Would Australians support mandates for the COVID-19 vaccine? Our research suggests most would


Dean Lewins/AAP

David Smith, University of Sydney; Katie Attwell, The University of Western Australia, and Uwana Evers, The University of Western AustraliaAustralia’s vaccine rollout is moving far more slowly than the government had hoped, and there is evidence of vaccine hesitancy in a significant part of the population.

Some governments and media outlets are already considering whether mandates will be needed to reach sufficient vaccine coverage.

Last year, Prime Minister Scott Morrison briefly suggested a vaccine would be mandatory before walking it back hours later.

Supply and rollout problems must clearly be solved first. But if mandates do come back on the table in the face of vaccine hesitancy, our research sheds light on how widely supported they would be.

Last year, with our research partner Pureprofile, we surveyed 1,200 Australians about whether they would take a COVID-19 vaccine when it became available. We also asked if they thought the government should make the vaccine a requirement for work, travel and study.

Our sample included 898 respondents we had previously surveyed in 2017. Back then, we asked their opinions about the safety and necessity of vaccines and whether they supported the federal government’s “No Jab, No Pay” policy, which takes away financial entitlements from vaccine refusers.




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Of those who participated in both the 2017 and 2020 surveys, 88% agreed in 2017 with the statement that “vaccines are safe, necessary and effective”. Yet 30% gave a hesitant response (“maybe” or “no”) when asked in 2020 if they would take the coronavirus vaccine.

We asked all hesitant respondents why they were hesitant. Just 8% of them were “against vaccines”. Another 16% indicated they weren’t personally concerned about the coronavirus. But an overwhelming 70% had safety concerns about the vaccine because of how quickly it was being developed.

New research has found widespread support among Australians for mandating COVID-19 vaccination.
David Caird/AAP

This level of vaccine hesitancy is very high by Australian standards, but it is unfortunately normal for COVID-19. Other local and international studies have also found much higher than normal hesitancy about COVID-19 vaccines, driven by a variety of factors. Despite this higher-than-usual hesitancy, a comfortable majority of Australians still want the vaccine.

Moreover, large majorities of Australians are in favour of government mandates for COVID-19 vaccines. Surprisingly, more respondents in our survey said they favoured the government making the vaccine a requirement (73%) than said they would definitely take it themselves (66%).

This is the opposite of what vaccination mandate studies usually find in the US, where there is less support for government mandates than there is for personally taking vaccines. However, it is in line with what other researchers have found about Australians during the pandemic. We have generally been highly accepting of strict government measures to control it, even if we don’t agree with them. This may also be evidence of a broader culture of rule-following.

Another crucial difference between Australians and Americans is in the political makeup of support for COVID-19 vaccines. While vaccine hesitancy in the US previously didn’t map onto party-political affiliation, it has very much done so for COVID-19.

Donald Trump’s opposition to other measures to fight the pandemic, his scepticism about the pandemic itself, and perhaps even his earlier statements about childhood vaccines seem to have caused widespread rejection of the COVID-19 vaccine among Republicans. This is in spite of the Trump administration’s significant support of vaccine development, and Trump’s own claim that he is the “father of the vaccine”.

Making vaccinations mandatory is even less popular with Republicans, and threatens to become a significant culture war issue.




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However, in Australia, the COVID-19 vaccine and the prospect of government requirements are popular. Supporters of both the Coalition parties and Labor, which between them form every state and federal government in the country, embrace both: 72% of these major party voters say they would definitely take the vaccine, while 79% of them support requirements for it. There is no statistically significant difference between supporters of the different parties.

Donald Trump has recently declared himself the ‘father’ of the vaccine, despite being publicly sceptical at first about the seriousness of the virus.
Gerald Herbert/AP/AAP

On the other hand, voters whose first preference would go to another party or independent were more hesitant about the vaccine and requiring it. Only 56% of them said they would definitely take the vaccine, while 61% said they would support a mandate.

Politicians from the Coalition and Labor have led Australia’s response to COVID-19, appearing alongside each other in a sometimes fractious but generally co-operative national cabinet. So perhaps it isn’t surprising that supporters of these parties also support vaccination in large numbers.

The biggest pockets of opposition are found in supporters of parties that usually don’t form government, and which challenge the major party consensus from both the left and right. It is important to emphasise that even a majority of these minor party voters would definitely take the vaccine, and would also support government requirements to do so. But we must keep in mind that vaccine hesitancy may well have an “anti-establishment” character in Australia, found among those who are less satisfied with the major parties.

We conducted our survey before any vaccine had been developed, let alone rolled out. Now that Australians have seen both the spectacular successes and rare but worrying adverse events following some brands of vaccination, should we expect them to have different views?

The market research company Ipsos undertook the only other national study we know of on attitudes to making COVID-19 vaccinations mandatory. In January, Ipsos asked whether this should be the case for those over 18, and found 54% of Australians said yes, 35% said no and 10% were unsure.

The stronger language of “mandates” and less clarity about what mandatory means in practice may have prompted less support than in our study. Comparisons to 13 other countries put Australians somewhere in the middle in terms of acceptance of mandates. The Ipsos survey, like ours, was conducted prior to the recent pivot away from AstraZeneca vaccination for under 50s.

However, a recent survey of Western Australians found much higher support when respondents were asked about a specific requirement. Some 86% of respondents said they would favour making a vaccine mandatory for anyone who wanted to travel overseas.

