New drives to counter China come with a major risk: throwing fuel on the Indo-Pacific arms race

Posted on September 28, 2021 by particularkev

Tony Walker, La Trobe UniversityAn accelerating arms race in the Indo-Pacific is all but guaranteed now that China finds itself a target of new security arrangements — AUKUS and the Quad — aimed at containing its power and influence.

This has the makings of a new great game in the region in which rival powers are no longer in the business of pretending things can continue as they are.

The AUKUS agreement, involving Australia, the US and UK to counter China’s rise means a military power balance in the Indo-Pacific will come more sharply into focus.

The region has been re-arming at rates faster than other parts of the world due largely to China’s push to modernise its defence capabilities.

In their latest surveys, the London-based International Institute of Strategic Studies (IISS) and the Stockholm International Peace Research Institute (SIPRI) report no let-up in military spending in the Indo-Pacific. This is despite the pandemic.

SIPRI notes a 47% increase in defence spending in the Indo-Pacific in the past decade, led by China and India.

China can be expected to respond to threats posed by the new security arrangements by further expediting its military program.

It will see the formation of AUKUS as yet another attempt to contain its ambitions — and therefore a challenge to its military capabilities.

The Quad makes clear its ambitions

Unambiguously, AUKUS implies a containment policy.

Likewise, the further elevation of the Quad security grouping into a China containment front will play into an atmosphere of heightened security anxiety in the Indo-Pacific.

The four Quad participants – the US, Japan, India and Australia – have their own reasons and agendas for wanting to push back against China.

Quad leaders in Washington — The Quad leaders unveiled a host of initiatives after their face-to-face meeting last week.
Evan Vucci/AP

After their summit last week in Washington, the Quad leaders used words in their joint statement that might be regarded as unexceptional in isolation.

Together with other developments such as AUKUS, however, the language was pointed, to say the least:

Together, we re-commit to promoting the free, open, rules-based order, rooted in international law and undaunted by coercion, to bolster security in the Indo-Pacific and beyond.

The “beyond” part of the statement was not expanded on, but might be read as a commitment to extend the Quad collaboration globally.

All this has come together at the dawn of a new US administration whose members include several conspicuous China hawks, and at a moment when China has shown itself to be ever-willing to throw its weight around.

Beijing’s crude campaign against Australian exports in an effort to bend Australia’s policy to its will is a prime example. It is doubtful an AUKUS or an invigorated Quad would have emerged without this development.

The Obama administration talked about pivoting to the Asia-Pacific without putting much meat on the bones.

Under President Joe Biden, this shift will be driven by a hardening in American thinking that now recognises time is running out, and may already have expired, in the US ability to constrain China’s rise.

These are profound geopolitical moments whose trajectory is impossible to predict.

Australia commits fully to China containment

Canberra is now a fully paid-up member of a China containment front, whether it wants to admit it, or not. In the process, it has yielded sovereignty to the US by committing itself to an interlocking web of military procurement decisions that includes the acquisition of a nuclear-propelled submarine fleet.

Whether these submarines are supplied by the US or Britain is a bit immaterial since the technology involved originates in America.

The submarines will not be available for the better part of two decades under the most optimistic forecasts. However, in the meantime, Australia could base US or British submarines in its ports or lease American submarines.

Meanwhile, Australia is committing itself to a range of US-supplied hardware aimed at enhancing the inter-operability of its military with the US.

This is the reality of fateful decisions taken by the Morrison government in recent months. Such a commitment involves a certain level of confidence in America remaining a predictable and steadfast superpower, and not one riven by internal disputes.

Australian defence spending likely to rise

What is absolutely certain in all of this is that an Indo-Pacific security environment will now become more, not less, contentious.

SIPRI notes that in 2020, military spending in Asia totalled $US528 billion (A$725 billion), 62% of which was attributable to China and India.

IISS singled out Japan and Australia, in particular, as countries that were increasing defence spending to take account of China. Tokyo, for example, is budgeting for record spending of $US50 billion (A$68 billion) for 2022-23.

Australia’s defence spending stands a tick over 2% of GDP in 2021-22 at A$44.6 billion, with plans for further increases in the forward estimates.

However, those projections will now have to be re-worked given the commitments that have been made under AUKUS.

Neglected in the flush of enthusiasm that accompanied the AUKUS announcement is the likely cost of Australia’s new defence spending under a “China containment policy”. It is hard to see these commitments being realised without significant increases in defence allocations to 3-4% of GDP.

This comes at a time when budgets will already be stretched due to relief spending as a consequence of the pandemic.

In addition to existing weapons acquisitions, Canberra has indicated it will ramp up its purchases of longer-range weapons. This includes Tomahawk cruise missiles for its warships and anti-ship missiles for its fighter aircraft.

At the same time, it will work with the US under the AUKUS arrangement to develop hypersonic missiles that would test even the most sophisticated defence systems.

What other Indo-Pacific nations are doing

Many other Indo-Pacific states can now be expected to review their military acquisition programs with the likelihood of a more combative security environment.

Taiwan, for example, is proposing to spend $US8.69 billion (A$11.9 billion) over the next five years on long-range missiles, and increase its inventory of cruise missiles. It is also adding to its arsenal of heavy artillery.

South Korea is actively adding to its missile capabilities. This includes the testing of a submarine-launched ballistic missile.

Seoul has also hinted it might be considering building its own nuclear-propelled submarines (this was among President Moon Jae-in’s election pledges in 2017). Signs that North Korea may have developed a submarine capable of firing ballistic missiles will be concentrating minds in Seoul.

All this indicates how quickly the strategic environment in the Indo-Pacific is shifting.

Australia — perhaps more so than others — is the prime example of a regional player that has put aside a conventional view of a region in flux. It now sees an environment so threatening that a policy of strategic ambiguity between its custodial partner (the US) and most important trade relationship (China) has been abandoned.

The price tag for this in terms of equipment and likely continuing economic fallout for Australian exporters will not come cheap.

