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.

What is mucormycosis, the fungal infection affecting COVID patients in India?


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Monica Slavin, Peter MacCallum Cancer Centre and Karin Thursky, The Peter Doherty Institute for Infection and ImmunityThis week we’ve seen reports of an infection called mucormycosis, often termed “black fungus”, in patients with COVID, or who are recovering from COVID, in India.

Fungal infections can be devastating. And in this case mucormycosis is adding to the burden of suffering in a country already in a deep COVID crisis.

As of March this year 41 cases of COVID-19-associated mucormycosis had been documented around the world, with 70% in India. Reports suggest the number of cases is now much higher, which is unsurprising given the current wave of COVID infections in India.

But what is mucormycosis, and how is it linked with COVID-19?

What is mucormycosis?

Mucormycosis, formerly known as zygomycosis, is the disease caused by the many fungi that belong to the fungal family “Mucorales”.

Fungi in this family are usually found in the environment (for example, in soil) and often associated with decaying organic material such as fruit and vegetables.

The member of this family which most often causes infection in humans is called Rhizopus oryzae. In India though, another family member called Apophysomyces, found in tropical and subtropical climates, is also common.

Fungus growing in a petri dish.
Mucormycosis is a disease caused by the Mucorales fungal family.
Shutterstock

In the lab, these fungi grow rapidly and have a black/brown fuzzy appearance.

The family members causing human disease grow well at body temperature and in an acidic environment (seen when tissue is dead or dying or with uncontrolled diabetes).

How do you get mucormycosis?

Mucorales are considered opportunistic fungi, meaning they usually infect people with an impaired immune system, or with damaged tissue. Use of drugs which suppress the immune system such as corticosteroids can lead to impaired immune function, as can a range of other immunocompromising conditions, like cancer or transplants. Damaged tissue can occur after trauma or surgery.

There are three ways humans can contract mucormycosis — by inhaling spores, by swallowing spores in food or medicines, or when spores contaminate wounds.

Inhalation is most common. We actually breathe in the spores of many fungi every day. But our immune system and healthy lungs generally prevent them from causing an infection.

When the lungs are damaged and the immune system is suppressed, such as is the case in patients with severe COVID, these spores can grow in our airways or sinuses and invade our bodies’ tissue.

Mucormycosis can manifest in the lungs, but the nose and sinuses are the most common site of mucormycosis infection. From there it can spread to the eyes, potentially causing blindness, or the brain, causing headache or seizures.

It can also affect the skin. Life-threatening wound infections have been seen after injuries sustained during natural disasters or on battle fields where wounds have been contaminated by soil and water.




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In the environment

We haven’t seen mucormycosis infections associated with COVID in Australia, and there have been very few in other countries. So why is the situation in India so different?

Before the pandemic, mucormycosis was already far more common in India than in any other country. It affects an estimated 14 per 100,000 people in India compared to 0.06 per 100,000 in Australia, for example.

Globally, outbreaks of mucormycosis have occurred due to contaminated products such as hospital linens, medications and packaged foods. But the widespread nature of the reports of mucormycosis in India suggests it’s not coming from a single contaminated source.

Mucorales can be found in soil, rotting food, bird and animal excretions, water and air around construction sites, and moist environments.

Although never compared, it may be that in Australia we have a lower environmental burden of Mucorales than in India.

Mucormycosis and diabetes

When diabetes is poorly controlled, blood sugar is high and the tissues relatively acidic — a good environment for Mucorales fungi to grow.

This was identified as a risk for mucormycosis in India (where diabetes is increasingly prevalent and often uncontrolled) and worldwide well before the COVID pandemic.

Of all mucormycosis cases published in scientific journals globally between 2000-2017, diabetes was seen in 40% of cases.

A recent summary of COVID-19-associated mucormycosis showed 94% of patients had diabetes, and it was poorly controlled in 67% of cases.

A man measures his blood sugar.
Diabetes is a risk factor for mucormycosis.
Shutterstock

A perfect storm

People with diabetes and obesity tend to develop more severe COVID infections. This means they’re more likely to receive corticosteroids, which are frequently used to treat COVID-19. But the corticosteroids — along with their diabetes — increase the risk of mucormycosis.

Meanwhile, COVID itself can damage airway tissue and blood vessels, which could also increase susceptibility to fungal infection.

So damage to tissue and blood vessels from COVID infection, treatment with corticosteroids, high background rates of diabetes in the population most severely affected by COVID, and, importantly, more widespread exposure to the fungus in the environment are all likely to be playing a part in the situation we’re seeing with mucormycosis in India.




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Treatment challenges

In Australia, as in many other Western countries, we’ve seen increased cases of another fungal infection, Aspergillosis, in patients who had severe COVID infections, needed intensive care management and received corticosteroids. This fungus is found in the environment but belongs to a different family.

As Aspergillosis is the most common opportunistic fungus globally, we have tests to rapidly diagnose this infection. But this is not the case with mucormycosis.

