India’s vaccine rollout is ignoring the many inequities in its society


Rajib Dasgupta, Jawaharlal Nehru University Some 6 months after India began what is said to be the largest COVID-19 vaccination drive in the world, equitable distribution has been a challenge.

A recent instance from a remote area in one of India’s hill states is illustrative. According to news reports, over 90% of vaccination slots meant for locals were booked by people from other areas.

Residents lost out because the area had no internet connectivity. To address the digital divide, local authorities had to appeal to the outsiders to cancel their bookings.

This access issue is just one of many ways India’s prioritisation strategy for COVID-19 vaccination has fallen short.




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Who gets the shot first: what did experts agree on?

The World Health Organization (WHO) had foreseen vaccine shortages and consequently, inequitable distribution. In 2020, it advocated a nuanced approach to ensure those who most needed the vaccine got it.

The WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) designed a document called the “Values Framework”. This document listed over 20 vulnerable groups such as homeless peoples, those living in informal settlements, and those in urban slums.

They underscored that countries ensure access to priority populations and take action to ensure equal access to everyone who qualifies under a priority group, particularly socially disadvantaged populations.

How did India prioritise vaccines?

The first phase of India’s rollout began in January, covering an estimated 30 million healthcare and front-line workers.

On March 1, the second phase began which incorporated people over 45 with chronic illnesses, and the over-60s. On April 1, this was expanded to everyone over 45.




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From May 1, it was decided all adults over 18 would be included.

Now, despite all adults being eligible, only 10% are fully protected with two doses. Despite the overall pace of vaccination increasing, the target of 135 million doses administered in July may be missed, and things look unlikely to improve in August.

With the threat of a third wave fuelled by variants, relaxing of lockdown restrictions, and the constant uptick in cases in two of the larger Indian states (Kerala and Maharashtra) as well as most of the North Eastern states, there’s an urgent need to increase vaccine coverage.

How should India prioritise vaccines?

India’s prioritisation strategy was limited to age, and to front-line workers specifically linked to COVID management — police and armed forces personnel, disaster management volunteers and municipal workers. It did not address the real-world diverse spectrum of vulnerabilities.




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The Values Framework points to a range of vulnerabilities and priorities and includes people unable to physically distance such as those in geographically remote and clustered populations (detention facilities, dormitories, refugee camps and dense urban neighbourhoods).

Levels of COVID-19 among prison populations and high levels of antibodies (suggesting prior infection) among slum residents shows this is a legitimate concern.

Then there are those who are at high risk of transmitting infection such as youth who are mobile but largely asymptomatic, and school-going children. Vaccinating them early would minimise disruption of their education and socio-emotional development. The union health minister has announced vaccination of children is likely to begin in August.

Workers in non-essential but economically critical sectors, particularly in occupations that do not permit remote work such as construction and food services, should also be vaccinated early.




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While only health workers were included in the category of essential workers, teachers, childcare providers, agriculture and food workers, and transport workers should have been added to this category.

Finally, to ensure equity, the needs of those who, at no fault of their own, are at risk of experiencing greater burdens from the COVID-19 pandemic, must be addressed.

This would include those living in extreme poverty, low-income migrant workers, nomadic populations, refugees or internally displaced persons, populations in conflict settings, those affected by humanitarian emergencies, and hard-to-reach groups.

At least one Indian state — Chhattisgarh — tried to reach out to its poorest, by proposing those under the state’s food scheme be vaccinated first in the 18–44 years category. However, after the intervention of the courts, the state had to reverse the order and allow vaccination for all adults.

What’s the fallout?

Rural-urban and gender inequities in the vaccine rollout have emerged as significant concerns.

By late May, 114 of India’s least developed districts had administered just 23 million doses to its 176 million residents. India’s nine major cities received the same number of doses, despite having half as many people.

During the same period, 17% more men were immunised than women.

Equity groups need to be given priority access to vaccinations to ensure those already more vulnerable to death, disease and destitution, and least likely to be able to seek treatment due to poverty, distance, or other social disadvantages, are protected.The Conversation

Rajib Dasgupta, Chairperson, Centre of Social Medicine and Community Health, Jawaharlal Nehru University

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

Is the COVID vaccine rollout the greatest public policy failure in recent Australian history?


Carolyn Holbrook, Deakin University; James Walter, Monash University, and Paul Strangio, Monash UniversityIs the Morrison government’s COVID vaccination rollout program one of Australia’s biggest ever public policy failures?

As COVID-19 infection numbers in locked-down Sydney show little sign of abating and Victoria extends its fifth lockdown, the prospect of life resuming some level of normality appears distant.

In recent weeks, we have learned more about the flaws in the federal Coalition government’s vaccination program. There’s the failure to procure sufficient vaccine and an accompanying over-reliance on the AstraZeneca vaccine.
The complications with rolling out the latter have exposed the shortage of supply of the Pfizer vaccine.

While other international leaders personally lobbied Pfizer executives for supplies, Prime Minister Scott Morrison and Health Minister Greg Hunt were inexplicably passive.

Then there is the sluggish pace of the “it’s not a race” vaccine rollout, particularly among vulnerable people, such as aged and disability care residents, and frontline health workers. Only 13% of Australia’s eligible population (those aged 16 and above) are fully vaccinated, while 35.3% are partially vaccinated. That’s a long way short of the goal of a fully inoculated adult population by October 2021, as initially promised.

Exacerbating these problems has been the lack of an effective public education campaign about the vaccine. This has left a vacuum, which anti-vaxxers and the vaccine-hesitant have filled.




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Fallout from a shambolic vaccine rollout

Public confidence in the government’s handling of the vaccine rollout has sharply diminished. The latest Newspoll shows disapproval of the rollout jumping 11 points to 57%.

The policy missteps, which have Australia languishing at the bottom of the OECD for the proportion of its population that is fully vaccinated, have elicited a rising chorus of condemnation.

Some of the criticism comes from usually supportive sources, such as right-wing commentators Janet Albrechtsen and Miranda Divine.

