Vaccinating the highest-risk groups first was the plan. But people with disability are being left behind


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Helen Dickinson, UNSW and Anne Kavanagh, The University of MelbourneWith Australia’s COVID vaccination campaign set to open up to over 50s on May 3, many at-risk Australians eligible under phase 1A are still waiting.

Last week we learned only 6.5% of residents in disability care homes had received the vaccine.

Aged care is faring slightly better, with roughly 30% of aged-care facilities having received both vaccine doses. But that’s still some way to go.

Also worrying, an estimated 15% of aged-care workers and only 1% of disability-care workers have so far been vaccinated.

Federal health department officials have conceded the vaccine rollout in the disability sector is progressing more slowly than they would have liked.

But critics like shadow minister for the National Disability Insurance Scheme (NDIS) Bill Shorten have described the situation as reflecting a “pathology of dangerous incompetence” in the government’s treatment of vulnerable Australians.

After failing to address the needs of people with disability at the height of the pandemic last year, the poorly executed rollout in disability care does little to reassure this group the government has their best interests at heart.




Read more:
4 ways Australia’s COVID vaccine rollout has been bungled


A high-risk group

Australians with disability are at heightened risk during the COVID pandemic because many have other health conditions (for example, respiratory problems, heart disease, and diabetes). This makes them more likely to get sicker or die if they become infected.

People with disability are also more likely to be poorer, unemployed and socially isolated, making them more likely to experience poor health outcomes.

Many people with disability, particularly those with complex needs, require personal support, which puts them in close contact with other people. Different workers will come through residential disability-care settings, sometimes moving between multiple homes and services, just as in aged care.

Should there be an outbreak of COVID-19 in residential disability care, there’s high potential for it to spread because some residents may have difficulties with physical distancing, personal hygiene, and other public health recommendations.

In Victoria’s second wave we saw outbreaks linked to at least 50 residential disability settings among workers and residents.

Two people with Down Syndrome cooking in the kitchen.
People with disability are at higher risk during the pandemic.
Shutterstock

In other countries we’ve seen people with disability die from COVID-19 at higher rates than their non-disabled peers. In England, nearly six out of every ten people who died with COVID in 2020 were disabled, and this risk increases with level of disability.

While Australia has not seen these levels of deaths, the longer this group goes without being vaccinated, the longer they’re contending with this risk. Discussions about reopening international borders only serve to heighten fears.

Given the unique risks this group faces, the disability community fought hard to ensure disabled people living in residential care and their support workers were included in phase 1A of the vaccine rollout.




Read more:
People with a disability are more likely to die from coronavirus – but we can reduce this risk


Repeating previous mistakes

Last year the disability royal commission was presented with extensive evidence to show the Australian government had not developed policies addressing the needs of people with disability in their initial emergency response plans.

For example, while others on welfare payments received the COVID supplement, people with disability and their carers were denied this.

Many schools didn’t make appropriate adjustments so children with disability could engage with remote learning. And families with a child with disability struggled to secure the basics.

Advocates did significant work before governments started to consider people with disability in their COVID response plans. But this was often made more challenging because no data were collected about disability in the case numbers, reflecting an endemic problem of lack of recognition of people with disability in the health system.

We’re seeing this again in the vaccine rollout, where daily updates on vaccination numbers group aged and disability care together, rather than breaking these figures down across the sectors.

Without this sort of data, we can’t effectively plan for people with disability.

Meanwhile, the government’s announcement that the Pfizer vaccine is recommended for under 50s because of the very rare but serious side effect of low platelet count (thrombocytopenia) and blood clots (thrombosis) will see further pressure on Australia’s limited Pfizer supplies.

It may be some time before people with disability under 50 living in residential care are vaccinated. Yet the government continues to roll out Pfizer in residential aged care where AstraZeneca could be used, further demonstrating the low priority of the disability sector.

It appears little has been learned from the government’s earlier pandemic response (or lack thereof) concerning people with a disability. This group is being forgotten once again.

Getting back on track

In the Senate’s recent COVID-19 committee we heard confirmation aged-care residents had been prioritised over disability-care residents as they’re perceived to be at higher risk. This has angered many in the disability community who were not told the phase 1a group would be broken into sub-groups.

The government has some way to go in mending its relationship with the disability community. In addition to bungling the vaccine rollout, at the moment there’s significant concern over proposed reforms to the NDIS.

What we need now is a clear plan to roll out vaccinations, not only to people with disability in residential care settings, but also those in the wider community and their support workers. The government needs to set a clear timeframe for vaccinating disability-care residents and staff — and stick to this.

The World Health Organization argues community engagement is key to a successful vaccination rollout. In this light, commonwealth and state governments need to do some substantial work to engage people with disability and the broader sector to turn this situation around.




Read more:
‘Dehumanising’ and ‘a nightmare’: why disability groups want NDIS independent assessments scrapped


The Conversation


Helen Dickinson, Professor, Public Service Research, UNSW and Anne Kavanagh, Professor of Disability and Health, 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.