The authors of this piece are neither anti- nor pro- vaccine mandates. We believe in certain circumstances it is appropriate for governments to require people to be vaccinated, and we prefer this to leaving vaccine mandates to the private sector. The development of any mandatory vaccination policies should involve robust and transparent engagement with the public.

However, we believe mandates should be a policy of last resort. Well-funded and targeted public communications, easy access and incentives should come first. We are still waiting for our own eligibility to be vaccinated, so there is a long way to go.The Conversation

David Smith, Associate Professor in American Politics and Foreign Policy, US Studies Centre, University of Sydney; Katie Attwell, Senior Lecturer, The University of Western Australia, and Uwana Evers, Adjunct Research Fellow, The University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The pressure is on for Australia to accept the coronavirus really can spread in the air we breathe


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C Raina MacIntyre, UNSWMore than a year into the pandemic, the World Health Organization (WHO) and US Centers for Disease Control finally changed their guidance to acknowledge SARS-CoV-2, the virus that causes COVID-19, can be transmitted through the air we breathe.

In Australia, we’ve just had the latest leak from hotel quarantine, this time in South Australia. Investigations are under way to find out whether a man may have caught the virus from someone in the hotel room next to his, before travelling to Victoria, and whether airborne transmission played a role.

These examples are further fuelling calls for Australia to officially recognise the role of airborne transmission of SARS-CoV-2. Such recognition would have widespread implications for how health-care workers are protected, how hotel quarantine is managed, not to mention public health advice more broadly.

Indeed, we’re waiting to hear whether official Australian guidelines will acknowledge the latest evidence on airborne transmission, and amend its advice about how best to protect front-line workers.

The evidence has changed and so must our advice

At the beginning of the pandemic, in the absence of any scientific studies, the WHO said the virus was spread by “large droplets” and promoted handwashing. Authorities around the world even discouraged us from wearing masks.

A false narrative dominated public discussion for over a year. This resulted in hygiene theatre — scrubbing of hands and surfaces for little gain — while the pandemic wreaked mass destruction on the world.

But handwashing did not mitigate the most catastrophic pandemic of our lifetime. And the airborne deniers have continually shifted the goalposts of the burden of proof of airborne spread as the evidence has accrued.




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What does the evidence say?

SARS-CoV-2 is a respiratory virus that multiplies in the respiratory tract. So it is spread by the respiratory route — via breathing, speaking, singing, coughing or sneezing.

Two other coronaviruses — the ones that cause MERS (Middle Eastern respiratory sydrome) and SARS (severe acute respiratory syndrome) — are also spread this way. Both are accepted as being airborne.

In fact, experimental studies show SARS-CoV-2 is as airborne as these other coronaviruses, if not more so, and can be found in the air 16 hours after being aerosolised.

Several hospital studies have also found viable virus in the air on a COVID-19 ward.

Established criteria for whether a pathogen is airborne scores SARS-CoV-2 highly for airborne spread, in the same range as tuberculosis, which is universally accepted as airborne.

A group of experts has also recently outlined the top ten reasons why SARS-CoV-2 is airborne.

So why has airborne denialism persisted for so long?

The role of airborne transmission has been denied for so long partly because expert groups that advise government have not included engineers, aerosol scientists, occupational hygienists and multidisciplinary environmental health experts.

Partly it is because the role of airborne transmission for other respiratory viruses has been denied for decades, accompanied by a long history of denial of adequate respiratory protection for health workers. For example, during the SARS outbreak in Canada in 2003, denial of protection against airborne spread for health workers in Toronto resulted in a fatal outbreak.

Even influenza is airborne, but this has been denied by infection control committees.




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What’s the difference between aerosols and droplets?

The distinction between aerosols and droplets is largely artificial and driven by infection control dogma, not science.

This dogma says large droplets (defined by WHO as larger than 5 micrometres across) settle to the ground and are emitted within 2 metres of an infected person. Meanwhile, fine particles under 5 micrometres across can become airborne and exist further away.

There is in fact no scientific basis for this belief. Most studies that looked at how far large droplets travelled found the horizontal distance is greater than 2 metres. And the size threshold that dictates whether droplets fall or float is actually 100 micrometres, not 5 micrometres. In other words, larger droplets travel further than what we’ve been led to believe.

Leading aerosol scientists explain the historical basis of these false beliefs, which go back nearly a century.

And in further evidence the droplet theory is false, we showed that even for infections believed to be spread by droplets, a N95 respirator protects better than a surgical mask. In fact airborne precautions are needed for most respiratory infections.

Why does this difference matter?

Accepting how SARS-CoV-2 spreads means we can better prevent transmission and protect people, using the right types of masks and better ventilation.

Breathing and speaking generate aerosols. So an infected person in a closed indoor space without good ventilation will generate an accumulation of aerosols over time, just like cigarette smoke accumulates.

A church outbreak in Australia saw spread indoors up to 15 metres from the sick person, without any close contact.

Masks work, both by preventing sick people from emitting infected aerosols, and by preventing well people from getting infected. A study in Hong Kong found most transmission occurred when masks weren’t worn inside, such as at home and in restaurants.




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Coughing generates more aerosols

The old dogma of droplet infection includes a belief that only “aerosol generating procedures” — such as inserting a tube into someone’s throat and windpipe to help them breathe — pose a risk of airborne transmission. But research shows a coughing patient generates more aerosols than one of these procedures.

Yet we do not provide health workers treating coughing COVID-19 patients with N95 respirators under current guidelines.

At the Royal Melbourne Hospital, where many health worker infections occurred in 2020, understanding airflow in the COVID ward helped explain how health workers got infected.