Former Coalition prime minister Malcolm Turnbull claimed recently he couldn’t recall “a more black and white failure of public administration” than the vaccine program. Historian Frank Bongiorno declared the rollout “the worst national public policy failure in modern Australian history”.

Public confidence in the Coalition government and the prime minister has dropped due to the vaccine rollout.
Lukas Coch/AAP

How do we measure public policy failure?

There’s no doubt the Commonwealth government, measured by its inability to reach professed objectives, which are then repeatedly revised, has performed poorly.

Disingenuous attempts by the prime minister and senior ministers to dissimulate, or deflect responsibility to others, have been well canvassed.

But are we ready to conclude that what we are seeing is a near-unprecedented instance of policy failure, especially when there are other pressing public policy issues on which the government has also been found wanting, most noticeably climate change?

There are three principal factors for measuring public policy success or failure.

The first is an assessment of how successfully the policy action ameliorates the problem it seeks to solve. This appraisal must take into account the consequences of that action. Consequences are often unintended and unanticipated. They might not become apparent for some time and can be difficult to quantify and link unequivocally to the policy in question. For example, the Coalition’s inclination to cease support for manufacturing in Australia has led, as is now evident, to our incapacity to meet the demand even for COVID vaccine production.

Second, an assessment of policy success or failure must consider the significance of the policy. That is, the failure of a minor government program has less negative impact than the failure of an economic, social, environmental or public health policy that affects the entire community.

Third, we must take account of the reputational enhancement or damage ensuing from a particular course of action. This may have decisive effects on a government’s electoral prospects.

Applying these measures, we can say that, to date, the Morrison government’s approach to the COVID vaccination rollout fares badly on all three criteria.

On all three measures of policy effectiveness, the vaccine rollout fails.
Mick Tsikas/AAP

The vaccine rollout has failed the tests of public policy success

The problem is not that the proposal – a level of vaccination that will enable the community to “live with” endemic COVID – is misconceived. It is that incompetent planning, logistics and implementation have so far prevented it from sufficiently ameliorating the threat we face.

We can see, from international comparisons, the dimensions of risk while COVID remains insufficiently checked and potentially able to generate more dangerous mutations.

Second, the significance of success or failure in this domain – brought home by recurrent lockdowns – is manifest. There are negative flow-on effects for the entire community, not only in containing the virus, but also with clear impact on the economy, mental health, domestic violence and trust in government.

We are also confronted with counter examples: Seattle, for instance, in dire circumstances not so long ago, is now more or less back to normal because of the swift uptake of vaccination.

Third, the reputational damage to the federal government is evident in a string of public opinion polls that have found a substantial decline in confidence in the Coalition and the prime minister.

… but there is one that is worse

Some other examples help us flesh out the picture. One is a public policy from recent decades that did not achieve its intended purpose: the Rudd government’s Resource Super Profits Tax and its successor negotiated by the Gillard government, the Minerals Resource Rent Tax.

These policies failed on at least two levels. First, they did not reap anything like the revenue that was forecast. Second, the taxes were electorally damaging for the Labor governments, engendering a fierce backlash from the mining industry.

A more significant public policy failure, with consequences that took much longer to become apparent, was the Howard government’s Aged Care Act of 1997. This legislation established the framework for the funding and regulation of the aged care system. Partially privatising the aged care sector, that policy regime is widely recognised as being responsible for the underfunding of the system and associated chronic shortcomings, which the recent royal commission thoroughly documented.

Perhaps the biggest public policy failure of recent times relates to climate action where, as with COVID vaccination, Australia ranks last among developed economies.

This has been a product of the failure of the parties, but in particular of internecine battles within the Coalition and a brutal politics that, as Martin Parkinson argues, brought about “a fracture of the political centre”, rendering it incapable of the negotiation and consensus necessary for resolution.

While the vaccine rollout has been a failure, inaction on climate change represents the biggest policy failure in recent times.
AAP/Department of Defence handout

Indeed, the intractability of climate change as a policy problem suggests that it, rather than the handling of vaccine rollout, is the biggest failure of modern times.

Despite the chaos that has been well documented, the required levels of vaccination can still be achieved, even if belatedly. The situation is potentially capable of resolution, and possibly in time for Seattle-like “normality” to be re-established. Adequate climate action, on the other hand, still appears to be incapable of resolution under this government.




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But will the Morrison government’s mishandling of the vaccine rollout be politically fatal? Certainly, falling confidence in the rollout is translating into a decline in support for the Coalition. Yet we should be wary of jumping to conclusions.

The prime minister has until next May to hold an election. The government has ample time to play catch-up with the rollout. If further outbreaks are contained and the elusive herd immunity is achieved by then, lockdowns will have become a thing of the past. The relief at being able to move on may obliterate current disquiet.

Further, in normal circumstances, policy virtue is not necessarily synonymous with political success. The last federal election was an indicator of this. The Coalition triumphed despite a threadbare policy program. In other words, policy prowess is only ever one measure of a government’s success.The Conversation

Carolyn Holbrook, ARC DECRA Fellow at Deakin University, Deakin University; James Walter, Professor of Political Science, Monash University, and Paul Strangio, Professor of Politics, Monash University

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

View from The Hill: Morrison and Coalition sink in Newspoll on the back of rollout shambles


Michelle Grattan, University of CanberraSupport for Scott Morrison and the government have slumped in Newspoll, in a major backlash against the botched vaccine rollout.

Labor has surged to a two-party lead of 53-47%, compared with 51-49% in the previous poll in late June.

The Australian reports the latest result is the worse for the Coalition this term, and if replicated at an election would deliver the government a clear loss.

Satisfaction with Morrison’s handling of the pandemic – which now sees lockdowns in the nation’s two largest states – plunged nine points in the last three weeks to 52%.

As the brought-forward Pfizer supplies start to arrive, confidence in the government’s management of the rollout is negative for the first time, with only 40% believing it being handled satisfactorily.

