Australian vaccine rollout needs all hands on deck after the latest AstraZeneca news, mass vaccination hubs included

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Mark Hanly, UNSW; C Raina MacIntyre, UNSW; Ian Caterson, University of Sydney; Louisa Jorm, UNSW; Oisin Fitzgerald, UNSW, and Timothy Churches, UNSWAustralia’s vaccine rollout is due to be reset after the news last night the AstraZeneca vaccine would not be recommended for people under 50. Instead, this age group will be offered the Pfizer vaccine, with the federal government today announcing it had secured an additional 20 million doses.

Although details of the redesigned rollout have yet to be released, our new modelling, which has yet to be published in a peer-reviewed journal, shows how this might work under a range of scenarios, including the logistical requirements of different vaccines, and different vaccination venues.

Once a steady stream of locally manufactured AstraZeneca vaccine is available in Australia, the bottleneck in the vaccine rollout will shift from supply to administration. That’s when expanded GP vaccination clinics and mass vaccination hubs will be needed to deliver these jabs to nine million people over 50 in phases 1b and 2a of the rollout.

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Here’s what we did and what we found

We used mathematical simulations of waiting in line, known as stochastic queue network models, to model the process of running a vaccination clinic.

Queue models allow us to assess the daily vaccination capacity for different venues, taking into account available staff numbers and estimated times to complete each stage of the vaccination process.

The two key venues we looked at were mass vaccination hubs — which could be large venues such as halls, parks or stadiums — and GP clinics.

Mass vaccination hubs and GP clinics lay out their vaccine clinics differently. Hubs with larger premises and more staff can adopt an assembly line approach to vaccination. They can divide the tasks of registration, clinical assessment, vaccine preparation and administration across a series of stations. Smaller clinics are likely to have fewer people available, each performing multiple tasks. We developed two distinct models to reflect these different set-ups.

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Australia urgently needs mass COVID vaccination hubs. But we need more vaccines first

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We used these models to estimate how many vaccines could be delivered in an eight-hour clinic based on a range of staffing levels, within an average overall waiting time of under an hour.

We estimate a small general practice could administer 100 doses, rising to 300 doses for a large practice. Mass vaccination clinics could deliver 500-1,400 doses in the same period, depending on staff numbers.

We also used our models to test how clinics would perform under service pressures, including increased vaccine availability and staff shortages.

For both delivery modes, sites with more staff were better able to keep waiting times under control as system pressures increased. Unsurprisingly, mass vaccination hubs were more robust compared to GP clinics.

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We can test different scenarios

Our models rely on subjective assumptions about the time needed to complete different stages in the vaccination process. In reality, these timings will vary in different contexts.

For instance, the Pfizer vaccine takes longer to prepare than the AstraZeneca vaccine. Our models can account for this by increasing the expected preparation time and seeing how many extra staff would be needed to run a vaccine clinic with the same number of appointments. When the Novavax or other vaccines come on board, we can re-run the model with updated preparation times.

In fact, we have developed an an app that allows anyone to re-run our simulations based on their own assumptions about service times, appointment schedules and staffing availability.

Anyone can use the app to plug in how vaccination might play out under different scenarios.
Author supplied/UNSW

This can support policymakers, individual GPs and community pharmacies to plan vaccination delivery, as the quantity and type of available vaccine varies throughout the rollout.

However, there are some aspects of vaccine rollout our models do not account for. This includes essential support staff, such as administrators, cleaners and marshals.

Neither do our models address the logistics of distributing vaccines to vaccination centres, which is a separate challenge.

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One isn’t ‘better’ than the other. We need both

Our models suggest mass vaccination hubs and GP clinics are equally efficient in terms of the number of doses delivered per staff member. This supports distribution through both modes, provided GPs are enabled to vaccinate at their peak capacity.

These two approaches offer distinct advantages. Older people or clinically vulnerable patients may benefit from attending their local GP, who will be familiar with their medical history.