Japan is facing a fourth COVID wave and sluggish vaccine rollout. Will it be ready for the Olympics?


KYDPL KYODO/AP

Craig Mark, Kyoritsu Women’s UniversityAs a fourth wave of the coronavirus pandemic worsens in Japan, Prime Minister Yoshihide Suga faces a formidable challenge to successfully host the increasingly beleaguered Tokyo Olympic and Paralympic Games, with less than 100 days left to go.

More contagious variants of COVID-19 are spreading from Japan’s second-largest city Osaka. Cases are already rising again in Tokyo, requiring a so-called “quasi state of emergency” to be reimposed in Japan’s major cities.

Anxieties are also rising over the country’s sluggish vaccine rollout, which is far behind many other countries, including Singapore, South Korea and Indonesia. Opinion polls show up to 70% of Japanese feel the vaccine rollout has been too slow.

As the head of one nursing care centre put it,

the government doesn’t seem to understand the urgency of the matter.

A delayed start to Japan’s vaccine rollout

Taro Kono, the minister in charge of the rollout, has said 100 million doses should be stockpiled by June to cover the country’s elderly population (36 million people), health care workers and those with pre-existing conditions. This means, however, less than half the population is likely to be vaccinated when the Olympics start on July 23.

The main cause of the slow rollout stems from the initial decision by the government to go through a delayed approval process for the Pfizer-BioNTech vaccine.

Japan only began vaccinating those over 65 years old this week.
Kyodo News/AP

Even though Phase 3 trials were concluded last November and the vaccine was approved by the World Health Organisation on December 31, the Japanese Pharmaceuticals and Medical Devices Agency (PMDA) took another six weeks to conclude its own trials before granting approval. The rollout has been further impeded by strains on Pfizer’s production capacity and export controls imposed by the European Union.

At least four Japanese pharmaceutical companies have been conducting their own vaccine trials, but these have been stymied by a lack of investment and the slow pace of bureaucratic approval by the PMDA.




Read more:
Yoshihide Suga – who is the man set to be Japan’s next prime minister?


Japan also has orders for 120 million doses of the AstraZeneca vaccine and 50 million doses of Moderna’s vaccine, with hopes they will be approved for distribution and domestic production by May. Local trials have also begun for the Novavax vaccine, with hopes of being able to produce it domestically by the end of 2021.

Though achingly slow to be delivered, this means Japan has secured the rights for 564 million doses — more than enough for its population of 120 million people.

Osaka’s torch relay was held in a park without any crowds due to COVID concerns.
Hiro Komae/AP

A history of vaccine scares

But vaccine supply isn’t the only issue the country is facing. There are also concerns over the relatively high rate of vaccine reluctance among the Japanese public. Less than 25% strongly agree vaccines are effective, important and safe, according to a survey by The Lancet.

This is the legacy of vaccine safety scares in past decades. A small number of infants died from whooping cough vaccinations in the 1970s, followed by some adverse reactions to a combined measles, mumps and rubella (MMR) vaccine in the 1980s.




Read more:
For now, the Tokyo Olympics will go ahead. But at what cost?


Unfounded safety fears even led to the government withdrawing a national vaccination program for the human papillomavirus (HPV) in 2013, with fewer than 1% of Japanese girls now vaccinated for HPV.

Two recent surveys, however, show more than 60% of Japanese people are willing to get a COVID vaccine. The groups with more hesitancy included women and younger generations, with just over half indicating they wanted to get vaccinated.

Political pressure on Suga

For over a year, Japan’s pandemic strategy has largely relied on requests for businesses and the public to take voluntary precautions, such as closing bars and restaurants by 8pm, rather than enforce strict lockdowns. The government’s goal was to minimise the impact on the economy.

The Suga government and that of his predecessor, Shinzo Abe, however, have been under constant criticism for what many perceive as a reactive approach to the crisis. There have been a number of missteps along the way, too.

Prime Minister Yoshihide Suga has seen his popularity drop significantly since the start of his term last year.
Kaname Yoneyama/AP

This has worsened the approval ratings for the governing conservative Liberal Democratic Party (LDP), which has to face a national election for the lower house of the Diet (Japan’s parliament) by October. Numerous corruption scandals implicating LDP Diet members, senior bureaucrats and even Suga himself have also undermined public support for the government, which could ultimately threaten Suga’s leadership.

Relations have also worsened between Suga and leaders of Japan’s prefectural governments, especially the governors of Osaka and Tokyo. They have been insisting a “quasi state of emergency” be reimposed for at least a month, following the premature lifting of the previous state of emergency on March 21.

Osaka’s governor has also called off the Olympic torch relay through the streets of his city.

Playbook for a COVID-safe Olympics

The Tokyo Olympics, themselves, however, are still proceeding as planned. The Suga and Tokyo governments and the International Olympic Committee believe there is simply too much at stake in terms of corporate sponsorships, broadcasting rights and political prestige — despite the vast majority of Japanese people believing the games should be cancelled or postponed.

Suga is even expected to invite US President Joe Biden to the Olympics during his official visit to the US this week.




