A vaccine will be a game-changer for international travel. But it’s not everything



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Adrian Esterman, University of South Australia

The United Kingdom yesterday became the first country to approve the Pfizer/BioNTech COVID-19 vaccine for widespread use. Following a review by the country’s drug regulator, the UK government announced it will begin rolling out the vaccine next week.

Other countries are likely to follow soon, authorising the Pfizer/BioNTech vaccine and possibly other leading candidates too. Australia’s Therapeutic Goods Administration says it’s continuing to assess the Pfizer/BioNTech data.

The world has been eagerly awaiting a COVID vaccine, touted since early in the pandemic as our best hope of returning to “normal”. A big part of this is the resumption of international travel.

Certainly, an effective vaccine brings this prospect much closer. But a vaccine alone won’t ensure a safe return to international travel. There are several other things Australia and other countries will need to consider.

International travel in the age of a COVID vaccine

When people are vaccinated before boarding a flight, we can have confidence there will be significantly less COVID risk associated with international travel. However, the data we have at the moment doesn’t tell us everything we need to know.

Let’s take the Pfizer/BioNTech vaccine as an example. They have reported the efficacy of their mRNA vaccine to be 95% in preventing symptomatic COVID-19, having tested it on around half of the 43,000 participants in their phase 3 trial (the other half received a placebo).

The vaccine appears to be safe with only mild side-effects in some participants. And notably, the study included people aged 65 and over and those with health conditions that put them at higher risk of more severe disease.

However, the study hasn’t officially reported the efficacy of the vaccine against becoming infected, as opposed to displaying symptoms. While it’s encouraging to know a vaccine stops people getting sick, this point is important because if people can still become infected with SARS-CoV-2 (the virus that causes COVID-19), they may still be able to spread it.




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Ugur Şahin, BioNTech’s cofounder and chief executive, believes the vaccine could reduce transmission by 50%. This puts something of a dampener on vaccination being the key to the safe resumption of international travel.

At this stage, we also don’t know how long immunity will last for those vaccinated with the Pfizer/BioNTech vaccine. But as the trial will continue for several more months, some of this data should become available in 2021.

A doctor or scientists fills a syringe from a vaccine vial.
Over time, vaccine trials will reveal more data.
Shutterstock

Not everyone will be vaccinated straight away, so we’ll still need quarantine

It’s going to take months — or, more realistically, years — to vaccinate everybody who wants to be vaccinated. It won’t be feasible to expect every single person travelling internationally to be vaccinated.

There are several countries that appear never to have had community transmission. As of November, these included many Pacific island nations such as Tonga, Kiribati, Micronesia, Palau, Samoa and Tuvalu.

Then there are countries that have COVID-19 under control with little, if any, community transmission. Examples include Australia, New Zealand, Vietnam and Singapore.

People arriving in Australia from these countries pose very little risk and should not need to quarantine, whether vaccinated or not. For other countries, it would very much depend on their epidemic situation at the time.

Some organisations have already developed COVID risk ratings for different countries or jurisdictions. For example, the European Centre for Disease Prevention and Control (ECDC) rates the COVID situation in each European country as “stable”, “of concern” or “of serious concern”.

These risk assessments are based on factors including each country’s 14-day COVID case notification rate, the proportion of tests coming back positive, and the rate of deaths.

Clearly, people from high-risk areas or countries will still need to quarantine on arrival, unless they have been vaccinated. It’s likely Australia will develop a similar rating system to the ECDC to streamline these decisions.




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Testing

Many countries now require a negative COVID test certificate before entry. For example, Spain requires a negative PCR test no more than 72 hours before travelling.

Similarly, some airlines, such as Emirates and Etihad, are mandating COVID testing before travel.

It would also make sense to have rapid antigen testing available at airport arrivals or border crossings. Although not as accurate as PCR tests, these tests would provide a second check that a traveller hasn’t incubated COVID-19 on the way to their destination.

Even with vaccination, testing will still be important, as vaccination doesn’t guarantee a passenger is not infected, or infectious.

Certificates and passports

Once COVID-19 vaccines become accessible, countries and airlines may well require visitors to produce a certificate of vaccination.

Qantas chief executive Alan Joyce has suggested all Qantas international passengers from next year would be required to have a COVID vaccination certificate.

There are also many groups around the world working on immunity passports and technologies to track travellers’ virus status.

For example, the International Air Transport Association is developing a digital health pass which will carry testing and vaccination status.




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It’s likely international travel will be allowed globally in the second half of next year, once vaccination is well underway.

