This COVID outbreak is a vaccination wake-up call, but who will heed it?

This COVID outbreak is a vaccination wake-up call, but who will heed it?

05/29/2021

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If there had been any doubt, last week hammered home the full weight of the intractable problems facing Australia as it tries to navigate its way out of the COVID-19 pandemic.

The vaccine rollout has been too slow and clunky. Key cohorts of the population are too complacent to get vaccinated, or see no urgency. The public and the media are too obsessed with case numbers, so that even small outbreaks seem calamitous. Premiers outside NSW are reliant on lockdowns and border closures and not enough people have been vaccinated to dissuade them of that inclination. Hotel quarantine remains a leaky sieve with an indefinite expiry date and no clear alternatives.

Prime Minister Scott Morrison responds to the announcement of Melbourne’s fourth lockdown on Thursday.Credit:Alex Ellinghausen

And as a result – in the same week the United States announced half its adult population had been fully vaccinated – Melbourne was placed under lockdown for a fourth time and no government was prepared to stump up and take the blame. By comparison, Australia has fully vaccinated 500,000 people – or 2 per cent of the total population.

For all the frenzy over ventilation in a South Australian hotel, the adequacy of Victorian contact tracers and the Morrison government’s failure to establish a federally-run quarantine system, the bottom line remains: outbreaks are going to happen, and until more Australians are vaccinated, responses to those outbreaks are going to be draconian.

It’s not as though we weren’t warned. All year Peter Collignon, a professor of infectious diseases at the Australian National University and a member of the expert group advising the nation’s chief medical officers, has warned of the increased danger of a winter outbreak.

On May 8, mathematical biologist and epidemiologist James McCaw told this newspaper the risk of a serious outbreak was at its highest level since the pandemic began, and the only solution was high vaccination coverage.

Professor Peter Collignon has been one of those warning about a winter outbreak.Credit:Alex Ellinghausen

The Victorian cluster is not a full-blown crisis at this stage. The daily totals of new cases have so far been: four, 10, 12, four. If this had happened in NSW, it’s unlikely Sydney would be locked down. But Melbourne is understandably scarred from previous experience and doubts still hover over Victoria’s contact tracing system (though Chief Health Officer Brett Sutton says that criticism is “absurd”).

As clinical epidemiologist Fiona Stanaway wrote on Friday, last week was “a wake-up call”. And it seems Australians are answering that call. Melbourne’s mass vaccination hubs had long queues for the first time, and vaccinations tripled in Queensland. The country’s complacent slumber ended.

The tenor of people’s conversations on this subject has also changed. Where once they might have laughed about lockdowns as an unfortunate but inevitable novelty of the pandemic, now they are angry that after 15 months and with vaccine protection possible, the pattern just keeps repeating.

But the outbreak must also be a wake-up call for governments. Authorities quickly made changes; on Wednesday night Health Minister Greg Hunt announced an extra 130,000 vaccines would be expedited to Victoria. Then on Thursday, the medical advice changed to allow Victorian aged care residents to get their COVID-19 vaccine within two weeks of receiving a flu shot. And in a major development, people inundated the phone lines when Victoria allowed people aged 40 to 49 to get their Pfizer jabs.

Queues at Victorian vaccination centres have increased sharply since the outbreak.Credit:Joe Armao

These tweaks showed that when push comes to shove, changes can be made. So now the question becomes: what else can we do to reduce the chances of this happening again? And who will do it?

Prime Minister Scott Morrison’s initial stance seems to be that the settings are right and we just have to wait. Asked on Thursday if he had too hastily abandoned the national cabinet’s so-called “war footing” – whereby it was supposed to meet more often to address problems plaguing the vaccine rollout – Morrison said “no” and that the extra meetings had achieved what was needed.

But Chief Medical Officer Paul Kelly plainly left the door open to more wholesale changes. He said it was worth considering whether vaccines currently held back for people’s second doses should be redirected toward getting younger Australians their first jabs.

“Let’s see how it goes over the next week in terms of cases and numbers,” he said. On Friday, in response to criticism that only 2 per cent of Australians had received both doses, he added: “First doses are important. Zero doses give you no protection, one dose gives you very good protection quite quickly.”

Other countries are revising their rollouts. Singapore last week opted to widen the gap between the two doses of Pfizer and Moderna jabs in order to prioritise getting all adults at least one dose by early August. From June 7, Germany will start offering the vaccine to everyone over 16. Forty per cent of Germans have had at least one jab and 15 per cent are fully vaccinated.

“I’m frustrated and would like to see more urgency”: 30-year-old Rose Drover said she would happily receive the AstraZeneca vaccine.Credit:James Brickwood

In Australia, one in four vaccine doses available for use have not gotten into arms. The latest health department data shows that out of the 5.5 million doses distributed by May 16, 3.6 million had been used by May 23, leaving nearly 2 million left over, for a utilisation rate of 75 per cent. Governments won’t break those figures down into Pfizer versus AstraZeneca.