Read more:
Why are Japan’s leaders clinging to their Olympic hopes? Their political fortunes depend on it


Foreign spectators have now been barred from attending, but organisers are still hopeful to have a domestic audience for the games, particularly since
socially-distanced sporting events have resumed in Japan, such as baseball, soccer and sumo wrestling.

However, there is so far no requirement that local spectators be vaccinated. And the IOC is only encouraging — not requiring — that athletes be vaccinated, according to IOC Vice President John Coates.

All athletes, coaches and support staff, as well as the foreign media, will instead have to show negative COVID-19 test results before entering Japan. They will also be required to follow a COVID-safe “Playbook”, which will strictly control their activities during the games and require testing every four days.

How the government handles the games may just determine its fate in the October elections.

Scandals and negative publicity have swirled around the event for months, putting enormous pressure on the government and organisers.

Last week, a report that priority vaccinations were being considered for the Japanese Olympic team ahead of the public sparked a social media backlash and prompted a denial by the government.

With less than 100 days to go until the opening ceremonies, the Suga government needs to take a stronger approach towards the pandemic and dramatically speed up its vaccine rollout. The success of the games — and the survival of Suga’s government — depend on it.The Conversation

Craig Mark, Professor, Faculty of International Studies, Kyoritsu Women’s University

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

National cabinet to meet twice weekly in Morrison’s effort to get vaccination rollout ‘back on track’


Michelle Grattan, University of CanberraScott Morrison will hold twice-weekly meetings of the national cabinet for the “foreseeable future”, as the government battles to get its slow and problem-laden vaccine rollout back on course.

The Prime Minister says he has asked national cabinet and health ministers to “move back to an operational footing” to tackle the program’s challenges.

This comes as the rollout is being recalibrated following the medical advice restricting the use of the AstraZeneca vaccine to people over 50. Morrison has refused to set a target date for having all those eligible and willing vaccinated with at least one shot, after abandoning the government’s previous October target.

Morison’s action on the national cabinet and his comments are his bluntest admission so far of the program’s difficulties, which started from its beginning and have multiplied ever since.

“There are serious challenges we need to overcome caused by patchy international vaccine supplies, changing medical advice and a global environment of need caused by millions of COVID-19 cases and deaths,” he said in a statement.

“This is a complex task and there are problems with the programme that we need to solve to ensure more Australians can be vaccinated safely and more quickly.”

He said the federal government was trying to deal with its issues “and I have been upfront about those”.

But states and territories were also tackling their own issues, he said.

“Working together we are all going to be in a better position to find the best solutions.”

The federal government has taken the main responsibility for the rollout, but it does not have the states’ experience at service delivery and this has added to the problems.

The new regime for national cabinet meetings will start on Monday and continue “until we solve the problems and get the programme back on track”. It has been recently meeting only about monthly.

Meanwhile, a second person has suffered a blood clot after receiving the AstraZeneca vaccine.

A woman in her 40s is recovering in the Darwin Hospital after being transferred from a regional hospital in northern Western Australia.
The Western Australian Health Minister, Roger Cook, said the woman was in a stable condition in ICU.

Earlier a man in his 40s in Melbourne developed a clot after receiving the vaccine.

Last week Morrison announced the Australian Technical Advisory Group on Immunisation had advised against giving AstraZeneca vaccine to people aged under 50.

On Monday more than 56,000 doses of Pfizer and AstraZeneca vaccines were administered.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.

View from The Hill: Voters could wreak vengeance if Scott Morrison can’t get rollout back on track


Mick Tsikas/AAP

Michelle Grattan, University of CanberraLast week, people were falling over themselves to get vaccination appointments and had to be told, by their doctors and their government, to be patient.

Patience is still needed — indeed, more than ever — but now there’s rising vaccination hesitation and the message from the government is people should remain eager for the jab.

Conservative advice from the Australian Technical Advisory Group on Immunisation (ATAGI), recommending against the AstraZeneca vaccine for the under 50s (because of the very small danger of blood clots), has alarmed many people.

The danger is the advice has a knock-on effect, spooking people to whom it doesn’t apply.

Apart from younger frontline workers in health and aged care, those with underlying health conditions, and certain others, under 50s are not presently being vaccinated.

But with changing messages, some of the over 70s — the cohort now at the head of the vaccination queue — might start to have second thoughts, despite being told they shouldn’t.

They may or may not be reassured by Prime Minister Scott Morrison on Friday declaring his mother is lining up for her AstraZeneca shot soon. Or Commonwealth Chief Medical Officer Paul Kelly sharing the fact he’s urging his 86-year-old father to do so.

Thursday’s unwelcome medical advice was just the latest setback to the rollout and the Morrison government.

There have been the blocks and delays imposed on supplies from Europe and CSL production (of AstraZeneca) has been slower than anticipated.

The logistics haven’t all gone smoothly. Despite protestations to the contrary, the Commonwealth’s distribution has been sub-optimal.

Some doctors have complained of getting inadequate supplies; the arrangements for nursing homes have had glitches.