Younger males, busy working people and marginalised populations are less likely to have a regular GP and may be easier to reach through mass vaccination hubs. The rollout of phase 2 to adults under 50 may require expansion of the hubs, as not all GPs may be able to store the Pfizer vaccine.

A diverse profile of vaccination sites, drawing on the benefits of different distribution modes, will help maximise the daily vaccination rate and vaccinate the Australian population against COVID-19 as quickly as possible.

Mark Hanly, Research Fellow, UNSW; C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Ian Caterson, Medical Lead, Royal Prince Alfred Hospital COVID Vaccination Clinic, Sydney Local Health District, Boden Professor of Human Nutrition, School of Life and Environmental Sciences, University of Sydney; Louisa Jorm, Director, Centre for Big Data Research in Health, UNSW; Oisin Fitzgerald, PhD Candidate, UNSW, and Timothy Churches, Senior Research Fellow, South Western Sydney Clinical School, UNSW

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

Australia urgently needs mass COVID vaccination hubs. But we need more vaccines first

Mary-Louise McLaws, UNSWAustralia’s COVID-19 vaccine rollout has been much maligned recently, as it’s become clear we’re way behind schedule.

So far Australia’s average daily rate since the rollout began in late February is around 22,000 doses a day according to my calculations. To achieve herd immunity, I calculate we’ll need to vaccinate 85% of the population, using a combination of the Pfizer and AstraZeneca vaccines. To achieve this by the end of March 2022, I calculate we need to vaccinate at least 133,000 people a day until December 31, and then around 79,000 a day in the first three months of 2022.

One way to achieve this would be to stop relying on small GP and respiratory clinics and urgently move towards using mass vaccination hubs.

However, we don’t yet have enough of the AstraZeneca vaccine to service large vaccination hubs. This I think is one reason why Australian authorities have not yet planned to use them.

What are mass vaccination sites?

Mass vaccination means vaccination on a large scale in a short time. Locations for mass vaccination would include stadiums and sportsgrounds, schools, parks, places of worship, and shopping centres.

This is what’s being done in countries like Israel, the United Kingdom and the United States.

According to the latest data, Israel has given at least one dose to 60% of its population; that figure is 46% in the UK and 32% in the US.

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In Australia we’ve given about 850,000 COVID vaccine doses, which is roughly 4% of the adult population.

As Australia moves into phase 1B of the rollout and beyond, the federal government’s plan has been to rely solely on GP, respiratory clinics and eventually community pharmacies. This plan presumes we’re all middle class and have the ability to access a local GP during work hours or early evenings. But many people who are unemployed, disadvantaged, working multiple part-time jobs, disaffected or can’t get away from work might not be able or willing to visit a GP clinic in their neighbourhood.

Instead, many might be more comfortable going to a mass site. For the placement of mass vaccination facilities to improve uptake of the vaccine, authorities should consult demographers who can identify the location of vaccination hubs to be most effective in attracting the most people.

We can’t rely on small GP clinics alone

Relying on small GP and respiratory clinics means the rollout is progressing very slowly. Local clinics might vaccinate around 50 people per day, depending on the size of their clinic. They also need to ensure physical distancing that allows space for people to wait for 15 minutes after their vaccination while they are monitored for any side effects.

GPs also need to continue to see patients with various health and well-being needs they should not ignore, even in a pandemic.

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Federal Deputy Chief Medical Officer Michael Kidd said mass hubs were “not off the agenda”. And today, the NSW government announced it will be setting up a mass COVID vaccination hub in Homebush, in Sydney’s inner west.

This is a good start but we need many more mass vaccination sites before we can get close to reaching the daily target.

So far there isn’t a formal plan detailing how the federal or state governments will introduce mass vaccination hubs in the COVID vaccine rollout.

Vaccine supply is the crucial issue

Vaccination is a huge logistical challenge amid a global pandemic and there’s an element of authorities learning to build the ship while it’s sailing.

Australian governments may also not yet be able to supply sufficient vaccines for mass vaccination hubs.

The federal government has repeatedly said Melbourne-based biotech company CSL will be producing one million doses of the AstraZeneca vaccine a week. It’s yet to reach that target, and it’s not yet clear exactly when it will.