It will be wonderful to be able to travel internationally again, but wherever we go — even with a vaccine — it will be some time before travel looks like it did before the pandemic.The Conversation

Adrian Esterman, Professor of Biostatistics and Epidemiology, University of South Australia

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

Almost half a million tests, zero positives: how statistics shows we can be confident COVID-19 is gone from Victoria


Michael P.H. Stumpf, University of Melbourne

How do you know that something you are looking for is not there? Looking for a needle in a haystack is fundamentally easy – however laborious and tedious – if you know it’s definitely there. Looking for something, not finding it, and therefore concluding it does not exist is a different problem.

In Victoria, at the time of writing, we have had 35 consecutive days of zero newly detected COVID-19 infections. But, obviously, not everyone in the state has been tested.




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So what does the lack of new cases tell us about the true frequency of infections in the Victorian population? Or, to put it another way, what is the maximum number of infections that could still lurk out there undetected?

Number of daily tests carried out in Victoria since October 31 2020.
Michael Stumpf

These are what statistician call sampling problems. We do not test everyone, but instead rely on people with symptoms to come forward for testing. If everyone with symptoms gets themselves tested, this should give us a good idea of how many cases there are.

There are caveats: some people do not come forward for testing while others get tested several times; cases tend to cluster in families. But we can account for such uncertainties in the analysis framework that we use below.

Plenty of people are still getting tested. People check the Department of Health and Human Services’ social media feeds to see the daily “0” (the celebrated “doughnut”); some are concerned about the number of tests performed each day; and many people seriously worry about the chance of a return of the virus.

Working out the probabilities

However, we can estimate the probability the virus is still out there in Victoria. There are different ways to do it, but ultimately they all give very similar results.

One good way is to adopt a “Bayesian” approach, which also lets us work out how accurate the estimate is likely to be, given the uncertainties in our assumptions and inputs. We could do the calculations exactly (using a paper and pencil, or computer algebra software), but for making predictions we usually use simulations.

For our estimate we need to know a few numbers:

  • N: the total number of people in Victoria (about 6.5 million)

  • n: the number of tests carried out

  • p₀: what we think (or fear) the frequency of infected people in the Victorian population is, before we look at the testing data.

With this we can estimate p, the frequency of cases, after taking into account that we found 0 positives among n tests. A p value of 1 would mean everybody in Victoria has COVID, and 0 would mean nobody does.

Running the numbers

In the Bayesian framework we calculate p as a compromise between our prior knowledge (or beliefs) and the new information gleaned from the data.

The prior forces us to state explicitly what we expect or believe reality to look like. And because it is a probability it also accounts for our level of certainty or ignorance. When possible we can, for example, use information from previous studies to generate the prior.




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To be cautious, we will start with the very pessimistic assumption that an average of 1% of people in Victoria are actually infected. (We can be confident the real number is much smaller, but we are interested in a worst-case scenario.)

We put this 1% figure into our model as a probability distribution (called a “beta distribution”) that produces variable results with an average of 0.01 (which is another way of writing 1%).

If there are 0 positive tests among n tests then this will happen with probability (1 – p)n. The bigger p is, the more people have the virus, and the smaller the chances we would see 0 positive results.

Just a few lines of code (here shown in the Julia programming language) can simulate the probability that there are still cases in Victoria.
Michael Stumpf

With these two ingredients, the prior knowledge and the information from the data, we can now estimate the true frequency of infection in the Victorian population.

On the first day of the ongoing sequence of zero cases, October 31, 2020, there were 19,850 tests performed (thus n=19,850). The expected value for the true positive rate in Victoria on that day was therefore a tiny 0.0000000041 (4.1 × 10–9). We ran a million simulations of this scenario, and only in 260 instances were there any cases at all left in the population, with a maximum of 986 possible hidden cases.

Now after over a month of zero cases, and a total number of 438,950 tests between October 31 and December 2, the estimated probability has gone down even further to 0.00000000011 (1.1 × 10–10). The highest number of lurking infections in one million simulations is now 39 cases (and only 132 of our million simulations contained any cases at all).

Expected number of cases in Victoria per day since the 31st of October 2020. We expect there is less than 1 case in the community (about 1/10,000). If this is true it would mean that we have achieved elimination of the virus in the community.

What we can learn from this

Three points are worth considering, especially when applying this approach in the context of other states and territories, or Australia as a whole.

  1. These estimates are based on assumptions, but we can test how changes (or errors) in our assumptions affect the analysis. In this case relatively little: it is extremely unlikely there is even a single COVID case left in the Victorian community.