Think about it. Airborne deniers tell us infection occurs after a ballistic strike by a single large droplet hitting the eye, nose or mouth. The statistical probability of this is much lower than simply breathing in accumulated, contaminated air.

The ballistic strike theory has driven an industry in plastic barriers and face shields, which offer no protection against airborne spread. In Switzerland, only hospitality workers using just a face shield got infected and those wearing masks were protected.




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In hotel quarantine, denial of airborne transmission stops us from fixing repeated breaches, which are likely due to airborne transmission.

We need to select quarantine venues based on adequacy of ventilation, test ventilation and mitigate areas of poor ventilation. Opening a window, drawing in fresh air or using air purifiers dramatically reduce virus in the air.




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We need to provide N95 respirators to health, aged-care and quarantine workers who are at risk of high-dose exposure, and not place them in poorly ventilated areas.

It’s time to accept the evidence and tighten protection accordingly, to keep Australia safe from SARS-CoV-2 and more dangerous variants of concern, some of which are vaccine resistant.The Conversation

C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Grattan on Friday: Is that the Coalition debt truck parked just past the election?


Michelle Grattan, University of CanberraIt was a small thing but a revealing moment during Scott Morrison’s Wednesday interview on Nine’s Today show.

Presenter Karl Stefanovic noticed Morrison seemed out of sorts, despite the government having delivered the night before a benign budget that was well received and likely to be popular.

“It is a very big budget. Josh Frydenberg had a very big smile on his face this morning. I thought you might be happier this morning, PM. Everything OK?” Stefanovic asked.

Morrison said he was “fine”. He went on: “I’ve got to tell you, Karl, the reason is this.

“I know, look, budgets are big events and that’s all fine, but I just know the fight we’re in – and the fight we’re in, and me as prime minister I’m in, is to be protecting Australians at this incredibly difficult time.

“I am very cognisant of how big those challenges are. It is with me every second of every day.”

There are a few points to be made here.




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First, the government is using the budget to talk up the current threat of the pandemic to an extent it hadn’t been recently.

Morrison, in particular, had previously been anxious to emphasise the return to as much normality as possible. Now it’s more about lurking dangers.

These provide a justification for the government’s mega spending in the budget. (“Did anyone miss out? Perhaps only the beekeepers of Australia,” quipped one cynical Liberal backbencher.)

The language also indicates Morrison wants to do what state and territory leaders have done – use the pandemic to pave the path to electoral victory.

The other point highlighted by the Today exchange is that Morrison was looking somewhat ragged.

This was accentuated by the contrast with Treasurer Josh Frydenberg who, on the face of it, would have been under the greater stress.

Frydenberg’s performances in the week of his third budget were smooth and, whatever nerves he felt, he appeared unfazed.

The week reinforced the impression he is in the box seat eventually to reach the prime ministership (assuming the Coalition lasts in government).

Pre-budget, he and wife Amie were out for the cameras on a Sunday charity run in Canberra. Post-budget, his staff rang around backbenchers to ask if they’d like a picture with the treasurer.

In question time, Morrison found old problems returning to irritate him. He was pressed on the two internal inquiries into who in his office knew or did what in relation to the Brittany Higgins matter, and he had to say neither was concluded (one had been on hold before this week while the police dealt with their investigation of her rape allegation). Whatever the results of these inquiries, Morrison needs to get them cleared away as soon as possible. They are “barnacles”.

Morrison has been travelling a lot recently and may be tired (although those around him say he’s energised by being on the road). Or he may not be used to sharing the limelight. Or the endless round of everything may be just taking its toll.

Then there’s the challenge of explaining this Labor-lite budget to the hardliners in the Liberal base and among the right-wing commentariat.

The budget has made the opposition’s already formidable task of carving out room for itself more difficult, but it is also proving a hard swallow for those rusted on to the Coalition’s old “debt and deficit” preoccupation.




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Many of these critics will be reluctant to buy the proposition the big spending must continue because the pandemic is a constant threat, given they’ve thought the threat was exaggerated in the first place.

The government could attempt to deal with these critics by saying it will “snap back” into tackling debt and deficit as quickly as possible.

But facing an election soon, it doesn’t want to do this, for obvious reasons.

In the budget the timing of the next stage, fiscal consolidation, is imprecise.

The budget papers say: “Progress on the economic recovery will be reviewed at each Budget update. This phase of the Strategy will remain in place until the economic recovery is secure and the unemployment rate is back to pre-crisis levels or lower.”

While some commentary is focused on how the Coalition has done a dramatic U-turn from its old debt-and-deficit rhetoric, there’s an opportunity for Labor to run a major scare campaign claiming it’s not a U-turn at all – that the debt truck is just in the parking lot.

Remember, it can say, when Tony Abbott promised no cuts to health, education and even the ABC – and recall what happened. This time, so the argument runs, cuts and savings will be Coalition priorities again as soon as it has secured the votes.

Morrison and Frydenberg this week have been invoking John Howard’s advice, given to Frydenberg in the early days of the pandemic, that “in times of crisis there are no ideological constraints”.

The question is whether the Liberals have softened their ideology, or just put it in storage during the crisis.

While there can be no definite answer, Tim Colebatch, writing in Inside Story. makes a strong case that the Coalition “won’t dump its political tactic of branding itself as the ‘fiscally responsible’ party and Labor as the party standing for deficits. This [budget] is a short-term tack that will be reversed after the election.

“Of course no government promising $503 billion of deficits in five years can be called fiscally responsible, so it will make cuts then to reclaim the brand,” Colebatch says.