Morrison’s net approval in Newspoll – plus 6 – is at its lowest since the bushfire crisis, with an eight point overall shift. Anthony Albanese’s position worsened a little – he is on net minus 8. Despite a small drop, Morrison retains a solid lead over Albanese as better PM – 51-33%

Both Labor and the Coalition are polling 39% on primary votes – a two point fall for the Coalition and an equal rise for Labor.

The poll saw an 18 point drop in satisfaction with Morrison’s handling of COVID since April.

Satisfaction with the government’s handling of the rollout was 53% in April and 50% in late June – in this poll 40% are satisfied with the handling and 57% are not.

Sky News at the weekend reported Morrison had urged NSW premier Gladys Berejiklian to strengthen the Sydney lockdown. She did so soon after.

The prime ministerial intervention was likely superfluous because it was already clear harsher measures were needed. But it was notable on a couple of grounds.

In the past Morrison strongly leaned to lockdown scepticism, praising Berejiklian as a woman after his own heart and pointing to the NSW gold standard of limiting restrictions.

The much more infectious Delta variant has forced a change in the positions of both leaders.

Also, the Morrison intervention looked like the prime minister playing himself into the sharp end of the current COVID action, which is concentrated at the state level.

As both the NSW and Victorian governments struggle with serious outbreaks and the detail of their lockdowns, Morrison must be frustrated with his lack of direct power – apart from repeatedly restocking the ATM.

That’s of course leaving aside the vaccine rollout, a federal responsibility, the mishandling of which Newspoll shows is dramatically burning the PM’s voter support.

Late last week, Morrison finally spoke with Pfizer chairman and CEO Albert Bouria. This call, federal sources say, had been scheduled some while ago. It is not clear whether that was before or after the PM heard of Kevin Rudd’s contact with Bouria.

The federal government insists the Pfizer bring-forward was entirely due to its efforts and nothing to do with Rudd. Even so, it was a bad look to be talking direct to Bouria so late in the piece, and after Rudd. It had all the appearance of catch up.

As things stand, Berejiklian, Victorian Premier Daniel Andrews and Morrison are simultaneously under a great deal of heat.

In dealing with COVID, as Berejiklian will attest, you can go from hero to villain very rapidly; hailed in May as “the woman who saved Australia”, she’s pilloried in July for stuffing things up.

Morrison is suffering the same shift in public judgement. And things are not likely to change in the near future – despite the brought-forward Pfizer supplies, there will be shortages for some time yet.

Of the two premiers fighting outbreaks, Berejiklian is under the greater pressure. She and Andrews took different approaches: Andrews locking down immediately and Berejiklian starting with a soft lockdown that had to be toughened (then going further on shutting construction than Andrews ever has).

Even if the five-day Victorian lockdown has to be extended, the situation there appears more manageable than in NSW. On Sunday, Victoria reported 16 locally acquired new cases, while in NSW there were 105.

Berejiklian is under siege simultaneously for not acting fast and strongly enough, and for abandoning her basic less restrictive approach.

The concentration of the NSW infection in south west Sydney has also complicated the situation, because (as Victoria knows) a heavily multicultural area needs particularly good communications and sensitive handling.

This new COVID crisis has seen another round of inter-governmental bickering.

Victoria seethes with retrospective resentment about how Coalition figures (federal and NSW) blamed it last year over its second wave that resulted in hundreds of deaths, mostly aged care residents.

Melbourne then and Sydney currently both had their crises triggered by lapses in quarantine arrangements. NSW is in a much better position to cope than Victoria was – but now the virus is more virulent, and there’s little confidence the Sydney lockdown won’t extend into August.

Last week the Andrews government labelled Morrison the “prime minister of NSW”, declaring that state had been treated more generously than Victoria was in its earlier lockdown this year. Treasurer Josh Frydenberg accused Andrews of “whingeing”. Andrews had a dig at NSW.

Andrews is always a tough operator – probably why he and Morrison have a grudging mutual respect. Last week Andrews made it clear he expected Victorian workers to get the latest full federal financial help, even though, if the lockdown were only five days, they’d fall short of fully meeting the federal conditions. Morrison complied.

The latest lockdowns come as polling just released by the Australia Institute, a progressive think tank, shows people’s faith in state governments’ handling of COVID at an all-time high.

The Australia Institute has been regularly polling the question “which level of government do you think is doing a better job of handling the COVID-19 crisis?”. Respondents were asked to choose between their state or territory, the federal government, both equally, or say they didn’t know.


The Australia Institute

In August last year, 31% chose their state/territory, 25% the federal government, and 32% rated the performances of both levels of government equally.

By April, 39% nominated their state or territory; 18% the federal government; 28% both.

Early this month (just as the NSW lockdown was starting) 42% rated their state or territory as the government doing better, 16% the federal government, and 24% both equally.

In NSW in July, 39% said the state government was doing the better job, 13% nominated the federal government; and 28% put both equally. The Victorian figures were 34%, 25% and 21%.

The Australia Institute interprets the response to COVID representing “a potential realignment of state-federal relations”.

Certainly the second year of the pandemic, like the first, is seeing the states showing little deference to the federal government when they perceive their core interests are at stake. They determine the lockdowns and, now JobKeeper has gone, NSW and Victoria have shown they are willing to play hardball to extract the best financial support for their citizens. And the Morrison government knows it will pay a political price if it is seen as a skinflint.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

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

We’re paying companies millions to roll out COVID vaccines. But we’re not getting enough bang for our buck


from www.shutterstock.com

Lesley Russell, University of SydneyHow we roll out vaccines is recognised as more important to the success of vaccination programs than how well a vaccine works. And the “last mile” of distribution to get vaccine into people’s arms is the most difficult.

The Morrison government, confronted with a public service ill-prepared for big challenges and with no expertise in rolling out vaccines nationally, has contracted out many aspects of the COVID vaccine rollout to a range of for-profit companies. These include strategies and planning, vaccine distribution, delivery of vaccination programs in aged care, and systems meant to monitor these activities.