  2. We can also ask when we would be likely to detect cases of COVID-19 if it re-enters the community. The current testing regime turns out to be remarkably sensitive. Even with only 5,000 randomly(!) administered tests we would have a better than 50-50 chance of detecting a case if only 0.0014% of Victorians – or about 91 people – were (asymptomatically) infected. If people with symptoms continue to get tested even single cases will be detected and that is what we want.

  3. Testing is therefore important and the key to prolonged suppression. The simplistic statement that you get more cases if you do more testing fails to take into account just how important testing is to control the disease, especially in the early and the final suppression stages. For as long as testing is easily accessible throughout the state and used by (a large fraction of) people exhibiting COVID-like symptoms we should be able to detect and quell any resurgence, even before a vaccine becomes available.

We were arguably lucky to get to zero cases, but we can be very confident that we have now eliminated COVID-19 in the community. The absence of evidence for coronavirus infections has slowly become evidence for the absence of the virus from Victoria.




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The Conversation


Michael P.H. Stumpf, Professor for Theoretical Systems Biology, University of Melbourne

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

Should Australians be worried about waiting for a COVID vaccine when the UK has just approved Pfizer’s?



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Joel Lexchin, University of Toronto; Barbara Mintzes, University of Sydney; Kellia Chiu, University of Sydney, and Lisa Parker, University of Sydney

The news that Pfizer’s COVID-19 vaccine has gained emergency approval in the United Kingdom and may be distributed to selected high-risk groups as early as next week is welcome.

Headlines also suggest people in the United States and some other European countries could start being vaccinated before the end of the year.

For instance, a US Food and Drug Administration (FDA) advisory committee is set to discuss the Pfizer vaccine on December 10 with a subsequent decision within a few weeks. And following the UK approval, there are reports the White House is putting pressure on the FDA to move faster.

However, Australia is set to wait until March for priority groups to be vaccinated, according to Federal Health Minister Greg Hunt. So why do Australians have to wait three months? And is that a worry?

What just happened?

According to Australia’s own drug regulator, the Therapeutic Goods Adminstration (TGA), the UK has provided an “emergency use” authorisation for the Pfizer vaccine, rather than going through the usual approval process. This emergency approval is temporary and is for a limited number of specific batches of the vaccine.

Meanwhile, the TGA says it continues to assess the safety and efficacy of the Pfizer vaccine as that information is submitted, and is working with regulators around the world to discuss vaccine development.

Hunt said that despite the Pfizer news in the UK, Australia’s plans have not changed:

Our advice remains that the timeline for a decision on approval is expected by the end of January 2021, and our planning is for first vaccine delivery in March 2021.




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Why the wait?

One reason Australia might be able to afford to wait is that we are not facing the same acute public health emergency as the US, UK and some European countries.

The US is recording almost 200,000 new cases a day, and the UK more than 10,000. Here in Australia, there have only been about 28,000 people infected since March. There are currently hardly any cases of community transmission and since the end of October only one person has died.




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There are also differences in how drug regulators around the world assess drug safety and efficacy.

In usual times, the TGA is about 120 days slower in approving drugs than the FDA. However, most studies show that there have been more safety problems with drugs fast-tracked by the FDA compared with drugs approved via its usual regulatory process.

The TGA is planning to use its provisional approval pathway which should speed up the process, but by how much is still a guess.

How fast is too fast? This is also unclear. The European Medicines Agency has criticised the UK’s quick emergency approval and said its own procedure relies on more evidence and checks.

There are many stages ahead

Regardless of the timing of regulatory approval, COVID vaccines still need to be made (and depending on the vaccine, imported), then distributed.

While all eyes are on the Pfizer vaccine at the moment, this is one of four for which the Australian government has agreements in place, should they prove safe and effective. Some of these vaccines are still in clinical trials.

Australia has also signed up for a shot at several other vaccines as part of the World Health Organization-backed COVAX agreement, should these prove safe and effective. Again, many of these are still in clinical trials.




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Finally, people still need to be willing to be vaccinated. An analysis of the Facebook page of the Australian Vaccination Risks Network, one of the country’s most prominent anti-vaccination groups, shows that since the start of the pandemic its page has attracted 36,962 likes and 32,350 comments; its posts have been shared 29,429 times.

In the meantime (and even for some time after vaccination), we will still need to wear masks when appropriate, physically distance and wash our hands. No vaccine will end the pandemic instantly.

So, should Australians be worried about the delay?

We don’t yet have long-term information about how long immunity will last and how common or serious any side-effects might be. There simply hasn’t been enough time.
This might be less important in an emergency situation, but Australia is no longer in an emergency.

Many of us can’t wait to open up to the world and it’s hard to remain patient. But Melburnians, with their second lockdown, have taught us a lot about patience this year.