But let’s look at that target and presume CSL reaches it soon. One million doses divided by seven days a week equals about 142,000 doses a day. This is only just on the cusp of being sufficient to reach our daily vaccination target. But it doesn’t take into account other delays that might occur such as problems with distribution, loss of stock, logistical hurdles, and bottlenecks at vaccination clinics.

In outbreak management you plan for the worst-case scenario. So when setting goals you should plan forward and look backwards to identify weaknesses in the plan, such as not receiving enough vaccine and logistical issues. You must also allow a buffer if things go “pear shaped”.

The fact we’re already behind the federal government’s initial target of vaccinating all Australian adults by the end of October this year suggests its plans were idealistic. It’s difficult to make further assessments without full transparency around vaccine supply and distribution.

There have been issues with Europe blocking and slowing supply. Planning appropriately for the rollout would have included considerations for delays for approval and batch testing. It begs the questions of why 2.5 million doses of the AstraZeneca vaccine are currently waiting for batch testing.

Authorities should be fully transparent about issues relating to vaccine supply, batch testing and distribution, so the public can feel fully informed and engaged in the vaccine rollout.

Great examples of transparency in vaccine rollouts can be seen in New Zealand and Canada. NZ includes weekly adverse reaction reports where people can read about vaccine side effects. Greater transparency like this can reduce anxiety, hesitancy and conspiracy theories.

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Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW

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

Youth anxiety and depression are at record levels. Mental health hubs could be the answer

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Christine Grové, Monash UniversityThe COVID pandemic has shone a light on the ongoing decline in young people’s mental health. Psychologists have warned if we don’t start to address the mental health emergency of young people’s anxiety and depression, it may become a “trans-generational disaster”.

Paediatricians have said they are seeing growing numbers of young people coming to the emergency room because of a lack of other treatment options.

In an effort to address the rising rates of anxiety and depression in children, Victoria trialled mental well-being coordinators in ten schools last year. The initiative is now expanding to 26 primary schools in 2021.

Meanwhile, the royal commission into Victoria’s mental health system has recommended youth mental health hubs, some of which will soon be rolled out in priority areas across the state.

Developing specialist youth mental health hubs is one of several strategies also suggested by the Australian Psychological Society to the federal government in a recent budget submission.

So, what are youth mental health hubs, and will they work to stem the tide of mental health issues young people are experiencing?

Everything in one place

Australia’s National Strategy for Young Australians defines youth as young people between 12-24 years of age. Evidence shows half of mental disorders first emerge by the age of 14, and 75% by the age of 24.

Left untreated, these mental health problems have high rates of recurrence and cause negative outcomes for the individual, including reduced economic productivity, as well as social costs.

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Youth mental health hubs provide mental health and social services in one location. This is partly because a range of risk behaviours come with mental health difficulties including tobacco, drug and alcohol use, sexual risk taking, reduced levels of physical activity and poor nutrition. Evidence also suggests young people prefer to have their needs met in one place, rather than across a number of locations and will then be more likely to seek help when they need it.

Youth hubs should therefore have a range of specialists on site, such as trained mental health clinicians, sexual health support counsellors and psychiatrists.

Young people also want and need access to mental health information and resources. So a youth hub should be a safe place for young people to get the information they need.

Youth hubs would be connected physically and/or in partnership with schools, community organisations (such as homelessness services) and with medical specialists.

They are ideally co-designed by experts and youth with lived experience, on equal grounds. Ideally, the hubs are a youth friendly, one-stop-shop for support ranging from referrals, assessment, therapies and intervention.

Don’t we already have youth hubs?

Traditionally, mental health services, including some youth services, have not been accessible to a range of youth needs, instead targeting children or adults. Others are geared towards specific certain types of conditions.

In Australia there are two youth-specific hubs: Orygen and Headspace.

Orygen is co-designed with young people. But it specialises in youth who have had an episode of psychosis, mood disorders, emerging borderline personality disorder, and youth at high risk for a psychotic disorder.