To date, vaccine rollout efforts have been clearly inadequate. Government planning has not involved all the possible players and there was no attempt to involve the states and territories in a concerted national effort. Companies have been contracted to give overlapping advice and to provide services where that expertise already exists.

The lack of transparency about how some of these contracts were awarded is also an issue, along with whether the expenditure of taxpayers’ dollars is delivering value and the needed outcomes.

Calling in the consultants

From late 2020, the federal government engaged a raft of consultancies to provide advice on the vaccine rollout. Companies PwC and Accenture were contracted as lead consultants.

PwC was described as a “program delivery partner”. It was engaged to oversee “the operation, and coordinate activities of several actors working on specific functional areas, including — for instance — logistics partners DHL and Linfox”. In other words, PwC was contracted to oversee other contractors.

Accenture was engaged as the primary digital and data contractor to develop a software solution to track and monitor vaccine doses. This included receipt of vaccines by health services, vaccination of patients and monitoring adverse reactions. It received at least A$7.8 million for this work. It is not known if any of these products were delivered or are in use.




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McKinsey received a two-month contract worth A$3 million to work with the health department on vaccine issues; EY was contracted for A$557,000 last November to deliver a “2020 Influenza Evaluation and Covid Vaccine System Readiness Review”. Later there was a A$1 million contract to assess vaccine system readiness and provide advice on on-shore manufacturing.

Despite all this “expert” — and expensive — advice, the vaccination rollout has become a shambles and is far behind schedule. So the military (Lieutenant General John Frewen) has been called in to take “operational control of the rollout and the messaging around the rollout”.

Let’s look at distribution and logistics

Last December health minister Greg Hunt announced the government had signed contracts with DHL and Linfox for vaccine distribution and logistics.

The value of the contracts remains undisclosed. However, the 2021-22 federal budget provides almost A$234 million for vaccine distribution, cold storage and purchase of consumables.




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The decision for these companies to be involved in vaccine distribution shocked many in the pharmaceutical supply industry. The government already has a well-established mechanism to supply pharmaceutical products to the most remote areas. It already does this via pharmacies and other outlets as part of the community service obligation funded under the Community Pharmacy Agreement.

This supply network, for which the government pays A$200 million per year, involves a small number of pharmaceutical wholesalers with decades of experience in delivering to pharmacies. In remote areas, the network also delivers to medical services and doctors’ offices. It’s the same network used every year to deliver flu vaccines.

Pharmaceutical wholesalers offered their expertise. But the government did not approach them to undertake this work. The federal government also ignored the capabilities of state hospital systems, which routinely deliver time-sensitive items such as radioisotopes and blood products.




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More contracts, this time for vaccination programs

The federal government took on responsibility for vaccinating people in aged and disability care, and GP respiratory clinics. It has contracts totalling A$155.9 million with Aspen Medical, Healthcare Australia, Sonic Healthcare and International SOS to deliver these services.

Despite the fact these companies were selected in January, planning has been abysmal.

Only now have most residents in aged care facilities been fully vaccinated. Meanwhile many workers in these facilities and people receiving and delivering care in the community are yet to receive a jab.

The health department has not made these contracts public, citing “commercial-in-confidence” issues. There has been confusion about what the contracts covered and concern the firms involved are significant Liberal Party donors.

There have been widespread logistical problems with juggling vaccine deliveries, having the workforce available to do vaccinations, and demand. Poor planning has led to cancelled vaccinations in aged care and thousands of doses thrown away in one clinic after problems with temperature-controlled storage.




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Where to next?

The key task now is to get all Australians vaccinated.

This will require a competent, reliable and integrated system operating at full efficiency. Those aspects of the system that are the responsibility of the federal government (or its contractors) must be better coordinated with the efforts of the states and territories, GPs and others involved in the vaccination rollout. That should be a key responsibility of Lieutenant General Frewen.

The effort to get more Australians vaccinated requires the public having trust in the system that will get us there and the communications that accompany that.

We have no way of knowing what advice the government has received and indeed, whether that advice was implemented. For-profit companies have been contracted to perform vital services, but we do not know at what cost to taxpayers and whether key performance indicators are being met — or even if they exist.

Openness and transparency are the pillars on which trust in government is built. Currently they are sadly lacking.The Conversation

Lesley Russell, Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney

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

Public trust in the government’s COVID response is slowly eroding. Here’s how to get it back on track


David Gray/AAP

Mark Griffith Evans, University of CanberraPublic trust is critically important during the pandemic. Without it, the changes to public behaviour that are necessary to contain and ultimately prevent the spread of infection are slower and more difficult to achieve.

In mid-2020, Australia was widely viewed by the public as having successfully managed the pandemic, especially compared to the US, UK and other European countries. Australians’ trust in their government almost doubled in a year from 29% to 54%.

The same is not the case today. Australia remains locked down with a stalled vaccine rollout, while the US, UK and other countries are opening up. And public trust in the government is eroding.

The latest Essential poll last week showed people’s support of the government’s handling of the pandemic sliding nine points from 53% to 44%. And 30% of respondents described the government’s COVID strategy as poor, compared to 24% a month earlier.

Why people tend to trust government in crises

It’s common for people to show support for their leaders during crises. In the initial stages of the pandemic in early 2020, surveys showed leaders in a large number of countries enjoyed an increase in public confidence.

The approval rating of Italian Prime Minister Giuseppe Conte hit 71% in March 2020 – 27 points higher than the previous month – despite the fact his country was in the throes of a deadly first wave of the pandemic.

German Chancellor Angela Merkel saw her approval rise to 79%, while the prime ministers of Canada and Australia, Justin Trudeau and Scott Morrison, saw similar surges in popularity during the early months of the pandemic.

Perceptions of political leadership during the pandemic, July 2020.
Adapted from Will Jennings and others, 2020, Political Trust and the Covid-19 Crisis – pushing populism to the backburner?, Author provided

The upsurge of support is partly explained by what is called the “rally-round-the-flag” effect.