Perhaps we owe it to them to do our bit for the health of all Australians, accepting that time is a necessary part of good decision-making and planning.

And that involves waiting for a safe and effective vaccine to help us return to something resembling normal life.




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The Conversation


Joel Lexchin, Professor Emeritus of Health Policy and Management, York University, Emergency Physician at University Health Network, Associate Professor of Family and Community Medicine, University of Toronto; Barbara Mintzes, Associate professor, School of Pharmacy and Charles Perkins Centre, University of Sydney; Kellia Chiu, PhD Candidate and Pharmacist, University of Sydney, and Lisa Parker, Honorary Lecturer, School of Pharmacy, Charles Perkins Centre, University of Sydney

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

Why Australian cities need post-COVID vision, not free parking



Brent Toderian/Twitter

Rebecca Clements, University of Sydney; Elizabeth Taylor, Monash University, and Thami Croeser, RMIT University

Many Australian cities have fallen back on offering free car parking to attract visitors back to the CBD after the pandemic. In contrast, cities around the world are basing their recovery strategies on bold and evidence-based urban transformations.




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In August, Adelaide City councillors voted for incentives for people to drive and park within the CBD, including a controversial “driver’s month” promotion. In Perth, free parking in the CBD during the holidays is expected to cost A$700,000.

In Victoria, the state hit hardest by the pandemic, the City of Geelong has announced a range of free CBD parking policies estimated to cost several million dollars. Melbourne City Council has endorsed free on-street parking via a voucher system estimated to cost $1.6 million in lost revenue. It’s also seeking to reduce the state-based congestion levy on off-street parking by 25%.

The move to increase car traffic into the central city is perhaps most surprising in the case of Melbourne. Planners have called it a “1960s solution” and a “lost opportunity”. Free parking and other incentives for car travel are at odds with the city’s recent Transport Strategy 2030, which seeks to prioritise walking, cycling and public transport.

Parking incentives don’t work

These car-led approaches to a hoped-for economic recovery were rushed out ahead of new evidence and modelling. This approach also goes against decades of available evidence on the detrimental impacts of conventional urban parking policies in Australia and internationally.

Free parking – pursued and mandated in many cities since the mid-20th century – has a nasty habit of building in unnecessary car use through narrowly targeted subsidies to car users, which directly undermine other transport modes. Parking researcher Liz Taylor recently explained the historical myths and troubled relationships between retail and parking we risk perpetuating.




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COVID has changed cities, and we must adjust

Cheap parking has poor prospects for attracting enough visitors to offset the changes the pandemic has brought to Australian CBDs. CBDs rely heavily on daily office workers – who are now largely working from home – and on large residential populations, including international students and tourists to whom borders are now closed.

In Melbourne, daily journeys into the city are down 90%. Only 8% of office towers are occupied.

Even so, car traffic is now at roughly 90% of its pre-COVID levels. Cars are already back, but that does not translate to people in CBDs – and road capacity means the city can’t manage many more cars.

Chart showing use of cars, public transport and walking in Melbourne from January to the end of November
Apple mobility data for Melbourne show car travel is back to almost pre-pandemic levels.
Apple Mobility Trends, CC BY

Similarly, Australian CBD retail landscapes have been drastically altered. Experts predict many lasting changes, including retail “localism” in the suburbs.




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Parking hasn’t played any role in these changes. Instead, major economic shifts and political decisions have forced and enabled changes in work and lifestyle.

Many CBD workers simply won’t have to come back. CBDs previously didn’t need to be pleasant to be full of people – many were forced to be there. That has changed, and so the city must change too – from a destination of default to a destination of choice.

The adjustment can create better cities

Encouraging cars back into the hearts of cities isn’t just a bad recovery strategy. It could be a huge missed opportunity to create more attractive, high-amenity cities.

Around the world, many cities are welcoming the chance to use parking and streets differently, farewelling the daily car commute to embrace something better.

In Paris, Mayor Anne Hidalgo’s visionary “15-minute city” plan aims to replace 60,000 surface parking spaces with green pedestrianised streets, safe dedicated cycling networks and “children streets” near schools. The plan actively turns away from car dominance.

Barcelona’s mayor has announced a massive green revamp of the central city. Its already successful Superblock model, based on large-scale pedestrianisation, will be super-sized. Intersections and parking are being turned into parks and plazas.




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London is creating hundreds of low-traffic neighbourhoods (LTNs), as is car-dependent Brussels. LTNs are based on transforming streets with quality cycling and pedestrian infrastructure, closing some streets to car traffic and otherwise instituting low speeds. Oslo’s “Vision Zero” strategy demonstrates the power of these measures to transform cities.

