Australia has not learned the lessons of its bungled COVID vaccine rollout

Posted on July 1, 2021 by particularkev

Stephen Duckett, Grattan InstituteAustralia is now over four months into its COVID vaccine rollout, and it’s still not going well.

At the six-week mark, I wrote about four ways the vaccine rollout had been bungled: the wrong pace, phasing, model, and messaging.

Nearly three months on, sadly none have been fixed, and new symptoms of these blunders are emerging.

With higher rates of vaccination, Australia’s current COVID outbreaks may have been more easily managed. Sydney, Perth, Darwin and now Brisbane are all in lockdown, and Victoria just exited one.

Bungle 1: the wrong pace

In April, I identified the first bungle as the federal government’s assertion the rollout was “a marathon not a sprint”. The government then said the rollout was “not a race”, but has since backed away from that message.

Despite abandoning the “not a race” excuse, the government hasn’t displayed a new sense of urgency. More doses are on order, but they won’t flow until September.

The continuing effects of the “stroll-out” are there for everyone to see. Only about 5% of the population is fully vaccinated, way behind the proportion in similar countries.

Bungle 2: the wrong phasing

At the three-month mark it was clear the phasing was wrong. Vaccination of quarantine and health workers, supposedly in phase 1a, was not completed before other phases were rolled out.

A driver transporting international arrivals appears to have been the vector for the current break out in NSW.

He was unvaccinated, yet he should have been in phase 1a.

The rollout to aged-care residents and workers, and people with a disability, is still not complete.

Bungle 3: the wrong model

Mass vaccination requires mass vaccination centres. The original federal government model placed almost sole reliance on GPs for the rollout. That didn’t work.

Although thousands of general practices are providing vaccines, they only provide about half of all vaccinations. A mixed model — both GPs and mass centres — seems to be working now and should continue.

Unfortunately, planning for the next stage — when more Pfizer doses start to flood into the country — seems to be going back to the old model of a GP emphasis.

This isn’t consistent with a speedy mass rollout and harks back to the lethargic approach of the start of the year. The wrong pace still appears to be creating another bungle, the wrong model.

Bungle 4: the wrong messaging

The early stages of the rollout were characterised by optimistic political messaging, complete with photos of the prime minister jumping the queue to get his Pfizer doses.

The biggest problem with the relentlessly optimistic political messaging is that it made it harder for the government to admit its mistakes, learn from them, and reset the rollout.

The wrong messaging continues on four fronts, albeit different from the earlier bungles.

First is the militarisation of the rollout. A navy commander, then an army general, and now the national security committee of cabinet have all been brought into the rollout fold.

The military men are no doubt competent people, but the signal the government is sending to the public service is appalling: that it’s not up to the task.

Unfortunately, that signal is consistent with the government’s undermining of the public service and its love of flags, military men, and labelling everything as “Operation” something, as if a new militaristic label will somehow overcome the government’s mishandling, or perhaps simply distract people’s attention.

The second messaging bungle has been about vaccine hesitancy. When the present outbreak-induced vaccine demand dies down, the government should mount a series of media campaigns to address vaccine hesitancy properly.

The third messaging bungle was with AstraZeneca restrictions: first to people over the age of 50 and then to people over 60.

And last night, the prime minister back-flipped on all of this and announced AstraZeneca would be available to anyone who wants it, of any age, if they request it from their GP. Unfortunately, many Australians appear to have voted with their feet (or arms) and are not interested in AstraZeneca so the take up of this option is likely to be trivial.

The tighter restrictions were about keeping people safe, but they were not marketed as such. As a consequence, the AstraZeneca vaccine now seems to be indelibly tarnished and will be phased out from about October, according to the government’s 2021 vaccination schedule.

The final contemporary messaging problem is about reopening borders. Obviously, now is not the right time to talk about opening borders, while COVID is spreading rapidly throughout the country.

But eventually we will need to have that conversation. Head-in-the-sand denialism — that the border reopening is far off in the future — is not good leadership. Even NSW Liberal premier Gladys Berejiklian argues we need to set a threshold for vaccinations for when opening up might happen. The federal government must lead this conversation, setting out the options and the timelines.

Over four months into the vaccine rollout, the bungling continues. It’s still too slow and badly managed, with devastating consequences for individuals and the economy. Can rollout 2.0 get it right? We can live in hope.

Stephen Duckett, Director, Health Program, Grattan Institute

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

COVID-19 and small island nations: what we can learn from New Zealand and Iceland

Posted on September 24, 2020 by particularkev

David Murdoch, University of Otago and Magnús Gottfreðsson, University of Iceland

Despite being at opposite ends of the Earth, Iceland and New Zealand have many similarities. Both are small island nations, heavily reliant on tourism and currently led by young female prime ministers.

Both countries have also been commended for their responses to the COVID-19 pandemic, characterised by science-informed policy and a high degree of public trust.

At the moment, Iceland and New Zealand have some of the lowest COVID-19 deaths per capita among OECD countries (2.83 and 0.51 per 100,000 population, respectively, compared with an OECD average of 24.01 per 100,000).

Both have been rated in the top 14 safest countries in the world for COVID-19.

But since the first cases were identified in each country in late February 2020, the two nations have taken different pathways in their COVID-19 responses. What lessons can we learn from their journeys so far?

New Zealand‘s strategy

A silhouette of New Zealand — Filip Bjorkman

New Zealand is one of the few countries to openly declare a COVID-19 elimination strategy. This involved a progressively strengthened contact-tracing and isolation system, with early and stringent use of shutdowns and border controls.

A nationwide shutdown was instigated on March 26 soon after community transmission was first demonstrated in the country and before any deaths had occurred. Alongside the shutdown, the border was closed to all but New Zealand citizens and residents.

A 14-day quarantine in managed facilities was implemented for all new arrivals. These border controls have continued to today despite the huge impact on the tourism industry.

New Zealand‘s “go hard and go early” strategy proved to be more effective than most had anticipated. The country moved back to its lowest alert level on June 8, after only seven weeks of shutdown.

A new cluster emerged

On August 11, after more than 100 days with no community transmission of COVID-19, a cluster of cases not linked to other known case was detected in Auckland. This outbreak is still being contained and no source has yet been identified.