The whole program is running massively behind the original schedule. The government on Friday was celebrating passing one million doses administered, when we should have been well past four million.

We’re marching at a much slower pace than the United States or the United Kingdom. In the UK, incidentally, the authorities are being less conservative about AstraZeneca — it’s the under 30s who are being offered an alternative.

One can only imagine Morrison’s reaction when he was delivered the ATAGI advice, which of course he had to follow (even though some experts disagree with it). As he said, “You don’t get to choose the medical advice that’s provided by the medical experts”.

One guide to the prime ministerial mood is the fact he stresses it’s only advice to avoid AstraZeneca if you are under 50. The decision is up to you, and your doctor (though you will be signing a rigorous consent form if you ignore it).

But that line just contributes to the muddled messaging many people will feel they’re receiving.

With an already disorderly program thrown into further disarray by the medical advice, the government on Thursday night and Friday went into overdrive.

Another 20 million doses of the Pfizer vaccine — now the one for the under 50s — were instantly procured (this is on top of the 20 million already purchased). This is good news, if you are patient. They are not due to land until the last quarter of the year.

Health Minister Greg Hunt says Pfizer doses scheduled to arrive in coming days will ramp up, but details are sketchy.

The government is anxious to say the immediate stage of the vaccination schedule should not be much delayed.

The elderly who are being vaccinated now are good to get AstraZeneca.

As for the health and aged care workers? Determinedly looking on the bright side, Morrison noted many are over 50. Pfizer vaccines will have to be arranged for the younger ones, however, which could involve some scrambling.

But the rollout generally has to be recalibrated and delays are expected to hit in coming months when the program gets to the younger section of the general population.

For these people, vaccination is not as critical in health terms as it is for those older. But for the economy, vaccinating them as soon as can be done is vital.

At one level, Australia is being protected by our previous (and continued) success on the health front, which has left us with little or no community transmission. The rollout problems would be a disaster if we had COVID raging.

But we are riding on our luck. There are no guarantees against serious outbreaks.

Even without those, the longer the rollout drags on, the more we have the disruption of small lockdowns, and the slower the re-opening of Australia’s international border, with all the consequences that brings.

Morrison, who recently talked so confidently about everyone who was eligible and willing receiving one vaccine shot by October, now won’t commit to any date.

It would be a nightmare for him if the rollout wasn’t finished by year’s end, and the international border remained substantially shut.

He’d be only months from an election campaign, and Australians would probably be suffering a bad dose of cabin fever.

Politically, state and territory leaders have reaped rewards in elections from being seen to handle COVID well. A few months ago the pundits predicted Morrison would do the same.

But if they come to believe he has comprehensively mishandled the vaccine rollout, the voters could wreak vengeance.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.

New AstraZeneca advice is a safer path, but it’s damaged vaccine confidence. The government must urgently restore it


Jane E Frawley, University of Technology SydneyThe federal government’s recommendation last week that the Pfizer COVID-19 vaccine is now the preferred vaccine for adults under 50 has shaken public confidence in the COVID-19 vaccine rollout.

The Australian Technical Advisory Group on Immunisation (ATAGI) advised the AstraZeneca vaccine, previously planned as Australia’s main vaccine, will no longer be the preferred vaccine for adults under 50. It came after an extensive review of data from the United Kingdom and Europe which found an association between a very rare type of blood clot and the AstraZeneca vaccine.

Public confusion has already resulted in mass cancellations of vaccine appointments at GP clinics, by adults both over and under 50.

It’s important to remember the Australian government can afford to choose a safer path because we are not in the midst of a large COVID-19 outbreak.

But a decrease in vaccine confidence may be an unintended consequence of this path.

Now, the federal government must urgently restore public confidence in the vaccine rollout. It needs to quickly reassure adults aged over 50 the AstraZeneca vaccine is safe.

It’s essential the government gets this right. Concerns about one vaccine can damage public trust in other vaccines.

Why has a safer approach decreased confidence?

Vaccine confidence can be fickle. There are many recent examples of established vaccine programs that have been undermined by unrelated events or errors. This has led to mass disease outbreak and preventable death. For example, in the Philippines, a new measles outbreak that infected 47,871 people in 2019 and killed 632, mostly children, was fuelled by a drop in measles vaccination spurred by concerns about a dengue fever vaccine.

Vaccine program resilience is an even bigger ask during a new vaccine rollout where rare effects are expected once the vaccine is given to hundreds of millions of people.

Research from the Australian National University published last week found young women are the most likely to avoid vaccination. Women who did not approve of the government’s handling of recent sexual harassment scandals were less likely to accept a COVID vaccine. This demonstrates the importance of trust, and shows a lack of trust in one area of the government’s remit can spill into other areas.

Because the risk of catching COVID-19 is currently so low in Australia, many people are feeling less interested in being vaccinated.

One Australian study, published in September last year, found fewer people were willing to accept a COVID-19 vaccine compared to a similar study done two months earlier. This decrease was evident following a decreased number of new COVID-19 cases in Australia in the time between these two studies. People can change their intention to be vaccinated when they fear the effects from the vaccine more than the disease.