As these cities are finding, street reclamation projects can succeed quickly, and local businesses and neighbourhoods of all income levels benefit. However, leaders need to “hold their nerve” through the complex period of change.

New ways of seeing cities

Australian cities are changing with COVID too. Melbourne in particular has been forced to radically rethink streets as public space at a metropolitan scale. Through innovative co-operation between retailers and local councils, hundreds of parklets have emerged across the city.

These spaces offer sensible, creative and exciting ways for people to re-embrace dining out after lockdown. The enthusiastic reception is already causing many retailers to forget about parking and call for permanent changes.

The City of Melbourne has issued 1,300 outdoor dining permits and transformed 200 on-street parking spaces. This raises the the question of whether free parking is the best use of its precious public space and funds.

Diners sit within a green parklet on Lygon Street in Melbourne, having fun on reclaimed street space.
A parklet on reclaimed street space on Lygon Street, Melbourne.
Liz Taylor (own photo)

While systematic study of parking is often scarce, far stronger evidence supports the economic value of space for active transport, green space and outdoor dining. Our future cities can be places where people “will see the street belongs to them”.

Street space can feel like the exclusive (and hostile) realm of cars, but it is simply public land that is currently (mis)allocated to cars. Perceptions are beginning to change, allowing city residents to reimagine what streets might offer beyond moving and storing cars.

The race is on to invite people back to our cities. But a return to streets full of cars, narrow sidewalks crowded with pedestrians, and parking problems that never go away simply isn’t much of an invitation.

When urbanist Brent Toderian asked people to post photos showing #TheBeautyofCities, the hundreds of submissions featured green streets full of people walking, cycling and having fun, not car parking and traffic.The Conversation

Rebecca Clements, Postdoctoral Research Associate, Faculty of Architecture, Building and Planning, University of Sydney; Elizabeth Taylor, Senior Lecturer in Urban Planning & Design, Monash University, and Thami Croeser, Research Officer, Centre for Urban Research, RMIT University

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

6 things to watch for as Australia crawls out of recession



Sergey Tinyakov/Shutterstock

Janine Dixon, Victoria University

Our economy has grown in the September quarter (the three months to September) after two quarters of going backwards.

Using the literal meaning of recession, we are no longer in one – economic output (the things we produce and consume) is no longer be going backwards.

But things won’t be like they were. Even a rebound in gross domestic product of 3.3% (the biggest in 40 years) doesn’t make up for the 7% we lost in the previous quarter, meaning we’ll remain worse off than we were at the start of the year and much worse off than we would have been had the pandemic not happened.

Here are six things to expect as the economy recovers:

1. Consumer spending will recover first, but might need help

Consumer spending will to return to normal first, as forecast in the budget.

(Don’t be fooled by the forecast decline of 1.5% for 2020-21 compared to 2019-20. From where we stood in the June quarter 2020 – an enormous decline of 12% on the March quarter – this is a massive recovery.)

So far the signs are promising, but in part this might be because the stimulus payments are still flowing, keeping household disposable income above pre-COVID levels.




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The coronavirus supplement that tops up JobKeeper and other benefits (originally A$225 per week) winds down to $75 per week after Christmas and expires on March 31.

JobKeeper, originally $1,500 per fortnight, became harder to get in October and will wind down to $1,000 per fortnight in January and $650 for part-time workers, before expiring on March 31.

Victoria has funded tutors to assist students left behind.
fizkes/Shutterstock

Treasury expects wage growth to be slower than price growth for the next two years, so a household-led recovery is by no means guaranteed.

If the recovery stalls in the household sector, activities such as hospitality, retail and arts and entertainment will suffer a second blow and unemployment will remain high.

After the year we’ve had, the household sector could be forgiven for losing confidence.

The government should consider extending the coronavirus supplement payments, and be ready for further one-off stimulus payments if required.

Unlike the imminent income tax cuts, these measures are temporary and can be discontinued as soon as they are no longer required.

Governments can also stimulate demand directly. Victoria has announced an additional 4000 tutors to assist school students left behind after an interrupted year. Other areas in which governments could usefully create meaningful jobs include the care sector and the arts.

2. Overseas demand won’t assist in the recovery

Exports face headwinds and are unlikely to recover over the next 18 months.

The International Monetary Fund expects the global economy to shrink by 4.4% in 2020 after growing 2.8% in 2019, a turnaround of more than 7%.

This will be apparent in all of Australia’s major customers including China and will depress demand for exports.




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More importantly, travel bans have come close to eliminating “exports” of tourism and education, which together account for almost one fifth of Australian export income.