The response from the government was immediately to reinstate stay-at-home orders in Auckland, raise the alert level for the rest of the country, and further tighten systems at the border and in quarantine and isolation facilities.

Key to management of this resurgence was the use of rapid genome sequencing and a new requirement for mask use when travelling on public transport.

Iceland’s strategy

A silhouette of Iceland — Filip Bjorkman

In contrast to New Zealand, Iceland’s strategy involved no shutdown period, no official border closure to non-residents, and negligible use of managed quarantine facilities.

The aim instead is to mitigate infection so it does not overwhelm the health-care system, and to keep the numbers as low as possible. As in New Zealand, there is a new requirement for wearing face masks when travelling on public transport and where physical distancing is difficult.

The cornerstone of Iceland‘s response has been easy access to COVID-19 testing and mass screening, alongside quarantine and contact tracing. This was enabled by a public-private partnership between the Icelandic health authorities, the National University Hospital of Iceland and local biopharmaceutical company deCODE Genetics.

At one stage, Iceland was performing more tests per head of population than any other country.

Testing for new arrivals

As Iceland became free of community transmission of COVID-19 in mid-May, pressure grew from the tourism industry and other stakeholders to reduce the 14-day quarantine policy for new arrivals into the country.

In response, a controversial new border screening program was implemented on June 15. This required all incoming travellers to be tested once for COVID-19 on arrival and then urged to self-quarantine until results came back, usually within 24 hours.

As a consequence, tourism in June and July exceeded all expectations in Iceland.

But increasing community transmission, with several clusters arising from travellers who had tested negative on arrival prompted a stepwise tightening of the border system.

Since August 19, all incoming travellers have had to undergo mandatory self-quarantine, during which they need to return two negative COVID-19 tests at least five days apart.

The change to this two-test strategy proved to be a wise move, as 25 (20%) of the 126 active infections in inbound travellers were detected only by the second test.

Science, trust and adaptability

Although they adopted different strategies, both Iceland and New Zealand demonstrate the importance of decisive, science-informed decision-making and clear communication involving regular public briefings by senior officials.

As a consequence, high levels of public trust have been recorded in both Iceland and New Zealand although this has varied through the pandemic.

The prominent role of scientists, the use of multi-institutional collaborations as part of COVID-19 response strategies, and the willingness to adapt to new knowledge have also been key features for both countries.

Only time will enable a full assessment of each country‘s COVID-19 strategy. More than ever, the global community needs to learn from each other’s experiences, avoid dogmatism and be adaptable in our national responses as we navigate a path out of this pandemic.

David Murdoch, Dean and Head of Campus, University of Otago, Christchurch, University of Otago and Magnús Gottfreðsson, Professor, infectious diseases, University of Iceland

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

From the COVID-19 epicentre: lessons from Latin American cities’ successes and failures

Posted on August 18, 2020 by particularkev

Hayley Henderson, Australian National University

Latin America is now the epicentre of the COVID-19 pandemic. The fastest spread of the disease in the region’s cities follows a pattern of contagion that is anything but arbitrary. Disturbing images in international media depict the unfolding crisis, from disinfection campaigns in the favelas of Rio de Janeiro, Brazil, to stockpiles of cardboard coffins in Guayaquil, Ecuador.

By this week, about 30% of the world’s reported cases were in the region. But some centres have been much worse hit than others.
Two factors underpin these variations: levels of inequality, and the ways governments and communities are handling the crisis.

World map showing distribution of reported COVID-19 cases per 100,000 population for each country — Worldwide distribution of 14-day cumulative number of reported COVID-19 cases per 100,000 population. Darkest colours indicate highest rates of infection.
ECDC, CC BY

Across the region’s largest cities, the first cases had appeared by early March in well-off neighbourhoods. Not until May were exponential rates of infection recorded in most Latin American countries. The surge in cases reflected the spread of coronavirus across cities and into their poorest neighbourhoods.

The poor are more vulnerable

Many of the urban poor have not been able to manage risk in the way that the better-off do. To make ends meet they often travel long distances in public transport to work in wealthier neighbourhoods. Those who have jobs are often employed in the informal economy: cleaning houses, fixing electrical problems, selling vegetables and so on.

By June 2020, infection rates were increasing in many middle-class neighbourhoods too –
for example, in Buenos Aires. However, self-isolation is a more realistic prospect in these areas. Medical care is also more accessible.

Inequality created ideal conditions for COVID-19 to spread. The disease disproportionately affects residents of informal settlements in the largest cities. One-fifth of the Latin American population lives in such settlements.

As well as their work being insecure, their living conditions add to their vulnerability. Some of the problems faced can include overcrowding, malnutrition, deficient sewer systems, limited (and often paid) access to drinkable water, overwhelmed or unaffordable health services and indoor air pollution from cooking (with open fires or simple stoves, for example).

Given these conditions, COVID-19 is far from a levelling force. It is the latest crisis to reveal old and hard truths about Latin America’s social and economic geography.

Quality of governance laid bare

The virus has not spread unabated in all Latin American cities. The quality of governance and the preparedness of services have greatly affected outcomes between cities and countries.

Some have paid a high price for the harmful impacts of inconsistent communications by authorities and political leaders, weak public health systems, liberalised employment conditions and lack of support for disadvantaged groups.

Mortality analyses conducted by the Coronavirus Resource Center at John Hopkins University show six of the countries most affected by COVID-19 worldwide are now in Latin America. Brazil, Chile and Peru have reached 50 or more deaths per 100,000 population. Nowhere has it been made clearer how a chronically underfunded public health system leaves behind vulnerable people.

The mortality rate is lower in other parts of the region. In these countries, strict restrictions have been introduced and the public health systems bolstered since the start of the pandemic. Leading examples include Uruguay, with 1.07 deaths per 100,000 people, and Argentina (11.7/100,000).

In June, Time included Argentina’s response in “The Best Global Responses to COVID-19 Pandemic”. In the capital, Buenos Aires, co-ordination between the three levels of government has been strong on public health as well as economic and social protection measures despite political differences. Shared communications have backed strict lockdown measures every fortnight since March 20 (read more about the Buenos Aires experience here).

Bottom-up efforts are vital too

It is not just top-down approaches by government that make a difference to local outcomes. The bottom-up work of social organisations in Latin American cities has also been vital.