Tony Walker, Vice-chancellor’s fellow, La Trobe University

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

The first Indigenous COVID death reminds us of the outsized risk NSW communities face

Posted on September 8, 2021 by particularkev

The second wave of COVID-19 in New South Wales brings concerns about vaccination rates in Aboriginal and Torres Strait Islander people.
Shutterstock

Kalinda Griffiths, UNSWOn Sunday, New South Wales saw four more deaths from COVID-19. One of them was a man from Dubbo who was in his 50s and unvaccinated. It was the first COVID-19 death of a First Nations person in Australia.

Aboriginal communities in remote areas have been pleading with the government for help with medical resourcing and food for families. It was recently found there were pleas for protection against COVID in Wilcannia, with Aboriginal health organisation Maari Ma Aboriginal Health contacting Ken Wyatt about this back in March last year.

There has been some progress in the nation’s vaccination rates with a little over 32% of the eligible population over the age of 12 now vaccinated. However, the second wave of COVID-19 in New South Wales highlights concerns for the unvaccinated and those with multiple risk factors. This includes Aboriginal and Torres Strait Islander people.

New South Wales is now in day 76 of their most recent outbreak with cases reaching over 20,000.

Aboriginal and Torres Strait Islander people were identified as a priority group early in the vaccine rollout, yet they still have lower vaccination rates than the NSW population.

Almost 12% of Aboriginal and Torres Strait Islander people are fully vaccinated in NSW compared to almost 30% of the non-Indigenous population.

Aboriginal and Torres Strait Islander people at risk

It’s well known Aboriginal and Torres Strait Islander people experience higher rates of disease than non-Indigenous people. Aboriginal and Torres Strait Islander people in New South Wales experience two or more health conditions at a rate that is over two and half times greater than non-Indigenous people.

In addition, there is increased risk of spread in families, as larger family groups often live together in regional and remote communities.

These risks, along with extreme yet ignored service gaps in regional and remote areas, mean our Indigenous community is facing severe risk of death and disease from the COVID-19 pandemic.

Children and young people under the age of 20 account for a little over 20% of Australia’s case numbers, with all children aged 12 to 15 now recommended to get the Pfizer vaccine.

Pre-existing conditions such as asthma, gastrointestinal disease, diabetes/prediabetes, as well as children who are immunocompromised and preterm, have been found to be predictors of severe COVID-19 disease.

This is of great concern to Aboriginal communities, considering Aboriginal children are up to two times more likely to be hospitalised for respiratory conditions than non-Indigenous children.

We need better data

The gaps in COVID-19 publicly available data are concerning, especially data specific to Aboriginal and Torres Strait Islander peoples.

There is currently no information on vaccination rates for children over the age of 12 in out-of-home care. In 2018 there were 45,800 children in out-of-home care. About 40% of these children are Aboriginal and Torres Strait Islander.

There is also little to no data available on the number of Aboriginal and Torres Strait Islander people tested for COVID, as well as issues with the accuracy of Indigenous status in the reporting of the case numbers.

Despite the daily high case numbers, this week the New South Wales government announced restrictions in the state will be relaxed across selected local government areas for those people who are fully vaccinated.

While the risk for those people who are vaccinated is relatively low, greater activity could still increase the spread of COVID-19 across the state, putting people in Aboriginal communities at greater risk.

Knowing exactly who is vaccinated and who is at greatest risk will be of the utmost importance as restrictions start to ease.

How the public can help

The increasing case numbers and resultant lockdowns across NSW local government areas have seen Aboriginal communities having limited access to health care and basic necessities due to limitations in the supply of regional and remote supermarkets. A number of First Nations people have rallied together to support their communities.

This has included pages that have been set up for:

emergency food packs across western NSW
support for Wilcannia community
fresh fruit and veggies in Wilcannia
a volunteer group to assist in coordinating water and food support in Wilcannia nd provides opportunities for people to volunteer.
an interstate fundraiser from Lullas Children and Family Centre to supply Aboriginal kids with educational toys, games and other items

People can donate or contact the volunteer group to get involved.

Where to next?

As the Delta variant makes its way across Australia, all people need access to vaccines. This means increasing government resources and health system efforts in Aboriginal and Torres Strait Islander communities as well as ensuring all Indigenous people have multiple access points to the vaccines.

This could include door-to-door vaccinations in Aboriginal and Torres Strait Islander communities, pop-up vaccination clinics in regional and remote local government areas as well as school-based vaccinations.

With the expected mRNA vaccine supplies to be sufficient for the entire Australian population in the coming months, the biggest next step is ensuring their distribution is prioritised to those who need it the most.

This requires moving beyond the rhetoric and supporting health services, particularly Aboriginal Community Controlled Organisations, to do the work.

Kalinda Griffiths, Scientia lecturer, UNSW

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

Calling out China for cyberattacks is risky — but a lawless digital world is even riskier

Posted on July 25, 2021 by particularkev

Alexander Gillespie, University of WaikatoToday’s multi-country condemnation of cyber-attacks by Chinese state-sponsored agencies was a sign of increasing frustration at recent behaviour. But it also masks the real problem — international law isn’t strong or coherent enough to deal with this growing threat.

The coordinated announcement by several countries, including the US, UK, Australia and New Zealand, echoes the most recent threat assessment from the US intelligence community: cyber threats from nation states and their surrogates will remain acute for the foreseeable future.

Joining the chorus against China may be diplomatically risky for New Zealand and others, and China has already described the claims as “groundless and irresponsible”. But there is no doubt the problem is real.

The latest report from New Zealand’s Government Communications Security Bureau (GCSB) recorded 353 cyber security incidents in the 12 months to the middle of 2020, compared with 339 incidents in the previous year.

Given the focus is on potentially high-impact events targeting organisations of national significance, this is likely only a small proportion of the total. But the GCSB estimated state-sponsored attacks accounted for up to 30% of incidents recorded in 2019-20.