This income will remain weak until international travel properly restarts.

3. We will lose four years population growth

Before the crisis, the 2019 mid-year budget update predicted Australia’s population would grow from 25.6 million to 28.4 million by June 2026.

Births and immigration will remain low for years.
KieferPix/Shutterstock

This year’s budget says we won’t get there until June 2030, a full four years later.

Even after travel resumes, net overseas migration is expected to remain lower than before due to economic uncertainty and weak labour market conditions.

Businesses will find it more difficult to get the staff they need through skilled migration, crating a greater role for higher education and vocational education.

By 2024 migration is assumed to return to normal, yet population growth will continue to be slow. This is because the birth rate is projected to be lower than usual for the remainder of the decade.

4. Business investment will be weaker, and different

2020 has been a difficult year, but it’s also been the year we’ve learnt to do things differently.

We have learnt about on-line shopping, working from home, telehealth and on-line entertainment, and we will continue to make use of what we have learnt after the pandemic is over.

These changes could drive the next genuine wave of productivity growth.




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Bricks-and-mortar retail, commercial office space, roads, bridges and railways are all investments that facilitate the meeting and movement of people.

With new technologies and a smaller population that is learning to keep things local, these old-world investments won’t be as generate the same returns as they once might have.

Where we might see the investment dollars being spent is on home improvements, while government investment dollars could be spent on improving local amenities such as parks and community centres.

5. We’ll need to get more people into paid work

A year ago, 66% of Australia’s adult population was participating in the labour market, either by being employed or looking for work.

During the crisis the participation rate dipped below 63%.

Australia’s economy could place more emphasis on caring.
Toa55/Shutterstock

It has since returned to 65.8%, a touch above where the budget expects it will stay.
Other countries including Canada, Britain, New Zealand and Germany do better than us.

There’s room to get more unpaid carers (many of them women) into the paid workforce.

More than 900,000 people who perform significant unpaid caring work say they would like more paid employment.

In my work for the National Foundation for Australian Women, I found the net budgetary cost of increasing caring services was modest, mainly because it brought about a strong increase in the tax-paying workforce.

6. One last dark cloud: the terms of trade

The terms of trade measure what we can buy for each unit of what we sell; how many imports we can buy for each unit we export.

The budget forecasts a fall of almost 11% in 2021-22 as a result of lower prices for iron ore.

Taking a long view, this may be nothing more than a correction, but it is as big a fall in a single year as we experienced in the dog days after the end of mining boom when the terms of trade declined for four consecutive years, and we experienced four years without real growth in income growth per capita.




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Population, participation and productivity are the “three P’s” that drive economic growth in the long run, but in the short run a big decline in the terms of trade poses a real risk to a household-led economic recovery.

Where to from here

In an effort to avoid more economic pain, the government has rightly abandoned fiscal restraint in the most recent budget.

Much of its recovery strategy (perhaps too much) is built around income tax cuts and investment incentives.

I see a need for a greater emphasis on temporary measures aimed at supporting household spending, given the role it will have to play in unwinding the recession.




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In the longer term, there is a case for paring back some of the larger income tax cuts to expand child care, aged care and disability care; measures that would support low-paid workers, boost labour force participation, and improve the standard of living for many Australians.The Conversation

Janine Dixon, Economist at Centre of Policy Studies, Victoria University

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

COVID has left Australia’s biomedical research sector gasping for air



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Gina Ravenscroft, University of Western Australia and Elizabeth E. Gardiner, Australian National University

While COVID-19 has highlighted the value of medical research, it has unfortunately also seriously disrupted it. Lack of funding is driving members of Australia’s once-vibrant virology research community out of the sector, and forcing early-career researchers to turn to fundraising or philanthropy amid intense competition for federal government grants.

This disruption disproportionately affects early- and mid-career researchers (EMCRs) and laboratory-based scientists, especially women (who typically also shoulder the bulk of caring and home-schooling responsibilities).

In Australia, national funding of medical research happens mainly via the National Health and Medical Research Council. Over the past ten years there has been near stagnant investment, leading to a decline in funding in real terms. In 2019, the average success rates across the main NHMRC Ideas and Investigator Grant schemes was just 11.9%.

NHMRC salary support 2003-17.
Australian Society for Medical Research

Stagnant investment, plummeting morale

Morale in the sector has plummeted and we have lost talented researchers to the United States, Europe and Asia, prompting leading universities to warn of a brain drain.

Eureka Prize-winning cancer biologist Darren Saunders and clinical geneticist Luke Hesson have both decided to leave academia altogether. The full-time medical research workforce declined by 20% between 2012 and 2017.

How did we get here?