We see this work especially in informal settlements that lack public services. Often run voluntarily and by women, these organisations cook meals for people in need, make masks, source medications, spread public information and fix broken houses.

Many of their actions are also directed toward the state. With an ethic of care, they seek to drive anti-neoliberal change and demonstrate a better urban future centred on people’s real lives and desires.

For example, across the region feminist social movements and politics are dismantling patriarchal perspectives about modern cities. Their collective response to the COVID-19 crisis is a demonstration of solidarity.

Posts by Latin American feminist groups — Feminist movements debate ‘ecofeminism’ and ‘the city we want to return to’.
Ecofeminism Encounters, Latin American Dialogue (https://www.ciudadfeminista.cl/, https://www.ciudaddeldeseo.com/), Author provided

Remaking cities after the pandemic

Looking forward to the post-pandemic city, there are valuable lessons to be learnt from Latin America.

First, debilitating inequality must be redressed. Poverty has been built into the way cities are developed. But this is now being denaturalised.

Second, co-ordinated and strong state-led action that made public health the priority has saved lives in cities like Buenos Aires. Bipartisan leadership and collaboration between levels of government can also help us deal with pressing urban challenges in the future.

Third, because of the ubiquitous albeit unequal way coronavirus has affected people across cities, there is potential for a post-pandemic future that focuses on collective well-being.

Many Latin American social organisations, and the networks between them, offer hope and direction for the challenge of recovery. Not only do they provide vital support in crisis management, they could play a democratising role in shaping politics and state responses to redress inequality over the long term.

Hayley Henderson, Postdoctoral Fellow, Crawford School of Public Policy, Australian National University

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

7 lessons for Australia’s health system from the coronavirus upheaval

Posted on June 23, 2020 by particularkev

Stephen Duckett, Grattan Institute and Anika Stobart, Grattan Institute

The COVID-19 pandemic forced us all to change the way we live. The lockdown altered fundamental aspects of our lives, not only to protect our own health but also the health and lives of others.

Just as Australians have shown a remarkable ability to adapt to a world with COVID-19, so too has Australia’s health system. In a report released today, the Grattan Institute outlines seven key lessons that can help make the health system more effective, efficient and equitable, and better able to deal with future crises.

Lesson 1: telehealth works

Since mid-March, Australians have been able to consult their GP or a specialist from the comfort of their own homes, via phone or video (known as telehealth). Although face-to-face consultations are sometimes still necessary, the pandemic has shown the enormous potential for telehealth to provide more efficient care in many instances, such as for routine appointments or mental health check-ups.

During the pandemic, telehealth was a no-brainer to protect patients and health professionals from getting sick or making others sick. But given its widespread adoption and success, it is also a no-brainer for telehealth to become a permanent fixture of health care in Australia.

The federal government should revise the temporary telehealth Medicare items to ensure they promote continuity of care and make them more appropriate for the longer term, couple them with e-referrals (to replace the museum-era fax machines), and introduce rules to prevent rorting.

Lesson 2: out-of-hospital care also works

Alongside telehealth, the pandemic prompted a rapid expansion of hospital-in-the-home care, including new “virtual hospitals”. Many people with chronic health conditions, or who are in rehabilitation or residential aged care, can be monitored by health professionals and given health advice without face-to-face contact, using technologies such as telemonitoring.

Commonwealth and state governments should fund further expansion of these services.

Telehealth consultations have become more commonplace during the pandemic.
Shutterstock

Lesson 3: Australia needs new funding arrangements for general practices

Australia’s rigid primary care funding model, in which doctors are paid on a fee-for-service basis, made it hard for GPs to set up new practice models during the pandemic – such as quickly establishing COVID-19 testing clinics or making outreach calls to vulnerable patients.

Governments should remove barriers in the Medicare system to allow for different models of care.

Lesson 4: public and private systems should be more integrated

The pandemic showed the potential for public and private health-care systems to work better together. Private hospitals were set up to deal with the overflow from potentially overwhelmed public hospitals. At the same time, private hospitals effectively came to a halt when governments suspended non-urgent elective surgeries, to free up resources to tackle the pandemic.

Now there is a huge backlog of patients who need elective surgeries. Clearing this backlog should not be a business-as-usual matter. The pandemic provides an opportunity for Australia to move away from the current inconsistent wait-list process, to a standardised, efficient, equitable process with a single wait-list priority system to properly manage elective surgeries.

State governments should also consider negotiating long-term contracts with private hospitals for extra help.

Lesson 5: there are gaps in Australia’s pandemic preparedness

Despite Australia’s largely successful response to the pandemic, our preparedness regime was not totally up to scratch. Australia had not contemplated a crisis of this scale, and as a consequence the early response was characterised by reactive policy-making and mixed messages to the public.

Future pandemic planning should include a workforce strategy to support the rapid expansion of health-care capacity; provide a national surveillance approach to quick and accurate reporting of disease data; and ensure that secondary health effects such as mental health problems and domestic violence are built into the plan and managed in the longer term.

Lesson 6: the health system needs a stronger supply chain

During the pandemic, health workers had to cope with inadequate supplies of testing kits and personal protective equipment (PPE) such as face masks. Problems with Australia’s supply chains hampered ready access to supplies, and the global surge in demand forced Australian health departments to join the global bidding for fast-tracked supplies from overseas.

We’ve seen shortages of PPE during the pandemic.
Shutterstock

Australian governments need to strengthen local supply chains, by drawing on a diverse set of suppliers and increasing product standardisation to enable easier substitution of products. The National Medical Stockpile also needs to be reviewed, because it did not have sufficient supplies.

Lesson 7: Commonwealth and state governments can better coordinate primary care

The creation of the National Cabinet improved national coordination in response to the pandemic, as the old fractured federal relationships were temporarily set aside.

Renewed cooperation through primary care agreements, and strengthened Primary Health Networks, could reduce – or, better still, end – the overlap in services provided by the Commonwealth and states, and improve primary care delivery.

The new normal can be better than the old

Australia’s health care must not “snap back” to the old order. The pandemic has shown us a better way. Now reform is needed to transform these temporary improvements into long-term successes.

But reform and a “new normal” won’t just happen automatically. Consumers and clinicians should be engaged now to build on what went well during the pandemic, to ensure our health system is better than it ever was before the pandemic.

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

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

We’ve known about pandemic health messaging since 1918. So when it comes to coronavirus, what has Australia learnt?