Headspace centres provide early intervention mental health services to 12-25 year olds. The service was created to provide youth with holistic mental health support. But there are shortcomings with the model. It has been described by some experts as not being able to support some youth with complex presentations such as those with personality disorders, schizophrenia and/or substance abuse issues.

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Many other services restrict youth access to support depending on age, diagnosis or additional illness.

Youth engagement in non-youth focused specific services is low, and transitioning youth between and across services is often unsuccessful.

Young people also prefer services that include young people as staff members, which is not common in traditional mental health support. Youth participation as staff was found in only just over half of the mental health services available in Australia.

Young people prefer mental health support that is youth led.
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So, what is the ideal youth hub?

There are youth hubs available across the world, including in Ireland, New Zealand, UK, Canada, France and Australia. All of these provide different services and care. However none provide a single example of best practice yet.

Key elements of youth mental health hubs identified in the World Health Organisation framework include:

• a co-designed youth-focused approach that is flexible and adapted to youth’s changing mental health needs
• an accessible, central location (close to shops or transport), with extended spread of opening hours as well as opportunity for self-referral and drop-in services
• a place that responds to all young people quickly
• youth working in the hub
• services and support types personalised as needed by the context.

Research also suggests the hubs should be an informal space, as opposed to clinical looking, such as a shop front or café design. They should also:

• provide recreational or arts activities, as well as a hang-out space
• be included and known by the community
• keep ongoing evaluation of the services provided and provide feedback back to young people.

Keeping all services in one location works well, but it doesn’t necessarily mean a coordinated, collaborative approach to care is provided. Some hubs may house a range of services in one spot but continue to work in a separated way. This defeats the purpose of coordinated care.

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We need better investment to improve current hubs or co-design new ones to enact the WHO guidelines of best practice. This is critical to ensuring more young people access the care they need, for the success of current and future generations.

Christine Grové, Senior Lecturer and Educational and Developmental Psychologist, Monash University

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

Mastermind of Church Bombing in Nepal Arrested

Christians’ fears little allayed; armed outfits mushrooming.

KATHMANDU, Nepal, September 10 (CDN) — Pastor John Vanlalhriata was reading the Bible at his home in Kathmandu valley Sunday afternoon (Sept. 6) when a friend called to give him the news that electrified the Christian community.

“Ram Prasad Mainali has been arrested by police along with three more accomplices,” the friend said. “Finally, our prayers have been answered.”

The 36-year-old Mainali, who claims to have worked in the national army, became a household name in May after the little-known underground organization he headed, the Nepal Defense Army (NDA), claimed responsibility for placing a bomb in one of Nepal’s oldest churches during mass, killing two women and a schoolgirl and injuring more than a dozen people.

Though police claimed a breakthrough in less than a fortnight, saying they had arrested a 27-year-old woman who planted the bomb in the prayer hall of the Catholic Assumption Church on May 23, the suspected mastermind remained elusive. Despite a red alert for Mainali’s arrest, he remained at large in the former Hindu kingdom, continuing to intimidate Christians by ordering them to leave the country or face further violence. He was arrested on Saturday (Sept. 5) in Biratnagar.

The NDA, founded in 2006 after Nepal deposed King Gyanendra Bir Bikram Shah and became a secular republic, claimed to be grooming an army of suicide bombers in a bid to turn Nepal into a Hindu state again. Since last year, it began to strike in earnest in eastern Nepal, Mainali’s home region.

In March 2008, the NDA bombed a mosque in eastern Nepal, killing two people at prayer, and four months later it gunned down a Catholic priest, the Rev. John Prakash Moyalan, at his residence.

“The Christian community is relieved that Mainali has been arrested,” Pastor Vanlalhriata of the Believers’ Church in Kathmandu told Compass. “They feel Mainali would now learn that it was not good to persecute the church and threaten God’s people. But they are also apprehensive that he might be released soon.”

After the initial joy, that thought is the prospect haunting Nepal’s Christian community – that Mainali and his accomplices could be released soon, either because of legal loopholes or the culture of impunity pervading Nepal since 1996, when Maoist guerrillas began an armed revolt and triggered grave human rights violations for a decade.

