The written language was carefully veiled. But when former federal and now global health bureaucrat Jane Halton spoke this week about her just-presented report on Covid-19 vaccine procurement, there was no missing the message.
“I think the thing we all knew was that this was a race,” Halton said.
Her contradiction of the phrase used by both former prime minister Scott Morrison and Health Department secretary Brendan Murphy to defend Australia’s slow start to vaccinating against Covid-19 confirmed what was woven in more muted terms through her findings: that the tardiness had a significant impact and must not be repeated.
Thirty months into the pandemic, Jane Halton’s examination of Australia’s Covid-19 vaccine and treatment readiness sounds an alarm about what could still lie ahead.
“Australia and the world are not yet ‘Covid-stable’, and we are unable to confidently predict the timing or impact of new waves and variants,” Halton said in an accompanying letter to Health Minister Mark Butler.
Later, she told The Saturday Paper that Australia was not prepared for another possible infection wave.
“We need to be ready,” said Halton, who formerly headed Australia’s finance and health departments and now chairs the international Coalition for Epidemic Preparedness Innovations, which funds vaccine research, and co-chairs COVAX, which works on equitable distribution.
“We should have arrangements in place to enable us to scale up availability of vaccines and therapies and therefore the delivery of those – so the purchase and delivery – in the event of another variant and spike in cases. Because we cannot say confidently that that will not happen.”
Butler has chosen to publish only Halton’s executive summary and recommendations, citing “commercial-in-confidence” concerns about releasing the full report.
Halton’s remit was to look ahead, not back, although making recommendations for the next two years required some examination of the past.
She depicts a slow-moving system mired in bureaucracy that did not react to changing circumstances, and a web of advisory arrangements that created public confusion – and still does.
Halton finds the former government produced no updated central policy statement on Covid-19 objectives after the nation moved from the initial emergency into the vaccination phase in 2021.
This meant there was no overarching guide in response to what by then was widespread Covid-19 infection, associated high levels of “hybrid immunity”, the possibility of future waves and variants, and developments in the science and manufacturing of both vaccines and treatments.
Halton recommends the new government urgently draft such a statement, outlining its objectives as the pandemic moves into its fourth year and beyond. She says this will better co-ordinate the future response.
“Why is this kind of approach now important? It’s because it does provide a clearer understanding to everybody about where we’re at and what our objectives are, and that helps frame the advice, the medical advice, that might be given,” Halton told The Saturday Paper this week.
She said it would help frame purchasing decisions and eligibility for antivirals and other treatments and form “a new baseline” to enable “all people who are making decisions and taking actions to be really clear about where we’re at and where we think we’re going”.
A new, clear public information campaign would also help Australians understand better how to get a booster, and what to do when they get sick. “They should be able to have confidence that these arrangements are in place and that the things that they need, when they need them, will be available,” she said. “That’s what people should be able to expect.”
Halton’s backward glance is careful but critical. She said procurement settings did not keep up with the speed of vaccine development. “We needed our regulatory systems, our funding and our procurement systems to move at great speed as well,” Halton said alongside Butler on Tuesday.
While people within various advisory bodies had done “a really outstanding job”, Australia was “at a different point now”.
Halton noted that in the initial “sellers’ market”, in which the whole world needed to buy vaccines, Australian decision-makers had stuck strictly to non-emergency procurement rules instead of moving fast to secure supply.
She suggested there was still confusion about multiple bodies giving advice. “It is important to clarify who the key decision-maker on vaccine eligibility is and which bodies act in an advisory capacity,” she found.
New advisory “structures and mandates” were required in response to changing circumstances, including new variants, vaccines and treatments.
She also found unclear advice presentation, and communication, was still fuelling needless hesitancy about certain vaccines – particularly Novavax – creating confusion and potentially significant wastage.
She warned this would likely cause an oversupply of Novavax next year, recommending the government clarify eligibility to both increase uptake and reduce the need to buy alternatives. She said they should also seek to defer delivery of already-ordered Novavax doses to 2024.
The Saturday Paper understands the advice about Novavax issued by the Australian Technical Advisory Group on Immunisation is frequently misinterpreted, prompting providers – and therefore patients – to prefer alternatives.
That advice suggests Novavax is available as a booster for people who have a contraindication to mRNA vaccines, such as the one produced by Pfizer. It goes on to say it can also be taken by “people who do not prefer an mRNA vaccine”, meaning it is a safe personal choice for everyone else.
But the second part is being overlooked. “I think one of the messages we should be giving people actually is that Novavax is a good vaccine, and it’s a good vaccine as a booster,” Halton said on Tuesday, suggesting booster rates needed to increase.
Butler reiterated that there would be a future “deep inquiry” into pandemic handling, given “the extraordinary level of dislocation, death, distress and spending, frankly, on this pandemic”.
“But now is not the time to conduct that review. That time will come.”
This article was first published in the print edition of The Saturday Paper on October 1, 2022 as "Keeping up with the vaxxes".
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