Posted on April 9, 2020 by particularkev

GPA Photoarchive/US Dept of State, CC BY-NC

Elizabeth Stephens, The University of Queensland

Australia’s coronavirus public health messaging has been criticised as confusing during a time when health guidelines and regulations are changing rapidly, and educating the public about health is more vital than ever.

The slow roll-out of its public information campaign of videos and posters, urging people to wash their hands and keep their distance, has also been criticised.

But we’ve known how pandemic public health messaging works since the 1918 influenza pandemic, a largely forgotten, but important historical precedent for the current crisis.

We know from 1918 that pandemic public health messages need to be communicated widely and clearly, and to be consistent with government messaging and policies.

For this, messaging needs to be regulated by centralised, government agencies.

So which lessons has Australia learnt from the past?

Communicating widely works

This 1918 advertisement warns about the spread of influenza.
National Museum of Health and Medicine, Author provided

Public health education campaigns have long played a pivotal role in managing public health, especially in moments of crisis.

Public health education, as we know it, is just over a century old. It is a product of the first world war, when more soldiers died of disease than injury.

Many of the earliest public health education campaigns focused on curbing the transmission of infectious diseases, more specifically, using posters to warn about venereal diseases (sexually transmitted infections).

But there are only a handful of posters warning about the influenza pandemic of 1918, which would go on to kill 50-100 million people, many times more than the war itself.

Partly this is because influenza broke out during the final stages of the war, when national resources were stretched thin.

It is also perhaps because it was initially overshadowed by that other great epidemic disease of the 19th century: tuberculosis.

Flyer warning about the spread of common infectious diseases made during the 1918 influenza epidemic.
US Library of Congress, Author provided

However, as influenza spread around the world with returning servicemen in 1918, efforts were made to slow its transmission through new public health education initiatives, such as distributing information flyers.

The US city of Philadelphia, for instance, distributed 20,000 flyers warning about the transmission of influenza in 1918.

At the same time, however, it also decided to proceed with a large public parade, which attracted 200,000 thousand people.

Within three days, every hospital in Philadelphia was full. By the end of the first week, 2,600 people had died. Six weeks later, over 12,000 were dead.

But the city of St Louis moved quickly to introduce measures like the ones we see today: shutting schools, cinemas, churches, and businesses. Some 700 died.

The difference between Philadelphia and St Louis is one of the most important lessons to learn from the 1918 influenza epidemic: “flattening the curve” works to limit transmission of infectious diseases, minimising the impact on health services.

It’s a message that’s been stressed in the current health messaging, not only by government, but by medical professionals and statistical modellers.

Current public health messaging to “flatten the curve” has had a demonstrable effect on public behaviour, encouraging widespread social distancing and self-isolation.

However, this message was undermined by what many perceived as the government’s slowness in introducing social distancing measures as a containment policy, and mixed messaging around their implementation.

In the middle of March, as events like the Melbourne Grand Prix seemed prepared to go ahead, some feared we were watching another Philadelphia in the making.

Effective government health messaging helps stem misinformation

Before the launch of the Australian government’s public education campaign, a wave of posts from the public on social media urged people to wash their hands for 20 seconds and physically distance from older relatives.

Millions of people watched the video of Arnold Schwarzenegger feeding carrots to a miniature donkey and pony, while encouraging his audience to stay inside.

And in the UK, a 17-year-old boy created a popular online tool that adds 20 seconds of your chosen song lyrics to a poster on hand-washing.

These examples represent something new: public health messages produced and circulated by the public, perhaps one of the most significant legacies of COVID-19, changing a century of practice in public health education.

While such initiatives are doubtlessly well-intentioned, they have moved public health education from government agencies and traditional media online, into a largely unregulated space.

Inevitably, we are seeing the circulation of medical misinformation.

This was also evident in the unregulated health sector of 1918, with a flourishing market in quack medical treatments, including ones that contained arsenic, camphor or mercury.

One of the key lessons of the 1918 influenza epidemic was, precisely, the importance of efficient and regulated public health communication.

This led directly to the foundation of national health organisations and media outlets. In the UK, the Ministry of Health was established in 1919, the BBC in 1922. In Australia, the Department of Health was established in 1921, the ABC in 1932.

However, with health regulations changing daily and announcements often made late at night, we need to ensure public health communication keeps pace with government health policy, and public messaging about both is clear and consistent.

How about future health campaigns?

The coronavirus is pushing so much of life online and the digital sphere grows more culturally influential.

To stem misinformation, robustly funded and well-resourced government health agencies and government public information campaigns are more important than ever.

During the current crisis, we have the opportunity to learn from the past, while taking advantage of new possibilities.

For instance, government health education can make greater use of social media to explain changing public health policy and regulations.

As Australia prepares for an extended and unprecedented period of mandatory self-isolating, ongoing clear and consistent messaging will be more important than ever.

Elizabeth Stephens, ARC Future Fellow and Associate Professor of Cultural Studies, The University of Queensland

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

Why Singapore’s coronavirus response worked – and what we can all learn

Posted on March 22, 2020 by particularkev

Yong Loo Lin School of Medicine, National University of Singapore

Dale Fisher, National University of Singapore

Singapore’s response to the coronavirus has been held up by many around the world as a model. As of this week, the country has had 266 total cases (with zero deaths), and its infection rate is much slower than the rest of the world.

The first thing that helped with its response was it was ready before the outbreak even occurred because of the SARS outbreak of 2002-03.

It was aware then that its infrastructure wasn’t ready for an outbreak of this kind. So, in the years since, isolation hospitals were built, more negative pressure rooms were created and legislation was put in place.

Then, on December 31, when the world first became aware of coronavirus in China, Singapore started to get prepared. By the time the World Health Organisation declared a public health emergency at the end of January, it was ready.

In February, Singapore made it clear again this virus had the potential to have major health, social and economic consequences. We knew that because we saw what happened in China. The virus brought a country of 1.4 billion people basically to its knees.

The rest of Asia was clearly frightened and scampering to get ready, too – Taiwan, Hong Kong, South Korea. There was no confusion in the minds of these countries what this virus could do.

Yet, still other parts of the world weren’t preparing.

Keeping people who test positive in hospitals

Looking at what we do differently today, I think the biggest one is Singapore didn’t let positive patients back into the community.