Since that report, more serious incidents have occurred, including attacks on the stock-exchange and Waikato hospital. The attacks are becoming more sophisticated and inflicting greater damage.

Globally, there are warnings that a major cyberattack could be as deadly as a weapon of mass destruction. The need to de-escalate is urgent.

Global solutions missing

New Zealand would be relatively well-prepared to cope with domestic incidents using criminal, privacy and even harmful digital communications laws. But most cybercrime originates overseas, and global solutions don’t really exist.

In theory, the attacks can be divided into two types — those by criminals and those by foreign governments. In reality, the line between the two is blurred.

Dealing with foreign criminals is slightly easier than combating attacks by other governments, and Prime Minister Jacinda Ardern has recognised the need for a global effort to fight this kind of cybercrime.

To that end, the government recently announced New Zealand was joining the Council of Europe’s Convention on Cybercrime, a global regime signed by 66 countries based on shared basic legal standards, mutual assistance and extradition rules.

Unfortunately, some of the countries most often suspected of allowing international cybercrime to be committed from within their borders have not signed, meaning they are not bound by its obligations.

That includes Russia, China and North Korea. Along with several other countries not known for their tolerance of an open, free and secure internet, they are trying to create an alternative international cybercrime regime, now entering a drafting process through the United Nations.

Cyberattacks as acts of war

Dealing with attacks by other governments (as opposed to criminals) is even harder.

Only broad principles exist, including that countries refrain from the threat or use of force against the territorial integrity or political independence of any state, and that they should behave in a friendly way towards one another. If one is attacked, it has an inherent right of self-defence.

Malicious state-sponsored cyber activity involving espionage, ransoms or breaches of privacy might qualify as unfriendly and in bad faith, but they are not acts of war.

However, cyberattacks directed by other governments could amount to acts of war if they cause death, serious injury or significant damage to the targeted state. Cyberattacks that meddle in foreign elections may, depending on their impact, dangerously undermine peace.

And yet, despite these extreme risks, there is no international convention governing state-based cyberattacks in the ways the Geneva Conventions cover the rules of warfare or arms control conventions limit weapons of mass destruction.

Vladimir Putin shaking hands with Joe Biden — Drawing a red line on cybercrime: US President Joe Biden meets Russian President Vladimir Putin in Geneva in June.
GettyImages

Risks of retaliation

The latest condemnation of Chinese-linked cyberattacks notwithstanding, the problem is not going away.

At their recent meeting in Geneva, US President Joe Biden told his Russian counterpart, Vladimir Putin, the US would retaliate against any attacks on its critical infrastructure. A new US agency aimed at countering ransomware attacks would respond in “unseen and seen ways”, according to the administration.

Such responses would be legal under international law if there were no alternative means of resolution or reparation, and could be argued to be necessary and proportionate.

Also, the response can be unilateral or collective, meaning the US might call on its friends and allies to help. New Zealand has said it is open to the proposition that victim states can, in limited circumstances, request assistance from other states to apply proportionate countermeasures against someone acting in breach of international law.

A drift towards lawlessness

But only a month after Biden drew his red line with Putin, another massive ransomware attack crippled hundreds of service providers across 17 countries, including New Zealand schools and kindergartens.

The Russian-affiliated ransomware group REvil that was probably behind the attacks mysteriously disappeared from the internet a few weeks later.

Things are moving fast and none of it is very reassuring. In an interconnected world facing a growing threat from cyberattacks, we appear to be drifting away from order, stability and safety and towards the darkness of increasing lawlessness.

The coordinated condemnation of China by New Zealand and others has considerably upped the ante. All parties should now be seeking a rules-based international solution or the risk will only grow.

Alexander Gillespie, Professor of Law, University of Waikato

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

Could Britain be sued for reopening and putting the world at risk from new COVID variants?

Posted on July 25, 2021 by particularkev

Kris Gledhill, Auckland University of TechnologyWith most COVID-19 restrictions now lifted in England, the world is watching to see what this so-called “freedom day” will bring.

Some scepticism is warranted, given Britain’s approach throughout the pandemic has hardly been a success. By July 19, there had been 128,985 deaths from COVID-19, and the death rate per million of population was just under 1,900.

True, there are countries with worse rates, including Hungary, Italy and the Czech Republic in Europe. But countries that have taken a different approach have vastly better figures: for example, 35.8 deaths per million of population in Australia, and 5.39 in New Zealand.

No doubt Boris Johnson’s government took its emphatic 2019 election victory and relatively successful vaccination program as a mandate for opening up.

But the current situation doesn’t support such optimism. Infection rates are now the worst in Europe and the death rate is climbing. By contrast, Australia has much lower death and infection rates but state authorities have responded with lockdowns.

Furthermore, many scientists have condemned the opening-up policy. The authors of the John Snow Memorandum stress the risks to the 17 million people in the UK who have not been vaccinated, and state:

[This approach] provides fertile ground for the emergence of vaccine-resistant variants. This would place all at risk, including those already vaccinated, within the UK and globally.

Taking the UK to court

Is it enough to hope Boris de Pfeffel Johnson will not just dismiss these concerns as piffle? Perhaps there is an alternative — taking the UK to court. Specifically, to the international courts that deal with matters of human rights.

For countries in the Council of Europe, this would be the European Court of Human Rights. Globally, there is the option of the Human Rights Committee of the United Nations.

How would this work? A court claim requires what lawyers call a “cause of action” — in this case, a breach of human rights, including the right to life and the right not to be subject to inhuman and degrading treatment.

In the main international human rights treaty, the International Covenant on Civil and Political Rights (ICCPR), article 6 requires that the right to life, which belongs to everyone, must be protected. Article 2 of the European Convention on Human Rights (ECHR) says the same.

In 2019, the UN Human Rights Committee noted this right to life amounts to an “entitlement […] to be free from acts and omissions that are intended or may be expected to cause their unnatural or premature death”.

It also noted the obligation on states to take steps to counter life-threatening diseases.