Morrison and Frydenberg are both pragmatists rather than ideologues. But opinions in the wider party are also relevant, as Malcolm Turnbull found on the climate issue.

Frydenberg has pledged there will not be “any sharp pivots towards ‘austerity’”.

Nevertheless, there must be a budgetary reset at some point. And whether a pivot is sharp or not, and what amounts to “austerity” depend in part on whether you are one of the losers.




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The Conversation


Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No vaccine ‘targets’, but Australians could still be vaccinated by end of year


Driss Ait Ouakrim, The University of Melbourne; Ameera Katar, The University of Melbourne, and Tony Blakely, The University of MelbourneThis week’s budget assumes Australians will be fully vaccinated against COVID-19 by the end of the year, despite Prime Minister Scott Morrison saying the government has no vaccination targets, modelling or forecasts.

Australians are eagerly watching the pace of the rollout, given this underpins a further budget assumption: international borders could re-open from mid-2022.

So are all Australians likely to be offered two COVID-19 doses by the end of the year?

Previous targets

In January, the government was aiming to vaccinate 80,000 people per week. It wanted 4 million Australians vaccinated by the end of March and the entire adult population vaccinated by October.

So far, we have only delivered 2.83 million doses.

The initial vaccination road map was derailed in part due to poor logistics, but more so due to lack of supply and sheer bad luck. Prioritising the AstraZeneca vaccine, with its local manufacturing capacity, seemed like a good bet but this was derailed by the rare — but real — possibility of blood clots.




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The announcement overnight of 10 million doses of Moderna mRNA vaccine this year, and 15 million next year, suggests we will see AstraZeneca quietly shuffled off stage and replaced with Moderna. However, it is unlikely to impact the current timeline.

Could we meet an end-of-year target?

In theory, yes.

Studies suggest around three-quarters of Australians are willing to have a COVID-19 vaccine. If we aim to have 75% of adults fully vaccinated with two doses this year, around 15 million Australians will need to receive 30 million doses over the next seven months.

About half of these people are 50+ or priority populations, and the other half are under 50. So that means 15 million doses before September 30 (assuming we continue using AstraZeneca), and 15 million doses from October 1, when greater stocks of the Pfizer and Moderna vaccine become available in the fourth quarter of the year.




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From now until September 30, we have 100 weekdays left to deliver 12.2 million vaccine doses, or 122,000 per day.

This is twice as many doses per day as we achieved in the past week. But it’s doable if we ramp up our vaccination capacity.

From October 1 to December 24, we have about 15 million doses to administer to vaccinate 75% of all remaining adults. This will mean 250,000 vaccinations per weekday, so doubling the daily number again in the “sprint”.

Again, this is doable if we get all our mass vaccination hubs well-oiled and efficient before then. And probably use weekends, too.

Where it gets more challenging is if many people 50 and over elect to wait for Pfizer or Moderna, meaning an even bigger “sprint”. That would require an extremely reliable supply of these two vaccines before Christmas, well-oiled delivery systems and mass vaccination sites to deliver in excess of 300,000 doses per weekday.

This implied goal of offering vaccines to all adults by the end of 2021 is ambitious, but not impossible.

So when could we open borders?

Australia will still not have COVID-19 resilience (or “herd immunity”, or something approaching it) by the end of 2021.




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If 25% of Australian adults are unvaccinated, plus 100% of children, some 40% to 45% of the population will remain unvaccinated, which is likely too low to achieve herd immunity.

Wholesale opening of our borders then is not possible – the virus would still spread with substantial disease and death.

To meet a mid-2022 target for substantially loosening border restrictions, we will need children to be vaccinated and further vaccination of adults hesitant in 2021.The Conversation

Driss Ait Ouakrim, Research Fellow, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne; Ameera Katar, Data Analyst and Research Coordinator, The University of Melbourne, and Tony Blakely, Professor of Epidemiology, Population Interventions Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What is the Moderna COVID vaccine? Does it work, and is it safe?


Adam Taylor, Griffith UniversityOvernight, Boston-based pharmaceutical company Moderna announced a new supply agreement with Australia for 25 million doses of its COVID-19 vaccine.

The deal includes ten million doses against the original strain of the coronavirus to be delivered this year.

This vaccine has been widely used in countries such as Canada, United States and the United Kingdom under emergency use authorisations granted by these countries and the World Health Organization.

Moderna’s deal with Australia also includes 15 million doses of its updated variant booster vaccine candidate, estimated to be delivered in 2022.

The agreement is subject to approval by Australia’s drug regulator, the Therapeutic Goods Administration (TGA), for both the original vaccine and the booster. Moderna expects to submit an application to the TGA “shortly”.

How does Moderna’s vaccine work?

Moderna’s vaccine against the original strain is given as two doses.

Both this vaccine, and the updated booster, are mRNA vaccines (like the Pfizer vaccine). The vaccine contains genetic instructions for our cells to make the coronavirus’ “spike protein”. The mRNA is wrapped in an oily shell that protects it from being immediately degraded by the body, and ensures it’s delivered into cells after injection.

Once in the cell, the mRNA is converted into spike protein that can be recognised by the immune system. Our immune system then builds an immune response against the spike protein, and learns how to fight off the coronavirus if we encounter it in future.

Moderna’s vaccine remains stable at -20°C, the temperature of a household freezer, for up to six months. It can remain refrigerated at 4°C for up to 30 days.