China also didn’t do that. Wuhan created 50,000 hospital beds in two big temporary hospitals. These weren’t hospitals for sick people, these were all the mild cases that Australia, Europe and US sends home.

Home quarantine is not easy. You’re not supposed to mix with your family, you’re supposed to have your own toilet, you’re not supposed to have visitors. If you’re going to keep people at home, you need to be really sure they’re not transmitting it.

In Singapore, we think it’s better to hive those people off and look after them elsewhere until the virus is clear. People with mild cases are kept in hospitals – we have enough space to put all the positives together.

If you’re going to look after people at home, how do you know they are complying with self-isolation rules? Are you doing phone tracking? Are you doing random checks regularly enough? Are there harsh enough penalties to frighten people from disobeying?

Singapore has contact tracing teams, who identify all the contacts of an infected person and ring them up. Often these people have early symptoms and we’ll arrange for them to be picked up and tested.

Singapore is very liberal with our testing. Less than 1% of our tests are positive, so that reflects just how many tests we are doing.

If people don’t have symptoms, they’re put in home quarantine. And home quarantine is very strict. A couple times a day, you’ll get an SMS and you have to click on a link that will show where your phone is.

In case you cheat and leave your phone at home with someone else, the government has people knocking on doors now and then. The penalties are pretty harsh.

The COVID Chronicles public awareness campaign.
Yong Loo Lin School of Medicine, National University of Singapore

Consistent, regular communication

We have been very strong on community engagement. The messages we send are: if you are sick, stay home. If you are sick and have had contact with a COVID-19 patient, come in for a test. If you can’t stay home and you have to go out, wear a mask. If you cough, cough into your elbow. Avoid crowds, particularly indoors.

To everyone else, we say social distancing. For restaurant and bar owners, try and reduce the number of people in your businesses. People know what to do and they know if there’s a lockdown, they’re going to be closed. There’s a lot of business and revenue to be lost.

Most restaurants, shopping malls and schools have remained open in Singapore during the pandemic.
HOW HWEE YOUNG/EPA

Everyone understands and adapts. You know what happens when people don’t adapt – we end up closing things down.

The messaging has also been very strategic. There’s a cross-ministerial task force – we regard this as a whole of government issue, not just a health issue. The prime minister comes on television every couple weeks, the chair of the task force is now a well-known face. Messaging is generally limited to a small number of authoritative people

There’s great transparency. There’s already great faith in government, so that helps quite a bit.

The messaging from the government is also consistent – they provide the latest numbers and say what’s happening in other countries and what might need to be done in Singapore.

We also created a public awareness campaign with cartoons. This is an alternative medium people might connect with. They are very popular, with over 1 million viewings online. The World Health Organisation is now translating them into other languages.

Why Singapore isn’t in lockdown

It’s pretty well-known that children are asymptomatic or only have mild disease, so there was no real reason to close schools. If you close schools, what’s the trigger to reopen them?

In Singapore, we want life to go on as normal. We want businesses, churches, restaurants and schools to stay open. This is what success looks like. Everything goes forward with modifications as needed, and you keep doing this until there’s a vaccine or a treatment.

On testing, the threshold for getting a test is pretty low. For the first week, we tested only people from Wuhan or Hubei province, then we tested anyone who had been in China within the last 14 days.

By the end of January, all of our public hospitals could do tests. Then we moved to enhanced screening – we tested anyone coming to a hospital with a respiratory illness, anyone who had been in contact with a COVID-19 patient.

Now, it’s even become more liberal. If you’re a hospital staff member with a mild cold, we’ll give you a test.

But if you’re a normal person with no contacts with anybody and mild symptoms, we’d just send them home. You can get a medical certificate that allows you to stay home from work for five days. If you are a casual worker, there’s financial help with that, too.

Temperature testing at the entrance to a library.
HOW HWEE YOUNG/EPA

Leadership needs to be organised

It’s nothing really fancy. We don’t have the magic answer here, we just do it well and efficiently.

It’s certainly more challenging to put these things in place in bigger countries with different political systems, but it just means people need to know their roles.

For instance, communicating to the nation should come from the national government, but the state level should talk about state-relevant things.

It’s really about leadership being organised enough to get the messaging right as a team. Then people will feel more comfortable and are much more likely to follow the rules.

Dale Fisher, Chair, Infection Control, National University Hospital, National University of Singapore

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

Australia: Bushfire Lessons

Posted on January 14, 2020 by particularkev

Lessons on terrorism and rehabilitation from the London Bridge attack

Posted on December 20, 2019 by particularkev

In a deeply tragic irony, the two victims who lost their lives to a man who made a mockery of their idealism were assisted by two others who appear to have genuinely benefited from prison rehabilitation programs.
AAP/EPA/Facundo Arrizabalaga

Greg Barton, Deakin University

Can prison rehabilitation programs work, and is it sensible to try and rehabilitate seriously radicalised individuals convicted on terrorism charges?

These are questions not just for the UK, in the wake of the second London Bridge attack over the weekend, but for the entire world.

There are no easy answers and no simple options. As the numbers of people detained and eventually released on terrorism charges mount up around the world, so too does the question of what to do with them. Politicians find it easy to speak in terms of “lock them up and throw away the key”. But our legal systems don’t allow this and the results, even if allowed, would almost certainly be worse.

Some answers, and some difficult questions, can be found in the lives of four participants in the events in London: Jack Merritt, Saskia Jones, Marc Conway and James Ford.

All four were participating in an event organised to reflect on the first five years of the University of Cambridge’s Learning Together program. Merritt was a young graduate who was helping coordinate the program. Jones was a volunteer in the program. Tragically, their idealism and desire to give back to society saw them lose their lives to a man whom they thought they had been able to help.

Merritt’s father told the media:

Jack lived his principles; he believed in redemption and rehabilitation, not revenge, and he always took the side of the underdog.

In her tribute to her murdered daughter, Jones’s mother said:

Saskia had a great passion for providing invaluable support to victims of criminal injustice, which led her to the point of recently applying for the police graduate recruitment programme, wishing to specialise in victim support.

Jones, 23, and Merritt, 25, were both University of Cambridge graduates working at the Learning Together program. They lost their lives to a knife-wielding murderer who does not deserve to have his name remembered. Their 28-year-old assailant had been released from prison 12 months earlier, having served but eight years of a 16 year sentence.