A duty to protect

European Court of Human Rights case law establishes that the duty to protect life includes a requirement on states to take reasonable steps if they know (or ought to know) there is a real and immediate risk to life.

This has usually involved the criminal actions of dangerous people, but there is no reason it should not cover government policy that rests on an acceptance that people will die.

After all, the entire human rights framework was put in place to limit states from breaching rights.

This duty to protect applies not just to deaths. Both the ICCPR and the ECHR have absolute prohibitions on inhuman and degrading treatment. For many people, the severity of COVID-19, including the consequences of long COVID, meet this standard.

If government policy can mitigate such consequences, human rights standards mandate that it should.

In short, this is not just a matter of the right to health. Because the UK will likely allow the virus to spread from its shores, the rest of the world is at risk and therefore has an interest here. So can other countries take action?

A political calculation

Human rights conventions are treaties — promises by states to each other as to how they will act. Article 33 of the ECHR is very clear: states can ask the European Court of Human Rights to adjudicate whether another state is breaching rights. There are many instances of this happening.

Importantly, the court can issue “interim measures” under its procedural rules to preserve the status quo while it hears a case.

The UN Human Rights Committee may also consider state-to-state complaints under article 41 of the ICCPR if a state has agreed to this — and the UK has made the relevant declaration.

Of course, any decision by a state to take another to court is political. But this pandemic is not just a health issue, it is also a matter of life and death. Protecting life should be a political priority precisely because it is such a fundamental right.

Politicians willing to stand up for human rights should use the tools that exist to achieve that aim.

Kris Gledhill, Professor of Law, Auckland University of Technology

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

The benefits of a COVID vaccine far outweigh the small risk of treatable heart inflammation

Posted on July 24, 2021 by particularkev

Jonathan Noonan, Baker Heart and Diabetes Institute and Karlheinz Peter, Baker Heart and Diabetes InstituteRepeated COVID-19 outbreaks in Australia have once again highlighted the need for rapid and widespread vaccination. We are extremely fortunate the global scientific community has been able to develop a handful of highly effective vaccines in such a short time.

As with any vaccine or medicine, the COVID vaccines do carry small risks. The rare blood clotting disorder caused by the AstraZeneca vaccine — thrombosis with thrombocytopenia syndrome, or TTS — has largely dominated the headlines.

But we’re also seeing reports of a potentially increased risk of myocarditis and pericarditis (heart inflammation) following the mRNA COVID-19 vaccines, developed by Pfizer/BioNTech and Moderna.

Here’s why this shouldn’t be cause for concern.

First, what are myocarditis and pericarditis?

There are three main types of heart inflammation: endocarditis, myocarditis, and pericarditis. These involve inflammation of the inner lining of the heart, the heart muscle, and the outer lining of the heart respectively.

Viruses, including the SARS-CoV-2 virus that causes COVID-19, are the most common cause of myocarditis and pericarditis. Essentially, the inflammation the immune system generates to combat infections can inadvertently lead to inflammation of the heart.

In the very rare cases of myocarditis and pericarditis observed after vaccination with a COVID mRNA shot, it’s possible a similar thing might be happening. That is, the vaccine causes the immune system to generate some level of inflammation so it’s prepared to mount a response against SARS-CoV-2, and this inflammation is partially misdirected to the heart.

But the risk is very small, and the conditions are treatable.

A heart diagram with an inflamed pericardium (pericarditis) next to a heart with inflammation showing myocarditis. — Shutterstock

What’s the risk?

The exact incidence of myocarditis and pericarditis following vaccination is still being defined, and it remains to be proven that mRNA vaccines are truly the cause of these conditions — although it seems likely.

In Australia, of roughly 3.7 million doses of the Pfizer vaccine administered up to July 11, the Therapeutic Goods Administration (TGA) reports there have been 50 cases of suspected myocarditis or pericarditis. This suggests a risk of one per 74,000 vaccines. The TGA notes most people who developed these conditions have recovered or are recovering.

However, given the relatively small number of vaccinations administered in Australia, it’s important to consider more complete data from countries with higher vaccination rates.

The United States’ Centres for Disease Control and Prevention (CDC) had received 1,226 reports of myocarditis following 296 million doses of mRNA vaccines administered up to June 11. This equates to a risk of roughly one in 240,000 doses. These cases were mostly in young men and predominantly occurred after the second dose.

Independently from vaccines, myocarditis occurs in roughly 23 per 100,000 people worldwide per year (we don’t have reliable figures for pericarditis). This shows us there’s a much lower risk from vaccination than exists in the population generally.

Symptoms to look out for

Normal side effects of COVID-19 vaccines include headache, fever, chills, muscle or joint pain, fatigue and nausea.

In contrast, chest pain, irregular heartbeat, heart palpitations, shortness of breath and light-headedness could indicate myocarditis or pericarditis. Symptoms of these conditions have generally occurred within seven days of vaccination. Anyone who experiences these symptoms should seek medical attention.

In most cases, myocarditis and pericarditis can be successfully treated with anti-inflammatory drugs, such as aspirin and corticosteroids.

In Israel, 95% of cases recently investigated were classified as mild. Similarly, the CDC has reported most patients in the US have recovered quickly.

While this very small risk of heart inflammation following vaccination may be alarming, it’s crucial to understand the risk of heart damage following severe COVID-19 is far greater.

COVID-19 and heart damage

Damage of the heart muscle is a common consequence of coronavirus. Research shows it occurs in up to 28% of patients hospitalised with COVID-19.

Importantly, the risk of death is markedly higher in COVID-19 patients who sustain heart muscle damage. While we need further research to understand precisely how COVID-19 damages the heart, myocarditis and pericarditis are major causes of the heart damage found in COVID-19 patients.

The benefit outweighs the risk

The recent limits applied to the use of the AstraZeneca vaccine in younger age groups suggests the relatively low risk of COVID-19 in Australia justifies being highly selective over vaccine use.

But while Australia has done incredibly well at containing COVID-19, the risk of transmission here remains high given the global COVID-19 situation. We’re seeing this daily as we contend with outbreaks and lockdowns around the country.