As most pharmaceutical logistic companies are capable of storing and transporting products at -20°C, it’s relatively easy to store and distribute this vaccine. By contrast, Pfizer’s mRNA COVID-19 vaccine needs to be stored long-term below -60°C, though unopened vials can be stored at freezer temperatures for up to two weeks.




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Is it safe and effective?

Phase 3 clinical trials of the vaccine, with over 30,000 participants, showed 94.1% efficacy at preventing COVID-19 as well as complete protection against severe forms of the disease.

Researchers did not identify safety concerns, with the most common side effects being transient pain at the injection site, and headache or tiredness that typically lasted for up to three days.

These clinical trials, however, largely occurred prior to the emergence of SARS-CoV-2 variants of concern. These include B.1.1.7, which emerged from the United Kingdom, and B.1.351, first detected in South Africa.




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Can it protect against variants?

Subsequent studies have investigated the potential for these variants to escape the protection offered by Moderna’s vaccine. Preliminary studies have identified slight, although not significant, reductions in the protection it offers against the B.1.351 variant, originating in South Africa.

In response to this data, Moderna updated its mRNA vaccine formulation to account for the changes in the spike protein present in the B.1.351 variant. In March this year, it started phase 1 and 2 clinical trials to investigate the safety and ability of its variant vaccine to provoke an immune response.

Preliminary, preclinical studies suggest vaccination with the variant vaccine was effective at increasing neutralising antibodies against the B.1.351 variant.

Preclinical studies also suggest a vaccine containing an equal mix of its original vaccine, and the B.1.351 vaccine, was most effective at providing broad cross-variant protection, including against the P.1 variant that originated in Brazil.

In people already fully vaccinated against the original strain, clinical studies demonstrated a booster dose of Moderna’s variant vaccine achieved a higher number of neutralising antibodies against the B.1.351 variant, than simply giving a booster dose of Moderna’s original strain vaccine.

Moderna’s vaccines can be rapidly reformulated to target emerging variants. This is largely thanks to the splendour of the mRNA technology, simply requiring the genetic sequence of the virus.

It’s possible Moderna will be able to update its vaccine to cover future variants of the coronavirus so we can quickly provide people with protection to emerging strains.




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Moderna revealed it’s in discussions with the federal government about manufacturing its vaccines onshore in Australia. This follows news that both Victoria and New South Wales have committed money towards developing mRNA vaccine manufacturing capability.

This is a move that would not only further secure Australia’s supply of COVID-19 vaccines, but kick start the development of an industry within Australia that has the potential to impact multiple diseases.The Conversation

Adam Taylor, Early Career Research Leader, Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Budget package doesn’t guarantee aged-care residents will get better care


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Stephen Duckett, Grattan Institute and Anika Stobart, Grattan InstituteThe big investment in aged care announced in last night’s federal budget – an extra A$17.7 billion over five years – is a welcome response to the Royal Commission into Aged Care Quality and Safety. But even an investment of this scale does not meet the level of ambition set by the royal commission.

The government has committed A$6.5 billion for more home-care packages (about A$2.5 billion more for home care per year when fully implemented), and A$7.1 billion for residential-care staffing and services (about $2.4 billion more for residential care per year when fully implemented).

But the government has failed to outline a clear vision of what older Australians should expect of their aged-care system.




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Immediate fixes with no guarantees

The budget includes funding for 80,000 extra home-care packages over two years. The current home-care packages program has numerous problems, including nearly a 100,000-strong waiting list.

But the government has not explicitly promised to clear the waiting list and bring waiting times down to 30 days, as the royal commission called for.

The budget has some good news for people in residential aged care. The Basic Daily Fee (for services including food) will be increased by A$10 per resident per day, as called for by the royal commission.

And there’s more funding for better staffing, with mandates for an average of at least 200 minutes of care for every resident every day (40 minutes of which must be by a nurse) by 2023.

This is a good start, given nearly 60% of residents presently get less than this. But residents will have to wait two years – not one, as recommended by the royal commission – before they get more care hours.




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The budget also provides additional funding to improve the aged-care workforce. The government will subsidise the training of new and existing aged-care workers, including 33,800 places to attain Certificate III.

But the government has not gone far enough in supporting the workforce. It stopped short of guaranteeing that every staff member providing care for older Australians will be trained to a minimum Certificate III level, and that all residential aged-care facilities will have a registered nurse on site 24 hours a day.

The budget commitments appear to be a once-off, with workforce funding plummeting to only A$86.5 million in 2024-25, compared to A$293.3 million in 2022-23. And there is no commitment to lift carers’ wages.

Residents won’t have access to a registered nurse 24 hours a day.
Shutterstock

Small steps towards a better system

The royal commission made it clear the aged-care system needed to be reformed from top to bottom. The government’s announcements foreshadow a shake-up of the system over five years. But the extent of reform is yet to be determined.

The budget papers show funding will be up by about A$5.5 billion per year once most reforms are in (see the chart below). That’s not enough to create a needs-driven, rights-based system, called for by the royal commission and the Grattan Institute.


Federal budget paper 2

The government has committed to a new Aged Care Act, to be legislated by mid-2023, though the details are yet to be filled in. This Act must put the rights of older Australians at its heart.

The government has also committed to designing a new home care program and will provide a single assessment process for both home care and residential care.

More home-care packages will be available but there won’t be enough for all those currently on the wait list.
Shutterstock

A local network of health department staff will be embedded in the regions, and there will be a network of 500 “care finders” to help older Australians get the support they need.

But the biggest risk to achieving real structural change is governance and transparency. Here, the government has fallen short.