In 2018, following extensive consultation, the NHMRC funding scheme was overhauled with major objectives to encourage innovation across the sector, reduce the burden on applicants and reviewers, and improve success rates of EMCRs.

In the first two years of this new scheme, the success rates for EMCR Investigator Grants (EL1-2) was just 11.7% (250 of 2,133 applications).




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The NHMRC program grant overhaul: will it change the medical research landscape in Australia?


Schemes specifically designed to develop emerging talent are also receiving dwindling support. In 2017 the NHMRC awarded 181 “early career and career development fellowships”; by 2020 that figure had fallen to 122.

The 2019 success rate for NHMRC Ideas Grants scheme (which sustains fundamental research, including on vaccines) in Australia was only 11.1%, despite almost three times as many applications being ranked as “fundable” by expert peer reviewers.

Onus on universities

With such low success rates, it has fallen to universities to prop up their research departments and laboratories.

If these trends continue, Australia stands to lose an entire generation of medical researchers. This prompted the Association of Australian Medical Research Institutes in August to call for the government to fund 300 new fellowships for EMCRs through the federal budget.

AAMRI president Jonathan Carapetis said the lack of grants and fellowships has forced EMCRs to rely on philanthropy or fundraising to support their research, adding:

…due to the economic downturn resulting from COVID-19 the holes in this imperfect system have turned into chasms. These are the researchers who have finished their PhDs, are testing hypotheses on what causes different diseases, developing new treatments and vaccines… Our EMCRs are tomorrow’s scientific leaders, and without action to support them we will lose them.

This call, however, was not heeded in the recent federal budget, which contained no new money for biomedical research.

Treasurer Josh Frydenberg delivers the federal budget in 2020.
Researchers called for more funding to be allocated in the 2020 federal budget.
AAP/Mick Tsikas

Funding the future?

The federal government’s Medical Research Future Fund (MRFF) was established in 2015 and began dispensing funds in 2017. As the MRFF website explains, the government uses some of the net interest from the A$20 billion fund to pay for medical research. This year it will disperse around A$650 million.

The MRFF represented a major and very welcome funding boost to Australia’s health and medical research sector.

But the combined NHMRC and MRFF budget still only represents 0.53% of the total health expenditure in the federal budget.

This is a fraction of the 3% of health expenditure that would bring Australia’s health and medical research spending into line with other OECD countries. An increase to 3% of health expenditure would generate A$58 billion in health and economic benefits, according to a Deloitte Access Economics report commissioned by the Australian Society for Medical Research.

The MRFF has recently come under scrutiny as it emerged during Senate estimates that up to 65% of funds were distributed without peer review.

What’s more, researchers who narrowly missed out on the incredibly competitive NHMRC Investigator funding cannot apply to the MRFF unless they are a clinical researcher, meaning fundamental biomedical researchers engaged in translational research, but without a medical degree, miss out.

Without investment, advances are not possible

In the post-COVID era, a robust health and medical research sector is essential to lead the discoveries and innovations that will fuel our long-term economic recovery.

The National Association of Research Fellows (a peak body representing biomedical researchers; the authors of this article are on the NARF Executive) is calling for:

  • at least a doubling of federal funds into the Australian health and medical research sector

  • transparent, 360-degree oversight of the targeted calls for expression of interest and allocation of funds from the MRFF with involvement of NHMRC peer review.

  • strictly equal support for clinical and fundamental biomedical research.

This investment would position Australia as an international leader in health and medical research. Without better support for the sector, advances in patient treatment and care are simply not possible.




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More than 10,000 job losses, billions in lost revenue: coronavirus will hit Australia’s research capacity harder than the GFC



This article originally stated Darren Saunders and Luke Hesson have left science altogether. They have in fact decided to continue their scientific research careers outside academia. This has been corrected.The Conversation

Gina Ravenscroft, Research Fellow, University of Western Australia and Elizabeth E. Gardiner, Professor, John Curtin School of Medical Research, Australian National University

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

Victoria’s hotel quarantine overhaul is a step in the right direction, but issues remain


Peta-Anne Zimmerman, Griffith University; Matt Mason, University of the Sunshine Coast, and Vanessa Sparke, James Cook University

On Monday the Victorian government announced an overhaul of the state’s hotel quarantine program. The government has introduced a new oversight agency, COVID-19 Quarantine Victoria, and crafted a “reset” of rules and regulations in the hotel quarantine process.

This robust suite of interventions, based on nationwide experience, aims to prevent transmission of COVID-19 to the Victorian community primarily from returning international travellers who have a high risk of infection.