Myocarditis and pericarditis are potentially associated with the mRNA vaccines, but these complications are extremely rare, most often mild, and seem to be treatable.

As has been the consistent message from the medical and scientific communities throughout this pandemic, the benefit of COVID-19 vaccines significantly outweighs the risk of rare side effects. This is particularly true for the highly effective mRNA-based vaccines as COVID-19 continues to spread around the world.

Jonathan Noonan, Research Officer, Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute and Karlheinz Peter, Interventional Cardiologist, Alfred Hospital; Professor of Medicine and Immunology, Monash University; Professor and Head, Department of Cardiometabolic Health, University of Melbourne; Lab Head, Atherothrombosis and Vascular Biology and Deputy Director, Baker Heart and Diabetes Institute

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

Concerned about the latest AstraZeneca news? These 3 graphics help you make sense of the risk

Posted on June 25, 2021 by particularkev

Hassan Vally, La Trobe UniversityYesterday’s announcement the AstraZeneca COVID vaccine would now only be recommended for the over 60s has highlighted the many ways we think about risk.

The decision reflects a greater understanding of the real, but extremely low, risk of the clotting disorder called thrombosis with thrombocytopenia (TTS) for people aged 50-59, who are now recommended to have the Pfizer vaccine.

But errors in the way we perceive these extremely small risks, called cognitive biases, reflect the fact that when our brains evolved we did not have to grapple with risks this small. So we struggle to make sense of them and perceive these events as being much more likely than they actually are.

This can lead us to make decisions, such as not having a vaccine that could potentially save our life. And the misperception of the likelihood of TTS is one of the main reasons many are hesitant about receiving the AstraZeneca vaccine.

So let’s start with what we know about the risk of dying from TTS associated with the AstraZeneca vaccine, expressed the traditional way, with words and numbers. Then we’ll present the same numbers graphically.

What’s the risk of dying from TTS?

Initially, we thought about 25% of people with TTS associated with the vaccine would die. But as we learnt more about how to recognise and treat these rare blood clots, the risk of dying from it has changed. In Australia, mortality is now down to around 4%.

This is a low risk of dying from a syndrome with a small likelihood of occurring. So we can express TTS risk in another way.

Two people in Australia have died from TTS after 3.8 million doses of the AstraZeneca vaccine delivered. This makes the likelihood of dying from this syndrome about 0.5 in a million, or if you prefer whole numbers, about 1 in 2 million.

And now, with graphics

Here’s one way of representing 1 in 2 million visually. This figure shows just how small this risk is. Are you ready for some scrolling?

As you can see, the risk of TTS is so small it is almost too small to communicate effectively in this format.

Perhaps even more visually powerful is to compare the risk of dying from TTS to other risks we face in our lives, using a risk scale. This allows you to compare a range of risks and put them into perspective.

As the risk of TTS is a one-off risk normally associated with the first dose of the AstraZeneca vaccine, one interesting comparison is with other one-off risks, such as adventure sports.

As you can see, the risk of dying from TTS is far lower than many activities some of us get up to at the weekend.

But not all of us spend our weekends scuba diving or rock climbing. So let’s look at the more common risks we take in our everyday lives but do not pay much attention to.

This is not a perfect comparison, as the risks are averaged across the whole population, across the entire year. But it’s useful nevertheless.

So the risk of dying from TTS after the first dose of the AstraZeneca vaccine is similar to the risk of being killed by lightning in a year in Australia. And this pales in comparison when compared to other risks, such as the risk of dying in a car accident.

So what happens next?

One of the challenges for public health has always been putting the risks and benefits of our health choices into perspective. This task is even harder when the risks involved are so small.

Using visualisations like these is one way to effectively communicate just how small the risk of TTS is and also put this risk into perspective by comparing it to other risks we incur in our lives.

When you fully appreciate how small the risk of TTS is, the decision to have the AstraZeneca vaccine to protect yourself and others becomes a much easier one to make.

Hassan Vally, Associate Professor, La Trobe University

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

Home quarantine for vaccinated returned travellers is extremely low risk, and won’t damage their mental health

Posted on June 24, 2021 by particularkev

Gregory Dore, UNSWMany thousands of people need to return to Australia, and many at home wish to reunite with partners and family abroad.

A move away from a one-size-fits-all approach to quarantine is a way to make this happen — including home quarantine for vaccinated returnees.

The federal government implemented home quarantine over a short period in March 2020, before switching to mandatory hotel quarantine for returned residents and other incoming passengers.

But the considerably changed circumstances — most importantly, access to effective vaccines — calls for its reintroduction despite caution among politicians and the community.

The low rate of positive cases, and proven effectiveness of further safeguards to limit breaches, make home quarantine a persuasive strategy.

It’s worth remembering people who contract COVID, and their contacts, have successfully self-isolated at home since the pandemic began.

How will we make sure it’s safe?

There are several protective layers which would ensure extremely limited risk of home quarantine for fully vaccinated returned overseas travellers.

The first is requiring a negative COVID test within three days of departure, which is currently a requirement for all returnees.

The second is COVID vaccination. Recent studies indicate full vaccination provides 60-90% infection risk reduction. In cases where fully vaccinated people do get infected, these “breakthrough cases” are less infectious.

It’s also important to test returnees in home quarantine. A positive case would trigger testing of any contacts and may extend self-isolation.

Also, high levels of testing in the broader community can ensure early detection of outbreaks, enabling a rapid public health response to limit spread, if it did leak out of home quarantine.

The risk would be extremely low

Data from hotel quarantine in New South Wales, which takes around half of returned travellers in Australia, suggests home quarantine for fully vaccinated returnees would likely present an extremely low risk.

In 2021, NSW has screened around 4,700 returnees a week, with the proportion of positive cases detected during quarantine averaging around 0.6%.

From March 1, since vaccination has become more accessible, only eight of 406 positive cases were fully vaccinated.