In Australia, Morrison’s approval rating soared on the back of his effective handling of the initial threat, judicious decision-making on early closure of international borders and an atypical coordination of state and federal governments via the National Cabinet.

Moreover, a severe threat like a pandemic can make people more information-hungry, anxious and fearful. COVID has become a powerful shared experience for people. It touched most households through people’s connections with health and social care workers and their communication with relatives, co-workers or friends who were in lockdown or unfortunate enough to get sick.




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Yet, research also suggests many people do not lose their capacity for reason or critical judgement in a crisis. For example, people can oppose wars or other heavy-handed responses to terrorist attacks even if such attacks make them more anxious or fearful.

Above all, the competence and outcomes of the government’s actions matter. If the government is perceived as not able or willing to adequately respond to a threat, then public support will fade.

How government can get public trust back

Fast-forward to today. The Australian public is disenchanted with the slow rollout of the vaccine program and mixed government messaging over the relative risks of the AstraZeneca vaccine. This has punctured public trust in government in a very short period of time.

At the same time, people are proving highly vulnerable to fake news and conspiracy theorists, who are taking advantage of mixed messaging by government to try to sow more confusion.

The dangerous implication of all of this: it’s fuelling vaccine hesitancy. One in six Australians now say they will never get a COVID vaccine, according to a recent poll.

So, what needs to be done to reverse the decline in public trust of the government? The Organisation for Economic Cooperation and Development (OECD) has provided some timely guidelines that suggest the need for greater community engagement.

This can be achieved by the government taking these steps:

  • proactively releasing timely information on vaccination strategies, forms of delivery and accomplishments in a user-friendly format
  • providing transparent and coherent public communication to address misinformation and what is known as the “infodemic
  • engaging the public when developing vaccination strategies.



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The public needs to have its say

At the start of the pandemic, co-designing strategies with citizens was a low priority. But in the later stages of crisis management when behavioural change – in this case, vaccine take-up – becomes critical to containing the virus, you ignore the views of citizens at your peril.

Moreover, in the recovery stage – when it’s time to reflect on the government response, take accountability for missteps and draw lessons for the future – citizen engagement becomes even more important.

As inquiries are eventually launched to explore what went right and what went wrong with the coronavirus response, the public must be invited to the discussion.

And there are models for how to do this. Just look at the citizen’s assemblies that have been formed in France and the UK to push for greater action on climate change in the post-COVID global recovery.

There’s no way of knowing if COVID-19 could have been managed more successfully if there had been more public participation and debate from the start, given the whirlwind of uncertainty and the need for rapid decisions to tackle a crisis.

But there is little doubt that at some point the public will have to have their say. Important nationwide discussions need to be had on how best to limit the creep of executive power, how to better facilitate public debate in a period of high anxiety, and how to get the best out of the experts.




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How to combat misinformation?

And what about the longer-term problem of combating truth decay in society?

Finland, Sweden and the Netherlands have an effective weapon to combat fake news: education. These countries all include digital literacy and critical thinking about misinformation in their national curriculums.

Moreover, the Finnish fact-checking organisation Faktabaari provides professional fact-checking methods for use in Finnish schools, focusing on misinformation, disinformation and malinformation (stories that are intended to cause harm).

This is where Australian public universities can play a critical role by providing independent, evidence-based, fact-checking services in their areas of expertise to the community. This is essential not only to combat truth decay, but to strengthen our responses to future crises.The Conversation

Mark Griffith Evans, Professor of Governance and Director of Democracy 2025 – strengthening democratic practice at Old Parliament House, University of Canberra

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

First Nations people urgently need to get vaccinated, but are not being consulted on the rollout strategy


A senior Aboriginal man is being vaccinated against COVID-19.
PR Handout Image/AAP

Kalinda Griffiths, UNSWThis year, just five cases of COVID-19 have been recorded among Aboriginal and Torres Strait Islander people in Australia. This good result is due to both significant government support measures and prompt and effective action by Aboriginal and Torres Strait Islander leaders and organisations.

As the highly contagious Delta variant spreads in Australia, the task of ensuring all Australians are vaccinated becomes even more urgent. But since the vaccine rollout began in late February, only about 9% of Australians have been fully vaccinated.

The Delta variant is a particular concern for higher-risk populations, including Aboriginal and Torres Strait Islanders. Vaccinations of First Nations people must be carried out more quickly.

And in light of the elite Sydney private school erroneously giving all Year 12 students vaccines that were intended only for First Nations students, there’s also a need for stricter guidelines and better oversight.

When questioned about the mistake this week, NSW Health Minister Brad Hazzard demanded that critics “move on”. But authorities should not dismiss public concern that vaccines are not being distributed to those who need them most.

To ensure this, the vaccination rollout for First Nations people needs to involve Aboriginal community-controlled health organisations in the planning and implementation. We have already seen that when community-controlled organisations take control, vaccine delivery is successful and communities feel safer.




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How many First Nations people have been vaccinated

Vaccine supply is a concern across the country, but the issue is most urgent at the moment in New South Wales, where a third of all Aboriginal and Torres Strait Islander people live, and where case numbers are growing.

Australia is now predominantly reliant on the 300,000 to 350,000 Pfizer vaccines coming into the country each week. Thankfully, this number is due to increase substantially in coming months.

In March, a vaccine implementation plan for Aboriginal and Torres Strait Islander peoples was published by the federal health department. The publication iterated the urgent need for Aboriginal and Torres Strait Islander people to be a high priority in the rollout.

First Nations people over the age of 55 have been able to get vaccinated since March. It’s also been a little over a month since Aboriginal and Torres Strait Islander people aged between 16 to 49 years have been eligible for COVID-19 vaccines.

However, there is currently limited publicly available data on just how many vaccines have actually been distributed to Aboriginal and Torres Strait Islander people so far.

Western Australia had completely vaccinated just over 2% of its Aboriginal and Torres Strait Islander population as of June 21.

In Queensland, about 5,277 total vaccines have been distributed in the Torres Strait and Cape York, where just under two-thirds of the population is Aboriginal and/or Torres Strait Islander.