On top of all of this, some members of the community are still concerned COVID-19 vaccines were developed too quickly and without appropriate checks and balances — even though this isn’t true.

Changing recommendations during a vaccine program rollout can compound these concerns.




Read more:
Less than a year to develop a COVID vaccine – here’s why you shouldn’t be alarmed


How can confidence be restored?

While the federal government was quick to accept the recommendation from ATAGI, the confusion has added to the rollout chaos. Public confidence has been damaged, and further vaccine delays are imminent across the board, including for younger health and aged-care workers.




Read more:
4 ways Australia’s COVID vaccine rollout has been bungled


Vaccine program resilience is essential to survive the bumps along the way and the government has not invested enough in understanding public sentiment and developing plain language information resources.

The challenge for public health and the federal government now is to address the understandable concerns and prevent them from contaminating the broader public dialog on COVID-19 vaccination.

With high numbers of Australians needing to be vaccinated to prevent further COVID-19 outbreaks, there’s very little room for vaccine rejection.

The government urgently needs to use clear messaging for all communities and health professionals. This includes communities with diverse cultural and language requirements

These efforts will greatly benefit from multidisciplinary teams of infectious disease, vaccine, social science and communication experts.

We need a compensation scheme

During Australia’s COVID-19 vaccine rollout, so far one man in his 40s has developed blood clots following vaccination with the AstraZeneca vaccine. There’s a 25% death rate following a vaccine-related clot according to ATAGI. Four to six clots are expected per million doses of AstraZeneca vaccine (first dose) and while this reaction is exceedingly rare, it is severe.

This also highlights the importance of a no-fault vaccine injury compensation scheme.

Such a scheme recognises that if the government promotes whole of community vaccination for collective good, then it also accepts the ethical and financial burden for the few people who will sustain a serious injury. The federal government should implement one as a matter of priority.




Read more:
Bad reactions to the COVID vaccine will be rare, but Australians deserve a proper compensation scheme


The Conversation


Jane E Frawley, NHMRC Research Fellow, University of Technology Sydney

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

As Australia’s vaccination bungle becomes clear, Morrison’s political pain is only just beginning


Mick Tsikas/AAP

Mark Kenny, Australian National UniversityAmong many surprising things about 2020 was how a novel coronavirus drove an equally novel upending of Australia’s political orthodoxy.

The hackneyed election straightener, “it’s the economy, stupid”, got shoved aside for a refreshing new imperative, “it’s the community, stupid”. Australians unhesitatingly turned to government, embraced expertise, and willingly abided by society-wide deprivations in the interests of the whole.




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


Reluctantly at first, centre-right politicians fell into line. Those who had built their careers on the virtues of small-government and gruff fiscal discipline, flipped to become big spending hyper-Keynesians.

Necessarily, political combat took a back seat to problem-solving. In an atmosphere of policy-not-politics, voters backed incumbent governments, marking them favourably for doing their jobs. Every election since the crisis began has returned the incumbents: in the Northern Territory, ACT, Queensland, and Western Australia. In the latter case, Labor’s Mark McGowan — arguably the country’s most aggressively parochial premier — was endorsed so strongly in March that the Liberal opposition officially ceased to exist.

Federally, Prime Minister Scott Morrison reaped the dividends of Australia’s tandem run of good management and good luck. While our closest allies, the United States and United Kingdom, descended into death and division, Australia closed its international borders early. It then compartmentalised further with the states episodically insulating their own populations and their own hospital systems.

Of course, there were mistakes. But the aggregate impact of these measures, high public trust, and the deliberately consensual mechanism of Morrison’s national cabinet has served the country well.

2021 brings new pressures

But 2021 has been a whole new ball game, and one for which a prime minister not accustomed to pressure, has proved far less equipped.

Prime Minister Scott Morrison, Health Minister Greg Hunt and health authorities at a Canberra press conference.
Prime Minister Scott Morrison and Health Minister Greg Hunt have found themselves in crisis-management mode over the vaccine rollout.
Mick Tsikas/AAP

The vaccine rollout — which remember, started stubbornly late — is in disarray. A promised four million inoculations by the end of March and completion by the end of October proved wildly unrealistic.

As of Sunday, the government says it hopes all Australians could receive at least one dose of vaccine by the end of the year. But as Morrison posted on Facebook, the government has no plans for any new targets because

it is not possible to set such targets given the many uncertainties involved.

Through the second half of last year, as it became clear there would be effective vaccines, Morrison, Health Minister Greg Hunt, and health authorities assured worried Australians the government was up to the global competition. And that Canberra was being sufficiently front-footed about procuring vaccines.

As Morrison boasted in a press statement on August 19,

Australians will be among the first in the world to receive a COVID-19 vaccine, if it proves successful, through an agreement between the Australian Government and UK-based drug company AstraZeneca.

In November, he also said,

Our strategy puts Australia at the head of the queue.

This was always unconvincing. That claimed “agreement” turned out to have been an over-egged letter of intent. Even ordinary observers could see demand from wealthy countries would be strong, and binding contracts would need to be signed quickly if Australia was to secure early adequate supplies.