Unfortunately we don’t have the overall data on how many returnees were fully vaccinated, but even if only 10-20%, this would equate to a positive rate of around 6-12 per 10,000 among the vaccinated. This is considerably lower than the overall rate of 66 COVID cases per 10,000 since March 1.

If home quarantine was initially restricted to fully vaccinated returnees from countries with low to moderate caseloads, the rate would be lower again, probably less than five per 10,000.

If NSW increased their quarantine intake by taking an extra 2,500 per week from this population into home quarantine, it would equate to maybe a few positive cases per month, compared to around 120 cases per month in hotel quarantine. As vaccination uptake increases, this capacity could be expanded, with reduced hotel quarantine requirements.

Will people comply?

The enormous desire for stranded Australian residents, overseas partners and family of residents in Australia to return and reunite should ensure a high level of compliance with home quarantine.

Home quarantine has been successfully implemented in other countries with elimination strategies such as Taiwan and Singapore. Taiwan’s system was deployed rapidly and has 99.7% compliance. Singapore uses a grading system to enable lower-risk returnee residents to do seven days in home quarantine, with a negative test required for release on day seven.

Two major reviews of the hotel quarantine system — the Victorian government-commissioned Coate report, and the national review of hotel quarantine — recommended implementing home quarantine with monitoring technology, such as electronic bracelets. Their recommendations were made prior to the approval of vaccines.

Recent data suggests the current hotel quarantine system has harmful effects. Research published in the Medical Journal of Australia in April found mental health issues were responsible for 19% of all emergency department presentations among people in NSW hotel quarantine. It’s highly likely home quarantine would be more beneficial for the mental health of returnees.

What are the barriers?

Issues which would need to be sorted through include:

methods for determining how risky different countries are
how returnees can prove they’ve been vaccinated
how we would test returnees and home-based contacts, and how frequently
and how long home quarantine would be for.

But none of these are insurmountable, and small-scale home quarantine already exists in the ACT.

Health authorities could ensure returnees can collect their own COVID testing samples, for example by doing nasal swabs or collecting saliva themselves. This would reduce contact with health workers.

Home quarantine is undoubtedly being considered by major Australian COVID policy committees, along with other measures to enable a larger number of returnees and to increase the safety of the quarantine system.

Australians’ excessive caution continues to have direct consequences for the well-being of many thousands of stranded Australian residents, together with non-resident partners and family members desperate to return.

It’s time to change this situation and make their human rights a public health priority.

The author would like to thank John Kaldor, Esther Rockett, and Liz Hicks for their input.

Gregory Dore, Scientia Professor, Kirby Institute; Infectious Diseases Physician, St Vincent’s Hospital, Sydney, UNSW

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

COVID is surging in unvaccinated Taiwan. Australia should take heed

Posted on May 24, 2021 by particularkev

Maximilian de Courten, Victoria UniversityAlarm bells rang internationally last week when Taiwan announced it was moving to its second highest COVID alert level after a recent surge of cases.

The country last year recorded zero cases of community transmission for eight straight months.

The recent increase in cases has led many people to wonder: what happened to Taiwan’s COVID success story?

One part of the answer is a very slow vaccine rollout. Australia should take heed.

How serious is Taiwan’s current outbreak?

On May 9, Taiwan recorded zero new community cases of COVID-19 (there was one imported case in quarantine). But only five days later, new local cases had risen exponentially to 29, and then to a peak of 333 on May 17. And on Saturday, the country’s health department retrospectively added an extra 400 cases to the previous week which were not included in earlier reports.

Although these numbers are still very low in comparison to many other countries, the fact that these new cases were spread across many cities and counties alarmed health officials. Previously, when Taiwan had its first peak — in March 2020 with 27 new cases — almost all cases were from overseas and were successfully isolated. Now the opposite is happening, with almost all new cases spreading in the community.

The current alert level three mandates wearing masks outside the home and limits people gatherings to five indoors and ten outdoors. This falls short of establishing a lockdown.

Taiwan is also temporarily barring any non-residents and transit travellers from entering the country. And there are restrictions on attending public venues, as well as sporting, entertainment and recreational events.

Level four, the highest level of the country’s restrictions would include the country’s first mass lockdown. This would only be triggered after 14 consecutive days of more than 100 cases, with 50% or more being of unknown origin.

Taiwan’s recent COVID surge

Data up to May 21, 2021.
Our World in Data, CC BY

What went wrong?

Until now, Taiwan was able to prevent the virus from spreading in the community, and contain it to a few imported cases, by its extensive public health infrastructure. This includes quarantine in a government facility or at home for incoming travellers, and quarantine of close contacts of positive cases. This infrastructure was established before COVID and enabled the country to respond quickly and in a coordinated manner to it.

Taiwan’s effective methods for isolation and quarantine were aided by using digital technologies for identifying potential cases, and widespread use of face masks.

This previous COVID success might have led to the government to focus on other priorities rather than investing in resources for mass COVID testing. Indeed, in Taiwan it hasn’t been seen as cost-effective to roll out mass testing without many (or any) cases.

Now, Taiwan has ramped up its testing capacity over the past week as much as possible, but still falls short in comparison to Australia, which conducts far more tests per 1,000 population.

Taiwan’s success also may have led to its people having less of an urgency to get vaccinated.

Where does Taiwan stand on COVID vaccinations?

Only about 1% of the population was vaccinated against COVID when this outbreak started.

Taiwan’s government invested early in developing a local vaccine, which has yet to come to market. This could be one explanation for why Taiwan came late to ordering vaccines from international suppliers, and is still awaiting further shipments from overseas.

Only last week did a second shipment of the AstraZeneca vaccine arrive in Taiwan through the global COVAX facility. However, this contained only 410,400 vaccine doses. Taiwan’s population is 23 million.

This is a warning sign for Australia

Whatever the reasons for the slow rollout of vaccines so far, for the time being and months to come, neither Taiwan nor Australia are even close to herd immunity against COVID.