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The government does not support the establishment of an independent aged care commission. Most disappointingly, it is pumping A$260 million into the Aged Care Quality and Safety Commission, which the royal commission found had demonstrably failed.

While some transparency will be provided through public reporting of staffing hours and star ratings to compare provider performance, clear transparency measures will be needed to ensure the additional billions don’t end up boosting providers’ profits.

The good news from budget 2021 is that the journey has begun. The government has made a substantial down payment to allow development of a new aged-care system. We must hope that more will follow, so the neglect ends and every older Australian can get the care and support they need.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute and Anika Stobart, Associate, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Did someone drop a zero? Australia’s digital economy budget spend should be 10 times bigger


Marek Kowalkiewicz, Queensland University of TechnologyThe federal budget for 2021-22 promises A$1.2 billion over the next six years to support the Digital Economy Strategy, a plan to make Australia “a leading digital economy and society by 2030”.

The Digital Economy Strategy proclaims

We are well placed to be a leading digital economy and have strong foundations, but many countries are investing heavily in their digital futures.

This may sound like a lot, but a closer look at the strategy and funding announcements, compared with what other countries are doing, shows we may not be so well placed after all.

Countries such as France and Singapore have implemented similar initiatives, with one key difference: they are spending about ten times as much money as Australia.




Read more:
Cuts, spending, debt: what you need to know about the budget at a glance


The world picture

To see how Australia compares worldwide, we can look to the most comprehensive global analysis of the digital evolution of nations, the Digital Intelligence Index produced by researchers at Tufts University in the United States.

This index looks at many factors, such as digital payment and logistics infrastructure, internet usage, regulations and research, to give each country scores for the current state of its digital economy and also how fast the digital economy is developing.

In the 2020 edition, Australia ranked as the 17th digital economy in the world — behind Sweden, Taiwan, New Zealand, and the leading nation, Singapore. In 2017 Australia came 11th, so we are already dropping down the rankings.

Just to maintain our position, we need to improve at least as rapidly as those behind us. Prime Minister Scott Morrison has acknowledged this, noting “we must keep our foot on the digital accelerator to secure our economic recovery from COVID-19”.

However, the Digital Intelligence Index ranks Australia 88th of the 90 countries analysed when it comes to our speed of improvement. The only two countries slower than Australia are Hungary and Nigeria, and there are 87 digital economies developing faster than us.

Since 2017, countries such as Slovenia, Egypt, Greece and Pakistan, which used to grow more slowly, are moving faster, increasing the pressure from the back of the pack.

Denmark and Sweden, two countries ahead of us in the Digital Evolution ranking above, used to grow slower, giving us a chance to overtake them. Not anymore. They have now picked up speed, and are increasing the gap we need to cover even to catch up with them.

The right ideas, but not enough funding

The Digital Economy Strategy package, announced in the budget, covers a broad range of initiatives. They are grouped into eight priorities, covering education, support for small and medium enterprises (SMEs), cyber security, artificial intelligence (AI), drone technologies, data sharing, support of government services, and tax incentives.

It is promising to see government’s dedicated investment, particularly in securing future skills and building Australia’s AI capability. But it is concerning to see the spending on some priorities fails to reflect the importance of these topics.

The federal government recognised the need for upskilling Australians. According to the Australia’s Digital Pulse report compiled by Deloitte and the Australian Computing Society, we will need 60,000 new technology workers every year for the next five years, just to meet the growing demand. Yet only 7,000 students graduated with IT degrees in Australia in 2019.

The new budget will support graduate and cadet programs, including through additional funding assigned to AI. Unfortunately, the government’s new programs will barely put a dent in our projected skills shortage of about 50,000 workers annually. The new programs will provide scholarships for only up to 468 graduates over a six-year period.

Artificial intelligence is another key topic. AI is upturning industries globally, and creating opportunities for emerging and transforming businesses. The federal government allocated $124.2 million to this priority, distributed among initiatives lasting between four and six years.

Compare this with France, which has allocated €1.5 billion (A$2.3 billion) to AI initiatives running between 2018 and 2022. Given France’s economy is roughly twice the size of Australia’s, an equivalent commitment from Australia would be slightly over A$1 billion — almost 10 times the promised A$124.2 million.

Not enough funding for private enterprise

A huge chunk of the $1.2 billion promised in the budget will be spent on the Enhancing Government Services Delivery priority. Aside from two small expenses of $13.2 million, it consists of just two large initiatives.

The first will deliver an enhanced version of the government’s online service platform, myGov. The second is for digital health, funding My Health Record and Australian Digital Health Agency activities. Together, they will consume more than half of the entire Digital Economy Strategy budget.


This seems grossly unbalanced and skewed toward digital transformation of the public sector, rather than supporting Australia’s digital economy holistically.

Are we really keeping our foot on the digital accelerator, or just pretending to?

We need to do better

Australia’s budget spending on the Digital Economy Strategy for 2021-22 is planned to be just shy of $500 million (with the remainder of the announced $1.2 billion to be spent over the following five years). That’s less than 0.1% of Australia’s entire projected budget spending. How does it compare to leading digital economies?

In Singapore (the world’s top digital economy), a single initiative to support organisations in adopting digital solutions and technologies received S$1 billion (A$960 million) in funding this year. That’s just shy of 1% of Singapore’s entire budget in 2021. Again, the commitment is around ten times higher than Australia’s investment.

To stop sliding down the rankings, Australia needs to put its (our) money where its mouth is. Countries ahead of us (Singapore) and behind us (France) are investing ten times as much as we do in digital economy initiatives.