It is now clear Australia’s risk-averse pandemic management — much of which was driven by premiers — has been followed by an insufficiently risk-aware vaccine contingency, controlled by the Commonwealth. And so we see another bizarre inversion: Australia being trounced by Britain and America, countries that had persistently botched their infection response.

Post-Trump America is now vaccinating three million people a day, and has gone above four million at least once. Covid-ravaged Britain is also roaring ahead. More than half of adults have had their first jab.

Textbook vaccination program?

What is not clear is why Morrison et al insisted the absence of urgency was an advantage because — combined with our judicious “portfolio” approach to multiple acquisitions — our health authorities could plan and execute a textbook public vaccination program.

Trouble is, the states have complained about a lack of genuine cooperation in the rollout, critical supply problems have been obscured, and the much vaunted broad “portfolio” approach has had its narrowness exposed.




Read more:
Blood clot risks: comparing the AstraZeneca vaccine and the contraceptive pill


Clearly, the slow and steady approach failed to build in redundancy for the wholly imaginable interruptions to supply from international competition and technical limitations in production and transporting. Then there is straight-out vaccine nationalism, as has been the cause of a blocked shipment from Italy.

Australia’s approach rather relied initially on two locally producible vaccines primarily with Pfizer (and later Novavax) as a back-up — the University of Queensland one which fell over in December, and AstraZeneca which is now “not preferred” for under 50s. While the AstraZeneca clotting risk is hardly a public health disaster — it has been compared to that of long-haul flights — it is certainly a disaster for an already fractious vaccine confidence.

Morrison now faces multiple, serious threats

Coupled with a poorly managed political crisis over the treatment of women, Morrison’s 2021 has been tin-eared. A sharp decline of public trust in government, in expertise, and in institutional competence looms as a clear and present danger for Morrison’s popularity.

Brittany Higgins walks through the crowd at the women's march in Canberra.
The prime minister has taken a hit to his approval ratings over his recent handling of gender issues.
Lukas Coch/AAP

Business-as-usual politics is already making a comeback with Labor’s Mark Butler toughening up of criticism of the rollout and calling for more transparency and a greater sense of urgency. Labor has little choice. Voters themselves see other countries are surging ahead while Australia inches along, tempting the fate of another outbreak, and delaying the economic recovery dependent on vaccination.

And that’s the next inversion we’re likely to see. Business and Coalition hardliners were outspoken last year against state border closures, lockdowns, and other restrictions, on economic grounds.

Expect to hear those voices too in coming weeks as the penny drops about a whole extra year lost to the pandemic.The Conversation

Mark Kenny, Professor, Australian Studies Institute, Australian National University

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

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


from www.shutterstock.com

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

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

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




Read more:
New setback for vaccine rollout, with AstraZeneca not advised for people under 50


Here’s what we did and what we found

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

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

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

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




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


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

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

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

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




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4 ways Australia’s COVID vaccine rollout has been bungled


We can test different scenarios

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

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

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

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

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

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

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




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

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

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

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

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

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

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

New setback for vaccine rollout, with AstraZeneca not advised for people under 50


Michelle Grattan, University of CanberraThe vaccine rollout was thrown into fresh uncertainty on Thursday night after the government received medical advice against using the AstraZeneca vaccine for people under 50 because of the very small risk of blood clots.

Most immediately, this means those younger health and aged care workers who have not yet been vaccinated will be offered the Pfizer shot. This may involve delays.

These people are in the cohort currently being vaccinated, together with over 70s who are unaffected by the new advice, which went to the government on Thursday evening.

Scott Morrison said the later stages of the rollout will now urgently be re-examined and re-calibrated. He said it was “far too early” to say what impact it would have on the rollout’s timetable.

The government’s deadline for all eligible people who want a vaccine to receive at least one shot by the end of October is set to blow out.

Vaccine purchases will also be reviewed.

Morrison unveiled the advice from the Australian Technical Advisory Group on Immunisation at a hastily summoned press conference on Thursday night, also attended by Health Minister Greg Hunt, Chief Medical Officer Paul Kelly, and Health Department Secretary Brendan Murphy.

Morrison said he had received the advice “in the last 15 minutes”.

The government had urgently sought the advice following evidence overseas of a link between the AstraZeneca vaccine and blood clots, with some deaths resulting.

There has been one clot case in Australia, a man in his 40s.

Explaining that the Pfizer vaccine should be preferred over AstraZenica for those under 50s, ATAGI said, “This recommendation is based on the increasing risk of severe outcomes from COVID-19 in older adults (and hence a higher benefit from vaccination) and a potentially increased risk of thrombosis with thrombocytopenia following AstraZeneca vaccine in those under 50 years”.

But it said AstraZeneca can be used in adults under 50 “where the benefits clearly outweigh the risk for that individual and the person has made an informed decision based on an understanding of the risks and benefits.”

Under 50s who’ve already had one AstraZeneca dose without serious adverse effects can be given a second dose, the advice said.