Testing, tracing and isolation are still going to be important long into the future for both countries.

In saying that, even countries with the highest per capita vaccine rollout can suffer a new wave of the virus, for example Seychelles.

There may be outbreaks in places where not enough people have been vaccinated to achieve herd immunity, or where variants of the coronavirus are resulting in less protection in those vaccinated against the original strain.

Nevertheless, short of attempting to eliminate the virus by strict isolation (not only of cases but of the whole population from abroad) and severe quarantine or lockdown measures, getting everyone vaccinated as soon as possible is the best approach to a lasting COVID-free world.

Taiwan’s COVID surge demonstrates this virus has the capacity to break through isolation and quarantine barriers at any time, in any country. Many countries need to be better prepared.

The current situation in Taiwan should be a warning to other countries that you can’t let your guard down anywhere yet.

Maximilian de Courten, Professor in Global Public Health and Director of the Mitchell Institute, Victoria University

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

What’s the risk if Australia opens its international borders? An epidemiologist explains

Posted on April 20, 2021 by particularkev

Tony Blakely, The University of MelbourneCoinciding with the Trans-Tasman travel bubble starting today, over the past week there have been murmurings Australia could soon relax its borders further, through mechanisms such as home quarantine or letting in vaccinated people.

But what are the risks?

Here I propose three things we must consider:

the prevalence of the virus in the country from where travellers are coming, including the strain of virus
measures taken for the people travelling, including home quarantine and whether travellers are vaccinated
the percentage of our population who are immune.

Importantly, all these factors matter. It’s not simply a case of needing to ensure all travellers are vaccinated.

The level of infection in the country of origin matters enormously

At around Christmas time, roughly 2% of the UK population was infected. That percentage is now considerably less, but it’s still likely around 1,000 times higher or more than the risk in China and other East Asian countries. The risk is near zero for New Zealand, Taiwan and many Pacific countries.

However, things will change. At the moment the United States seems to be maintaining high infection rates while also rapidly vaccinating the population. This is probably because of more transmissible variants, and society loosening up, offsetting gains from more people being immune. But at some point, perhaps around mid-year, the infection rate in the US should plummet as the percentage of people immune increases to somewhere around 60-80%. All this is to say we can expect infection rates in countries to vary a lot in the next six to 12 months.

Let’s work through an example of the United Kingdom. Assume the UK has another surge of infections such that 0.5% of British people are infected and unaware of it, and could jump on a plane to Australia. Let’s assume we decide to let 10,000 Brits come to Australia each month. So 0.5% of 10,000 would mean roughly 50 infected people arriving per month.

Mitigating the risk of travellers

Of course, we would do more to reduce the risk. We could test people before they get on the plane and when they arrive. Let’s assume that weeds out another 50%, as the other half may be still incubating and not yet testing positive. That’s 25 COVID-positive British people arriving per month.

Next, let’s assume we require all travellers to be vaccinated. That will reduce their risk of unwittingly carrying the virus (through either symptomatic or asymptomatic infection) by between 66% for the UK variant and 81% for “normal” virus for the AstraZeneca vaccine. Data are still sketchy on any infection for Pfizer, but it’s likely 90% or more, given 95% protection against symptomatic disease in Pfizer’s clinical trial. If we assume 80%, we are now down to five infected Brits arriving here per month.

Importantly, the vaccine also reduces both the duration of the disease and its infectiousness, for vaccinated people unlucky enough to get infected. We don’t know by how much as the real-world evidence is still accruing, although animal data on peak viral load and duration of likely infective viral load supports this contention.

If we assume (conservatively in my view) that there is a 50% reduction in duration and 50% reduction in peak infectivity for hapless vaccinated people who still get infected, that is 25% of the risk of passing it on (that is, 50% of 50%).

Therefore, if an unvaccinated person, infected with the UK variant, was going to infect an average of 3.5 people in the absence of any social measures such as mask-wearing, the infected-after-vaccination person would only infect 0.875 other people – a 75% reduction in the reproductive rate. So our remaining five infected Brits are less infectious.

Intensity of quarantine measures for arrivals

Let’s consider the option of home quarantine. We don’t know how effective this will be, because of potential compliance issues.

But the risk of home quarantine breaches can be reduced by technology like ankle bracelets, GPS tracking on travellers’ phones to ensure they stay home, and only allowing home quarantine if any other members of the household are also vaccinated, to give an extra layer of protection.

Let’s assume home quarantine with these extra measures stops 80% of infected people getting out and about in Australia while infectious.

So we are now down to one infected British person who has slipped through per month. But given they are also vaccinated, they’re less likely to pass on the infection. And this risk can be reduced further still by ensuring they’re wearing a mask – although if they “breached” home quarantine rules they may not be likely to wear a mask.

It’s important to remember even “proper” quarantine isn’t foolproof. About one in 250 infected people last year in hotel quarantine caused a leakage.

Is Australia a tinderbox?

Yes. Perhaps only 5% of us are immune. Even if, via the above measures, we get just one infected person a month in Australia – the situation could blow up. Keep in mind the above example assumes we’re only allowing travellers from one country too. More countries means more travellers means more risk – although as above, the risk varies based on the infection rate in the origin country.

You can play with various scenarios in our COVID-19 Pandemic Trade-offs tool, launched two weeks ago. What you’ll find is that until most adults in Australia are vaccinated, any loosening up of how we respond to the virus incursion is unwise. If contact tracing cannot mop up the inevitable incursions, we’ll still need to use social restrictions, including lockdowns, until the vaccination rollout is complete.

But we can probably think about inching forward to some increased risk once all over-50s are vaccinated (phase 2A), with some modest relaxation of the border. Yet we can never totally escape the risk of outbreaks.

So what can we do now with borders?

First, continue with the Trans-Tasman bubble.