In the Northern Territory, 17% of the total population was fully vaccinated as of July 7. In remote areas, 26% of residents had received their first dose at the start of the month.

This is good news for Aboriginal and Torres Strait Islander people in the territory, who make up just under a third of the total population.

Community-controlled organisations addressing vaccine hesitancy

While the media has reported on vaccine hesitancy in Aboriginal and Torres Strait Islander communities, there is anecdotal evidence that hesitancy is actually decreasing and that remote community clinics are vaccinating many First Nations people.

This includes the Mala’la clinic at Maningrida in Arnhem Land where media reports say 50 people were vaccinated across three days in July. The clinic became community-run in March of this year after 45 years of government oversight.

This success highlights the importance of having Aboriginal and Torres Strait Islander organisations involved in the rollout. This involves recognising that self-determination, as well as health information being delivered in first languages, results in improved uptake of services and better health outcomes.

For example, in Pitjantjatjara, community worker Frank Dixon provided the men of his community with information about the vaccine and accompanied them to their vaccinations. Mala’la Health Service’s chairman, Charlie Gunabarra, has also delivered information about the vaccine to his community and was the first among them to get vaccinated.




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Despite this, there is evidence First Nations people are not being sufficiently included in planning and implementation of the rollout.

For example, a meeting of the national COVID vaccine taskforce last week excluded the National Aboriginal Community Controlled Health Organisation. The Aboriginal and Torres Strait Islander Advisory Group on COVID-19 was also excluded from the discussion.

Pat Turner, the head of the National Aboriginal Community Controlled Health Organisation, said the lack of First Nations inclusion was “deeply concerning”.

The vaccine rollout must be managed so First Nations people and other vulnerable groups are prioritised. This means securing better vaccine supplies and putting Aboriginal and Torres Strait Islander people at the heart of decision-making.The Conversation

Kalinda Griffiths, Scientia lecturer, UNSW

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

Grattan on Friday: General’s vaccine advance waits on more fuel


Michelle Grattan, University of CanberraDespite some questioning about a military man being in charge of the vaccine rollout, when it comes to communicating, Lieutenant General JJ Frewen is a refreshing change from the pollie-speak and fudges we hear all the time.

At a Tuesday news conference, after his virtual meeting with the states and territories, Frewen answered questions directly and briefly.

He was distinctly “forward leaning”, indeed pre-empting the content of the roundtable Treasurer Josh Frydenberg and he were to have with business representatives the following day.

Frewen sounds like a man who knows what he’s doing. Coming days will tell whether that’s the reality. (You can find a touch of scepticism in certain state quarters.)

Prime Minister Scott Morrison is naturally inclined to put faith in the military, especially after his Sovereign Borders experience. But bringing in Frewen was also a response to what was becoming a desperate situation. It was a call to Triple Zero. He’s now very impressed with the general and relying on him heavily.

While critics baulk at the “men in uniform” pictures (Frewen flanked by colleagues), a degree of concern is also being expressed from quite another quarter. Some defence sources are wary of the danger of politicising the military.

The Australia Defence Association tweeted this week: “Relying on the ADF to head emergency efforts (not just assist the civil community) risks dragging a necessarily non-partisan institution into #auspol controversy”.

The ADA referenced the 2007 Northern Territory intervention over child sex abuse, when the seconded general heading a multi-departmental operation was targeted in a highly politicised environment.

At the moment, however, Frewen has more immediate worries. The general has landed on the beach, reworked the maps, and is marshalling available forces. But his advance is hampered by the shortage of fit-for-purpose fuel.

As each day goes by, the limited quantities of Pfizer and the absence of any other currently available alternative to AstraZeneca (which is subject to restrictive health advice) is being highlighted more starkly.

The fact this will change later (we are assured) doesn’t help when the here-and-now is urgent, as the Sydney outbreak and the extension of the lockdown there underline.

It’s a time-gap that up until now Australia has not been able to significantly narrow.

We’re hearing about vaccine transfers abroad – for example, Israel is providing doses to South Korea, to be repaid later.

But it is hard for a country like Australia, with relatively few cases, to make a plea. Morrison was asked why we haven’t been able to use our “special relationship” with the US to get some of its surplus doses. Unsurprisingly, others have greater needs or better arrangements.

Announcing on Thursday a liberalising of the COVID disaster payment to assist in the Sydney outbreak, Morrison also said the state would be provided with 300,000 extra vaccine doses next week, equally divided between Pfizer and AstraZeneca. This won’t affect what other states receive (on the per head of population formula), and NSW’s numbers will be smoothed out later.

The federal government has now rustled up additional shots of Pfizer.

On Friday, it was announced the supply of Pfizer had been brought forward, with 4.5 million doses expected to be available in August instead of September.

The supply problem came through strongly when Frydenberg and Frewen spoke after Wednesday’s business meeting.

The roundtable canvassed workplace vaccinations. Frydenberg said there were a lot of offers. Virgin Group CEO Jayne Hrdlicka said, “Big employers have the ability to stand up vaccination programs very quickly and would welcome the opportunity to be able to vaccinate as much of the workforce as quickly as possible”.

According to Treasury sources, when the rollout was being prepared, Treasury put forward the view that employers should be used as a channel, as with the flu vaccine. But up to now, we’ve heard little from the government about such an obvious way to boost rates. And, among other things, that goes back to supply.

If we had more Pfizer, there is no reason why this could not have been happening now. (Except where there’s lockdown and work from home!) But employers can’t be in the thick of the rollout when the supply problem means the younger people in their workforces could not be given the vaccine preferred for them. The workplace sites will be for later in the year.

If there had been more Pfizer, the under 40 cohort could have been brought into the general rollout program much earlier – these people are still waiting, unless their job or health puts them into a special category, or they choose AstraZeneca.

And with adequate Pfizer supplies the PM wouldn’t have needed to encourage younger people to consult their doctor about taking AstraZeneca.