Are we really well placed to be a leading digital economy? Like so much in life, you get what you pay for.




Read more:
To change our economy we need to change our thinking


The Conversation


Marek Kowalkiewicz, Professor and Founding Director of QUT Centre for the Digital Economy, Queensland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia: Budget 2021


Frydenberg spends the budget bounty to drive unemployment down to new lows


Peter Martin, Crawford School of Public Policy, Australian National UniversityNever before has a budget spent so much to supercharge the economy after the worst of a recession has already passed.

The economy bounced back from last year’s COVID recession far more sharply than the treasury (or just about anyone else) expected.

The bounty from the higher-than-expected tax collections that flowed from more people than expected in work, a much higher-than-expected iron ore price, and lower than expected unemployment benefits, should amount to A$26.8 billion this financial year, $15.5 billion the next, and $18.6 billion the year after that.

But rather than bank those riches and improve the budget bottom line, as the Coalition’s budget strategy used to require it to do, the government has instead decided to spend the lot.



It will spend $21 billion of this year’s $26.8 billion; it will spend or give up in new tax concessions $26.9 billion — far more than next year’s $15.5 billion bounty, and so on.

Treasurer Josh Frydenberg has come good on his historic promise to keep spending way beyond the crisis, to drive the unemployment rate down below where it was when the pandemic started.




Read more:
View from The Hill: Frydenberg finds the money tree


The budget predicts an unemployment rate of 4.75% by mid-2023 and 4.5% by mid-2024.

If delivered (and the treasurer’s revised strategy published in the budget requires him to keep spending until it is), it will mark what the budget papers describe as, “the first sustained period of unemployment below 5% since before the global financial crisis, and only the second time since the early 1970s”.



In the same way as Australia emerged from the early-1990s recession with a dramatically lower inflation rate because the Reserve Bank was determined to salvage something from the carnage, Frydenberg has decided to exit the COVID recession with an ongoing lower floor under unemployment.




Read more:
Less hard hats, more soft hearts: budget pivots to women and care


Both the treasury and Reserve Bank believe Australia can sustain much lower unemployment than the 5-6% it has grown used to. The treasury’s estimate is 4.5%; the Reserve Bank’s is nearer 4%. Before COVID, the United States managed 3.5%.

If achieved, it will mean hundreds of thousands more Australians providing services, drawing paycheques, and paying tax. And no longer on benefits.



A dramatic budget graph tracking the fortunes of every Australian whose payroll was reported to the tax office throughout 2020 shows the biggest victims of the COVID recession — by far — were those without post-school education. At the deepest point of the COVID recession in May, they were almost three times as likely to have lost their jobs as Australians with degrees.

The budget provides an extra $400 million for low-fee or no-cost training for jobseekers, to be matched by the states; an extra $481 million for the transition to work employment service directed at Australians aged 24 and under; and a further $2.4 billion to the Boosting Apprenticeship Commencements program.




Read more:
Budget 2021: the floppy-V-shaped recovery


But most of what it intends to do for jobs is the indirect result of a barely precedented expansion in spending and tax concessions in all sorts of areas.

The extra $17.7 billion it is spending on aged care over four years ought to create many jobs, as should the extra $13.2 billion it is spending on the National Disability Insurance Scheme.

The $1.7 billion it is spending on making childcare more affordable should both create jobs in the sector and free up more parents to return to work.

An extra $20 billion in business tax concessions should help as well.




Read more:
Cuts, spending, debt: what you need to know about the budget at a glance


The budget’s break with the past isn’t its dramatic expansion of discretionary spending. That’s common in recessions. What’s unusual is that spending is being ramped up when we are not in recession.

In the words beloved of economists, the spending is “pro-cyclical” rather than “counter-cyclical”. It is designed to supercharge our exit from recession rather than merely bring it about.

And there’s little sign of the spending stopping.

If this government or the next achieves success in driving the unemployment rate down to 4.5%, it will want to go further. It will keep going further right up until we get inflation near the top of the Reserve Bank’s 2-3% target band and wage growth in excess of 3%, neither of which this budget foresees in forecasts going out four years.




Read more:
Budget splashes cash, with $17.7 billion for aged care and a pitch to women


Government debt, anathema to the Coalition when Labor ran it up during and after the global financial crisis, isn’t much of a constraint.

The Reserve Bank holds much of the government’s debt (it didn’t during Labor’s time) and is buying as much as it needs to to keep interest rates low. Recently, interest rates have been rising, but not for most of the government’s borrowings, which are long-term.

The budget papers show that even with net government debt at 34% of GDP and heading to 44%, interest payments on that debt are much less of a drain on the budget than they were back in the mid 1990s when net debt hit 18% of GDP.



And the times have changed. Worldwide, few nations have an aversion to government debt, especially not the United States. In Australia, the only side of politics that used to complain about debt is in currently in office.

Before COVID, the fiscal strategy spelled out in the budget as part of the Charter of Budget Honesty required the government to eliminate net debt.

Frydenberg’s revised strategy merely requires him to stabilise and then reduce net debt “as a share of the economy”.

His priority is driving down unemployment. If that helps expand the economy and so drives down net debt as a share of the economy so much the better. But he wants to do it regardless.

The Conversation

Peter Martin, Visiting Fellow, Crawford School of Public Policy, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Budget splashes cash, with $17.7 billion for aged care and a pitch to women


AAP/Mick Tsikas

Michelle Grattan, University of CanberraThe Morrison government has brought down a big-spending, expansionary budget that forecasts Australia’s unemployment rate will fall to 4.75% in two years time.