ATAGI described the possible blood clot side effect as “rare but serious”.

Advice is being provided to GPs involved in the rollout.

This is the latest difficulty to hit the rollout. The government this week stressed the main problem was shortage of supply, with AstraZeneca doses from Europe being held back and CLS, which is manufacturing the vaccine locally, not gearing up to the one million weekly target as fast as expected.

As of Thursday, one million doses of one or other of the two vaccines had been administered in Australia. At present Australia only has the two vaccines available.

Morrison stressed that decisions were up to individuals and their doctors – this was advice only.

“There is not a prohibition on the use of the AstraZeneca vaccine for persons under 50. There is an expression of a preference.”

Kelly said a clot was very rare. “At the moment, it seems to be around four to six per million doses of vaccine. It’s only been found in the first dose of the AstraZeneca vaccine, usually within four to 10 days after that vaccine. But it is serious, and it can cause up to a 25% death rate when it occurs.”

In a late night statement AstraZeneca said it respected the government’s decision based on advice to recommend AstraZeneca’s vaccine be used in those over 50.

It noted that, “Overall, regulatory agencies have reaffirmed the vaccine offers a high-level of protection against all severities of COVID-19 and that these benefits continue to far outweigh the risks”.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.

4 ways Australia’s COVID vaccine rollout has been bungled


Stephen Duckett, Grattan InstituteAustralia’s vaccine rollout has so far been overhyped and under-delivered.

The first announcement, in August last year — that Australia had negotiated vaccine deals — set the tone for the rollout of “announceables”. Within hours, this initial announcement unravelled as it became clear it wasn’t a “deal”, but in fact a letter of intent.

The federal government has made vaccine announcements thick and fast since then, with every minor milestone celebrated with media hype. It was only when vaccine announcements had to become actual vaccinations that the public became aware of the chasm between the rhetoric and the reality.

The vaccine rollout has been characterised by four key mistakes, mainly caused by our leaders giving priority to a good political story over good policy.

Bungle 1: the wrong pace

Australians started the year in the happy position of having essentially eliminated domestic transmission of coronavirus. Australia didn’t have the high daily COVID death tolls of other countries, and so didn’t have the same sense of urgency about the speed of the vaccine rollout.

But this relaxed attitude — which federal health minister Greg Hunt called “a marathon not a sprint” — has continued for too long.

Delays in the rollout come with risks. We know the virus can escape hotel quarantine, and vaccination delays slow border reopenings and economic recovery.




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Where is Australia at with the COVID vaccine rollout? Our interactive shows how we compare with the rest of the world


Bungle 2: the wrong phasing

The first phase of the rollout included three main groups: hotel quarantine workers, health-care workers, and people in residential aged care.

Vaccination of hotel quarantine workers is especially important because it appears the vaccine protects against both severe disease and, to some extent, transmission. In these circumstances, vaccination of all quarantine workers should have been an urgent first priority. Health-care workers, especially those treating patients with COVID, was a logical second priority.

But given there wasn’t widespread community transmission of the virus, there was probably no reason for the federal government to scramble to vaccinate people in residential aged care early, especially as the vaccine was in short supply.

States should have been allocated all the vaccines to roll out first doses as quickly as possible to workers in hotel quarantine and on the health-care frontline.




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On March 22 Hunt announced the second phase, which includes more than six million people, and encouraged people to call their GP to organise a vaccination. He made this announcement knowing Australia didn’t have enough vaccines to meet demand.

GPs hadn’t been warned of the impending tsunami of calls, nor did they know how many doses they would get and when. The federal government didn’t have a robust logistics system to ensure the right doses got to the right places at the right times. GPs were, rightly, extremely angry.

The logistics nightmares continue, with the federal government persistently failing to provide clarity about dose distribution to either states or GPs.

Bungle 3: the wrong model

The federal government has seen the vaccine rollout not as a public health program but as a political issue, complete with the Liberal Party logo on a vaccine announcement. The focus has been on announcables and good news stories, with the glory to shine back on the government in the lead-up to an election.

This focus has meant the government’s initial priority was a rollout through GPs and, later, pharmacies.

Involvement of GPs was the right call — it’s good for doctors to provide a comprehensive range of services to their patients. But reliance on GPs was the mistake.

GP clinics rarely have the space for significant numbers of people waiting to be vaccinated and to be observed after being vaccinated. Mass vaccination requires large centres such as sports venues and town halls.

Despite adopting a slow, boutique strategy for rollout, the federal government still set ambitious goals. At one stage, Prime Minister Scott Morrison said the goal was four million people to be vaccinated by the end of March. Here we are in April, and he has delivered less than a fifth of that.

Some of the shortfall is due to problems with international supply chains. The European Union blocked some deliveries to Australia. The federal government should have immediately shared the implications of this with the public, but delayed disclosing the reality until forced to do so at Senate Estimates a week later.

Delivery of vaccines from the warehouses to states or GPs has been a debacle. Neither the states nor GPs knew from one week to the next how many vaccines they were due, which made planning impossible. GPs booked patients expecting hundreds of doses but got a fraction of that, causing massive extra work to cancel appointments.

