting finished, Scott Morrison and Greg Hunt called an evening press conference to announce that advice had changed. No one under 50 should get the AZ shot.
“It was an agonising decision,” one person familiar with the formulation of advice tells The Saturday Paper. “There was certainly an understanding that this would sound the vaccine alarm on the centrepiece of Australia’s rollout, the AstraZeneca product, and that once we did this there was no turning back. You cannot unscramble that egg.”
The key concern was balancing the likelihood of further outbreaks in Australia – which were acknowledged even in April to be a real threat – and the vanishingly rare occurrence of the clotting risk known as thrombosis with thrombocytopenia syndrome or TTS. It was always accepted that, should conditions deteriorate in Australia, the advice would have to shift.
Between April and June the true state of the vaccine rollout failures became well publicised in Australia. And then the Covid-19 spot fires reignited.
It is worth reiterating the opaque decision-making that affected priority groups in Phase 1A when officials realised targets would not be met. First, they sidelined disability residents and care workers who were initially treated with equal urgency under the phases. When it emerged so few aged-care residents were getting even a first vaccine dose, the government quietly abandoned aged-care workers.
In the middle of April, the Coalition appointed the Royal Australian Navy’s Commodore Eric Young to manage the vaccine rollout. By mid-May, Morrison said he could not promise all Australians will have access to two doses of a Covid-19 vaccine by the end of the year. On May 27, Victoria entered its fourth lockdown as cases of the Kappa variant began to spread. It was only a matter of luck that the more contagious Delta variant, which made its way across the border from New South Wales and into Melbourne, was detected while the city was already in lockdown.
In early June, Morrison appointed another military leader, Lieutenant-General John Frewen, as the uniformed head of the vaccination program, apparently freezing out Eric Young while renaming the taskforce Operation Covid Shield.
The prime minister’s office also began briefing against former chief medical officer Brendan Murphy, the government’s hand-picked new secretary of the Department of Health, as he floundered before senate committees. Morrison was unhappy both with Murphy’s performance in public and his advice in private. Both were under sustained pressure for critical failures.
What follows is a series of events, decisions and sliding doors moments, all connected to the original failure of the nation’s vaccine procurement deals. These all happen in June.
In the absence of federal leadership, state and territory governments were left to make their own decisions about which priority groups in the broad categories ought to be vaccinated. As the original vaccine plan fell apart, there was no new strategy. Hesitancy among older Australians combined with the lack of flexibility for younger Australians created gaps that some states sought to fill.
Take one example: before Sydney’s outbreak of the Delta variant, NSW Health approached Qantas and offered to provide vaccinations for all its staff. This offer was made not just for those flying internationally or directly connected to border and quarantine operations, but accountants, commercial teams, loyalty program managers and communications staff. Every back-office employee could be vaccinated, even if aged under 40 – a cohort not yet eligible under national guidelines.
The shots were administered at the state’s hub at the Royal Prince Alfred Hospital, the same hub where 150 boarders from the prestigious independent school St Joseph’s College were vaccinated with Pfizer shots despite only a handful of its students being eligible because they were Indigenous.
The offer made to Qantas was not made to Virgin Australia or Regional Express. No reason was given. Decisions were being made on the fly.
The Saturday Paper sent follow-up questions to NSW Health about this apparent discrepancy and was met with a curt response: “We have nothing further to add to the statement provided.”
In June ATAGI again changed its AstraZeneca advice, telling Australians under 60 that they should not get the shot unless the benefits for them outweighed the risks.
About the same time, according to sources in the NSW government, there was a serious discussion about whether the state could bypass the federal government and secure its own independent supply of vaccines.
The push was led by Deputy Premier John Barilaro, Treasurer Dom Perrottet and Jobs Minister Stuart Ayres, who were fed up with the Commonwealth’s abdication of responsibility. Barilaro declined to comment.
The idea never made it far, as the state became engulfed in its own outbreak.
The Sydney lockdown, announced in late June, began with an unvaccinated limousine driver transporting a freight crew for quarantine. The man, in his 60s, told at least one reporter he was waiting for what he thought was the better vaccine – Pfizer.
In this one case, which seeded an outbreak and a continuing lockdown, is the story of the nation’s vaccine rollout. The lack of vaccine options helped exacerbate a budding hesitancy, inflamed by public figures and the media, which was then backed in by ATAGI advice and the Health minister himself, who said in May that there would be “enough vaccine of mRNA vaccines for every Australian” towards the end of the year.
The sequence of reinforcing factors is like an Escher drawing of cause and effect, where the stairways lead back, always, to the same place: there was never enough supply.
Data released this week from the Australian Bureau of Statistics shows that 35 per cent of unvaccinated people aged 50 to 69 and 26 per cent aged 70 and over cited “wanting a different vaccine” as a factor in their “ability to get a Covid-19 vaccination”. This compares with 7 and 9 per cent of those aged 18 to 34 and 35 to 49.
But what if the problems plaguing the AZ vaccine were breathtakingly simple all along?
On June 29, scientists from Germany authored a paper that was published in pre-print form on the biology server hosted by the world-leading Cold Spring Harbor Laboratory. It provided compelling evidence that the clotting syndrome associated with the AZ vaccine is caused by accidental intravenous injection.
The paper, which has not yet been peer-reviewed, showed in animal tests that the clotting can be induced when the injection site nicks a blood vessel instead of hitting the deltoid muscle. It could be avoided with a harmless procedure known as aspirating the syringe, which is standard in some countries around the world. Simply, the health professional draws back on the syringe at the injection site to check for blood before delivering the inoculation. In March, Denmark changed its guidelines to account for this as a precautionary measure. The theory had been circulating for months.
The Saturday Paper can reveal the TGA is aware of the paper and is considering its implications. “If the TGA determines that further regulatory action is required on the basis of emerging evidence,” a spokesperson said, “we will make this information available promptly.”
On Wednesday and Thursday this week, Morrison gave two radio interviews in which he ratcheted up his campaign against the government’s health advice, this time directly blaming the core science advisory body, ATAGI. It was an extraordinary intervention.
“I know ATAGI has been very cautious and that had a massive impact on the rollout of the vaccine program,” he told 2GB on Wednesday.
“It really did. It slowed it considerably and it put us behind, and we wish that wasn’t the result but it was. Those decisions are made independent of government and should be.”
There has been some good news in the past fortnight, however. Novavax published the final analysis of its vaccine trials, showing almost 90 per cent and 96.4 per cent efficacy against Alpha and non-Alpha strains. This data means it will soon be ready to submit a request for approval through the TGA. It can’t come soon enough. Moderna has also submitted its vaccine for approval in Australia.
On Thursday, after finishing a press conference touting Australia’s strong and resilient economy, Josh Frydenberg looked at his phone in shock. He turned to an adviser and said: “Fuck, I just got a text from the PM. Victoria is going into lockdown.”
This is the final part of a two part series. To read part one, on the vaccine rollout, go to part one: The true story of Australia's vaccine failure.
This article was first published in the print edition of The Saturday Paper on Jul 17, 2021 as "Vaccines, part two: ‘Is this guy serious?’".
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