In a catastrophic system-failure, his automatic release was processed without his case ever being reviewed by a parole board, despite the sentencing judge identifying him as a serious risk who should only ever be released after careful review. He had gamed the system, presenting himself as repentant and reformed.

In fact, he had never undergone a rehabilitation program in prison and only had cursory processing on his release. Systemic mistakes and the lack of resources to fund sufficient and appropriate rehabilitation programs meant he was one of many whose risk was never adequately assessed.

Conway had formerly served time at a London prison and is now working as a policy officer at the Prison Reform Trust. He witnessed the fatal attack and rushed directly towards the attacker, joining others who sought to pin him down.

Another man participating in the offender rehabilitation event was James Ford. He too saw the attack unfolding and immediately confronted the assailant.

In a deeply tragic irony, the two victims who lost their lives to a man who made a mockery of their idealism were assisted by two others who appear to have genuinely benefited from prison rehabilitation programs. But even here, the complexities and ambiguities of this sort of difficult endeavour were played out as clearly as any playwright could ever conceive of scripting.

Ford was a convicted murderer attending the Learning Together conference on day-release. He had brutally killed 21-year-old Amanda Campion, a young women who was particularly vulnerable because of her intellectual disability. In the eyes of Campion’s family, Ford is no hero.

However, Professor of Criminology at Birmingham City University David Wilson, who chairs the Friends of Grendon Prison program, says that Ford underwent extensive rehabilitation initiatives, including an intensive period of psychotherapy.

On this occasion, the convicted murderer did the right thing. Even though this doesn’t make him a hero, it does give some reason for hope. For Wilson, the murderous terrorist and the convicted murderer who rushed to contain him represent a tale of two prisoners:

I know through my work that people do change and they change as a consequence of innovative but challenging regimes such as the one at HMP Grendon.

In the wake of the attack, UK Prime Minister Boris Johnson said the cases of 74 people released early after being jailed for terror offences will be reviewed. This is certainly sensible and necessary, but much more is required. Indefinite detention is not an option in the majority of cases, and the UK is dealing with hundreds of people convicted of terrorism offences either currently in prison or recently released.

The numbers in Australia are only a fraction of this but still run into the high dozens and are growing every year. For Australia’s near neighbours, Indonesia, Malaysia and the Philippines, the numbers, including projected returnees from the Middle East, run into the thousands.

Professor Ian Acheson, who has advised the government on how to handle extremist prisoners, told the BBC it was not “a question of an arms race on sentencing toughness”, but about what is done when offenders are in custody.

Acheson said his panel’s recommendations had been agreed to but not implemented due to “the merry-go-round of political replacements of secretaries of state”, and the “fairly recalcitrant and unwilling bureaucracy”. He also cited “crazy failed and ideological austerity cuts” to the police, prison and probation services.

Jack Merritt and Saskia Jones were not naïve idealists. They had studied the problem closely and believed rehabilitation programs could make a difference. Their tragic deaths speak to the challenges involved. To give up and do nothing is not merely cynical, but self-defeating. Without adequate resourcing and reforms the problem everywhere will only become much worse.

Greg Barton, Chair in Global Islamic Politics, Alfred Deakin Institute for Citizenship and Globalisation, Deakin University

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

How might Labor win in 2022? The answers can all be found in the lessons of 2019

Posted on June 1, 2019 by particularkev

If Anthony Albanese wants to lead Labor to victory in 2022, he’ll need to grasp the full suite of lessons from 2019’s shock loss.
AAP/Joel Carrett

Chris Wallace, Australian National University

The high tide of analysis concerning the Australian Labor Party’s shock 2019 federal election loss has been reached. It looks like so much flotsam and jetsam with the odd big log – leadership popularity, Queensland – prominent among the debris. Sorting through it, making sense of it, and weighting the factors driving the result really matters. It matters because decisions influencing the outcome of the next federal election will flow from it.

The learner’s error is to grasp onto a couple of factors without considering the full suite, weighting them and seeing the connections between them. What does the full suite look like?

1. Leadership popularity

Labor’s Bill Shorten was an unpopular leader, neither liked nor trusted by voters. The shift from Shorten in private to Shorten in leadership mode in the media was comparable to the shift in Julia Gillard when she moved from the deputy prime ministership to prime minister: the charm and wit went missing, replaced by woodenness and lack of relatability.

Shorten accepted advice to appear “leader-like”, creating a barrier Prime Minister Scott Morrison, who sought to directly connect with voters, was not hampered by. “It is often said of democratic politics,” historian David Runciman has said, “that the question voters ask of any leader is: ‘Do I like this person?’ But it seems more likely that the question at the back of their minds is: ‘Would this person like me?’” Morrison passed and Shorten flunked that test.

Shorten generally failed the “theatre of politics”. His suits often looked too big, making him look small. Television footage of him jogging in oversized athletic clothes during the campaign made him look small. Poor production of Shorten in these ways diminished perceptions of him as an alternative prime minister – a professionalism fail that could have easily been fixed but was not.

Lesson: Leadership unpopularity costs votes. Successful “theatre of politics” matters.

2. Supporting players’ unpopularity

Shorten was weighed down by frontbenchers in the key economic and environment portfolios who fell well short in the performativity stakes too. The camera is not kind to shadow treasurer Chris Bowen. While he developed serious policy chops, partly through sustained study of Paul Keating’s history as a reforming treasurer of historic stature, he also picked up Keating’s hauteur, but without actually being Keating and able to pull it off.

The arrogance of Bowen’s franking credits policy comment that “if people very strongly feel that they don’t want this to happen they are perfectly entitled to vote against us” was a defining misstep of the Shorten opposition. It made the leader’s job that much harder.

Shadow environment minister Mark Butler is another to whom the camera is unkind. He embodied the soft, urban environmentalist persona that is poison in those parts of Australia where Labor needed to pick up seats. An equally knowledgeable but more knockabout environment spokesperson – Tony Burke, for example – would have been the cannier choice in a “climate election” where regional voters had to be persuaded to Labor’s greener policy agenda.

Lesson: Appoint frontbenchers capable of winning public support in their portfolios.

3. Misleading polls
The maths wasn’t wrong but the models on which the two-party-preferred vote is calculated have been blown up by this election, an event foreshadowed by recent polling miscalls in Britain.