For the many patients affected with mucormyosis, the outcome is poor. About half of patients affected will die and many will sustain permanent damage.

Diagnosis and intervention as early as possible is important. This includes control of blood sugar, urgent removal of dead tissue, and antifungal drug treatment.

But unfortunately many infections will be diagnosed late and access to treatment limited. This was the case in India prior to COVID and the current demands on the health system will only make things worse.

Controlling these fungal infections will require increased awareness, better tests to diagnose them early, a focus on controlling diabetes and using corticosteroids wisely, access to timely surgery and antifungal treatment, and more research into prevention.The Conversation

Monica Slavin, Head, Department Infectious Diseases, Peter MacCallum Cancer Centre, Peter MacCallum Cancer Centre and Karin Thursky, Professor, The Peter Doherty Institute for Infection and Immunity

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.

Charging Indians for COVID vaccines is bad, letting vaccine producers charge what they like is unconscionable


R. Ramakumar, Tata Institute of Social SciencesCountries around the world are racing against time to vaccinate their populations against the coronavirus.

But India has thus far been a poor performer, with only 9.6% of its population receiving a vaccine so far (compared to 51.8% in the UK, 45% in the US, 32.1% in Germany and 14.9% in Brazil).

While there are a few issues plaguing the vaccine roll out, the most egregious is the fact most Indians, many of whom live in poverty, are being made to pay for their shots. And the government is allowing vaccine producers to charge whatever they like.




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Not enough jabs

To cover its entire adult (over 18 years) population, India needs 1.9 billion doses of vaccines. If these vaccines were to be administered over the next 12 months, India would need 161 million doses each month, or 5.4 million doses each day.

At present, India produces only about 2.5 million doses per day, which may rise at best to three million doses per day over the next few months. At the present rate, India would be able to cover only 30% of its population by early 2022.

Only by 2023 would it be able to administer the shot to everyone above 18, which would be late, given the pace and spread of the pandemic.

How did it come to this?

There are three major reasons for this issue.

First, while many countries permitted a diverse basket of vaccines for domestic use, India limited its emergency approvals to just two — Covishield and Covaxin.

Covishield is the Indian name for the Oxford-AstraZeneca vaccine, produced by the Serum Institute of India. Covaxin, on the other hand, was developed jointly by India’s public sector and a private company named Bharat Biotech.

The reason appears to be a belief – based on zero evidence – that the two “Made in India” vaccines would be sufficient to meet India’s domestic needs and international commitments.




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For example, India could have granted emergency approval to the Russian vaccine Sputnik V, and the US-based Pfizer vaccine, in February 2021. Sputnik V was refused approval in February on the grounds that it had not supplied data on immunogenicity (immune response).

However, the same standards did not appear to have been applied to the other two vaccines – Covishield was given approval in January, even though its immunogenicity data were not yet available. Trial data from the UK, South Africa and Brazil published in The Lancet was considered adequate at the time.

Similarly, Pfizer was compelled to withdraw its application for emergency approval because the drug regulator insisted conducting a local bridging study would be necessary. However, Covaxin was given approval in January even when its Phase 3 data on efficacy were not available.

Second, the vaccine business is risky, given the amount of money that has to go into research, development, and testing, and many won’t end up being effective. Early public investments reduce risk exposure for vaccine companies and help raise their production capacities. Countries such as the United States, the United Kingdom and Germany made large at-risk investments in vaccine companies for research and capacity expansion. India failed to do so.

Third, India failed to place advance purchase orders for adequate quantities of vaccines. The first purchase order wasn’t placed until January this year. By this time, capacities of vaccine producers were already locked into other supply commitments elsewhere.

As a result, vaccination centres are being closed, and people are being turned away. In most cities, the mobile application – CoWin – used to book appointments for vaccination, isn’t allowing people to register. And even if people manage to register, appointments are not available for many months.

There is enormous public anger against the government of India for this, as well as for the serious flaws in its public health system which have been exposed by the sharp rise of infections in the second wave. This includes a lack of oxygen in hospitals and even a lack of space for funerals in crematoriums.




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Vaccine price deregulation

In April the government of India undertook a curious policy shift in its vaccine policy. It deregulated vaccine prices. Vaccine producers could “self-set” the price for their vaccines. Consequently, the two vaccine producers steeply raised the prices of vaccines by two to six times in just a week.

For the same vaccine, the government of India, state governments and private hospitals have different price tags. And the only people in India who receive the vaccine for free are healthcare and frontline workers, and those aged over 45.

The vaccine prices are now so unaffordable that informal workers are forced to spend about half of the household’s monthly salary on vaccinating all the adult members of their households. While it may only be about 800 Rupees for both doses (A$14), when a person at the poverty line may only earn around 50 Rupees (A$0.87) a day on average, this is a large portion of their monthly income. Depending on the definition, one-quarter to one-third of the Indian population is below the poverty line.