The extension for another week of the Sydney lockdown further removes the special status NSW has claimed – and has been accorded by the federal government – as the gold standard for handling COVID without having to resort to extreme measures. The virus again has proved itself the great leveller.

NSW’s decision would be especially disappointing to Morrison. But there is a tone of greater tolerance towards his home state than he displayed to Victoria, in its recent troubles, when he held out for some days before announcing assistance. (In fairness, the Delta outbreak in Sydney is particularly bad.)

“We’re working very cooperatively and positively together [with NSW] because let me be clear – what is happening in Sydney just doesn’t have implications for Sydney,” he said.

“What is happening in Sydney has very serious implications not only for the health of Sydneysiders but also for the economy of Sydney, but also the economy of NSW and indeed the national economy.”

At the moment, one in three eligible people in Australia has had a first vaccine dose, and one in ten has received both doses.

The government has been foreshadowing for a while that by year’s end, all eligible Australians will have had the opportunity of a first jab. On Thursday, Morrison pointedly said this was the government’s intention “based on the advice of Lieutenant General John Frewen that that will be possible”.

That’s assuming “the supply lines hold”.

The PM said this would mean the vaccination program would be only two months behind the schedule the government had when it talked about an October deadline.

No pressure, JJ.

This article has been updated to take into account the prime minister’s Friday announcement on bringing forward Pfizer dosesThe Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

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

Vaccine Rollout 2.0: Australia needs to do 3 things differently


Unsplash/CDC

Stephen Duckett, Grattan Institute and Anika Stobart, Grattan InstituteAustralia’s vaccine rollout started just over four months ago. It has not gone well, to put it mildly. To date, only 24% of the population have had at least one dose of a vaccine, and nearly 5% – 1.2 million people – have been fully vaccinated.

This rate is far too slow. The United Kingdom and the United States are showing that effective mass vaccination programs can work, with more than 80% of Brits and 54% of Americans having received their first dose. Australia should be just as ambitious.

The federal government should press the reset button and shift to Rollout 2.0.

Rollout 1.0 was plagued with supply problems – there just wasn’t enough of either vaccine available. But from July, there will be more supply, with about two million Pfizer doses, and half a million Moderna doses available per week from October – more than enough to cover the whole adult population.

With supply looking sorted, the federal government should set a new goal for when all adults will be able to receive full vaccination by.

The government – and its army of rollout consultants – has had months to learn from its mistakes. The actual army has also been called in.




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The government has no excuse not to have all arrangements in place for an efficient vaccination program when the vaccines begin rolling in.

Three key things need to be done differently to achieve this goal.

1. Fix the logistics

The supply side of Rollout 1.0 was a shemozzle. GPs and state governments had no idea how many doses were going to arrive and when. This was partly due to slow supply of doses from overseas, but mainly due to slow supply from the local producer, CSL.

That should not be a worry under Rollout 2.0.

But Rollout 1.0 was also a distribution nightmare. It was seemingly impossible for anyone to organise to get doses from place A to place B.

There are now fewer anecdotes about distribution disasters than a few months ago, but the government needs to assure the public that the supply chain and distribution networks are working efficiently.




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If I can be notified when my book or beer is due to arrive – and even the driver’s name – then GPs and state vaccine hubs should be able to be notified when their doses are due to arrive.

And it should be as easy for me to book my vaccination online as it is to book a restaurant table or parcel pick-up online, with advance bookings helping to guide where extra doses should be allocated.

2. Widen the channels

Of the Australians who are getting vaccinated, just over half are doing so through GPs and primary care clinics.

If Rollout 2.0 is to make use of the millions of new doses arriving every week, it will need to deliver at least three times as many doses every week as it has been able to achieve so far.

Government planning seems to be putting GPs front and centre of Rollout 2.0 – the same strategy that failed in Rollout 1.0.

Sure, GPs should be invited to step up, but governments should continue to put a focus on mass state-run vaccination hubs that can vaccinate up to 1,400 people every eight hours, compared to GP clinics that can vaccinate only 100 to 300 people in the same time.

Rollout 2.0 needs to increase both the hours existing outlets are available and expand the number of large vaccination hubs. It should also introduce new outlets such as pharmacies.

States should bring vaccines to people, by providing on-site pop-up vaccination centres at major sports events, workplace hubs, universities, major public transport stations, housing commissions, and regional town centres.

When the Pfizer vaccine is approved for people under 16, states should also arrange for vaccinations to be done in schools.

Because more doses will be available within one month, states should no longer stockpile doses to ensure second-dose availability but rely on fewer supplies for this purpose.

A faster rollout will need a bigger workforce. Planning needs to start now on how we should draw on medical, nursing, and pharmacy students to contribute to Rollout 2.0.

3. Tackle vaccine hesitancy

As the government fixes the supply side, it also needs to tackle the demand side – vaccine hesitancy. About 25% of Australian adults say they may not get the jab. The aim should be to change the minds of those who are unsure, rather than focusing on those who are much less willing.

There is a science behind what works in addressing COVID vaccine hesitancy, drawing on previous vaccine campaigns. Government should use it, rather than developing ads that look like the cheapest possible bland offering, which compare poorly to international offerings.

There is not one slick answer, and no one campaign. Different demographics will respond to different messaging. Different reasons for hesitancy will need to be addressed differently.

Ads should be placed at times when target audiences might be watching TV.

A text message campaign could be used, sent to all Australian adults, regardless of their vaccination status, encouraging them to get vaccinated and telling them how, as is done in the UK.

Some campaigns could start now, promoting the benefits of vaccines to individuals and their efficacy. Messaging should also emphasise the collective benefits of high vaccination rates, including protecting the vulnerable and bringing stranded Australians home, just as our collective effort saved lives to date.

Better real-time tracking of vaccine uptake by demographics can be used to develop different messages for different audiences.

The campaigns should go beyond simply pronouncing that all the vaccines are safe and effective. The communication should be ongoing, clear and actionable, address concerns, and de-bunk misunderstandings, without over-reassuring.