From an infection prevention and control standpoint, the new system definitely has some improvements. But there are still issues yet to be resolved, and some unknowns that haven’t been made clear to the public.

No more private security

One of the most obvious changes, and possibly the most controversial, is Victoria Police taking the lead on security and management. They will be assisted by the Australian Defence Force (ADF), in a bid to avoid a repeat of the previous program’s high-profile breaches.

Corrections Commissioner Emma Cassar will lead the new agency, and will report to police minister Lisa Neville, who will have overall responsibility for the new system.

But we are concerned this could be perceived to be an armed security detail, with a custodial approach rather than a public health focus. Experience has shown this can be detrimental. Gaining community trust, rather than appearing to take a punitive approach, is vital. Recent events in Adelaide highlight the crucial importance of people being able to cooperate with contact tracers without fear of the ramifications.

Infection control must be handled by experts

The government has repeatedly said the new system will have stronger infection prevention and control protocols, with rigorous training and evaluation. Failure to comply with infection prevention and control resulted in numerous incidences of transmission in hotel quarantine in the past.

Reinforcing these procedures can only be a good thing, as long as the expertise is sourced from recognised experts, and supported by advice from other specialities such as public health and occupational hygiene.




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Aged-care facilities need accredited infection control experts. Who are they, and what will they do?


Staff ‘bubbles’ and daily testing

The new system will also feature “staff bubbles”. Having a group of staff who consistently work together on the same shifts, with no crossover with staff on other shifts, aims to minimise the number of people an infected person can be in contact with.

This approach has been used in a range of industries, and has been recommended by occupational hygiene experts throughout the COVID-19 response.

The addition of the current active simulation exercises, which stress-test Victoria’s strategy, can only be a positive.

Daily COVID testing of staff and weekly testing of their household contacts is another big change. Daily testing of staff has some merit, although the suggested changes and restrictions being placed on their household contacts such as increased testing and limitations on where they can work is concerning.

There are significant privacy concerns with the new “contact tracing in advance” system, which will identify staff and all their significant contacts, such as members of their households and other frequent contacts, in advance. These contacts will have to provide information on their places of work, schooling and so on. In the event a staff member contracts COVID, part of the legwork is already done.

But while undoubtedly useful for contact tracing, privacy breaches from government IT systems are not uncommon.

Also troubling is the suggestion that recruitment may exclude those with contacts who work in other high-risk industries, such as aged care. This measure could potentially put existing staff out of work. COVID-19 Quarantine Victoria suggests that other places to live may be found if workers live with an at-risk contact, which has human rights implications and doesn’t take into account family or carer responsibilities.

The hotel quarantine overhaul will also see staff exclusively employed or contracted by COVID-19 Quarantine Victoria, with cleaners and others only working at one site. This will mean more secure work for some, which is a positive, and may reduce the risk of transmission between workplaces. Indeed, insecure and casual employment has been a common theme in the spread of COVID-19.

But we don’t yet know exactly how this will work. For example, it’s not clear whether this also applies to the police, who may have casual jobs on the side.




Read more:
Mapping COVID-19 spread in Melbourne shows link to job types and ability to stay home


Regional quarantine not necessarily better

Some experts have raised the possibility of having quarantine facilities in regional areas, to reduce the risk of breaches in dense urban areas.

The Northern Territory’s quarantine program for returned travellers at Howard Springs has shown that this approach can work, but there are potential issues.

Such a facility needs a sustainable workforce who aren’t travelling between locations. There is little point in moving quarantine outside of cities only to have the workforce commute from cities or elsewhere, with the associated transmission risks this brings.

Also, extensive health care would need to be provided for returned travellers. Returnees could have many chronic and acute health-care needs that may strain local health services. A proliferation of sites like Howard Springs would test the capabilities of AUSMAT (multi-disciplinary medical assistance teams deployed during crises) and the state and territory health services that support them, particularly as we head into the storm and bushfire season.

As with anything during COVID-19, only time will tell how successful this new strategy will be. The Victorian government is certainly showing a capacity for reflection, and a determination to do better. But there is only so much preparation we can do when facing the greatest variable and challenge in any outbreak response: human nature.




Read more:
AUSMAT teams start work in aged care homes today. But what does this ‘SAS of the medical world’ actually do?


The Conversation


Peta-Anne Zimmerman, Senior Lecturer/Program Advisor Griffith Graduate Infection Prevention and Control Program, Griffith University; Matt Mason, Lecturer and Program Co-ordinator: Nursing, University of the Sunshine Coast, and Vanessa Sparke, Lecturer in Nursing and Midwifery, and Course Coordinator of the Graduate Certificate of Infection Control, James Cook University

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