Long-time conservative political consultant Lynton Crosby’s presence in the Coalition campaign has been invisible except for the tiny but crucial, and completely overlooked, detail that the Liberals’ polling “was conducted by Michael Brooks, a London-based pollster with Crosby Textor who was brought out from the United Kingdom for the campaign”.

The Coalition had better polling. Labor and everyone else were relying on faulty polling that misallocated preferences and uniformly predicted a Labor win – false comfort to Labor, which stayed a flawed course instead of making necessary changes to avoid defeat.

Lesson: Focus on the primary vote, the polling figure least vulnerable to modelling assumptions.

4. Media hostile to Labor

The Murdoch media have created an atmospheric so pervasively hostile to Labor that it has become normalised. It contributed significantly to Shorten’s unpopularity and Labor’s loss. Its impact is only going to get worse with Australia’s nakedly partisan Fox News-equivalent, “Sky After Dark”, extending from pay-TV to free-to-air channels in regional areas.

Lesson: Labor has to be so much better than the Coalition to win in this dire and deteriorating media environment. It needs a concrete plan to match and/or neutralise the Murdoch media’s influence.

5. Regional variations

Labor failed to win support in resource-rich states where it needed to pick up seats to win, and suffered a big fall in its primary vote in Queensland.

There is a danger of this being overplayed as a factor since, in fact, not much really changed at this election: the Coalition has two more seats and Labor two less seats than in the last parliament. Further, there are nuances to be engaged with even in hard-core resource areas. More Queenslanders, for example, are employed in the services sector in industries like tourism than are employed in the coal sector; and Labor has a strong tradition in Queensland and is capable of renewal.

The concerns of both sides need to be woven into a plausible policy path forward, with opportunities for different, deeply-held views to be heard and acknowledged as part of the process.

Lesson: Develop “ground up” rather than “top down” policies that integrate diverse concerns without overreacting to what was actually a modest change in electoral fortunes.

6. Weak advertising strategy

Labor’s advertising campaign was complacent, unfocused and completely failed to exploit the leadership chaos and chronic division in the Coalition parties for the previous six years. Why? Labor’s decision not to run potent negative ads on coalition chaos in parallel with its positive advertising campaign is the biggest mystery of the 2019 election – naive in the extreme. It left Labor defenceless in the face of a relentlessly negative, untruthful campaign from the other side.

Lesson: Have brilliant ads in a sharply focused campaign that doesn’t fail to hit your opponents’ weaknesses.

7. Massive advertising spending gap

Along with the hostile media environment created by the Murdoch press, the unprecedented spending gap between the Labor and anti-Labor sides of politics and its role in the Coalition win has passed largely unremarked.

The previous election was bought by Prime Minister Malcolm Turnbull with a $1.7 million personal donation that boosted Coalition election advertising in the campaign’s crucial last fortnight. That now looks like small beer next to the 2019 election’s anti-Labor advertising spending (approximately $80 million when one adds the Coalition’s $20 million spend to the Clive Palmer-United Australia Party spend of $60 million-plus). This is four times the size of Labor’s $20 million ad budget – a huge disparity.

Palmer’s gambit, which creates a friendly environment for him to gain regulatory approval for a Queensland coal mine vastly bigger than Adani’s during this term of parliament, takes Australia into banana republic territory in terms of money politics.

Lesson: Australia already needed campaign finance laws to stop the purchasing of elections. It needs them even more urgently now.

8. Large policy target

Misleading polling showing it was persistently ahead gave Labor false comfort pursuing a “big” policy agenda – that is, making policy offerings normally done from government rather than opposition. If everything else goes right in an election, and with a popular leader and effective key supporting frontbenchers, this may be possible. That was not the case in the 2019 election.

Lesson: When in opposition, don’t go to an election promising tax changes that make some people worse off. Save it for government.

9. Green cannibalisation of the Labor vote

The primary vote of the Labor Party (33.5%) and the Greens (9.9%) adds up to 43.4% – a long way off the 50%-plus required to beat the conservatives. For a climate-action-oriented government to be elected in Australia, Labor and the Greens are going to have to find a better modus vivendi.

They don’t have to like each other; after all, the mutual hatred of the Liberals and Nationals within the Coalition is long-standing and well-known. But like the Liberals and Nationals, though without a formal agreement, Labor and the Greens are going to have to craft a way forward that forestalls indulgent bus tours by Green icons through Queensland coal seats and stops prioritising cannibalisation of the Labor vote over beating conservatives.

Lesson: For climate policy to change in Australia, Labor and the Greens need to strategise constructively, if informally, to get Labor elected to office.

10. Every election is winnable

Paul Keating won an “unwinnable” election in 1993 and pundits spoke of the Keating decade ahead. John Howard beat Keating in a landslide three years later, despite being the third Coalition leader in a single tumultuous parliamentary term.

Morrison won the 2019 election despite internal Coalition leadership turmoil, political scandals and a revolt of the party’s women MPs against the Liberals’ bullying internal culture.

Lesson: Every election is there to be won or lost. Take note of Lessons 1 to 9 to do so.

Chris Wallace, ARC DECRA Fellow, Australian National University

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

Four lessons we must take away from the Christchurch terror attack

Posted on March 23, 2019 by particularkev

File 20190317 28479 10a290i.jpg?ixlib=rb 1.1 — Across the world, marches took place during a UN anti-racism day, condemning the attacks on muslims in New Zealand this week.
EPA/Andy Rain, CC BY-SA

Joe Burton, University of Waikato

In the aftermath of the tragic loss of life in Christchurch on Friday, the focus needs to be on supporting those who have lost their loved ones and on fostering a sense of national unity in the face of an heinous act of terrorism.

At this early stage we know the perpetrator of the most devastating terrorist attack in New Zealand’s history was a white supremacist. We know he accessed and stockpiled firearms over a long period of time, and that his racist beliefs motivated his actions.

But there are other lessons and important points to make about the attack. These should shape the longer-term response by the New Zealand government.

1. Muslims the biggest victims of terror across the globe

The first is a more sustained governmental and societal focus on right-wing extremism. It may turn out that the extremist who committed this attack acted alone, but the ideology that motivated him has spread around the globe and is infecting our politics and discourse.