But Australia’s international borders won’t be properly open for at least a year, according to the budget’s assumptions.

“Australia is coming back,” Treasurer Josh Frydenberg told parliament on Tuesday night.

“Employment is at a record high, with 75,000 more Australians in jobs than before the pandemic.

“This budget will help to create more than 250,000 jobs by the end of 2022-23,” Frydenberg said.

“This budget secures the recovery and sets Australia up for the future.”




Read more:
Frydenberg spends the budget bounty to drive unemployment down to new lows


The deficit for next financial year is expected to be A$106.6 billion, with cumulative deficits of $342.4 billion over the forward estimates.

As the government continues to spend to underpin the recovery, net debt will increase to 30% of GDP at the end of June, before peaking at 40.9% at June 30, 2025.

Aged care centrepiece

The centrepiece of Frydenberg’s third budget – which had been largely pre-announced by the government – is a $17.7 billion aged care package, spent over five years and including 80,000 extra home care packages.

Frydenberg said this would make a total of 275,000 packages available. The present waiting list is 100,000.

The aged care package is designed as long term structural reform after the royal commission found the system in a parlous state and needing a comprehensive overhaul.

“We will increase the time nurses and carers are required to spend with their patients,” Frydenberg said.

“We will make an additional payment of $10 per resident per day to enhance the viability and sustainability of the residential aged care sector.

“We will support over 33,000 new training places for personal carers, and a new Indigenous workforce.

“We will increase access for respite services for carers.

“We will strengthen the regulatory regime to monitor to monitor and enforce standards of care.”

In other major initiatives, there is $2.3 billion for mental health, while the earlier-announced adjustment to the JobSeeker rate will cost nearly $9.5 billion over the budget period.

Tax cuts and a focus on women

Some 10.2 million low and middle income earners will benefit from the extension of the tax offset for another year, at a cost of $7.8 billion.

As Morrison seeks to repair his image with women, there is a range of measures on women’s safety, economic security, health and wellbeing totalling $3.4 billion.

This includes $1.7 billion for changes to child care, $351.6 million for women’s health, and $1.1 billion for women’s safety.

There will be another $1.9 billion for the rollout of COVID vaccines.

Quizzed at his news conference on the future of Australia’s closed border, Frydenberg hedged his bets. “When it comes to international borders, it’s an imprecise business.”

The budget papers assume a gradual return of temporary and permanent migrants from mid-2022, and small arrivals of international students, starting late this year and increasing from next year.

“The rate of international arrivals will continue to be constrained by state and territory quarantine caps over 2021 and the first half of 2022, with the exception of passengers from Safe Travel Zones.

“Inbound and outbound international travel is expected to remain low through to mid-2022, after which a gradual recovery in international tourism is assumed to occur,” the papers say.




Read more:
Budget 2021: the floppy-V-shaped recovery


The budget is heavy on continued help for business, with more than $20 billion extra in support.

With the country facing a skill shortage and skilled workers not able to enter, Frydenberg said the government would create more than 170,000 new apprenticeships at a cost of $2.7 billion.

“We will help more women break into non-traditional trades, with training support for 5,000 places,” he said

There will be 2,700 places in Indigenous girls academies to help them finish school and enter the workforce.

More STEM scholarships will be provided for women.

Another 5,000 places are being made available in higher education short courses.

Housing and support for retirees

The budget’s housing package includes another 10,000 places under the New Home Guarantee for first home buyers who build or buy a newly-built home. It will also increase the amount that can be released under the First Home Super Saver Scheme.

From July 1, 10,000 guarantees will be provided over four years to single parents with dependants to build or buy a home with a deposit as low as 2%.

Retirees will benefit from a measure to encourage them to downsize.

Older people will no longer have to meet a work test before they can make voluntary contributions to superannuation. People aged over 60 will be able to contribute up to $300,000 into their superannuation if they downsize.

Given the housing shortage, this is aimed at freeing up more housing for younger people.

The government will also enhance the Pension Loan Scheme by providing immediate access to lump sums of $12,000 for single people and $18,000 for couples.

Although modest, one measure that will help women, who retire on average with much less superannuation than men, is that the government will remove the $450-a-month minimum income threshold for the superannuation guarantee.

Frydenberg said the government was committing another $15 billion over a decade to infrastructure, including roads, airports and light rail.

There is also $1.2 billion for multiple measures to promote the digital economy.

Labor says it’s ‘just more of the same’

The opposition was dismissive. Anthony Albanese said, “Australians have endured eight long years of flat wages, insecure work and skyrocketing cost of living under the Liberals and Nationals – and this budget does nothing to change that.

“It’s just more of the same from a tired old government.”

The Business Council of Australia welcomed the budget, saying it “strikes a prudent balance between growth and fiscal discipline by making sensible investments in the levers of growth”.

But the ACTU said while the Coalition’s rejection of austerity was welcome, “the government has failed to use the spending in this budget to tackle the underlying problems of low wages and insecure jobs”.

Instead, it was “handing billions of dollars to business including in the critical areas of aged care, mental health and vocational training, with little accountability or strings attached”.

The Australian Aged Care Collaboration, which represents more than 1,000 providers, congratulated the government on agreeing to implement most of the royal commission’s 148 recommendations.

AACC representative Patricia Sparrow said “after 20 government reviews in 20 years, this budget, and the government’s response to the royal commission’s recommendations, finally addressed many of the challenges facing aged care”.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.