The vaccine producers lobbied hard to “free” vaccine prices. One producer said in a television interview he was hoping for “super profits”, and another said he wished the “maximum price” for his vaccine.

The government’s decision to deregulate the vaccine prices allowed “super profits” for private companies, even as an economic and humanitarian crisis was building and unemployment was rising.




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Predatory capitalism during human tragedy

Many commentators welcomed the new vaccine policy in the hopes increased prices would incentivise producers to increase supply. But they fail to see that vaccines are global public goods. They impart not just private benefits, but also social benefits, and so every barrier to vaccination must be minimised.

This is why most other nations, including Australia, the US, UK, Germany, France and China, are providing vaccines free of cost to all. India is an unfortunate exception to this global trend, and vaccines are now unaffordable to many.

Poor and faulty planning by the government of India has led to an acute shortage of vaccines. In the midst of the vaccine shortage, the government has effectively withdrawn from the social responsibilities of a welfare state. It has also opened the flood gates for a vulgar form of predatory capitalism to take the stage amid a raging human tragedy.The Conversation

R. Ramakumar, Professor of Economics, Tata Institute of Social Sciences

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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UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic


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.




Read more:
3 doses, then 1 each year: why Pfizer, not AstraZeneca, is the best bet for the long haul


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.

How can the world help India — and where does that help need to go?


Channi Anand/Ap/AAP

Dileep Mavalankar, Public Health Foundation of IndiaIndia is in the grip of an unprecedented second wave of COVID-19.

Official data suggests new cases have crossed 400,000 per day, and the daily death count is around 4,200. But the actual numbers may be significantly higher.

We know the hospital system is stretched beyond its limits and there are dire shortages in the country’s expanded vaccine drive.

Clearly, India is in need of help from beyond its borders. What can other countries do?

Help already pledged

In this moment of crisis, the international community has already stepped in to provide some help.




Read more:
‘Each burning pyre is an unspeakable, screeching horror’ – one researcher on the frontline of India’s COVID crisis


Several countries including the United States, United Kingdom, United Arab Emirates, Russia, Germany, and France have already sent aid such as oxygen and related equipment, ventilators, medicines and ICU equipment. The US has also said it will provide vaccine help, and critical drugs.

Australia has announced it will send ventilators, surgical masks and other personal protective equipment.

How should this help be used?

This aid is all critical. But given the size of India’s population — almost 1.4 billion — more will be needed and even this will not be enough.

Given this, we need to make best use of the incoming aid. India needs to conduct a quick national and state-level needs assessment exercise. Where is help most needed? And where can it be most useful?

Indians in Prayagraj line up for a COVID vaccine.
India’s vaccine program has begun but has been hit by shortages.
Rajesh Kumar Singh/AP/AAP

This should include an assessment of capacities for care and utilisation by each major city and rural area. For instance, there’s a need to evaluate diagnostic and testing capacities and their distribution across the country. An important measure missing at this point is high capacity testing systems which can help increase testing.

The review would also help answer: what are the strengths of the private and NGO sectors and how can they be harnessed? Where exactly are the most vulnerable, and how best can we reach them? Such a review would also help in ensuring that sophisticated machines such as ventilators are not sent to places where they cannot be operated or maintained.

At the same time, there’s a need to look for available internal funds and services that can strengthen India’s efforts.

The importance of vaccines

Given the emerging shortage of vaccines, they will, of course, be the most helpful gift in the long run. Many countries have booked more than they need. Such excess vaccine doses can be offered to India, as it will need millions of doses of imported vaccine to cover its population rapidly.

Besides the very visible gaps in emergency and critical care — such as oxygen and ventilators — technical expertise in epidemiology, biostatistics, data sciences and modelling as well as diagnostic technology would be very useful.




Read more:
COVID crisis in India: why its public health strategy failed


We need help in conducting expert analysis of the situation, prediction modelling by each state and city, and assistance on how to improve systems to record and analyse the huge amount of data that is streaming in.

Sharing knowledge and collaboration in areas such as understanding mutations via gene sequencing, identification of variants of concern, and studying their virulence and transmissibility will also help.

Such efforts are intangible and would fall in the realm of “knowledge aid”, and hence, governments may not be keen to prioritise this. But foreign support could also come in the form of specific funds and grants.

Help must come with no strings attached

In this process, the countries offering the support should not put any conditions or delay the process. Immediate assistance is needed as the peak of the current wave seems to be only a few weeks away.

This support should reach where the most vulnerable get COVID services: public hospitals, healthcare centres run by non-government organisations, and community COVID care centers. The technical help in epidemiology and data sciences should be given to state health departments and major research centres located in cities.

Most importantly, foreign support should strengthen the health system and not be a burden on it.

Only if we are in it together, can we all hope to defeat the virus.The Conversation

Dileep Mavalankar, Vice President western region, Public Health Foundation of India

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

Australia: Budget 2021