Second, remove or greatly reduce quarantine for vaccinated travellers from many East Asian countries, which present a low risk to Australia. As an example, the average number of known active infectious people in China at any point in time recently is about 250. Let’s assume this equates to about 100 unknown infections at any point in time (that is, people who are not yet symptomatic or detected). For a population of 1.4 billion, that’s a 0.000007% risk of any person in China being infected.

This suggests that for 10,000 vaccinated arrivals from China per month with modified quarantine, the expected number of infected people unwittingly getting out into the Australian population per month is 0.000014. Or, put another way, our above UK example presents 70,000 times the risk of an arrival from China. Given such low risk, it’s hard to justify why university students from China cannot start in time for semester two this year if they’re vaccinated and going into some form of modified quarantine.

Third, we need a national framework to assess the risk. Focusing on one measure alone isn’t wise — you have to look at the whole system. Such a framework can be developed now, at the same time as setting our risk thresholds so policy-makers, airlines and other industries can start planning.

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.

Doctors do not face a greater legal risk if they give AstraZeneca to younger Australians — here’s why

Posted on April 16, 2021 by particularkev

Cameron Stewart, University of SydneyLast week, the federal government changed its recommendation for COVID-19 vaccines. The Pfizer vaccine is now the “preferred” jab for adults under 50.

Amid the political fallout and worries about what it means for Australia’s COVID recovery, doctors have expressed concern about their liability. Some said they would even stop giving the AstraZeneca jab until they were more certain of their position.

Are they at greater legal risk if they give AstraZeneca to younger Australians? The government insists they are not. This is correct — here’s why.

Proving fault

In Australia, medical liability is, for the most part, fault-based. This means patients who are injured by medicines, medical devices and medical interventions must prove the doctors who used them were to blame for any injury they suffered before any compensation will be paid.

Australian liability laws are state-based, but generally speaking, fault can only be proven when the doctor has acted outside of the professional standard of care in a way that is not supported widely in Australia by professional peers.

What is the standard of care?

The standard of care for diagnosis and treatment is effectively set by the medical profession. In cases — such as COVID vaccines — where the treatment is new and knowledge about the treatment is emerging, the standard of care is also developing.

Importantly, doctors are judged by measuring their behaviour against the standard of care at the time the treatment was given. This means that if, in 2020 a doctor administers a COVID vaccine in a way that was supported by their peers at that time, they will not be found to have breached the standard of care if, years later, other side effects become known.

Prime Minister Scott Morrison inspecting AstraZeneca production. — Last week the Morrison government changed its advice around the AstraZeneca vaccine.
David Caird/AAP

We should also be careful not to automatically equate the government’s advice concerning the AstraZeneca vaccine with what the standard of care should be at the individual level.

The government’s advice is concerned with the big picture and with risks across a population. Doctors have the task of treating individuals. So, the government’s advice should be considered by doctors when working out which vaccines to offer to patients, but there may well be situations where the AstraZeneca is the best option for individual adult patients under 50.

Giving advice and accepting risks

Doctors also have a duty to inform individual patients about material risks of the treatments they provide. Every intervention comes with a set of risks but only the material ones need to be disclosed.

Material risks include those the profession would usually notify patients of (objective material risks), as well as risks the individual patient may have a particular concern about (subjective material risks).

The classic example of this is the 1993 case of Rogers v Whitaker where a woman who was blind in one eye was considering cosmetic surgery on that eye. She was concerned about any risk (no matter how remote) of going blind in her “good eye”. Later, she became blind from a complication of her treatment, which was known but very rare. The doctor’s failure to inform her was considered a breach of the duty to inform — even though it was not a risk normally disclosed — because the risk was subjectively material to her.

Again, the doctor will always be judged by what the profession knew at the time regarding these risks. If a patient is told about the material risks of the treatment and decides to go ahead with the treatment, the doctor has satisfied their legal duty to advise and cannot be held liable for subsequent injuries.

What now for GPs and AstraZeneca?

As long as doctors consider the government advice, keep up with professional news about best practice and communicate material risks to patients, they face no greater liability for providing COVID vaccines than they do for any other treatment.

The reality is the risks of people being injured by vaccines, and of doctors being sued for vaccine-related injury, is incredibly low.

At the weekend, the Australian Medical Association also said if a patient makes an informed decision to receive the AstraZeneca vaccine, GPs are protected under professional indemnity insurance.

Of course, the reality of low risk may not match the fear practitioners experience. So, are there things we can do to reduce the anxiety practitioners feel regarding liability?

One obvious measure is to move to no-fault systems of compensation. Many countries including the United States and New Zealand have no-fault compensation schemes for vaccine-related injury. Putting such a scheme in place may very well help doctors get over the fear of being sued. It might also give patients confidence knowing that in an extremely rare case of injury, they will be covered.

This could be done either with a one-off scheme or by expanding the National Injury Insurance Scheme, which covers personal injuries from motor vehicle accidents.

Without such schemes, Australian patients will only have access to compensation for vaccine-related injury if they can prove it was caused by a failure to act according to medical standards of care or a failure to properly inform the patient of material risks.

Cameron Stewart, Professor at Sydney Law School, University of Sydney

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

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Australia commits fully to China containment

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What other Indo-Pacific nations are doing

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Aboriginal and Torres Strait Islander people at risk

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Global solutions missing

Cyberattacks as acts of war

Risks of retaliation

A drift towards lawlessness

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Taking the UK to court

A duty to protect

A political calculation

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First, what are myocarditis and pericarditis?

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What’s the risk of dying from TTS?

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So what happens next?

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How will we make sure it’s safe?

The risk would be extremely low

Will people comply?

What are the barriers?

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How serious is Taiwan’s current outbreak?

Taiwan’s recent COVID surge

What went wrong?

Where does Taiwan stand on COVID vaccinations?

This is a warning sign for Australia

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The level of infection in the country of origin matters enormously

Mitigating the risk of travellers

Intensity of quarantine measures for arrivals

Is Australia a tinderbox?

So what can we do now with borders?

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Proving fault

What is the standard of care?

Giving advice and accepting risks

What now for GPs and AstraZeneca?

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