“We will have to wait and watch what happens now,” said Balan Joseph, a 42-year-old garment factory employee who lost his teenage daughter, Celeste, in the bombing; eight days later, his wife Buddha Laxmi succumbed to an internal hemorrhage from the blast. “Mainali’s arrest doesn’t mean his gang has been wiped out. Unless the government takes tough action, the morale of all potential killers will rise, and recruits will continue to flock to these gangs.”

Christians have been further anguished by the revelation that Mainali had been arrested previously for an explosion. There were no casualties, and a court granted him bail. On being freed, he promptly went underground, resurfacing Saturday (Sept. 5) in the tea garden district of Jhapa, in eastern Nepal, when police arrested him on a tipoff.

Chirendra Satyal, spokesperson at the Assumption Church, said the possibility of release is the overriding concern. He said a priest told him, only half-jokingly, “I hope the authorities don’t release him again.”

Satyal said he also feels that the threat to Christians has not ended.

“There is a culture of impunity in Nepal,” he told Compass. “This government may fall, and the new one that replaces it may decide to release Mainali. Or he can have a successor stepping into his shoes.”

Ongoing Insecurity

A sense of insecurity still pervades the Assumption Church, which has not relaxed safety measures even after the arrest. Cars are not allowed inside the compound, and handbags have to be left at the gate. Professional security guards have been employed, reinforced by policemen deployed by the government.

The arrests have also failed to erase the terror from the hearts of those who were present in the church on that fatal day, especially the children. While widower Joseph said God has given him strength to bear his loss, his surviving children – Chelsea, 11, and Sylvester, 9, are still traumatized.

“My friends told me about the arrest,” Chelsea told Compass. “But I am still afraid. So is my brother. And though he too knows about the arrest, he has not talked about it with us.”

On Tuesday, authorities brought Mainali to Kathmandu valley, and he appeared before the chief district officer, who gave police permission to hold him in remand for 10 days for further investigation.

“We feel the threat of religious attacks has ended,” said Police Superintendent Devendra Subedi, whose team arrested Mainali. “A day later, we also arrested Vinod Pandey, who headed another underground organization, the Ranavir Sena, which too was demanding the restoration of Hinduism as the state religion. With the heads in the police net, the outfits are bound to collapse.”

Pandey, also arrested from eastern Nepal with an aide, was reportedly planning a series of bomb attacks in the capital and three other major towns: Pokhara, a popular tourist destination, and Biratnagar and Birgunj, two key trade hubs.

Dr. K.B. Rokaya, general secretary of the National Council of Churches of Nepal (NCCN), said the arrests of the militant group leaders will not resolve the problems of violence in Nepal.

“There are over 100 armed groups in Nepal that are engaged in extortion, abductions and killings,” said Rokaya, who is also a member of Nepal’s National Human Rights Commission. “Nepal passed through a decade of armed conflict to reach a transitional period where there is still political instability due to the weak government. Many armed groups are trying to take advantage of the vacuum. It’s not only Christians who are suffering, the entire nation is.”

In the Terai, lowlands in southern Nepal running across the open border with neighboring India, armed gangs have mushroomed since the fall of the royal government three years ago. The Believers’ Church is concentrated there. It is part of Christian Unity, an umbrella of churches of different denominations on the plains that the NDA has repeatedly threatened.

The NCCN is putting its hope in a new constitution being drafted by a 601-member Constituent Assembly in consultation with different political parties, organizations and communities. It is scheduled to be presented in May 2010. The NCCN has submitted its recommendations for protection of religious minorities to the Constituent Assembly, as well as to Prime Minister Madhav Kumar Nepal and President Ram Baran Yadav.

The NCCN’s Rokaya said the recommendations can be summed up in four points: freedom to practice the religion of choice; freedom to change it (a tacit reference to past laws that made conversion a punishable offence); freedom not to practice any religion; and the state not interfering in religious matters.

Report from Compass Direct News