States ended up with doses on hand that they haven’t been able to distribute to hospitals, and came under political attack from some members of the federal government. The tension mounted and the behind-the-scenes political disputes came out into the public domain as some states defended their performance.

Bungle 4: the wrong messaging

The federal government’s original plan was to “underpromise and overdeliver”, according to Hunt. But the reverse is a better description of what has played out.

A more logical approach would have been to implement more phases, each with smaller numbers, and to make the phasing consistent with local production by CSL, which aims to manufacture about one million doses per week.

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

The government should engage with the states, not alienate them.

What’s more, it should set realistic targets to get vaccines into arms as quickly as possible and be prepared to admit when it falls short.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.

Where is Australia at with the COVID vaccine rollout? Our interactive shows how we compare with the rest of the world


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Sunanda Creagh, The ConversationAs COVID vaccination programs roll out around the world, our new interactive tool allows you to see where each country is at with its immunisation program. Using data from Our World in Data, you can see how each country is performing when it comes to:

  • total COVID-19 vaccinations administered given so far
  • total COVID-19 vaccinations administered per 100 people.

Due to some limitations with the source data, not all countries are shown. Our World in Data explains how they collect their data, which is being used by the WHO, over here. We’ve shown data as of March 28 below because that’s the latest data set available that’s relatively complete for a good range of countries.

Australia has administered about 600,000 doses at the time of writing (although, as shown on the interactive, it was 510,000 on March 28). That is a long way short of the target set by the prime minister to administer 4 million doses by the end of March.

Data visualisation: Kaho Cheung. Data source: Our World in Data https://ourworldindata.org. Australian data via https://covidlive.com.au/.

The Conversation asked Hassan Vally, an epidemiologist and infectious diseases expert, to reflect on what the data reveal at date of this article’s publication.

Here’s what he told us:


This visualisation provides a useful and easy way to track where countries are at in their COVID vaccine rollouts.

We are in the midst of one of the largest logistical exercises in world history and it’s easy to drown in the sheer magnitude of the numbers.

The numbers are astounding even though we have only just begun. As of March 31, we have delivered about 574 million doses of the vaccine across 141 countries across the globe, reaching 3.7% of the population.

Total doses administered

The United States has done extremely well in terms of the total number of doses given. It has clearly administered the most doses so far in total.

President Joe Biden promised to deliver 100 million doses of vaccine by his 100th day in office, which was achieved by March 19, approximately six weeks ahead of schedule. Regardless of how hard a marker you are, given the obstacles in the US, this is an impressive achievement.

China comes in second, having recently passed a significant milestone of delivering more than 100 million doses of the vaccine. The numbers of people currently being vaccinated each day are extraordinary, with goals to increase delivery to more than 10 million doses per day and immunise 40% of the population by June.

India comes in next at around 61 million doses, which is impressive given the unique challenges it faces.

The United Kingdom is also doing well on total number of doses given. After these countries, you have Brazil a fair way back at about 18 million doses at the time of writing, and then a pack of countries further back.




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Total doses given per 100 people

A different picture emerges when you adjust the data for the population sizes of countries by looking at the number of doses given per 100 people.

As has been well publicised, Israel leads the pack by a fair margin.

United Arab Emirates is doing really, as is Chile, the UK, Bahrain and the US.

Interestingly, the large countries such as China, India and the US that have delivered large total amounts of vaccine fall back from the lead when you adjust for population size.

Taking into account the size of countries to better assess the progress of the vaccination programs highlights the benefit of having a smaller population size and small geographical size.

Wealthier countries are ahead

This interactive tool also highlights that wealthier countries are generally ahead of poorer countries when it comes to the vaccination rollout. Unless addressed, that’s going to be a significant problem. Until the pandemic is stamped out everywhere, huge risks remain for all countries.

Global equitable access to vaccines is the right thing to do. But it’s also in the interests of rich nations, too. As the WHO says:

With a fast-moving pandemic, no one is safe, unless everyone is safe.

It’s fantastic to see Australia playing its role as a good regional citizen by providing vaccines and assistance to PNG to help deal with their serious COVID situation. One could argue however, that we could and should be doing more.




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How’s Australia doing compared with the rest of the world?

At first glance, Australia looks to be tracking poorly compared to the rest of the world.

However, context is really important. We need to remember Australia is virtually COVID-free, making it the envy of the world.

We have access to two good vaccines suitable for all age groups, and the immunisation program has begun.

Although things have started slowly and we are behind where we would like to be, our slow start will likely ramp up significantly in the coming weeks.

It is significant that we have now entered phase 1b of the rollout, which means many millions more are now eligible to get the vaccine. We have also now started onshore vaccine production, which ensures vaccine supplies into the future.

Yes, there have been frustrations. But unlike many places, Australia has the luxury of time to carefully and safely deliver the vaccines due to our excellent performance so far in containing the spread of COVID-19.The Conversation

Sunanda Creagh, Head of Digital Storytelling, The Conversation

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