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Younger people, women, and people who live beyond the inner-city are more likely to be hesitant. Communications should build trust and confidence in government, and not pit groups against each other, which would only increase hesitancy.

The government has over-promised and under-delivered on Rollout 1.0. It needs to push the reset button so that Rollout 2.0 takes Australians to a vaccine-protected future as soon as possible.The Conversation

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.

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


Morgan Sette/AAP

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.




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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.




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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.The Conversation

Stephen Duckett, Director, Health Program, Grattan Institute

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

Can I get AstraZeneca now and Pfizer later? Why mixing and matching COVID vaccines could help solve many rollout problems


Attila Balazs/EPA/AAP

Fiona Russell, The University of Melbourne and John Hart, Murdoch Children’s Research InstituteIn the face of changing eligibility for the AstraZeneca vaccine, new variants of the coronavirus and supply constraints, many people are wondering whether they can “mix and match” COVID-19 vaccines.

This means, for example, having the AstraZeneca vaccine as the first dose, followed by a different vaccine such as Pfizer as the second dose, and boosters with other vaccines later on.

While many studies are ongoing, data has recently been released from mix and match trials in Spain and the United Kingdom.

This data is very promising, and suggests mix and match schedules may give higher antibody levels than two doses of a single vaccine.

While Australia’s drug regulator, the Therapeutic Goods Administration (TGA), hasn’t yet approved a mix and match COVID-19 vaccination schedule, some countries are already doing this.

So how does this work, and why might it be a good idea?

What’s the benefit of mixing and matching?

If the COVID-19 vaccine rollout can mix and match vaccines, this will greatly increase flexibility.

Having a flexible immunisation program allows us to be nimble in the face of global supply constraints. If there’s a shortage of one vaccine, instead of halting the entire program to wait for supply, the program can continue with a different vaccine, regardless of which one has been given as a first dose.

If one vaccine is less effective than another against a certain variant, mix and match schedules could ensure people who’ve already received one dose of a vaccine with lower effectiveness could get a booster with a vaccine that’s more effective against the variant.

Some countries are already using mix and match vaccine schedules following changing recommendations regarding the AstraZeneca vaccine because of a very rare side effect of a blood clotting/bleeding condition.




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Several countries in Europe are now advising younger people previously given this vaccine as a first dose should receive an alternative vaccine as their second dose, most commonly mRNA vaccines such as Pfizer’s.

Germany, France, Sweden, Norway and Denmark are among those advising mixed vaccination schedules due to this reason.

Is it safe?

In a UK mix and match study published in the Lancet in May, 830 adults over 50 were randomised to get either the Pfizer or AstraZeneca vaccines first, then the other vaccine later.

It found people who received mixed doses were more likely to develop mild to moderate symptoms from the second dose of the vaccine including chills, fatigue, fever, headache, joint pain, malaise, muscle ache and pain at the injection site, compared to those on the standard non-mixed schedule.

However, these reactions were short-lived and there were no other safety concerns. The researchers have now adapted this study to see whether early and regular use of paracetamol reduces the frequency of these reactions.

Another similar study (not-peer reviewed) in Spain found most side effects were mild or moderate and short-lived (two to three days), and were similar to the side effects from getting two doses of the same vaccine.

Is it effective?

The Spanish study found people had a vastly higher antibody response 14 days after receiving the Pfizer booster, following an initial dose of AstraZeneca.

These antibodies were able to recognise and inactivate the coronavirus in lab tests.

This response to the Pfizer boost seems to be stronger than the response after receiving two doses of the AstraZeneca vaccine, according to earlier trial data. The immune response of getting Pfizer followed by AstraZeneca isn’t known yet, but the UK will have results available soon.

There’s no data yet on how effective mix and match schedules are in preventing COVID-19. But they’re likely to work well as the immune response is similar, or even better, compared with studies using the same vaccine as the first and second dose. This indicates they will work well in preventing disease.

Might this be one way to help resolve Australia’s slow rollout?

In Australia, we’ve seen many people wanting to “wait for Pfizer” and not have the AstraZeneca vaccine. This is despite the UK’s recent real-world findings that, following two doses, both vaccines are similarly effective against the variants circulating in the UK.

Delays in vaccine uptake have also been due to concerns regarding the very rare but serious blood clotting/bleeding syndrome after the first dose of AstraZeneca, as well as changing age restrictions in terms of who can receive this vaccine.

This caused widespread uncertainty and meant some younger people in some countries in Europe who had already received a first dose were excluded from getting a second dose.

The results from these mix and match studies support the possibility of vaccinating people who have received the first dose from AstraZeneca, with a different booster, if the need arises.

Further studies are underway to evaluate mix and match schedules with Moderna and Novavax vaccines, both of which Australia has supply deals with.

Don’t delay getting vaccinated

As Victoria tackles its current outbreak, many other countries in our region are experiencing a surge in cases too. These include Fiji, Taiwan and Singapore, countries previously hailed as excellent examples of how to manage COVID-19.

These examples highlight the difficulty of sustained suppression in the absence of high vaccination coverage. This will be further exacerbated by the new, more transmissible variants.

The current cases in Victoria are caused by the B.1.617.1 (“Indian”) variant. Both vaccines are effective against the closely related B.1.617.2 variant (albeit a bit lower than against B.1.1.7) and we would expect similar effectiveness against B.1.617.1.




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It’s not clear what kind of evidence regulatory authorities, like Australia’s TGA, would require for a mixed schedule to be approved for use.

While we are waiting, it’s critical eligible people don’t delay getting vaccinated with the vaccine that’s offered to them now. Vaccination is an essential part of the pandemic exit strategy.

It’s likely the vaccination schedule will be modified in the future as boosters may be needed. This is normal for vaccination programs — we already do this each year with the influenza vaccine. This shouldn’t be seen as a policy failure, but instead an evidence-based response to new information.The Conversation

Fiona Russell, Senior Principal Research Fellow; paediatrician; infectious diseases epidemiologist, The University of Melbourne and John Hart, Clinical researcher, Murdoch Children’s Research Institute

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