The staggered nature of the vaccine rollout is intended to prioritise those most at risk, but it has created inter-generational conflict in the process. Many younger Australians are furious about baby boomers refusing to take the AstraZeneca vaccine and hanging out for a Pfizer shot. They’re itching to get vaccinated themselves and many would happily accept the very low risk associated with the AstraZeneca jab.

“I’m frustrated and would like to see more urgency from people around me that are eligible to get the vaccine,” says Rose Drover, a 30-year-old from Manly who works in science communication at a university. “Most people are walking around like there’s not a pandemic raging.”

Older people have been hit with a barrage of conjecture, misinformation and hyperbole about the vaccine they’re being offered. The blood clot risk from the AstraZeneca jab is extremely low, but it has terrified large numbers of people. The government has sent mixed messages, with Hunt telling people “do not wait” at the same time as confirming there would be 2 million Pfizer doses a week arriving from the start of October.

Nick Coatsworth says under-50s should get the AstraZeneca vaccine if they wish.Credit:Alex Ellinghausen

Former deputy chief medical officer Nick Coatsworth said health officials would likely keep a keen eye on the Victorian outbreak and national vaccination uptake over the coming days to determine whether wholesale changes to the rollout were needed.

“The phased approach was always intended to be flexible and that if the public health situation demands it we [can] absolutely adapt the vaccination program,” he said. “I think it will be dictated by the numbers in Victoria.”

Coatsworth had no problem with people under 50 taking the AstraZeneca vaccine if they wished. “There’s an issue of patient autonomy there,” he said. “If a patient has made a judgment that they’re prepared to accept a risk for a known benefit then they should be able to.”

As he locked down his state on Thursday, Victoria’s acting premier James Merlino laid the blame squarely on the federal government, saying “we would not be here today” if alternatives to hotel quarantine had been established and if more people were vaccinated.

However, neither Victoria nor NSW are making serious complaints about vaccine supplies. In fact, they say vaccine supply is adequate for the present level of demand.

“The issue now in Victoria is people coming forward to get the vaccine,” the state’s chief health officer Brett Sutton said during the week. “We’ve got the supply, we’ve got the infrastructure to deliver it, we want people to book in, to walk in and to get the vaccine.”

Victorian deputy health secretary Jeroen Weimar reiterated on Friday: “We have a decent supply at this point in time to do at least double the numbers we have been doing every week.”

NSW Premier Gladys Berejiklian made clear she wants to vaccinate people faster than currently planned, but said her state had good certainty about vaccine supplies for the coming six weeks.

Victoria’s Acting Premier, James Merlino, has blamed the federal government for the outbreak.Credit:Justin McManus

“There’s never enough because we always want to do more [but] there’s enough to keep us more than busy in the next six weeks,” Berejiklian said on Wednesday. “We’re really starting to get a rhythm. I’m expecting – apologies to anyone who I work with, they know what I’m like – but we’re expecting to see those targets pushed through in the next few weeks.”

Then there is hotel quarantine. Federal Labor has pummelled the Morrison government for the 17 leaks out of the hotel quarantine system in six months. The Melbourne outbreak, linked to a leak in Adelaide several weeks prior, has again underlined the seriousness of the problem.

“The complacency over hotel quarantine is scientifically and economically unsustainable,” tweeted ABC coronavirus commentator Norman Swan. “One leak and a state might be shut down.”

Morrison has made it fairly clear his government will support Victoria’s proposal for an alternative quarantine facility, now likely to be near Avalon Airport. This is in addition to hotel quarantine, not a replacement, and would help the state increase its intake of returning travellers from the 1310 a week it accepts presently.

On Friday afternoon, Hunt was optimistic about the Victorian proposal becoming blueprint for new quarantine facilities nationally, though he noted it was an issue for the national cabinet.

“The Victorian proposal is far and away the most advanced and we think an excellent model that could be considered elsewhere in the country,” he said.

The problem is inherently linked to the vaccination rollout because of the time frame. Built-for-purpose quarantine facilities will take a long time to establish – is it worth it this far into the pandemic? That depends on how much longer we will need a quarantine system for returning travellers and others. And that depends on how quickly the rest of the country gets vaccinated.

As Coatsworth observes, while hotel quarantine and the vaccination program have become targets for buck-passing between the Commonwealth and the states, in reality all these projects are joint efforts. “It always has to be a co-operative relationship,” he says. “It doesn’t matter what the Constitution says.”

Coatsworth’s main message is that the blame-shifting theatrics amid every outbreak need to end.

“It’s neither helpful to over-egg the criticism of the vaccination campaign or hotel quarantine, nor helpful to criticise Victoria’s contact tracing system. All three of those things are immeasurably better than when they started and none of them are perfect,” he says.

“It probably erodes the trust of the community when we see people from both sides of politics saying ‘this is happening because this isn’t good enough’. Maybe leave that discussion for when this [outbreak] is sorted.”

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