We know right-wing radicals have committed atrocities before. The most notable perhaps was an extremist who killed 77 people in Norway in 2011. But this is part of a long history of extremist violence on the right.

According to research by the Anti-Defamation League, over the last decade, 73.3% of all extremist-related fatalities in the US could be linked to domestic right-wing extremists, while 23.4% were attributable to Islamist extremists. We should pay attention to these statistics in New Zealand. The fear that jihadist terrorism will occur sometime in New Zealand is real, but we haven’t adequately recognised the threat from neofascist ideology.

It is a tragic footnote to this story that globally Muslims have been by far the most victimised group by terrorism in the post-9/11 era. In a 2011 report, the US government’s National Counter-Terrorism Center (NCTC), said:

In cases where the religious affiliation of terrorism casualties could be determined, Muslims suffered between 82% and 97% of terrorism-related fatalities over the past five years.

Clearly, we need to do more to protect Muslim communities from acts of violence and to focus more tightly on the ideology of fascism, which underpins both right-wing groups and those who commit violence in the name of Islam.

In cities across New Zealand and the world, people have gathered at prayer services and vigils to honour victims of the Christchurch mosque terror attack.
(AAP/Jono Searle, CC BY-SA

2. Extremists share a lot in common

A second lesson relates to the process of radicalisation. We need to better understand why people who commit mass murder fall into a set of hateful beliefs. This is clearly a serious social problem caused by many variables, including demographic change, inequality, poverty and lack of education.

The latest research on radicalisation suggests many of those responsible for “lone wolf” acts are socially illiterate and have fallen out of the mainstream of society. They often indicate these beliefs via social media, suggesting we could do more to report these viewpoints to authorities.

Radicals also tend to share a set of psychological or cognitive traits that underpin their actions. According to recent reports by the European Institute for Peace these include grievances that are galvanised by a unifying ideology, a process of cognitive “de-pluralisation”, in which they tend to focus on a very limited set of ideas to interpret the world, and confirmation bias, where events are re-packaged into existing beliefs and assumptions.

Other research shows radicals climb a “staircase” to violent acts involving a series of incremental steps over a period of years. This suggests earlier intervention will be the key to having people back away from violence.

The social and cognitive alienation of young people in contemporary society is a growing problem. Radicalisation expert Scott Atran says:

Violent extremism represents not the resurgence of traditional cultures, but their collapse, as young people unmoored from millennial traditions flail about in search of a social identity that gives personal significance and glory. This is the dark side of globalisation.

3. The dark web is a breeding ground for hatred

A third lesson is that global communications technology is providing a breeding ground for extremism and hatred. In this sense “lone wolves” aren’t acting alone. They are connected to a structured and well-financed global neo-Nazi ideology that uses the internet to propagate its beliefs.

According to a recent report by the Data & Society Research Institute, far-right actors are regularly spreading white supremacist thought, Islamophobia and misogyny on the internet through sites such as 4chan and 8chan.

Right-wing groups have regularly circulated propaganda within social media channels and have sown racial and ethnically charged divisions within society through memes and disinformation. This was a tactic of the far right in the US elections in 2016, and has been used regularly since, including in the Brexit debates.

These websites aren’t easy to take down. As recent efforts by Google show, neo-Nazi sites that are blocked or banned “go dark” behind encrypted platforms that are out of reach of tech companies and security services.

Timothy Snyder, a renowned holocaust historian, notes this form of “mass manipulation” is based on appealing to emotions rather than reason. The spread of fake news and propaganda on the internet creates a perfect platform to increase fear, anger and anxiety. These are the psychological conditions from which acts of violence are committed.

4. New Zealand does have a right-wing problem

The final lesson is a wider, political one for New Zealand. There has undoubtedly been a tendency in some quarters of New Zealand politics to assume we are living in a largely benign international environment. This is part of a troubling isolationist tendency in New Zealand politics that contributes to us not taking security seriously and investing in it accordingly. The Christchurch attacks have shattered these illusions.

The right-wing problem in New Zealand has historical roots. White pride marches have taken place in Christchurch on numerous occasions. A far-right candidate who was convicted of firebombing a marae (Māori meeting place) stood for mayor three times in recent years, most recently in 2013 when he received a small but significant number of votes.

On the international stage we need to stand up against the beliefs that underpin right-wing extremism. Jacinda Ardern’s call to Donald Trump to be compassionate to Muslims was a good start and reminds us racism at the top of society can create a permissive environment for extremism.

We also need to reorient our foreign and security policy towards de-radicalisation processes both domestically and internationally. The UK’s Prevent programme, which has seen a big increase in efforts to prevent right-wing extremism, may be a good model to follow.

New Zealanders now know the fear and chaos that follows terrorism. But the goal of terrorism is to use that fear to undermine our democracy and way of life. So we need to channel our response in a way that protects our values.

We must be aware of the perils of over-reacting, but nevertheless need to redouble our efforts to create multi-level, evidence-led strategies to target radicalism, recognising global and local drivers of extremism.

Joe Burton, Senior Lecturer, New Zealand Institute for Security and Crime Science, University of Waikato

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

Sharing my thoughts with the world from a Particular Baptist perspective

Bungle 1: the wrong pace

Bungle 2: the wrong phasing

Bungle 3: the wrong model

Bungle 4: the wrong messaging

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New Zealand‘s strategy

A new cluster emerged

Iceland’s strategy

Testing for new arrivals

Science, trust and adaptability

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The poor are more vulnerable

Quality of governance laid bare

Bottom-up efforts are vital too

Remaking cities after the pandemic

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Lesson 1: telehealth works

Lesson 2: out-of-hospital care also works

Lesson 3: Australia needs new funding arrangements for general practices

Lesson 4: public and private systems should be more integrated

Lesson 5: there are gaps in Australia’s pandemic preparedness

Lesson 6: the health system needs a stronger supply chain

Lesson 7: Commonwealth and state governments can better coordinate primary care

The new normal can be better than the old

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Communicating widely works

Effective government health messaging helps stem misinformation

How about future health campaigns?

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Keeping people who test positive in hospitals

Consistent, regular communication

Why Singapore isn’t in lockdown

Leadership needs to be organised

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1. Muslims the biggest victims of terror across the globe

2. Extremists share a lot in common

3. The dark web is a breeding ground for hatred

4. New Zealand does have a right-wing problem

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